Control In Tanzania Research Articles

Lymphatic filariasis control in Tanzania: infection, disease perceptions and drug uptake patterns in an endemic community after multiple rounds of mass drug administration

BackgroundLymphatic filariasis (LF) control in most countries of sub-Saharan Africa is based on annual mass drug administration (MDA) with a combination of ivermectin and albendazole, in order to interrupt transmission. However, attaining and maintaining high treatment coverage has been a challenge in many LF control programmes. This study was designed to elucidate reasons for continued transmission of LF in an endemic area of Tanga, northeastern Tanzania, where control activities based on MDA had been in place for eight years by the time of this study in 2012.MethodsA cross-sectional questionnaire survey was conducted in three sentinel villages used for monitoring the impact of MDA on LF transmission. A total of 747 individuals were interviewed, out of which 172 (23.0%), 27 (3.6%) and 49 (6.5%) had been shown to have circulating filarial antigens (CFA), microfilaraemia (MF) and LF gross lesions, respectively, prior to the interviews.ResultsThe interviewed population had a mean age of 33.7 years and a male to female ratio of 0.8. Males, individuals aged 30 years and above, peasants/fishermen and recent immigrants to the study communities were significantly more affected (CFA, MF and/ or LF gross lesions) than the other population groups. However, drug uptake rates were not significantly different between LF affected (those with CFA, MF and/ or LF gross lesions) and non-affected individuals. Likewise, drug uptake rates were not significantly different across different demographic parameters of the study population, some of which differed significantly in the level of infection. Moreover, it was found that misconceptions on how LF can be acquired were still evident, linking its transmission to witchcraft, heredity and sexual behaviour.ConclusionsThe findings indicated that misconceptions about LF and its transmission still existed despite eight years of control activities in the area. Improved communication on the rationale of MDA and an enhanced drug delivery strategy that is adapted to the local settings and targeting important demographic groups that serve as reservoir of infection will help in reaching the elimination target within a reasonable timeframe.

Cost-Effectiveness of Indoor Residual Spraying of Households with Insecticide for Malaria Prevention and Control in Tanzania.

Using a decision-tree approach, we examined the cost-effectiveness of indoor residual spraying (IRS) of households with insecticide combined with insecticide-treated bed net (ITN) distribution (IRS + ITN), compared with ITN distribution alone in the programmatic context of mainland Tanzania. The primary outcome of our model was the expected economic cost to society per case of malaria averted in children ≤ 5 years of age. Indoor residual spraying of households with insecticide data came from a program implemented in northwest Tanzania from 2008 to 2012; all other data originated from the published literature. Through sensitivity and scenario analyses, the model also examined the effects of variations in insecticide resistance, malaria prevalence, and different IRS modalities. In the base case, IRS + ITN is expected to be more expensive and more effective than the ITN-only intervention (incremental cost-effectiveness ratio [ICER]: $152.36). The number of IRS rounds, IRS insecticide costs, ITN use, malaria prevalence, and the probability that a child develops symptoms following infection drove the interventions' cost-effectiveness. Compared with universal spraying, targeted spraying is expected to lead to a higher number of malaria cases per person targeted (0.211-0.256 versus 0.050-0.076), but the incremental cost per case of malaria averted is expected to be lower (ICER: $41.70). In a scenario of increasing pyrethroid resistance, the incremental expected cost per case of malaria averted is expected to increase compared with the base case (ICER: $192.12). Tanzania should pursue universal IRS only in those regions that report high malaria prevalence. If the cost per case of malaria averted of universal IRS exceeds the willingness to pay, targeted spraying could provide an alternative, but may result in higher malaria prevalence.

An investigative journalism perspective on tobacco control in Tanzania

An investigative journalism perspective on tobacco control in Tanzania

Multiple insecticide resistance in Anopheles gambiae from Tanzania: a major concern for malaria vector control

BackgroundMalaria vector control in Tanzania is based on use of long-lasting insecticide treated nets (LLINs) and indoor residual spraying (IRS), which both rely on the use of chemical insecticides. The effectiveness of these control tools is endangered by the development of insecticide resistance in the major malaria vectors. This study was carried out to monitor the susceptibility status of major malaria vectors to insecticides used for IRS and LLINs in mainland Tanzania.MethodsMosquito larvae were collected in 20 sites of Tanzania mainland in 2015. Phenotypic resistance was determined using standard WHO susceptibility tests. Molecular assay were used to determine distribution of Anopheles gambiae sub-species. A microplate assay approach was used for identifying enzyme levels on single mosquitoes from each sites compared with a susceptible reference strain, An. gambiae sensu stricto (s.s.) Kisumu strain.ResultsAnopheles arabiensis was the dominant malaria specie in the country, accounting for 52% of the sibling species identified, while An. gambiae s.s. represented 48%. In Arumeru site, the dominant species was An. arabiensis, which was resistant to both pyrethroids (permethrin and deltamethrin), and pirimiphos-methyl, and had significant elevated levels of GSTs, non-specific esterases, and oxidase enzymes. An. arabiensis was also a dominant species in Kilombero and Kondoa sites, both were resistant to permethrin and deltamethrin with significant activity levels of oxidase enzymes. Resistance to bendiocarb was recorded in Ngara site where specie composition is evenly distributed between An. gambiae s.s. and An.arabiensis. Also bendiocarb resistance was recorded in Mbozi site, where An. gambiae s.s. is the dominant species.ConclusionsOverall, this study confirmed resistance to all four insecticide classes in An. gambiae sensu lato in selected locations in Tanzania. Results are discussed in relation to resistance mechanisms and the optimization of resistance management strategies.

Legal Framework for Marine Oil Pollution Control in Tanzania

Tanzania is among the countries in the west of the Indian Ocean. The country is endowed with maritime resources and a considerable coastline of about 1500 Kilometers. The well being of people leaving along the coast depend on the use of resources of the ocean. The country is facing current and potential danger of marine oil pollution caused by ships calling its ports and terminals, ships using the West Indian Ocean route, land based activities, and the developments in offshore oil and gas activities in the country and within East Africa region.In order to achieve sustainable use of the oceans and its resource, this article provide a legal framework for marine oil pollution control in the context of prevention of oil pollution, response to marine pollution incident and compensation for oil pollution damage. Specifically, the article assesses national legislation in the light of international agreements. The article assists in the analysis of the established legal regime and institutional framework for purposes of improving the status of marine oil pollution control.

Insecticide resistance testing in malaria vectors in Tanzania: Challenges in mosquito sampling and rearing under field conditions

Background: The National Institute for Medical Research, Amani centre, in collaboration with National Malaria Control Programme, has been conducting annual insecticide resistance surveillance since 1999, aimed at early detection of resistance to insecticides used for malaria control in Tanzania. The Standard WHO method for larvae collection and rearing were used but challenges and limitations were encountered. For example rearing the larvae and adult mosquitoes using the Standard WHO method experienced 100% mortality for larvae; and adults in three days. The researchers therefore made modifications to the Standard WHO method to create suitable tools for the field environment. Methods: A ladle was created from an empty water bottle in which an oval hole longitudinally cut halfway from the bottom. Instead of using TetraMin as mosquito larval food, green algae were collected from mosquito breeding sites and used as larval food. Improvised heater of charcoal stoves and humidifier of wet fabric such as “Kanga” and “Kitenge” were also used. Results and conclusion: There was 90% larval survival, adult mosquito survived much better and the scientists had a total of 467 mosquitoes to run the insecticide susceptibility tests. Innovative ways are necessary under field conditions for mosquito breeding in susceptibility studies. Key words : Malaria, Anopheles gambiae complex, larvae, fabric, resistance, susceptibility, Tanzania.

Challenges and opportunities for implementing an intersectoral approach in malaria control in Tanzania.

Malaria is a complex health problem related to socio-economic and environmental factors that cut across a number of sectors. Establishing intersectoral linkages is important to facilitate joint efforts to address the problem at all levels. The objectives of this study were to explore key sectoral engagements in malaria control policy formulation and implementation, and to determine decision and policy makers’ opinions about different sectoral activities that contribute to malaria transmission and control in Tanzania. This study included documentary review, self-administered interviews and group discussion. Interviews and group discussions involved key informants at district and national levels. The sectors involved were health, agriculture, environment, livestock, fisheries, education, works, irrigation, water resources, land development, forestry, and community development. Institutions and organizations that were involved in the development of the previous and current National Malaria Strategic Plan (2007-2013 and 2013-2020) were the Ministries of Health and Social Welfare, Prime Minister’s Office of Regional Administration and Local Government, Public universities and non-governmental organizations. All the individuals involved in the development of the plans were either medical or health professionals. According to key informants, sectoral activities identified to contribute to malaria transmission included farming systems, deforestation, fishing, nomadic pastoralism, household water storage, water resource development projects, road and house construction and mining. The lack of intersectoral approaches in malaria control programme included the facts that the Health Sector does not involve other sectors during planning and development of policy guidelines, differences in sectoral mandates and management culture, lack of a national coordinating framework and lack of budget for intersectoral activities. The current strategies for malaria control in Tanzania need to address socio-economic and development activities across sectors and emphasise the need for intersectoral collaboration. It is recommended that the future of malaria control strategies should, therefore, be broad based and intersectoral in planning and implementation.

Cost-effectiveness of larviciding for urban malaria control in Tanzania.

BackgroundLarviciding for malaria control can contribute to an Integrated Vector Management (IVM) approach. This intervention is currently supported in settings where breeding habitats are ‘few, fixed, and findable’, such as urban areas of sub-Saharan Africa, but the knowledge base regarding the cost-effectiveness of larviciding is non-existent.MethodsProgramme costs and effectiveness data were collected from the Dar es Salaam Urban Malaria Control Programme in Tanzania. Cost-effectiveness ratios (CER) were estimated from the provider and societal perspectives for standard indicators using different malaria transmission scenarios.ResultsCER for microbial larviciding were highly dependent on the assumed baseline malaria incidence rates. Using the societal perspective, net CER were estimated (in 2012 US dollars) at $43 (95% uncertainty intervals [UI]: $15-181) per disability-adjusted life year averted (DALY) when malaria incidence was 902 infections per 1,000 individuals, increasing to $545 (95% UI: $337-1,558) per DALY at an incidence of 122 per 1,000. Larviciding was shown to be cost-effective in Tanzania for incidences as low as 40 infections per 1,000 people per year.ConclusionThis is believed to be the first study to estimate the cost-effectiveness of larviciding for urban malaria control in sub-Saharan Africa. The results support the use of larviciding as a cost-effective intervention in urban areas and managers of national malaria control programme should consider this intervention as part of an IVM approach.Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2875-13-477) contains supplementary material, which is available to authorized users.

Constituents of Essential Oils from Three Plant Species Used in Traditional Medicine and Insect Control in Tanzania

The essential oils of three aromatic plant species, Lantana viburnoides sp. viburnoides var. kisi (A. Rich.) Verdc., Clausena anisata (Willd.) Benth. and Uvariodendron gorgonis Verdc., were analysed for their chemical compositions and repellency activity against Anopheles gambiae s.s. The major chemical constituents were piperitenone (25.25%) and artemisia ketone (13.96%) in L. viburnoides oil; Estragol (88.38%) in C. anisata; and eugenol (89.82%) in U. gorgonis. The essential oils exhibited varying repellency properties against An. gambiae confirming the ethnobotanical usage as insect repellent. Further prospect exist of improving repellency of U. gorgonis and L. viburnoides essential oils by incorporating some inactive carriers.

Educational innovation for infection control in Tanzania: bridging the policy to practice gap.

The incidence of hospital acquired infection in developing countries is between two to 20 times higher than in developed countries and is attributable to multiple causes. Evidence-based international policies and guidelines developed to improve infection prevention and control are often not used in practice in these countries. To combat this challenge, this article presents an innovative educational framework used to bridge the gap between policy written by global health agencies and the realities of practice in Tanzania.

Lymphatic filariasis control in Tanzania: effect of six rounds of mass drug administration with ivermectin and albendazole on infection and transmission

BackgroundControl of lymphatic filariasis (LF) in most countries of sub-Saharan Africa is based on annual mass drug administration (MDA) with a combination of ivermectin and albendazole, in order to interrupt transmission. We present findings from a detailed study on the effect of six rounds of MDA with this drug combination as implemented by the National Lymphatic Filariasis Elimination Programme (NLFEP) in a highly endemic rural area of north-eastern Tanzania.MethodsThe effect of treatment on transmission and human infection was monitored in a community- and a school-based study during an 8-year period (one pre-intervention and 7 post-intervention years) from 2003 to 2011.ResultsBefore intervention, 24.5% of the community population had microfilariae (mf) in the blood, 53.3% had circulating filarial antigens (CFA) and 78.9% had specific antibodies to the recombinant filarial antigen Bm14. One year after the sixth MDA, these values had decreased considerably to 2.7%, 19.6% and 27.5%, respectively. During the same period, the CFA prevalence among new intakes of Standard 1 pupils in 10 primary schools decreased from 25.2% to 5.6%. In line with this, transmission by the three vectors (Anopheles gambiae, An. funestus and Culex quinquefasciatus) as determined by dissection declined sharply (overall vector infectivity rate by 99.3% and mean monthly transmission potential by 99.2% between pre-intervention and fifth post-intervention period). A major shift in vector species composition, from predominantly anopheline to almost exclusively culicine was observed over the years. This may be largely unrelated to the MDAs but may have important implications for the epidemiology of LF in the area.ConclusionsSix MDAs caused considerable decrease in all the measured indices for transmission and human infection. In spite of this, indices were still relatively high in the late period of the study, and it may take a long time to reach the recommended cut-off levels for interruption of transmission unless extra efforts are made. These should include increased engagement of the target population in the control activities, to ensure higher treatment coverage. It is expected that the recent initiative to distribute insecticide impregnated bed nets to every household in the area will also contribute towards reaching the goal of successful LF elimination.

'Alternatives to Development' and Acute Dependency: HIV/AIDS as a Blind Spot of Post-Development Theory?

AIDS control in Tanzania is nearly entirely donor-funded. The fact that an increasing share of the country’s population directly depends on foreign aid for survival raises dependency concerns with unprecedented acuteness. Based on fieldwork conducted between 2007 and 2009, this article confronts post-development theorists’ calls to ‘end aid’ with the Tanzanian reality. It argues that HIV/AIDS poses a serious challenge to post-development thought. While an exclusively humanitarian focus on the sole preservation of life makes radical critique of aid impossible, genuinely emancipatory critical theory must grapple with, rather than shy away from, the contradictions and tensions that arise from its confrontation with empirical situations where ‘bare life’ is immediately at stake for millions of people.

Variations in breast cancer awareness among urban Tanzanian women.

e12561 Background: Nearly 70% of the 7.6 million cancer deaths occur annually in developing countries like Tanzania, with breast cancer being among the most common causes of cancer mortality. Although data are incomplete, late-stage disease is believed to limit breast cancer control in Tanzania, with delayed diagnosis linked to low levels of breast cancer awareness among women. The goal of this study was to explore awareness of this disease among low-income women accessing routine medical care from three district hospitals in Dar es Salaam, Tanzania. Methods: This survey-based study examined participants' knowledge, attitudes, and beliefs regarding breast cancer causes, risk factors, symptoms, early detection measures, treatment, and preferred education sources. Sociodemographic variations in knowledge of breast cancer risk factors, symptoms, and treatments were assessed. Results: Two hundred and twenty-five women, ages 18-55 years, participated. Over half (52%) reported a primary school education or less; 69.9% were married; 26.2% were unemployed. The average monthly household income was just below the Dar es Salaam mean. Ninety-eight percent were aware of breast cancer; 22% knew someone with a history of breast cancer. Among the 126 women who heard of breast self exam, 25% and 34% practiced it regularly and occasionally, respectively; 41% never practiced it. Only 6.2% had regular clinical breast exams. A minority knew of mammography (32%); <2% had undergone a mammogram. Of the items listed, respondents correctly identified symptoms (51%), risk factors (31%), and treatments (51%). Data reflecting sociodemographic variations in knowledge will be shown. Preferred sources of breast cancer educational materials included group sessions, television or radio programs, and meetings with breast cancer survivors. Conclusions: This work provides valuable insight into preferred sources of breast cancer education among Tanzanian women.

Towards malaria elimination and its implication for vector control, disease management and livelihoods in Tanzania.

Over the years, malaria has remained the number one cause of morbidity and mortality in Tanzania. Population based studies have indicated a decline in overall malaria prevalence among under-fives from 18.1% in 2008 to 9.7% in 2012. The decline of malaria infection has occurred in all geographical zones of the country. Malaria mortality and cumulative probability of deaths have also shown a marked decline from 2000 to 2010. During the same period, area specific studies in Muheza, Korogwe, Muleba and Mvomero have also reported a similar declining trend in malaria prevalence and incidence. The decline in malaria prevalence has been observed to coincide with a decline in transmission indices including anopheline mosquito densities. The decline in malaria prevalence has been attributed to a combination of factors including improved access to effective malaria treatment with artemisinin combination therapy and protection from mosquito bites by increased availability of insecticide treated bednets and indoor residual spraying. The objective of this paper was to review the changing landscape of malaria and its implication for disease management, vector control, and livelihoods in Tanzania. It seeks to examine the links within a broad framework that considers the different pathways given the multiplicity of interactions that can produce unexpected outcomes and trade-offs. Despite the remarkable decline in malaria burden, Tanzania is faced with a number of challenges. These include the development of resistance of malaria vectors to pyrethroids, changing mosquito behaviour and livelihood activities that increase mosquito productivity and exposure to mosquito bites. In addition, there are challenges related to health systems, community perceptions, community involvement and sustainability of funding to the national malaria control programme. This review indicates that malaria remains an important and challenging disease that illustrates the interactions among ecosystems, livelihoods, and health systems. Livelihoods and several sectoral development activities including construction, water resource development and agricultural practices contribute significantly to malaria mosquito productivity and transmission. Consequently, these situations require innovative and integrative re-thinking of the strategies to prevent and control malaria. In conclusion, to accelerate and sustain malaria control in Tanzania, the prevention strategies must go hand in hand with an intersectoral participation approach that takes into account ecosystems and livelihoods that have the potential to increase or decrease malaria transmission.

Susceptibility status of malaria vectors to insecticides commonly used for malaria control in Tanzania

The aim of the study was to monitor the insecticide susceptibility status of malaria vectors in 12 sentinel districts of Tanzania. WHO standard methods were used to detect knock-down and mortality in the wild female Anopheles mosquitoes collected in sentinel districts. The WHO diagnostic doses of 0.05% deltamethrin, 0.05% lambdacyhalothrin, 0.75% permethrin and 4% DDT were used. The major malaria vectors in Tanzania, Anopheles gambiae s.l., were susceptible (mortality rate of 98-100%) to permethrin, deltamethrin, lambdacyhalothrin and DDT in most of the surveyed sites. However, some sites recorded marginal susceptibility (mortality rate of 80-97%); Ilala showed resistance to DDT (mortality rate of 65% [95% CI, 54-74]), and Moshi showed resistance to lambdacyhalothrin (mortality rate of 73% [95% CI, 69-76]) and permethrin (mortality rate of 77% [95% CI, 73-80]). The sustained susceptibility of malaria vectors to pyrethroid in Tanzania is encouraging for successful malaria control with Insecticide-treated nets and IRS. However, the emergency of focal points with insecticide resistance is alarming. Continued monitoring is essential to ensure early containment of resistance, particularly in areas that recorded resistance or marginal susceptibility and those with heavy agricultural and public health use of insecticides.

Fifty years of tsetse control in Tanzania: challenges and prospects for the future.

Tsetse flies are the vectors of trypanosomes, the causative organisms of trypanosomiasis, nagana, in animals and sleeping sickness in man. In Tanzania, tsetse transmitted trypanosomiasis is one of the most important disease affecting both animals and humans. About 40% of land suitable for grazing and areas with high agricultural potential are currently tsetse infested. It is estimated that about 4.4 million livestock and 4 million people are at risk of contracting tsetse borne trypanosomiasis. African animal trypanosomiasis (AAT) causes loss in animals due to mortality and reduced milk yield, which is estimated at US$ 7.98 million annually. Even after 50 years of independence, Human African Trypanosomiasis (HAT) or Sleeping Sickness is still one of the major public health problems with about 300 cases being reported annually. Tsetse control has been sporadic and uncoordinated hence no tangible results have been accrued since independence despite the fact that technologies which have facilitated tsetse control in other places are available. Fifty years of independence have seen shrinkage of tsetse belt to 43% in 16 surveyed regions. Opportunities for future are wide open if tsetse control will involve all stakeholders, who are directly or indirectly affected by the tsetse problem; if tsetse and trypanosomiasis eradication will adopt an area wide and participatory approach with emphasis on environmentally and user friendly techniques for expanded livestock sector; improved food security and livelihood in affected communities, for achievement of the millennium development goals.

Response to Rift Valley Fever in Tanzania: Challenges and Opportunities.

Rift Valley Fever (RVF) is an arthropod borne viral disease affecting livestock (cattle, sheep, goats and camels), wildlife and humans caused by Phlebovirus. The disease occurs in periodic cycles of 4-15 years associated with flooding from unusually high precipitations in many flood-prone habitats. Aedes and Culex spp and other mosquito species are important epidemic vectors. Because of poor living conditions and lack of knowledge on the pathogenesis of RVF, nomadic pastoralists and agro-pastoralists are at high risk of contracting the disease during epidemics. RVF is a professional hazard for health and livestock workers because of poor biosafety measures in routine activities including lack of proper Personal Protective Equipment (PPE). Direct exposure to infected animals can occur during handling and slaughter or through veterinary and obstetric procedures or handling of specimens in laboratory. The episodic nature of the disease creates special challenges for its mitigation and control and many of the epidemics happen when the governments are not prepared and have limited resource to contain the disease at source. Since its first description in 1930s Tanzania has recorded six epidemics, three of which were after independence in 1961. However, the 2007 epidemic was the most notable and wide spread with fatal human cases among pastoralists and agro-pastoralists concurrent with high livestock mortality. Given all the knowledge that exist on the epidemiology of the disease, still the 2006/2007 epidemic occurred when the government of Tanzania was not prepared to contain the disease at source. This paper reviews the epidemiology, reporting and outbreak-investigation, public awareness, preparedness plans and policy as well as challenges for its control in Tanzania.

"Alternatives to Development" and Acute Dependency: HIV/AIDS as a Blind Spot of Post-Development Theory?

AIDS control in Tanzania is nearly entirely donor-funded. The fact that an increasing share of the country’s population directly depends on foreign aid for survival raises dependency concerns with unprecedented acuteness. Based on fieldwork conducted between 2007 and 2009, this article confronts post-development theorists’ calls to ‘end aid’ with the Tanzanian reality. It argues that HIV/AIDS poses a serious challenge to post-development thought. While an exclusively humanitarian focus on the sole preservation of life makes radical critique of aid impossible, genuinely emancipatory critical theory must grapple with, rather than shy away from, the contradictions and tensions that arise from its confrontation with empirical situations where ‘bare life’ is immediately at stake for millions of people.

Monitoring lymphatic filariasis control in Tanzania: effect of repeated mass drug administration on circulating filarial antigen prevalence in young schoolchildren

In most countries of Sub-Saharan Africa the control of lymphatic filariasis (LF) is based on annual mass drug administration (MDA) with a combination of ivermectin and albendazole, in order to interrupt transmission. We monitored the effect of four repeated MDAs with this combination, as implemented by the Tanzanian National Lymphatic Filariasis Elimination Programme (NLFEP), on the circulating filarial antigen (CFA) status of young schoolchildren. A new batch of Standard 1 pupils from 10 rural primary schools in Tanga Municipality were examined for CFA each year in September/October (691-848 children per survey; mean age of 7.5-8.1 years), from immediately before the first MDA until eight months after the fourth MDA. The overall pre-MDA prevalence of CFA was 25.2%. Only minor and non-significant change in prevalence was seen after the first two MDAs. However, this was followed by substantial and statistically significant decreases in subsequent surveys, and eight months after the fourth MDA the prevalence was only 6.4%. Continuous entomological surveillance in a village accommodating one of the schools showed progressive decrease in transmission right from the first MDA. The usefulness of screening young schoolchildren for CFA as a tool for monitoring the impact of MDA on LF transmission is discussed.

East Coast fever immunisation field trial in crossbred dairy cattle in Hanang and Handeni districts in northern Tanzania

East Coast fever (ECF) causes considerable mortality and production losses in the Tanzania smallholder dairy sector and limits the introduction of improved dairy breeds in areas where the disease is present. The infection and treatment method (ITM) was adopted by smallholder dairy farms for ECF immunisation in Hanang and Handeni districts of Tanzania. This study recorded incidence rates for ECF and other tick-borne diseases (TBDs) for ECF-immunised and non-immunised cattle between 1997 and 2000. Approximately 80% of smallholder households from both sites (n = 167) participated in this longitudinal study, with immunisations carried out at the request of the livestock owners. Efficacy of ITM for preventing ECF cases in these crossbred dairy cattle was estimated at 97.6%, while that for preventing ECF deaths was 97.9%. One percent of the cattle developed clinical ECF as a result of immunisation. Since ECF immunisation permits a reduction in acaricide use, an increase in other TBDs is a potential concern. Sixty-three percent of farmers continued to use the same acaricide after immunisation, with 80% of these reducing the frequency of applications. Overall, 78% of farmers increased the acaricide application interval after immunisation beyond that recommended by the manufacturer, resulting in annual savings in the region of USD 4.77 per animal. No statistical difference was observed between the immunised and non-immunised animals in the incidence of non-ECF TBDs. However, immunised animals that succumbed to these diseases showed fewer case fatalities. ITM would therefore appear to be a suitable method for ECF control in Tanzania's smallholder dairy sector.