Public Health Problem In Tanzania Research Articles

Prevalence of human schistosomiasis in various regions of Tanzania Mainland and Zanzibar: A systematic review and meta-analysis of studies conducted for the past ten years (2013-2023).

Schistosomiasis is a significant public health problem in Tanzania, particularly for the people living in the marginalized settings. We have conducted a systematic review with meta-analysis on the prevalence of schistosomiasis to add knowledge towards the development of effective approaches to control the disease in Tanzania. Online databases namely, Pub Med, SCOPUS and AJOL, were systematically searched and a random effect model was used to calculate the pooled prevalence of the disease. Heterogeneity and the between studies variances were determined using Cochran (Q) and Higgins (I2) tests, respectively. A total of 55 articles met the inclusion criterion for this review and all have satisfactory quality scores. The pooled prevalence of the disease in Tanzania was 26.40%. Tanzania mainland had the highest schistosomiasis prevalence (28.89%) than Zanzibar (8.95%). Sub-group analyses based on the year of publication revealed the going up of the pooled prevalence, whereby for (2013-2018) and (2018-2023) the prevalence was 23.41% and 30.06%, respectively. The prevalence of the Schistosoma mansoni and Schistosoma hematobium were 37.91% and 8.86% respectively. Mara, Simuyu, and Mwanza were the most prevalent regions, with a pooled prevalence of 77.39%, 72.26%, and 51.19%, respectively. The pooled prevalence based on the diagnostic method was 64.11% for PCR and 56.46% for POC-CCA, which is relatively high compared to other tests. Cochrans and Higgins (I2) test has shown significant heterogeneity (p-value = 0.001 and I2 = 99.6). Factors including age, region, diagnostic method and sample size have shown significant contribution to the displayed heterogeneity. The pronounced and increasing prevalence of the disease suggests potential low coverage and possibly lack of involvement of some regions in the control of the disease. This, therefore, calls for an intensive implementation of control interventions in all endemic regions, preferably using an integrated approach that targets several stages of the disease lifecycle.

Ethnobotanical Survey on the Knowledge and Use of Medicinal Plants for Malaria Management among University Students

Malaria remains a public health problem in Tanzania, escalated by the emergence of both parasite and vector resistance. Plant-based traditional medicines have been widely utilized as alternatives to malaria management. However, proper documentation is minimal, especially among the younger generation. This study assessed the knowledge of medicinal plants for malaria management among 532 Dar es Salaam University College of Education students. Overall, twenty-four plant species, most belonging to the family Asteraceae, were identified with Azaradichta indica being the most dominant species. These results reveal a substantial knowledge of medicinal plants for malaria management among university students.

Urogenital schistosomiasis among pre-school and school aged children in four districts of north western Tanzania after 15 years of mass drug administration: Geographical prevalence, risk factors and performance of haematuria reagent strips.

Urogenital schistosomiasis remains as a public health problem in Tanzania and for the past 15 years, mass drug administration (MDA) targeting primary school children has remained as the mainstay for its control. However, after multiple rounds of MDA in highly risk groups, there are no data on the current status of Schistosoma haematobium in known endemic areas. Furthermore, the performance of commonly used diagnostic test, the urine reagent strips is not known after the decline in prevalence and intensities of infection following repeated rounds of treatment. Thus, after 15 of national MDA, there is a need to review the strategy and infection diagnostic tools available to inform the next stage of schistosomiasis control in the country. A analytical cross-sectional study was conducted between October and November, 2019 among pre-school (3-5years old) and school aged children (6-17 years old) living in four (4) districts with low (<10%) and moderate (10%-<50%) endemicity for schistosomiasis as per WHO classification at the start of the national control programme in 2005/06, with mean prevalence of 20.7%. A total of 20,389 children from 88 randomly selected primary schools participated in the study. A questionnaire was used to record demographic information. A single urine sample was obtained from each participant and visually examined for macrohaematuria, tested with a dipstick for micro-haematuria, to determine blood in urine; a marker of schistosome related morbidity and a proxy of infection. Infection intensity was determined by parasitological examination of the urine sample for S. haematobium eggs. Overall, mean infection prevalence was 7.4% (95%CI: 7.0-7.7, 1514/20,389) and geometric mean infection intensity was 15.8eggs/10mls. Both infection prevalence (5.9% versus 9%, P<0.001) and intensity (t = -6.9256, P<0.001) were significantly higher in males compared to females respectively. Light and heavy infections were detected in 82.3% and 17.7% of the positive children respectively. The prevalence of macrohaematuria was 0.3% and that of microhaematuria was 9.3% (95%CI:8.9-9.7). The sensitivity and specificity of the urine reagent strip were 78% (95%CI: 76.1-79.9) and 99.8% (95%CI: 99.7-99.9). Having light (P<0.001) and heavy infection intensities (P<0.001) and living in the study districts increased the odd of having microhaematuria. Predictors of S. haematobium infection were being male (P<0.003), microhaematuria (P<0.001), and living in the three study districts (P<0.001) compared to living at Nzega district. The findings provide an updated geographical prevalence which gives an insight on the planning and implementation of MDA. Comparing with the earlier mapping survey at the start of the national wide mass drug administration, the prevalence of S. haematobium infection have significantly declined. This partly could be attributed to repeated rounds of mass drug administration. The urine reagent strips remain as a useful adjunct diagnostic test for rapid monitoring of urogenital schistosomiasis in areas with low and high prevalence. Based on prevalence levels and with some schools having no detectable infections, review of the current blanket mass drug administration is recommended.

Sero-prevalence of Mumps among Unvaccinated Children Attending Regional Referral Hospitals in Dar es Salaam, Tanzania

Aims: Mumps infection and its complication remain under recognized public health problem in Tanzania, as there are no national screening program and sero-epidemiological surveys. This makes it difficult to devise control interventions including administration of vaccinations. We therefore determined the Sero-prevalence of Mumps among Unvaccinated Children Attending Regional Referral Hospitals in Dar es salaam, Tanzania.&#x0D; Study Design: A hospital based cross-sectional study.&#x0D; Place and Duration of Study: Outpatient departments of three regional hospitals in Dar es Salaam Tanzania: Amana, Mwananyamala, and Temeke hospitals, from March to June 2021.&#x0D; Methodology: Three hundred and sixty children aged 1 - 16 years were included in the study. A structured questionnaire was used to collect participants' information. Serum samples were tested for mumps immunoglobulin G antibodies using an enzyme linked immune-sorbent assay. Proportions were used to describe children's social demographic and clinical characteristics, and binary logistic regression was used to estimate the odds of exposure to mumps virus. A p-value &lt; 0.05 was considered statistically significant.&#x0D; Results: The mean age was 7.6 ± 4.1, half of them were females. More than three quarters (77%) of the children had Mumps Immunoglobulin-G. Mumps sero-prevalence among under-fives was 58.8%, among 5-8 years was 80%, 9-12 years was 86% and for 13-16 year was 88%. Compared to under-fives, children in the ages of 5-8, 9-12 and 13-16 had four times.&#x0D; (OR 4.19 95% CI 1.49-11.7), five times (OR 5.84 95% CI 1.89-18.12) and six times (OR 6.00 95% CI 1.63-21.43) higher odd of mumps exposure respectively. The number of siblings in the house, going to school, and previous history of parotid gland enlargement were not associated with mumps sero-positivity.&#x0D; Conclusion: The mumps virus is circulating in a high proportion among children in Dar es Salaam and the likelihood of exposure increases with age.

Abstract P221: Effect Of Instructional Videos To Enhance Healthcare Provider Knowledge For Hypertension (htn) Management In Tanzania

Introduction: The growing burden of HTN is a major public health problem in Tanzania, with the estimated prevalence of 28%. The healthcare system faces major capacity constraints, including inadequate provider competencies; &lt;60% of providers reported fair knowledge of HTN, and only 42% had access to HTN guidelines. Knowledge of HTN management standards and guidelines is prerequisite to improving HTN management. Objective: Determine the effect of instructional training videos in improving healthcare provider knowledge for HTN management. Methods: Eighteen primary healthcare facilities in the Dar es Salaam region were selected using stratified random sampling. In each facility, providers, who screened and managed patients for HTN, completed pre-test knowledge assessments. Subsequently, they were invited to an instructional training, using four, 4-5minute videos developed by investigators at Johns Hopkins. Post-test was conducted 5 months after the introduction of the videos. Results: Thirty-three clinicians participated in the pre-post study and consented to attending the video training workshop. Knowledge competencies showed significant improvement in most but not all aspects of HTN management (Table). For example, adequate knowledge about HTN increased from 78.8% to 100% (p&lt;0.01), and knowledge of patient preparation prior to Blood Pressure (BP) screening increased from 69.7% to 93.9% ( p&lt;0.05). Conclusion: In the context of a resource-constrained setting, low-cost training videos have the potential to improve healthcare provider knowledge for HTN management.

Coping strategies available for women living with HIV/AIDS experiencing intimate partner violence in the Singida region, Tanzania

Background: Intimate partner violence is a major public health problem in Tanzania, yet little is known about the coping strategies among women living with HIV/AIDS who experiencing IPV. The objective of the study was to explore the coping strategies employed by women living with HIV/AIDS experiencing IPV who attended care and treatment services in the Singida region.Methods: A qualitative phenomenology study design was performed in which data were collected through in-depth interviews with 35 women living with HIV/AIDS who also experienced IPV. Content analysis was used to analyse the data.Results: We found that women living with HIV/AIDS experienced IPV used family members, such as their mothers, sisters, and brothers as a coping mechanism to express their pains. Spiritual leaders counselled them spiritually and psychologically and they were advised on how to live with their violent partners. Other coping mechanisms included reporting to the police and the legal system, and the use of support groups. Through support groups, they obtained relief from depression, loneliness, isolation, stigma and discrimination.Conclusions: This study concludes that coping mechanisms helped women living with HIV/AIDS to reduce the stress associated with HIV/AIDS and intimate partner violence. The government of Tanzania should strengthen policies related to IPV and HIV/AIDS among all women in Tanzania. Moreover, local government authorities should build safe homes for all survivors of intimate partner violence throughout the country.

Prevalence, Intensity, and Factors Associated with Urogenital Schistosomiasis among Women of Reproductive Age in Mbogwe District Council, Geita Region, Tanzania.

Background Urogenital schistosomiasis remains a public health problem in Tanzania. Control programs mostly target school-going children ignoring other vulnerable groups like women of child bearing age. Previous evidence has shown that women of reproductive age suffer greatest morbidities in endemic areas. This study sought to determine the prevalence, intensity, and factors associated with urogenital schistosomiasis among women of reproductive age in the Mbogwe District. Methods A population-based analytical cross-section study was conducted in the Mbogwe District. A semistructured questionnaire was administered. Urine samples of 20-30 mils collected between 10.00 am to 02.00 pm and examined for Schistosoma eggs and infection intensity microscopically. Data analysis was done using SPSS version 20. Results A total of 426 women of reproductive age, with median age of 26, and interquartile range of 11years were recruited and assessed. The prevalence of urogenital schistosomiasis was 4.5% and mean egg intensity of 19.5eggs/10mil of urine. After adjusting for confounders, lower level of education was associated with an increased risk of urogenital schistosomiasis infections (AOR 8.355, 95% CI 3.055-23.001). Conclusion Urogenital schistosomiasis among women of reproductive age in the Mbogwe District is a problem. Education is the factor associated with the disease; the neglected tropical disease control program should develop strategies that should include provision of health education and should involve women of reproductive age as they act as infection reservoir. More studies are recommended to explore the possibility of reproductive complications among infected women in endemic areas.

Nurses' and midwives' awareness of intimate partner violence-related mental healthcare and associated factors in Tanzania.

Although intimate partner violence (IPV) is a significant public health problem in Tanzania, the country's system to provide IPV-related mental healthcare is not sufficiently prepared to respond to IPV care needs. This study aimed to assess nurses' and midwives' awareness of IPV-related mental healthcare and associated factors to encourage care provision. A cross-sectional, anonymous, self-administered survey was conducted among nurses and midwives in health facilities in the Mbeya region, from December 2018 to January 2019. The questions gauged awareness of IPV-related mental disorders, availability of screening tools, confidence in providing IPV-related mental healthcare and the presence of a mental health focal/resource person, in addition to socio-demographic and institutional characteristics. Of 1,321 nurses and midwives in the region, 662 (50.1%) participated in the study, and the analysis included 568 (85.8%) responses without missing values. The median awareness score was 5 (range: 0-6), and 34.0% of the participants were aware of all six examined IPV-related mental health disorders. Separate logistic regression analyses were conducted for those working in hospitals and those working in health centres (HCs), assessing potential factors associated with nurses' and midwives' awareness of IPV-related mental disorders. Among nurses and midwives in hospitals, high professional education (adjusted odds ratio [AOR]: 1.207; 95% confidence interval [CI]: 0.787, 1.852; p=.045) and long work experience (AOR: 1.479; 95% CI: 1.009, 2.169; p=.007) were associated with high awareness of IPV-related mental disorders. For those in HCs, government ownership (AOR: 3.526; 95% CI: 1.082, 11.489; p=.037) and having a mental health focal/resource person (AOR: 3.251; 95% CI: 1.184, 8.932; p=.036) were associated with high awareness of IPV-related mental disorders. Appropriate distribution of mental health focal/resource persons is required for improving awareness of IPV-related mental healthcare provision among nurses and midwives in remote areas of Tanzania.

Evaluation of Newborns Screening Laboratory Tests for Sickle Cell Disease and Other Haemoglobinopathies in Tanzania

Affiliation 1Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania. 2Department of Oncology, University of Oxford, Oxford UK. 3Dar es salaam University College of Education, Dar es salaam, Tanzania. ABSTRACT. Background; SCD constitutes to be a major public health problem in Tanzania. NBS for SCD identify infants with SCD at birth and subsequently enroll them into SCD comprehensive care program and it has been reported to reduce early childhood mortality and morbidity due to SCD and increase life expectancy. There are different methods for Newborn screening for SCD such as HPLC, IEF, DNA analysis, sickle scan and hemotype SC that helps in early detection of SCD and other haemoglobinopathies but we are lacking sufficient information on alternative screening methods that can be used for NBS in Tanzania so this study is aiming at investigating the effectiveness and feasibility of NBS laboratory tests. Aim of the study; To evaluate newborn screening Laboratory assays for sickle cell disease and other haemoglobinopathies in Tanzania. Methodology; This will be a retrospective and prospective study which will be conducted in Dar es Salaam and Mwanza.1000 newborns and 100 children with SCD under five years old will be enrolled. DBS samples will be collected and analyzed by DNA Analysis, sickle scan, Hemotype SC, HPLC, and IEF. SPSS version 16.0 will be used to analyze data. Statistically, significant tests will be declared at a level of p-value &lt; 0.05. Progress: Initially we have conducted a pilot of 12 individuals who were screened for SCD and turned out to be carriers ( Hb AS). However these individuals continuously reported to experience painful events. Initial analysis has include Hb subtyping and quantification by HPLC,Sickle scan and HemotypeSC to ascertain indicator for thalassaemia syndrome. Definitive analysis involved sequencing of thalassaemia and SCD associated regions by using Oxford Nanopore Technology and NGS Expected outcomes; The findings of this study will inform Newborn screening stakeholders on the best point of care screening test and definitive test, in terms of turnaround time and cost. Such findings will assist in planning and scaling up of newborn screening services across the country. Corresponding Author; HChristopher, Email; hchristopher@blood.ac.tz, Tel; +255762175732. Disclosures Schuh: AbbVie: Consultancy, Speakers Bureau; Genentech: Consultancy, Speakers Bureau; Pharmacyclics: Consultancy, Speakers Bureau; Kite: Speakers Bureau; Gilead: Speakers Bureau; Seattle Genetics: Speakers Bureau; Jazz Pharmaceuticals: Speakers Bureau; Bristol-Myers Squibb: Research Funding; Janssen: Speakers Bureau; Verastem: Speakers Bureau.

Epidemiological characterization of malaria in rural southern Tanzania following China-Tanzania pilot joint malaria control baseline survey

BackgroundMalaria is an important public health problem in Tanzania. The latest national malaria data suggests rebound of the disease in the country. Anopheles arabiensis, a mosquito species renowned for its resilience against existing malaria vector control measures has now outnumbered the endophagic and anthrophilic Anopheles gambiae sensu stricto as the dominant vector. Vector control measures, prophylaxis and case management with artemisinin-based combination therapy (ACT) are the main control interventions. This paper presents and discusses the main findings from a baseline household survey that was conducted to determine malaria parasite prevalence and associated risk exposures prior to piloting the T3-initiative of World Health Organization integrated with Chinese malaria control experience aimed at additional reduction of malaria in the area.MethodsThe study was conducted from 4 sub-district divisions in Rufiji District, southern Tanzania: Ikwiriri, Kibiti, Bungu, and Chumbi. Malaria transmission is endemic in the area. It involved 2000 households that were randomly selected from a list of all households that had been registered from the area. Residents in sampled households were interviewed on a range of questions that included use of long-lasting insecticidal nets (LLINs) the night prior to the interview and indicators of socio-economic status. Blood drops were also collected on blood slides that were examined for malaria parasites using microscopes.ResultsThe study observed an average malaria parasite prevalence of 13% across the selected site. Its distribution was 5.6, 12.8, 16.7, and 18% from Ikwiriri, Kibiti, Bungu, and Chumbi wards, respectively. The corresponding LLIN use discovered were 57.5% over the district. The highest usage was observed from Ikwiriri at 69.6% and the lowest from Bungu at 46.3%. A statistically significant variation in parasitaemia between socio-economic quintiles was observed from the study. Males were more parasitaemic than females (p value = 0.000).Discussion and conclusionThe findings have been discussed in the light of results from Tanzania Demographic and Health Survey-Malaria Indicator Survey, 2015–2016 and other related studies, together with goals and targets set for malaria control. The paper also discusses the observed parasitaemia in relation to reported LLIN use and its distribution by some important factors as they were explored from the study. It has been concluded that malaria burden is now concentrated on the fringes of the settlements where the poorest section of the population is concentrated and LLIN usage is lower than the national average and targets set by national and global malaria control initiatives.

Intimate partner violence victimization increases the risk of under-five morbidity: A stratified multilevel analysis of pooled Tanzania Demographic Health Surveys, 2010-2016.

IntroductionA hidden determinant such as intimate partner violence victimization has been associated with under-five morbidity and mortality. However, there is lack of information regarding which exactly age group of under-five is more vulnerable to morbidity when their mothers exposed to intimate partner violence victimization. This study aimed to determine the effect of mothers’ exposure to intimate partner violence victimization on age groups specific under-five morbidity that could lead to mortality.Material and methodsThe current study pooled and analyzed data from 2010 and 2016 Tanzania Demographic Health Survey datasets. We used a stratified multilevel modeling to assess the association between under-five morbidity and intimate partner violence victimization according to age groups. The Statistical approach using Stata 14 was used to adjust for clustering effect and weighted the estimates to correct for non-responses and disproportionate sampling employed during designing of the surveys.ResultsA total of 13,639 singleton live-births babies within three years prior to interview dates from the ever-married women were included in the analysis. We found a significant reduction of the three main symptoms of under-five morbidity namely; a cough with difficult or fast breathing from 21.7 to 15.7%, fever from 22.5 to 18.3%, and diarrhoea from 15.5 to 12.7% for the survey years from 2010 to 2016 respectively (P<0.05). Overall, about 40% of mothers reported experiencing any forms of intimate partner violence victimization. After adjusting for individual and cluster variables, we found that under-five in post-neonatal period (Adjusted odds ratios = 1.50; 95%CI, 1.21–1.86) and childhood period (Adjusted odds ratios = 1.40; 95%CI, 1.24–1.57) were significantly affected with morbidity when their mothers’ exposed to any form of intimate partner violence victimization.ConclusionThis analysis revealed that intimate partner violence victimization is still a major and public health problem in Tanzania that threatens child health during the period of post-neonatal and childhood. There is a need to introduce screening for intimate partner violence victimization in maternal and child care for effective monitoring and prevention of the problem.

Spatial and space-time clustering of mortality due to malaria in rural Tanzania: evidence from Ifakara and Rufiji Health and Demographic Surveillance System sites.

BackgroundAlthough, malaria control interventions are widely implemented to eliminate malaria disease, malaria is still a public health problem in Tanzania. Understanding the risk factors, spatial and space–time clustering for malaria deaths is essential for targeting malaria interventions and effective control measures. In this study, spatial methods were used to identify local malaria mortality clustering using verbal autopsy data.MethodsThe analysis used longitudinal data collected in Rufiji and Ifakara Health Demographic Surveillance System (HDSS) sites for the period 1999–2011 and 2002–2012, respectively. Two models were used. The first was a non-spatial model where logistic regression was used to determine a household’s characteristic or an individual’s risk of malaria deaths. The second was a spatial Poisson model applied to estimate spatial clustering of malaria mortality using SaTScan™, with age as a covariate. ArcGIS Geographical Information System software was used to map the estimates obtained to show clustering and the variations related to malaria mortality.ResultsA total of 11,462 deaths in 33 villages and 9328 deaths in 25 villages in Rufiji and Ifakara HDSS, respectively were recorded. Overall, 2699 (24 %) of the malaria deaths in Rufiji and 1596 (17.1 %) in Ifakara were recorded during the study period. Children under five had higher odds of dying from malaria compared with their elderly counterparts aged five and above for Rufiji (AOR = 2.05, 95 % CI = 1.87–2.25), and Ifakara (AOR = 2.33, 95 % CI = 2.05–2.66), respectively. In addition, ownership of mosquito net had a protective effect against dying with malaria in both HDSS sites. Moreover, villages with consistently significant malaria mortality clusters were detected in both HDSS sites during the study period.ConclusionsClustering of malaria mortality indicates heterogeneity in risk. Improving targeted malaria control and treatment interventions to high risk clusters may lead to the reduction of malaria deaths at the household and probably at country level. Furthermore, ownership of mosquito nets and age appeared to be important predictors for malaria deaths.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0905-y) contains supplementary material, which is available to authorized users.

"In a situation of rescuing life": meanings given to diabetes symptoms and care-seeking practices among adults in Southeastern Tanzania: a qualitative inquiry.

BackgroundDiabetes mellitus is an emerging public health problem in Tanzania. For the community and the health system to respond adequately to this problem, it is important that we understand the meanings given to its symptoms, and the care-seeking practices of individuals.MethodsTo explore collective views on the meanings given to diabetes symptoms, we conducted nine focus group discussions with adult diabetes patients and members of the general community. To gain a better understanding of how the meanings in the community inform the care-seeking practices of individuals, 19 in-depth interviews were conducted with diabetes patients. The data were analyzed using principles of grounded theory and applying cultural schema theory as a deductive framework.ResultsIn the communities and among the patients, knowledge and awareness of diabetes are limited. Both people with diabetes and community members referred to their prevailing cultural meaning systems and schemas for infectious diseases to interpret and assign meaning to the emerging symptoms. Diabetes patients reported that they had initially used anti-malarial medicines because they believed their symptoms—like headache, fever, and tiredness—were suggestive of malaria. Schemas for body image informed the meaning given to diabetes symptoms similar to those of HIV, like severe weight loss. Confusion among members of the community about the diabetes symptoms instigated tension, causing patients to be mistrusted and stigmatized. The process of meaning-giving and the diagnosis of the diabetes symptoms was challenging for both patients and health care professionals. Diabetes patients reported being initially misdiagnosed and treated for other conditions by medical professionals. The inability to assign meaning to the symptoms and determine their etiologies informed the decision made by some patients to consult traditional healers, and to associate their symptoms with witchcraft causes.ConclusionThe meanings given to diabetes symptoms and the care-seeking practices described in the study are shaped by the prevailing cultural schemas for infectious diseases and their treatments. Efforts to educate people about the symptoms of diabetes and to encourage them to seek out appropriate care should build on the prevailing cultural meaning system and schemas for diseases, health and illness.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1504-0) contains supplementary material, which is available to authorized users.

Bovine tuberculosis at the human-livestock-wildlife interface: Is it a public health problem in Tanzania? A review

Despite the apparent public health concern about Bovine tuberculosis (BTB) in Tanzania, little has been done regarding the zoonotic importance of the disease and raising awareness of the community to prevent the disease. Bovine tuberculosis is a potential zoonotic disease that can infect a variety of hosts, including humans. The presence of multiple hosts including wild animals, inefficient diagnostic techniques, absence of defined national controls and eradication programs could impede the control of bovine TB. In Tanzania, the diagnosis of Mycobacterium bovis in animals is mostly carried out by tuberculin skin testing, meat inspection in abattoirs and only rarely using bacteriological techniques. The estimated prevalence of BTB in animals in Tanzania varies and ranges across regions from 0.2% to 13.3%, which is likely to be an underestimate if not confirmed by bacteriology or molecular techniques. Mycobacterium bovis has been detected and isolated from different animal species and has been recovered in 10% of apparently healthy wildebeest that did not show lesions at post-mortem. The transmission of the disease from animals to humans can occur directly through the aerosol route and indirectly by consumption of raw milk. This poses an emerging disease threat in the current era of HIV confection in Tanzania and elsewhere. Mycobacterium bovis is one of the causative agents of human extra pulmonary tuberculosis. In Tanzania there was a significant increase (116.6%) of extrapulmonary cases reported between 1995 and 2009, suggesting the possibility of widespread M. bovis and Mycobacterium tuberculosis infection due to general rise of Human Immunodeficiency virus (HIV). This paper aims to review the potential health and economic impact of bovine tuberculosis and challenges to its control in order to safeguard human and animal population in Tanzania.

Screening of women for intimate partner violence: a pilot intervention at an outpatient department in Tanzania

Intimate partner violence (IPV) is a public health problem in Tanzania with limited health care interventions.ObjectivesTo study the feasibility of using an abuse screening tool for women attending an outpatient department, and describe how health care workers perceived its benefits and challenges.MethodsPrior to screening, 39 health care workers attended training on gender-based violence and the suggested screening procedures. Seven health care workers were arranged to implement screening in 3 weeks, during March–April 2010. For screening evaluation, health care workers were observed for their interaction with clients. Thereafter, focus group discussions (FGDs) were conducted with 21 health care workers among those who had participated in the training and screening. Five health care workers wrote narratives. Women's responses to screening questions were analyzed with descriptive statistics, whereas qualitative content analysis guided analysis of qualitative data.ResultsOf the 102 women screened, 78% had experienced emotional, physical, or sexual violence. Among them, 62% had experienced IPV, while 22% were subjected to violence by a relative, and 9.2% by a work mate. Two-thirds (64%) had been abused more than once; 14% several times. Almost one-quarter (23%) had experienced sexual violence. Six of the health care workers interacted well with clients but three had difficulties to follow counseling guidelines. FGDs and narratives generated three categories Just asking feels good implied a blessing of the tool; what next? indicated ethical dilemmas; and fear of becoming a 'women hospital’ only indicated a concern that abused men would be neglected.ConclusionsScreening for IPV is feasible. Overall, the health care workers perceived the tool to be advantageous. Training on gender-based violence and adjustment of the tool to suit local structures are important. Further studies are needed to explore the implications of including abuse against men and children in future screening.

P2-402 TB diagnostic interventions in resource poor areas: the role of sputum fixers in Tanzania

IntroductionTB is among of the major public health problem in Tanzania. The National TB and leprosy program among of their strategy is intensive case finding which has drawbacks taking the...

Community perceptions of intimate partner violence--a qualitative study from urban Tanzania.

BackgroundIntimate partner violence against women is a prevailing public health problem in Tanzania, where four of ten women have a lifetime exposure to physical or sexual violence by their male partners. To be able to suggest relevant and feasible community and health care based interventions, we explored community members' understanding and their responses to intimate partner violence.MethodsA qualitative study using focus group discussions with 75 men and women was conducted in a community setting of urban Tanzania. We analysed data using a grounded theory approach and relate our findings to the ecological framework of intimate partner violence.ResultsThe analysis resulted in one core category, "Moving from frustration to questioning traditional gender norms", that denoted a community in transition where the effects of intimate partner violence had started to fuel a wish for change. At the societal level, the category "Justified as part of male prestige" illustrates how masculinity prevails to justify violence. At the community level, the category "Viewed as discreditable and unfair" indicates community recognition of intimate partner violence as a human rights concern. At the relationship level, the category "Results in emotional entrapment" shows the shame and self-blame that is often the result of a violent relationship. At the individual level, the risk factors for intimate partner violence were primarily associated with male characteristics; the category "Fed up with passivity" emerged as an indication that community members also acknowledge their own responsibility for change in actions.ConclusionsPrevailing gender norms in Tanzania accept women's subordination and justify male violence towards women. At the individual level, an increasing openness makes it possible for women to report, ask for help, and become proactive in suggesting preventive measures. At the community level, there is an increased willingness to intervene but further consciousness-raising of the human rights perspective of violence, as well as actively engaging men. At the macro level, preventive efforts must be prioritized through re-enforcement of legal rights, and provision of adequate medical and social welfare services for both survivors and perpetrators.

Climate prediction of El Niño malaria epidemics in north-west Tanzania.

BackgroundMalaria is a significant public health problem in Tanzania. Approximately 16 million malaria cases are reported every year and 100,000 to 125,000 deaths occur. Although most of Tanzania is endemic to malaria, epidemics occur in the highlands, notably in Kagera, a region that was subject to widespread malaria epidemics in 1997 and 1998. This study examined the relationship between climate and malaria incidence in Kagera with the aim of determining whether seasonal forecasts may assist in predicting malaria epidemics.MethodsA regression analysis was performed on retrospective malaria and climatic data during each of the two annual malaria seasons to determine the climatic factors influencing malaria incidence. The ability of the DEMETER seasonal forecasting system in predicting the climatic anomalies associated with malaria epidemics was then assessed for each malaria season.ResultsIt was found that malaria incidence is positively correlated with rainfall during the first season (Oct-Mar) (R-squared = 0.73, p < 0.01). For the second season (Apr-Sep), high malaria incidence was associated with increased rainfall, but also with high maximum temperature during the first rainy season (multiple R-squared = 0.79, p < 0.01). The robustness of these statistical models was tested by excluding the two epidemic years from the regression analysis. DEMETER would have been unable to predict the heavy El Niño rains associated with the 1998 epidemic. Nevertheless, this epidemic could still have been predicted using the temperature forecasts alone. The 1997 epidemic could have been predicted from observed temperatures in the preceding season, but the consideration of the rainfall forecasts would have improved the temperature-only forecasts over the remaining years.ConclusionThese results demonstrate the potential of a seasonal forecasting system in the development of a malaria early warning system in Kagera region.

Epidemiology of measles in Tanzania: A hospital-based survey of measles morbidity and mortality

Objective: To estimate measles morbidity and mortality in selected regions on mainland Tanzania Design: Cross-sectional study Setting: Hospital-based review of existing records on measles morbidity and mortality in the selected district hospitals on mainland Tanzania. Methods: Review of records on measles morbidity and mortality was performed using a standard instrument adopted from the Ministry of Health. The instrument was pre-tested before use. Researchers were recruited from the Muhimbili University College of Health Sciences and were trained on how to collect data from the hospital records. Ethical clearance was obtained from the Ministry of Health in Dar es Salaam. Upon arrival in the respective regions, the researchers recruited and trained local research assistants on methods of data collection. Completed questionnaire forms were entered into a computer and data cleaning was done before data analysis. Results: Measles was found to occur in individuals of over 15 years of age and beyond. Overall 35% (N=2277) of all measles cases were reported from the Iringa region while Mara region had the lowest number of cases. On the other hand Shinyanga had the highest case fatality rate (6%) compared with other regions. Mortality was higher in children below two years of age and among individuals who had no history of measles vaccination. Conclusion: We conclude that despite high measles vaccination coverage, measles is still a public health problem in Tanzania. Efforts should be made to give several booster doses up to the age of 15 years.

Mob justice in Tanzania: a medico-social problem.

To investigate the magnitude of mob justice and associated factors. Mob justice is a social and public health problem that has grown in Tanzania in recent decades that has negative effects on social and health of the country, communities, and families. A four-year autopsy study was conducted at the Department of Pathology, MUCHS. Information on the cases was obtained from police, the relatives, friends and other witnesses if available. 1,249 persons were killed by mobs in Dar es Salaam during the period of 5 years (2000-2004). The alleged offense ranged from a serious crime like theft or murder to a mere violation of local customs or religious beliefs. The mode of the killings were mostly burning (48.11%) and stoning (49.96%). Other modes accounted for only 3.0% of the cases. The pattern of injuries ranged from skull and other skeletal fractures to viscera rupture. MJ is a social, legal and public health problem in Tanzania that needs immediate attention. Unemployment of youth and perceived economic inequalities should be addressed. As long as the judicial system doesn't work and corruption is not punished, people will continue to organize their own trials and judge their suspects in the street. These must be tackled in order to reduce the growing incidences of mob justice, hence saving life. It must be ensured that criminals do not violate the freedom, dignity and respect of each and every human or member of the society.