A cross-sectional survey of agricultural areas, combined with routinely monitored mosquito larval informa- tion, was conducted in urban Dar es Salaam, Tanzania, to investigate how agricultural and geographical features may influence the presence of Anopheles larvae. Data were integrated into a geographical information systems framework, and predictors of the presence of Anopheles larvae in farming areas were assessed using multivariate
Stefan Dongus; Dickson Nyika; Khadija Kannady; Deo Mtasiwa; Hassan Mshinda; Laura Gosoniu; Axel W. Drescher; Ulrike Fillinger; Marcel Tanner; Gerry F. Killeen; Marcia C. Castro
Background Although data are sparse, it has been estimated that the highest rates of homicide death amongst children are in Africa. Little information is available on ages 0 -< 15 years. No reliable quantitative surveillance analysis of neonaticide (killed at less than one week) has been done. Methods A Violent Death Survey following WHO/CDC Guidelines was completed in Dar es Salaam region, Tanzania (DSM) (population 2.845 million) in 2005. Qualitative and quantitative data were gathered and analyzed using mixed methods techniques. Results The overall age adjusted rate of discarded and killed children in DSM was 2.05. The rate of neonaticide was 27.7 per 100,000) while the rate of homicide incidence for children > one day was Discussion The overall estimated homicide rate for Africa of children under age 15 was 4.53 per 100,000, whereas. The estimated global rate is 1.7 per 100,000 closer to DSM‘s rate. The results in DSM show that broad age groupings such as ” <1 year” or “0–4 years” or “0 – <15 years” may mask a high incidence of neonaticide and an otherwise low incidence of murdered children. The print media provided good in-depth coverage for a few cases but it is not known if the reported cases are representative. Conclusion Eighty percent of homicides of children in DSM are neonaticides. Since it is believed that the forces behind neonaticide are fundamentally different than homicides of older children, it is suggested that data of future surveys be parsed to include neonates, until the phenomenon is more clearly understood and addressed. Further understanding of the mother and father of the deceased is needed. Continued surveillance data collection is important to expand the sample size. PMID:22066333
Outwater, Anne; Mgaya, Edward; Campbell, Jacquelyn C.; Becker, Stan; Kinabo, Linna; Menick, Daniel Mbassa
BACKGROUND: Workers in informal small-scale industries (SSI) in developing countries involved in welding, spray painting, woodwork and metalwork are exposed to various hazards with consequent risk to health. Aim To assess occupational exposure and health problems in SSI in Dar es Salaam, Tanzania. METHODS: Focused group discussions (FGD) were conducted among SSI workers. Participants were assessed for exposure to occupational
L. M. B. Rongo; F. J. M. H. Barten; G. I. Msamanga; D. Heederik; W. M. V. Dolmans
This article addresses the shift in gender planning from Women in Development (WID) to Gender and Development (GAD), and explores why WID programs continue to dominate despite a general consensus that the GAD approach is superior. Drawing on the experience of organized women in Dar es Salaam, Tanzania, it is argued that not only are WID programs politically and practically
Andrea M. Brown
Rapid urbanization is arguably one of the most complex and important socioeconomic phenomena of the new millennium. It represents major and irreversible changes in production and consumption patterns and the way people interact with nature. The impact of urbanization will continue to bring about major changes especially in many countries in the developing world that are experiencing rapid urbanization. The serious environmental and development challenges facing Dar es Salaam, the largest commercial center of Tanzania, are highlighted in this report. PMID:15253912
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.
Topa, Maria Elena; Herslund, Lise; Cavan, Gina; Printz, Andreas; Simonis, Ingo; Bucchignani, Edoardo; Jean-Baptiste, Nathalie; Hellevik, Siri; Johns, Regina; Kibassa, Deusdedit; Kweka, Clara; Magina, Fredrick; Mangula, Alpha; Mbuya, Elinorata; Uhinga, Guido; Kassenga, Gabriel; Kyessi, Alphonce; Shemdoe, Riziki; Kombe, Wilbard
This study was carried out to determine the rate of agreement or disagreement of microscopy reading and culture positivity rate among smear positixe and negative specimens between peripheral tuberculosis diagnostic centres (PDCs) and Central Reference luberculosis laboratory (CTRL). In this study 13 PDCs in Dar es Salaam, Tanzania were involved. Lot Quality Assurance Sampling (LQAS) method was used to collect 222 sputum smear slides. A total of 190 morning sputum specimens with corresponding slides were selected for culture. First readings were done by technicians at PDCs and thereafter selected slides and specimens were sent to CTRL for re-examination and culture. Culture results were used as a gold standard. Of 222 slides selected, 214 were suitable for re-examination. Percentage of agreement of smear reading between PDCs and CTRL was 42.9% and 100% for positive and negative slides, respectively. Measure of agreement (Kappa statistic) was 0.5, indicating moderate agreement. Of 190 samples cultured, percentage of agreement between smear reading from PDCs and CTRL was 37% and 88.9% for smear positive and negative slides, respectively. Kappa statistic was 0.3 indicating poor-fair agreements. Comparison of smear reading from PDCs with culture showed sensitivity of 36.9% and specificity of 88.9%. Comparison of smear readings from CTRL with culture results showed sensitivity of 95.6% and specificity of 98.6%. In conclusion there was inadequate performance in diagnosis of TB using smear microscopy among peripheral diagnostic centres in Dar es Salaam. This calls for immediate and rigorous measures to improve the quality of smear microscopy. It is therefore important to strengthen the capacity of laboratory personnel in smear microscopy techniques through supportive supervision and training. PMID:18087893
Mfinanga, G S; Ngadaya, E; Mtandu, R; Mutayoba, B; Basra, D; Kimaro, G; Chonde, T M; Ngowi, P; Mfaume, S; Kilale, A M; Egwaga, S; Kitua, A Y
Background Childhood obesity has increased dramatically and has become a public health concern worldwide. Childhood obesity is likely to persist through adulthood and may lead to early onset of NCDs. However, there is paucity of data on obesity among primary school children in Tanzania. This study assessed the prevalence and determinants of obesity among primary school children in Dar es Salaam. Methods A cross sectional study was conducted among school age children in randomly selected schools in Dar es Salaam. Anthropometric and blood pressure measurements were taken using standard procedures. Body Mass Index (BMI) was calculated as weight in kilograms divided by the square of height in meters (kg/m2). Child obesity was defined as BMI at or above 95th percentile for age and sex. Socio-demographic characteristics of children were determined using a structured questionnaire. Logistic regression was used to determine association between independent variables with obesity among primary school children in Dar es Salaam. Results A total of 446 children were included in the analysis. The mean age of the participants was 11.1±2.0 years and 53.1% were girls. The mean BMI, SBP and DBP were 16.6±4.0 kg/m2, 103.9±10.3mmHg and 65.6±8.2mmHg respectively. The overall prevalence of child obesity was 5.2% and was higher among girls (6.3%) compared to boys (3.8%). Obese children had significantly higher mean values for age (p=0.042), systolic and diastolic blood pressures (all p<0.001). Most obese children were from households with fewer children (p=0.019) and residing in urban areas (p=0.002). Controlling for other variables, age above 10 years (AOR=3.3, 95% CI=1.5-7.2), female sex (AOR=2.6, 95% CI=1.4-4.9), urban residence (AOR=2.5, 95% CI=1.2-5.3) and having money to spend at school (AOR=2.6, 95% CI=1.4-4.8) were significantly associated with child obesity. Conclusions The prevalence of childhood obesity in this population was found to be low. However, children from urban schools and girls were proportionately more obese compared to their counterparts. Primary preventive measures for childhood obesity should start early in childhood and address socioeconomic factors of parents contributing to childhood obesity. PMID:24094276
The aim of this study was to investigate the awareness of the oral manifestations of HIV\\/AIDS and general issues about HIV and AIDS among people living with HIV (PLHIV) in Dar es Salaam, Tanzania. A structured questionnaire was used to collect information from 187 participants chosen by convenience sampling from NGOs supporting PLHIV. A total of 13.4% of the participants
FK Kahabuka; F Fabian; PE Petersen; H Nguvumali
The prevalence of urinary schistosomiasis among the schoolchildren living in Kigogo administrative ward of the Kinondoni district of Dar-es-Salaam city, Tanzania, and the factors influencing the transmission of the causative agent, Schistosoma haematobium, were investigated in a cross-sectional study. The estimate of overall prevalence, based on microscopical examination of a single urine sample/subject, was 47.6%. Compared with the girls, the boys were more likely to be excreting schistosome eggs (54.6% v. 40.8%; P = 0.004) and had, in general, higher intensities of infection (54 v. 38 eggs/10 ml urine; P = 0.001). The children aged 10-14 years had higher prevalences and intensities of infection than those in the younger or older age-group studied. The sensitivity of micro-haematuria as an indicator of infection (compared with the microscopical examination of single urine samples) was 84.3% overall, reaching 92% among the children excreting > or = 50 eggs/10 ml urine. The corresponding positive and negative predictive values were 77% and 84%, respectively. The sensitivity, specificity and positive and negative predictive values of the history of haematuria as an indirect screening technique for S. haematobium were 60.4%, 72.7%, 67% and 67%, respectively. Recreational activities such as bathing, swimming and playing in the water were the most frequent activities attracting children to water bodies and carried the highest risks of infection with S. haematobium. Knowledge about the disease, especially on the symptoms and mode of transmission, was generally good but the methods of prevention were inadequately known. Chemotherapy to control urinary schistosomiasis in schoolchildren is recommended; infected children may be identified on the basis of haematuria, detected using questionnaires or reagent strips. Additional health education, to heighten awareness of the disease and its prevention, would also be beneficial. PMID:11784423
Ndyomugyenyi, R; Minjas, J N
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. PMID:23977099
Maheu-Giroux, Mathieu; Castro, Marcia C.
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. PMID:23216949
Background Obesity is on the rise worldwide, not sparing developing countries. Both demographic and socio-economic factors play parts in obesity causation. Few surveys have been conducted in Tanzania to determine the magnitude of obesity and its association with these risk factors. This study aimed at determining the prevalence of obesity and its associated risk factors among adults aged 18 - 65 years in Kinondoni municipality, Dar es Salaam, Tanzania from April 2007 to April 2008. Methods Random sampling of households was performed. Interviews and anthropometric measurement were carried out to eligible and consenting members of the selected households. Obesity was defined using Body Mass Index (BMI). Results Out of 1249 subjects recruited, 814 (65.2%) were females. The overall prevalence of obesity was 19.2% (240/1249). However, obesity was significantly more prevalent in women (24.7%) than men (9%), p < 0.001, among respondents with high socio-economic status (29.2%) as compared to those with medium (14.3%) and low socio-economic status (11.3%), p value for trend < 0.001, and among respondents with light intensity activities (26.0%), p value for trend < 0.001. Conclusion This study revealed a higher prevalence of obesity among Kinondoni residents than previously reported in other parts of the country. Independent predictors of obesity in the population studied were increasing age, marriage and cohabitation, high SES, female sex and less vigorous physical activities. PMID:21605360
The consumption of bottled and plastic-bagged drinking water in Tanzania has increased largely because of the deteriorating quality of tap water. It is uncertain whether these water products are safe for drinking. In this study, the microbiological quality of bottled and plastic-bagged drinking water sold in Dar es Salaam, Tanzania, was investigated. One hundred and thirty samples representing 13 brands of bottled water collected from shops, supermarkets and street vendors were analysed for total coliform and faecal coliform organisms as well as heterotrophic bacteria. These were compared with 61 samples of tap water. Heterotrophic bacteria were detected in 92% of the bottled water samples analysed. Total and faecal coliform bacteria were present in 4.6% and 3.6%, respectively, of samples analysed with a tendency for higher contamination rates in plastic-bagged drinking water. Microbiological quality of tap water was found to be worse compared with bottled water, with 49.2% and 26.2% of sampling points showing the presence of total coliform and faecal coliform organisms, respectively. The results suggest caution and vigilance to avert outbreaks of waterborne diseases from these types of drinking water. PMID:17402289
Kassenga, Gabriel R
Urban agriculture and operational mosquito larvae control: mitigating malaria risk in Dar es Salaam........................................................................................................... 6 1.3 Urban agriculture ...................................................................................10 1.5 Urban agriculture in Dar es Salaam
This study was conducted to determine self-care practices and diabetes related emotional distress among people with Type 2 diabetes mellitus in Dar es Salaam, Tanzania. A cross sectional survey-involving 121 Types 2 diabetics was conducted in 4 diabetic clinics located in Dar es Salaam. Anthropometric and biomedical measurements namely weight, height, waist, hip, mid-upper arm circumference, blood pressure and fasting
Theobald C. E. Mosha; Heri Rashidi
This paper examines predictors of breastfeeding cessation among a cohort of human immunodeficiency virus (HIV)-infected women. This was a prospective follow-up study of HIV-infected women who participated in a randomized micronutrient supplementation trial conducted in Dar es Salaam, Tanzania. 795 HIV-infected Tanzanian women with singleton newborns were utilized from the cohort for this analysis. The proportion of women breastfeeding declined from 95% at 12 months to 11% at 24 months. The multivariate analysis showed breastfeeding cessation was significantly associated with increasing calendar year of delivery from 1995 to 1997 [risk ratio (RR), 1.36; 95% confidence interval (CI) 1.13–1.63], having a new pregnancy (RR 1.33; 95% CI 1.10–1.61), overweight [body mass index (BMI) ?25 kg m?2; RR 1.37; 95% CI 1.07–1.75], underweight (BMI <18.5 kg m?2; RR 1.29; 95% CI 1.00–1.65), introduction of cow’s milk at infant’s age of 4 months (RR 1.30; 95% CI 1.04–1.63). Material and social support was associated with decreased likelihood of cessation (RR 0.83; 95% CI 0.68–1.02). Demographic, health and nutritional factors among women and infants are associated with decisions by HIV-infected women to cease breastfeeding. The impact of breastfeeding counselling programs for HIV-infected African women should consider individual maternal, social and health contexts. PMID:21689270
Petraro, Paul; Duggan, Christopher; Msamanga, Gernard; Peterson, Karen E.; Spiegelman, Donna; Fawzi, Wafaie
More than 90% of pregnant women take prescription or non-prescription drugs at some time during pregnancy. In general, unless absolutely necessary, drugs should not be used during pregnancy because many of them are harmful to the fetus. Appropriate dispensing is one of the steps for rational drug use; so, it is necessary that drug dispensers should have relevant and updated knowledge and skills regarding drug use in pregnancy. To assess the knowledge of drug dispensers and pregnant women regarding drug use in pregnancy, focusing on four commonly used drugs that are teratogenic or cause unwanted effects to the fetus and babies. The study was conducted in two parts: consumers? perception and providers? practice. It was a cross-sectional study involving visits to 200 private retail community pharmacies (as simulated client) within Temeke, Ilala and Kinondoni municipals in Dar es Salaam, Tanzania. The second part of the study was conducted at the antenatal clinics of the three municipal hospitals in Dar es Salaam. A semi-structured questionnaire was used to gather information from pregnant women. In total, 200 pregnant women were interviewed. Out of 200 drug dispensers, 86 (43%) were willing to dispense artemether-lumefantrine (regardless of the age of pregnancy), 56 (29%) were willing to dispense sodium valproate, 104 (52%) were willing to dispense captopril and 50 (25%) were willing to dispense tetracycline. One hundred and thirty-three (66.5%) pregnant women reported that they hesitated to take medications without consulting their physicians, 47 (23.5%) indicated that it was safe to take medications during pregnancy, while 123 (61.5%) mentioned that it was best to consult a doctor, while 30 (15%) did not have any preference. Sixty-three (31.5%) women reported that they were aware of certain drugs that are contraindicated during pregnancy. It is evident that most drug dispensers have low knowledge regarding the harmful effects of drugs during pregnancy. Drug dispensing personnel should be considered part of the therapeutic chain and, if appropriately trained, they will play a very important role in promoting rational use of medicines. PMID:21713045
Kamuhabwa, Appolinary; Jalal, Rashida
This study investigated the gender difference between male and female injection drug users’ (IDUs) life circumstances, income and risky sexual and drug behaviors. The study sample comprised of 318 male and 249 female injection drug users in Dar es Salaam, Tanzania. There were gender differences between male and female IDUs in terms of life circumstances and sexual behaviors. There were
Rosemary Olisa Ojogwu
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
Background: Home visits by community health workers (CHW) could be effective in identifying pregnant women in the community before they have presented to the health system. CHW could thus improve the uptake of antenatal care (ANC), HIV testing, and prevention of mother-to-child transmission (PMTCT) services. Methods: Over a 16-month period, we carried out a quantitative evaluation of the performance of CHW in reaching women early in pregnancy and before they have attended ANC in Dar es Salaam, Tanzania. Results: As part of the intervention, 213 CHW conducted more than 45,000 home visits to about 43,000 pregnant women. More than 75% of the pregnant women identified through home visits had not yet attended ANC at the time of the first contact with a CHW and about 40% of those who had not yet attended ANC were in the first trimester of pregnancy. Over time, the number of pregnant women the CHW identified each month increased, as did the proportion of women who had not yet attended ANC. The median gestational age of pregnant women contacted for the first time by a CHW decreased steadily and significantly over time (from 21/22 to 16 weeks, P-value for test of trend <0.0001). Conclusions: A large-scale CHW intervention was effective in identifying pregnant women in their homes early in pregnancy and before they had attended ANC. The intervention thus fulfills some of the conditions that are necessary for CHW to improve timely ANC uptake and early HIV testing and PMTCT enrollment in pregnancy. PMID:25436818
Sando, David; Magesa, Lucy; Machumi, Lameck; Mungure, Esther; Mwanyika Sando, Mary; Geldsetzer, Pascal; Foster, Dawn; Kajoka, Deborah; Naburi, Helga; Ekström, Anna M.; Spiegelman, Donna; Li, Nan; Chalamilla, Guerino; Fawzi, Wafaie; Bärnighausen, Till
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. Methods We conducted a criteria based audit of 389 eclampsia patients admitted to Muhimbili National Hospital (MNH), Dar es Salaam Tanzania between April 14, 2006 and December 31, 2006. Cases were assessed using evidence-based criteria for appropriate care. Results Antepartum, intrapartum and postpartum eclampsia constituted 47%, 41% and 12% of the eclampsia cases respectively. Antepartum eclampsia was mostly (73%) preterm whereas the majority (71%) of postpartum eclampsia cases ware at term. The case fatality rate for eclampsia was 7.7%. Medical histories were incomplete, the majority (75%) of management plans were not reviewed by specialists in obstetrics, specialist doctors live far from the hospital and do not spend nights in hospital even when they are on duty, monitoring of patients on magnesium sulphate was inadequate, and important biochemical tests were not routinely done. Two thirds of the patient scheduled for caesarean section did not undergo surgery within agreed time. Conclusion Potential areas for further improvement in quality of emergency care for eclampsia relate to standardizing management guidelines, greater involvement of specialists in the management of eclampsia and continued medical education on current management of eclampsia for junior staff. PMID:19323846
Kidanto, Hussein Lesio; Mogren, Ingrid; Massawe, Siriel N; Lindmark, Gunilla; Nystrom, Lennarth
The poor state of solid waste management in Dar es Salaam (DSM), Tanzania, the large fraction of organic waste generated and a high charcoal consumption by city residents has triggered this research on carbonization of municipal biowaste. Char produced by the thermochemical conversion method of slow pyrolysis can be briquetted and used as cooking fuel alternative to wood-based charcoal. To explore the potential of biowaste carbonization in DSM, the most suitable organic wastes were selected and pyrolyzed in a simple, externally heated carbonization system developed as part of this study. A Multi-Criteria Analysis framework allowed to assess prevailing biowaste types regarding availability and accessibility, and respective suitability in terms of physical-chemical properties. The assessment, using data from a survey and lab analysis, revealed the following biowaste types with highest overall potential for char production in DSM: packaging grass/leaves (PG) used for transportation of fruit and vegetables to the markets, wood waste (WW) from wood workshops, and cardboard (CB) waste. Best practice carbonization of these biowastes in the pyrolyzer showed satisfactory char yields (PG: 38.7%; WW: 36.2%; CB: 35.7% on dry basis). Proximate composition (including volatile, fixed carbon and ash content) and heating value (PG: 20.1 MJ kg(-1); WW: 29.4 MJ kg(-1); CB: 26.7 MJ kg(-1)) of the produced char also compare well with literature data. The energy and emission-related aspects of the system still require further research and optimizations to allow financially viable and safe operation. PMID:25649406
Lohri, Christian Riuji; Faraji, Adam; Ephata, Elia; Rajabu, Hassan Mtoro; Zurbrügg, Christian
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. PMID:23825620
Lambdin, Barrot H.; Bruce, R. Douglas; Chang, Olivia; Nyandindi, Cassian; Sabuni, Norman; Zamudio-Haas, Sophia; McCurdy, Sheryl; Masao, Frank; Ivo, Yovin; Msami, Amani; Ubuguy, Omar; Mbwambo, Jessie
Background Half of the population of Africa will soon live in towns and cities where it can be protected from malaria by controlling aquatic stages of mosquitoes. Rigorous but affordable and scaleable methods for mapping and managing mosquito habitats are required to enable effective larval control in urban Africa. Methods A simple community-based mapping procedure that requires no electronic devices in the field was developed to facilitate routine larval surveillance in Dar es Salaam, Tanzania. The mapping procedure included (1) community-based development of sketch maps and (2) verification of sketch maps through technical teams using laminated aerial photographs in the field which were later digitized and analysed using Geographical Information Systems (GIS). Results Three urban wards of Dar es Salaam were comprehensively mapped, covering an area of 16.8 km2. Over thirty percent of this area were not included in preliminary community-based sketch mapping, mostly because they were areas that do not appear on local government residential lists. The use of aerial photographs and basic GIS allowed rapid identification and inclusion of these key areas, as well as more equal distribution of the workload of malaria control field staff. Conclusion The procedure developed enables complete coverage of targeted areas with larval control through comprehensive spatial coverage with community-derived sketch maps. The procedure is practical, affordable, and requires minimal technical skills. This approach can be readily integrated into malaria vector control programmes, scaled up to towns and cities all over Tanzania and adapted to urban settings elsewhere in Africa. PMID:17784963
Dongus, Stefan; Nyika, Dickson; Kannady, Khadija; Mtasiwa, Deo; Mshinda, Hassan; Fillinger, Ulrike; Drescher, Axel W; Tanner, Marcel; Castro, Marcia C; Killeen, Gerry F
Objectives To assess HIV and sexually transmitted infection (STI) prevalence and associated risk factors in men who have sex with men (MSM) in two cities in mainland Tanzania. Methods We conducted respondent-driven sampling of 300 MSM in Dar es Salaam and Tanga. Results In Dar es Salaam, 172 (86%) men (median age 23, IQR 21–28) consented to HIV/STI testing, and 30.2% were HIV seropositive. Only five reported a previous positive HIV test: >90% were new HIV detections. 2.5% were syphilis-exposed and none hepatitis B positive, but 21.4% had a curable STI. Over 90% of the gonorrhoea and chlamydia was rectal. In Tanga, 11.1% of MSM were HIV seropositive, 8% hepatitis B positive and 0% were syphilis-exposed, with 4.4% having a curable STI. Predictors of HIV infection were number of MSM known, city, identifying as gay and having first sex with a man. Predictors for STIs were recent unprotected receptive anal intercourse, and number of MSM seen in the last month. 30% of the sample reported that they sold sex. There was no significant association between HIV and STI infection. Conclusions HIV and STI rates were substantially lower in MSM in a provincial city than in a large metropolis and rates appear to depend on larger numbers of MSM known. Most HIV detected were new cases, and there was a high burden of asymptomatic curable rectal STIs (>1 in 5 MSM). Owing to stigma, MSM may not report homosexuality and thus not have rectal STIs treated. High need for tailored HIV testing and STI screening and treatment of MSM in Tanzania is apparent. PMID:25168042
Ross, Michael W; Nyoni, Joyce; Ahaneku, Hycienth O; Mbwambo, Jessie; McClelland, R Scott; McCurdy, Sheryl A
Background The last decades have seen a considerable increase in urbanization in Sub-Saharan Africa, and it is estimated that over 50% of the population will live in urban areas by 2040. Rapid growth of cities combined with limited economic resources often result in informal settlements and slums with favorable conditions for proliferation of vectors of lymphatic filariasis (LF). In Dar es Salaam, which has grown more than 30 times in population during the past 55 years (4.4 million inhabitants in 2012), previous surveys have indicated high prevalences of LF. This study investigated epidemiological aspects of LF in Dar es Salaam, as a background for planning and implementation of control. Methods Six sites with varying distance from the city center (3–30 km) and covering different population densities, socioeconomic characteristics, and water, sewerage and sanitary facilities were selected for the study. Pupils from one public primary school at each site were screened for circulating filarial antigen (CFA; marker of adult worm infection) and antibodies to Bm14 (marker of exposure to transmission). Community members were examined for CFA, microfilariae and chronic manifestations. Structured questionnaires were administered to pupils and heads of community households, and vector surveys were carried out in selected households. Results The study indicated that a tremendous decrease in the burden of LF infection had occurred, despite haphazard urbanisation. Contributing factors may be urban malaria control targeting Anopheles vectors, short survival time of the numerous Culex quinquefasciatus vectors in the urban environment, widespread use of bed nets and other mosquito proofing measures, and mass drug administration (MDA) in 2006 and 2007. Although the level of ongoing transmission was low, the burden of chronic LF disease was still high. Conclusions The development has so far been promising, but continued efforts are necessary to ensure elimination of LF as a public health problem. These will include improving the awareness of people about the role of mosquitoes in transmission of LF, more thorough implementation of environmental sanitation to reduce Cx. quinquefasciatus breeding, continued MDA to high-risk areas, and set-up of programmes for management of chronic LF disease. PMID:24289718
Urban agriculture in Dar es Salaam was found to use child labor of both children with parents of higher and lower socioeconomic status (SES). Discusses policy implications and calls for the education of parents of lower SES not to expect an economic contribution from their children's labor, and the education of children about their rights. (LZ)
Mlozi, Malongo R. S.
Tanzania (TZ) has one of the highest rates of child mortality due to enteric disease in the world. NGOs and local agencies have introduced numerous technologies (e.g., chlorine tablets, borewells) to increase the quantity and quality of water in Dar es Salaam, the capital of Tanzania, in hopes of reducing morbidity and mortality of waterborne disease. The objective of the present study is to determine if providing personalized information about water quality and hand surface quality, as determined by concentrations of enterococci and E. coli, results in improved health and water quality in households. A cohort study was completed in June-September 2008 in 3 communities ranging from urban to per-urban in Dar es Salaam, Tanzania to achieve our objective. The study consisted of 4 cohorts that were visited 4 times over the 3 month study. One cohort received no information about water and hand quality until the end of the summer, while the other groups received either just information on hand surface quality, just information on water quality, and information on both hand surface and water quality after the first (baseline) household visit. We report concentrations of enterococci and E. coli in water sources (surface waters and bore wells), water stored in households, and environmental waters were children and adults swim and bathe. In addition, we report concentrations of enterococci and E. coli on hands of caregivers and children in households. Preliminary results of surveys on health and perceptions of water quality and illness from the households are provided. Ongoing work will integrate the microbiological and sociological data sets to determine if personalized information interventions resulted in changes in health, water quality in the household, or perceptions of water quality, quantity and relation to human health. Future work will analyze DNA samples from hands and water for human-specific Bacteroides bacteria which are only present in human feces. Our study has the potential to provide empirical evidence to promote large scale monitoring and education campaigns in Africa to improve health and reduce the burden of waterborne disease.
Davis, J.; Pickering, A.; Horak, H.; Boehm, A.
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. PMID:21358826
Tarimo, Edith A. M.; Thorson, Anna; Kohi, Thecla W.; Bakari, Muhammad; Mhalu, Fred; Kulane, Asli
Background Many blinding eye conditions of childhood are preventable or treatable, particularly in developing countries. However, primary eye care (PEC) for children is poorly developed, leading to unnecessary visual loss. Activities for control by health workers entail interventions for systemic conditions (measles, vitamin A deficiency), identification and referral of children with sight threatening conditions and health education for caregivers. This pilot study evaluated integrating a package of activities to promote child eye health into Reproductive and Child Health (RCH) services in Dar-es-Salaam, Tanzania. Methods Design: historical comparison study. Fifteen Clinical Officers and 15 nurses in 15 randomly selected RCH clinics were trained in PEC for children in July 2010. They were given educational materials (poster and manual) and their supervisors were orientated. Knowledge and practices were assessed before and 3 weeks after training. One year later their knowledge and practices were compared with a different group of 15 Clinical Officers and 15 nurses who had not been trained. Results Before training staff had insufficient knowledge to identify, treat and refer children with eye diseases, even conjunctivitis. Some recommended harmful practices or did not know that cataract requires urgent referral. Eye examination, vitamin A supplementation of mothers after delivery and cleaning the eyes at birth with instillation of antibiotics (Crede’s prophylaxis) were not routine, and there were no eye-specific educational materials. Three weeks after training several clinics delivering babies started Crede’s prophylaxis, vitamin A supplementation of women after delivery increased from 83.7% to 100%, and all staff included eye conditions in health education sessions. At one year, trained staff were more likely to correctly describe, diagnose and treat conjunctivitis (z=2.34, p=0.04)(30%-vs-60.7%). Mystery mothers observed health education sessions in 7/10 RCH clinics with trained staff, five (71.4%) of which included eye conditions. Conclusions Primary eye care for children in Dar-es-Salaam is inadequate but training RCH staff can improve knowledge in the short term and change practices. Attendance by mothers and their children is high in RCH clinics, making them ideal for delivery of PEC. Ongoing supportive supervision is required to maintain knowledge and practices, as well as systems to track referrals. PMID:24932133
Background The aim of the present study was to assess the occurrence of glutamic acid decarboxylase autoantibodies (GADA) and insulinoma antigen 2 autoantibodies (IA2A) among patients of African origin in Dar es Salaam, Tanzania and to compare the occurrence of autoimmune mediated Type 1 diabetes with findings previously reported from the same place and from other African diabetic populations. Methods Two hundred and forty five patients from the diabetic clinic at Muhimbili Hospital were recruited for a cross sectional study. Patients were clinically classified into groups with Type 1 (T1D) and Type 2 diabetes (T2D); there were 94 patients with T1D and 151 with T2D. Autoantibodies for GAD and IA2 were measured with an assay based on radioligand binding. Fasting and random blood glucose, HbA1c, and C-peptide levels were also determined. Results Of the patients with T1D, 28 (29.8%) were GADA positive and 20 (21.3%) were IA2A positive. The overall occurrence of any autoantibody was 42.6%. The GAD and IA2 autoantibodies were detected more frequently among patients with T1D than among patients with T2D (P < 0.001). A higher autoantibody prevalence was observed with combined GADA and IA2A measurements compared to individual autoantibody measurements; 40 (42.6%) patients with T1D versus 11 (7.3%) with T2D had at least one positive autoantibody titer. There was no correlation between duration of disease and detection of autoantibodies in patients with T1D. There was a strong association with family history of diabetes among the autoantibody positive versus autoantibody negative patients with T1D (p < 0.01). Conclusion The prevalence of GAD and IA2 autoantibodies among African patients with T1D in Dar es Salaam was the same as that reported previously for South Africa and Ethiopia. It was much higher than the prevalence of islet cell autoantibodies (ICA) reported from the same clinic about 15 years ago. For unknown reasons the prevalence of pancreatic related autoantibodies in this African population is lower than the prevalence found among Caucasian populations. PMID:17963519
Lutale, JJK; Thordarson, H; Holm, PI; Eide, GE; Vetvik, K
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 According to WHO estimates, tuberculosis case detection rate in Tanzania is less than 50% and this poses a major challenge to control tuberculosis in the country. Currently, one of the defining criteria for suspecting tuberculosis is cough for two weeks or more. We wanted to find out whether the prevalence of tuberculosis was different in patients who reported cough for two weeks or more, compared to patients with cough for less than two weeks. Methods We conducted a cross sectional study in six health facilities in Dar es Salaam, between September and October 2007. All patients aged five years and above with cough were screened for pulmonary tuberculosis (PTB) by smear microscopy. Patients were divided into two groups, those who coughed for less than two weeks (<2 wks) and those who coughed for two weeks or more (? 2 wks). Results A total of 65,530 patients attended outpatients department (OPD). Out of these, 2274 (3.5%) patients reported cough. Among patients who reported cough, 2214 (97.4%) remembered their cough duration. One thousand nine hundred and seventy three patients (89.1%) coughed for ? 2 wks as compared to 241 (10.9%) patients who coughed for <2 wks. Of those who coughed for two weeks or more, 250 (12.7%) had smear positive PTB, and of those who had coughed for less than two weeks, 21 (8.7%) had smear positive PTB. There was no statistically significant difference in prevalence of smear positive tuberculosis among the two groups (Pearson Chi-Square 3.2; p = 0.074). Conclusion Detection of smear positive PTB among patients who coughed for less than two weeks was as high as for those who coughed for two weeks or more. PMID:19570233
Ngadaya, Esther S; Mfinanga, Godfrey S; Wandwalo, Eliud R; Morkve, Odd
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. PMID:20509908
Data on the clinical presentations and magnitude of tuberculosis (TB)-human immunodeficiency virus (HIV) co-infection is limited. The objective of this study was to describe the clinical presentation and prevalence of TB-HIV co-infection among patients admitted at Muhimbili National Hospital between August 2008 and July 2009 in Dar es Salaam, Tanzania. Of 387 TB patients included, 117 (30.2%) were in the age group 30-39 years. The overall mean age of patients was 38.1 years (range 8 to 86 years) and 216 (55.8%) were male. Two hundred and five (53%) had pulmonary tuberculosis (PTB), 58 (15%) had extra pulmonary tuberculosis (EPTB) and 124 (32%) had both PTB and EPTB. Common sites of EPTB were pleural cavity 80 (44%), lymph node 31 (17%) and 30 (16.5%) abdomen. Of the 300 TB patients tested for HIV, 175 (58.3%) were HIV-infected and 97 (55.4%) of these were already on antiretroviral therapy (ART) at time of admission. Overall, 104 (26.9%) of the TB patients admitted died. About two thirds of patients who died had PTB. About three quarters (73.1%; N=283) of the patients were discharged home to continue with anti-TB treatment. There was significantly higher proportion of deaths among HIV-infected TB patients (29.1% versus 15.2%) than in the HIV uninfected TB patients (P=0.005). Age was a significant predictor for PTB (OR 0.946, 95% CI 0.917-0.976) while age (OR 1.019, 95% CI 1.002-1.036) and HIV serostatus (OR 2.143, 95% CI 1.313-3.497) were significant risk factors for EPTB. It is concluded that more than half of the patients had PTB and pleural cavity was the most common site of EPTB. TB-HIV co-infected patients had significantly higher mortality than the TB-HIV- uninfected patients. It is recommended to emphasize on the provision of HIV counselling and testing to all TB patients to ensure proper management and timely initiation of ART in TB-HIV co-infected patients in order to improve the outcome and reduce mortality. PMID:24409643
Kamenju, Pili; Aboud, Said
Background Community-based service delivery is vital to the effectiveness, affordability and sustainability of vector control generally, and to labour-intensive larval source management (LSM) programmes in particular. Case description The institutional evolution of a city-level, community-based LSM programme over 14 years in urban Dar es Salaam, Tanzania, illustrates how operational research projects can contribute to public health governance and to the establishment of sustainable service delivery programmes. Implementation, management and governance of this LSM programme is framed within a nested set of spatially-defined relationships between mosquitoes, residents, government and research institutions that build upward from neighbourhood to city and national scales. Discussion and evaluation The clear hierarchical structure associated with vertical, centralized management of decentralized, community-based service delivery, as well as increasingly clear differentiation of partner roles and responsibilities across several spatial scales, contributed to the evolution and subsequent growth of the programme. Conclusions The UMCP was based on the principle of an integrated operational research project that evolved over time as the City Council gradually took more responsibility for management. The central role of Dar es Salaam’s City Council in coordinating LSM implementation enabled that flexibility; the institutionalization of management and planning in local administrative structures enhanced community-mobilization and funding possibilities at national and international levels. Ultimately, the high degree of program ownership by the City Council and three municipalities, coupled with catalytic donor funding and technical support from expert overseas partners have enabled establishment of a sustainable, internally-funded programme implemented by the National Ministry of Health and Social Welfare and supported by national research and training institutes. PMID:24964790
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. PMID:19765312
Kidanto, Hussein L; Mogren, Ingrid; van Roosmalen, Jos; Thomas, Angela N; Massawe, Siriel N; Nystrom, Lennarth; Lindmark, Gunilla
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) to detect mosquito breeding sites and larvae in areas with and without larviciding. Potential environmental and programmatic determinants of habitat detection coverage and detection sensitivity of mosquito larvae were recorded during guided walks with 64 different CORPs to assess the accuracy of data each had collected the previous day. Results CORPs reported the presence of 66.2% of all aquatic habitats (1,963/2,965), but only detected Anopheles larvae in 12.6% (29/230) of habitats that contained them. Detection sensitivity was particularly low for late-stage Anopheles (2.7%, 3/111), the most direct programmatic indicator of malaria vector productivity. Whether a CORP found a wet habitat or not was associated with his/her unfamiliarity with the area (Odds Ratio (OR) [95% confidence interval (CI)] = 0.16 [0.130, 0.203], P < 0.001), the habitat type (P < 0.001) or a fence around the compound (OR [95%CI] = 0.50 [0.386, 0.646], P < 0.001). The majority of mosquito larvae (Anophelines 57.8% (133/230) and Culicines 55.9% (461/825) were not reported because their habitats were not found. The only factor affecting detection of Anopheline larvae in habitats that were reported by CORPs was larviciding, which reduced sensitivity (OR [95%CI] = 0.37 [0.142, 0.965], P = 0.042). Conclusions Accessibility of habitats in urban settings presents a major challenge because the majority of compounds are fenced for security reasons. Furthermore, CORPs under-reported larvae especially where larvicides were applied. This UMCP system for larval surveillance in cities must be urgently revised to improve access to enclosed compounds and the sensitivity with which habitats are searched for larvae. PMID:20042071
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
Mbwambo, H A; Magwisha, H B; Mfinanga, J M
BACKGROUND Limited disease awareness among women may impact breast cancer stage-at-diagnosis in Tanzania, reducing survival. This study assessed breast cancer knowledge, screening practices, and educational preferences among outpatients at Tanzanian government-supported hospitals. METHODS A convenience sample of women was surveyed regarding (1) knowledge/beliefs of breast cancer etiology, risk factors, symptoms, treatment, (2) early detection knowledge/practice, and (3) educational preferences. RESULTS Among 225 respondents, 98.2% knew of breast cancer; 22.2% knew someone affected by breast cancer. On average, 30% of risk factors and 51% of symptoms were identified. Most accepted one or more breast cancer myths. Among 126 aware of breast self-exam, 40% did not practice it; only 0.9% underwent regular clinical breast examinations despite 68% being aware of the procedure. Among treatments, 87% recognized surgery, 70% radiation, and fewer systemic therapy. Preferred educational sources were group sessions, television/radio, and meetings with breast cancer survivors. CONCLUSIONS This work reveals incomplete breast cancer awareness among Tanzanian women and promises to inform development of user-focused educational resources. PMID:24855371
Morse, Emma Perry; Maegga, Bertha; Joseph, Gertrud; Miesfeldt, Susan
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 Bakari, Muhammad; Urassa, Willy; Mhalu, Fred; Biberfeld, Gunnel; Pallangyo, Kisali; Sandström, Eric 2008-01-01
Bakari, Muhammad; Urassa, Willy; Mhalu, Fred; Biberfeld, Gunnel; Pallangyo, Kisali; Sandström, Eric
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. PMID:20027266
Tarimo, Edith A.M.; Thorson, Anna; Bakari, Muhammad; Mwami, Joachim; Sandström, Eric; Kulane, Asli
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. PMID:23914842
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 of Dar es Salaam, between October 2007 and June 2008. All women with cough attending FP and MCH clinics were screened for TB by smear microscopy. Pearson chi-square was used to compare group difference for categorical variables. Risk factors for smear positive were estimated by logistics regression with 95% confidence intervals (CI) given for odds ratios indicating statistically significant relationship if the CI did not include one. Results We enrolled a total of 749 TB suspects. Five hundred and twenty nine patients (70.6%) were from MCH clinics. Mean (SD) age was 27.6 (5.2) years. A total of 616 (82.2%) patients were coughing for less than two weeks as compared to 133 (17.8%), who coughed for two or more weeks. Among 616 TB suspects, 14 (2.3%) were smear positive TB patients, and of the 133 who had coughed for two or more weeks, 13 (9.8%) were smear positive TB patients. Risk factors associated with smear positive results were having attended more than one visit to any facility prior to diagnosis (OR = 6.8; 95%CI 2.57–18.0) and having HIV/AIDS (OR = 4.4; 95%CI 1.65–11.96). Long duration of cough was not a risk factor for being smear positive (OR = 1.6; 95%CI 0.59–4.49). Conclusion The proportion of smear positive TB patients among women with cough attending MCH and FP was 3.8%. Visits to any health facility prior to Diagnosis and HIV infection were risk for having a smear positive TB. PMID:19646288
Ngadaya, Esther S; Mfinanga, Godfrey S; Wandwalo, Eliud R; Morkve, Odd
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.
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
Edmund J Kayombo; Zakaria H Mbwambo; Mariam Massila
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. PMID:22717748
Mushi, Douglas; Byamukama, Denis; Kirschner, Alexander K.T.; Mach, Robert L.; Brunner, K.; Farnleitner, Andreas H.
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))
Background HIV/AIDS continues to destroy the lives of young people especially in low-income countries. The inclusion of youths in HIV vaccine trials is of utmost importance in obtaining an effective vaccine that is acceptable to them. Objective To characterize the willingness of young adults in Tanzania to participate in an HIV vaccine trial and the factors that influence this willingness. Design Four hundred and fifty young adults who visited a youth-friendly Infectious Diseases Clinic (IDC) from February 2012 to September 2012 completed a self-administered questionnaire concerning sociodemographic information, their knowledge about and perception of HIV vaccine studies, and the availability of social support. Results Of our participants, 50.6% expressed willingness to participate in HIV vaccine trials, and this willingness was positively correlated with having some knowledge about HIV vaccine studies (AOR, 2.2; 95% CI: 1.4–3.4), a positive perception toward such studies (AOR, 2.3; 95% CI: 1.5–3.6), having a relationship with someone who could help them make a decision (AOR, 2.5; 95% CI: 1.3–4.9), and age at the time of sexual debut (AOR, 2.6; 95% CI 1.0–6.7) for 15- to 19-year-olds and (AOR, 2.7; 95% CI 1.0–7.1) for older participants. Conclusions The participants exhibited a moderate willingness to participate in HIV vaccine trials, which was associated with a positive perception of and some knowledge about such trials, having a relationship with someone who might influence their decision as well as age at time of sexual debut. More efforts should be made to inform the youths about specific HIV vaccine trials and related matters, as well as to engage significant others in the decision-making process. PMID:24572007
Mbunda, Theodora; Bakari, Muhammad; Tarimo, Edith A. M.; Sandstrom, Eric; Kulane, Asli
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...
The treatment of malignancies with radiotherapy and intracavitary techniques at the Tanzanian Tumor Center in Dar es Salaam, Tanzania, during an eight-month period in 1979 is reported. Cancer of the uterine cervix was the tumor most frequently treated by radiation, as well as breast, esophagus, skin, and bladder cancers. ImagesFigure 2Figure 3Figure 4Figure 5Figure 6 PMID:6854664
Alexander, George A.
Introduction There has been an increase in the prevalence of erectile dysfunction (ED) in the general population especially among Diabetic patients. This seems to be neglected problem in low-income countries. This study aims at establishing the prevalence of ED and associated risk factors in diabetic patients attended at Diabetic Clinic at Muhimbili National Hospital. Methods A cross-sectional hospital based study was conducted among 312 diabetic patients attending diabetic clinic at Muhimbili National Hospital between May and December 2011. Results More than half (55.1%) of the patients were found to have some form of ED (12.8% had mild dysfunction, 11.5% moderate and 27.9% severe dysfunction). The severity of ED was correlated with increased age. Multivariate logistic regression revealed that ED was significantly predicted by old age (odds ratio (OR) = 7.1, 95% CI 1.2-40.7), evidence of peripheral neuropathy (OR) =5.9, 95% CI 1.6-21.3), and evidence of peripheral vascular disease (OR =2.5, 95% CI 1.2-5.3). Also longer duration of DM was marginally associated with ED (p=0.056). Patients with ED were also more likely to suffer other sexual domains (p<0.001). No lifestyle factor was associated with ED. Conclusion The prevalence of ED is high among DM patients. Interventions aimed at prevention, early diagnosis and detection of DM and its complications, and adherence to treatment to prevent complications should be implemented. Further studies should emphasize on temporal variation to show true causality of DM on erectile dysfunction. PMID:25170371
Mutagaywa, Reuben Kato; Lutale, Janeth; Aboud, Muhsin; Kamala, Benjamin Anathory
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…
Whereas Tanzania has seen considerable improvements in water and sanitation infrastructure over the past 20 years, the country still faces high rates of childhood morbidity from diarrheal diseases. This study utilized a qualitative, cross-sectional, modified Photovoice method to capture daily activities of Dar es Salaam mothers. A total of 127 photographs from 13 households were examined, and 13 interviews were conducted with household mothers. The photographs and interviews revealed insufficient hand washing procedures, unsafe disposal of wastewater, uncovered household drinking water containers, a lack of water treatment prior to consumption, and inappropriate toilets for use by small children. The interviews revealed that mothers were aware and knowledgeable of the risks of certain household practices and understood safer alternatives, yet were restricted by the perceived impracticality and financial constraints to make changes. The results draw attention to the real economic and behavioral challenges faced in reducing the spread of disease. PMID:21969836
Badowski, Natalie; Castro, Cynthia M.; Montgomery, Maggie; Pickering, Amy J.; Mamuya, Simon; Davis, Jennifer
Background Tanzania is East Africa’s largest country. Although it is socially diverse, it has experienced general political stability since independence in 1964. Despite gradual economic development and Tanzania’s status as one of the biggest recipients of aid in Africa, health status remains poor. This paper explores Tanzania’s science-based health innovation system, and highlights areas which can be strengthened. Methods Qualitative case study research methodology was used. Data were collected through reviews of academic literature and policy documents, and through open-ended, face-to-face interviews with 52 people from across the science-based health innovation system over two visits to Tanzania from July to October 2007. Results and discussion Tanzania has a rich but complex S&T governance landscape, with the public sector driving the innovation agenda through a series of different bodies which are not well-coordinated. It has some of the leading health research on the continent at the University of Dar es Salaam, Muhimbili University of Health and Applied Sciences, the National Institute for Medical Research and the Ifakara Medical Institute, with strong donor support. Tanzania has found developing an entrepreneurial culture difficult; nevertheless projects such as the clusters initiative at the University of Dar es Salaam are encouraging low-tech innovation and overcoming knowledge-sharing barriers. In the private sector, one generics company has developed a South-South collaboration to enable technology transfer and hence the local production of anti-retrovirals. Local textile company A to Z Textiles is now manufacturing 30 million insecticide impregnated bednets a year. Conclusions To have a coherent vision for innovation, Tanzania may wish to address some key issues: coordination across stakeholders involved with health research, increasing graduates in health-related disciplines, and building capabilities in biological testing, preclinical testing, formulation and standardization, and related areas important to moving from basic research to applications. The private sector can be encouraged to innovate through improved access to financing, and incentives for R&D. The diaspora community represents an untapped source for partnerships and access to other developing world markets and technology. The government may wish to set up mechanisms to encourage south-south collaborations, and to bring the public and private sector together around specific projects to help realize the country’s innovation potential. PMID:21144075
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 participated…
Onguko, Brown Bully; Abdalla, Mohamed; Webber, Charles F.
The aim of this study is to reassess the early Acheulean at Peninj, on the western shore of Lake Natron (Tanzania). This paper describes the archaeological contexts and technological strategies of two assemblages, RHS-Mugulud and MHS-Bayasi, dated to 1.5–1.1 myr ago. The study of lithic artefacts from Glynn Isaac’s excavations in 1960s–1980s, curated at the National Museum of Dar-es-Salaam (Tanzania),
Ignacio de la Torre; Rafael Mora; Jorge Martínez-Moreno
We report on the occurrence and diversity of cyanobacteria in intertidal seagrass meadows at Ocean Road and Mjimwema, Dar es Salaam, Tanzania. Nutrients, temperature and salinity were measured as comparative environmental factors. A total of 19 different cyanobacteria taxa were encountered, out of which eight were found exclusively in Mjimwema, four exclusively in Ocean Road and seven were common to
Mariam I. Hamisi; Thomas J. Lyimo; Masoud H. S. Muruke
This article discusses urban agriculture in the city of Dar es Salaam, Tanzania, and how it helps people to cope with the country's economic crisis. Urban agriculture is also associated with environmental degradation. The article identifies factors that encourage urban agriculture at four different levels and suggests that to check further environmental degradation, concerted efforts should be made at all
Malongo RS Mlozi
Between August 2002 and April 2004, a man-eating lion killed 35 people and injured at least 9 in a 350-km2 area 150 km south-west of Dar es Salaam in Tanzania. Man-eating by lions is common in Southern Tanzania, but this case was\\u000a exceptional due to the high number of victims attributed to a single animal. After having been killed by game
Rolf D. Baldus
The research for this thesis was carried out in Tanzania during the period 1985- 89 and focuses on the Mgeta division in the Uluguru mountains, Morogoro rural district. Research was also undertaken among migrants from the area living in Dar es Salaam where they traded in foodstuffs. I made a return visit to the area in November 1991 to look
Donge van J. K
Outlines a strategy for marketing the information products and services of the Water and Sanitation Information and Documentation Centre (MAJIDOC) of the Water Resources Institute in Dar es Salaam, Tanzania. Objectives of the marketing strategy are explained, ideas for internal and external promotion are described, and a budget plan is included.…
Michael, Benedict P.
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. PMID:23467278
Mboya, Beati; Temu, Florence; Awadhi, Bayoum; Ngware, Zubeda; Ndyetabura, Elly; Kiondo, Gloria; Maridadi, Janneth
Recent work in anthropology points to the recognition of multispecies entanglements as the grounds for a more ethical politics. In this article, we examine efforts to control mosquitoes in Dar es Salaam, Tanzania, as an example of the laborious tasks of disentanglement that characterize public health interventions. The mosquito surveillance and larval elimination practices of an urban malaria control program offer an opportunity to observe how efforts to create distance between species relate to the physical and civic textures of the city. Seen in the particular context of the contemporary African metropolis, the work of public health appears less a matter of control than a commitment to constant urban maintenance and political mobilization. PMID:25429167
KELLY, ANN H.; LEZAUN, JAVIER
A 14-item human immunodeficiency virus/acquired immunodeficiency syndrome knowledge scale was used among school students in 80 schools in 3 sites in Sub-Saharan Africa (Cape Town and Mankweng, South Africa, and Dar es Salaam, Tanzania). For each item, an incorrect or don't know response was coded as 0 and correct response as 1. Exploratory factor…
Aaro, Leif E.; Breivik, Kyrre; Klepp, Knut-Inge; Kaaya, Sylvia; Onya, Hans E.; Wubs, Annegreet; Helleve, Arnfinn; Flisher, Alan J.
BackgroundIn many developing countries, initiatives are underway to strengthen voluntary community based health insurance as a means of expanding access to affordable care among the informal sector. However, increasing coverage with voluntary health insurance in low income settings can prove challenging. There are limited studies on determinants of enrolling in these schemes using mixed methods. This study aims to shed light on the characteristics of those joining a community health fund, a type of community based health insurance, in Tanzania and the reasons for their membership and subsequent drop out using mixed methods.MethodsA cross sectional survey of households in four rural districts was conducted in 2008, covering a total of 1,225 (524 members of CHF and 701 non-insured) households and 7,959 individuals. In addition, 12 focus group discussions were carried out with CHF members, non-scheme members and members of health facility governing committees in two rural districts. Logistic regression was used to assess the determinants of CHF membership while thematic analysis was done to analyse qualitative data.ResultsThe quantitative analysis revealed that the three middle income quintiles were more likely to enrol in the CHF than the poorest and the richest. CHF member households were more likely to be large, and headed by a male than uninsured households from the same areas. The qualitative data supported the finding that the poor rather than the poorest were more likely to join as were large families and of greater risk of illness, with disabilities or persons with chronic diseases. Households with elderly members or children under-five years were also more likely to enrol. Poor understanding of risk pooling deterred people from joining the scheme and was the main reason for not renewing membership. On the supply side, poor quality of public care services, the limited benefit package and a lack of provider choice were the main factors for low enrolment.ConclusionsDeterminants of CHF membership are diverse and improving the quality of health services and expanding the benefit package should be prioritised to expand voluntary health insurance coverage. PMID:25411021
Macha, Jane; Kuwawenaruwa, August; Makawia, Suzan; Mtei, Gemini; Borghi, Josephine
Background The United Republic of Tanzania, like many other countries in sub-Saharan Africa, faces a human resources crisis in its health sector, with a small and inequitably distributed health workforce. Rural areas and other poor regions are characterised by a high burden of disease compared to other regions of the country. At the same time, these areas are poorly supplied with human resources compared to urban areas, a reflection of the situation in the whole of Sub-Saharan Africa, where 1.3% of the world's health workforce shoulders 25% of the world's burden of disease. Medical schools select candidates for training and form these candidates' professional morale. It is therefore likely that medical schools can play an important role in the problem of geographical imbalance of doctors in the United Republic of Tanzania. Methods This paper reviews available research evidence that links medical students' characteristics with human resource imbalances and the contribution of medical schools in perpetuating an inequitable distribution of the health workforce. Existing literature on the determinants of the geographical imbalance of clinicians, with a special focus on the role of medical schools, is reviewed. In addition, structured questionnaires collecting data on demographics, rural experience, working preferences and motivational aspects were administered to 130 fifth-year medical students at the medical faculties of MUCHS (University of Dar es Salaam), HKMU (Dar es Salaam) and KCMC (Tumaini University, Moshi campus) in the United Republic of Tanzania. The 130 students represented 95.6% of the Tanzanian finalists in 2005. Finally, we apply probit regressions in STATA to analyse the cross-sectional data coming from the aforementioned survey. Results The lack of a primary interest in medicine among medical school entrants, biases in recruitment, the absence of rural related clinical curricula in medical schools, and a preference for specialisation not available in rural areas are among the main obstacles for building a motivated health workforce which can help correct the inequitable distribution of doctors in the United Republic of Tanzania. Conclusion This study suggests that there is a need to re-examine medical school admission policies and practices. PMID:20187942
In Tanzania, the earth sciences are only taught at the University of Dar es Salaam, in the Department of Geology. The Department was founded in 1974, acquired its first Tanzanian staff in 1975 and produced its first graduates in 1977. Now the Department is completely run by Tanzanian staff and about 25 Geology students graduate annually. The Department offers B.Sc., M.Sc. (taught and by research) and Ph.D. degrees. Students enter the University after 13 years of schooling, thus, upon completion of A levels. Currently, about 30 students a year are admitted to the Geology course, of whom about five will fail to complete. Normally, only 5 to 10% of the undergraduates are women. Currently, most students obtain employment with exploration and mining companies. The Department has dedicated laboratories for teaching and research and has several items of analytical equipment. There are 15 academic staff, most with Ph.D.s, many of whom were trained in the 1980s and 1990s in Germany and Finland through collaborative training programmes. Current research projects are funded by Sweden, the Netherlands and the Tanzanian Government.
Kinabo, C.; Muhongo, S.
Objective: Most research on child abuse in Tanzania and Kenya is unpublished in the international literature. The purpose of this paper is to examine the various commentaries and reports extant, toward an overview of the nature and frequency of child sexual abuse in Tanzania and Kenya. Methods: Contacts were made with academics, government…
Rapid urbanization, and consequently, the dramatic spatial expansion of mostly informal urban areas increases the vulnerability of African cities to the effects of climate change such as sea level rise, more frequent flooding, droughts and heat waves. The EU FP 7 funded project CLUVA (Climate Change and Urban Vulnerability in Africa, www.cluva.eu) aims to develop strategies for minimizing the risks of natural hazards caused by climate change and to improve the coping capacity of African cities. Green infrastructure may play a particular role in climate change adaptation by providing ecosystem services for flood protection, stormwater retention, heat island moderation and provision of food and fuel wood. In this context, a major challenge is to gain a better understanding of the spatial and temporal dynamics of the cities and how these impact on green infrastructure and hence their vulnerability. Urban growth scenarios for two African cities, namely Addis Ababa, Ethiopia and Dar es Salaam, Tanzania, were developed based on a characterization of their urban morphology. A population growth driven - GIS based - disaggregation modeling approach was applied. Major impact factors influencing the urban dynamics were identified both from literature and interviews with local experts. Location based factors including proximity to road infrastructure and accessibility, and environmental factors including slope, surface and flood risk areas showed a particular impact on urban growth patterns. In Addis Ababa and Dar es Salaam, population density scenarios were modeled comparing two housing development strategies. Results showed that a densification scenario significantly decreases the loss of agricultural and green areas such as forests, bushland and sports grounds. In Dar es Salaam, the scenario of planned new settlements with a population density of max. 350 persons per hectare would lead until 2025 to a loss of agricultural land (-10.1%) and green areas (-6.6%). On the other hand, 12.4% of agricultural land and 16.1% of green areas would be lost in the low density development scenario of unplanned settlements of max. 150 persons per hectare. Relocating the population living in flood prone areas in the case of Addis Ababa and keeping those areas free from further settlements in the case of Dar es Salaam would result in even lower losses (agricultural land: -10.0%, green areas: -5.6%) as some flood prone areas overlap with agricultural/ green areas. The scenario models introduced in this research can be used by planners as tools to understand and manage the different outcomes of distinctive urban development strategies on growth patterns and how they interact with different climate change drivers such as loss of green infrastructure and effects such as frequent flooding hazards. Due to the relative simplicity of their structure and the single modeling environment, the models can be transferred to similar cities with minor modifications accommodating the different conditions of each city. Already, in Addis Ababa the results of the model will be used in the current revision of the Master plan of the city. Keywords: GIS, modeling, Urban Dynamics, Dar es Salaam, Addis Ababa, urbanization
Buchta, Katja; Abo El Wafa, Hany; Printz, Andreas; Pauleit, Stephan
Population strategies to relieve the density pressures on land and resources in Tanzania have not considered the basic causes of population growth. Resettlement results in the same environmental degradation as in the original settlement. There should be a reduction in the population growth and planning of proper land use and resource exploitation before resettlement. Rural development must include a decline in the dependency on subsistence agriculture. Population in Tanzania increased by 213% during 1948-88. An absolute increase in population size during 1978-88 is recorded despite a slight decline in the rate of growth. Death rates declined, but birth rates were relatively stable at around 50 per 1000 population. Regions with the highest growth rates were Dar es Salaam (4.8%), Rukwa (4.3%), Arusha (3.8%), Mbeya (3.1%), and Ruvuma (3.2%). The regions with the lowest rates were Tanga and Kilimanjaro (2.1%), Coast (2.1%), Lindi (2%), and Mtwara (1.4%). Low growth rates are attributed to low fertility and high infertility. Other factors affecting high growth rates are culture, rates of natural increase, intensity of internal and international migration, climatic conditions, and availability of resources. In 1988 46% of the population was under 15 years old. Per capita land availability declined from 11.8 hectares in 1948 to 3.8 hectares in 1988. The number of landless peasants increased. Productivity declined, and distances to farms increased. The total fertility rate was 6.5 children per woman in 1988 and 6.1 during 1991-92. Slight declines were apparent in the crude birth rate also. High fertility was a response to universal marriage, low contraceptive use (7% using modern methods during 1991-92), declining lactation periods, high mortality rates, and old traditions favoring large families. Children were used extensively in time-consuming and labor-intensive activities, such as fetching water. The mean number of children ever born was higher among women with 1-4 years of schooling compared to women with no formal education and women with 5 or more years of education. Population growth contributes to deforestation, soil erosion, desertification, famine, drought, flooding, and demand for firewood. PMID:12179895
Madulu, N F
Bovine tuberculosis (bTB), caused by Mycobacterium bovis, is a disease of zoonotic concern, especially in countries with no control programs in livestock and where routine pasteurization of milk is not practiced. In Tanzania, bTB is widespread in livestock and has been diagnosed in humans; however, herd bTB testing is primarily carried out for bTB-free certification in commercial dairy herds at the expense of the dairy cattle owner. For rural livestock holders, such an expense is prohibitive, and consequently there is no control of bTB in most areas. Although effective long-term solutions to control bTB in livestock are desirable, there is a need to assess the effect of preventive measures on reducing human exposure to bTB in such settings. We utilized locally relevant cattle herd characteristics and management data from the Health for Animals and Livelihood Improvement (HALI) project in south-central Tanzania to build a Reed-Frost model that compared the efficacy of alternative methods aimed at reducing the exposure of humans to infectious milk from a typical pastoralist cattle herd. During a 10-year simulation period, the model showed that boiling milk 80% of the time is necessary to obtain a reduction in liters of infectious milk approximately equivalent to what would be obtained with a standard 2-year testing and removal regimen, and that boiling milk was more effective than animal test and removal early in the time period. In addition, even with testing and removing infected cattle, a residual risk of exposure to infectious milk remained due to imperfect sensitivity of the skin test and a continuous risk of introduction of infectious animals from other herds. The model was sensitive to changes in initial bTB prevalence but not to changes in herd size. In conclusion, continuous complimentary treatment of milk may be an effective strategy to reduce human exposure to M. bovis-infected milk in settings where bTB is endemic and a comprehensive bTB control program is yet to be implemented. PMID:24853050
Roug, Annette; Perez, Andres; Mazet, Jonna A K; Clifford, Deana L; VanWormer, Elizabeth; Paul, Goodluck; Kazwala, Rudovick R; Smith, Woutrina A
We are currently developing a proposal for a new International Continental Scientific Drilling Program (ICDP) project to recover a stratigraphic and paleoclimatic record from the full succession of Eocene hemipelagic sediments that are now exposed on land in southern Tanzania. Funding for a workshop was provided by ICDP, and the project was advertised in the normal way. A group of about 30 delegates assembled in Dar-es-Salaam for 3 intensive days of discussion, project development, and proposal writing. The event was hosted by the Tanzania Petroleum Development Corporation (TPDC) and was attended by several geologists, geochemists, geophysicists, and micropaleontologists from TPDC and the University of Dar-es-Salaam. International delegates were from Canada, Germany, India, Ireland, Italy, the Netherlands, United Kingdom, and United States (and we also have project partners from Australia, Belgium, and Sweden who were not able to attend). Some of the scientists are veterans of previous scientific drilling in the area, but over half are new on the scene, mostly having been attracted by Tanzania's reputation for world-class paleoclimate archives. Here we outline the broad aims of the proposed drilling and give a flavor of the discussions and the way our proposal developed during the workshop. A video of the workshop with an introduction to the scientific goals and interviews of many of the participants is available at http://vimeo.com/107911777.
Pearson, P. N.; Hudson, W.
This paper addresses the performance of institutions in water supply systems for improving social and economic benefits of people living in Dar es Salaam city. The methods employed in field data and information collection included interviews, questionnaire, focus group discussions and participatory observation. Kinondoni and Ilala Districts were used as case study. The study revealed that, the main water sources in the study areas are boreholes, shallow wells, rain water and water vendors. Other minor sources are piped water and natural water sources, such as rivers and streams. The supply of piped water by Dar es Salaam Water Sewerage and Sanitation Company (DAWASA/DAWASCO) meets only 45% of the total water demands. Individuals own and sell water from boreholes, shallow wells, piped water connected to their individual houses and natural wells located in their individual plots. The price of one 20 l bucket of water from a water vendor depends on the availability of water and the distance walked from the water source to the customer. Majority of the respondents (77.5%) indicated that individual water delivery systems provide sufficient water as compared to five years ago in the study areas. Few of the respondents (6.3%) said individual water delivery systems have no capacity to provide sufficient water while 16.3% indicate that individual water delivery systems provide moderate water supply but are important in supplementing other water providers in the study areas. The study reveals that a majority of the local population are satisfied with the capacity of individual water delivery systems in providing water for household uses. This paper recommends some improvements to be done to water supply systems in the Dar es Salaam city.
Background Tanzania currently rolls out vaccination against rotavirus-diarrhea, a major cause of child illness and death. As the vaccine covers a limited number of rotavirus variants, this study describes the molecular epidemiology of rotavirus among children under two years in Dar es Salaam, Tanzania, prior to implementation of vaccination. Methods Stool specimens, demographic and clinical information, were collected from 690 children admitted to hospital due to diarrhea (cases) and 545 children without diarrhea (controls) during one year. Controls were inpatient or children attending child health clinics. Rotavirus antigen was detected using ELISA and positive samples were typed by multiplex semi-nested PCR and sequencing. Results The prevalence of rotavirus was higher in cases (32.5%) than in controls (7.7%, P<0.001). The most common G genotypes were G1 followed by G8, G12, and G4 in cases and G1, G12 and G8 in controls. The Tanzanian G1 variants displayed 94% similarity with the Rotarix vaccine G1 variant. The commonest P genotypes were P, P and P, and the commonest G/P combination G1 P (n?=?123), G8 P and G12 P. Overall, rotavirus prevalence was higher in cool (23.9%) than hot months (17.1%) of the year (P?=?0.012). We also observed significant seasonal variation of G genotypes. Rotavirus was most frequently found in the age group of four to six months. The prevalence of rotavirus in cases was lower in stunted children (28.9%) than in non-stunted children (40.1%, P?=?0.003) and lower in HIV-infected (15.4%, 4/26) than in HIV-uninfected children (55.3%, 42/76, P<0.001). Conclusion This pre-vaccination study shows predominance of genotype G1 in Tanzania, which is phylogenetically distantly related to the vaccine strains. We confirm the emergence of genotype G8 and G12. Rotavirus infection and circulating genotypes showed seasonal variation. This study also suggests that rotavirus may not be an opportunistic pathogen in children infected with HIV. PMID:24844631
Moyo, Sabrina J.; Blomberg, Bjørn; Hanevik, Kurt; Kommedal, Oyvind; Vainio, Kirsti; Maselle, Samuel Y.; Langeland, Nina
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. PMID:23663299
Background Plants represent one of the most accessible resources available for mosquito control by communities in Tanzania. However, no documented statistics exist for their contribution in the management of mosquitoes and other insects except through verbal and some publications. This study aimed at assessing communities’ knowledge, attitudes and practices of using plants as an alternative method for mosquito control among selected communities in a malaria-prone area in Tanzania. Methods Questionnaires were administered to 202 respondents from four villages of Bagamoyo District, Pwani Region, in Tanzania followed by participatory rural appraisal with village health workers. Secondary data collection for plants mentioned by the communities was undertaken using different search engines such as googlescholar, PubMED and NAPRALERT. Results Results showed about 40.3% of respondents used plants to manage insects, including mosquitoes. A broad profile of plants are used, including “mwarobaini” (Azadirachta indica) (22.5%), “mtopetope” (Annona spp) (20.8%), “mchungwa/mlimau” (Citrus spp) (8.3%), “mvumbashi/uvumbati” (Ocimum spp) (7.4%), “mkorosho” (Anacadium occidentale) (7.1%), “mwembe” (5.4%) (Mangifera indica), “mpera” (4.1%) (Psidium spp) and “maganda ya nazi” (4.1%) (Cocos nucifera). Majority of respondents collected these plants from the wild (54.2%), farms (28.9%) and/or home gardens (6%). The roles played by these plants in fighting mosquitoes is reflected by the majority that deploy them with or without bed-nets (p > 0.55) or insecticidal sprays (p >0.22). Most respondents were aware that mosquitoes transmit malaria (90.6%) while few respondents associated elephantiasis/hydrocele (46.5%) and yellow fever (24.3%) with mosquitoes. Most of the ethnobotanical uses mentioned by the communities were consistent with scientific information gathered from the literature, except for Psidium guajava, which is reported for the first time in insect control. Conclusion This survey has indicated some knowledge gap among community members in managing mosquito vectors using plant. The communities need a basic health education and sensitization for effective exploitation of this valuable tool for reducing mosquitoes and associated disease burdens. On the other hand, the government of Tanzania should strengthen advocacy of botanical pesticides development, registration and regulation for public health benefits because they are source of pest control tools people rely on them. PMID:25015092
Summary Background The burden of stroke on health systems in low-income and middle-income countries is increasing. However, high-quality data for modifiable stroke risk factors in sub-Saharan Africa are scarce, with no community-based, case-control studies previously published. We aimed to identify risk factors for stroke in an incident population from rural and urban Tanzania. Methods Stroke cases from urban Dar-es-Salaam and the rural Hai district were recruited in a wider study of stroke incidence between June 15, 2003, and June 15, 2006. We included cases with first-ever and recurrent stroke. Community-acquired controls recruited from the background census populations of the two study regions were matched with cases for age and sex and were interviewed and assessed. Data relating to medical and social history were recorded and blood samples taken. Findings We included 200 stroke cases (69 from Dar-es-Salaam and 131 from Hai) and 398 controls (138 from Dar-es-Salaam and 260 from Hai). Risk factors were similar at both sites, with previous cardiac event (odds ratio [OR] 7·39, 95% CI 2·42–22·53; p<0·0001), HIV infection (5·61, 2·41–13·09; p<0·0001), a high ratio of total cholesterol to HDL cholesterol (4·54, 2·49–8·28; p<0·0001), smoking (2·72, 1·49–4·96; p=0·001), and hypertension (2·14, 1·09–4·17; p=0·026) identified as significant independent risk factors for stroke. In Hai, additional risk factors of diabetes (4·04, 1·29–12·64) and low HDL cholesterol (9·84, 4·06–23·84) were also significant. Interpretation We have identified many of the risk factors for stroke already reported for other world regions. HIV status was an independent risk factor for stroke within an antiretroviral-naive population. Clinicians should be aware of the increased risk of stroke in people with HIV, even in the absence of antiretroviral treatment. Funding The Wellcome Trust. PMID:24748275
Walker, Richard W; Jusabani, Ahmed; Aris, Eric; Gray, William K; Unwin, Nigel; Swai, Mark; Alberti, George; Mugusi, Ferdinand
Groundwater is globally important for human consumption, and changes in quality can have serious consequences. The study area is within a coastal aquifer where groundwater quality is influenced by various potential sources of salinity that determine the composition of water extracted from wells. Groundwater chemistry data from the aquifer have been acquired to determine the geochemical conditions and processes that occur in this area and assess their implications for aquifer susceptibility. Analysis of groundwater samples shows that the dominant watertype is mostly NaCl with pH < 7 in both aquifers (i.e. upper and lower) except for the shallow wells where CaHCO3 prevails with pH ? 7, and boreholes located near the Indian Ocean, where coral reef limestone deposits are located and the watertype evolves towards CaHCO3. In the lower aquifer, Cl- is higher than in the upper aquifer. The origin of salinity in the area is strongly influenced by groundwater ascending from deep marine Miocene Spatangid Shales through faults, seawater incursion on the border of the Indian Ocean, and throughout, there is some salinity within the Quaternary aquifer, especially in intercalated deltaic clays in the fluviatile deposits, showing some marine influences. The seawater intrusion is linked to the strongly increasing groundwater exploitation since 1997. Another process that plays a major role to the concentration of major ions in the groundwater is calcite dissolution. Next to geogenic salinity and seawater intrusion, anthropogenic pollution as well is affecting groundwater quality in the aquifer. An important result of this study is the observation of high nitrate concentrations, that call for improved sanitation in the area, where domestic sewage with on-site sanitation (mainly pit latrines) also threatens the groundwater resource.
Walraevens, Kristine; Mjemah, Ibrahimu Chikira; Mtoni, Yohana; Van Camp, Marc
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.
Fischer, B. M. C.; Mul, M. L.; Savenije, H. H. G.
In Tanzania, pastoralists such as the Maasai and small urban farmers are responsible for the country's milk production, and 95% of the national milk supply is sold without regulation. This study was conducted using hygiene checklists and milk sampling to investigate milk quality and safety at various steps throughout the milk production chain. In regions of Dar es Salaam and Lake Victoria, 196 milk samples were collected: 109 samples of raw milk, 41 samples of packed or open served heat-treated products, and 46 samples of fermented products. Samples were taken from (i) the production level (pastoralists and urban farmers), (ii) the collection level (middlemen and depots), (iii) processors (dairies), and (iv) retailers (kiosks). Samples were analyzed for hygiene criteria (total bacteria, total coliforms, Escherichia coli, and coagulase-positive staphylococci) and foodborne pathogens such as Salmonella, enterohemorrhagic E. coli O157:H7, and Listeria monocytogenes. Adequate heating of milk for drinking was determined via heat labile alkaline phosphatase and lactoperoxidase analysis. Total bacterial counts indicated that only 67% (73 of 109) of raw milk samples and 46% (19 of 41) of heat-treated samples met national Tanzanian standards. Bulk milk samples taken from the traditional milking vessels of Maasai pastoralists had the lowest total bacterial counts: ? 1 × 10(2) CFU/ml. Foodborne pathogens such as E. coli O157:H7 and Salmonella were isolated from 10.1% (11 of 109) of raw milk samples but were not detected in heat-treated or fermented products, and 83% of heat-treated milk samples were lactoperoxidase negative, indicating overpasteurization. Coliforms were detected in 41% (17 of 41) of processed milk samples, thus indicating a high rate of recontamination. A progressive decrease in microbial quality along the milk production chain was attributed to departures from traditional methods, inadequate milk containers, long transport distances, lack of cooling, and lack of a basic understanding of hygiene. PMID:24215695
Schoder, Dagmar; Maichin, Andreas; Lema, Benedict; Laffa, John
Adolescent girls' early sexual activity, early pregnancy, induced abortions and the increase in HIV infections have become major concerns in Sub-Saharan Africa. Efforts, though, to understand their sexual behaviour and to prevent reproductive health problems are almost non-existent. Adolescent girls are normally seen as victims and easy preys of (often older and married) men's sexual exploitation. This article, which is based on a qualitative study of 51 adolescent girls who had just had an illegal abortion in Dar es Salaam, Tanzania, reveals that these girls are not only victims but also willing preys and active social agents engaging in high-risk sexual behaviour. In order to get material benefits they expose themselves to serious health risks, including induced abortion - without realising their own vulnerability. In our study, one out of four girls had more than one partner at the time they became pregnant, and many counted on an illegally induced abortion if they got pregnant. Even if adolescents are now allowed free access to family planning information, education and services, our study shows that this remains in the realm of theory rather than practice. Moreover, most adolescent girls are not aware about their right to such services. The paper concludes that the vulnerability of adolescent girls increases without the recognition that sexuality education and contraceptive services do not constitute a licence to practice illicit sex - but rather a means to create more mature and responsible attitudes and to increase sexual and reproductive health. PMID:11352408
Silberschmidt, M; Rasch, V
Background Traditional birth attendants retain an important role in reproductive and maternal health in Tanzania. The Tanzanian Government promotes TBAs in order to provide maternal and neonatal health counselling and initiating timely referral, however, their role officially does not include delivery attendance. Yet, experience illustrates that most TBAs still often handle complicated deliveries. Therefore, the objectives of this research were to describe (1) women’s health-seeking behaviour and experiences regarding their use of antenatal (ANC) and postnatal care (PNC); (2) their rationale behind the choice of place and delivery; and to learn (3) about the use of traditional practices and resources applied by traditional birth attendants (TBAs) and how they can be linked to the bio-medical health system. Methods Qualitative and quantitative interviews were conducted with over 270 individuals in Masasi District, Mtwara Region and Ilala Municipality, Dar es Salaam, Tanzania. Results The results from the urban site show that significant achievements have been made in terms of promoting pregnancy- and delivery-related services through skilled health workers. Pregnant women have a high level of awareness and clearly prefer to deliver at a health facility. The scenario is different in the rural site (Masasi District), where an adequately trained health workforce and well-equipped health facilities are not yet a reality, resulting in home deliveries with the assistance of either a TBA or a relative. Conclusions Instead of focusing on the traditional sector, it is argued that more attention should be paid towards (1) improving access to as well as strengthening the health system to guarantee delivery by skilled health personnel; and (2) bridging the gaps between communities and the formal health sector through community-based counselling and health education, which is provided by well-trained and supervised village health workers who inform villagers about promotive and preventive health services, including maternal and neonatal health. PMID:23448583
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 Sub-Saharan Africa is among the countries where 10% of girls become mothers by the age of 16 years old. The United Republic of Tanzania located in Sub-Saharan Africa is one country where teenage pregnancy is a problem facing adolescent girls. Adolescent pregnancy has been identified as one of the reasons for girls dropping out from school. This study's purpose was to evaluate a reproductive health awareness program for the improvement of reproductive health for adolescents in urban Tanzania. Methods A quasi-experimental pre-test and post-test research design was conducted to evaluate adolescents' knowledge, attitude, and behavior about reproductive health before and after the program. Data were collected from students aged 11 to 16, at Ilala Municipal, Dar es Salaam, Tanzania. An anonymous 23-item questionnaire provided the data. The program was conducted using a picture drama, reproductive health materials and group discussion. Results In total, 313 questionnaires were distributed and 305 (97.4%) were useable for the final analysis. The mean age for girls was 12.5 years and 13.2 years for boys. A large minority of both girls (26.8%) and boys (41.4%) had experienced sex and among the girls who had experienced sex, 51.2% reported that it was by force. The girls' mean score in the knowledge pre-test was 5.9, and 6.8 in post-test, which increased significantly (t = 7.9, p = 0.000). The mean behavior pre-test score was 25.8 and post-test was 26.6, which showed a significant increase (t = 3.0, p = 0.003). The boys' mean score in the knowledge pre-test was 6.4 and 7.0 for the post-test, which increased significantly (t = 4.5, p = 0.000). The mean behavior pre-test score was 25.6 and 26.4 in post-test, which showed a significant increase (t = 2.4, p = 0.019). However, the pre-test and post-test attitude scores showed no statistically significant difference for either girls or boys. Conclusions Teenagers have sexual experiences including sexual violence. Both of these phenomena are prevalent among school-going adolescents. The reproductive health program improved the students' knowledge and behavior about sexuality and decision-making after the program for both girls and boys. However, their attitudes about reproductive health were not likely to change based on the educational intervention as designed for this study. PMID:21707996
A multi-mycotoxin method based on liquid chromatography/tandem mass spectrometry (LC-MS/MS) was used for a mycotoxin survey in 627 samples of processed cassava collected from different districts across Tanzania and Rwanda after the method performance for this matrix had been determined. Matrix effects as well as extraction efficiencies were found to be similar to most other previously investigated matrices with the exception of distinct matrix effects in the negative ionisation mode for early eluting compounds. Limits of detection were far below the regulatory limits set in the European Union for other types of commodities. Relative standard deviations were generally lower than 10% as determined by replicates spiked on two concentration levels. The sample-to-sample variation of the apparent recoveries was determined for 15 individually spiked samples during three different analytical sequences. The related standard deviation was found to be lower than 15% for most of the investigated compounds, thus confirming the applicability of the method for quantitative analysis. The occurrence of regulated mycotoxins was lower than 10% (with the exception of zearalenone) and the related limits were exceeded only in few samples, which suggests that cassava is a comparatively safe commodity as regards mycotoxins. The most prevalent fungal metabolites were emodin, kojic acid, beauvericin, tryptophol, 3-nitropropionic acid, equisetin, alternariol methylether, monocerin, brevianamide F, tenuazonic acid, zearalenone, chrysophanol, monilifomin, enniatins, apicidin and macrosporin. The related concentrations exceeded 1 mg kg(-1) only in few cases. However, extremely high levels of cyanogenic plant toxins, which had been previously added to the method, were observed in few samples, pointing out the need for improved post-harvest management to decrease the levels of these compounds. PMID:25350522
Sulyok, M; Beed, F; Boni, S; Abass, A; Mukunzi, A; Krska, R
Background Pyrethroid resistance has been slower to emerge in Anopheles arabiensis than in An. gambiae s.s and An. funestus and, consequently, studies are only just beginning to unravel the genes involved. Permethrin resistance in An. arabiensis in Lower Moshi, Tanzania has been linked to elevated levels of both P450 monooxygenases and ?-esterases. We have conducted a gene expression study to identify specific genes linked with metabolic resistance in the Lower Moshi An. arabiensis population. Methods Microarray experiments employing an An. gambiae whole genome expression chip were performed on An. arabiensis, using interwoven loop designs. Permethrin-exposed survivors were compared to three separate unexposed mosquitoes from the same or a nearby population. A subsection of detoxification genes were chosen for subsequent quantitative real-time PCR (qRT-PCR). Results Microarray analysis revealed significant over expression of 87 probes and under expression of 85 probes (in pairwise comparisons between permethrin survivors and unexposed sympatric and allopatric samples from Dar es Salaam (controls). For qRT-PCR we targeted over expressed ABC transporter genes (ABC ‘2060’), a glutathione-S-transferase, P450s and esterases. Design of efficient, specific primers was successful for ABC ‘2060’and two P450s (CYP6P3, CYP6M2). For the CYP4G16 gene, we used the primers that were previously used in a microarray study of An. arabiensis from Zanzibar islands. Over expression of CYP4G16 and ABC ‘2060’ was detected though with contrasting patterns in pairwise comparisons between survivors and controls. CYP4G16 was only up regulated in survivors, whereas ABC ‘2060’ was similar in survivors and controls but over expressed in Lower Moshi samples compared to the Dar es Salaam samples. Increased transcription of CYP4G16 and ABC ‘2060’ are linked directly and indirectly respectively, with permethrin resistance in Lower Moshi An. arabiensis. Conclusions Increased transcription of a P450 (CYP4G16) and an ABC transporter (ABC 2060) are linked directly and indirectly respectively, with permethrin resistance in Lower Moshi An. arabiensis. Our study provides replication of CYP4G16 as a candidate gene for pyrethroid resistance in An. arabiensis, although its role may not be in detoxification, and requires further investigation. PMID:24946780
A preparatory course and a three-week study safari to Tanzania were conducted jointly by the University of Southampton and Nottingham University. The course sought to increase the participants' understanding of Tanzania's geography, economy, politics, education, and social systems. The actual visit is also described. (Author/EC)
Epidemiological data on carbapenemase-producing Gram-negative bacteria on the African continent are limited. Here, we report the identification of VIM-2-producing Pseudomonas aeruginosa isolates in Tanzania. Eight out of 90 clinical isolates of P. aeruginosa from a tertiary care hospital in Dar es Salaam were shown to harbor blaVIM-2. The blaVIM-2-positive isolates belonged to two different sequence types (ST), ST244 and ST640, with blaVIM-2 located in an unusual integron structure lacking the 3' conserved region of qac?E1-sul1. PMID:25331700
Moyo, Sabrina; Haldorsen, Bjørg; Aboud, Said; Blomberg, Bjørn; Maselle, Samuel Y; Sundsfjord, Arnfinn; Langeland, Nina; Samuelsen, Ørjan
of development. The Partnership represents a model of sustainable community development that integrates socialTanzania Partnership Program An Overview PartnershipsforSustainableCommunityDevelopment Michigan Â to address society's most pressing needs. Partnerships for Sustainable Community Development (PSCD) uses
Objective: To assess the validity of sexual behaviour data collected from African adolescents using five methods. Methods: 9280 Tanzanian adolescents participated in a biological marker and face to face questionnaire survey and 6079 in an assisted self-completion questionnaire survey; 74 participated in in-depth interviews and 56 person weeks of participant observation were conducted. Results: 38% of males and 59% of females reporting sexual activity did so in only one of the two 1998 questionnaires. Only 58% of males and 29% of females with biological markers consistently reported sexual activity in both questionnaires. Nine of 11 (82%) in-depth interview respondents who had had biological markers provided an invalid series of responses about sex in the survey and in-depth interview series. Only one of six female in-depth interview respondents with an STI reported sex in any of the four surveys, but five reported it in the in-depth interviews. Conclusion: In this low prevalence population, biological markers on their own revealed that a few adolescents had had sex, but in combination with in-depth interviews they may be useful in identifying risk factors for STIs. Self-reported sexual behaviour data were fraught with inconsistencies. In-depth interviews seem to be more effective than assisted self-completion questionnaires and face to face questionnaires in promoting honest responses among females with STIs. Participant observation was the most useful method for understanding the nature, complexity, and extent of sexual behaviour. PMID:15572640
Plummer, M; Ross, D; Wight, D; Changalucha, J; Mshana, G; Wamoyi, J; Todd, J; Anemona, A; Mosha, F; Obasi, A; Hayes, R
BACKGROUND: Suitable algorithms based on a combination of two or more simple rapid HIV assays have been shown to have a diagnostic accuracy comparable to double enzyme-linked immunosorbent assay (ELISA) or double ELISA with Western Blot strategies. The aims of this study were to evaluate the performance of five simple rapid HIV assays using whole blood samples from HIV-infected patients,
Eligius F Lyamuya; Said Aboud; Willy K Urassa; Jaffer Sufi; Judica Mbwana; Faustin Ndugulile; Charles Massambu
Background Eventual control of HIV/AIDS is believed to be ultimately dependent on a safe, effective and affordable vaccine. Participation of sub-Saharan Africa in the conduct of HIV trials is crucial as this region still experiences high HIV incidences. We describe the experience of recruiting and retaining volunteers in the first HIV vaccine trial (HIVIS03) in Tanzania. Methods In this trial enrolled volunteers from amongst Police Officers (POs) in Dar es Salaam were primed with HIV-1 DNA vaccine at months 0, 1 and 3; and boosted with HIV-1 MVA vaccine at months 9 and 21. A stepwise education provision/sensitization approach was employed to eventual recruitment. Having identified a “core” group of POs keen on HIV prevention activities, those interested to participate in the vaccine trial were invited for a first screening session that comprised of provision of detailed study information and medical evaluation. In the second screening session results of the initial assessment were provided and those eligible were assessed for willingness to participate (WTP). Those willing were consented and eventually randomized into the trial having met the eligibility criteria. Voluntary participation was emphasized throughout. Results Out of 408 POs who formed the core group, 364 (89.0%) attended the educational sessions. 263 out of 364 (72.2%) indicated willingness to participate in the HIV vaccine trial. 98% of those indicating WTP attended the pre-screening workshops. 220 (85.0%) indicated willingness to undergo first screening and 177 POs attended for initial screenings, of whom 162 (91.5%) underwent both clinical and laboratory screenings. 119 volunteers (73.5%) were eligible for the study. 79 were randomized into the trial, while 19 did not turn up, the major reason being partner/family advice. 60 volunteers including 15 females were recruited during a one-year period. All participated in the planned progress updates workshops. Retention into the schedule was: 98% for the 3 DNA/placebo vaccinations, while it was 83% and 73% for the first and second MVA/placebo vaccinations respectively. Conclusion In this first HIV vaccine trial in Tanzania, we successfully recruited the volunteers and there was no significant loss to follow up. Close contact and updates on study progress facilitated the observed retention rates. Trial registration numbers ISRCTN90053831 ISRNCT01132976 and ATMR2009040001075080 PMID:24321091
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 length of dry spells for fixed probabilities of non-exceedance. 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. The dry spell map thus obtained is compared to the spatially variable critical dry spell duration, based on soil properties and crop water requirements, to assess the probability of crop failure in different locations. The results show that in the Makanya catchment the length of dry spell occurrence is highly variable in space, even over relatively short distances. In certain areas the probability of crop failure reaches levels that make rainfed agricultural unsustainable, even close to areas where currently rainfed agriculture is successfully being practised. 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.
Fischer, B. M. C.; Mul, M. L.; Savenije, H. H. G.
Background Tanzania has recently experienced a significant rise in the burden of diabetes, and it is estimated that more than 400,000 people are living with diabetes. A major concern in the management of diabetes is the occurrence of diabetic complications that occur as a result of poor glycemic control. Identification of the factors associated with poor glycemic control is important in order to institute appropriate interventions for the purpose of improving glycemic control and prevention of chronic complications. Aim The aim of this study was to determine the level of glycemic control and explore the factors associated with poor glycemic control among patients with type 2 diabetes mellitus (T2DM). Methodology A cross-sectional study was carried out at the diabetic clinics for T2DM patients at the national and municipal hospitals in Dar es Salaam. A total of 469 patients were enrolled over a period of 8 weeks from March 2013 to May 2013. Patients’ information such as sociodemographic characteristics, self-care management behaviors, and medication adherence were obtained through interviews. Blood pressure, weight, and height were measured during the day of the interview. All available last readings for fasting blood glucose (FBG) measurements, lipid profile, and other clinical characteristics were obtained from patients’ records. Results The mean age of patients was 54.93 years. The majority (63.5%) of patients were females and only eight patients had records of lipid profile measurements. Out of 469 patients, 69.7% had FBG of ?7.2 mmol/L, indicating poor glycemic control. Females aged between 40 years and 59 years had significantly higher poor glycemic control (76.1%) as compared with their male counterparts. Thirty-eight percent of patients had poor medication adherence, which was associated with poor glycemic control. The proportion of poor glycemic control increased with age. A significantly high proportion of poor glycemic control was observed in patients who had had the disease for more than 20 years since diagnosis. Factors associated with poor glycemic control included lack of health insurance, using more than one oral hypoglycemic agent, normal body mass index, obesity, and nonadherence to diabetic medications. Conclusion Patients in this study had generally poor glycemic control. From these findings it is recommended that diabetic patients should be routinely screened for lipid profile to determine levels of cholesterol, triglycerides, and low-density lipoproteins, which are risk factors for cardiovascular events. An education program should be developed to educate patients on the importance of medication adherence and weight management for better glycemic control. PMID:25368533
Kamuhabwa, Appolinary R; Charles, Emmanuel
This report documents the efforts conducted primarily under the Noor al Salaam (“Light of Peace”) program under DOE GRANT NUMBER DE-FC36-02GO12030, together with relevant technical results from a closely related technology development effort, the U.S./Israel Science and Technology Foundation (USISTF) High Concentration Solar Central Receiver program. These efforts involved preliminary design, development, and test of selected prototype power production subsystems and documentation of an initial version of the system definition for a high concentration solar hybrid/gas electrical power plant to be built in Zaafarana, Egypt as a first step in planned commercialization. A major part of the planned work was halted in 2007 with an amendment in October 2007 requiring that we complete the technical effort by December 31, 2007 and provide a final report to DOE within the following 90 days. This document summarizes the work conducted. The USISTF program was a 50/50 cost-shared program supported by the Department of Commerce through the U.S./Israel Science and Technology Commission (USISTC). The USISTC was cooperatively developed by President Clinton and the late Prime Minister Rabin of Israel "to encourage technological collaboration" and "support peace in the Middle East through economic development". The program was conducted as a follow-on effort to Israel's Magnet/CONSOLAR Program, which was an advanced development effort to design, fabricate, and test a solar central receiver and secondary optics for a "beam down" central receiver concept. The status of these hardware development programs is reviewed, since they form the basis for the Noor al Salaam program. Descriptions are provided of the integrated system and the major subsystems, including the heliostat, the high temperature air receiver, the power conversion unit, tower and tower reflector, compound parabolic concentrator, and the master control system. One objective of the USISTF program was to conduct marketing research, identify opportunities for use of this technology, and to the extent possible, secure an agreement leading to a pre-commercialization demonstration or prototype plant. This was accomplished with the agreement to conduct the Noor al Salaam program as a tri-lateral project between Egypt, Israel, and the U.S. The tri-lateral project was led by the University of Alabama in Huntsville (UAH); this included the Egyptian New and Renewable Energy Authority and the Israeli USISTC participants. This project, known was Noor al Salaam, was funded by the U.S. Agency for International Development (USAID) through the Department of Energy (DOE). The Egyptian activity was under the auspices of the Egyptian Ministry of Energy and Electricity, New and Renewable Energy Authority (NREA) as part of Egypt's plans for renewable energy development. The objective of the Noor al Salaam project was to develop the conditions necessary to obtain funding and construct and operate an approximately 10 to 20 Megawatt hybrid solar/natural gas demonstration power plant in Zaafarana, Egypt that could serve both as a test bed for advanced solar technology evaluations, and as a forerunner to commercial plant designs. This plant, termed Noor Al Salaam, or “Light of Peace”, reached the initial phase of system definition before being curtailed, in part by changes in USAID objectives, coupled with various delays that were beyond the scope of the program to resolve. The background of the USISTF technology development and pre-commercialization effort is provided in this report, together with documentation of the technology developments conducted under the Noor al Salaam program. It should be noted that only a relatively small part of the Noor al Salaam funding was expended over the approximately five years for which UAH was prime contractor before the program was ordered closed (Reference 1) so that the remaining funds could be returned to USAID.
Blackmon, James B
Background Fostering adolescents’ communication on sexuality issues with their parents and other significant adults is often assumed to be an important component of intervention programmes aimed at promoting healthy adolescent sexual practices. However, there are few studies describing the relationship between such communication and sexual practices, particularly in sub-Saharan Africa. This study examined the relationships between adolescents’ communication with significant adults and their condom use in three sites in this region. Methods Data stem from a multi-site randomized controlled trial of a school-based HIV prevention intervention implemented in Cape Town and Mankweng, South Africa and Dar es Salaam, Tanzania. Only data from comparison schools were used. The design is therefore a prospective panel study with three waves of data collections. Data were collected in 2004 from 6,251 participants in 40 schools. Associations between adolescents’ communication with adults about sexuality issues and their use of condoms were analysed cross-sectionally using analysis of variance, as well as prospectively using multiple ordinal logistic regression analysis. Results Cross-sectional analyses showed that consistent condom users had significantly higher mean scores on communication (across topics and communication partners) than both occasional users and never-users, who had the lowest scores. After controlling for condom use at the first data collection occasion in each model as well as for possible confounders, communication scores significantly predicted consistent condom use prospectively in all three ordinal logistic regression models (Model R2 = .23 to .31). Conclusion The findings are consistent with the assertion that communication on sexuality issues between adolescents and significant adults results in safer sexual practices, as reflected by condom use, among in-school adolescents. The associations between communication variables and condom use might have been stronger if we had measured additional aspects of communication such as whether or not it was initiated by the adolescents themselves, the quality of advice provided by adults, and if it took place in a context of positive adult-adolescent interaction. Studies with experimental designs are needed in order to provide stronger evidence of causality. PMID:24053420
Background Resistance of mosquitoes to insecticides is a growing concern in Africa. Since only a few insecticides are used for public health and limited development of new molecules is expected in the next decade, maintaining the efficacy of control programmes mostly relies on resistance management strategies. Developing such strategies requires a deep understanding of factors influencing resistance together with characterizing the mechanisms involved. Among factors likely to influence insecticide resistance in mosquitoes, agriculture and urbanization have been implicated but rarely studied in detail. The present study aimed at comparing insecticide resistance levels and associated mechanisms across multiple Anopheles gambiae sensu lato populations from different environments. Methods Nine populations were sampled in three areas of Tanzania showing contrasting agriculture activity, urbanization and usage of insecticides for vector control. Insecticide resistance levels were measured in larvae and adults through bioassays with deltamethrin, DDT and bendiocarb. The distribution of An. gambiae sub-species and pyrethroid target-site mutations (kdr) were investigated using molecular assays. A microarray approach was used for identifying transcription level variations associated to different environments and insecticide resistance. Results Elevated resistance levels to deltamethrin and DDT were identified in agriculture and urban areas as compared to the susceptible strain Kisumu. A significant correlation was found between adult deltamethrin resistance and agriculture activity. The subspecies Anopheles arabiensis was predominant with only few An. gambiae sensu stricto identified in the urban area of Dar es Salaam. The L1014S kdr mutation was detected at elevated frequency in An gambiae s.s. in the urban area but remains sporadic in An. arabiensis specimens. Microarrays identified 416 transcripts differentially expressed in any area versus the susceptible reference strain and supported the impact of agriculture on resistance mechanisms with multiple genes encoding pesticide targets, detoxification enzymes and proteins linked to neurotransmitter activity affected. In contrast, resistance mechanisms found in the urban area appeared more specific and more related to the use of insecticides for vector control. Conclusions Overall, this study confirmed the role of the environment in shaping insecticide resistance in mosquitoes with a major impact of agriculture activities. Results are discussed in relation to resistance mechanisms and the optimization of resistance management strategies. PMID:24460952
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…
Hardman, Frank; Abd-Kadir, Jan; Tibuhinda, Audax
The Misimbazi River in Dar es Salaam is polluted with industrial, urban and agricultural waste waters. A preliminary investigation on the extent of metal pollution (Hg, Cr, Cu, Zn, Fe, Ni, Cd, Mn, Al) was made from samples of sediments and biological indicators. The metal concentrations were in general low, but some of our results indicated industrial pollution.
Ak'habuhaya, J.; Lodenius, M. (Tropical Pesticides Research Institute, Arusha (Tanzania))
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 blood, breast milk, or lower genital tract secretions; and/or by strengthening the placental barrier to infection. Eligible pregnant women were randomized to receive vitamin A, multivitamins excluding A, vitamin A and multivitamins, or placebo. The main endpoints include vertical transmission of HIV infection, as assessed by examination of infection in infants using polymerase chain reaction (PCR), and progression of HIV disease as measured by the WHO clinical staging system. Over a period of 2 years, 13,876 women were tested for HIV infection, with appropriate pre- and posttest counseling, to enroll 1085 consenting HIV-positive women. The trial assesses women and their children once a month for a minimum of 18 months after delivery or up to the end of this 5-year study. We examine recruitment strategies and means of enhancing cohort retention in long-term follow-up. We assess compliance with the use of supplements by direct questioning, by counting pills, and biochemically by using serum beta-carotene and urine riboflavin levels. Briefly, we discuss ethical issues related to the conduct of AIDS prevention trials in this setting. In sub-Saharan Africa, most HIV-infected persons lack access to the relevant antiretroviral and prophylactic drugs, and the region urgently needs low-cost treatments and preventive strategies. The Tanzania trial should provide valuable data to address the effect of vitamin supplements in the transmission and progression of HIV infection. PMID:10027501
Fawzi, W W; Msamanga, G I; Spiegelman, D; Urassa, E J; Hunter, D J
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
Greg M. Wagner
This paper begins by telling the story of Edward, a preacher/teacher in Tanzania who, although poor and uneducated himself, managed to teach his parishioners how to read. The paper describes the experience of one man and his wife who spent 4 years at Katoke Teachers College in northwest Tanzania during the early 1970s, after which they returned to…
Watson, Alan J.
Workers in small-scale wood industries (SSWI) have increased risks of developing asthma and other respiratory diseases. Wood dust and microbial agents have both been suggested to play a role, but few studies have measured endotoxin exposure in SSWI in Africa. We assessed inhalable dust levels in 281 samples from 115 workers and bacterial endotoxins levels in 157 samples from 136 workers from SSWI in Dar es Salaam, Tanzania. The overall geometric mean of personal exposure was 3.3 mg/m(3); geometric standard deviation (GSD) 2.5; range 0.45-67.0 mg/m(3)) and 91 EU/m(3) (GSD 3.7; range 9-4914.8 EU/m(3)) for wood dust and endotoxins, respectively. Dust and endotoxin levels were weakly correlated (r = 0.44, n = 157, P < 0.0001). Between- and within-worker variances and percentages explained by the differences among job titles and seasons were 0.31 (9%) and 0.35 (30%), respectively, for wood dust exposure, and 0.35 (0%) and 0.35 (38%) for endotoxin exposure. Higher dust and endotoxin exposure levels were observed in the dry compared to the wet season, after correcting for differences in exposure between jobs. Carving and manual cleaning were associated with the highest dust exposures. Sewing seat covers and manual cleaning were associated with the highest endotoxin exposures. Dust and endotoxin exposure levels in SSWI are high and appropriate control measures are necessary. PMID:15114366
Rongo, Larama Mb; Msamanga, Gernard I; Burstyn, Igor; Barten, Françoise; Dolmans, Wil Mv; Heederik, Dick
Multivitamin supplementation has been shown to reduce the risk of low birthweight. This effect could be mediated through gestational weight gain. However, the effect of multivitamin supplementation on weight gain during pregnancy has not been fully studied. The objective of this study was to examine the effects of multivitamins on pregnancy weight gain. We enrolled 8468 HIV-negative women from Dar es Salaam, Tanzania, in a randomised, placebo-controlled trial of multivitamins on birth outcomes. Women were randomly assigned to receive either a daily oral dose of multivitamin tablets or a placebo and were weighed every 4?weeks from enrolment until the last visit before delivery. Intent-to-treat analyses were carried out to examine the effects of multivitamins on pregnancy weight gain. Multivariate linear and binomial regression models with the log-link function were used to examine the association of weight gain during pregnancy to birthweight. The overall total weight gain was 253?g (SE: 69, P: 0.0003) more, while the overall 4?weekly weight gain was 59?g greater (SE: 18, P: 0.005) among women who received multivitamins compared to placebo. Women in the lowest quartile of gestational weight gain had babies with an average birthweight of 3030?g (SD: 524), while women in the highest quartile had babies weighing 3246?g (SD: 486), on average. Prenatal multivitamin supplements increased gestational weight gain, which was a significant predictor of birthweight. PMID:23253638
Changamire, Freeman T; Mwiru, Ramadhani S; Peterson, Karen E; Msamanga, Gernard I; Spiegelman, Donna; Petraro, Paul; Urassa, Willy; Fawzi, Wafaie W
Environmentally sustainable waste management practices have a limited relevance and viability in developing countries. Despite a technological potential, composting initiatives often share this fate. Little is known about the functioning of community level composting, which is reportedly the optimal level for viable compost production. This paper presents a multidisciplinary analysis of factors influencing the success and failure of the composting initiative of KIWODET, a community based organization in Dar es Salaam, Tanzania. The results show that despite the ready availability and good compostability of the waste stream, not all fractions of municipal organic wastes qualify as feedstock. Negative consumer attitude hindered the acceptance of compost produced from residential wastes. KIWODET did manage to successfully implement a composting operation for commercial organic wastes. Their additional waste collection and sorting activities also contributed to an increased feedstock control as well as the integration of informal waste collecting activities. When KIWODET was forced to suspend its composting activities because of land use issues, their diversified waste sector activities proved crucial in reducing the negative financial impact on their overall performance. This paper emphasizes that successful composting initiatives can arise from local capacity in developing countries. However, the lack of municipal integration and support leaves such technically viable initiatives strongly vulnerable to external factors. PMID:21558081
Oberlin, Aisa S; Szántó, Gábor L
The latest Demographic and Health Surveys Report on Knowledge, Attitudes, and Practice documents an increase in the level of use of modern contraceptive methods in Tanzania between 1991 and 1994 from 5.9% to 11.3% of reproductive-age women. 53.2% of all women of reproductive age were exposed to mass media messages about family planning, which large majorities of men and women consider acceptable. 48.3% were exposed through radio, 22.9% reported listening to the US Agency for International Development-funded family planning promotional radio soap opera "Zinduka]", 22.5% read newspaper items, 17.5% saw posters, and 7.3% saw leaflets. 4.5% were visited by a family planning worker, 24.7% discussed family planning with a friend or relative, and 24.7% discussed family planning with health facility personnel. Zinduka], a popular 52-episode soap opera, depicts how the lives of Bomu wa Kabuma's family, in Msongano Town and Tawanya village in Tanzania, are affected because he is unable to provide for his eight children, parents, wife, mistress, and the mistress's child. The soap was produced with technical assistance from the Johns Hopkins University Center for Communication Programs Population Communication Services project. The 15-minute episodes were first broadcast in Swahili on Radio Tanzania from October 1993 through October 1994. The series was then resumed in September 1995 for another 12 months. PMID:12347311
A descriptive account of factors that influence women's health in Tanzania is given. The social and cultural processes that enhance or undermine women's health are emphasized. Recommendations for changes to improve women's health are made. PMID:8169170
Lugina, H I
The development of technology and innovation in any country depends on a strong investment in science education from the lower to the upper levels of education. In most of the Sub-Saharan African nations, science education curriculum and teaching still faces many issues and problems that are inhibiting the growth of technology and innovation in these nations. In order to address these issues, an interpretive qualitative study that aims to examine how Tanzanian secondary science educators perceive secondary science education was conducted in the summer of 2013. The purpose of this study is to investigate problems and educational issues that might be limiting the growth of science, technology, and innovation in the Tanzanian society. Additionally, this research investigates the impacts of the colonial legacy that relates to language, politics, and economics, as they affect science education in Tanzania secondary schools. This study focuses on the governmental four-year ordinary level secondary science education; it took place in Dar-es-Salaam, Tanzania. The researcher interviewed nine secondary science educators: three secondary science teachers and six secondary science education administrators. The researcher also conducted classroom observations. The data results from both interview and classroom observations were contextualized with data from existing documentation on Tanzanian secondary science education and data from previous research. The emergent themes from the study indicate that most of the problems and issues that are currently facing secondary science education are historically connected to the impact of the colonization period in 19th and 20th centuries. This study suggests that in order to improve science education in Tanzanian society, the people, especially the elites, need to break away from an "Orientalist" mindset and start integrating the Tanzanian culture and science into the still existing Eurocentric science curriculum. In addition, the Tanzanian government needs to invest in industries and economic initiatives that will support strong science education at all levels of education, as well as the graduates produced through this system.
Wandela, Eugenia L.
Sensitive diagnostic tools are crucial for an accurate assessment of helminth infections in low-endemicity areas. We examined stool samples from Tanzanian individuals and compared the diagnostic accuracy of a real-time polymerase chain reaction (PCR) with the FLOTAC technique and the Kato-Katz method for hookworm and the Baermann method for Strongyloides stercoralis detection. Only FLOTAC had a higher sensitivity than the Kato-Katz method for hookworm diagnosis; the sensitivities of PCR and the Kato-Katz method were equal. PCR had a very low sensitivity for S. stercoralis detection. The cycle threshold values of the PCR were negatively correlated with the logarithm of hookworm egg and S. stercoralis larvae counts. The median larvae count was significantly lower in PCR false negatives than true positives. All methods failed to detect very low-intensity infections. New diagnostic approaches are needed for monitoring of progressing helminth control programs, confirmation of elimination, or surveillance of disease recrudescence. PMID:24445211
Knopp, Stefanie; Salim, Nahya; Schindler, Tobias; Karagiannis Voules, Dimitrios A; Rothen, Julian; Lweno, Omar; Mohammed, Alisa S; Singo, Raymond; Benninghoff, Myrna; Nsojo, Anthony A; Genton, Blaise; Daubenberger, Claudia
BACKGROUND: Religion shapes everyday beliefs and activities, but few studies have examined its associations with attitudes about HIV. This exploratory study in Tanzania probed associations between religious beliefs and HIV stigma, disclosure, and attitudes toward antiretroviral (ARV) treatment. METHODS: A self-administered survey was distributed to a convenience sample of parishioners (n = 438) attending Catholic, Lutheran, and Pentecostal churches in
James Zou; Yvonne Yamanaka; Muze John; Melissa Watt; Jan Ostermann; Nathan Thielman
Objective: The objective of this paper was to assess students' attitudes towards school-based sex and relationships education (SRE). Design: This study featured a cross-sectional survey design. Method: A sample of 715 students from two districts in Tanzania completed a survey questionnaire assessing various aspects related to their attitudes…
Mkumbo, Kitila A. K.
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
Like many countries, the southeastern African country of Malawi faces the challenge of balancing a growing population's need for food and energy with preservation of natural resources. This MODIS image from November 8, 2001, shows Malawi surrounded by (starting from top and moving clockwise) Tanzania, Mozambique, and northern Zambia. Lake Malawi runs north-south through the eastern part of the country, and is the southern-most of Africa's Great Rift Lakes, a series of deep lakes that run roughly north-south along the Great Rift Valley in eastern Africa, formed when the Earth buckled and then sank after the collision of Africa and Eurasia millions of years ago. Most of the land around the lake and throughout the country has been cleared of its natural vegetation and converted to agricultural land. This causes soil erosion problems and sedimentation in the lake, which affects the sustainability of fishing in the lake. In this image, greenish swirls in the water around the shores could indicate a mixture of sediment and phytoplankton or algae. Deforestation is also a major issue, especially since wood for fuel is the primary source of the country's energy. The difference between the lands protected by parks and preserves stand out dramatically. The largest protected area is halfway down the western border of the country-Kasungu National Park. Several smaller preserves also exist, and where they do, they stand out in green against the paler landscape. Image courtesy Jacques Descloitres, MODIS Land Rapid Response Team at NASA GSFC
A transcultural nursing course in Tanzania was offered in fall 2010 at Williston State College, located in North Dakota. Madeleine Leininger's Culture Care: Diversity and Universality Theory (Principles of Developing Cultural Competence) was the framework used for the experience. The course provided nursing students the opportunity to learn about the culture, health, and illness beliefs of Tanzanians; their values and practices; the prevalence of HIV/AIDS; and the differences and similarities between the healthcare systems, hospice/palliative care, and home visits in Tanzania as compared to the United States. PMID:22647987
Cancer is an important cause of morbidity and mortality in Tanzania. According to the Tanzanian Cancer Registry, which records all histologically confirmed malignant tumors, the number of reported cancer cases has increased significantly over the past three decades. The most commonly diagnosed tumors are cervix cancer, skin cancer, primary liver cancer, Kaposi's sarcoma, and Burkitt's lymphoma. Geographical and tribal variations exist in disease frequency. Environmental factors appear to have a major role in the distribution. Through elimination of these factors, cancer in Tanzania could be reduced if not totally prevented. ImagesFigure 3Figure 4Figure 5Figure 6Figure 7Figure 8 PMID:6631988
Alexander, George A.
Purpose Breast cancer is a highly heterogeneous disease globally. Public health prevention measures require an understanding of the burden of breast cancer and its risk factors. The purpose of this study was to describe the clinical, pathologic, and epidemiologic characteristics of breast cancer patients in Tanzania. Methods Data was abstracted from the medical records of all breast cancer patients attending Ocean Road Cancer Institute (ORCI) over a 2-year period from July 2007 to June 2009. Tumor tissue paraffin blocks were collected for all patients with available tissues for the determination of estrogen receptor (ER) and progesterone receptor (PR). Data for all patients was analyzed descriptively and by using unconditional logistic regression, by comparing early stage (ES), defined as stages I and II and late stage (LS), defined as stages III and IV patients to obtain odds ratios (ORs), 95% confidence intervals (CIs), and P -values. Results Among the 488 patients, stage was determined for 356 patients, 90.7% of whom presented in LS. Of the 57 tumor tissues, 49.1% were ER?/PR?. Patients with ulceration (OR = 4.97; 95% CI = 1.07, 23.04; p = 0.04) and peau d’orange (OR = 6.78; 95% CI = 1.48, 31.17; p = 0.01) were more likely to present in LS rather than ES. Male breast cancer accounted for 2.9% of all breast cancers and inflammatory breast cancer (IBC) comprised 4.3–5.5% of cases based on registered t4d diagnosis or the criteria of IBC signs, if t4d was not reported in the medical records. Conclusion Most breast cancer patients in Tanzania are diagnosed at advanced disease stages with about half of the tumors being ER?/PR?. These data strongly support that reducing barriers to care, down-staging of disease at diagnosis, implementation of clinical guidelines for management of advanced cases, and palliative care are the four most essential factors that need to be addressed to reduce morbidity and mortality from breast cancer in Tanzania. Further research is needed to quantify the magnitude and molecular features of two relatively rare forms of breast cancer that may account for a greater proportion of the burden of breast cancer in Tanzania compared to the USA and Western Europe: male breast cancer and IBC. PMID:21109721
Burson, Ashley M.; Soliman, Amr S.; Ngoma, Twalib A.; Mwaiselage, Julius; Ogweyo, P.; Eissa, Mohab S.; Dey, Subhojit; Merajver, Sofia D.
Purpose: The purpose of this paper is to present an overview of the principal preparation programming available to school leaders in Kenya and Tanzania. Design/methodology/approach: The authors analyzed information about the educational leadership programmes offered by a range of public and private institutions in East Africa. Data were gathered…
Onguko, Brown; Abdalla, Mohammed; Webber, Charles F.
The Laetolil Beds in Tanzania, 20-30 miles south of Olduvai Gorge, have been extensively sampled by parties under the leadership of Mrs. Dr. Mary D. Leakey, who very kindly sent me Hipparion material collected in 1974, 1975, and 1976. In a restudy of proboscidean material from these beds described by Dietrich (1942), Maglio (1969) arrived at the conclusion that the
D. A. Hooijer
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…
Norman, A. S.; Mdegella, O. M.; Lubawa, R. M.
A study was undertaken to investigate Cryptosporidium infection in crossbreed dairy calves in two districts in Tanzania. A total of 943 fecal samples from 601 dairy calves were included in the study, with calves from both smallholder dairy farms and from large-scale and medium-scale dairy farms. The modified Ziehl-Neelsen (mZN) technique was used to examine 710 samples, and 13 of these were considered to be positive for Cryptosporidium. These 13 samples considered positive by mZN, along with the remaining 233 samples, were analysed by immunofluorescent antibody test (IFAT). Of these 246 samples examined by IFAT, 15 samples, 10 of which were considered positive by mZN, were also examined by the auramine phenol technique, and 5 samples, all of which were considered positive by mZN, were analysed by PCR. The results from the IFAT, auramine phenol and PCR analyses demonstrated that none of the samples contained Cryptosporidium oocysts, indicating that, cryptosporidiosis is currently not a problem in dairy calves in these regions of Tanzania. These unexpected results are discussed with respect to other reports on cryptosporidiosis in calves that suggest that this parasite is a serious calf disease globally, and particularly in relation to studies from Tanzania. We suggest that results from studies of cattle in Tanzania, in which mZN has been used as the sole analytical method, should be treated with caution. PMID:22185946
Chang'a, J S; Robertson, L J; Mtambo, M M A; Mdegela, R H; Løken, T; Reksen, O
The geology of Oldonyo Lengai volcano and the southernmost Lake Natron basin, Tanzania, is presented on this geologic map at scale 1:50,000. The map sheet can be downloaded in pdf format for online viewing or ready to print (48 inches by 36 inches). A 65-page explanatory pamphlet describes the geologic history of the area. Its goal is to place the new findings into the framework of previous investigations while highlighting gaps in knowledge. In this way questions are raised and challenges proposed to future workers. The southernmost Lake Natron basin is located along the East African rift zone in northern Tanzania. Exposed strata provide a history of volcanism, sedimentation, and faulting that spans 2 million years. It is here where Oldonyo Lengai, Tanzania’s most active volcano of the past several thousand years, built its edifice. Six new radiometric ages, by the 40Ar/39Ar method, and 48 new geochemical analyses from Oldonyo Lengai and surrounding volcanic features deepen our understanding of the area. Those who prefer the convenience and access offered by Geographic Information Systems (GIS) may download an electronic database, suitable for most GIS software applications. The GIS database is in a Transverse Mercator projection, zone 36, New (1960) Arc datum. The database includes layers for hypsography (topography), hydrography, and infrastructure such as roads and trails.
Sherrod, David R.; Magigita, Masota M.; Kwelwa, Shimba
A recent discussion debates the extent of human in-migration around protected areas (PAs) in the tropics. One proposed argument is that rural migrants move to bordering areas to access conservation outreach benefits. A counter proposal maintains that PAs have largely negative effects on local populations and that outreach initiatives even if successful present insufficient benefits to drive in-migration. Using data from Tanzania, we examined merits of statistical tests and spatial methods used previously to evaluate migration near PAs and applied hierarchical modeling with appropriate controls for demographic and geographic factors to advance the debate. Areas bordering national parks in Tanzania did not have elevated rates of in-migration. Low baseline population density and high vegetation productivity with low interannual variation rather than conservation outreach explained observed migration patterns. More generally we argue that to produce results of conservation policy significance, analyses must be conducted at appropriate scales, and we caution against use of demographic data without appropriate controls when drawing conclusions about migration dynamics. PMID:24476123
Salerno, Jonathan D; Borgerhoff Mulder, Monique; Kefauver, Shawn C
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. PMID:23902713
Calvert, Clara; Baisley, Kathy; Doyle, Aoife M; Maganja, Kaballa; Changalucha, John; Watson-Jones, Deborah; Hayes, Richard J; Ross, David A
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. PMID:23800028
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. PMID:22014374
Finkelstein, Julia L; Mehta, Saurabh; Duggan, Christopher P; Spiegelman, Donna; Aboud, Said; Kupka, Roland; Msamanga, Gernard I; Fawzi, Wafaie W
The approximately 1.58 million pigs in Tanzania represent 3.7% of the national population of quadruped meat-producing animals. Pigs are kept mainly by small producers who own 99.5% of the national stock in units that average 3.04 animals (range 2-48). Government policy has had little practical application. African swine fever, foot-and-mouth disease and Cysticercosis are important diseases. The first two are notifiable diseases under Tanzania legislation; the last has widespread distribution and relevance as a major zoonosis. Ascariasis (Ascaris suum), hydatidosis (Echinococcus granulosus), leptospirosis (Leptospira interrogans) and thermophilic Campylobacter are other zoonoses associated with pigs. Gastrointestinal helminths and external parasites, especially Sarcoptes scabiei, are common. Risk factors associated with cysticercosis for humans working with pigs or eating their meat include the free-range or semi-confined management systems, the use of rivers or ponds as a source of water, lack of household sanitation, informal home slaughter, pork not being inspected at slaughter slabs and undercooked and barbecued meat. Pigs are a minor component of Tanzania's livestock sector but there is potential for increasing their contribution to human welfare. Prospects are enhanced by the shorter life cycle, greater number of young produced per year and the possibility of producing high-quality animal protein at a lower cost than meat produced by cattle and small ruminants. PMID:23733144
Wilson, Richard Trevor; Swai, Emmanuel
This article contributes to the understanding of the changes in distribution and total area of mangrove forests along the mainland Tanzania coast over the past decade. Mangroves are recognized as critical coastal habitat requiring protection and special attention. The Tanzania coastline forms a suitable habitat for establishment of mangrove forests. Mangrove forests are distributed from Tanga in the north to
Yeqiao Wang; Gregory Bonynge; Jarunee Nugranad; Michael Traber; Amani Ngusaru; James Tobey; Lynne Hale; Robert Bowen; Vedast Makota
Summary objectives To synthesise data from four recent studies in Tanzania examining maternal syphilis screening and its operational implementation in routine antenatal clinics (ANC), drawing lessons for strengthened antenatal services for the prevention of mother-to-child transmission (PMTCT) of HIV. methods The impact of untreated maternal syphilis was examined in a retrospective cohort of 380 Tanzanian women. Effectiveness and cost-effectiveness of
Deborah Watson-Jones; Monique Oliff; Fern Terris-Prestholt; John Changalucha; Balthazar Gumodoka; Philippe Mayaud; Ave Maria Semakafu; Lilani Kumaranayake; Awene Gavyole; David Mabey; Richard Hayes
Background Brucellosis is a zoonosis of veterinary, public health and economic significance in most developing countries. Human brucellosis is a severely debilitating disease that requires prolonged treatment with a combination of antibiotics. The disease can result in permanent and disabling sequel, and results in considerable medical expenses in addition to loss of income due to loss of working hours. A study was conducted in Northern Tanzania to determine the risk factors for transmission of brucellosis to humans in Tanzania. Methods This was a matched case-control study. Any patient with a positive result by a competitive ELISA (c-ELISA) test for brucellosis, and presenting to selected hospitals with at least two clinical features suggestive of brucellosis such as headache, recurrent or continuous fever, sweating, joint pain, joint swelling, general body malaise or backache, was defined as a case. For every case in a district, a corresponding control was traced and matched by sex using multistage cluster sampling. Other criteria for inclusion as a control included a negative c-ELISA test result and that the matched individual would present to hospital if falls sick. Results Multivariable analysis showed that brucellosis was associated with assisted parturition during abortion in cattle, sheep or goat. It was shown that individuals living in close proximity to other households had a higher risk of brucellosis. People who were of Christian religion were found to have a higher risk of brucellosis compared to other religions. The study concludes that assisting an aborting animal, proximity to neighborhoods, and Christianity were associated with brucellosis infection. There was no association between human brucellosis and Human Immunodeficiency Virus (HIV) serostatus. Protecting humans against contact with fluids and tissues during assisted parturition of livestock may be an important means of reducing the risk of transferring brucellosis from livestock to humans. These can be achieved through health education to the communities where brucellosis is common. PMID:20376363
John, Kunda; Fitzpatrick, Julie; French, Nigel; Kazwala, Rudovick; Kambarage, Dominic; Mfinanga, Godfrey S.; MacMillan, Alastair; Cleaveland, Sarah
Tanzania is facing a double burden of disease, with non-communicable diseases being an increasingly important contributor. Evidence-based preventive measures are important to limit the growing financial burden. This article aims to estimate the cost of providing medical primary prevention interventions for cardiovascular disease (CVD) among at-risk patients, reflecting actual resource use and if the World Health Organization (WHO)'s CVD medical preventive guidelines are implemented in Tanzania. In addition, we estimate and explore the cost to patients of receiving these services. Cost data were collected in four health facilities located in both urban and rural settings. Providers' costs were identified and measured using ingredients approach to costing and resource valuation followed the opportunity cost method. Unit costs were estimated using activity-based and step-down costing methodologies. The patient costs were obtained through a structured questionnaire. The unit cost of providing CVD medical primary prevention services ranged from US$30-41 to US$52-71 per patient per year at the health centre and hospital levels, respectively. Employing the WHO's absolute risk approach guidelines will substantially increase these costs. The annual patient cost of receiving these services as currently practised was estimated to be US$118 and US$127 for urban and rural patients, respectively. Providers' costs were estimated from two main viewpoints: 'what is', that is the current practice, and 'what if', reflecting a WHO guidelines scenario. The higher cost of implementing the WHO guidelines suggests the need for further evaluation of whether these added costs are reasonable relative to the added benefits. We also found considerably higher patient costs, implying that distributive and equity implications of access to care require more consideration. Facility location surfaced as the main explanatory variable for both direct and indirect patient costs in the regression analysis; further research on the influence of other provider characteristics on these costs is important. PMID:25113027
Ngalesoni, Frida; Ruhago, George; Norheim, Ole F; Robberstad, Bjarne
Background In the Tanga District of coastal Tanzania, malaria is one of the primary causes of mortality for children under the age of five. While some children are treated with malaria medications in biomedical facilities, as the World Health Organization recommends, others receive home-care or treatment from traditional healers. Recognition of malaria is difficult because symptoms can range from fever with uncomplicated malaria to convulsions with severe malaria. This study explores why caregivers in the Tanga District of Tanzania pursue particular courses of action to deal with malaria in their children. Methods Qualitative data were collected through interviews with three samples: female caregivers of children under five (N = 61), medical practitioners (N = 28), and traditional healers (N = 18) in urban, peri-urban, and rural areas. The female caregiver sample is intentionally stratified to reflect the greater population of the Tanga District in level of education, marital status, gender of household head, religion, and tribal group affiliation. Qualitative data were counted, coded and analysed using NVivo7 software. Results Results indicate that a variety of factors influence treatment choice, including socio-cultural beliefs about malaria symptoms, associations with spiritual affliction requiring traditional healing, knowledge of malaria, and fear of certain anti-malaria treatment procedures. Most notably, some caregivers identified convulsions as a spiritual condition, unrelated to malaria. While nearly all caregivers reported attending biomedical facilities to treat children with fever (N = 60/61), many caregivers stated that convulsions are best treated by traditional healers (N = 26/61). Qualitative interviews with medical practitioners and traditional healers confirmed this belief. Conclusion Results offer insight into current trends in malaria management and have implications in healthcare policy, educational campaigns, and the importance of integrating traditional and biomedical approaches. PMID:19860900
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.
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 for advancing astronomy education per se and natural sciences in general is presented. Limiting factors such as teachers in general and science and astronomy literate teachers in particular, infrastructure and running costs of providing ICT based education, cultural impediments need to be overcome.
Jiwaji, N. T.
Background Scaling up voluntary medical male circumcision (VMMC) to 80% of men aged 15–49 within five years could avert 3.4 million new HIV infections in Eastern and Southern Africa by 2025. Since 2009, Tanzania and Zimbabwe have rapidly expanded VMMC services through different delivery (fixed, outreach or mobile) and intensity (routine services, campaign) models. This review describes the modality and intensity of VMMC services and its influence on the number and age of clients. Methods and Findings Program reviews were conducted using data from implementing partners in Tanzania (MCHIP) and Zimbabwe (PSI). Key informant interviews (N?=?13 Tanzania; N?=?8 Zimbabwe) were conducted; transcripts were analyzed using Nvivo. Routine VMMC service data for May 2009–December 2012 were analyzed and presented in frequency tables. A descriptive analysis and association was performed using the z-ratio for the significance of the difference. Key informants in both Tanzania and Zimbabwe believe VMMC scale-up can be achieved by using a mix of service delivery modality and intensity approaches. In Tanzania, the majority of clients served during campaigns (59%) were aged 10–14 years while the majority during routine service delivery (64%) were above 15 (p<0.0001). In Zimbabwe, significantly more VMMCs were done during campaigns (64%) than during routine service delivery (36%) (p<0.00001); the difference in the age of clients accessing services in campaign versus non-campaign settings was significant for age groups 10–24 (p<0.05), but not for older groups. Conclusions In Tanzania and Zimbabwe, service delivery modalities and intensities affect client profiles in conjunction with other contextual factors such as implementing campaigns during school holidays in Zimbabwe and cultural preference for circumcision at a young age in Tanzania. Formative research needs to be an integral part of VMMC programs to guide the design of service delivery modalities in the face of, or lack of, strong social norms. PMID:24801882
Ashengo, Tigistu Adamu; Hatzold, Karin; Mahler, Hally; Rock, Amelia; Kanagat, Natasha; Magalona, Sophia; Curran, Kelly; Christensen, Alice; Castor, Delivette; Mugurungi, Owen; Dhlamini, Roy; Xaba, Sinokuthemba; Njeuhmeli, Emmanuel
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. PMID:22747578
Background Rape of women and children is recognized as a health and human rights issue in Tanzania and internationally. Exploration of the prevailing perceptions in rural areas is needed in order to expand the understanding of sexual violence in the diversity of Tanzania’s contexts. The aim of this study therefore was to explore and understand perceptions of rape of women and children at the community level in a rural district in Tanzania with the added objective of exploring those perceptions that may contribute to perpetuating and/or hindering the disclosure of rape incidences. Methods A qualitative design was employed using focus group discussions with male and female community members including religious leaders, professionals, and other community members. The discussions centered on causes of rape, survivors of rape, help-seeking and reporting, and gathered suggestions on measures for improvement. Six focus group discussions (four of single gender and two of mixed gender) were conducted. The focus group discussions were recorded, transcribed verbatim, and analyzed using manifest qualitative content analysis. Results The participants perceived rape of women and children to be a frequent and hidden phenomenon. A number of factors were singled out as contributing to rape, such as erosion of social norms, globalization, poverty, vulnerability of children, alcohol/drug abuse and poor parental care. Participants perceived the need for educating the community to raise their knowledge of sexual violence and its consequences, and their roles as preventive agents. Conclusions In this rural context, social norms reinforce sexual violence against women and children, and hinder them from seeking help from support services. Addressing the identified challenges may promote help-seeking behavior and improve care of survivors of sexual violence, while changes in social and cultural norms are needed for the prevention of sexual violence. PMID:25132543
Objective To investigate promoters and barriers for cervical cancer screening in rural Tanzania. Methods We interviewed 300 women of reproductive age living in Kiwangwa village, Tanzania. The odds of attending a free, 2-day screening service were compared with sociodemographic variables, lifestyle factors, and knowledge and attitudes surrounding cervical cancer using multivariable logistic regression. Results Compared with women who did not attend the screening service (n = 195), women who attended (n = 105) were older (OR 4.29; 95% CI, 1.61–11.48, age 40–49 years versus 20–29 years), listened regularly to the radio (OR 24.76; 95% CI, 11.49–53.33, listened to radio 1–3 times per week versus not at all), had a poorer quality of life (OR 4.91; CI, 1.96–12.32, lowest versus highest score), had faced cost barriers to obtaining health care in the preceding year (OR 2.24; 95% CI, 1.11–4.53, yes versus no), and held a more positive attitude toward cervical cancer screening (OR 4.64; 95% CI, 1.39–15.55, least versus most averse). Conclusion Efforts aimed at improving screening rates in rural Tanzania need to address both structural and individual-level barriers, including knowledge and awareness of cervical cancer prevention, cost barriers to care, and access to health information. PMID:24095307
Perng, Powell; Perng, Wei; Ngoma, Twalib; Kahesa, Crispin; Mwaiselage, Julius; Merajver, Sofia D.; Soliman, Amr S.
The aim of this paper is provide an overview of the capacity building programmes in maritime and underwater cultural heritage (MUCH) conducted by the authors in Tanzania and Mozambique. Tanzania and Mozambique have long histories of indigenous cultures, foreign contacts and influences and African adaptations beginning in the late Greco-Roman period, when the coastal populations exploited the peoples and riches of the interior. Today the coastline contains numerous examples of indigenous tangible and intangible heritage and many sites and histories related to the Swahili culture. Some exploratory research and training has been conducted in Tanzania and Mozambique, but the implementation by local residents of their own MUCH programme is still at an early stage. Under a UNESCO agreement framework, Tanzania in particular has started to develop a MUCH programme, which can assist in highlighting their extensive histories, cultural landscapes and cultural identity.
Jeffery, Bill; Parthesius, Robert
. Livestock productivity measurements for each zone were determined by the inventory approach whereby imputed values for livestock sold, traded, given for dowry and gifts, slaughtered and the value of milk per herd inventory, in case of cattle, were... Interviewed in Each District by Sub-Zones, Tanzania 1975. 55 13. Estimated Annual Deaths of Livestock by Zone, Tanzania 1975. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. Livestock Productivity and Adoption Scores by Zone. 63 15...
Njukia, James Wambugu
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 shows that social relations influence the decisions individuals make about disclosure. Most people preferred to reveal their HIV status to close family members. Most also mentioned the fear of being rejected and discriminated against as major reasons for not disclosing their test results to others. PMID:21936654
Lugalla, Joe; Yoder, Stanley; Sigalla, Huruma; Madihi, Charles
Background Pig keeping is becoming increasingly common across sub-Saharan Africa. Domestic pigs from the Arusha region of northern Tanzania were screened for trypanosomes using PCR-based methods to examine the role of pigs as a reservoir of human and animal trypanosomiasis. Methods A total of 168 blood samples were obtained from domestic pigs opportunistically sampled across four districts in Tanzania (Babati, Mbulu, Arumeru and Dodoma) during December 2004. A suite of PCR-based methods was used to identify the species and sub-species of trypanosomes including: Internally Transcribed Sequence to identify multiple species; species specific PCR to identify T. brucei s. l. and T. godfreyi and a multiplex PCR reaction to distinguish T. b. rhodesiense from T. brucei s. l. Results Of the 168 domestic pigs screened for animal and human infective trypanosome DNA, 28 (16.7%) were infected with one or more species of trypanosome; these included: six pigs infected with Trypanosoma vivax (3.6%); three with Trypanosoma simiae (1.8%); two with Trypanosoma congolense (Forest) (1%) and four with Trypanosoma godfreyi (2.4%). Nineteen pigs were infected with Trypanosoma brucei s. l. (10.1%) of which eight were identified as carrying the human infective sub-species Trypanosoma brucei rhodesiense (4.8%). Conclusion These results show that in Tanzania domestic pigs may act as a significant reservoir for animal trypanosomiasis including the cattle pathogens T. vivax and T. congolense, the pig pathogen T. simiae, and provide a significant reservoir for T. b. rhodesiense, the causative agent of acute Rhodesian sleeping sickness. PMID:24499540
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. PMID:20577807
Mdegela, Robinson H.; Ryoba, Ruth; Løken, Torleiv; Reksen, Olav
BACKGROUND: Monitoring dynamics in HIV-1 infection and risk behaviours is important in evaluating, adjusting and scaling up prevention programmes. The objective of this study was to estimate trends in the prevalence of HIV-1 infection and risk behaviours over 15 years in a rural village population in Kilimanjaro region of Tanzania using repeated population-based cross-sectional surveys. METHODS: Four rounds of HIV-1
Elia J Mmbaga; Akhtar Hussain; Germana H Leyna; Carol Holm-Hansen; Kagoma S Mnyika; Noel E Sam; Elise Klouman; Knut-Inge Klepp
Poor micronutrient status has been associated, in HIV-positive women, with faster progression of HIV disease and adverse birth outcomes. This randomized, double-blind, placebo-controlled study assessed the effects of vitamin A and multivitamins on birth outcomes in 1075 HIV-positive pregnant women at 12-27 weeks' gestation from Dar es Salaam, Tanzania. There were no differences in baseline plasma vitamin concentrations between groups. 267 women received a placebo, 269 were given vitamin A, 269 were administered a multivitamin excluding vitamin A, and 270 received a multivitamin including vitamin A. There were 30 fetal deaths in the group of women who received multivitamins (with and without vitamin A) compared with 49 among those not given multivitamins (relative risk (RR), 0.61; 95% confidence interval (CI), 0.39-0.94). Multivitamin supplementation decreased the risk of low birth weight (2500 g) by 44% (RR, 0.56; 95% CI, 0.38-0.82), of preterm birth (prior to 34 weeks gestation) by 39% (RR, 0.61; 95% CI, 0.38-0.96), and of small size for gestational age at birth by 43% (RR, 0.57; 95% CI, 0.39-0.82). Vitamin A had no significant effect on these variables. Multivitamins, but not vitamin A, were associated with significant increases in CD4, CD8, and CD3 counts. The clinical relevance of multivitamin supplementation for vertical transmission of HIV and the progression of disease remain unknown. However, these results indicate such supplementation is a low-cost means of substantially decreasing adverse pregnancy outcomes and increasing T cell counts in HIV-infected women. The observed beneficial effects of multivitamins on birth outcomes may have been mediated through improved maternal immune status. PMID:9605804
Fawzi, W W; Msamanga, G I; Spiegelman, D; Urassa, E J; McGrath, N; Mwakagile, D; Antelman, G; Mbise, R; Herrera, G; Kapiga, S; Willett, W; Hunter, D J
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 2004 to assess the extent to which iodated salt was used and its apparent impact on the total goitre prevalence (TGP) and urinary iodine concentrations (UIC) among the schoolchildren after USI was initiated. In 2004, a cross-sectional goitre survey was conducted; covering 140,758 schoolchildren aged 6 - 18 years were graded for goitre according to new WHO goitre classification system. Comparisons were made with district surveys conducted throughout most of the country during the 1980s and 90s. 131,941 salt samples from households were tested for iodine using rapid field test kits. UIC was determined spectrophotometrically using the ammonium persulfate digestion method in 4523 sub-sampled children. Results 83.6% (95% CI: 83.4 - 83.8) of salt samples tested positive for iodine. Whereas the TGP was about 25% on average in the earlier surveys, it was 6.9% (95%CI: 6.8-7.0) in 2004. The TGP for the younger children, 6-9 years old, was 4.2% (95%CI: 4.0-4.4), n = 41,965. In the 27 goitre-endemic districts, TGP decreased from 61% (1980s) to 12.3% (2004). The median UIC was 204 (95% CF: 192-215) ?g/L. Only 25% of children had UIC <100 ?g/L and 35% were ? 300 ?g/L, indicating low and excess iodine intake, respectively. Conclusion Our study demonstrates a marked improvement in iodine nutrition in Tanzania, twelve years after the initiation of salt iodation programme. The challenge in sustaining IDD elimination in Tanzania is now two-fold: to better reach the areas with low coverage of iodated salt, and to reduce iodine intake in areas where it is excessive. Particular attention is needed in improving quality control at production level and perhaps the national salt iodation regulations may need to be reviewed. PMID:19728863
Assey, Vincent D; Peterson, Stefan; Kimboka, Sabas; Ngemera, Daniel; Mgoba, Celestin; Ruhiye, Deusdedit M; Ndossi, Godwin D; Greiner, Ted; Tylleskär, Thorkild
This article describes observations of a monitoring mission by JOICFP, the IPPF Regional Africa Office, and JICA in Tanzania, during June 7-13, 1998. The team visited the Morogoro region to review and assess the current major Integrated Program (IP) activities. The community-based distribution agents have been successful in gaining the trust of the community and contributing to social change. Agents are motivated to work and receive additional training, even though they do not receive a salary. Communities recognize the agents as their representatives. Training agents at the grass roots level has been cost effective. The visiting doctor scheme has been successful in maximizing use of health personnel. In one example, 92 patients from 3 villages were treated by a visiting doctor, who had an adequate supply of basic drugs. Service fees paid by patients cover the cost of medicine. Women receive reproductive health and sexually transmitted disease check-ups. The Income Generation Activities (IGA) program strengthens income generation and women's organizations. IGA also provides tools for masonry and carpentry to encourage male participation in the program. The IP has cooperative support from UMATI, the Ministry of Health, UNFPA, and the Japanese government. Essential drugs and equipment are procured by JICA, and delivered through the UMATI-JOICFP distribution channels to government health centers and dispensaries and UMATI's clinics. The experience has confirmed the ability of nongovernmental organizations to supply a multi-bilateral project. Grassroots staff are most appreciative. PMID:12321789
When goats in Eastern Tanzania were screened for skin diseases, Dermatophilus congolensis was isolated from the skin lesions in 8 of 484 animals examined. In one severely affected case, the disease was also characterized by histological studies (Gram stain, Giemsa stain and routine HE studies) and electron microscopy. The histological picture was characterized by hyperkeratosis, parakeratosis, acanthosis, folliculitis and an inflammatory cellular reaction involving the epidermis. Gram stain and Giemsa stain revealed longitudinal and transverse branching filaments in the deeper layers of the epidermis. Ultrastructural studies demonstrated D. congolensis in various morphological forms, ranging from filamentous to tuber-shaped structures, mixed with numerous coccoid bodies of variable size. In some instances, the organisms were geometrically arranged in parallel rows of beading and were present in and among the degenerated epithelial cells. Several host cells showed degenerative changes. Ticks present on the goats were Amblyomma variegatum, Rhipicephalus evertsi, Rhipicephalus pravus and Boophilus sp. The clinical signs, pathological lesions, diagnosis, epidemiology and pathogenesis of the disease are discussed. PMID:11556616
Msami, H M; Khaschabi, D; Schöpf, K; Kapaga, A M; Shibahara, T
Introduction Globally, health facility delivery is encouraged as a single most important strategy in preventing maternal and neonatal morbidity and mortality. However, access to facility-based delivery care remains low in many less developed countries. This study assesses facilitators and barriers to institutional delivery in three districts of Tanzania. Methods Data come from a cross-sectional survey of random households on health behaviours and service utilization patterns among women and children aged less than 5 years. The survey was conducted in 2011 in Rufiji, Kilombero, and Ulanga districts of Tanzania, using a closed-ended questionnaire. This analysis focuses on 915 women of reproductive age who had given birth in the two years prior to the survey. Chi-square test was used to test for associations in the bivariate analysis and multivariate logistic regression was used to examine factors that influence institutional delivery. Results Overall, 74.5% of the 915 women delivered at health facilities in the two years prior to the survey. Multivariate analysis showed that the better the quality of antenatal care (ANC) the higher the odds of institutional delivery. Similarly, better socioeconomic status was associated with an increase in the odds of institutional delivery. Women of Sukuma ethnic background were less likely to deliver at health facilities than others. Presence of couple discussion on family planning matters was associated with higher odds of institutional delivery. Conclusion Institutional delivery in Rufiji, Kilombero, and Ulanga district of Tanzania is relatively high and significantly dependent on the quality of ANC, better socioeconomic status as well as between-partner communication about family planning. Therefore, improving the quality of ANC, socioeconomic empowerment as well as promoting and supporting inter-spousal discussion on family planning matters is likely to enhance institutional delivery. Programs should also target women from the Sukuma ethnic group towards universal access to institutional delivery care in the study area. PMID:24934657
Background Inadequate water and sanitation during childbirth are likely to lead to poor maternal and newborn outcomes. This paper uses existing data sources to assess the water and sanitation (WATSAN) environment surrounding births in Tanzania in order to interrogate whether such estimates could be useful for guiding research, policy and monitoring initiatives. Methods We used the most recent Tanzania Demographic and Health Survey (DHS) to characterise the delivery location of births occurring between 2005 and 2010. Births occurring in domestic environments were characterised as WATSAN-safe if the home fulfilled international definitions of improved water and improved sanitation access. We used the 2006 Service Provision Assessment survey to characterise the WATSAN environment of facilities that conduct deliveries. We combined estimates from both surveys to describe the proportion of all births occurring in WATSAN-safe environments and conducted an equity analysis based on DHS wealth quintiles and eight geographic zones. Results 42.9% (95% confidence interval: 41.6%–44.2%) of all births occurred in the woman's home. Among these, only 1.5% (95% confidence interval: 1.2%–2.0%) were estimated to have taken place in WATSAN-safe conditions. 74% of all health facilities conducted deliveries. Among these, only 44% of facilities overall and 24% of facility delivery rooms were WATSAN-safe. Combining the estimates, we showed that 30.5% of all births in Tanzania took place in a WATSAN-safe environment (range of uncertainty 25%–42%). Large wealth-based inequalities existed in the proportion of births occurring in domestic environments based on wealth quintile and geographical zone. Conclusion Existing data sources can be useful in national monitoring and prioritisation of interventions to improve poor WATSAN environments during childbirth. However, a better conceptual understanding of potentially harmful exposures and better data are needed in order to devise and apply more empirical definitions of WATSAN-safe environments, both at home and in facilities. PMID:25191753
Benova, Lenka; Cumming, Oliver; Gordon, Bruce A.; Magoma, Moke; Campbell, Oona M. R.
ABSTRACT Background: For many developing countries, obesity and its sequelae have become a challenge of a magnitude similar to hunger and undernutrition. The main objective of this study was, therefore, to investigate the weight status of women in rural Tanzania with reference to season as well as the link between women's weight, food consumption, and attitudes toward obesity. Methods: Three cross-sectional surveys in 3 different seasons within 1 year interviewed the same 210 women, ages 17–45 years, from 3 rural districts of northeastern and central Tanzania. These surveys assessed body mass index (BMI), food intake, and dietary diversity through 24-hour recalls, women's attitudes toward obesity, vegetable production, and socioeconomic status. Results: Although 71% of the women had a normal BMI, 7% were underweight, 16% overweight, and 6% obese. The BMI was correlated with the Dietary Diversity Score (DDS), the Food Variety Score (FVS), with the consumption of foods from the food groups “bread/cakes,” “sugar,” and “tea,” and with the production of exotic vegetables. In a multiple regression model, FVS was directly associated with BMI. When asked to describe the typical characteristics of an obese person, women mentioned more negative than positive characteristics. Conclusion: The prevalence of overweight and obesity was 3 times higher than that of underweight. Apparently, even in rural areas of Tanzania, a nutrition transition is underway. No direct association was identified between vegetable consumption and BMI. Although this study did not assess behavioral factors, such behavioral factors as activity levels as well as attitudes need to be considered, even in rural settings, to address all facets of malnutrition. PMID:25276549
Keding, Gudrun B; Msuya, John M; Maass, Brigitte L; Krawinkel, Michael B
Diarrheal diseases account for 7% of deaths in children under five years of age in Tanzania. Improving sanitation is an essential step towards reducing these deaths. This secondary analysis examined rural Tanzanian households' sanitation behaviors and attitudes in order to identify barriers and drivers to latrine adoption. The analysis was conducted using results from a cross-sectional study of 1000 households in five rural districts of Tanzania. Motivating factors, perceptions, and constraints surrounding open defecation and latrine adoption were assessed using behavioral change theory. Results showed a significant association between use of improved sanitation and satisfaction with current sanitation facility (OR: 5.91; CI: 2.95-11.85; p = 0.008). Livestock-keeping was strongly associated with practicing open defecation (OR: 0.22; CI 0.063-0.75; p < 0.001). Of the 93 total households that practiced open defecation, 79 (85%) were dissatisfied with the practice, 62 (67%) had plans to build a latrine and 17 (18%) had started saving for a latrine. Among households that planned to build a latrine, health was the primary reason stated (60%). The inability to pay for upgrading sanitation infrastructure was commonly reported among the households. Future efforts should consider methods to reduce costs and ease payments for households to upgrade sanitation infrastructure. Messages to increase demand for latrine adoption in rural Tanzania should integrate themes of privacy, safety, prestige and health. Findings indicate a need for lower cost sanitation options and financing strategies to increase household ability to adopt sanitation facilities. PMID:25247427
Sara, Stephen; Graham, Jay
Diarrheal diseases account for 7% of deaths in children under five years of age in Tanzania. Improving sanitation is an essential step towards reducing these deaths. This secondary analysis examined rural Tanzanian households’ sanitation behaviors and attitudes in order to identify barriers and drivers to latrine adoption. The analysis was conducted using results from a cross-sectional study of 1000 households in five rural districts of Tanzania. Motivating factors, perceptions, and constraints surrounding open defecation and latrine adoption were assessed using behavioral change theory. Results showed a significant association between use of improved sanitation and satisfaction with current sanitation facility (OR: 5.91; CI: 2.95–11.85; p = 0.008). Livestock-keeping was strongly associated with practicing open defecation (OR: 0.22; CI 0.063–0.75; p < 0.001). Of the 93 total households that practiced open defecation, 79 (85%) were dissatisfied with the practice, 62 (67%) had plans to build a latrine and 17 (18%) had started saving for a latrine. Among households that planned to build a latrine, health was the primary reason stated (60%). The inability to pay for upgrading sanitation infrastructure was commonly reported among the households. Future efforts should consider methods to reduce costs and ease payments for households to upgrade sanitation infrastructure. Messages to increase demand for latrine adoption in rural Tanzania should integrate themes of privacy, safety, prestige and health. Findings indicate a need for lower cost sanitation options and financing strategies to increase household ability to adopt sanitation facilities. PMID:25247427
Sara, Stephen; Graham, Jay
AIM To describe chest radiographic abnormalities and assess their usefulness for predicting causes of fever in a resource-limited setting. MATERIALS AND METHODS Febrile patients were enrolled in Moshi, Tanzania, and chest radiographs were evaluated by radiologists in Tanzania and the United States. Radiologists were blinded to the results of extensive laboratory evaluations to determine the cause of disease. RESULTS Of 870 febrile patients, 515 (59.2%) had a chest radiograph available; including 268 (66.5%) of the adults and adolescents, the remainder were children and infants. One hundred and nineteen (44.4%) adults and 51 (20.6%) children were human immunodeficiency virus (HIV)-infected. Among adults, radiographic abnormalities were present in 139 (51.9%), including 77 (28.7%) with homogeneous and heterogeneous lung opacities, 26 (9.7%) with lung nodules, 25 (9.3%) with pleural effusion, 23 (8.6%) with cardiomegaly, and 13 (4.9%) with lymphadenopathy. Among children, radiographic abnormalities were present in 87 (35.2%), including 76 (30.8%) with homogeneous and heterogeneous lung opacities and six (2.4%) with lymphadenopathy. Among adults and adolescents, the presence of opacities was predictive of Streptococcus pneumoniae and Coxiella burnetii, whereas the presence of pulmonary nodules was predictive of Histoplasma capsulatum and Cryptococcus neoformans. CONCLUSIONS Chest radiograph abnormalities among febrile inpatients are common in northern Tanzania. Chest radiography is a useful adjunct for establishing a causal diagnosis of febrile illness and may provide useful information for patient management, in particular for pneumococcal disease, Q fever, and fungal infections. PMID:23809268
Fiorillo, Suzanne P.; Diefenthal, Helmut C.; Goodman, Philip C.; Ramadhani, Habib O.; Njau, Boniface N.; Morrissey, Anne B.; Maro, Venance P.; Saganda, Wilbrod; Kinabo, Grace D.; Mwako, Mtumwa S.; Bartlett, John A.; Crump, John A.
Background The incidence of leptospirosis, a neglected zoonotic disease, is uncertain in Tanzania and much of sub-Saharan Africa, resulting in scarce data on which to prioritize resources for public health interventions and disease control. In this study, we estimate the incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania. Methodology/Principal Findings We conducted a population-based household health care utilization survey in two districts in the Kilimanjaro Region of Tanzania and identified leptospirosis cases at two hospital-based fever sentinel surveillance sites in the Kilimanjaro Region. We used multipliers derived from the health care utilization survey and case numbers from hospital-based surveillance to calculate the incidence of leptospirosis. A total of 810 households were enrolled in the health care utilization survey and multipliers were derived based on responses to questions about health care seeking in the event of febrile illness. Of patients enrolled in fever surveillance over a 1 year period and residing in the 2 districts, 42 (7.14%) of 588 met the case definition for confirmed or probable leptospirosis. After applying multipliers to account for hospital selection, test sensitivity, and study enrollment, we estimated the overall incidence of leptospirosis ranges from 75–102 cases per 100,000 persons annually. Conclusions/Significance We calculated a high incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania, where leptospirosis incidence was previously unknown. Multiplier methods, such as used in this study, may be a feasible method of improving availability of incidence estimates for neglected diseases, such as leptospirosis, in resource constrained settings. PMID:24340122
Biggs, Holly M.; Hertz, Julian T.; Munishi, O. Michael; Galloway, Renee L.; Marks, Florian; Saganda, Wilbrod; Maro, Venance P.; Crump, John A.
Eleven years of data from the globally available MODIS burned area and the MODS Active Fire Product have been analysed for Tanzania in conjunction with GIS data on land use and cover to provide a baseline for fire activity in this East African country. The total radiated energy (FRE) emitted by fires that were picked up by the burned area and active fire product is estimated based on a spatio-temporal clustering algorithm over the burned areas, and integration of the fire radiative power from the MODIS Active Fires product over the time of burning and the area of each burned area cluster. Resulting biomass combusted by unit area based on Wooste?s scaling factor for FRE to biomass combusted is compared to values found in the literature, and to values found in the Global Fire Emissions Database (GFED). Pyrogenic emissions are then estimated using emission factors. According to our analysis, an average of 11 million ha burn annually (ranging between 8.5 and 12.9 million ha) in Tanzania corresponding to between 10 and 14 % of Tanzaniás land area. Most burned area is recorded in the months from May to October. The land cover types most affected are woodland and shrubland cover types: they comprise almost 70 % of Tanzania's average annual burned area or 6.8 million ha. Most burning occurs in gazetted land, with an annual average of 3.7 million ha in forest reserves, 3.3 million ha in game reserves and 1.46 million ha in national parks, totalling close to 8.5 million ha or 77 % of the annual average burned area of Tanzania. Annual variability of burned area is moderate for most of the analysed classes, and in most cases there is no clear trend to be detected in burned area, except for the Lindi region were annual burned area appears to be increasing. Preliminary results regarding emissions from fires show that for larger fires that burn over a longer time, biomass burned derived through the FRP method compares well to literature values, while the integration over smaller fires with fewer observations yields unstable results due to undersampling issues and uncertainty in the start and end time of the fire events. Options for mitigating these issues using ancillary data such as fire weather information are discussed.
Ruecker, Gernot; Hoffmann, Anja; Leimbach, David; Tiemann, Joachim; Ng'atigwa, Charles
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. PMID:23256530
Background Regulation of the pharmaceutical sector is a challenging task for most governments in the developing countries. In Tanzania, this task falls under the Food and Drugs Authority and the Pharmacy Council. In 2010, the Pharmacy Council spearheaded policy reforms in the pharmaceutical sector aimed at taking over the control of the regulation of the business of pharmacy from the Tanzania Food and Drugs Authority. This study provides a critical analysis of these reforms. Methods The study employed a qualitative case-study design. Data was collected through in-depth interviews, focus group discussions and document reviews. Data was analyzed thematically using a policy triangle framework. The analysis was done manually. Results The reforms adopted an incremental model of public policy-making and the process was characterized by lobbying for political support, negotiations and bargaining between the interest groups. These negotiations were largely centred on vested interests and not on the impact of the reforms on the efficiency of pharmaceutical regulations in the country. Stakeholders from the micro and meso levels were minimally involved in the policy reforms. Conclusion Recent pharmaceutical regulation reforms in Tanzania were overshadowed by vested interests, displacing a critical analysis of optimal policy options that have the potential to increase efficiency in the regulation of the business of pharmacy. Politics influenced decision-making at different levels of the reform process. PMID:23849334
A microearthquake network with six stations and a diameter of about 50 km has been in operation in the Stiegler's Gorge area (Rufiji Basin), Tanzania, between 1978 and 1981. The network, which used radiotelemetry and digital recording at 30 Hz based on a triggering system, has recorded a large number of teleseismic and regional earthquakes in addition to several thousand
Hilmar Bungum; Abdueli A. Nnko
A single specimen of the anterior portion of a small fish was collected from the Eocene Mahenge site of Tanzania in 1996. The specimen, preserved as part and counterpart natural mold, is identified as belonging to a characiform fish, although the presence of a Weberian apparatus has not been confirmed beyond doubt. Features of the bones, such as the prominent
Alison M. Murray
Recent excavation of the tuffs of the Laetolil Beds in Tanzania has revealed the presence of a large variety of footprints from the Pliocene. Many of these prints can be correlated with fossilised remains of Pliocene animals found in the same area.
M. D. Leakey; R. L. Hay
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.
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…
Tedre, Matti; Bangu, Nicholas; Nyagava, Seth I.
A discussion of the role of Swahili in Tanzania looks at its elaboration as an indigenous language, involving both internal modification of the written language and the extension of its institutionalized domains of use. Because of its role as the lingua franca of the independence movement, Swahili became a vehicle for national political…
artesian borehole, Singhida (central Tanzania) Hydrology, weather and groundwater NERC EQUIP;protected spring in Kampala (Uganda) Â· groundwater supplies 50% of world's drinking water Kundzewicz and DÃ¶ll (2009) #12;maize plantation irrigated by a groundwater-fed pivot, Katwe (Zambia) Â· and 42
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
A. E. Temu; G. P. Hill
A description is given of an explosion crater area in the eastern Rift Valley of Northern Tanzania. The features comprise maar-type explosion craters, tuff rings and tuff cones, the location of which is controlled by minor faults on the floor of the Rift Valley. In some tuff rings and cones biotite and pyroxene are common, and olivine-biotite pyroxenite is common
J. B. Dawson; D. G. Powell
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
Is improved school accessibility an effective policy tool for reducing child labor in developing countries? We address this question using microdata from rural Tanzania and a regression strategy that attempts to control for nonrandom location of households around schools as well as classical and nonclassical measurement error in self-reported…
Kondylis, Florence; Manacorda, Marco
Women all over the globe report physical and appetite sensations in early pregnancy, and this study contributes to this growing literature by reporting on the appetite sensations experienced by pregnant women from rural Tanzania. Appetite changes associated with 545 pregnancies were compiled from surveys conducted to report on the prevalence of appetite loss, nausea, vomiting, dizziness, joint pain, cravings, aversions,
Crystal L. Patil
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
Tomasz Potkanski; William M. Adams
The fundamental base of volcanic hazard assessment on any volcano is the study of its most recent eruptive history. Although the presence of extensive surficial pumice deposits was long known in the Rungwe Volcanic Province (RVP, SW Tanzania, East African Rift), the recent eruptive history was never studied in detail and is presented here for the first time. The RVP
K. Fontijn; G. G. Ernst; M. A. Elburg; D. Williamson; P. Jacobs
The consequences of climate change for agriculture and food security in developing countries are of serious concern. Due to their reliance on rain-fed agriculture both as a source of income and consumption, many low-income countries are generally considered to be most vulnerable to climate change. Here, we estimate the impact of climate change on food security in Tanzania. Representative climate
Channing Arndt; Ken Strzepek; James Thurlow
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
Dill, Tatjana; Dobler, Gerhard; Saathoff, Elmar; Clowes, Petra; Kroidl, Inge; Ntinginya, Elias; Machibya, Harun; Maboko, Leonard; Löscher, Thomas; Hoelscher, Michael
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
than 600 hours of chimpanzee video footage from the Jane Goodall Institute's (JGI) Videographer Bill extraordinary," Goodall said in a campus press conference. "It Dr. Jane Goodall with an orphan Chimpanzee I n the lush tropical forest of Tanzania's Gombe National Park, famed chimpanzee expert Dr. Jane
Minnesota, University of
Olmoti Crater is part of the Plio-Pleistocene Ngorongoro Volcanic Highland (NVH) in northern Tanzania to the south of Gregory Rift. The Gregory Rift is part of the eastern branch of the East African Rift System (EARS) that stretches some 4000km from the Read Sea and Gulf of Aden in the north to the Zambezi River in Mozambique. Here, we (1)
Godwin F. Mollel; Carl C. Swisher III; Lindsay J. McHenry; Mark D. Feigenson; Michael J. Carr
Olduvai Gorge, northern Tanzania, exposes a Plio-Pleistocene sedimentary record that includes lake and lake-margin sediments and fossil remains of ancient plants and early humans. There are rich paleontological and cultural records at Olduvai Gorge that include thousands of vertebrate fossils and stone tools. Previous studies of plant biomarkers in lake sediments from Olduvai Gorge reveal repeated, abrupt changes in landscape dominance by woodland or grassland vegetation during the early Pleistocene, about 1.8 million years ago. However, the reconstruction of wetland vegetation in the past is limited by a dearth of published lipid signatures for modern wetland species. Here, we present lipid and isotopic data for leaf tissues from eight modern plants (i.e., sedge and Typha species) living in wetlands near Olduvai Gorge. Trends in values for molecular and leaf ?13C and average chain length (ACL) of n-alkanes in plant tissues are similar to values for underlying soils. Compound-specific ?13C values for n-alkanes C25 to C33 range between -36.4 to -23.1‰ for C3 plants and -22.3 to -19.5‰ for C4 plants. Fractionation factors between leaf and lipids, ?29 and ?33, fall within the range reported in the literature, but they differ more widely within a single plant. For C3 plants, the average difference between ?29 and ?33 is 6.5 ‰, and the difference between ?29 and ?33 for C4 plants is less than 2‰. Both plant types show a parabolic relationship between chain length and ?13C values, in which C29 typically has the most depleted value, and typically shift by 3-5‰ between alkane homologs. This pattern has not been previously reported, and could be unique for sedge lipids. If so, these data help constrain the application of plant wax biomarkers from sedges for paleo-vegetation reconstruction in paleoclimate studies and at archaeological sites.
Tamalavage, A.; Magill, C. R.; Barboni, D.; Ashley, G. M.; Freeman, K. H.
Introduction Multiple insurance funds serving different population groups may compromise equity due to differential revenue raising capacity and an unequal distribution of high risk members among the funds. This occurs when the funds exist without mechanisms in place to promote income and risk cross-subsidisation across the funds. This paper analyses whether the risk distribution varies across the Community Health Fund (CHF) and National Health Insurance Fund (NHIF) in two districts in Tanzania. Specifically we aim to 1) identify risk factors associated with increased utilisation of health services and 2) compare the distribution of identified risk factors among the CHF, NHIF and non-member households. Methods Data was collected from a survey of 695 households. A multivariate logisitic regression model was used to identify risk factors for increased health care utilisation. Chi-square tests were performed to test whether the distribution of identified risk factors varied across the CHF, NHIF and non-member households. Results There was a higher concentration of identified risk factors among CHF households compared to those of the NHIF. Non-member households have a similar wealth status to CHF households, but a lower concentration of identified risk factors. Conclusion Mechanisms for broader risk spreading and cross-subsidisation across the funds are necessary for the promotion of equity. These include risk equalisation to adjust for differential risk distribution and revenue raising capacity of the funds. Expansion of CHF coverage is equally important, by addressing non-financial barriers to CHF enrolment to encourage wealthy non-members to join, as well as subsidised membership for the poorest. PMID:25574326
Chomi, Eunice Nahyuha; Mujinja, Phares Gamba; Enemark, Ulrika; Hansen, Kristian; Kiwara, Angwara Dennis
Department of Molecular Biology and Genetics, Democritus University of Thrace, 68 100 Alexandroupoli, Greece University, Dar es Salaam, Tanzania V. G. Manolopoulos Laboratory of Pharmacology, Medical School, Democritus
Background Primary eye care (PEC) in sub-Saharan Africa usually means the diagnosis, treatment, and referral of eye conditions at the most basic level of the health system by primary health care workers (PHCWs), who receive minimal training in eye care as part of their curricula. We undertook this study with the aim to evaluate basic PEC knowledge and ophthalmologic skills of PHCWs, as well as the factors associated with these in selected districts in Kenya, Malawi, and Tanzania. Methods A standardized (26 items) questionnaire was administered to PHCWs in all primary health care (PHC) facilities of 2 districts in each country. Demographic information was collected and an examination aimed to measure competency in 5 key areas (recognition and management of advanced cataract, conjunctivitis, presbyopia, and severe trauma plus demonstrated ability to measure visual acuity) was administered. Results Three-hundred-forty-three PHCWs were enrolled (100, 107, and 136 in Tanzania, Kenya, and Malawi, respectively). The competency scores of PHCW varied by area, with 55.7%, 61.2%, 31.2%, and 66.1% scoring at the competency level in advanced cataract, conjunctivitis, presbyopia, and trauma, respectively. Only 8.2% could measure visual acuity. Combining all scores, only 9 (2.6%) demonstrated competence in all areas. Conclusion The current skills of health workers in PEC are low, with a large per cent below the basic competency level. There is an urgent need to reconsider the expectations of PEC and the content of training.
Objective: Assess whether reform in the Tanzanian medicines delivery system from a central 'push' kit system to a decentralized 'pull' Integrated Logistics System (ILS) has improved medicines accountability. Methods: Rufiji District in Tanzania was used as a case study. Data on medicines ordered and patients seen were compiled from routine information at six public health facilities in 1999 under the kit system and in 2009 under the ILS. Three medicines were included for comparison: an antimalarial, anthelmintic and oral rehydration salts (ORS). Results: The quality of the 2009 data was hampered by incorrect quantification calculations for orders, especially for antimalarials. Between the periods 1999 and 2009, the percent of unaccounted antimalarials fell from 60 to 18%, while the percent of unaccounted anthelmintic medicines went from 82 to 71%. Accounting for ORS, on the other hand, did not improve as the unaccounted amounts increased from 64 to 81% during the same period. Conclusions: The ILS has not adequately addressed accountability concerns seen under the kit system due to a combination of governance and system-design challenges. These quantification weaknesses are likely to have contributed to the frequent periods of antimalarial stock-out experienced in Tanzania since 2009. We propose regular reconciliation between the health information system and the medicines delivery system, thereby improving visibility and guiding interventions to increase the availability of essential medicines. PMID:25013720
Mikkelsen-Lopez, Inez; Cowley, Peter; Kasale, Harun; Mbuya, Conrad; Reid, Graham; de Savigny, Don
Objective: Assess whether reform in the Tanzanian medicines delivery system from a central ‘push' kit system to a decentralized ‘pull' Integrated Logistics System (ILS) has improved medicines accountability. Methods: Rufiji District in Tanzania was used as a case study. Data on medicines ordered and patients seen were compiled from routine information at six public health facilities in 1999 under the kit system and in 2009 under the ILS. Three medicines were included for comparison: an antimalarial, anthelmintic and oral rehydration salts (ORS). Results: The quality of the 2009 data was hampered by incorrect quantification calculations for orders, especially for antimalarials. Between the periods 1999 and 2009, the percent of unaccounted antimalarials fell from 60 to 18%, while the percent of unaccounted anthelmintic medicines went from 82 to 71%. Accounting for ORS, on the other hand, did not improve as the unaccounted amounts increased from 64 to 81% during the same period. Conclusions: The ILS has not adequately addressed accountability concerns seen under the kit system due to a combination of governance and system-design challenges. These quantification weaknesses are likely to have contributed to the frequent periods of antimalarial stock-out experienced in Tanzania since 2009. We propose regular reconciliation between the health information system and the medicines delivery system, thereby improving visibility and guiding interventions to increase the availability of essential medicines. PMID:25013720
Mikkelsen-Lopez, Inez; Cowley, Peter; Kasale, Harun; Mbuya, Conrad; Reid, Graham; de Savigny, Don
Background Rabies remains a major public health threat in many parts of the world and is responsible for an estimated 55,000 human deaths annually. The burden of rabies is estimated to be around US$20 million in Africa, with the highest financial expenditure being the cost of post-exposure prophylaxis (PEP). However, these calculations may be substantial underestimates because the costs to households of coping with endemic rabies have not been investigated. We therefore aimed to estimate the household costs, health-seeking behaviour, coping strategies, and outcomes of exposure to rabies in rural and urban communities in Tanzania. Methods and Findings Extensive investigative interviews were used to estimate the incidence of human deaths and bite exposures. Questionnaires with bite victims and their families were used to investigate health-seeking behaviour and costs (medical and non-medical costs) associated with exposure to rabies. We calculated that an average patient in rural Tanzania, where most people live on less than US$1 per day, would need to spend over US$100 to complete WHO recommended PEP schedules. High costs and frequent shortages of PEP led to poor compliance with PEP regimens, delays in presentation to health facilities, and increased risk of death. Conclusion The true costs of obtaining PEP were twice as high as those previously reported from Africa and should be considered in re-evaluations of the burden of rabies. PMID:24244767
Sambo, Maganga; Cleaveland, Sarah; Ferguson, Heather; Lembo, Tiziana; Simon, Cleophas; Urassa, Honorati; Hampson, Katie
The development of insecticide resistance is a threat to the control of malaria in Africa. We report the findings of a national survey carried out in Tanzania in 2011 to monitor the susceptibility of malaria vectors to pyrethroid, organophosphate, carbamate and DDT insecticides, and compare these findings with those identified in 2004 and 2010. Standard World Health Organization (WHO) methods were used to detect knock-down and mortality rates in wild female Anopheles gambiae s.l. (Diptera: Culicidae) collected from 14 sentinel districts. Diagnostic doses of the pyrethroids deltamethrin, lambdacyhalothrin and permethrin, the carbamate propoxur, the organophosphate fenitrothion and the organochlorine DDT were used. Anopheles gambiae s.l. was resistant to permethrin in Muleba, where a mortality rate of 11% [95% confidence interval (CI) 6-19%] was recorded, Muheza (mortality rate of 75%, 95% CI 66-83%), Moshi and Arumeru (mortality rates of 74% in both). Similarly, resistance was reported to lambdacyhalothrin in Muleba, Muheza, Moshi and Arumeru (mortality rates of 31-82%), and to deltamethrin in Muleba, Moshi and Muheza (mortality rates of 28-75%). Resistance to DDT was reported in Muleba. No resistance to the carbamate propoxur or the organophosphate fenitrothion was observed. Anopheles gambiae s.l. is becoming resistant to pyrethoids and DDT in several parts of Tanzania. This has coincided with the scaling up of vector control measures. Resistance may impair the effectiveness of these interventions and therefore demands close monitoring and the adoption of a resistance management strategy. PMID:24192019
Kabula, B; Tungu, P; Malima, R; Rowland, M; Minja, J; Wililo, R; Ramsan, M; McElroy, P D; Kafuko, J; Kulkarni, M; Protopopoff, N; Magesa, S; Mosha, F; Kisinza, W
Background A drug resistance survey is an essential public health management tool for evaluating and improving the performance of National Tuberculosis control programmes. The current manuscript describes the implementation of the first national drug resistance survey in Tanzania. Methods Description of the implementation process of a national anti-tuberculosis drug resistance survey in Tanzania, in relation to the study protocol and Standard Operating Procedures. Results Factors contributing positively to the implementation of the survey were a continuous commitment of the key stakeholders, the existence of a well organized National Tuberculosis Programme, and a detailed design of cluster-specific arrangements for rapid sputum transportation. Factors contributing negatively to the implementation were a long delay between training and actual survey activities, limited monitoring of activities, and an unclear design of the data capture forms leading to difficulties in form-filling. Conclusion Careful preparation of the survey, timing of planned activities, a strong emphasis on data capture tools and data management, and timely supervision are essential for a proper implementation of a national drug resistance survey. PMID:19116022
Chonde, Timothy M; Doulla, Basra; van Leth, Frank; Mfinanga, Sayoki GM; Range, Nyagosya; Lwilla, Fred; Mfaume, Saidi M; van Deun, Armand; Zignol, Matteo; Cobelens, Frank G; Egwaga, Saidi M
Dr. Sutton is now a Lecturer at University College, Dar es Salaam, and was formerly a Research Student of the Institute, when he carried out extensive field-work mainly in the western highlands of Kenya. In this important article, based largely on that work, he reviews our knowledge of the Late Stone Age, Iron Age, and histories of the peoples of
J. E. G. Sutton
This study aimed at finding out from parents what they knew to be the causes of their children's disabilities. One hundred and twenty six parents from four regions, namely Dar es Salaam, Dodoma, Kilimanjaro and Morogoro were involved in this study. Data was collected through interview, narratives and observation. It was obvious from the findings…
Tungaraza, Frida D.
\\u000a Tanzania is one of the world’s leading nations in terms of wildlife conservation, with rich and diverse wildlife resources.\\u000a Game controlled areas in Tanzania are used for wildlife conservation and most of them were set aside when human populations\\u000a were low and global climate was stable. Under the climate change scenario realised for Tanzania for the next few decades,\\u000a a
Siima Bakengesa; Pantaleo Munishi; Stale Navrud
This study examines the film industry in Tanzania from the 1960s to 2010 and assesses how government policies, legislation, and cultural institutions have impacted filmmaking in Tanzania. By employing a critical political ...
Mwakalinga, Mona Ngusekela
Background Job satisfaction is an important determinant of health worker motivation, retention, and performance, all of which are critical to improving the functioning of health systems in low- and middle-income countries. A number of small-scale surveys have measured the job satisfaction and intention to leave of individual health worker cadres in different settings, but there are few multi-country and multi-cadre comparative studies. Objective The objective of this study was to compare the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa. Methods We undertook a cross-sectional survey of a stratified cluster sample of 2,220 health workers, 564 from Tanzania, 939 from Malawi, and 717 from South Africa. Participants completed a self-administered questionnaire, which included demographic information, a 10-item job satisfaction scale, and one question on intention to leave. Multiple regression was used to identify significant predictors of job satisfaction and intention to leave. Results There were statistically significant differences in job satisfaction and intention to leave between the three countries. Approximately 52.1% of health workers in South Africa were satisfied with their jobs compared to 71% from Malawi and 82.6% from Tanzania (?2=140.3, p<0.001). 18.8% of health workers in Tanzania and 26.5% in Malawi indicated that they were actively seeking employment elsewhere, compared to 41.4% in South Africa (?2=83.5, p<0.001). The country differences were confirmed by multiple regression. The study also confirmed that job satisfaction is statistically related to intention to leave. Conclusions We have shown differences in the levels of job satisfaction and intention to leave between different groups of health workers from Tanzania, Malawi, and South Africa. Our results caution against generalising about the effectiveness of interventions in different contexts and highlight the need for less standardised and more targeted HRH strategies than has been practised to date. PMID:23364090
Blaauw, Duane; Ditlopo, Prudence; Maseko, Fresier; Chirwa, Maureen; Mwisongo, Aziza; Bidwell, Posy; Thomas, Steve; Normand, Charles
Background Promoting family planning (FP) is a key strategy for health, economic and population growth. Sub-Saharan Africa, with one of the lowest contraceptive prevalence and highest fertility rates globally, contributes half of the global maternal deaths. Improving the quality of FP services, including enhancing pre-service FP teaching, has the potential to improve contraceptive prevalence. In efforts to improve the quality of FP services in Tanzania, including provider skills, this study sought to identify gaps in pre-service FP teaching and suggest opportunities for strengthening the training. Methods Data were collected from all medical schools and a representative sample of pre-service nursing, Assistant Medical Officer (AMO), Clinical Officer (CO) and assistant CO schools in mainland Tanzania. Teachers responsible for FP teaching at the schools were interviewed using a semi-structured questionnaire. Observations on availability of teaching resources and other evidence of FP teaching and evaluation were documented. Relevant approved teaching documents were assessed for their suitability as competency-based FP teaching tools against predefined criteria. Quantitative data were analyzed using EPI Info 6 and qualitative data were manually analyzed using content analysis. Results A total of 35 pre-service schools were evaluated for FP teaching including 30 technical education and five degree offering schools. Of the assessed 11 pre-service curricula, only one met the criteria for suitability of FP teaching. FP teaching was typically theoretical with only 22.9% of all the schools having systems in place to produce graduates who could skillfully provide FP methods. Across schools, the target skills were the same level of competence and skewed toward short acting methods of contraception. Only 23.3% (n?=?7) of schools had skills laboratories, 76% (n?=?22) were either physically connected or linked to FP clinics. None of the degree providing schools practiced FP at its own teaching hospital. Teachers were concerned with poor practical exposure and lack of teaching material. Conclusions Pre-service FP teaching in Tanzania is theoretical, poorly guided, and skewed toward short acting methods; a majority of the schools are unable to produce competent FP service providers. Pre-service FP training should be strengthened with more focus on practical skills. PMID:25016391
A study was conducted using a structured questionnaire to obtain information about the nature and extent of rodent damage to crops, farmer's perceptions of crop pests and their knowledge, attitudes and practices to their management in Tanzania and Ethiopia. The study was carried out in five localities (Makuyu -Central Tanzania; Chunya-Southwest Tanzania; Ziway and Adami Tulu (south of Addis Ababa)
Rhodes H. Makundi; Afework Bekele; Herwig Leirs; Winnie Rwamugira; Loth S. Mulungu
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. PMID:23192005
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
The volatiles from the aerial parts of edible plants growing in Tanzania, Leucas glabrata, Plectranthus laxiflorus, Salvia nilotica and Vernonia smithiana, were investigated by GC and GC\\/MS. Thirty-five compounds were identified from L. glabrata, representing 80.4% of the total oil; forty-three from P. laxiflorus (86.7%); twenty-four from S. nilotica (94.3%); and thirty-nine compounds from V. smithiana (92.9%). Among the identified
K. Vagionas; O. Ngassapa; D. Runyoro; K. Graikou; O. Gortzi; I. Chinou
A description is given of an explosion crater area in the eastern Rift Valley of Northern Tanzania. The features comprise\\u000a maar-type explosion craters, tuff rings and tuff cones, the location of which is controlled by minor faults on the floor of\\u000a the Rift Valley. In some tuff rings and cones biotite and pyroxene are common, and olivine-biotite pyroxenite is common
J. B. Dawson; D. G. Powell
The continental crust is stratified in composition; the upper crust is generally enriched in highly incompatible trace elements relative to the lower crust . The Western Granulite section of the Mozambique Belt of Northern Tanzania yields Archean Nd model ages and has zircons with U-Pb ages of ~2.6 Ga [2,3], but was strongly re-worked during the Pan-African Orogeny, ca. 560
J. J. Bellucci; W. F. McDonough; R. L. Rudnick; R. J. Walker
Equines are minor species in Tanzania's array of domestic livestock. Attempts to use them for transport by early explorers from the mid-nineteenth century usually failed. Donkeys were used extensively as pack animals to complement human porters by both British and German forces in the First World War, but their advantages were often outweighed by slow progress and competition with troops and porters for water, and they died in huge numbers. The British had regular cavalry troops in their campaign and mules found limited use as individual mounts for officers. In modern times, there are very few horses in Tanzania but they find several uses. Exotic safaris are made on horseback, they are used as stock horses on ranches, there is a polo club in northern Tanzania and there are leisure riding activities around the capital city. Official census records for donkeys estimate numbers at under 300,000 with concentrations in the northern pastoral and agropastoral areas where they are used as pack animals with water being the main commodity transported. Elsewhere donkeys are used to a limited extent in transport and traction work. There is little interest in equines by the central and local governments or the general public and the status quo can be expected to continue. PMID:24834000
Wilson, R Trevor
This article demonstrates how aid dependence operates in very concrete terms in the process of consultancy and technical assistance. It draws on the author's experiences in preparing a monitoring and evaluation system for Tanzania's Local Government Reform Program. It illustrates how a comprehensive system of aid dependence, such as prevails in Tanzania, has meant that concern with local ownership, institutional
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…
In Tanzania, the Records and Archives Management Act of 2002 established the Records and Archives Management Department (RAMD) to provide for the proper administration and better management of public records and archives throughout their life cycle. This article is based on findings from an ongoing study of the government ministries of Tanzania which examines the current state of records management
Esther Ndenje-Sichalwe; Patrick Ngulube; Christine Stilwell
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 analyzed trends, challenges and prospects of academia-industry-government linkages in Tanzania. Using case study design, and documentary review to gather the required data, the study sought to answer three research questions: (1) what are the trends of academia-industry-government linkages in Tanzania?, (2) what are the challenges…
Purpose: The purpose of this paper is to provide information on development of standards in Tanzania which may be of help to training providers in other countries as they seek to improve the quality and standards of their provision. Design/methodology/approach: The need to provide quality assured tertiary qualifications in Tanzania to win both…
The mangroves of Tanzania are currently not being managed although they are legally gazetted as forest reserves. The management of this overexploited and under estimated natural resource rests with the Forest and Beekeeping Division in the Ministry of Natural Resources and Tourism. It is the Division's intention to conserve the mangroves of Tanzania, therefore steps are being taken to reach
Adelaida K. Semesi
- extraction, contamination, land-use changes, and climate change, this groundwater supply and its sources over Kilimanjaro, Tanzania, the highest mountain in Africa, has undergone extensive hydrologic changes over (Tanzania). Sample sources included four glaciers, seven groundwater wells, 12 rivers, 10 springs
Howat, Ian M.
Upper mantle Q and thermal structure beneath Tanzania, East Africa from teleseismic P wave spectra. Introduction  East Africa is a geologically unique region with Cenozoic volcanism and a developing., A. A. Nyblade, and J. Ritsema (2004), Upper mantle Q and thermal structure beneath Tanzania, East
Background HIV-associated anemia is common and associated with poor prognosis. However, its response to antiretroviral treatment (ART) in rural Africa is poorly understood. Methods HIV-infected adults (?15 years) who enrolled in HIV care at Haydom Lutheran Hospital in northern Tanzania were included in the study. The effect of ART (zidovudine/stavudine + lamivudine + efavirenz/nevirapine) on HIV-associated anemia was studied in a subset of patients who were anemic at the time they started ART and had a follow-up hemoglobin measurement 12 months later. Pregnant women were excluded from the study, as were women who had given birth within the past 6 weeks. Anemia was defined as hemoglobin <12 g/dL in women and <13 g/dL in men. We applied paired sample T-tests to compare hemoglobin levels before and one year after ART initiation, and logistic regression models to identify predictors of persistent anemia. Results At enrollment, mean hemoglobin was 10.3 g/dL, and 649 of 838 patients (77.4%) were anemic. Of the anemic patients, 254 (39.1%) had microcytosis and hypochromia. Among 102 patients who were anemic at ART initiation and had a follow-up hemoglobin measurement after 12 months, the mean hemoglobin increased by 2.5 g/dL (P < 0.001); however, 39 patients (38.2%) were still anemic after 12 months of ART. Independent predictors of persistent anemia were mean cell volume in the lower quartile (<76.0 fL; Odds Ratio [OR] 4.34; 95% confidence interval [CI] 1.22-15.5) and a zidovudine-containing initial regimen (OR 2.91; 95% CI 1.03-8.19). Conclusions Most patients had anemia at enrollment, of whom nearly 40% had microcytosis and hypochromia suggestive of iron deficiency. The mean hemoglobin increased significantly in patients who received ART, but one third were still anemic 12 months after ART initiation indicating that additional interventions to treat HIV-associated anemia in rural Africa might be warranted, particularly in patients with microcytosis and those treated with zidovudine. PMID:21745396
Background Intimate partner violence against women is a prevailing public health problem in Tanzania, where four of ten women have a lifetime exposure to physical or sexual violence by their male partners. To be able to suggest relevant and feasible community and health care based interventions, we explored community members' understanding and their responses to intimate partner violence. Methods A qualitative study using focus group discussions with 75 men and women was conducted in a community setting of urban Tanzania. We analysed data using a grounded theory approach and relate our findings to the ecological framework of intimate partner violence. Results The analysis resulted in one core category, "Moving from frustration to questioning traditional gender norms", that denoted a community in transition where the effects of intimate partner violence had started to fuel a wish for change. At the societal level, the category "Justified as part of male prestige" illustrates how masculinity prevails to justify violence. At the community level, the category "Viewed as discreditable and unfair" indicates community recognition of intimate partner violence as a human rights concern. At the relationship level, the category "Results in emotional entrapment" shows the shame and self-blame that is often the result of a violent relationship. At the individual level, the risk factors for intimate partner violence were primarily associated with male characteristics; the category "Fed up with passivity" emerged as an indication that community members also acknowledge their own responsibility for change in actions. Conclusions Prevailing gender norms in Tanzania accept women's subordination and justify male violence towards women. At the individual level, an increasing openness makes it possible for women to report, ask for help, and become proactive in suggesting preventive measures. At the community level, there is an increased willingness to intervene but further consciousness-raising of the human rights perspective of violence, as well as actively engaging men. At the macro level, preventive efforts must be prioritized through re-enforcement of legal rights, and provision of adequate medical and social welfare services for both survivors and perpetrators. PMID:21501506
Introduction Retail pharmaceutical products are commonly used to treat fever and malaria in sub-Saharan African countries. Small scale studies have suggested that poor quality antimalarials are widespread throughout the region, but nationwide data are not available that could lead to generalizable conclusions about the extent to which poor quality drugs are available in African communities. This study aimed to assess the quality of antimalarials available from retail outlets across mainland Tanzania. Methods and Findings We systematically purchased samples of oral antimalarial tablets from retail outlets across 21 districts in mainland Tanzania in 2005. A total of 1080 antimalarial formulations were collected including 679 antifol antimalarial samples (394 sulfadoxine/pyrimethamine and 285 sulfamethoxypyrazine/pyrimethamine), 260 amodiaquine samples, 63 quinine samples, and 51 artemisinin derivative samples. A systematic subsample of 304 products was assessed for quality by laboratory based analysis to determine the amount of the active ingredient and dissolution profile by following the published United States Pharmacopoeia (USP) monogram for the particular tablet being tested. Products for which a published analytical monogram did not exist were assessed on amount of active ingredient alone. Overall 38 or 12.2% of the samples were found to be of poor quality. Of the antifolate antimalarial drugs tested 13.4% were found to be of poor quality by dissolution and content analysis using high-performance liquid chromatography (HPLC). Nearly one quarter (23.8%) of quinine tablets did not comply within the tolerance limits of the dissolution and quantification analysis. Quality of amodiaquine drugs was relatively better but still unacceptable as 7.5% did not comply within the tolerance limits of the dissolution analysis. Formulations of the artemisinin derivatives all contained the stated amount of active ingredient when analysed using HPLC alone. Conclusions Substandard antimalarial formulations were widely available in Tanzania at the time of this study. No products were detected that did not contain any amount of the stated active ingredient. Quinine and sulfadoxine/pyrimethamine products were the most widely available and also the most likely to be of poor quality. Substandard products were identified in all parts of the country and were labeled as made by both domestic and international manufacturers. With the expansion of the retail pharmaceutical sector as a delivery channel for antimalarial formulations the need for regular nationwide monitoring of their quality will become increasingly important. PMID:18923672
Kaur, Harparkash; Goodman, Catherine; Thompson, Eloise; Thompson, Katy-Anne; Masanja, Irene; Kachur, S. Patrick; Abdulla, Salim
Abstract Background Leptospirosis and human immunodeficiency virus (HIV) infection are prevalent in many areas, including northern Tanzania, yet little is known about their interaction. Methods We enrolled febrile inpatients at two hospitals in Moshi, Tanzania, over 1 year and performed HIV antibody testing and the microscopic agglutination test (MAT) for leptospirosis. Confirmed leptospirosis was defined as ?four-fold rise in MAT titer between acute and convalescent serum samples, and probable leptospirosis was defined as any reciprocal MAT titer ?800. Results Confirmed or probable leptospirosis was found in 70 (8.4%) of 831 participants with at least one serum sample tested. At total of 823 (99.0%) of 831 participants had HIV testing performed, and 203 (24.7%) were HIV infected. Among HIV-infected participants, 9 (4.4%) of 203 had confirmed or probable leptospirosis, whereas among HIV-uninfected participants 61 (9.8%) of 620 had leptospirosis. Leptospirosis was less prevalent among HIV-infected as compared to HIV-uninfected participants [odds ratio (OR) 0.43, p=0.019]. Among those with leptospirosis, HIV-infected patients more commonly presented with features of severe sepsis syndrome than HIV-uninfected patients, but differences were not statistically significant. Among HIV-infected patients, severe immunosuppression was not significantly different between those with and without leptospirosis (p=0.476). Among HIV-infected adolescents and adults, median CD4 percent and median CD4 count were higher among those with leptospirosis as compared to those with other etiologies of febrile illness, but differences in CD4 count did not reach statistical significance (p=0.015 and p=0.089, respectively). Conclusions Among febrile inpatients in northern Tanzania, leptospirosis was not more prevalent among HIV-infected patients. Although some indicators of leptospirosis severity were more common among HIV-infected patients, a statistically significant difference was not demonstrated. Among HIV-infected patients, those with leptospirosis were not more immunosuppressed relative to those with other etiologies of febrile illness. PMID:23663165
Biggs, Holly M.; Galloway, Renee L.; Bui, Duy M.; Morrissey, Annie B.; Maro, Venance P.
Background The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. In particular, determinants of health workers' performance have not yet been fully understood. This paper uses ethnographic methods to document health workers' antenatal care practices with reference to the national Focused Antenatal Care guidelines and identifies factors influencing health workers' performance. Potential implications for improving antenatal care provision in Tanzania are discussed. Methods Combining different qualitative techniques, we studied health workers' antenatal care practices in four public antenatal care clinics in the Kilombero Valley, south-eastern Tanzania. A total of 36 antenatal care consultations were observed and compared with the Focused Antenatal Care guidelines. Participant observation, informal discussions and in-depth interviews with the staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision. Results The delivery of antenatal care services to pregnant women at the selected antenatal care clinics varied widely. Some services that are recommended by the Focused Antenatal Care guidelines were given to all women while other services were not delivered at all. Factors influencing health workers' practices were poor implementation of the Focused Antenatal Care guidelines, lack of trained staff and absenteeism, supply shortages and use of working tools that are not consistent with the Focused Antenatal Care guidelines. Health workers react to difficult working conditions by developing informal practices as coping strategies or "street-level bureaucracy". Conclusions Efforts to improve antenatal care should address shortages of trained staff through expanding training opportunities, including health worker cadres with little pre-service training. Attention should be paid to the identification of informal practices resulting from individual coping strategies and "street-level bureaucracy" in order to tackle problems before they become part of the organizational culture. PMID:21599900
Estimates of the effect of employment on women's risk of partner violence in cross-sectional studies are subject to potential "self-selection bias." Women's personal choice of whether to pursue employment or not may create fundamental differences between the group of women who are employed and those who are not employed that standard regression methods cannot account for even after adjusting for confounding. The aim of this study is to demonstrate the utility of propensity score matching (PSM), a technique used widely in econometrics, to address this bias in cross-sectional studies. We use PSM to estimate an unbiased effect-size of women's employment on their risk of experiencing partner violence in urban and rural Tanzania using data from the 2010 Tanzania Demographic and Health Survey (DHS). Three different measures of women's employment were analyzed: whether they had engaged in any productive work outside of the home in the past year, whether they received payment in cash for this productive work, and whether their employment was stable. Women who worked outside of the home were significantly different from those who did not. In both urban and rural Tanzania, women's risk of violence appears higher among women who worked in the past year than among those who did not, even after using PSM to account for underlying differences in these two groups of women. Being paid in cash reversed this effect in rural areas whereas stability of employment reduced this risk in urban centers. The estimated size of effect varied by type of matching estimator, but the direction of the association remained largely consistent. This study's findings suggest substantial self-selection into employment. PSM methods, by compensating for this bias, appear to be a useful tool for estimating the relationship between women's employment and partner violence in cross-sectional studies. PMID:24729130
Vyas, Seema; Heise, Lori
OBJECTIVE: To examine the progress made towards the Safe Motherhood Initiative goals in three areas of the United Republic of Tanzania during the 1990s. METHODS: Maternal mortality in the United Republic of Tanzania was monitored by sentinel demographic surveillance of more than 77,000 women of reproductive age, and by prospective monitoring of mortality in the following locations; an urban site; a wealthier rural district; and a poor rural district. The observation period for the rural districts was 1992-99 and 1993-99 for the urban site. FINDINGS: During the period of observation, the proportion of deaths of women of reproductive age (15-49 years) due to maternal causes (PMDF) compared with all causes was between 0.063 and 0.095. Maternal mortality ratios (MMRatios) were 591-1099 and maternal mortality rates (MMRates; maternal deaths per 100,000 women aged 15-49 years) were 43.1-123.0. MMRatios in surveillance areas were substantially higher than estimates from official, facility-based statistics. In all areas, the MMRates in 1999 were substantially lower than at the start of surveillance (1992 for rural districts, 1993 for the urban area), although trends during the period were statistically significant at the 90% level only in the urban site. At the community level, an additional year of education for household heads was associated with a 62% lower maternal death rate, after controlling for community-level variables such as the proportion of home births and occupational class. CONCLUSION: Educational level was a major predictor of declining MMRates. Even though rates may be decreasing, they remained high in the study areas. The use of sentinel registration areas may be a cost-effective and accurate way for developing countries to monitor mortality indicators and causes, including for maternal mortality. PMID:12751416
Mswia, Robert; Lewanga, Mary; Moshiro, Candida; Whiting, David; Wolfson, Lara; Hemed, Yusuf; Alberti, K. G. M. M.; Kitange, Henry; Mtasiwa, Deo; Setel, Philip
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. PMID:22357353
Background This paper is based on data gathered from a 2006 survey of 1,098 "street children" in Northern Tanzania. It examines the role that school may play in preventing the migration of vulnerable youth to become homeless "street children". Specific focus is placed on the correlations found between children's attendance in school, their reports of abuse or support in their family, and their status of living "on the street" full-time or part-time. Methods This study is from quantitative interview data gathered from 1,098 children and youth between 5 and 24 years old on the streets of Moshi and Arusha, Tanzania, over a 48-hour period during the school year on October 26th and 27th, 2006. Respondents were given survey questions about their home, school and street life experiences, in order to measure the impact of outreach work being performed by a Tanzanian NGO. Interviewers used purposive sampling, approaching all young people who appeared to be under the age of 25 years within a number of precincts in each town known to be where 'street children' were known to congregate. Results Results suggest that regular attendance in school may be a significant protective factor for children in preventing migration to the street life. Statistical analysis revealed that those young people who dropped out of school had nearly 8 times higher chances for ending up on the streets permanently than those who attended school daily. Conclusions This study supports the new concept of "multi-layered social resilience", providing evidence from research completed by one NGO on how community-based organizations can help enhance resilience in a broader social context, spanning individuals, households and community structures. PMID:21108808
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. PMID:21810740
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 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. PMID:23115621
Watson-Jones, Deborah; Tomlin, Keith; Remes, Pieter; Baisley, Kathy; Ponsiano, Riziki; Soteli, Selephina; de Sanjosé, Silvia; Changalucha, John; Kapiga, Saidi; Hayes, Richard J.
Background Human resource capacity is vital to the scale-up of voluntary medical male circumcision (VMMC) services. VMMC providers are at risk of “burnout” from performing a single task repeatedly in a high volume work environment that produces long work hours and intense work effort. Methods and findings The Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-up (SYMMACS) surveyed VMMC providers in Kenya, South Africa, Tanzania, and Zimbabwe in 2011 (n?=?357) and 2012 (n?=?591). Providers self-reported on their training, work experience, levels of job-fulfillment and work fatigue/burnout. Data analysis included a descriptive analysis of VMMC provider characteristics, and both bivariate and multivariate analyses of factors associated with provider work fatigue/burnout. In 2012, Kenyan providers had worked in VMMC for a median of 31 months compared to South Africa (10 months), Tanzania (15 months), and Zimbabwe (11 months). More than three-quarters (78 – 99%) of providers in all countries in 2012 reported that VMMC is a personally fulfilling job. However, 67% of Kenyan providers reported starting to experience work fatigue/burnout compared to South Africa (33%), Zimbabwe (17%), and Tanzania (15%). Despite the high level of work fatigue/burnout in Kenya, none of the measured factors (i.e., gender, age, full-time versus part-time status, length of service, number of operations performed, or cadre) were significantly associated with work fatigue/burnout in 2011. In 2012, logistic regression found increases in age (p<.05) and number of months working in VMMC (p<.01) were associated with an increased likelihood of experiencing work fatigue/burnout, while higher career total VMMCs decreased the likelihood of experiencing burnout. Conclusion Given cross-country differences, further elucidation of cultural and other contextual factors that may influence provider burnout is required. Continuing to emphasize the contribution that providers make in the fight against HIV/AIDS is important. PMID:24802260
Perry, Linnea; Rech, Dino; Mavhu, Webster; Frade, Sasha; Machaku, Michael D.; Onyango, Mathews; Aduda, Dickens S. Omondi.; Fimbo, Bennett; Cherutich, Peter; Castor, Delivette; Njeuhmeli, Emmanuel; Bertrand, Jane T.
Background Inequality in health services access and utilization are influenced by out-of-pocket health expenditures in many low and middle-income countries (LMICs). Various antecedents such as social factors, poor health and economic factors are proposed to direct the choice of health care service use and incurring out-of-pocket payments. We investigated the association of these factors with out-of-pocket health expenditures among the adult and older population in the United Republic of Tanzania. We also investigated the prevalence and associated determinants contributing to household catastrophic health expenditures. Methods We accessed the data of a multistage stratified random sample of 7279 adult participants, aged between 18 and 59 years, as well as 1018 participants aged above 60 years, from the first round of the Tanzania National Panel survey. We employed multiple generalized linear and logistic regression models to evaluate the correlates of out-of-pocket as well as catastrophic health expenditures, accounting for the complex sample design effects. Results Increasing age, female gender, obesity and functional disability increased the adults’ out-of-pocket health expenditures significantly, while functional disability and visits to traditional healers increased the out-of-pocket health expenditures in older participants. Adult participants, who lacked formal education or worked as manual laborers earned significantly less (p?0.001) and spent less on health (p?0.001), despite having higher levels of disability. Large household size, household head’s occupation as a manual laborer, household member with chronic illness, domestic violence against women and traditional healer’s visits were significantly associated with high catastrophic health expenditures. Conclusion We observed that the prevalence of inequalities in socioeconomic factors played a significant role in determining the nature of both out-of-pocket and catastrophic health expenditures. We propose that investment in social welfare programs and strengthening the social security mechanisms could reduce the financial burden in United Republic of Tanzania. PMID:24597486
Peste des petits ruminants (PPR) is an acute viral disease of small ruminants. The disease was first reported in Tanzania in 2008 when it was confined to the Northern Zone districts bordering Kenya. The present study was carried out to confirm the presence of PPR virus (PPRV) in Tanzania and to establish their phylogenetic relationships. Samples (oculonasal swabs, tissues and whole blood) were obtained from live goats with clinical presentation suggestive of PPR and goats that died naturally in Ngorongoro (Northern Tanzania) and Mvomero (Eastern Tanzania) districts. The clinical signs observed in goats suspected with PPR included fever, dullness, diarrhea, lacrimation, matting of eye lids, purulent oculonasal discharges, cutaneous nodules, erosions on the soft palate and gums and labored breathing. Post mortem findings included pneumonia, congestion of the intestines, and hemorrhages in lymph nodes associated with the respiratory and gastrointestinal systems. PPRV was detected in 21 out of 71 tested animals using primers targeting the nucleoprotein (N) gene. Phylogenetic analysis, based on the N gene, indicated that PPRV obtained from Northern and Eastern Tanzania clustered with PPRV strains of Lineage III, together with PPRV from Sudan and Ethiopia. The findings of this study indicate that there are active PPRV infections in Northern and Eastern Tanzania, suggesting risks for potential spread of PPR in the rest of Tanzania. PMID:25135464
Kgotlele, T; Macha, E S; Kasanga, C J; Kusiluka, L J M; Karimuribo, E D; Van Doorsselaere, J; Wensman, J J; Munir, M; Misinzo, G
Summary There is a substantial debate over the direction of the causal relation between income and health. This is important for our understanding of the health production process and for the policy debate over improving healthcare. We instrument income with rainfall measurements by matching satellite information on timing and positioning of 21 rainfall stations to longitudinal data (1991–94) of over 4,000 individuals in 51 villages in Tanzania. A 10% increase in income reduces the number of illnesses by 0.02. We also find that a 10% increase in income implies an increase of about 0.1 vaccinations of children under six. PMID:25648157
Fichera, Eleonora; Savage, David
The objective of this study was to explore the reasons for the persistence of human cysticercosis (HCC) transmission in Mbulu District, northern Tanzania. The study was carried out in 25 villages, whereby five major risks were identified. The risks were indiscriminate defaecation and improper use of toilets; a free-range system of keeping pigs; indiscriminate or unregulated slaughtering and inadequate meat hygiene and inspection; consumption of undercooked and porcine cysticerci infected pork; and social structure and roles. All of the identified risks were backed up by the immanent lifestyles of the community involved. These findings are important for the development of intervention strategies in the study area. PMID:25005750
Mwang'onde, Beda J; Nkwengulila, Gamba; Chacha, Mwita
In this commentary we introduce the population age and gender distributions, the birth rate, and life expectancy in Tanzania's largely agricultural society and highlight the vulnerable status of mothers and children. We present underlying causes of poor health, the leading causes of Disability-Adjusted Life Years and review threats from exposure to disease, toxic substances, and injuries that require protection of populations and control efforts. We summarize health challenges posed by malaria, tuberculosis, and HIV/AIDS, non-communicable diseases, and by new threats that may change the picture of disease and require adjustments in how training institutions prepare the health workforce. PMID:23254846
Kwesigabo, Gideon; Mwangu, Mughwira A; Kakoko, Deodatus C; Killewo, Japhet
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)
Background In sub-Saharan Africa the availability of intensive care unit (ICU) services is limited by a variety of factors, including lack of financial resources, lack of available technology and well-trained staff. Tanzania has four main referral hospitals, located in zones so as to serve as tertiary level referral centers. All the referral hospitals have some ICU services, operating at varying levels of equipment and qualified staff. We analyzed and describe the disease patterns and clinical outcomes of patients admitted in ICUs of the tertiary referral hospitals of Tanzania. Methods This was a retrospective analysis of ICU patient records, for three years (2009 to 2011) from all tertiary referral hospitals of Tanzania, namely Muhimbili National Hospital (MNH), Kilimanjaro Christian Medical Centre (KCMC), Mbeya Referral Hospital (MRH) and Bugando Medical Centre (BMC). Results MNH is the largest of the four referral hospitals with 1300 beds, and MRH is the smallest with 480 beds. The ratio of hospital beds to ICU beds is 217:1 at MNH, 54:1 at BMC, 39:1 at KCMC, and 80:1 at MRH. KCMC had no infusion pumps. None of the ICUs had a point-of-care (POC) arterial blood gas (ABG) analyzer. None of the ICUs had an Intensive Care specialist or a nutritionist. A masters-trained critical care nurse was available only at MNH. From 2009–2011, the total number of patients admitted to the four ICUs was 5627, male to female ratio 1.4:1, median age of 34 years. Overall, Trauma (22.2%) was the main disease category followed by infectious disease (19.7%). Intracranial injury (12.5%) was the leading diagnosis in all age groups, while pneumonia (11.7%) was the leading diagnosis in pediatric patients (<18 years). Patients with tetanus (2.4%) had the longest median length ICU stay: 8 (5,13) days. The overall in-ICU mortality rate was 41.4%. Conclusions The ICUs in tertiary referral hospitals of Tanzania are severely limited in infrastructure, personnel, and resources, making it difficult or impossible to provide optimum care to critically ill patients and likely contributing to the dauntingly high mortality rates. PMID:25245028
Health care utilization in many developing countries, Tanzania included, is mainly through the use of traditional medicine (TRM) and its practitioners despite the presence of the conventional medicine. This article presents findings on the study that aimed to get an experience of health care utilization from both urban and rural areas of seven administrative regions in Tanzania. A total of 33 health facility managers were interviewed on health care provision and availability of supplies including drugs, in their respective areas. The findings revealed that the health facilities were overburden with higher population to serve than it was planned. Consequently essential drugs and other health supplies were available only in the first two weeks of the month. Conventional health practitioners considered traditional health practitioners to be more competent in mental health management, and overall, they were considered to handle more HIV/AIDS cases knowingly or unknowingly due to shear need of healthcare by this group. In general conventional health practitioners were positive towards traditional medicine utilization; and some of them admitted using traditional medicines. Traditional medicines like other medical health systems worldwide have side effects and some contentious ethical issues that need serious consideration and policy direction. Since many people will continue using traditional/alternative medicine, there is an urgent need to collaborate with traditional/alternative health practitioners through the institutionalization of basic training including hygiene in order to improved healthcare in the community and attain the Millennium Development Goals by 2015. PMID:22284539
The 19th anniversary of the Safe Motherhood Initiative was marked in Tanzania this year. In addition to special celebrations, the anniversary was also marked by the launching of a campaign to eliminate female genital mutilation. The celebrations, which lasted several weeks, were inaugurated by a statement from the Minister of Health, Dr. Aaron Chiduo. The events included the showing of video films on sexual and reproductive health in 7 primary and 8 secondary schools, as well as public showings. Traditional birth attendants and nurse-midwives in one district were shown the safe motherhood film "Why did Mrs. X die?" Panel discussions on safe motherhood were broadcast on the radio in both English and Swahili. Posters and leaflets were distributed on various aspects of reproductive health. A press conference with representatives of the Tanzanian Ministry of Women's Affairs and Ministry of Health, together with representatives of WHO and UNICEF, focused on safe motherhood and female genital mutilation. The meeting attracted 100 journalists. The celebrations ended with a day of traditional dances and songs to mark the 10th anniversary of safe motherhood. A statement from the Minister of Health stressed that female genital mutilation "has no religious or scientific value" and needs to be stopped. The practice has been officially banned in Tanzania since the 1970s but is still prevalent in certain regions of the country. PMID:12321358
The significance of animals in research cannot be over-emphasized. The use of animals for research and training in research centres, hospitals and schools is progressively increasing. Advances in biotechnology to improve animal productivity require animal research. Drugs being developed and new interventions or therapies being invented for cure and palliation of all sorts of animal diseases and conditions need to be tested in animals for their safety and efficacy at some stages of their development. Drugs and interventions for human use pass through a similar development process and must be tested pre-clinically in laboratory animals before clinical trials in humans can be conducted. Therefore, animals are important players in research processes which directly and indirectly benefit animals and humans. However, questions remain as to whether these uses of animals consider the best interests of animals themselves. Various research and training institutions in Tanzania have established some guidelines on animal use, including establishing animal ethics committees. However, most institutions have not established oversight committees. In institutions where there may be guidelines and policies, there are no responsible committees or units to directly oversee if and how these guidelines and policies are enforced; thus, implementation becomes difficult or impossible. This paper endeavours to raise some issues associated with the responsible use of animals in research and training in Tanzania and highlights suggestions for improvement of deficiencies that exist in order to bridge the gap between what ought to be practised and what is practised. PMID:23006770
Seth, Misago; Saguti, Fredy
Acute and convalescent serum samples were collected from febrile inpatients identified at two hospitals in Moshi, Tanzania. Confirmed brucellosis was defined as a positive blood culture or a ? 4-fold increase in microagglutination test titer, and probable brucellosis was defined as a single reciprocal titer ? 160. Among 870 participants enrolled in the study, 455 (52.3%) had paired sera available. Of these, 16 (3.5%) met criteria for confirmed brucellosis. Of 830 participants with ? 1 serum sample, 4 (0.5%) met criteria for probable brucellosis. Brucellosis was associated with increased median age (P = 0.024), leukopenia (odds ratio [OR] 7.8, P = 0.005), thrombocytopenia (OR 3.9, P = 0.018), and evidence of other zoonoses (OR 3.2, P = 0.026). Brucellosis was never diagnosed clinically, and although all participants with brucellosis received antibacterials or antimalarials in the hospital, no participant received standard brucellosis treatment. Brucellosis is an underdiagnosed and untreated cause of febrile disease among hospitalized adult and pediatric patients in northern Tanzania. PMID:23091197
Bouley, Andrew J.; Biggs, Holly M.; Stoddard, Robyn A.; Morrissey, Anne B.; Bartlett, John A.; Afwamba, Isaac A.; Maro, Venance P.; Kinabo, Grace D.; Saganda, Wilbrod; Cleaveland, Sarah; Crump, John A.
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. PMID:21813847
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.
Soil organic carbon (SOC), held in soil organic matter, is a key indicator of soil health and plays an important role in the global carbon cycle. The soil can act as a net source or sink of carbon depending on land use and management. Deforestation and forest degradation lead to the release of vast amounts of carbon from the soil in the form of greenhouse gasses, especially in tropical countries. Tanzania has a high deforestation rate: it is estimated that the country loses 1.1% of its total forested area annually. During 2010-2013 Tanzania has been a pilot country under the UN-REDD programme. This programme has supported Tanzania in its initial efforts towards reducing greenhouse gas emission from forest degradation and deforestation and towards preserving soil carbon stocks. Formulation and implementation of the national REDD strategy requires detailed information on the five carbon pools among these the SOC pool. The spatial distribution of SOC contents and stocks was not available for Tanzania. The initial aim of this research, was therefore to develop high-resolution maps of the SOC content for the country. The mapping exercise was carried out in a collaborative effort with four Tanzanian institutes and data from the Africa Soil Information Service initiative (AfSIS). The mapping exercise was provided with over 3200 field observations on SOC from four sources; this is the most comprehensive soil dataset collected in Tanzania so far. The main source of soil samples was the National Forest Monitoring and Assessment (NAFORMA). The carbon maps were generated by means of digital soil mapping using regression-kriging. Maps at 250 m spatial resolution were developed for four depth layers: 0-10 cm, 10-20 cm, 20-30 cm, and 0-30 cm. A total of 37 environmental GIS data layers were prepared for use as covariates in the regression model. These included vegetation indices, terrain parameters, surface temperature, spectral reflectances, a land cover map and a small-scale Soil and Terrain (SOTER) map. Prediction uncertainty was quantified by the 90% prediction interval and the predictions were validated by cross-validation. The SOTER map proved to be the best predictor of SOC content, followed by the terrain parameters, mid-infrared reflectance, surface temperature, several vegetation indices, and the land cover map. The maps show that the SOC content decreases with depth, which is typically observed in soils. For the 0-10 cm layer the average predicted SOC content is 1.31%, for the 10-20 cm layer this is 0.93%, for the 20-30cm layer 0.72%, and for the 0-30cm layer 1.00%. The mean absolute error of the 0-10cm layer was 0.54%, that of the 10-20cm layer 0.38%, that of the 20-30cm layer 0.31%, and that of the 0-30cm layer 0.34%. The R2-value of the 0-10 cm layer was 0.47, that of the 10-20cm layer 0.49, that of the 20-30cm layer 0.44, and that of the 0-30cm layer 0.59. The next step will be the development of maps of SOC stock and key properties that are of interest for soil fertility management such as pH and the textural fractions.
Kempen, Bas; Kaaya, Abel; Ngonyani Mhaiki, Consolatha; Kiluvia, Shani; Ruiperez-Gonzalez, Maria; Batjes, Niels; Dalsgaard, Soren
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. PMID:23121718
Economic development and public health are tied to water resources development in many parts of the world. Effective use of water management infrastructure investments requires projections of future climatic and water use conditions. This is particularly true in developing countries. We explore in this work water resource availability in the Rovuma River, which lies in a sparsely-populated region of southeastern Africa, on the border of Mozambique and Tanzania. While there are only limited documented observations of flow of the Rovuma River and it's tributaries, particularly in recent years, there is widespread interest in development of the water resources of the region. The national governments are interested in hydropower potential while private companies, many of them large multinational organizations, have started irrigation programs to increase agricultural output. While the Mozambique and Tanzania governments have a joint agreement over the river development, there is a need to assess both current and potential future water resource conditions in the basin. The sustainability of these developments, however, may be affected by climate change. Here we quantify potential changes in streamflow in the Rovuma River under dry and wet climate projection scenarios using the delta method and the Variable Infiltration Capacity (VIC) macro-scale hydrology model. We then evaluate streamflow changes relative to water withdrawals required for a range of irrigated agriculture scenarios. Our analysis is intended to be a starting point for planners to consider potential impacts of both streamflow withdrawal permits (for irrigated agriculture) and future uncertain climate conditions.
Minihane, M.; Lettenmaier, D. P.
Background To date, Alphavirus infections and their most prominent member, chikungunya fever, a viral disease which first became apparent in Tanzania in 1953, have been very little investigated in regions without epidemic occurrence. Few data exist on burden of disease and socio-economic and environmental covariates disposing to infection. Methods A cross-sectional seroprevalence study was undertaken in 1,215 persons from Mbeya region, South-Western Tanzania, to determine the seroprevalence of anti-Alphavirus IgG antibodies, and to investigate associated risk factors. Results 18% of 1,215 samples were positive for Alphavirus IgG. Seropositivity was associated with participant age, low to intermediate elevation, flat terrain and with IgG positivity for Rift Valley fever, Flaviviridae, and rickettsiae of the spotted fever group. When comparing the geographical distribution of Alphavirus seropositivity to that of Rift Valley fever, it was obvious that Alphaviruses had spread more widely throughout the study area, while Rift Valley fever was concentrated along the shore of Lake Malawi. Conclusion Alphavirus infections may contribute significantly to the febrile disease burden in the study area, and are associated with several arthropod-borne infections. Their spread seems only limited by factors affecting mosquitoes, and seems less restricted than that of Rift Valley fever. PMID:25079964
Dobler, Gerhard; Saathoff, Elmar; Kroidl, Inge; Ntinginya, Nyanda Elias; Maboko, Leonard; Löscher, Thomas; Hoelscher, Michael; Heinrich, Norbert
We report 12 new focal mechanisms from earthquakes in NE and SW Tanzania where the stress regime within the East African rift system is not well constrained. Focal mechanisms for events at the intersection of the Lake Tanganyika and Rukwa rifts in SW Tanzania indicate a complicated stress pattern with possible dextral strike-slip motion on some faults but oblique motion on others (either sinistral on NW striking faults or dextral on NE striking faults). Within the Rukwa rift, focal mechanisms indicate normal dip-slip motion with NE-SW opening. In NE Tanzania where the Eastern rift impinges on the margin of the Tanzania Craton, fault motions are consistent with a zone of distributed block faults and sub E-W extension. All twelve earthquakes likely nucleated within the crust.
Brazier, Richard A.; Nyblade, Andrew A.; Florentin, Juliette
Inappropriate complementary feeding is one of the major causes of undernutrition among young children in Tanzania. Prevalence of newly developed World Health Organization complementary feeding indicators and their associated factors were determined among 2402 children aged 6-23 months in Tanzania using data from the 2010 Tanzania Demographic and Health Survey. The survey used a multistage cluster sample of 10?300 households from the eight geographical zones in the country. The prevalence of the introduction of soft, semi-solid or solid foods among infants aged 6-8 months was 92.3%. Of all the children aged 6-23 months, the prevalence of minimum dietary diversity, meal frequency and acceptable diet were 38.2%, 38.6% and 15.9%, respectively. Results from multivariate analyses indicated that the main risk factors for inappropriate complementary feeding practices in Tanzania include young child's age (6-11 months), lower level of paternal/maternal education, limited access to mass media, lack of post-natal check-ups, and poor economic status. Overall, complementary feeding practices in Tanzania, as measured by dietary diversity, meal frequency and acceptable diet, are not adequately met, and there is a need for interventions to improve the nutritional status of young children in Tanzania. PMID:22925557
Victor, Rose; Baines, Surinder K; Agho, Kingsley E; Dibley, Michael J
INDIANA UNIVERSITY GEO-PALEOANTHROPOLOGY FIELD COURSE IN TANZANIA G349/549 2014 APPLICATION/549: Introductory Level Geology Sedimentology Paleo-Anthropology Introductory Level Anthropology Stratigraphy
JOICFP's reproductive health(RH)-oriented Integrated Project (IP) is being implemented by JOICFP's counterpart, the Family Planning Association of Tanzania (UMATI). The Japanese government usually provides support to help governmental programs. However, through this collaborative effort, the government of Japan is providing commodity and equipment assistance to support the RH/family planning and safe motherhood activities promoted by UMATI in collaboration with the Tanzanian government, with support provided through multilateral-bilateral assistance in collaboration with UNFPA. The Japanese government has agreed to provide US$170,000 annually in commodity and equipment assistance to the project over the period 1997-2000. The funds will be used to support family planning/maternal and child health clinics and dispensaries in project areas run by the government, as well as to support UMATI activities. PMID:12293752
Rift Valley fever virus (RVFV) is an acute, zoonotic viral disease caused by a Phlebovirus, which belongs to the Bunyaviridae family. Among livestock, outbreaks of the disease are economically devastating. They are often characterised by large, sweeping abortion storms and have significant mortality in adult livestock. The aim of the current study was to investigate RVFV infection in the Kigoma region, which is nestled under the hills of the western arm of the Great Rift Valley on the edge of Lake Tanganyika, Tanzania. A region-wide serosurvey was conducted on non-vaccinated small ruminants (sheep and goats, n = 411). Sera samples were tested for the presence of anti-RVFV antibodies and viral antigen, using commercial enzyme-linked immunosorbent assay and reverse transcriptase polymerase chain reaction, respectively. The overall past infections were detected in 22 of the 411 animals, 5.4% (Confidence Interval (CI) 95% = 3.5% - 8.1%). The Kigoma rural area recorded the higher seroprevalence of 12.0% (CI 95% = 7.3% - 18.3%; p < 0.0001), followed by Kibondo at 2.3% (CI 95% = 0.5% - 6.5%; p > 0.05) and the Kasulu district at 0.8% (CI 95% = 0.0% - 4.2%; p > 0.05). The prevalence was 12.5% and 4.7% for sheep and goats, respectively. Reverse transcriptase polymerase chain reaction results indicated that only eight samples were found to be positive (n = 63). This study has confirmed, for the first time, the presence of the RVFV in the Kigoma region four years after the 2007 epizootic in Tanzania. The study further suggests that the virus activity exists during the inter-epizootic period, even in regions with no history of RVFV. PMID:25005550
Kifaro, Emmanuel G; Nkangaga, Japhet; Joshua, Gradson; Sallu, Raphael; Yongolo, Mmeta; Dautu, George; Kasanga, Christopher J
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. PMID:23077702
Fenton, Carol; Hatfield, Jennifer; McIntyre, Lynn
Access to household water connections remains low in sub-Saharan Africa, representing a public health concern. Previous studies have shown water stored in the home to be more contaminated than water at the source; however, the mechanisms of post-supply contamination remain unclear. Using water quality measurements and structured observations of households in Bagamoyo, Tanzania, this study elucidates the causal mechanisms of the microbial contamination of drinking water after collection from a communal water source. The study identifies statistically significant loadings of fecal indicator bacteria (FIB) occurring immediately after filling the storage container at the source and after extraction of the water from the container in the home. Statistically significant loadings of FIB also occur with various water extraction methods, including decanting from the container and use of a cup or ladle. Additionally, pathogenic genes of Escherichia coli were detected in stored drinking water but not in the source from which it was collected, highlighting the potential health risks of post-supply contamination. The results of the study confirm that storage containers and extraction utensils introduce microbial contamination into stored drinking water, and suggest that further research is needed to identify methods of water extraction that prevent microbial contamination of drinking water. PMID:23981881
Harris, Angela R; Davis, Jennifer; Boehm, Alexandria B
Background Taenia solium cysticercosis/taeniosis is emerging as a serious public health and economic problem in many developing countries. This study was conducted to determine prevalence and risk factors of human T. solium infections in Mbeya Region, Tanzania. Methods and Findings A cross-sectional survey was conducted in 13 villages of Mbozi district in 2009. Sera of 830 people (mean 37.9±11.3 years (SD); 43% females) were tested for circulating cysticerci antigen (Ag-ELISA) and antibody (Ab-ELISA). A subset of persons found seropositive by Ag-ELISA underwent computed tomography (CT) scan of the brain for evidence of neurocysticercosis. Stool samples from 820 of the same participants were tested for taeniosis by copro-antigens (copro-Ag-ELISA) and formol-ether concentration technique. Cases of T. solium taeniosis were confirmed serologically by EITB assay (rES38). A questionnaire was used for identification of risk factors. Active cysticercosis by positive Ag-ELISA was found in 139 (16.7%) persons while anti-cysticercal antibodies were detected in 376 (45.3%) persons by Ab-ELISA. Among 55 persons positive for Ag-ELISA undergoing CT scan, 30 (54.6%) were found to have structures in the brain suggestive of neurocysticercosis. Using faecal analysis, 43 (5.2%) stool samples tested positive for taeniosis by copro-Ag-ELISA while Taenia eggs were detected in 9 (1.1%) stool samples by routine coprology. Antibodies specifically against adult T. solium were detected in 34 copro-Ag-ELISA positive participants by EITB (rES38) indicating T. solium taeniosis prevalence of 4.1%. Increasing age and hand washing by dipping in contrast to using running water, were found associated with Ag-ELISA seropositivity by logistic regression. Gender (higher risk in females) and water source were risk factors associated with Ab-ELISA seropositivity. Reported symptoms of chronic severe headaches and history of epileptic seizures were found associated with positive Ag-ELISA (p?0.05). Conclusion The present study indicates T. solium infection in humans is highly endemic in the southern highlands of Tanzania. PMID:23516650
Mwanjali, Gloria; Kihamia, Charles; Kakoko, Deodatus Vitalis Conatus; Lekule, Faustin; Ngowi, Helena; Johansen, Maria Vang; Thamsborg, Stig Milan; Willingham, Arve Lee
Background Pesticides in Tanzania are extensively used for pest control in agriculture. Their usage and unsafe handling practices may potentially result in high farmer exposures and adverse health effects. The aim of this study was to describe farmers’ pesticide exposure profile, knowledge about pesticide hazards, experience of previous poisoning, hazardous practices that may lead to Acute Pesticide Poisoning (APP) and the extent to which APP is reported. Methods The study involved 121 head- of-household respondents from Arumeru district in Arusha region. Data collection involved administration of a standardised questionnaire to farmers and documentation of storage practices. Unsafe pesticide handling practices were assessed through observation of pesticide storage, conditions of personal protective equipment (PPE) and through self-reports of pesticide disposal and equipment calibration. Results Past lifetime pesticide poisoning was reported by 93% of farmers. The agents reported as responsible for poisoning were Organophosphates (42%) and WHO Class II agents (77.6%). Storage of pesticides in the home was reported by 79% of farmers. Respondents with higher education levels were significantly less likely to store pesticides in their home (PRR High/Low = 0.3; 95% CI = 0.1-0.7) and more likely to practice calibration of spray equipment (PRR High/Low = 1.2; 95% CI = 1.03-1.4). However, knowledge of routes of exposure was not associated with safety practices particularly for disposal, equipment wash area, storage and use of PPE . The majority of farmers experiencing APP in the past (79%) did not attend hospital and of the 23 farmers who did so in the preceding year, records could be traced for only 22% of these cases. Conclusions The study found a high potential for pesticide exposure in the selected community in rural Tanzania, a high frequency of self-reported APP and poor recording in hospital records. Farmers’ knowledge levels appeared to be unrelated to their risk. Rather than simply focusing on knowledge-based strategies, comprehensive interventions are needed to reduce both exposure and health risks, including training, improvements in labeling, measures to reduce cost barriers to the adoption of safe behaviours, , promotion of control measures other than PPE and support for Integrated Pest Management (IPM). PMID:24754959
Background Disclosing HIV serostatus is important for HIV prevention and maintenance of health for people living with HIV their spouses and the community, it plays a role in the social relation which is critical in reducing HIV transmission. The process may have positive and negative effects to the HIV infected people who disclose their status. The present study was undertaken to describe HIV serostatus disclosure among HIV infected people attending care and treatment clinic at Sekou-Toure hospital in Mwanza, Tanzania. Methods A cross-sectional study was carried out on 270 HIV infected adults attending Care and Treatment Clinic (CTC) at Sekou-Toure hospital between September and October, 2010. A Swahili questionnaire was used to obtain demographic and HIV disclosure information. Results Hundred and ninety five (72.5%) of all recruited participants were females, 88.1% (238/270) were aged above 30 years and 44.1% (119/270) were married. The prevalence of serostatus disclosure was 93.3% (252/270) with participants aged above 30 years having significantly higher proportion of serostatus disclosure compared to those aged below 30 years (94.5% vs. 84.4%, p?0.05). Among the participants who disclosed their status, 69.3% reported closeness to the disclosed person as the reason for disclosure while 25.8% (65/252) disclosed because they needed help. Two hundred (79.4%) reported to have received emotional support following disclosure while 25.8% and 29.7% received financial support and freedom to use their anti-retroviral drugs around the person they disclosed their status respectively. Thirty four participants reported to have been discriminated following disclosure and 12 participants reported to have been divorced. Conclusions Rate of disclosure of HIV serostatus was noted to be high in this study. Delayed disclosure was also noted in small proportion of participants. Negative outcomes following disclosure of serostatus were reported by participants. Efforts need to be increased to promote disclosure of HIV serostatus in Tanzania through health education and awareness for both HIV infected individuals and the community. PMID:24450933
Background Trauma remains a leading cause of morbidity and mortality in resource limited countries. There is paucity of published reports on trauma care in Tanzania, particularly the study area. This study was carried out to describe our experiences in trauma management outlining the etiological spectrum, injury characteristics and treatment outcome of trauma patients at our local setting and compare our results with those from other centers in the world. Methods A descriptive prospective study of trauma patients was conducted at Bugando Medical Centre from April 2010 to March 2012. Statistical data analysis was done using SPSS software version 17.0. Results A total of 5672 trauma patients were enrolled in the study. The male to female ratio was 2.3: 1. The majority of patients were in the 2nd decade of life. Road traffic accident was the most common cause of trauma accounting for 60.7% of cases. The majority of patients (76.6%) sustained blunt injuries. Musculoskeletal (68.5%) and head/neck (52.6%) were the most frequent body region injured. Soft tissue injuries (open wounds) and fractures were the most common injuries accounting for 82.8% and 76.8% respectively. Majority of patients (74.4%) were treated surgically with wound debridement (94.0%) being the most frequently performed procedure. Postoperative complications were recorded in 31.5% of cases. The overall median duration of hospitalization was 26 days (range 1 day to 144 days). Mortality rate was 16.7%. Patients who had polytrauma, burn injuries and those who had tetanus and long bone fractures stayed longer in the hospital and this was statistically significant (P?0.001), whereas the age?>?65 years, severe trauma, admission Systolic Blood Pressure?90 mmHg, presence of tetanus, severe head injury, the duration of loss of consciousness, the need for intensive care unit admission and finding of space occupying lesion on CT scan of the brain significantly influenced mortality (P?0.001). Conclusion Trauma resulting from road traffic accidents remains a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of road traffic accidents is necessary to reduce the incidence of trauma in this region. PMID:24499566
Background Burn injuries constitute a major public health problem and are the leading cause of childhood morbidity and mortality worldwide. There is paucity of published data on childhood burn injuries in Tanzania, particularly the study area. This study was conducted to describe the pattern of childhood burn injuries in our local setting and to evaluate their management outcome. Methods A cross sectional study was conducted at Bugando Medical Centre (in Northwestern Tanzania) over a 3-year period from January 2008 to December 2010. Data was collected using a pre-tested coded questionnaire and statistical analyses performed using SPSS software version 15.0. Results A total of 342 burned children were studied. Males were mainly affected. Children aged = 2 were the majority accounting for 45.9% of cases. Intentional burn injuries due to child abuse were reported in 2.9% of cases. Scald was the most common type of burns (56.1%). The trunk was the most commonly involved body region (57.3%). Majority of patients (48.0%) sustained superficial burns. Eight (2.3%) patients were HIV positive. Most patients (89.8%) presented to the hospital later than 24 h. The rate of burn wound infection on admission and on 10th day were 32.4% and 39.8% respectively.Staphylococcus aureus were more common on admission wound swabs, with Pseudomonas aeruginosa becoming more evident after 10th day. MRSA was detected in 19.2% of Staphylococcus aureus. Conservative treatment was performed in 87.1% of cases. Surgical treatment mainly skin grafting (65.9%) was performed in 44 (12.9%) of patients. The overall average of the length of hospital stay (LOS) was 22.12 ± 16.62 days. Mortality rate was 11.7%. Using multivariate logistic regression analysis; age of the patient, type of burn, delayed presentation, clothing ignition, %TBSA and severity of burn were found to be significantly associated with LOS (P < 0.001), whereas mortality rate was found to be independently and significantly related to the age of the patient, type of burn, HIV positive with stigmata of AIDS, CD4 count, inhalation injury, %TBSA and severity of burn (P < 0.001). Conclusion Childhood burn injuries still remain a menace in our environment with virtually unacceptable high morbidity and mortality. There is need for critical appraisal of the preventive measures and management principles currently being practiced. PMID:22070934
Introduction Although the burden of malaria in many parts of Tanzania has declined, the proportion of children with fever has not changed. This situation underscores the need to explore the possible causes of febrile episodes in patients presenting with symptoms at the Korogwe District Hospital (KDH). Methods A hospital based cross-sectional study was conducted at KDH, north-eastern Tanzania. Patients aged 2 to 59 months presenting at the outpatient department with an acute medical condition and fever (measured axillary temperature ?37.5°C) were enrolled. Blood samples were examined for malaria parasites, human immunodeficiency virus (HIV) and bacterial infections. A urine culture was performed in selected cases to test for bacterial infection and a chest radiograph was requested if pneumonia was suspected. Diagnosis was based on both clinical and laboratory investigations. Results A total of 867 patients with a median age of 15.1 months (Interquartile range 8.6–29.9) were enrolled from January 2013 to October 2013. Respiratory tract infections were the leading clinical diagnosis with 406/867 (46.8%) of patients diagnosed with upper respiratory tract infection and 130/867 (15.0%) with pneumonia. Gastroenteritis was diagnosed in 184/867 (21.2%) of patients. Malaria infection was confirmed in 72/867 (8.3%) of patients. Bacterial infection in blood and urine accounted for 26/808 (3.2%) infections in the former, and 66/373 (17.7%) infections in the latter. HIV infection was confirmed in 10/824 (1.2%) of patients. Respiratory tract infections and gastroenteritis were frequent in patients under 36 months of age (87.3% and 91.3% respectively). Co-infections were seen in 221/867 (25.5%) of patients. The cause of fever was not identified in 65/867 (7.5%) of these patients. Conclusions The different proportions of infections found among febrile children reflect the causes of fever in the study area. These findings indicate the need to optimise patient management by developing malaria and non-malaria febrile illnesses management protocols. PMID:25090651
Mahende, Coline; Ngasala, Billy; Lusingu, John; Butichi, Allvan; Lushino, Paminus; Lemnge, Martha; Premji, Zul
Background/objectives: There is an urgent need for effective interventions to improve the sexual and reproductive health of adolescents. Reliable data on the sexual health of adolescents are needed to guide the development of such interventions. The aim was to describe the sexual health of pupils in years 4 to 6 of 121 rural primary schools in north western Tanzania, before the implementation of an innovative sexual health intervention in 58 of the schools. Methods: A cross sectional survey of primary school pupils in rural Tanzania was carried out. The study population comprised pupils registered in years 4 to 6 of 121 primary schools in 20 rural communities in 1998. Basic demographic information was collected from all pupils seen. Those born before 1 January 1985 (aged approximately 14 years and over) were invited to participate in the survey, and asked about their knowledge and attitudes towards sexual health issues, and their sexual experience. A urine specimen was requested and tested for HIV, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and, for females, pregnancy. Results: 9283 pupils born before 1 January 1985 were enrolled and provided demographic information and a urine sample. Male pupils were significantly older than females (mean age 15.5 years v 14.8 years, p<0.001), but all other demographic characteristics were similar between the sexes. 14 (0.2%) of the enrolled pupils (four male and 10 female) were HIV positive, 83 (0.9%) were positive for CT, and 12 (0.1%) for NG. 32 female pupils (0.8%) were positive by pregnancy test. Sexual experience was reported by one fifth of primary school girls, and by almost half of boys. Only 45/114 (39%) girls with biological markers of sexual activity reported having had sex. Conclusions: HIV, CT, NG, and pregnancy were present though at relatively low levels among pupils in years 4 to 6 of primary school. A high proportion of pupils with a biological marker of sexual activity denied ever having had sex. Alternative ways of collecting sensitive data about the sexual behaviour of school pupils should be explored. PMID:14755033
Todd, J; Changalucha, J; Ross, D; Mosha, F; Obasi, A; Plummer, M; Balira, R; Grosskurth, H; Mabey, D; Hayes, R
Background Adolescents in Tanzania require health services that respond to their sexual and reproductive health – and other – needs and are delivered in a friendly and nonjudgemental manner. Systematizing and expanding the reach of quality adolescent friendly health service provision is part of the Tanzanian Ministry of Health and Social Welfare's (MOHSW) multi-component strategy to promote and safeguard the health of adolescents. Objective We set out to identify the progress made by the MOHSW in achieving the objective it had set in its National Adolescent Health and Development Strategy: 2002–2006, to systematize and extend the reach of Adolescent Friendly Health Services (AFHS) in the country. Methods We reviewed plans and reports from the MOHSW and journal articles on AFHS. This was supplemented with several of the authors’ experiences of working to make health services in Tanzania adolescent friendly. Results The MOHSW identified four key problems with what was being done to make health services adolescent friendly in the country – firstly, it was not fully aware of the various efforts under way; secondly, there was no standardized definition of AFHS; thirdly, it had received reports that the quality of the AFHS being provided by some organizations was poor; and fourthly, only small numbers of adolescents were being reached by the efforts that were under way. The MOHSW responded to these problems by mapping existing services, developing a standardized definition of AFHS, charting out what needed to be done to improve their quality and expand their coverage, and integrating AFHS within wider policy and strategy documents and programmatic measurement instruments. It has also taken important preparatory steps to stimulate and support implementation. Conclusion The MOHSW is aware that the focus of the effort must now shift from the national to the regional, council and local levels. The onus is on regional and council health management teams as well as health facility managers to take the steps needed to ensure that all adolescents in the country obtain the sexual and reproductive health (SRH) services they need, delivered in a friendly and non-judgemental manner. But they cannot do this without substantial and ongoing support. PMID:23763703
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,…
Nyambo, Brigitte; Ligate, Elly
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
This preliminary, community-based study examines major stressors identified by Iraqw and Datoga women of Mbulu District, Tanzania, and describes steps in creating a culturally specific questionnaire to assess mental health burdens. This area of Tanzania is remote, with limited access to goods and services, and is undergoing dramatic social and economic changes. Iraqw and Datoga reside in close proximity and
Ivy L. Pike; Crystal L. Patil
SUMMARY The impact of market concentration has been little studied in markets for ambulatory care in the developing world, where the retail sector often accounts for a high proportion of treatments. This study begins to address this gap through an analysis of the consumer market for malaria treatment in rural areas of three districts in Tanzania. We developed methods for investigating market definition, sales volumes and concentration, and used these to explore the relationship between antimalarial retail prices and competition. The market was strongly geographically segmented and highly concentrated in terms of antimalarial sales. Antimalarial prices were positively associated with market concentration. High antimalarial prices were likely to be an important factor in the low proportion of care seekers obtaining appropriate treatment. Retail sector distribution of subsidised antimalarials has been proposed to increase the coverage of effective treatment, but this analysis indicates that local market power may prevent such subsidies from being passed on to rural customers. Policymakers should consider the potential to maintain lower retail prices by decreasing concentration among antimalarial providers and recommending retail price levels. PMID:19301420
GOODMAN, CATHERINE; KACHUR, S. PATRICK; ABDULLA, SALIM; BLOLAND, PETER; MILLS, ANNE
Remote sensing data and hydrologic models can respond to monitoring and forecasting needs in Africa and other poorly gauged regions. We present here the progress to date in developing a multi-model platform to provide hydrologic monitoring and forecasting using real time remote sensing observations. Satellite precipitation products such as CMORPH, TMPA (at 0.25° resolution) and PERSIANN-CCS (at 4km resolution) are used to force two models of different structure. One model is physically based and distributed, and the other is conceptual and lumped at the sub-basin level. The performance of both models is evaluated using different metrics, and the uncertainty in their predictions based on the errors incurred during the historical simulations period is computed. The models were compared and the potential increase in performance from using both models versus a single one will be assessed. This work provides insights into the advantages of a multi-model platform over a single model, with respect to different management and decision-making purposes. The methods were applied to the Mara Basin (Kenya/Tanzania), where growing human demands on water and land use are likely to alter significantly the hydrologic balance of the basin and the ecosystems that depend on it. These efforts are part of the Applied Sciences Team of the NASA SERVIR Program in collaboration with its East Africa Hub at the Regional Center for Mapping of Resources for Development (Nairobi,Kenya).
Serrat-Capdevila, A.; Valdes, J. B.; Valdes, R.; Demaria, E. M.; Durcik, M.; Maitaria, K.; Roy, T.
AIM. To assess prevalence, type and covariates of abnormal left ventricular (LV) geometry in untreated native Tanzanian patients with hypertension in relation to normotensive controls. METHODS. Echocardiography was performed in 161 untreated hypertensive outpatients and 80 normotensive controls at a tertiary hospital in Tanzania. Hypertensive heart disease was defined as presence of increased LV mass or relative wall thickness (RWT). RESULTS. The prevalence of hypertensive heart disease increased with the severity of hypertension and was on average 62.1% among patients and 12.5% in controls. In multivariate analyses, higher LV mass index was associated with higher systolic blood pressure (? = 0.28), body mass index (? = 0.20), peak early transmitral to medial mitral annulus velocity ratio (? = 0.16), and with lower stress-corrected midwall shortening (scMWS) (? = - 0.44) and estimated glomerular filtration rate (? = - 0.16), all p < 0.05. Higher RWT was associated with higher systolic blood pressure (? = 0.16), longer E-wave deceleration time (? = 0.23) and lower scMWS (? = - 0.66), irrespective of LV mass (all p < 0.05). CONCLUSION. Subclinical hypertensive heart disease is highly prevalent in untreated native hypertensive Tanzanians and associated with both systolic and diastolic LV dysfunction. Management of hypertension in Africans should include high focus on subclinical hypertensive heart disease. PMID:23721542
Chillo, Pilly; Lwakatare, Johnson; Rieck, Ashild E; Lutale, Janet; Gerdts, Eva
Background Fetal hemoglobin (HbF) is an important modulator of sickle cell disease (SCD). HbF has previously been shown to be affected by variants at three loci on chromosomes 2, 6 and 11, but it is likely that additional loci remain to be discovered. Methods and Findings We conducted a genome-wide association study (GWAS) in 1,213 SCA (HbSS/HbS?0) patients in Tanzania. Genotyping was done with Illumina Omni2.5 array and imputation using 1000 Genomes Phase I release data. Association with HbF was analysed using a linear mixed model to control for complex population structure within our study. We successfully replicated known associations for HbF near BCL11A and the HBS1L-MYB intergenic polymorphisms (HMIP), including multiple independent effects near BCL11A, consistent with previous reports. We observed eight additional associations with P<10?6. These associations could not be replicated in a SCA population in the UK. Conclusions This is the largest GWAS study in SCA in Africa. We have confirmed known associations and identified new genetic associations with HbF that require further replication in SCA populations in Africa. PMID:25372704
Rooks, Helen; Mgaya, Josephine; Mariki, Harvest; Soka, Deogratius; Mmbando, Bruno; Msaki, Evarist; Kolder, Iris; Thein, Swee Lay; Menzel, Stephan; Cox, Sharon E.; Makani, Julie; Barrett, Jeffrey C.
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. PMID:22518328
Mrisho, Mwifadhi; Schellenberg, David; Manzi, Fatuma; Tanner, Marcel; Mshinda, Hassan; Shirima, Kizito; Msambichaka, Beverly; Abdulla, Salim; Schellenberg, Joanna Armstrong
Guided by the conceptual framework of the Health Belief Model, this study aimed to identify factors associated with pregnant women's expressed willingness to accept voluntary counselling and HIV-testing (VCT). A cross-sectional interview survey of 500 pregnant women, complemented by focus group discussions, was conducted in the Kilimanjaro region of Tanzania. Constructs derived from the Health Belief Model explained 41.7% of women's willingness to accept VCT. Perceived high personal susceptibility to HIV/AIDS, barriers related to confidentiality and partner involvement, self-efficacy regarding alternative feeding methods and religion were all shown to be associated with willingness to accept VCT. The women's acceptance of VCT seems to depend upon their perceiving that VCT and alternative feeding strategies provide clear benefits, primarily for the child. Whether a positive attitude to VCT and alternative feeding strategies are transformed into actual behaviour depends on a set of complicated decisions in which several potential psychological consequences are assessed. Sharing the diagnosis with partners may not have the intended effect if there is a lack of sensitivity to the women's fear of blame and rejection. If pregnant women are to fully participate in and benefit from mother-to-child-transmission prevention efforts, their partners must be committed and involved in the process. PMID:15203410
de Paoli, M M; Manongi, R; Klepp, K-I
Background Maternal morbidity and mortality in sub-Saharan Africa remains high despite global efforts to reduce it. In order to lower maternal morbidity and mortality in the immediate term, reduction of delay in the provision of quality obstetric care is of prime importance. The aim of this study is to assess the occurrence of severe maternal morbidity and mortality in a rural referral hospital in Tanzania as proposed by the WHO near miss approach and to assess implementation levels of key evidence-based interventions in women experiencing severe maternal morbidity and mortality. Methods A prospective cross-sectional study was performed from November 2009 until November 2011 in a rural referral hospital in Tanzania. All maternal near misses and maternal deaths were included. As not all WHO near miss criteria were applicable, a modification was used to identify cases. Data were collected from medical records using a structured data abstraction form. Descriptive frequencies were calculated for demographic and clinical variables, outcome indicators, underlying causes, and process indicators. Results In the two-year period there were 216 maternal near misses and 32 maternal deaths. The hospital-based maternal mortality ratio was 350 maternal deaths per 100,000 live births (95% CI 243–488). The maternal near miss incidence ratio was 23.6 per 1,000 live births, with an overall case fatality rate of 12.9%. Oxytocin for prevention of postpartum haemorrhage was used in 96 of 201 women and oxytocin for treatment of postpartum haemorrhage was used in 38 of 66 women. Furthermore, eclampsia was treated with magnesium sulphate in 87% of all cases. Seventy-four women underwent caesarean section, of which 25 women did not receive prophylactic antibiotics. Twenty-eight of 30 women who were admitted with sepsis received parenteral antibiotics. The majority of the cases with uterine rupture (62%) occurred in the hospital. Conclusion Maternal morbidity and mortality remain challenging problems in a rural referral hospital in Tanzania. Key evidence-based interventions are not implemented in women with severe maternal morbidity and mortality. Progress can be made through up scaling the use of evidence-based interventions, such as the use of oxytocin for prevention and treatment of postpartum haemorrhage. PMID:23826935
Background Tanzania achieved universal coverage with long-lasting insecticidal nets (LLINs) in October 2011, after three years of free mass net distribution campaigns and is now faced with the challenge of maintaining high coverage as nets wear out and the population grows. A process of exploring options for a continuous or “Keep-Up” distribution system was initiated in early 2011. This paper presents for the first time a comprehensive national process to review the major considerations, findings and recommendations for the implementation of a new strategy. Methods Stakeholder meetings and site visits were conducted in five locations in Tanzania to garner stakeholder input on the proposed distribution systems. Coverage levels for LLINs and their decline over time were modelled using NetCALC software, taking realistic net decay rates, current demographic profiles and other relevant parameters into consideration. Costs of the different distribution systems were estimated using local data. Results LLIN delivery was considered via mass campaigns, Antenatal Care-Expanded Programme on Immunization (ANC/EPI), community-based distribution, schools, the commercial sector and different combinations of the above. Most approaches appeared unlikely to maintain universal coverage when used alone. Mass campaigns, even when combined with a continuation of the Tanzania National Voucher Scheme (TNVS), would produce large temporal fluctuations in coverage levels; over 10 years this strategy would require 63.3 million LLINs and a total cost of $444 million USD. Community mechanisms, while able to deliver the required numbers of LLINs, would require a massive scale-up in monitoring, evaluation and supervision systems to ensure accurate application of identification criteria at the community level. School-based approaches combined with the existing TNVS would reach most Tanzanian households and deliver 65.4 million LLINs over 10 years at a total cost of $449 million USD and ensure continuous coverage. The cost of each strategy was largely driven by the number of LLINs delivered. Conclusions The most cost-efficient strategy to maintain universal coverage is one that best optimizes the numbers of LLINs needed over time. A school-based approach using vouchers targeting all students in Standards 1, 3, 5, 7 and Forms 1 and 2 in combination with the TNVS appears to meet best the criteria of effectiveness, equity and efficiency. PMID:23641705
OBJECTIVE--To investigate the relation between undernutrition and diabetes. DESIGN--Survey of glucose tolerance in rural Tanzania. SETTING--Eight villages in three widely separated regions of Tanzania. SUBJECTS--8581 people aged 15 and above: 3705 men and 4876 women. MAIN OUTCOME MEASURES--Oral glucose tolerance, body mass index, height, and low haemoglobin and cholesterol concentrations. RESULTS--In the eight villages 42.7-56.9% of all men and 30.0-45.2% of all women had a body mass index below 20 kg/m2; the lowest quintile was 18.2 kg/m2 in men and 18.6 kg/m2 in women. The prevalence of diabetes did not change significantly from the lowest to the highest fifths of body mass index in men (lowest 1.6% (95% confidence interval 0.8% to 2.9%) v highest 1.3% (0.7% to 2.5%)) or women (1.1% (0.6% to 2.1%) v 0.5% (0.2% to 1.2%)). In men and in women prevalence of impaired glucose tolerance was greater in the lowest fifths of height (8.2% (6.3% to 10.6%), and 11.1% (9.2% to 13.3%)) respectively and body mass index (9.6% (7.5% to 12.1%), and 8.4% (6.7% to 10.5%)) than in the highest fifths (impaired glucose tolerance 4.7% (3.4% to 6.5%); and 5.1% (3.9% to 6.7%); body mass index 5.1% (3.7% to 7.0%), and 7.7% (6.2% to 9.6%). CONCLUSION--Rates of diabetes were not significantly associated with low body mass index or height, but overall rates were much lower than those in well nourished Western populations. Increased impaired glucose tolerance in the most malnourished people may reflect the larger glucose load per kilogram weight. The role of undernutrition in the aetiology of diabetes must be questioned. PMID:1467685
Swai, A. B.; Kitange, H. M.; Masuki, G.; Kilima, P. M.; Alberti, K. G.; McLarty, D. G.
The 2007 drilling season by the Tanzania drilling project (TDP) reveals a much more expanded Upper Cretaceous sequence than was recognized previously in the Lindi region of southern Tanzania. This TDP expedition targeted recovery of excellently preserved microfossils (foraminifera and calcareous nannofossils) for Late Cretaceous paleoclimatic, paleoceanographic and biostratigraphic studies. A total of 501.17 m of core was drilled at six Upper Cretaceous sites (TDP Sites 21, 22, 23, 24, 24B and 26) and a thin Miocene-Pleistocene section (TDP Site 25). Microfossil preservation at all these sites is good to excellent, with foraminifera often showing glassy shells and consistently good preservation of small and delicate nannofossil taxa. In addition to adding to our knowledge of the subsurface geology, new surface exposures were mapped and the geological map of the region is revised herein. TDP Sites 24, 24B and 26 collectively span the upper Albian to lower-middle Turonian (planktonic foraminiferal Planomalina buxtorfi- Whiteinella archaeocretacea Zones and calcareous nannofossil zones UC0a-UC8a). The bottom of TDP Site 21 is barren, but the rest of the section represents the uppermost Cenomanian-Coniacian ( W. archaeocretacea- Dicarinella concavata Zones and nannofossil zones UC5c-UC10). Bulk organic ? 13C data suggest recovery of part of Ocean Anoxic Event 2 (OAE2) from these four sites. In the upper part of this interval, the lower Turonian nannofossil zones UC6a-7 are characterized by a low-diversity nannoflora that may be related to OAE2 surface-water conditions. TDP Site 22 presents a 122-m-thick, lower-middle Turonian ( W. archaeocretacea- Helvetoglobotruncana helvetica Zones) sequence that includes the nannofossil zones UC6a(-7?), but invariable isotopic curves. Further, a lower to upper Campanian ( Globotruncana ventricosa- Radotruncana calcarata Zones and nannofossil subzones UC15b TP-UC15d TP) succession was drilled at TDP Site 23. Lithologies of the new sites include thin units of gray, medium to coarse sandstones, separating much thicker intervals of dark claystones with organic-rich laminated parts, irregular silty to fine sandstone partings, and rare inoceramid and ammonite debris. These lithofacies are interpreted to have been deposited in outer shelf and upper slope settings and indicate relatively stable sedimentary conditions during most of the Late Cretaceous on the Tanzanian margin.
Jiménez Berrocoso, Álvaro; MacLeod, Kenneth G.; Huber, Brian T.; Lees, Jacqueline A.; Wendler, Ines; Bown, Paul R.; Mweneinda, Amina K.; Isaza Londoño, Carolina; Singano, Joyce M.
Adolescent pregnancy places girls at increased risk for poor health and educational outcomes that limit livelihood options, economic independence, and empowerment in adulthood. In Tanzania, adolescent pregnancy remains a significant concern, with over half of all first births occurring before women reach the age of 20. A participatory research and action project (Vitu Newala) conducted formative research in a rural district on the dynamics of sexual risk and agency among 82 girls aged 12-17. Four major risk factors undermined girls' ability to protect their own health and well-being: poverty that pushed them into having sex to meet basic needs, sexual expectations on the part of older men and boys their age, rape and coercive sex (including sexual abuse from an early age), and unintended pregnancy. Transactional sex with older men was one of the few available sources of income that allowed adolescent girls to meet their basic needs, making this a common choice for many girls, even though it increased the risk of unintended (early) pregnancy. Yet parents and adult community members blamed the girls alone for putting themselves at risk. These findings were used to inform a pilot project aimed to engage and empower adolescent girls and boys as agents of change to influence powerful gender norms that perpetuate girls' risk. PMID:23684192
McCleary-Sills, Jennifer; Douglas, Zayid; Rwehumbiza, Annagrace; Hamisi, Aziza; Mabala, Richard
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
Bamford, Marion K
Pollen, spore, macrofossil and stable isotope (C and N) analyses from a 266-cm sediment core collected from a swamp on the Eastern Arc Mountains, Tanzania, are used to reconstruct vegetation and environmental history. An estimated time scale based on five 14C ages records approximately 38,000 yr. This palaeorecord is the first from this biodiversity hotspot and importantly extends through the last glacial maximum (LGM). The altitudinal transition from montane to upper montane forest shifted from 1700-1800 m (38,000 14C yr BP) to 1800-1900 m (35,000-29,000 14C yr BP). From 29,000 to 10,000 14C yr BP, it shifted from 1850-1950 m across the LGM to 1750-1800 m (during 10,000-3500 14C yr BP), and to present-day elevations at 2000 m during the last 3500 14C yr BP. The relative ecosystem stability across the LGM may be explained by the Indian Ocean's influence in maintaining continuous moist forest cover during a period of East African regional climate aridity. During the late Holocene, presence of abundant coprophilous fungi and algal blooms demonstrates increasing human impact. Neurospora spores indicate frequent fires, coinciding with clear signals of decline in Podocarpus and Psychotria trees that possibly represent selective logging.
Mumbi, C. T.; Marchant, R.; Hooghiemstra, H.; Wooller, M. J.
In 2003 UNIDO (United Nations Industrial Development Organization) conducted an environmental and health assessment in a small-scale mining area in Tanzania. BGS (British Geological Survey) performed the environmental assessment. The Institute of Forensic Medicine - University of Munich performed the health assessment. The results of the medical, neurological and neuro-psychological examination of 180 participants from the affected area of Rwamagasa and 31 controls were analyzed. Urine, blood and hair samples were analyzed to detect the level of mercury body burden. Mercury concentrations in the bio-monitors urine, blood and hair were statistically significantly higher in the exposed population from Rwamagasa compared to the control group from Katoro. Only amalgam burners showed mercury levels above the toxicological threshold limits. A speciation of mercury in hair indicated that mainly elemental mercury vapor contributed to the high body burden of the artisanal miners. 104 amalgam-burners, the most exposed population group, were examined. 25 of these workers were found to be intoxicated. Small-scale mining is a serious health hazard for amalgam burners. Reduction of the exposure is essential to prevent further damage. PMID:19945738
Bose-O'Reilly, Stephan; Drasch, Gustav; Beinhoff, Christian; Tesha, Aloyce; Drasch, Katalin; Roider, Gabriele; Taylor, Helen; Appleton, Don; Siebert, Uwe
This article summarises child abuse as a global problem of increasing breadth and complexity. It reviews the development of procedures for prosecuting alleged abusers and treating complainants appropriately in the course of investigations, medical examinations and court hearings. It contrasts the diverse environments of the UK, Tajikistan and Tanzania. The author draws on his experience of practising criminal law since 1984 in England and Wales and working as a consultant in 2011 with the Girls Support Service in Tajikistan, a European-and UN-funded NGO, and with UNICEF in Tanzania in 2012. PMID:24069954
Owen, David M
Introduction Although malaria has been the leading cause of fever for many years, with improved control regimes malaria transmission, morbidity and mortality have decreased. Recent studies have increasingly demonstrated the importance of non-malaria fevers, which have significantly improved our understanding of etiologies of febrile illnesses. A number of non-malaria febrile illnesses including Rift Valley Fever, dengue fever, Chikungunya virus infection, leptospirosis, tick-borne relapsing fever and Q-fever have been reported in Tanzania. This study aimed at assessing the awareness of communities and practices of health workers on non-malaria febrile illnesses. Methods Twelve focus group discussions with members of communities and 14 in-depth interviews with health workers were conducted in Kilosa district, Tanzania. Transcripts were coded into different groups using MaxQDA software and analyzed through thematic content analysis. Results The study revealed that the awareness of the study participants on non-malaria febrile illnesses was low and many community members believed that most instances of fever are due to malaria. In addition, the majority had inappropriate beliefs about the possible causes of fever. In most cases, non-malaria febrile illnesses were considered following a negative Malaria Rapid Diagnostic Test (mRDT) result or persistent fevers after completion of anti-malaria dosage. Therefore, in the absence of mRDTs, there is over diagnosis of malaria and under diagnosis of non-malaria illnesses. Shortages of diagnostic facilities for febrile illnesses including mRDTs were repeatedly reported as a major barrier to proper diagnosis and treatment of febrile patients. Conclusion Our results emphasize the need for creating community awareness on other causes of fever apart from malaria. Based on our study, appropriate treatment of febrile patients will require inputs geared towards strengthening of diagnostic facilities, drugs availability and optimal staffing of health facilities. PMID:24852787
Chipwaza, Beatrice; Mugasa, Joseph P.; Mayumana, Iddy; Amuri, Mbaraka; Makungu, Christina; Gwakisa, Paul S.
Background To protect the most vulnerable groups from malaria (pregnant women and infants) the Tanzanian Government introduced a subsidy (voucher) scheme in 2004, on the basis of a public-private partnership. These vouchers are provided to pregnant women at their first antenatal care visit and mothers of infants at first vaccination. The vouchers are redeemed at registered retailers for a long-lasting insecticidal net against the payment of a modest top-up price. The present work analysed a large body of data from the Tanzanian National Voucher Scheme, focusing on interactions with concurrent mass distribution campaigns of free nets. Methods In an ecologic study involving all regions of Tanzania, voucher redemption data for the period 2007 2011, as well as data on potential determinants of voucher redemption were analysed. The four outcome variables were: pregnant woman and infant voucher redemption rates, use of treated bed nets by all household members and by under- five children. Each of the outcomes was regressed with selected determinants, using a generalized estimating equation model and accounting for regional data clustering. Results There was a consistent improvement in voucher redemption rates over the selected time period, with rates >80% in 2011. The major determinants of redemption rates were the top-up price paid by the voucher beneficiary, the retailer- clinic ratio, and socio-economic status. Improved redemption rates after 2009 were most likely due to reduced top-up prices (following a change in policy). Redemption rates were not affected by two major free net distribution campaigns. During this period, there was a consistent improvement in net use across all the regions, with rates of up to 75% in 2011. Conclusion The key components of the National Treated Nets Programme (NATNETS) seem to work harmoniously, leading to a high level of net use in the entire population. This calls for the continuation of this effort in Tanzania and for emulation by other countries with endemic malaria. PMID:24884786
Background Lack of rapid and reliable susceptibility testing for second-line drugs used in the treatment of multidrug-resistant tuberculosis (MDR-TB) may limit treatment success. Methods Mycobacterium tuberculosis isolates from patients referred to Kibong’oto National TB Hospital in Tanzania for second-line TB treatment underwent confirmatory speciation and susceptibility testing. Minimum inhibitory concentration (MIC) testing on MYCOTB Sensititre plates was performed for all drugs available in the second-line formulary. We chose to categorize isolates as borderline susceptible if the MIC was at or one dilution lower than the resistance breakpoint. M. tuberculosis DNA was sequenced for resistance mutations in rpoB (rifampin), inhA (isoniazid, ethionamide), katG (isoniazid), embB (ethambutol), gyrA (fluoroquinolones), rrs (amikacin, kanamycin, capreomycin), eis (kanamycin) and pncA (pyrazinamide). Results Of 22 isolates from patients referred for second-line TB treatment, 13 (59%) were MDR-TB and the remainder had other resistance patterns. MIC testing identified 3 (14%) isolates resistant to ethionamide and another 8 (36%) with borderline susceptibility. No isolate had ofloxacin resistance, but 10 (45%) were borderline susceptible. Amikacin was fully susceptible in 15 (68%) compared to only 11 (50%) for kanamycin. Resistance mutations were absent in gyrA, rrs or eis for all 13 isolates available for sequencing, but pncA mutation resultant in amino acid change or stop codon was present in 6 (46%). Ten (77%) of MDR-TB patients had at least one medication that could have logically been modified based on these results (median 2; maximum 4). The most common modifications were a change from ethioniamide to para-aminosalicylic acid, and the use of higher dose levofloxacin. Conclusions In Tanzania, quantitative second-line susceptibility testing could inform and alter MDR-TB management independent of drug-resistance mutations. Further operational studies are warranted. PMID:24034230
Background Rift Valley fever (RVF) is a mosquito-borne viral zoonosis that primarily affects ruminants but also has the capacity to infect humans. Objective To determine the abundance and distribution of mosquito vectors in relation to their potential role in the virus transmission and maintenance in disease epidemic areas of Ngorongoro district in northern Tanzania. Methods A cross-sectional entomological investigation was carried out before the suspected RVF outbreak in October 2012. Mosquitoes were sampled both outdoors and indoors using the Centre for Disease Control (CDC) light traps and Mosquito Magnets baited with attractants. Outdoor traps were placed in proximity with breeding sites and under canopy in banana plantations close to the sleeping places of animals. Results A total of 1,823 mosquitoes were collected, of which 87% (N=1,588) were Culex pipiens complex, 12% (N=226) Aedes aegypti, and 0.5% (N=9) Anopheles species. About two-thirds (67%; N=1,095) of C. pipiens complex and nearly 100% (N=225) of A. aegypti were trapped outdoors using Mosquito Magnets. All Anopheles species were trapped indoors using CDC light traps. There were variations in abundance of C. pipiens complex and A. aegypti among different ecological and vegetation habitats. Over three quarters (78%) of C. pipiens complex and most (85%) of the A. aegypti were trapped in banana and maize farms. Both C. pipiens complex and A. aegypti were more abundant in proximity with cattle and in semi-arid thorn bushes and lower Afro-montane. The highest number of mosquitoes was recorded in villages that were most affected during the RVF epidemic of 2007. Of the tested 150 pools of C. pipiens complex and 45 pools of A. aegypti, none was infected with RVF virus. Conclusions These results provide insights into unique habitat characterisation relating to mosquito abundances and distribution in RVF epidemic-prone areas of Ngorongoro district in northern Tanzania. PMID:25613346
Mweya, Clement N.; Kimera, Sharadhuli I.; Mellau, Lesakit S. B.; Mboera, Leonard E. G.
Background In countries with high maternal and newborn morbidity and mortality, reliable access to quality healthcare in rural areas is essential to save lives. Health workers who are satisfied with their jobs are more likely to remain in rural posts. Understanding what factors influence health workers’ satisfaction can help determine where resources should be focused. Although there is a growing body of research assessing health worker satisfaction in hospitals, less is known about health worker satisfaction in rural, primary health clinics. This study explores the workplace satisfaction of health workers in primary health clinics in rural Tanzania. Methods Overall, 70 health workers in rural Tanzania participated in a self-administered job satisfaction survey. We calculated mean ratings for 17 aspects of the work environment. We used principal components analysis (PCA) to identify groupings of these variables. We then examined the bivariate associations between health workers demographics and clinic characteristics and each of the satisfaction scales. Results Results showed that 73.9% of health workers strongly agreed that they were satisfied with their job; however, only 11.6% strongly agreed that they were satisfied with their level of pay and 2.9% with the availability of equipment and supplies. Two categories of factors emerged from the PCA: the tools and infrastructure to provide care, and supportive interpersonal environment. Nurses and medical attendants (compared to clinical officers) and older health workers had higher satisfaction scale ratings. Conclusions Two dimensions of health workers’ work environment, namely infrastructure and supportive interpersonal work environment, explained much of the variation in satisfaction among rural Tanzanian health workers in primary health clinics. Health workers were generally more satisfied with supportive interpersonal relationships than with the infrastructure. Human resource policies should consider how to improve these two aspects of work as a means for improving health worker morale and potentially rural attrition. Trial registration (ISRCTN 17107760) PMID:25086596
Background Like other African countries, Tanzania has in recent years, been implementing various exemptions and targeting programmes to protect and ensure equitable access to health care by poorer segments of the population. A body of evidence indicates that exemption policies, while potentially effective in principle, are ineffective in implementation. However, there is evidence that some districts, despite the challenges, perform better than others in terms of identifying the poor and allocating funds for the poor and vulnerable groups. Methods Drawing from the review of minutes, health facility visits, and key informant interviews with the community representatives and the district health managers, the study explored why exemption policies in Tanzania are relatively better implemented in some districts than in others. Results The findings indicate that in Lindi district the pro-poor exemption mechanism was ineffective in implementation. There were no clear ways of identifying and protecting the poor household members. In contrast, in Iramba district the policy was relatively better implemented. The poor were identified at the village, ward, health facility and district levels. In some villages, the poor were grouped in 10s to form one household. Then, using the village funds, the Community Health Fund cards were purchased for them. Personal initiatives of the key district leaders, commitment of the district health management team and local government officials, regular supervisory visits, as well as incentives to the health facility committees and boards were the main factors that facilitated the implementation of the pro-poor exemption policy. Conclusions It is concluded from this study that management and leadership practices including personal initiatives of the key district leaders, effective supervision mechanisms, commitment of the district health management team and local government officials, as well as incentives for the health facility committees and board members are pivotal for the implementation of the pro-poor exemption policies. PMID:24069940
Background While unintended pregnancies pose a serious threat to the health and well-being of families globally, characteristics of Tanzanian women who conceive unintentionally are rarely documented. This analysis identifies factors associated with unintended pregnancies—both mistimed and unwanted—in three rural districts of Tanzania. Methods A cross-sectional survey of 2,183 random households was conducted in three Tanzanian districts of Rufiji, Kilombero, and Ulanga in 2011 to assess women’s health behavior and service utilization patterns. These households produced 3,127 women age 15+?years from which 2,199 gravid women aged 15–49 were selected for the current analysis. Unintended pregnancies were identified as either mistimed (wanted later) or unwanted (not wanted at all). Correlates of mistimed, and unwanted pregnancies were identified through Chi-squared tests to assess associations and multinomial logistic regression for multivariate analysis. Results Mean age of the participants was 32.1 years. While 54.1% of the participants reported that their most recent pregnancy was intended, 32.5% indicated their most recent pregnancy as mistimed and 13.4% as unwanted. Multivariate analysis revealed that young age (<20 years), and single marital status were significant predictors of both mistimed and unwanted pregnancies. Lack of inter-partner communication about family planning increased the risk of mistimed pregnancy significantly, and multi-gravidity was shown to significantly increase the risk of unwanted pregnancy. Conclusions About one half of women in Rufiji, Kilombero, and Ulanga districts of Tanzania conceive unintentionally. Women, especially the most vulnerable should be empowered to avoid pregnancy at their own will and discretion. PMID:25102924
Background Contraceptive use is low in developing countries which are still largely driven by male dominated culture and patriarchal values. This study explored family planning (FP) decisions, perceptions and gender dynamics among couples in Mwanza region of Tanzania. Methods Twelve focus group discussions and six in-depth interviews were used to collect information from married or cohabiting males and females aged 18–49. The participants were purposively selected. Qualitative methods were used to explore family planning decisions, perceptions and gender dynamics among couples. A guide with questions related to family planning perceptions, decisions and gender dynamics was used. The discussions and interviews were tape-recorded, transcribed verbatim and analyzed manually and subjected to content analysis. Results Four themes emerged during the study. First, “risks and costs” which refer to the side effects of FP methods and the treatment of side -effects as well as the costs inherit in being labeled as an unfaithful spouse. Second, “male involvement” as men showed little interest in participating in family planning issues. However, the same men were mentioned as key decision-makers even on the number of children a couple should have and the child spacing of these children. Third, “gender relations and communication” as participants indicated that few women participated in decision-making on family planning and the number of children to have. Fourth, “urban–rural differences”, life in rural favoring having more children than urban areas therefore, the value of children depended on the place of residence. Conclusion Family Planning programs should adapt the promotion of communication as well as joint decision-making on FP among couples as a strategy aimed at enhancing FP use. PMID:23721196
Background An estimated 0.5 to 1.5 million informal miners, of whom 30-50% are women, rely on artisanal mining for their livelihood in Tanzania. Mercury, used in the processing gold ore, and arsenic, which is a constituent of some ores, are common occupational exposures that frequently result in widespread environmental contamination. Frequently, the mining activities are conducted haphazardly without regard for environmental, occupational, or community exposure. The primary objective of this study was to assess community risk knowledge and perception of potential mercury and arsenic toxicity and/or exposure from artisanal gold mining in Rwamagasa in northwestern Tanzania. Methods A cross-sectional survey of respondents in five sub-villages in the Rwamagasa Village located in Geita District in northwestern Tanzania near Lake Victoria was conducted. This area has a history of artisanal gold mining and many of the population continue to work as miners. Using a clustered random selection approach for recruitment, a total of 160 individuals over 18 years of age completed a structured interview. Results The interviews revealed wide variations in knowledge and risk perceptions concerning mercury and arsenic exposure, with 40.6% (n=65) and 89.4% (n=143) not aware of the health effects of mercury and arsenic exposure respectively. Males were significantly more knowledgeable (n=59, 36.9%) than females (n=36, 22.5%) with regard to mercury (x2=3.99, p<0.05). An individual’s occupation category was associated with level of knowledge (x2=22.82, p=<0.001). Individuals involved in mining (n=63, 73.2%) were more knowledgeable about the negative health effects of mercury than individuals in other occupations. Of the few individuals (n=17, 10.6%) who knew about arsenic toxicity, the majority (n=10, 58.8%) were miners. Conclusions The knowledge of individuals living in Rwamagasa, Tanzania, an area with a history of artisanal gold mining, varied widely with regard to the health hazards of mercury and arsenic. In these communities there was limited awareness of the threats to health associated with exposure to mercury and arsenic. This lack of knowledge, combined with minimal environmental monitoring and controlled waste management practices, highlights the need for health education, surveillance, and policy changes. PMID:23351708
Background The HIV/AIDS pandemic remains a leading challenge for global health. Although condoms are acknowledged for their key role on preventing HIV transmission, low and inappropriate use of condoms persists in Tanzania and elsewhere in Africa. This study assesses factors affecting acceptability of condom promotion and distribution among adolescents in Mpwapwa and Mbeya rural districts of Tanzania. Methods Data were collected in 2011 as part of a larger cross-sectional survey on condom use among 10–19?year-olds in Mpwapwa and Mbeya rural districts of Tanzania using a structured questionnaire. Associations between acceptability of condom promotion and distribution and each of the explanatory variables were tested using Chi Square. Multivariate logistic regression model was used to examine independent predictors of the acceptability of condom promotion and distribution using STATA (11) statistical software at 5% significance level. Results Mean age of the 1,327 adolescent participants (50.5% being males) was 13.5?years (SD?=?1.4). Acceptance of condom promotion and distribution was found among 37% (35% in Mpwapwa and 39% in Mbeya rural) of the adolescents. Being sexually active and aged 15–19 was the strongest predictor of the acceptability of condom promotion and distribution (OR?=?7.78, 95% CI 4.65-12.99). Others were; not agreeing that a condom is effective in preventing transmissions of STIs including HIV (OR?=?0.34, 95% CI 0.20-0.56), being a resident of Mbeya rural district (OR?=?1.67, 95% CI 1.28-2.19), feeling comfortable being seen by parents/guardians holding/buying condoms (OR?=?2.20, 95% CI 1.40-3.46) and living with a guardian (OR?=?1.48, 95% CI 1.08-2.04). Conclusion Acceptability of condom promotion and distribution among adolescents in Mpwapwa and Mbeya rural is low. Effect of sexual activity on the acceptability of condom promotion and distribution is age-dependent and was the strongest. Feeling comfortable being seen by parents/guardians buying or holding condoms, perceived ability of condoms to offer protection against HIV/AIDS infections, district of residence and living arrangements also offered significant predictive effect. Knowledge of these factors is vital in designing successful and sustainable condom promotion and distribution programs in Tanzania. PMID:22892205
Objectives: To determine prevalence of, and risk factors for, bacterial vaginosis (BV) among herpes simplex virus (HSV) 2 seropositive Tanzanian women at enrolment into a randomised, placebo-controlled trial of HSV suppressive treatment. Methods: 1305 HSV-2 seropositive women aged 16–35 years working in bars, guesthouses and similar facilities were interviewed, examined and tested for HIV, syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, BV, candidiasis and trichomoniasis. Factors associated with BV were analysed using logistic regression to estimate odds ratios and 95% confidence intervals. Results: BV prevalence was 62.9%; prevalence of Nugent score 9–10 was 16.1%. Independent risk factors for BV were work facility type, fewer dependents, increasing alcohol consumption, sex in the last week (adjusted OR 2.03; 95% CI 1.57 to 2.62), using cloths or cotton wool for menstrual hygiene, HIV (adjusted OR 1.41; 95% CI 1.09 to 1.83) and Trichomonas vaginalis infection. There was no association between BV and the frequency or method of vaginal cleansing. However, BV was less prevalent among women who reported inserting substances to dry the vagina for sex (adjusted OR 0.44; 95% CI 0.25 to 0.75). Conclusion: BV was extremely prevalent among our study population of HSV-2 positive female facility workers in North-western Tanzania. Although recent sex was associated with increased BV prevalence, vaginal drying was associated with lower BV prevalence. Further studies of the effects of specific practices on vaginal flora are warranted. PMID:19473997
Baisley, K; Changalucha, J; Weiss, H A; Mugeye, K; Everett, D; Hambleton, I; Hay, P; Ross, D; Tanton, C; Chirwa, T; Hayes, R; Watson-Jones, D
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. PMID:22401037
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 is…
Frankenberg, Sofia Johnson; Holmqvist, Rolf; Rubenson, Birgitta; Rindstedt, Camilla
Purpose: The primary aim of the work reported here is to determine whether a low cost teaching approach which had been successfully used in one region of Tanzania (Tanga) could be introduced to other teachers in a different region by teachers, rather than outside experts. A second aim is to determine whether changes occurred in children's…
Lansdow, Richard; Issae, Wahab; Katala, Sidney; Mwaisumo, Rose
Spiders were sampled using insecticide knockdown in an African montane forest in the Uzungwa Mountains of Tanzania. The results are used to discuss the faunal composition at the site and in comparison to other sites, and the implications of the results for estimating spider diversity in Africa are discussed. A total of 5233 adults comprising 149 species were collected from
Line L. Sørensen
The objective of this paper is to compare soil fertility evaluation based on experience and knowledge of smallholder farmer communities with the evaluation by scientists based on soil analysis and model calculations. The role of the smallholder farmer community in soil fertility evaluation and management was examined from two ‘research for development’ projects in northern Tanzania. These are the African
Jeremias G. Mowo; Bert H. Janssen; Oene Oenema; Laura A. German; Jerome P. Mrema; Riziki S. Shemdoe
Decentralisation is a key element in the new wave of land reforms that have been introduced in sub-Saharan Africa. However, not much research has been carried out into their implementation at the local level. Consequently, reforms are described in old-fashioned terms. Through comparative case studies in Tanzania, this article unpacks implementation as a process consisting of multiple administrative layers and
Rasmus Hundsbæk Pedersen
In 1976, a fossil hominid skull was recovered from the Ngaloba Beds at Laetoli, Northern Tanzania; its morphology is discussed here. The discovery of this skull is of great interest and importance because of its very substantial presumed antiquity and its largely anatomically modern morphology. The discovery has considerable implications for the antiquity and origin of modern Homo sapiens, a
M. H. Day; M. D. Leakey; C. Magori
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…
This paper is based on primary fieldwork conducted in Lugufu refugee camp in the rural Kigoma Region of western Tanzania. It is an anthropological inquiry into the paradox of refugee food aid based on the prevailing dynamic of domination and submission currently advanced by the international aid community. This inquiry asks fundamental questions…
This volume describes and analyzes the initiation of a Bachelors in Education course carried out as part-time (distance) and full-time (seminar) studies at Teacher's College in Morogoro, Tanzania. The volume contains six chapters, including: (1) "Framework for English Content Instruction at the Department of Teacher Education at Abo Akademi…
Malmberg, Lars-Erik, Ed.
Despite considerable attention to chimpanzee intergroup violence, the number of observed cases remains small. We report 4 cases of intergroup violence that occurred in Gombe National Park, Tanzania, between 1993 and 2002. We observed (3 cases) or inferred (1 case) males from the Kasekela community to attack members of their 2 neighboring communities: Mitumba and Kalande. In 1993, Kasekela males
Michael L. Wilson; William R. Wallauer; Anne E. Pusey
An assemblage of 1·5Ma Oldowan sites situated on a paleosol of Maritanane, Peninj (Tanzania) presents a new type of archaeological record characterized by abundant faunal remains associated to a small amount of stone tools over an extensive area. The widespread nature of the archaeological materials, together with different weathering stages of the fauna and articulated clusters of bones suggests that
Manuel Dom??nguez-Rodrigo; Ignacio de La Torre; Luis de Luque; Luis Alcalá; Rafael Mora; Jordi Serrallonga; Victoria Medina
This paper looked at students' perceived level of English proficiency among Dodoma secondary schools in Tanzania. Factors like attitude, anxiety, classroom activities, motivation, and learning resources were considered as influencing English learning. The study was guided by three theories: Input Hypothesis, Inter-language and Vygotsky's theory of…
Makewa, Lazarus Ndiku; Role, Elizabeth; Tuguta, Ellen
In a population of spotted hyenas (Crocuta crocuta) monitored between 1996 and 2005 in the Ngorongoro Crater, Tanzania, 16 individuals from five of eight social groups displayed clinical signs of an infection, including severe unilateral swelling of the head followed by abscess formation at the mandibular angle, respiratory distress, mild ataxia, and lethargy. Two (12.5%) of these 16 individuals died
Oliver P. Höner; Bettina Wachter; Stephanie Speck; Gudrun Wibbelt; Arne Ludwig; Robert D. Fyumagwa; Peter Wohlsein; Dietmar Lieckfeldt; Heribert Hofer; Marion L. East
Precambrian Research xxx (2006) xxxÂxxx Anorthosites in the Eastern Granulites of Tanzania March 2006 Abstract Several occurrences of anorthosites are known in the Neoproterozoic Mozambique Belt of the Eastern Granulites. Two larger anorthosite bodies and associated rocks from the Pare Mountains
This study compares hope in street youth, former street youth, and school youth (aged 12-18) in Tanzania. Responding to Snyder's hope theory, the author argues that not only personal agency but also the stability of living context (street, shelter, home) shapes hopefulness. Employing qualitative and quantitative analyses, the author presents a…
Nalkur, Priya G.
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…
Potential for Rabies Control through Dog Vaccination in Wildlife-Abundant Communities of Tanzania States of America Abstract Canine vaccination has been successful in controlling rabies in diverse indicate that rabies transmission in this region is driven by transmission within domestic dogs. Different
Myers, Lauren Ancel
In the face of scarce public resources and burgeoning demand from the growing population for agricultural land and woodland products, Tanzania has increasingly recognized the need to bring individuals, local groups, and communities into the policy, planning, and management process if woodlands are to remain productive in the coming decades.Central control of forests takes management responsibility away from the communities
Liz Alden Wily; Peter A. Dewees
We investigated peste des petits ruminants (PPR) infection in cattle and wildlife in northern Tanzania. No wildlife from protected ecosystems were seropositive. However, cattle from villages where an outbreak had occurred among small ruminants showed high PPR seropositivity, indicating that spillover infection affects cattle. Thus, cattle could be of value for PPR serosurveillance. PMID:24274684
Lembo, Tiziana; Oura, Christopher; Parida, Satya; Hoare, Richard; Frost, Lorraine; Fyumagwa, Robert; Kivaria, Fredrick; Chubwa, Chobi; Kock, Richard; Batten, Carrie
Between 1974 and 2003, blood samples were collected from wild and commensal rodents, and wild and domestic small carnivores in selected villages of seven districts in Tanzania that have experienced human plague outbreaks and seven districts that have not experienced any outbreak of the disease. The samples were tested for antibodies against Yersinia pestis Fraction I antigen, using passive haemagglutination
Bukheti Kilonzo; Julius Mhina; Christopher Sabuni; Georgies Mgode
Presence of antimicrobial residues in broiler meat was determined in a cross-sectional study conducted in Morogoro, Tanzania between January and February, 2007. Twenty smallholder broiler chicken farmers were interviewed on the types of antimicrobials used and their awareness on withdrawal period. In addition, 70 broiler chicken liver samples were collected for qualitative antimicrobial residues analysis by use of two parallel
H. E. Nonga; M. Mariki; E. D. Karimuribo; R. H. Mdegela
Tanzania holds most of the remaining large populations of African lions (Panthera leo) and has extensive areas of leopard habitat (Panthera pardus), and both species are subjected to sizable harvests by sport hunters. As a first step toward establishing sustainable management strategies, we analyzed harvest trends for lions and leopards across Tanzania's 300,000 km(2) of hunting blocks. We summarize lion population trends in protected areas where lion abundance has been directly measured and data on the frequency of lion attacks on humans in high-conflict agricultural areas. We place these findings in context of the rapidly growing human population in rural Tanzania and the concomitant effects of habitat loss, human-wildlife conflict, and cultural practices. Lion harvests declined by 50% across Tanzania between 1996 and 2008, and hunting areas with the highest initial harvests suffered the steepest declines. Although each part of the country is subject to some form of anthropogenic impact from local people, the intensity of trophy hunting was the only significant factor in a statistical analysis of lion harvest trends. Although leopard harvests were more stable, regions outside the Selous Game Reserve with the highest initial leopard harvests again showed the steepest declines. Our quantitative analyses suggest that annual hunting quotas be limited to 0.5 lions and 1.0 leopard/1000 km(2) of hunting area, except hunting blocks in the Selous Game Reserve, where harvests should be limited to 1.0 lion and 3.0 leopards/1000 km(2) . PMID:20825444
Packer, C; Brink, H; Kissui, B M; Maliti, H; Kushnir, H; Caro, T
This study examined the relationship between pre-primary educational policy and actual practice in Tanzania. Policy relevant to pre-primary education was analyzed and 15 pre-primary lessons from two urban and two rural schools were videotaped. Although the national educational policy specifies the same standards for pre-primary education…
Mtahabwa, Lyabwene; Rao, Nirmala
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…
Miles, Susie; Kaplan, Ian
Most analyses of the determinants of HIV infection are performed at the individual level. The recent Demographic and Health Surveys which include results from HIV tests allow studying HIV infection at the level of the cohabiting couple. The paper exploits this feature of the data for Burkina Faso, Cameroon, Ghana, Kenya, and Tanzania. The analysis yields two surprising findings about
Damien de Walque
Fecal samples from 33 lions (Panthera leo) in Serengeti National Park and Ngorongoro Crater Conser- vation Area in northern Tanzania contained 19 different parasites, 12 of which, including Aelurostrongylussp., a species of Acanthocephala, a species of Anoplocephalidae, Capillaria sp., Demodex sp., Eimeria sp., Habronema sp., Isospora felis, Isospora rivolta, one species of Isospora that was previously undescribed from lions, one
Kathe E. Bjork; Gary A. Averbeck; Bert E. Stromberg
We investigated habitat use of the common warthog (Phacochoerus africanus) on a large, recently abandoned ranch in Tanzania. Fifty years of ranching had heavily modified the savanna vegetation, especially close to the paddocks where cattle were kept overnight. We recognized 4 characteristic vegetation zones along transects radiating from these paddocks: paddock center (PC), paddock margin (PM), acacia scrub (AS), and
ANNA C. TREYDTE; STEPHANIE A. HALSDORF; EWALD WEBER; PETER J. EDWARDS
In developing countries, higher education is a powerful instrument for social mobility and economic prosperity. An in-depth study of the relationship between higher education and certain equity issues has revealed that in Ghana and Tanzania there is inadequate effort to widen higher education participation to include traditionally disadvantaged…
Time preferences for health has a role in informing discounting practice in economic evaluation of health care interventions. Yet virtually no empirical evidence on time preferences for health are available for sub-Saharan Africa. The objectives of this paper are therefore to estimate time preferences for health in Tanzania, and to explore the relationship between time preferences for one's own private
Aim: The discounted utility (DU) model has dominated economic evaluation for almost 7 decades, despite the fact that important assumptions of the model are commonly found to be violated. This paper formally explores whether the key assumption of stationarity is violated in a sample of the general population of Northern Tanzania. Furthermore, three hyperbolic discounting models are fitted to the
Bjarne Robberstad; John Cairns
Anthrax is endemic throughout Africa, causing considerable livestock and wildlife losses and severe, sometimes fatal, infection in humans. Predicting the risk of infection is therefore important for public health, wildlife conservation and livestock economies. However, because of the intermittent and variable nature of anthrax outbreaks, associated environmental and climatic conditions, and diversity of species affected, the ecology of this multihost pathogen is poorly understood.We explored records of anthrax from the Serengeti ecosystem in north-west Tanzania where the disease has been documented in humans, domestic animals and a range of wildlife. Using spatial and temporal case-detection and seroprevalence data from wild and domestic animals, we investigated spatial, environmental, climatic and species-specific associations in exposure and disease.Anthrax was detected annually in numerous species, but large outbreaks were spatially localized, mostly affecting a few focal herbivores.Soil alkalinity and cumulative weather extremes were identified as useful spatial and temporal predictors of exposure and infection risk, and for triggering the onset of large outbreaks.Interacting ecological and behavioural factors, specifically functional groups and spatiotemporal overlap, helped to explain the variable patterns of infection and exposure among species.Synthesis and applications. Our results shed light on ecological drivers of anthrax infection and suggest that soil alkalinity and prolonged droughts or rains are useful predictors of disease occurrence that could guide risk-based surveillance. These insights should inform strategies for managing anthrax including prophylactic livestock vaccination, timing of public health warnings and antibiotic provision in high-risk areas. However, this research highlights the need for greater surveillance (environmental, serological and case-detection-orientated) to determine the mechanisms underlying anthrax dynamics. PMID:22318563
Hampson, Katie; Lembo, Tiziana; Bessell, Paul; Auty, Harriet; Packer, Craig; Halliday, Jo; Beesley, Cari A; Fyumagwa, Robert; Hoare, Richard; Ernest, Eblate; Mentzel, Christine; Metzger, Kristine L; Mlengeya, Titus; Stamey, Karen; Roberts, Keith; Wilkins, Patricia P; Cleaveland, Sarah
Researchers have independently documented the effects of land use on rivers and threats to river management institutions, but the relationship between changes in institutional context and river condition is not well described. This study assesses the connections between resource management institutions, land use, and rivers by integrating social science, geospatial analysis, and geomorphology. In particular, we measured hydraulic geometry, sediment size distributions, and estimated sediment yield for four rivers in northern Tanzania and conducted semistructured interviews that assessed corresponding resource management institutions. Communities managed rivers through both customary (traditional, nonstate) and government institutions, but the differences in the resource management policies and practices of the study rivers themselves were fairly subtle. Clearer differences were found at broader scales; the four watersheds exhibited substantial differences in land-cover change and sediment yield associated with the location of settlements, roadways, and cultivation. Unexpectedly, these recent land-use changes did not initiate a geomorphic response in rivers. The long history of grazing by domestic and wild ungulates may have influenced water and sediment supplies such that river channel dimensions are more resistant to changes in land use than other systems or have already adjusted to predominant changes in boundary conditions. This would suggest that not all rivers will have the anticipated responses to contemporary land-use changes because of antecedent land-use patterns; over long time scales (centuries to millennia), the presence of grazers may actually increase the ability of rivers to withstand changes in land use. Our findings point to a need for further interdisciplinary study of dryland rivers and their shifts between system states, especially in areas with a long history of grazing, relatively recent changes in land use, and a dynamic social and institutional context.
Miller, Brian W.; Doyle, Martin W.
A model was developed to assess the impact of possible moves towards universal coverage in Tanzania over a 15-year time frame. Three scenarios were considered: maintaining the current situation ('the status quo'); expanded health insurance coverage (the estimated maximum achievable coverage in the absence of premium subsidies, coverage restricted to those who can pay); universal coverage to all (government revenues used to pay the premiums for the poor). The model estimated the costs of delivering public health services and all health services to the population as a proportion of Gross Domestic Product (GDP), and forecast revenue from user fees and insurance premiums. Under the status quo, financial protection is provided to 10% of the population through health insurance schemes, with the remaining population benefiting from subsidized user charges in public facilities. Seventy-six per cent of the population would benefit from financial protection through health insurance under the expanded coverage scenario, and 100% of the population would receive such protection through a mix of insurance cover and government funding under the universal coverage scenario. The expanded and universal coverage scenarios have a significant effect on utilization levels, especially for public outpatient care. Universal coverage would require an initial doubling in the proportion of GDP going to the public health system. Government health expenditure would increase to 18% of total government expenditure. The results are sensitive to the cost of health system strengthening, the level of real GDP growth, provider reimbursement rates and administrative costs. Promoting greater cross-subsidization between insurance schemes would provide sufficient resources to finance universal coverage. Alternately, greater tax funding for health could be generated through an increase in the rate of Value-Added Tax (VAT) or expanding the income tax base. The feasibility and sustainability of efforts to promote universal coverage will depend on the ability of the system to contain costs. PMID:22388504
Borghi, Josephine; Mtei, Gemini; Ally, Mariam
Summary Anthrax is endemic throughout Africa, causing considerable livestock and wildlife losses and severe, sometimes fatal, infection in humans. Predicting the risk of infection is therefore important for public health, wildlife conservation and livestock economies. However, because of the intermittent and variable nature of anthrax outbreaks, associated environmental and climatic conditions, and diversity of species affected, the ecology of this multihost pathogen is poorly understood. We explored records of anthrax from the Serengeti ecosystem in north-west Tanzania where the disease has been documented in humans, domestic animals and a range of wildlife. Using spatial and temporal case-detection and seroprevalence data from wild and domestic animals, we investigated spatial, environmental, climatic and species-specific associations in exposure and disease. Anthrax was detected annually in numerous species, but large outbreaks were spatially localized, mostly affecting a few focal herbivores. Soil alkalinity and cumulative weather extremes were identified as useful spatial and temporal predictors of exposure and infection risk, and for triggering the onset of large outbreaks. Interacting ecological and behavioural factors, specifically functional groups and spatiotemporal overlap, helped to explain the variable patterns of infection and exposure among species. Synthesis and applications. Our results shed light on ecological drivers of anthrax infection and suggest that soil alkalinity and prolonged droughts or rains are useful predictors of disease occurrence that could guide risk-based surveillance. These insights should inform strategies for managing anthrax including prophylactic livestock vaccination, timing of public health warnings and antibiotic provision in high-risk areas. However, this research highlights the need for greater surveillance (environmental, serological and case-detection-orientated) to determine the mechanisms underlying anthrax dynamics. PMID:22318563
Hampson, Katie; Lembo, Tiziana; Bessell, Paul; Auty, Harriet; Packer, Craig; Halliday, Jo; Beesley, Cari A.; Fyumagwa, Robert; Hoare, Richard; Ernest, Eblate; Mentzel, Christine; Metzger, Kristine L.; Mlengeya, Titus; Stamey, Karen; Roberts, Keith; Wilkins, Patricia P.; Cleaveland, Sarah
Background Between 1997 and 2009, a number of key malaria control interventions were implemented in the Kilombero and Ulanga Districts in south central Tanzania to increase insecticide-treated nets (ITN) coverage and improve access to effective malaria treatment. In this study we estimated the contribution of these interventions to observed decreases in child mortality. Methods The local Health and Demographic Surveillance Site (HDSS) provided monthly estimates of child mortality rates (age 1 to 5 years) expressed as cases per 1000 person-years (c/1000py) between 1997 and 2009. We conducted a time series analysis of child mortality rates and explored the contribution of rainfall and household food security. We used Poisson regression with linear and segmented effects to explore the impact of malaria control interventions on mortality. Results Child mortality rates decreased by 42.5% from 14.6 c/1000py in 1997 to 8.4 c/1000py in 2009. Analyses revealed the complexity of child mortality patterns and a strong association with rainfall and food security. All malaria control interventions were associated with decreases in child mortality, accounting for the effect of rainfall and food security. Conclusions Reaching the fourth Millenium Development Goal will require the contribution of many health interventions, as well as more general improvements in socio-environmental and nutritional conditions. Distinguishing between the effects of these multiple factors is difficult and represents a major challenge in assessing the effect of routine interventions. However, this study suggests that credible estimates can be obtained when high-quality data on the most important factors are available over a sufficiently long time period. PMID:24355745
Alba, Sandra; Nathan, Rose; Schulze, Alexander; Mshinda, Hassan; Lengeler, Christian
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 observed over a period of three months at each hospital. All clinicians were also interviewed individually as well as being observed during routine working activities with colleagues. Interviews with five tutors and 10 clinical officer students at a nearby clinical officer training college were subsequently conducted. Results Four, primarily social, spheres of influence on malaria over-diagnosis were identified. Firstly, the influence of initial training within a context where the importance of malaria is strongly promoted. Secondly, the influence of peers, conforming to perceived expectations from colleagues. Thirdly, pressure to conform with perceived patient preferences. Lastly, quality of diagnostic support, involving resource management, motivation and supervision. Rather than following national guidelines for the diagnosis of febrile illness, clinician behaviour appeared to follow 'mindlines': shared rationales constructed from these different spheres of influence. Three mindlines were identified in this setting: malaria is easier to diagnose than alternative diseases; malaria is a more acceptable diagnosis; and missing malaria is indefensible. These mindlines were apparent during the training stages as well as throughout clinical careers. Conclusion Clinicians were found to follow mindlines as well as or rather than guidelines, which incorporated multiple social influences operating in the immediate and the wider context of decision making. Interventions to move mindlines closer to guidelines need to take the variety of social influences into account. PMID:18384669
Chandler, Clare IR; Jones, Caroline; Boniface, Gloria; Juma, Kaseem; Reyburn, Hugh; Whitty, Christopher JM
Background Successful implementation of malaria treatment policy depends on the prescription practices for patients with malaria. This paper describes prescription patterns and assesses factors associated with co-prescription of antibiotics and artemether-lumefantrine (AL) for patients presenting with fever in rural Tanzania. Method From June 2009 to September 2011, a cohort event monitoring program was conducted among all patients treated at 8 selected health facilities in Ifakara and Rufiji Health and Demographic Surveillance System (HDSS). It included all patients presenting with fever and prescribed with AL. Logistic regression was used to model the predictors on the outcome variable which is co-prescription of AL and antibiotics on a single clinical visit. Results A cohort of 11,648 was recruited and followed up with 92% presenting with fever. Presumptive treatment was used in 56% of patients treated with AL. On average 2.4 (1 – 7) drugs was prescribed per encounter, indicating co-prescription of AL with other drugs. Children under five had higher odds of AL and antibiotics co-prescription (OR?=?0.63, 95% CI: 0.46 – 0.85) than those aged more than five years. Patients testing negative had higher odds (OR?=?2.22, 95% CI: 1.65 – 2.97) of AL and antibiotics co-prescription. Patients receiving treatment from dispensaries had higher odds (OR?=?1.45, 95% CI: 0.84 – 2.30) of AL and antibiotics co-prescription than those served in health centres even though the deference was not statistically significant. Conclusion Regardless the fact that Malaria is declining but due to lack of laboratories and mRDT in most health facilities in the rural areas, clinicians are still treating malaria presumptively. This leads them to prescribe more drugs to treat all possibilities. PMID:24279303
Weathering of silicate rocks permanently sequesters a significant amount CO2 on our planet (Berner et al., 1983; Dessert et al., 2003; Gaillardet et al., 1999). Therefore, the investigation of soils and their conjugate protoliths have implications for a wide range of disciplines from soil to atmospheric sciences. This study investigates soil formed in Northern Tanzania on the southern slope of the dormant volcano Mt. Kilimanjaro. Our sample site is in the Machame region at an elevation of ~1640 m where the phonotephrite to basaltic bedrock has been dated at 0.4 to 0.5 million years (Evernden and Curtis, 1965). We determined bulk elemental concentrations of soil and bedrock samples from this region using an ICP-MS and XRF. From initial investigations into the bulk soil and bedrock chemistry using a novel mass balance method, we were able to investigate the relative mobility of a suite of elements. Relative abundances of Ta, Nb, Hf, and Zr are constant and therefore these elements are immobile. In contrast, Ti, an element commonly thought to be immobile, is clearly not immobile in our samples. The entire soil column appears to be highly depleted in Si and Ca but enriched in Al. These features indicate extensive weathering and indeed some samples approach bauxite compositions. Surprisingly, however, weathering versus depth is reversed. Si and Ca have been removed by 60 and 70 % respectively from the upper 2 meters, but below 2 m, they have been removed by 95 and 99 %. This means that the soil is more weathered at depth than in the shallowest 2 meters. We believe that ground water weathering is responsible for this inverted soil profile and may increase CO2 consumption estimates by 10-30 % for similarly affected basalts.
Little, M. G.; Lee, C. A.
Background There is growing evidence that informal payments for health care are fairly common in many low- and middle-income countries. Informal payments are reported to have a negative consequence on equity and quality of care; it has been suggested, however, that they may contribute to health worker motivation and retention. Given the significance of motivation and retention issues in human resources for health, a better understanding of the relationships between the two phenomena is needed. This study attempts to assess whether and in what ways informal payments occur in Kibaha, Tanzania. Moreover, it aims to assess how informal earnings might help boost health worker motivation and retention. Methods Nine focus groups were conducted in three health facilities of different levels in the health system. In total, 64 health workers participated in the focus group discussions (81% female, 19% male) and where possible, focus groups were divided by cadre. All data were processed and analysed by means of the NVivo software package. Results The use of informal payments in the study area was confirmed by this study. Furthermore, a negative relationship between informal payments and job satisfaction and better motivation is suggested. Participants mentioned that they felt enslaved by patients as a result of being bribed and this resulted in loss of self-esteem. Furthermore, fear of detection was a main demotivating factor. These factors seem to counterbalance the positive effect of financial incentives. Moreover, informal payments were not found to be related to retention of health workers in the public health system. Other factors such as job security seemed to be more relevant for retention. Conclusion This study suggests that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. Policy action is needed that not only provides better financial incentives for individuals but also tackles an environment in which corruption is endemic. PMID:19566926
Stringhini, Silvia; Thomas, Steve; Bidwell, Posy; Mtui, Tina; Mwisongo, Aziza
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. PMID:23166132
Ae-Ngibise, Kenneth Ayuurebobi; Masanja, Honorati; Kellerman, Ronel; Owusu-Agyei, Seth
Introduction The syndrome of fever is a commonly presenting complaint among persons seeking healthcare in low-resource areas, yet the public health community has not approached fever in a comprehensive manner. In many areas, malaria is over-diagnosed, and patients without malaria have poor outcomes. Methods and Findings We prospectively studied a cohort of 870 pediatric and adult febrile admissions to two hospitals in northern Tanzania over the period of one year using conventional standard diagnostic tests to establish fever etiology. Malaria was the clinical diagnosis for 528 (60.7%), but was the actual cause of fever in only 14 (1.6%). By contrast, bacterial, mycobacterial, and fungal bloodstream infections accounted for 85 (9.8%), 14 (1.6%), and 25 (2.9%) febrile admissions, respectively. Acute bacterial zoonoses were identified among 118 (26.2%) of febrile admissions; 16 (13.6%) had brucellosis, 40 (33.9%) leptospirosis, 24 (20.3%) had Q fever, 36 (30.5%) had spotted fever group rickettsioses, and 2 (1.8%) had typhus group rickettsioses. In addition, 55 (7.9%) participants had a confirmed acute arbovirus infection, all due to chikungunya. No patient had a bacterial zoonosis or an arbovirus infection included in the admission differential diagnosis. Conclusions Malaria was uncommon and over-diagnosed, whereas invasive infections were underappreciated. Bacterial zoonoses and arbovirus infections were highly prevalent yet overlooked. An integrated approach to the syndrome of fever in resource-limited areas is needed to improve patient outcomes and to rationally target disease control efforts. PMID:23875053
Crump, John A.; Morrissey, Anne B.; Nicholson, William L.; Massung, Robert F.; Stoddard, Robyn A.; Galloway, Renee L.; Ooi, Eng Eong; Maro, Venance P.; Saganda, Wilbrod; Kinabo, Grace D.; Muiruri, Charles; Bartlett, John A.
Preliminary results are presented on a comparative study of two Permian coal-bearing successions in the Paraná Basin of Brazil and in the Rukwa Basin of Tanzania. The sedimentary fill of the intra-cratonic Paraná Basin of Brazil was controlled by eustatic-tectonic events, which are reflected in the coal-bearing Early Permian succession by four third-order depositional sequences. In Tanzania, coal-bearing strata formed
Wolfgang Kalkreuth; Michael Holz; Miriam Cazzulo-Klepzig; Marleni Marques-Toigo; John Utting; Pascal Semkiwa
Granulite-facies xenoliths from tuff cones erupted on the margin of the Tanzanian craton and within the adjacent Mozambique belt in northern Tanzania offer an opportunity to assess the role of lower crustal processes in the tectonic evolution of these two terranes. Both terranes are Archean, but record very different histories, starting in the Proterozoic and continuing today. Whereas the craton experienced little metamorphism or igneous activity following its stabilization around 2.8 Ga, Archean rocks of the Mozambique belt in the study area experienced at least one episode of high-grade metamorphism during the East African orogeny (ca. 640 Ma). Today, the East African rift exists at the contact between the Mozambique belt and the craton, implying a fundamental lithospheric weakness at this boundary. Granulite xenoliths come from Labait, on the craton margin, and Lashaine and Naibor Soito in the metamorphic belt. Most xenoliths are mafic and all are igneous in origin. Cratonic xenoliths (pl- opx±cpx±gt±hbl) are primarily anhydrous two-pyroxene granulites that likely originated as crystallized high-Ni, Archean basaltic melts. Xenoliths from the Mozambique belt are dominated by mafic granulites (pl-cpx-gt±opx) at Lashaine and banded, mafic to intermediate granulites at Naibor Soito. Positive Sr and Eu anomalies imply that the Lashaine granulites originated as plagioclase cumulates. The wide range in SiO2 (47-65 wt%) and correlation of Ni-MgO in the Naibor Soito xenoliths suggests they may have originated as igneous rocks that subsequently underwent partial melting to form the mafic (pl- opx±cpx±gt±hbl±bt) and felsic bands (pl-qtz-opx±kfs). U-Pb zircon ages for xenoliths from both terranes are Archean, as are most TDM ages, though younger TDM ages are seen in some Lashaine samples that were contaminated by rift magma. High pressures (up to 2.7GPa) are recorded by the Mozambique belt xenoliths, suggesting equilibration in thickened crust during the East African orogeny, but no igneous activity related to metamorphism has been detected and our samples suggest that the Tanzanian lower crust has persisted without significant chemical modification since the Archean. Proterozoic magmatism is also absent from the upper crust in this section of the Mozambique belt, raising the question of the heat source during metamorphism.
Mansur, A. T.; Manya, S.; Rudnick, R.
Tropical mountain ecosystems with their mostly immense biodiversity are important regions for natural resources but also for agricultural production. Their supportive ecosystem processes are particularly vulnerable to the combined impacts of global warming and the conversion of natural to human-modified landscapes. Data of impacts of climate and land use change on soil-atmosphere interactions due to GHG (CO2, CH4, and N2O) exchange from these ecosystems are still scarce, in particular for Africa. Tropical forest soils are underestimated as sinks for atmospheric CH4 with regard to worldwide GHG budgets (Werner et al. 2007, J GEOPHYS RES Vol. 112). Even though these soils are an important source for the atmospheric N2O budget, N2O emissions from tropical forest ecosystems are still poorly characterized (Castaldi et al. 2013, Biogeosciences 10). To obtain an insight of GHG balances of selected ecosystems soil-atmosphere exchange of N2O, CH4 and CO2 was investigated along the southern slope of Mt. Kilimanjaro, Tanzania. We will present results for tropical forests in three different altitudes (lower montane, Ocotea, and Podocarpus forest), home garden (extensive agro-forestry), and coffee plantation (intensive agro-forestry). Therefore we used a combined approach consisting of a laboratory parameterization experiment (3 temperature and 2 moisture levels) and in situ static chamber measurements for GHG exchange. Field measurements were conducted during different hygric seasons throughout two years. Seasonal variation of temperature and especially of soil moisture across the different ecosystems resulted in distinct differences in GHG exchange. In addition environmental parameters like soil bulk density and substrate availability varying in space strongly influenced the GHG fluxes within sites. The results from parameterization experiments and in situ measurements show that natural forest ecosystems and extensive land use had higher uptakes of CH4. For the investigated forest ecosystems we found considerable differences in soil sink strength for CH4. N2O emissions were highest in natural forest ecosystems even though N input in the intensively managed system was considerably higher. Highest N2O efflux rates were identified in the region of highest mean annual precipitation. CO2 emissions reduced from managed to natural ecosystems. In general an increase in temperature as well as in soil moisture caused higher GHG fluxes throughout all investigated natural and managed ecosystems. With increasing altitude of the investigated forests GHG emissions reduced overall.
Gerschlauer, Friederike; Kikoti, Imani; Kiese, Ralf
The continental crust is stratified in composition; the upper crust is generally enriched in highly incompatible trace elements relative to the lower crust . The Western Granulite section of the Mozambique Belt of Northern Tanzania yields Archean Nd model ages and has zircons with U-Pb ages of ~2.6 Ga [2,3], but was strongly re-worked during the Pan-African Orogeny, ca. 560 Ma [2,3,4]. Here we use time-integrated Pb isotopic modeling for lower and middle crustal xenoliths, as well as upper crustal granulites to determine the timing of, and degree of intra-crustal differentiation. The Pb isotopic compositions of most feldspars in the lower crustal samples, measured via LA-MC-ICPMS, fall on the trend defined by the Tanzanian Craton  and therefore, were most likely extracted from the mantle at a similar time, ca. 2.7 Ga. However, some xenoliths fall off this trend and show enrichment in 207Pb/204Pb, which we interpret as reflecting derivation from more heterogeneous mantle than that sampled in the Tanzanian Craton. In contrast to lower crustal xenoliths from the Tanzanian Craton , we see no single feldspar Pb-Pb isochrons, which indicates complete re-homogenization of the Pb isotopic composition of the feldspars in the lower crust of the Mozambique Belt during the Pan-African Orogeny, and heating to > 600°C . Using time integrated Pb modeling, the upper crust of the Western Granulites is enriched in U by ˜ 2.5 relative to that of the lower crust, which must have taken place around the time of mantle extraction (ca. 2.7 Ga). In addition, these calculations are consistent with a Th/U ratio of ˜ 4 for the bulk lower crust and ˜ 3 for the bulk upper crust. The common Pb isotopic composition of a single middle crustal xenolith implies a Th/U of 20, but is unlikely to be generally representative of the middle crust.  Rudnick, R. L. and Gao, S. (2003). In the Crust, vol. 3, Treatise on Geochemistry:1-64.  Mansur, A. (2008) Masters Thesis, University of Maryland College-Park, http://hdl.handle.net/1903/8993  Johnson, S. P et al. (2003). Tectonophysics, 375(1-4):125-145.  Blondes, M. S. et al. (2009). EOS Transactions, AGU, Fall Meeting(V13E-2073).  Bellucci, J. J. et al. (2010). Earth and Planetary Science Letters, in review.
Bellucci, J. J.; McDonough, W. F.; Rudnick, R. L.; Walker, R. J.
Background Feeding practices and child undernutrition can be improved when trained health workers provide proper nutrition counseling to caregivers. However, this important management component is difficult to achieve in countries where trained health workers are limited; Tanzania is no exception. In rural and semi-urban areas, mid-level providers (MLPs) are left to manage diseases such as HIV/AIDS. Training health workers in nutrition has been shown to be an effective intervention among HIV-negative children elsewhere, but no studies have been conducted among HIV-positive children. Furthermore, in Tanzania and other countries with MLPs, no evidence currently exists demonstrating an improvement in nutrition among children who receive health services given by MLPs. This study thus aims to examine the efficacy of nutrition training of MLPs on feeding practices and the nutrition status of HIV-positive children in Tanga, Tanzania. Methods/Design We will conduct a cluster randomized controlled trial in care and treatment centers (CTCs) in Tanga, Tanzania. The CTCs will be the unit of randomization. We will select 16 CTCs out of 32 for this study, of which we will randomly assign 8 to the intervention arm and 8 to the control arm by coin flipping. From the selected CTCs we will attempt to recruit a total of 800 HIV-positive children aged 6 months to 14 years, half of whom will be receiving care and/or treatment in the CTCs of the intervention arm, and the other half of whom will be receiving care and/or treatment in the CTCs of the control arm (400 children in each condition). We will provide nutrition training to MLPs of the CTCs selected for the intervention arm. In this intervention, we will use the World Health Organization guidelines on nutrition training of health workers for HIV-positive children aged 6 months to 14 years. The trained MLPs will then provide tailored nutrition counseling to caregivers of children being treated at the 8 CTCs of the intervention arm. We will measure nutrition status and child feeding practices monthly for a total of six months. Conclusions Results of this trial will help expanding undernutrition interventions among HIV-positive children in Tanzania and other countries. Trial registration Current Controlled Trials: ISRCTN65346364. PMID:24156500
of Oxford, UK David Stern Maseno University, Kenya; AIMS-Ghana Balazs Szendroi University of Oxford, UK Rugeihyamu (Chair of LOC), Dar Es Salaam, Tanzania David Stern, Maseno, Kenya; AIMS-Ghana Balazs Szendroi
processes in the peri-urban zone of Dar es Salaam, Tanzania Libby Porter (Lecturer School of Social Friday 11 February 2011 at 4.00pm Venue to be confirmed. Study on Housing Exclusion: Welfare Policies
The issue of language of instruction (LOI) and its effects on education in Tanzanian secondary education has been widely researched since the early 1980s. In 2009, the Ministry of Education and Vocational Training proposed a new education and training policy that allows English to be used as LOI from nursery school to tertiary education. The proposed policy goes against what researchers in this area have recommended over the years. In the light of the proposed policy, the author of this article felt the need to review studies done on LOI in Tanzania from 1974 to date, aiming to eliminate or greatly reduce the negative effects of the policy on education in Tanzania. Quoting examples, the paper demonstrates students' levels of proficiency in English; suggests reasons why governmental policy has over time ignored research findings; and recommends as well as proposes the way forward.
Qorro, Martha A. S.
Ticks and tick-borne diseases are important in human and livestock health worldwide. In November 2012, ixodid ticks were collected and identified morphologically from cattle and wild animals in the Maswa district and Iringa urban, Tanzania. Amblyomma gemma, A. lepidum, and A. variegatum were identified from Maswa cattle, and A. variegatum was the predominant species. A. marmoreum, Hyalomma impeltatum, and Rhipicephalus pulchellus were identified from Iringa cattle in addition to the above 3 Amblyomma species, and A. gemma was the most abundant species. Total 4 Amblyomma and 6 Rhipicephalus species were identified from wild animals of the 2 areas. A. lepidum was predominant in Maswa buffaloes, whereas A. gemma was predominant in Iringa buffaloes. Overall, A. variegatum in cattle was predominant in the Maswa district and A. gemma was predominant in Iringa, Tanzania. PMID:25352709
Kwak, You Shine; Kim, Tae Yun; Nam, Sung-Hyun; Lee, In-Yong; Kim, Hyung-Pyo; Mduma, Simon; Keyyu, Julius; Fyumagwa, Robert
In 2008, a government hospital in southwest Tanzania added a "first-class ward," which, unlike existing inpatient wards defined by sex, age, and ailment, would treat patients according to their wealth. A generation ago, Tanzanians viewed health care as a right of citizenship. In the 1980s and 1990s, structural adjustment programs and user fees reduced people's access to biomedical attention. Tanzania currently promotes "amenity" wards and health insurance to increase health care availability, generate revenue from patients and potential patients, and better integrate for-profit care. In this article, I examine people's discussions of these changes, drawing on ethnographic fieldwork in the 2000s and 1990s. I argue that Tanzanians criticize unequal access to care and health insurance, although the systemic structuring of inequalities is becoming normalized. People transform the language of socialism to frame individualized market-based care as mutual interdependence and moral necessity, articulating a new biomedical citizenship. PMID:24753314
The Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) was established in 2008 as a partnership among the Ministry of Health and Social Welfare (MOHSW), Muhimbili University of Health and Allied Sciences, National Institute for Medical Research, and local and international partners. TFELTP was established to strengthen the capacity of MOHSW to conduct public health surveillance and response, manage national disease control and prevention programs, and to enhance public health laboratory support for surveillance, diagnosis, treatment and disease monitoring. TFELTP is a 2-year full-time training program with approximately 25% time spent in class, and 75% in the field. TFELTP offers two tracks leading to an MSc degree in either Applied Epidemiology or, Epidemiology and Laboratory Management. Since 2008, the program has enrolled a total of 33 trainees (23 males, 10 females). Of these, 11 were enrolled in 2008 and 100% graduated in 2010. All 11 graduates of cohort 1 are currently employed in public health positions within the country. Demand for the program as measured by the number of applicants has grown from 28 in 2008 to 56 in 2011. While training the public health leaders of the country, TFELTP has also provided essential service to the country in responding to high-profile disease outbreaks, and evaluating and improving its public health surveillance systems and diseases control programs. TFELTP was involved in the country assessment of the revised International Health Regulations (IHR) core capabilities, development of the Tanzania IHR plan, and incorporation of IHR into the revised Tanzania Integrated Disease Surveillance and Response (IDSR) guidelines. TFELTP is training a competent core group of public health leaders for Tanzania, as well as providing much needed service to the MOHSW in the areas of routine surveillance, outbreak detection and response, and disease program management. However, the immediate challenges that the program must address include development of a full range of in-country teaching capacity for the program, as well as a career path for graduates. PMID:22359697
Mmbuji, Peter; Mukanga, David; Mghamba, Janeth; Ahly, Mohamed; Mosha, Fausta; Azima, Simba; Senga, Sembuche; Moshiro, Candida; Semali, Innocent; Rolle, Italia; Wiktor, Stefan; McQueen, Suzzane; McElroy, Peter; Nsubuga, Peter
Leptospirosis is the zoonosis of worldwide distribution and common cause of economic loss and ill health among animals and\\u000a human populations. A cross-sectional seroprevalence study, using a microscopic agglutination test (MAT) with a threshold titre\\u000a of ?1:160, to elucidate disease magnitude, distribution and associated risk factors in cattle in Tanga, Tanzania was conducted\\u000a from May 2003 to January 2004. Serum
L. Schoonman; Emanuel Senyael Swai
The macrobenthic (coral, algae, and sea urchins) and fish communities in 15 back-reef sites on the patch and rock-island reefs of southern Kenya and northern Tanzania (?250 km of coastline) were studied in order to (1) test an overfishing model developed in Kenya’s fringing reef (McClanahan, 1995a, A coral reef ecosystem-fisheries model: impacts of fishing intensity and catch selection on
T. R. McClanahan; N. A. Muthiga; A. T. Kamukuru; H. Machano; R. W. Kiambo
This study examines the behavioral ecology of a chimpanzee population on Rubondo Island in Lake Victoria, Tanzania, over 40years after chimpanzees were first introduced to the island from captivity. Despite little pre-release habitat assessment, rehabilitation, or post-release monitoring, these chimpanzees are one of the only released populations to survive over decades without provisioning. We surveyed habitat structure and plant composition
Liza R. Moscovice; Frank Mbago; Charles T. Snowdon; Michael A. Huffman
This article uses the revealed preference, willingness-to-pay approach to estimate the benefits in a cost-benefit analysis of a condom social marketing (CSM) programme in Tanzania. The demand curve used to derive the consumer surplus had unit elasticity and it was estimated from a cross-sectional sample of 1272 persons. People were willing to pay different prices for the condoms because perceived
This study presents the results of an environmental assessment of mercury (Hg) contamination in the Rwamagasa artisanal gold mining area, northwest Tanzania, and the potential downstream dispersion along the River Malagarasi to Lake Tanganyika. At the time of sampling, generally low concentrations of Hg (<0.05 mg\\/kg) occurred in most cultivated soils although higher Hg (0.05–9.2 mg\\/kg) was recorded in urban
H. Taylor; J. d. Appletonsupasu; R. Lister; B. Smith; D. Chitamweba; O. Mkumbo; J. F. Machiwa; A. L. Tesha; C. Beinhoff
This paper evaluates effects of community-level women's property and inheritance rights on women's economic outcomes using a 13 year longitudinal panel from rural Tanzania. In the preferred model specification, inverse probability weighting is applied to a woman-level fixed effects model to control for individual-level time invariant heterogeneity and attrition. Results indicate that changes in women's property and inheritance rights are
River-bed sediments from the Pangani basin, Tanzania, were characterized for elemental compositions, following contamination risks from rapid expansions of human activities in the area. Samples were collected during two individual seasons and analyzed by high-polarizing beam energy dispersive X-ray fluorescence (EDXRF) for eight major and 14 trace elements. Evaluation of enrichment factors (EFs) was used to investigate the elemental flux
Harieth Hellar-Kihampa; Sanja Potgieter-Vermaak; Katleen Van Meel; Giuliana Gatto Rotondo; Michael Kishimba; Réne Van Grieken
In September, Human Rights Watch posted five new reports on their Website. The first, Seeking Protection: Addressing Sexual and Domestic Violence in Tanzania's Refugee Camps, is a 151-page indictment of the United Nation's High Commission for Refugees and the Tanzanian host government's failure to address violence against Burundi women refugees in Tanzanian camps in a "timely and effective manner, despite ample evidence that women's lives were in danger in their homes and in the general camp community."
The fundamental base of volcanic hazard assessment on any volcano is the study of its most recent eruptive history. Although the presence of extensive surficial pumice deposits was long known in the Rungwe Volcanic Province (RVP, SW Tanzania, East African Rift), the recent eruptive history was never studied in detail and is presented here for the first time. The RVP had several Plinian-style explosive eruptions in its Holocene history, originating from the two main volcanoes, Rungwe and Ngozi. Field observations are combined with whole-rock major (ICP-OES) and trace (ICP-MS) element analyses as well as major element analyses (EMPA) on glass. 14C ages of paleosols constrain all recognized deposits to <10 ka. Trace element data, e.g. Zr/Y ratios, allow discriminating between Ngozi and Rungwe as deposit source. All studied samples are trachyte to phonolitic trachyte. A ~30 m long sediment core in the Masoko maar lake (26 and 42 km SSE of Rungwe and Ngozi resp.) reveals >60 tephra layers deposited during the last 50 ky. Its Holocene record shows 7 tephra layers of which 2 (10.2 and 4.35 ka calBP) contain abundant pumice lapilli. Based on chemical constraints, the oldest of these pumice layers is believed to correspond to the Kitulo Pumice, the oldest on-land deposit found, originating from Ngozi. This eruption likely formed the 3 x 3 km Ngozi caldera. The 4.35 ka calBP pumice layer in the Masoko core was correlated with a Plinian pumice fallout deposit from Rungwe, the Rungwe Pumice, based on its appearance and paleosol 14C dating. It was traced over an area of ~1,500 km2 and probably extends even further. The Rungwe Pumice postdates a debris avalanche that was generated by a flank collapse of the volcano. This collapse left an amphitheatre-shaped depression on the summit that is now filled with domes, cones and explosion craters produced by effusive and explosive eruptions. A second large explosive eruption from Rungwe, the Isongole Pumice, is underlain by a 2.0 ± 0.1 ka calBP old paleosol. This deposit can easily be traced in the field due to its characteristic lithic content, being very lithic-rich at the base and lithic-poor at the top. It is believed to result from a blast through a Rungwe summit lava dome. The deposit morphology is cone-like rather than sheet-like and thus likely results from a moderate-size event. Two smaller explosive eruptions are <1 ka old. The oldest one is called Aphyric Pumice because of its characteristic aphyric nature, and is underlain by a 600 ± 35 a calBP old paleosol. Its Zr/Y ratios suggest it belongs to Ngozi rather than to Rungwe. The younger deposit is the Kizungu Tephra, originating from Rungwe. At the time of writing, no dating for this deposit exists yet. The youngest recognized deposit is made up of pyroclastic flow deposits from Ngozi, extending at least 10 km S of the volcano. A paleosol underneath the deposits was dated at 505 ± 44 a calBP. The stratigraphic record shows that both Ngozi and Rungwe experienced several large explosive eruptions, including eruptions forming pyroclastic flows, in their recent past. The late Holocene record is characterized by ca. 1 Rungwe eruption every 1 ky and calls for a thorough volcanic hazard assessment in this densely populated area.
Fontijn, K.; Ernst, G. G.; Elburg, M. A.; Williamson, D.; Jacobs, P.
Background Bowel obstruction resulting from intestinal tuberculosis has been reported to be more prevalent in developing countries including Tanzania. This study was undertaken to describe the clinicopathological profile, surgical management and outcome of tuberculous intestinal obstruction in our local setting and to identify factors responsible for poor outcome among these patients. Methods This was a prospective descriptive study of patients operated for tuberculous intestinal obstruction at Bugando Medical Centre (BMC) in northwestern Tanzania from April 2008 to March 2012. Ethical approval to conduct the study was obtained from relevant authorities. Statistical data analysis was performed using SPSS version 17.0. Results A total of 118 patients with tuberculous intestinal obstruction were studied. The male to female ratio was 1.8: 1. The median age was 26 years (range 11-67 years). The modal age group was 21-30 years. Thirty-one (26.3%) patients had associated pulmonary tuberculosis and 25 (21.2%) patients were HIV positive with a median CD4+ count of 225 cells /?l. Small bowel strictures were the most common operative findings accounting for 72.9% of cases. The ileo-caecal region was the commonest area of involvement in 68 (57.6%) patients. The right hemicolectomy with ileo-transverse anastomosis was the most frequent surgical procedure performed in 66 (55.9%) patients. Postoperatively all the patients received antituberculous drugs for a period of one year. Postoperative complication rate was 37.3% and surgical site infection (SSI) was the most frequent complication in 42.8% of cases. HIV positivity and low CD4+ count were the main predictors of SSI (p?0.001). The overall median length of hospital stay was 24 days. Patients who had postoperative complications stayed longer in the hospital and this was statistically significant (p?=?0.011). Mortality rate was 28.8% and it was significantly associated with co-existing medical illness, delayed presentation, HIV positivity, low CD 4 count (<200 cells/?l), ASA class and presence of complications (p?0.001). The follow up of patients was generally poor as more than fifty percent of patients were lost to follow up. Conclusion Tuberculous bowel obstruction remains rampant in our environment and contributes significantly to high morbidity and mortality. The majority of patients present late when the disease becomes complicated. A high index of suspicion, proper evaluation and therapeutic trial in suspected patients is essential for an early diagnosis and timely definitive treatment, in order to decrease the morbidity and mortality associated with this disease. PMID:23497503
Background Intermittent preventive treatment during pregnancy (IPTp) at routine antenatal care (ANC) clinics is an important and efficacious intervention to reduce adverse health outcomes of malaria infections during pregnancy. However, coverage for the recommended two IPTp doses is still far below the 80% target in Tanzania. This paper investigates the combined impact of pregnant women's timing of ANC attendance, health workers' IPTp delivery and different delivery schedules of national IPTp guidelines on IPTp coverage. Methods Data on pregnant women's ANC attendance and health workers' IPTp delivery were collected from ANC card records during structured exit interviews with ANC attendees and through semi-structured interviews with health workers in south-eastern Tanzania. Women's timing of ANC visits and health worker's timing of IPTp delivery were analyzed in relation to the different national IPTp schedules and the outcome on IPTp coverage was modelled. Results Among all women eligible for IPTp, 79% received a first dose of IPTp and 27% were given a second dose. Although pregnant women initiated ANC attendance late, their timing was in line with the national guidelines recommending IPTp delivery between 20-24 weeks and 28-32 weeks of gestation. Only 15% of the women delayed to the extent of being too late to be eligible for a first dose of IPTp. Less than 1% of women started ANC attendance after 32 weeks of gestation. During the second IPTp delivery period health workers delivered IPTp to significantly less women than during the first one (55% vs. 73%) contributing to low second dose coverage. Simplified IPTp guidelines for front-line health workers as recommended by WHO could lead to a 20 percentage point increase in IPTp coverage. Conclusions This study suggests that facility and policy factors are greater barriers to IPTp coverage than women's timing of ANC attendance. To maximize the benefit of the IPTp intervention, revision of existing guidelines is needed. Training on simplified IPTp messages should be consolidated as part of the extended antenatal care training to change health workers' delivery practices and increase IPTp coverage. Pregnant women's knowledge about IPTp and the risks of malaria during pregnancy should be enhanced as well as their ability and power to demand IPTp and other ANC services. PMID:21599999
Background Traditional medicine is readily available in Tanzania, and local terms like degedege is widely used for malaria-like illnesses, often associated with supernatural forces. Malaria prevention and intervention efforts can benefit from policy-makers’ awareness of local perceptions and beliefs in the rural areas affected by malaria. This study measured knowledge, attitudes and behaviour towards malaria and malaria-like illnesses. Methods A cross-sectional survey was conducted in a rural area in Rufiji, Tanzania. A case report form employing a scoring system was used to capture participants’ knowledge of malaria and another for preventive actions against malaria. Logistic regression was used to assess factors associated with knowledge and preventive action. Results Most of the participants possessed good knowledge about malaria transmission (82.1%), prevention (85.2%) and where to get treatment (96.4%). Fewer were familiar with fever (58.2%) and other common symptoms of malaria (32.7%), and even fewer actually put their knowledge into action. The action score measured the use of bed net, treatment of nets, indoor use of insecticide residual spraying (IRS), and proportion of households with tight windows, among the participants. As many as 35.7% scored zero on preventive actions, while 37.2% achieved a high action score. Education level and belonging to the age group 30 to 49 were significantly associated with higher knowledge. Education level was associated with higher score for preventive action (OR 2.3, CI 95% 1.2-1.4). Participants generally perceived degedege, a local name for an illness with convulsion, as different from malaria both with regards to cause and possible preventive and curative interventions. Conclusion Respondents considered degedege to have supernatural causes and to need treatment by a traditional healer. This may be one reason for care-seeking shopping and care-seeking delay. Regarding degedege as a separate entity may explain why malaria is not perceived as a serious health problem in the area, and why little preventive actions are taken. While the elders have high status in the society, their lack of knowledge of malaria may impact the care-seeking pattern of their families. PMID:24885180
Background There is increasing evidence to suggest that different Mycobacterium tuberculosis lineages cause variations in the clinical presentation of tuberculosis (TB). Certain M. tuberculosis genotypes/lineages have been shown to be more likely to cause active TB in human populations from a distinct genetic ancestry. This study describes the genetic biodiversity of M. tuberculosis genotypes in Mwanza city, Tanzania and the clinical presentation of the disease caused by isolates of different lineages. Methods Two-hundred-fifty-two isolates from pulmonary TB patients in Mwanza, Tanzania were characterized by spoligotyping, and 45 isolates were further characterized by mycobacterium interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR). The patients’ level of the acute phase reactants AGP, CRP and neutrophil counts, in addition to BMI, were measured and compared to the M. tuberculosis lineage of the infectious agent for each patient. Results The most frequent genotype was ST59 (48 out of 248 [19.4%]), belonging to the Euro-American lineage LAM11_ZWE, followed by ST21 (CAS_KILI lineage [44 out of 248 [17.7%]). A low degree of diversity (15.7% [39 different ST’s out of 248 isolates]) of genotypes, in addition to a high level of mixed M. tuberculosis sub-populations among isolates with an unreported spoligotype pattern (10 out of 20 isolates [50.0%]) and isolates belonging to the ST53 lineage (13 out of 25 [52%]) was observed. Isolates of the ‘modern’ (TbD1-) Euro-American lineage induced higher levels of ?1-acid glycoprotein (? = 0.4, P = 0.02; 95% CI [0.06-0.66]) and neutrophil counts (? = 0.9, P = 0.02; 95% CI [0.12-1.64]) and had lower BMI score (? = -1.0, P = 0.04; 95% CI[-1.89 – (-0.03)]). LAM11_ZWE (‘modern’) isolates induced higher levels of CRP (? = 24.4, P = 0.05; 95% CI[0.24-48.63]) and neutrophil counts (? = 0.9, P = 0.03; 95% CI[0.09-1.70]). Conclusion The low diversity of genotypes may be explained by an evolutionary advantage of the most common lineages over other lineages combined with optimal conditions for transmission, such as overcrowding and inadequate ventilation. The induction of higher levels of acute phase reactants in patients infected by ‘modern’ lineage isolates compared to ‘ancient’ lineages may suggest increased virulence among ‘modern’ lineage isolates. PMID:24903071
The Mozambique belt (MB) of East Africa contains large areas of granulite-facies rocks as well as migmatitic orthogneisses of Neoproterozoic, Palaeoproterozoic and Archaean age. The studied area is situated in central Tanzania along the Great Ruaha River where granitoid orthogneisses are interlayered with granulite-facies migmatitic metasediments. Our study concentrated on the evolution of mineral assemblages, fluid inclusions and zircon geochronology to constrain the evolution of high-grade metamorphic rocks. Mineral data suggests a clockwise PT-path with the peak assemblage Grt-Bt-Ky-Kf-Plg±Ox±melt and the retrograde assemblage Grt-Bt-Sill-Ms-Kf-Plg-Qtz±Ox. This is consistent with the presence of Ky inclusions, complete chemical homogenisation in the core of garnets, and a well developed retrograde zoning pattern in the outermost garnet rims. The positions of the melt-bearing peak metamorphic assemblage and the melt-free retrograde assemblage in PT-space were estimated using bulk composition dependent pseudo-sections (Thermocalc software), whereas the exact PT-conditions for formation of the granulites and the retrograde overprint were calculated from mineral compositions using the Vertex software. The granulites reveal PT-conditions of 12-13 kbar at 700-800 oC. Retrogression and the release of fluids from crystallising melt occurred at ~7 kbar and 650-700 oC. The fluid inclusions study has shown two non-mixing groups consisting of H2O-NaCl and H2O-CO2 mixtures. We suggest that these two groups represent trapped fluids from in-situ crystallised melt. The PT-conditions did not allow for mixing of the above components, resulting in the appearance of two groups of inclusions with different composition. The granulite-facies event was dated using the Pb-Pb single zircon evaporation method, and the estimated age of ~640 Ma is consistent with ages from other parts of the MB in Tanzania, but slightly higher than in Mozambique and significantly higher than in Malawi.
Sommer, H.; Kröner, A.; Konopasek, J.; Hauzenberger, C.; Muhongo, S.
In this study we explore the potential for re-insurance schemes built on regional climatic forecasts. We focus on micro-insurance contracts indexed on precipitation in 9 villages in Kenya, Tanzania (Eastern Africa) and Malawi (Southern Africa), and analyze the precipitation patterns and payouts resulting from El Niño Southern Oscillation (ENSO). The inability to manage future climate risk represents a “poverty trap” for several African regions. Weather shocks can potentially destabilize not only household, but also entire countries. Governments in drought-prone countries, donors and relief agencies are becoming aware of the importance to develop an ex-ante risk management framework for weather risk. Joint efforts to develop innovative mechanisms to spread and pool risk such as microinsurance and microcredit are currently being designed in several developing countries. While ENSO is an important component in modulating the rainfall regime in tropical Africa, the micro-insurance experiments currently under development to address drought risk among smallholder farmers in this region do not take into account ENSO monitoring or forecasting yet. ENSO forecasts could be integrated in the contracts and reinsurance schemes could be designed at the continental scale taking advantage of the different impact of ENSO on different regions. ENSO is associated to a bipolar precipitation pattern in Southern and Eastern Africa. La Niña years (i.e. Cold ENSO Episodes) are characterized by dry climate in Eastern Africa and wet climate in Southern Africa. During El Niño (or Warm Episode) the precipitation dipole is inverted, and Eastern Africa experiences increased probability for above normal rainfall (Halpert and Ropelewski, 1992, Journal of Climate). Our study represents the first exercise in trying to include ENSO forecasts in micro weather index insurance contract design. We analyzed the contracts payouts with respect to climate variability. In particular (i) we simulated possible payouts using historical precipitation data and analyzed the differences between years with different ENSO states from 1961 to 2005; (ii) we applied Monte Carlo methods to simulate precipitation distributions in each location and calculated the mean and variance of payouts associated to different ENSO states. The results obtained from historical precipitation data indicate that more abundant rainfall reduces payouts and the risk of loan default during La Niña in southern Kenya and Malawi, during El Niño in Tanzania. The results of the Monte Carlo simulations confirm our findings. Our results suggest that re-insurance schemes could be successfully designed to exploit the anti-correlation patterns related to interannual climate variability for different regions in Africa. Moreover, the exploratory framework presented can potentially be refined applied to other regions (e.g. Central and Latin America).
Vicarelli, M.; Giannini, A.; Osgood, D.
Background Although antenatal care coverage in Tanzania is high, worrying gaps exist in terms of its quality and ability to prevent, diagnose or treat complications. Moreover, much less is known about the utilisation of postnatal care, by which we mean the care of mother and baby that begins one hour after the delivery until six weeks after childbirth. We describe the perspectives and experiences of women and health care providers on the use of antenatal and postnatal services. Methods From March 2007 to January 2008, we conducted in-depth interviews with health care providers and village based informants in 8 villages of Lindi Rural and Tandahimba districts in southern Tanzania. Eight focus group discussions were also conducted with women who had babies younger than one year and pregnant women. The discussion guide included information about timing of antenatal and postnatal services, perceptions of the rationale and importance of antenatal and postnatal care, barriers to utilisation and suggestions for improvement. Results Women were generally positive about both antenatal and postnatal care. Among common reasons mentioned for late initiation of antenatal care was to avoid having to make several visits to the clinic. Other concerns included fear of encountering wild animals on the way to the clinic as well as lack of money. Fear of caesarean section was reported as a factor hindering intrapartum care-seeking from hospitals. Despite the perceived benefits of postnatal care for children, there was a total lack of postnatal care for the mothers. Shortages of staff, equipment and supplies were common complaints in the community. Conclusion Efforts to improve antenatal and postnatal care should focus on addressing geographical and economic access while striving to make services more culturally sensitive. Antenatal and postnatal care can offer important opportunities for linking the health system and the community by encouraging women to deliver with a skilled attendant. Addressing staff shortages through expanding training opportunities and incentives to health care providers and developing postnatal care guidelines are key steps to improve maternal and newborn health. PMID:19261181
Mrisho, Mwifadhi; Obrist, Brigit; Schellenberg, Joanna Armstrong; Haws, Rachel A; Mushi, Adiel K; Mshinda, Hassan; Tanner, Marcel; Schellenberg, David
Background Curable, non-viral pathogens account for a significant burden of sexually transmitted infections (STIs), and there is established evidence that STIs increase both HIV acquisition and transmission. We investigated the prevalence, trends, and factors associated with Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Treponema pallidum, and the performance of syndromic management, among a cohort of women working in bars, hotels, and other food and recreational facilities near large-scale mines in northwestern Tanzania. Methods HIV-negative women aged 18–44 years (N?=?966) were enrolled and followed for 12 months in a microbicides feasibility study. We collected sociodemographic and behavioural data, performed clinical examinations, and tested for STIs, at enrolment and 3-monthly. Risk factors for STIs were investigated using logistic regression models with random effects. Sensitivity, specificity and predictive values of syndromic management were calculated. Results At enrolment, the prevalences of C. trachomatis, N. gonorrhoeae, T. vaginalis, and high-titre active syphilis were 111/956 (12%), 42/955 (4%), 184/945 (19%) and 46/965 (5%), respectively. There were significant decreases over time for C. trachomatis and T. vaginalis (OR trend per month: 0.94 [95% CI 0.91, 0.97]; and 0.95 [0.93, 0.98], respectively; both p<0.001). The majority of these infections were not diagnosed by the corresponding syndrome; therefore, most participants were not treated at the diagnosis visit. Syndromic management was poorly predictive of laboratory-diagnosed infections. We identified a number of risk factors for STIs, including low educational level, some sexual behaviours, and ever having been pregnant. Conclusions This analysis demonstrates that the prevalences of curable STIs are high among women who work in food and recreational facilities in northwestern Tanzania. Most of these infections are missed by syndromic management. Accurate and affordable rapid-point-of-care tests and innovative interventions are needed to reduce the burden of STIs in this population which is at increased risk for HIV. PMID:25025338
Francis, Suzanna C.; Ao, Trong T.; Vanobberghen, Fiona M.; Chilongani, Joseph; Hashim, Ramadhan; Andreasen, Aura; Watson-Jones, Deborah; Changalucha, John; Kapiga, Saidi; Hayes, Richard J.
Human health and development are threatened in many parts of the world either from lack of water or poor water quality. Human development has partially contributed to water quality deterioration. In Tanzania, for instance, rapid population growth that caused expansion of agricultural activities, livestock keeping, deforestation, biomass burning and human settlement have exerted pressures within the Lake Victoria Basin. These developments have led to land degradation and increased levels of pollution mainly from non-point sources. The Governments of Kenya, Tanzania and Uganda initiated the program of Lake Victoria Environmental Management Project, (LVEMP), in 1994 to rehabilitate the Lake Ecosystem through restoration and conservation of biodiversity in the lake as well as within the catchment. This paper presents the five years (1997-2002) experience of LVEMP in Tanzania on the issues of water quality; focusing on water pollution, water quality monitoring and LVEMP strategies to accomplish water quality management in the Lake Zone (Kagera, Mara and Mwanza regions). The findings show that non-point source pollution from agricultural practices; as well as unplanned urban settlements contribute more to siltation and eutrophication of the of Lake Victoria than that from point source pollution. Recommendations for water quality management and sustainability are presented.
Machiwa, Praxeda K.
The coconut mite Aceria guerreronis (Eriophyidae) is considered the most important pest of coconut fruits in Africa; however, quantitative knowledge about its distribution and abundance is lacking. We conducted four diagnostic surveys-three in Southern Benin and one along the coast of Tanzania-to determine the distribution of A. guerreronis and the severity of its damage to coconut fruits, as well as the diversity and abundance of other associated mites and potential natural enemies. Aceria guerreronis was found in all visited plantations with the percentage of damaged fruits varying considerably among plantations-67-85% in Benin and 43-81% in Tanzania. Overall, 30-40% of the fruit surfaces were damaged by A. guerreronis. Damage severity increased with fruit age and negatively affected fruit weight of 7- to 12-months-old fruits. Aceria guerreronis was by far the most abundant mite on coconut fruits but its abundance depended on fruit age. The highest densities of A. guerreronis were observed on 3- to 4-months-old fruits. Neocypholaelaps sp. (Ameroseiidae) was the most abundant mite on inflorescences. Three species of predatory mites (Phytoseiidae)-Neoseiulus baraki, N. neobaraki and N. paspalivorus-were the most commonly found predatory mites beneath the coconut bracts in association with A. guerreronis. Neoseiulus neobaraki was the prevailing predator in Tanzania while N. paspalivorus was the most frequent predator in Benin. Other mites found beneath the bracts were the herbivore Steneotarsonemus furcatus (Tarsonemidae) and the detritivore and fungivore Tyrophagus putrescentiae (Acaridae). PMID:21789564
Negloh, K; Hanna, R; Schausberger, P
A habit of eating clay soil especially among pregnant women is a common practice in Tanzania. This practice known as geophagy might introduce toxic elements in the consumer's body to endanger the health of the mother and her child. Therefore it is very important to have information on the elemental composition of the eaten soil so as to assess the safety nature of the habit. In this study 100 samples of clay soil, which were reported to be originating from five regions in Tanzania and are consumed by pregnant women were analyzed to determine their levels of essential and toxic elements. The analysis was carried out using energy dispersive X-ray fluorescent technique (EDXRF) of Tanzania Atomic Energy Commission, Arusha. Essential elements Fe, Zn, Cu, Se and Mn and toxic elements As, Pb, Co, Ni, U and Th were detected in concentrations above WHO permissible limits in some of the samples. The results from this study show that the habit of eating soil is exposing the pregnant mothers and their children to metal toxicity which is detrimental to their health. Hence, further actions should be taken to discourage the habit of eating soil at all levels.
Mwalongo, D.; Mohammed, N. K.
Super-resistant Plasmodium falciparum threatens the effectiveness of sulfadoxine–pyrimethamine in intermittent preventive treatment for malaria during pregnancy. It is characterized by the A581G Pfdhps mutation on a background of the double-mutant Pfdhps and the triple-mutant Pfdhfr. Using samples collected during 2004–2008, we investigated the evolutionary origin of the A581G mutation by characterizing microsatellite diversity flanking Pfdhps triple-mutant (437G+540E+581G) alleles from 3 locations in eastern Africa and comparing it with double-mutant (437G+540E) alleles from the same area. In Ethiopia, both alleles derived from 1 lineage that was distinct from those in Uganda and Tanzania. Uganda and Tanzania triple mutants derived from the previously characterized southeastern Africa double-mutant lineage. The A581G mutation has occurred multiple times on local Pfdhps double-mutant backgrounds; however, a novel microsatellite allele incorporated into the Tanzania lineage since 2004 illustrates the local expansion of emergent triple-mutant lineages. PMID:25061906
Alifrangis, Michael; Schousboe, Mette L.; Ishengoma, Deus; Lusingu, John; Pota, Hirva; Kavishe, Reginald A.; Pearce, Richard; Ord, Rosalynn; Lynch, Caroline; Dejene, Seyoum; Cox, Jonathan; Rwakimari, John; Minja, Daniel T.R.; Lemnge, Martha M.; Roper, Cally
Maternal mortality rates in rural Tanzania are high. In preparation for the introduction of an intervention to reduce maternal deaths by distribution of misoprostol and erythromycin to women living in rural Rorya District, Mara Region, Tanzania, we conducted a limited verbal autopsy by surveying family members of women who died in childbirth in the previous five years. The purpose of this survey was to understand the circumstances surrounding these deaths. Thirty six family members were interviewed. The majority of the deaths occurred on the roadside as the women made their way to a health facility (23/36). Most of the women were delivered by a TBA (16/36) or family member (13/36). The majority of the family members attributed the death of their loved one to bleeding or retained placenta (32/36). Maternal deaths are common in this rural district of Tanzania because of long distances from the health facilities, difficulty finding transportation, costs of transport and hospital, and women's beliefs about being able to deliver at home and fear of medication. There is a need for increased education of women and their families about the benefits of childbirth in a healthcare facility attended by skilled providers. There is also a role for the community distribution of misoprostol to be used as an alternative uterotonic medication if a facility birth is not possible, as the rates of maternal death from hemorrhage are unacceptably high. PMID:25438517
Webber, Gail C; Chirangi, Bwire
Maternal mortality rates in rural Tanzania are high. In preparation for the introduction of an intervention to reduce maternal deaths by distribution of misoprostol and erythromycin to women living in rural Rorya District, Mara Region, Tanzania, we conducted a limited verbal autopsy by surveying family members of women who died in childbirth in the previous five years. The purpose of this survey was to understand the circumstances surrounding these deaths. Thirty six family members were interviewed. The majority of the deaths occurred on the roadside as the women made their way to a health facility (23/36). Most of the women were delivered by a TBA (16/36) or family member (13/36). The majority of the family members attributed the death of their loved one to bleeding or retained placenta (32/36). Maternal deaths are common in this rural district of Tanzania because of long distances from the health facilities, difficulty finding transportation, costs of transport and hospital, and women's beliefs about being able to deliver at home and fear of medication. There is a need for increased education of women and their families about the benefits of childbirth in a healthcare facility attended by skilled providers. There is also a role for the community distribution of misoprostol to be used as an alternative uterotonic medication if a facility birth is not possible, as the rates of maternal death from hemorrhage are unacceptably high. PMID:25508048
Webber, Gail C; Chirangi, Bwire
Since independence in 1961, Tanzania's political ideology (known as Ujamaa-familyhood) has gone hand in hand with the country's education philosophy. The most important feature of this combination is that people should be educated to fit in Tanzania's environment and culture. Education should emancipate man from mental slavery…
Tanzania, a country with low access to essential drugs, receives substantial drug donations (DDs) as in-kind gifts. To support the ongoing health sector reform and to promote a good donation practice, stakeholders' and recipients' views on the appropriateness and acceptability of DDs are of particular interest. The objectives were to collect information on the situation of in-kind DDs in Tanzania, to assess the characteristics of the DD system in Tanzania and to collect stakeholders' and recipients' views on problematic areas in DD processes including all strategies of drug donation. Using a qualitative approach, data were collected through validated postal questionnaires in Swahili and English, which were sent out in June 2001 countrywide to stakeholders of all sectors and levels of decision-making involved in healthcare in Tanzania. Of 1,383 mailed questionnaires, 496 were returned, of which 411 (30%) were eligible for analysis. All respondents perceived in-kind DDs as an important resource to assure drug availability in a context of poverty. Half of the respondents were recipients of in-kind DDs. On average, an estimated 27% of the recipients' drug supply was covered through DDs. The main problem for recipients of all sectors involved in healthcare was the insufficient quantity of DDs for sustainable treatment. Representatives of the public sector asked for more transparency in the DD processes. NGOs and religious facilities with better developed structures raised problems such as shipment fees, insufficient infrastructure and training. Recipients suggested that optimizing communication would have the greatest impact on improving the DD processes. In Tanzania, DDs were highly accepted by recipients and stakeholders. The primary concern of DD recipients was less the quality of drugs, although quality assurance remained an ongoing concern, than the discrepancy between the recipients' needs and the donors' supply. DDs often failed to cover priority needs. Suggestions of recipients for DD process optimization corresponded fully with the principles of the Tanzanian and the World Health Organization (WHO) guidelines for DDs, with the call for better implementation of the guidelines among donors and recipients. PMID:18270501
Mariacher, Gaby Gehler; Mtasiwa, Deo; Wiedenmayer, Karin; Bruppacher, Rudolf; Tanner, Marcel; Hersberger, Kurt E
A national ART program was launched in Tanzania in October 2004. Due to the existence of multiple HIV-1 subtypes and recombinant viruses co-circulating in Tanzania, it is important to monitor rates of drug resistance. The present study determined the prevalence of HIV-1 drug resistance mutations among ART-naive female bar and hotel workers, a high-risk population for HIV-1 infection in Moshi, Tanzania. A partial HIV-1 pol gene was analyzed by single-genome amplification and sequencing in 45 subjects (622 pol sequences total; median number of sequences per subject, 13; IQR 5–20) in samples collected in 2005. The prevalence of HIV-1 subtypes A1, C, and D, and inter-subtype recombinant viruses, was 36%, 29%, 9% and 27%, respectively. Thirteen different recombination patterns included D/A1/D, C/A1, A1/C/A1, A1/U/A1, C/U/A1, C/A1, U/D/U, D/A1/D, A1/C, A1/C, A2/C/A2, CRF10_CD/C/CRF10_CD and CRF35_AD/A1/CRF35_AD. CRF35_AD was identified in Tanzania for the first time. All recombinant viruses in this study were unique, suggesting ongoing recombination processes among circulating HIV-1 variants. The prevalence of multiple infections in this population was 16% (n?=?7). Primary HIV-1 drug resistance mutations to RT inhibitors were identified in three (7%) subjects (K65R plus Y181C; N60D; and V106M). In some subjects, polymorphisms were observed at the RT positions 41, 69, 75, 98, 101, 179, 190, and 215. Secondary mutations associated with NNRTIs were observed at the RT positions 90 (7%) and 138 (6%). In the protease gene, three subjects (7%) had M46I/L mutations. All subjects in this study had HIV-1 subtype-specific natural polymorphisms at positions 36, 69, 89 and 93 that are associated with drug resistance in HIV-1 subtype B. These results suggested that HIV-1 drug resistance mutations and natural polymorphisms existed in this population before the initiation of the national ART program. With increasing use of ARV, these results highlight the importance of drug resistance monitoring in Tanzania. PMID:25003939
Kiwelu, Ireen E.; Novitsky, Vladimir; Kituma, Elimsaada; Margolin, Lauren; Baca, Jeannie; Manongi, Rachel; Sam, Noel; Shao, John; McLane, Mary F.; Kapiga, Saidi H.; Essex, M.
Background Since 2008, Tanzanian guidelines for prevention of mother-to-child-transmission of HIV (PMTCT) recommend combination regimen for mother and infant starting in gestational week 28. Combination prophylaxis is assumed to be more effective and less prone to resistance formation compared to single-drug interventions, but the required continuous collection and intake of drugs might pose a challenge on adherence especially in peripheral resource-limited settings. This study aimed at analyzing adherence to combination prophylaxis under field conditions in a rural health facility in Kyela, Tanzania. Methods and Findings A cohort of 122 pregnant women willing to start combination prophylaxis in Kyela District Hospital was enrolled in an observational study. Risk factors for decline of prophylaxis were determined, and adherence levels before, during and after delivery were calculated. In multivariate analysis, identified risk factors for declining pre-delivery prophylaxis included maternal age below 24 years, no income-generating activity, and enrolment before 24.5 gestational weeks, with odds ratios of 5.8 (P?=?0.002), 4.4 (P?=?0.015) and 7.8 (P?=?0.001), respectively. Women who stated to have disclosed their HIV status were significantly more adherent in the pre-delivery period than women who did not (P?=?0.004). In the intra- and postpartum period, rather low drug adherence rates during hospitalization indicated unsatisfactory staff performance. Only ten mother-child pairs were at least 80% adherent during all intervention phases; one single mother-child pair met a 95% adherence threshold. Conclusions Achieving adherence to combination prophylaxis has shown to be challenging in this rural study setting. Our findings underline the need for additional supervision for PMTCT staff as well as for clients, especially by encouraging them to seek social support through status disclosure. Prophylaxis uptake might be improved by preponing drug intake to an earlier gestational age. Limited structural conditions of a healthcare setting should be taken into serious account when implementing PMTCT combination prophylaxis. PMID:21695214
Kirsten, Inga; Sewangi, Julius; Kunz, Andrea; Dugange, Festo; Ziske, Judith; Jordan-Harder, Brigitte; Harms, Gundel; Theuring, Stefanie
Background Early childhood dental caries impacts on the quality of life of children and their families. This study set out to assess the psychometric properties of an oral health related quality of life, OHRQoL, measure, based on items emanating from the Child-and Family impact sections of the Early Childhood Oral Health Impact Scale (ECOHIS), in Kiswahili and Luganda speaking communities. It was hypothesized that the Child- and Family impact scores would discriminate between children with and without clinically defined dental problems and reported good and bad oral health. Method Kiswahili and Luganda versions of the Child- and Family impact scores were derived through translation in pilot studies. Totals of 1221 and 816 child/caretaker pairs attending health care facilities in Manyara, Tanzania and Kampala, Uganda, were recruited into the study. After caretakers completed the interview, their children underwent oral clinical examination. Results Internal consistency reliability (Cronbach’s alpha) was > 0.80 with respect to the Child impact score and 0.79 regarding the Family impact score. Multiple variable logistic- and Poisson regression analyses revealed that the Kiswahili and Luganda versions of the Child- and Family impact score associated in the expected direction with child’s oral diseases as with their reported health and oral health status. In Manyara, multiple logistic regression revealed that the ORs of reporting Child impacts were 1.8 (95% CI 1.0-3.4) and 2.2 (1.3-3.4) among caretakers who confirmed linear hypoplasia and teething symptoms, respectively. In Kampala, the ORs for reporting Child impacts were 2.3 (95% CI 1.3-3.9), 1.7 (95% CI 1.1-2.5), 1.6 (95% CI 1.2-2.3) and 2.7 (95% CI 1.3-5.8) among those who confirmed teeth present, hypoplasia, teething symptoms and tooth bud extractions, respectively. The odds ratios for reporting Family impacts were 2.7 (95% CI 1.5-4.7), 1.5 (95% CI 1.1- 2.1) and 4.6 (95% CI 2.0-10.7) if reporting LEH, teething symptoms and toothbud experience, respectively. Conclusion The Child and Family impact scores demonstrated acceptable internal consistency reliability and reproducibility whereas the discriminative validity was more ambiguous. The OHRQoL scores should be developed further and tested among Kiswahili and Luganda speaking caretakers. PMID:23016603
Background With a decline of infant mortality rates, neonatal mortality rates are striking high in development countries particularly sub Saharan Africa. The toolkit for high quality neonatal services describes the principle of patient satisfaction, which we translate as mother’s involvement in neonatal care and so better outcomes. The aim of the study was to assess mothers’ experiences, perception and satisfaction of neonatal care in the hospitals of Kilimanjaro region of Tanzania. Methods A cross sectional study using qualitative and quantitative approaches in 112 semi structured interviews from 14 health facilities. Open ended questions for detection of illness, care given to the baby and time spent by the health worker for care and treatment were studied. Probing of the responses was used to extract and describe findings by a mix of in-depth interview skills. Closed ended questions for the quantitative variables were used to quantify findings for statistical use. Narratives from open ended questions were coded by colours in excel sheet and themes were manually counted. Results 80 mothers were interviewed from 13 peripheral facilities and 32 mothers were interviewed at a zonal referral hospital of Kilimanjaro region. 59 mothers (73.8%) in the peripheral hospitals of the region noted neonatal problems and they assisted for attaining diagnosis after a showing a concern for a request for further investigations. 11 mothers (13.8%) were able to identify the baby’s diagnosis directly without any assistance, followed by 7 mothers (8.7%) who were told by a relative, and 3 mothers (3.7%) who were told of the problem by the doctor that their babies needed medical attention. 24 times mothers in the peripheral hospitals reported bad language like “I don’t have time to listen to you every day and every time.” 77 mothers in the periphery (90.6%) were not satisfied with the amount of time spent by the doctors in seeing their babies. Conclusion Mothers of the neonates play great roles in identifying the illness of the newborn. Mother’s awareness of what might be needed during neonatal support strategies to improve neonatal care in both health facilities and the communities. PMID:23642257
Background Injuries continue to be the leading cause of death and disability for children. The is a paucity of published data on paediatric injuries in our local environment. This study describes the etiological spectrum, injury characteristics and treatment outcome of paediatric injuries in our local setting and provides baseline data for establishment of prevention strategies as well as treatment guidelines. Methods This was a descriptive cross-sectional study involving paediatric injury patients admitted to Bugando Medical Centre from August 2011 to April 2012. Statistical data analysis was done using SPSS version 17.0 and STATA version 12.0. Results A total of 150 patients were studied. The age of patients ranged from 1 month to 10 years with a median age of 5 years. The male to female ratio was 2.3:1. Road traffic accident was the most common cause of injury (39.3%) and motorcycle (71.2%) was responsible for the majority of road traffic accidents. Only 11 (7.3%) patients received pre-hospital care. The head /neck (32.7%) and musculoskeletal (28.0%) were the most frequent body region injured. Open wounds (51.4%), foreign bodies (31.3%) and fractures (17.3%) were the most common type of injuries sustained. The majority of patients 84 (56.0%) were treated surgically. Complication rate was 3.9%. The mean duration of hospitalization was 9.7?±?13.1 days. Mortality rate was 12.7%. Age of the patient (< 5 years), late presentation and presence of complications were the main predictors of length of hospital stay (P 0.001), whereas burn injuries, severe head injuries and severity of injury (Paediatric trauma score =?0–5) significantly predicted mortality (P 0.0001). Conclusion Paediatric injuries resulting from road traffic accidents (RTAs) remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of paediatric injuries in this region. PMID:24499558
Background Abdominal tuberculosis continues to be a major public health problem worldwide and poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. This study was conducted to describe the clinicopathological profile and outcome of surgical treatment of abdominal tuberculosis in our setting and compare with what is described in literature. Methods A prospective descriptive study of patients who presented with abdominal tuberculosis was conducted at Bugando Medical Centre (BMC) in northwestern Tanzania from January 2006 to February 2012. Ethical approval to conduct the study was obtained from relevant authorities. Statistical data analysis was performed using SPSS version 17.0. Results Out of 256 patients enrolled in the study, males outnumbered females. The median age was 28 years (range = 16–68 years). The majority of patients (77.3%) had primary abdominal tuberculosis. A total of 127 (49.6%) patients presented with intestinal obstruction, 106 (41.4%) with peritonitis, 17 (6.6%) with abdominal masses and 6 (2.3%) patients with multiple fistulae in ano. Forty-eight (18.8%) patients were HIV positive. A total of 212 (82.8%) patients underwent surgical treatment for abdominal tuberculosis. Bands /adhesions (58.5%) were the most common operative findings. Ileo-caecal region was the most common bowel involved in 122 (57.5%) patients. Release of adhesions and bands was the most frequent surgical procedure performed in 58.5% of cases. Complication and mortality rates were 29.7% and 18.8% respectively. The overall median length of hospital stay was 32 days and was significantly longer in patients with complications (p < 0.001). Advanced age (age ? 65 years), co-morbid illness, late presentation, HIV positivity and CD4+ count < 200 cells/?l were statistically significantly associated with mortality (p < 0.0001). The follow up of patients were generally poor as only 37.5% of patients were available for follow up at twelve months after discharge. Conclusion Abdominal tuberculosis constitutes a major public health problem in our environment and presents a diagnostic challenge requiring a high index of clinical suspicion. Early diagnosis, early anti-tuberculous therapy and surgical treatment of the associated complications are essential for survival. PMID:23758837
OBJECTIVE To investigate the association, if any, between child mortality and distance to the nearest hospital. METHODS The study was based on data from a 1-year study of the cause of illness in febrile paediatric admissions to a district hospital in north-east Tanzania. All villages in the catchment population were geolocated, and travel times were estimated from availability of local transport. Using bands of travel time to hospital, we compared admission rates, inpatient case fatality rates and child mortality rates in the catchment population using inpatient deaths as the numerator. RESULTS Three thousand hundred and eleven children under the age of 5 years were included of whom 4.6% died; 2307 were admitted from <3 h away of whom 3.4% died and 804 were admitted from ?3 h away of whom 8.0% died. The admission rate declined from 125/1000 catchment population at <3 h away to 25/1000 at ?3 h away, and the corresponding hospital deaths/catchment population were 4.3/1000 and 2.0/1000, respectively. Children admitted from more than 3 h away were more likely to be male, had a longer pre-admission duration of illness and a shorter time between admission and death. Assuming uniform mortality in the catchment population, the predicted number of deaths not benefiting from hospital admission prior to death increased by 21.4% per hour of travel time to hospital. If the same admission and death rates that were found at <3 h from the hospital applied to the whole catchment population and if hospital care conferred a 30% survival benefit compared to home care, then 10.3% of childhood deaths due to febrile illness in the catchment population would have been averted. CONCLUSIONS The mortality impact of poor access to hospital care in areas of high paediatric mortality is likely to be substantial although uncertainty over the mortality benefit of inpatient care is the largest constraint in making an accurate estimate. PMID:24661618
Manongi, Rachel; Mtei, Frank; Mtove, George; Nadjm, Behzad; Muro, Florida; Alegana, Victor; Noor, Abdisalan M.; Todd, Jim; Reyburn, Hugh
This project was designed to help develop the US Initiative on Joint Implementation activities in Eastern Africa. It has been communicated in meetings with representatives from the Ministry of Environment of Tanzania and the consultant group that developed Tanzania's National Climate Change Action Plan, the Centre for Energy, Environment, Science and Technology, that this project fits very well with the developmental and environmental goals of the Government of Tanzania. The goal of the Activities Implemented Jointly ruminant livestock project is to reduce ruminant methane emissions in Eastern Africa. The project plans a sustainable cattle multiplication unit (CMU) at Mabuki Ranch in the Mwanza Region of Tanzania. This CMU will focus on raising genetically improved animals to be purchased by farmers, developmental organizations, and other CMUs in Tanzania. Through the purchase of these animals farmers will raise their income generation potential and reduce ruminant methane emissions.
OBJECTIVES—To determine the age specific prevalence of impairment and disability relating to hemiplegic stroke in one rural area of Tanzania.?METHODS—During the yearly house to house census of the study population of 148 135 (85 152 aged 15 and over) in August 1994, specific questions were asked to identify those who might be disabled from stroke. People thus identified were subsequently interviewed and examined by one investigator. In those in whom the clinical diagnosis of stroke was confirmed a more detailed interview and examination relating to risk factors and recovery was carried out.?RESULTS—One hundred and eight patients, 61 men and 47 women, were identified with a median age of 70 (range 18-100). Median age at first stroke was 65 years. The age specific rates in this study were lower than previous studies in developed countries. All were cared for at home although 23 (21%) were bedbound.?CONCLUSIONS—Although prevalence of impairment and disability related to stroke in this population as a whole was low this is mainly explained by the age structure, with less than 6% being aged 65 and over. Age standardised rates for stroke with residual disability were about half those found in previous studies in developed countries. Death from stroke in Africa may be higher but data are limited. With the demographic transition stroke is likely to become a more important cause of disability in sub-Saharan Africa.?? PMID:10811698
Walker, R.; McLarty, D.; Masuki, G.; Kitange, H.; Whiting, D.; Moshi, A.; Massawe, J.; Amaro, R.; Mhina, A.; Alberti, K
Background Routine tuberculosis culture remains unavailable in many high-burden areas, including Tanzania. This study sought to determine the impact of providing mycobacterial culture results over standard of care [unconcentrated acid-fast (AFB) smears] on management of persons with suspected tuberculosis. Methods Adults and children with suspected tuberculosis were randomized to standard (direct AFB smear only) or intensified (concentrated AFB smear and tuberculosis culture) diagnostics and followed for 8 weeks. The primary endpoint was appropriate treatment (i.e. antituberculosis therapy for those with tuberculosis, no antituberculous therapy for those without tuberculosis). Results Seventy participants were randomized to standard (n?=?37, 53%) or intensive (n?=?33, 47%) diagnostics. At 8 weeks, 100% (n?=?22) of participants in follow up randomized to intensive diagnostics were receiving appropriate care, vs. 22 (88%) of 25 participants randomized to standard diagnostics (p?=?0.14). Overall, 18 (26%) participants died; antituberculosis therapy was associated with lower mortality (9% who received antiuberculosis treatment died vs. 26% who did not, p?=?0.04). Conclusions Under field conditions in a high burden setting, the impact of intensified diagnostics was blunted by high early mortality. Enhanced availability of rapid diagnostics must be linked to earlier access to care for outcomes to improve. PMID:24552306
Background Vitamin D may help prevent adverse pediatric outcomes, including infectious diseases and growth failure, based on its role in immune and metabolic functions. We examined the association of maternal vitamin D status and pediatric health outcomes in children born to HIV-infected women. Methods Vitamin D status was determined in 884 HIV-infected pregnant women at 12 to 27 weeks of gestation in a trial of vitamin supplementation (not including vitamin D) in Tanzania. Information on child morbidities, anemia and hypochromic microcytosis, and anthropometry was recorded through monthly clinic visits. Generalized estimated equations and Cox proportional hazards models were used to assess the relationships of outcomes with maternal vitamin D status. Results A total of 39% of women had low vitamin D levels (<32 ng/mL). Children born to women with low vitamin D status were 1.11 times more likely to report cough during follow-up (RR: 1.11; 95% CI: 1.02-1.21). No significant associations were noted for other respiratory symptoms, diarrhea, or anemia outcomes. Low maternal vitamin D status was associated with significantly increased risk of stunting (height-for-age z-score <-2; RR: 1.29; 95% CI: 1.05-1.59) and underweight (weight-for-age z-score <-2; RR: 1.33; 95% CI: 1.03-1.71). Conclusions Maternal vitamin D status may be an important risk factor for respiratory infections, and ensuring optimal growth in HIV-exposed children. PMID:22252204
Finkelstein, Julia L.; Mehta, Saurabh; Duggan, Christopher; Manji, karim P.; Mugusi, Ferdinand M.; Aboud, Said; Spiegelman, Donna; Msamanga, Gernard I.; Fawzi, Wafaie W.
Background Although poor maternal mental health is a major public health problem, with detrimental effects on the individual, her children and society, information on its correlates in low-income countries is sparse. Aims This study investigates the prevalence of common mental disorders (CMD) among at-risk mothers, and explores its associations with sociodemographic factors. Methods This population-based survey of mothers of children aged 0–36 months used the 14-item Shona Symptom Questionnaire (SSQ). Mothers whose response was “yes” to 8 or more items on the scale were defined as “at risk of CMD.” Results Of the 1,922 mothers (15–48 years), 28.8% were at risk of CMD. Risk of CMD was associated with verbal abuse, physical abuse, a partner who did not help with the care of the child, being in a polygamous relationship, a partner with low levels of education, and a partner who smoked cigarettes. Cohabiting appeared to be protective. Conclusions Taken together, our results indicate the significance of the quality of relations with one’s partner in shaping maternal mental health. The high proportion of mothers who are at risk of CMD emphasizes the importance of developing evidence-based mental health programmes as part of the care package aimed at improving maternal well-being in Tanzania and other similar settings. PMID:23844249
Uriyo, Jacqueline G.; Abubakar, Amina; Swai, Mark; Msuya, Sia E.; Stray-Pedersen, Babill
The present study aimed at analysing the content of fluorine (F), calcium (Ca) and magnesium (Mg) in the hair of young male students (n =52) of a secondary school in Mafinga in Tanzania (Africa) who participated in anthropological examinations. Ca and Mg concentrations were determined using atomic absorption spectrophotometer while F levels using a potentiometric method. F in the hair of boys from older group (?16 years old; n =24) was significantly higher than in the younger group (<16 years old; n =28) versus Ca and Mg levels. High carbohydrate diet was predominant- mainly based on corn or bean and meat served once a week, with few fruit and raw vegetables. Collective catering in the dormitory reflected habits and culinary preferences at home. The lack of balanced diet, with majority of the nutritional energy supplied by easily accessible and cheap carbohydrates, was reflected in dietary deficiencies, characterised, among others, by visible skin conditions and tooth decay. PMID:24234514
R?bacz-Maron, Ewa; Baranowska-Bosiacka, Irena; Gutowska, Izabela; Krzywania, Natalia; Chlubek, Dariusz
Background Geophagy, a form of pica, is the deliberate consumption of soil and is relatively common across Sub-Saharan Africa. In Tanzania, pregnant women commonly eat soil sticks sold in the market (pemba), soil from walls of houses, termite mounds, and ground soil (kichuguu). The present study examined geophagy practices of pregnant women in a gold mining area of Geita District in northwestern Tanzania, and also examined the potential for exposure to chemical elements by testing soil samples. Method We conducted a cross sectional study using a convenience sample of 340 pregnant women, ranging in age from 15–49 years, who attended six government antenatal clinics in the Geita District, Tanzania. Structured interviews were conducted in June-August, 2012, to understand geophagy practices. In addition, soil samples taken from sources identified by pregnant women practicing geophagy were analysed for mineral element content. Results Geophagy was reported by 155 (45.6%) pregnant women with 85 (54.8%) initiating the practice in the first trimester. A total of 101 (65%) pregnant women reported eating soil 2 to 3 times per day while 20 (13%) ate soil more than 3 times per day. Of 155 pregnant women 107 (69%) bought pemba from local shops, while 48 (31%) consumed ground soil kichuguu. The estimated mean quantity of soil consumed from pemba was 62.5 grams/day. Arsenic, chromium, copper, iron, manganese, nickel and zinc levels were found in both pemba and kichuguu samples. Cadmium and mercury were found only in the kichuguu samples. Based on daily intake estimates, arsenic, copper and manganese for kichuguu and copper and manganese for pemba samples exceed the oral Minimum Risk Levels designated by the U.S. Agency for Toxic Substance and Disease Registry. Conclusion Almost 50% of participants practiced geophagy in Geita District consistent with other reports from Africa. Both pemba and kichuguu contained chemical elements at varying concentration, mostly above MRLs. As such, pregnant women who eat soil in Geita District are exposed to potentially high levels of chemical elements, depending upon frequency of consumption, daily amount consumed and the source location of soil eaten. PMID:24731450
Background This project examined the surgical productivity and attrition of non-physician cataract surgeons (NPCSs) in Tanzania, Malawi, and Kenya. Methods Baseline (2008-9) data on training, support, and productivity (annual cataract surgery rate) were collected from officially trained NPCSs using mailed questionnaires followed by telephone interviews. Telephone interviews were used to collect follow-up data annually on productivity and semi-annually on attrition. A detailed telephone interview was conducted if a surgeon left his/her post. Data were entered into and analysed using STATA. Results Among the 135 NPCSs, 129 were enrolled in the study (Kenya 88, Tanzania 38, and Malawi 3) mean age 42 years; average time since completing training 6.6 years. Employment was in District 44%, Regional 24% or mission/ private 32% hospitals. Small incision cataract surgery was practiced by 38% of the NPCSs. The mean cataract surgery rate was 188/year, median 76 (range 0-1700). For 39 (31%) NPCSs their surgical rate was more than 200/year. Approximately 22% in Kenya and 25% in Tanzania had years where the cataract surgical rate was zero. About 11% of the surgeons had no support staff. Factors significantly associated with increased productivity were: 1) located at a regional or private/mission hospital compared to a district hospital (OR = 8.26; 95 % CI 2.89 – 23.81); 2) 3 or more nurses in the eye unit (OR = 8.69; 95% CI 3.27-23.15); 3) 3 or more cataract surgical sets (OR = 3.26; 95% CI 1.48-7.16); 4) a separate eye theatre (OR = 5.41; 95% CI 2.15-13.65); 5) a surgical outreach program (OR = 4.44; 95% CI 1.88-10.52); and 6) providing transport for patients to hospital (OR = 6.39; 95% CI 2.62-15.59). The associations were similar for baseline and follow-up assessments. Attrition during the 3 years occurred in 13 surgeons (10.3%) and was due to retirement or promotion to administration. Conclusions High quality training is necessary but not sufficient to result in cataract surgical activity that meets population needs and maintains surgical skill. Needed are supporting institutions and staff, functioning equipment and programs to recruit and transport patients.
Background In the past decade there has been increasing visibility of malaria control efforts at the national and international levels. The factors that have enhanced this scenario are the availability of proven interventions such as artemisinin-based combination therapy, the wide scale use of insecticide-treated nets (ITNs) and a renewed emphasis in indoor residual house-spraying. Concurrently, there has been a window of opportunity of financial commitments from organizations such as the Global Fund for HIV/AIDS, Tuberculosis and Malaria (GFATM), the President's Malaria Initiative and the World Bank Booster programme. Methods The case study uses the health policy analysis framework to analyse the implementation of a public-private partnership approach embarked upon by the government of Tanzania in malaria control – 'The Tanzania National Voucher Scheme'- and in this synthesis, emphasis is on the challenges faced by the scheme during the pre-implementation (2001 – 2004) and implementation phases (2004 – 2005). Qualitative research tools used include: document review, interview with key informants, stakeholder's analysis, force-field analysis, time line of events, policy characteristic analysis and focus group discussions. The study is also complemented by a cross-sectional survey, which was conducted at the Rufiji Health Demographic Surveillance Site, where a cohort of women of child-bearing age were followed up regarding access and use of ITNs. Results The major challenges observed include: the re-introduction of taxes on mosquito nets and related products, procurement and tendering procedures in the implementation of the GFATM, and organizational arrangements and free delivery of mosquito nets through a Presidential initiative. Conclusion The lessons gleaned from this synthesis include: (a) the consistency of the stakeholders with a common vision, was an important strength in overcoming obstacles, (b) senior politicians often steered the policy agenda when the policy in question was a 'crisis event', the stakes and the visibility were high, (c) national stakeholders in policy making have an advantage in strengthening alliances with international organizations, where the latter can become extremely influential in solving bottlenecks as the need arises, and (d) conflict can be turned into an opportunity, for example the Presidential initiative has inadvertently provided Tanzania with important lessons in the organization of 'catch-up' campaigns. PMID:19698109
Background Non-Hodgkin’s Lymphomas (NHL) are common in African children, with endemic Burkitt’s lymphoma (BL) being the most common subtype. While the role of Epstein-Barr Virus (EBV) in endemic BL is known, no data are available about clinical presentations of NHL subtypes and their relationship to Human Immunodeficiency Virus (HIV) infection and Epstein Barr Virus (EBV) load in peripheral blood of children in north-western, Tanzania. Methods A matched case control study of NHL subtypes was performed in children under 15 years of age and their respective controls admitted to Bugando Medical Centre, Sengerema and Shirati district designated hospitals in north-western, Tanzania, between September 2010 and April 2011. Peripheral blood samples were collected on Whatman 903 filter papers and EBV DNA levels were estimated by multiplex real-time PCR. Clinical and laboratory data were collected using a structured data collection tool and analysed using chi-square, Fisher and Wilcoxon rank sum tests where appropriate. The association between NHL and detection of EBV in peripheral blood was assessed using conditional logistic regression model and presented as odds ratios (OR) and 95% confidence intervals (CI). Results A total of 35 NHL cases and 70 controls matched for age and sex were enrolled. Of NHLs, 32 had BL with equal distribution between jaw and abdominal tumour, 2 had large B cell lymphoma (DLBCL) and 1 had NHL-not otherwise specified (NHL-NOS). Central nervous system (CNS) presentation occurred only in 1 BL patient; 19 NHLs had stage I and II of disease. Only 1 NHL was found to be HIV-seropositive. Twenty-one of 35 (60%) NHL and 21 of 70 (30%) controls had detectable EBV in peripheral blood (OR?=?4.77, 95% CI 1.71 – 13.33, p?=?0.003). In addition, levels of EBV in blood were significantly higher in NHL cases than in controls (p?=?0.024). Conclusions BL is the most common childhood NHL subtype in north-western Tanzania. NHLs are not associated with HIV infection, but are strongly associated with EBV load in peripheral blood. The findings suggest that high levels of EBV in blood might have diagnostic and prognostic relevance in African children. PMID:23294539
Background Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. Methods In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys. Discussion EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings. Trial registration PACTR201311000681314 PMID:24690284
Background Since 2004, the Tanzanian National Voucher Scheme has increased availability and accessibility of insecticide-treated nets (ITNs) to pregnant women and infants by subsidizing the cost of nets purchased. From 2008 to 2010, a mass distribution campaign delivered nine million long-lasting insecticidal nets (LLINs) free-of-charge to children under-five years of age in Tanzania mainland. In 2010 and 2011, a Universal Coverage Campaign (UCC) led by the Ministry of Health and Social Welfare (MoHSW) was implemented to cover all sleeping spaces not yet reached through previous initiatives. Methods The UCC was coordinated through a unit within the National Malaria Control Programme. Partners were contracted by the MoHSW to implement different activities in collaboration with local government authorities. Volunteers registered the number of uncovered sleeping spaces in every household in the country. On this basis, LLINs were ordered and delivered to village level, where they were issued over a three-day period in each zone (three regions). Household surveys were conducted in seven districts immediately after the campaign to assess net ownership and use. Results The UCC was chiefly financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria with important contributions from the US President’s Malaria Initiative. A total of 18.2 million LLINs were delivered at an average cost of USD 5.30 per LLIN. Overall, 83% of the expenses were used for LLIN procurement and delivery and 17% for campaign associated activities. Preliminary results of the latest Tanzania HIV Malaria Indicator Survey (2011–12) show that household ownership of at least one ITN increased to 91.5%. ITN use, among children under-five years of age, improved to 72.7% after the campaign. ITN ownership and use data post-campaign indicated high equity across wealth quintiles. Conclusion Close collaboration among the MoHSW, donors, contracted partners, local government authorities and volunteers made it possible to carry out one of the largest LLIN distribution campaigns conducted in Africa to date. Through the strong increase of ITN use, the recent activities of the national ITN programme will likely result in further decline in child mortality rates in Tanzania, helping to achieve Millennium Development Goals 4 and 6. PMID:23496881
BackgroundEvery year, more than a million of the world¿s newborns die on their first day of life; as many as two-thirds of these deaths could be saved with essential care at birth and the early newborn period. Simple interventions to improve the quality of essential newborn care in health facilities ¿ for example, improving steps to help newborns breathe at birth ¿ have demonstrated up to 47% reduction in newborn mortality in health facilities in Tanzania. We conducted an evaluation of the effects of a large-scale maternal-newborn quality improvement intervention in Tanzania that assessed the quality of provision of essential newborn care and newborn resuscitation.MethodsCross-sectional health facility surveys were conducted pre-intervention (2010) and post intervention (2012) in 52 health facilities in the program implementation area. Essential newborn care provided by health care providers immediately following birth was observed for 489 newborns in 2010 and 560 in 2012; actual management of newborns with trouble breathing were observed in 2010 (n¿=¿18) and 2012 (n¿=¿40). Assessments of health worker knowledge were conducted with case studies (2010, n¿=¿206; 2012, n¿=¿217) and a simulated resuscitation using a newborn mannequin (2010, n¿=¿299; 2012, n¿=¿213). Facility audits assessed facility readiness for essential newborn care.ResultsIndex scores for quality of observed essential newborn care showed significant overall improvement following the quality-of-care intervention, from 39% to 73% (p <0.0001). Health worker knowledge using a case study significantly improved as well, from 23% to 41% (p <0.0001) but skills in resuscitation using a newborn mannequin were persistently low. Availability of essential newborn care supplies, which was high at baseline in the regional hospitals, improved at the lower-level health facilities.ConclusionsWithin two years, the quality improvement program was successful in raising the quality of essential newborn care services in the program facilities. Some gaps in newborn care were persistent, notably practical skills in newborn resuscitation. Continued investment in life-saving improvements to newborn care through the health services is a priority for reduction of newborn mortality in Tanzania. PMID:25406496
Makene, Christina; Plotkin, Marya; Currie, Sheena; Bishanga, Dunstan; Ugwi, Patience; Louis, Henry; Winani, Kiholeth; Nelson, Brett D
Background International policy towards access to essential medicines in Africa has focused until recently on international procurement of large volumes of medicines, mainly from Indian manufacturers, and their import and distribution. This emphasis is now being challenged by renewed policy interest in the potential benefits of local pharmaceutical production and supply. However, there is a shortage of evidence on the role of locally produced medicines in African markets, and on potential benefits of local production for access to medicines. This article contributes to filling that gap. Methods This article uses WHO/HAI data from Tanzania for 2006 and 2009 on prices and sources of a set of tracer essential medicines. It employs innovative graphical methods of analysis alongside conventional statistical testing. Results Medicines produced in Tanzania were equally likely to be found in rural and in urban areas. Imported medicines, especially those imported from countries other than Kenya (mainly from India) displayed 'urban bias’: that is, they were significantly more likely to be available in urban than in rural areas. This finding holds across the range of sample medicines studied, and cannot be explained by price differences alone. While different private distribution networks for essential medicines may provide part of the explanation, this cannot explain why the urban bias in availability of imported medicines is also found in the public sector. Conclusions The findings suggest that enhanced local production may improve rural access to medicines. The potentia