Arusha, Tanzania

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Furahini G.,Tumaini University Makumira | Lewallen S.,The Good
Ophthalmic Epidemiology | Year: 2010

Purpose: To estimate the incidence of suspected ocular surface squamous neoplasia (OSSN) by Region in Tanzania and learn where these lesions are treated. Methods: We performed an analysis of existing theater records from three Tanzanian referral hospitals from 2006 to 2008 plus a prospective analysis of records from all other eye health workers who remove suspected OSSN outside the referral hospitals over 1 year. Results: Approximately 40% of suspected OSSN are operated on outside of referral hospitals. The estimated annual incidence of ocular surface squamous neoplasia in Tanzania was 2.2 per 100,000 persons. Regional incidence rates were significantly correlated with Regional HIV (Human immunodeficiency virus) prevalence (Pearson's r=0.53, P=0.03). Conclusion: The incidence rate is high, in line with estimates from other East African countries. Management of these cases requires improvement as most patients are still not tested for HIV. © 2010 Informa UK Ltd.


West P.A.,London School of Hygiene and Tropical Medicine | Protopopoff N.,London School of Hygiene and Tropical Medicine | Wright A.,London School of Hygiene and Tropical Medicine | Kivaju Z.,National Institute for Medical Research | And 4 more authors.
PLoS Medicine | Year: 2014

Background:Insecticide-treated nets (ITNs) and indoor residual spraying (IRS) of houses provide effective malaria transmission control. There is conflicting evidence about whether it is more beneficial to provide both interventions in combination. A cluster randomised controlled trial was conducted to investigate whether the combination provides added protection compared to ITNs alone.Methods and Findings:In northwest Tanzania, 50 clusters (village areas) were randomly allocated to ITNs only or ITNs and IRS. Dwellings in the ITN+IRS arm were sprayed with two rounds of bendiocarb in 2012. Plasmodium falciparum prevalence rate (PfPR) in children 0.5-14 y old (primary outcome) and anaemia in children <5 y old (secondary outcome) were compared between study arms using three cross-sectional household surveys in 2012. Entomological inoculation rate (secondary outcome) was compared between study arms.IRS coverage was approximately 90%. ITN use ranged from 36% to 50%. In intention-to-treat analysis, mean PfPR was 13% in the ITN+IRS arm and 26% in the ITN only arm, odds ratio = 0.43 (95% CI 0.19-0.97, n = 13,146). The strongest effect was observed in the peak transmission season, 6 mo after the first IRS. Subgroup analysis showed that ITN users were additionally protected if their houses were sprayed. Mean monthly entomological inoculation rate was non-significantly lower in the ITN+IRS arm than in the ITN only arm, rate ratio = 0.17 (95% CI 0.03-1.08).Conclusions:This is the first randomised trial to our knowledge that reports significant added protection from combining IRS and ITNs compared to ITNs alone. The effect is likely to be attributable to IRS providing added protection to ITN users as well as compensating for inadequate ITN use. Policy makers should consider deploying IRS in combination with ITNs to control transmission if local ITN strategies on their own are insufficiently effective. Given the uncertain generalisability of these findings, it would be prudent for malaria control programmes to evaluate the cost-effectiveness of deploying the combination.Trial registration http://www.clinicaltrials.gov/ct2/show/NCT01697852?term=NCT01697852 Please see later in the article for the Editors' Summary. © 2014 West et al.


Habiyakire C.,Tumaini University Makumira | Kabona G.,Tumaini University Makumira | Courtright P.,The Good | Lewallen S.,The Good
Ophthalmic Epidemiology | Year: 2010

Purpose: To estimate the prevalence and causes of avoidable blindness and visual impairment in persons 50 years of age and older, and to assess the impact of cataract surgical services. Methods: In this cross-sectional population-based survey, 72 clusters of 50 people 50 years and older were selected by probability proportionate to size sampling. Households within clusters were selected through compact segment sampling. Participants underwent an ophthalmic examination in their homes, including measurement of visual acuity (VA) with a tumbling-E chart and diagnosis of the principal cause of visual impairment. Patients who had been operated on were questioned about details of their cataract surgery. Results: Three thousand six hundred eligible subjects were selected, of whom 3,436 (95.5%) were examined. The prevalence of bilateral blindness (presenting VA < 3/60) was 2.4% (95% confidence interval [CI], 1.9%̈C2.9%); prevalence of severe visual impairment was 0.99% (95% CI, 0.98%̈C0.99%); and prevalence of visual impairment (VA of < 6/18 and ≥ 6/60) was 5.4% (95% CI, 4.6%̈C6.2%) in the sample. Unoperated cataract accounted for 52.4% of blindness and 70.6% of severe visual impairment. Cataract surgical coverage among people at 3/60 was 68.9%. Overall, 58.6% and 69.6% of the 191 eyes that had undergone cataract surgery had VA greater than or equal to 6/18 with available correction and best correction respectively. Conclusions: The prevalence of blindness in this population in Kilimanjaro Region was low, reflecting high cataract surgical coverage from an outreach program. Even with high cataract surgical coverage, cataract remains the leading cause of vision loss and an emphasis on quality is needed. © 2010 Informa UK Ltd.


Crump J.A.,Centers for Disease Control and Prevention | Crump J.A.,Duke University | Crump J.A.,Tumaini University Makumira | Mintz E.D.,Centers for Disease Control and Prevention
Clinical Infectious Diseases | Year: 2010

Typhoid and paratyphoid fever continue to be important causes of illness and death, particularly among children and adolescents in south-central and Southeast Asia, where enteric fever is associated with poor sanitation and unsafe food and water. High-quality incidence data from Asia are underpinning efforts to expand access to typhoid vaccines. Efforts are underway to develop vaccines that are immunogenic in infants after a single dose and that can be produced locally in countries of endemicity. The growing importance of Salmonella enterica serotype Paratyphi A in Asia is concerning. Antimicrobial resistance has sequentially emerged to traditional first-line drugs, fluoroquinolones, and third-generation cephalosporins, posing patient treatment challenges. Azithromycin has proven to be an effective alternative for treatment of uncomplicated typhoid fever. The availability of full genome sequences for S. enterica serotype Typhi and S. enterica serotype Paratyphi A confirms their place as monomorphic, human-adapted pathogens vulnerable to control measures if international efforts can be redoubled.


Lewallen S.,Tumaini University Makumira | Taylor T.E.,Michigan State University | Taylor T.E.,University of Malawi | Molyneux M.E.,Malawi Liverpool Wellcome Trust Clinical Research Programme
Future Microbiology | Year: 2011

Accurate diagnosis of cerebral malaria (CM) is important for patient management, epidemiological and end point surveillance, and enrolling patients with CM in studies of pathogenesis or therapeutic trials. In malaria-endemic areas, where asymptomatic Plasmodium falciparum parasitemia is common, a positive blood film in a comatose individual does not prove that the coma is due to malaria. A retinopathy consisting of two unique features - patchy retinal whitening and focal changes of vessel color - is highly specific for encephalopathy of malarial etiology. White-centered retinal hemorrhages are a common but less specific feature. Either indirect or direct ophthalmoscopy can be used to identify the changes, and both procedures can be learned and practiced by nonspecialist clinicians. In view of its important contributions to both clinical care and research, examination of the retina should become a routine component of the assessment of a comatose child or adult when CM is a possible diagnosis. © 2011 Future Medicine Ltd.


Reddy E.A.,Duke University | Reddy E.A.,Kilimanjaro Christian Medical Center | Shaw A.V.,Duke University | Crump J.A.,Duke University | And 2 more authors.
The Lancet Infectious Diseases | Year: 2010

Data on the prevalence and causes of community-acquired bloodstream infections in Africa are scarce. We searched three databases for studies that prospectively studied patients admitted to hospital with at least a blood culture, and found 22 eligible studies describing 58 296 patients, of whom 2051 (13·5%) of 15 166 adults and 3527 (8·2%) of 43 130 children had bloodstream infections. 1643 (29·1%) non-malaria bloodstream infections were due to Salmonella enterica (58·4% of these non-typhoidal Salmonella), the most prevalent isolate overall and in adults, and 1031 (18·3% overall) were due to Streptococcus pneumoniae, the most common isolate in children. Other common isolates included Staphylococcus aureus (531 infections; 9·5%) and Escherichia coli (412; 7·3%). Mycobacterium tuberculosis complex accounted for 166 (30·7%) of 539 isolates in seven studies that used mycobacterial culture techniques. HIV infection was associated with any bloodstream infection, particularly with S enterica and M tuberculosis complex bacteraemia. Where recorded, patients with bloodstream infections had an in-hospital case fatality of 18·1%. Our results show that bloodstream infections are common and associated with high mortality. Improved clinical microbiology services and reassessment of empirical treatment guidelines that account for the epidemiology of bloodstream infections might contribute to better outcomes. © 2010 Elsevier Ltd. All rights reserved.


Byamukama E.,Tumaini University Makumira | Courtright P.,Kilimanjaro Center for Community Ophthalmology
International Health | Year: 2010

The aim of this study was to assess the primary eye care knowledge, skills, and productivity of primary health workers at dispensaries in a district in Tanzania. Factors likely to contribute to knowledge, skills, and productivity were also assessed. A descriptive cross-sectional study design was used. All health workers employed at government dispensaries in Mwanga District, Kilimanjaro Region, Tanzania were included. A skills score of respondents, comprising knowledge and ability to test visual acuity and diagnosis and management of common eye conditions, was measured through interview and direct observation. Factors associated with the skills score were assessed. Forty nine health workers were assessed. There was poor understanding of basic ocular conditions and how to assess visual acuity; the mean skills score of all respondents was 6.2 out of 12. There was little association between having received training and the skills score. The mean number of eye patients managed per health worker was three per month. Findings suggest that a reassessment of the roles and responsibilities in primary eye care of dispensary health workers, review of training curriculum and teaching, and supervisory procedures may be necessary. © 2010 Royal Society of Tropical Medicine and Hygiene.


Nkala T.E.,Tumaini University Makumira | Msuya S.E.,Tumaini University Makumira
International Breastfeeding Journal | Year: 2011

Background: Exclusive breastfeeding (EBF) for the first six months of infants' lives is a cost effective intervention in saving children's lives and can avert 13 - 15% of the 9 million deaths of children under 5 years old in resource poor settings. However, EBF rates have been shown to be low in resource poor settings, ranging between 20 and 40%. In Tanzania, the prevalence of EBF among infants under 6 months is 41%, with limited information on predictors of EBF. The aim of the study was to determine prevalence of EBF and its predictors in Kigoma Municipality, Western Tanzania.Methods: A cross-sectional study was conducted in March to May 2010 among 402 consenting women, with infants aged 6 to 12 months, from randomly selected households. A questionnaire was used to collect information on demographic characteristics, knowledge of EBF, infant feeding practices, and on HIV status.Results: The prevalence of EBF among women in Kigoma Municipality was 58%. Knowledge of EBF was relatively higher (86%) compared to the practice. In the multivariable analysis, women with adequate knowledge of EBF (AOR 5.4), women who delivered at health facilities (AOR 3.0) and women who had no problems related to breasts, like engorgement/cracked nipples (AOR 6.6) were more likely to exclusively breastfeed compared to others.Conclusions: Prevalence of EBF in Kigoma municipality was slightly higher than the national figure of 41%, however it was way below the EBF prevalence of 90% recommended by the WHO. Strategies that target improving knowledge and skills for lactation management among women, as well as strategies to improve health facility delivery, may help to improve EBF in this setting. © 2011 Nkala and Msuya; licensee BioMed Central Ltd.


Adolescents in Zanzibar are at risk of reproductive health problems including teenage pregnancies, STIs and HIV, early sexual debut and abortion complications. The national policy guideline of adolescents reproductive health needs parents to support and provide information on sexuality and reproductive health to their adolescents, however, Zanzibar has been observed to be a rich and splendid cultural and religious legacy country whereby information related to sexuality is an avoided topic of explicit discussion. Therefore the purpose of this study was to assess acceptability of caretakers in providing information on sexuality to adolescents in health centers, family, community and schools using information motivation behavioral skills (IMB) model. Probability 3 stages sampling technique was used to obtain a representative sample of 192 participant of the study (98 were female and 94 were male) who were interviewed with the use of structured questionnaire in Urban District, Zanzibar. About 100 (54.3%) respondents accept the provision of information on sexuality to their adolescents. Only 81 (44%) respondents reported to have knowledge on information on sexuality. Only 48(26%) respondents perceived that their adolescents are more vulnerable to get reproductive health problems, 73 (39.7%) reported to have less restrictive social norms regarding the provision of information on sexuality, 106 (57.6%) have positive attitude towards the provision of information on sexuality to adolescent and 96 (52.20%) have high self efficacy in the provision of information on sexuality. Indicators of motivation showed significant association and were the predictors of acceptability and self efficacy. The level of acceptability of caretakers in the provision of information on sexuality to their adolescents was nearly at the border line (54%). Providing information on sexuality and improve self efficacy are the most important factors to consider in the interventions of increasing caretakers' acceptability in the provision of information on sexuality to adolescents; however, creating less restrictive social norms, build up positive attitude and sensitizing on realization of feelings of vulnerability to caretakers add weight in plans to increase acceptability.


Okwen M.,Tumaini University Makumira | Lewallen S.,Kilimanjaro Center for Community Ophthalmology | Courtright P.,Kilimanjaro Center for Community Ophthalmology
Public Health | Year: 2014

Introduction: Primary health care in Tanzania is provided at two types of health units, the dispensary and the health centre. Theoretically, primary health workers (with knowledge of primary eye care [PEC]) are ideally placed to identify people in need of eye care services. In Tanzania, they are expected to be able to identify, treat, or correctly refer a number of eye conditions including cataract, trauma, presbyopia, and the 'red eye'. They are also expected to be able to measure visual acuity correctly and to educate the community about prevention. Objectives: The objective was to determine the effect of enhanced supervision of health workers on PEC knowledge and skills in Kilimanjaro Region, Tanzania. Study design: This was a quasi-experimental, cluster randomized intervention study of an enhanced supervisory method compared to a routine supervisory method; 36 dispensaries were randomly allocated into the two groups. Participants: Health workers based at government dispensaries in Mwanga District. Data collection: Participants were interviewed pre and post intervention and the information was recorded using a standardized pretested questionnaire. Results: Mean scores of knowledge in healthcare workers was higher in the intervention group (score=6.43, 80.4% improvement) compared to the non-intervention group (score=4.71, 58.9% improvement). The ability to describe and demonstrate vision testing was better (score=1.8) in the enhanced supervision group compared to the routine supervision group (score=0.88, P=0.03). There was a high level of attrition (24%) within one year from the time of baseline survey, especially amongst clinical officers (44%). Conclusion: During the pilot study, enhanced supervision improved PEC knowledge and skills of health workers compared to health workers with routine supervision. Recommendations: Training in PEC needs revision to become more practicum-based. There is need to revise supervision guidelines (to be skills-based) and the supervision skills of district eye coordinators (DECs) need to be enhanced. There is a huge need to improve governance (accountability and rule of law) of health staff. © 2013 The Royal Society for Public Health.

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