Dynamics of P. falciparum gametocytemia in symptomatic patients in an area of intense perennial transmission in Tanzania.

We investigated the dynamics of Plasmodium falciparum gametocytemia in symptomatic patients attending a local dispensary in the Kilombero district, Tanzania. Consenting individuals aged one and above, with varying asexual and sexual parasitemias were treated appropriately and asked to return weekly for 28 days. Gametocyte prevalence was highest on Day 7 of follow-up in all age groups (overall 30.5%). Multifactorial analysis showed that young age (chi2 = 18.4; P = 0.004), high asexual parasitemia on presentation (chi2 = 19.4; P = 0.0007) and gametocyte positivity on presentation (chi2 = 29.4; P = 0.001) were all significantly associated with the presence of gametocytes on Days 7 and 14 of follow-up. High presentation of asexual parasitemia alone was positively correlated with higher gametocyte densities on both days of follow-up (F4, 297 = 2.0; P = 0.049). Gametocyte incidence rates decreased significantly with age (chi2 = 7.6, P < 0.005). In summary, in this group of chloroquine-treated individuals, gametocyte prevalence and incidence rates decreased with age, while densities remained relatively constant

Dynamics of P. Falciparum Gametocytemia in Symptomatic Patients in an Area of Intense Perennial Transmission in Tanzania.

We investigated the dynamics of Plasmodium falciparum gametocytemia in symptomatic patients attending a local dispensary in the Kilombero district, Tanzania. Consenting individuals aged one and above, with varying asexual and sexual parasitemias were treated appropriately and asked to return weekly for 28 days. Gametocyte prevalence was highest on Day 7 of follow-up in all age groups (overall 30.5%). Multifactorial analysis showed that young age (chi2 = 18.4; P = 0.004), high asexual parasitemia on presentation (chi2 = 19.4; P = 0.0007) and gametocyte positivity on presentation (chi2 = 29.4; P = 0.001) were all significantly associated with the presence of gametocytes on Days 7 and 14 of follow-up. High presentation of asexual parasitemia alone was positively correlated with higher gametocyte densities on both days of follow-up (F4, 297 = 2.0; P = 0.049). Gametocyte incidence rates decreased significantly with age (chi2 = 7.6, P < 0.005). In summary, in this group of chloroquine-treated individuals, gametocyte prevalence and incidence rates decreased with age, while densities remained relatively constant

Mosquito Net Coverage and Utilisation for Malaria\ud Control in Tanzania\ud

\ud In recent years malaria parasites have developed resistance to the most commonly used antimalarial drugs in Tanzania, posing a major challenge for its control. This has led to frequent changes of malaria treatment guidelines, more recently to expensive, yet more effective arthemether/lumefantrine. The use of insecticide treated mosquito nets (ITNs) and long lasting nets (LLINs) in Tanzania has increased slowly over the past few years. Despite the introduction of a voucher scheme to the vulnerable groups, the proportion of households with at least an ITN/LLIN in the country has not been able to achieve the Abuja Declaration of 60% net coverage. Statistics available on the utilisation of nets do not provide a good estimate of the coverage, because of the different study design used to collect the information. This survey was carried out in 21 districts of Tanzania to determine the coverage and utilisation of insecticide treated nets to provide baseline information of the net requirement to cover every sleeping bed in the country. Specifically, this study aimed to (i) determine the ITN coverage by and its distribution in the country; and (ii) determine knowledge, attitudes and practice of the householders as regards to malaria prevention and control Twenty one districts (one from each region) of Mainland Tanzania were selected for the survey. Selection of the district was random. In each district, two wards were selected, one urban (within the district capital) and one rural or sub‐urban. Households were selected randomly using a table of random numbers. At household level, the head or any adult who represented the head of household was interviewed. A structured pre‐tested questionnaire was used to collect information on knowledge, attitude and practices in malaria control, with emphasis on mosquito net ownership and utilisation. Of the 9549 targeted households, 9166 (96%) participated in the survey. Majority of the respondents (76.8%) were from rural district.The mean household size was 3.9 persons. On average, children <5 years old accounted for 39.3% of the members of the households. Respondents with no formal education accounted for 15.8‐37.4% of the interviewees. Most of them were from Mkuranga (55%), Kigoma‐Ujiji (44.2%) and Newala (37.9%). High literate rates were observed in Arumeru and Moshi districts. The majority of the respondents knew that the mosquito is the vector of the malaria parasite (92.6‐99.4%) and infection is through a mosquito bite (92.7‐99.8%). The knowledge of respondents on malaria transmission was generally high (94.0‐99.0%). The majority of the respondents (95.2%) considered the use of mosquito nets as the most effective way of malaria prevention. However, of these, only 66.7% said to have actually used nets in their life time. Knowledge on the use of mosquito nets in the control of malaria was highest and lowest in Eastern and Central zones, respectively.\ud Seventy‐seven percent (4457/8933) agreed to have the investigator entry into their houses and verify the\ud number of nets owned. On average, 62.9% (5,785/8933) of the households had at least a mosquito net. Majority of the respondents in Northern (76.5%) and Southern (76.5%) zones owned at least a mosquito net. The lowest mosquito net ownership was observed among respondents in Western Zone (39.6%). District‐wise, net ownership was highest in Lindi (94.5%), Kyela (91.3%) Arumeru (86.1%), Ilala (83.1%)\ud and Nyamagana (80.0%). Ownership of net was very low in Kilolo (34.8%), Kigoma (36.5%) and Musoma Rural (41.3%). Of the households with nets, 74.4% were using nets all year round. A larger proportion of respondents in Kilolo (68.5%), Mpwapwa (51.9%), Songea Rural (49.2%) and Shinyanga Rural (46.3%) were only using the nets during the rainy season. Out of 9,166 households visited, 3,610 (39.3%) had at least one under five child. Of these, in 1,939 (53.7%) of the households the child slept under a mosquito net during the previous night. Use of nets in children <5 years was most common in northern zone (74%); followed by eastern (66.9%) and southern zone (61.1%). Districts with the largest proportion of <5 year children sleeping under a mosquito nets were Lindi (90.0%), Kyela (85.2%), Ilala (83.2%) and Arumeru (78.2%). Only about a quarter (27%) of the children <5% in western zone were sleeping under a mosquito net. Lowest net coverage for <5 year was in Kigoma (22.7%), Kilolo (25%) and Bukoba Rural (31.2%). A total of 5,785 (62.9%) owned at least a mosquito net. Of these, 4,219 and 1,566 were from the rural and urban districts, respectively. More households in the urban districts (73.4%) than rural districts (59.7%) owned at least a mosquito net. Likewise, there were more households (64.9%) in the urban districts with <5years children sleeping under mosquito nets than in the rural districts (50.4%). More households in urban (32.8%) than in rural districts (25.1%) had at least one insecticide treated net. The number of households with mosquito nets enough for all members of the households ranged from 18.9% (in Urambo) to 37.4% (in Hanang). Households with at least 50% or more occupants using mosquito nets ranged from 16.4% (in Urambo) to 42.8% (in Arumeru). Districts with the largest proportion of ≥50% of the household members sleeping under mosquito nets were Arumeru (46.9%) and Lindi (46.7%). In Manyoni and Lindi, 3.1% and 5% of the households were found to have more nets than the number of household occupants. Only 9% (801/9196) of the households had all occupants sleeping under a mosquito net. Kyela district had about a quarter (23.9%) of the households with all occupants sleeping under nets. Only 29% of the households had at least one insecticide treated mosquito nets. All nets in 51.4% of the households surveyed were ITNs. The largest proportion of households with ITN was observed in northern zone (40.2%), with Arumeru (46%) and Hanang (44.1%) districts having the highest ITN coverage. The lowest proportion (15.5%) of households with ITN was found in the Western Zone. Districts which had the lowest ITN coverage were Musoma Rural (12.6%), Kigoma‐Ujiji (13.2%), and Shinyanga Rural (14.4%). On average, 90.7% (8,123/8,953) of the respondents would prefer using ITN than having their house sprayed with long lasting residual insecticide. More households in urban (32.8%) than in rural districts (25.1%) had at least an ITN> A total of 1939 children underfives were sleeping under mosquito net (any type). Of these, 1140 (58.8%) were using insecticide treated nets (ITN). Overall, 31.6% of the underfives slept under an insecticide treated net during the previous night. Highest coverage was reported in Kyela (47.7%), Nyamagana (47.7%) and Arumeru (46.4%). Lowest ITN in underfives was reported in Kigoma‐Ujiji (16.0%), Musoma (17.2%) and Urambo (17.7%). In Songea more underfives children were sleeping under ITN (43.6%) than in untreated nets (40.9%). Control of bedbugs, lice, fleas, mites and cockroaches was the major added advantage of using insecticide treated nets. On average, 30.8% and 19.6% of the respondents mentioned cockroach and bedbug control as the main advantage of using ITN, respectively. The majority (52.9%) preferred blue coloured net (Northern=45.6%; Central=59.2%; Eastern=56.4%; Lake= 54.4%; Southern= 60.3%, Western= 58.5%) and Southern Highlands= 49.1%). Other colour preferences were white (29.6%), green (14.1%), black (2.1%) and pink (1.2%). A strong preference for blue mosquito nets was observed among respondents in Musoma (77.3%) and Newala (75.5%) districts. On the other hand, the weakest preference (24.7%) for blue nets was observed among respondents in Arumeru district. The majority of the respondents (82%) preferred rectangular shaped net. A larger percent (61.8%) the respondents preferred to have the map of Tanzania as a national logo to identify nets distributed in the country. On average, 62.7% and 28.8% of the households in Tanzania own at least one mosquito net (any type) and insecticide treated net, respectively. Tanzania expects that ITN coverage of under fives in 2009, after the Under Five Catch‐up Campaign is complete, to be at least 80%. If this is to be achieved, there is a need for concerted effort in scaling up the distribution and demand for long lasting nets throughout the country. Moreover, the planned use of IRS in malaria control, currently considered unpopular should be accompanied by rigorous community health education to avoid resistance from household members.\u

Population impact of factors associated with prevalent pulmonary tuberculosis in Tanzania

SETTING: Tanzania has an estimated tuberculosis (TB) prevalence of 295 per 100 000 adult population. There is currently no nationally representative information on factors associated with TB in Tanzania. OBJECTIVE: To determine the demographic and clinical factors associated with bacteriologically confirmed TB in the adult general population of Tanzania. DESIGN: A case-control study nested in a nationally representative TB prevalence survey. All patients with bacteriologically confirmed pulmonary TB (PTB) constituted cases and a representative sample of people without bacteriologically confirmed PTB constituted controls. We calculated adjusted odds ratios (aORs) to identify factors associated with TB. RESULTS: Age groups 25–34 years (aOR 3.7, 95%CI 1.5–8.8) and 55–64 years (aOR 2.5, 95%CI 1.1–5.5), male sex (aOR 1.6, 95%CI 1.1–2.3) and low body mass index (BMI) (aOR 1.7, 95%CI 1.1–2.8) were significantly associated with TB. Association with human immunodeficiency virus (HIV) and diabetes mellitus (DM) was not statistically significant. The population attributable fraction (PAF) was 2% (95%CI −2 to 5) for DM and 3% (95%CI −2 to 8) for HIV. CONCLUSION: Being in an older age group, being male and having a low BMI were associated with bacteriologically confirmed PTB. On the population level, classic risk factors for TB have no major effect on prevalent TB from which future transmission may occur.acceptedVersio

Prevalence of Oral Pain and Barriers to use of Emergency Oral Care Facilities Among Adult Tanzanians.

Oral pain has been the major cause of the attendances in the dental clinics in Tanzania. Some patients postpone seeing the dentist for as long as two to five days. This study determines the prevalence of oral pain and barriers to use of emergency oral care in Tanzania. Questionnaire data were collected from 1,759 adult respondents aged 18 years and above. The study area covered six urban and eight rural study clusters, which had been selected using the WHO Pathfinder methodology. Chi-square tests and logistic regression analyses were performed to identify associations.\ud Forty two percent of the respondents had utilized the oral health care facilities sometimes in their lifetime. About 59% of the respondents revealed that they had suffered from oral pain and/or discomfort within the twelve months that preceded the study, but only 26.5% of these had sought treatment from oral health care facilities. The reasons for not seeking emergency care were: lack of money to pay for treatment (27.9%); self medication (17.6%); respondents thinking that pain would disappear with time (15.7%); and lack of money to pay for transport to the dental clinic (15.0%). Older adults were more likely to report that they had experienced oral pain during the last 12 months than the younger adults (OR = 1.57, CI 1.07-1.57, P < 0.001). Respondents from rural areas were more likely report dental clinics far from home (OR = 5.31, CI = 2.09-13.54, P < 0.001); self medication at home (OR = 3.65, CI = 2.25-5.94, P < 0.001); and being treated by traditional healer (OR = 5.31, CI = 2.25-12.49, P < 0.001) as reasons for not seeking emergency care from the oral health care facilities than their counterparts from urban areas. Oral pain and discomfort were prevalent among adult Tanzanians. Only a quarter of those who experienced oral pain or discomfort sought emergency oral care from oral health care facilities. Self medication was used as an alternative to using oral care facilities mainly by rural residents. Establishing oral care facilities in rural areas is recommended

Imaging the Woman through Tanzanian Women’s Maxims

Women’s maxims, as well as other forms of oral literature in Tanzania, are a popular genre. They are verbal arts that can be self-addressed or addressed to a fellow woman among womenfolk. This paper intends to examine the role of these maxims in imaging women in Tanzania. This study was prompted by the findings of previous studies regarding the portrayal of women in Kiswahili literature where, generally, women are depicted as inferior beings compared to men, partly due to the fact that most authors are men. Hence, we found it imperative to investigate women’s maxims that are created and uttered by women themselves. The study was also prompted by other studies worldwide on language and gender. The questions to be addressed in this paper are: What is generally portrayed in such maxims? Why do women create, use and perpetuate such maxims? How do women consider themselves in relation to men? The data of this study was collected in Dar es Salaam through interviews and observation techniques. This study is significant to literary critics, sociolinguists, gender practitioners, cultural theorists and researchers on women studies. The study revealed that women’s maxims make much contribution to group identity formation, gender relations and culture. Through these maxims women marginalize their role, empower themselves, create gender constructs and gender differences and give themselves new outlook in the modern society

Ethnobotany and conservation biology of Warburgia salutaris (G.Bertol.) Chiov., a threatened medicinal plant in southern Mozambique

Warburgia salutaris, locally known as “chibaha” (Ronga, Tsonga), “isiBhaha” (Zulu) and “siBhaha” (Siswati), is one of the most highly-valued medicinal plant species in southern Africa. Its bark has long been employed to treat bacterial and fungal infections, and it is often a front line herbal treatment for malaria. The species is popular in rural and urban areas due to its lower price compared to commercial pharmaceuticals and because of its long-standing spiritual and symbolic significance. Consequently, W. salutaris is threatened in Malawi, South Africa and Swaziland and is believed to be extincted in the wild in Zimbabwe. In Mozambique, where the tree is confined to the southern part of the country, it is considered vulnerable due to high local demand and cross-border export. Although there is limited research, further work is urgently needed to provide the basis for options and strategies to achieve desired outcomes. This study aimed to explore different approaches for the conservation of W. salutaris in the Lebombo Mountains (LM), the Tembe River (TR) and the Futi Corridor (FC) areas, in southern Mozambique. For this, potential distribution, socio cultural factors that influenced sustainable management of the species, demography, harvest impact, genetic diversity and population differentiation were considered. The kuenm package in R, 2 846 occurrence and 11 environmental data were used to model the potential current and future distribution in 2050 and 2070 using four general circulation models (CESM1(BGC), ACCESS1.3, FIO-ESM and IPSL-CM5A-MR) under representative concentration pathways (RCPs) 4.5 and 8.5. The extent of occurrence (EOO) and habitat suitability (HS) were also determined. Stratified random semi-structured interviews with 182 heads of households were carried out to explore cultural and socio incentives of use, compared knowledge distribution, determine local management practices and explore local ecological knowledge related to the species in the three study areas. In addition, 17 focus group discussion were conducted to clarify issues raised during household interviews. One hundred and twenty four quadrants were used to determine the abundance and population structure. The Simpson index of dominance, permutation index and quotient between consecutive classes were used to assess population stability, and an eight point scale was used to evaluate the extent of bark damages. Genomic deoxyribonucleic acid (gDNA) (n=48) was used to assessed genetic diversity and population structure through the newly developed single sequence repeats (SSR) molecular markers. Model selected was statistical significant for prediction of potential distribution of W. salutaris in southern Mozambique (partial ROC =0.00, omission rate = 0.04 and delta AICc = 0.00). The current environmental conditions mostly explained by climatic predictor, indicated in general, the potential distribution on areas of occurrence observed during the field work in southern Mozambique. Future project suggested an increase of climatic suitable areas in all the general circulation models in both conservative and pessimistic climatic scenarios (RCPs 4.5 and 8.5, respectively) in 2050 and 2070, and consequently the increase of HS and the EOO. Results of this work suggests W. salutaris would not extinct at least in the coming 50 years due to climate change but other threats such as overexploitation of the species need to be addressed. With increase of climatic suitable areas, conservation and management of this species could focus on reintroduction and cultivation for recovery of the species, with the help of time. W. salutaris was used for medicinal purposes to treat 12 health problems, with the bark being the most commonly used part (92% of informants). Knowledge of the species uses differed significantly between the three study areas but not with respondent gender or age. Informants also mentioned a considerable number of alternative species of W. salutaris (37 species in LM, 33 species in TR and 17 species in FC). Local ecological knowledge on the ecological niche of the species also varied substantial in the three areas with both types of knowledge generally higher in the Tembe River area. Local management practises were revealed mostly on harvesting through vertical bark stripping cited by 100% of informants in TR, 61.6% FC and 51.7 LM (71% of all informants). Yet most (64.3% of all informants, corresponding to 98.4% in TR, 51.7% in Fc and 41.7% LM) used non-traditional harvesting tools (machete) bark removal. For sustainable use of the species, consideration should be given to combined conservation strategies such as the use of alternative species with the same application, substitution of bark by leaves, and increases in alternative sources of plant material through cultivation. The densities of alive stems were not statistically different in the three areas but was higher in LM (mean of 4500.3±9209.8 stems/ha). Equally the mean densities of recruits (diameter ≤2 cm) were not considerable different but was higher in the FC (3296.8±9116.7 stems/ha). The regression analyses for the three study area revealed negative slopes, indicating more recruits and fewer individuals in larger classes. The Simpson indexes of dominance, permutation indexes and quotients between the consecutive size classes suggested some levels of population instability in the three areas. Harvesting took place in the eight point scale, all size classes were harvested but preference was higher on intermediate (15.1-20 cm) or larger (>20 cm) size classes in all the study areas but gatherers avoided harvesting bark from recruits. Although the mean densities of harvested stem was not significant this work indicated higher levels of stem destruction in FC. Harvested dead stems ware significant in the three areas and FC had the higher of (39.5±85.9 stems/ha) compared to 7.6±19.1 and 2.1±4.3 in TR and LM, respectively. Equally, the density of physiologically stressed stems differed substantially in the three areas with higher in FC 20.5± 75.5 stems/ha compared to 18.7±82.9 stems/ha in TR and 3.8±11.8 stems/ha in LM. This results suggests implementation of protection measures such as the inclusion of the species in the national CITES list to regulated cross-border trade and strengthening of the law enforcement. Genetic diversity, structure and gene flow in the exiting populations of southern Mozambique revealed that despite fragmentation and overexploitation, this species maintains a relatively high level of genetic diversity supporting the existence of random mating. Two genetic groups were found corresponding to the northern (LM and TR) and southern (FC) areas. The study suggests that, if local extinctions occurred in Mozambique, the pepper-bark tree persisted in sufficient numbers to retain a large proportion of genetic diversity. Management plans should concentrate on maintaining this high level of genetic variability through both in and ex-situ conservation actions.Thesis (PhD) -- Faculty of Science, Environmental Science, 202

Heterosexual HIV-1 infectiousness and antiretroviral use : systematic review of prospective studies of discordant couples

Background: Recent studies have estimated the reduction in HIV-1 infectiousness with antiretroviral therapy (ART), but high-quality studies such as randomized controlled trials, accompanied by rigorous adherence counseling, are likely to overestimate the effectiveness of treatment-as-prevention in real-life settings. Methods: We attempted to summarize the effect of ART on HIV transmission by undertaking a systematic review and meta-analysis of HIV-1 infectiousness per heterosexual partnership (incidence rate and cumulative incidence over study follow-up) estimated from prospective studies of discordant couples. We used random-effects Poisson regression models to obtain summary estimates. When possible, the analyses were further stratified by direction of transmission (man-to-woman or woman-to-man) and economic setting (high- or low-income countries). Potential causes of heterogeneity of estimates were explored through subgroup analyses. Results: Fifty publications were included. Nine allowed comparison between ART and non-ART users within studies (ART-stratified studies), in which summary incidence rates were 3.6/100 person-years (95% confidence interval = 2.0-6.5) and 0.2/100 person-years (0.07-0.7) for non-ART- and ART-using couples, respectively (P < 0.001), constituting a 91% (79-96%) reduction in per-partner HIV-1 incidence rate with ART use. The 41 studies that did not stratify by ART use provided estimates with high levels of heterogeneity (I2 statistic) and few reported levels of ART use, making interpretation difficult. Nevertheless, estimates tended to be lower with ART use. Infectiousness tended to be higher for low-income than high-income settings, but there was no clear pattern by direction of transmission (man-to-woman and woman-to-man). Conclusions: ART substantially reduces HIV-1 infectiousness within discordant couples, based on observational studies, and could play a major part in HIV-1 prevention efforts. However, the non-zero risk from partners receiving ART demonstrates that appropriate counseling and other risk-reduction strategies for discordant couples are still required. Additional estimates of ART effectiveness by adherence level from real-life settings will be important, especially for persons starting treatment early without symptoms

"Linkage to care" among people living with HIV - definition in the era of "universal test and treat" in a sub-Sahara African setting

BACKGROUND: Prompt linkage to human immunodeficiency virus (HIV) care after diagnosis is of utmost importance for individual health and reduction of HIV transmission. Different definitions for "linkage to care" have challenged comparisons as a public health marker. Its meaning in the era of "universal test and treat" has transformed in all settings, but is most relevant in sub-Sahara Africa, where the burden of new HIV infection is still highest. METHODS: For this narrative review on "linkage to care" definitions with a focus on sub-Saharan Africa, we searched PubMed/Medline between September and December 2020, restricted to the period 2000-2020 using Boolean operators: "HIV" AND ("linkage to care" OR "engagement in care") and screened for institutional definitions of "linkage to care". Additionally, as one example of a rural sub-Saharan African setting, we analysed linkage steps within the Chronic Diseases Clinic Ifakara (CDCI) and its associated Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) in rural Tanzania between 1 January 2017 and 31 March 2019. RESULTS: We analysed 81 articles that included "linkage to care" within different study settings and HIV organisations. Major differences in defining "linkage to care" exist, according to setting and location, patient populations and the timing of steps within the linkage process. We identified 16 different numerators and 10 denominators used to define linkage with time periods ranging from "same day as diagnosis" up to 12 months after diagnosis among 34 original articles from sub-Saharan Africa. At the CDCI, 1149/1671 (69%) newly diagnosed individuals were enrolled into care after diagnosis. Three months after enrolment into care, 94%, 86%, 85% and 71% of enrolled patients had a laboratory evaluation, a clinical evaluation, were initiated on treatment and had a first clinical follow-up visit after initiation of treatment, respectively. DUSCUSSION: To address the inconsistency in defining "linkage to care" and in order to guarantee the comparability of "linkage to care" in the sub-Saharan Africa region, we support the definition from the European region with some adaptions. We suggest a priority list of care indicators if more than one care indicator is available for successful "linkage to care" in the era of "universal test and treat" for sub-Sahara Africa