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A foundational implementation of the WHO/CDC Injury Surveillance Guidelines was conducted in Dar es Salaam region of the United Republic of Tanzania in 2005. The Guidelines were adapted to gather qualitative as well as quantitative data about intentional injury mortality which were collected concurrently at the Muhimbili National Hospital Mortuary. An interview schedule of 12 quantitative variables and one open-ended question, participant observation and newspaper reports were used. Mixed methods allowed an understanding of intentional injury mortality to emerge, even for those with the least amount of data, the 22% of homicides whose bodies were never claimed. Mixed methods made it possible to quantify intentional injury mortality rates, describe subpopulations with scanty data, and learn how to embed ongoing injury mortality surveillance into daily practice.
Outwater, Anne H.; Campbell, Jacquelyn C.; Mgaya, Edward
BACKGROUND: The prevalences and risk factors of microalbuminuria are not full described among black African diabetic patients. This study aimed at determining the prevalence of microalbuminuria among African diabetes patients in Dar es Salaam, Tanzania, and relate to socio-demographic features as well as clinical parameters. METHODS: Cross sectional study on 91 Type 1 and 153 Type 2 diabetic patients. Two
Objective To describe how demographic characteristics and knowledge of cervical cancer influence screening acceptance among women living in Dar es Salaam, Tanzania. Methods Multistage cluster sampling was carried out in 45 randomly selected streets in Dar es Salaam. Women between the ages of 25–59 who lived in the sampled streets were invited to a cervical cancer screening; 804 women accepted and 313 rejected the invitation. Information on demographic characteristics and knowledge of cervical cancer were obtained through structured questionnaire interviews. Results Women aged 35–44 and women aged 45–59 had increased ORs of 3.52 and 7.09, respectively, for accepting screening. Increased accepting rates were also found among single women (OR 2.43) and among women who had attended primary or secondary school (ORs of 1.81 and 1.94). Women who had 0–2 children were also more prone to accept screening in comparison with women who had five or more children (OR 3.21). Finally, knowledge of cervical cancer and awareness of the existing screening program were also associated with increased acceptance rates (ORs of 5.90 and 4.20). Conclusion There are identifiable subgroups where cervical cancer screening can be increased in Dar es Salaam. Special attention should be paid to women of low education and women of high parity. In addition, knowledge and awareness raising campaigns that goes hand in hand with culturally acceptable screening services will likely lead to an increased uptake of cervical cancer screening.
BACKGROUND: Results from HIV vaccine trials on potential volunteers will contribute to global efforts to develop an HIV vaccine. The purpose of this study among police officers in Dar es Salaam, Tanzania, was to explore the underlying reasons that induce people to enrol in an HIV vaccine trial. METHODS: We conducted discussions with eight focus groups, containing a total of
Edith A. M. Tarimo; Anna Thorson; Thecla W. Kohi; Joachim Mwami; Muhammad Bakari; Eric Sandström; Asli Kulane
Background Successful malaria vector control depends on understanding behavioural interactions between mosquitoes and humans, which are highly setting-specific and may have characteristic features in urban environments. Here mosquito biting patterns in Dar es Salaam, Tanzania are examined and the protection against exposure to malaria transmission that is afforded to residents by using an insecticide-treated net (ITN) is estimated. Methods Mosquito biting activity over the course of the night was estimated by human landing catch in 216 houses and 1,064 residents were interviewed to determine usage of protection measures and the proportion of each hour of the night spent sleeping indoors, awake indoors, and outdoors. Results Hourly variations in biting activity by members of the Anopheles gambiae complex were consistent with classical reports but the proportion of these vectors caught outdoors in Dar es Salaam was almost double that of rural Tanzania. Overall, ITNs confer less protection against exophagic vectors in Dar es Salaam than in rural southern Tanzania (59% versus 70%). More alarmingly, a biting activity maximum that precedes 10 pm and much lower levels of ITN protection against exposure (38%) were observed for Anopheles arabiensis, a vector of modest importance locally, but which predominates transmission in large parts of Africa. Conclusion In a situation of changing mosquito and human behaviour, ITNs may confer lower, but still useful, levels of personal protection which can be complemented by communal transmission suppression at high coverage. Mosquito-proofing houses appeared to be the intervention of choice amongst residents and further options for preventing outdoor transmission include larviciding and environmental management.
|In this dissertation, I draw on research carried out at the University of Dar es Salaam (UDSM), Tanzania in 2008 to examine Tanzanian academics' experience with research throughout the history of this institution. This dissertation is designed as an historical case study and investigates how economic and political changes in Tanzania's…
Objective: To determine the effect of vitamin A supplementation on the risk of diarrhea and of acute respiratory infection. Design: Double-blind, randomized, placebo-controlled trial. Setting: Dar-es-Salaam, Tanzania. Subjects: Six hundred eighty-seven children, 6 to 60 months old, hospitalized with pneumonia, who received vitamin A or placebo at baseline and at 4 and 8 months after discharge from hospital. Main outcome
Wafaie W. Fawzi; Roger Mbise; Donna Spiegelman; Maulidi Fataki; Ellen Hertzmark; Godwin Ndossi
CLUVA (CLimate change and Urban Vulnerability in Africa; http://www.cluva.eu/) is a 3 years project, funded by the European Commission in 2010. The main objective of CLUVA is to develop context-centered methods and knowledge to be applied to African cities to assess vulnerabilities and increase knowledge on managing climate related risks. The project estimates the impacts of climate changes in the next 40 years at urban scale and downscales IPCC climate projections to evaluate specific threats to selected African test cities. These are mainly from floods, sea-level rise, droughts, heat waves, and desertification. The project evaluates and links: social vulnerability; urban green structures and ecosystem services; urban-rural interfaces; vulnerability of urban built environment and lifelines; and related institutional and governance dimensions of adaptation. The multi-scale and multi-disciplinary qualitative, quantitative and probabilistic approach of CLUVA is currently being applied to selected African test cities (Addis Ababa - Ethiopia; Dar es Salaam - Tanzania; Douala - Cameroun; Ouagadougou - Burkina Faso; St. Louis - Senegal). In particular, the poster will present preliminary findings for the Dar es Salaam case study. Dar es Salaam, which is Tanzania's largest coastal city, is exposed to floods, coastal erosion, droughts and heat waves, and highly vulnerable to impacts as a result of ineffective urban planning (about 70% unplanned settlements), poverty and lack of basic infrastructure (e.g. lack of or poor quality storm water drainage systems). Climate change could exacerbate the current situation increasing hazard-exposure alongside the impacts of development pressures which act to increase urban vulnerability for example because of informal (unregulated) urbanization. The CLUVA research team - composed of climate and environmental scientists, risk management experts, urban planners and social scientists from both European and African institutions - has started to produce research outputs suitable for use in evidence-based planning activities in the case study cities through interdisciplinary methods and analysis. Climate change projections at 8 km resolution are ready for regions containing each of the case study cities; a preliminary hazard assessment for floods, droughts and heat waves has been performed, based on historical data; urban morphology and related green structures have been characterized; preliminary findings in social vulnerability provide insights how communities and households can resist and cope with, as well as recover from climate induced hazards; vulnerability of informal settlements to floods has been assessed for a case study area (Suna sub ward) and a GIS based identification of urban residential hotspots to flooding is completed. Furthermore, a set of indicators has been identified and the most relevant for Dar es Salaam has been selected by local stakeholders to identify particular vulnerable high risk areas and communities. An investigation of the existing urban planning and governance system and its interface with climate risks and vulnerability has inter-alia suggested severe institutional deficits including over-centralized institutions for disaster risk management and climate change adaptation. A multi-risk framework considering climate-related hazards, and physical and social fragilities has been set up.
Background Tanzania has a high tuberculosis incidence, and genotyping studies of Mycobacterium tuberculosis in the country are necessary in order to improve our understanding of the epidemic. Spoligotyping is a potentially powerful genotyping method due to fast generation of genotyping results, high reproducibility and low operation costs. The recently constructed SpolDB4 database and the model-based program 'Spotclust' can be used to assign isolates to families, subfamilies and variants. The results of a study can thus be analyzed in a global context. Results One hundred forty-seven pulmonary isolates from consecutive tuberculosis patients in Dar es Salaam were spoligotyped. SpolDB4 and 'Spotclust' were used to assign isolates to families, subfamilies and variants. The CAS (37%), LAM (22%) and EAI (17%) families were the most abundant. Despite the dominance of these three families, diversity was high due to variation within M. tuberculosis families. Of the obtained spoligopatterns, 64% were previously unrecorded. Conclusion Spoligotyping is useful to gain an overall understanding of the local TB epidemic. This study demonstrates that the extensive TB epidemic in Dar es Salaam, Tanzania is caused by a few successful M. tuberculosis families, dominated by the CAS family. Import of strains was a minor problem.
BACKGROUND: Preventing malaria by controlling mosquitoes in their larval stages requires regular sensitive monitoring of vector populations and intervention coverage. The study assessed the effectiveness of operational, community-based larval habitat surveillance systems within the Urban Malaria Control Programme (UMCP) in urban Dar es Salaam, Tanzania. METHODS: Cross-sectional surveys were carried out to assess the ability of community-owned resource persons (CORPs)
Prosper P Chaki; Nicodem J Govella; Bryson Shoo; Abdullah Hemed; Marcel Tanner; Ulrike Fillinger; Gerry F Killeen
Knowledge, perception and utilisation of malaria prophylaxis were assessed among pregnant women attending antenatal care clinic in Dar es Salaam, Tanzania. Of the 301 women interviewed, 71.1% reported having used chloroquine prophylaxis while 28.9% did not. Women with high knowledge of malaria were more likely to use malaria prophylaxis than those with low knowledge. However, there was no significant association between knowledge of malaria and perceived effectiveness of the various methods of malaria control. Chloroquine side effects and perceived lack of protective effect against malaria were mentioned as causes of failure to use chloroquine prophylaxis. Fear of chloroquine-induced pruritus accounted for the largest proportion (49.4%) of women who reported having failed to use chloroquine prophylaxis. Occurrence of malaria episodes was reported to be similar among users and non-users of malaria prophylaxis probably due to inconsistent use of malaria prophylaxis and reduced chloroquine sensitivity of malaria parasites. It is suggested that, in addition to chemoprophylaxis, pregnant women should be encouraged to use bednets in combination with mosquito repellents throughout the course of pregnancy. PMID:7498025
Background Tanzania is among the countries in the world where the cervical cancer incidence is estimated to be highest. Acknowledging an increase in the burden of cervical cancer, VIA was implemented as a regional cervical cancer screening strategy in Tanzania in 2002. With the aim of describing risk factors for VIA positivity and determinants of screening attendances in Tanzania, this paper present the results from a comparative analysis performed among women who are reached and not reached by the screening program”. Methods 14 107 women aged 25–59 enrolled in a cervical cancer screening program in Dar es Salaam in the period 2002 – 2008. The women underwent VIA examination and took part in a structured questionnaire interview. Socioeconomic characteristics, sexual behavior, HIV status and high-risk (HR) HPV infection were determined in a subpopulation of 890 who participated and 845 who did not participate in the screening. Results Being widowed/separated OR=1.41 (95% CI: 1.17-1.66), of high parity OR=3.19 (95% CI: 1.84-5.48) of low education OR= 4.30 (95% CI: 3.50-5.31) and married at a young age OR=2.17 (95% CI: 1.37-3.07) were associated with being VIA positive. Women who participated in the screening were more likely to be HIV positive OR= 1.59 (95% CI. 1.14-2.25) in comparison with women who had never attended screening, while no difference was found in the prevalence of HR-HPV infection among women who had attended screening and women who had not attended screening. Conclusion Women who are widowed/separated, of high parity, of low education and married at a young age are more likely to be VIA positive and thus at risk of developing cervical cancer. The study further documents that a referral linkage between the HIV care and treatment program and the cervical cancer screening program is in place in the setting studied, where HIV positive were more likely to participate in the cervical cancer screening program than HIV negative women.
|There is growing evidence of the association between gender-based violence and HIV from the perspective and experiences of women. The purpose of this study is to examine these associations from the perspective of young men living in Dar es Salaam, Tanzania. A community-based sample of 951 men were interviewed, of whom 360 had sex in the past 6…
From 18th December, 1968 to 5th January, 1970, zooplankton samples were taken in darkness and using artificial light in selected areas of the Dar es Salaam coast (Tanzania, S. E. Africa). Surface sea temperature was measured on most occasions, salinity for the first 7 months only. The neritic waters of Dar es Salaam experience a warm period during January to
Background Malaria transmission in Africa occurs predominantly inside houses where the primary vectors prefer to feed. Human preference and investment in blocking of specific entry points for mosquitoes into houses was evaluated and compared with known entry point preferences of the mosquitoes themselves. Methods Cross-sectional household surveys were conducted in urban Dar es Salaam, Tanzania to estimate usage levels of available options for house proofing against mosquito entry, namely window screens, ceilings and blocking of eaves. These surveys also enabled evaluation of household expenditure on screens and ceilings and the motivation behind their installation. Results Over three quarters (82.8%) of the 579 houses surveyed in Dar es Salaam had window screens, while almost half (48.9%) had ceilings. Prevention of mosquito entry was cited as a reason for installation of window screens and ceilings by 91.4% (394/431) and 55.7% (127/228) of respondents, respectively, but prevention of malaria was rarely cited (4.3%, 22/508). The median cost of window screens was between US $ 21-30 while that of ceilings was between US $301-400. The market value of insecticide-treated nets, window screening and ceilings currently in use in the city was estimated as 2, 5 and 42 million US$. More than three quarters of the respondents that lacked them said it was too expensive to install ceilings (82.2%) or window screens (75.5%). Conclusion High coverage and spending on screens and ceilings implies that these techniques are highly acceptable and excellent uptake can be achieved in urban settings like Dar es Salaam. Effective models for promotion and subsidization should be developed and evaluated, particularly for installation of ceilings that prevent entry via the eaves, which are the most important entry point for mosquitoes that cause malaria, a variety of neglected tropical diseases and the nuisance which motivates uptake.
Ogoma, Sheila B; Kannady, Khadija; Sikulu, Maggy; Chaki, Prosper P; Govella, Nicodem J; Mukabana, Wolfgang R; Killeen, Gerry F
Background The use of larval source management is not prioritized by contemporary malaria control programs in sub-Saharan Africa despite historical success. Larviciding, in particular, could be effective in urban areas where transmission is focal and accessibility to Anopheles breeding habitats is generally easier than in rural settings. The objective of this study is to assess the effectiveness of a community-based microbial larviciding intervention to reduce the prevalence of malaria infection in Dar es Salaam, United Republic of Tanzania. Methods and Findings Larviciding was implemented in 3 out of 15 targeted wards of Dar es Salaam in 2006 after two years of baseline data collection. This intervention was subsequently scaled up to 9 wards a year later, and to all 15 targeted wards in 2008. Continuous randomized cluster sampling of malaria prevalence and socio-demographic characteristics was carried out during 6 survey rounds (2004–2008), which included both cross-sectional and longitudinal data (N?=?64,537). Bayesian random effects logistic regression models were used to quantify the effect of the intervention on malaria prevalence at the individual level. Effect size estimates suggest a significant protective effect of the larviciding intervention. After adjustment for confounders, the odds of individuals living in areas treated with larviciding being infected with malaria were 21% lower (Odds Ratio?=?0.79; 95% Credible Intervals: 0.66–0.93) than those who lived in areas not treated. The larviciding intervention was most effective during dry seasons and had synergistic effects with other protective measures such as use of insecticide-treated bed nets and house proofing (i.e., complete ceiling or window screens). Conclusion A large-scale community-based larviciding intervention significantly reduced the prevalence of malaria infection in urban Dar es Salaam.
OBJECTIVE The determinants of anemia during both pregnancy and postpartum recovery remain incompletely understood in sub-Saharan African women. SUBJECTS/METHODS In a prospective cohort study among pregnant women, we assessed dietary, biochemical, anthropometric, infectious and sociodemographic factors at baseline. In multivariate Cox proportional hazards models, we examined predictors of incident anemia (hemoglobin <11 g/dl) and iron deficiency anemia (anemia plus mean corpuscular volume <80 fL), and recovery from anemia and iron deficiency anemia through 18 months postpartum at antenatal clinics in Dar es Salaam, Tanzania between 2001 and 2005. A total of 2364 non-anemic pregnant women and 4884 anemic women were enrolled between 12 and 27 weeks of gestation. RESULTS In total, 292 women developed anemia during the postpartum period and 165 developed iron deficiency anemia, whereas 2982 recovered from baseline anemia and 2044 from iron deficiency anemia. Risk factors for postpartum anemia were delivery complications (RR 1.6, 95% confidence interval (CI) 1.13, 2.22) and low postpartum CD4 cell count (RR 1.73, 95% CI 0.96, 3.17). Iron/folate supplementation during pregnancy had a protective relationship with the incidence of iron deficiency anemia. Absence of delivery complications, education status and iron/folate supplementation were positively associated with time to recovery from iron deficiency. CONCLUSION Maternal nutritional status during pregnancy, prenatal iron/folate supplementation, perinatal care, and prevention and management of infections, such as malaria, are modifiable risk factors for the occurrence of, and recovery from, anemia.
Millions of people die from diarrheal and respiratory diseases every year due to lack of proper sanitation, hygiene, and access to clean water. The act of handwashing with soap has been found to effectively reduce both diarrheal and respiratory illness, however, handwashing at critical times (i.e. after using the toilet, before preparing food) remains infrequent around the world. This research investigates the potential for alcohol- based hand sanitizer (ABHS) to be an effective and appropriate hand hygiene option in developing countries. A study was conducted to assess the microbiological effectiveness of ABHS, as compared to handwashing with soap and water, in field conditions in Dar es Salaam, Tanzania. A total of 205 participants, including mothers, nurses, students, and teachers, were introduced to ABHS, given a standardized amount (2ml) of product, and instructed on how to use the product correctly. Hand samples were obtained using the hand rinse method before and after the use of ABHS from 152 participants. The other 53 participants were hand sampled before and after handwashing with a non-antimicrobial liquid soap and clean water (prior to using ABHS). Visual inspections of the hands were performed before hand sampling to record the level of dirt on the hands. All hand samples were processed and analyzed by membrane filtration for concentrations of two microbial indicators, enterococci and E. coli. User perceptions of the product and willingness to pay are also documented. The results of this study provide valuable insight on the prospective of promoting ABHS in developing countries and water scarce areas.
Background The number of people newly infected with human immunodeficiency virus (HIV) has been decreasing in sub-Saharan Africa, but prevalence of the infection remains unacceptably high among young people. Despite the alarming pervasiveness of the virus, young people in this region continue to engage in risky sexual behaviors including unprotected sexual intercourse. In developed countries, parents can play important roles in protecting young people from such behaviors, but evidence regarding the impact of parental involvement is still limited in sub-Saharan Africa. Therefore, we conducted this study to examine the magnitude of risky sexual behaviors and the association of parental monitoring and parental communication with condom use at last sexual intercourse among secondary school students in Dar es Salaam, Tanzania. Methods We conducted this cross-sectional study among 2,217 male and female students aged 15 to 24 years from 12 secondary schools in Dar es Salaam. From October to November 2011, we collected data using a self-administered questionnaire. Multiple logistic regression analyses were conducted to examine the association of parental monitoring and parental communication with condom use at last sexual intercourse, adjusting for potential confounders. Results A total of 665 (30.3%) secondary school students reported being sexually active within the year prior to data collection. Among them, 41.7% had multiple sexual partners, 10.5% had concurrent sexual partners, and 41.1% did not use a condom at last sexual intercourse. A higher level of parental monitoring was associated with increased likelihood of condom use at last sexual intercourse among male students (AOR: 1.56, 95% CI: 1.05-2.32; p?=?0.03) but not among female students (AOR: 1.54, 95% CI: 0.71-3.37; p?=?0.28). The association between parental communication and condom use at last sexual intercourse among both male and female students was not statistically significant. Conclusions A high level of parental monitoring is associated with more consistent condom use among male students in Dar es Salaam, Tanzania -- many of whom have engaged in high-risk sexual behaviors such as multiple sexual partnerships, concurrent sexual partnerships, and unprotected sexual intercourse in the past one year. Interventions should thus be strengthened to reduce multiple sexual partnerships, concurrent sexual partnerships, and to improve parental monitoring among such students toward increasing condom use.
Better understanding of urban microclimate and bioclimate of any city is imperative today when the world is constrained by both urbanisation and global climate change. Urbanisation generally triggers changes in land cover and hence influencing the urban local climate. Dar es Salaam city in Tanzania is one of the fast growing cities. Assessment of its urban climate and the human biometeorological conditions was done using the easily available synoptic meteorological data covering the period 2001-2011. In particular, the physiologically equivalent temperature (PET) was calculated using the RayMan software and results reveal that the afternoon period from December to February (DJF season) is relatively the most thermal stressful period to human beings in Dar es Salaam where PET values of above 35 °C were found. Additionally, the diurnal cycle of the individual meteorological elements that influence the PET index were analysed and found that air temperature of 30-35 °C dominate the afternoon period from 12:00 to 15:00 hours local standard time at about 60 % of occurrence. The current results, though considered as preliminary to the ongoing urban climate study in the city, provide an insight on how urban climate research is of significant importance in providing useful climatic information for ensuring quality of life and wellbeing of city dwellers.
Background The prevalence of HIV/AIDS has exacerbated the impact of childhood undernutrition in many developing countries, including Tanzania. Even with the provision of antiretroviral therapy, undernutrition among HIV-positive children remains a serious problem. Most studies to examine risk factors for undernutrition have been limited to the general population and ART-naive HIV-positive children, making it difficult to generalize findings to ART-treated HIV-positive children. The objectives of this study were thus to compare the proportions of undernutrition among ART-treated HIV-positive and HIV-negative children and to examine factors associated with undernutrition among ART-treated HIV-positive children in Dar es Salaam, Tanzania. Methods From September to October 2010, we conducted a cross-sectional survey among 213 ART-treated HIV-positive and 202 HIV-negative children in Dar es Salaam, Tanzania. We measured the children's anthropometrics, socio-demographic factors, food security, dietary habits, diarrhea episodes, economic status, and HIV clinical stage. Data were analyzed using both univariate and multivariate methods. Results ART-treated HIV-positive children had higher rates of undernutrition than their HIV-negative counterparts. Among the ART-treated HIV-positive children, 78 (36.6%) were stunted, 47 (22.1%) were underweight, and 29 (13.6%) were wasted. Households of ART-treated HIV-positive children exhibited lower economic status, lower levels of education, and higher percentages of unmarried caregivers with higher unemployment rates. Food insecurity was prevalent in over half of ART-treated HIV-positive children's households. Furthermore, ART-treated HIV-positive children were more likely to be orphaned, to be fed less frequently, and to have lower body weight at birth compared to HIV-negative children. In the multivariate analysis, child's HIV-positive status was associated with being underweight (AOR = 4.61, 95% CI 1.38-15.36 P = 0.013) and wasting (AOR = 9.62, 95% CI 1.72-54.02, P = 0.010) but not with stunting (AOR = 0.68, 95% CI 0.26-1.77, P = 0.428). Important factors associated with underweight status among ART-treated HIV-positive children included hunger (AOR = 9.90, P = 0.022), feeding frequency (AOR = 0.02, p < 0.001), and low birth weight (AOR = 5.13, P = 0.039). Factors associated with wasting among ART-treated HIV-positive children were diarrhea (AOR = 22.49, P = 0.001) and feeding frequency (AOR = 0.03, p < 0.001). Conclusion HIV/AIDS is associated with an increased burden of child underweight status and wasting, even among ART-treated children, in Dar es Salaam, Tanzania. In addition to increasing coverage of ART among HIV-positive children, interventions to ameliorate poor nutrition status may be necessary in this and similar settings. Such interventions should aim at promoting adequate feeding patterns, as well as preventing and treating diarrhea.
The purpose of this study was to describe the postpartum concerns of primiparas. A cohort study included 79 mothers in Dar es Salaam, Tanzania. Mothers sorted topics into worry, interest, and confidence. Trends of decreasing worry and increasing interest and confidence for baby-related and mother-related topics were observed from 1 to 6 weeks. At 1 week mothers worried about baby’s
Helen I Lugina; Kyllike Christensson; Siriel Massawe; Lennarth Nystrom; Gunilla Lindmark
Eight hundred and two (802) primary school children in rural and urban Dar es Salaam, Tanzania, were examined to determine the prevalence of otitis media, hearing impairment and cerumen impaction by otoscopy and pure tone audiometry. Ear disease was found in 222 (27.7%) of the children. One hundred and twenty six (15.7%) had cerumen impaction, 70 (8.7%) had sensorineural hearing
Background Understanding people’s views about HIV transmission by investigating a specific population may help to design effective HIV prevention strategies. In addition, knowing the inherent sexual practices of such a population, as well as the risky circumstances that may facilitate HIV transmission, is crucial for the said strategies to become effective. In this article, we report how police officers in Dar es Salaam, Tanzania, perceived the problem of HIV and AIDS in their local context, particularly in relation to unsafe sexual practices. The study was done with the view to recommending ways by which HIV transmission could be minimised within the police force. Methods The study was conducted among members of the police force in Dar es Salaam, Tanzania. Eight focus group discussions (FGDs) were conducted, with a total of 66 participants who were mixed in terms of age, gender, and marital status. Some of these were caregivers to patients with AIDS. Data were analysed using the interpretive description approach. Results The participants believed that both individual sexual behaviour and work-related circumstances were sources of HIV infection. They also admitted that they were being tempted to engage in risky sexual practices because of the institutional rules that prohibit officers from getting married during their training and for three years after. Nevertheless, as members of the Police Force, they stressed the fact that the risky sexual behaviour that exposes them to HIV is not limited to the force; it is rather a common problem that is faced by the general population. However, they complained, the nature of their job exposes them to road accident victims, subjecting them further to possible infection, especially when they have to handle these road accident casualties without proper protective gear. Conclusion Individual sexual behaviour and job-related circumstances are worth investigating if proper advice is to be given to the police regarding HIV prevention strategies. In order to improve the lives of these police officers, there is a need to review the existing institutional rules and practices to accommodate individual sexual needs. In addition, improving their working environment may minimize the risk of HIV transmission from handling casualties in emergency situations.
The effectiveness of a cheap and easy method of household protection against Culex quinquefasciatus Say and other mosquitoes (Diptera: Culicidae) was investigated in Dar es Salaam, Tanzania. Kerosene-burning lamps (korobois) were modified to heat and vaporize transfluthrin, a volatile pyrethroid insecticide. When transfluthrin was added to fuel of the lamp, protection against biting was poor unless a very high concentration of insecticide was used. A modified lamp (= vaporizing koroboi) was designed to overcome this problem by mixing the insecticide with vegetable oil and heating it to 120 degrees C in a tin held just above the flame. The concentration of 0.1% transfluthrin in vegetable oil gave 50-75% reduction in biting, a similar degree of protection to that obtained from burning a mosquito coil containing a synthetic pyrethroid (0.25% d-allethrin) and significantly better protection than a locally bought coil (brand 'White Crane', probably containing DDT). Greater protection (consistently > 90%) was achieved with a higher concentration of transfluthrin (0.5%) in the vegetable oil. This modified lamp is simple, cheap and employs locally available technology. With further development, and due regard to inhalation toxicity of the vaporized materials, it may offer a more cost-effective alternative to a mosquito coil as a means of personal protection, and a useful complement to a net for the early part of the evening before bedtime. PMID:12243228
Introduction By 2030, more than 50% of the African population will live in urban areas. Controlling malaria reduces the disease burden and further improves economic development. As a complement to treated nets and prompt access to treatment, measures targeted against the larval stage of Anopheles sp. mosquitoes are a promising strategy for urban areas. However, a precise knowledge of the geographic location and potentially of ecological characteristics of breeding sites is of major importance for such interventions. Methods In total 151 km2 of central Dar es Salaam, the biggest city of Tanzania, were systematically searched for open mosquito breeding sites. Ecologic parameters, mosquito larvae density and geographic location were recorded for each site. Logistic regression analysis was used to determine the key ecological factors explaining the different densities of mosquito larvae. Results A total of 405 potential open breeding sites were examined. Large drains, swamps and puddles were associated with no or low Anopheles sp. larvae density. The probability of Anopheles sp. larvae to be present was reduced when water was identified as "turbid". Small breeding sites were more commonly colonized by Anopheles sp. larvae. Further, Anopheles gambiae s.l. larvae were found in highly organically polluted habitats. Conclusions Clear ecological characteristics of the breeding requirements of Anopheles sp. larvae could not be identified in this setting. Hence, every stagnant open water body, including very polluted ones, have to be considered as potential malaria vector breeding sites.
Sattler, Michael A; Mtasiwa, Deo; Kiama, Michael; Premji, Zul; Tanner, Marcel; Killeen, Gerry F; Lengeler, Christian
The objective of this study was to identify the incidence of burn injuries among children in a sub-Saharan urban area and describe contributing factors in the home environment. A cross-sectional household survey was conducted in Dar es Salaam, Tanzania between 8 and 22 July 2009. Demographic characteristics of participants were reported using descriptive statistics. Bivariate analyses using Pearson's chi-square tests for categorical variables were used to explore possible associations. Burns represented 16.3% of reported injuries. The one-month incidence was calculated to be 1.73%. The most common contributor to burn injury was open flame 36.9%, followed by hot liquids 33.8%. Most burns occurred in urban areas with 88% occurring in the home. A significant association with burn injury was found in the 0-4 age category. There exists a continued need for research examining the mechanisms of safety provision in the home in low resource settings, especially concerning burn injury. PMID:22054222
Roman, Iwona M; Lewis, Erin R; Kigwangalla, Hamisi A; Wilson, Michael L
Background The United Republic of Tanzania is one of the 22 high M. tuberculosis burden countries. Data collected between 2002 and 2007 indicate that the global prevalence of drug-resistant M. tuberculosis including MDR vary greatly. The varied drug-resistance patterns make continuous surveillance of drug resistance an essential component of tuberculosis control program. Findings M. tuberculosis isolates were obtained from consenting adult tuberculosis patients involved in a placebo-controlled study to evaluate the efficacy of multivitamin supplements on response to anti-Tb treatment in Dar es Salaam, Tanzania. Antimicrobial susceptibility testing was done on four antimicrobial agents namely streptomycin, isoniazid, ethambutol and rifampicin. HIV testing and CD4+ T lymphocytes enumeration were also done. A total of 280 M. tuberculosis isolates from 191 (68%) males and 89 (32%) female patients with no previous history of anti-tuberculosis treatment exceeding 4 weeks in the previous 12 months were tested. Among these, 133 (47%) patients were HIV seropositive. Fourteen (5.0%) isolates were resistant to any of the anti-tuberculosis drugs. The prevalence of primary resistance was 5.0%, 0.7%, 0.4% and 0% for isoniazid, streptomycin, rifampicin and ethambutol respectively. One isolate (0.4%) was MDR, with resistance to isoniazid, streptomycin and rifampicin. Conclusion M. Tb primary resistance rate in a selected population in Dar es SalaamTanzania is low and efforts should be undertaken to support the Tuberculosis program.
The seasonal dynamics of larval populations of Aedes aegypti was studied in two different biotopes in Dar es Salaam, Tanzania. The first biotope was located on the Msasani peninsula on the coast 6 km north of Dar es Salaam, where A. aegypti breeds exclusively in coral rock holes. The population dynamics was studied during both the rainy and the dry season. Seasonal changes in the density of A. aegypti larvae depend primarily on variation in rainfall. The population of larvae dropped to zero only for a short time during the driest period while the adult population was maintained at a low level. The second biotope was in an automobile dump in a Dar es Salaam suburb, where A. aegypti breeds in artificial containers such as tires, automobile parts, tins, coconut shells, and snail shells. The greater part of the A. aegypti population of this biotope is maintained in the egg stage during the dry season. It serves as a focal point for breeding during the dry season: with the coming of the rains, the population expands into the surrounding residential areas. More than 70% of the larval population developed in tires, 20% in tins, 5% in coconut shells, and 1% in snail shells.
Urban green structure provides important regulating ecosystem services, such as temperature and flood regulation, and thus, has the potential to increase the resilience of African cities to climate change. Green structures within urban areas are not only limited to discrete units associated with recreational parks, agricultural areas and open spaces: they also exist within zones which have other primary functions, such as church yards, along transport routes, and within residential areas. Differing characteristics of urban areas can be conceptualised and subsequently mapped through the idea of urban morphology types. Urban morphology types are classifications which combine facets of urban form and function. When mapped, UMT units provide biophysically relevant meso-scale geographical zones which can be used as the basis for understanding climate-related impacts and adaptations. For example, they support the assessment of urban temperature patterns and the temperature regulating services provided by urban green structures. There are some examples of the use of UMTs for assessing regulating ecosystem services in European cities but little similar knowledge is available in an African context. This paper outlines the concept of urban morphology types (UMTs) and how they were applied to African case study cities (Cavan et al., 2012). It then presents the methods used to understand temperature regulating ecosystem services across an example African case study city, including (i) a GIS-based assessment of urban green structures, and (ii) applying an energy balance model to estimate current and future surface temperatures under climate change projections. The assessment is carried out for Dar es Salaam, Tanzania. Existing evidence suggests increases in both mean and extreme temperatures in the city. Historical analysis of the number of hot days per year suggests a rise from a maximum of 47 days per year in the period 1961-87 to 72 days per year in 2003-2011 (Giugni et al., 2012). Mean temperatures in the climate zone are estimated to increase by at least 1°C between 1971-2000 and 2021-2050(CSIR, 2012). Dar es Salaam is represented using around 1700 UMT units mapped across 43 UMT categories for the year 2008. Modelled surface temperature profiles for the city are presented, including an assessment of the potential impact of changing green structure cover within selected UMT categories. Provisional recommendations are made concerning the potential contribution of green structures as a climate adaptation response to the increasing temperatures in Dar es Salaam, which could be relevant for other African cities in similar climate zones. References Cavan, G., Lindley, S., Yeshitela, K., Nebebe, A., Woldegerima, T., Shemdoe, R., Kibassa, D., Pauleit, S., Renner, R., Printz, A., Buchta, K., Coly, A., Sall, F., Ndour, N. M., Ouédraogo, Y., Samari, B. S., Sankara, B. T., Feumba, R. A., Ngapgue, J. N., Ngoumo, M. T., Tsalefac, M., Tonye, E. (2012) CLUVA deliverable D2.7 Green infrastructure maps for selected case studies and a report with an urban green infrastructure mapping methodology adapted to African cities. http://www.cluva.eu/deliverables/CLUVA_D2.7.pdf. Accessed 18/12/12. CSIR (2012) CLUVA deliverable D1.5 Regional climate change simulations available for the selected areas http://www.cluva.eu/deliverables/CLUVA_D1.5.pdf. Accessed 8/1/13. Giugni, M., Adamo, P., Capuano, P., De Paola, F., Di Ruocco, A., Giordano, S., Iavazzo, P., Sellerino, M., Terracciano, S., Topa, M. E. (2012) CLUVA deliverable D.1.2 Hazard scenarios for test cities using available data. http://www.cluva.eu/deliverables/CLUVA_D1.2.pdf. Accessed 8/1/13
Cavan, Gina; Lindley, Sarah; Kibassa, Deusdedit; Shemdoe, Riziki; Capuano, Paolo; De Paola, Francesco; Renner, Florian; Pauleit, Stephan
Introduction Current estimates suggest an HIV prevalence of 42% among people who inject drugs (PWIDs) in Dar es Salaam, while HIV prevalence is estimated to be 8.8% among the general population in the city. To address the HIV epidemic in this population, the government of Tanzania began establishing HIV prevention, treatment and care services including outreach and medication assisted treatment (MAT) for PWIDs in 2010. We assessed gender inequities in utilization of outreach and MAT services and evaluated differences in HIV risk behaviors between female and male PWIDs. Materials and Methods Routine outreach data between December 2010 to mid-August 2012 and baseline data on clients enrolling in methadone from February 2011 to August 2012 were utilized. Binomial regression was used to estimate adjusted relative risk estimates comparing females to males. Results From December 2010 to August 2012, 8,578 contacts were made to drug users; among them 1,898 were injectors. A total of 453 injectors were eligible and referred to MAT, of which, 443 enrolled in treatment. However, regarding total outreach contacts, outreach to PWID, referral to MAT and enrollment in MAT, 8% or less of drug users accessing services were women. In contrast, weighted estimations from surveys suggest that 34% of PWIDs are female, and this approximation is similar to recent population size estimations. Overall, 43% of traditional outreach workers conducting outreach with drug users were female. Though reporting higher levels of condom usage, female PWID were more likely to report multiple sex partners, anal sex, commercial sex work and struggle under a higher burden of addiction, mental disorders and abuse. Conclusions Services have not been mobilized adequately to address the clear needs of females who inject drugs. A clear and urgent need exists for women-centered strategies that effectively engage female PWID into HIV prevention services.
Background The thinking behind malaria research and control strategies stems largely from experience gained in rural areas and needs to be adapted to the urban environment. Methods A rapid assessment of urban malaria was conducted in Dar es Salaam in June-August, 2003 using a standard Rapid Urban Malaria Appraisal (RUMA) methodology. This study was part of a multi-site study in sub-Saharan Africa supported by the Roll Back Malaria Partnership. Results Overall, around one million cases of malaria are reported every year by health facilities. However, school surveys in Dar es Salaam during a dry spell in 2003 showed that the prevalence of malaria parasites was low: 0.8%, 1.4%, 2.7% and 3.7% in the centre, intermediate, periphery and surrounding rural areas, respectively. Health facilities surveys showed that only 37/717 (5.2%) of presenting fever cases and 22/781 (2.8%) of non-fever cases were positive by blood slide. As a result, malaria-attributable fractions for fever episodes were low in all age groups and there was an important over-reporting of malaria cases. Increased malarial infection rates were seen in persons who travelled to rural areas within the past three months. A remarkably high coverage of insecticide-treated nets and a corresponding reduction in malarial infection risk were found. Conclusion The number of clinical malaria cases was much lower than routine reporting suggested. Improved malaria diagnosis and re-defined clinical guidelines are urgently required to avoid over-treatment with antimalarials.
The emission estimation of nine volatile organic compounds (VOCs) from eight organic liquids storage tanks companies in Dar-es-Salaam\\u000a City Tanzania has been done by using US EPA standard regulatory storage tanks emission model (TANKS 4.9b). Total VOCs atmospheric\\u000a emission has been established to be 853.20 metric tones\\/yr. It has been established further that petrol storage tanks contribute\\u000a about 87% of
This paper draws on interviews and discussions with 40 Congolese refugee boys and girls who live in Dar es Salaam. It describes their lives and the difficulties they face, and discusses the implications of their clandestine existence (since refugees are not meant to live in Dar but to stay in refugee camps). Children have to conceal their identities and often
The fact that groundwater exploitation has largely increased since 1997 in the Dar-es-Salaam aquifer, calls for a directed attention towards possible problems of aquifer overexploitation that may arise in the near future. Hydraulic parameters are important for developing local and regional water plans as well as developing numerical groundwater flow models to predict the future availability of the water resource.
Ibrahimu Chikira Mjemah; Marc Van Camp; Kristine Walraevens
Background Criteria-based audits (CBA) have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the use of a CBA to improve quality of care among eclampsia patients admitted at a University teaching hospital in Dar es SalaamTanzania. Objective The prevalence of eclampsia in MNH is high (?6%) with the majority of cases arriving after start of convulsions. In 2004–2005 the case-fatality rate in eclampsia was 5.1% of all pregnant women admitted for delivery (MNH obstetric data base). A criteria-based audit (CBA) was used to evaluate the quality of care for eclamptic mothers admitted at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania after implementation of recommendations of a previous audit. Methods A CBA of eclampsia cases was conducted at MNH. Management practices were evaluated using evidence-based criteria for appropriate care. The Ministry of Health (MOH) guidelines, local management guidelines, the WHO manual supplemented by the WHO Reproductive Health Library, standard textbooks, the Cochrane database and reviews in peer reviewed journals were adopted. At the initial audit in 2006, 389 case notes were assessed and compared with the standards, gaps were identified, recommendations made followed by implementation. A re-audit of 88 cases was conducted in 2009 and compared with the initial audit. Results There was significant improvement in quality of patient management and outcome between the initial and re-audit: Review of management plan by senior staff (76% vs. 99%; P=0.001), urine for albumin test (61% vs. 99%; P=0.001), proper use of partogram to monitor labour (75% vs. 95%; P=0.003), treatment with steroids for lung maturity (2.0% vs. 24%; P=0.001), Caesarean section within 2 hours of decision (33% vs. 61%; P=0.005), full blood count (28% vs. 93%; P=0.001), serum urea and creatinine (44% vs. 86%; P=0.001), liver enzymes (4.0% vs. 86%; P=0.001), and specialist review within 2 hours of admission (25% vs. 39%; P=0.018). However, there was no significant change in terms of delivery within 24 hours of admission (69% vs. 63%; P=0.33). There was significant reduction of maternal deaths (7.7% vs. 0%; P=0.001). Conclusion CBA is applicable in low resource setting and can help to improve quality of care in obstetrics including management of pre-eclampsia and eclampsia.
Background HIV/AIDS is associated with an increased burden of undernutrition among children even under antiretroviral therapy (ART). To treat undernutrition, WHO endorsed the use of Ready to Use Therapeutic Foods (RUTF) that can reduce case fatality and undernutrition among ART-naïve HIV-positive children. However, its effects are not studied among ART-treated, HIV-positive children. Therefore, we examined the association between RUTF use with underweight, wasting, and stunting statuses among ART-treated HIV-positive children in Dar es Salaam, Tanzania. Methods This cross-sectional study was conducted from September-October 2010. The target population was 219 ART-treated, HIV-positive children and the same number of their caregivers. We used questionnaires to measure socio-economic factors, food security, RUTF-use, and ART-duration. Our outcome variables were underweight, wasting, and stunting statuses. Results Of 219 ART-treated, HIV-positive children, 140 (63.9%) had received RUTF intervention prior to the interview. The percentages of underweight and wasting among non-RUTF-receivers were 12.4% and 16.5%; whereas those of RUTF-receivers were 3.0% (P?=?0.006) and 2.8% (P?=?0.001), respectively. RUTF-receivers were less likely to have underweight (Adjusted Odd Ratio (AOR) =0.19, CI: 0.04, 0.78), and wasting (AOR?=?0.24, CI: 0.07, 0.81), compared to non RUTF-receivers. Among RUTF receivers, children treated for at least four months (n?=?84) were less likely to have underweight (P?=?0.049), wasting (P?=?0.049) and stunting (P?0.001). Conclusions Among HIV-positive children under ART, the provision of RUTF for at least four months was associated with low proportions of undernutrition status. RUTF has a potential to improve undernutrition among HIV-positive children under ART in the clinical settings in Dar es Salaam, Tanzania.
Background Recruitment, enrollment and retention of volunteers in an HIV vaccine trial is important in the efforts to ultimately develop a vaccine that can prevent new HIV infections. Following recruitment, some randomized individuals decline to be enrolled in an HIV vaccine trial. The reasons for such a decision are not well known. This article describes why individuals who were randomized in a phase I and II HIV vaccine trial in Dar es Salaam, Tanzania declined to be enrolled. Methods Face-to-face interviews were conducted with 14 individuals (7 men and 7 women). Repeated readings of the 14 interview transcripts to look for reasons for declining to enroll in the trial were performed. Data was analyzed using the content analysis approach. Results Informants expressed fear of the outcome of an experimental HIV vaccine in their lives. Unlike women, some men were concerned over the effect of the vaccine on their reproduction intentions. Women were concerned about the unknown effects of the vaccine in their bodies. Also, to a large extent, informants faced resistance from significant others such as fiancées, parents, relatives, and friends. Women were influenced by their potential intimate sexual partners; men were forbidden by their parents, and mothers had the most influential opinion. Conclusions Fear of the negative outcome of an experimental vaccine and resistance from significant others are the main reasons for declining to enroll in the HIV vaccine trial among eligible volunteers after randomization. The resistance from the significant others provides valuable guidance for designing future trials in Tanzania; for example, expanding the HIV vaccine trial education to the general population from the onset of the trial design.
Tarimo, Edith A. M.; Thorson, Anna; Kohi, Thecla W.; Bakari, Muhammad; Mhalu, Fred; Kulane, Asli
Management of groundwater resources can be improved by using groundwater models to perform risk analyses and to improve development strategies, but a lack of extensive basic data often limits the implementation of sophisticated models. Dar es Salaam in Tanzania is an example of a city where increasing groundwater use in a Pleistocene aquifer is causing groundwater-related problems such as saline intrusion along the coastline, lowering of water-table levels, and contamination of pumping wells. The lack of a water-level monitoring network introduces a problem for basic data collection and model calibration and validation. As a replacement, local water-supply wells were used for measuring groundwater depth, and well-top heights were estimated from a regional digital elevation model to recalculate water depths to hydraulic heads. These were used to draw a regional piezometric map. Hydraulic parameters were estimated from short-time pumping tests in the local wells, but variation in hydraulic conductivity was attributed to uncertainty in well characteristics (information often unavailable) and not to aquifer heterogeneity. A MODFLOW model was calibrated with a homogeneous hydraulic conductivity field and a sensitivity analysis between the conductivity and aquifer recharge showed that average annual recharge will likely be in the range 80-100 mm/year.
Van Camp, Marc; Mjemah, Ibrahimu Chikira; Al Farrah, Nawal; Walraevens, Kristine
There is growing evidence of the association between gender-based violence and HIV from the perspective and experiences of women. The purpose of this study is to examine these associations from the perspective of young men living in Dar es Salaam, Tanzania. A community-based sample of 951 men were interviewed, of whom 360 had sex in the past 6 months and were included in these analyses. Almost a third of the men (29.2%) reported that they had been physically violent at least once with an intimate partner. Men who reported more lifetime sexual partners (OR = 8.75; 95% CI = 2.65, 28.92), experienced physical violence as a child at home (OR = 1.73; 95% CI = 1.09, 2.76), and were more educated (OR = 1.91; 95% CI = 1.18, 3.11) were significantly more likely to report perpetrating violence. These associations persisted after adjusting for other variables. These data from the perspective of young men reinforce earlier findings from women that HIV risk and violence are occurring together in relationships of young adults. Interventions are needed to identify men at high risk for HIV and engage them in interventions that are designed to change norms and behaviors related to power and control with their sexual partners. PMID:19966247
Molecular typing of Mycobacterium tuberculosis can be used to elucidate the epidemiology of tuberculosis, including the rates of clustering, the frequency of polyclonal disease, and the distribution of genotypic families. We performed IS6110 typing and spoligotyping on M. tuberculosis strains isolated from HIV-infected subjects at baseline or during follow-up in the DarDar Trial in Tanzania and on selected community isolates. Clustering occurred in 203 (74%) of 275 subjects: 124 (80%) of 155 HIV-infected subjects with baseline isolates, 56 (69%) of 81 HIV-infected subjects with endpoint isolates, and 23 (59%) of 39 community controls. Overall, 113 (41%) subjects had an isolate representing the East Indian "GD" family. The rate of clustering was similar among vaccine and placebo recipients and among subjects with or without cellular immune responses to mycobacterial antigens. Polyclonal disease was detected in 6 (43%) of 14 patients with multiple specimens typed. Most cases of HIV-associated tuberculosis among subjects from this study in Dar es Salaam resulted from recently acquired infection. Polyclonal infection was detected and isolates representing the East Indian GD strain family were the most common. PMID:22649022
Adams, Lisa V; Kreiswirth, Barry N; Arbeit, Robert D; Soini, Hanna; Mtei, Lillian; Matee, Mecky; Bakari, Muhammad; Lahey, Timothy; Wieland-Alter, Wendy; Shashkina, Elena; Kurepina, Natalia; Driscoll, Jeffrey R; Pallangyo, Kisali; Horsburgh, C Robert; von Reyn, C Fordham
Effective handwashing with soap requires reliable access to water supplies. However, more than three billion persons do not have household-level access to piped water. This research addresses the challenge of improving hand hygiene within water-constrained environments. The antimicrobial efficacy of alcohol-based hand sanitizer, a waterless hand hygiene product, was evaluated and compared with handwashing with soap and water in field conditions in Dar es Salaam, Tanzania. Hand sanitizer use by mothers resulted in 0.66 and 0.64 log reductions per hand of Escherichia coli and fecal streptococci, respectively. In comparison, handwashing with soap resulted in 0.50 and 0.25 log reductions per hand of E. coli and fecal streptococci, respectively. Hand sanitizer was significantly better than handwashing with respect to reduction in levels of fecal streptococci (P = 0.01). The feasibility and health impacts of promoting hand sanitizer as an alternative hand hygiene option for water-constrained environments should be assessed. PMID:20134005
Pickering, Amy J; Boehm, Alexandria B; Mwanjali, Mathew; Davis, Jennifer
Molecular typing of Mycobacterium tuberculosis can be used to elucidate the epidemiology of tuberculosis, including the rates of clustering, the frequency of polyclonal disease, and the distribution of genotypic families. We performed IS6110 typing and spoligotyping on M. tuberculosis strains isolated from HIV-infected subjects at baseline or during follow-up in the DarDar Trial in Tanzania and on selected community isolates. Clustering occurred in 203 (74%) of 275 subjects: 124 (80%) of 155 HIV-infected subjects with baseline isolates, 56 (69%) of 81 HIV-infected subjects with endpoint isolates, and 23 (59%) of 39 community controls. Overall, 113 (41%) subjects had an isolate representing the East Indian “GD” family. The rate of clustering was similar among vaccine and placebo recipients and among subjects with or without cellular immune responses to mycobacterial antigens. Polyclonal disease was detected in 6 (43%) of 14 patients with multiple specimens typed. Most cases of HIV-associated tuberculosis among subjects from this study in Dar es Salaam resulted from recently acquired infection. Polyclonal infection was detected and isolates representing the East Indian GD strain family were the most common.
Kreiswirth, Barry N.; Arbeit, Robert D.; Soini, Hanna; Mtei, Lillian; Matee, Mecky; Bakari, Muhammad; Lahey, Timothy; Wieland-Alter, Wendy; Shashkina, Elena; Kurepina, Natalia; Driscoll, Jeffrey R.; Pallangyo, Kisali; Horsburgh, C. Robert; von Reyn, C. Fordham
Background HIV/AIDS is associated with a wide range of mucocutaneous disorders some of which are useful in the clinical staging and prognosis of the syndrome. There is paucity of information regarding the prevalence and pattern of mucocutaneous disorders among HIV infected children attending paediatric Care and Treatment Centres (CTC) in Dar es Salaam. Objective To determine the prevalence and pattern of mucocutaneous disorders among HIV infected children attending public paediatric 'Care and Treatment Centres' in Dar es Salaam. Methods This was a cross sectional descriptive study involving public paediatric 'Care and Treatment Centres' in Dar es Salaam. Clinical information was obtained using a questionnaire. Dermatological examination was carried out in daylight. Investigations were taken as appropriate. Data was analysed using the Statistical Package for Social Sciences (SPSS) program version 10.0. Chi-squared and Fisher's exact tests were utilized. A p-value of less than 0.05 was considered statistically significant. Results Three hundred and forty seven HIV infected children (52% males) attending CTCs were recruited into the study. Mucocutaneous disorders were encountered in 85% of them. There was no gender difference in the prevalence of the infective mucocutaneous disorders but males had a higher prevalence of non-infective/inflammatory dermatoses (58%) than females (42%) (p = 0.02). Overall, mucocutaneous disorders (infective + non infective) were more prevalent in advanced stages of HIV disease. Children with advanced HIV disease had a significantly increased frequency of fungal and viral infections (43% and 25% respectively than those with less advanced disease; 24% and 13% respectively (p = 0.01). Seventy four percent of the HIV-infected children with mucocutaneous disorders were already on ART. Conclusion Mucocutaneous disorders among HIV infected children attending Care and Treatment Centres are common and highly variable. Comprehensive management should also emphasize on the management of mucocutaneous disorders.
Panya, Millembe F; Mgonda, Yassin M; Massawe, Augustine W
Last decades, new records were set in the world for tornadoes, drought, wind, floods, wildfires and hot temperatures, testifying unusual weather and climate patterns with increasing frequency and intensity of extreme weather events. Extreme heat events are natural hazards affecting many regions in the world, nevertheless limited work has been done on the analysis and effects of extreme heat events in Africa, that is considered a continent particularly vulnerable to the effects of climate change. In fact, the increase of temperature expected in the African continent during the 21st century is larger than the global mean warming, being about 3° to 4° C, about 1.5 times the global temperature increase (Christensen et al., 2007; Gualdi et al., 2012), with the subtropical regions projected to warm more than the tropical regions. Observations and downscaled model simulations (RCP4.5 and RCP8.5 IPCC scenarios) are analyzed to describe heat wave characteristics in Dar es Salaam (Tanzania) and Addis Ababa (Ethiopia), spanning the last five decades as well as that projected for the 21st century. Observed data are daily maximum and minimum temperature collected in the period 1961-2011; downscaled model simulations span up to 2050. Heat waves are defined following a peak over threshold approach by statistical comparison to historical meteorological baselines (site dependent), using a fixed absolute threshold. Projected future warming in the Dar es Salaam and Addis Ababa shows a further increase in the heat waves parameters. Heat wave duration and hot days number are strictly correlated showing that the temperature rise could generate not only an increase of heat waves number but mainly a longer average duration, that can strongly affect the resilience capacity of the population, particularly the elder people. In fact, the impacts of heat waves on the society are determined also by temporal duration (Stephenson, 2008), in addition to their frequency, in fact the capacity of adaptation can be reduced with prolonged exposure to high temperature and humidity. The expected persistence of long-lived heat waves lasting approximately 1.5-2 weeks is clearly longer with respect to the climatological period (1961-1990). During 100 years, short lived but more intense waves are more than doubled in duration. It is evident the needs for the national health services to develop strategies for the mitigation of the heat wave effects, to enhance the resilience of the population, particularly the elder people.
Background Skin diseases are underestimated and overlooked by most clinicians despite being common in clinical practice. Many patients are hospitalized with co-existing dermatological conditions which may not be detected and managed by the attending physicians. The objective of this study was to determine the burden of co-existing and overlooked dermatological disorders among patients admitted to medical wards of Muhimbili National hospital in Dar es Salaam. Study design and settings A hospital-based descriptive cross-sectional study conducted at Muhimbili National hospital in Dar es Salaam, Tanzania. Methods Patients were consecutively recruited from the medical wards. Detailed interview to obtain clinico-demographic characteristics was followed by a complete physical examination. Dermatological diagnoses were made mainly clinically. Appropriate confirmatory laboratory investigations were performed where necessary. Data was analyzed using the 'Statistical Package for Social Sciences' (SPSS) program version 10.0. A p-value of < 0.5 was statistically significant. Results Three hundred and ninety patients admitted to medical wards were enrolled into the study of whom, 221(56.7%) were females. The mean age was 36.7 ± 17.9 (range 7-84 years). Overall, 232/390 patients (59.5%) had co-existing dermatological disorders with 49% (191/390) having one, 9% (36/390) two and 5 patients (1%) three. A wide range of co-existing skin diseases was encountered, the most diverse being non-infectious conditions which together accounted for 36.4% (142/390) while infectious dermatoses accounted for 31.5% (123/390). The leading infectious skin diseases were superficial fungal infections accounting for 18%. Pruritic papular eruption of HIV/AIDS (PPE) and seborrheic eczema were the most common non-infectious conditions, each accounting for 4.3%. Of the 232/390 patients with dermatological disorders, 191/232 (82.3%) and 154/232 (66.3%) had been overlooked by their referring and admitting doctors respectively. Conclusion Dermatological disorders are common among patients admitted to medical wards and many are not detected by their referring or admitting physicians. Basic dermatological education should be emphasized to improve knowledge and awareness among clinicians.
Background A safe effective and affordable HIV vaccine is the most cost effective way to prevent HIV infection worldwide. Current studies of HIV prevalence and incidence are needed to determine potentially suitable cohorts for vaccine studies. The prevalence and incidence of HIV-1 infection among the police in Dar es Salaam in 1996 were 13.8% and 19.6/1000 PYAR respectively. This study aimed at determining the current prevalence and incidence of HIV in a police cohort 10 years after a similar study was conducted. Methods Police officers in Dar es Salaam, Tanzania were prospectively enrolled into the study from 2005 and followed-up in an incidence study three years later. HIV infection was determined by two sequential enzyme linked immunosorbent assays (ELISAs) in the prevalence study and discordant results between two ELISAs were resolved by a Western blot assay. Rapid HIV assays (SD Bioline and Determine) were used for the incidence study. Results A total of 1,240 police participated in the HIV prevalence study from August 2005 to November 2008. Of these, 1101 joined the study from August 2005-September 2007 and an additional 139 were recruited between October 2007 to November 2008 while conducting the incidence study. A total of 726 (70%) out of the 1043 eligible police participated in the incidence study. The overall HIV-1 prevalence was 65/1240 (5.2%). Females had a non-statistically significant higher prevalence of HIV infection compared to males 19/253, (7.5%) vs. 46/987 (4.7%) respectively (p?=?0.07). The overall incidence of HIV-1 was 8.4 per 1000 PYAR (95% CI 4.68-14.03), and by gender was 8.8 and 6.9 per 1000 PYAR, among males and females respectively, (p?=?0.82). Conclusions The HIV prevalence and incidence among the studied police has declined over the past 10 years, and therefore this cohort is better suited for phase I/II HIV vaccine studies than for efficacy trials.
The human immunodeficiency virus (HIV) has contributed to an increase in tuberculosis (TB) worldwide. HIV voluntary counselling and testing (VCT) centres are cost-effective for HIV screening. Therefore there is a potential of tapping into the success of VCT centres by incorporating TB screening. The aim of this study was to determine the extent of TB and TB/HIV co-infection among VCT centre attendees. We enrolled 1318 consecutive subjects from 2 VCT centres in Dar es Salaam. The diagnosis of TB was based on evidence of Mycobacterium tuberculosis in sputum or tissue aspirates following microscopy or culture. In the absence of M. tuberculosis, the presence of 2 of the following was considered: clinical features of TB, suggestive chest radiographs and response to anti-tuberculosis trial therapy. HIV was diagnosed in 347 (26%) subjects. TB was present in 101 (7.7%) subjects of whom 63 (62%) were diagnosed at VCT centres and 38 (38%) were known TB cases who came for HIV testing. Pulmonary TB (PTB) was detected in 52 (83%) subjects. The diagnosis of PTB was based on sputum culture in 35 (67%), sputum microscopy in 20 (38%), and clinical and radiological findings in 17 (33%) subjects. TB/HIV co-infection was detected in 70 (5.3%) subjects. PTB was common in stand-alone VCT centres. Therefore VCT centres could serve as an entry point for TB screening. PMID:20586671
Munseri, Patricia J; Bakari, Muhammad; Pallangyo, Kisali; Sandstrom, Eric
Background Results from HIV vaccine trials on potential volunteers will contribute to global efforts to develop an HIV vaccine. The purpose of this study among police officers in Dar es Salaam, Tanzania, was to explore the underlying reasons that induce people to enrol in an HIV vaccine trial. Methods We conducted discussions with eight focus groups, containing a total of 66 police officers. The information collected was analyzed using interpretive description. Results The results showed that participants were motivated to participate in the trial by altruism, and that the participants experienced some concerns about their participation. They stated that altruism in the fight against HIV infection was the main reason for enrolling in the trial. However, young participants were seriously concerned about a possible loss of close relationships if they enrolled in the HIV vaccine trial. Both men and women feared the effect of the trial on their reproductive biology, and they feared interference with pregnancy norms. They were unsure about risks such as the risks of acquiring HIV infection and of suffering physical harm, and they were unsure of the intentions of the researchers conducting the trial. Further, enrolling in the trial required medical examination, and this led some participants to fear that unknown diseases would be revealed. Other participants, however, saw an opportunity to obtain free health services. Conclusions We have shown that specific fears are important concerns when recruiting volunteers to an HIV vaccine trial. More knowledge is needed to determine participants' views and to ensure that they understand the conduct of the trial and the reasons it is being carried out.
Background Sub-Saharan Africa has been severely affected by the HIV and AIDS pandemic. Global efforts at improving care and treatment has included scaling up use of antiretroviral therapy (ART). In Tanzania, HIV care and treatment program, including the provision of free ART started in 2004 with a pilot program at Muhimbili National Hospital in Dar es Salaam. This study describes the socio-demographic and clinical features of patients enrolled at the care and treatment clinic at MNH, Dar es Salaam, Tanzania. Methods A cross-sectional study looking at baseline characteristics of patients enrolled at the HIV clinic at MNH between June 2004 - Dec 2005 compared to those enrolled between 2006 and September 2008. Results Of all enrolled patients, 2408 (58.5%) were used for analysis. More females than males were attending the clinic. Their baseline median CD4 cell count was low (136 cells/?l) with 65.7% having below 200 cells/?l. Females had higher CD4 cell counts (150 cells/?l) than males (109 cells/?l) p < 0.001). The most common presenting features were skin rash and/or itching (51.6%); progressive weight loss (32.7%) and fever (23.4). Patients enrolled earlier at the clinic (2004-5) were significantly more symptomatic and had significantly lower CD4 cell count (127 cells/?l) compared to CD4 of 167 cells/?l in those seen later (2006-8) (p < 0.001). Conclusion Patients enrolled to the MNH HIV clinic were predominantly females, and presented with advanced immune-deficiency. Improved access to HIV care and treatment services seems to be associated with patients' early presentation to the clinics in the course of HIV disease.
Background In Tanzania, and many sub-Saharan African countries, postpartum health programs have received less attention compared to other maternity care programs and therefore new parents rely on informal support. Knowledge on how informal support is understood by its stakeholders to be able to improve the health in families after childbirth is required. This study aimed to explore discourses on health related informal support to first-time parents after childbirth in low-income suburbs of Dar es Salaam, Tanzania. Methods Thirteen focus group discussions with first-time parents and female and male informal supporters were analysed by discourse analysis. Results The dominant discourse was that after childbirth a first time mother needed and should be provided with support for care of the infant, herself and the household work by the maternal or paternal mother or other close and extended family members. In their absence, neighbours and friends were described as reconstructing informal support. Informal support was provided conditionally, where poor socio-economic status and non-adherence to social norms risked poor support. Support to new fathers was constructed as less prominent, provided mainly by older men and focused on economy and sexual matters. The discourse conveyed stereotypic gender roles with women described as family caretakers and men as final decision-makers and financial providers. The informal supporters regulated the first-time parents' contacts with other sources of support. Conclusions Strong and authoritative informal support networks appear to persist. However, poverty and non-adherence to social norms was understood as resulting in less support. Family health in this context would be improved by capitalising on existing informal support networks while discouraging norms promoting harmful practices and attending to the poorest. Upholding stereotypic notions of femininity and masculinity implies great burden of care for the women and delimited male involvement. Men's involvement in reproductive and child health programmes has the potential for improving family health after childbirth. The discourses conveyed contradicting messages that may be a source of worry and confusion for the new parents. Recognition, respect and raising awareness for different social actors' competencies and limitations can potentially create a health-promoting environment among families after childbirth.
Background As the population of Africa rapidly urbanizes it may be possible to protect large populations from malaria by controlling aquatic stages of mosquitoes. Here we present a baseline evaluation of the ability of community members to detect mosquito larval habitats with minimal training and supervision in the first weeks of an operational urban malaria control program. Methods The Urban Malaria Control Programme of Dar es Salaam recruited and provided preliminary training to teams of Community-Owned Resource Persons (CORPs) who performed weekly surveys of mosquito breeding sites. Two trained mosquito biologists accompanied each of these teams for one week and evaluated the sensitivity of this system for detecting potential Anopheles habitats. Results Overall, 42.4% of 986 habitats surveyed by an inspection team had previously been identified by CORPs. Agricultural habitats were detected less often than other habitats (30.8% detected, Odds Ratio [95%CI] = 0.46 [0.29–0.73], P = 0.001). Non-agricultural artificial habitats were less suitable than other habitats (29.3% occupancy, OR = 0.69 [0.46–1.03], P = 0.066) but still constituted 45% (169/289) of occupied habitats because of their abundance (51 % of all habitats). Conclusion The levels of coverage achieved by modestly trained and supported CORPs at the start of the Dar es Salaam UMCP were insufficient to enable effective suppression of malaria transmission through larval control. Further operational research is required to develop surveillance systems that are practical, affordable, effective and acceptable so that community-based integrated vector management can be implemented in cities across Africa.
Vanek, Michael J; Shoo, Bryson; Mtasiwa, Deo; Kiama, Michael; Lindsay, Steven W; Fillinger, Ulrike; Kannady, Khadija; Tanner, Marcel; Killeen, Gerry F
Background: This article presents part of the findings from a larger study that sought to assess the role that gender relations play in influencing equity regarding access and adherence to antiretroviral therapy (ART). Review of the literature has indicated that, in Southern and Eastern Africa, fewer men than women have been accessing ART, and the former start using ART late, after HIV has already been allowed to advance. The main causes for this gender gap have not yet been fully explained. Objective: To explore how masculinity norms limit men's access to ART in Dar es Salaam. Design: This article is based on a qualitative study that involved the use of focus group discussions (FGDs). The study employed a stratified purposive sampling technique to recruit respondents. The study also employed a thematic analysis approach. Results: Overall, the study's findings revealed that men's hesitation to visit the care and treatment clinics signifies the superiority norm of masculinity that requires men to avoid displaying weakness. Since men are the heads of families and have higher social status, they reported feeling embarrassed at having to visit the care and treatment clinics. Specifically, male respondents indicated that going to a care and treatment clinic may raise suspicion about their status of living with HIV, which in turn may compromise their leadership position and cause family instability. Because of this tendency towards 'hiding', the few men who register at the public care and treatment clinics do so late, when HIV-related signs and symptoms are already far advanced. Conclusion: This study suggests that the superiority norm of masculinity affects men's access to ART. Societal expectations of a 'real man' to be fearless, resilient, and emotionally stable are in direct conflict with expectations of the treatment programme that one has to demonstrate health-promoting behaviour, such as promptness in attending the care and treatment clinic, agreeing to take HIV tests, and disclosing one's status of living with HIV to at least one's spouse or partner. Hence, there is a need for HIV control agencies to design community-based programmes that will stimulate dialogue on the deconstruction of masculinity notions. PMID:24152373
Nyamhanga, Tumaini M; Muhondwa, Eustace P Y; Shayo, Rose
Background This article presents part of the findings from a larger study that sought to assess the role that gender relations play in influencing equity regarding access and adherence to antiretroviral therapy (ART). Review of the literature has indicated that, in Southern and Eastern Africa, fewer men than women have been accessing ART, and the former start using ART late, after HIV has already been allowed to advance. The main causes for this gender gap have not yet been fully explained. Objective To explore how masculinity norms limit men's access to ART in Dar es Salaam. Design This article is based on a qualitative study that involved the use of focus group discussions (FGDs). The study employed a stratified purposive sampling technique to recruit respondents. The study also employed a thematic analysis approach. Results Overall, the study's findings revealed that men's hesitation to visit the care and treatment clinics signifies the superiority norm of masculinity that requires men to avoid displaying weakness. Since men are the heads of families and have higher social status, they reported feeling embarrassed at having to visit the care and treatment clinics. Specifically, male respondents indicated that going to a care and treatment clinic may raise suspicion about their status of living with HIV, which in turn may compromise their leadership position and cause family instability. Because of this tendency towards ‘hiding’, the few men who register at the public care and treatment clinics do so late, when HIV-related signs and symptoms are already far advanced. Conclusion This study suggests that the superiority norm of masculinity affects men's access to ART. Societal expectations of a ‘real man’ to be fearless, resilient, and emotionally stable are in direct conflict with expectations of the treatment programme that one has to demonstrate health-promoting behaviour, such as promptness in attending the care and treatment clinic, agreeing to take HIV tests, and disclosing one's status of living with HIV to at least one's spouse or partner. Hence, there is a need for HIV control agencies to design community-based programmes that will stimulate dialogue on the deconstruction of masculinity notions.
Nyamhanga, Tumaini M.; Muhondwa, Eustace P.Y.; Shayo, Rose
Background In recent randomized controlled trials, male circumcision has been proven to complement the available biomedical interventions in decreasing HIV transmission from infected women to uninfected men. Consequently, Tanzania is striving to scale-up safe medical male circumcision to reduce HIV transmission. However, there is a need to investigate the perceptions of male circumcision in Tanzania using specific populations. The purpose of the present study was to assess the perceptions of male circumcision in a cohort of police officers that also served as a source of volunteers for a phase I/II HIV vaccine (HIVIS-03) trial in Dar es Salaam, Tanzania. Methods In-depth interviews with 24 men and 10 women were conducted. Content analysis informed by the socio-ecological model was used to analyze the data. Results Informants perceived male circumcision as a health-promoting practice that may prevent HIV transmission and other sexually transmitted infections. They reported male circumcision promotes sexual pleasure, confidence and hygiene or sexual cleanliness. They added that it is a religious ritual and a cultural practice that enhances the recognition of manhood in the community. However, informants were concerned about the cost involved in male circumcision and cleanliness of instruments used in medical and traditional male circumcision. They also expressed confusion about the shame of undergoing circumcision at an advanced age and pain that could emanate after circumcision. The participants advocated for health policies that promote medical male circumcision at childhood, specifically along with the vaccination program. Conclusions The perceived benefit of male circumcision as a preventive strategy to HIV and other sexually transmitted infections is important. However, there is a need to ensure that male circumcision is conducted under hygienic conditions. Integrating male circumcision service in the routine childhood vaccination program may increase its coverage at early childhood. The findings from this investigation provide contextual understanding that may assist in scaling-up male circumcision in Tanzania.
BACKGROUND: Tuberculosis (TB) case detection in women has remained low in developing world. This study was conducted to determine the proportion of smear positive TB among women with cough regardless of the duration attending family Planning (FP) and Maternal and child health (MCH) clinics in Dar es Salaam. METHODS: We conducted a cross sectional study in all three municipal hospitals
Esther S Ngadaya; Godfrey S Mfinanga; Eliud R Wandwalo; Odd Morkve
Elemental and water-soluble ionic compounds (WSICs) of atmospheric aerosols (total suspended particulate – TSP) and some gaseous pollutants (SO2, NO2 and O3) from a coastal, semi-urban and rural site in and near Dar es Salaam, Tanzania were investigated during dry and wet seasons of January 2005–November 2007. Na+, Ca2+, SO42?, NO3? and Cl? made up the dominant fraction of WSICs during the dry season with average concentrations ranging from non-detectable (n.d.)–5.4, 0.26–2.6, 0.74–14.7, 0.4–1.5 and 1.1–3.4 ?g m?3, respectively, while in the wet season, from n.d. up to 1.7, 1.2, 4.4, 2.1 and 3.0 ?g m?3, respectively. The total air concentrations of the detected elements (Al, Si, S, Cl, K, Ca, Fe and Zn) showed seasonal and site-specific variation in the range of 7.5–26.6 with an average of 14.5 ?g m?3. Most of the air concentrations of pollutants were observed to decrease with increasing distance from the coastal site, which is under urban and industrial pollutant emissions. Sulphur and nitrogen oxidation ratios during the dry season ranged from 0.08 to 0.91 and 0.013 to 0.049, respectively, while they were between 0.09–0.65 and 0.002–0.095, respectively, in the wet season. These values indicate the photochemical oxidation of SO2 and a high extent of NO3?formation in the atmosphere. Neutralization ratios revealed the presence of acidic SO42? and NO3? aerosols. Principal component analysis identified sea spray, local combustion, vehicular traffic, biomass burning and re-suspended road dust as dominant sources of aerosols at the studied coastal and semi-urban sites. However, at the rural site, besides sea spray, crustal sources, soil dust re-suspension and long-range transport are the possible origins of suspended particulates.
Mmari, Albert G.; Potgieter-Vermaak, Sanja S.; Bencs, László; McCrindle, Robert I.; Van Grieken, René
East Africa was at the forefront of early achievements and discoveries in paediatric oncology thanks to Denis Burkitt's seminal work. Although these successes have been built upon and continued elsewhere, they were sadly not sustained in sub-Saharan Africa for a variety of reasons. In recent years however this situation is slowly changing in countries across the continent. Tanzania is one such African country. Until very recently, survival rates of 5-10% for all children's cancers were expected. However, change has been brought about thanks to the combined efforts and commitments of the Tanzanian Ministry of Health, non-governmental organizations--such as The International Network for Cancer Treatment and Research, and Children in Crossfire-- and the participation of the private sector. Services are rapidly developing and outcomes are continuing to improve with 1-year survival rates of approximately 60% achieved. Efforts to maintain this early progress are concentrated around providing high quality local subspecialty medical training and continued local ownership of the programme. PMID:22233461
Voluntary Counseling and Testing (VCT) remains low among men in sub-Saharan Africa. The factors associated with previous HIV testing and knowledge of partner's HIV status are described for 9,107 men who visited the Muhimbili University College of Health Sciences' VCT site in Dar es Salaam, Tanzania, between 1997 and 2008. Data are from intake forms administered to clients seeking VCT services. Most of the men (64.5%) had not previously been tested and 75% were unaware of their partner's HIV status. Multivariate logistic regression revealed that age, education, condom use, and knowledge of partner's HIV status were significant predictors of previous HIV testing. Education, number of sexual partners, and condom use were also associated with knowledge of partner's HIV status. The low rate of VCT use among men underscores the need for more intensive initiatives to target men and remove the barriers that prevent HIV disclosure. PMID:23221684
Conserve, Donaldson; Sevilla, Luis; Mbwambo, Jessie; King, Gary
Background This study aimed to determine the age-specific aetiologic agents of diarrhoea in children aged less than five years. The study also assessed the efficacy of the empiric treatment of childhood diarrhoea using Integrated Management of Childhood Illness (IMCI) guidelines. Methods This study included 280 children aged less than 5 years, admitted with diarrhoea to any of the four major hospitals in Dar es Salaam. Bacterial pathogens were identified using conventional methods. Enzyme Linked Immunosorbent Assay (ELISA) and agglutination assay were used to detect viruses and intestinal protozoa, respectively. Antimicrobial susceptibility was determined using Kirby-Bauer disk diffusion method. Results At least one of the searched pathogens was detected in 67.1% of the cases, and mixed infections were detected in 20.7% of cases. Overall, bacteria and viruses contributed equally accounting for 33.2% and 32.2% of all the cases, respectively, while parasites were detected in 19.2% patients. Diarrhoeagenic Escherichia coli (DEC) was the most common enteric pathogen, isolated in 22.9% of patients, followed by Cryptosporidium parvum (18.9%), rotavirus (18.1%) and norovirus (13.7%). The main cause of diarrhoea in children aged 0 to 6 months were bacteria, predominantly DEC, while viruses predominated in the 7-12 months age group. Vibrio cholerae was isolated mostly in children above two years. Shigella spp, V. cholerae and DEC showed moderate to high rates of resistance to erythromycin, ampicillin, chloramphenicol and tetracycline (56.2-100%). V. cholerae showed full susceptibility to co-trimoxazole (100%), while DEC and Shigella showed high rate of resistance to co-trimoxazole; 90.6% and 93.3% respectively. None of the bacterial pathogens isolated showed resistance to ciprofloxacin which is not recommended for use in children. Cefotaxime resistance was found only in 4.7% of the DEC. Conclusion During the dry season, acute watery diarrhoea is the most common type of diarrhoea in children under five years in Dar es Salaam and is predominantly due to DEC, C. parvum, rotaviruses and noroviruses. Constant antibiotic surveillance is warranted as bacteria were highly resistant to various antimicrobial agents including co-trimoxazole and erythromycin which are currently recommended for empiric treatment of diarrhoea.
Background Community participation in vector control and health services in general is of great interest to public health practitioners in developing countries, but remains complex and poorly understood. The Urban Malaria Control Program (UMCP) in Dar es Salaam, United Republic of Tanzania, implements larval control of malaria vector mosquitoes. The UMCP delegates responsibility for routine mosquito control and surveillance to community-owned resource persons (CORPs), recruited from within local communities via the elected local government. Methods A mixed method, cross-sectional survey assessed the ability of CORPs to detect mosquito breeding sites and larvae, and investigated demographic characteristics of the CORPs, their reasons for participating in the UMCP, and their work performance. Detection coverage was estimated as the proportion of wet habitats found by the investigator which had been reported by CORP. Detection sensitivity was estimated as the proportion of wet habitats found by the CORPS which the investigator found to contain Anopheles larvae that were also reported to be occupied by the CORP. Results The CORPs themselves perceived their role as professional rather than voluntary, with participation being a de facto form of employment. Habitat detection coverage was lower among CORPs that were recruited through the program administrative staff, compared to CORPs recruited by local government officials or health committees (Odds Ratio = 0.660, 95% confidence interval = [0.438, 0.995], P = 0.047). Staff living within their areas of responsibility had > 70% higher detection sensitivity for both Anopheline (P = 0.016) and Culicine (P = 0.012): positive habitats compared to those living outside those same areas. Discussion and conclusions Improved employment conditions as well as involving the local health committees in recruiting individual program staff, communication and community engagement skills are required to optimize achieving effective community participation, particularly to improve access to fenced compounds. A simpler, more direct, less extensive community-based surveillance system in the hands of a few, less burdened, better paid and maintained program personnel may improve performance and data quality.
Introduction Prevention with a positive approach has been advocated as one of the main strategies to reduce new instances of HIV infection. Risky sexual behaviours among people living with HIV/AIDS are the cornerstone for this approach. Understanding the extent to which infected individuals practice risky behaviours is fundamental in designing appropriate population-specific interventions. With the HIV infection transmission rates remaining high among young people in sub-Saharan Africa, continued prevention among them remains a priority. This study therefore seeks to describe the magnitude and determinants of risky sexual behaviours among young people living with HIV. Methods A cross-sectional study was conducted between June and July 2010 in selected Care and Treatment Clinics (CTCs) in Dar Es Salaam, Tanzania. A total of 282 HIV-positive patients aged 15–24 were interviewed about their sexual behaviours using a questionnaire. Results Prevalence of unprotected sex was 40.0% among young males and 37.5% among young females (p<0.001). Multiple sexual partnerships were reported by 10.6% of males and 15.9% of females (p<0.005). More than 50% of the participants did not know about the HIV status of their sexual partners. A large proportion of participants had minimal knowledge of transmission (46.7% males vs. 60.4% females) and prevention (65.3% males vs. 73.4% females) of sexually transmitted infections (STIs). Independent predictors of condom use included non-use of alcohol [adjusted odds ratio (AOR), 0.40 95% confidence interval (CI); 0.17–0.84] and younger age (15–19 years) (AOR, 2.76, 95% CI: 1.05–7.27). Being on antiretroviral therapy (AOR, 0.38, 95% CI: 0.17–0.85) and not knowing partners’ HIV sero-status (AOR, 2.62, 95% CI: 1.14–5.10) predicted the practice of multiple sexual partnership. Conclusions Unprotected sex and multiple sexual partnerships were prevalent among young people living with HIV. Less knowledge on STI and lack of HIV disclosure increased the vulnerability and risk for HIV transmission among young people. Specific intervention measures addressing alcohol consumption, risky sexual behaviours, and STI transmission and prevention knowledge should be integrated in the routine HIV/AIDS care and treatment offered to this age group.
Introduction: Prevention with a positive approach has been advocated as one of the main strategies to reduce new instances of HIV infection. Risky sexual behaviours among people living with HIV/AIDS are the cornerstone for this approach. Understanding the extent to which infected individuals practice risky behaviours is fundamental in designing appropriate population-specific interventions. With the HIV infection transmission rates remaining high among young people in sub-Saharan Africa, continued prevention among them remains a priority. This study therefore seeks to describe the magnitude and determinants of risky sexual behaviours among young people living with HIV. Methods: A cross-sectional study was conducted between June and July 2010 in selected Care and Treatment Clinics (CTCs) in Dar Es Salaam, Tanzania. A total of 282 HIV-positive patients aged 15-24 were interviewed about their sexual behaviours using a questionnaire. Results: Prevalence of unprotected sex was 40.0% among young males and 37.5% among young females (p<0.001). Multiple sexual partnerships were reported by 10.6% of males and 15.9% of females (p<0.005). More than 50% of the participants did not know about the HIV status of their sexual partners. A large proportion of participants had minimal knowledge of transmission (46.7% males vs. 60.4% females) and prevention (65.3% males vs. 73.4% females) of sexually transmitted infections (STIs). Independent predictors of condom use included non-use of alcohol [adjusted odds ratio (AOR), 0.40 95% confidence interval (CI); 0.17-0.84] and younger age (15-19 years) (AOR, 2.76, 95% CI: 1.05-7.27). Being on antiretroviral therapy (AOR, 0.38, 95% CI: 0.17-0.85) and not knowing partners' HIV sero-status (AOR, 2.62, 95% CI: 1.14-5.10) predicted the practice of multiple sexual partnership. Conclusions: Unprotected sex and multiple sexual partnerships were prevalent among young people living with HIV. Less knowledge on STI and lack of HIV disclosure increased the vulnerability and risk for HIV transmission among young people. Specific intervention measures addressing alcohol consumption, risky sexual behaviours, and STI transmission and prevention knowledge should be integrated in the routine HIV/AIDS care and treatment offered to this age group. PMID:24119708
BACKGROUND: Human bites in the maxillofacial region compromise function and aesthetics, resulting in social and psychological effects. There is paucity of information regarding human bite injuries in Tanzania. The aim of the study was to assess the occurrence, treatment modalities and prognosis of human bite injuries in the oro-facial region at the Muhimbili National Hospital Dar es Salaam, Tanzania. METHODS:
Farrid M Shubi; Omar JM Hamza; Boniphace M Kalyanyama; Elison NM Simon
The second International African Federation of Neurological Surgeons course was organized on January 24 to 28, 2011, at the Seacliff Hotel and Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania. President Jakaya Mrisho Kikwete graced the official opening with high ranking government officials in attendance. The targeted participants were young neurosurgeons in the East, Central, and South African region. More than 80 surgeons, residents, and neurosurgical nurses came from Tanzania, Kenya, Uganda, Rwanda, Ethiopia, Zambia, and Zimbabwe. The objectives of the course were to teach and train young local surgeons in the essential-relevant for the region-and current techniques and management principles of brain and spinal diseases, acquire new skills through hands-on practical sessions, and share experiences. The course consisted of didactic sessions, practical aspects on spine internal fixation, cadaver dissections, and live microscopic and endoscopic surgery. Experienced faculty from different states of the United States, Spain, Turkey, India, Egypt, and Ethiopia facilitated the course. The objectives of the course were met with a favorable evaluation report. The collaboration and experience gained will be reinvested in organizing similar courses in the region. PMID:22120325
Kahamba, Joseph F; Assey, Anthony B; Dempsey, Robert J; Qureshi, Mahmood M; Härtl, Roger
Evaluation trials of the efficacy of buparvaquone (BUTA-kel KELA Laboratoria, N.V. Belgium), as a treatment of field cases of Theileria parva infection (East Coast fever - ECF) were carried out on 63 cattle in the peri-urban of Dar Es Salaam city, Tanzania, during the period November 2004 to August 2005. Thirty-two cattle (56%) received single-dose treatment (2.5 mg buparvaquone per kg body weight), while two and three-dose treatment with interval(s) of 48 h was given to 33% and 11% of total treated cattle, respectively; 38 cattle (60.3%) were treated at an early stage of the disease, while 25 cattle (39.7%) were treated at an advanced stage of the disease. The rectal body temperature of 90.5% of buparvaquone-treated cattle dropped to normal values (37.5-39.5 degrees C) by day 7 of treatment, and by day 15 of treatment 96.8% of treated cattle showed normal values. Pulmonary signs were observed in 8/68 (11.8%) of total ECF diagnosed cattle and were successfully treated, albeit with parvaquone plus frusemide (Fruvexon); were not included in final evaluation of the efficacy of BUTA-kel. The present evaluation trials record a recovery rate of 95.2%. Buparvaquone (BUTA-kel KELA Laboratoria, N.V. Belgium), therefore, records another efficacious and valuable alternative treatment against East Coast fever in Tanzania. PMID:16567050
BACKGROUND: Historically, environmental management has brought important achievements in malaria control and overall improvements of health conditions. Currently, however, implementation is often considered not to be cost-effective. A community-based environmental management for malaria control was conducted in Dar es Salaam between 2005 and 2007. After community sensitization, two drains were cleaned followed by maintenance. This paper assessed the impact of
Background Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality rate (PMR). Methods From 1st August, 2007 to 31st December, 2007 we conducted an audit of perinatal deaths (n = 133) with birth weight 1500 g or more at Muhimbili National Hospital (MNH). The audit was done by three obstetricians, two external and one internal auditors. Each auditor independently evaluated the cases narratives. Suboptimal factors were identified in the antepartum, intrapartum and early neonatal period and classified into three levels of delay (community, infrastructure and health care). The contribution of each suboptimal factor to adverse perinatal outcome was identified and the case graded according to possible avoidability. Degree of agreement between auditors was assessed by the kappa coefficient. Results The PMR was 92 per 1000 total births. Suboptimal factors were identified in 80% of audited cases and half of suboptimal factors were found to be the likely cause of adverse perinatal outcome and were preventable. Poor foetal heart monitoring during labour was indirectly associated with over 40% of perinatal death. There was a poor to fair agreement between external and internal auditors. Conclusion There are significant areas of care that need improvement. Poor monitoring during labour was a major cause of avoidable perinatal mortality. This type of audit was a good starting point for quality assurance at MNH. Regular perinatal audits to identify avoidable causes of perinatal deaths with feed back to the staff may be a useful strategy to reduce perinatal mortality.
The emission estimation of nine volatile organic compounds (VOCs) from eight organic liquids storage tanks companies in Dar-es-Salaam City Tanzania has been done by using US EPA standard regulatory storage tanks emission model (TANKS 4.9b). Total VOCs atmospheric emission has been established to be 853.20 metric tones/yr. It has been established further that petrol storage tanks contribute about 87% of total VOCs emitted, while tanks for other refined products and crude oil were emitting 10% and 3% of VOCs respectively. Of the eight sources (companies), the highest emission value from a single source was 233,222.94 kg/yr and the lowest single source emission value was 6881.87 kg/yr. The total VOCs emissions estimated for each of the eight sources were found to be higher than the standard level of 40,000 kg/yr per source for minor source according to US EPA except for two sources, which were emitting VOCs below the standard level. The annual emissions per single source for each of the VOCs were found to be below the US EPA emissions standard which is 2,000 kg/yr in all companies except the emission of hexane from company F1 which was slightly higher than the standard. The type of tanks used seems to significantly influence the emission rate. Vertical fixed roof tanks (VFRT) emit a lot more than externally floating roof tanks (EFRT) and internally floating roof tanks (IFRT). The use of IFRT and EFRT should be encouraged especially for storage of petrol which had highest atmospheric emission contribution. Model predicted atmospheric emissions are less than annual losses measured by companies in all the eight sources. It is possible that there are other routes for losses beside atmospheric emissions. It is therefore important that waste reduction efforts in these companies are directed not only to reducing atmospheric emissions, but also prevention of the spillage and leakage of stored liquid and curbing of the frequently reported illegal siphoning of stored products. Emission rates for benzene, toluene, and xylene were used as input to CALPUFF air dispersion model for the calculation of spatial downwind concentrations from area sources. By using global positioning system (GPS) and geographical information system (GIS) the spatial benzene concentration contributed by organic liquid storage tanks has been mapped for Dar-es-Salaam City. Highest concentrations for all the three toxic pollutants were observed at Kigamboni area, possibly because the area is located at the wind prevailing direction from the locations of the storage tanks. The model predicted concentrations downwind from the sources were below tolerable concentrations by WHO and US-OSHA. The highest 24 hrs averaging time benzene concentration was used for risk assessment in order to determine maximum carcinogenic risk amongst the population exposed at downwind. Established risk for adult and children at 2.9x10(-3) and 1.9x10(-3) respectively, are higher than the acceptable US-EPA risk of 1x10(-6). It is very likely that the actual VOCs concentrations in some urban areas in Tanzania including Dar-es-Salaam City are much higher than the levels reported in this study when other sources such as petrol stations and motor vehicles on the roads are considered. Tanzania Government therefore need to put in place: an air quality policy and legislation, establish air quality guidelines and acquire facilities which will enable the implementation of air quality monitoring and management programmes. PMID:16779602
Background Historically, environmental management has brought important achievements in malaria control and overall improvements of health conditions. Currently, however, implementation is often considered not to be cost-effective. A community-based environmental management for malaria control was conducted in Dar es Salaam between 2005 and 2007. After community sensitization, two drains were cleaned followed by maintenance. This paper assessed the impact of the intervention on community awareness, prevalence of malaria infection, and Anopheles larval presence in drains. Methods A survey was conducted in neighbourhoods adjacent to cleaned drains; for comparison, neighbourhoods adjacent to two drains treated with larvicides and two drains under no intervention were also surveyed. Data routinely collected by the Urban Malaria Control Programme were also used. Diverse impacts were evaluated through comparison of means, odds ratios (OR), logistic regression, and time trends calculated by moving averages. Results Individual awareness of health risks and intervention goals were significantly higher among sensitized neighbourhoods. A reduction in the odds of malaria infection during the post-cleaning period in intervention neighbourhoods was observed when compared to the pre-cleaning period (OR = 0.12, 95% CI 0.05–0.3, p < 0.001). During the post-cleaning period, a higher risk of infection (OR = 1.7, 95% CI 1.1–2.4, p = 0.0069) was observed in neighbourhoods under no intervention compared to intervention ones. Eighteen months after the initial cleaning, one of the drains was still clean due to continued maintenance efforts (it contained no waste materials and the water was flowing at normal velocity). A three-month moving average of the percentage of water habitats in that drain containing pupae and/or Anopheles larvae indicated a decline in larval density. In the other drain, lack of proper resources and local commitment limited success. Conclusion Although environmental management was historically coordinated by authoritarian/colonial regimes or by industries/corporations, its successful implementation as part of an integrated vector management framework for malaria control under democratic governments can be possible if four conditions are observed: political will and commitment, community sensitization and participation, provision of financial resources for initial cleaning and structural repairs, and inter-sectoral collaboration. Such effort not only is expected to reduce malaria transmission, but has the potential to empower communities, improve health and environmental conditions, and ultimately contribute to poverty alleviation and sustainable development.
Data on slow progression following HIV-1 infection in Africa are sparse. From a study on the natural history of HIV-1 infection in Dar es Salaam, Tanzania, an analysis of immunological and clinical data from 237 HIV-1 seropositive individuals was performed. Annual CD4 cell determinations were carried out by flow cytometry. None was on antiretroviral treatment. CD4+ cell slopes were obtained by fitting a linear regression model. A study population of 50 individuals with >3 CD4 cell determinations and followed for >5 y had a mean follow-up of 72.7 months, and mean 5.7 CD4+ cell determinations. With a criterion of maintaining a CD4 cell count >or=500 cells/ml, 8 of the 50 (16.0%) were long-term non-progressors (LTNP). With a definition of maintaining a CD4+ cell slope
In Tanzania, the most serious solid waste management problem currently is disposal, but since the largest fraction of the waste is organics which are amenable to anaerobic digestion and composting, it makes environmental and economic sense to explore these options. This prompted the conception of the Taka (waste) Gas Project which is meant to utilise organic solid waste from Dar
Background Obesity is on the rise worldwide, not sparing developing countries. Both demographic and socio-economic factors play parts\\u000a in obesity causation. Few surveys have been conducted in Tanzania to determine the magnitude of obesity and its association\\u000a with these risk factors. This study aimed at determining the prevalence of obesity and its associated risk factors among adults\\u000a aged 18 - 65
Background As HIV infection continues to devastate low-income countries, efforts to search for an effective HIV vaccine are crucial. Therefore, participation in HIV vaccine trials will be useful for the development of a preventive vaccine that will work and thus reduce the global HIV epidemic. Objective The objective of this study was to analyse the willingness to volunteer (WTV) in a Phase I/II HIV vaccine trial among police officers in Dar es Salaam, Tanzania. Design We included a convenience sample of 329 participants (79% males) from sensitisation workshops that were held once at each of the 32 police stations. Participants were recruited from 23 stations which were included according to availability. Data about personal characteristics, general HIV and AIDS knowledge and sexual behaviour, attitudes towards vaccines and willingness to participate in the HIV vaccine trial were obtained through an interview-administered questionnaire with both closed and open-ended questions. Results Overall, 61% of the participants expressed WTV in HIV vaccine trials. WTV was significantly associated with: positive attitude towards use of effective vaccine, Odds ratio (OR), 36.48 (95% CI: 15.07–88.28); the intention to tell others about one's decision to participate in the trial, OR, 6.61 (95% CI: 3.89–11.24); Tanzania becoming a partner in developing the vaccine, OR, 4.28 (95% CI: 2.28–8.03); having an extra sexual partner, OR, 3.05 (95% CI: 1.63–5.69); perceived higher risk of getting HIV infection, OR, 2.11 (95% CI: 1.34–3.33); and high knowledge about HIV and AIDS, OR, 1.92 (95% CI: 1.22–3.01). Conclusion The results indicated that a majority of police officers in this study were willing to participate in HIV vaccine trials. However, there is a need to provide the respondents with precise information about the purpose of a Phase I/II HIV vaccine trial and the fact that it does not protect against HIV infection, in order to avoid increasing risky behaviour.
Background Impacted teeth predispose to periodontal disease and dental caries of adjacent teeth resulting in pain, discomfort and loss of function. This study analyzed the pattern of occurrence of impacted teeth, associated symptoms, treatment and complications of treatment in patients who presented at the Muhimbili National Hospital, Tanzania. Method This was a crossectional descriptive study which utilized notes and x rays of patients who were treated for impacted teeth at the Oral and Maxillofacial firm in Muhimbili National Hospital over five years, from January 2005 to August 2010. These records were retrieved and examined for the major complaint of the patient at presentation to hospital, demography, impacted tooth, type of impaction (for third molars), treatment offered and complications after treatment. Similar information was collected from all patients with impacted teeth attended in the same centre from 1st September 2010 to 31st August 2011. Results A total of 896 patients (496 males and 400 females) treated for complaints related to impacted teeth were recorded. The male to female ratio was 1.2:1, age range of 16 to 85 years and a mean age of 28.9 years (SD = 9.5). Slightly more than 84% of the patients presented with mandibular third molar impactions. Most (44.7%) of these patients had an impacted lower right third molar followed by those presenting with a lower left third molar impaction (39.7%). In 1.3% of the patients all the four third molars were impacted. Sixty nine (7.7%) patients had impacted upper 3rd molars while 2% had impacted upper canines. Of the mandibular 3rd molar impactions 738 (76%) were mesio-angular type, 87 (8.9%) horizontal type and 69 (7.1%) disto-angular. Patients presented with a variety of complaints. About 85% of the patients presented to hospital due to varying degrees of pain. In 4.9% the detection of the impacted tooth/teeth was coincidental after presenting to hospital for other reasons not related to the impaction. Majority of the patients with impacted mandibular third molars had carious lesions on the impacted teeth, neighbouring tooth or both. Four hundred and five (45.2%) patients had a carious lesion on one of the impacted teeth while 201(22.4%) patients had a carious lesion on the adjacent second molar. In 122 (13.6%) patients both the impacted third molar and the adjacent second molar were carious. In twelve patients who presented with a main complaint of fracture of the angle of the mandible there was an associated impacted 3rd molar. Eight hundred and fifteen (91%) patients with impacted teeth were treated by surgical removal. Among these only 15 (1.8%) had complications that ranged from excessive swellings, trismus and severe pain post operatively. One patient was reported to have fracture of the angle of the mandible sustained during surgical removal of an impacted 48. Conclusions The majority of patients with impacted teeth were young with an almost equal sex distribution. The most commonly impacted teeth were mandibular third molars followed by the maxillary third molars. Patients with impacted teeth reported for health care predominantly because of pain due to dental caries or infection. There is a need of creating appropriate programmes that would further raise peoples’ awareness to regular dental checkups so that appropriate measures are taken before complications arise.
Developing effective place-based health interventions requires understanding of the dynamic between place and health. The therapeutic landscape framework explains how place-based social processes and physical geography interact and influence health behavior. This study applied this framework to examine how venues, or social gathering places, influenced HIV risk behavior among young, urban men in Tanzania. Eighty-three public venues where men ages 15–19 met new sexual partners were identified by community informants in one city ward. The majority (86%) of the venues were called ‘camps’, social gathering places that had formal leaders and members. Observations were conducted at 23 camps and in-depth interviews were conducted with 36 camp members and 10 camp leaders in 15 purposively selected camps. Geographic and social features of camps were examined to understand their contributions to men’s behaviors. Camps were characterized by a geographic space claimed by members, a unique name and a democratic system of leadership and governance. Members were mostly men and socialized daily at their camp. They reported strong social bonds and engaging in health-promoting activities such as playing sports and generating income. Members also engaged in HIV risk behaviors, such as meeting new sexual partners and having sex in or around the camp at night. Some members promoted concurrent sexual partnerships with their friends and resisted camp leaders’ efforts to change their sexual risk behavior. We conclude that camps are strategic venues for HIV prevention programs for young Tanzanian men. They served as both protective and risk landscapes, illustrating three domains of the therapeutic landscape framework: the built environment; identities of landscape occupants; and sites for collective efficacy. The framework and data suggest HIV intervention components that might augment the protective features of the camps, while changing environmental features to reduce risk.
The most promising strategies for improving management of solid wastes have been identified as minimisation of the amount of the solid wastes generated and maximisation of waste recycling as well as resource recovery. The latter strategy includes composting. A composting research and pilot scale demonstration project was implemented in Dar es Salaam City. It was meant to try out the
S. E. Mbuligwe; G. R. Kassenga; M. E. Kaseva; E. J. Chaggu
Background As the population of Africa rapidly urbanizes, large populations could be protected from malaria by controlling aquatic stages of mosquitoes if cost-effective and scalable implementation systems can be designed. Methods A recently initiated Urban Malaria Control Programme in Dar es Salaam delegates responsibility for routine mosquito control and surveillance to modestly-paid community members, known as Community-Owned Resource Persons (CORPs). New vector surveillance, larviciding and management systems were designed and evaluated in 15 city wards to allow timely collection, interpretation and reaction to entomologic monitoring data using practical procedures that rely on minimal technology. After one year of baseline data collection, operational larviciding with Bacillus thuringiensis var. israelensis commenced in March 2006 in three selected wards. Results The procedures and staff management systems described greatly improved standards of larval surveillance relative to that reported at the outset of this programme. In the first year of the programme, over 65,000 potential Anopheles habitats were surveyed by 90 CORPs on a weekly basis. Reaction times to vector surveillance at observations were one day, week and month at ward, municipal and city levels, respectively. One year of community-based larviciding reduced transmission by the primary malaria vector, Anopheles gambiae s.l., by 31% (95% C.I. = 21.6–37.6%; p = 0.04). Conclusion This novel management, monitoring and evaluation system for implementing routine larviciding of malaria vectors in African cities has shown considerable potential for sustained, rapidly responsive, data-driven and affordable application. Nevertheless, the true programmatic value of larviciding in urban Africa can only be established through longer-term programmes which are stably financed and allow the operational teams and management infrastructures to mature by learning from experience.
Fillinger, Ulrike; Kannady, Khadija; William, George; Vanek, Michael J; Dongus, Stefan; Nyika, Dickson; Geissbuhler, Yvonne; Chaki, Prosper P; Govella, Nico J; Mathenge, Evan M; Singer, Burton H; Mshinda, Hassan; Lindsay, Steven W; Tanner, Marcel; Mtasiwa, Deo; de Castro, Marcia C; Killeen, Gerry F
This document summarizes the activities of a conference held at the Institute of Finance Management in Tanzania on information resource sharing in Southern and Central Africa. Delegates and observers from Lesotho, Swaziland, Mozambique, Botswana, Zimbabwe, Malawi, Zambia, and Tanzania attended the conference. The 15 participants, 8 sponsored by…
United Nations Educational, Scientific and Cultural Organization, Paris (France). General Information Programme.
Background Dar es Salaam has an extensive drain network, mostly with inadequate water flow, blocked by waste, causing flooding after rainfall. The presence of Anopheles and Culex larvae is common, which is likely to impact the transmission of lymphatic filariasis and malaria by the resulting adult mosquito populations. However, the importance of drains as larval habitats remains unknown. Methodology Data on mosquito larval habitats routinely collected by the Urban Malaria Control Program (UMCP) and a special drain survey conducted in 2006 were used to obtain a typology of habitats. Focusing on drains, logistic regression was used to evaluate potential factors impacting the presence of mosquito larvae. Spatial variation in the proportion of habitats that contained larvae was assessed through the local Moran's I indicator of spatial association. Principal Findings More than 70% of larval habitats in Dar es Salaam were human-made. Aquatic habitats associated with agriculture had the highest proportion of Anopheles larvae presence and the second highest of Culex larvae presence. However, the majority of aquatic habitats were drains (42%), and therefore, 43% (1,364/3,149) of all culicine and 33% (320/976) of all anopheline positive habitats were drains. Compared with drains where water was flowing at normal velocity, the odds of finding Anopheles and Culex larvae were 8.8 and 6.3 (p<0.001) times larger, respectively, in drains with stagnant water. There was a positive association between vegetation and the presence of mosquito larvae (p<0.001). The proportion of habitats with mosquito larvae was spatially correlated. Conclusion Restoring and maintaining drains in Dar es Salaam has the potential to eliminate more than 40% of all potential mosquito larval habitats that are currently treated with larvicides by the UMCP. The importance of human-made larval habitats for both lymphatic filariasis and malaria vectors underscores the need for a synergy between on-going control efforts of those diseases.
The sanitary inspection of wells was performed according to World Health Organization (WHO) procedures using risk-of-contamination (ROC) scoring to determine the capacity of ROC scoring to predict bacterial faecal pollution of well water in the peri-urban tropical lowlands of Dar es Salaam, Tanzania. The analysis was based on a selection of wells representing environments with low to high presumptive faecal pollution risk and a multi-parametric data set of bacterial indicators, generating a comprehensive picture of the level and characteristics of faecal pollution (such as vegetative Escherichia coli cells, Clostridium perfringens spores and human-associated sorbitol fermenting Bifidobacteria). ROC scoring demonstrated a remarkable ability to predict bacterial faecal pollution levels in the investigated well water (e.g. 87% of E. coli concentration variations were predicted by ROC scoring). Physicochemical characteristics of the wells were not reflected by the ROC scores. Our results indicate that ROC scoring is a useful tool for supporting health-related well water management in urban and suburban areas of tropical, developing countries. The outcome of this study is discussed in the context of previously published results, and future directions are suggested.
Mushi, Douglas; Byamukama, Denis; Kirschner, Alexander K.T.; Mach, Robert L.; Brunner, K.; Farnleitner, Andreas H.
Current HIV management guidelines are based on natural history studies from the developed world. Data on the similarity of the natural course of HIV-1 infection conflict with studies in the developing world. A cohort of 1887 hotel workers with no access to antiretroviral therapy was followed between 1990 and 1998 in Dar es Salaam through annual clinical evaluations and CD4+ T-lymphocyte (CD4 cell) count determinations. 196 (10.4%) were HIV-1 sero-prevalents; 133 (7.9%) were HIV-1 sero-incidents; and 1558 (82.6%) remained HIV seronegative. Follow-up duration was 13,719 and 82,742 months for HIV-1 seropositives and HIV seronegatives respectively. Clinical events occurred at median CD4 cell counts similar to those previously reported from the developed world, but death occurred at higher counts. Off-duty last 6 months, chronic diarrhoea and a faster CD4 cell count decline were associated with faster disease progression and death. In Tanzania HIV natural history is similar to that from the developed world and similar management guidelines could be employed. PMID:15307570
A review of the malaria control programs and the problem encountered in the United Republic of Tanzania since 1945 to the year 1986 is discussed. Buguruni, one of the squatter areas in the city of Dar es Salaam, is chosen as a case study in order to evaluate the economic advantage of engineering methods for the control of malaria infection. Although the initial capital cost of engineering methods may be high, the cost effectiveness requires a much lower financial burden of only about Tshs. 3 million compared with the conventional methods of larviciding and insecticiding which requires more than Tshs. 10 million. Finally, recommendations for the adoption of engineering methods are made concerning the upgrading of existing roads and footpaths in general with particular emphasis on drainage of large pools of water which serve as breeding sites for mosquitoes.
Yhdego, M.; Majura, P. (Ardhi Institute, Dar es Salaam (Tanzania))
A statistical survey of households based upon questionnaires distributed via primary schools has been carried out in five wards of Dar es Salaam, Tanzania, to estimate disposal frequencies (number of items disposed per week) for newsprint, metal cans, glass and plastic containers and plastic shopping bags. Plastic shopping bags are disposed most frequently while glass containers are disposed least frequently.
Background Tanzania is currently scaling-up access to anti-retro viral therapy (ART) to reach as many eligible persons as possible. Hepatitis viral co-infections are known to influence progression, management as well as outcome of HIV infection. However, information is scarce regarding the prevalence and predictors of viral hepatitis co-infection among HIV-infected individuals presenting at the HIV care and treatment clinics in the country. Methods A cross-sectional study conducted between April and September 2006 enrolled 260 HIV-1 infected, HAART naïve patients aged ?18 years presenting at the HIV care and treatment clinic (CTC) of the Muhimbili National Hospital (MNH). The evaluation included clinical assessment and determination of CD4+ T-lymphocyte count, serum transaminases and serology for Hepatitis A, B and C markers by ELISA. Results The prevalence of anti HAV IgM, HBsAg, anti-HBc IgM and anti-HCV IgG antibodies were 3.1%, 17.3%, 2.3% and 18.1%, respectively. Dual co-infection with HBV and HCV occurred in 10 individuals (3.9%), while that of HAV and HBV was detected in two subjects (0.8%). None of the patients had all the three hepatitis viruses. Most patients (81.1%) with hepatitis co-infection neither had specific clinical features nor raised serum transaminases. History of blood transfusion and jaundice were independent predictors for HBsAg and anti-HBc IgM positivity, respectively. Conclusion There is high prevalence of markers for hepatitis B and C infections among HIV infected patients seeking care and treatment at MNH. Clinical features and a raise in serum alanine aminotransferase were of limited predictive values for the viral co-infections. Efforts to scale up HAART should also address co-infections with Hepatitis B and C viruses.
Background notes on Tanzania present a profile of nationality, population count of 26 million, growth rate of 3.5%, ethnic groups (130), religions (33% Muslim, 33% animist, 33% Christian), languages, education (86% primary), literacy (79%), health (infant mortality of 106/1000), and work force (90% agriculture). Geographic data are given for the area, cities, terrain, and climate. The Tanzanian government is a republic with executive, legislative, and judicial branches of government. There is 1 political party and everyone 18 years is eligible to vote. 4% of the gross domestic product (GDP) ($5.9 billion) is devoted to defense. Economic growth is 4.3%/year and person income is $240/capita. Natural resources, agriculture, industry, and trade are identified. $400 million has been received between 1970-92 in US economic aid. The 1992 official exchange rate is 300 Tanzanian shillings to the US dollar. Descriptive text is given for the population, the history of Tanganyika and Zanzibar, the government, principal government officials (President, 1st Vice President [VP], 2nd VP and President of Zanzibar, Prime Minister, Foreign Affairs Minister, Ambassador to the US, Ambassador to the UN, and US embassy address and phone number), political conditions, the economy, the defense, foreign relations, and US-Tanzanian relations. Principal US officials are identified for the Ambassador, Deputy Chief of Mission, USAID Director, and Public Affairs Officer; the US embassy address is given also. The population is 80% rural with a density of 1/sq km in arid areas, 51/sq km on the mainland, and 134/sq km on Zanzibar. The new capital will be Dodoma in central Tanzania. Most residents are of Bantu stock; nomadic groups are the Masai and the Luo. 1% are non-Africans. Government has a strong central executive. The current President is Ali Hassan Mwinyi. The Revolutionary Party is in the primary policymaking body and provides all government leaders. The government seeks to foster the Kiswahili concept of "ujamaa" or a kind of communal cooperation. 47% of GDP comes from agriculture. There is little foreign investment. Diversification of export crops is needed. Foreign policy is nonaligned, and friendly to the US. PMID:12178040
Orphans are an increasing problem in developing countries particularly in Africa; due to the HIV/AIDS pandemic; and needs collective effort in intervention processes by including all stakeholders right from the grass roots level. This paper attempts to present the role of traditional healers in psychosocial support for orphan children in Dar-es-Salaam City with special focus on those whose parents have died because of HIV/AIDS. Six traditional healers who were involved in taking care of orphans were visited at their "vilinge" (traditional clinics). In total they had 72 orphans, 31 being boys and 41 being girls with age range from 3 years to 19. It was learned that traditional healers, besides providing remedies for illnesses/diseases of orphans, they also provided other basic needs. Further, they even provided psychosocial support allowing children to cope with orphan hood life with ease. Traditional healers are living within communities at the grass roots level; and appear unnoticed hidden forces, which are involved in taking care of orphans. This role of traditional healers in taking care of orphans needs to be recognised and even scaling it up by empowering them both in financial terms and training in basic skills of psychosocial techniques in how to handle orphans, in order to reduce discrimination and stigmatisation in the communities where they live.
Kayombo, Edmund J; Mbwambo, Zakaria H; Massila, Mariam
Aims: Widespread adolescent dating violence (DV) in Sub-Saharan Africa calls for immediate action, particularly since it is linked to the spread of HIV\\/AIDS. This article presents prevalence and demographic correlates of DV among school students in Cape Town and Mankweng (South Africa) and Dar es Salaam (Tanzania). Methods: Data were derived from the baseline data collection of a multi-site randomized
ANNEGREET G. WUBS; LEIF E. AARØ; ALAN J. FLISHER; SHERI BASTIEN; HANS E. ONYA; SYLVIA KAAYA; CATHERINE MATHEWS
Extended-spectrum beta-lactamases (ESBLs) were present in high proportions of Escherichia coli (25% [9 of 36]) and Klebsiella pneumoniae isolates (17% [9 of 52]) causing pediatric septicemia at a tertiary hospital in Tanzania. Patients with septicemia due to ESBL-producing organisms had a significantly higher fatality rate than those with non-ESBL isolates (71% versus 39%, P = 0.039). This is the first report of the CTX-M-15 genotype of ESBLs on the African continent and the first observation of SHV-12 genotype in an isolate of Salmonella enterica serotype Newport.
Blomberg, Bj?rn; Jureen, Roland; Manji, Karim P.; Tamim, Bushir S.; Mwakagile, Davis S. M.; Urassa, Willy K.; Fataki, Maulidi; Msangi, Viola; Tellevik, Marit G.; Maselle, Samwel Y.; Langeland, Nina
Extended-spectrum beta-lactamases (ESBLs) were present in high proportions of Escherichia coli (25% [9 of 36]) and Klebsiella pneumoniae isolates (17% [9 of 52]) causing pediatric septicemia at a tertiary hospital in Tanzania. Patients with septicemia due to ESBL-producing organisms had a significantly higher fatality rate than those with non-ESBL isolates (71% versus 39%, P = 0.039). This is the first report of the CTX-M-15 genotype of ESBLs on the African continent and the first observation of SHV-12 genotype in an isolate of Salmonella enterica serotype Newport. PMID:15695674
Blomberg, Bjørn; Jureen, Roland; Manji, Karim P; Tamim, Bushir S; Mwakagile, Davis S M; Urassa, Willy K; Fataki, Maulidi; Msangi, Viola; Tellevik, Marit G; Maselle, Samwel Y; Langeland, Nina
Objectives This study was performed to examine the potential contributions of sociocultural activities to reduce risks of death by homicide. Methods This study was designed as a case control study. Relatives of 90 adult homicide victims in Dar es Salaam Region, Tanzania, in 2005 were interviewed. As controls, 211 participants matched for sex and 5-year age group were randomly selected from the same region and interviewed regarding the same contents. Results Bivariate analysis revealed significant differences between victims and controls regarding educational status, occupation, family structure, frequent heavy drinking, hard drug use and religious attendance. Conditional logistic regression analysis indicated that the following factors were significantly related to not becoming victims of homicide: being in employment (unskilled labour: OR=0.04, skilled labour: OR=0.07, others: OR=0.04), higher educational status (OR=0.02), residence in Dar es Salaam after becoming an adult (compared with those who have resided in Dar es Salaam since birth: OR=3.95), living with another person (OR=0.07), not drinking alcohol frequently (OR=0.15) and frequent religious service attendance (OR=0.12). Conclusions Frequent religious service attendance, living in the same place for a long time and living with another person were shown to be factors that contribute to preventing death by homicide, regardless of place of residence and neighbourhood environment. Existing non-structural community resources and social cohesive networks strengthen individual and community resilience against violence.
HPLC analysis of anti-malaria agent, chloroquine (CQ) in blood and tissues with a simple HCl back extraction method was applied to three forensic autopsy cases in Dar es Salaam, Tanzania. CQ concentrations in femoral vein blood were 8.5, 48.4 and 43.8?g\\/ml in three cases, respectively, which were high enough to attribute the cause of deaths to an acute CQ poisoning.
Kosei Yonemitsu; Ako Koreeda; Kazuhiko Kibayashi; Paul Ng'walali; Martin Mbonde; James Kitinya; Shigeyuki Tsunenari
Background It is estimated that world-wide up to 20?% of children suffer from debilitating mental illness. Mental disorders that pose a significant concern include learning disorders, hyperkinetic disorders (ADHD), depression, psychosis, pervasive development disorders, attachment disorders, anxiety disorders, conduct disorder, substance abuse and eating disorders. Living with such children can be very stressful for caregivers in the family. Therefore, determination of challenges of living with these children is important in the process of finding ways to help or support caregivers to provide proper care for their children. The purpose of this study was to explore the psychological and emotional, social, and economic challenges that parents or guardians experience when caring for mentally ill children and what they do to address or deal with them. Methodology A qualitative study design using in-depth interviews and focus group discussions was applied. The study was conducted at the psychiatric unit of Muhimbili National Hospital in Tanzania. Two focus groups discussions (FGDs) and 8 in-depth interviews were conducted with caregivers who attended the psychiatric clinic with their children. Data analysis was done using content analysis. Results The study revealed psychological and emotional, social, and economic challenges caregivers endure while living with mentally ill children. Psychological and emotional challenges included being stressed by caring tasks and having worries about the present and future life of their children. They had feelings of sadness, and inner pain or bitterness due to the disturbing behaviour of the children. They also experienced some communication problems with their children due to their inability to talk. Social challenges were inadequate social services for their children, stigma, burden of caring task, lack of public awareness of mental illness, lack of social support, and problems with social life. The economic challenges were poverty, child care interfering with various income generating activities in the family, and extra expenses associated with the child’s illness. Conclusion Caregivers of mentally ill children experience various psychological and emotional, social, and economic challenges. Professional assistance, public awareness of mental illnesses in children, social support by the government, private sector, and non-governmental organizations (NGOs) are important in addressing these challenges.
|The majority of undocumented Congolese refugee children living in Dar es Salaam, Tanzania, experience extreme poverty and social exclusion, harassment and discrimination. Their fear of deportation, forcible removal to refugee camps and imprisonment is coupled with a strong feeling that they are unwelcome in Tanzania. These realities require that…
This article reports on a study of induced abortion among adolescent girls in Dar es Salaam, Tanzania, who were admitted to a district hospital in Dar es Salaam because of an illegally induced abortion in 1997. In the quantitative part of the study, 197 teenage girls (aged 14–19) were asked for socio-economic details, contraceptive knowledge\\/use, age at first intercourse and
Participated in the Uncommon Dialogue meeting, in which we were able to meet with local water authorities, tour various communities, and learn about the larger scale water challenges that unplanned communities face. Piloted rapid method in n...
With reference to bannaids in Dar es Salaam city the underlying factors for marginal labour female rural-urban migration in Tanzania and the main adjustment problems faced by female migrants once they move into urban areas are examined. Above all it has been established that most of the female migrants in marginal jobs such as bannaids and house girls are from
|Purpose: The purpose of this study is to describe the preappointment experiences of early-career headteachers in Tanzania and to discuss implications for postsecondary institutions and ministries of education in East Africa. Research Design: Seven novice headteachers in a suburb of Dar es Salaam, Tanzania, completed questionnaires and…
Onguko, Brown Bully; Abdalla, Mohamed; Webber, Charles F.
Major deficiencies in urbanisation and transportation systems are reinforcing patterns of social and urban segregation in Dar es Salaam, Tanzania's largest city. Analysis of the 1993 Human Resources Development Survey shows that there are numerous obstacles to the daily travel of the city's inhabitants, notably the poor. These barriers weigh heavily on schedules, complicate access to services ever further, limit
Background Laboratory capacity to confirm malaria cases in Tanzania is low and presumptive treatment of malaria is being practiced widely. In malaria endemic areas WHO now recommends systematic laboratory testing when suspecting malaria. Currently, the use of Rapid Diagnostic Tests (RDTs) is recommended for the diagnosis of malaria in lower level peripheral facilities, but not in health centres and hospitals. In this study, the following parameters were evaluated: (1) the quality of routine microscopy, and (2) the effects of RDT implementation on the positivity rate of malaria test results at three levels of the health system in Dar es Salaam, Tanzania. Methods During a baseline cross-sectional survey, routine blood slides were randomly picked from 12 urban public health facilities in Dar es Salaam, Tanzania. Sensitivity and specificity of routine slides were assessed against expert microscopy. In March 2007, following training of health workers, RDTs were introduced in nine public health facilities (three hospitals, three health centres and three dispensaries) in a near-to-programmatic way, while three control health facilities continued using microscopy. The monthly malaria positivity rates (PR) recorded in health statistics registers were collected before (routine microscopy) and after (routine RDTs) the intervention in all facilities. Results At baseline, 53% of blood slides were reported as positive by the routine laboratories, whereas only 2% were positive by expert microscopy. Sensitivity of routine microscopy was 71.4% and specificity was 47.3%. Positive and negative predictive values were 2.8% and 98.7%, respectively. Median parasitaemia was only three parasites per 200 white blood cells (WBC) by routine microscopy compared to 1226 parasites per 200 WBC by expert microscopy. Before RDT implementation, the mean test positivity rates using routine microscopy were 43% in hospitals, 62% in health centres and 58% in dispensaries. After RDT implementation, mean positivity rates using routine RDTs were 6%, 7% and 8%, respectively. The sensitivity and specificity of RDTs using expert microscopy as reference were 97.0% and 96.8%. The positivity rate of routine microscopy remained the same in the three control facilities: 71% before versus 72% after. Two cross-sectional health facility surveys confirmed that the parasite rate in febrile patients was low in Dar es Salaam during both the rainy season (13.6%) and the dry season (3.3%). Conclusions The quality of routine microscopy was poor in all health facilities, regardless of their level. Over-diagnosis was massive, with many false positive results reported as very low parasitaemia (1 to 5 parasites per 200 WBC). RDTs should replace microscopy as first-line diagnostic tool for malaria in all settings, especially in hospitals where the potential for saving lives is greatest.
The work presented in this paper is part of the study which aims at determining the levels of elements in hair of children in Tanzania as a bioindicator of their nutrition and health. In this paper, the levels of trace elements in hair from children living in Dar es Salaam have been analysed. The analysis was carried out by long and short irradiation INAA at the reactor centre of the Institute of Nuclear Physics, Rez Czech Republic. 22 samples were collected from children living at Kiwalani about 12 km from Dar es Salaam city and 16 samples from children living at Mlimani, the main campus of University of Dar es Salaam. A total of 34 elements were found in the hair of the children. There were no big differences between the concentration levels of the essential elements in hair samples collected from the children which might indicate the same food consumption habits.
Background Violence by an intimate partner is increasingly recognized as an important public and reproductive health issue. The aim of this study is to investigate the extent to which physical and/or sexual intimate partner violence is associated with induced abortion and pregnancy loss from other causes and to compare this with other, more commonly recognized explanatory factors. Methods This study analyzes the data of the Tanzania section of the WHO Multi-Country Study on Women's Health and Domestic Violence, a large population-based cross-sectional survey of women of reproductive age in Dar es Salaam and Mbeya, Tanzania, conducted from 2001 to 2002. All women who answered positively to at least one of the questions about specific acts of physical or sexual violence committed by a partner towards her at any point in her life were considered to have experienced intimate partner violence. Associations between self reported induced abortion and pregnancy loss with intimate partner violence were analysed using multiple regression models. Results Lifetime physical and/or sexual intimate partner violence was reported by 41% and 56% of ever partnered, ever pregnant women in Dar es Salaam and Mbeya respectively. Among the ever pregnant, ever partnered women, 23% experienced involuntary pregnancy loss, while 7% reported induced abortion. Even after adjusting for other explanatory factors, women who experienced intimate partner violence were 1.6 (95%CI: 1.06,1.60) times more likely to report an pregnancy loss and 1.9 (95%CI: 1.30,2.89) times more likely to report an induced abortion. Intimate partner violence had a stronger influence on induced abortion and pregnancy loss than women's age, socio-economic status, and number of live born children. Conclusions Intimate partner violence is likely to be an important influence on levels of induced abortion and pregnancy loss in Tanzania. Preventing intimate partner violence may therefore be beneficial for maternal health and pregnancy outcomes.
Public-private partnerships are increasingly being promoted in Tanzania and the central argument of this paper is that institutional framework of a given local authority determines the nature and character of the formation and operational performance of such partnerships. The paper focuses on the public-private partnerships established in the area of solid waste management in the City of Dar-es-Salaam, and more
Effluent, air, and soil samples near a battery factory in Dar es Salaam, Tanzania, where HgCl2 is used to prevent mold growth, were collected to explore the potential for pollution of the environment from industrial discharge of Hg. Flameless atomic absorption spectrophotometry was used for Hg determinations. The concentration of Hg in the effluent ranged from -1 and the Hg
Introduction Currently, Tanzania's HIV prevalence is 5.7%. Gender inequality and Gender Based Violence (GBV) are among factors fuelling the spread of HIV in Tanzania. This study was conducted to assess universal access to HIV prevention services among GBV survivors in Iringa and Dar-es-Salaam where HIV prevalence is as high as 14.7% and 9% respectively compared to a national average of 5.7%. Methods In 2010, a mixed methods study using triangulation model was conducted in Iringa and Dar-es-Salaam regions to represent rural and urban settings respectively. Questionnaires were administered to 283 randomly selected survivors and 37 health providers while 28 in-depth interviews and 16 focus group discussions were conducted among various stakeholders. Quantitative data was analyzed in SPSS by comparing descriptive statistics while qualitative data was analyzed using thematic framework approach. Results Counseling and testing was the most common type of HIV prevention services received by GBV survivors (29%). Obstacles for HIV prevention among GBV survivors included: stigma, male dominance culture and fear of marital separation. Bribery in service delivery points, lack of confidentiality, inadequate GBV knowledge among health providers, and fear of being involved in legal matters were mentioned to be additional obstacles to service accessibility by survivors. Reported consequences of GBV included: psychological problems, physical trauma, chronic illness, HIV infection. Conclusion GBV related stigma and cultural norms are obstacles to HIV services accessibility. Initiation of friendly health services, integration of GBV into HIV services and community based interventions addressing GBV related stigma and cultural norms are recommended.
The aim of the study was to investigate social and behavioral correlates of perceived vulnerability to traffic injuries in an urban and rural setting in Tanzania. In 2002, a sample of 494 adults aged 15 years and above participated in household interviews in Dar es Salaam (urban) and Hai District (rural). The study was part of a population-based survey that
Anne Nordrehaug Åstrøm; Candida Moshiro; Yusuf Hemed; Ivar Heuch; Gunnar Kvåle
In Tanzania, like in many other developing countries in Southern and Eastern Africa, bioenergy planning has received relatively little attention, compared to planning for 'modern' energy sources, although it accounts for about 90% of the country's energy ...
A. S. Kauzeni H. P. Masao E. N. Sawe F. C. Shechambo A. Ellegaard
Purpose – The main goal of this project is to study the wife-battering in one of the traditional groups of semi-nomadic herders of Eastern Africa, the Datoga of Northern Tanzania. Design\\/methodology\\/approach – The study examines wife-battering among the Datoga pastoralists of Tanzania. The interviews with 142 women provide the information on types and regularity of wife-beating in the Datoga. Data
BACKGROUND: Universal salt iodation will prevent iodine deficiency disorders (IDD). Globally, salt-iodation technologies mostly target large and medium-scale salt-producers. Since most producers in low-income countries are small-scale, we examined and improved the performance of hand and knapsack-sprayers used locally in Tanzania. METHODS: We studied three salt facilities on the Bagamoyo coast, investigating procedures for preparing potassium-iodate solution, salt spraying and
Vincent D Assey; Thorkild Tylleskär; Philip B Momburi; Michael Maganga; Nicholaus V Mlingi; Marie Reilly; Ted Greiner; Stefan Peterson
Through in-depth interviews, this study explored perceptions and experiences of key players handling child sexual offense cases in Dar es Salaam, Tanzania. The informants included public police investigators, magistrates, legal workers, and social workers working with nongovernmental organizations. The interviews were recorded, transcribed…
BACKGROUND: Dermatologic disorders are common in many countries but the spectrum varies greatly. Many studies have reported a significant burden of skin diseases in school children. The objective of this study was to determine the current spectrum of dermatological disorders in primary school children in Dar es Salaam city. METHODS: Primary school children were recruited by multistage sampling. Detailed interview,
We present the rationale and design of a randomized, double-blind, placebo-controlled trial of vitamin supplements among HIV-positive pregnant women in Dar es Salaam, Tanzania. Higher levels of intake of vitamins A, B, C, and E may decrease the risk of vertical transmission and progression of HIV infection by enhancing maternal and infant immune function; by reducing viral load in the
Wafaie W Fawzi; Gernard I Msamanga; Donna Spiegelman; Ernest J. N Urassa; David J Hunter
Background: Anemia is a frequent complication among HIV- infected persons and is associated with faster disease progression and mortality. Objective: We examined the effect of multivitamin supplementa- tion on hemoglobin concentrations and the risk of anemia among HIV-infected pregnant women and their children. Design: HIV-1-infected pregnant women (n 1078) from Dar es Salaam,Tanzania,wereenrolledinadouble-blindtrialandprovided daily supplements of preformed vitamin A and
Wafaie W Fawzi; Gernard I Msamanga; Roland Kupka; Donna Spiegelman; Eduardo Villamor; Ferdinand Mugusi; Ruilan Wei; David Hunter
The objective of this cross-sectional study was to identify risk factors for anemia among human immunodeficiency virus (HIV)-positive pregnant women in Dar es Salaam, Tanzania. Baseline data from 1064 women enrolled in a clinical trial on the effect of vitamin supplementation in HIV infection were examined to identify potential determinants of anemia. The mean hemoglobin (Hb) level was 94 g\\/L,
Gretchen Antelman; Gernard I. Msamanga; Donna Spiegelman; Ernest J. N. Urassa; Raymond Narh; David J. Hunter; Wafaie W. Fawzi
A questionnaire survey was carried out among 1041 students in secondary schools and colleges in Dar-es-Salaam, Tanzania to evaluate the rela- tionship between HIV-risky sexual behaviour and anti-condom bias, as well as with AIDS- related information, knowledge, perceptions and attitudes. Self-reportedly, 54% of students (75% of the boys and 40% of the girls) were sexually active, 39% had a regular
E. S. Maswanya; K. Moji; I. Horiguchi; K. Nagata; K. Aoyagi; S. Honda; T. Takemoto
Purpose: The objective of this study was, first, to assess the knowledge, attitude and practice of commercial drivers in Dar es Salaam with regard to medicines that impair driving, and second, to evaluate the adequacy of antihistamine label information. Methods: Drivers were interviewed using a questionnaire after obtaining their informed consent. Labels of medicines containing antihistamines were also evaluated for
This article discusses the Urban Management Program (UMP) in Dar es Salaam, Tanzania. The UMP is a joint effort of UNCHS (Habitat), UNDP, and the World Bank. The UMP established the Sustainable Cities Program (SCP) in August 1990. The aim was to provide city officials and their partners in private, public, and popular sectors with improved environmental planning and management capacity. Dar es Salaam has 4 major land formations that constrain management options. About 70% of urban population live in unplanned areas with marginal access to piped water, sanitation, drainage, or basic social services. Improper waste disposal has contributed to water pollution. Under 3% of the city's solid waste is collected. Low lying areas along the coast become flooded, and poor drainage causes continually flooded road systems. SCP began a 4-stage process to identify issues, develop and implement strategy and action plans, and institutionalize the process. An environmental profile was established in 1992. Plans were developed for solid waste management, upgrading unplanned settlements, servicing planned land and city center renewal, and managing open spaces, wastes, and petty trading. These efforts were institutionalized. The efforts are noteworthy for their active participation in plan preparation by key urban managers, multisectoral coordination on environmental issues, involvement of the private sector, establishment of priorities, and detailed action plans. Political support at the highest levels combined with community participation were key to program success. The lessons learned are identified. PMID:12178488
Background Recently global health advocates have called for the introduction of artemisinin-containing antimalarial combination therapies to help curb the impact of drug-resistant malaria in Africa. Retail trade in artemisinin monotherapies could undermine efforts to restrict this class of medicines to more theoretically sound combination treatments. Methods This paper describes a systematic search for artemisinin-containing products at a random sample of licensed pharmacies in Dar-es-Salaam, Tanzania in July 2005. Results Nineteen different artemisinin-containing oral pharmaceutical products, including one co-formulated product, one co-packaged product, and 17 monotherapies were identified. All but one of the products were legally registered and samples of each product were obtained without a prescription. Packaging and labeling of the products seldom included local language or illustrated instructions for low-literate clients. Packaging and inserts compared reasonably well with standards recommended by the national regulatory authority with some important exceptions. Dosing instructions were inconsistent, and most recommended inadequate doses based on international standards. None of the monotherapy products mentioned potential benefits of combining the treatment with another antimalarial drug. Conclusion The findings confirm the widespread availability of artemisinin monotherapies that led the World Health Organization to call for the voluntary withdrawal of these drugs in malaria-endemic countries. As the global public health community gathers resources to deploy artemisinin-containing combination therapies in Africa, planners should be mindful that these drugs will coexist with artemisinin monotherapies in an already well-established market place. In particular, regulatory authorities should be incorporated urgently into the process of planning for rational deployment of artemisinin-containing antimalarial combination therapies.
Kachur, S Patrick; Black, Carolyn; Abdulla, Salim; Goodman, Catherine
Background In Tanzania, half of all pregnant women access a health facility for delivery. The proportion receiving skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out to increase health facility deliveries by skilled care. The aim of this study was to describe the weaknesses in the provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric fistula, nurse-midwives at both BEmOC and CEmOC health facilities and local community members. Methods Semi-structured interviews involving 16 women affected by obstetric fistula and five nurse-midwives at maternity wards at both BEmOC and CEmOC health facilities, and Focus Group Discussions with husbands and community members were conducted between October 2008 and February 2010 at Comprehensive Community Based Rehabilitation in Tanzania and Temeke hospitals in Dar es Salaam, and Mpwapwa district in Dodoma region. Results Health care users and health providers experienced poor quality caring and working environments in the health facilities. Women in labour lacked support, experienced neglect, as well as physical and verbal abuse. Nurse-midwives lacked supportive supervision, supplies and also seemed to lack motivation. Conclusions There was a consensus among women who have suffered serious birth injuries and nurse midwives staffing both BEmOC and CEmOC maternity wards that the quality of care offered to women in birth was inadequate. While the birth accounts of women pointed to failure of care, the nurses described a situation of disempowerment. The bad birth care experiences of women undermine the reputation of the health care system, lower community expectations of facility birth, and sustain high rates of home deliveries. The only way to increase the rate of skilled attendance at birth in the current Tanzanian context is to make facility birth a safer alternative than home birth. The findings from this study indicate that there is a long way to go.
BACKGROUND: Although the association between cerebrovascular and coronary artery disease (CAD) is well known in high-income countries, this association is not well documented in black Africans. AIMS: The aim of this study was to document electrocardiographic (ECG) evidence of CAD in stroke cases and controls and to identify other common ECG abnormalities related to known stroke risk factors in a community-based population of incident stroke cases in Tanzania, East Africa. METHODS: This was a case-control study. Incident stroke cases were identified by the Tanzanian Stroke Incidence Project. Age- and sex-matched controls were randomly selected from the background population. Electrocardiograms were manually analyzed using the Minnesota Coding System, looking for evidence of previous myocardial infarction (MI), atrial fibrillation (AF) or atrial flutter (AFl), and left ventricular hypertrophy (LVH). RESULTS: In Hai, there were 93 cases and 241 controls with codable electrocardiograms, and in Dar-es-Salaam, there were 39 cases and 72 controls with codable electrocardiograms. Comparing cases and controls, there was a higher prevalence of MI and AF or AFl (but not LVH) in cases compared with controls. CONCLUSIONS: This is the first published study of ECG assessment of CAD and other stroke risk factors in an incident population of stroke cases in sub-Saharan Africa. It suggests that concomitant CAD in black African stroke cases is more common than previously suggested. PMID:23545320
Walker, Richard W; Dewhurst, Matthew; Gray, William K; Jusabani, Ahmed; Aris, Eric; Unwin, Nigel; Swai, Mark; Adams, Philip C; Mugusi, Ferdinand
Background Molecular markers of insecticide resistance can provide sensitive indicators of resistance development in malaria vector populations. Monitoring of insecticide resistance in vector populations is an important component of current malaria control programmes. Knockdown resistance (kdr) confers resistance to the pyrethroid class of insecticides with cross-resistance to DDT through single nucleotide polymorphisms (SNPs) in the voltage-gated sodium channel gene. Methods To enable detection of kdr mutations at low frequency a method was developed that uses polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA)-based technology, allowing rapid, reliable and cost-effective testing of large numbers of individual mosquitoes. This was used to assay mosquitoes from sites in lower Moshi, Tanzania. Results Sequence-specific oligonucleotide probes (SSOP) were used for simultaneous detection of both East and West African kdr mutations with high specificity and sensitivity. Application of the SSOP-ELISA method to 1,620 field-collected Anopheles arabiensis from Tanzania identified the West African leucine-phenylalanine kdr mutation in two heterozygous individuals, indicating the potential for resistance development that requires close monitoring. Conclusion The presence of the West African kdr mutation at low frequency in this East African population of An. arabiensis has implications for the spread of the kdr gene across the African continent.
Although the network in Tanzania is still small and in poor condition, progress has been made since the publication of the Missing Link Report in 1984. Despite daunting social and economic obstacles, the country has set a goal of one telephone per hundred people by the year 2000. To accelerate the improvements necessary in the telecommunication sector in Tanzania, the
OBJECTIVE: To obtain baseline information on sexually transmitted diseases (STDs) in the Rwandan refugees camps in Tanzania, prior to establishment of STD services. SETTING: The largest camps of Rwandan refugees in the Ngara District of Tanzania (estimated population 300,000). The study was carried out in 8 days in August 1994. SUBJECTS AND METHODS: A rapid assessment technique was used to
P. Mayaud; W Msuya; J Todd; G Kaatano; G Begkoyian; H Grosskurth; D Mabey
Background Obstetric fistula is a physically and socially disabling obstetric complication that affects about 3,000 women in Tanzania every year. The fistula, an opening that forms between the vagina and the bladder and/or the rectum, is most frequently caused by unattended prolonged labour, often associated with delays in seeking and receiving appropriate and adequate birth care. Using the availability, accessibility, acceptability and quality of care (AAAQ) concept and the three delays model, this article provides empirical knowledge on birth care experiences of women who developed fistula after prolonged labour. Methods We used a mixed methods approach to explore the birthing experiences of women affected by fistula and the barriers to access adequate care during labour and delivery. Sixteen women were interviewed for the qualitative study and 151 women were included in the quantitative survey. All women were interviewed at the Comprehensive Community Based Rehabilitation Tanzania in Dar es Salaam and Bugando Medical Centre in Mwanza. Results Women experienced delays both before and after arriving at a health facility. Decisions on where to seek care were most often taken by husbands and mothers-in-law (60%). Access to health facilities providing emergency obstetric care was inadequate and transport was a major obstacle. About 20% reported that they had walked or were carried to the health facility. More than 50% had reported to a health facility after two or more days of labour at home. After arrival at a health facility women experienced lack of supportive care, neglect, poor assessment of labour and lack of supervision. Their birth accounts suggest unskilled birth care and poor referral routines. Conclusions This study reveals major gaps in access to and provision of emergency obstetric care. It illustrates how poor quality of care at health facilities contributes to delays that lead to severe birth injuries, highlighting the need to ensure women's rights to accessible, acceptable and adequate quality services during labour and delivery.
In an attempt to prevent the transmission of Schistosoma mansoni on an irrigated sugar-cane estate, molluscicide experiments were carried out to find the optimum methods for controlling the intermediate-host snails, Biomphalaria pfeifferi. The ease of application of N-tritylmorpholine led to its adoption as the molluscicide of choice for the two separate irrigation systems on the estate. Experiments on the frequency and duration of molluscicide treatments were carried out, and from these it was concluded that 5-day applications of N-tritylmorpholine at 0.025 ppm every 7 weeks might lead to a break in transmission by control of the snails. In another set of trials, drainage ditches were treated alternately with N-tritylmorpholine and niclosamide ethanolamine salt, and although the chemicals differed only slightly in their effect, the latter—being ovicidal—was chosen to be applied at approximately 4 ppm by knapsack sprayer every 8 weeks. Extra treatment of small pools with the same compound was carried out during the long rains when irrigation was unnecessary and most of the canals were dry. It is pointed out that the effect of the control methods on S. mansoni transmission will need to be evaluated by studying the incidence of the disease in the population.
With a growing world population and a trend towards more resource intensive diets, pressure on land and water resources for food production will continue to increase in the coming decades. Large parts of the world rely on rainfed agriculture for their food security. In Africa, 90% of the food production is from rainfed agriculture, generally with low yields and a high risk of crop failure. One of the main reasons for crop failure is the occurrence of dry spells during the growing season. Key indicators are the critical dry spell duration and the probability of dry spell occurrence. In this paper a new Markov-based framework is presented to spatially map the probability of dry spell occurrence. The framework makes use of spatially varying Markov coefficients that are correlated to readily available spatial information such as elevation and distance to the sea. This map is then related to the critical dry spell duration, based on soil properties and crop water requirements, to assess the probability of crop failure. The results show that in the Makanya catchment the probability of dry spell occurrence is highly variable in space, even over relatively short distances. In certain areas the probability of crop failure reaches levels, which makes rainfed agricultural practices unsustainable, even close to areas where currently rainfed agriculture is successfully practiced. This method can be used to identify regions that are vulnerable to dry spells, and subsequently to develop strategies for supplementary irrigation or rainwater harvesting.
|A teacher developed multidisciplinary unit for teaching elementary and secondary students about Tanzania (Africa) is described. The unit can involve students and teachers from geography, economics, history, language arts, mathematics, literature, and art courses. (RM)|
HIV risk through needle sharing is now an emerging phenomenon in Africa. This article describes the practices that heroin users are producing as they establish the rules and organization surrounding their drug use. Their practices and interactions reveal the ways that they become initiated into its use, how they progress to injecting, and the important role of local neighbourhood hangouts
S. A. McCurdy; M. L. Williams; G. P. Kilonzo; M. W. Ross; M. T. Leshabari
BACKGROUND: Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality
Hussein L. Kidanto; Ingrid Mogren; Jos van Roosmalen; Siriel N. Massawe; Lennarth Nystrom; Gunilla Lindmark
BACKGROUND: Syndromic management of STIs has been advocated as simplified and cheap approach. Youth have been reported to be at increased risk of acquiring STIs which can facilitate HIV transmission. We have investigated the relationship between the syndromic management and specific aetiology diagnosis and its relationship with HIV infection and health seeking behaviour among youth attending a reproductive health clinic
Guerino Chalamilla; Judica Mbwana; Fred Mhalu; Eunice Mmari; Mtebe Majigo; Andrew Swai; Willy Urassa; Eric Sandstrom
Millions of people die from diarrheal and respiratory diseases every year due to lack of proper sanitation, hygiene, and access to clean water. The act of handwashing with soap has been found to effectively reduce both diarrheal and respiratory illness, however, handwashing at critical times (i.e. after using the toilet, before preparing food) remains infrequent around the world. This research
This article examines two seemingly contradictory notions found in the anthropological literature that address so-called traditional healers. First, it suggests that despite their purportedly holistic approach, healers in coastal Tanzania may not be as popularly sought after by "local" people as they are made out to be by some academics and health policy researchers. Second, it contends that although there may be a tendency among the people of Tanzania to consult "distant" healers for social relationship-related conditions, the decision-making process involved in seeking out such healers is far more dynamic and context dependent than has been previously reported in the literature. People who seek help from distant healers have often unsuccessfully tried locally available health care resources. In making these arguments, I draw on ethnographic data gathered in a large village in the Dar es Salaam region of coastal Tanzania. In particular, I examine the divinatory practices of a well-known Zaramo healer (mganga) and discuss narrative case studies of two patients who had traveled from distant places to seek the mganga's help. The article concludes with a call for the critical reevaluation of propositions for the integration of "traditional healers" in programs aimed at the prevention and treatment of life-threatening infectious diseases that are predicated mainly on the assumption that healers are popular among the local people and provide effective consultations. PMID:18464126
The United Republic of Tanzania was formed in 1964 by the merger of Tanganyika and Zanzibar and is located on the eastern coast of Africa between the Great Lakes of the Rift Valley. Tanzania has a diverse mineral resource base that includes gold and base metals, diamond-bearing kimberlites, nickel, cobalt, copper, coal resources, and a variety of industrial minerals and rocks such as kaolin, graphite, and dimension stone. This web site was created by the Mineral Resources Department (MRD), a subsidiary of the Ministry of Energy and Minerals, and contains basic information about the country's logistical environment, mineral sector policy, geological database, and more.
Background Tuberculosis is the most common cause of death among patients with HIV infection living in tuberculosis endemic countries, but many cases are not diagnosed pre-mortem. We assessed the test characteristics of urinary lipoarabinomannan (LAM) and predictors of mortality among HIV-associated tuberculosis suspects in Tanzania. Methods We prospectively enrolled hospitalized HIV-infected patients in Dar es Salaam, with ?2 weeks of cough or fever, or weight loss. Subjects gave 2 mLs of urine to test for LAM using a commercially available ELISA, ?2 sputum specimens for concentrated AFB smear and solid media culture, and 40 mLs of blood for culture. Results Among 212 evaluable subjects, 143 (68%) were female; mean age was 36 years; and the median CD4 count 86 cells/mm3. 69 subjects (33%) had culture confirmation of tuberculosis and 65 (31%) were LAM positive. For 69 cases of sputum or blood culture-confirmed tuberculosis, LAM sensitivity was 65% and specificity 86% compared to 36% and 98% for sputum smear. LAM test characteristics were not different in patients with bacteremia but showed higher sensitivity and lower specificity with decreasing CD4 cell count. Two month mortality was 64 (53%) of 121 with outcomes available. In multivariate analysis there was significant association of mortality with absence of anti-retroviral therapy (p?=?0.004) and a trend toward association with a positive urine LAM (p?=?0.16). Among culture-negative patients mortality was 9 (75%) of 12 in LAM positive patients and 27 (38%) of 71 in LAM negative patients (p?=?0.02). Conclusions Urine LAM is more sensitive than sputum smear and has utility for the rapid diagnosis of culture-confirmed tuberculosis in this high-risk population. Mortality data raise the possibility that urine LAM may also be a marker for culture-negative tuberculosis.
Background Evaluating experiences of volunteers in an HIV vaccine trial will be useful for the conduct of future trials. The purpose of this study among volunteers who participated in a phase I/II HIV vaccine trial in Dar es Salaam, Tanzania was to assess what characterized their experiences during the trial. Methods We conducted four focus group discussions with 35 out of the 60 individuals (women and men) after the five scheduled vaccinations. An interpretive description approach was applied to data analysis. Results As a result of the trial interventions, both men and women gained confidence in their own abilities to have safer, less risky sexual behaviour. The participants experienced the trial as a way of accessing free [insured] medical services. Most of the men said they had gone from self-medication to professional medical consultation. Despite these benefits, the participants faced various challenges during the trial. Such challenges included mistrust of the trial shown by health care providers who were not connected to the trial and discouragement from friends, colleagues and family members who questioned the safety of the trial. However, they managed to cope with these doubts by using both personal and trial related interventions. Conclusion We found that during the phase I/II HIV vaccine trial, participants had both the opportunities and the ability to cope with the doubts from the surrounding community. Follow up visits enhanced the opportunities and individuals' abilities to cope with the doubts during the trial. Understanding this discourse may be useful for the trial implementers when designing future trials. Trials Registration ISRCTN: ISRCTN90053831 Pan African Clinical Trials Registry (PACTR): ATMR2009040001075080
Background In the Kilimanjaro region the mother-in-law has traditionally had an important role in matters related to reproduction and childcare. The aim of this study was to explore the role of the mothers-in-law in prevention of mother-to-child transmission (PMTCT) service utilization and adherence to infant feeding guidelines. Methods The study was conducted during 2007-2008 in rural and urban areas of Moshi district in the Kilimanjaro region of Tanzania. Mixed methods were used and included focus group discussions with mothers-in-law, mothers and fathers; in-depth interviews with mothers-in-law, mothers, fathers and HIV-infected mothers, and a survey of 446 mothers bringing their four-week-old infants for immunisation at five reproductive and child health clinics. Results The study demonstrated that the mother-in-law saw herself as responsible for family health issues in general and child care in particular. However she received limited trust, and couples, in particular couples living in urban areas, tended to exclude her from decisions related to childbearing and infant feeding. Mothers-in-law expected their daughters-in-law to breastfeed in a customary manner and were generally negative towards the infant feeding methods recommended for HIV-infected mothers; exclusive replacement feeding and exclusive breastfeeding. Conclusions Decreasing influence of the mother-in-law and increasing prominence of the conjugal couples in issues related to reproduction and child care, reinforce the importance of continued efforts to include male partners in the PMTCT programme. The potential for involving mothers-in-law in the infant feeding component, where she still has influence in some areas, should be further explored.
BACKGROUND: In many low-income countries, children are at high risk of iodine deficiency disorders, including brain damage. In the early 1990s, Tanzania, a country that previously suffered from moderate to severe iodine deficiency, adopted universal salt iodation (USI) as an intervention strategy, but its impact remained unknown. METHODS: We report on the first national survey in mainland Tanzania, conducted in
Vincent D Assey; Stefan Peterson; Sabas Kimboka; Daniel Ngemera; Celestin Mgoba; Deusdedit M Ruhiye; Godwin D Ndossi; Ted Greiner; Thorkild Tylleskär
Understanding hydrological processes in poorly or ungauged catchments is of utmost importance for the management of water resources. This paper shows that a high resolution time series of hydrological data (rainfall, evaporation and runoff) collected over a limited period of time (i.e. 1.5 years), can give a good picture of the hydrological processes occurring in a 25 km2 catchment in Tanzania (Vudee catchment). In addition, several techniques, incl. tracer and mapping studies, have been applied to identify flow paths and contribution from different sources. All this information was used for the development of a conceptual hydrological model. The conceptual model is based on the Lumped Elementary Watershed (LEW) concept, restructured for hourly time steps. An additional flux, representing the drainage into the neighbouring catchment, identified using a multi-method approach, increased the model performance significantly, particularly related to a recession curve occurring at high flows. This corroborates the assumption that there is water draining towards the neighbouring catchment. The model runs show that surface runoff only occurs during heavy rains or directly thereafter, which is consistent with results from hydrograph separation. Overall, the major part of the runoff is generated by groundwater. Moreover, the model shows that the unsaturated zone has a relatively large storage capacity. At the meso-scale, hydrological processes are governed by a sub-daily timescale. As a result, only a high resolution conceptual model is able to mimic the hydrological processes accurately. By applying the LEW model, incorporating the hydrological processes as observed in the catchment, a better understanding has been obtained of the dominant hydrological processes at this scale. This is a prerequisite for sustainable management of the water resources in a water scarce region.
Background Despite the increased attention on maternal mortality during recent decades, which has resulted in maternal health being defined as a Millennium Development Goal (MDG), the disability and suffering from obstetric fistula remains a neglected issue in global health. Continuous leaking of urine and the physical, emotional and social suffering associated with it, has a profound impact on women's quality of life. This study seeks to explore the physical, cultural and psychological dimensions of living with obstetric fistula, and demonstrate how these experiences shape the identities of women affected by the condition. Methods A cross-sectional study with qualitative and quantitative components was used to explore the experiences of Tanzanian women living with obstetric fistula and those of their husbands. The study was conducted at the Comprehensive Community Based Rehabilitation Tanzania hospital in Dar es Salaam, Bugando Medical Centre in Mwanza, and Mpwapwa district, in Dodoma region. Conveniently selected samples of 16 women were interviewed, and 151 additional women responded to a questionnaire. In addition, 12 women affected by obstetric fistula and six husbands of these affected women participated in a focus group discussions. Data were analysed using content data analysis framework and statistical package for the social sciences (SPSS) version 15 for Microsoft windows. Results The study revealed a deep sense of loss. Loss of body control, loss of the social roles as women and wives, loss of integration in social life, and loss of dignity and self-worth were located at the core of these experiences. Conclusion The women living with obstetric fistula experience a deep sense of loss that had negative impact on their identity and quality of life. Acknowledging affected women's real-life experiences is important in order to understand the occurrence and management of obstetric fistula, as well as prospects after treatment. This knowledge will help to improve women's sense of self-worth and maintain their identity as women, wives, friends and community members. Educational programmes to empower women socially and economically and counselling of families of women living with obstetric fistula may help these women receive medical and social support that is necessary.
Objective Heat-treating expressed breastmilk is recommended as an interim feeding strategy for HIV-exposed infants in resource-poor countries, but data on its feasibility are minimal. Flash-heating (FH) is a simple in-home technique for heating breastmilk that inactivates HIV while preserving its nutritional and anti-infective properties. Our primary objective was to determine, among HIV-infected mothers, the feasibility and protocol adherence of FH expressed breastmilk after 6 months of exclusive breastfeeding. Design Prospective longitudinal Participants 101 HIV-infected breastfeeding mothers Setting Dar es Salaam, Tanzania Intervention Peer counselors provided in-home counseling and support on infant feeding from 2 to 9 months postpartum. Mothers were encouraged to exclusively breastfeed for 6 months followed by FH expressed breastmilk if her infant was HIV-negative. Clinic-based staff measured infant growth and morbidity monthly and mothers kept daily logs of infant morbidity. FH behavior was tracked until 9 months postpartum using daily logs, in-home observations, and clinic-and home-based surveys. Bacterial cultures of unheated and heated milk samples were performed. Results Thirty-seven of 72 eligible mothers (51.4%) chose to Flash-heat. Median (range) frequency of milk expression was 3 (1–6) times daily and duration of method use on-study was 9.7 (0.1–15.6) weeks. Mean (SD) daily milk volume was 322 (201) mL (range 25–1120). No heated and 32 (30.5%) unheated samples contained bacterial pathogens. Conclusion FH is a simple technology that many HIV-positive women can successfully use after exclusive breastfeeding to continue to provide the benefits of breastmilk while avoiding maternal-to-child transmission associated with non-exclusive breastfeeding. Based on these feasibility data, a clinical trial of the effects of FH breastmilk on infant health outcomes is warranted.
The aim of the study was to investigate social and behavioral correlates of perceived vulnerability to traffic injuries in an urban and rural setting in Tanzania. In 2002, a sample of 494 adults aged 15 years and above participated in household interviews in Dar es Salaam (urban) and Hai District (rural). The study was part of a population-based survey that collected self-report data on non-fatal injuries. In Dar es Salaam 75 and 82% of males and females, respectively, perceived it as likely that they would experience a traffic injury in general. The corresponding figures in Hai were 63 and 64%. Men rated their road traffic vulnerability similarly to women (OR=0.8, 95% CI 0.5-1.3). Factors associated with high perceived vulnerability as a pedestrian or being injured by a bicycle were amount of road safety information received from health workers and friends, having caused a car to swerve and having crossed a road while talking. Respondents perceived driver recklessness and driver drunkenness as the leading causes of traffic injuries in both areas. Differences were found between the urban and rural setting with respect to perceived risk for traffic injury. The implications of these findings in the context of traffic injury prevention are discussed. PMID:16112069
Astrøm, Anne Nordrehaug; Moshiro, Candida; Hemed, Yusuf; Heuch, Ivar; Kvåle, Gunnar
The report reviews the initial evolution and implementation of educational policies through the Tanzania government five-year development plans. From 1969-1978, the Education for Self-Reliance (ESR) program became the basis for all major educational polic...
The effect of traditional food proceesing, preservation and storage methods on vegetable nutrients was studied using cassava, pumpkin and mwage leaves. Traditional cooking method for 90 min for cassava, 50 min for pumpkin and mwage leaves resulted in significant losses in protein, fats and vitamins. Sundrying using traditional mats caused losses of vitamin A of 36.3%, 38.0% and 50.3% for
This paper describes a community enumeration and mapping programme in five low-income settlements in Dar es Salaam. The inhabitants documented their settlement and its problems in detail, especially for water and sanitation, with support from the UK charity Water Aid and PEVODE, a Tanzanian NGO. The paper describes the planning and implementation of the enumeration and mapping, the information gathered,
Objectives: There are no prevalence data for childhood sexual abuse among Tanzanian university students. This investigation addressed this paucity. The nature of sexual abuse was also investigated. Method: Participants (N=487) from a university in Tanzania completed a questionnaire which assessed abusive childhood sexual experiences, gathering…
BackgroundExperimental data suggest a role for iron in the course of tuberculosis (TB) infection, but there is limited evidence on the potential effects of iron deficiency or iron overload on the progression of TB disease in humans. The aim of the present analysis was to examine the association of iron status with the risk of TB progression and death.Methodology\\/Principal FindingsWe
Sheila Isanaka; Said Aboud; Ferdinand Mugusi; Ronald J. Bosch; Walter C. Willett; Donna Spiegelman; Christopher Duggan; Wafaie W. Fawzi
BACKGROUND: Criteria-based audits have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the introduction of a criteria-based audit in a tertiary hospital in an African setting, assesses the quality of care among eclampsia patients and discusses possible interventions in order to improve the quality of care.
Hussein Lesio Kidanto; Ingrid Mogren; Siriel N Massawe; Gunilla Lindmark; Lennarth Nystrom
Preparation and implementation of urban general and detailed planning schemes, according to respective legislation, preoccupies most practitioners of the profession of urban and regional development planning and management worldwide. For a century lasting from 1850s to 1940s the professional practice was guided by the urban design paradigm, which embodies architectural concepts and principles of municipal engineering. For the following half
BACKGROUND: Postabortion contraceptive service is considered an effective means in addressing the problem of unsafe abortion; in spite this fact this component remains one of the weakest parts of postabortion care. In this context, the paper aims to describe the impact of a postabortion contraceptive service intervention among women admitted with complications from unsafe abortions and to explore the women's
Traditionally solid waste management has evolved as mainly the removal of municipal wastes by hauling them out of the city boundaries and dumping them ‘there’. This is in conformity with the ‘out of sight out of mind’ philosophy. However, with the ever increasing tonnage of refuse due to the expansion of urban centers, which implies increased collection, transportation and disposal
Solid waste disposal sites are potentially serious sources of pollution to the environment, especially when located very close to water sources and operated haphazardly. The high pollution potential of these sites is due to the fact that they usually contain almost all types of pollutants from the source community. The contaminants can leach out through the soil, contaminating the soil
|It is widely acknowledged that in order to improve the quality of education in primary schools in developing countries there is a need to place pedagogy and its training implications at the centre of teacher education reform. Like many countries in Eastern and Southern Africa, Tanzania has introduced various initiatives and reforms to improve the…
Background: The government of the United Republic of Tanzania has initiated the Integrated Management of Childhood Illness program to improve the health and wellbeing of children. Methods: Tanzania’s under-five mortality rate is still 1.7 times higher than the world average and, in order to achieve its Millennium Development Goal 4 target, its annual reduction rate is quite low at 2.2. The main aim of the study is to examine under-five mortality combined with the Data from the Tanzania Demographic and Health Survey 2008 data was used. Odds ratios for infant and under-five mortality were estimated using logistic regression; crude and adjusting models were adopted. Results: Mortality cases (18.3%) have been reported to children born with an interval of <24 months. Mothers with no education reported 14.6%, primary education mothers reported 11.1% and higher education reported only 5.3% (P<0.001). Therefore, maternal education plays is a major role on fertility and infant and under-five mortality behavior. Conclusion: Maternal education also influences a mother’s behavior in her usage of available health services to improve the health of the children. Further in-depth analysis is immensely needed in this situation.
Tanzania is host to one of the highest refugee populations in the world, with over half a million refugees in 2006. The purpose of this case study was to explore the application of the UNHCR ART policy for the provision of therapeutic, long-term antiretroviral therapy (ART) to refugees in Tanzania. A case study method was used and 18 semi-structured key-informants
Purpose: To test whether environmental pollutants could affect fertility in humans.\\u000a Methods: 31 women and 16 men from Tanzania and 21 couples from Germany were included (n=89). Pesticides and polychlorinated biphenyls were measured in serum, follicular fluid or seminal plasma by gaschromatography and related to sperm quality and pregnancy rates.\\u000a Results: Higher concentrations of DDT+DDE and dieldrin in Tanzania and
Jürgen M. Weiss; Otmar Bauer; Albrecht Blüthgen; Annika K. Ludwig; Elke Vollersen; Malise Kaisi; Safaa Al-Hasani; Klaus Diedrich; Michael Ludwig
Tanzania is host to one of the highest refugee populations in the world, with over half a million refugees in 2006. The purpose of this case study was to explore the application of the UNHCR ART policy for the provision of therapeutic, long-term antiretroviral therapy (ART) to refugees in Tanzania. A case study method was used and 18 semistructured key-informants interviews were conducted in July 2007 with a cross-section of stakeholders involved in provision of ART to refugees in Tanzania. The results suggest positive implementation of the key principles of the UNHCR policy. Some differing opinions existed between respondents over the key principles of considering ART provision at earliest possible stage of displacement, and the criteria for repatriation of refugees. The right of refugees to access ART is increasingly accepted and Tanzania provides a positive example of how ART services can be scaled up for refugees. PMID:19655639
Background Sexual activities are increasingly changing from the cultural point of view what they used to be. Knowledge of these practices among adolescents may be a basis to create awareness among adolescents on practices that involve risks. This study aims to assess sexual practices among unmarried adolescents in Tanzania. Methods A cross-sectional survey was conducted among in-school and out-of-school but unmarried adolescents aged 10 to 19 in five locations in Tanzania. A questionnaire was used to collect information and to characterize sexual practices among these adolescents. Results About 32% of adolescents reported being sexually active; a higher proportion being males than females. The only inquired and reported sexual practices include vaginal sex, masturbation, oral and anal sex. About 15% of sexually active adolescents reported having multiple sexual partners. Significantly more males reported having multiple partners than females. Nearly 42% of sexually active adolescents reported having used a condom during most recent sexual act. Females reported older partners at first sexual act. Conclusion Adolescents experience several sexual practices that include penetrative and non-penetrative. More males reported being sexually active than females. Despite adolescents reporting having multiple sexual partners, reported condom use during the most recent sexual act was low. We advocate for a more enhanced approach of reproductive health education that includes safer sex to adolescents without forgetting those in-schools.
From February 1977 through January 1979, 206 patients with histologically confirmed cervix carcinoma were treated with high dose rate afterloading irradiation at the Muhimbili Medical Center of the University of Dar es Salaam, Tanzania. Tribal and regional patterns of disease conform to geographical distributions of referring hospitals. The age at presentation, namely, at over 40 years, is similar to that reported elsewhere from East Africa. Parity among patients ranged from 0 to 14 pregnancies. Vaginal bleeding was the most common symptom in 69 percent of patients. Squamous cell carcinoma was noted in 96 percent of cases. Seventy-six percent of patients had early stage disease. Good initial responses to treatment were recorded in 57 percent of patients. Follow-up of cervical cancer patients is poor. Fifty-six (27 percent) patients were followed 1 to 17 months after treatment. Due to poor follow-up, no definite conclusions are reached regarding late radiation reactions and patient survival. The role or radiotherapy in reducing morbidity, however, is of importance.
Background:Childhood cataract is becoming increasingly recognised as a priority for reducing childhood blindness in developing countries. However, there have been no standard methods to monitor progress in providing this service, besides sporadic reports of surgeries performed.Methods:Information on all children receiving surgery for congenital\\/developmental cataract in the two Child Eye Health Tertiary Facilities (CEHTF) in Tanzania was collected for 2004–6. An
P Courtright; T Williams; C Gilbert; E Kishiki; S Shirima; R Bowman; S Lewallen
Coral reefs are very important in Tanzania, both ecologically and socio-economically, as major fishing grounds and tourist attractions. Numerous fringing and patch reefs are located along about two-thirds of Tanzania's coastline. These reefs have been partially to severely degraded by human (primarily destructive fishing practices) and natural (particularly coral bleaching) causes. These immediate human causes have been brought about by
Summary This paper gives a brief discussion on water supply from wetlands in Tanzania. The major drainage basins in Tanzania are described and the status and role of the Division of Water Research in the monitoring of water resources and data collection from wetlands and water sources are highlighted. The role of wetlands in the hydrological cycle, and the utilisation
Background Dermatologic disorders are common in many countries but the spectrum varies greatly. Many studies have reported a significant burden of skin diseases in school children. The objective of this study was to determine the current spectrum of dermatological disorders in primary school children in Dar es Salaam city. Methods Primary school children were recruited by multistage sampling. Detailed interview, dermatological examination and appropriate laboratory investigations were performed. Data was analyzed using the 'Statistical Package for Social Sciences' (SPSS) program version 10.0 and EPI6. A p-value of < 0.5 was significant. Results A total of 420 children were recruited (51% males; mean age 11.4 ± 2.8 years; range 6-19 years). The overall point prevalence of any skin disorder was 57.3% and it was 61.9% and 52.6% in males and females respectively (p = 0.05). Infectious dermatoses accounted for 30.4% with superficial fungal infections (dermatophytoses and pityriasis versicolor) being the commonest (20%). Dermatophytoses were diagnosed in 11.4% (48/420); the prevalence in males and females being 12.6% and 10.1% respectively (p = 0.41) and higher (21.8%) in the age-group 6-10 years (p = 0.045). Fungal cultures were positive in 42/48 children (88%). All three dermatophyte genera were isolated. Tinea capitis was the commonest disease among culture-positive dermatophytoses (30/42; 71.4%) with an overall prevalence of 7.1% (30/420) followed by tinea pedis (11/42; 26.1%) whose overall prevalence was 2.6%. Microsporum canis was common in tinea capitis (14/30; 46.7%) followed by Trichophyton violaceum (6/30; 20%). Trichophyton rubrum was common in tinea pedis (5/11; 45.5%). Thirty six children (8.6%) had pityriasis versicolor which was more prevalent (6/27; 22.l2%) in the age group 16-19 years (p = 0.0004). The other common infectious dermatoses were pyodermas (4%) and pediculosis capitis (3.6%). Common non-infectious dermatoses were: acne vulgaris (36.4%), non-specific dermatoses (10.7%), non-specific ulcers (5%) and atopic eczema (2.6%). Rare conditions (prevalence < 1%) included: vitiligo, alopecia areata and intertrigo. The majority of the affected children (67.2%) did not seek any medical assistance. Conclusions Skin disorders are common in primary school children; infectious dermatoses are still rampant and many children do not seek medical assistance.
BACKGROUND: Effective and timely case management remains one of the fundamental pillars for control of malaria. Tanzania introduced artemisinin-combination therapy [ACT] for uncomplicated malaria; however, the policy change is challenged by limited availability of ACTs due to high cost. This study aimed to determine factors influencing prompt access to ACTs among febrile children in rural Kilosa, Tanzania. METHODS AND FINDINGS:
Daudi O. Simba; Marian Warsame; Deodatus Kakoko; Zakayo Mrango; Goran Tomson; Zul Premji; Max Petzold
A new strategy to control African armyworm in Tanzania is reviewed, with the utilization of the natural disease of the armyworm, Spodoptera exempta nucleopolyhedrovirus (SpexNPV) for control of armyworm outbreaks in Tanzania serving as case- study. Also the opportunity of linking novel control methods with Community Based Armyworm Forecasting (CBAF) is reviewed. Results from both ground and aerial application have
Wilfred L Mushobozi; David Grzywacz; Ken Wilson; Richard Musebe; Martin Kimani; Chatham Maritime
P. H. BARRY1*, D. R. HILTON1, T. P. FISCHER2, J. M. DE MOOR2, F. MANGASINI3 C. RAMIREZ4 1 Geosciences Research Division, Scripps Institution of Oceanography, UCSD, La Jolla, California 92093-0244, USA (*Correspondence: firstname.lastname@example.org) 2 Department of Earth and Planetary Sciences, MSC 03 2040, 1 University of New Mexico, Albuquerque, New Mexico 87131-0001, USA. 3 Department of Mining and Mineral Processing Engineering, University of Dar Es Salaam, PO Box 35131, Dar Es Salaam, Tanzania. 4 Centro de Investigaciones en Ciencias Geologicas, Escuela Centroamericana de Geologia, Universidad de Costa Rica. The East African Rift (EAR) is the largest modern example of continental rifting, extending from the Afar depression in the north to the Rungwe region in southern Tanzania. EAR volcanism is attributed to the presence of one or more mantle plumes . Late Miocene to recent volcanism and geothermal activity mark the Rungwe region , with mafic eruptions as recently as 200 years ago. Our aim is to delineate the southern geographical extent of plume influence on the propagating EAR by investigating the He-CO2 characteristics of geothermal fluids in the Rungwe region. We report new helium (He) and carbon (C) isotopes (3He/4He, ?13C) and relative abundance (CO2/3He) characteristics for a suite of 20 geothermal gas and fluid samples from 11 different localities in the Rungwe region. He-isotopes are in good agreement with previous reports , and range from ~1 RA to ~7 RA (MORB-like values), indicating admixture between upper mantle He and variable proportions of radiogenic He. C-isotopes ranges from -2.8 to -6.5 ‰ (vs. PDB) with all falling in the MORB range (~4.5 ± 2‰). CO2/3He ratios vary over 5 orders of magnitude from ~3 x 10^9 (MORB-like) to higher values (up to ~3 x 10^13) normally associated with crustal lithologies. Taken together, the He-CO2 data can be explained by 2-component mixing of a deep-seated mantle source with crustal component(s). There are no observed latitudinal isotopic trends in He-CO2. However, the two localities with MORB-like 3He/4He ratios ~6 to 7 RA, ?13C ~ -4 to -5 ‰ and CO2/3He ~ 4 x10^9 are both cold temperature (~ 15°C) CO2 gas vents. The MORB-like characteristics of these cold vents are comparable to MORB-like values observed at Oldoinyo Lengai in northern Tanzania , suggesting that both Rungwe region and Oldoinyo Lengai may derive their volatile compositions from a homogeneous (MORB-like) mantle source common to the entire segment of the southern EAR.  Furman (2007) Journal of African Earth Sciences 48, 147-160.  Ebinger et al. (1989) Journal of Geophysical Research 94, 15,785-15,803.  Pik et al. (2006) Chemical Geology 226, 100-114.  Fisher et al. (2009) Nature 459, 77-80.
Background Published data on the existence and magnitude of extended spectrum beta-lactamase (ESBL) production in urinary pathogens in local setting is limited. The aim of the present study was to determine the prevalence of antimicrobial resistance and ESBL production among Escherichia coli and Klebsiella spp from urine samples in a tertiary hospital. This was a cross sectional study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. Findings A total of 270 E.coli and Klebsiella spp urinary pathogens from children and adults isolated from January to March 2010 were included in the study. E. coli and Klebsiella spp isolates were tested for antimicrobial susceptibility by the Clinical and Laboratory Standard Institute's disc diffusion method. These isolates were further screened for ESBL phenotype using cefotaxime and ceftazidime discs. Isolates with reduced sensitivity were confirmed using ESBL E-test strips. Of 270 isolates, 138 (51.1%) were E. coli and 132 (48.9%) were Klebsiella spp. ESBL was detected in 122 (45.2%) of all the isolates. ESBL- producing E. coli strains were significantly more resistance to cotrimoxazole (90.7%), ciprofloxacin (46.3%) and nalidixic acid (61.6%) than strains that did not produce ESBL (p < 0.05). Similarly, ESBL- producing Klebsiella spp strains were significantly more resistance to cotrimoxazole (92.6%), ciprofloxacin (25.0%), nalidixic acid (66.2%), and gentamicin (38.2%) than strains that did not produce ESBL (P < 0.05). Multi-drug resistance was found to be significantly (P < 0.05) more in ESBL producing isolates (90.5%) than non ESBL producers (68.9%). The occurrence of ESBL was significantly higher among isolates from inpatients than outpatients [95 (50.5%) vs. 27(32.9%)] (p = 0.008). The occurrence of ESBL was significantly higher among isolates from children than in adults [84 (54.9%) vs. 38(32.5%)] (p < 0.001). Conclusions High prevalence of ESBL-producing E. coli and Klebsiella spp strains was found among inpatients and children. Most of the ESBL- producing isolates were multi-drug resistant making available therapeutic choices limited. We recommend continued antibiotic surveillance as well comprehensive multi-center studies to address the emerging problem of ESBL-associated infections in order to preserve the continued usefulness of most antimicrobial drugs. Further more conducting molecular studies will help to evaluate the various ESBL types.
Background In a study of prevention of mother-to-child transmission of HIV (PMTCT) by triple antiretroviral therapy (ART) in Dar es Salaam, Tanzania (the Mitra Plus study), retrospective viral load testing revealed a high and increasing frequency of detectable viral load during follow-up for two years postnatally in women given continuous ART for their own health suggesting poor adherence. This study explored women’s own perceived barriers to adherence to ART post-delivery so as to identify ways to facilitate better drug adherence among women in need of ART for their own health. Methods Semi-structured interviews were conducted with 23 of the 48 women who had detectable viral load at 24 months postnatally. Content analysis was used to analyze the data. Results Most women in the study did not acknowledge poor adherence until confronted with the viral load figures. Then, however, they revealed multiple reasons for failing to adhere. They said that their motivation to take ART decreased once they had protected their children from becoming infected and successfully weaned them. Feeling well for some, and a feeling of hopelessness for others, also decreased motivation to continue ART. The overwhelming demands of everyday life, poverty and lack of empowerment also posed significant barriers to long-term adherence. The need to keep their HIV status a secret and not let anyone see them taking the drugs was another steep barrier. Conclusion Reasons for postnatal failure to adhere by mothers put on ART for life during pregnancy included lack of motivation to continue ART after weaning the child, poverty and stigma. Projects that simultaneously address stigma, poverty and women’s lack of empowerment may be necessary for PMTCT and ART to reach their full potential. Our results indicate that the new WHO proposal to start all HIV-infected pregnant women on lifelong ART regardless of CD4 cell count needs to address the challenging realities of women in resource-poor contexts if it is to be successful.
In colonial Tanganyika, popular music and football were the most important genres of popular culture in urban areas then as now. From the 1930s, these modern forms of recreation grew out of a precedent tradition of the competitive dance societies among the Swahili on the coast. In the capital Dar es Salaam, various musical and sporting organizations developed in the
BackgroundUnsafe abortion is estimated to account for 13% of maternal mortality globally. Medical abortion is a safe alternative.MethodsBy estimating mortality risks for unsafe and medical abortion and childbirth for Tanzania and Ethiopia, we modelled changes in maternal mortality that are achievable if unsafe abortion were replaced by medical abortion. We selected Ethiopia and Tanzania because of their high maternal mortality
Rebecca F. Baggaley; Joanna Burgin; Oona M. R. Campbell
Present rural electrification in Tanzania means supplying electricity to townships and to only a few of the existing 8000 registered villages, which are not yet electrified in any considerable numbers due to technical and economical problems. The initial ...
This document provides a review of past and present IAEA Technical Co-operation Activities in Tanzania and gives descriptions of the current status of nuclear applications in food and agriculture, human health, water resources and industrial applications/...
As a part of a comprehensive evaluation of post-treatment techniques for upgrading waste stabilization pond (WSP) effluents, coupled dynamic roughing filters (DyRF) and subsurface horizontal flow constructed wetland system (HSSFCW) system was evaluated in Tanzania. Coupled DyRF and HSSFCW were considered as cheaper and yet effective and appropriate alternative technology for upgrading WSP effluents in tropical environments like Tanzania. The main objective of the study was to determine the performance treatment of coupled DyRF and HSSFCW for upgrading WSP effluents with respect to organic compounds (TSS and BOD5) and pathogen (FC). A pilot of coupled DyRF and HSSFCW was constructed at the outlet of the Maturation WSP at the University of Dar es Salaam, Tanzania. The study was carried out in a 2.2 m × 0.7 m × 0.7 m deep DyRF as a first stage, using three different fractions of gravel ranging from 8 mm to 32 mm, from the top to the bottom respectively. In the second stage, a HSSFCW planted with Phragmites Mauritianus with 0.6-m wide, 1.75-m long and 0.6-m deep was used. The DyRF HSSFCW system achieved TSS load reduction by 89.35%, which is 15.97 g TSS/m2/day, while BOD5 load reduction by 84.47% which is 9.29 g BOD5/m2/day was achieved. The FC mean removal rate of 99.99% was also achieved. By achieving mean effluent TSS (12.63 ± 4.12 mg/l), BOD5 (14.12 ± 3.84 mg/l), and mean effluent FC concentrations of 790 FC/100 ml it was concluded that application of coupled DyRF and HSSFCW in the tropics can be considered technically one of the most appropriate technology for upgrading WSP effluents.
Kimwaga, R. J.; Mashauri, D. A.; Mbwette, T. S. A.; Katima, J. H. Y.; Jørgensen, S. E.
A questionnaire survey was carried out among 1041 students in secondary schools and colleges in Dar-es-Salaam, Tanzania to evaluate the relationship between HIV-risky sexual behaviour and anti-condom bias, as well as with AIDS-related information, knowledge, perceptions and attitudes. Self-reportedly, 54% of students (75% of the boys and 40% of the girls) were sexually active, 39% had a regular sexual partner and 13% had multiple partners in the previous year. The condom use rate was higher than previous reports. However, 30% of sexually active respondents did not always use condoms (Risk-1 behaviour) and 35% of those with multiple partners in the previous year did not always use condoms (Risk-2 behaviour). Multiple logistic regression analyses indicated that 'sex partner hates condom' had association with both Risk-1 behaviour (OR 2.47; 95% CI 1.58-3.85) and Risk-2 behaviour (OR 2.47; 95% CI 1.10-5.48). 'Use of condom prevents HIV infection' also had association with both Risk-1 behaviour (OR 2.09; 95% CI 1.19-3.67) and Risk-2 behaviour (OR 3.73; 95% CI 1.28-11.03). Students engaging in risky behaviour were aware of the risk, even though they failed to change their behaviour. Reasons for the AIDS epidemic among Tanzanian students and the importance of more effective AIDS education are also discussed. PMID:10387499
Maswanya, E S; Moji, K; Horiguchi, I; Nagata, K; Aoyagi, K; Honda, S; Takemoto, T
Reviews the task of providing adequate newspaper information services to meet the demands of 21st century Tanzania. Defines what is meant by newspaper information, and outlines the present situation of the provision of newspaper information in Africa and mainland Tanzania. Discusses the problems of providing access to newspaper information and the newspaper services provided by libraries in Tanzania. Analyses the
With only the most basic astronomy content officially included in the Physics syllabus of Secondary Schools in Tanzania and a one semester Astrophysics option course offered in the Physics Department of one University, the reasons for apathy towards astronomy education in Tanzania are discussed. Using the current focus on introducing ICT into Primary and Secondary schools in Tanzania, the potential
SUMMARY BACKGROUND Low body mass index (BMI) is a known risk factor for tuberculosis (TB) in people without human immunodeficiency virus (HIV), but there are no prospective studies linking BMI to the risk of HIV-associated TB. DESIGN In HIV-infected adults with CD4 counts ? 200 cells/µl receiving placebo in a TB booster vaccine trial in Dar es Salaam, Tanzania, we measured BMI at baseline and Year 1, and related baseline BMI and change in BMI to the risk of developing TB. RESULTS We documented 92 cases of TB among 979 subjects followed for a mean of 3.2 years. Compared to subjects who did not develop TB, subjects who developed TB had a lower baseline BMI (23.2 vs. 24.6 kg/m2, P = 0.006), and a greater BMI decline from baseline to Year 1 (?0.4 vs. 0.6 kg/m2, P < 0.001). In multivariate analyses, baseline BMI was associated with the risk of developing TB (hazard ratio [HR] per kg/m2 0.94, 95%CI 0.90–0.99, P = 0.028), as was the change in BMI from baseline to Year 1 (HR per kg/m2 0.79, 95%CI 0.71–0.87, P < 0.001). Subjects with a baseline BMI < 17 kg/m2 were more likely to develop TB (HR 3.72, 95%CI 1.16–12.0, P = 0.028). CONCLUSION Low BMI and falling BMI predict HIV-associated TB.
Maro, I.; Lahey, T.; MacKenzie, T.; Mtei, L.; Bakari, M.; Matee, M.; Pallangyo, K.; von Reyn, C. F.
African healing systems have always been pluralistic in form and structure, capable of absorbing new traditions and practices. The spread of Chinese medicine in Tanzania over the past decade is a testament to the flexibility of pluralistic healing systems, as well as evidence of south-south processes of globalisation that are often ignored by the literature on globalisation. This article suggests,
The Family Planning Association of Tanzania (UMATI)/JOICFP Integrated Project to promote the use of contraceptive methods was launched in 1984 to a target population of 20,000 spread over three villages. The project now covers 117 villages with a total population of 356,000. In initial project areas, the project has increased the contraceptive prevalence rate (CPR) to more than 50% compared to the national average of 11.3% in five years. In overwhelmingly Catholic areas in Mgeta, Morogoro Region, the CPR increased from 1.0% in 1990 at the project start to reach 50.4% in 1994. The community-based distribution (CBD) system is one of the most impressive aspects of the UMATI/JOICFP project. The flexibility and ready accessibility of CBD personnel have made them more effective in reaching community people than clinical services. CBD personnel also work closely with government health workers. To further improve the CBD system, UMATI is concentrating upon the development of an effective CBD supervision system. PMID:12290709
OBJECTIVES: To determine the prevalence of sexually transmitted infections (STIs) and other reproductive tract infections (RTIs) among pregnant women in Moshi, Tanzania and to compare the occurrence of STIs\\/RTIs among human immunodeficiency virus (HIV)-infected and uninfected women. METHODS: Pregnant women in their 3rd trimester (N = 2654) were recruited from two primary health care clinics between June 2002 and March
Sia E Msuya; Jacqueline Uriyo; Akhtar Hussain; Elizabeth M Mbizvo; Stig Jeansson; Noel E Sam; Babill Stray-Pedersen
BACKGROUND: Efficient delivery strategies for health interventions are essential for high and sustainable coverage. We report impact of a change in programmatic delivery strategy from routine delivery through the Expanded Programme on Immunization (EPI+) approach to twice-yearly mass distribution campaigns on coverage of vitamin A supplementation in TanzaniaMETHODS: We investigated disparities in age, sex, socio-economic status, nutritional status and
Honorati Masanja; Joanna Armstrong Schellenberg; Hassan M Mshinda; Meera Shekar; Joseph KL Mugyabuso; Godwin D Ndossi; Don de Savigny
BACKGROUND: Previous studies on change in maternal age composition in Tanzania do not indicate its impact on adverse pregnancy outcomes. We sought to establish temporal changes in maternal age composition and their impact on annual Caesarean section (CS) and low birth weight deliveries (LBWT) at Muhimbili National Hospital in Tanzania. METHODS: We conducted data analysis of 91,699 singleton deliveries that
This paper discusses emerging issues in selection and acquisition of electronic information resources in academic libraries of developing countries paying particular attention to the situation at the University of Dar es Salaam Library (www.udsm.ac.tz\\/library\\/). First, it discusses in historical perspective the application of information technology in provision of information services and specifically the provision of electronic information services at this
Cost–benefit considerations of wildlife monitoring are essential, particularly, in areas outside national park boundaries,\\u000a where resources for conducting wildlife censuses are scarce, but that, at the same time, are subject to high pressure for\\u000a wildlife utilization, such as hunting. Large mammal survey data from various sources were collated and analyzed to investigate\\u000a which methods are best suited for monitoring purposes
Fortunata Msoffe; Fatina A. Mturi; Valeria Galanti; Wilma Tosi; Lucas A. Wauters; Guido Tosi
Background In the Kilimanjaro region the mother-in-law has traditionally had an important role in matters related to reproduction and\\u000a childcare. The aim of this study was to explore the role of the mothers-in-law in prevention of mother-to-child transmission\\u000a (PMTCT) service utilization and adherence to infant feeding guidelines.\\u000a \\u000a \\u000a \\u000a \\u000a Methods The study was conducted during 2007-2008 in rural and urban areas of Moshi district
Eli Fjeld Falnes; Karen Marie Moland; Thorkild Tylleskär; Marina Manuela de Paoli; Sebalda Charles Leshabari
This study sought to understand how individuals reveal their HIV test results to others and the ways in which social relations affect the disclosure process. The data were collected through open-ended interviews administered in Swahili to informants who had just been tested for HIV and to those who were living with HIV in Dar es Salaam and Iringa regions. Analysis
Joe Lugalla; Stanley Yoder; Huruma Sigalla; Charles Madihi
The main objective of this work was to assess the relative bioavailability of two tablet formulations containing sulfadoxine/pyrimethamine (SP) and marketed in Tanzania. Twelve healthy volunteers were randomized to receive a single oral dose of three SP tablets each containing 500 mg sulfadoxine (SDX) and 25 mg pyrimethamine (PYR) in a form of either A (a locally manufactured SP tablet formulation, manufactured by a local pharmaceutical industry in Tanzania) or B (Fansidar), Hoffmann La Roche, Basel, Switzerland, an innovator's SP) after an overnight fasting. Serial blood samples (100 microL) were collected from a finger prick in duplicate up to 10 days and dried on Whatman filter paper. The samples were assayed for SDX and PYR using high-performance liquid chromatographic methods. Pharmacokinetic parameters of SDX and PYR were estimated by single compartment method. The pharmacokinetics of formulation A--maximum plasma concentration, the areas under the plasma concentration--time curve and the relative bioavailability (A versus B) were significantly lower than those of formulation B (P < 0.1). These observed differences indicate bioinequivalence between the two products. PMID:16611442
Minzi, Omary M S; Massele, Amosy; Justin-Temu, Mary; Ericsson, Orjan; Gustafsson, Lars L
In these short notes the authors provide some insight to their' visit to displaced persons camps in Kigoma, Tanzania. This trip marks the fourth set of camps examined in the PostEmergency Phase Indicators Project, a joint collaboration between the Johns Hopkins Center for Refugee and Disaster Studies, and the International Emergency and Refugee Health Branch at the Centers for Dis-
|This paper provides a discussion on the evolution of elections management in Tanzania with a focus on technological advancement in administering registration of voters. The paper provides the merits that permanent voters register has brought over the thumb practice. It traces the management of elections during colonialism, after independence…
Economic reforms in Tanzania have resulted in low inflation and solid economic growth, but many observers question whether the standard of living of ordinary Tanzanians has improved. Furthermore, there is a strong suspicion that the benefits have been concentrated among the urban population and among rural households with good market access, leaving remote rural households behind. In this paper, we
BACKGROUND: Malaria control strategies emphasize the need for prompt and effective treatment of malaria episodes. To increase treatment efficacy, Tanzania changed its first-line treatment from chloroquine to sulphadoxine-pyrimethamine (SP) in 2001. The effect of this policy change on the availability of antimalarials was studied in rural south-eastern Tanzania. METHODS: In 2001 and 2004, the study area was searched for commercial
Manuel W Hetzel; June J Msechu; Catherine Goodman; Christian Lengeler; Brigit Obrist; S Patrick Kachur; Ahmed Makemba; Rose Nathan; Alexander Schulze; Hassan Mshinda
Tanzania’s Pilot Rural Investment Climate Assessment (RICA) measures the economic environment of non-farm entrepreneurs. The pilot assessment has three key objectives: it aims to better understand the rural non-farm economy in Tanzania, shed light on rural enterprise dynamics and business constraints, and reflect on areas where government policies are readily directed to help promote rural non-farm enterprise activity. The RICA
Background With effective contraceptives available, unplanned pregnancies are preventable and educational interventions have been cited as a promising platform to increase contraceptive use through improving knowledge. However, results from trials of educational interventions have been disappointing. In order to effectively target future interventions, this study aimed to identify risk factors for unplanned pregnancy among young women in Mwanza, Tanzania. Methods Data were analysed from the MEMA kwa Vijiana Trial Long-term Evaluation Survey, a cross-sectional study of 13?814 young adults aged 15–30?years in Mwanza, Tanzania. Potential risk factors for unplanned pregnancy were grouped under three headings: socio-demographic, knowledge of and attitude towards sexual health, and sexual behaviour and contraceptive use. Conditional logistic regression was used to identify predictors of reported unplanned pregnancy among all sexually active women. Results Increasing age, lower educational level, not being currently married, knowing where to access condoms, increasing number of sexual partners and younger reported age at sexual debut were associated with unplanned pregnancy. Discussion A number of demographic and sexual behaviour risk factors for pregnancy are identified which will help guide future intervention programmes aiming to reduce unplanned pregnancies. This study suggests effective measures to prevent unplanned pregnancies should focus on encouraging girls to stay in school.
Calvert, Clara; Baisley, Kathy; Doyle, Aoife M; Maganja, Kaballa; Changalucha, John; Watson-Jones, Deborah; Hayes, Richard J; Ross, David A
Objective Anaemia is common during pregnancy, and prenatal Fe supplementation is the standard of care. However, the persistence of anaemia despite Fe supplementation, particularly in HIV infection, suggests that its aetiology may be more complex and warrants further investigation. The present study was conducted to examine predictors of incident haematological outcomes in HIV-infected pregnant women in Tanzania. Design Prospective cohort study. Cox proportional hazards and binomial regression models were used to identify predictors of incident haematological outcomes: anaemia (Hb < 110 g/l), severe anaemia (Hb < 85 g/l) and hypochromic microcytosis, during the follow-up period. Setting Antenatal clinics in Dar es Salaam, Tanzania. Subjects Participants were 904 HIV-infected pregnant women enrolled in a randomized trial of vitamins (1995–1997). Results Malaria, pathogenic protozoan and hookworm infections at baseline were associated with a two-fold increase in the risk of anaemia and hypochromic microcytosis during follow-up. Higher baseline erythrocyte sedimentation rate and CD8 T-cell concentrations, and lower Hb concentrations and CD4 T-cell counts, were independent predictors of incident anaemia and Fe deficiency. Low baseline vitamin D (<32 ng/ml) concentrations predicted a 1·4 and 2·3 times greater risk of severe anaemia and hypochromic microcytosis, respectively, during the follow-up period. Conclusions Parasitic infections, vitamin D insufficiency, low CD4 T-cell count and high erythrocyte sedimentation rate were the main predictors of anaemia and Fe deficiency in pregnancy and the postpartum period in this population. A comprehensive approach to prevent and manage anaemia, including micronutrient supplementation and infectious disease control, is warranted in HIV-infected women in resource-limited settings – particularly during the pre- and postpartum periods.
Finkelstein, Julia L; Mehta, Saurabh; Duggan, Christopher P; Spiegelman, Donna; Aboud, Said; Kupka, Roland; Msamanga, Gernard I; Fawzi, Wafaie W
Condoms remain a cost-effective and relatively simple intervention to prevent HIV infection. However, condom use is still very low, particularly among youths aged 15 to 24. 348 individuals (186 males and 162 females) completed a pre-tested questionnaire. Logistic regression analysis was used to identify factors associated with condom use. Out of 348 respondents, 296 (85.0%) were sexually experienced, and 260 (87.8%) reported noncondom use in the past 3 months prior to the study. Among men, noncondom use was independently associated with feeling shy to buy condoms (AOR = 1.16; 95% CI 1.12–1.34), condoms reducing sexual pleasure (AOR = 8.19; 95% CI 3.98–17.01), and HIV is a serious and deadly disease (AOR = 0.36; 95% CI 0.28–0.46). Among women, experiencing forced sex (AOR = 1.16; 95% CI 1.10–2.78), condoms reduce sexual pleasure (AOR = 8.29; 95% CI 3.36–20.73), and inability to convince a partner to use condoms (AOR = 1.14; 95% CI 1.04–1.28) were predictors of noncondom use. In conclusion, sexually active youths in this population practice risky sexual behaviours, with low condom use practices. Strategies to improve condom use should address these psychosocial barriers associated with noncondom use.
HIV-associated Kaposi's sarcoma (KS) is reported to be the most common tumor among people infected with HIV and accounts for significant morbidity and mortality. A study was conducted at Muhimbili Medical Center among consecutive patients presenting at the skin clinic or admitted to the surgical or medical wards during April-December 1992 and suspected to have KS. Patients completed a questionnaire, had venous blood samples and biopsies of the suspicion skin lesion taken, and were tested for infection with HIV. 81 adult patients with histologically proven KS were seen during the study period. Epidemic KS (EKS) was diagnosed in 72 patients of whom 49 were male, while African endemic Kaposi's sarcoma (AEKS) was diagnosed in nine patients of whom seven were male. No patient presented with classical KS. Compared to AEKS, EKS was more aggressive and disseminated in patients. The mean duration of illness for patients with AEKS was 37.3 months compared to 8.3 months for those with EKS. The presenting symptoms and past history of HIV-related illness were most pronounced among patients with EKS. Patients with EKS also demonstrated profound T4 lymphopenia and inverted T4:T8 ratio suggestive of advanced HIV infection. PMID:8783952
Bakari, M; Pallangyo, K; Kitinya, J; Mbena, E; Urassa, W
In 1978 a team of three people was formed to survey the existing library training facilities in East Africa and to suggest possibilities as to how the elements of information science could be introduced either into existing programs or into special courses organized for the purpose. The team submitted its report to a joint meeting of the…
Background Skin diseases are underestimated and overlooked by most clinicians despite being common in clinical practice. Many patients\\u000a are hospitalized with co-existing dermatological conditions which may not be detected and managed by the attending physicians.\\u000a The objective of this study was to determine the burden of co-existing and overlooked dermatological disorders among patients\\u000a admitted to medical wards of Muhimbili National hospital
This paper explores the impacts of the HIV\\/AIDS epidemic on children and families in northern Tanzania using the concept of social resilience.1 The study is based on the findings of child-focused research with street children and children and families from HIV\\/AIDS-affected households. The paper illustrates the coping strategies that children and young people, and parents and caregivers adopt at the
|This comprehensive treatment of the state of the publishing industry in Tanzania provides a general description of the book trade in Africa, including discussions of the types of publishers active in Africa and of the recording of African publishing output, and a review of publishing activities in Tanzania, which covers the history of Tanzanian…
A recent in-depth study commissioned by the Government of Tanzania (de Soto 2006) revealed that only 11% of the land properties in Tanzania are legally registered. The value of extralegal Tanzanian assets is estimated to 29.3 billion US$, capital that goes largely underutilized due to the lack of protection by the Government. Creating the legal and organizational framework to turn
This paper examines development planning in one particular developing country, namely Tanzania, and the problem of dependency associated with it. It analyses Tanzania's shift from a comprehensive development planning to a decentralized planning in 1980 in terms of sector and area plans and indicative planning, in the form of Poverty Reduction Strategy. This shift, which had more to do with
Tanzania is undergoing an unprecedented boom of IT industries. But awareness of environmental issues connected with ICT is almost nonexistent in Tanzania. ICT development without an eye on environmental protection is not sustainable. As of 2009 Tumaini University's B.Sc. program in IT has included a Green Computing course as an obligatory part of IT studies. That course aims at raising
|Students in rural and urban areas in Tanzania, and elsewhere in Africa, continue to have limited or lack access to culturally and employment-relevant science education. The current case study, a 2007-2009 examination of barriers to the reform movement of science education in Tanzania, uses data from interviews, classroom observations, document…
Heavy metals were determined in the soft tissue and shells of the littorinid, Littoraria scabra, and in the sediments of four mangrove areas along the Dar es Salaam coastline where L. scabra was collected. Several metals accumulate, preferentially in the animals' soft body parts, but do not seem to affect the shell morphology of this species. Sediment-metal levels, measured in
Hans De Wolf; S. A Ulomi; T Backeljau; H. B Pratap; R Blust
Background Clefts of the lip (CL), the palate (CP), or both (CLP) are the most common orofacial congenital malformations found among live births, accounting for 65% of all head and neck anomalies. The frequency and pattern of orofacial clefts in different parts of the world and among different human groups varies widely. Generally, populations of Asian or Native American origin have the highest prevalence, while Caucasian populations show intermediate prevalence and African populations the lowest. To date, little is known regarding the epidemiology and pattern of orofacial clefts in Tanzania. Methods A retrospective descriptive study was conducted at Bugando Medical Centre to identify all children with orofacial clefts that attended or were treated during a period of five years. Cleft lip and/or palate records were obtained from patient files in the Hospital's Departments of Surgery, Paediatrics and medical records. Age at presentation, sex, region of origin, type and laterality of the cleft were recorded. In addition, presence of associated congenital anomalies or syndromes was recorded. Results A total of 240 orofacial cleft cases were seen during this period. Isolated cleft lip was the most common cleft type followed closely by cleft lip and palate (CLP). This is a departure from the pattern of clefting reported for Caucasian and Asian populations, where CLP or isolated cleft palate is the most common type. The distribution of clefts by side showed a statistically significant preponderance of the left side (43.7%) (?2 = 92.4, p < 0.001), followed by the right (28.8%) and bilateral sides (18.3%). Patients with isolated cleft palate presented at very early age (mean age 1.00 years, SE 0.56). Associated congenital anomalies were observed in 2.8% of all patients with orofacial clefts, and included neural tube defects, Talipes and persistent ductus arteriosus. Conclusions Unilateral orofacial clefts were significantly more common than bilateral clefts; with the left side being the most common affected side. Most of the other findings did not show marked differences with orofacial cleft distributions in other African populations.
We present a total of 59 new data points of run-up of the 2004 Sumatra tsunami in the Comoros and Tanzania, surveyed in 2006-2008 by International Tsunami Survey Teams. Run-up at the Northeastern tip of Grande Comore (6.8 m) is comparable to Socotra (6.1 m), and surpassed only in the Western Indian Ocean by the catastrophic values in Somalia (run-up 9 m; inundation 700 m). Run-up in Mayotte, and to a lesser extent Zanzibar, show considerable variations (from 1 to 5 m), attributed to the influence of the local structure of the reef surrounding these islands. By contrast, the unreefed islands of Anjouan and Moheli, and the mainland coast of Tanzania around Dar-es-Salaam, feature more consistent values in the 2 to 3 m range. The death toll in Tanzania is revised to at least 20. We then use the MOST code to simulate the propagation on the high seas of both the 2004 tsunami, and of potential future tsunamis under scenarios of mega earthquakes rupturing in the South Sumatra region; in particular, we consider the case of a probable event releasing the strain left over from the 1833 rupture after the 2007 Bengkulu earthquake. While these studies are not carried to the full extent of run-up calculations at individual sites, they give a general estimate of expectable hazard, relative to 2004, under the relevant scenarios, at 17 offshore virtual gauges strategically located from Oman to South Africa. We confirm more quantitatively the results of Okal and Synolakis (2008), namely that the change of directivity characteristics results in an increase of tsunami amplitude (with respect to 2004) at all sites South of Kenya (including Madagascar and the Mascarenes), while amplitudes at the Horn of Africa (Socotra, Somalia) remain large, due to focusing by individual bathymetric features. In short, potential earthquake sources along the Southern coast of Sumatra could result in higher wave heights than in 2004, along most of the Eastern shores of Africa, Madagascar and the Mascarenes.
Synolakis, C. E.; Okal, E. A.; Fritz, H. M.; Sladen, A.
BACKGROUND: An HIV behavioral surveillance survey was undertaken in November 2005 at Lugufu refugee camp and surrounding host villages, located near western Tanzania's border with the Democratic Republic of Congo (DRC). METHODS: The sample size was 1,743 persons based on cluster survey methodology. All members of selected households between 15–49 years old were eligible respondents. Questions included HIV-related behaviors, population
Elizabeth A Rowley; Paul B Spiegel; Zawadi Tunze; Godfrey Mbaruku; Marian Schilperoord; Patterson Njogu
BACKGROUND: Substantial heterogeneity in HIV prevalence has been observed within sub-Saharan Africa. It is not clear which factors can explain these differences. Our aim was to identify risk factors that could explain the large differences in HIV-1 prevalence among pregnant women in Harare, Zimbabwe, and Moshi, Tanzania. METHODS: Cross-sectional data from a two-centre study that enrolled pregnant women in Harare
Munyaradzi P Mapingure; Sia Msuya; Nyaradzai E Kurewa; Marshal W Munjoma; Noel Sam; Mike Z Chirenje; Simbarashe Rusakaniko; Letten F Saugstad; Sake J de Vlas; Babill Stray-Pedersen
Background\\/Objectives:There is limited published research examining lipid-soluble vitamins in human immunodeficiency virus (HIV)-infected pregnant women, particularly in resource-limited settings.Subjects\\/Methods:This is an observational analysis of 1078 HIV-infected pregnant women enrolled in a trial of vitamin supplementation in Tanzania. Baseline data on sociodemographic and anthropometric characteristics, clinical signs and symptoms, and laboratory parameters were used to identify correlates of low plasma vitamin
S Mehta; D Spiegelman; S Aboud; E L Giovannucci; G I Msamanga; E Hertzmark; F M Mugusi; D J Hunter; W W Fawzi
BACKGROUND: Malaria over-diagnosis in Africa is widespread and costly both financially and in terms of morbidity and mortality from missed diagnoses. An understanding of the reasons behind malaria over-diagnosis is urgently needed to inform strategies for better targeting of antimalarials. METHODS: In an ethnographic study of clinical practice in two hospitals in Tanzania, 2,082 patient consultations with 34 clinicians were
Clare IR Chandler; Caroline Jones; Gloria Boniface; Kaseem Juma; Hugh Reyburn; Christopher JM Whitty
Aim:Childhood blindness is included in the VISION 2020 initiative. However, childhood blindness is rare, so there is limited population-based evidence to assist with the planning of services. We carried out a survey of childhood blindness in Kilimanjaro Region, Tanzania, to generate information needed for planning eye care services.Methods:The study was carried out in parallel with a Rapid Assessment of Avoidable
S Shirima; S Lewallen; G Kabona; C Habiyakare; P Massae; P Courtright
BACKGROUND: Malaria control measures were initiated from in October 2005 to August 2006 in the Lower Moshi irrigation schemes, Tanzania. This manuscript reports on the entomological evaluation of the impact of pyrethroid-treated cattle in reducing the population of the Anopheles arabiensis for selected houses in the Lower Moshi irrigation scheme. METHODS: Cattle were sprayed with the pyrethroid (deltamethrin) acaricide. Grazing
Aneth M Mahande; Franklin W Mosha; Johnson M Mahande; Eliningaya J Kweka
Sanitary landfilling is considered to be the most appropriate means of final disposal of solid wastes. Currently in Tanzania, the cheapest method of developing a landfill is by making use of natural depressions or former borrow pits and mine pits. This paper examines the impacts associated with the relocation of a waste disposal site from a crude disposal site at
Background In order to ensure their population’s regular access to essential medicines, many least developed countries and developing countries are faced with the policy question of whether to import or manufacture drugs locally, in particular for life-saving antiretroviral medicines for HIV/AIDS patients. In order for domestic manufacturing to be viable and cost-effective, the local industry must be able to compete with international suppliers of medicines by producing sufficiently low cost ARVs. Methods This paper considers the ‘make-or-buy’ dilemma by using Tanzania as a case study. Key informant interviews, event-driven observation, and purposive sampling of documents were used to evaluate the case study. The case study focused on Tanzania’s imitation technology transfer agreement to locally manufacture a first-line ARV (3TC?+?d4T?+?NVP), reverse engineering the ARV. Results Tanzania is limited by weak political support for the use of TRIPS flexibilities, limited production capacity for ARVs and limited competitiveness in both domestic and regional markets. The Ministry of Health and Social Welfare encourages the use of flexibilities while others push for increased IP protection. Insufficient production capacity and lack of access to donor-financed tenders make it difficult to obtain economies of scale and provide competitive prices. Conclusions Within the “make-or-buy” context, it was determined that there are significant limitations in domestic manufacturing for developing countries. The case study highlights the difficulty of governments to make use of economies of scale and produce low-cost medicines, attract technology transfer, and utilize the flexibilities of the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). The results demonstrate the importance of evaluating barriers to the use of TRIPS flexibilities and long-term planning across sectors in future technology transfer and manufacturing initiatives.
background Results from observational studies suggest that micronutrient status is a determinant of the progression of human immunodeficiency virus (HIV) disease. methods We enrolled 1078 pregnant women infected with HIV in a double-blind, placebo-con- trolled trial in Dar es Salaam, Tanzania, to examine the effects of daily supplements of vitamin A (preformed vitamin A and beta carotene), multivitamins (vitamins B,
Wafaie W. Fawzi; Gernard I. Msamanga; Donna Spiegelman; Ruilan Wei; Saidi Kapiga; Eduardo Villamor; Davis Mwakagile; Ferdinand Mugusi; Ellen Hertzmark; Max Essex; David J. Hunter
The United Republic of Tanzania is a multiparty state led by the President of the mainland, Benjamin Mkapa. The Zanzibar archipelago, although integrated into the country's governmental and party structure, has its own president and parliament and continu...
This report provides a master plan and implementation strategy for environmental sanitation training based on the existing status of the water supply and sanitation sector in Tanzania. After summarizing the technical and institutional aspects of the prese...
Tanzania contains some of the world's greatest natural wonders. Following major reforms in its foreign tourism policies in the mid-1980s, tourism has increased to become the nation's second leading foreign exchange earner. Tanzania is a less developed nation than its East African neighbours, and seeks to offer a low-density, high-quality, and high-priced tourism experience. Numerous deficiencies, however, are present in
Background Human African trypanosomiasis is a severely neglected vector-borne disease that is always fatal if untreated. In Tanzania it is highly focalised and of major socio-economic and public health importance in affected communities. Objectives This study aimed to estimate the public health burden of rhodesiense HAT in terms of DALYs and financial costs in a highly disease endemic area of Tanzania using hospital records. Materials and Methods Data was obtained from 143 patients admitted in 2004 for treatment for HAT at Kaliua Health Centre, Urambo District. The direct medical and other indirect costs incurred by individual patients and by the health services were calculated. DALYs were estimated using methods recommended by the Global Burden of Disease Project as well as those used in previous rhodesiense HAT estimates assuming HAT under reporting of 45%, a figure specific for Tanzania. Results The DALY estimate for HAT in Urambo District with and without age-weighting were 215.7 (95% CI: 155.3–287.5) and 281.6 (95% CI: 209.1–362.6) respectively. When 45% under-reporting was included, the results were 622.5 (95% CI: 155.3–1098.9) and 978.9 (95% CI: 201.1–1870.8) respectively. The costs of treating 143 patients in terms of admission costs, diagnosis, hospitalization and sleeping sickness drugs were estimated at US$ 15,514, of which patients themselves paid US$ 3,673 and the health services US$ 11,841. The burden in terms of indirect non-medical costs for the 143 patients was estimated at US$ 9,781. Conclusions This study shows that HAT imposes a considerable burden on affected rural communities in Tanzania and stresses the urgent need for location- and disease-specific burden estimates tailored to particular rural settings in countries like Tanzania where a considerable number of infectious diseases are prevalent and, due to their focal nature, are often concentrated in certain locations where they impose an especially high burden.
Matemba, Lucas E.; Fevre, Eric M.; Kibona, Stafford N.; Picozzi, Kim; Cleaveland, Sarah; Shaw, Alexandra P.; Welburn, Susan C.
BACKGROUND: This paper describes the process used to develop an integrated set of culturally sensitive, evidence-based counselling tools (job aids) by using qualitative participatory research. The aim of the intervention was to contribute to improving infant feeding counselling services for HIV positive women in the Kilimanjaro Region of Tanzania. METHODS: Formative research using a combination of qualitative methods preceded the
Sebalda C Leshabari; Peggy Koniz-Booher; Anne N Åstrøm; Marina M de Paoli; Karen M Moland
This paper examines how government policies affect inter-ethnic relations by comparing outcomes across two nearby districts, one in Kenya and one in Tanzania. Despite similar geography and colonial legacies, post-independence governments in Kenya and Tanzania have followed radically different language, education, and local institutional policies, with Tanzania consistently pursuing more serious \\
Socio-economic characteristics of caretakers of bed-ridden AIDS patients in two rural communities of Rungwe district, Tanzania were sought. The study also explored what caretaking entailed. Data were collected from 60 caretakers between September and November 2002. The proportion of female caretakers was significantly higher than that of male caretakers; the majority of the caretakers were old. The majority of the AIDS patients were family members of the caretakers. The caretakers' households lacked basic needs for the patients. Some of the caretakers sold family assets in order to buy medicines for the patients. Most of the caretakers worked under stress and there was no one to counsel them. Community members offered very little or no support to caretakers and the households were stigmatized. People in the communities knew about HIV/AIDS transmission, but their behaviour did not match their knowledge. PMID:15479504
It is a challenge to design and manage projects capable of reaching people over large geographical areas. The community-based Integrated Project (IP) in Tanzania, however, has creatively overcome obstacles to produce broadly successful interventions in family planning and maternal-child health care. Reaching out to people with effective IEC and distribution strategies, the IP was introduced to Tanzania in 1984 on a pilot basis to a population of 20,000 and has since expanded to cover more than 200,000 people. The project has developed from the bottom-up through community groups and leaders at different levels. for example, a 42-member women's club was established at the Masama Rural Health Center through which family planning, maternal and child health, and nutrition education activities are promoted. Further, women have formed a family planning association of 74 members of Sonu to talk about family planning and take part in collective activities such as gardening and animal raising; income generated by these women has been used to help further the goals of the IP. Other areas have gained the support of community leaders, politicians, and local groups. Churches, mosques, outpost clinics, MCH clinics, films, and home visits have all been used by the project. Together, these approaches and involved parties have positively affected the rate of contraceptive prevalence in the original IP areas such that they are in the range of 35-49%, compared to the national average of 0-7%. Rates of contraceptive prevalence range 16-34% in new project areas. PMID:12318576
Two years after the introduction of free antiretroviral therapy (ART) in Tanzania and in spite of the logistical support provided to facilitate clinic attendance, a considerable level of attrition from the program was identified among clients from a semi-rural ward. Qualitative research on ART patients’ health-seeking behavior identified factors affecting sustained attendance at treatment clinics. A mix of methods was used for data collection including semi-structured interviews with 42 clients and 11 service providers and 4 participatory group activities conducted with members of a post-test group between October and December 2006. A socio-ecological framework guided data analysis to categorize facilitators and barriers into individual, social, programmatic, and structural level influences, and subsequently explored their interaction and relative significance in shaping ART clients’ behavior. Our findings suggest that personal motivation and self-efficacy contribute to program retention, and are affected by other individual-level experiences such as perceived health benefits or disease severity. However, these determinants are influenced by others’ opinions and beliefs in the community, and constrained by programmatic and structural barriers. Individuals can develop the requisite willingness to sustain strict treatment requirements in a challenging context, but are more likely to do so within supportive family and community environments. Effectiveness and sustainability of ART roll-out could be strengthened by strategic intervention at different levels, with particular attention to community-level factors such as social networks’ influence and support.
Smallholder farmers’ knowledge and practice of dairy calf management on 129 farms with calves less than 10 months of age in Southeastern and Southern Highland areas of Tanzania was assessed. The method of study included both a farm visit and completion of a questionnaire. Most of the farmers were female, with a primary level of education, and majority kept 1–3 milking cows that yielded 6–10 l milk/cow/day. Most of the calves were fed milk using a residual calf suckling system. Weaning age was 3–8 months. Overall, the body condition of the calves was poor, ranged from 1 to 2.5 with a mode of 2. The majority of the farmers believed that helminthosis was the most common disease condition affecting the calves; diarrhea was ranked as the second. Calf death was reported by 20% of the farmers to have occurred in their herd lasting the 2 years prior to the study. Calf body condition score was related to body weight for calves younger than 9 weeks, and older than 23 weeks of age, whereas no such relationship existed in the age group 9 to 23 weeks. The sex distribution was skewed with less male calves being older than 23 weeks. We hypothesize that male calves experience inferior management compared with female calves. This study demonstrates a low level of knowledge on, and poor practices of calf management among the surveyed farmers that suggest the need for educational intervention.
Mdegela, Robinson H.; Ryoba, Ruth; L?ken, Torleiv; Reksen, Olav
Background Breast cancer is more common in Western Countries compared to African populations. However in African population, it appears\\u000a that the disease tends to be more aggressive and occurring at a relatively young age at the time of presentation. The aim\\u000a of this study was to describe the trend of Breast Cancer in Northwestern Tanzania.\\u000a \\u000a \\u000a \\u000a \\u000a Methods This was a retrospective study which
Peter F Rambau; Philipo L Chalya; Mange M Manyama; Kahima J Jackson
Background Face washing is important to interrupt the transmission of trachoma, the leading infectious cause of blindness worldwide.\\u000a We aimed to assess the household and personal factors that affected water use and face washing practices in Kongwa, Tanzania.\\u000a \\u000a \\u000a \\u000a \\u000a Methods We conducted a household water use survey in 173 households (329 children) in January, 2010. Self reported data on water use\\u000a practices, observed
Morgan Rog; Bonnielin Swenor; Luis C Cajas-Monson; Wilson Mchiwe; Steven Kiboko; Harran Mkocha; Sheila West
Background Intimate partner violence against women is a prevailing public health problem in Tanzania, where four of ten women have a\\u000a lifetime exposure to physical or sexual violence by their male partners. To be able to suggest relevant and feasible community\\u000a and health care based interventions, we explored community members' understanding and their responses to intimate partner\\u000a violence.\\u000a \\u000a \\u000a \\u000a \\u000a Methods A qualitative study
Rose M Laisser; Lennarth Nyström; Helen I Lugina; Maria Emmelin
BACKGROUND: Variability in stages of the HIV-1 epidemic and hence HIV-1 prevalence exists in different areas in sub-Saharan Africa. The purpose of this study was to investigate the magnitude of HIV-1 infection and identify HIV-1 risk factors that may help to develop preventive strategies in rural Kilimanjaro, Tanzania. METHODS: A cross-sectional study was conducted between March and May of 2005
Elia J Mmbaga; Akhtar Hussain; Germana H Leyna; Kagoma S Mnyika; Noel E Sam; Knut-Inge Klepp
BACKGROUND: The study examined the relationship between oral health status (periodontal disease and carious pulpal exposure (CPE)) and preterm low-birth-weight (PTLBW) infant deliveries among Tanzanian-African mothers at Muhimbili National Hospital (MNH), Tanzania. METHODS: A retrospective case-control study was conducted, involving 373 postpartum mothers aged 14–44 years (PTLBW – 150 cases) and at term normal-birth-weight (TNBW) – 223 controls), using structured
OBJECTIVE--To determine HIV-1 incidence and HIV-1 associated mortality in a prospective cohort study. To determine whether the cohort is suitable for studies aiming to determine the impact of interventions on HIV-1 incidence. METHODS--The study population was a cohort of 1772 urban factory workers (1478 men and 294 women) in northwest Tanzania. The study took place from October 1991 to September
M W Borgdorff; L R Barongo; A H Klokke; J N Newell; K P Senkoro; J P Velema; R M Gabone
Summary Background Insecticide-treated nets have proven efficacy as a malaria-control tool in Africa. However, the transition from efficacy to effectiveness cannot be taken for granted. We assessed coverage and the effect on child survival of a large- scale social marketing programme for insecticide-treated nets in two rural districts of southern Tanzania with high perennial malaria transmission. Methods Socially marketed insecticide-treated
Joanna RM Armstrong Schellenberg; Salim Abdulla; Rose Nathan; Oscar Mukasa; Tanya J Marchant; Nassor Kikumbih; Adiel K Mushi; Haji Mponda; Happiness Minja; Hassan Mshinda; Marcel Tanner; Christian Lengeler
OBJECTIVES: To describe the prospects, achievements, challenges and opportunities for implementing intermittent preventive treatment for malaria in pregnancy (IPTp) in Tanzania in light of national antenatal care (ANC) guidelines and ability of service providers to comply with them. METHODS: In-depth interviews were made with national level malaria control officers in 2006 and 2007. Data was analysed manually using a qualitative
Godfrey M Mubyazi; Ib C Bygbjerg; Pascal Magnussen; Øystein Olsen; Jens Byskov; Kristian S Hansen; Paul Bloch
A route census was carried out by one observer using the same methods along the same survey routes during the same seasons in 1996 and 2000 to estimate the abundance of medium- and large-sized diurnal mammals within the home range of the chimpanzees of M Group in the Mahale Mountains, western Tanzania. All eight mammalian species censused were known to
This paper presents villagers' assessments of young people's sexual and reproductive health vulnerability and of community-based interventions that may reduce both vulnerability and risk in rural Mwanza, Tanzania. The primary methods used were 28 group discussions and 18 in-depth interviews with representatives of various social groups in four villages. The majority of participants attributed young people's sexual and reproductive health
Pieter Remes; Jenny Renju; Kija Nyalali; Lemmy Medard; Michael Kimaryo; John Changalucha; Angela Obasi; Daniel Wight
An intervention programme aiming at a reduction of maternal deaths in the Regional Hospital, Kigoma, Tanzania, is analyzed. A retrospective study was carried out from 1984-86 to constitute a background for an intervention programme in 1987-91. The retrospective study revealed gross under-registration of data and clarified a number of potentially useful issues regarding avoidable maternal mortality. An intervention programme comprising 22 items was launched and the maternal mortality ratio was carefully followed in 1987-91. The intervention programme paid attention to professional responsibilities with regular audit-oriented meeting, utilization of local material resources, schedules for regular maintenance of equipment, maintenance of working skills by regular on-the-job training of staff, norms for patient management, provision of blood, norms for referral of severely ill patients, use of antibiotics, regular staff evaluation, public complaints about patient management, travel distance of all essential staff to the hospital, supply of essential drugs, the need of a small infusion production unit, the creation of culture facilities for improved quality of microbiology findings, and to efforts to stimulate local fund-raising. The results indicate that the maternal mortality ratio fell from 933 to 186 per 100,000 live births over the period 1984-91. Thus it is underscored that the problem of maternal mortality can be successfully approached by a low-cost intervention programme aiming at identifying issues of avoidability and focusing upon locally available problem solutions. PMID:10141624
Background The focus on the determinants of the quality of health services in low-income countries is increasing. Health workers' motivation has emerged as a topic of substantial interest in this context. The main objective of this article is to explore health workers' experience of working conditions, linked to motivation to work. Working conditions have been pointed out as a key factor in ensuring a motivated and well performing staff. The empirical focus is on rural public health services in Tanzania. The study aims to situate the results in a broader historical context in order to enhance our understanding of the health worker discourse on working conditions. Methods The study has a qualitative study design to elicit detailed information on health workers' experience of their working conditions. The data comprise focus group discussions (FGDs) and in-depth interviews (IDIs) with administrators, clinicians and nursing staff in the public health services in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in the same part of Tanzania. Results The article provides insights into health workers' understanding and assessment of their working conditions. An experience of unsatisfactory working conditions as well as a perceived lack of fundamental fairness dominated the FGDs and IDIs. Informants reported unfairness with reference to factors such as salary, promotion, recognition of work experience, allocation of allowances and access to training as well as to human resource management. The study also revealed that many health workers lack information or knowledge about factors that influence their working conditions. Conclusions The article calls for attention to the importance of locating the discourse of unfairness related to working conditions in a broader historical/political context. Tanzanian history has been characterised by an ambiguous and shifting landscape of state regulation, economic reforms, decentralisation and emerging democratic sentiments. Such a historic contextualisation enhances our understanding of the strong sentiments of unfairness revealed in this study and assists us in considering potential ways forward.
Background Many factors have been mentioned as contributing to under-diagnosis and under-reporting of zoonotic diseases particularly in the sub-Sahara African region. These include poor disease surveillance coverage, poor diagnostic capacity, the geographical distribution of those most affected and lack of clear strategies to address the plight of zoonotic diseases. The current study investigates the knowledge of medical practitioners of zoonotic diseases as a potential contributing factor to their under-diagnosis and hence under-reporting. Methods The study was designed as a cross-sectional survey. Semi-structured open-ended questionnaire was administered to medical practitioners to establish the knowledge of anthrax, rabies, brucellosis, trypanosomiasis, echinococcosis and bovine tuberculosis in selected health facilities within urban and rural settings in Tanzania between April and May 2005. Frequency data were analyzed using likelihood ratio chi-square in Minitab version 14 to compare practitioners' knowledge of transmission, clinical features and diagnosis of the zoonoses in the two settings. For each analysis, likelihood ratio chi-square p-value of less than 0.05 was considered to be significant. Fisher's exact test was used where expected results were less than five. Results Medical practitioners in rural health facilities had poor knowledge of transmission of sleeping sickness and clinical features of anthrax and rabies in humans compared to their urban counterparts. In both areas the practitioners had poor knowledge of how echinococcosis is transmitted to humans, clinical features of echinococcosis in humans, and diagnosis of bovine tuberculosis in humans. Conclusion Knowledge of medical practitioners of zoonotic diseases could be a contributing factor to their under-diagnosis and under-reporting in Tanzania. Refresher courses on zoonotic diseases should be conducted particularly to practitioners in rural areas. More emphasis should be put on zoonotic diseases in teaching curricula of medical practitioners' training institutions in Tanzania to improve the diagnosis, reporting and control of zoonotic diseases. Veterinary and medical collaboration should be strengthened to enable more effective control of zoonotic diseases in Tanzania.
John, Kunda; Kazwala, Rudovic; Mfinanga, Godfrey S
Background HIV/AIDS remains being a disease of great public health concern worldwide. In regions such as sub-Saharan Africa (SSA) where women are disproportionately infected with HIV, women are reportedly less likely capable of negotiating condom use. However, while knowledge of condom use for HIV prevention is extensive among men and women in many countries including Tanzania, evidence is limited about the role of condom negotiation on condom use among women in rural Tanzania. Methods Data originate from a cross-sectional survey of random households conducted in 2011 in Rufiji, Kilombero and Ulanga districts in Tanzania. The survey assessed health-seeking behaviour among women and children using a structured interviewer-administered questionnaire. A total of 2,614 women who were sexually experienced and aged 15-49 years were extracted from the main database for the current analysis. Linkage between condom negotiation and condom use at the last sexual intercourse was assessed using multivariate logistic regression. Results Prevalence of condom use at the last sexual intercourse was 22.2% overall, ranging from12.2% among married women to 54.9% among unmarried (single) women. Majority of the women (73.4%) reported being confident to negotiate condom use, and these women were significantly more likely than those who were not confident to have used a condom at the last sexual intercourse (OR = 3.13, 95% CI 2.22-4.41). This effect was controlled for marital status, age, education, religion, number of sexual partners, household wealth and knowledge of HIV prevention by condom use. Conclusion Confidence to negotiate condom use is a significant predictor of actual condom use among women in rural Tanzania. Women, especially unmarried ones, those in multiple partnerships or anyone needing protection should be empowered with condom negotiation skills for increased use of condoms in order to enhance their sexual and reproductive health outcomes.
Background Health worker motivation can potentially affect the provision of health services. The HIV pandemic has placed additional strain on health service provision through the extra burden of increased testing and counselling, treating opportunistic infections and providing antiretroviral treatment. The aim of this paper is to explore the challenges generated by HIV care and treatment and their impact on health worker motivation in Mbeya Region, Tanzania. Methods Thirty in-depth interviews were conducted with health workers across the range of health care professions in health facilities in two high HIV-prevalence districts of Mbeya Region, Tanzania. A qualitative framework analysis was adopted for data analysis. Results The negative impact of HIV-related challenges on health worker motivation was confirmed by this study. Training seminars and workshops related to HIV contributed to the shortage of health workers in the facilities. Lower status workers were frequently excluded from training and were more severely affected by the consequent increase in workload as seminars were usually attended by higher status professionals who controlled access. Constant and consistent complaints by clients have undermined health workers' expectations of trust and recognition. Health workers were forced to take responsibility for dealing with problems arising from organisational inefficiencies within the health system. Conclusion HIV-related challenges undermine motivation among health workers in Mbeya, Tanzania with the burden falling most heavily on lower status workers. Strained relations between health workers and the community they serve, further undermine motivation of health workers.
Background Little is known about the interconnectedness of maternal deaths and impacts on children, beyond infants, or the mechanisms through which this interconnectedness is established. A study was conducted in rural Tanzania to provide qualitative insight regarding how maternal mortality affects index as well as other living children and to identify shared structural and social factors that foster high levels of maternal mortality and child vulnerabilities. Methods and Findings Adult family members of women who died due to maternal causes (N?=?45) and key stakeholders (N?=?35) participated in in-depth interviews. Twelve focus group discussions were also conducted (N?=?83) among community leaders in three rural regions of Tanzania. Findings highlight the widespread impact of a woman’s death on her children’s health, education, and economic status, and, by inference, the roles that women play within their families in rural Tanzanian communities. Conclusions The full costs of failing to address preventable maternal mortality include intergenerational impacts on the nutritional status, health, and education of children, as well as the economic capacity of families. When setting priorities in a resource-poor, high maternal mortality country, such as Tanzania, the far-reaching effects that reducing maternal deaths can have on families and communities, as well as women’s own lives, should be considered.
Yamin, Alicia Ely; Boulanger, Vanessa M.; Falb, Kathryn L.; Shuma, Jane; Leaning, Jennifer
In January 1997, Tanzania requested international assistance against rinderpest on the grounds that the virus had probably entered the country from southern Kenya. Over the next few months, a variety of attempts were made to determine the extent of the incursion by searching for serological and clinical evidence of the whereabouts of the virus. At the clinical level, these attempts
W. P. Taylor; P. L. Roeder; M. M. Rweyemamu; J. N. Melewas; P. Majuva; R. T. Kimaro; J. N. Mollel; B. J. Mtei; P. Wambura; J. Anderson; P. B. Rossiter; R. Kock; T. Melengeya; R. Van den Ende
Tumaini University at Iringa, Tanzania, started a new B.Sc. program in IT in 2007. In the course of planning and implementation of the program, we found out that standard ACM/IEEE IT curricula are not adequate for an IT program in a poor, developing country. The standard curricula describe, in detail, the competences that IT specialists in…
|This paper assesses educational planning in Tanzania as moving from one of hope to despair as the country becomes more reliant upon foreign aid. As the country moved from colonialism, basic education was to be accessible to all children and adult illiteracy was to be eliminated. By the 1980s financial crisis and the conditions that accompanied…
|We study the effects of accessing better healthcare on the schooling and labor supply decisions of sick children in Tanzania. Using variation in the cost of formal-sector healthcare to predict treatment choice, we show that accessing better healthcare decreases length of illness and changes children's allocation of time to school and work.…
Does a government's source of revenue explain its policies? The predominate view in development studies contends that policy variation results directly from institutional variation. Building on a literature which we label fiscal theories of governance, we argue that a government's sources of revenue strongly affect its public expenditures, independent of institutions. Using data from local government budgets in Tanzania and
This paper assesses educational planning in Tanzania as moving from one of hope to despair as the country becomes more reliant upon foreign aid. As the country moved from colonialism, basic education was to be accessible to all children and adult illiteracy was to be eliminated. By the 1980s financial crisis and the conditions that accompanied…
This study focuses on the agro-ecological background of an intensive cultiva- tion system called ngolo, which has been practiced for over 100 years among the Matengo people in southern Tanzania. The ngolo system is highly sustainable, as it both conserves soil and water and matures the soil; moreover, the high productivity of this system allows for a steady food supply
The aim of this study was to explore community perceptions about child sexual abuse in Tanzania. Thirteen focus group discussions were conducted with adult community members. The core category, children's rights challenged by lack of agency, was supported by eight categories. Aware but distressed portrayed feelings of hopelessness, lack of trust in the healthcare and legal systems reflected perceived malpractice,
Felix Kisanga; Lennarth Nystrom; Nora Hogan; Maria Emmelin
At first glance, Kenya and Tanzania, the scene of some of Al Qaida's most impressive attacks, would appear to be fertile ground for recruiting militants into the global Islamist jihad. Substantial Muslim populations, widespread poverty, poor policing, inadequate border control, and systemic political and economic corruption would seem to make these East African countries potentially rich environments in which to
Why do many African women continue to use damaging skin-bleaching cosmetics that contain dangerous chemicals (e.g., mercury) that may increase their rates of infertility, skin cancer, and serious skin/brain/kidney disease? To address this question, our study investigated motivations driving the preservation of skin-bleaching practices in Tanzania.…
Lewis, Kelly M.; Robkin, Navit; Gaska, Karie; Njoki, Lillian Carol
In this paper it is claimed that the relation between literacy and power is complex. What people do with literacy has effects on power relations but literacy is not democratic "per se". Drawing from two cases from Tanzania and Rwanda it is argued that plans for adult education and literacy education should consider the perspectives of target…
This paper uses an original dataset from rural Tanzania to explore both the determinants of domestic violence and the relationship of violence with other welfare outcomes for household members. A quarter of all women report being victims of domestic violence, half of these women report being victims of violence in the previous year. Preliminary results suggest that women are more
The United Republic of Tanzania amended its Constitution in 1992 to become a multiparty state. In 1995 the nation conducted its first multiparty general elections for president and parliament in more than 30 years. The ruling party, Chama Cha Mapinduzi (C...
The article analyses the different income portfolios of households using survey data from rural Ethiopia and rural Tanzania. It suggests that the different portfolios held by households cannot be explained by their behaviour towards risk as is usually suggested. It is better explained by differences in ability, location, and in access to credit. A logit analysis of households with different
Tanzania has a generalised AIDS epidemic but the estimated adult HIV prevalence of 6% is much lower than in many countries in Southern Africa. HIV infection rates are reportedly higher in urban areas, among women and among those with more education. Stigma has been found to be more common in poorer, less-educated people, and those in rural areas. We examined
Mbaraka Amuri; Steve Mitchell; Anne Cockcroft; Neil Andersson
|Most autism has a genetic cause although post-encephalitis cases are reported. In a case-series (N = 20) from Tanzania, 14 met research criteria for autism. Three (M:F = 1:2) had normal development to age 22, 35, and 42 months, with onset of autism upon recovery from severe malaria, attended by prolonged high fever, convulsions, and in one case…
Mankoski, Raymond E.; Collins, Martha; Ndosi, Noah K.; Mgalla, Ella H.; Sarwatt, Veronica V.; Folstein, Susan E.
|The purpose of this study was to reveal the ways in which first-generation women in Tanzania explained their success in pursuing a university education despite cultural and social obstacles. Such obstacles include social policies, socio-cultural factors, and academic factors. A review of the literature revealed that issues such as patriarchy,…
The informal sector in Tanzania contains a large number of small-scale business entrepreneurs filling a largely service role in the economy. The subsectors of the informal sector included in this study were food preparation, beer brewing, grain milling, c...
This article explores the dynamics of property rights in irrigation water in Sonjo, Tanzania. It analyses an unsuccessful attempt by the ruling political group to change the institutional arrangements of water control, to serve better their private goals. This example shows that not all internal institutional innovations in the field of utilising natural resources lead to increased efficiency of the
|Trachoma remains a public health problem in a number of sub-Saharan Africa countries; behavioral change and environmental improvements are cornerstones of prevention efforts. Evidence of successful health education are few in Africa. Health education efforts through primary schools have recently been developed and adopted in Tanzania. We…
We study the effects of accessing better healthcare on the schooling and labor supply decisions of sick children in Tanzania. Using variation in the cost of formal-sector healthcare to predict treatment choice, we show that accessing better healthcare decreases length of illness and changes children's allocation of time to school and work.…
The purpose of this paper is to provide a historical perspective on the reform process initiated in Tanzania in 1986, and deepened in 1996. In order to do this I concentrate mostly on the period spanning from 1967, when the Arusha Declaration was adopted by the official political party the TANU, and 1996, when a new approach towards foreign aid
The aim of this study was to explore community perceptions about child sexual abuse in Tanzania. Thirteen focus group discussions were conducted with adult community members. The core category, "children's rights challenged by lack of agency", was supported by eight categories. "Aware but distressed" portrayed feelings of hopelessness, "lack of…
Kisanga, Felix; Nystrom, Lennarth; Hogan, Nora; Emmelin, Maria
The purpose of this article is to discuss the funding constraints as related to higher education in Tanzania. The article discusses also the trend of internal and external efficiency indicators. The funding constraints include: the low growth rate of GDP, balance of payment problems, inflation, devaluation of the shilling, absence of cost-sharing and resources mismanagement. Higher education is characterized by
|This report on the key findings from a series of assessments of successful community nutrition programming conducted in Kenya, Tanzania, and Uganda between 1999 and 2000. The aim of the assessments was to identify key lessons learned from the successful processes and outcomes in these programs. The report is divided into eight chapters: (1)…
|The aim of this study was to explore community perceptions about child sexual abuse in Tanzania. Thirteen focus group discussions were conducted with adult community members. The core category, "children's rights challenged by lack of agency", was supported by eight categories. "Aware but distressed" portrayed feelings of hopelessness, "lack of…
Kisanga, Felix; Nystrom, Lennarth; Hogan, Nora; Emmelin, Maria
The AIDS epidemic has caused an increase in adult mortality and consequently an increase in the numbers of orphaned children. Data were used from the Kisesa Community Study in northwest Tanzania, to assess the prevalence and consequences of orphanhood in the context of existing child care practices in a rural area with moderately high HIV-prevalence. This study was carried out
Rickettsioses caused by typhus group rickettsiae have been reported in various African regions. We conducted a cross-sectional survey of 1,227 participants from 9 different sites in the Mbeya region, Tanzania; overall seroprevalence of typhus group rickettsiae was 9.3%. Risk factors identified in multivariable analysis included low vegetation density and highway proximity. PMID:23347529
Efforts to develop rural financial markets in low income countries by using formal banks have experienced many difficulties and failures. Development economists are increasingly recognising the importance of learning from the operations of informal financial markets. This paper explores informal financial practices that take place in the Kilimanjaro region of Tanzania. The aim is to identify operational features of informal
The state of agricultural libraries and potentials of electronic communications in disseminating agricultural information in Tanzania are discussed. Poor communication between the Sokoine National Agricultural Library and its partner libraries within the country is cited to be one of the reasons for inferior information services to library users. Due to low level of information technology development and financial constraints facing
|The educational philosophy of Julius Nyerere, President of the United Republic of Tanzania, is examined, including that which was published in "Education for Self-Reliance" (1968). Major changes and reforms that have taken place in the Tanzanian educational system are reported. (CJ)|
OBJECTIVE: To make quantitative predictions about the magnitude of underreporting of human rabies deaths in the United Republic of Tanzania. METHODS: Human rabies deaths were estimated by using a series of probability steps to calculate the likelihood of rabies developing after the bite of a suspected rabid dog, incorporating field data on the incidence of animal bite injuries, the accuracy of rabies recognition, the distribution of bite wounds, and post-exposure treatment. FINDINGS: Predicted human rabies mortality was estimated to be (a) 1499 deaths per year (95% confidence interval 891-2238), equivalent to an annual incidence of 4.9 (2.9-7.2) deaths/100,000, when active surveillance data on bite incidence were used, and (b) 193 deaths per year (32-409), corresponding to an annual incidence of 0.62 (0.1-1.32) deaths/100,000, when national bite statistics were used. The annual mean number of rabies deaths officially recorded for the same period was 10.8 (7.7-14.0). CONCLUSION: In the United Republic of Tanzania, cases of rabies in humans have been greatly underreported. Dog bite injuries are an accessible source of epidemiological data that may be used to estimate the public health burden of rabies and to monitor epidemiological trends in developing countries.
Cleaveland, Sarah; Fevre, Eric M.; Kaare, Magai; Coleman, Paul G.
Background Parkinson disease (PD) causes physical disability that negatively affects the quality of life of the sufferer's and their families. There are no Parkinson's disease (PD) social science studies published from Africa. This paper presents findings from a qualitative research study on how PD is perceived and treated in a population of approximately 161,000 within a demographic surveillance site in rural Tanzania. Methods We conducted in-depth interviews with 28 PD sufferers, 28 carers, 4 health workers and 2 traditional healers. In addition, 6 focus group discussions were conducted in 3 villages to investigate wider community views of PD. Results PD sufferers expressed frustration with the physical, psychological, social and economic consequences of the illness. Feelings of a diminished quality of life characterised by dependency, stigma and social isolation were common. Additionally, a handful of male sufferers related their sexual incompetence to the illness. Carers complained of lost income opportunities and social isolation resulting from caring for sufferers. Misconceptions about the cause, symptoms and appropriated PD treatment were widespread. Only 2 PD sufferers had commenced western type treatment through outsourcing drugs from other parts of the country and outside of Tanzania. Conclusions This study highlights the urgent need for PD awareness and treatment interventions in such settings. Such interventions need to address the concerns and needs of sufferers, their carers and the wider community, including the health care system.
Adherence to the policy guidelines and standards is necessary for family planning services. We compared public and private facilities in terms of provision of family planning services. We analyzed data from health facility questionnaire of the 2006 Tanzania Service Provision Assessment survey, based on 529 health facilities. Majority of public facilities (95.4%) offered family planning services, whereas more than half of private facilities (52.1%) did not offer those. Public facilities were more likely to offer modern contraceptives as compared to private facilities. However, private facilities were more likely to offer counseling on natural methods of family planning [AOR = 2.12 (1.15-3.92), P < or = 0.001]. Public facilities were more likely to report having guidelines or protocols for family planning services and various kinds of visual aids for family planning and STIs when compared to private facilities. This comparative analysis entails the need to enforce the standards of family planning services in Tanzania. PMID:23444551
Introduction and hypothesis Authors sought evidence from the testimonies of women living with fistula regarding local risk factors for fistula and the\\u000a impact of fistula on women's lives.\\u000a \\u000a \\u000a \\u000a \\u000a Methods One hundred thirty-seven women recruited from health facilities and at the community level in Tanzania and Uganda were interviewed\\u000a using quantitative and qualitative methods, including participatory approaches.\\u000a \\u000a \\u000a \\u000a \\u000a Results Women of all ages and parities
Data on the burden of acute kidney injury (AKI) in resource-poor countries such as Tanzania are minimal because of a lack of nephrology services and an inability to recognize and diagnose AKI with any certainty. In the few published studies, high morbidity and mortality are reported. Improved nephrology care and dialysis may lower the mortality from AKI in these settings. Hemodialysis is expensive and technically challenging in resource-limited settings. The technical simplicity of peritoneal dialysis and the potential to reduce costs if consumables can be made locally, present an opportunity to establish cost-effective programs for managing AKI. Here, we document patient outcomes in a pilot peritoneal dialysis program established in 2009 at a referral hospital in Northern Tanzania. PMID:22641736
This article reports parental experiences of legally reporting child sexual abuse in Tanzania. Based on in-depth interviews, four types of sexual abuse incidents are portrayed. Each evokes different reactions from parents and the community. An incident characterized as the innocent child was associated with a determination to seek justice. The forced-sex youth elicited feelings of parental betrayal of their child. The consenting curious youth resulted in uncertainty of how to proceed, while the transactional-sex youth evoked a sense of parental powerlessness to control the child because of low economic status. Differentiating between types of sexual abuse incidents may increase awareness of the complexities of child sexual abuse reporting. Education on laws regulating sexual offenses and a functional national child protection system are needed to address child sexual abuse complexities and safeguard the rights of children in Tanzania. PMID:23829829
Kisanga, Felix; Nyström, Lennarth; Hogan, Nora; Emmelin, Maria
In Tanzania, the first cases of schistosomiasis were reported in the early 19th century. Since then, various studies have reported prevalences of up to 100% in some areas. However, for many years, there have been no sustainable control programmes and systematic data from observational and control studies are very limited in the public domain. To cover that gap, the present article reviews the epidemiology, malacology, morbidity, and the milestones the country has made in efforts to control schistosomiasis and discusses future control approaches. The available evidence indicates that, both urinary and intestinal schistosomiasis are still highly endemic in Tanzania and cause significant morbidity.Mass drug administration using praziquantel, currently used as a key intervention measure, has not been successful in decreasing prevalence of infection. There is therefore an urgent need to revise the current approach for the successful control of the disease. Clearly, these need to be integrated control measures.
Three methods were used to measure the level of transmission of infections of Schistosoma mansoni on an irrigated sugar estate in northern Tanzania. The studies were carried out over a period of 3 years, during a programme for the control of the host snail Biomphalaria pfeifferi. During the second and third years a mass diagnosis and treatment campaign against the infection was also carried out. Examinations for infection were made in newly employed subjects on arrival and after 6 and 12 months. Two studies were made in young children at an interval of 18 months, to determine age prevalence curves. In the third method, subjects were examined for infection 18 months after being found free from infection in a previous survey. Results are compared with data recorded in a previous study, made before snail control was commenced. The results suggest that the control programme has led to a great reduction in the incidence of S. mansoni on the estate.
Surveys were carried out for chimpanzees, Pan troglodytes schweinfurthii, in the areas of Ntakata (300 km² between the Mkamba River and the Lubalisi River, 05°45' -06°15' S, 30°00' -30°15' E), and Kakungu (200 km² between the Lubalisi River and the sources of the Rubufu River, 05°55' -06°15' S, 30°00' -30°15' E), Tanzania, during the dry seasons of 2001 and 2003.
Faith-based organizations (FBOs) have a long tradition of providing HIV/AIDS prevention and mitigation services in Africa. The overall response of FBOs, however, has been controversial, particularly in regard to HIV/AIDS prevention and FBO's rejection of condom use and promotion, which can conflict with and negatively influence national HIV/AIDS prevention response efforts. This article reports the findings from a study that explored the factors influencing the HIV/AIDS prevention policy process within faith-based non-governmental organizations (NGOs) of different faiths. These factors were examined within three faith-based NGOs in Dar es Salaam, Tanzania-a Catholic, Anglican and Muslim organization. The research used an exploratory, qualitative case-study approach, and employed a health policy analysis framework, examining the context, actor and process factors and how they interact to form content in terms of policy and its implementation within each organization. Three key factors were found to influence faith-based NGOs' HIV/AIDS prevention response in terms of both policy and its implementation: (1) the faith structure in which the organizations are a part, (2) the presence or absence of organizational policy and (3) the professional nature of the organizations and its actors. The interaction between these factors, and how actors negotiate between them, was found to shape the organizations' HIV/AIDS prevention response. This article reports on these factors and analyses the different HIV/AIDS prevention responses found within each organization. By understanding the factors that influence faith-based NGOs' HIV/AIDS prevention policy process, the overall faith-based response to HIV/AIDS, and how it corresponds to national response efforts, is better understood. It is hoped that by doing so the government will be better able to identify how to best work with FBOs to meet national HIV/AIDS prevention targets, improving the overall role of FBOs in the fight against HIV/AIDS. PMID:23543222
Emergency oral health care, as conceived in Tanzania, is an on-demand service provided at a rural health center or dispensary by a Rural Medical Aide. The service includes: simple tooth extraction under local anesthesia, draining of abscesses, control of acute oral infection with appropriate drug therapy, first aid for maxillo-facial trauma, and recognition of oral conditions requiring patient referral for further care at the district or regional hospital dental clinic. The objective of the present study was to describe patient satisfaction with emergency oral health care services in rural Tanzania and determine the relative importance of factors influencing patient satisfaction. The study was carried out as a cross-sectional interview survey between April 1993 and May 1994 using a patient satisfaction questionnaire in rural villages in the Rungwe district of Tanzania. It included 206 patients aged 18 years or more who had received emergency oral health care between April 1993 and March 1994. Overall, 92.7% of the respondents reported that they were satisfied with the service. Patients who were married, had no formal education and lived more than 3 km from the dispensary were more likely to be satisfied with treatment. In a logistic regression model, a good working atmosphere at the dispensary, a good relationship between care provider and patients (art of care) and absence of post-treatment complications significantly influenced patient satisfaction with odds ratios of 10.3, 17.4 and 6.2, respectively. PMID:9792119
In recent times the term 'Building Procurement Syst ems' has become fashionable within the Tanzania building industry. It is a term that is surrounded by controversy and evokes strongly held opinion by both practitioners and researchers. This paper attempts to identify the forces that have caused change to the procurement systems used in Tanzania. In the first part of the
The Tanzania Peoples Defense Force (TPDF) was established as a people's army entrusted with the traditional roles and missions of defending the United Republic of Tanzania against external enemies. The end of the Cold War and the collapse of the Soviet Un...
The assertion of cratonic stability put forward in the model for deep continental structure can be tested by examining upper mantle structure beneath the Tanzania Craton, which lies within a tectonically active region in east Africa. Tomographic inversions of about 1200 teleseismic P and $ travel times indicate that high-velocity lithosphere beneath the Tanzania Craton extends to a depth of
Jeroen Ritsema; Andrew A. Nyblade; Thomas J. Owens; Charles A. Langston; John C. VanDecar
We measure P wave spectral amplitude ratios from deep-focus earthquakes recorded at broadband seismic stations of the Tanzania network to estimate regional variation of sublithospheric mantle attenuation beneath the Tanzania craton and the eastern branch of the East African Rift. One-dimensional profiles of QP adequately explain the systematic variation of P wave attenuation in the sublithospheric upper mantle: QP ?
Anupama Venkataraman; Andrew A. Nyblade; Jeroen Ritsema
We measure P wave spectral amplitude ratios from deep-focus earthquakes recorded at broadband seismic stations of the Tanzania network to estimate regional variation of sublithospheric mantle attenuation beneath the Tanzania craton and the eastern branch of the East African Rift. One-dimensional profiles of QP adequately explain the systematic variation of P wave attenuation in the sublithospheric upper mantle: QP ~
Anupama Venkataraman; Andrew A. Nyblade; Jeroen Ritsema
This paper examines the teaching of English in Tanzania under four main headings, (1) changing view of language and language syllabus design; (2) the role of socio?linguistic environments in second language learning; (3) the role of objectives in second language teaching; and (4) the emerging trend of documenting second language teachers’ classroom practices. In Tanzania there are major obstacles under
Purpose – This paper aims to investigate the potential role of property taxes as a revenue source for local government in Tanzania. Often this tax is beset with political and administrative problems that affect its operational efficiencies. Design\\/methodology\\/approach – The research is the result of extensive fieldwork undertaken in Tanzania during 2002 to investigate and evaluate the valuations done for
Applying the orders of outcome framework introduced by Olsen et al. (Crafting Coastal Governance in a Changing World, The Coastal Resources Center, Narragansett, 2003, 376pp.), this article describes how the Tanzania Coastal Management Partnership (TCMP) built the enabling conditions necessary to establish a national integrated coastal management (ICM) program in Tanzania. The article shows how the TCMP created a nested
Elin C. Torell; Mark Amaral; Thomas G. Bayer; Jeremiah Daffa; Gratian Luhikula; Lynne Z. Hale
This paper seeks to describe the experience of Tanzania in nation building with a view to drawing lessons from the experience taking a multidisciplinary approach to this multifaceted story capturing historical, sociological, cultural and economic developments during the post-colonial period. The Tanzania experience with social integration resulting in a relatively high degree of social stability is worth examining closely with
This monograph discusses policies designed to deal with food and nutrition problems in Tanzania. Available information on food supplies and nutritional conditions in Tanzania clearly shows that the country faces nutritional problems; protein energy malnutrition is the most serious and requires priority action. Iron deficiency anemia, goiter, and…
Much remains unknown about the status of early child development and care in Tanzania. The little information available has never been put together to provide a holistic picture of the progress so far made in this important area. This paper intends to synchronise the information available in Tanzania for the purpose of depicting the country's…
|Of the three East African British colonies (Kenya, Uganda, and Tanzania), Tanzania was the least well off at the time of independence in 1961. At that time, only 16,691 students were enrolled in secondary schools, and all general education at higher levels was provided outside the country. Thus, the goals of post-independence educational policy…
Of the three East African British colonies (Kenya, Uganda, and Tanzania), Tanzania was the least well off at the time of independence in 1961. At that time, only 16,691 students were enrolled in secondary schools, and all general education at higher levels was provided outside the country. Thus, the goals of post-independence educational policy…
BACKGROUND: The use of plant repellents against nuisance biting insects is common and its potential for malaria vector control requires evaluation in areas with different level of malaria endemicity. The essential oils of Ocimum suave and Ocimum kilimandscharicum were evaluated against malaria vectors in north-eastern Tanzania. METHODOLOGY: An ethnobotanical study was conducted at Moshi in Kilimanjaro region north-eastern Tanzania, through
Eliningaya J Kweka; Franklin Mosha; Asanterabi Lowassa; Aneth M Mahande; Jovin Kitau; Johnson Matowo; Michael J Mahande; Charles P Massenga; Filemoni Tenu; Emmanuel Feston; Ester E Lyatuu; Michael A Mboya; Rajabu Mndeme; Grace Chuwa; Emmanuel A Temu
This paper describes the process adopted for the redevelopment of Kurasini ward in Dar-es-Salaam to allow for the expansion of the port. The redevelopment includes the resettlement of more than 36,000 people who have been living in various informal settlements within the ward. However, the resettlement and compensation offer nothing to most residents who are tenants. It has also failed
In eastern Tanzania an electric grid trap carried in the back of a moving pick-up truck was used to capture engorged Glossina morsitans morsitans and G. pallidipes for an analysis of their food sources. Although 12 000 head of domestic cattle represented c. 75% of the animal biomass in the survey area, they provided only 5.6% of the total blood meals, while 74.8% were from warthogs and bushpigs. The percentage of females among the captured flies was 12 and 47 for G. m. morsitans and G. pallidipes, respectively. The incidence of engorged flies captured by this method ranged from 15 to 20% in males and 26 to 42% in females. PMID:6486936
Background Diagnostic imaging services are scarce in much of the developing world. Ultrasound is a low-cost, safe, and widely applicable\\u000a imaging modality.\\u000a \\u000a \\u000a \\u000a Aims We delivered a portable ultrasound machine to the Lugufu refugee camp in Tanzania and conducted a course on its use in order\\u000a to assess the feasibility of introducing this technology into a very low-resource setting.\\u000a \\u000a \\u000a \\u000a Methods We conducted an intensive
David Adler; Katanga Mgalula; Daniel Price; Opal Taylor
Background The implementation of decentralisation reforms in the health sector of Tanzania started in the 1980s. These reforms were intended to relinquish substantial powers and resources to districts to improve the development of the health sector. Little is known about the impact of decentralisation on recruitment and distribution of health workers at the district level. Reported difficulties in recruiting health workers to remote districts led the Government of Tanzania to partly re-instate central recruitment of health workers in 2006. The effects of this policy change are not yet documented. This study highlights the experiences and challenges associated with decentralisation and the partial re-centralisation in relation to the recruitment and distribution of health workers. Methods An exploratory qualitative study was conducted among informants recruited from five underserved, remote districts of mainland Tanzania. Additional informants were recruited from the central government, the NGO sector, international organisations and academia. A comparison of decentralised and the reinstated centralised systems was carried out in order to draw lessons necessary for improving recruitment, distribution and retention of health workers. Results The study has shown that recruitment of health workers under a decentralised arrangement has not only been characterised by complex bureaucratic procedures, but by severe delays and sometimes failure to get the required health workers. The study also revealed that recruitment of highly skilled health workers under decentralised arrangements may be both very difficult and expensive. Decentralised recruitment was perceived to be more effective in improving retention of the lower cadre health workers within the districts. In contrast, the centralised arrangement was perceived to be more effective both in recruiting qualified staff and balancing their distribution across districts, but poor in ensuring the retention of employees. Conclusion A combination of centralised and decentralised recruitment represents a promising hybrid form of health sector organisation in managing human resources by bringing the benefits of two worlds together. In order to ensure that the potential benefits of the two approaches are effectively integrated, careful balancing defining the local-central relationships in the management of human resources needs to be worked out.
ObjectivesFew studies have examined the frequency and duration of genital herpes simplex virus (HSV) shedding in sub-Saharan Africa. This study describes HSV shedding patterns among a sample of HSV-2-seropositive women enrolled in a placebo-controlled trial of HSV suppressive therapy (acyclovir 400 mg twice a day) in Tanzania.MethodsTrial participants were invited to participate in a substudy involving 12 clinic visits over
Clare Tanton; Helen A Weiss; Jerome LeGoff; John Changalucha; Tim C Clayton; David A Ross; Laurent Belec; Richard J Hayes; Deborah Watson-Jones
OBJECTIVE--To determine risk factors for syphilis and sexually transmitted disease (STD) syndromes, and to study health seeking behaviour among those with STD syndromes, in the population of Mwanza Region, North-Western Tanzania. METHODS--A population-based random cluster sample survey, stratified by rural, roadside or urban residence, of 4173 individuals aged 15-54 years was performed in 1990-91. The seroprevalence of syphilis and the
J Newell; K Senkoro; F Mosha; H Grosskurth; A Nicoll; L Barongo; M Borgdorff; A Klokke; J Changalucha; J Killewo
BACKGROUND: During a microbicide trial feasibility study among women at high-risk of HIV and sexually transmitted infections in Mwanza, northern Tanzania we used participatory research tools to facilitate open dialogue and partnership between researchers and study participants. METHODS: A community-based sexual and reproductive health service was established in ten city wards. Wards were divided into seventy-eight geographical clusters, representatives at
Andrew Vallely; Charles Shagi; Stella Kasindi; Nicola Desmond; Shelley Lees; Betty Chiduo; Richard Hayes; Caroline Allen; David Ross
PurposeTo determine the incidence and predictors of adolescent’s early sexual debut after three decades of HIV interventions in Tanzania.MethodsIn a cross-section study of adolescents aged 16–19 residing in Morogoro Municipality, information on socio-demographic, parental-and-peer communication, and sexual behaviors were collected. Cox-regression analysis was used to examine predictors of time to sexual debut.ResultsA total of 316 adolescents with mean age of
Elia John Mmbaga; Frida Leonard; Germana Henry Leyna
Background Major improvements are required in the coverage and quality of essential childhood interventions to achieve Millennium Development Goal Four (MDG 4). Long distance to health facilities is one of the known barriers to access. We investigated the effect of networked and Euclidean distances from home to formal health facilities on childhood mortality in rural Tanzania between 2005 and 2007. Methods A secondary analysis of data from a cohort of 28,823 children younger than age 5 between 2005 and 2007 from Ifakara Health and Demographic Surveillance System was carried out. Both Euclidean and networked distances from the household to the nearest health facility were calculated using geographical information system methods. Cox proportional hazard regression models were used to investigate the effect of distance from home to the nearest health facility on child mortality. Results Children who lived in homes with networked distance >5 km experienced approximately 17% increased mortality risk (HR=1.17; 95% CI 1.02–1.38) compared to those who lived <5 km networked distance to the nearest health facility. Death of a mother (HR=5.87; 95% CI 4.11–8.40), death of preceding sibling (HR=1.9; 95% CI 1.37–2.65), and twin birth (HR=2.9; 95% CI 2.27–3.74) were the strongest independent predictors of child mortality. Conclusions Physical access to health facilities is a determinant of child mortality in rural Tanzania. Innovations to improve access to health facilities coupled with birth spacing and care at birth are needed to reduce child deaths in rural Tanzania.
Kadobera, Daniel; Sartorius, Benn; Masanja, Honorati; Mathew, Alexander; Waiswa, Peter
The study estimated the prevalence of HIV-1 intra-subtype recombinant variants among female bar and hotel workers in Tanzania. While intra-subtype recombination occurs in HIV-1, it is generally underestimated. HIV-1 env gp120 V1-C5 quasispecies from 45 subjects were generated by single-genome amplification and sequencing (median (IQR) of 38 (28-50) sequences per subject). Recombination analysis was performed using seven methods implemented within the recombination detection program version 3, RDP3. HIV-1 sequences were considered recombinant if recombination signals were detected by at least three methods with p-values of ?0.05 after Bonferroni correction for multiple comparisons. HIV-1 in 38 (84%) subjects showed evidence for intra-subtype recombination including 22 with HIV-1 subtype A1, 13 with HIV-1 subtype C, and 3 with HIV-1 subtype D. The distribution of intra-patient recombination breakpoints suggested ongoing recombination and showed selective enrichment of recombinant variants in 23 (60%) subjects. The number of subjects with evidence of intra-subtype recombination increased from 29 (69%) to 36 (82%) over one year of follow-up, although the increase did not reach statistical significance. Adjustment for intra-subtype recombination is important for the analysis of multiplicity of HIV infection. This is the first report of high prevalence of intra-subtype recombination in the HIV/AIDS epidemic in Tanzania, a region where multiple HIV-1 subtypes co-circulate. HIV-1 intra-subtype recombination increases viral diversity and presents additional challenges for HIV-1 vaccine design. PMID:23940702
Background While severe shortages, inadequate skills and a geographical imbalance of health personnel have been consistently documented over the years as long term critical challenges in the health sector of the United Republic of Tanzania, there is limited evidence on the gender-based distribution of the health workforce and its likely implications. Extant evidence shows that some people may not seek healthcare unless they have access to a provider of their gender. This paper, therefore, assesses the gender-based distribution of the United Republic of Tanzania’s health workforce cadres. Methods This is a secondary analysis of data collected in a cross-sectional health facility survey on health system strengthening in the United Republic of Tanzania in 2008. During the survey, 88 health facilities, selected randomly from 8 regions, yielded 815 health workers (HWs) eligible for the current analysis. While Chi-square was used for testing associations in the bivariate analysis, multivariate analysis was conducted using logistic regression to assess the relationship between gender and each of the cadres involved in the analysis. Results The mean age of the HWs was 39.7, ranging from 15 to 63 years. Overall, 75% of the HWs were women. The proportion of women among maternal and child health aides or medical attendants (MCHA/MA), nurses and midwives was 86%, 86% and 91%, respectively, while their proportion among clinical officers (COs) and medical doctors (MDs) was 28% and 21%, respectively. Multivariate analysis revealed that the odds ratio (OR) and 95% confidence interval (CI) that a HW was a female (baseline category is “male”) for each cadre was: MCHA/MA, OR?=?3.70, 95% CI 2.16-6.33; nurse, OR?=?5.61, 95% CI 3.22-9.78; midwife, OR?=?2.74, 95% CI 1.44-5.20; CO, OR?=?0.08, 95% CI 0.04-0.17 and MD, OR?=?0.04, 95% CI 0.02-0.09. Conclusion The distribution of the United Republic of Tanzania’s health cadres is dramatically gender-skewed, a reflection of gender inequality in health career choices. MCHA/MA, nursing and midwifery cadres are large and female-dominant, whereas COs and MDs are fewer in absolute numbers and male-dominant. While a need for more staff is necessary for an effective delivery of quality health services, adequate representation of women in highly trained cadres is imperative to enhance responses to some gender-specific roles and needs.
Serum resistance associated (SRA) gene has been found to confer resistance to the innate trypanolytic factor (TLF) found in normal human serum; thus allowing Trypanosoma brucei brucei to survive exposure to normal human serum. This study was carried out to examine the presence of SRA gene and identify the origin of T. b. rhodesiense isolates from three districts in Tanzania, namely Kibondo, Kasulu and Urambo. Twenty-six T. b. rhodesiense isolates and two references T. b. rhodesiense isolates from Kenya were examined for SRA gene using simple Polymerase Chain Reaction technique. The gene was found to be present in all 26 T. b. rhodesiense isolates including the two references isolates from Kenya. The SRA gene was confirmed to be specific to T. b. rhodesiense since it could not be amplified from all other Trypanozoon including T. b. gambiense; and gave an amplified fragment of the expected size (3.9kb), confirming that all these isolates were T. b. rhodesiense of the northern variant. Although the geographic distributions of T. b. gambiense and T. b. rhodesiense are clearly localized to west/central Africa and eastern Africa, respectively, natural movement of people and recent influx of large number of refugees into Tanzania from the Democratic Republic of Congo, could have brought T. b. gambiense in western Tanzania. The overlap in distribution of both of these pathogenic sub-species could result in erroneous diagnoses since both trypanosome sub-species are morphologically identical, and currently serologic methods have low specificity. Both the susceptible and resistant T. b. rhodesiense isolates possessed the SRA gene suggesting that there is no correlation between drug resistance and presence of SRA gene. The use of SRA gene helps to confirm the identity and diversity of some of the isolates resistant to various drugs. PMID:17547097
Background There are few data on factors influencing human papillomavirus (HPV) vaccination uptake in sub-Saharan Africa. We examined the characteristics of receivers and non-receivers of HPV vaccination in Tanzania and identified reasons for not receiving the vaccine. Methods We conducted a case control study of HPV vaccine receivers and non-receivers within a phase IV cluster-randomised trial of HPV vaccination in 134 primary schools in Tanzania. Girls who failed to receive vaccine (pupil cases) and their parents/guardians (adult cases) and girls who received dose 1 (pupil controls) of the quadrivalent vaccine (Gardasil™) and their parents/guardians (adult controls) were enrolled from 39 schools in a 1?1 ratio and interviewed about cervical cancer, HPV vaccine knowledge and reasons why they might have received or not received the vaccine. Conditional logistic regression was used to determine factors independently associated with not receiving HPV vaccine. Results We interviewed 159 pupil/adult cases and 245 pupil/adult controls. Adult-factors independently associated with a daughter being a case were older age, owning fewer household items, not attending a school meeting about HPV vaccine, and not knowing anyone with cancer. Pupil-factors for being a case included having a non-positive opinion about the school de-worming programme, poor knowledge about the location of the cervix, and not knowing that a vaccine could prevent cervical cancer. Reasons for actively refusing vaccination included concerns about side effects and infertility. Most adult and pupil cases reported that they would accept the HPV vaccine if it were offered again (97% and 93% respectively). Conclusions Sensitisation messages, especially targeted at older and poorer parents, knowledge retention and parent meetings are critical for vaccine acceptance in Tanzania. Vaccine side effects and fertility concerns should be addressed prior to a national vaccination program. Parents and pupils who initially decline vaccination should be given an opportunity to reconsider their decision.
Watson-Jones, Deborah; Tomlin, Keith; Remes, Pieter; Baisley, Kathy; Ponsiano, Riziki; Soteli, Selephina; de Sanjose, Silvia; Changalucha, John; Kapiga, Saidi; Hayes, Richard J.
Health worker training is a key component of the integrated management of childhood illness (IMCI). However, training coverage remains low in many countries. We conducted in-depth case studies in two East African countries to examine the factors underlying low training coverage 10 years after IMCI had been adopted as policy. A document review and in-depth semi-structured interviews with stakeholders at facility, district, regional/provincial and national levels in two districts in Kenya (Homa Bay and Malindi) and Tanzania (Bunda and Tarime) were carried out in 2007–08. Bunda and Malindi achieved higher levels of training coverage (44% and 25%) compared with Tarime and Homa Bay (5% and 13%). Key factors allowing the first two districts to perform better were: strong district leadership and personal commitment to IMCI, which facilitated access to external funding and encouraged local-level policy adaptation; sensitization and training of district health managers; and lower staff turnover. However, IMCI training coverage remained well below target levels across all sites. The main barrier to expanding coverage was the cost of training due to its duration, the number of facilitators and its residential nature. Mechanisms for financing IMCI also restricted district capacity to raise funds. In Tanzania, districts could not spend more than 10% of their budgets on training. In Kenya, limited financial decentralization meant that district managers had to rely on donors for financial support. Critically, the low priority given to IMCI at national and international levels also limited the expansion of training. Levels of domestic and donor support for IMCI have diminished over time in favour of vertical programmes, partly due to the difficulty in monitoring and measuring the impact of an integrated intervention like IMCI. Alternative, lower cost methods of IMCI training need to be promoted, and greater advocacy for IMCI is needed both nationally and internationally.
Background.?The importance of Q fever, spotted fever group rickettsiosis (SFGR), and typhus group rickettsiosis (TGR) as causes of febrile illness in sub-Saharan Africa is unknown; the putative role of Q fever as a human immunodeficiency virus (HIV) coinfection is unclear. Methods.?We identified febrile inpatients in Moshi, Tanzania, from September 2007 through August 2008 and collected acute- and convalescent-phase serum samples. A ?4-fold increase in immunoglobulin (Ig) G immunfluorescence assay (IFA) titer to Coxiella burnetii phase II antigen defined acute Q fever. A ?4-fold increase in IgG IFA titer to Rickettsia conorii or Rickettsia typhi antigen defined SFGR and TGR, respectively. Results.?Among 870 patients, 483 (55.5%) were tested for acute Q fever, and 450 (51.7%) were tested for acute SFGR and TGR. Results suggested acute Q fever in 24 (5.0%) patients and SFGR and TGR in 36 (8.0%) and 2 (0.5%) patients, respectively. Acute Q fever was associated with hepato- or splenomegaly (odds ratio [OR], 3.1; P = .028), anemia (OR, 3.0; P = .009), leukopenia (OR, 3.9; P = .013), jaundice (OR, 7.1; P = .007), and onset during the dry season (OR, 2.7; P = .021). HIV infection was not associated with acute Q fever (OR, 1.7; P = .231). Acute SFGR was associated with leukopenia (OR, 4.1; P = .003) and with evidence of other zoonoses (OR, 2.2; P = .045). Conclusions.?Despite being common causes of febrile illness in northern Tanzania, Q fever and SFGR are not diagnosed or managed with targeted antimicrobials. C. burnetii does not appear to be an HIV-associated co-infection.
Prabhu, Malavika; Nicholson, William L.; Roche, Aubree J.; Kersh, Gilbert J.; Fitzpatrick, Kelly A.; Oliver, Lindsay D.; Massung, Robert F.; Morrissey, Anne B.; Bartlett, John A.; Onyango, Jecinta J.; Maro, Venance P.; Kinabo, Grace D.; Saganda, Wilbrod
Background Recent years have seen an unprecedented increase in funds for procurement of health commodities in developing countries. A major challenge now is the efficient delivery of commodities and services to improve population health. With this in mind, we documented staffing levels and productivity in peripheral health facilities in southern Tanzania. Method A health facility survey was conducted to collect data on staff employed, their main tasks, availability on the day of the survey, reasons for absenteeism, and experience of supervisory visits from District Health Teams. In-depth interview with health workers was done to explore their perception of work load. A time and motion study of nurses in the Reproductive and Child Health (RCH) clinics documented their time use by task. Results We found that only 14% (122/854) of the recommended number of nurses and 20% (90/441) of the clinical staff had been employed at the facilities. Furthermore, 44% of clinical staff was not available on the day of the survey. Various reasons were given for this. Amongst the clinical staff, 38% were absent because of attendance to seminar sessions, 8% because of long-training, 25% were on official travel and 20% were on leave. RCH clinic nurses were present for 7 hours a day, but only worked productively for 57% of time present at facility. Almost two-third of facilities had received less than 3 visits from district health teams during the 6 months preceding the survey. Conclusion This study documented inadequate staffing of health facilities, a high degree of absenteeism, low productivity of the staff who were present and inadequate supervision in peripheral Tanzanian health facilities. The implications of these findings are discussed in the context of decentralized health care in Tanzania.
Background Malaria is a significant public health problem in Tanzania. Approximately 16 million malaria cases are reported every year and 100,000 to 125,000 deaths occur. Although most of Tanzania is endemic to malaria, epidemics occur in the highlands, notably in Kagera, a region that was subject to widespread malaria epidemics in 1997 and 1998. This study examined the relationship between climate and malaria incidence in Kagera with the aim of determining whether seasonal forecasts may assist in predicting malaria epidemics. Methods A regression analysis was performed on retrospective malaria and climatic data during each of the two annual malaria seasons to determine the climatic factors influencing malaria incidence. The ability of the DEMETER seasonal forecasting system in predicting the climatic anomalies associated with malaria epidemics was then assessed for each malaria season. Results It was found that malaria incidence is positively correlated with rainfall during the first season (Oct-Mar) (R-squared = 0.73, p < 0.01). For the second season (Apr-Sep), high malaria incidence was associated with increased rainfall, but also with high maximum temperature during the first rainy season (multiple R-squared = 0.79, p < 0.01). The robustness of these statistical models was tested by excluding the two epidemic years from the regression analysis. DEMETER would have been unable to predict the heavy El Niño rains associated with the 1998 epidemic. Nevertheless, this epidemic could still have been predicted using the temperature forecasts alone. The 1997 epidemic could have been predicted from observed temperatures in the preceding season, but the consideration of the rainfall forecasts would have improved the temperature-only forecasts over the remaining years. Conclusion These results demonstrate the potential of a seasonal forecasting system in the development of a malaria early warning system in Kagera region.
Jones, Anne E; Wort, Ulrika Uddenfeldt; Morse, Andrew P; Hastings, Ian M; Gagnon, Alexandre S
Background Cancer is among the three leading causes of death in low income countries and the highest increase with regard to incidence figures for cancer diseases are found in these countries. This is the first report of the health-related quality of life (HRQOL) and needs of care and support of adult Tanzanians with cancer. Methods A mixed-methods design was used. The study was conducted at Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania. One hundred and one patients with a variety of cancer diagnoses treated and cared for at ORCI answered the Kiswahili version of the EORTC QLQ-C30 investigating HRQOL. Thirty-two of the patients participated in focus group interviews discussing needs of care and support. Data from focus group interviews were analyzed with content analysis. Results The findings show that the patients, both women and men, report a low quality of life, especially with regard to physical, role, and social function and a high level of symptoms and problems especially with financial difficulties and pain. Financial difficulties are reported to a remarkably high extent by both women and men. The patients, both women and men report least problems with emotional function. A content analysis of the interview data revealed needs of food and water, hygienic needs, emotional needs, spiritual needs, financial needs, and needs of closeness to cancer care and treatment services. Conclusion The high score for pain points out that ORCI is facing severe challenges regarding care and treatment. However, when considering this finding it should be noted that the pain subscale of the Kiswahili version of the EORTC QLQ-C30 did not reach acceptable internal consistency and showed less than satisfactory convergent validity. This also applies to the subscales cognitive function and global health/quality of life. Attention should be drawn to meet the identified needs of Tanzanian cancer patients while hospitalized but also when at home. Increased accessibility of mosquito nets, pads, and pain-killers would help to fulfil some needs.
There is a growing body of evidence that voluntary HIV counseling and testing (VCT) is effective for the primary prevention of HIV as well as for the care and support of individuals affected by HIV in developing countries. This qualitative study offers an additional perspective: the experiences and perceptions of men and women receiving VCT services. As a substudy of
M. Gloria Sangiwa; Ariane van der Straten; Olga A. Grinstead
After 5 years of stagnant exploration in East Africa, Canadian independent Tanganyika Oil Co. of Vancouver, B.C., will drill two wildcats in Tanzania to evaluate the hydrocarbon potential of the coastal Jurassic Mandawa salt basin. Mita-1, spudded around Oct. 1, will be drilled to about 7,000 ft, East Lika-1 will be drilled in early December 1996 to approximately 6,000 ft. The two wells will test different structures and play concepts. The paper describes the exploration history, source rock potential, hydrocarbon shows, potential reservoir, and the prospects.
Nagati, M. [Tanganyika Oil Co., Dubai (United Arab Emirates)
This study argues for the integration of African oral traditions and other elements of traditional learning into the modern school curriculum. It thus contributes to supporting the increased relevance of education to local communities. In particular, using the example of riddles collected from one of the main ethnic groups in Northwestern Tanzania, the Haya people, the present study challenges the views of those social and cultural anthropologists who hold that African riddles have no substantially meaningful educational value. Instead, it is maintained that riddles make an important contribution to children's full participation in the social, cultural, political, and economic life of African communities, especially by fostering critical thinking and transmitting indigenous knowledge.
Objective To determine whether the IDSR system meets its purpose and objectives, to evaluate the system attributes, and provide recommendations to improve the IDSR system, using the example of bacillary dysentery, a priority disease in Tanzania. Introduction Each year Ministry of Health and Social welfare of Tanzania under Epidemiology Section has been reporting many suspected cases of Shigella throughout the country. However only fewer laboratories have been reporting the confirmed cases. Methods The study was conducted between November 2011 and February 2012. Hospital staff including nurses, physicians and laboratory personnel and other stakeholders from the Ministry of Health and Social Welfare (MOHSW) were enrolled in the study. Data was collected from a review of documents, questionnaires and interview of stakeholders. Surveillance system attributes were evaluated using updated guidelines for evaluating public health surveillance system (2007) from Morbidity and Mortality Weekly Report (MMWR). Results Questionnaires were administered to fifteen health personnel from four regional hospitals. Four health staff from epidemiology and laboratory section of MOHSW were interviewed. Only one regional hospital laboratory was conducting laboratory diagnosis for bacillary dysentery and sending reports to MOHSW. Data from this laboratory was reviewed. Out of 641 records from bacillary dysentery testing, 271 (42.3%) did not include age data, 5 (0.78%) missed sex, 624 (97.3%) missed the district where the patient came from, 26 (4.4%) did not include information on specimen quality, 1(0.2%) had no report of pathogens found and 636 (99.2%) did not include antimicrobial sensitivity testing (AST). The Predictive Value Positive (PVP) of the system was 0.62%. One (6.7%) of the health workers was trained in IDSR. Conclusions IDSR in Tanzania generally is not performing well as only one (25%) of the four visited hospitals conducts and reports laboratory diagnosis of bacillary dysentery. However the system is representative as it covers all regions of the United Republic of Tanzania and all ages of people. The system is flexible since National IDSR guideline (2001) was revised in 2011. More emphasis should be placed on strengthening laboratory capacity in disease diagnosis and reporting at all levels.
Mwanyika, Alfred G.; Sembuche, Senga; Joachim, Agricola
Background HIV prevalence trends in Tanzania differ between socioeconomic groups. While HIV prevalence was initially higher among those with higher levels of educational attainment, it has fallen fastest among these groups. Among those with lower levels of education HIV prevalence has been stable. The behavioural dynamics underlying this phenomenon remain unclear, and a theory to guide interpretation of these trends and enable predictions of future patterns has not emerged. Methods We analysed data from two large nationally representative surveys conducted in Tanzania in 2003/2004 and 2007/2008. We focused on young people aged 15 to 24 years and explored reports of (i) first sex, (ii) having had more than one sexual partner in the last year and (iii) unprotected last sex with a non-cohabiting partner. Our analysis explored whether the behaviours differed by educational attainment in 2003/2004 and in 2007/2008, and whether changes over time in these behaviours differed between educational groups. Results The rate of first sex was lower among more educated males in 2007/2008 but not in 2003/2004, and among females in both surveys. The change over time in educational patterning of the rate of first sex in males was mostly due to a declining rate among the secondary educated groups. Among males, having had more than one sexual partner in the last year was associated with lower education in 2003/2004 and in 2007/2008. Among females, those with less education were more likely to report more than one partner in 2003/2004, although by 2007/2008 there was little association between education and reporting more than one partner. Unprotected last sex with a non-cohabiting partner was less common among the more educated. Among both sexes this decreased over time among those with no education and increased among those with secondary education. Conclusions Patterns of behaviour suggest that differences in HIV incidence might explain trends in HIV prevalence among different educational groups in Tanzania between 2003/2004 and 2007/2008. The “inverse equity hypothesis” from child health research might partially help explain the changing social epidemiology of HIV incidence in Tanzania.
Hargreaves, James R; Slaymaker, Emma; Fearon, Elizabeth; Howe, Laura D
Background Resistance to third generation cephalosporins due to acquisition and expression of extended spectrum ?-lactamase (ESBL) enzymes among Gram-negative bacteria is on the increase. Presence of ESBL producing organisms has been reported to significantly affect the course and outcome of an infection. Therefore infections due to ESBL isolates continue to pose a challenge to infection management worldwide. The aim of this study was to determine the existence and to describe phenotypic and genotypic characteristics of ESBLs in an Intensive Care Unit (ICU) setting in Tanzania. Methods Between October 2002 and April 2003, clinical information and samples were collected from patients suspected to have nosocomial infections in an Intensive Care Unit of a tertiary hospital in Tanzania. The isolates were identified, tested for antimicrobial susceptibility and analysed for presence of ESBL genes. Results Thirty-nine Gram-negative bacteria were isolated from clinical samples of 39 patients. These isolates included 13 Escherichia coli, 12 Enterobacter spp, 5 Pseudomonas spp, 4 Proteus spp, 2 Klebsiella. pneumoniae, 2 Citrobacter freundii and 1 Chryseomonas luteola. Eleven (28.2%) of these isolates were ESBL producing. The ESBL genes characterised were SHV-12, SHV-28 and CTX-M-15. The ESBL producing isolates were more resistant to gentamicin and ciprofloxacin than non-ESBL producing isolates. Conclusion This study shows the presence of ESBL genes among Gram-negative bacteria in the ICU setting in Tanzania. There is a need to institute strict hospital infection control policy and a regular surveillance of resistance to antimicrobial agents.
Rwanda erupted in civil war in the spring of 1994, leading to the flight from the country of hundreds of thousands of refugees into neighboring Tanzania and Zaire. Within days, the population of the Benaco refugee camp grew to more than 250,000, making it the second largest city in Tanzania. HIV infection rates in some sectors of the Rwandan population had been among the highest observed in Africa. High levels of HIV infection thus remain among the refugees from Rwanda. Four months after the beginning of the exodus from Rwanda, the AIDS Control and Prevention (AIDSCAP) Project contracted with CARE International to manage a broad-based HIV prevention pilot project for Rwandan refugees at the Benaco refugee camp. Conditions in the camp and the project are described, followed by consideration of the prevailing culture and behavior change. The author believes that the pioneering work at Benaco and three other Ngara District camps offers valuable lessons on working with displaced populations under crisis conditions. PMID:12347593
Recent immigrants and refugees constitute a substantial proportion of malaria cases in the United States, accounting for nearly one in 10 imported malaria cases involving persons with known resident status in 2006. This report describes three cases of Plasmodium falciparum malaria and two cases of Plasmodium ovale malaria that occurred during June 27-October 15, 2007 in King County, Washington. The infections were diagnosed in Burundian refugees who had recently arrived in the United States from two refugee camps in Tanzania. Since 2005, CDC has recommended presumptive malaria treatment with artemisinin-based combination therapy (ACT) (e.g., artemether-lumefantrine) for refugees from sub-Saharan Africa before their departure for the United States (2). Rising levels of resistance to the previous mainstays of treatment, chloroquine and sulfadoxine-pyrimethamine, prompted CDC to make this recommendation. Implementation has been delayed in some countries, including Tanzania, where predeparture administration of presumptive ACT for refugees started in July 2007. The cases in this report highlight the need for health-care providers who care for recently arrived Burundian and other refugee populations to be vigilant for malaria, even among refugees previously treated for the disease. PMID:18701876
We enrolled consecutive febrile admissions to two hospitals in Moshi, Tanzania. Confirmed leptospirosis was defined as a ? 4-fold increase in microscopic agglutination test (MAT) titer; probable leptospirosis as reciprocal MAT titer ? 800; and exposure to pathogenic leptospires as titer ? 100. Among 870 patients enrolled in the study, 453 (52.1%) had paired sera available, and 40 (8.8%) of these met the definition for confirmed leptospirosis. Of 832 patients with ? 1 serum sample available, 30 (3.6%) had probable leptospirosis and an additional 277 (33.3%) had evidence of exposure to pathogenic leptospires. Among those with leptospirosis the most common clinical diagnoses were malaria in 31 (44.3%) and pneumonia in 18 (25.7%). Leptospirosis was associated with living in a rural area (odds ratio [OR] 3.4, P < 0.001). Among those with confirmed leptospirosis, the predominant reactive serogroups were Mini and Australis. Leptospirosis is a major yet underdiagnosed cause of febrile illness in northern Tanzania, where it appears to be endemic.
Biggs, Holly M.; Bui, Duy M.; Galloway, Renee L.; Stoddard, Robyn A.; Shadomy, Sean V.; Morrissey, Anne B.; Bartlett, John A.; Onyango, Jecinta J.; Maro, Venance P.; Kinabo, Grace D.; Saganda, Wilbrod; Crump, John A.
A number of adult education innovations were introduced in Tanzania in the late 1960s and early 1970s. This article analyzes the context of three innovations, namely functional literacy, workers' education and the programme of the Folk Development Colleges. The analysis reveals that these innovations had firm roots within the socio-economic conditions prevailing in the country in the 1960s and 1970s, Nyerere's influence as President and Party leader, Tanzania's ideology of development, the policy of popular participation, the roots of educational policy in a humanistic philosophy of education, and indigenous education. Some of the factors which affected their implementation included lack of trained educators, inadequate financial resources, ineffective evaluation mechanisms, and a mis-match between participants' needs and actual programmes. It is suggested that there is a need to introduce economic innovations alongside educational innovations, to involve participants in determining their training needs, and to train and retain adult educators with a view to improving adult education initiatives in the country.
The Sinya Beds of the Amboseli Basin in Tanzania and Kenya consist largely of carbonate rocks and Mg-rich clays that are intensely deformed where exposed in and near former meerschaum mines. The carbonate rocks consist of limestone and dolomite in Tanzania, but only dolomite has been identified in Kenya. Sepiolite and mixed-layered kerolite\\/stevensite (Ke\\/St) are subordinate constituents of the carbonate
R. L. Hay; R. E. HUGHES; T. K. KYSER; H. D. GLASS; J. Lxu
Chimpanzees manufacture flexible fishing probes to fish for termites in Issa, Ugalla, western Tanzania. These termite-fishing tools are similar in size and material to those used by long-studied communities of chimpanzees in western Tanzania (Pan troglodytes schweinfurthii) and in West Africa (P. t. verus), but not central African populations (P. t. troglodytes). This report adds to the patchwork of evidence of termite-fishing tool use behaviour by chimpanzees across Africa. PMID:23720026
Tick-borne diseases, namely, anaplasmosis, babesiosis, cowdriosis and theileriosis, constrain cattle production and improvement\\u000a in Tanzania, leading to considerable economic losses. A simple spreadsheet model was used to estimate the economic losses\\u000a resulting from production losses, treatment and control costs associated with tick-borne diseases (TBD) in Tanzania. Model\\u000a parameters included the national cattle population, reported TBD morbidity, fatality risk, and chemotherapy
This paper analyses how tourism development in Tanzania is shaped in fundamental ways by the political–economic forces governing many post-colonial African states. Politics in Tanzania are characterized by a highly centralized and weakly accountable state, a prevalence of informal rent-seeking interests, institutionalized corruption in government at all levels and the intermingling of a developmentalist discourse built on foreign and private
This paper analyses how tourism development in Tanzania is shaped in fundamental ways by the political–economic forces governing many post-colonial African states. Politics in Tanzania are characterized by a highly centralized and weakly accountable state, a prevalence of informal rent-seeking interests, institutionalized corruption in government at all levels and the intermingling of a developmentalist discourse built on foreign and private
Despite recent improvements in child survival in sub-Saharan Africa, neonatal mortality rates remain largely unchanged. This study aimed to determine the frequency of delivery and newborn-care practices in southern Tanzania, where neonatal mortality is higher than the national average. All households in five districts of Southern Tanzania were approached to participate. Of 213,220 female residents aged 13–49 years, 92% participated.
Suzanne Penfold; Zelee Hill; Mwifadhi Mrisho; Fatuma Manzi; Marcel Tanner; Hassan Mshinda; David Schellenberg; Joanna R. M. Armstrong Schellenberg; Abdisalan Mohamed Noor
BackgroundHuman African trypanosomiasis is a severely neglected vector-borne disease that is always fatal if untreated. In Tanzania it is highly focalised and of major socio-economic and public health importance in affected communities.ObjectivesThis study aimed to estimate the public health burden of rhodesiense HAT in terms of DALYs and financial costs in a highly disease endemic area of Tanzania using hospital
Lucas E. Matemba; Eric M. Fèvre; Stafford N. Kibona; Kim Picozzi; Sarah Cleaveland; Alexandra P. Shaw; Susan C. Welburn
Tanzania and southern Kenya hold a key position for reconstructing Gondwana consolidation because here different orogen belts with different tectonic styles interfere. The older, ca. 650-620 Ma East African Orogeny resulted from the amalgamation of arc terranes in the northern Arabian-Nubian Shield (ANS) and continental collision between East African pieces and parts of the Azania terrane in the south (Collins and Pisarevsky, 2005). The change form arc suturing to continental collision settings is found in southern Kenya where southernmost arcs of the ANS conjoin with thickened continental margin suites of the Eastern Granulite Belt. The younger ca. 570-530 Ma Kuunga orogeny heads from the Damara - Zambesi - Irumide Belts (De Waele et al., 2006) over Tanzania - Mozambique to southern India and clashes with the East African orogen in southern-central Tanzania. Two transitional orogen settings may be defined, (1) that between island arcs and inverted passive continental margin within the East African Orogen and, (2) that between N-S trending East African and W-E trending Kuungan orogenies. The Neoproterozoic island arc suites of SE-Kenya are exposed as a narrow stripe between western Azania and the Eastern Granulite belt. This suture is a steep, NNW stretched belt that aligns roughly with the prominent southern ANS shear zones that converge at the southern tip of the ANS (Athi and Aswa shear zones). Oblique convergence resulted in low-vorticity sinstral shear during early phases of deformation. Syn-magmatic and syn-tectonic textures are compatible with deformation at granulite metamorphic conditions and rocks exhumed quickly during ongoing transcurrent motion. The belt is typified as wrench tectonic belt with horizontal northwards flow of rocks within deeper portions of an island arc. The adjacent Eastern Granulite Nappe experienced westward directed, subhorizontal, low-vorticity, high temperature flow at partly extreme metamorphic conditions (900°C, 1.2 to 1.4 GPa) (Fritz et al., 2009). Majority of data suggest an anticlockwise P-T loop and prolonged, slow cooling at deep crustal levels without significant exhumation. Isobaric cooling is explained by horizontal flow with rates faster than thermal equilibration of the lower crust. Those settings are found in domains of previously thinned lithosphere such as extended passive margins. Such rheolgically weak plate boundaries do not produce self-sustaining one-sided subduction but large areas of magmatic underplating that enable melt enhanced lateral flow of the lower crust. Western Granulites deformed by high-vorticity westwards thrusting at c. 550 Ma (Kuunga orogeny). Rocks exhibit clockwise P-T paths and experienced significant exhumation during isothermal decompression. Overprint between Kuungan structures and 620 Ma East African fabrics resulted in complex interference pattern within the Eastern Granulites. The three orogen portions that converge in Tanzania / Southern Kenya have different orogen styles. The southern ANS formed by transcurrent deformation of an island arc root; the Eastern Granulites by lower crustal channelized flow of a hot inverted passive margin; the Western Granulites by lower to mid crustal stacking of old and cold crustal fragments. Collins, A.S., Pisarevsky, S.A. (2005). Amalgamating eastern Gondwana: The evolution of the Circum-Indian Orogens. Earth-Science Reviews, 71, 229-270. De Waele, B., Kampunzu, A.B., Mapani, B.S.E., Tembo, F. (2006). The Mesoproterozoic Irumide belt of Zambia. Journal of African Earth Sciences, 46, 36-70 Fritz, H., Tenczer, V., Hauzenberger, C., Wallbrecher, E., Muhongo, S. (2009). Hot granulite nappes — Tectonic styles and thermal evolution of the Proterozoic granulite belts in East Africa. Tectonophysics, 477, 160-173.
We compared 19 stocks of Trypanosoma brucei rhodesiense collected in 1991 and 1994 from Tanzania with representative stocks from other foci of Rhodesian sleeping sickness in Zambia, Kenya and Uganda. Stocks were characterized by isoenzyme electrophoresis, restriction fragment length polymorphisms in variant surface glycoprotein genes and random amplification of polymorphic DNA; the banding patterns obtained were coded for numerical analysis. In addition, the Tanzanian stocks were compared by pulsed field gel electrophoresis. Overall the Tanzanian stocks formed a homogeneous group and the predominant genotype isolated in 1991 was still present in the 1994 sample, although at a reduced level. The Tanzanian stocks were distinct from representative stocks from other East African foci. This observation does not support the proposal that there are northern and southern strains of T. b. rhodesiense, but is consistent with the view that T. b. rhodesiense stocks form a mosaic of different genotypes varying from focus to focus in East Africa. PMID:9488868
Komba, E K; Kibona, S N; Ambwene, A K; Stevens, J R; Gibson, W C
A survey of trichinellosis among sylvatic carnivore mammals from the Serengeti ecosystem (Tanzania) demonstrated the presence of Trichinella nelsoni in 5 of 9 species examined. Muscle samples were collected from carcasses of 56 carnivores from 1993 to 1995 and frozen before transport and examination. Following artificial digestion of the samples, collected larvae were analyzed by the random amplified polymorphic DNA technique. Trichinella nelsoni was identified in 1 bat-eared fox (Otocyon megalotis), 1 cheetah (Acinonyx jubatus), 1 leopard (Panthera pardus), 3 lions (Panthera leo), and 3 spotted hyenas (Crocuta crocuta). The numbers of bat-eared foxes (6), cheetahs (5), and leopards (3) examined were too small to reveal the roles of these carnivore species in the ecology of T. nelsoni. The numbers of lions and spotted hyenas examined, with a prevalence of 12% and 23%, respectively, suggest that these species may be reservoirs of T. nelsoni in the area under study. PMID:9406805
Pozio, E; De Meneghi, D; Roelke-Parker, M E; La Rosa, G
In the late 1980s, many developing countries were forced to adopt structural adjustment policies as a condition for securing loans from the International Monetary Fund (IMF) and the World Bank. One of the World Bank's recommended policies was to change the mix of private and public health facilities. This study, based on fieldwork done in Tanzania in 1993, examines the impact of this policy on health-care accessibility in two northern Tanzanian districts, one rural and one urban. Accessibility was measured in terms of equality and equity of coverage. The placement of the very few government clinics opened during the years 1985-1993 did much more to improve coverage than the haphazard location of many new private clinics. Equity was not improved as very few clinics were placed in demographically needy areas. PMID:11352415
Food preparation methods play a role in micronutrient retention and ultimately intake. Analyses for carotenoids retention and in vitro iron bioavailability of five cowpea leaf dishes prepared according to the traditional methods of rural Tanzania were carried out. All the five dishes are commonly eaten as relishes for staple meals of maize or rice. Laboratory analyses were carried out at the Nutrition Laboratory of the World Vegetable Centre in Taiwan. Carotenoids were analysed by high-performance liquid chromatography while iron bioavailability was analysed by an in vitro method. Results showed that traditional cowpea leaf dish consisting of sunflower oil, onion, tomatoes and coconut milk cooked for 30 min had the highest retention of ?-carotene (40.83 ± 7.00%) and lutein (34.60 ± 3.30%) compared to other traditional recipes (p < 0.05). The highest iron bioavailability (10.04 ± 0.49%) was observed in the traditional recipe which involved boiling fresh cowpea leaves for 15 min. Although recipe variation can affect carotenoids retention and iron bioavailability, simple practices such as reduced cooking time and avoiding direct sun drying also need to be promoted. PMID:21942714
Background Food insecurity is an ongoing threat in rural sub-Saharan Africa and is complicated by cultural practices, the rise of chronic conditions such as HIV and land use availability. In order to develop a successful food security intervention program, it is important to be informed of the realities and needs of the target population. The purpose of this study was to pilot a qualitative method to understand food insecurity based on the lived experience of women of the Maasai population in the Ngorongoro Conservation Area of Tanzania. Methods Short semi-structured qualitative interviews with 4 Maasai women. Results Food insecurity was present in the Maasai community: the participants revealed that they did not always have access to safe and nutritious food that met the needs of themselves and their families. Themes that emerged from the data fell into three categories: Current practices (food sources, planning for enough, food preparation, and food preservation), food Insecurity (lack of food, emotions, coping strategies, and possible solutions), and division (co-wives, food distribution, and community relationships). Conclusion This pilot study suggested the presence of food insecurity in the Maasai community. Larger sample studies are needed to clarify the extent and severity of food insecurity among this population. Having a detailed understanding of the various aspects of the food insecurity lived experience could inform a targeted intervention program.
The aim of this study was to assess the primary eye care knowledge, skills, and productivity of primary health workers at dispensaries in a district in Tanzania. Factors likely to contribute to knowledge, skills, and productivity were also assessed. A descriptive cross-sectional study design was used. All health workers employed at government dispensaries in Mwanga District, Kilimanjaro Region, Tanzania were
BACKGROUND: Women continue to be disproportionately affected by HIV in Tanzania, and factors contributing to this situation need to be identified. The objective of this study was to determine social, behavioral and biological risk factors of HIV infection among pregnant women in Moshi urban, Tanzania. In 2002 – 2004, consenting women (N = 2654), attending primary health clinics for routine
Sia E Msuya; Elizabeth Mbizvo; Akhtar Hussain; Jacqueline Uriyo; Noel E Sam; Babill Stray-Pedersen
Background Directly observed therapy (DOT) remains the cornerstone of the global tuberculosis (TB) control strategy. Tanzania, one of the 22 high-burden countries regarding TB, changed the first-line treatment regimen to contain rifampicin-containing fixed-dose combination for the full 6 months of treatment. As daily health facility-based DOT for this long period is not feasible for the patient, nor for the health system, Tanzania introduced patient centred treatment (PCT). PCT allows patients to choose for daily DOT at a health facility or at their home by a supporter of choice. The introduction of fixed dose combinations in the intensive and continuation phase made PCT feasible by eliminating the risk of selective drug taking by patients and reducing the number of tablets to be taken. The approach was tested in three districts with the objective to assess the effect of this strategy on TB treatment outcomes Methods Cohort analysis comparing patients treated under the PCT strategy (registered April-September 2006) with patients treated under health-facility-based DOT (registered April-September 2005). The primary outcome was the cure rate. Differences were assessed by calculating the risk ratios. Associations between characteristics of the supporters and treatment outcomes in the group of patients opting for home-based DOT were assessed through logistic regression. Results In the PCT cohort there were 1208 patients and 1417 were included in the historic cohort. There was no significant difference in cure rates between the cohorts (risk ratio [RR]: 1.06; 95% confidence interval [CI]: 0.96-1.16). In the PCT cohort, significantly more patients had successful treatment (cure or treatment completed; RR: 1.10; 95%CI: 1.01-1.15). There were no characteristics of supporters that were associated with treatment outcome. Conclusion The PCT approach showed similar cure rates and better treatment success rates compared to daily health-facility DOT. The results indicate that there are no specific prerequisites for the supporter chosen by the patient. The programmatic setting of the study lends strong support for scaling-up of TB treatment observation outside the health facility.
Background Reduction in neonatal mortality has been slower than anticipated in many low income countries including Tanzania. Adequate neonatal care may contribute to reduced mortality. We studied factors associated with transfer of babies to a neonatal care unit (NCU) in data from a birth registry at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania. Methods A total of 21 206 singleton live births registered from 2000 to 2008 were included. Multivariable analysis was carried out to study neonatal transfer to NCU by socio-demographic factors, pregnancy complications and measures of the condition of the newborn. Results A total of 3190 (15%) newborn singletons were transferred to the NCU. As expected, neonatal transfer was strongly associated with specific conditions of the baby including birth weight above 4000 g (relative risk (RR) = 7.2; 95% confidence interval (CI) 6.5-8.0) or below 1500 g (RR = 3.0; 95% CI: 2.3-4.0), five minutes Apgar score less than 7 (RR = 4.0; 95% CI: 3.4-4.6), and preterm birth before 34 weeks of gestation (RR = 1.8; 95% CI: 1.5-2.1). However, pregnancy- and delivery-related conditions like premature rupture of membrane (RR = 2.3; 95% CI: 1.9-2.7), preeclampsia (RR = 1.3; 95% CI: 1.1-1.5), other vaginal delivery (RR = 2.2; 95% CI: 1.7-2.9) and caesarean section (RR = 1.9; 95% CI: 1.8-2.1) were also significantly associated with transfer. Birth to a first born child was associated with increased likelihood of transfer (relative risk (RR) 1.4; 95% CI: 1.2-1.5), while the likelihood was reduced (RR = 0.5; 95% CI: 0.3-0.9) when the father had no education. Conclusions In addition to strong associations between neonatal transfer and classical neonatal risk factors for morbidity and mortality, some pregnancy-related and demographic factors were predictors of neonatal transfer. Overall, transfer was more likely for babies with signs of poor health status or a complicated pregnancy. Except for a possibly reduced use of transfer for babies of non-educated fathers and a high transfer rate for first born babies, there were no signs that transfer was based on non-medical indications.
Objectives: To measure the prevalence of urethral infections including trichomoniasis in rural Tanzanian men, to assess the prevalence of symptoms and signs among men with Trichomonas vaginalis, and to analyse the risk factors for trichomoniasis. Design: A cross sectional study of 1004 men aged 15–54 years in a rural community in north west Tanzania. Methods: Participants were interviewed about sexual behaviour and symptoms of sexually transmitted diseases. First fraction urine samples and urethral swabs were collected and used to test for T vaginalis by wet preparation and culture, Neisseria gonorrhoeae by culture, Chlamydia trachomatis by ligase chain reaction and non-specific urethritis by Gram stain. Urine was also tested for the presence of leucocytes using a leucocyte esterase dipstick. Men were re-interviewed 2 weeks later to document new symptoms and signs of urethritis. Results: Complete laboratory results were available on 980 men. One in four men had laboratory evidence of urethritis. T vaginalis was found in 109 individuals (11%), gonorrhoea in eight (0.8%), and chlamydial infection in 15 (1.5%). Over 50% of men with urethritis were asymptomatic. The prevalence of signs and symptoms was similar among men with T vaginalis alone compared with men with other urethral infections. The sensitivity and specificity of the leucocyte esterase dipstick (LED) test for detecting T vaginalis were 80% and 48% respectively in symptomatic men and 60% and 68% in asymptomatic men. Factors associated with trichomoniasis included religion, type of employment, and marital status. Conclusions: A high prevalence of urethritis was found in men in this community based study. More than half of the urethral infections detected were asymptomatic. The most prevalent pathogen was T vaginalis. Studies are needed on the prevalence of trichomoniasis in men presenting to health services with complaints suggestive of urethritis since treatment for T vaginalis is not included in the syndromic management of urethritis in most countries. The performance of the LED test as a screening test for trichomoniasis was unsatisfactory in both symptomatic and asymptomatic men. Improved screening tests are urgently needed to identify urethral infections that are asymptomatic and which are not covered by current syndromic management algorithms. Key Words: urethritis; Tanzania; Trichomonas vaginalis
Background Tanzania has a well-developed network of commercial ITN retailers. In 2004, the government introduced a voucher subsidy for pregnant women and, in mid 2005, helped distribute free nets to under-fives in small number of districts, including Rufiji on the southern coast, during a child health campaign. Contributions of these multiple insecticide-treated net delivery strategies existing at the same time and place to coverage in a poor rural community were assessed. Methods Cross-sectional household survey in 6,331 members of randomly selected 1,752 households of 31 rural villages of Demographic Surveillance System in Rufiji district, Southern Tanzania was conducted in 2006. A questionnaire was administered to every consenting respondent about net use, treatment status and delivery mechanism. Findings Net use was 62.7% overall, 87.2% amongst infants (0 to1 year), 81.8% amongst young children (>1 to 5 years), 54.5% amongst older children (6 to 15 years) and 59.6% amongst adults (>15 years). 30.2% of all nets had been treated six months prior to interview. The biggest source of nets used by infants was purchase from the private sector with a voucher subsidy (41.8%). Half of nets used by young children (50.0%) and over a third of those used by older children (37.2%) were obtained free of charge through the vaccination campaign. The largest source of nets amongst the population overall was commercial purchase (45.1% use) and was the primary means for protecting adults (60.2% use). All delivery mechanisms, especially sale of nets at full market price, under-served the poorest but no difference in equity was observed between voucher-subsidized and freely distributed nets. Conclusion All three delivery strategies enabled a poor rural community to achieve net coverage high enough to yield both personal and community level protection for the entire population. Each of them reached their relevant target group and free nets only temporarily suppressed the net market, illustrating that in this setting that these are complementary rather than mutually exclusive approaches.
Khatib, Rashid A; Killeen, Gerry F; Abdulla, Salim MK; Kahigwa, Elizeus; McElroy, Peter D; Gerrets, Rene PM; Mshinda, Hassan; Mwita, Alex; Kachur, S Patrick
Background Early antenatal care (ANC) initiation is a doorway to early detection and management of potential complications associated with pregnancy. Although the literature reports various factors associated with ANC initiation such as parity and age, pregnancy intentions is yet to be recognized as a possible predictor of timing of ANC initiation. Methods Data originate from a cross-sectional household survey on health behaviour and service utilization patterns. The survey was conducted in 2011 in Rufiji, Kilombero and Ulanga districts in Tanzania on 3,127 women from whom 910 of reproductive age who had given birth in the past two years and sought ANC at least once during pregnancy were selected for the current analysis. ANC initiation was considered to be early only if it occurred in the first trimester of pregnancy gestation. A recently completed pregnancy was defined as mistimed if a woman wanted it later, and if she did not want it at all the pregnancy was termed as unwanted. Chi-square was used to test for associations and multinomial logistic regression was conducted to examine how mistimed and unwanted pregnancies relate with timing of ANC initiation. Results Although 49.3% of the women intended to become pregnant, 50.7% (34.9% mistimed and 15.8% unwanted) became pregnant unintentionally. While ANC initiation in the 1st trimester was 18.5%, so was 71.7% and 9.9% in the 2nd and 3rd trimesters respectively. Multivariate analysis revealed that ANC initiation in the 2nd trimester was 1.68 (95% CI 1.10–2.58) and 2.00 (95% CI 1.05–3.82) times more likely for mistimed and unwanted pregnancies respectively compared to intended pregnancies. These estimates rose to 2.81 (95% CI 1.41–5.59) and 4.10 (95% CI 1.68–10.00) respectively in the 3rd trimester. We controlled for gravidity, age, education, household wealth, marital status, religion, district of residence and travel time to a health facility. Conclusion Late ANC initiation is a significant maternal and child health consequence of mistimed and unwanted pregnancies in Tanzania. Women should be empowered to delay or avoid pregnancies whenever they need to do so. Appropriate counseling to women, especially those who happen to conceive unintentionally is needed to minimize the possibility of delaying ANC initiation.
Background In Tanzania, many people seek malaria treatment from retail drug sellers. The National Malaria Control Program identified the accredited drug dispensing outlet (ADDO) program as a private sector mechanism to supplement the distribution of subsidized artemisinin-based combination therapies (ACTs) from public facilities and increase access to the first-line antimalarial in rural and underserved areas. The ADDO program strengthens private sector pharmaceutical services by improving regulatory and supervisory support, dispenser training, and record keeping practices. Methods The government's pilot program made subsidized ACTs available through ADDOs in 10 districts in the Morogoro and Ruvuma regions, covering about 2.9 million people. The program established a supply of subsidized ACTs, created a price system with a cost recovery plan, developed a plan to distribute the subsidized products to the ADDOs, trained dispensers, and strengthened the adverse drug reactions reporting system. As part of the evaluation, 448 ADDO dispensers brought their records to central locations for analysis, representing nearly 70% of ADDOs operating in the two regions. ADDO drug register data were available from July 2007-June 2008 for Morogoro and from July 2007-September 2008 for Ruvuma. This intervention was implemented from 2007-2008. Results During the pilot, over 300,000 people received treatment for malaria at the 448 ADDOs. The percentage of ADDOs that dispensed at least one course of ACT rose from 26.2% during July-September 2007 to 72.6% during April-June 2008. The number of malaria patients treated with ACTs gradually increased after the start of the pilot, while the use of non-ACT antimalarials declined; ACTs went from 3% of all antimalarials sold in July 2007 to 26% in June 2008. District-specific data showed substantial variation among the districts in ACT uptake through ADDOs, ranging from ACTs representing 10% of all antimalarial sales in Kilombero to 47% in Morogoro Rural. Conclusions The intervention increased access to affordable ACTs for underserved populations. Indications are that antimalarial monotherapies are being "crowded out" of the market. Importantly, the transition to ACTs has been accomplished in an environment where the safety and efficacy of the drugs and the quality of services are being monitored and regulated. This paper presents a description of the pilot program implementation, results of the program evaluation, and a discussion of the challenges and recommendations that will be used to guide rollout of subsidized ACT in ADDOs in the rest of Tanzania and possibly in other countries.
Background Splenic injuries constitute a continuing diagnostic and therapeutic challenge to the trauma or general surgeons practicing in developing countries where sophisticated imaging facilities are either not available or exorbitantly expensive. The purpose of this review was to describe our own experience in the management of the splenic injuries outlining the aetiological spectrum, injury characteristics and treatment outcome of splenic injuries in our local environment and to identify predictors of outcome among these patients. Methods A prospective descriptive study of splenic injury patients was carried out at Bugando Medical Centre in Northwestern Tanzania between March 2009 and February 2011. Statistical data analysis was done using SPSS software version 17.0. Results A total of 118 patients were studied. The male to female ratio was 6.4:1. Their ages ranged from 8 to 74 years with a median age of 22 years. The modal age group was 21-30 years. The majority of patients (89.8%) had blunt trauma and road traffic accidents (63.6%) were the most frequent cause of injuries. Most patients sustained grade III (39.0%) and IV (38.1%) splenic injuries. Majority of patients (86.4%) were treated operatively with splenectomy (97.1%) being the most frequently performed procedure. Postoperative complications were recorded in 30.5% of cases. The overall length of hospital stay (LOS) ranged from 1 day to 120 days with a median of 18 days. Mortality rate was 19.5%. Patients who had severe trauma (Kampala Trauma Score II ? 6) and those with associated injuries stayed longer in the hospital (P < 0.001), whereas age of the patient, associated injuries, trauma scores (KTS II), grade of splenic injuries, admission systolic blood pressure ? 90 mmHg, estimated blood loss > 2000 mls, HIV infection with CD4 ? 200 cells/?l and presence of postoperative complications were significantly associated with mortality (P < 0.001). Conclusion Trauma resulting from road traffic accidents (RTAs) remains the most common cause of splenic injuries in our setting. Most of the splenic injuries were Grade III & IV and splenectomy was performed in majority of the cases. Non-operative management can be adopted in patients with blunt isolated and low grade splenic injuries but operative management is still indispensable in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of splenic injuries in our centre.
|Purpose: To identify and review production and marketing information sources and flows for smallholder cashew (Anacardium occidentale L.) growers in Tanzania and recommend systems improvements for better technology uptake. Design/methodology/approach: Two-stage purposive samples were drawn. First, two districts in the main cashew producing areas,…
In recent years, relationships among religion, development, and globalization have been discussed critically with regard to the potentially beneficial as well as detrimental opportunities that the work of faith-based organizations (FBOs) presents in relation to HIV\\/AIDS. Drawing on the case studies of two neo-Pentecostal congregations in Dar es Salaam, this article describes how religious actors in urban Tanzaniaâ€”including those who
Background Largely due to the lack of diagnostic reagents, the prevalence and clinical presentation of cryptococcal meningitis in Tanzania is poorly understood. This in turn is limiting the impact of increased fluconazole availability. Methods We evaluated a cohort of 149 consecutive HIV-infected adult inpatients presenting with headache or altered mental status for clinical features, CD4 count, cryptococcal infection, and outcome. Cryptococcal meningitis was diagnosed via India ink and latex agglutination assay of CSF (n = 24 and 40 positive, respectively). Associations between cryptococcal meningitis and clinical features were evaluated by t-test. The sensitivity, specificity, and positive likelihood ratio of such features were determined. Results Cryptococcal meningitis was associated with confusion, social withdrawal, seizures, fever, tachycardia, meningismus, oral candidiasis, and low Glasgow coma scales and CD4 count. CD4 count < 100/?l provided the highest sensitivity for the diagnosis (93%), coma (Glasgow coma scale ? 8) provided the highest specificity (84%), and the combination provided the highest positive likelihood ratio (3.8). All cryptococcal meningitis patients were initiated on 800 milligrams of fluconazole daily and 50% survived to discharge, however no clinical or laboratory findings correlated with prognosis. Conclusion Cryptococcal meningitis is common among Tanzanian HIV inpatients presenting with headache or altered mental status. Purely clinical features are insensitive for establishing the diagnosis or prognosis. We advocate expanding laboratory capacity for cryptococcal antigen testing to maximize survival.
Kisenge, Peter R; Hawkins, Alexander T; Maro, Venance P; Mchele, John PD; Swai, Ndealilia S; Mueller, Andreas; Houpt, Eric R
Objectives. We fielded a population-based discrete choice experiment (DCE) in rural western Tanzania, where only one third of women deliver children in a health facility, to evaluate health-system factors that influence women's delivery decisions. Methods. Women were shown choice cards that described 2 hypothetical health centers by means of 6 attributes (distance, cost, type of provider, attitude of provider, drugs and equipment, free transport). The women were then asked to indicate which of the 2 facilities they would prefer to use for a future delivery. We used a hierarchical Bayes procedure to estimate individual and mean utility parameters. Results. A total of 1203 women completed the DCE. The model showed good predictive validity for actual facility choice. The most important facility attributes were a respectful provider attitude and availability of drugs and medical equipment. Policy simulations suggested that if these attributes were improved at existing facilities, the proportion of women preferring facility delivery would rise from 43% to 88%. Conclusions. In regions in which attended delivery rates are low despite availability of primary care facilities, policy experiments should test the effect of targeted quality improvements on facility use.
Paczkowski, Magdalena; Mbaruku, Godfrey; de Pinho, Helen; Galea, Sandro
Background Face washing is important to interrupt the transmission of trachoma, the leading infectious cause of blindness worldwide. We aimed to assess the household and personal factors that affected water use and face washing practices in Kongwa, Tanzania. Methods We conducted a household water use survey in 173 households (329 children) in January, 2010. Self reported data on water use practices, observed water in the household, and observed clean faces in children were collected. Contingency table analyses and logistic regression analyses were used to measure associations between unclean faces and risk factors. Results We found that women are recognized as primary decision makers on water use in a household, and respondents who reported laziness as a reason that others do not wash children's faces were significantly more likely to have children with clean faces. Washing was reported as a priority for water use in most households. Sixty four percent (95% Confidence Interval = 59%-70%) of children had clean faces. Conclusions Attitudes toward face washing and household water use appear to have changed dramatically from 20 years ago when clean faces were rare and men made decisions on water use in households. The sources of these attitudinal changes are not clear, but are positive changes that will assist the trachoma control program in strengthening its hygiene efforts.
OBJECTIVE: Household willingness to pay for treatment provides important information for programme planning. We tested for relationships between socioeconomic status, risk of trachoma, perceptions of the effects of azithromycin, and the household willingness to pay for future mass treatment with azithromycin. METHODS: We surveyed 394 households in 6 villages located in central United Republic of Tanzania regarding their willingness to pay for future azithromycin treatment. A random sample of households with children under 8 years of age was selected and interviewed following an initial treatment programme in each village. Data were gathered on risk factors for trachoma, socioeconomic status, and the perceived effect of the initial azithromycin treatment. Ordered probit regression analysis was used to test for statistically significant relationships. FINDINGS: 38% of responding households stated that they would not be willing to pay anything for future azithromycin treatment, although they would be willing to participate in the treatment. A proxy for cash availability was positively associated with household willingness to pay for future antibiotic treatment. Cattle ownership (a risk factor) and being a household headed by a female not in a polygamous marriage (lower socioeconomic status) were associated with a lower willingness to pay for future treatment. A perceived benefit from the initial treatment was marginally associated with a willingness to pay a higher amount. CONCLUSIONS: As those at greatest risk of active trachoma indicated the lowest willingness to pay, imposing a cost recovery fee for azithromycin treatment would likely reduce coverage and could prevent control of the disease at the community level.
Frick, Kevin D.; Lynch, Matthew; West, Sheila; Munoz, Beatriz; Mkocha, Harran A.
Introduction. We report cause of death and care-seeking prior to death in neonates based on interviews with relatives using a Verbal Autopsy questionnaire. Materials and Methods. We identified neonatal deaths between 2004 and 2007 through a large household survey in 2007 in five rural districts of southern Tanzania. Results. Of the 300 reported deaths that were sampled, the Verbal Autopsy (VA) interview suggested that 11 were 28 days or older at death and 65 were stillbirths. Data was missing for 5 of the reported deaths. Of the remaining 219 confirmed neonatal deaths, the most common causes were prematurity (33%), birth asphyxia (22%) and infections (10%). Amongst the deaths, 41% (90/219) were on the first day and a further 20% (43/219) on day 2 and 3. The quantitative results matched the qualitative findings. The majority of births were at home and attended by unskilled assistants. Conclusion. Caregivers of neonates born in health facility were more likely to seek care for problems than caregivers of neonates born at home. Efforts to increase awareness of the importance of early care-seeking for a premature or sick neonate are likely to be important for improving neonatal health.
Hypertension, congestive heart failure, and valvular heart disease are frequently seen among hospital inpatients in the United Republic of Tanzania. A population survey was therefore carried out to determine the prevalence of hypertension and cardiac murmurs in a random sample of people aged 25-64 years living in an undeveloped rural area. Standard cardiovascular survey methods as recommended by WHO were used. Only mean systolic blood pressure in women increased with age; even so, the difference in mean levels between those aged 25-34 and 55-64 years was only about 1.6 kPa (12 mmHg). Hypertension was found to be uncommon, only 2% of subjects having blood pressures ? 21.3/ 12.7 kPa (? 160/95 mmHg). By means of multiple regression analysis, less than 10% of the variance in blood pressure levels could be explained by age and anthropometric measurements. Murmurs of grade 2 or more were detected in 17% of the men and 22% of the women, being most commonly heard at the apex (54%) and the left lower border of the sternum (31%). Mitral valve diastolic murmurs were heard in 4 of 275 women and these were asymptomatic. The cause of the high prevalence of systolic murmurs is unknown.
Background To design effective, tailored interventions to support antiretroviral therapy (ART) adherence, a thorough understanding of the barriers and facilitators of ART adherence is required. Factors at the individual and interpersonal level, ART treatment characteristics and health care factors have been proposed as important adherence determinants. Methods To identify the most relevant determinants of adherence in northern Tanzania, in-depth interviews were carried out with 61 treatment-experienced patients from four different clinics. The interviews were ad-verbatim transcribed and recurrent themes were coded. Results Coding results showed that the majority of patients had basic understanding of adherence, but also revealed misconceptions about taking medication after alcohol use. Adherence motivating beliefs were the perception of improved health and the desire to live like others, as well as the desire to be a good parent. A de-motivating belief was that stopping ART after being prayed for was an act of faith. Facilitators of adherence were support from friends and family, and assistance of home based care (HBC) providers. Important barriers to ART adherence were the use of alcohol, unavailability of food, stigma and disclosure concerns, and the clinics dispensing too few pills. Strategies recommended by the patients to improve adherence included better Care and Treatment Centre (CTC) services, recruitment of patients to become Home Based Care ( HBC) providers, and addressing the problem of stigma through education. Conclusion This study underscores the importance of designing tailored, patient-centered adherence interventions to address challenges at the patient, family, community and health care level.
Background Diagnostic delay in patients with tuberculosis (TB) leads to ongoing TB transmission, higher mortality rates and increased patient and government health expenditure. Qualitative research focussed on patients’ self-perceptions of disease and their care-seeking behaviour helps to guide health education programmes by providing us with the understanding of the knowledge, attitudes and practices that underlie diagnostic delay. Patients and methods Semi-structured interviews with 28 recently diagnosed TB patients and four traditional healers were conducted. The interviews were audio-recorded and content analysis was performed. Results The median total delay was 188 days. The health provider delay (31 days) was longer than the patient delay (21 days) and the health system delay (26 days). The health system delay was longest in patients not being diagnosed at their first hospital visit and subsequently visiting other health care providers, mostly traditional healers. Conclusions A poor knowledge of TB signs and symptoms and patients’ beliefs about curses as the origin of diseases lead to delayed care-seeking at the hospital level in an area of North-Western Tanzania. Failure to identify TB cases by formal and non-formal health providers indicates that the education of both communities as well as health workers is essential in order to reduce diagnostic delays.
Background Injuries rank high among the leading causes of death and disability annually, injuring over 50 million and killing over 5 million people globally. Approximately 90% of these deaths occur in developing countries. Objectives To estimate and identify the risk factors for injury mortality in the Rufiji Health and Demographic Surveillance System (RHDSS) in Tanzania. Methods Secondary data from the RHDSS covering the period 2002 and 2007 was examined. Verbal autopsy data was used to determine the causes of death based on the 10th revision of the International Classification of Diseases (ICD-10). Trend and Poisson regression tests were used to investigate the associations between risk factors and injury mortality. Results The overall crude injury death rate was 33.4/100?000 population. Injuries accounted for 4% of total deaths. Men were three times more likely to die from injuries compared with women (adjusted IRR (incidence risk ratios)=3.04, p=0.001, 95% CI (2.22 to 4.17)). The elderly (defined as 65+) were 2.8 times more likely to die from injuries compared with children under 15?years of age (adjusted IRR=2.83, p=0.048, 95% CI (1.01 to 7.93)). The highest frequency of deaths resulted from road traffic crashes. Conclusions Injury is becoming an important cause of mortality in the Rufiji district. Injury mortality varied by age and gender in this area. Most injuries are preventable, policy makers need to institute measures to address the issue.
Background Insecticide-treated nets (ITNs) and indoor residual spraying (IRS) represent the front-line tools for malaria vector control\\u000a globally, but are optimally effective where the majority of baseline transmission occurs indoors. In the surveyed area of\\u000a rural southern Tanzania, bed net use steadily increased over the last decade, reducing malaria transmission intensity by 94%.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Starting before bed nets were introduced (1997), and
Tanya L Russell; Nicodem J Govella; Salum Azizi; Christopher J Drakeley; S Patrick Kachur; Gerry F Killeen
Background The success of the universal parasite-based malaria testing policy for fever patients attending primary health care (PHC) facilities in Tanzania will depend highly on health workers’ perceptions and practices. The aim of this study was, therefore, to assess the present use of malaria diagnostics (rapid diagnostic tests (RDTs) and microscopy), prescription behaviour and factors affecting adherence to test results at PHC facilities in Kibaha District, Coast Region, Tanzania. Methods Exit interviews were conducted with fever patients at PHC facilities and information on diagnostic test performed and treatment prescribed were recorded. Interviews with prescribers to assess their understanding, perceptions and practices related to RDTs were conducted, and health facility inventory performed to assess availability of staff, diagnostics and anti-malarial drugs. Results The survey was undertaken at ten governmental PHC facilities, eight of which had functional diagnostics. Twenty health workers were interviewed and 195 exit interviews were conducted with patients at the PHC facilities. Of the 168 patients seen at facilities with available diagnostics, 105 (63%) were tested for malaria, 31 (30%) of whom tested positive. Anti-malarial drugs were prescribed to all patients with positive test results, 14% of patients with negative results and 28% of patients not tested for malaria. Antibiotics were more likely to be prescribed to patients with negative test results compared to patients with positive results (81 vs 39%, p?0.01) and among non-tested compared to those tested for malaria (84 vs 69%, p?=?0.01). Stock-outs of RDTs and staff shortage accounted for the low testing rate, and health worker perceptions were the main reason for non-adherence to test results. Conclusions Anti-malarial prescription to patients with negative test results and those not tested is still practiced in Tanzania despite the universal malaria testing policy of fever patients. The use of malaria diagnostics was also associated with higher prescription of antibiotics among patients with negative results. Strategies to address health system factors and health worker perceptions associated with these practices are needed.
Background In 2006, researchers and decision-makers launched a five-year project - Response to Accountable Priority Setting for Trust in Health Systems (REACT) - to improve planning and priority-setting through implementing the Accountability for Reasonableness framework in Mbarali District, Tanzania. The objective of this paper is to explore the acceptability of Accountability for Reasonableness from the perspectives of the Council Health Management Team, local government officials, health workforce and members of user boards and committees. Methods Individual interviews were carried out with different categories of actors and stakeholders in the district. The interview guide consisted of a series of questions, asking respondents to describe their perceptions regarding each condition of the Accountability for Reasonableness framework in terms of priority setting. Interviews were analysed using thematic framework analysis. Documentary data were used to support, verify and highlight the key issues that emerged. Results Almost all stakeholders viewed Accountability for Reasonableness as an important and feasible approach for improving priority-setting and health service delivery in their context. However, a few aspects of Accountability for Reasonableness were seen as too difficult to implement given the socio-political conditions and traditions in Tanzania. Respondents mentioned: budget ceilings and guidelines, low level of public awareness, unreliable and untimely funding, as well as the limited capacity of the district to generate local resources as the major contextual factors that hampered the full implementation of the framework in their context. Conclusion This study was one of the first assessments of the applicability of Accountability for Reasonableness in health care priority-setting in Tanzania. The analysis, overall, suggests that the Accountability for Reasonableness framework could be an important tool for improving priority-setting processes in the contexts of resource-poor settings. However, the full implementation of Accountability for Reasonableness would require a proper capacity-building plan, involving all relevant stakeholders, particularly members of the community since public accountability is the ultimate aim, and it is the community that will live with the consequences of priority-setting decisions.
Background The development of antimalarial drug resistance has led to increasing calls for the introduction of artemisinin-based combination therapy (ACT). However, little evidence is available on the full costs associated with changing national malaria treatment policy. This paper presents findings on the actual drug and non-drug costs associated with deploying ACT in one district in Tanzania, and uses these data to estimate the nationwide costs of implementation in a setting where identification of malaria cases is primarily dependant on clinical diagnosis. Methods Detailed data were collected over a three year period on the financial costs of providing ACT in Rufiji District as part of a large scale effectiveness evaluation, including costs of drugs, distribution, training, treatment guidelines and other information, education and communication (IEC) materials and publicity. The district-level costs were scaled up to estimate the costs of nationwide implementation, using four scenarios to extrapolate variable costs. Results The total district costs of implementing ACT over the three year period were slightly over one million USD, with drug purchases accounting for 72.8% of this total. The composite (best) estimate of nationwide costs for the first three years of ACT implementation was 48.3 million USD (1.29 USD per capita), which varied between 21 and 67.1 million USD in the sensitivity analysis (2003 USD). In all estimates drug costs constituted the majority of total costs. However, non-drug costs such as IEC materials, drug distribution, communication, and health worker training were also substantial, accounting for 31.4% of overall ACT implementation costs in the best estimate scenario. Annual implementation costs are equivalent to 9.5% of Tanzania's recurrent health sector budget, and 28.7% of annual expenditure on medical supplies, implying a 6-fold increase in the national budget for malaria treatment. Conclusion The costs of implementing ACT are substantial. Although drug purchases constituted a majority of total costs, non-drug costs were also considerable. It is clear that substantial external resources will be required to facilitate and sustain effective ACT delivery across Tanzania and other malaria-endemic countries.
Njau, Joseph D; Goodman, Catherine A; Kachur, S Patrick; Mulligan, Jo; Munkondya, John S; Mchomvu, Naiman; Abdulla, Salim; Bloland, Peter; Mills, Anne
Background In 1995, Tanzania introduced the voluntary Community Health Fund (CHF) with the aim of ensuring universal health coverage by increasing financial investment in the health sector. The uptake of the CHF is low, with an enrolment of only 6% compared to the national target of 75%. Mandatory models of community health financing have been suggested to increase enrolment and financial capacity. This study explores communities’ views on the introduction of a mandatory model, the Compulsory Community Health Fund (CCHF) in the Liwale district of Tanzania. Methods A cross-sectional study which involved 387 participants in a structured face to face survey and 33 in qualitative interviews (26 in focus group discussions (FGD) and 7 in in-depth interviews (IDI). Structured survey data were analyzed using SPSS version 16 to produce descriptive statistics. Qualitative data were analyzed using content analysis. Results 387 people completed a survey (58% males), mean age 38 years. Most participants (347, 89.7%) were poor subsistence farmers and 229 (59.2%) had never subscribed to any form of health insurance scheme. The idea of a CCHF was accepted by 221 (57%) survey participants. Reasons for accepting the CCHF included: reduced out of pocket expenditure, improved quality of health care and the removal of stigma for those who receive waivers at health care delivery points. The major reason for not accepting the CCHF was the poor quality of health care services currently offered. Participants suggested that enrolment to the CCHF be done after harvesting when the population were more likely to have disposable income, and that the quality care of care and benefits package be improved. Conclusions The CHF is acceptable to the most of study participants and feasible in rural Tanzania as an alternative mechanism to finance health care for the rural poor. Community members are willing to join the scheme provided they are well informed, involved in the design and implementation, and assured quality health care. Strong political will and a supportive environment are key ingredients for the success of the CCHF.
Background The majority of adolescents in Africa experience pregnancy, childbirth and enter motherhood without adequate information about maternal health issues. Information about these issues could help them reduce their pregnancy related health risks. Existing studies have concentrated on adolescents' knowledge of other areas of reproductive health, but little is known about their awareness and knowledge of safe motherhood issues. We sought to bridge this gap by assessing the knowledge of school pupils regarding safe motherhood in Mtwara Region, Tanzania. Methods We used qualitative and quantitative descriptive methods to assess school pupils' knowledge of safe motherhood and HIV/AIDS in pregnancy. An anonymous questionnaire was used to assess the knowledge of 135 pupils ranging in age from 9 to 17 years. The pupils were randomly selected from 3 primary schools. Underlying beliefs and attitudes were assessed through focus group interviews with 35 school children. Key informant interviews were conducted with six schoolteachers, two community leaders, and two health staffs. Results Knowledge about safe motherhood and other related aspects was generally low. While 67% of pupils could not mention the age at which a girl may be able to conceive, 80% reported it is safe for a girl to be married before she reaches 18 years. Strikingly, many school pupils believed that complications during pregnancy and childbirth are due to non-observance of traditions and taboos during pregnancy. Birth preparedness, important risk factors, danger signs, postpartum care and vertical transmission of HIV/AIDS and its prevention measures were almost unknown to the pupils. Conclusion Poor knowledge of safe motherhood issues among school pupils in rural Tanzania is related to lack of effective and coordinated interventions to address reproductive health and motherhood. For long-term and sustained impact, school children must be provided with appropriate safe motherhood information as early as possible through innovative school-based interventions.
Mushi, Declare L; Mpembeni, Rose M; Jahn, Albrecht
Because thiacetazone has been linked with serious adverse cutaneous reactions, we undertook 1 year of systematic surveillance for cutaneous thiacetazone-associated adverse reactions within the national tuberculosis programme of Tanzania. For individual cases, we collected information on age, sex, interval between commencing thiacetazone-containing treatment and occurrence of adverse reaction, most severe clinical presentation (toxic epidermal necrolysis, rash without necrolysis, itching without rash), and outcome (dead or alive) within 2 weeks of onset. Univariate and multivariate analyses were done of variables relevant to outcome. 1273 patients with adverse reactions were reported. The frequency of fatal outcome from any cutaneous reaction was 3.1 per 1000 among all tuberculosis patients, and 19.1% among patients with toxic epidermal necrolysis. About 60% of all adverse reactions and deaths occurred within 20 days of starting thiacetazone. Case fatality from adverse cutaneous reactions was considerably less frequent than reported previously, suggesting that improved management might allow retention of thiacetazone in the armamentarium of national tuberculosis programmes even where infection with HIV is prevalent. PMID:7544858
Parasitological surveillance in primates has been performed using coprological observation and identification of specimens from chimpanzees (Pan troglodytes schweinfurthii) in Mahale Mountains National Park, Tanzania (Mahale). In this study, we conducted coprological surveillance to identify the fauna of parasite infection in five primate species in Mahale: red colobus (Procolobus badius tephrosceles), red-tailed monkeys (Cercopithecus ascanius schmidti), vervet monkeys (Cercopithecus aethiops pygerythrus), yellow baboons (Papio cynocephalus), and chimpanzees. Fecal samples were examined microscopically, and parasite identification was based on the morphology of cysts, eggs, larvae, and adult worms. Three nematodes (Oesophagostomum spp., Strongyloides sp., and Trichuris sp.), Entamoeba coli, and Entamoeba spp. were found in all five primate species. The following infections were identified: Bertiella studeri was found in chimpanzees and yellow baboons; Balantidium coli was found in yellow baboons; three nematodes (Streptopharagus, Primasubulura, an undetermined genus of Spirurina) and Dicrocoeliidae gen. sp. were found in red-tailed monkeys, vervet monkeys, and yellow baboons; Chitwoodspirura sp. was newly identified in red colobus and red-tailed monkeys; Probstmayria gombensis and Troglocorys cava were newly identified in chimpanzees, together with Troglodytella abrassarti; and Enterobius sp. was newly identified in red colobus. The parasitological data reported for red colobus, vervet monkeys, and yellow baboons in Mahale are the first reports for these species. PMID:22661394
A variety of macroplants has been recorded and collected from the eastern paleolake margin of Olduvai Gorge, Tanzania, from Upper Bed I and Lower Bed II, dated at ~1.7-1.85 Ma. The plant groups represented are sedges, grasses, and woody and herbaceous dicotyledons. Most of these plants are fragmented, but the roots are in situ. The modes and quality of preservation, however, are very variable. Silicification is the dominant type of preservation; it ranges from high quality faithful replacement of cells resulting in silicified wood and sedge culms that are identifiable on the basis of their internal anatomy, to poor quality biotubes lacking internal anatomy or external features that prevent assignment to a specific plant or invertebrate origin. In between this range are silicified roots and grass culms identified by their external anatomy, and leaf and stem impressions. Interpretation of the paleoecology is limited by the quality of preservation. The in situ root horizons are useful for recognizing paleo-surfaces. The best quality preservation where internal anatomy is preserved occurs at HWK E and MCK, localities that are in the middle of the fault compartments so the vegetation can be reconstructed for these sites. Some sedge culms are described, illustrated, and identified as possible species of Cyperus, Fuirena, and Schoenoplectus. PMID:21930291
The aim of this study was to identify factors that influenced career choice among high school students in Tanzania. The information obtained would be used to formulate effective recruitment strategies and counseling students on their career expectations in dentistry. All 352 high school students who were studying in five randomly selected high schools completed a pre-tested questionnaire containing twenty-four items addressing five factors. Image of a profession (good experiences from the work of professionals, professionals who are attractive to respondents, and professionals who command high respect in the community) was perceived as an important factor in career choice by the majority of respondents (over 88 percent). Work/profession characteristics (knowledge about work to be done, treating patients, giving medicines to patients, helping relatives, etc.) was ranked as the second most important factor, and course characteristics (availability of postgraduate studies, size of annual intake, pass rate, geographic location, etc.) was ranked third. Direct gains and advice from important persons were perceived as least important in career choice. PMID:10914094
Mugonzibwa, E A; Kikwilu, E N; Rugarabamu, P N; Ntabaye, M K
Vitamin D has a potential role in preventing HIV-related complications, based on its extensive involvement in immune and metabolic function, including preventing osteoporosis and premature cardiovascular disease. However, this association has not been examined in large studies or in resource-limited settings. Vitamin D levels were assessed in 884 HIV-infected pregnant women at enrollment in a trial of multivitamin supplementation (excluding vitamin D) in Tanzania. Information on HIV related complications was recorded during follow-up (median, 70 months). Proportional hazards models and generalized estimating equations were used to assess the relationship of vitamin D status with these outcomes. Women with low vitamin D status (serum 25-hydroxyvitamin D<32 ng/mL) had 43% higher risk of reaching a body mass index (BMI) less than 18 kg/m(2) during the first 2 years of follow-up, compared to women with adequate vitamin D levels (hazard ratio [HR]: 1.43; 95% confidence intervals: [1.03-1.99]). The relationship between continuous vitamin D levels and risk of BMI less than 18 kg/m(2) during follow-up was inverse and linear (p=0.03). Women with low vitamin D levels had significantly higher incidence of acute upper respiratory infections (HR: 1.27 [1.04-1.54]) and thrush (HR: 2.74 [1.29-5.83]) diagnosed during the first 2 years of follow-up. Low vitamin D status was a significant risk factor for wasting and HIV-related complications such as thrush during follow-up in this prospective cohort in Tanzania. If these protective associations are confirmed in randomized trials, vitamin D supplementation could represent a simple and inexpensive method to improve health and quality of life of HIV-infected patients, particularly in resource-limited settings. PMID:21916603
Mehta, Saurabh; Mugusi, Ferdinand M; Spiegelman, Donna; Villamor, Eduardo; Finkelstein, Julia L; Hertzmark, Ellen; Giovannucci, Edward L; Msamanga, Gernard I; Fawzi, Wafaie W
Background There is growing evidence that patients frequently bypass primary health care (PHC) facilities in favour of higher level hospitals regardless of substantial additional time and costs. Among the reasons given for bypassing are poor services (including lack of drugs and diagnostic facilities) and lack of trust in health workers. The World Health Report 2008 “PHC now more than ever” pointed to the importance of organizing health services around people’s needs and expectations as one of the four main issues of PHC reforms. There is limited documentation of user’s expectations to services offered at PHC facilities. The current study is a community extension of a hospital-based survey that showed a high bypassing frequency of PHC facilities among caretakers seeking care for their underfive children at two district hospitals. We aimed to explore caretakers’ perceptions and expectations to services offered at PHC facilities in their area with reference to their experiences seeking care at such facilities. Methods We conducted four community-based focus group discussions (FGD’s) with 47 caretakers of underfive children in Muheza district of Tanga region, Tanzania in October 2009. Results Lack of clinical examinations and laboratory tests, combined with shortage of drugs and health workers, were common experiences. Across all the focus group discussions, unpleasant health workers’ behaviors, lack of urgency and unnecessary delays were major complaints. In some places, unauthorized fees reduced access to services. Conclusion The study revealed significant disappointments among caretakers with regard to the quality of services offered at PHC facilities in their areas, with implications for their utilization and proper functioning of the referral system. Practices regarding partial drugs administrations, skipping of injections, unofficial payments and consultations by unskilled health care providers need urgent action. There is also a need for proper accountability mechanisms to govern appropriate allocation and monitoring of health care resources and services in Tanzania.
A national HIV/AIDS and malaria parasitological survey was carried out in Tanzania in 2007–2008. In this study the parasitological data were analyzed: i) to identify climatic/environmental, socio-economic and interventions factors associated with child malaria risk and ii) to produce a contemporary, high spatial resolution parasitaemia risk map of the country. Bayesian geostatistical models were fitted to assess the association between parasitaemia risk and its determinants. Bayesian kriging was employed to predict malaria risk at unsampled locations across Tanzania and to obtain the uncertainty associated with the predictions. Markov chain Monte Carlo (MCMC) simulation methods were employed for model fit and prediction. Parasitaemia risk estimates were linked to population data and the number of infected children at province level was calculated. Model validation indicated a high predictive ability of the geostatistical model, with 60.00% of the test locations within the 95% credible interval. The results indicate that older children are significantly more likely to test positive for malaria compared with younger children and living in urban areas and better-off households reduces the risk of infection. However, none of the environmental and climatic proxies or the intervention measures were significantly associated with the risk of parasitaemia. Low levels of malaria prevalence were estimated for Zanzibar island. The population-adjusted prevalence ranges from in Kaskazini province (Zanzibar island) to in Mtwara region. The pattern of predicted malaria risk is similar with the previous maps based on historical data, although the estimates are lower. The predicted maps could be used by decision-makers to allocate resources and target interventions in the regions with highest burden of malaria in order to reduce the disease transmission in the country.
Background Of global concern is the decline in under five children mortality which has reversed in some countries in sub Saharan Africa (SSA) since the early 1990 s which could be due to disparities in access to preventive services including immunization. This paper is aimed at determining the trend in disparities in completion of immunization using Tanzania Demographic and Health Surveys (DHS). Methods DHS studies randomly selected representative households from all regions in Tanzania since 1980 s, is repeated every five years in the same enumeration areas. The last three data sets (1990, 1996 and 2004) were downloaded and analyzed using STATA 9.0. The analysis included all children of between 12-23 months who would have completed all vaccinations required at 12 months. Results Across the time periods 1990, 1996 to 2004/05 the percentage of children completing vaccination was similar (71.0% in 1990, 72.7% in 1996 and 72.3% in 2005). There was no disparity in completion of immunization with wealth strata in 1990 and 1996 (p > 0.05) but not 2004. In 2004/05 there was marked disparity as most poor experienced significant decline in immunization completion while the least poor had significant increase (p < 0.001). All three periods children from households whose head had low education were less likely to complete immunization (p < 0.01). Conclusion Equity that existed in 1990 and more pronounced in 1996 regressed to inequity in 2005, thus though at national level immunization coverage did not change, but at sub-group there was significant disparity associated with the changing contexts and reforms. To address sub-group disparities in immunization it is recommended to adopt strategies focused at governance and health system to reach all population groups and most poor.
Background In Tanzania, malaria is the major cause of morbidity and mortality, accounting for about 30% of all hospital admissions and around 15% of all hospital deaths. Severe anaemia and cerebral malaria are the two main causes of death due to malaria in Tanga, Tanzania. Methods This was a prospective observational hospital-based study conducted from October 2004 to September 2005. Consent was sought from study participants or guardians in the wards. Finger prick blood was collected from each individual for thick and thin smears, blood sugar levels and haemoglobin estimations by Haemocue machine after admission. Results A total of 494 patients were clinically diagnosed and admitted as cases of severe malaria. Majority of them (55.3%) were children below the age of 5 years. Only 285 out of the total 494 (57.7%) patients had positive blood smears for malaria parasites. Adults aged 20 years and above had the highest rate of cases with fever and blood smear negative for malaria parasites. Commonest clinical manifestations of severe malaria were cerebral malaria (47.3%) and severe anaemia (14.6%), particularly in the under-fives. Case fatality was 3.2% and majority of the deaths occurred in the under-fives and adults aged 20 years and above with negative blood smears. Conclusion Proper laboratory diagnosis is crucial for case management and reliable data collection. The non-specific nature of malaria symptomatologies limits the use of clinical diagnosis and the IMCI strategy. Strengthening of laboratory investigations to guide case management is recommended.
Background Trimethoprim-sulfamethoxazole (SXT) reduces morbidity and mortality among HIV-infected persons in Africa, but its impact on antimicrobial resistance is of concern. Methods HIV-uninfected (group A), HIV-infected but not requiring SXT (group B), and HIV-infected and eligible for SXT (group C) adults were recruited into a prospective observational cohort study in Moshi, Tanzania. Stool was examined for Escherichia coli nonsusceptible to SXT at baseline and at weeks 1, 2, 4, and 24. General estimating equation models were used to assess differences in susceptibility over time and cross-resistance to other antimicrobials. Results Of 181 subjects, 118 (65.1%) were female and the median (range) age was 36 (20 to 72) years. At baseline, E. coli nonsusceptible to SXT was isolated from 23 (53.5%) of 43 patients in group A, 25 (67.6%) of 37 patients in group B, and 37 (64.9%) of 57 patients in group C. The odds ratios (P value) for SXT nonsusceptibility in group C at weeks 1, 2, 4, and 24 compared with baseline were 3.4 (0.013), 3.0 (0.019), 2.9 (0.030), and 1.5 (0.515), respectively. SXT nonsusceptibility was associated with nonsusceptibility to ampicillin, chloramphenicol, ciprofloxacin, and nalidixic acid (P ? 0.006). Conclusion In Tanzania, carriage of fecal E. coli nonsusceptible to SXT is common before SXT prophylaxis. Initiation of SXT leads to further loss of susceptibility to SXT and to other antimicrobials.
Morpeth, Susan C.; Thielman, Nathan M.; Ramadhani, Habib O.; Hamilton, John D.; Ostermann, Jan; Kisenge, Peter R.; Shao, Humphrey J.; Reller, L. Barth; Itemba, Dafrosa K.; Sam, Noel E.; Bartlett, John A.; Shao, John F.; Crump, John A.
Background Antimicrobial resistance is fast becoming a global concern with rapid increases in multidrug-resistant Gram negative organisms. The prevalence of extended spectrum beta-lactamase (ESBL)-producing clinical isolates increases the burden on implementing infectious disease management in low socio-economic regions. As incidence can vary widely between regions, this study was done to determine resistance patterns of Gram-negative organisms at Bugando Medical Center, a tertiary hospital in Mwanza, Tanzania. Methods A total of 800 clinical samples (urine, wound swab, pus, blood, aspirate, sputum etc) were processed over a period of 6 months. Gram-negative bacteria were identified using conventional in-house biochemical tests and susceptibility to common antibiotics done using disc diffusion methods. The disc approximation method was used to identify ESBL producers. Results A total of 377 Gram-negative bacteria (GNB) recovered from 377 clinical specimens were analyzed of which 76.9% were Enterobacteriaceae. Among all GNB, 110/377 (29.2%) were found to be ESBL producers. Species specific ESBLs rate among Klebsiella pneumoniae, Escherichia coli, Acinetobacter spp, Proteus spp and other enterobacteria were 63.7%, 24.4%, 17.7%, 6.4% and 27.9% respectively. A statistically significant higher number of inpatients 100/283 (35.3%) compared to 10/94 (10.6%) of outpatients had ESBL-producing organisms (p = 0.000023). Rates of resistances to gentamicin, tetracycline, sulphamethaxazole/trimethoprim and ciprofloxacin were significantly higher among ESBLs isolates than non-ESBL isolates (p = 0.000001). Conclusion ESBL producing organisms are common at BMC (Bugando Medical Center) and pose a challenge to antibiotic therapy. Successful implementation of a routine detection of ESBL production is essential in designing appropriate antibiotic prescribing policies and infection control intervention programmes.
Mshana, Stephen E; Kamugisha, Erasmus; Mirambo, Mariam; Chakraborty, Trinad; Lyamuya, Eligius F
Background After a national voucher scheme in 2004 provided pregnant women and infants with highly subsidized insecticide-treated nets (ITNs), use among children under five years (U5s) in mainland Tanzania increased from 16% in 2004 to 26.2% in 2007. In 2008, the Ministry of Health and Social Welfare planned a catch-up campaign to rapidly and equitably deliver a free long-lasting insecticidal net (LLIN) to every child under five years in Tanzania. Methods The ITN Cell, a unit within the National Malaria Control Programme (NMCP), coordinated the campaign on behalf of the Ministry of Health and Social Welfare. Government contractors trained and facilitated local government officials to supervise village-level volunteers on a registration of all U5s and the distribution and issuing of LLINs. The registration results formed the basis for the LLIN order and delivery to village level. Caregivers brought their registration coupons to village issuing posts during a three-day period where they received LLINs for their U5s. Household surveys in five districts assessed ITN ownership and use immediately after the campaign. Results Nine donors contributed to the national campaign that purchased and distributed 9.0 million LLINs at an average cost of $7.07 per LLIN, including all campaign-associated activities. The campaign covered all eight zones of mainland Tanzania, the first region being covered separately during an integrated measles immunization/malaria LLIN distribution in August 2008, and was implemented one zone at a time from March 2009 until May 2010. ITN ownership at household level increased from Tanzania's 2008 national average of 45.7% to 63.4%, with significant regional variations. ITN use among U5s increased from 28.8% to 64.1%, a 2.2-fold increase, with increases ranging from 22.1-38.3% percentage points in different regions. Conclusion A national-level LLIN distribution strategy that fully engaged local government authorities helped avoid additional burden on the healthcare system. Distribution costs per net were comparable to other public health interventions. Particularly among rural residents, ITN ownership and use increased significantly for the intended beneficiaries. The upcoming universal LLIN distribution and further behaviour change communication will further improve ITN ownership and use in 2010-2011.
Background In Tanzania, decentralisation processes and reforms in the health sector aimed at improving planning and accountability in the sector. As a result, districts were given authority to undertake local planning and set priorities as well as allocate resources fairly to promote the health of a population with varied needs. Nevertheless, priority setting in the health care service has remained a challenge. The study assessed the priority setting processes in the planning of the prevention of mother to child transmission of HIV (PMTCT) programme at the district level in Tanzania. Methods This qualitative study was conducted in Mbarali district, south-western Tanzania. The study applied in-depth interviews and focus group discussions in the data collection. Informants included members of the Council Health Management Team, regional PMTCT managers and health facility providers. Results Two plans were reported where PMTCT activities could be accommodated; the Comprehensive Council Health Plan and the Regional PMTCT Plan that was donor funded. As donors had their own globally defined priorities, it proved difficult for district and regional managers to accommodate locally defined PMTCT priorities in these plans. As a result few of these were funded. Guidelines and main priority areas of the Ministry of Health and Social Welfare (MoHSW) also impacted on the ability of the districts and regions to act, undermining the effectiveness of the decentralisation policy in the health sector. Conclusion The challenges in the priority setting processes revealed within the PMTCT initiative indicate substantial weaknesses in implementing the Tanzania decentralisation policy. There is an urgent need to revive the strategies and aims of the decentralisation policy at all levels of the health care system with a view to improving health service delivery.
Background International debates on improving health system performance and quality of care are strongly coined by systems thinking. There is a surprising lack of attention to the human (worker) elements. Although the central role of health workers within the health system has increasingly been acknowledged, there are hardly studies that analyze performance and quality of care from an individual perspective. Drawing on livelihood studies in health and sociological theory of capitals, this study develops and evaluates the new concept of workhood. As an analytical device the concept aims at understanding health workers' capacities to access resources (human, financial, physical, social, cultural and symbolic capital) and transfer them to the community from an individual perspective. Methods Case studies were conducted in four Reproductive-and-Child-Health (RCH) clinics in the Kilombero Valley, south-eastern Tanzania, using different qualitative methods such as participant observation, informal discussions and in-depth interviews to explore the relevance of the different types of workhood resources for effective health service delivery. Health workers' ability to access these resources were investigated and factors facilitating or constraining access identified. Results The study showed that lack of physical, human, cultural and financial capital constrained health workers' capacity to act. In particular, weak health infrastructure and health system failures led to the lack of sufficient drug and supply stocks and chronic staff shortages at the health facilities. However, health workers' capacity to mobilize social, cultural and symbolic capital played a significant role in their ability to overcome work related problems. Professional and non-professional social relationships were activated in order to access drug stocks and other supplies, transport and knowledge. Conclusions By evaluating the workhood concept this study highlights the importance of understanding health worker performance by looking at their resources and capacities. Rather than blaming health workers for health system failures, applying a strength-based approach offers new insights into health workers' capacities and identifies entry points for target actions.
The international community has set ambitious goals (Millennium Development Goals) to improve health in developing countries by 2015. Effective and often cheap interventions exist to achieve these goals. In the mainland of Tanzania, one of the poorest countries of the world, we explored the human resources challenges of expanding the coverage of such priority interventions. We projected human resources for
Christoph Kurowski; Kaspar Wyss; Salim Abdulla; Anne Mills
Vital registration of causes of death in Tanzania is incomplete and many deaths occur outside health care settings. Verbal autopsies (VA) are used to determine the underlying cause of death, and the probable diagnosis helps to estimate reasonably cause-specific mortality. In this paper, we report findings of a verbal autopsy survey which involved eight villages in both low and highlands
M. L. KAMUGISHA; S. GESASE; T. D. MLWILO; B. P. MMBANDO; M. D. SEGEJA; D. T. MINJA
The AIDS crisis in Africa and elsewhere compels us to design appropriate assistance policies for households experience a death. Policies should take into account and strengthen existing household coping strategies, rather than duplicate or undermine them. The authors investigate the nature of coping mechanisms among a sample of households in Kagera, Tanzania in 1991-1994. They estimate the magnitude and timing
This article examines recent educational reforms in Tanzania by looking at the cultural politics of pedagogical change in secondary and teacher education. It presents an ethnography of a teachers college founded on the principles of social constructivism in a country where formalistic, teacher-centered pedagogy is the norm. Using data collected…
|This study presents findings from analyses of naturally occurring literacy events, where children jointly focus on reading and writing letters of the alphabet, illustrating social constructions of learning created through language and embodied action. Video recorded data from two different families living in an urban low-income area in Tanzania…
Frankenberg, Sofia Johnson; Holmqvist, Rolf; Rubenson, Birgitta; Rindstedt, Camilla
Undernutrition and malnutrition are still problems of unacceptable proportions in many developing countries. However, the debate on the roles of income and other socio-economic variables such as women’s education and household size on food and nutrient demand continues. This study examines the demand for food and nutrients amongst households in Tanzania, using recent survey data. A quadratic almost ideal demand
In this paper, it is argued that local knowledge for adapting to water scarcity is important for integrated resource management by taking into consideration both the natural and social constraints in a particular setting based on accumulated experience. The paper examines the relevance of local knowledge in sustaining agricultural production in the semiarid areas of central Tanzania. The paper specifically
In Tanzania today there is an acute shortage of soap. This has been caused by a shortage of the raw materials necessary for making soap. The report gives technical description of soap, a listing of the ingredients needed for making soap and their sources ...
This article provides the first comprehensive scientific data on land-use and land-cover change in the coastal zone of Tanzania over the 1990 and 2000 time periods. The research was part of an African region initiative to demonstrate the practical application of geographic information for sustainable development. Remotely sensed images from close to 1990 Landsat Thematic Mapper (TM) sensor and 2000
YEQIAO WANG; JAMES TOBEY; GREGORY BONYNGE; JARUNEE NUGRANAD; VEDAST MAKOTA; AMANI NGUSARU; MICHAEL TRABER
|This article is based on an ESRC/DFID funded research project on Widening Participation in Higher Education in Ghana and Tanzania: Developing an Equity Scorecard (http://www.sussex.ac.uk/education/wideningparticipation). There are questions about whether widening participation in higher education is a force for democratisation or differentiation.…
The distribution of Taenia saginata cysts among organs and muscle groups was determined by slicing the heart, masseters, liver and muscles of the half carcass of 21 naturally infected Zebu cattle from Morogoro abattoir, Tanzania. The carcasses harboured from 1 to 310 cysts. In the muscle groups, normally considered predilection sites, the heart and Musculus triceps brachii harboured the highest
Godfrey E. Maeda; Niels Chr. Kyvsgaard; Peter Nansen; Henrik O. Bøgh
A review of plague records from 1986 to 2002 and household interviews were carried out in the plague endemic villages to establish a pattern and spatial distribution of the disease in Lushoto district, Tanzania. Spatial data of households and village centres were collected and mapped using a hand held Global Positioning System and Geographical Information System. During the 16-year period,
M. L. KAMUGISHA; S. GESASE; D. MINJA; S. MGEMA; T. D. MLWILO; B. K. MAYALA
A study was done to assess utilization of medicinal plants in Nyachilo village situated in eastern Uluguru Mountains, Tanzania. Semi-structured questionnaires were administered and informal discussions conducted to traditional healers and midwives. The respondents were selected from Changa, Mselelo, Tanana, Mitamba, Kimeza, Mandani and Kibundi subvillages. Within the subvillages random sampling was used to determine the number of respondents to
C. P. I. Mahonge; J. V. Nsenga; E. J. Mtengeti; A. Z. Mattee
Tanzania is one of the leading countries in the world in terms of biodiversity. With a broad range of habitats including marine ecosystems, savannah, forests, lakes, it also contains some of the largest remaining herds of wildlife in the world. Neverthele...
Despite the large and growing number of humanitarian emergencies, there is little economic research on the impact of refugees and internally displaced people on the communities that receive them. This analysis of the impact of the refugee inflows from Burundi and Rwanda in 1993 and 1994 on host populations in western Tanzania shows large increases in the prices of nonaid
Despite the large and growing number of humanitarian emergencies, there is little economic research on the impact of refugees and internally displaced people on the communities that receive them. This analysis of the impact of the refugee inflows from Burundi and Rwanda in 1993 and 1994 on host populations in western Tanzania shows large increases in the prices of nonaid
Five new species of Nectophrynoides Noble 1926 are described from the forests of the Eastern Arc Mountains of Tanzania. Two of the new species were already recognised as such, but not formally described. Two more were recognised as undescribed in the collection of the Natural History Museum, London. The fifth was collected during a field survey of the udzungwa Scarp
The carnivore community of Arusha National Park, Tanzania, was monitored using live trapping and diurnal and nocturnal visual\\u000a counts and recording of tracks and signs along line transects. Nine carnivore species were recorded. Hyena (Crocuta crocuta), the most common large species, leopard (Panthera pardus) and African civet (Civettictis civetta) were detected along line transects, while the smaller species were counted
Adriano Martinoli; Damiano Preatoni; Valeria Galanti; Paola Codipietro; Morris Kilewo; Carlos A. R. Fernandes; Luc A. Wauters; Guido Tosi
The paper reports on research in Tanzania about the scope for developing biofuels from an oil-seed bearing plant called Jatropha curcas Linnaeus. The plant is widely seen to have potential to help combat the greenhouse effect, help to stop local soil erosion, create additional income for the rural poor, and provide a major source of energy both locally and internationally.
|Quantitative increases tell a partial story about the quality of women's participation in higher education. Women students' reporting of sexual harassment has been noteworthy in a recent study that I directed on widening participation in higher education in Ghana and Tanzania. The hierarchical and gendered power relations within universities have…
This paper develops a soil conservation model that is relevant to smallholder farmers who apply little or no fertilizer. Empirical results drawn from northern Tanzania imply that, ignoring fertility mining problem in model specification leads to overestimation of profits for farms that apply little or no fertilizer. The model also shows that, the impact of output price on soil conservation
Ephraim M. Nkonya; Andrew P. Barkley; Stephen F. Hamilton; Daniel J. Bernardo
|For Tanzanians, education to be meaningful implies human development through education. Tanzania's commitment to build a socialist state, based on traditional African socialism, is also a commitment to socialist education, the necessary tool for social development. Since work is a lifelong duty for any socialist, work-oriented education is also a…
This paper explores the historical emergence of Islam in East Africa, details the political background of Tanzania and Kenya, the role of Islam in each country, and US foreign policy in the region. The recent US strategy of intelligence-sharing with Kenya...
|Approximately 200 items are listed in this bibliography of materials pertaining to adult literacy in Nigeria, Rhodesia, South Africa, the Sudan, and Tanzania. The listed materials are categorized according to country and deal with a variety of topics, including the following: (1) adult education and adaptation to change in Nigeria; (2) adult…
International Inst. for Adult Literacy Methods, Teheran (Iran).
This paper gives an overview of the energy demands in Tanzania, and highlights the current serious shortage of electricity. Government strategy to alleviate the problem include exploitation of the country's big natural gas reserves for power generation, and utilization of the renewable energies such as solar, wind and biogas. Important agro-industrial residues with a large potential for anaerobic conversion into
The objectives of this study were to identify risk and protective factors for engaging in unsafe sex among orphans and non-orphans and to explore whether risk and protection differs by gender and orphan status. The study was carried out in Kisesa ward, in the Mwanza region of Northwest Tanzania. A combination of in-depth interviews and focus group discussions were used
Through 1996 into 1997, a spot investigation on mercury contamination was conducted three times in Tanzania, especially around the Lake Victoria. A total of 150 goldminers, 103 fishermen and their families, and 19 residents of Mwanza City volunteered for the current study. A high total mercury level of 48.3 ppm (near to 50 ppm, a critical level of Minamata disease)
Levels of transaction costs in community-based forest management (CBFM) in four communities adjacent to the Ambangulu mountain forests of the north-east of Tanzania were assessed through questionnaire responses from 120 households. Costs and benefits of CBFM to the rich, med- ium and poor groups of forest users were estimated. Costs of CBFM were participation in forest monitoring and time spent
Charles K. Meshack; Bhim Ahdikari; Nike Doggart; Jon C. Lovett
This paper focuses on the use of images to promote reflection and analysis of inclusive practices. The image-based work was set in the context of a two-year action research study, which took place in Tanzania and Zambia, 2001-2003, in collaboration with researchers from the Enabling Education Network (EENET), based at the University of…
The aims of the study were to elicit the perceptions of young people in Tanzania on the role of fear appeals in HIV-prevention messages and to identify important contextual factors that may influence young people's perceptions of HIV-prevention posters. A total of 10 focus groups were conducted to investigate the role of fear appeals using the extended parallel process model
The purpose of this study was to investigate demographic, cognitive and behavioral factors associated with levels of AIDS knowledge and perceived susceptibility to HIV. Cross-sectional, population-based surveys were conducted in two urban communities, two townships and two rural villages in Arusha region, Tanzania. Eligible participants were 15 to 54 years old living in randomly selected household clusters. A total of
Knut-Inge Klepp; Kagoma S. Mnyika; Naphtal Ole-Kingóri; Melkizedeck T. Leshabari; Peter E. Kissila
|The author examines in detail the social, cultural, religious, and political influences on Tanzania in order to see education for self-reliance in better perspective. He follows this examination with a discussion of the precept and practice of education for self-reliance. (KC)|
In this paper we discuss two Participatory Design (PD) projects, one in Tanzania-Zanzibar and the other one in Sweden. In both countries the design process was done through the analysis of work practices involving both designers and users. The discussion focuses on a number of factors such as location, time and scene. We also ask how different projects can be
Pirjo Elovaara; Faraja Teddy Igira; Christina Mörtberg
Prior to Arab and European imperialism, the farmers of eastern Africa's Swahili coast engaged in a mixed economy, including fishing, animal husbandry and trade in the Indian Ocean's early global economy. This trade network also exposed eastern Africans to new Asian foodways. Botanical data from archaeological sites on northern Pemba Island, Tanzania, show that ancient Pembans first relied heavily on
A research project on community-based theatre in Tanzania questions the efficacy of the genre in combating the AIDS epidemic. If performances are well attended, and participants are informed on the causes of the virus, why is it still rampant? Efficacy will be possible only when gender inequities and taboos are openly confronted.
A group of islands off the coast of East Africa, Zanzibar has been a semi?autonomous part of the United Republic of Tanzania since 1964. Despite a common language (Swahili), religion (Islam), and a high rate of intermarriage among the islands' multi?racial communities (including Africans and individuals of Arab, Persian, and Indian descent), Zanzibar politics has been marred by political conflicts
In this paper I argue that language policies for education have effects on pupils' educational possibilities. With the case of the Karagwe district in Tanzania the research suggests that the policy of "Swahili only" in primary school education favours the small minority of the children that live in a context where Swahili is used. This appears to…
In this article I explore insights gained from participating in an exploratory, small?scale study led by the Enabling Education Network (EENET) in 17 schools in northern Zambia and five schools in Tanzania. Facilitating South?based research, while based in a Northern university, raises complex ethical issues about voice and control which are discussed in the article. The main aim of the
Purpose – The purpose of this paper is to provide insights into cross-cultural conflicts and their management in ecclesiastical organizations in Tanzania. It aims at increasing the understanding of these complexities from an emic perspective of employees with a Christian background, thereby providing in-depth information on the topic. These new insights provide fresh ideas for further research on this topic
Summary • The study was carried out in rural areas of Tanzania, where we were looking at the function and adoption of low cost small scale biogas digesters made of plastic. Our work was accomplished with the help from a Tanzanian non governmental organization, SURUDE, who has been responsible for installing the digesters. In spite of a general satisfaction with
|This paper is a critical analysis of the role of the Tanzanian education system in enhancing young children's awareness of economic aspects around them. The major factors the paper considers are: the poverty of the country; the prominence of the education system as a socializing agent for children; the aim of early education in Tanzania; and…
This paper analyzes characteristics of nonfarm enterprises, their employment growth patterns, and constraints in doing business in rural Tanzania. Using unique survey data, the authors describe a low-return sector struggling to compete in a difficult business environment. However, about one-third of rural enterprises are growing fast. Most enterprises engage in agricultural trade. Due to a rapidly growing agricultural sector in
This paper analyzes characteristics of nonfarm enterprises, their employment growth patterns, and constraints in doing business in rural Tanzania. Using unique survey data, the we describe a low-return sector struggling to compete in a challenging business environment. However, about one-third of rural enterprises are growing fast. Most enterprises engage in agricultural trade. Due to a rapidly growing agricultural sector in
:This essay considers the role of Hindi films in urban Tanzania in writing new chronologies of Indian Ocean world history. Examining films and movie theatres through overlapping local, national and transnational lenses, the article contributes to our understandings of the encounter between the Indian diaspora and nationalism in East Africa, and extends the history of Indian Ocean world connections into