Tanzania health research bulletin最新文献

This study was carried out to determine the rate of agreement or disagreement of microscopy reading and culture positivity rate among smear positixe and negative specimens between peripheral tuberculosis diagnostic centres (PDCs) and Central Reference luberculosis laboratory (CTRL). In this study 13 PDCs in Dar es Salaam, Tanzania were involved. Lot Quality Assurance Sampling (LQAS) method was used to collect 222 sputum smear slides. A total of 190 morning sputum specimens with corresponding slides were selected for culture. First readings were done by technicians at PDCs and thereafter selected slides and specimens were sent to CTRL for re-examination and culture. Culture results were used as a gold standard. Of 222 slides selected, 214 were suitable for re-examination. Percentage of agreement of smear reading between PDCs and CTRL was 42.9% and 100% for positive and negative slides, respectively. Measure of agreement (Kappa statistic) was 0.5, indicating moderate agreement. Of 190 samples cultured, percentage of agreement between smear reading from PDCs and CTRL was 37% and 88.9% for smear positive and negative slides, respectively. Kappa statistic was 0.3 indicating poor-fair agreements. Comparison of smear reading from PDCs with culture showed sensitivity of 36.9% and specificity of 88.9%. Comparison of smear readings from CTRL with culture results showed sensitivity of 95.6% and specificity of 98.6%. In conclusion there was inadequate performance in diagnosis of TB using smear microscopy among peripheral diagnostic centres in Dar es Salaam. This calls for immediate and rigorous measures to improve the quality of smear microscopy. It is therefore important to strengthen the capacity of laboratory personnel in smear microscopy techniques through supportive supervision and training.

A school-based study was carried out to assess the knowledge on malaria and its prevention among children in Kyela District, south-western, Tanzania in August-September 2004. A total of 400 schoolchildren (age = 10-20 years) from four schools were selected. A structured questionnaire was used to collect data on knowledge on malaria transmission, methods of prevention, source of information and use of mosquito nets. More than 85% of the respondents were knowledgeable on malaria and preventive measures. Sources of information about malaria and its control were mainly from their teachers (47.4%), print materials (21.9%), family members (20.4%), television and radio (7.3%) and medical personnel (2.2.%). The perceived best control measures were untreated nets (32.1%), treated nets (21.4%), environmental management (25.7%) and burning mosquito coils and insect repellents (20.8%). Availability of mosquito nets was relatively high (70%), but only 38% of the pupils were using insecticide treated nets (ITNs). Low ITN use was due to its unavailability (57.5%), cost (35%) and foul smell and fear of side effects (7.5%). These findings suggest schoolchildren are aware about malaria and its prevention methods, but are not well-informed of the benefits of using ITNs. More education and advocacies on use of ITNs to parents and children is needed.

A study was carried out to estimate the prevalence and associated factors of sexual intercourse among school adolescents in Coast Province, Kenya. Data were obtained through the Kenya Global School-Based Health Survey. Overall the prevalence of sexual intercourse within the last 12 months was 14.9% (22.2% in males and 5.0% in females). Among males, the protective factors against having sex were being of age < 15 years (OR = 0.60, 95% CI 0.58, 0.62) and ever been drunk (OR = 0.63, 95% CI 0.59, 0.67). The risk factors for having sex among males were ever smoked (OR = 2.05, 95% CI 1.92, 2.19), having close friends (OR = 1.68, 95% CI 1.56, 1.81), currently drinking alcohol (OR = 1.13, 95% CI 1.06, 1.20), ever used drugs (OR = 2.36, 95% CI 2.24, 2.49) and parental supervision (OR = 1.30, 95% CI 1.25, 1.34). Meanwhile among female respondents, parental supervision was protective (OR = 0.88, 95% CI 0.81, 0.94) and the only risk factor was ever used drugs (OR = 2.85, 95% CI 2.57, 3.15). It is suggested that public health interventions aimed to promote adolescent sexual health should be designed with the appreciation of the factors associated with sexual activity in due consideration.

This study was conducted to determine frequency and pattern of antimicrobial susceptibility of Shigella species isolated from stool specimens collected from patients presenting with bloody diarrhoea in Mwanza City, Tanzania. The study was carried out from October 2004 to October 2005 and involved patients attending Sekou Toure Regional Hospital and Butimba Health Centre. Bacteriological cultures were done at the National Institute for Medical Research laboratory. A total of 489 patients (median age = 20 years) participated in the study and were able to provide stool specimens. Shigella species were isolated from 14% (69/489) of the stool specimens collected. Of the sixty nine strains of Shigella spp isolated, 62 (90%) were S. flexneri and 7 (10%) were S. dysenteriae. All Shigella strains isolated showed high resistance to ampicillin, tetracycline, trimethoprim-sulphamethoxazole and chloramphenicol, drugs commonly used for management of shigellosis in Tanzania. However all isolates were fully susceptible to ciprofloxacin, nalidixic acid, erythromycin, cefuroxime and gentamycin. S. flexneri showed resistance to amoxy-clavulanic_acid and azithromycin in 5% and 2% of isolates, respectively. None of the S. dysenteriae isolates were resistant to these two drugs. Entamoeba histolytica, Giardia lamblia and Schistosoma mansoni were microscopically detected in 16.5%, 4.4% and 5.3% of patients, respectively. These findings suggest that there is a need to carry out extensive susceptibility studies in different parts of the country with view of re-appraising the current guidelines for management of bloody diarrhoea in Tanzania.

Inadequate dietary intake, often combined with an infection can lead to malnutrition that often manifest as growth failure or deficiency of essentials nutrients including iron leading to iron deficiency anaemia. In an effort to investigate diet in relation to nutrition status of children, diet and dietary intake were investigated in rural Tanzania. The effect of germination of finger millet based food recipe on its nutritional value was evaluated. The food consisted of finger millet flour, kidney beans, ground peanuts and dried mangoes at predetermined proportions of 75:10:10:5 respectively. Dietary habits of young children were investigated and effects of a fortified food supplement and the cereal based recipe on nutrition status of children were investigated. The two diets were then supplemented to children for 6 months and changes on anaemia and anthropometrical indices of children were evaluated at follow up periods. To assess anaemia and iron status, haemoglobin (Hb), haematocrit (Hct), erythrocyte protoporphyrin (EP) and serum ferritin (SF); and weights and heights were measured to assess growth. A significant improvement in nutrient density was noted in processed cereals. Bioavailability of iron in cereal based diet increased from 0.75 +/- 18 to 1.25 +/- 41 mg/100 g (P = 008), viscosity was significantly raised by 12% and phytate concentration was reduced from 4.5 +/- 0.5 to 4.1 +/- 0.5 mg/g (P = 0.03). Significantly lower intake of iron was observed in schoolchildren with Hb < 11.5 g/dl) compared to those who were normal. Total iron intake was 22+/- 7 and 27 +/- 13 mg/day, respectively (P < 0.05). There was a significant correlation between iron intake and serum ferritin (r = 0.233, P < 0.05). After six months of supplementing children with the fortified beverage a significantly larger increase in haemoglobin concentration was shown in the fortified group than in the non-fortified group (a difference of 6.2 versus 3.2 g/dl respectively). Supplementing infants with the germinated cereal based food supplement showed a general improvement on Hb status and growth that was not significantly different to that in the control group (P > 0.05). In conclusion, consumption of foods with low iron bioavailability is a major cause of anaemia. Germination improves the nutritional value of foods however there is need to fortify such processed foods for infant feeding.

A survey was carried out to determine seasonal epidemiological variation of human African trypanosomiasis (HAT) in Tarangire National Park and villages around it in Babati District, Tanzania. Concentration and Field's stain techniques were employed to examine the presence of trypanosomes in human blood samples. Tsetse flies were collected using traps and dissected under light microscope to examine for presence of trypanosomes. Retrospective data on HAT were sought from health facilities. Blood samples were collected from a total 509 individuals (306 during the dry and 203 during wet seasons). None of the individuals was infected with trypanosomes in the area. A total of 766 tsetse flies were collected. Of these, Glossina swynnertoni accounted for 94.6% and G. pallidipes for 5.4% of the total collection. The largest proportion (63.8%) of the tsetse flies was collected during the wet season. Glossina swynnertoni was most abundant tsetse species during both wet and dry seasons. Salivary gland examination revealed the presence of Trypanosoma brucei type of infection in 3.2% of tsetse flies collected. All infective trypanosomes were found during the dry season. This study concludes that the transmission and prevalence of HAT among human population in Tarangire National Pars and its surrounding villages is low despite the recent reports on tourists acquiring the infection during their visits to the Park. However, disease surveillance needs to be strengthened to monitor any impending epidemic.

Pulmonary tuberculosis diagnosis commonly relies on the bacteriological examination of sputum. A cross-sectional hospital-based study was carried out to compare on "on the spot" sputum staining using sodium hypochlorite (bleach method) and routine Ziel-Neelsen (ZN) staining technique. Study candidates included individual patients presenting with cough <3 weeks (Group I) and > or =3 weeks (Group II). Sensitivity and specificity of the bleach method was calculated and compared at 100% using the ZN staining technique as the standard. A total of 171 patients (94 males, 77 females) with mean age 34.9 years (SD +/- 12.9) were recruited. Fifty-eight patients had coughed for <3 weeks while 113 had coughed for 23 weeks. Smear-positive TB in Group I was 13.8% (95% CI = 5-23) while in Group II was 25.7% (95% CI = 21-29). Using the bleach method, the prevalence of smear-positive TB in Group II was 28.3% (CI 95% = 20-36). This was an increase in smear-positivity rate of 15.6% as compared to the ZN technique. These results suggest that the use of bleach technique "on the spot" improve the sensitivity of tuberculosis diagnosis among patients with a history of coughing of over three weeks. However, further studies in different settings are recommended to validate the technique.

Health-seeking patterns of persons with tuberculosis (TB) before reporting at the Directly Observed Treatment Short-course (DOTS) clinic for diagnosis and treatment were analysed. A total of 221 persons registered in the DOTS programme in 12 randomly selected rural and urban Local Government Areas in southern Nigeria were interviewed using a semi-structured questionnaire. Perceived causes of TB influenced first choice of treatment. Patients re-evaluated initial choices and shop for alternatives in persistent TB. Chemists were the first port of call for most patients. Those with unscientific causative theories of tuberculosis such as witchcraft engaged more in multiple health-seeking than those who indicated bacterial infection (P < 0.0001). The respondents had a median diagnostic-delay of 90 days. Delay in commencement of DOTS treatment was attributable to ignorance among patients and poor attitude of health workers. In conclusion, delay exists between recognition of symptoms and initiation of treatment in DOTS clinics partly because of ignorance among patients. Health workers' attitude to patients reporting at health clinics also discouraged the use of DOTS facilities. Consequently, it is recommended to address such delay through social mobilization of communities and through engaging Chemists in TB service delivery in this area.

Non-communicable diseases are the major health burden in the industrialized countries and are increasing rapidly in the developing countries owing to demographic transitions and changing lifestyles among the people. Cardiovascular diseases (CVD) are increasingly becoming a great cause of morbidity and mortality. A total of 100 senior and 141 junior staff in Federal University of Technology, Owerri (FUTO), Imo State, Nigeria was randomly selected for a study on cardiac risk factors. A questionnaire was used to record cardiac risk indices like age, heredity, body mass index (BMI), tobacco smoking, exercise, serum cholesterol estimation, systolic blood pressure and sex. There was no significant difference between the senior and junior staff in sex distribution (P = 0.71), family history of CVD (P = 0.34), smoking habit (P = 0.85) and serum cholesterol (P = 0.89). Senior staff had significantly higher values in age distribution (P < 0.001), presence of systolic hypertension (P<0.001) and overweight (P < 0.001). Senior staff workers, were however, significantly less involved in moderate exercise than junior staff (P < 0.001). The senior staff had a significantly higher total score in CVD risk scoring than junior staff (chi2 = 7.25; P = 0.01). In conclusion, the risk of CVD among staff of FUTO is high especially among the senior staff. Health education campaign targeted at improving life style is strongly recommended.