Taking oral health in Tanzania a step forward

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Physician tracking in sub-Saharan Africa: current initiatives and opportunities

Background Physician tracking systems are critical for health workforce planning as well as for activities to ensure quality health care - such as physician regulation, education, and emergency response. However, information on current systems for physician tracking in sub-Saharan Africa is limited. The objective of this study is to provide information on the current state of physician tracking systems in the region, highlighting emerging themes and innovative practices. Methods This study included a review of the literature, an online search for physician licensing systems, and a document review of publicly available physician registration forms for sub-Saharan African countries. Primary data on physician tracking activities was collected as part of the Medical Education Partnership Initiative (MEPI) - through two rounds over two years of annual surveys to 13 medical schools in 12 sub-Saharan countries. Two innovations were identified during two MEPI school site visits in Uganda and Ghana. Results Out of twelve countries, nine had existing frameworks for physician tracking through licensing requirements. Most countries collected basic demographic information: name, address, date of birth, nationality/citizenship, and training institution. Practice information was less frequently collected. The most frequently collected practice fields were specialty/degree and current title/position. Location of employment and name and sector of current employer were less frequently collected. Many medical schools are taking steps to implement graduate tracking systems. We also highlight two innovative practices: mobile technology access to physician registries in Uganda and MDNet, a public-private partnership providing free mobile-to-mobile voice and text messages to all doctors registered with the Ghana Medical Association. Conclusion While physician tracking systems vary widely between countries and a number of challenges remain, there appears to be increasing interest in developing these systems and many innovative developments in the area. Opportunities exist to expand these systems in a more coordinated manner that will ultimately lead to better workforce planning, implementation of the workforce, and better health

The One-Health Approach to Infectious Disease Outbreaks Control

Close contact between people, animals, plants, and their shared environment provides more disease transmission opportunities. Host characteristics, environmental conditions, and habitat disruption can provide new opportunities for disease to occur. These changes may lead to the spread of existing and new diseases. Bacteria, viruses, fungi, protozoans, sporozoans, worms, and others cause infectious diseases. Some of these diseases may be prone to explosive outbreaks and may constitute deadly epidemic threats that could rapidly reach pandemic proportions. Drugs and vaccines can successfully control many infectious diseases; however, this is challenged by the lack of facilities and resources. In all parts of the world, infectious disease is an essential constraint to increased human, animal, and environmental interactions. Identifying hot-spot and interventions for prevention while considering the heterogeneity of target diseases to places, population time, or situation is essential. Therefore, successful infectious disease control measures must be based on understanding disease transmission pathways, strengthening surveillance systems, and intervention. Application of the One Health method is a responsive approach to infectious disease control. Much of the One-Health based approach to managing an infectious disease has been utilized with a promising effect on controlling current outbreaks. More deliberate efforts should encourage understanding of disease determinants to analyze infectious disease issues through a One-Health lens. Only through the extensive participation of all related field stakeholders can One-Health truly reach its potential to mitigate infectious disease outbreaks. This chapter reviews utilization of the One Health approach to infectious disease outbreak control

Recombinant anticoccidial vaccines - a cup half full?

Eimeria species parasites can cause the disease coccidiosis, most notably in chickens. The occurrence of coccidiosis is currently controlled through a combination of good husbandry, chemoprophylaxis and/or live parasite vaccination; however, scalable, cost-effective subunit or recombinant vaccines are required. Many antigens have been proposed for use in novel anticoccidial vaccines, supported by the capacity to reduce disease severity or parasite replication, increase body weight gain in the face of challenge or improve feed conversion under experimental conditions, but none has reached commercial development. Nonetheless, the protection against challenge induced by some antigens has been within the lower range described for the ionophores against susceptible isolates or current live vaccines prior to oocyst recycling. With such levels of efficacy it may be that combinations of anticoccidial antigens already described are sufficient for development as novel multi-valent vaccines, pending identification of optimal delivery systems. Selection of the best antigens to be included in such vaccines can be informed by knowledge defining the natural occurrence of specific antigenic diversity, with relevance to the risk of immediate vaccine breakthrough, and the rate at which parasite genomes can evolve new diversity. For Eimeria, such data are now becoming available for antigens such as apical membrane antigen 1 (AMA1) and immune mapped protein 1 (IMP1) and more are anticipated as high-capacity, high-throughput sequencing technologies become increasingly accessible

Seroprevalence and molecular analysis of yellow fever virus in mosquitoes at Namanga and Mutukula borders in Tanzania

This research article was published by International Journal of Infectious Diseases Volume 150, January 2025Objectives Yellow fever (YF) is a major public health concern, particularly in Africa and South America. This study aimed to detect YF in human and mosquito samples to understand transmission dynamics in the Tanzania–Uganda and Tanzania–Kenya cross-border areas. Methods Blood samples were collected from individuals aged ≥9 months for serological testing. Mosquitoes were captured and tested for YF virus RNA. Logistic regression models were used to predict seroprevalence and associated risk factors. Results The overall YF seroprevalence was 12.5%, with higher rates among older individuals (7.0%) and female participants (immunoglobulin [Ig] G 4.4%, IgM 6.0%). Notably, YF virus RNA was detected in three out of 46 pools of 192 mosquitoes. The odds of testing positive for YF IgG were lower among those with primary education compared with college education (AOR = 0.27, CI: 0.08-0.88) and increased with those experiencing muscle pain (AOR = 4.5, CI: 1.08-18.78) while the odds of testing positive to YF IgM increased with being female (AOR = 4.7, CI: 1.5-14.7), traveling to YF endemic areas (AOR = 5.2, CI: 1.35-44.75), exposure to Aedes mosquitoes (AOR = 3.7, CI: 1.27-10.84) and exhibiting bruising (AOR = 13.5, CI: 1.23-145.72) Conclusions Although Tanzania has not experienced YF outbreaks, evidence of YF exposure at the studied borders highlights the need for strengthening cross-border surveillance, vector control, and vaccination efforts. Further research is needed to evaluate the country's overall YF risk

Seroprevalence and associated risk factors of chikungunya, dengue, and Zika in eight districts in Tanzania

Background: This study was conducted to determine the seroprevalence and risk factors of chikungunya (CHIKV), dengue (DENV), and Zika (ZIKV) viruses in Tanzania. Methods: The study covered the districts of Buhigwe, Kalambo, Kilindi, Kinondoni, Kondoa, Kyela, Mvomero, and Ukerewe in Tanzania. Blood samples were collected from individuals recruited from households and healthcare facilities. An ELISA was used to screen for immunoglobulin G antibodies against CHIKV, DENV, and ZIKV. Results: A total of 1818 participants (median age 34 years) were recruited. The overall CHIKV, DENV, and ZIKV seroprevalence rates were 28.0%, 16.1%, and 6.8%, respectively. CHIKV prevalence was highest in Buhigwe (46.8%), DENV in Kinondoni (43.8%), and ZIKV in Ukerewe (10.6%) and Mvomero (10.6%). Increasing age and frequent mosquito bites were significantly associated with CHIKV and DENV seropositivity (P < 0.05). Having piped water or the presence of stagnant water around the home (P < 0.01) were associated with higher odds of DENV seropositivity. Fever was significantly associated with increased odds of CHIKV seropositivity (P < 0.001). Visiting mines had higher odds of ZIKV seropositivity (P < 0.05). Conclusions: These findings indicate that DENV, CHIKV, and ZIKV are circulating in diverse ecological zones of Tanzania. There is a need to strengthen the control of mosquito-borne viral diseases in Tanzania

Socio-demographic disparity in oral health among the poor: a cross sectional study of early adolescents in Kilwa district, Tanzania

There is a lack of studies considering social disparity in oral health emanating from adolescents in low-income countries. This study aimed to assess socio-demographic disparities in clinical- and self reported oral health status and a number of oral health behaviors. The extent to which oral health related behaviors might account for socio-demographic disparities in oral health status was also examined. A cross-sectional study was conducted in Kilwa district in 2008. One thousand seven hundred and forty five schoolchildren completed an interview and a full mouth clinical examination. Caries experience was recorded using WHO criteria, whilst type of treatment need was categorized using the ART approach. The majority of students were caries free (79.8%) and presented with a low need for dental treatment (89.3%). Compared to their counterparts in opposite groups, rural residents and those from less poor households presented more frequently with caries experience (DMT>0), high need for dental treatment and poor oral hygiene behavior, but were less likely to report poor oral health status. Stepwise logistic regressions revealed that social and behavioral variables varied systematically with caries experience, high need for dental treatment and poor self reported oral health. Socio-demographic disparities in oral health outcomes persisted after adjusting for oral health behaviors. Socio-demographic disparities in oral health outcomes and oral health behaviors do exist. Socio-demographic disparities in oral health outcomes were marginally accounted for by oral health behaviors. Developing policies and programs targeting both social and individual determinants of oral health should be an urgent public health strategy in Tanzania

Medical schools in sub-Saharan Africa

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/85361/1/MedicalSchoolsinSubSaharaAfrica.pd

The prevalence, distribution and risk of viral haemorrhagic fevers in Tanzania

Ph.D DissertationsViral haemorrhagic fevers (VHFs) are a group of infectious diseases caused by viruses belonging to the Flaviviridae, Phenuiviridae, Arenaviridae, and Filoviridae families. They are characterized by fever, a constellation of initially nonspecific signs and symptoms, and a propensity for bleeding and shock. The VHFs reported in Sub-Saharan Africa include Crimean-Congo haemorrhagic fever (CCHF), Ebola virus disease (EVD), Lassa fever (LF), Lujo haemorrhagic fever (LUHF), Marburg virus disease (MVD), Rift Valley fever (RVF), and yellow fever (YF). Knowledge surrounding the distribution and risk of VHFs in Tanzania is limited. Accurate epidemiological information of VHFs is critical to implementing appropriate control and prevention strategies. This study aimed to determine the prevalence, risk of introduction, and factors associated with VHF in Tanzania. The findings provided in this thesis consolidate our knowledge of the diseases in Tanzania and the need for improved surveillance, early detection, and prompt response. The thesis is divided into two major approaches, namely systematic review and research studies. A systematic review was undertaken to analyse EVD outbreak reports, identify challenges and opportunities in detection and response in sub-Saharan Africa and propose effective control approaches. A research study was conducted to estimate the probability of introducing EVD from DRC to Tanzania. This study involved collection of national data for flights, boats, and car transport schedules from DRC to Tanzania covering a period between May 2018 to June 2019. A population study was carried out in all ecological zones of Tanzania to determine the seroprevalence and associated risk of selected five VHFs. In this epidemiological study, blood samples were collected from households and healthcare facilities in Buhigwe, Kalambo, Kilindi, Kinondoni, Kondoa, Kyela, Mvomero, and Ukerewe districts of Tanzania. The samples were screened for immunoglobulin G (IgG) and M (IgM) antibodies against CCHF, EVD, MVD, RVF, and YF. The prevalence of VHF and malaria co-infections was also determined among participants seeking care from health care facilities. Malaria infections were investigated using rapid diagnostics tests (RDT). In addition, Community knowledge, awareness and practices regarding VHF was assessed in eight districts of Tanzania. Archived sera that tested positive for immunoglobulin IgG antibodies to EBOV and RVFV using a commercially available ELISA were reanalysed using the in-house EBOV whole antigen (WAg) and RVFV inhibition enzyme-linked immunosorbent assay. The findings of the systematic review indicate that between 1979 and 2020 a total of 34 EVD outbreaks affecting 34,356 cases and causing 14,823 deaths were reported in 11 countries in Sub-Saharan Africa. The overall case fatality rate (95% CI) was 66% (62 to 71) and this did not change substantially over time (OR in 2019 versus 1976=1.6 (95% CI 1.5 to 1.8), p<0.001). The challenges to control EVD outbreaks are related to epidemiological, sociocultural and health system factors. As regards to the risk of introduction of EVD from DRC to Tanzania, the findings indicate that the most likely pathways were the entry of infected humans through air, land, and water travels. The land border crossings were considered the most frequently used means of travel (highest), while water and air travel were deemed less often (high). High probabilities of introducing EVD from DRC to Tanzania were associated with the viability of the pathogen and low detection capacity at the ports of entry. The epidemiological survey indicated that the overall, CCHF, EVD, MVD, RVF, and YF seroprevalence were 2.0%, 3.4%, 1.2%, 4.8%, and 1.4, respectively. The highest VHF antibody seroprevalence was recorded in western Tanzania (6.0%), characterized by unimodal rainfall pattern and altitude below 2,300m. The lowest seroprevalence (0.4%) was observed in the semi-arid central Tanzania, characterized by moderate precipitation and a unimodal rainfall pattern. The association between seroprevalence of VHFs and geographical location was found to be significant (P= 0.001). Contact with wild animals (OR = 1.2, CI = 1.3–1.6) and keeping goats (OR = 1.3, CI = 1.5–1.9) were significantly associated with RVF while contact with bats (OR = 1.2, CI = 1.1–1.5) was associated with MVD. The prevalence of VHF and malaria co-infections was 1.9%. The age group 46-60 years had the highest malaria co-infection p < 0.05. Over half (57%) of malaria and VHF- infected individuals reported headaches, while over one-third (37%) reported muscle, bone, back, and joint pains (p= 0.001). All EBOV positive sera turned out to be negative by In-House WAg EBOV ELISA. Two of the nine positive IgG RVF commercial ELISA samples were reactive to the RVF Inhouse ELISA, with inhibitory rates ranging from 66% to 99.6%. A slight agreement was observed between the RVF in-house and the commercial ELISA (kappa value, 0.08; 28%, 11/40 in disagreement). As regards to community, knowledge, attitudes and practice, slightly over a quarter (29.4%) of the respondents was knowledgeable, 25% had a positive attitude, and 17.9% had unfavourable practice habits. There were increased odds of having poor practice among participants aged 36–45 years (AOR: 3.566, 95% CI: 1.593– 7.821) and those living in Buhigwe, Kilindi and Ukerewe areas (AOR: 2.529, 95% CI: 1.071–6.657; AOR: 2.639, 95% CI: 1.130–7.580 AOR: 2.248, 95% CI: 1.073–3.844) than their peers. In conclusion, Sub-Saharan Africa faces considerable challenges in EVD control, whereby there are no significant changes in case fatality rates observed during the past four decades. Socioeconomic and cultural factors need to be critically considered to shape the community behaviours that lead to EVD outbreaks. The risk of introducing EVD from DRC to Tanzania is high. Infected humans arriving via land are the most likely pathway of EVD entry, and therefore, mitigation strategies should be directed towards this pathway. Although, CCHF, EVD, MVD, and YF outbreaks have not been reported in Tanzania, the viruses are prevalent and vary from one ecological zone to another, with the western part of the country at the highest risk. Co-infections of malaria and viral haemorrhagic fevers are frequent in Tanzania. The rate was higher in the age group 46-60 years. Both malaria and VHF presented with similar symptoms. There were increased odds of having poor practice among participants aged 36–45 years (AOR: 3.566, 95% CI: 1.593– 7.821) and those who reside in Buhigwe, Kilindi and Ukerewe areas (AOR: 2.529, 95% CI: 1.071– 6.657; AOR: 2.639, 95% CI: 1.130–7.580 AOR: 2.248, 95% CI: 1.073–3.844) than their peers. According to the study, 29.4% of respondents were knowledgeable, 25% had a positive mindset, and 17.9% had unfavourable practice habits. We found poor agreement between in-house and commercial ELISA tests for EBOV and fair agreement between in-house and commercial ELISA tests for RVFV, with the commercial ELISA detecting more cases than the validated in-house ELISA. The current study emphasizes the difficulties in diagnosing viral hemorrhagic fever in Tanzania. Frequent EVD outbreaks in DRC urge the need to intensify the surveillance system, including laboratory screening of suspects, thermal screening of all arrivals from endemic areas, and registering travellers within all the border entry points to prevent disease importation. Equally important, there is a need for strengthening the sensitization and awareness campaigns focusing on cross-border communities. The border healthcare facilities need to be well equipped to ensure a high disease containment capacity. The findings that VHFs are prevalent in Tanzania call for the need to strengthen the surveillance system and management of febrile illnesses in Tanzania. The discrepancy was observed between validated in-house and commercial ELISA tests. Hence, the serological results should be interpreted with caution and this emphasizes the challenges related to the diagnosis of VHFs. Overall, broad-based, one-health approach, effective communication, social mobilisation, and strengthening of the health systems need to be addressed to prevent future outbreaks.SACIDS Foundation for One Health African Centre of Excellence for Infectious Disease of Humans and Animals in Southern and Eastern Africa (grant WB-ACE II Grant PAD1436 from the World Bank and the Government of Tanzani