Tanzania health research bulletin最新文献

A survey was conducted to study the existing medical waste management (MWM) systems in Tanzanian hospitals during a nationwide health-care waste management-training programme conducted from 2003 to 2005. The aim of the programme was to enable health workers to establish MWM systems in their health facilities aimed at improving infection prevention and control and occupational health aspects. During the training sessions, a questionnaire was prepared and circulated to collect information on the MWM practices existing in hospitals in eight regions of the Tanzania. The analysis showed that increased population and poor MWM systems as well as expanded use of disposables were the main reasons for increased medical wastes in hospitals. The main disposal methods comprised of open pit burning (50%) and burying (30%) of the waste. A large proportion (71%) of the hospitals used dust bins for transporting waste from generation points to incinerator without plastic bags. Most hospitals had low incineration capacity, with few of them having fire brick incinerators. Most of the respondents preferred on-site versus off-site waste incineration. Some hospitals were using untrained casual labourers in medical waste management and general cleanliness. The knowledge level in MWM issues was low among the health workers. It is concluded that hospital waste management in Tanzania is poor. There is need for proper training and management regarding awareness and practices of medical waste management to cover all carders of health workers in the country.

A simple, sensitive, specific assay technique for the detection and semi-quantification of chloroquine, amodiaquine, quinine, primaquine, sulfadoxine and pyrimethamine in formulations and in human urine by using thin layer chromatography (TLC) was developed and tested in the laboratory. The method involved developing test samples spotted on TLC chromatogram by diethylamine-toluene-isopropanol (1:4:5 v/v/v) as the eluting solvent. The solvent system diethylamine-toluene-isopropanol (1:4:5 v/v/v) enabled the elution and detection of all the tested antimalarial drugs in solution and those spiked in human urine. Detection limits for chloroquine, amodiaquine, quinine and primaquine were the lowest at 0.00025 mg/ml. Sulfadoxine exhibited a detection limit of 0.0005 mg/ml whereas that of pyrimethamine was 0.001 mg/ml. The results indicate the suitability of this technique in antimalarial drug quality and bioavailability studies. It is envisaged that this technique will adequately address the role of drug absorption and excretion in the chemotherapy of malaria as well as to detect types of antimalarial drugs commonly used in the community.

Persistence of malaria symptoms after treatment with over the counter available antimalarial drugs has resulted in a gradual loss of faith in orthodox drugs. There is thus an increased tendency towards the use of herbs in the treatment of malaria in Imo State, Nigeria. In this study we report activities of two herbalists in the treatment of malaria as well as the effectiveness of the herbal treatment. The study covered two areas namely, Umuneke Ugiri in Isiala Mbano Local Government Area (LGA) and Odummara Obi-Orodo in Mbaitoli LGA of Imo State, Nigeria. A participant-observation technique was used. Finger prick blood samples were collected from patients who visited the herbalists complaining of malaria, and blood smears were stained with Field's B stain. Blood smears were taken again one-week post-treatment. A total of 75 patients from Umuneke Ugiri and 265 patients from Odumara Obi-Orodo were involved in the study. All the 75 patients (100%) from Umuneke Ugiri and 163 (61.51%) patients from Odummara Obi-Orodo were positive for malaria parasites. Only 13 (17.3%) patients from Umuneke Ugiri and 149 (56.23%) from Odummara Obi-Orodo returned for the post-treatment blood parasite analysis. From Umuneke Ugiri 4 (31%) were still positive for malaria parasite while 9 (69%) were negative. All 149 patients from Odummara Obi-Orodo were negative. This indicates that the herbal treatment was effective. However, there is need for further studies into the efficacy of herbal concoctions, their effective life span, as well as possible toxic effects.

The presence of concomitant bacteria was assessed in the blood of 125 malaria positive patients and 60 malaria negative controls, resident in Owerri, southeastern Nigeria. Blood samples were cultured in MacConkey, Chocolate and Blood agar, respectively using oxoid signal system after the manufacturer's instructions. Blood cultures of 44 (35.2%) of the 125 malaria positive patients had bacterial growth while none was observed in the blood cultures of malaria negative patients. The bacteria species identified included: Staphylococcus aureus 4 (3.2%), Escherichia coli 3 (2.4%) Salmonella typhi 25 (20%), Klebsiella pneumoniae 10 (2.4%) and Pseudomonas aeruginosa 2 (1.6%). The presence of concomitant bacteria in malaria-positive cases usually results in persistence of malaria-like symptoms after treatment with antimalarials and subsequently taken as resistance of the parasites to the particular drugs in question. The significance of concomitant bacteria in the management of malaria should be given priority.

Entomological surveys were carried out in six villages at different altitudes in Mpwapwa and Iringa Districts in central Tanzania in March 2002. A total of 1291 mosquitoes were collected. Of these, 887 mosquitoes were collected by light traps and 404 by indoor pyrethrum spray catch technique. Seventy-nine percent (1026) were Anopheles gambiae s.l., 0.2% (N = 3) were An. funestus, and 20.3% (N = 262) were Culex quinquefasciatus. Other species including Cx cinereus, An. coustani and Aedes spp accounted for 0.5% of the mosquito population. In Iringa, more mosquitoes were collected by pyrethrum spray catch than light trapping technique. The light trap catch: spray catch ratio in Iringa and Mpwapwa was 1:1.15 and 2.5:1, respectively. Indoor pyrethrum spray catch gave an overall estimate of An. gambiae density of 8 and 0.6 mosquitoes per room in Iringa and Mpwapwa, respectively, whereas light trap collections gave an overall respective density of An. gambiae of 63.9 and 2.9 mosquitoes per room. The densities of house entering mosquitoes were found to range from 0 to 135 in Iringa and from 2.6 to 3.5 per room in Mpwapwa. An.funestus mosquitoes were collected in Iringa only. None of the dissected An. gambiae collected in the two districts was infected with malaria sporozoites. Despite low mosquito densities and absence of infective mosquitoes in our study, the two districts are malaria epidemic prone, thus a continuous surveillance is critical for a prompt response to any impending outbreak. Further longitudinal studies are required to determine the transmission potential of the malaria mosquitoes in the two districts.

A study was undertaken to investigate knowledge, attitudes and practices about sleeping sickness (human African trypanosomiasis) among communities living in and around Serengeti National Park (SENAPA). Structured questionnaires were administered to a total of 1490 consenting participants. Of the respondents, 924 (62%) knew sleeping sickness, and 807 (87.3%) knew the right place to seek healthcare. Of 924 who knew sleeping sickness, 386 (42%) said the disease was present in the areas they live. Most respondents (85.4%) knew that sleeping sickness infections were acquired in the bush and forest. The most common (69.3%) sources of information about sleeping sickness were relatives and friends. Symptoms of sleeping sickness mentioned included abnormal sleep (45.2%), fever (35.3%), body malaise (14.5%), headache (7.6%) and lymph node enlargement (6.1%). Of 1490 people interviewed 90.4% knew tsetse flies and 89.8% had been bitten by tsetse flies. The majority (86.6%) of the respondents knew that sleeping sickness is transmitted through a tsetse bite. Activities that exposed people to tsetse bites included working in tsetse infested bushes/forests, grazing livestock in tsetse infested areas and hunting game animals. In conclusion, communities living in and around SENAPA were knowledgeable about tsetse and sleeping sickness. The communities can thus understand and support community based tsetse and sleeping sickness control programmes to ensure success.

Addressing the malaria-agriculture linkages requires a broad inter-disciplinary and integrated approach that involves farming communities and key public sectors. In this paper, we report results of participatory involvement of farming communities in determining malaria control strategies in Mvomero District, Tanzania. A seminar involving local government leaders, health and agricultural officials comprising of a total of 27 participants was held. Public meetings in villages of Komtonga, Mbogo, Mkindo, Dihombo and Luhindo followed this. Findings from a research on the impact of agricultural practices on malaria burden in the district were shared with local communities, public sector officials and other key stakeholders as a basis for a participatory discussion. The community and key stakeholders had an opportunity to critically examine the linkages between agricultural practices and malaria in their villages and to identify problems and propose practical solutions. Several factors were identified as bottlenecks in the implementation of malaria control in the area. Lack of community participation and decision making in malaria interventions was expressed as among the major constraints. This denied the community the opportunities of determining their health priorities and accessing knowledge needed to effectively implement malaria interventions. In conclusion, this paper emphasizes the importance of participatory approach that involves community and other key stakeholders in malaria control using an ecosystem approach. An interdisciplinary and integrated approach is needed to involve farmers and more than one sector in malaria control effort.

Understanding community perceptions and attitudes towards childhood illness is important in developing appropriate interventions. A cross sectional survey was therefore, conducted in a riparian community of Lake Victoria basin in Tanzania to determine caretakers' perception, attitudes and practices on childhood malaria and diarrhoeal diseases. Among 336 caretakers interviewed, 61.1% (205) reported febrile illness in children within three months and 26.0% reported a diarrhoeal episode among children within two weeks before the survey. The majority of the respondents reported high fever (98.7%) and prostration (53.7%) as major symptoms of severe malaria. Convulsions were associated with high fever by only 13.7% of the respondents. Forty percent of the respondents attributed convulsions in children to either fever or malaria, and 24.4% correctly mentioned high fever or malaria. A health facility was the first point of care for childhood malaria for the majority (73%) of the respondents. In diarrhoeal diseases, prostration-weakness (67.7%) and dysentery (20.4%) were commonly reported among the respondents. Typical symptoms of severe dehydration (sunken eyes, loss of skin turgor, dry tears) were poorly recognised as characteristics of severe diarrhoeal diseases. Over 85% of the respondents practiced appropriate dietary measures or increased fluid intake for a child who had diarrhoea. Use of anti-diarrhoea (40.8%) and antibiotic medications (34.8%) were common in the treatment of diarrhoeal diseases. It is important that health education emphasizing recognitions of danger signs/symptoms of malaria and diarrhoeal diseases and their management is strengthened among riparian communities in Lake Victoria basin.

This study was undertaken to assess the nutritional status and feeding practices of < 5 year children among the pastoral communities of Simanjiro district, northern Tanzania. Face-to-face interviews with the sampled mothers were conducted using a semi-structured questionnaire. Anthropometric measurements using weight-for-age criterion were employed to assess the nutritional status. The study showed that 31% of the children were undernourished, some (6%) of them severely. Children 2 - 3 years old were the most affected. Breastfeeding duration of more than one year was common among the mothers. Fifty-four percent of the mothers weaned their children as early as two months after birth. The most common type of weaning food was maize porridge (gruel) mixed with cow's milk (46%). Generally, 87% of households were facing some degree of food insecurity where some of them either experienced food shortage for 3-4 months (40%) or reported to eat less than three meals per day (75%). An educated mother was less likely to have an undernourished child, while a child from a teenage mother was more likely to be undernourished. Small size of a household was in favour of nutrition status. There is a great need to undertake interventions through community education to rescue the situation in Simanjiro district. Efforts should also be undertaken to mobilize the community members to adopt practices that favour good nutrition of children.

HIV/AIDS represents one of the critical challenges to human development in sub Saharan Africa. This study was carried out to assess the knowledge of HIV/AIDS and its relationship with sexual practices among communities in Tabora and Igunga Districts in western Tanzania. The study employed both qualitative and quantitative methods, which included interviews and group discussions. A total of 568 participants (female = 49%; males = 51%) were involved in the study. Two hundred and eighty-four of the respondents were adults (> 25 years) and 284 were youths of 12 - 25 years. The results showed although the knowledge of the disease and its prevention was high (90%) among the community, some gaps regarding the knowledge on modes of transmission were observed. About 17.2% of the respondents reported to have multiple sexual partners and only about half of the respondents reported the use of condoms. The level of education correlated significantly with the individual knowledge on HIV/AIDS (P = 0.003). There was no significant difference between urban and rural communities on their knowledge on HIV/AIDS (P > 0.05). Health education on HIV/AIDS prevention needs to be strengthened and improved to include cognitive behavioural interventions that emphasize attitude changes, negotiation skills and decision-making skills that could be effective in changing and maintaining safe sexual behaviour.