37 research outputs found
Lancet Glob Health
No full textBackgroundMore timely estimates of malaria prevalence are needed to inform optimal control strategies and measure progress. Since 2014, Tanzania has implemented nationwide malaria screening for all pregnant women within the antenatal care system. We aimed to compare malaria test results during antenatal care to two population-based prevalence surveys in Tanzanian children aged 6\u201359 months to examine their potential in measuring malaria trends and progress towards elimination.MethodsMalaria test results from pregnant women screened at their first antenatal care visits at health-care facilities (private and public) in all 184 districts of Tanzania between Jan 1, 2014, and Dec 31, 2017, were collected from the Health Management Information Systems and District Health Information System 2. We excluded facilities with no recorded antenatal care attendees during the time period. We standardised results to account for testing uptake and weighted them by the timing of two population-based surveys of childhood malaria prevalence done in 2015\u201316 (Demographic and Health Survey) and 2017 (Malaria Indicator Survey). We assessed regional-level correlation using Spearman\u2019s coefficient and assessed the consistency of monthly district-level prevalence ranking using Kendall\u2019s correlation coefficient.FindingsCorrelation between malaria prevalence at antenatal care and among children younger than 5 years was high (r 650\ub783 for both surveys), although declines in prevalence at antenatal care were generally smaller than among children. Consistent heterogeneity (p<0\ub705) in antenatal care prevalence at the district level was evident in all but one region (Kilimanjaro). Data from antenatal care showed declining prevalence in three regions (Arusha, Kilimanjaro, and Manyara) where surveys estimated zero prevalence.InterpretationRoutine antenatal care-based screening can be used to assess heterogeneity in transmission at finer resolution than population-based surveys, and provides sample sizes powered to detect changes, notably in areas of low transmission where surveys lack power. Declines in prevalence at antenatal care might lag behind those among children, highlighting the value of monitoring burden and continuing prevention efforts among pregnant women as transmission declines. The pregnancy-specific benefits and cost-effectiveness of antenatal care-based screening remain to be assessed.WT_/Wellcome TrustUnited Kingdom/CC999999/ImCDC/Intramural CDC HHSUnited States/MR/R015600/1/MRC_/Medical Research CouncilUnited Kingdom
Informal urban settlements and cholera risk in Dar es Salaam, Tanzania.
No full textBACKGROUND: As a result of poor economic opportunities and an increasing shortage of affordable housing, much of the spatial growth in many of the world's fastest-growing cities is a result of the expansion of informal settlements where residents live without security of tenure and with limited access to basic infrastructure. Although inadequate water and sanitation facilities, crowding and other poor living conditions can have a significant impact on the spread of infectious diseases, analyses relating these diseases to ongoing global urbanization, especially at the neighborhood and household level in informal settlements, have been infrequent. To begin to address this deficiency, we analyzed urban environmental data and the burden of cholera in Dar es Salaam, Tanzania. METHODOLOGY/PRINCIPAL FINDINGS: Cholera incidence was examined in relation to the percentage of a ward's residents who were informal, the percentage of a ward's informal residents without an improved water source, the percentage of a ward's informal residents without improved sanitation, distance to the nearest cholera treatment facility, population density, median asset index score in informal areas, and presence or absence of major roads. We found that cholera incidence was most closely associated with informal housing, population density, and the income level of informal residents. Using data available in this study, our model would suggest nearly a one percent increase in cholera incidence for every percentage point increase in informal residents, approximately a two percent increase in cholera incidence for every increase in population density of 1000 people per km(2) in Dar es Salaam in 2006, and close to a fifty percent decrease in cholera incidence in wards where informal residents had minimally improved income levels, as measured by ownership of a radio or CD player on average, in comparison to wards where informal residents did not own any items about which they were asked. In this study, the range of access to improved sanitation and improved water sources was quite narrow at the ward level, limiting our ability to discern relationships between these variables and cholera incidence. Analysis at the individual household level for these variables would be of interest. CONCLUSIONS/SIGNIFICANCE: Our results suggest that ongoing global urbanization coupled with urban poverty will be associated with increased risks for certain infectious diseases, such as cholera, underscoring the need for improved infrastructure and planning as the world's urban population continues to expand
Stakeholder Engagement in Policy Development: Observations and Lessons from International Experience
No full textThis chapter provides a starting point for better understanding how different approaches, tools, and technologies can support effective stakeholder participation in policy development. Participatory policy making involves stakeholders in various stages of the policy process and can focus on both the substance of the policy problem or on improving the tools and processes of policy development. We examine five international cases of stakeholder engagement in policy development to explore two questions: (1) what types of engagement tools and processes are useful for different stakeholders and contexts? And (2) what factors support the effective use of particular tools and technologies toward constructive outcomes? The cases address e-government strategic planning in a developing country, energy policy in a transitional economy, development of new technology and policy innovations in global trade, exploration of tools for policy-relevant evidence in early childhood decision making, and development of indicators for evaluating policy options in urban planning. Following a comparison of the cases, we discuss salient factors of stakeholder selection and representation, stakeholder support and education, the value of stakeholder engagement for dealing with complexity, and the usefulness of third-party experts for enhancing transparency and improving tools for engagement.Multi Actor SystemsTechnology, Policy and Managemen
Malar J
No full textBackgroundRecent malaria control efforts in mainland Tanzania have led to progressive changes in the prevalence of malaria infection in children, from 18.1% (2008) to 7.3% (2017). As the landscape of malaria transmission changes, a sub-national stratification becomes crucial for optimized cost-effective implementation of interventions. This paper describes the processes, data and outputs of the approach used to produce a simplified, pragmatic malaria risk stratification of 184 councils in mainland Tanzania.MethodsAssemblies of annual parasite incidence and fever test positivity rate for the period 2016\u20132017 as well as confirmed malaria incidence and malaria positivity in pregnant women for the period 2015\u20132017 were obtained from routine district health information software. In addition, parasite prevalence in school children (PfPR5to16) were obtained from the two latest biennial council representative school malaria parasitaemia surveys, 2014\u20132015 and 2017. The PfPR5to16 served as a guide to set appropriate cut-offs for the other indicators. For each indicator, the maximum value from the past 3\ua0years was used to allocate councils to one of four risk groups: very low (<\u20091%PfPR5to16), low (1 12\u2009<\u20095%PfPR5to16), moderate (5 12\u2009<\u200930%PfPR5to16) and high ( 65\u200930%PfPR5to16). Scores were assigned to each risk group per indicator per council and the total score was used to determine the overall risk strata of all councils.ResultsOut of 184 councils, 28 were in the very low stratum (12% of the population), 34 in the low stratum (28% of population), 49 in the moderate stratum (23% of population) and 73 in the high stratum (37% of population). Geographically, most of the councils in the low and very low strata were situated in the central corridor running from the north-east to south-west parts of the country, whilst the areas in the moderate to high strata were situated in the north-west and south-east regions.ConclusionA stratification approach based on multiple routine and survey malaria information was developed. This pragmatic approach can be rapidly reproduced without the use of sophisticated statistical methods, hence, lies within the scope of national malaria programmes across Africa.20202020-05-08T00:00:00Z-/NETCELL Project - Swiss TPH, Swiss Agency for Development and Cooperation/-/Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM) and the Swiss Tropical and Public Health Institute/103602/WT_/Wellcome Trust/United Kingdom212176/WT_/Wellcome Trust/United Kingdom203155/Department for International Development/32384923PMC72066741040
Summary statistics of surveyed drain segments.
No full text<p>Summary statistics of surveyed drain segments.</p
Study area and administrative units in Dar es Salaam, Tanzania.
No full text<p>Administratively, Dar es Salaam comprises three municipalities – Ilala, Kinondoni and Temeke – and is divided into 73 wards (22 in Ilala, 27 in Kinondoni, and 24 in Temeke), classified by the Tanzania National Bureau of Statistics (NBS) as urban, rural or mixed. The wards are further divided into smaller areal units called <i>mitaa</i>, which are subdivided into ten-cell units (TCU), the smallest administrative unit in the city. The map highlights the 15 wards included in the study (5 in each municipality), which comprise the targeted area for an urban malaria control effort.</p
Sketches of drain segments that compose one unique surveyed drain.
No full text<p>The Figure shows two hypothetical drains, indicating how different segments were identified and surveyed during the Drain Assessment Survey. <b>A</b>. The drain follows the same linear direction throughout its entire extension, but five drain segments are identified: three are open (AB, CD, and EF) and two are covered – car and/or pedestrian passage (BC and DE). <b>B</b>. The drain follows local areal characteristics, and each change in direction corresponds to a unique drain segment.</p
Clustering pattern in the proportion of aquatic habitats classified as drains that contained larvae, 2005–2007.
No full text<p>Clusters in the proportion of aquatic habitats that contained larvae, utilizing the ten-cell unit (TCU) as the spatial unit of analysis, were assessed through the use of local Moran's I indicator of spatial association, with a first order queen neighborhood. Cluster significance was determined based on a normal distribution and corrected for multiple comparisons utilizing the false discovery rate procedure (as described in Data and Methods).</p
Percentage distribution of aquatic habitats that contained larvae by habitat type, 2005–2007.
No full text<p>Data on aquatic habitats containing <i>Anopheles</i> or <i>Culex</i> larvae were retrieved from the Urban Malaria Control Program (UMCP) routine larval habitat survey.</p
Average number of habitats surveyed weekly between 2005–2007.
No full text<p>Average number of habitats surveyed weekly between 2005–2007.</p
