Deaths In Tanzania Research Articles

Micronutrient Deficiencies among Breastfeeding Infants in Tanzania.

Infant mortality accounts for the majority of child deaths in Tanzania, and malnutrition is an important underlying cause. The objectives of this cross-sectional study were to describe the micronutrient status of infants in Tanzania and assess predictors of infant micronutrient deficiency. We analyzed serum vitamin D, vitamin B12, folate, and ferritin levels from 446 infants at two weeks of age, 408 infants at three months of age, and 427 mothers three months post-partum. We used log-Poisson regression to estimate relative risk of being deficient in vitamin D and vitamin B12 for infants in each age group. The prevalence of vitamin D and vitamin B12 deficiency decreased from 60% and 30% at two weeks to 9% and 13% at three months respectively. Yet, the prevalence of insufficiency at three months was 49% for vitamin D and 17% for vitamin B12. Predictors of infant vitamin D deficiency were low birthweight, urban residence, maternal education, and maternal vitamin D status. Maternal vitamin B12 status was the main predictor for infant vitamin B12 deficiency. The majority of infants had sufficient levels of folate or ferritin. Further research is necessary to examine the potential benefits of improving infants’ nutritional status through vitamin D and B12 supplements.

Geographical disparities of cause-specific under-5 mortality in Rufiji District, Coastal Region, Tanzania: a longitudinal-based study

BackgroundStudies elsewhere have documented substantial regional variation in child mortality between poorly developed rural areas and well-developed urban areas. We extend this body of research by hypothesising that even within rural, remote areas there exists spatial variation in child mortality and that this disparity varies by cause of mortality. The aim of this study is to investigate the geographical variation of cause-specific death of children under-5 in Rufiji District, Tanzania. MethodsWe recorded all deaths of children under the age of 5 years that occurred between 2007 and 2010 in each village and calculated the cause-specific under-5 mortality rate (5q0). We ranked the mortality rate and focused on the leading four causes in subsequent statistical analyses. A Poisson generalised linear model was used for analysis. We calculated the local Moran's I using ArcGIS to determine the presence of spatial clustering and tested for associations between the mortality clustering, contextual factors, and sociodemographic characteristics. FindingsA total of 2801 under-5 deaths were recorded. Cause-specific mortality rates varied by village, with Nyamwimbe leading with 14·9 deaths per 1000 livebirths from malaria (average 5q0 was 6·5 [SD 2·7] for all villages) and 3·74 deaths per 1000 livebirths from pneumonia (average 5q0 was 1·1 [SD 1·2]). Mangwi had the next highest cause-specific mortality rate, with 6·01 deaths per 1000 livebirths from birth asphyxia (average 5q0 of 0·89 [SD 1·2]), followed by Nyambili with 5·69 per 1000 livebirths from low birth weight (average 5q0 of 0·85 [SD 1·3]). We find evidence of significant spatial clustering of cause-specific mortality rates by village. InterpretationWe observe geographical disparities of cause-specific under-5 mortality in Rufiji District. These disparities may be due to differences in socioeconomic circumstances and access to health care. Ultimately, this research offers potential for identifying the fundamental role that place (environmental characteristics of an area) versus people (structural attributes of an area) play in influencing the leading causes of death in Tanzania. FundingDoris Duke Charitable Foundation through Columbia University and the Ifakara Health Institute.

Costs of delivering human papillomavirus vaccination to schoolgirls in Mwanza Region, Tanzania

BackgroundCervical cancer is the leading cause of female cancer-related deaths in Tanzania. Vaccination against human papillomavirus (HPV) offers a new opportunity to control this disease. This study aimed to estimate the costs of a school-based HPV vaccination project in three districts in Mwanza Region (NCT ID: NCT01173900), Tanzania and to model incremental scaled-up costs of a regional vaccination program.MethodsWe first conducted a top-down cost analysis of the vaccination project, comparing observed costs of age-based (girls born in 1998) and class-based (class 6) vaccine delivery in a total of 134 primary schools. Based on the observed project costs, we then modeled incremental costs of a scaled-up vaccination program for Mwanza Region from the perspective of the Tanzanian government, assuming that HPV vaccines would be delivered through the Expanded Programme on Immunization (EPI).ResultsTotal economic project costs for delivering 3 doses of HPV vaccine to 4,211 girls were estimated at about US$349,400 (including a vaccine price of US$5 per dose). Costs per fully-immunized girl were lower for class-based delivery than for age-based delivery. Incremental economic scaled-up costs for class-based vaccination of 50,290 girls in Mwanza Region were estimated at US$1.3 million. Economic scaled-up costs per fully-immunized girl were US$26.41, including HPV vaccine at US$5 per dose. Excluding vaccine costs, vaccine could be delivered at an incremental economic cost of US$3.09 per dose and US$9.76 per fully-immunized girl. Financial scaled-up costs, excluding costs of the vaccine and salaries of existing staff were estimated at US$1.73 per dose.ConclusionsProject costs of class-based vaccination were found to be below those of age-based vaccination because of more eligible girls being identified and higher vaccine uptake. We estimate that vaccine can be delivered at costs that would make HPV vaccination a very cost-effective intervention. Potentially, integrating HPV vaccine delivery with cost-effective school-based health interventions and a reduction of vaccine price below US$5 per dose would further reduce the costs per fully HPV-immunized girl.

Investigating risk factors for preterm birth in rural Tanzania: a case-control study

BackgroundPreterm birth (before 37 weeks gestation) is the third leading cause of neonatal death in Tanzania and accounts for 28% of neonatal deaths worldwide. Preterm infants are at greater risk...

Malaria specific mortality in lowlands and highlands of Muheza district, north-eastern Tanzania

Vital registration of causes of death in Tanzania is incomplete and many deaths occur outside health care settings. Verbal autopsies (VA) are used to determine the underlying cause of death, and the probable diagnosis helps to estimate reasonably cause-specific mortality. In this paper, we report findings of a verbal autopsy survey which involved eight villages in both low and highlands of Muheza district, north-eastern Tanzania. The survey was conducted following a rapid census, which was done to identify households that had lost one or more members within a period of two years from the date of census. Trained research assistants administered VA questionnaires to parents/close relatives. Two physicians reviewed each report independently and a third opinion was sought where there was discordant report between the two. A total of 9,872 households were surveyed and 134 deaths were recorded. A total of 96 (71.6%) deaths were from lowland villages representing high malaria transmission. Majority (72.4%) of the reported deaths occurred at home whilst 32.1% occurred at heath facility settings. Overall, severe malaria was the leading cause accounting for 34.3% of all deaths. Infants were most affected and accounted for 43.5% of the total deaths. Pulmonary tuberculosis ranked second (8.2%) cause of deaths and was exclusively confined to individuals > or = 15 years. Probable cause of death could not be determined in 13.4% of deaths. In conclusion, majority of deaths in rural north-eastern Tanzania occur at home and the immediate causes are usually unknown or not documented. These findings indicate that the verbal autopsy is a useful tool for detecting leading causes of death at community level in the absence of health facility-based data.

Estimating and projecting HIV prevalence and AIDS deaths in Tanzania using antenatal surveillance data

BackgroundThe Estimations and Projections Package (EPP 2005) for HIV/AIDS estimates and projects HIV prevalence, number of people living with HIV and new HIV infections and AIDS cases using antenatal clinic (ANC) surveillance data. The prevalence projection produced by EPP can be transferred to SPECTRUM, a demographic projectionmodel, to calculate the number of AIDS deaths. This paper presents estimates and projections of HIV prevalence, new cases of HIV infections and AIDS deaths in Tanzania between 2001 and 2010 using the EPP 2005 and SPECTRUM soft-wares on ANC data.MethodsFor this study we used; the 1985 – 2004 ANC data set, the 2005 UN population estimates for urban and rural adults, which is based on the 2002 population census, and results of the 2003 Tanzania HIV Indicator Survey. The ANC surveillance sites were categorized into urban and rural areas on the basis of the standard national definitions of urban and rural areas, which led to 40 urban and 35 rural clinic sites. The rural and urban epidemics were run independently by fitting the model to all data and on level fits.ResultsThe national HIV prevalence increased from 0% in 1981 to a peak of 8.1% in 1995, and gradually decreased to 6.5% in 2004 which stabilized until 2010. The urban HIV epidemic increased from 0% in 1981 peaking at 12.6% in 1992 and leveled to between 10.9% and 11.8% from 2003 to 2010. The rural epidemic peaked in 1995 at 7.0% and gradually declined to 5.2% in 2004, and then stabilized at between 5.1% and 5.3% from 2005 to 2010. New infections are projected to rise steadily, resulting in 250,000 new cases in 2010. Deaths due to AIDS started in 1985 and rose steadily to reach 120,000 deaths in 2010, with more females dying than men.ConclusionThe fact that the number of new infections is projected to increase steadily to reach 250,000 per year in 2010 calls for more concerted efforts to combat the spread of HIV infection particularly in the rural areas where the infrastructure needed for prevention programmes such as counseling and testing, condom accessibility and AIDS information is less developed.

Validity of verbal autopsy procedures for determining cause of death in Tanzania

To validate verbal autopsy (VA) procedures for use in sample vital registration. Verbal autopsy is an important method for deriving cause-specific mortality estimates where disease burdens are greatest and routine cause-specific mortality data do not exist. Verbal autopsies and medical records (MR) were collected for 3123 deaths in the perinatal/neonatal period, post-neonatal <5 age group, and for ages of 5 years and over in Tanzania. Causes of death were assigned by physician panels using the International Classification of Disease, revision 10. Validity was measured by: cause-specific mortality fractions (CSMF); sensitivity; specificity and positive predictive value. Medical record diagnoses were scored for degree of uncertainty, and sensitivity and specificity adjusted. Criteria for evaluating VA performance in generating true proportional mortality were applied. Verbal autopsy produced accurate CSMFs for nine causes in different age groups: birth asphyxia; intrauterine complications; pneumonia; HIV/AIDS; malaria (adults); tuberculosis; cerebrovascular diseases; injuries and direct maternal causes. Results for 20 other causes approached the threshold for good performance. Verbal autopsy reliably estimated CSMFs for diseases of public health importance in all age groups. Further validation is needed to assess reasons for lack of positive results for some conditions.

Gender differences in the factors influencing consistent condom use among young people in Tanzania

AIDS has become a major cause of death in Tanzania and young people represent the most vulnerable group. Recent HIV prevalence data showed that young women are more likely than young men to become infected. This paper examined commonalties and differences in the sociodemographic and ideational predictors of condom use among young men and women in Tanzania. The data derive from a 2004 sample survey among young people aged 15-24 years in five regions of Tanzania. The sample on which the analyses were based included 1,523 single women and 1,200 single men. An ideation framework guided the analyses of the predictors of consistent condom use. Logistic regression was the main analytic method used and separate models were estimated for men and women. The most significant correlates of consistent condom use for men included perceived self-efficacy for correct condom use, discussing condom use with friends, and perceived self-efficacy for using condoms with a long-term partner. Discussing condom use with a sex partner and the perceived self-efficacy to refuse sex if the sex partner refused to use a condom were the most significant predictors for women. One implication of the findings is that for men, effective interventions should emphasize correct condom use know-how and address the issue of negative peer pressure and group norms around condom use. For women, interventions should focus on sexual empowerment.

Impacts of the 26 December 2004 tsunami in Eastern Africa

The tsunami of 26 December 2004 was the largest ever recorded in the Indian Ocean, triggered by the 3rd largest earthquake in 100 years measuring 9.2 moment magnitude. The epicenter of the earthquake was off Banda Aceh on the Indian Ocean coast of the island of Sumatra in Indonesia, centered at 3.316°N, 95.854°E. A sudden upward movement of the seafloor that averaged ∼6 m occurred along almost 1300 km of the north-east Indian Ocean plate at 0059 Coordinated Universal Time (UTC) and lasted 8 min. Because of the lack of preparedness and absence of warning systems in the Indian Ocean the tsunami spread silently across the ocean over a span of 8 h causing massive destruction including the deaths of over 250,000 people, with maximum damages occurring in Indonesia, Thailand, Sri Lanka, India and the Maldives. Moderate to low damages were recorded in the Seychelles, Socotra (Yemen) and Somalia, though in the latter a highly vulnerable town was impacted resulting in over 300 deaths. Most of eastern Africa was spared massive damages from the waves due to (a) distance from the epicenter (>6000 km), (b) the dissipation of energy of the tsunami by shallow banks in the middle of the Indian Ocean (the Seychelles banks, Saya de Malha and Cargados Carajos Shoals) and (c) at least for Kenya and Tanzania, the first and largest waves hit at low tide. In Kenya and Tanzania these factors resulted in the waves being experienced as tidal surges of 1–1.5 m amplitude lasting 5–10 min. Damages recorded for eastern Africa include 11 deaths in Tanzania and 1 in Kenya, of people walking and swimming over shallow intertidal flats being trapped by the advancing and receding tidal surges, damage to boats anchored in shallow water and inundation in Mauritius and Rodrigues. Official information, warning and response networks were nonexistent, and even when an official response was generated in Kenya the public demonstrated no faith or willingness to act on warnings from officials such as the police. Importantly, information on the tsunami and the generation of an official response was dependent on two technologies, satellite television and mobile telephony, and these should be built into future warning systems as key mechanisms and backups to official information and warning networks.

Creating an "enabling environment" for taking insecticide treated nets to national scale: the Tanzanian experience.

IntroductionMalaria is the largest cause of health services attendance, hospital admissions and child deaths in Tanzania. At the Abuja Summit in April 2000 Tanzania committed itself to protect 60% of its population at high risk of malaria by 2005. The country is, therefore, determined to ensure that sustainable malaria control using insecticide-treated nets is carried out on a national scale.Case descriptionTanzania has been involved for two decades in the research process for developing insecticide-treated nets as a malaria control tool, from testing insecticides and net types, to assessing their efficacy and effectiveness, and exploring new ways of distribution. Since 2000, the emphasis has changed from a project approach to that of a concerted multi-stakeholder action for taking insecticide-treated nets to national scale (NATNETS). This means creating conditions that make insecticide-treated nets accessible and affordable to all those at risk of malaria in the country. This paper describes Tanzania's experience in (1) creating an enabling environment for insecticide-treated nets scale-up, (2) promoting the development of a commercial sector for insecticide-treated nets, and (3) targeting pregnant women with highly subsidized insecticide-treated nets through a national voucher scheme. As a result, nearly 2 million insecticide-treated nets and 2.2 million re-treatment kits were distributed in 2004.ConclusionNational upscaling of insecticide-treated nets is possible when the programme is well designed, coordinated and supported by committed stakeholders; the Abuja target of protecting 60% of those at high risk is feasible, even for large endemic countries.

The elderly and AIDS: Coping with the impact of adult death in Tanzania

The elderly are one of the key groups of survivors who may be adversely affected by the death of prime-age adults from AIDS. We use a longitudinal survey of households from Northwestern Tanzania in 1991–94 to compare the activities and welfare of the elderly in households before and after the death of a prime-age adult with that of the elderly in households that did not have an adult death. The elderly in households that had an adult death were more educated, more likely to engage in wage employment and spent less time farming than the elderly in households that did not have a death during the survey. Time spent by the elderly in household chores rose following an adult death and participation in wage employment fell; there was no evidence of increased participation in farm work. The physical well-being of the elderly, as measured by body mass index (BMI), was lower prior to an adult death and higher afterward. Finally, the elderly with the lowest BMI are those in poor households that did not have an adult death during the survey. Thus, policymakers should be concerned about the adverse impacts of adult deaths on the physical well-being of the elderly—primarily during the period of illness prior to a prime-age adult death—but they should also focus on the larger groups of poor elderly with much lower physical health status.

ParaSite: Night bites on the Net

Emmanuel Temu (University of the Witswatersrand, South Africa) started a long discussion when he posted an article from a Tanzanian newspaper about local attitudes to malaria. A team from Alberta University, Canada, who visited >700 households found the view prevailed that ‘there was no way one could avoid catching the disease’. Malaria causes 24% of hospital deaths in Tanzania which could be greatly reduced by treated bednets, but most people did not have them and thought they were useless because mosquitoes bite and spread malaria during the day. The team leader said ‘anopheles mosquitoes which cause malaria, transmit the parasites only at night…due to the anopheles’ biological make-up, the insects were unable to spread the disease during day time’. Temu commented, ‘If that is sociological way of promoting nets usage, I agree, but it is wrong’. He suggested that, as the white man has been associated with charity ever since missionaries first arrived, the locals had them but hid them from visitors, hoping to be given free nets and insecticide!

Community-based sale, distribution and insecticide impregnation of mosquito nets in Bagamoyo District, Tanzania

Malaria is the leading cause of outpatient attendances hospital admissions and hospital deaths in Tanzania. Malaria also contributes significantly to the high rate of mortality in Africa among pregnant women and to the high levels of anemia among both women and children in Tanzania. Although malaria control in sub-Saharan Africa has focused upon the early treatment of clinical malaria with chloroquine the emergence and spread of chloroquine-resistant Plasmodium falciparum has sparked the search for alternative methods of malaria control. Bed nets impregnated every six months with pyrethroid insecticides seem to be a simple low-cost intervention ideally suited to village conditions. When used regularly the nets seem to have a positive impact upon both the frequency of episodes in children and upon the level of infection in the mosquito population. When insecticide-impregnated mosquito nets are used in malaria control programs however their distribution promotion of use and impregnation with insecticide are typically the responsibility of program personnel. In order to create a more sustainable system for implementing bed net interventions a bed net committee was formed in each of 13 villages in Bagamoyo District Tanzania. Once nominated and confirmed in a village meeting committee members attend a day-long seminar in which they discuss how distribution sales of nets and impregnation should take place. Committee members help on distribution days as well as promote the proper use of nets and help villagers set up the nets. A revolving fund is being established from which each village can pay committee members and purchase nets and insecticide after the project ends. Factors which may affect the sustainability of the system are discussed.

Continuous fetal monitoring in the ambulant patient in labour.

Fetal heart rate was monitored continuously in 30 ambulant women in labour by radiotelemetry. The procedure was practicable and, since contractions were less uncomfortable with the patient standing or walking about, reduced the need for analgesia. It also resulted in a more natural labour. Use of the procedure may lessen the risk of thromboembolism.