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Impact of early diagnosis of impaired glucose regulation in tuberculosis: Comparison of clinical outcomes in people with tuberculosis in Tanzania
Get PDFThis research article was published by John Wiley & Sons, Inc., 2022Objective
Diabetes mellitus (DM) has been known to compromise tuberculosis (TB) treatment outcomes. Association data are limited for early hyperglycaemia detection and TB treatment outcomes. Thus, we assessed treatment outcomes including time to sputum conversion and death in TB participants with or without hyperglycaemia.
Methods
A prospective cohort study recruited TB participants receiving anti-TB treatment at health facilities in Tanzania between October 2019 and September 2020. Hyperglycaemia was defined as having pre-existing DM or pre-treatment random blood glucose of ≥7.8mmol/L, in combination categorised as impaired glucose regulation (IGR). Those with IGR were further screened for hyperglycaemia severity using glycated haemoglobin. In case of unknown status, participants were tested for HIV. Time to death was determined at 6 months of TB treatment.
Results
Of 1,344 participants, 187 (13.9%) had IGR, of whom 44 (23.5%) were HIV co-infected. Overall treatment success was 1,206 (89.7%), and was similar among participants with or without IGR (p>0.05). Time to death for participants with and without IGR was 18 versus 28 days (p=0.870), respectively. Age ≥40 years (p=0.038), bacteriological positive (p=0.039), HIV (p=0.009), or recurrent TB (p=0.017) predicted death or treatment success during TB treatment in adjusted multivariable models.
Conclusion
IGR did not influence clinical outcomes in TB patients with or without IGR in a programme of early IGR diagnosis and integration TB, HIV and DM care. Early detection and co-management of multi-morbidities among people diagnosed with TB may reduce likelihood of poor treatment outcomes in a programmatic setting
In starvation, a bone can also be meat”: a mixed methods evaluation of factors associated with discarding of long-lasting insecticidal nets in Bagamoyo, Tanzania
Get PDFThis research article was published by Springer Nature, 2022Background: Between 2000 and 2019, more than 1.8 billion long-lasting insecticidal nets (LLINs) were distributed in
Africa. While the insecticidal durability of LLINs is around 3 years, nets are commonly discarded 2 years post distribu tion. This study investigated the factors associated with the decision of users to discard LLINs.
Methods: A mixed-method sequential explanatory approach using a structured questionnaire followed by focus
group discussions (FGDs) to collect information on experiences, views, reasons, how and when LLINs are discarded.
Out of 6,526 households that responded to the questionnaire of LLINs durability trial, 160 households were randomly
selected from the households in four villages in Bagamoyo Tanzania for FGDs but only 155 households participated
in the FGDs. Five of the household representatives couldn’t participate due to unexpected circumstances. A total of
sixteen FGDs each comprising of 8–10 adults were conducted; older women (40–60 years), older men (40–60 years),
younger women (18–39 years), younger men (18–39 years). During the FGDs, participants visually inspected seven
samples of LLINs that were “too-torn” based on Proportionate Hole Index recommended by the World Health Organi zation (WHO) guidelines on LLIN testing, the nets were brought to the discussion and participants had to determine
if such LLINs were to be kept or discarded. The study assessed responses from the same participants that attended
FGD and also responded to the structured questionnaire, 117 participants fulflled the criteria, thus data from only 117
participants are analysed in this study.
Results: In FGDs, integrity of LLIN infuenced the decision to discard or keep a net. Those of older age, women, and
householders with lower income were more likely to classify a WHO “too-torn” net as “good”. The common methods
used to discard LLINs were burning and burying. The fndings were seen in the quantitative analysis. For every addi tional hole, the odds of discarding a WHO “too-torn” LLIN increased [OR=1.05 (95%CI (1.04–1.07)), p<0.001]. Younger
age group [OR=4.97 (95%CI (3.25–7.32)), p<0.001], male-headed households [OR=6.85 (95%CI (4.44 –10.59)),
p<0.001], and wealthy households [OR=3.88 (95%CI (2.33–6.46)), p<0.001] were more likely to discard LLINs
A Review of Methods for Removal of Ceftriaxone from Wastewater
Get PDFThis research article was published by MDPI, 2022The presence of pharmaceuticals in surface water and wastewater poses a threat to public
health and has significant effects on the ecosystem. Since most wastewater treatment plants are
ineffective at removing molecules efficiently, some pharmaceuticals enter aquatic ecosystems, thus
creating issues such as antibiotic resistance and toxicity. This review summarizes the methods used
for the removal of ceftriaxone antibiotics from aquatic environments. Ceftriaxone is one of the
most commonly prescribed antibiotics in many countries, including Tanzania. Ceftriaxone has been
reported to be less or not degraded in traditional wastewater treatment of domestic sewage. This
has piqued the interest of researchers in the monitoring and removal of ceftriaxone from wastewater.
Its removal from aqueous systems has been studied using a variety of methods which include
physical, biological, and chemical processes. As a result, information about ceftriaxone has been
gathered from many sources with the searched themes being ceftriaxone in wastewater, ceftriaxone
analysis, and ceftriaxone removal or degradation. The methods studied have been highlighted and
the opportunities for future research have been described
Prevalence and Predictors of Antibiotic Prescriptions at Primary Healthcare Facilities in the Dodoma Region, Central Tanzania: A Retrospective, Cross-Sectional Study
Get PDFThis research article was published by MDPI, 2022Background: Accelerated by the misuse or overuse of antibiotics, antibiotic resistance remains a global public health threat. We report the prevalence and predictors of antibiotic prescriptions in primary healthcare facilities in Dodoma, Tanzania. Methods: This retrospective cross-sectional study by medical records review was conducted in the Dodoma region, Central Tanzania. Results: In this study, children < 5 years accounted for over 45% (474/1021) of the patients consulted. The majority, 76.3% (779/1021), of consultations had an antibiotic prescribed; amoxicillin and cotrimoxazole were the most prescribed. Over 98% (766/779) of the antibiotics prescribed were on the National Essential Medicines List, but only 45% (429/779) of the antibiotic prescriptions adhered to the Standard Treatment Guidelines. The prescribing of antibiotics by clinical officers was almost 2.55 times higher than that among medical doctors (Odds Ratio (OR) = 2.546; 95% Confidence Interval (CI): 1.359, 4.769; p = 0.0035). Patients with pneumonia and upper respiratory tract infection were 15.9 (OR = 15.928; 95% CI: 2.151, 17.973; p = 0.0067) and 2 (OR = 2.064; 95% CI: 1.184, 3.600; p = 0.0106) times more likely to be prescribed antibiotics, respectively. Conclusions: We, therefore, report high rates of antibiotic prescriptions, poor adherence to standard treatment guidelines and high levels of antibiotic prescribing practices among prescribers with a diploma in clinical medicin
Entomopathogenic fungi (Aspergillus oryzae) as biological control agent of cattle ticks in Tanzania
Get PDFThis research article was published by Academic Journals, 2022Ticks are the most important ectoparasites that are responsible for severe economic losses in livestock
industry. The use of chemical acaricides is the most common method used to control ticks in livestock.
This study was conducted to determine the efficacy of Aspergillus oryzae as an alternative biological
agent in controlling ticks to enhance livestock productivity. The efficacy of A. oryzae at different
concentrations was evaluated against larvae and adults of the hard tick genera Rhipicephalus,
Boophilus, and Amblyomma using an immersion test under laboratory conditions. Field trials were
conducted in two purposively selected cattle herds in Monduli district, northern Tanzania. A. oryzae at a
concentration of 1 × 106 conidial/ml was sprayed on all cattle tick-infested areas. The results
demonstrated a concentration-related increase in mortality for both larvae and adult female engorged
ticks. The mean mortality of larvae and female engorged ticks was statistically significant at p ˂ 0.05
and p ˂ 0.001, respectively. Egg production was found to decrease with increased A. oryzae
concentration. Additionally, there was a statistically significant difference in egg production index and
oviposition reduction (p = 0.009) while there was no significant difference in egg hatching and product
effectiveness at p = 0.089 and p = 0.004, respectively between the tested ticks’ genera. Under field
conditions, the bio-acaricide demonstrated a statistically significant tick reduction in all the treated
cattle. This study concludes that A. oryzae has good acaricidal activity against ticks and hence, is one
of the potential tick control methods for sustainable tick control schemes
Challenges Affecting Effective Implementation of Financial Management Information Systems in Local Government Authorities in Tanzania as Part of the Digital Ecosystem
Get PDFThis research article was published by Scientific Research Publishing Inc.,2022This study examined the obstacles to the efficient implementation of the Fi nancial Management Information System (FMIS) by Tanzanian local gov ernment authorities. To formulate and test the dependency of variables, the
researchers used both descriptive and inferential statistics, including a
chi-square test. According to the findings, FMIS deployment faces technical,
user, and organizational-related challenges. The study recommended that the
Tanzanian government, through the Ministries of Finance and Planning,
President’s Office Regional Administration, and Local Government Authori ties, continue to offer a full commitment to ensuring the effective implemen tation of FMIS by guaranteeing the constant supply of electricity in all district
councils; the supply of modern computing machines; good organizational
management; as well as staff facilitation and motivation. In addition to the
internal workforce, the engagement of qualified firms and consultants from
the private sector to assist with the implementation of successful change
management is strongly advised
Evaluation of the direct health facility financing program in improving maternal health services in Pangani district, Tanzania
Get PDFA Dissertation Submitted in Partial Fulfilment of the Requirements for the Degree of Master of Science in Public Health Research of the Nelson Mandela African Institution of Science and TechnologyMaternal morbidity and mortality remain significant public health concerns globally, with
Tanzania reporting 524 deaths per 100 000 live births annually in 2022. While national level data
provide some insights into the issue, a focus on sub-national levels is required because of
differences in contexts such as rural-urban disparities in maternal mortality. This study examined
Direct Health Facility Financing (DHFF) and its effects on the quality of maternal health services
in Pangani, a rural district in Tanzania. The study used qualitative and quantitative methods.
Direct disbursement of funds from the central government through the Ministry of Finance and
Planning to the primary health facilities reduced delays in procurement, improved community
outreach services, and improved community leaders’ engagements. Deliveries occurring at health
facilities increased by 33.6% (p<0.001) one year after the DHFF implementation. Various
medicines, delivery kits, and some reagents increased significantly (p<0.05). However,
unavailability of computers and poor internet connectivity, insufficient supply of medical
equipment and stock out at Medical Stores Department increased the difficulty of obtaining the
missed items from the selected prime vendor. Overall, this study shows a positive impact of the
DHFF on maternal health service delivery in Pangani district. Specifically, increase in the number
of medical supplies, equipment, and reagents necessary to provide maternal health services
contributed to the observed increase in facility deliveries by a third. Moreover, the system
minimizes unnecessary delays in the procurement processes of required drugs, supplies, and other
facility reagents. To maximize the impact of the DHFF system, unavailability of computers,
unstable internet, limited knowledge of the staff about the system, and inadequate health
workforce should be addressed. Furthermore, training could include refreshers models on DHFF
implementation
Valorization of Mango By-Products to Enhance the Nutritional Content of Maize Complementary Porridges
Get PDFThis research article was published by MDPI, 2022Mango by-products are disregarded as waste contributing to greenhouse gas emissions.
This study used mango seed and kernel to enhance the nutritional content of maize complementary
porridges. Composite maize-based porridges (MBP) were formulated by fortifying maize flour with
fine ground mango seed and kernel at different levels (31%, 56%, 81%). The by-products and formu lated porridges were characterized for their nutritional composition, mineral content, total phenolic
content, and antioxidant capacity. Furthermore, the bioaccessibility of essential minerals during
in vitro gastrointestinal digestion of the formulated porridges was determined using inductively
coupled plasma optical emission spectrometry. Mango seed had a high fat (12.0 g/100 g dw) and
protein content (4.94 g/100 g dw), which subsequently doubled the fat content of the porridges.
Mango by-products increased the total phenolic content of maize porridge by more than 40 times and
the antioxidant capacity by 500 times. However, fortification with mango by-products significantly
decreased the bioaccessibility of minerals, especially manganese, copper, and iron, as the highest
percentages of insoluble minerals were recorded in MBP 81 at 78.4%, 71.0%, and 62.1%, respectively.
Thus, the results suggest that mango seed and kernel could increase the nutritional value of maize
porridge, but fortification should be done at lower levels of about 31–56%.Mango by-products are disregarded as waste contributing to greenhouse gas emissions.
This study used mango seed and kernel to enhance the nutritional content of maize complementary
porridges. Composite maize-based porridges (MBP) were formulated by fortifying maize flour with
fine ground mango seed and kernel at different levels (31%, 56%, 81%). The by-products and formu lated porridges were characterized for their nutritional composition, mineral content, total phenolic
content, and antioxidant capacity. Furthermore, the bioaccessibility of essential minerals during
in vitro gastrointestinal digestion of the formulated porridges was determined using inductively
coupled plasma optical emission spectrometry. Mango seed had a high fat (12.0 g/100 g dw) and
protein content (4.94 g/100 g dw), which subsequently doubled the fat content of the porridges.
Mango by-products increased the total phenolic content of maize porridge by more than 40 times and
the antioxidant capacity by 500 times. However, fortification with mango by-products significantly
decreased the bioaccessibility of minerals, especially manganese, copper, and iron, as the highest
percentages of insoluble minerals were recorded in MBP 81 at 78.4%, 71.0%, and 62.1%, respectively.
Thus, the results suggest that mango seed and kernel could increase the nutritional value of maize
porridge, but fortification should be done at lower levels of about 31–56%
C-reactive protein as a triage test in guiding who should get a confirmatory test for pulmonary tuberculosis diagnosis among adults: a case-control proof - of - concept study from urban Tanzania
Get PDFA Dissertation Submitted in Partial Fulfilment of the Requirements for the Degree in Master of Science in Public Health Research at Nelson Mandela African Institution of Science and TechnologyThe current screening tools for tuberculosis (TB) are inadequate resulting in insufficient TB
case detection and continued community transmission of TB. As the world is geared into
finding missing TB cases, new strategies are called for to aid in rapid identification of TB cases.
This study aimed to evaluate the role C-reactive protein (CRP) in triaging patients to get a
confirmatory test for active PTB diagnosis in urban Tanzania. A case-control study was
conducted among PTB (PTB) patients and contacts without active PTB. The diagnosis of PTB
was performed using GeneXpert MTB/RIF assay and culture. Blood was collected from cases
and controls for measuring CRP levels during recruitment. We compared socio-demographic
characteristics, clinical and laboratory parameters obtained during recruitment and performed
diagnostic accuracy analyses for CRP. Out of all 193 study participants who were involved in
final analysis, 147 (76.2%) were males. PTB cases had significantly lower median body mass
index (BMI) than controls (median 17.4 kg/m2
[IQR: 15.8-19.2 kg/m2
] vs., 24.9 kg/m2
[IQR:
22.1-28.5 kg/m2
), p < 0.001). There was no statistical difference in prevalence of human
immunodeficiency virus (HIV) between PTB cases and controls i.e., 13.33% vs., 11.7%, p =
0.48. CRP was significantly higher in PTB cases vs., controls (median 67.8 mg/L, [IQR: 36.5-
116.9 mg/L] vs., 1.55 mg/L, [IQR: 0.59-6.0mg/L], p = 0.003). Furthermore, CRP at cut-off ≥
10 mg/L was associated with adequate combination of sensitivity, specificity and area under
the curve (AUC) of 89.9%, 95% CI: 82.2-95.0, 80.9%, 95% CI: 71.4-88.2 and 0.85, 95%CI:
0.80-0.90 respectively. A multivariate logistic regression model adjusted for fever, night sweats
and body mass index showed that CRP above 10 mg/L was significantly associated with PTB,
adjusted odds ratio (aOR) 5.2, 95% CI 1.2-22.8. C-reactive protein at cut-off ≥ 10 mg/L can be
used to screen PTB. These findings can be utilized to improve TB screening algorithm by
incorporating CRP in combination with TB symptoms to identify patients who need further
confirmatory TB tests. However, additional prospective studies are required to support our
findings and contribute into policy recommendations on use of CRP in a screening algorithm
for PTB
Development of an internet of things based customer water-meter reading system at Arusha city
Get PDFProject Report Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Science in Embedded and Mobile Systems of the Nelson Mandela African Institution of Science and TechnologyWater management is a fundamental factor that helps to make sure that water is available and well
utilized. Meter reading process is required by Arusha Urban Water Supply and Sanitation
Authority (AUWSA) so as to be able to bill the clients according to their water usage. Currently,
the process of meter reading is manual which require at the end of each month, meter reading
officials from AUWSA have to read all the meters in Arusha, the process which cost AUWSA
time and financial resources. The objective of this project was therefore, to develop an IoT based
customer water meter system where meter readings can be automated and the readings sent to the
cloud. The AUWSA then receives the readings on a weekly basis and can continue with reading
verification and billing. The Method used on the development of this system is a Dynamic System
Development Method (DSDM) which is one of the methods in Agile methodology. The system is
recommended to solve the existing challenges of reading of water meters and improve customer
satisfaction in water service and management. Preliminary results of the prototype testing indicate
that the system would send readings data to the server as well as the nodes receiving the
instructions from the server. The developed prototype would also send weekly messages to
customers about their weekly usage. This communication allows any billing issues to be resolved
timely. Also, the system would highlight the readings which are doubtful for example zero
readings for easily notification and verification