Diseases In Tanzania Research Articles

Economic cost of primary prevention of cardiovascular diseases in Tanzania.

Tanzania is facing a double burden of disease, with non-communicable diseases being an increasingly important contributor. Evidence-based preventive measures are important to limit the growing financial burden. This article aims to estimate the cost of providing medical primary prevention interventions for cardiovascular disease (CVD) among at-risk patients, reflecting actual resource use and if the World Health Organization (WHO)’s CVD medical preventive guidelines are implemented in Tanzania. In addition, we estimate and explore the cost to patients of receiving these services. Cost data were collected in four health facilities located in both urban and rural settings. Providers’ costs were identified and measured using ingredients approach to costing and resource valuation followed the opportunity cost method. Unit costs were estimated using activity-based and step-down costing methodologies. The patient costs were obtained through a structured questionnaire. The unit cost of providing CVD medical primary prevention services ranged from US$30–41 to US$52–71 per patient per year at the health centre and hospital levels, respectively. Employing the WHO’s absolute risk approach guidelines will substantially increase these costs. The annual patient cost of receiving these services as currently practised was estimated to be US$118 and US$127 for urban and rural patients, respectively. Providers’ costs were estimated from two main viewpoints: ‘what is’, that is the current practice, and ‘what if’, reflecting a WHO guidelines scenario. The higher cost of implementing the WHO guidelines suggests the need for further evaluation of whether these added costs are reasonable relative to the added benefits. We also found considerably higher patient costs, implying that distributive and equity implications of access to care require more consideration. Facility location surfaced as the main explanatory variable for both direct and indirect patient costs in the regression analysis; further research on the influence of other provider characteristics on these costs is important.

Public Knowledge, Perceptions and Practices in Relation to Infectious and other Communicable Diseases in Tanzania: Lessons Learnt from Babati District

Background: We report public knowledge, perceptions and practices on selected infectious diseases in Tanzania using a study done in Babati district, and identify policy related messages in light of health promotion strategies instituted for communicable disease control. Methods: Data were gathered through semi-structured interviews with individual household members and focus group discussions with other residents in several villages; in-depth interviews with health workers, local government leaders, and district health managers. Results: Many villagers associated malaria transmission with people’s exposure to intense sunrays; TB and brucellosis with people drinking raw-milk, animal blood and meat; sharing a bed or utensils with TB/brucellosis patients; TB with smoking or inhaling cigarette smoke; leprosy with witchcraft; and lymphatic filariasis and schistosomiasis with people contacting dirty-water or through sexual intercourse. Occasional shortage of drugs and laboratory services, lack of reliable transport facilities, low public use of latrines, unaffordable bednet prices, and common sale of counterfeit drugs by unregulated retailers were perceived to perpetuate the existence and widespread communicable diseases. Use of traditional medicines to treat these diseases was reported to be a common practice. Conclusion: Culturally rooted knowledge and beliefs about diseases influence people’s health care seeking practices and may perpetuate prevalence and transmission of diseases. There should be educational policy program considerations among the strategies aimed at effective disease control.Key words: Communicable diseases; psycho-social, health care-seeking behaviour; Tanzania

Responses of Compact Coffee Clones Against Coffee Berry and Coffee Leaf Rust Diseases in Tanzania

The utilization of resistant Arabica coffee ( Coffea arabica ) varieties is considered as the most economical control for coffee berry disease (CBD) and coffee leaf rust (CLR) in Tanzania. The resistance levels of varieties at field and laboratory conditions were assessed through their phenotypic disease reaction response to CBD and CLR. In this study sixteen (16) compact hybrids of C. arabica plus four (4) standard cultivars were evaluated under a range of environmental conditions in on-station and on-farm trials in Tanzania. Also four (4) Colletotrichum kahawae strains of the pathogen responsible for CBD infection; 2010/1, 2010/2, 2006/7 and 2006/14, and Hemileia vastatrix uredospores were used to test the sixteen (16) hybrids through artificial inoculation under controlled conditions (temperatures between 19 to 22 oC, R. H. 100%). Results showed that a significant level of variability (P < 0.05) occurred between the sixteen (16) compacts, three (3) standard checks and N39 a commercial susceptible variety across trials. Compact genotype CVT14 (PNI086 x (N39 x Rume Sudan Selfed F 2 ) showed resistance to the four strains of C. kahawae and Hemileia vastatrix . Differential reactions on compact genotypes were found to C. kahawae and H. vastatrix strains existing in different coffee growing regions in Tanzania; genotypes CVT4 (PNI088 x (SL34 x HdT) x Kent x Rume Sudan) and CVT13 (PRO127 x (Blue Mountain Jamaica x Cioccie) x Rume Sudan) showed partial resistance to C. kahawae strains 2010/1, the genotypes were susceptible to strains 2010/2 but resistant to strains 2006/7 and 2006/14. This shows that host response reaction can be used as criteria for varietal assessment when evaluated at different locations.

Non communicable diseases in Tanzania: a call for urgent action.

Globally there is evidence of the growing burden of Non Communicable diseases (NCDs) especially in developing countries including Tanzania. This paper summarises the review of published papers on the magnitude of Non Communicable Diseases in the country. Current opportunities for management and control of NCDs are also explored. In this review diseases such as diabetes and hypertension have been shown to have increased over the years. Prevalence of risk factors such as obesity, dyslipidemia and smoking has been shown to be high with clear gender and urban rural differences. Generally there is paucity of national representative data on the burden of risk factors and prevalence of non-communicable diseases. The main risk factors for NCDs namely smoking, alcohol intake, unhealthy diet and low physical activity are prevalent in both rural and urban communities. The socio-demographic and economic transition has a big role in the current rise of non-communicable diseases in Tanzania. There are initiatives to control the burden of non-communicable diseases in the country. However there is need to focus more on primary prevention at population level targeting interventions to reduce exposure to tobacco, reduce alcohol intake, reduce salt intake, promote healthy diets and physical activity. For the prevention and control of NCDs, there needs to be a continuum from primary to tertiary prevention and a scope of interventions from the community level up to the national level. Community-based interventions are needed targeting the risk factors for primary prevention. In addition, secondary prevention measures are needed targeting those at high risk to ensure that they are identified early through a high risk targeted screening for early identification and appropriate care. Effective policies are needed to support such interventions.

Public health concern along side with global initiative on the priority action for “silent uprising epidemic” on Non-Communicable Diseases in Tanzania

Tanzania is already facing challenges caused by existing burden of communicable diseases, and the growing trend of nonconununicable diseases (NCDs), which raises a lot of concerns and challenges. The objective of this review is to provide broad insight of the "silent epidemic" of NCDs, existing policies, strategies and interventions, and recommendations on prioritized actions. A review of existing literature including published articles, technical reports, and proceedings from national and international NCDs meetings was carried out. The burden, existing interventions, socio-economic impact, lessons learnt, and potential for expanding cost effective interventions in Tanzania were explored. Challenges to catch up with global momentum on NCD agenda were identified and discussed. The review has indicated that the burden of NCDs and its underlying risk factors in Tanzania is alarming, and affects people of all socio-economic status. The costs of health care for managing NCDs are high, and thus impoverishing the already poor people. The country leadership has a high political commitment; there are policies and strategies, which need to be implemented to address the growing NCD burden. In conclusion, NCDs in Tanzania are a silent rising health burden and has enormous impact on an individual and country's social-economical status. From the experience of other countries, interventions for NCDs are affordable, feasible and some are income generating. Multisectoral approach, involving national and international partners has a unique role in intensifying action on NCDs. Tanzania should strategize on implementation research on how to adapt the interventions and apply multi-sectoral approach to control and prevent NCDs in the country.

Is sickle cell disease sufficiently prioritized in policy and socio-economic research on diseases in Tanzania? Lessons for the past 50 years.

Catastrophic health consequences associated with chronic and genetic disorders, including those related to sickle cell disease (SCD) remain lowly measured and understood. Illnesses associated with SCD, especially the, sickle cell anaemia (SCA) pose significant tolls to individual patients and their families and contribute to poverty due to loss in production and retardation of economic development. This paper synthesises evidence from systematic literature reviews on policy priorities both in theory and practice and studies carried out on SCD. The review was systematically done by drawing evidence from published and unpublished literature searched through online search engines and other sources. The magnitude of SCA problem is yet to be adequately measured and documented in terms of the scale of its prevalence in many countries including Tanzania. However, a few reports available pinpoint Tanzania as one of the African countries with a large number of patients with SCD. Social stigma and discrimination against patients with SCD pose psychological affect to either the individual patients or their family members and this is partly due to low community knowledge on this disease on one hand and the perceived socio-economic disturbances associated with the disease that at times reduce the morale of caregivers/ takers in families to attend patients. A few studies so far seem to have much focused on the medical dimensions of the disease usually reported at health facilities therefore, failing to establish the actual magnitude and socio-economic consequences of the disease, thus limiting the room for more informed policy decisions. Unfortunately, the inadequate public policy and research attention to this disease indicates that there is need for revisiting research and policy agenda towards making a difference in its interventions, and this include creation of public awareness and prioritizing research. '

Perceptions, Facilitators, and Barriers to Consumption of Whole Grain Staple Foods among Overweight and Obese Tanzanian Adults: A Focus Group Study

Background. Stiff porridge (ugali) made from unrefined maize flour has been a staple food in Tanzania. Recently, high intakes of refined carbohydrates and energy-dense foods have been documented in urban areas in Tanzania. We assessed cultural acceptability, perceptions and barriers to consumption of unrefined carbohydrates in Tanzania. Methods. Twelve focus group discussions (FGDs) were conducted among 44 overweight and obese adults aged 40–65 years. All FGDs were audio-recorded, and QSR N6 software was used for data analysis. Results. Most participants (77%) had tried and liked unrefined maize ugali prior to our study. For unrefined sorghum ugali, 12 participants had tried it before, and 9 of them liked it. Brown rice was found to be unpopular and was considered a diet for diabetic patients; four participants had tried it before and all reported to like it. Sensory appeal, availability, and affordability were key facilitators whereas high cost, scarcity, and negative perceptions toward whole grains were mentioned as barriers to consumption of unrefined carbohydrates. Conclusion. Our study has identified facilitators and barriers to consumption of unrefined carbohydrates in Tanzania. Educational strategies are recommended in order to increase consumption of unrefined carbohydrates and consequently reduce diet-related chronic diseases in Tanzania.

Knowledge of causes, clinical features and diagnosis of common zoonoses among medical practitioners in Tanzania

BackgroundMany factors have been mentioned as contributing to under-diagnosis and under-reporting of zoonotic diseases particularly in the sub-Sahara African region. These include poor disease surveillance coverage, poor diagnostic capacity, the geographical distribution of those most affected and lack of clear strategies to address the plight of zoonotic diseases. The current study investigates the knowledge of medical practitioners of zoonotic diseases as a potential contributing factor to their under-diagnosis and hence under-reporting.MethodsThe study was designed as a cross-sectional survey. Semi-structured open-ended questionnaire was administered to medical practitioners to establish the knowledge of anthrax, rabies, brucellosis, trypanosomiasis, echinococcosis and bovine tuberculosis in selected health facilities within urban and rural settings in Tanzania between April and May 2005. Frequency data were analyzed using likelihood ratio chi-square in Minitab version 14 to compare practitioners' knowledge of transmission, clinical features and diagnosis of the zoonoses in the two settings. For each analysis, likelihood ratio chi-square p-value of less than 0.05 was considered to be significant. Fisher's exact test was used where expected results were less than five.ResultsMedical practitioners in rural health facilities had poor knowledge of transmission of sleeping sickness and clinical features of anthrax and rabies in humans compared to their urban counterparts. In both areas the practitioners had poor knowledge of how echinococcosis is transmitted to humans, clinical features of echinococcosis in humans, and diagnosis of bovine tuberculosis in humans.ConclusionKnowledge of medical practitioners of zoonotic diseases could be a contributing factor to their under-diagnosis and under-reporting in Tanzania. Refresher courses on zoonotic diseases should be conducted particularly to practitioners in rural areas. More emphasis should be put on zoonotic diseases in teaching curricula of medical practitioners' training institutions in Tanzania to improve the diagnosis, reporting and control of zoonotic diseases. Veterinary and medical collaboration should be strengthened to enable more effective control of zoonotic diseases in Tanzania.

Prioritization of intervention methods for prevention of communicable diseases in Tanzania

Water, sanitation, housing and hygienic behavior plays dominant role in the transmission and intensification of diseases. To effectively utilize limited financial resources, it is important to prioritize disease intervention methods in order to minimize mortality and morbidity cases. Realization of the environmental health components that respond to the practical effects of their contribution to transmission of diseases has greater chances of effectively enhancing health. Data of frequency of diseases and mortality rate were collected from four municipal hospitals from districts of Ilala, Kinondoni, Temeke and Kibaha in Dar es Salaam and Coast Regions. The populations at risk were sub-categorized in relation to age; below five years and above five years. The age parameter assists on envisaging the major causes to be either in-house or in public domain. Data were analyzed to assess the role of water quality, water quantity, excreta disposal, waste disposal and hygiene education on spreading the diseases in order to come up with scientifically evaluated information. Scores were given to each intervention method depending on its importance in controlling a particular disease. The results indicate that incidences of malaria, skin and eye infections, pneumonia and diarrhea are frequent in these districts. Children under 5 years are particularly affected by pneumonia and diarrhea more than adults. Malaria, tuberculosis and pneumonia are the major causes of mortality rates in these districts. Fatality cases are caused largely by malaria, pneumonia and diarrhea for children less than 5 years, but malaria, tuberculosis and pneumonia are responsible for mortality rates in adults and children over 5 years. Statistical analysis revealed that in all districts, hygiene education is the major factor responsible for transmission of diseases accounting for 32–39%. Other factors, which are the major contributors to the incidences of diseases, are inadequacy of water (15.6–22.5%) and poor housing environment (14.5–24.0%). Water quality played the least role in transmission of diseases accounting for only 3–8%. It was concluded that provision of hygiene education, and improvement of water quantity and housing, in that order can significantly contribute to reduction of communicable diseases in the area. Improvement of water quality has potentially the least effect on the number of morbidity and mortality cases.

The determination of safety of Muhanse M4&lt;sup&gt;®&lt;/sup&gt;, a traditional herbal preparation used to treat HIV/AIDS-related conditions and diseases in Tanzania

Muhanse M4 is a traditional herbal preparation that has been in use in Tanzania for the past 17 years to improve the quality of life among people living with HIV/AIDS. This study was carried out to determine the safety of the extract Muhanse M4 in animal models. The qualitative test to identify alkaloids and saponins compounds was carried out. The toxicity tests in Swiss albino mice and rats were done according to WHO guidelines of 1993. Muhanse M4 was dissolved homogeneously in distilled water and was administered both intraperitonially and orally for 14 days for sub-acute test and 24 hours for acute test. Qualitatively, the extract was found to contain no alkaloids or saponins. In rats intraperitoneal doses that caused 100% lethality were 758.55 mg/kg and 553.7415mg/kg when administered singly and repeated, respectively. Single oral dose up to 3034.200mg/kg did not cause any death in the tested mice or rats. NOEL during intraperitoneal repeated doses for liver in rats was 424.788mg/kg, and NOAEL was 455.130mg/kg. In rats LD10%, LD50% and LD100% were 485.472mg/kg, 526.4337mg/kg and 553.7415mg/kg, respectively. In conclusion, Muhanse M4 extract is considered to be safe in laboratory animals.

Current and future prospects of integrating traditional and alternative medicine in the management of diseases in Tanzania

Traditional medicine and medicinal plants, in general, continue to be a powerful source of new drugs, now contributing about 90% of the newly discovered pharmaceuticals. Traditional medicine continues to provide health coverage for over 80% of the world population, especially in the developing world. The past and the present are all full of living examples of discoveries of drugs, ranging from anticancer, antiasthma, antidiabetic, antihypertensives and many others which owe their origin to traditional medicine. The current era of HIV/AIDS is not short of contributions from traditional medicine. The recent discovery of the non-nucleoside reverse transcriptase inhibitor (NNRTI), calanolide A, is a new addition from traditional medicine. Many more such discoveries are yet to come. While this potential is much acknowledged, little has been done in African countries, to utilize the plants that are already known and proven to be safe for use by patients. A number of plants could be widely cultivated for local industrial production of medicines and herbal nutritional supplements. There is need to ensure that what is known is made use of, for financial gain, and for improvement of the health of our people. We need to establish the necessary expertise for development of traditional medicines and deliberate efforts should be made to encourage local industrial production of traditional/herbal medicines so that cultivation may become possible and hence contribute to poverty reduction.

Implications of decentralization for the control of tropical diseases in Tanzania: a case study of four districts

Decentralization has been and is still high on the agenda in contemporary health sector reforms. However, despite extensive literature on the topic, little is known about the processes and results of decentralization, including the relationship with the control of major public health problems caused by communicable diseases. This paper reports from a study of decentralization and control of tropical diseases in districts implementing health sector and local government reforms in Tanzania. The study was undertaken in four districts, involving interviews and discussions with key stakeholders from individual household members to the district commissioner, and a review of official health policy, planning and management documents. The study findings reveal devolution of financial, planning and managerial authority being theoretical rather than practical, as district health plans are largely directed by national and international priorities rather than by local priorities. Vertical programmes still exist, focusing narrowly on single diseases. The local mechanisms for multisectoral collaboration, as well as community participation functions, are far from optimal. Further, inappropriate and weak information systems prevent adequate local responsiveness in setting priorities. In conclusion, decentralization might have a large potential for improving health system performance, but problems of implementation pose serious challenges to releasing this potential.

Improved Services for Sexually Transmitted Diseases in Tanzania are Cost- Effective in Cutting HIV Rates

A highly cost-effective program which improved local health facilities ability to diagnose and treat sexually transmitted diseases (STDs) in rural Tanzania reduced the incidence of HIV-1 infection by 40% during a 2-year trial period. The intervention was conducted during the early 1990s in 6 rural communities with a total population of approximately 150000 which were compared with 6 communities matched for location type and rates of STD presentation at health units. Primary health care workers in the program communities health units were taught to diagnose and treat STDs using simple decision-making flow charts based upon readily detectable signs and symptoms and were also given basic diagnostic instruments and kept supplied with drugs and other necessary materials. Supervisors visited the health units regularly to monitor the quality of care provided and to offer informal training when needed while health education teams visited the villages. Annual program costs totaled $59060 or $0.39/person in the communities served by the intervention. The annual cost per HIV infection prevented was lower than the likely cost of treating someone infected with HIV while the cost of averting the loss of 1 healthy life-year because of HIV-related disability or death compared well with other costs associated with other public health programs in low-income countries.

Survey of cassava virus diseases in Tanzania

A survey was carried out of African cassava mosaic geminivirus and cassava brown streak virus diseases (ACMD and CBSD) in Tanzania. ACMD occurred throughout the country at low to moderate incidences in the fifteen different regions surveyed (1- 64%). The incidence was generally higher along the coastalplain than in higher altitude areas in the interior. There was a significant correlation between numbers ofadults ofthe whitefly vector, Bemisia tabaci, and incidence of recently infected plants ( R = 0.77, p < 0.01), although most infection was attributable to the use of infected cuttings. CBSD was more restricted in distribution and, where present, incidence was low to moderate (1- 36%). Cassava plantings along the southern border with Mozambique link the highest incidence area on the south-east coast near Mtwara, with the other important area ofCBSD incidence along the shore ofLake Malawi. The effects of climatic parameters on ACMD and CBSD incidence are discussed. The survey data suggest that both diseases could be controlled in Tanzania by the use of phytosanitation which involves the use of disease-free planting material and the removal (roguing) of diseased plants.

Formulae of sugar-salt solutions recommended for treatment of diarrhoeal dehydration at home in African countries

During a conference on diarrhoeal diseases in Tanzania in 1984, 19 participants representing 16 countries in Africa gave the formulae for oral rehydration solutions therapy (ORS) which they recommended or instructed for home use in their own countries. There were gross variations in recommended quantities of sugar, salt and water. Theoretical calculations indicated that the glucose concentration ranged from 29 to 174 mmol/l (recommended 30-112 mmol/l) and that of sodium from 9 to 116 mmol/l (recommended 30-80 mmol/l). It is very important that countries should ensure that the recommendations for making up oral rehydration solutions be standardized, otherwise dangerous or ineffectual concentrations of salt and sugar solutions may be used for rehydrating children.

Trematode–gastropod associations in nine non-lacustrine habitats in the Mwanza region of Tanzania

SUMMARYBetween August 1978 and July 1979, freshwater gastropods were collected at monthly intervals from 9 different non-lacustrine habitats in the Mwanza region of Tanzania. Of a total of 11708 gastropods representing 14 species, 1748 (14–9%) were infected with trematode sporocysts and/or rediae. Altogether 38 morphologically distinguishable ‘species’ of cercariae were recovered (13 furcocercous, 10 xiphidiocercaria, 6 echin-ostome, 4 cystophorous, 3 gymnocephalous and 2 amphistome species), 22 of which did not conform to previously described African species. The majority (63–8%) of all mature infections were xiphidiocercariae. Biomphalaria pfeifferi, B. sudanica and Ceratophallus natalensis each yielded 11 species of cercariae. Lymnaea natalensis had the highest overall prevalence of infection (36–9%). Cercaria guttera from L. natalensis accounted for 20–4% of all recovered trematode infections and C. blukwa from Biomphalaria accounted for 18–4% of all infections; the high prevalence of these two xiphidiocercariae may alter the transmission patterns of Fasciola gigantica and Schistosoma mansoni, respectively. S. mansoni was recovered from both B. sudanica (22 of 2393 infected) and B. pfeifferi (79 of 1913 infected); S. haematobium (or related species) was recovered from Bulinus (Physopsis) nasutus (50 of 1503 infected) and to a lesser extent from B. (P.) africanus (6 of 186 infected). The findings are discussed in relation to the biological control of trematode diseases in Tanzania.

タンザニアの風土病

タンザニアの風土病