131 research outputs found
Malaria control in the context of integrated management of childhood illness in Tanzania: the challenges ahead
No full textMalaria and Mosquito net Utilisation among Schoolchildren in Villages with or without Healthcare Facilities at Different Altitudes in Iringa District, Tanzania.
No full textThe endemicity of malaria in Tanzania is heterogenous, mainly associated with physical factors such as topography, climate and socio-economic status. The contributions of these factors in many regions of Tanzania have not been studied in detail. This study was carried out to determine the prevalence and transmission of malaria and mosquito nets coverage among schoolchildren in relation to altitude in villages with or without healthcare facilities in Iringa District,Tanzania. A cross-sectional survey of schoolchildren was carried out in six villages in three altitude transects (965-2075 m). In each transect a village with and without a healthcare facility were selected. The villages included Idodi (965m), Makifu (985m), Tosamaganga (1561m) Mangalali (1520m) Lulanzi (1917) and Kilolo (2075m). For the purpose of this study, the villages were categorised as lowlands (Idodi and Makifu), intermediate (Tosamaganga and Mangalali) and highlands (Lulanzi and Kilolo. Healthcare facilities were available at Idodi,Tosamaganga and Kilolo. Each child was asked whether or not slept under a mosquito net during the previous night. Mosquitoes were collected using pyrethrum spray catch technique in ten houses in each study village.\ud
Blood smears from a total of 1643 schoolchildren (mean age = 5.9-12.3 years) were examined for malaria infection. Plasmodium falciparum accounted for 93.1% of the malaria parasites. The prevalence of P. falciparum among children in Idodi, Makifu, Mangalali,Tosamaganga, was 51.51%, 73.66%, 22.79%, and 14.83%, respectively. Malaria parasites were not found among children in the highland villages of Lulanzi and Kilolo). The prevalence of malaria parasitaemia, packed cell volume, geometric mean parasite density and spleen rates were higher in children living in villages without healthcare facilities (P<0.001). Of the children, 16.1% (264/1643) slept under a mosquito net during the previous night. About three quarters (253/344) of the schoolchildren who had malaria parasites were not using mosquito nets. Mosquito net coverage was higher in lowland villages, accounting for 61.7% (163/264) of the total net use in the district. The majority (75.5%) of the mosquito net users were from village with health facilities (P<0.001). A total of 228 mosquitoes were collected, with Anopheles gambiae s.l. accounting for the majority (53.5%). Overall, 8.7% of the An. gambiae s.l. were infected with malaria sporozoites. Higher sporozoite rates were observed in mosquitoes collected in the lowlands. Communities living in areas without health facilities form the largest proportion of malaria-infected populations in Iringa district. Availability of healthcare service has an influence on mosquito net coverage. The results provide more evidence of the existence of a relationship between altitude variability or accessibility to healthcare services, and the burden of malaria in rural communities of Tanzania
Conquering malaria: enhancing the impact of effective interventions towards elimination in the diverse and changing epidemiology.
No full textMalaria remains a major global disease burden causing just under a million deaths each year, mainly of children and pregnant women in sub-Saharan Africa. It consumes up to 40% of public health expenditure of these poor countries, causing in Africa US$ 12 billion in lost GDP every year. This should not be acceptable since malaria is preventable, and there is clear evidence that optimal use of current tools can reduce much of the suffering and deaths. Three major factors allowing this to happen include: (i) inadequate funding to implement a massive initial surge, to achieve universal coverage, (ii) weak country capacities for rapid scale up of such interventions and little or no use of evidence-guided methods, and (iii) insufficient coordination of efforts between national programmes, donors and technical agencies in strategic planning for sustaining gains and in building capacity. We discuss the importance of the surge and the kind of approaches that would accelerate the pace toward elimination and eventual eradication
Use of traditional medicines in the management of HIV/AIDS opportunistic infections in Tanzania: a case in the Bukoba rural district
No full textKisangau DP, Lyaruu HVM, Hosea KM, Joseph CC. Use of traditional medicines in the management of HIV/AIDS opportunistic infections in Tanzania: a case in the Bukoba rural district. Journal of Ethnobiology and Ethnomedicine. 2007;3(1): 29.Background: Ethnobotanical surveys were carried out to document herbal remedies used in the management of HIV/AIDS opportunistic infections in Bukoba Rural district, Tanzania. The district is currently an epicenter of HIV/AIDS and although over 90% of the population in the district relies on traditional medicines to manage the disease, this knowledge is impressionistic and not well documented. The HIV/AIDS opportunistic conditions considered during the study were Tuberculosis (TB), Herpes zoster (Shingles), Herpes simplex (Genital herpes), Oral candidiasis and Cryptococcal meningitis. Other symptomatic but undefined conditions considered were skin rashes and chronic diarrhea. Methods: An open-ended semi-structured questionnaire was used in collecting field information. Descriptive statistics were used to analyze the ethnobotanical data collected. Factor of informant consensus (Fic) was used to analyze the ethnobotanical importance of the plants. Results: In the present study, 75 plant species belonging to 66 genera and 41 families were found to be used to treat one or more HIV/AIDS related infections in the district. The study revealed that TB and oral candidiasis were the most common manifestations of HIV/AIDS opportunistic infections affecting most of the population in the area. It unveils the first detailed account of ethnomedical documentation of plants focusing the management of HIV/AIDS related infections in the district. Conclusion: It is concluded that the ethnopharmacological information reported forms a basis for further research to identify and isolate bioactive constituents that can be developed to drugs for the management of the HIV/AIDS opportunistic infections
Evaluation of a national universal coverage campaign of long-lasting insecticidal nets in a rural district in north-west Tanzania.
No full text\ud
\ud
Insecticide-treated nets (ITN) are one of the most effective measures for preventing malaria. Mass distribution campaigns are being used to rapidly increase net coverage in at-risk populations. This study had two purposes: to evaluate the impact of a universal coverage campaign (UCC) of long-lasting insecticidal nets (LLINs) on LLIN ownership and usage, and to identify factors that may be associated with inadequate coverage. In 2011 two cross-sectional household surveys were conducted in 50 clusters in Muleba district, north-west Tanzania. Prior to the UCC 3,246 households were surveyed and 2,499 afterwards. Data on bed net ownership and usage, demographics of household members and household characteristics including factors related to socio-economic status were gathered, using an adapted version of the standard Malaria Indicator Survey. Specific questions relating to the UCC process were asked. The proportion of households with at least one ITN increased from 62.6% (95% Confidence Interval (CI) = 60.9-64.2) before the UCC to 90.8% (95% CI = 89.0-92.3) afterwards. ITN usage in all residents rose from 40.8% to 55.7%. After the UCC 58.4% (95% CI = 54.7-62.1) of households had sufficient ITNs to cover all their sleeping places. Households with children under five years (OR = 2.4, 95% CI = 1.9-2.9) and small households (OR = 1.9, 95% CI = 1.5-2.4) were most likely to reach universal coverage. Poverty was not associated with net coverage. Eighty percent of households surveyed received LLINs from the campaign. The UCC in Muleba district of Tanzania was equitable, greatly improving LLIN ownership and, more moderately, usage. However, the goal of universal coverage in terms of the adequate provision of nets was not achieved. Multiple, continuous delivery systems and education activities are required to maintain and improve bed net ownership and usage.\ud
\u
Confirmed Malaria Cases Among Children Under Five with Fever and History of Fever Rural Western Tanzania.
No full textThe World Health Organization recommends that malaria treatment should begin with parasitological diagnosis. This will help to control misuse of anti-malarial drugs in areas with low transmission. The present study was conducted to assess the prevalence of parasitologically confirmed malaria among children under five years of age presenting with fever or history of fever in rural western Tanzania. A finger prick blood sample was obtained from each child, and thin and thick blood smears were prepared, stained with 10% Giemsa and examined under the light microscope. A structured questionnaire was used to collect each patient's demographic information, reasons for coming to the health center; and a physical examination was carried out on all patients. Fever was defined as axillary temperature ≥ 37.5°C. A total of 300 children with fever or a history of fever (1 or 2 weeks) were recruited, in which 54.3% (163/300, 95%CI, 48.7-59.9) were boys. A total of 76 (76/300, 25.3%, 95%CI, 22.8 - 27.8) of the children had fever. Based on a parasitological diagnosis of malaria, only 12% (36/300, 95%CI, 8.3-15.7) of the children had P. falciparum infection. Of the children with P. falciparum infection, 52.7% (19/36, 95%CI, 47.1-58.3) had fever and the remaining had no fever. The geometrical mean of the parasites was 708.62 (95%CI, 477.96-1050.62) parasites/μl and 25% (9/36, 95%CI, 10.9 -- 39.1) of the children with positive P. falciparum had ≥ 1001 parasites/μl. On Univariate (OR = 2.13, 95%CI, 1.02-4.43, P = 0.044) and multivariate (OR = 2.15, 95%CI, 1.03-4.49) analysis, only children above one year of age were associated with malaria infections. Only a small proportion of the children under the age of five with fever had malaria, and with a proportion of children having non-malaria fever. Improvement of malaria diagnostic and other causes of febrile illness may provide effective measure in management of febrile illness in malaria endemic areas
Predictors of Antibiotics Co-prescription with Antimalarials for Patients Presenting with Fever in Rural Tanzania.
No full textSuccessful 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. 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. 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 from served in health centres even though the deference was not statistically significant. 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
Bridging the gap between mass media journalists and health research scientists in Tanzania
No full textNo Abstract
Mosquito Net Coverage and Utilisation for Malaria\ud Control in Tanzania\ud
No full text\ud
In recent years malaria parasites have developed resistance to the most commonly used antimalarial drugs in Tanzania, posing a major challenge for its control. This has led to frequent changes of malaria treatment guidelines, more recently to expensive, yet more effective arthemether/lumefantrine. The use of insecticide treated mosquito nets (ITNs) and long lasting nets (LLINs) in Tanzania has increased slowly over the past few years. Despite the introduction of a voucher scheme to the vulnerable groups, the proportion of households with at least an ITN/LLIN in the country has not been able to achieve the Abuja Declaration of 60% net coverage. Statistics available on the utilisation of nets do not provide a good estimate of the coverage, because of the different study design used to collect the information. This survey was carried out in 21 districts of Tanzania to determine the coverage and utilisation of insecticide treated nets to provide baseline information of the net requirement to cover every sleeping bed in the country. Specifically, this study aimed to (i) determine the ITN coverage by and its distribution in the country; and (ii) determine knowledge, attitudes and practice of the householders as regards to malaria prevention and control Twenty one districts (one from each region) of Mainland Tanzania were selected for the survey. Selection of the district was random. In each district, two wards were selected, one urban (within the district capital) and one rural or sub‐urban. Households were selected randomly using a table of random numbers. At household level, the head or any adult who represented the head of household was interviewed. A structured pre‐tested questionnaire was used to collect information on knowledge, attitude and practices in malaria control, with emphasis on mosquito net ownership and utilisation. Of the 9549 targeted households, 9166 (96%) participated in the survey. Majority of the respondents (76.8%) were from rural district.The mean household size was 3.9 persons. On average, children <5 years old accounted for 39.3% of the members of the households. Respondents with no formal education accounted for 15.8‐37.4% of the interviewees. Most of them were from Mkuranga (55%), Kigoma‐Ujiji (44.2%) and Newala (37.9%). High literate rates were observed in Arumeru and Moshi districts. The majority of the respondents knew that the mosquito is the vector of the malaria parasite (92.6‐99.4%) and infection is through a mosquito bite (92.7‐99.8%). The knowledge of respondents on malaria transmission was generally high (94.0‐99.0%). The majority of the respondents (95.2%) considered the use of mosquito nets as the most effective way of malaria prevention. However, of these, only 66.7% said to have actually used nets in their life time. Knowledge on the use of mosquito nets in the control of malaria was highest and lowest in Eastern and Central zones, respectively.\ud
Seventy‐seven percent (4457/8933) agreed to have the investigator entry into their houses and verify the\ud
number of nets owned. On average, 62.9% (5,785/8933) of the households had at least a mosquito net. Majority of the respondents in Northern (76.5%) and Southern (76.5%) zones owned at least a mosquito net. The lowest mosquito net ownership was observed among respondents in Western Zone (39.6%). District‐wise, net ownership was highest in Lindi (94.5%), Kyela (91.3%) Arumeru (86.1%), Ilala (83.1%)\ud
and Nyamagana (80.0%). Ownership of net was very low in Kilolo (34.8%), Kigoma (36.5%) and Musoma Rural (41.3%). Of the households with nets, 74.4% were using nets all year round. A larger proportion of respondents in Kilolo (68.5%), Mpwapwa (51.9%), Songea Rural (49.2%) and Shinyanga Rural (46.3%) were only using the nets during the rainy season. Out of 9,166 households visited, 3,610 (39.3%) had at least one under five child. Of these, in 1,939 (53.7%) of the households the child slept under a mosquito net during the previous night. Use of nets in children <5 years was most common in northern zone (74%); followed by eastern (66.9%) and southern zone (61.1%). Districts with the largest proportion of <5 year children sleeping under a mosquito nets were Lindi (90.0%), Kyela (85.2%), Ilala (83.2%) and Arumeru (78.2%). Only about a quarter (27%) of the children <5% in western zone were sleeping under a mosquito net. Lowest net coverage for <5 year was in Kigoma (22.7%), Kilolo (25%) and Bukoba Rural (31.2%). A total of 5,785 (62.9%) owned at least a mosquito net. Of these, 4,219 and 1,566 were from the rural and urban districts, respectively. More households in the urban districts (73.4%) than rural districts (59.7%) owned at least a mosquito net. Likewise, there were more households (64.9%) in the urban districts with <5years children sleeping under mosquito nets than in the rural districts (50.4%). More households in urban (32.8%) than in rural districts (25.1%) had at least one insecticide treated net. The number of households with mosquito nets enough for all members of the households ranged from 18.9% (in Urambo) to 37.4% (in Hanang). Households with at least 50% or more occupants using mosquito nets ranged from 16.4% (in Urambo) to 42.8% (in Arumeru). Districts with the largest proportion of ≥50% of the household members sleeping under mosquito nets were Arumeru (46.9%) and Lindi (46.7%). In Manyoni and Lindi, 3.1% and 5% of the households were found to have more nets than the number of household occupants. Only 9% (801/9196) of the households had all occupants sleeping under a mosquito net. Kyela district had about a quarter (23.9%) of the households with all occupants sleeping under nets. Only 29% of the households had at least one insecticide treated mosquito nets. All nets in 51.4% of the households surveyed were ITNs. The largest proportion of households with ITN was observed in northern zone (40.2%), with Arumeru (46%) and Hanang (44.1%) districts having the highest ITN coverage. The lowest proportion (15.5%) of households with ITN was found in the Western Zone. Districts which had the lowest ITN coverage were Musoma Rural (12.6%), Kigoma‐Ujiji (13.2%), and Shinyanga Rural (14.4%). On average, 90.7% (8,123/8,953) of the respondents would prefer using ITN than having their house sprayed with long lasting residual insecticide. More households in urban (32.8%) than in rural districts (25.1%) had at least an ITN> A total of 1939 children underfives were sleeping under mosquito net (any type). Of these, 1140 (58.8%) were using insecticide treated nets (ITN). Overall, 31.6% of the underfives slept under an insecticide treated net during the previous night. Highest coverage was reported in Kyela (47.7%), Nyamagana (47.7%) and Arumeru (46.4%). Lowest ITN in underfives was reported in Kigoma‐Ujiji (16.0%), Musoma (17.2%) and Urambo (17.7%). In Songea more underfives children were sleeping under ITN (43.6%) than in untreated nets (40.9%). Control of bedbugs, lice, fleas, mites and cockroaches was the major added advantage of using insecticide treated nets. On average, 30.8% and 19.6% of the respondents mentioned cockroach and bedbug control as the main advantage of using ITN, respectively. The majority (52.9%) preferred blue coloured net (Northern=45.6%; Central=59.2%; Eastern=56.4%; Lake= 54.4%; Southern= 60.3%, Western= 58.5%) and Southern Highlands= 49.1%). Other colour preferences were white (29.6%), green (14.1%), black (2.1%) and pink (1.2%). A strong preference for blue mosquito nets was observed among respondents in Musoma (77.3%) and Newala (75.5%) districts. On the other hand, the weakest preference (24.7%) for blue nets was observed among respondents in Arumeru district. The majority of the respondents (82%) preferred rectangular shaped net. A larger percent (61.8%) the respondents preferred to have the map of Tanzania as a national logo to identify nets distributed in the country. On average, 62.7% and 28.8% of the households in Tanzania own at least one mosquito net (any type) and insecticide treated net, respectively. Tanzania expects that ITN coverage of under fives in 2009, after the Under Five Catch‐up Campaign is complete, to be at least 80%. If this is to be achieved, there is a need for concerted effort in scaling up the distribution and demand for long lasting nets throughout the country. Moreover, the planned use of IRS in malaria control, currently considered unpopular should be accompanied by rigorous community health education to avoid resistance from household members.\u
Hospital-based safety and telerability study to assesss efficacy of oral doxycycline in the treatment of <i> Wuchereria bancrofti infection in north-eastern Tanzania
No full textNo Abstract
- …
