21 research outputs found
Using Community-Owned Resource Persons to Provide Early Diagnosis and Treatment and Estimate Malaria Burden at Community Level in North-Eastern Tanzania.
No full textAlthough early diagnosis and prompt treatment is an important strategy for control of malaria, using fever to initiate presumptive treatment with expensive artemisinin combination therapy is a major challenge; particularly in areas with declining burden of malaria. This study was conducted using community-owned resource persons (CORPs) to provide early diagnosis and treatment of malaria, and collect data for estimation of malaria burden in four villages of Korogwe district, north-eastern Tanzania.In 2006, individuals with history of fever within 24 hours or fever (axillary temperature ≥37.5°C) at presentation were presumptively treated using sulphadoxine/pyrimethamine. Between 2007 and 2010, individuals aged five years and above, with positive rapid diagnostic tests (RDTs) were treated with artemether/lumefantrine (AL) while under-fives were treated irrespective of RDT results. Reduction in anti-malarial consumption was determined by comparing the number of cases that would have been presumptively treated and those that were actually treated based on RDTs results. Trends of malaria incidence and slide positivity rates were compared between lowlands and highlands. Of 15,729 cases attended, slide positivity rate was 20.4% and declined by >72.0% from 2008, reaching <10.0% from 2009 onwards; and the slide positivity rates were similar in lowlands and highlands from 2009 onwards. Cases with fever at presentation declined slightly, but remained at >40.0% in under-fives and >20.0% among individuals aged five years and above. With use of RDTs, cases treated with AL decreased from <58.0% in 2007 to <11.0% in 2010 and the numbers of adult courses saved were 3,284 and 1,591 in lowlands and highlands respectively. Malaria incidence declined consistently from 2008 onwards; and the highest incidence of malaria shifted from children aged <10 years to individuals aged 10-19 years from 2009. With basic training, supervision and RDTs, CORPs successfully provided early diagnosis and treatment and reduced consumption of anti-malarials. Progressively declining malaria incidence and slide positivity rates suggest that all fever cases should be tested with RDTs before treatment. Data collected by CORPs was used to plan phase 1b MSP3 malaria vaccine trial and will be used for monitoring and evaluation of different health interventions. The current situation indicates that there is a remarkable changing pattern of malaria and these areas might be moving from control to pre-elimination levels
Genital tract infections in women attending sexually transmitted infection clinics in Mwanza, north-west Tanzania
No full textFactors Associated with Severe Disease from Malaria, Pneumonia and Diarrhea among Children in Rural Tanzania - a Hospital-Based Cross-Sectional Study.
No full textMild cases of malaria, pneumonia and diarrhea are readily treatable with complete recovery and with inexpensive and widely available first-line drugs. However, treatment is complicated and expensive, and mortality is higher when children present to the hospital with severe forms of these illnesses. We studied how care seeking behaviours and other factors contributed to severity of malaria, pneumonia and diarrhoea among children less than five years in rural Tanzania. We interviewed consecutive care-takers of children diagnosed with malaria, pneumonia and/or diarrhea at Korogwe and Muheza district hospitals, in north-eastern Tanzania, between July 2009 and January 2010, and compared characteristics of children presenting with severe and those with non-severe disease. A total of 293 children with severe and 190 with non-severe disease were studied. We found persistent associations between severity of disease and caretaker's lack of formal education (OR 6.6; 95% confidence interval (CI) 2.7-15.8) compared to those with post-primary education, middle compared to high socio-economic status (OR 1.9; 95% CI 1.2-3.2), having 4 or more children compared to having one child (OR 2.5; 95% CI 1.4-4.5), having utilized a nearer primary health care (PHC) facility for the same illness compared to having not (OR 5.2; 95% CI 3.0-9.1), and having purchased the first treatment other than paracetamol from local or drug shops compared to when the treatment was obtained from the public hospitals for the first time (OR 3.2; 95% CI 1.9-5.2). The old officially abandoned first line anti-malaria drug Sulfadoxin-pyrimethamine (SP) was found to still be in use for the treatment of malaria and was significantly associated with childrens' presentation to the hospital with severe malaria (OR 12.5; 95% CI 1.6-108.0). Our results indicate that caretakers with no formal education, with lower SES and with many children can be target groups for interventions in order to further reduce child mortality from treatable illnesses. Furthermore, the quality of the available drug shops and PHC facilities need to be closely monitored
Risk factors for low birth-weight in areas with varying malaria transmission in Korogwe, Tanzania: implications for malaria control
No full textLow birth weight (LBW) is a risk factor for infant mortality,
morbidity, growth retardation, poor cognitive development, and chronic
diseases. Maternal exposure to diseases such as malaria, HIV, and
syphilis has been shown to have a significant impact on birth weight
(BW). This study was aimed at determining whether there was a
difference in rates of LBW in areas of varying malaria transmission
intensity in Korogwe, Tanzania. Retrospective data for one year (June
2004-May 2005) in three maternal and child health (MCH) clinics in the
district were analysed. Villages were stratified into three strata:
lowlands-semi urban (average altitude of 320m), lowlands-rural (below
600m) and highlands (≥600m). There was a significant decreasing
trend of rate of LBW from rural lowlands to highlands (X2 trend =7.335,
P=0.007). Adjusting for covariates, women in parity-two were at reduced
risk of delivering LBW babies compared to first parity women (OR=0.44,
95% CI 0.19-0.98, P=0.045). Similarly, the risk of LBW was higher in
women who had delayed MCH gestational booking and in women who
conceived during high malaria transmission seasons. There was high
degree of preference of digits ending with 0/5 in reporting BW in the
studied MCHs. In conclusion, a rate of LWB was high in rural lowlands
where malaria is also endemic, and was associated with high malaria
transmission seasons
Using rapid diagnostic tests as source of malaria parasite DNA for molecular analyses in the era of declining malaria prevalence.
No full textBACKGROUND: Malaria prevalence has recently declined markedly in many parts of Tanzania and other sub-Saharan African countries due to scaling-up of control interventions including more efficient treatment regimens (e.g. artemisinin-based combination therapy) and insecticide-treated bed nets. Although continued molecular surveillance of malaria parasites is important to early identify emerging anti-malarial drug resistance, it is becoming increasingly difficult to obtain parasite samples from ongoing studies, such as routine drug efficacy trials. To explore other sources of parasite DNA, this study was conducted to examine if sufficient DNA could be successfully extracted from malaria rapid diagnostic tests (RDTs), used and collected as part of routine case management services in health facilities, and thus forming the basis for molecular analyses, surveillance and quality control (QC) testing of RDTs. METHODS: One hyper-parasitaemic blood sample (131,260 asexual parasites/μl) was serially diluted in triplicates with whole blood and blotted on RDTs. DNA was extracted from the RDT dilution series, either immediately or after storage for one month at room temperature. The extracted DNA was amplified using a nested PCR method for Plasmodium species detection. Additionally, 165 archived RDTs obtained from ongoing malaria studies were analysed to determine the amplification success and test applicability of RDT for QC testing. RESULTS: DNA was successfully extracted and amplified from the three sets of RDT dilution series and the minimum detection limit of PCR was <1 asexual parasite/μl. DNA was also successfully amplified from (1) 70/71 (98.6%) archived positive RDTs (RDTs and microscopy positive) (2) 52/63 (82.5%) false negative RDTs (negative by RDTs but positive by microscopy) and (3) 4/24 (16.7%) false positive RDTs (positive by RDTs but negative by microscopy). Finally, 7(100%) negative RDTs (negative by RDTs and microscopy) were also negative by PCR. CONCLUSION: This study showed that DNA extracted from archived RDTs can be successfully amplified by PCR and used for detection of malaria parasites. Since Tanzania is planning to introduce RDTs in all health facilities (and possibly also at community level), availability of archived RDTs will provide an alternative source of DNA for genetic studies such as continued surveillance of parasite resistance to anti-malarial drugs. The DNA obtained from RDTs can also be used for QC testing by detecting malaria parasites using PCR in places without facilities for microscopy
Plasma cytokine levels in Tanzanian HIV-1-infected adults and the effect of antiretroviral treatment
No full textOBJECTIVE: To evaluate the role immune activation leading to the production and circulation of cytokines has in the pathogenesis of HIV infection in sub-Saharan Africa and the effect of antiretroviral treatment (ART) on these parameters. METHODS: Plasma concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8, monocyte chemotactic protein (MCP)-1, IL-10, and IL-1 receptor antagonist; plasma HIV RNA; hemoglobin concentration; and white blood cells were measured in 229 HIV-infected, 54 HIV-uninfected, and after 2 and 4 months, respectively, of ART in 35 eligible individuals in northeastern Tanzania. RESULTS: Plasma levels of tumor necrosis factor-alpha, IL-6, IL-8, monocyte chemotactic protein-1, and IL-1 receptor antagonist were significantly higher in HIV-infected individuals compared with HIV-uninfected individuals and also significantly higher in HIV-infected individuals with CD4 cell counts below 200 cells per microliter than individuals with CD4 cell counts above 200 cells per microliter. HIV RNA was the strongest predictor of all cytokine expression in multivariate analysis. ART leads to a decrease in all cytokines to levels close to those of HIV-uninfected individuals. CONCLUSIONS: Our findings support the role of HIV viral replication as the most important promoter of immune activation and prove the importance of ART in reducing immune activation and viral replication even in sub-Saharan Africa where patients are exposed to an abundance of other infectious agents Udgivelsesdato: 2009/12/
Risk factors for low birth-weight in areas with varying malaria transmission in Korogwe, Tanzania: implications for malaria control
No full textUdgivelsesdato: 2008-JulLow birth weight (LBW) is a risk factor for infant mortality, morbidity, growth retardation, poor cognitive development, and chronic diseases. Maternal exposure to diseases such as malaria, HIV, and syphilis has been shown to have a significant impact on birth weight (BW). This study was aimed at determining whether there was a difference in rates of LBW in areas of varying malaria transmission intensity in Korogwe, Tanzania. Retrospective data for one year (June 2004-May 2005) in three maternal and child health (MCH) clinics in the district were analysed. Villages were stratified into three strata: lowlands-semi urban (average altitude of 320m), lowlands-rural (below 600m) and highlands (> or =600m). There was a significant decreasing trend of rate of LBW from rural lowlands to highlands (chi2trend = 7.335, P=0.007). Adjusting for covariates, women in parity-two were at reduced risk of delivering LBW babies compared to first parity women (OR=0.44, 95% CI 0.19-0.98, P=0.045). Similarly, the risk of LBW was higher in women who had delayed MCH gestational booking and in women who conceived during high malaria transmission seasons. There was high degree of preference of digits ending with 0/5 in reporting BW in the studied MCHs. In conclusion, a rate of LWB was high in rural lowlands where malaria is also endemic, and was associated with high malaria transmission seasons
Epidemiology of Malaria in an Area Prepared for Clinical Trials in Korogwe, North-eastern Tanzania.
No full textSite preparation is a pre-requesite in conducting malaria vaccines trials. This study was conducted in 12 villages to determine malariometric indices and associated risk factors, during long and short rainy seasons, in an area with varying malaria transmission intensities in Korogwe district, Tanzania. Four villages had passive case detection (PCD) of fever system using village health workers. Four malariometric cross-sectional surveys were conducted between November 2005 and May 2007 among individuals aged 0-19 years, living in lowland urban, lowland rural and highland strata. A total of 10,766 blood samples were collected for malaria parasite diagnosis and anaemia estimation. Blood smears were stained with Giemsa while haemoglobin level was measured by HaemoCue. Socio-economic data were collected between Jan-Apr 2006. Adjusting for the effect of age, the risk of Plasmodium falciparum parasitaemia was significantly lower in both lowland urban, (OR = 0.26; 95%CI: 0.23-0.29, p < 0.001) and highlands, (OR = 0.21; 95%CI: 0.17-0.25, p < 0.001) compared to lowland rural. Individuals aged 6-9 years in the lowland rural and 4-19 years in both lowland urban and highlands had the highest parasite prevalence, whilst children below five years in all strata had the highest parasite density. Prevalence of splenomegaly and gametocyte were also lower in both lowland urban and highlands than in lowland rural. Anaemia (Hb <11 g/dl) prevalence was lowest in the lowland urban. Availability of PCD and higher socio-economic status (SES) were associated with reduced malaria and anaemia prevalence. Higher SES and use of bed nets in the lowland urban could be the important factors for low malaria infections in this stratum. Results obtained here were used together with those from PCD and DSS in selecting a village for Phase 1b MSP3 vaccine trial, which was conducted in the study area in year 2008
Accuracy of Malaria Rapid Diagnostic Tests in Community Studies and their Impact on Treatment of Malaria in an Area with Declining Malaria Burden in North-Eastern Tanzania.
No full textDespite some problems related to accuracy and applicability of malaria rapid diagnostic tests (RDTs), they are currently the best option in areas with limited laboratory services for improving case management through parasitological diagnosis and reducing over-treatment. This study was conducted in areas with declining malaria burden to assess; 1) the accuracy of RDTs when used at different community settings, 2) the impact of using RDTs on anti-malarial dispensing by community-owned resource persons (CORPs) and 3) adherence of CORPs to treatment guidelines by providing treatment based on RDT results. Data were obtained from: 1) a longitudinal study of passive case detection of fevers using CORPs in six villages in Korogwe; and 2) cross-sectional surveys (CSS) in six villages of Korogwe and Muheza districts, north-eastern, Tanzania. Performance of RDTs was compared with microscopy as a gold standard, and factors affecting their accuracy were explored using a multivariate logistic regression model. Overall sensitivity and specificity of RDTs in the longitudinal study (of 23,793 febrile cases; 18,154 with microscopy and RDTs results) were 88.6% and 88.2%, respectively. In the CSS, the sensitivity was significantly lower (63.4%; χ2=367.7, p<0.001), while the specificity was significantly higher (94.3%; χ2=143.1, p<0.001) when compared to the longitudinal study. As determinants of sensitivity of RDTs in both studies, parasite density of<200 asexual parasites/μl was significantly associated with high risk of false negative RDTs (OR≥16.60, p<0.001), while the risk of false negative test was significantly lower among cases with fever (axillary temperature ≥37.5 °C) (OR≤0.63, p≤0.027). The risk of false positive RDT (as a determinant of specificity) was significantly higher in cases with fever compared to afebrile cases (OR≥2.40, p<0.001). Using RDTs reduced anti-malarials dispensing from 98.9% to 32.1% in cases aged ≥5 years. Although RDTs had low sensitivity and specificity, which varied widely depending on fever and parasite density, using RDTs reduced over-treatment with anti-malarials significantly. Thus, with declining malaria prevalence, RDTs will potentially identify majority of febrile cases with parasites and lead to improved management of malaria and non-malaria fevers
Uptake of Measles Vaccination Services and Associated Factors Among under Fives in Temeke district, Dar es salaam Region, Tanzania
No full textMeasles outbreaks have been recurring in Tanzania despite ongoing efforts in immunization. In May 2011, there was a large Measles outbreak in the Temeke district, Dar es salaam where a total 588 cases were reported. The investigation found that a large percentage of underfives had not received measles vaccination. Although measles vaccination coverage figures are easily available, information about factors affecting uptake of measles vaccination services is not easily available. In order to plan and implement interventions that aim to improve uptake of measles vaccination services, information on the determinants of measles uptake level such as community, health facility, household and children factors is needed. This study investigated the factors associated with the low uptake of vaccination services in Temeke district. A cross-sectional survey was conducted to assess the uptake of measles vaccination services and associated factors among children aged 12-23 months. Uptake of measles vaccination services was defined as the act of taking a child for vaccination which shows the level of acceptance of vaccination services by a caretaker. Uptake of measles vaccination was categorized into two groups; Low uptake and high uptake of vaccination services. Any child who had received both routine and supplementary measles vaccines was said to have high uptake and a child was said to have a low uptake of vaccination services if he/she had received either routine or supplementary only or neither of the two vaccines. Household and children determinants of low uptake for measles services were assessed. Bivariate and multivariate logistic regression were performed to identify significant determinants of low uptake. Analysis was done using EpiInfo version 3.5.1. A total of 295 children aged between 12-23 months were involved in the study. The mean age was 17 months. A total of 82 out 295 (27.8%) children had received either routine or supplementary vaccine or neither of the two vaccine i.e had a low uptake of vaccination services. A total of 23 (7.8%) out of 295 children had not received routine measles vaccination while 66 out of 295 (23.4%) children had not received supplementary measles vaccination. The number of children who neither received routine nor supplementary vaccinations was 9 out of 295 (3%). Factors which were significantly associated with low uptake of vaccination services were younger age of the child (Adjusted Odds Ratio (AOR) 2.11 CI 1.10-4.38), low education level of the caretaker (AOR 3.36 CI 1.17-9.62), caretaker’s lack of knowledge on the purpose of supplementary measles vaccine (AOR 2.04 CI 1.06-3.93), caretaker’s lack of knowledge of the age for routine measles vaccination (AOR 4.71 CI 2.47-8.99), residing in a ward where there are high measles cases (AOR 2.29 CI 1.23- 4.27) and residing in a ward less than 2 years duration (AOR 2.24 CI 1.12-4.48). The uptake of both routine and supplementary measles vaccine is below the Tanzania estimated coverage. Household and childhood factors played a role in determining the uptake of measles vaccination services. There is a need for the DHMT to revisit the Health education sessions during RCH services covering vaccine preventable diseases and identify gaps to be addressed. The team should also find out reasons behind mothers not sending children for vaccination especially supplementary vaccines
