Tanzania health research bulletin最新文献

A cross-sectional survey was conducted among 402 children (10-15 years) randomly selected from twelve public and private primary schools in Akure community of Ondo State, Nigeria. Self-administered questionnaire was used to collect information on children's demographic features and parent's socio-economic characteristics. The subject's weight, height, height-for-age and weight-for-height z-score were measured and determined respectively. Raven Standard Progressive Matrices consisted of 60 questions was administered in a quiet classroom within 60 minutes to assess intelligence quotient (IQ) of the children. The means of measured parameters were: age, 11.5 +/- 0.08 years; weight, 33.3 +/- 0.35 kg; height, 1.4 +/- 0.0 m; height-for-age z-score, -0.003 +/- 0.04; weight-for-height z-score -7.2E-7 +/- 0.1 and IQ, 20.9 +/- 0.56 (34.8%). The occupations of the children's parents were civil service (43.3%), petty business (21.9%), farming (15.8%), vocational jobs (16.0%) and none (3.2%). The majority of the parents (31.8%) had secondary school education. Parents with no formal education, primary education, tertiary education and higher degrees accounted for 7.2%, 30.6%, 22.9% and 7.4%, respectively. Monthly incomes ranged between $38.5 and 230.8. Weight-for-height z-score of the children showed that 49.8% were normal, 40% mildly wasted, 9.7% moderately wasted and 0.5% severely wasted. Height-for-age z-score was 50% normal, 35.1% mildly stunted, 13.4% moderately stunted and 1.5% severely stunted. IQ scores were 5% superior 11.2% above average, 11.4% average, 8.2% below average and 64.2% intellectual deficit. The interrelationship between height-for-age, IQ and socio-demographic characteristics showed that there were insignificant differences between the age groups, gender and socio-economic status of the pupils. Conclusively, this study showed that the proportion of malnourished and intellectual deficit among the studied population were high. However, it is not clear whether the findings are specific to the studied population alone or applicable to other parts of Nigeria. Further studies are therefore needed to confirm these findings.

Traditional health practitioners (THPs) and their role in traditional medicine health care system are worldwide acknowledged. Trend in the use of Traditional medicine (TRM) and Alternative or Complementary medicine (CAM) is increasing due to epidemics like HIV/AIDS, malaria, tuberculosis and other diseases like cancer. Despite the wide use of TRM, genuine concern from the public and scientists/biomedical heath practitioners (BHP) on efficacy, safety and quality of TRM has been raised. While appreciating and promoting the use of TRM, the World Health Organization (WHO), and WHO/Afro, in response to the registered challenges has worked modalities to be adopted by Member States as a way to addressing these concerns. Gradually, through the WHO strategy, TRM policy and legal framework has been adopted in most of the Member States in order to accommodate sustainable collaboration between THPs and the scientist/BHP. Research protocols on how to evaluate traditional medicines for safety and efficacy for priority diseases in Africa have been formulated. Creation of close working relationship between practitioners of both health care systems is strongly recommended so as to revamp trust among each other and help to access information and knowledge from both sides through appropriate modalities. In Tanzania, gaps that exist between THPs and scientists/BHP in health research have been addressed through recognition of THPs among stakeholders in the country's health sector as stipulated in the National Health Policy, the Policy and Act of TRM and CAM. Parallel to that, several research institutions in TRM collaborating with THPs are operating. Various programmed research projects in TRM that has involved THPs and other stakeholders are ongoing, aiming at complementing the two health care systems. This paper discusses global, regional and national perspectives of TRM development and efforts that have so far been directed towards bridging the gap between THPs and scientist/BHP in contemporary health research in Tanzania.

Patients with post mastectomy soft tissue shoulder disorders usually benefit from various lines of physiotherapy treatment. However, the controversy about their efficacy persists. The aim of this work was to study and assess the efficacy of each, and to identify the best intervention. One hundred female patients with ipsilateral post mastectomy shoulder problems were enrolled in the study, from September 2003 until December 2004. They were followed up for 32 weeks. Mastectomy, both radical and conservative and axillary lymph node clearance, was the standard surgery applied for operable breast carcinoma in this series. Clinical examination was followed by testing for the shoulder complaint by measuring maximal protrusion at the inferior scapular angle, scapular stabilization and the lift-off tests. Approved physiotherapy modalities were then applied, viz: no treatment (randomly chosen 12 patients), passive and active motion therapy (14 patients), oral diclofenac sodium (19 patients), local triamcinilone injection (40 patients) and manually applied low intensity laser therapy (15 patients). Assessment was by determining overall success rate for each intervention modality. Intervention outcome was assessed at 8, 16, and 32 weeks as shown by physical examination using the healthy shoulder as a reference, and by measuring restricted mobility during passive lateral rotation and glenohumeral abduction. "Success rate" was determined separately for each group at the end of the intervention period. The applied surgery was followed by radiotherapy in 96%, chemotherapy in 24% and both in 11%. The presenting post mastectomy symptoms at the shoulder were pain (100%), shoulder weakness (88%), winging of the scapula (11%) and inability to perform everyday shoulder movements (23%). Evaluation was by overall improvement score. The results were: 14.3% for untreated patients, 43.3% for those treated by motion therapy, 42% for diclofenac therapy, 80.7% for local triamcinolone, and lastly 68% for low intensity laser therapy. All treatment regimens for shoulder disabilities in those patients gave little long-term advantage, local steroid injections were the most effective. Low level laser therapy may augment its effect. It is concluded that all treatment regimens provide little long-term advantage; however, trimcinilone local injections may be the most useful in terms of pain relief and improvement in shoulder movement.

Blindness survey remains a useful tool for eye care needs assessment. A cross sectional survey of Atakunmosa West Local Government Area, a rural community of southwest Nigeria with no form of eye care facility was carried out. The objective of this study was to define areas of eye care need and develop programme for elimination of avoidable blindness in the region. Multistage cluster sampling technique selected 1248 respondents across all the eleven health districts. Respondents had visual acuity and ocular examination. Blindness was defined as presenting visual acuity (pva) of < 3/60 in the better eye and visual impairment as pva of < 6/18 in the better eye. Out of the 1,248 respondents screened, 14 (1.1%) were blind and 78 (6.3%) were visually impaired. There was an increasing risk of blindness and visual impairment with age; occurring more commonly after 60 years of age. The prevalence of blindness and visual impairment were higher in females although not statistically significant (P = 0.70; 0.46 respectively). Blindness was caused mainly by cataract (57.2%), glaucoma (14.3%) and congenital childhood blindness (14.3%). Cataract (57.7%), glaucoma (16.7%) and uncorrected refractive error (15.4%) were the leading causes of visual impairment. Blindness was avoidable in 85.7% of cases. Qualitative and subsidised cataract surgical and refractive services are needed urgently in this region and therefore, the incorporation of eye health care into the existing primary health care system may ensure programme sustainability.

It is estimated that Malawi has about 900,000 orphans, the majority of whom are orphaned as a result of AIDS. Orphans in rural areas are mostly neglected by economic and social empowerment initiatives. This study was conducted to explore the living situation of orphans in rural Thyolo District, southern Malawi. Qualitative methodology was used in data collection and analysis to explore orphan children's living situation and specifically with regard to access to health care, education, food and basic needs. In addition, issues of love and companionship, discrimination and the future. Twenty-three orphan children and four adults were interviewed. The children reported experience with lack of food, school drop out and truancy, lack of social support to obtain present needs and prepare for the future. Public health programs aimed to prevent and mitigate the effects of AIDS in Malawi should be tailored to provide support to orphan children.

Tanzania is currently implementing the antiretroviral treatment programme, and has a target of putting about 400,000 eligible HIV infected individuals on treatment by 2008. This will involve screening a large number of people, which will require non-laboratory personnel to be involved in doing HIV testing. In order to guarantee reliable and quality HIV test results, there is a need to ensure that quality assurance (QA) procedures are followed from specimen collection, testing and reporting of results. In light of the above a survey was conducted to assess QA in HIV testing in health facilities in Lake Victoria zone, Tanzania. A total of 89 health facilities (29 hospitals, 34 health centres, 9 dispensaries and 17 voluntary and counselling testing centres) were surveyed. Only three (10.3%) health facilities reported performing Uniform II ELISA for HIV diagnosis. All other health facilities reported to be using HIV rapid tests Capillus and Determine. Five (5.6%) of health facility laboratories performed CD4 counts. Internal quality control (IQC) were performed in 21 (63.6%) of the hospitals. Kits for HIV testing were reported to be readily available by 54 (60.7%) of the facilities. Only 16 (18%) of the health facilities had standard operating procedures in place. Systems of equipment calibration were reported by 13 (14.6%) of the health facilities. Counselling services were available in all health facilities and all counsellors had received the 6-week mandatory training course. These findings show that most of health facilities in the Lake Victoria zone do not adhere to QA procedures in HIV testing. There is therefore, a need to establish a monitoring system to laboratories performing HIV testing for the purpose of ensuring QA procedures are done. Personnel doing HIV testing should be re-trained at a regular basis to cope with new techniques and ensure QA procedures are followed.

Tuberculosis (TB) is one of the leading causes of adult mortality with 32% of the global population infected with Mycobacterium tuberculosis. The current control of TB depends mainly on case management using the Direct-Observed Treatment, Short-course (DOTs) regimen. Despite the measures taken, the disease burden is still on increase especially in the developing countries including Tanzania. Correct knowledge and positive perception of the community towards TB and its management is a prerequisite to early treatment seeking. This study was carried out in Mpwapwa district, central Tanzania, to assess the knowledge, attitudes and practice as regards to TB and its treatment. Focus group discussions involving men and women were conducted in six villages. Results show that TB was an important public health problem. However, community knowledge on its cause was poor. Symptoms of TB as mentioned by the community included persistent cough and weight loss. TB was reported to be transmitted mainly through air. Self medication was the first most preferred option, whereas health care facility consultation was the last one. Focus group discussants knew that TB cure requires a 8-month period of treatment. Friends and relatives were the main source of TB information in the community. In conclusion, rural communities of Mpwapwa District have a low knowledge on the causes and the transmission of tuberculosis which is a likely cause of the delay in seeking treatment. An intensive appropriate community health education is required for a positive behavioural change in tuberculosis control.

Water quality is an important aspect in human health, as the majority of infectious diseases that cause morbidity and mortality in population are water related. The present study was undertaken to assess the quality of water in Kingolwira, Morogoro Rural District, Tanzania. Water was collected from different sites in the village and analysed for a period of six months. Physical, chemical and microbiological qualities of water were examined. The pH of the water ranged from 7.02 to 7.20 and the water temperature ranged from 25.7 degrees C to 27.0 degrees C. The total dissolved solids of the water samples ranged from 110 to 510 ppm. The water contained considerable levels of lead and copper ranging from 0.034 to 0.090 ppm and 0.022 to 0.030 ppm, respectively. Total water hardness ranged from 19.60 to 228.10 ppm as calcium carbonate. The total viable counts and faecal coliform counts ranged from 2.75 x 10(3) to 5.4 x 10(3) c.f.u/ml and 0.93 x 10(2) to 2.1 x 10(2) counts/100ml, respectively. Overall, water supplies in the village were judged as of poor quality. Water is usually used for domestic purposes including cooking, drinking, washing and preparation of infant foods without any treatment. In conclusion therefore, water in Kingolwira village is of poor quality and needs to be treated before consumption. Theres is also a need for the rural population to be educated on hazards of using untreated water. In general, sanitary facilities in rural areas in Tanzania need to be improved in order to avoid health hazards.

Tukuyu onchocerciasis focus was earmarked for vector control using insecticide against larval stages. Susceptibility tests of mature larvae of Simulium damnosum s.l. vectors to temephos insecticide were carried out before and after two years of insecticide treatment of rivers within Tukuyu onchocerciasis focus, south-western Tanzania. The tests were done in 1999/2000 and 2004 using WHO standard methods. Mature larvae were exposed to 9 concentrations of temephos active ingredient, from the weakest 0.00975mg/litre to the strongest of 2.5mg/l. Each test concentration and control was run in duplicates of 25 larvae each, set for three hours in a cool temperature. After incubation, test solution was discarded and larval condition checked. Numbers of larvae in each category were recorded and used to determine mortality rate for each concentration as well as for the LC50 and LC95. A total of 1,666 larvae were tested, 942 during the pre- and 724 post-treatment. Results showed that both pre and post-treatment samples were susceptible, attaining 100% mortality at the diagnostic dose of 1.25mg/l, and LC50 between 0.129-0.34mg/l pre - and 0.144-0.211 mg/l (95% CI, P < 0.05) post- treatment. These values fall within the standard diagnostic dose of < or = 0.4mg/l for susceptible S. damnosum s.l populations. It was concluded that the endemic S. damnosum population was susceptible to temephos before and after two years of intermittent field application. Temephos was thus recommended for continued use in onchocerciasis vector control in the Tukuyu focus, to complement Community Directed Treatment with Ivermectin, but close monitoring of vector susceptibility should be done.

Vital registration of causes of death in Tanzania is incomplete and many deaths occur outside health care settings. Verbal autopsies (VA) are used to determine the underlying cause of death, and the probable diagnosis helps to estimate reasonably cause-specific mortality. In this paper, we report findings of a verbal autopsy survey which involved eight villages in both low and highlands of Muheza district, north-eastern Tanzania. The survey was conducted following a rapid census, which was done to identify households that had lost one or more members within a period of two years from the date of census. Trained research assistants administered VA questionnaires to parents/close relatives. Two physicians reviewed each report independently and a third opinion was sought where there was discordant report between the two. A total of 9,872 households were surveyed and 134 deaths were recorded. A total of 96 (71.6%) deaths were from lowland villages representing high malaria transmission. Majority (72.4%) of the reported deaths occurred at home whilst 32.1% occurred at heath facility settings. Overall, severe malaria was the leading cause accounting for 34.3% of all deaths. Infants were most affected and accounted for 43.5% of the total deaths. Pulmonary tuberculosis ranked second (8.2%) cause of deaths and was exclusively confined to individuals > or = 15 years. Probable cause of death could not be determined in 13.4% of deaths. In conclusion, majority of deaths in rural north-eastern Tanzania occur at home and the immediate causes are usually unknown or not documented. These findings indicate that the verbal autopsy is a useful tool for detecting leading causes of death at community level in the absence of health facility-based data.