Mainland Tanzania Research Articles

Improvements in malaria surveillance through the electronic Integrated Disease Surveillance and Response (eIDSR) system in mainland Tanzania, 2013–2021

BackgroundTanzania has made remarkable progress in reducing malaria burden and aims to transition from malaria control to sub-national elimination. In 2013, electronic weekly and monthly reporting platforms using the District Health Information System 2 (DHIS2) were introduced. Weekly reporting was implemented through the mobile phone-based Integrated Disease Surveillance and Response (eIDSR) platform and progressively scaled-up from 67 to 7471 (100%) public and private health facilities between 2013 and 2020. This study describes the roll-out and large-scale implementation of eIDSR and compares the consistency between weekly eIDSR and monthly DHIS2 malaria indicator data reporting, including an assessment of its usefulness for malaria outbreak detection and case-based surveillance (CBS) in low transmission areas.MethodsThe indicators included in the analysis were number of patients tested for malaria, number of confirmed malaria cases, and clinical cases (treated presumptively for malaria). The analysis described the time trends of reporting, testing, test positivity, and malaria cases between 2013 and 2021. For both weekly eIDSR and monthly DHIS2 data, comparisons of annual reporting completeness, malaria cases and annualized incidence were performed for 2020 and 2021; additionally, comparisons were stratified by malaria epidemiological strata (parasite prevalence: very low < 1%, low 1 ≤ 5%, moderate 5 ≤ 30%, and high > 30%).ResultsWeekly eIDSR reporting completeness steadily improved over time, with completeness being 90.2% in 2020 and 93.9% in 2021; conversely, monthly DHIS2 reporting completeness was 98.9% and 98.7% in 2020 and 2021, respectively. Weekly eIDSR reporting completeness and timeliness were highest in the very low epidemiological stratum. Annualized malaria incidence as reported by weekly eIDSR was 17.5% and 12.4% lower than reported by monthly DHIS2 in 2020 and 2021; for both 2020 and 2021, annualized incidence was similar across weekly and monthly data in the very low stratum.ConclusionThe concurrence of annualized weekly eIDSR and monthly DHIS2 reporting completeness, malaria cases and incidence in very low strata suggests that eIDSR could be useful tool for early outbreak detection, and the eIDSR platform could reliably be expanded by adding more indicators and modules for CBS in the very low epidemiological stratum.

Phylogeography and evolutionary lineage diversity in the small-eared greater galago, Otolemur garnettii (Primates: Galagidae)

Abstract Assessing the true lineage diversity in elusive nocturnal organisms is particularly challenging due to their subtle phenotypic variation in diagnostic traits. The cryptic small-eared greater galago (Otolemur garnettii) offers a great opportunity to test if currently recognized subspecies, suggested by discontinuities in coat colour pattern and geographic barriers, represent distinct evolutionary lineages. To answer this question, we conducted the first population-level phylogeographic study of the species, sampling wild specimens from across almost its entire latitudinal range, including the Zanzibar Archipelago. We applied five species-delimitation algorithms to investigate the genetic diversity and distribution pattern of mitochondrial DNA across the geographic range of three out of four subspecies. Our results suggest that far-northern populations of O. g. lasiotis potentially represent an independently evolving lineage, but populations assigned to O. g. garnettii from Zanzibar Island and of O. g panganiensis from mainland Tanzania do not constitute two independent lineages. A dated phylogeny suggests that this northern clade diverged from all remaining samples approximately 4 Mya. Such old divergence age is in line with the split between many galagid species. This northern lineage could potentially represent an incipient species; however, there is not yet enough evidence to support a new taxonomic status for this unique mitochondrial group.

The impact of reactive case detection on malaria transmission in Zanzibar in the presence of human mobility

Malaria persists at low levels on Zanzibar despite the use of vector control and case management. We use a metapopulation model to investigate the role of human mobility in malaria persistence on Zanzibar, and the impact of reactive case detection. The model was parameterized using survey data on malaria prevalence, reactive case detection, and travel history. We find that in the absence of imported cases from mainland Tanzania, malaria would likely cease to persist on Zanzibar. We also investigate potential intervention scenarios that may lead to elimination, especially through changes to reactive case detection. While we find that some additional cases are removed by reactive case detection, a large proportion of cases are missed due to many infections having a low parasite density that go undetected by rapid diagnostic tests, a low rate of those infected with malaria seeking treatment, and a low rate of follow up at the household level of malaria cases detected at health facilities. While improvements in reactive case detection would lead to a reduction in malaria prevalence, none of the intervention scenarios tested here were sufficient to reach elimination. Imported cases need to be treated to have a substantial impact on prevalence.

Annual distributions of insecticide-treated nets to schoolchildren and other key populations to maintain higher ITN access than with mass campaigns: a modelling study for mainland Tanzania

BackgroundSince 2013, the National Malaria Control Programme in mainland Tanzania has deployed annual distributions of insecticide-treated nets (ITNs) through primary schools to maintain ITN access and use. This School Net Programme (SNP) is slated to be used throughout mainland Tanzania by 2023. This modelling study projects ITN access under different ITN distribution strategies and quantification approaches.MethodsA stock and flow model with a Tanzania-specific ITN decay rate was used to calculate annual net crops for four different ITN distribution strategies, varying quantification approaches within each strategy. Annual nets-per-capita (NPC) was derived from net crop and a standardized population projection. Nonparametric conditional quartile functions for the proportion of the population with access to an ITN (ITN access) as a function of NPC were used to predict ITN access and its variability. The number of ITNs required under the varying quantification approaches for the period 2022–2030 was calculated.ResultsAnnual SNP quantified using a “population times 15%” approach maintained ITN access between 80 and 90%, when combined with reproductive and child health (RCH) ITN distribution, requiring 133.2 million ITNs. The same strategy quantified with “population times 22%” maintained ITN access at or above 90%, requiring 175.5 million ITNs. Under 5-year mass campaigns with RCH distribution for pregnant women and infants, ITN access reached 90% post-campaign and fell to 27–35% in the 4th year post-campaign, requiring 120.5 million ITNs over 8 years. 3-yearly mass campaigns with RCH reached 100% ITN access post-campaign and fell to 70% in the 3rd year post-campaign, requiring 154.4 million ITNs.ConclusionGiven an ITN retention time in Tanzania of 2.15 years, the model predicts that mass campaigns conducted every 3 years in mainland Tanzania will not maintain ITN access at target levels of 80%, even with strong RCH channels. Mainland Tanzania can however expect to maintain ITN access at 80% or above by quantifying SNP using “population × 15%”, in addition to RCH ITN delivery. This strategy requires 14% fewer ITNs than a 3-year campaign strategy while providing more consistent ITN coverage. Meeting the targets of 80% ITN use would require maintaining 90% ITN access, achievable using a “population times 22%” quantification approach for SNP.

Patterns of fish community structure in protected and non-protected marine areas of mainland Tanzania

Information on the benefits of Marine Protected Areas (MPAs) for the condition of fish stocks is not well documented in Tanzania. Fish landing sites located in Tanga and Mtwara regions were surveyed to assess patterns of fish community structure; particularly fish abundance, species diversity, growth patterns, and maturity stages, based on catches landed at sites with different protection status. Fish abundance in the catch from protected areas was significantly lower than in non-protected areas (p=0.002). Species diversity was relatively higher in catches from non-protected (H=2.742) compared to protected areas (H=2.232). A high percentage of species (63.24 %) exhibiting negative allometric growth was observed in catches from non-protected areas. Further, a large number of mature fish was observed in catches from protected areas compared to non-protected areas (p&lt;0.01). These indices are useful indicators of the performance of MPAs. The observed negative allometric growth and reduced number of mature fishes in the non-protected areas suggest that extractive pressure and disturbances from fishing gears have negative impacts on the fish stock. Continued high extraction may induce a decline in general fish size due to the constant selection for large-trait fish specimens, potentially causing evolutionally change in morphological traits. In contrast, the lower abundance and species diversity from the protected areas reflected low catch effort as a result of regulated fishing pressure in MPAs, rather than indicating the actual diversity in the fish stocks in these protected waters. Based on these findings it is recommended that more regulatory strategies are implemented in non-protected waters to allow more time for fish to attain appropriate harvest sizes and to ensure the effective protection of marine resources.

Factors Hindering Couples from Accessing Marriage Conciliation Boards in Mainland Tanzania

AbstractTo safeguard marriage, the Law of Marriage Act of Mainland Tanzania, established marriage conciliation boards (MCBs) to reconcile disputing spouses. Divorce cases are referred to MCBs before they are filed in court. The divorce rate in Mainland Tanzania is increasing and case law indicates that some parties are by-passing MCBs without good cause. The authors were motivated to study the causes of this trend. Data were collected in Morogoro and Kilimanjaro regions through documentary review and in-depth interviews. They identified six factors limiting parties’ access to MCBs: set-up of the boards; MCBs’ regulatory framework; jurisdiction; costs; choice of forum; and inadequate provisions governing the process followed by MCBs. The study concluded that the government attaches minimal significance to MCBs and recommends that the government should intervene, including by reforming the law governing MCBs.

Vulnerability of Poverty between Male and Female Headed Household in Tanzania

The study analyzes how the male and female headship of households affects poverty vulnerability in Tanzania. The study uses a sample for the 2017–18 HBS covered the population residing in private households in Tanzania Mainland. A representative probability sample of 9,552 households was selected. Probit regression with instrument variables for the endogenous variable (education) is used for estimation. The results imply that, in general, female-headed households are less likely to face extreme poverty than their male counterparts. The study also reveals that extreme poverty is less likely with the female head when divorced or widowed. Finally, the results imply that extreme poverty varies across different regional zones in the country. Therefore, female in Tanzania can shield their households from extreme poverty.

A Model for Sustainable Adoption of Solar Photovoltaic Technology in Tanzania

Solar photovoltaic (PV) technology has been used for several decades to meet the electric energy need of various communities in Tanzania, particularly in rural areas that face a supply gap, due to various reasons. This study builds on three previous projects that were implemented at different locations of the United Republic of Tanzania. These projects are the Sustainable Solar Market Packages 1 (SSMP 1) Project, which was implemented in Sumbawanga District; the Sida/MEM Solar Project, which was implemented in several regions of Tanzania Mainland and the UNDP/MEM Solar PV Project, which was implemented in Mwanza region. The aim was to develop a sustainable model for enhancement of the solar PV technology adoption in Tanzania. The model was developed based on the identified barriers that hinder the adoption of solar PV technology and adopted the best strategies from successful projects. Further, the drivers and activities were developed based on selected best strategies from successful projects. The identified barriers to the adoption of solar PV technology were grouped into five categories based on their significances. These include; limited access to finance (32%), weak enforcement of relevant policy and regulations (31%), technical capacity (18%), lack of awareness (9%) and other social drivers (10%). The analysis of information and data that was obtained from the project reports shows that there are prevailing challenges on awareness on solar PV technology and non-enforcement of quality standards. However, major barriers are on the high price of solar PV systems and lack of access to finance. A model for adoption of solar PV technology in Tanzania was developed and tested by validating it with a successfully implemented solar PV project in Tanzania. In the validation, thirteen (13) out of twenty-one (21) activities of the UNDP/MEM Solar PV Project demonstrated the moderate compliance with the model prescription by 62%. The UNDP/MEM Solar PV project developed a financing mechanism but it was not sustainable due to low application of sustainable adoptions strategies. Also, most of the strategies lacked some important drivers and activities due to financial constraints and technical know-how. The mechanism was not opening opportunities for new users to adopt the solar PV technology or maintain the existing ones. Moreover, stakeholders have not put in place the conducive conditions for existing projects to be sustainable. Recommended future interventions include application of the developed adoption model for Solar PV by using data from other solar PV projects for sensitivity analysis of identified barriers and best strategies.

Challenges Encountered by School Heads in Carrying out Instructional Supervisory Activities in Public Secondary Schools in Lindi Region-Tanzania

The purpose of this study was to determine the challenges heads of schools encounter while carrying out their instructional supervisory activities in schools. The study conducted in Lindi region, Tanzania Mainland. Creswell (2014) elaborates, “mixed-methods research involves the collection of both qualitative and quantitative data, integrating the two forms of data using a distinct design with philosophical assumptions as well as the theoretical framework”. The study used descriptive design in which qualitative and quantitative approaches were involved. The study sample comprised of teachers (N=114), heads of schools (N=57) from 57 randomly selected secondary schools. Data collected through questionnaires, focus group discussion and interview. The study findings revealed several challenges encountered by heads of schools while carrying out their instructional supervisory activities in public secondary schools in Lindi Region. The challenges identified by this study included; multiple responsibilities, lack of qualification, negative attitude of teachers toward supervision, inadequate training among heads of schools and large number of teachers as well as poor communication skills. Heads of schools have to be relieved with multiple responsibilities by school boards. The study recommends leadership training to heads of schools, establishment of good communication system through which teachers will not consider supervision negatively. Moreover, provision of awareness seminars to teachers on the importance of supervision. As for further research, the study recommends the comparative study involving a number of heads of schools to determine the role of an individual head of school in effective supervision at school.

Post marketing surveillance of selected veterinary medicines in Tanzania mainland

BackgroundVeterinary medicines have been widely used for the prevention and treatment of animal diseases. Globally, the veterinary medicine industry is growing. However, there is a significant increase of concern on the quality of veterinary medicines in various developing countries’ legal markets. Poor-quality medicines are associated with treatment failure, development of drug resistance, increased healthcare cost, and death. These reasons warrant a need for monitoring the quality of the medicines circulating in the Tanzania Mainland.MethodsThis was a survey study and veterinary medicines samples were collected from 9 out of 26 regions of Tanzania mainland between 2014 and 2017. Veterinary medicines were sampled from wholesale pharmacies, retail pharmacies, veterinary clinics and Veterinary Accredited Drug Dispensing Outlets (ADDO-vet). All sampled medicines were subjected to product information review and full quality control testing at the Tanzania Medicines and Medical Devices Authority-World Health Organization prequalified laboratory.ResultsA total of 238 samples of veterinary medicines were collected. Out of these, 97.1% (231/238) were subjected to full quality control testing and product information review. All sampled veterinary medicines conformed to visual appearance, clarity, pH, solubility and sterility tests. Also, of the sampled veterinary medicines 97.8% (226/231) and 89.2% (206/231) passed identification and assay tests, respectively. As well as, the majority of the collected samples 92% (219/238) failed to comply with product information requirements. The most observed deficiencies on product information were inadequate information on the package insert 94.1% (224/238), inappropriate storage conditions 55.5% (132/238) and lack of Tanzania registration number 27% (64/238).ConclusionVeterinary medicines with poor quality were found circulating in the legal markets of Tanzania. This can potentiate treatment failure and the development of drug resistance in animals and humans. Post marketing surveillance program will continue to be implemented to ensure that only good quality, safe and efficacious medicines are circulating in the Tanzania Mainland market.

Impoliteness in Modern Taarab Music

This paper is about impoliteness in modern taarab music. It focuses mainly on impoliteness strategies occasionally used by some artists of selected modern taarab music on the island of Zanzibar and mainland Tanzania; where politeness is culturally embedded. Although taarab music is composed, played and performed across the East African coast, we selected taarab from Zanzibar island and mainland Tanzania for this study because these regions are arguably the hub of modern styles, innovations, presentations, performances and singing of taarab music. Data for this study were obtained from YouTube where some lyrics from modern taarab were purposively selected for analysis. We selected a sample of eight taarab songs that we thought were representative in answering the question of impoliteness in taarab music. The data were qualitatively analysed using Culpeper’s (1996) impoliteness model. It was found that modern taarab music is a highly dialogic and interactive sub-genre which is sensational, has specialised lyrics and employs some impoliteness strategies for contestation, open correction, rivalry and grandstanding between fellow artists and their audience. Only four mega strategies were observed in the data, namely positive impoliteness, negative impoliteness, sarcasm and bald on record, with withhold politeness missing. Some of the impoliteness sub-strategies that were observed in modern taarab are ridicule, admonishing, open threats, segregation, exhibitionism, boasting, and teasing, blaming and name-calling.

Grassland Loss in Tanzania: Causes, Consequences and Control

Grasslands are an important component of rangelands. The work presented in this paper is based on spatial statistical analysis of grassland change between 1995 and 2010 using land use and land cover maps covering the whole of mainland Tanzania and GIS. Further arguments for discussion in the paper are sourced from literature review. Results show that grasslands are lost at an alarming rate of almost 1 million hectares annually. Between 1995 and 2010 Tanzania lost more than 14 million hectares of grassland. Main direct causes of grassland loss are conversion to cultivation and to forest cover, almost at an equal rate of more than 6 million hectares over the 15 year period (about 400,000 ha annually). Bush encroachment is also an important direct driver of grassland loss. Indirect causes of grassland loss include population growth, economic growth, challenges in grassland governance and management and globalization. Consequences of grassland loss include reduced areas for grazing, increased soil erosion, floods, increased land use conflicts and their repercussions including loss of property and life. Control measures include those addressing the direct and indirect drivers of change. However, most of the control measures are ineffective and hence the observed trend of grassland loss. The paper concludes by suggesting some topics for further research into ways to improve the effectiveness of the control measures against grassland loss in terms of potential and possibility of more agricultural intensification, improvements of markets and profits to cultivators, nature of grassland loss to forest cover, ways to apply existing extensive research on bush encroachment and, the role of formal and informal institutions that control grassland loss.

Strengthening Teacher Education in Tanzania: Student-Teachers’ and Tutors’ Satisfaction with College Facilities and Environment

Assessing customers’ satisfaction with service quality has been a common practice that allows leaders and managers to improve service delivery to the customers in business studies. In education, the measurement of student satisfaction has received popularity and so does the satisfaction of teaching staff. Studies examining student teachers’ and tutors’ satisfaction with service quality particularly in teacher education are scant. The aims of this study are threefold: to determine the level of support that the Teacher Education Support Project (TESP) provides to strengthen teacher education in Tanzania; to explore the student teachers’ and tutors’ perceptions and satisfaction with the facilities and overall college environment in public TCs and to determine the factors explaining student teachers’ and tutors’ satisfaction with service quality. A survey study involving 2772 student teachers and 302 tutors from all 35 public TCs was conducted in the Tanzania Mainland. The study findings revealed that the TESP has provided significant support of textual and non-textual facilities and learning materials in all public TCs. Besides, student teachers’ satisfaction is most strongly predicted by in-class teaching aids and practical materials albeit other factors such as library and ICT facilities had a considerable prediction. Whereas tutors’ teaching strategies made a significant contribution in regression analysis to explain student teachers’ satisfaction Tutors’ satisfaction was most strongly explained by ICT-supported teaching environments followed up by teaching aids and science facilities. The study concludes by proposing that the measurement of student teachers’ and tutors’ satisfaction be approached and improved separately. Implications for these findings are discussed.

Strengthening access to long-acting reversible contraception within postabortion care in Tanzania: A pre-post evaluation.

Postabortion care services provide lifesaving treatment for abortion-related complications and addresses women's needs by offering family planning (FP) counseling and voluntary access to contraception. Between 2016 and 2020, the Government of Tanzania sought to strengthen its PAC program by enhancing FP counseling and clients' access to a wide range of contraceptive options. The project team conducted a pre-post evaluation in 17 public sector healthcare facilities in mainland Tanzania and 8 in Zanzibar. It comprised structured client exit interviews (CEIs), completed first in 2016 (n=412) and again in 2020 (n=484). These data complemented an evaluation that used routine service statistics to demonstrate the intervention's effects on client-reported outcomes. Primary outcomes of the CEIs reflected client experience and satisfaction with services, and researchers compared pre-post differences using chi-square tests. There were improvements in numerous indicators, including client waiting times, recall of emergency procedure counseling, contraceptive uptake, and satisfaction with the quality of overall counseling and FP information and services; however, triangulation of CEI data with service statistics indicated that some outcomes, though still improved since baseline, attenuated. Strengthening the FP component of PAC is feasible in Tanzania and Zanzibar, but strategies to sustain quality improvements over time are needed.

Stump height: a potential escalator of wood volume and carbon removals in miombo woodlands of mainland Tanzania

Stump height: a potential escalator of wood volume and carbon removals in miombo woodlands of mainland Tanzania

The effects of interventions to integrate long-acting reversible contraception with treatment for incomplete abortion: Results of a 6-year interrupted time series analysis in hospitals in mainland Tanzania and Zanzibar.

To evaluate an intervention that aimed at strengthening voluntary access to long-acting reversible contraception (LARC) within postabortion care (PAC) in hospitals in mainland Tanzania and Zanzibar. From 2016 to 2018, we conducted PAC quality improvement interventions, emphasizing family planning (FP) counseling and voluntary access to LARC. Researchers conducted an interrupted time-series analysis of service statistics compiled from 2014 to 2020 using segmented linear mixed effects regression models to assess the interventions' effect on postabortion contraceptive uptake. The intervention in mainland Tanzania was associated with an immediate 38% increase in postabortion LARC uptake, a trend that declined from late 2016 to mid-2020 to 34%. In Zanzibar, the intervention was associated with a gradual increase in LARC uptake that peaked in late 2018 at 23% and stabilized at approximately 15% by mid-2020. Whereas the interventions in mainland facilities did not generate significant changes in postabortion FP uptake overall, the launch of interventions in Zanzibar in mid-2016 was associated with a precipitous rise in that outcome over time, which plateaued at approximately 54% by 2019. Increased voluntary uptake of postabortion contraception was associated with the introduction of training in PAC, including FP, and quality improvement interventions and gains were sustained over time.

A comprehensive evaluation of organic micropollutants (OMPs) pollution and prioritization in equatorial lakes from mainland Tanzania, East Africa

A lack of understanding the fate of highly toxic organic micropollutants (OMPs) in the equatorial lakes of Tanzania hinders public awareness for protecting these unique aquatic ecosystems, which are precious water resources and stunning wildlife habitats. To address this knowledge gap, the occurrence of 70 anthropogenically-sourced OMPs, including phthalates (PAEs), polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs), was investigated in the water and sediment of 18 lakes in Tanzania. Similar residue concentrations were found in both compartments, showing higher pollution of PAEs ranging from 835.0 to 13,153.1 ng/L in water and 244.6–8691.8 ng/g dw in sediment, followed by PAHs, while OCPs and PCBs were comparatively lower. According to the multi-criteria scoring method for prioritization, the final OMP priority list for the lake environment in Tanzania comprised 25 chemicals, specifically 5 PAEs (DEHP, DIBP, DBP, DCHP and DMPP), 6 PCBs (PCB153, PCB105, PCB28, PCB156, PCB157 and PCB167), 6 PAHs (BaP, BaA, BbF, Pyr, DahA and InP) and 8 OCPs (cis-chlordane, trans-chlordane, p,p’-DDD, p,p’-DDE, p,p’-DDT, endrin, methoxychlor and heptachlor epoxide), suggesting the key substances for conventional monitoring and pollution control in these equatorial lakes, with an emphasis on PAEs, especially DEHP, due to the top priority and endocrine disruptor properties.

Genetic relatedness, virulence factors and antibiotics susceptibility pattern of Vibrio cholerae isolates from various regions during cholera outbreak in Tanzania.

BackgroundCholera continues to cause morbidity and mortality in developing countries, including Tanzania. Since August 2015, Tanzania Mainland has experienced cholera outbreaks affecting 26 regions and a 1.6% case fatality rate. The current study determined the virulence factors, genetic relatedness and antimicrobial susceptibility patterns of the Vibrio cholerae isolated from different regions in Tanzania.MethodsA cross-sectional study that involved the genetic characterization of V. cholerae isolates from eleven regions in Tanzania was carried out. There were 99 V. cholerae isolates collected between January 2016 and December 2017. The study perfomed a Multi-locus Variable-number tandem-repeat analysis for genetic relatedness and Mismatch Amplification Mutation Analysis polymerase chain reaction for analyzing toxin genes. All the isolates were tested for antimicrobial susceptibility using the Kirby Bauer disk diffusion method. Data were generally analyzed using Microsoft excel, where genetic relatedness was analyzed using eBurst software v3.ResultsAll isolates were V. cholerae O1. Ogawa was the most predominant 97(98%) serotype. Isolates were genetically related with a small genetic diversity and were positive for ctxA, tcpA El Tor virulence genes. All isolates (100%) were sensitive to doxycycline, trimethoprim-sulphamethoxazole, tetracycline, ceftriaxone, and chloramphenicol, while 87.8% were sensitive to ciprofloxacin. A high resistance rate (100%) was detected towards erythromycin, nalidixic acid, amoxicillin, and ampicillin.ConclusionThe V.cholerae O1 serotypes Ogawa, El Tor variant predominantly caused cholera outbreaks in Tanzania with strains clonally related regardless of the place and time of the outbreak. Most of the isolates were susceptible to the antibiotic regimen currently used in Tanzania. The high resistance rate detected for the other common antibiotics calls for continuous antimicrobial susceptibility testing during outbreaks.

Sub-national tailoring of malaria interventions in Mainland Tanzania: simulation of the impact of strata-specific intervention combinations using modelling

BackgroundTo accelerate progress against malaria in high burden countries, a strategic reorientation of resources at the sub-national level is needed. This paper describes how mathematical modelling was used in mainland Tanzania to support the strategic revision that followed the mid-term review of the 2015–2020 national malaria strategic plan (NMSP) and the epidemiological risk stratification at the council level in 2018.MethodsIntervention mixes, selected by the National Malaria Control Programme, were simulated for each malaria risk strata per council. Intervention mixes included combinations of insecticide-treated bed nets (ITN), indoor residual spraying, larval source management, and intermittent preventive therapies for school children (IPTsc). Effective case management was either based on estimates from the malaria indicator survey in 2016 or set to a hypothetical target of 85%. A previously calibrated mathematical model in OpenMalaria was used to compare intervention impact predictions for prevalence and incidence between 2016 and 2020, or 2022.ResultsFor each malaria risk stratum four to ten intervention mixes were explored. In the low-risk and urban strata, the scenario without a ITN mass campaign in 2019, predicted high increase in prevalence by 2020 and 2022, while in the very-low strata the target prevalence of less than 1% was maintained at low pre-intervention transmission intensity and high case management. In the moderate and high strata, IPTsc in addition to existing vector control was predicted to reduce the incidence by an additional 15% and prevalence by 22%. In the high-risk strata, all interventions together reached a maximum reduction of 76%, with around 70% of that reduction attributable to high case management and ITNs. Overall, the simulated revised NMSP was predicted to achieve a slightly lower prevalence in 2020 compared to the 2015–2020 NMSP (5.3% vs 6.3%).ConclusionModelling supported the choice of intervention per malaria risk strata by providing impact comparisons of various alternative intervention mixes to address specific questions relevant to the country. The use of a council-calibrated model, that reproduces local malaria trends, represents a useful tool for compiling available evidence into a single analytical platform, that complement other evidence, to aid national programmes with decision-making processes.

Malaria prevalence and performance of diagnostic tests among patients hospitalized with acute undifferentiated fever in Zanzibar

BackgroundControl efforts in Zanzibar reduced the burden of malaria substantially from 2000 to 2015, but re-emergence of falciparum malaria has been observed lately. This study evaluated the prevalence of malaria and performance of routine diagnostic tests among hospitalized fever patients in a 1.5 years period in 2015 and 2016.MethodsFrom March 2015 to October 2016, paediatric and adult patients hospitalized with acute undifferentiated fever at Mnazi Mmoja Hospital, Zanzibar were included. The malaria prevalence, and performance of rapid diagnostic test (RDT) and microscopy, were assessed using polymerase chain reaction (PCR) as gold standard.ResultsThe malaria prevalence was 9% (63/731). Children under 5 years old had lower malaria prevalence (5%, 14/260) than older children (15%, 20/131, p = 0.001) and persons aged 16 to 30 years (13%, 15/119, p = 0.02), but not different from persons over 30 years old (6%, 14/217, p = 0.7). All cases had Plasmodium falciparum infection, except for one case of Plasmodium ovale. Ten malaria patients had no history of visiting mainland Tanzania. The RDT had a sensitivity of 64% (36/56) and a specificity of 98% (561/575), and microscopy had a sensitivity of 50% (18/36) and a specificity of 99% (251/254), compared to PCR. The malaria parasitaemia was lower in patients with false negative results on RDT (median 7 × 103 copies/µL, interquartile range [IQR] 2 × 103 – 8 × 104, p = 0.002) and microscopy (median 9 × 103 copies/µL, IQR 8 × 102 – 7 × 104, p = 0.006) compared to those with true positive RDT (median 2 × 105 copies/µL, IQR 3 × 104 – 5 × 105) and microscopy (median 2 × 105 copies/µL, IQR 6 × 104 – 5 × 105).ConclusionsThe study emphasizes that malaria was a frequent cause of febrile illness in hospitalized patients in Zanzibar in the years 2015-2016, particularly among school age children and young adults. We found evidence of autochthonous malaria transmission in Zanzibar. Compared to PCR, both RDT and microscopy had low sensitivity, and false negative results were associated with low parasitaemia. While low parasitaemia identified only by PCR in a semi-immune individual could be coincidental and without clinical relevance, clinicians should be aware of the risk of false negative results on routine tests.