Tanzania health research bulletin最新文献

Both urinary bilharziasis and urothelial neoplasia are associated with increased production of tissue carcinoembryonic antigen (CEA). Urine and serum CEA were determined in 43 patients with urinary bladder carcinoma including 22 post bilharzial and 21 non-biharzial cases, in addition to 10 normal control cases. A significant increase was detected in both urine and serum CEA levels with bladder carcinoma compared to control cases. Urinary CEA was significantly elevated in 86% of bilharzial versus 62% in nonbilharzial bladder carcinoma. Only 10.5% of control cases had urinary CEA elevation. The mean urinary CEA in bilharzial was higher than that of nonbilharzial carcinoma, but the difference was not statistically significant. There was a definite relationship between urine CEA and the stage of malignancy; the higher the stage, the higher the level of urine CEA. No relationship could be detected between the stage of malignancy and serum CEA, or between the grades of malignancy and urine or serum CEA levels. In conclusion, urinary CEA is more useful than serum CEA in the early detection of bilharziasis-associated urothelial carcinoma.

A study was carried out in six villages located at different altitudes in Mpwapwa district of central Tanzania to determine malaria parasitaemia and transmission levels in villages with or without health care facilities. A total of 1119 schoolchildren (age = 5.9-12.3 years) were examined for malaria parasitaemia. Plasmodiumfalciparum was the predominant malaria species accounting for 92.8% of all species. The average malaria prevalence rate among schoolchildren was 25.8% (range 1.5-53.8%). The geometric mean parasite densities for P.falciparum was 361 (N = 286). Higher malaria prevalence was observed in villages at lower (< 1000 m) than at intermediate (1000-1500m) or higher (> 1500m) altitudes. Schoolchildren in areas with health care facilities were less at risk of acquiring malaria by 33.4% as compared with those living in areas without health facilities. Mean packed cell volume in schoolchildren was 38.5% (range = 35.2-41.0%). Splenomegaly was observed in 18.1% (0-40.2%) of the schoolchildren examined and it was higher among those in villages without health care facilities. Anopheles gambiae sensu lato was the only malaria vector found in the district and was found in all villages and at all altitudes. Sporozoite rate in An. gambiae s.l. ranged from 0-10.5%, with the lowland villages recording the highest rates. This study indicates that altitude and geographical accessibility to healthcare service are important determinants of malaria infection among rural communities in Tanzania.

Commensal and field rodents and wild small carnivores were live-trapped in five villages of Karatu district and one settlement in the Ngorongoro Conservation Area in Ngorongoro district in Tanzania. Blood samples were taken and serologically tested for plague, using the Blocking ELISA technique. Some domestic dogs and cats in the Karatu villages were aseptically bled and similarly tested for plague. Fleas were collected from the examined animals and from randomly selected residential houses. A total of 241 rodents, 1 Crocidura spp, 43 dogs, 12 cats and 4 slender mongooses were involved in the survey. Of the rodents, 14.5% were infested with fleas, which comprised of Xenopsylla brasiliensis (45.8%) and Dinopsyllus lypusus (54.2%), with an overall population density of 0.2 fleas/animal. Thirty one (72.1%) of the dogs were infested with fleas, all of which were Ctenocephalides spp. Thirty five (63.3%) houses were infested with fleas whose population was composed of Ctenocephalides spp, Pulex irritans, Tunga penetrans and Echinophaga gallinacea. Infected rodents were found in all the villages while the infected dog was found at Rhotia-Kati. Nineteen (11%) of the rodents and one (2%) dog harboured specific plague antibodies. It was broadly concluded that sylvatic plague was endemic in Karatu district and Ngorongoro Conservation Area and that outbreaks of the disease can occur in the area any time if and when relevant conditions become favourable. Prompt application of appropriate preventive and control measures and survey for substantiating the status in the Lake Manyara National Park, which is adjacent to some of the infected villages, are recommended.

This study was carried out to determine malaria situation in Bulambya Division, Ileje district in southwest Tanzania. Outpatient attendance records from 1999 to 2002 were examined for malaria cases in eleven health facilities. A cross-sectional study to determine malaria prevalence and its potential vectors was done in May 2004. Blood samples were collected from 502 schoolchildren from 16 primary schools and examined microscopically for malaria parasites. Indoor resting mosquitoes were collected in ten houses in each of the ten villages covered. Health facility data for 1999 showed the highest (60.7%) and lowest (11.5%) annual malaria morbidity rates were recorded at Itumba and at Ibaba, respectively. Malaria parasitaemia rate among schoolchildren ranged from 0-36.7%; the lowest prevalence was observed in the high altitude mountainous range and the highest in the lower altitude plateaux. Of 1,504 mosquitoes caught, 205 (13.6%) were female Anopheles gambiae s.l., 215 (14.3%) An. funestus and 68.9% were culicines. Data from both health facility records and school surveys indicate that there is high malaria morbidity in the lower plateaux (1100 to =1350 m), around Itumba and Isongole, where indoor anopheles mosquito densities were relatively higher than in the higher altitudes (> 1,350 m) around Ibaba. In the lower altitude range, there was less malaria on steep slopes than on flat terrain. Further studies are recommended to closely monitor malaria situation in these epidemic prone highlands of southwest Tanzania.

Lumbar puncture (LP) is an important diagnostic tool for investigating neurological conditions/diseases. This study was carried out to compare the indications for lumbar puncture and findings of cerebrospinal fluid examination in children admitted to Muhimbili National Hospital (MNH) in Dar-es-salaam, Tanzania and Kilifi District Hospital (KDH) in Kenya. Records of all children admitted to the paediatric wards of the two hospitals from 1st November 2004 to 30th April 2005 with suspected central nervous system infections and had LPs performed were analysed. Overall, 8,741 paediatric admissions were recorded in the two hospitals (Muhimbili = 6,228; Kilifi = 2,513). Of these, 607 (6.9%) had a LP performed; 154 out 6,228 (2.5%) in MNH and 453 out of 2,513 (18.0%) in KDH. LPs were performed less frequently in Muhimbili than in Kilifi Hospital. The most common indications for LP at MNH were convulsions (62.5%), neck stiffness (14.3%) and prostration (17%), whereas at KDH were convulsions (56.3%), neck stiffness (7.3%) and prostration (22.1%). The bacterial isolates were rarely (23%) obtained on culture at both hospitals. Streptococcus pneumonaie and Salmonella species were the commonest causes of pyogenic meningitis. In conclusion, the rate of LP performance in the two hospitals is low. There is need therefore to improve the rates of LP and the isolation of bacterial pathogens from cerebrospinal fluid cultures. Other possible causes for meningitis such as viruses need to be investigated.

Pre and post-diethylcarbamazine treatment clinical expression, microfilaraemia prevalence and cellular responses were investigated in individuals in Tanga, Tanzania. Fifty-seven male individuals (aged = 15 years old) were identified for further studies on IL-4, IL-6, IL-8. IFN-gamma, IL-beta, TNF-alpha and nitric oxide in plasma and hydrocoele fluid. Microfilarial prevalence in the examined individuals was 12% with a geometric mean intensity (GMI) of 838 mff/ml in a community with a population of 1018 individuals. Microfilaraemic hydrocoele stage II and III were the most frequent pathologies observed with prevalence of 17.5% and 42. 1 %, respectively. All study individuals treated with diethylcarbamazine (DEC) standard dose of 6 mg/kg experienced post-treatment adverse events. There was no direct relationship between elevated IL-6 and the occurrence and severity of clinical adverse effects post-treatment. The findings from this study suggests that, blood elevated cytokine profile is not the main etiological factor in the inflammatory responses developing after treatment of bancroftian filariasis infections and pathology with DEC. Plasma levels of cellular (cytokines) responses during treatment revealed a proportion of symptomatic patients. Prior to treatment, patients with hydroecoele had high levels of IL-6 than those without the pathology. In conclusion these findings do not support the hypothesis that pro-inflammatory cytokines are directly responsible for adverse events to DEC chemotherapy in bancroftian filariasis infections and pathologies such as hydrocoele, lymphoedema and elephantiasis.

A study was carried out to determine the levels of two heavy metals, Lead (Pb) and Copper (Cu), in two popular leafy vegetables grown around Morogoro Municipality in Tanzania. Vegetable samples of Pumpkin leaves (Cucurbita moschata) and Chinese cabbage (Brassica chinensis) were collected from three sites and analysed for their concentrations of the two metals using an Atomic Absorption Spectrophotometer. The three sites, namely Mazimbu, Kihonda and Towelo are located within a 10 km perimeter. The site selection was based on the anticipated levels of contamination of the water used for irrigation. The results showed that the levels (mg/100g dry weight) ranged from 0.885 to 1.39 for Copper and 0.05 to 0.315 for Lead. The levels of Lead and Copper varied between the vegetable varieties and from site to site. Vegetables from Mazimbu showed higher concentration levels of the two metals compared to the other sites in both varieties. Towelo vegetables had relatively low concentrations. There was a significant difference (P < 0.05) in levels of the two metals across the sites but there was no significant difference (P > 0.05) in the levels of Copper between the two vegetable varieties from all the three sites. There was a significant difference (P < 0.05) in the levels of Lead between the vegetable varieties. The levels of both Lead and Copper in the two vegetables were found to be below the maximum permissible levels recommended by FAO/WHO for the two metals in vegetables.

A prospective study was carried out to determine the relationship between weight gain in the second and third trimesters with the corresponding birth weights in Morogoro, Tanzania. A total of 270 pregnant women who gave birth to singleton deliveries and their consecutive newborns were randomly selected from among women who were attending one antenatal clinic. Average weight gains in second and third trimesters were 2.45 +/- 0.68 and 2.14 +/- 0.43 kg, respectively (a total of 4.59 +/- 1.11 kg) for the two trimesters. Weight gains per week were 0.47 +/- 0.16 and 0.33 +/- 0.13 kg for the second and third trimesters, respectively. Weight gain in the two trimesters was lower than the expected value for the same period. Results from Pearson correlation analysis found a positive correlation (P < 0.001) between birth weight and variables such as maternal age, gestational period, parity, weight gain in both second and third trimester, birth length and sex of an infant. Multiple regression analysis indicated that birth weight (dependent variable) was significantly affected by maternal weight gain in the third trimester, maternal age (both at P < 0.05) and birth length (P < 0.001). The incidence of low birth weight was about 8% and was significantly higher among infants of teenager mothers. It appears that despite of possibility of some physiological adaptations, which tend to protect the foetus when the woman is subjected to inadequate weight gain during pregnancy, weight gains in the second and third trimesters are important in determining the birth weight.