• Are sputum samples of retreatment tuberculosis reaching the reference laboratories? A 9-year audit in Tanzania

      Kilale, A M; Ngowi, B J; Mfinanga, G S; Egwaga, S; Doulla, B; Kumar, A M V; Khogali, M; van Griensven, J; Harries, A D; Zachariah, R; et al. (2013-06-21)
    • The case for reactive mass oral cholera vaccinations

      Reyburn, R; Deen, J L; Grais, RF; Bhattacharya, S K; Sur, D; Lopez, A L; Jiddawi, M S; Clemens, J D; von Seidlein, L; International Vaccine Institute (IVI), Seoul, Korea; Epicentre, Paris, France; NICED, Kolkata, India; Ministry of Health and Social Welfare, Zanzibar, Tanzania; Menzies School of Health Research, Casuarina, Australia (2011-01-25)
      The outbreak of cholera in Zimbabwe intensified interest in the control and prevention of cholera. While there is agreement that safe water, sanitation, and personal hygiene are ideal for the long term control of cholera, there is controversy about the role of newer approaches such as oral cholera vaccines (OCVs). In October 2009 the Strategic Advisory Group of Experts advised the World Health Organization to consider reactive vaccination campaigns in response to large cholera outbreaks. To evaluate the potential benefit of this pivotal change in WHO policy, we used existing data from cholera outbreaks to simulate the number of cholera cases preventable by reactive mass vaccination.
    • Estimating antimalarial drugs consumption in Africa before the switch to artemisinin-based combination therapies (ACTs)

      Kindermans, Jean-Marie; Vandenbergh, Daniel; Vreeke, Ed; Olliaro, Piero; D'Altilia, Jean-Pierre; AEDES Foundation, Brussels, Belgium; Médecins Sans Frontières, Brussels, Belgium; UNICEF/UNDP/WB/WHO Special Programme for Research & Training in Tropical Diseases (TDR), Geneva, Switzerland (2007-07-10)
      BACKGROUND: Having reliable forecasts is critical now for producers, malaria-endemic countries and agencies in order to adapt production and procurement of the artemisinin-based combination treatments (ACTs), the new first-line treatments of malaria. There is no ideal method to quantify drug requirements for malaria. Morbidity data give uncertain estimations. This study uses drug consumption to provide elements to help estimate quantities and financial requirements of ACTs. METHODS: The consumption of chloroquine, sulphadoxine/pyrimethamine and quinine both through the private and public sector was assessed in five sub-Saharan Africa countries with different epidemiological patterns (Senegal, Rwanda, Tanzania, Malawi, Zimbabwe). From these data the number of adult treatments per capita was calculated and the volumes and financial implications derived for the whole of Africa. RESULTS: Identifying and obtaining data from the private sector was difficult. The quality of information on drug supply and distribution in countries must be improved. The number of adult treatments per capita and per year in the five countries ranged from 0.18 to 0.50. Current adult treatment prices for ACTs range US$ 1-1.8. Taking the upper range for both volumes and costs, the highest number of adult treatments consumed for Africa was estimated at 314.5 million, corresponding to an overall maximum annual need for financing ACT procurement of US$ 566.1 million. In reality, both the number of cases treated and the cost of treatment are likely to be lower (projections for the lowest consumption estimate with the least expensive ACT would require US $ 113 million per annum). There were substantial variations in the market share between public and private sources among these countries (the public sector share ranging from 98% in Rwanda to 33% in Tanzania). CONCLUSION: Additional studies are required to build a more robust methodology, and to assess current consumptions more accurately in order to better quantify volumes and finances for production and procurement of ACTs.
    • Influence of rapid malaria diagnostic tests on treatment and health outcome in fever patients, Zanzibar: a crossover validation study

      Msellem, Mwinyi I; Mårtensson, Andreas; Rotllant, Guida; Bhattarai, Achuyt; Strömberg, Johan; Kahigwa, Elizeus; Garcia, Montse; Petzold, Max; Olumese, Peter; Ali, Abdullah; et al. (2009-04-28)
      BACKGROUND: The use of rapid diagnostic tests (RDTs) for Plasmodium falciparum malaria is being suggested to improve diagnostic efficiency in peripheral health care settings in Africa. Such improved diagnostics are critical to minimize overuse and thereby delay development of resistance to artemisinin-based combination therapies (ACTs). Our objective was to study the influence of RDT-aided malaria diagnosis on drug prescriptions, health outcomes, and costs in primary health care settings. METHODS AND FINDINGS: We conducted a cross-over validation clinical trial in four primary health care units in Zanzibar. Patients of all ages with reported fever in the previous 48 hours were eligible and allocated alternate weeks to RDT-aided malaria diagnosis or symptom-based clinical diagnosis (CD) alone. Follow-up was 14 days. ACT was to be prescribed to patients diagnosed with malaria in both groups. Statistical analyses with multilevel modelling were performed. A total of 1,887 patients were enrolled February through August 2005. RDT was associated with lower prescription rates of antimalarial treatment than CD alone, 361/1005 (36%) compared with 752/882 (85%) (odds ratio [OR] 0.04, 95% confidence interval [CI] 0.03-0.05, p<0.001). Prescriptions of antibiotics were higher after RDT than CD alone, i.e., 372/1005 (37%) and 235/882 (27%) (OR 1.8, 95%CI 1.5-2.2, p<0.001), respectively. Reattendance due to perceived unsuccessful clinical cure was lower after RDT 25/1005 (2.5%), than CD alone 43/882 (4.9%) (OR 0.5, 95% CI 0.3-0.9, p = 0.005). Total average cost per patient was similar: USD 2.47 and 2.37 after RDT and CD alone, respectively. CONCLUSIONS: RDTs resulted in improved adequate treatment and health outcomes without increased cost per patient. RDTs may represent a tool for improved management of patients with fever in peripheral health care settings. TRIAL REGISTRATION: (Clinicaltrials.gov) NCT00549003.
    • Magnitude of screening for gestational diabetes mellitus in an urban setting in Tanzania; a cross-sectional analytic study.

      Mukuve, A; Noorani, M; Sendagire, I; Mgonja, M (BioMed Central, 2020-07-23)
      Background: Medical screening detects risk factors for disease or presence of disease in otherwise well persons in order to intervene early and reduce morbidity and mortality. During antenatal care (ANC) it is important to detect conditions that complicate pregnancy, like gestational diabetes mellitus (GDM). Despite international and local guidelines recommending screening for GDM during ANC, there is evidence to suggest that the practice was not being carried out adequately. A major challenge may be lack of consensus on uniform GDM screening and diagnostic guidelines internationally and locally. The primary objective was to determine the magnitude of screening for GDM among women receiving ANC at the Aga Khan Hospital, Dar es Salaam and Muhimbili National Hospital, Dar es Salaam. Secondary objectives were: to determine the methods used by health practitioners to screen for GDM, to determine the magnitude of undiagnosed gestational diabetes mellitus among women attending ANC and factors associated with screening for GDM among these women. Methods: A cross-sectional analytical study was done. Data collection was done using pre-tested questionnaires and reviewing antenatal care records. The proportion of women attending ANC who were screened for GDM was determined. The 75 g Oral Glucose Tolerance Test (OGTT) was offered to women who had not been screened after education and consent. Results: Only 107 out of 358 (29.9%) had been offered some form of GDM screening. Tests used for GDM screening were random blood sugar (56.8%), fasting blood sugar (32.8%), HbA1C (6%) and 75 g OGTT (3.4%). The uptake of the OGTT was 27%. Of these women the prevalence of GDM was 27.9%. Factors associated with screening for GDM were history of big baby, history of pregnancy induced hypertension and participant awareness of GDM (all p: < 0.05). Conclusions: Screening for GDM among women attending ANC was lower than the World Health Organization target. Efforts should be directed towards promoting GDM screening, increasing awareness about GDM and developing more effective screening methods.
    • Magnitude of screening for gestational diabetes mellitus in an urban setting in Tanzania; a cross-sectional analytic study.

      Mukuve, A; Noorani, M; Sendagire, I; Mgonja, M (BioMed Central, 2020-07-23)
      Background: Medical screening detects risk factors for disease or presence of disease in otherwise well persons in order to intervene early and reduce morbidity and mortality. During antenatal care (ANC) it is important to detect conditions that complicate pregnancy, like gestational diabetes mellitus (GDM). Despite international and local guidelines recommending screening for GDM during ANC, there is evidence to suggest that the practice was not being carried out adequately. A major challenge may be lack of consensus on uniform GDM screening and diagnostic guidelines internationally and locally. The primary objective was to determine the magnitude of screening for GDM among women receiving ANC at the Aga Khan Hospital, Dar es Salaam and Muhimbili National Hospital, Dar es Salaam. Secondary objectives were: to determine the methods used by health practitioners to screen for GDM, to determine the magnitude of undiagnosed gestational diabetes mellitus among women attending ANC and factors associated with screening for GDM among these women. Methods: A cross-sectional analytical study was done. Data collection was done using pre-tested questionnaires and reviewing antenatal care records. The proportion of women attending ANC who were screened for GDM was determined. The 75 g Oral Glucose Tolerance Test (OGTT) was offered to women who had not been screened after education and consent. Results: Only 107 out of 358 (29.9%) had been offered some form of GDM screening. Tests used for GDM screening were random blood sugar (56.8%), fasting blood sugar (32.8%), HbA1C (6%) and 75 g OGTT (3.4%). The uptake of the OGTT was 27%. Of these women the prevalence of GDM was 27.9%. Factors associated with screening for GDM were history of big baby, history of pregnancy induced hypertension and participant awareness of GDM (all p: < 0.05). Conclusions: Screening for GDM among women attending ANC was lower than the World Health Organization target. Efforts should be directed towards promoting GDM screening, increasing awareness about GDM and developing more effective screening methods.
    • A Novel Electronic Algorithm using Host Biomarker Point-of-Care tests for the Management of Febrile Illnesses in Tanzanian children (e-POCT): A randomized, controlled non-inferiority trial

      Keitel, K; Kagoro, F; Samaka, J; Masimba, J; Said, Z; Temba, H; Mlaganile, T; Sangu, W; Rambaud-Althaus, C; Gervaix, A; et al. (Public Library of Science, 2017-10-23)
      The management of childhood infections remains inadequate in resource-limited countries, resulting in high mortality and irrational use of antimicrobials. Current disease management tools, such as the Integrated Management of Childhood Illness (IMCI) algorithm, rely solely on clinical signs and have not made use of available point-of-care tests (POCTs) that can help to identify children with severe infections and children in need of antibiotic treatment. e-POCT is a novel electronic algorithm based on current evidence; it guides clinicians through the entire consultation and recommends treatment based on a few clinical signs and POCT results, some performed in all patients (malaria rapid diagnostic test, hemoglobin, oximeter) and others in selected subgroups only (C-reactive protein, procalcitonin, glucometer). The objective of this trial was to determine whether the clinical outcome of febrile children managed by the e-POCT tool was non-inferior to that of febrile children managed by a validated electronic algorithm derived from IMCI (ALMANACH), while reducing the proportion with antibiotic prescription.
    • Targeting the vulnerable in emergency situations: who is vulnerable?

      Davis, A; Médecins Sans Frontières Holland, Nairobi, Kenya. (Elsevier, 1996-09-28)
      BACKGROUND: Emergencies such as wars and natural disasters increase the vulnerability of affected populations and expose these populations to risks such as disease, violence, and hunger. Emergency public health interventions aim to mitigate these effects by providing basic minimum requirements, reducing vulnerability, and reducing exposure to risk. Targeted services are generally aimed at children under 5. Mortality rates among young children are higher than the crude mortality rate (CMR) among the whole population in emergency settings, so attention is focused on this age group. However, even under normal conditions mortality is higher in young children. This analysis compared the relative risk of death for young children with that for older children and adults under normal conditions and in emergency settings. METHODS: Mortality data from refugee camps set up in response to three different emergencies were examined. Baseline mortality rates in the refugees' countries of origin were calculated from published data. Relative risks between normal and emergency conditions were calculated and compared. FINDINGS: Mortality rates were higher among children under 5 than among older children and adults both under normal circumstances and in the emergency setting in camps in Tanzania, Uganda, and Zaire. However, the relative risk for under-5 versus over-5 mortality was smaller under emergency conditions than under normal circumstances. Thus, children over 5 and adults are disproportionately more affected by exposure to emergency risks than are younger children. INTERPRETATION: If the objective of intervention, to reduce mortality, is to be achieved, the population over the age of 5 cannot be ignored. Emergency public health needs to develop specific tools to investigate risk in other age groups (as well as children under 5), to identify causes, and to design programmes to address such needs.