Smokeless Tobacco Use among Adolescents in Ilala Municipality; Tanzania

Smokeless tobacco use is a significant part of the overall world tobacco problem. When the habit is introduced early in life; it increases the chance for permanent addiction and primes adolescents for use of harder drugs; exposing them to higher risk of oral cancer and other adverse effects of tobacco. This baseline study aimed at providing descriptive information on smokeless tobacco knowledge and use among adolescents at a time just before the ban on such products was enforced nationally on 1st December 2006. Six out of 101 primary and four out of 11 secondary schools were randomly selected in Ilala Municipality; Tanzania. A total of 1011 students were randomly selected and interviewed; boys (mean age= 14.5 years) accounted for 50.7and girls (mean age= 13.6 years) 49.3. The prevalence of tobacco use was 5.9(boys= 9; girls= 2.4). Prevalence of smokeless tobacco use was 3.6; about half of all who have ever smoked. Most popular brand of smokeless tobacco reported was Kuberi (44.8) followed by Gutka (6.9). Twelve (41) of the smokeless tobacco users were using the products almost everyday. Among the reasons reported for smokeless tobacco use were pleasure (27.6); smell (17.2) and taste (6.9). However; 48.3of the users did not know why they used the product for the first time. Smokeless tobacco products were branded as nutritional supplements with different tastes and strengths; ideal for enticing the curiosity of adolescents. Given the crafty practice of the tobacco industry and salesmen; there is need for monitoring of availability of these products in circulation and enforcement of the ban nationally and globally to institute measures for effective elimination of this harmful practice

Capacity of Healthcare Facilities in the Implementation of Direct Observed Treatment Strategy for Tuberculosis in Arumeru and Karatu Districts; Tanzania

Directly Observed Treatment Short course strategy (DOTS) has proved to have potential improvement in tuberculosis (TB) control in Tanzania. The objective of this cross sectional study was to assess the capacity of health facilities in implementing DOTS; in Arumeru and Karatu districts; Tanzania. Information sought included the capacity to offer TB service and availability of quali?ed staff and equipment for TB diagnosis. Information on availability and utilization of TB registers and treatment outcome for the year 2004 were also collected. A total of 111 health facilities were surveyed; 86 (77.5) in Arumeru and 25 (22.5) in Karatu. Only 23.4(26/111) facilities were offering TB treatment services in the two districts. Majority 17/26 (65.38) of them were government owned. Thirty eight (44.7) facilities were offering TB laboratory services. All facilities with TB services (TB laboratory investigation and treatment) had TB registers. Seventy two (85.0) of health facilities which do not provide any TB services had qualifed clinical offcers and at least a microscopy. Of the 339 cases notified in Arumeru in 2004; 187 (60.7) had treatment outcome available; 124 (66.3) were cured and 55 (29.4) completed treatment. In Karatu 638 cases were noti?ed in 2004; 305 (47.8) had treatment outcome available; 68 (22.3) cured and 165 (54.1) completed treatment. In conclusion; the overall capacity for implementing DOTS among the facilities surveyed is found only in about 20and 30for clinical and laboratory components of DOTS; respectively. The capacity to provide TB diagnosis and treatment in Karatu district was relatively lower than Arumeru. It is important that capacity of the facilities is strengthened concurrently with the planned introduction of community-based DOTS in Tanzania

Biological and Haematological Safety Profile of Oral Amodiaquine and Chloroquine in Healthy Volunteers with or without Plasmodium falciparum Infection in Northeast Tanzania

Amodiaquine (AQ); an effective antimalarial drug for uncomplicated malaria; has been greatly restricted after cases of life-threatening agranulocytosis and hepatic toxicity during prophylactic use. We conducted a hospital based open-label randomised clinical trial in 40 indigenous semi-immune healthy adult male volunteers with and without malaria parasites. The objective was to collect data on biological and haematological safety; tolerability; and parasitological efficacy to serve as baseline in the evaluation of the effectiveness of AQ preventive intermittent treatment against malaria morbidity in infants. Volunteers were stratified according to parasitaemia status and randomly assigned 20 participants each arm to three days treatment with either AQ or chloroquine (CQ). The level of difference of selected haematological and hepatological values pre-and post-trial were marginal and within the normal limits. Clinical adverse effects mostly mild and transient were noticed in 33.3CQ treated-aparasitaemic; 23.8of CQ treated-parasitaemic; 28.6of AQ-treated parasitaemic and 14.3of aparasitaemic receiving AQ. Amodiaquine attained 100parasitological clearance rate versus 70in CQ-treated volunteers. The findings indicate that there was no agranulocytosis or hepatic toxicity suggesting that AQ may pose no public health risk in its wide therapeutic dosage uses. Larger studies are needed to exclude rare adverse effects

Quality of HIV laboratory testing in Tanzania: a situation analysis

Tanzania is scaling up prevention; treatment; care and support of individuals affected with HIV. There is therefore a need for high quality and reliable HIV infection testing and AIDS staging. The objective of this study was to assess laboratories capacities of services in terms of HIV testing and quality control. A baseline survey was conducted from December 2004 to February 2005 in 12 laboratories which were conveniently selected to represent all the zones of Tanzania. The questionnaires comprised of questions on laboratory particulars; internal and external quality control for HIV testing and quality control of reagents. Source and level of customer satisfaction of HIV test kits supply was established. Of 12 laboratories; nine used rapid tests for screening and two used rapid tests for diagnosis. In the 12 laboratories; four used double ELISA and five used single ELISA and three did not use ELISA. Confirmatory tests observed were Western Blot in three laboratories; DNA PCR in two laboratories; CD4 counting in seven laboratories; and viral load in two laboratories. Although all laboratories conducted quality control (QC) of the HIV kits; only two laboratories had Standard Operating Procedures (SOPs). Internal and external quality control (EQC) was done at varied proportions with the highest frequency of 55.6(5/9) for tnternal quality control (IQC) for rapid tests and EQC for ELISA; and the lowest frequency of 14.3(1/ 7) for IQC for CD4 counting. None of the nine laboratories which conducted QC for reagents used for rapid tests and none of the five which performed IQC and EQC had SOPs. HIV kits were mainly procured by the Medical Store Department and most of laboratories were not satisfied with the delay in procurement procedures. Most of the laboratories used rapid tests only; while some used both rapid tests and ELISA method for HIV testing. In conclusion; the survey revealed inadequacy in Good Laboratory Practice and poor laboratory quality control process for HIV testing reagents; internal and external quality control

The Future of Malaria Research and Control : an African Perspective

Century after Sir Ronal Ross' discovery of the malaria parasite in the mosquito gut; unveiling the mode of malaria transmission; 40 per cent of the global population is still exposed to the disease. The exposed population lives in the tropical world. Africa bears the heaviest burden of the disease estimated at 31.6 million DALYs equivalent to 62.1 DALYs per 1;000 population. Children and pregnant women are the most affected groups. Control methods of source reduction which were effective in Europe and America using DDT spraying; larviciding and drainage of swamps and stagnant waters were not effective in the tropics. The complexity of the disease; the parasite' life cycle and the tropical environment within which it thrives calls for a new approach to malaria control; multilateral collaboration and funding an d above all commitment from the south and south-south collaboration. The long-term challenge lies on the discovery of better methods for malaria control. However; Africa cannot wait. Better utilization of existing tools exploiting their synergistic effect will save millions of lives

Field trials of malaria vaccines.

Malaria due to Plasmodium falciparum is probably the most important infectious disease in the tropical world. About 2000 million people live in areas exposed to malaria and 300 million individuals are infected every year. In Africa south of the Sahara alone, over 1 million children die annually as a result of malaria. It is a difficult parasitic disease both to diagnose and control. It does not provide sterile immunity even after long exposure periods. However, acquisition of partial immunity allows over 60 per cent of individuals with long exposure to carry the parasite in their blood without symptoms, posing difficulties for case definition, malaria attributable morbidity and deaths. Further, it is extremely difficult to establish the extent to which malaria has influence over the adverse outcome of other infectious disease like measles and malnutrition. The complex life cycle of the parasite involving human and vector mosquitos as well as its allelic diversity and antigenic variations makes the development and implementation of effective malaria control intervention problematic. It is now becoming evident that multi-intervention approach may be the most appropriate way of combating malaria in view of the increasing resistance of the parasite to antimalarial drugs as well as vector mosquitoes to insecticides. Malaria vaccines will therefore play a major role in future malaria interventions. New malaria vaccine candidates will require testing in malaria endemic countries. Sufficient sites for testing potential malaria vaccines must be prepared. In this paper we discuss the necessary preparations required for field testing of malaria vaccines in tropical countries.