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1.
PLoS One ; 17(10): e0276620, 2022.
Article in English | MEDLINE | ID: covidwho-2089437

ABSTRACT

INTRODUCTION: The risk of contracting COVID-19 through dental treatment is potentially high, thus several guidelines have been developed to minimize the spread of COVID-19 in the dental office worldwide. These changes have posed some relevant questions among oral health professionals regarding the understanding and attitudes of dental patients toward COVID-19. This study aimed to assess the knowledge, attitude, and practices of dental patients in Dar es Salaam, Tanzania. METHODOLOGY: This cross-sectional study was carried out in 4 public hospitals in Dar es Salaam, Tanzania involving 472 adult patients. Data were collected using a questionnaire that had a set of questions regarding knowledge, attitude, and practices (KAP) related to COVID-19. Data were analyzed using the SPSS computer software version 26. For descriptive analysis means, standard error of the mean, and proportion were used. Multivariate regression analysis was utilized for the response analysis. Alpha of less than 0.05 was considered to indicate statistical significance. RESULTS: Good levels of knowledge, attitude, and practices related to COVID-19 were found in 76.5%, 74.8%, and 58.1% of participants respectively. On performing multivariate analysis, odds of having good knowledge regarding COVID-19 were almost 2 folds higher in participants who were females, with high education levels, those without partners, and those with stable income. Females were 1.5 folds more likely to have a good attitude toward COVID-19 and odds of good practice against COVID-19 were 3 folds higher in young adults compared to the elderly. CONCLUSION: A majority of dental patients have good knowledge and attitude related to COVID-19. Predictors of good knowledge were sex, education level, marital status, and income of the participants. Sex predicted good attitude and age predicted good practice.


Subject(s)
COVID-19 , Young Adult , Female , Humans , Aged , Male , COVID-19/epidemiology , Cross-Sectional Studies , Health Knowledge, Attitudes, Practice , Tanzania/epidemiology , Dental Clinics , Surveys and Questionnaires
2.
Int J Environ Res Public Health ; 19(18)2022 Sep 16.
Article in English | MEDLINE | ID: covidwho-2055229

ABSTRACT

The transmission of the SARS-CoV-2 virus, which causes COVID-19, has been documented worldwide. However, the evidence of the extent to which transmission has occurred in different countries is still to be established. Understanding the magnitude and distribution of SARS-CoV-2 through seroprevalence studies is important in designing control and preventive strategies in communities. This study investigated the seropositivity of the SARS-CoV-2 virus antibodies in the communities of three different districts in the Mwanza region, Tanzania. A household cross-sectional survey was conducted in September 2021 using the modified African Centre for Disease and Prevention (ACDC) survey protocol. A blood sample was obtained from one member of each of the selected households who consented to take part in the survey. Immunochromatographic rapid test kits were used to detect IgM and IgG SARS-CoV-2 antibodies, followed by descriptive data analysis. Overall, 805 participants were enrolled in the study with a median age of 35 (interquartile range (IQR):27-47) years. The overall SARS-CoV-2 seropositivity was 50.4% (95%CI: 46.9-53.8%). The IgG and IgM seropositivity of the SARS-CoV-2 antibodies was 49.3% and 7.2%, respectively, with 6.1% being both IgG and IgM seropositive. A history of runny nose (aOR: 1.84, 95%CI: 1.03-3.5, p = 0.036), loss of taste (aOR: 1.84, 95%CI: 1.12-4.48, p = 0.023), and living in Ukerewe (aOR: 3.55, 95%CI: 1.68-7.47, p = 0.001) and Magu (aOR: 2.89, 95%CI: 1.34-6.25, p= 0.007) were all independently associated with SARS-CoV-2 IgM seropositivity. Out of the studied factors, living in the Ukerewe district was independently associated with IgG seropositivity (aOR 1.29, CI 1.08-1.54, p = 0.004). Twenty months after the first case of COVID-19 in Tanzania, about half of the studied population in Mwanza was seropositive for SARS-CoV-2.


Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Viral , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Immunoglobulin G , Immunoglobulin M , Seroepidemiologic Studies , Tanzania/epidemiology
3.
Glob Health Sci Pract ; 10(3)2022 06 29.
Article in English | MEDLINE | ID: covidwho-1994496

ABSTRACT

INTRODUCTION: We introduce the iDARE methodology and present the results of iDARE implementation in Uganda, Kenya, and Tanzania during the coronavirus disease (COVID-19) pandemic. IDARE METHODOLOGY: iDARE drives locally led solutions that address barriers to achieving improved health outcomes. WI-HER supported the governments of Uganda, Kenya, and Tanzania, to design and implement solutions to improve (1) HIV health outcomes, (2) gender-based violence identification and response, and (3) mass drug administration coverage, respectively. RESULTS: In Uganda, the iDARE team at Nagongera Health Center IV increased viral load suppression (VLS) among actively enrolled men in care from 65% to 95% and increased VLS among actively enrolled children in care from 60% to 96% in 12 months. In 11 months, the Mulanda Health Center IV iDARE team increased VLS among actively enrolled men in care from 85% to 93% and actively enrolled children in care from 73% to 96%. In Kenya, 8 facility iDARE teams improved identification, management, and response for gender-based violence survivors by a monthly average of 642% in 10 months. Additionally, the identification, management, and response for male survivors of gender-based violence increased from an average of 8 to 188 men per month and from an average of 81 to 364 women per month. In Tanzania, the government applied iDARE to improve mass drug administration (MDA) access and uptake among school-age children. Eighteen percent of the children (equal male and female) had missed or refused treatment during school-based MDA. After 1 month of application of iDARE, the 4 schools achieved 99% MDA uptake among registered children (enrolled and nonenrolled). DISCUSSION: Due to the various lockdowns, restrictions, and safety implications during the COVID-19 pandemic, iDARE was used to rapidly adjust from planned in-person to sometimes virtual engagements. Despite these challenges, iDARE demonstrated improvements in Uganda, Kenya, and Tanzania.


Subject(s)
COVID-19 , Pandemics , Child , Female , Male , Humans , Kenya/epidemiology , COVID-19/epidemiology , Uganda/epidemiology , Tanzania/epidemiology , Communicable Disease Control , Outcome Assessment, Health Care
4.
Acta Trop ; 233: 106566, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1930664

ABSTRACT

BACKGROUND: Rodents are known to be reservoirs of plague bacteria, Yesinia pestis in the sylvatic cycle. A preliminary investigation of the suspected plague outbreak was conducted in Madunga Ward, Babati District Council in Manyara Region December-2019-January 2020 Following reported two cases which were clinically suspected as showing plague disease symptoms. METHOD: The commensal and field rodents were live trapped using Sherman traps in Madunga Ward, where plague suspect cases were reported and, in the Nou-forest reserve areas at Madunga Ward, Babati District Council, to assess plague risk in the area. Fleas were collected inside the houses using light traps and on the rodents 'body after anaesthetizing the captured rodent to determine flea indices which are used to estimate the risk of plague transmission. Lung impression smears were made from sacrificed rodents to examine for possible bipolar stained Yersinia spp bacilli. RESULTS: A total of 86 rodents consisting of ten rodent species were captured and identified from the study sites. Nine forest rodent species were collected. Field/fallow rodent species were dominated by Mastomys natalensis. whereas domestic rodent species captured was Rattus rattus. Overall lung impression smear showed bipolar stain were 14 (16.28%) while House Flea Index (HFI) was 3.1 and Rodent Flea Index (RFI) was 1.8. CONCLUSION: The findings of this study have shown that, the presence of bipolar stained bacilli in lung impression smears of captured species of rodents indicates (not confirmed) possible circulation of Yesrsinia pests in rodents and the high flea indices in the area which included the most common flea species known to be plague vectors in Tanzania could have played transmission role in this suspected outbreak. The study recommends surveillance follow-up in the area and subject collected samples to the standard plague confirmatory diagnosis.


Subject(s)
Plague , Siphonaptera , Animals , Disease Outbreaks , Forests , Plague/diagnosis , Plague/epidemiology , Plague/microbiology , Rats , Rodentia/microbiology , Siphonaptera/microbiology , Tanzania/epidemiology
5.
Pan Afr Med J ; 41: 174, 2022.
Article in English | MEDLINE | ID: covidwho-1847712

ABSTRACT

Introduction: on 16th March 2020, Tanzania announced its first COVID-19 case. The country had already developed a 72-hour response plan and had enacted three compulsory infection prevention and control interventions. Here, we describe public compliance to Infection Prevention and Control (IPC) public health measures in Dar es Salaam during the early COVID-19 response and testing of the feasibility of an observational method. Methods: a cross sectional study was conducted between April and May 2020 in Dar es Salaam City. At that time, Dar es Salaam was the epi centre of the epidemic. Respondents were randomly selected from defined population strata (high, medium and low). Data were collected using a structured questionnaire and through observations. Results: a total of 390 subjects were interviewed, response rate was 388 (99.5%). Mean age of the respondents was 34.8 years and 168 (43.1%) had primary level education. Out of the 388 respondents, 384 (98.9%) reported to have heard about COVID-19 public health and social measures, 90.0% had heard from the television and 84.6% from the radio. Covering coughs and sneezes using a handkerchief was the most common behaviour observed among 320 (82.5%) respondents; followed by hand washing hygiene practice, 312 (80.4%) and wearing face masks, 240 (61.9%). Approximately 215 (55.4%) adhered to physical distancing guidance. Age and gender were associated with compliance to IPC measures (both, p<0.05). Conclusion: compliance to public health measures during the early phase of COVID-19 pandemic in this urban setting was encouraging. As the pandemic continues, it is critical to ensure compliance is sustained and capitalize on risk communication via television and radio.


Subject(s)
COVID-19 , Adult , COVID-19/prevention & control , Cross-Sectional Studies , Humans , Masks , Pandemics , Tanzania/epidemiology
6.
J Int Assoc Provid AIDS Care ; 21: 23259582221084543, 2022.
Article in English | MEDLINE | ID: covidwho-1794048

ABSTRACT

Background: Adherence to antiretroviral therapy (ART) is the key determinant of virological suppression in people living with HIV (PLHIV). This study reports factors associated with non-adherence among PLHIV one year after introducing dolutegravir (DTG) based regimens in Tanzania. Methods: A hospital-based cross-sectional study was conducted in two health facilities in Dar es Salaam, Tanzania, in 2020. Results: A total of 406 PLHIV were recruited, where the majority (73.4%) were females, with 94.6% of patients being on DTG based regimens. Factors such as refill interval and sharing of antiretrovirals had significant effects on adherence. Multivariate analysis found that patients attending care and treatment center (CTC) at Temeke Regional Referral Hospital (RRH) were 4.3 times more likely to have non-adherence compared to those attending Amana RRH (aOR [adjusted odds ratio] 4.3, 95% CI [confidence interval]: 2.38 - 7.91, p-value < 0.0001). Conclusions: Sustainable adherence counseling is warranted to overcome non-adherence to ART.


Subject(s)
HIV Infections , Anti-Retroviral Agents/therapeutic use , Cross-Sectional Studies , Female , HIV Infections/psychology , Heterocyclic Compounds, 3-Ring , Humans , Male , Oxazines , Piperazines , Pyridones , Tanzania/epidemiology
7.
Front Public Health ; 9: 724562, 2021.
Article in English | MEDLINE | ID: covidwho-1775840

ABSTRACT

Introduction: The burden of anemia in pregnancy is of global health importance. Tanzania is no exception. Its effects vary from one region to another due to the differing causes. Overall, it is a significant cause of maternal mortality. This study sought to assess the prevalence and factors associated with anemia among pregnant women attending the antenatal clinic (ANC) in the Mkuranga district of the Pwani region of Tanzania. Methodology: This cross sectional study was conducted among 418 pregnant women aged 15-49 years attending the Mkuranga District Hospital and Kilimahewa Health Center. The outcome variable of interest was anemia in pregnancy defined as a hemoglobin concentration of 11 g/dl or less. Data was collected using face-to-face interviews with a standardized pretested questionnaire, and through blood samples collected for hemoglobin testing. Descriptive analysis was used to determine the prevalence of anemia while multiple logistic regression was used to determine factors associated with anemia in pregnancy. Results: Anemia was prevalent among 83.5% of pregnant women attending the two major ANCs in Mkuranga district. Categorically, the hemoglobin of 16.3% of the included women was normal, 51.9% had moderate anemia, 24.4% had mild anemia, and 7.2% had severe anemia. Factors associated with anemia included being in the third trimester (AOR = 2.87, p = 0.026), not consuming vegetables (AOR = 2.62, p = 0.008), meat (AOR = 2.71, p = 0.003), eggs (AOR = 2.98, p = 0.002), and fish (AOR = 2.38, p = 0.005). The finding of unadjusted analysis revealed that women with inadequate minimum dietary diversity were having significantly greater odds of being anemic as compared with those with adequate dietary diversity (OR = 1.94, P = 0.016). Conclusion: More than 80% of pregnant women attending ANC in Mkuranga districts were anemic. Such unprecedented burden of anemia is associated with several factors, which include poor dietary practices such as not consuming iron-rich foods, for example vegetables, meat, eggs, and fish. Women in their third trimester were also more likely to suffer from anemia. This unprecedented burden of anemia in pregnancy can be addressed if efforts to improve feeding practices and early monitoring at the ANCs are sustained.


Subject(s)
Anemia , Pregnancy Complications, Hematologic , Anemia/epidemiology , Cross-Sectional Studies , Female , Humans , Pregnancy , Pregnancy Complications, Hematologic/epidemiology , Prenatal Care , Tanzania/epidemiology
8.
Front Public Health ; 9: 719485, 2021.
Article in English | MEDLINE | ID: covidwho-1775832

ABSTRACT

The association between hunger and adherence to antiretroviral therapy (ART) is less known especially in vulnerable populations receiving HIV care and treatment services. Caregivers of orphans and vulnerable children (OVC) are vulnerable and likely to experience hunger due to additional economic pressure in caring for OVC. Using data from the community-based, USAID-funded Kizazi Kipya project, this study assesses the association between hunger and ART adherence among caregivers of OVC in Tanzania. HIV positive caregivers enrolled in the project from January to July 2017 were analyzed. The outcome variable was adherence to ART, defined as "not having missed any ART dose in the last 30 days," and household hunger, measured using the Household Hunger Scale (HHS), was the main independent variable. Data analysis included multivariable logistic regression. The study analyzed 11,713 HIV positive caregivers who were on ART at the time of enrollment in the USAID Kizazi Kipya project in 2017. Aged 48.2 years on average, 72.9% of the caregivers were female. While 34.6% were in households with little to no hunger, 59.4 and 6.0% were in moderate hunger and severe hunger households, respectively. Overall, 90.0% of the caregivers did not miss any ART dose in the last 30 days. ART adherence rates declined as household hunger increased (p < 0.001). Multivariable analysis showed that the odds of adhering to ART was significantly lower by 42% among caregivers in moderate hunger households than those in little to no hunger households (OR = 0.58, 95% CI 0.50-0.68). The decline increased to 47% among those in severe hunger households (OR = 0.53, 95% CI 0.41-0.69). Hunger is an independent and a significant barrier to ART adherence among caregivers LHIV in Tanzania. Improving access to adequate food as part of HIV care and treatment services is likely to improve ART adherence in this population.


Subject(s)
Child, Orphaned , HIV Infections , Caregivers , Child , Female , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Hunger , Middle Aged , Tanzania/epidemiology
9.
Antimicrob Resist Infect Control ; 11(1): 34, 2022 02 14.
Article in English | MEDLINE | ID: covidwho-1679967

ABSTRACT

BACKGROUND: The current Coronavirus disease pandemic reveals political and structural inequities of the world's poorest people who have little or no access to health care and yet the largest burdens of poor health. This is in parallel to a more persistent but silent global health crisis, antimicrobial resistance (AMR). We explore the fundamental challenges of health care in humans and animals in relation to AMR in Tanzania. METHODS: We conducted 57 individual interviews and focus groups with providers and patients in high, middle and lower tier health care facilities and communities across three regions of Tanzania between April 2019 and February 2020. We covered topics from health infrastructure and prescribing practices to health communication and patient experiences. RESULTS: Three interconnected themes emerged about systemic issues impacting health. First, there are challenges around infrastructure and availability of vital resources such as healthcare staff and supplies. Second, health outcomes are predicated on patient and provider access to services as well as social determinants of health. Third, health communication is critical in defining trusted sources of information, and narratives of blame emerge around health outcomes with the onus of responsibility for action falling on individuals. CONCLUSION: Entanglements between infrastructure, access and communication exist while constraints in the health system lead to poor health outcomes even in 'normal' circumstances. These are likely to be relevant across the globe and highly topical for addressing pressing global health challenges. Redressing structural health inequities can better equip countries and their citizens to not only face pandemics but also day-to-day health challenges.


Subject(s)
Health Services Accessibility/standards , Poverty/statistics & numerical data , Public Health/standards , Social Determinants of Health/standards , Animals , COVID-19/epidemiology , COVID-19/prevention & control , Global Health/standards , Global Health/statistics & numerical data , Health Services Accessibility/economics , Health Services Accessibility/statistics & numerical data , Humans , Public Health/statistics & numerical data , Social Determinants of Health/economics , Social Determinants of Health/statistics & numerical data , Tanzania/epidemiology
10.
BMC Med ; 19(1): 160, 2021 07 09.
Article in English | MEDLINE | ID: covidwho-1301851

ABSTRACT

BACKGROUND: East Africa is home to 170 million people and prone to frequent outbreaks of viral haemorrhagic fevers and various bacterial diseases. A major challenge is that epidemics mostly happen in remote areas, where infrastructure for Biosecurity Level (BSL) 3/4 laboratory capacity is not available. As samples have to be transported from the outbreak area to the National Public Health Laboratories (NPHL) in the capitals or even flown to international reference centres, diagnosis is significantly delayed and epidemics emerge. MAIN TEXT: The East African Community (EAC), an intergovernmental body of Burundi, Rwanda, Tanzania, Kenya, Uganda, and South Sudan, received 10 million € funding from the German Development Bank (KfW) to establish BSL3/4 capacity in the region. Between 2017 and 2020, the EAC in collaboration with the Bernhard-Nocht-Institute for Tropical Medicine (Germany) and the Partner Countries' Ministries of Health and their respective NPHLs, established a regional network of nine mobile BSL3/4 laboratories. These rapidly deployable laboratories allowed the region to reduce sample turn-around-time (from days to an average of 8h) at the centre of the outbreak and rapidly respond to epidemics. In the present article, the approach for implementing such a regional project is outlined and five major aspects (including recommendations) are described: (i) the overall project coordination activities through the EAC Secretariat and the Partner States, (ii) procurement of equipment, (iii) the established laboratory setup and diagnostic panels, (iv) regional training activities and capacity building of various stakeholders and (v) completed and ongoing field missions. The latter includes an EAC/WHO field simulation exercise that was conducted on the border between Tanzania and Kenya in June 2019, the support in molecular diagnosis during the Tanzanian Dengue outbreak in 2019, the participation in the Ugandan National Ebola response activities in Kisoro district along the Uganda/DRC border in Oct/Nov 2019 and the deployments of the laboratories to assist in SARS-CoV-2 diagnostics throughout the region since early 2020. CONCLUSIONS: The established EAC mobile laboratory network allows accurate and timely diagnosis of BSL3/4 pathogens in all East African countries, important for individual patient management and to effectively contain the spread of epidemic-prone diseases.


Subject(s)
COVID-19/prevention & control , Community Networks , Dengue/epidemiology , Hemorrhagic Fever, Ebola/epidemiology , Laboratories , Mobile Health Units , Burundi/epidemiology , COVID-19/therapy , Dengue/prevention & control , Epidemics , Hemorrhagic Fever, Ebola/prevention & control , Hemorrhagic Fever, Ebola/therapy , Humans , Kenya/epidemiology , Mobile Health Units/economics , Public Health , Rwanda/epidemiology , SARS-CoV-2 , South Sudan/epidemiology , Tanzania/epidemiology , Uganda/epidemiology
14.
Infect Dis Poverty ; 10(1): 5, 2021 Jan 07.
Article in English | MEDLINE | ID: covidwho-1015905

ABSTRACT

BACKGROUND: The pandemic of the coronavirus disease 2019 (COVID-19) has caused substantial disruptions to health services in the low and middle-income countries with a high burden of other diseases, such as malaria in sub-Saharan Africa. The aim of this study is to assess the impact of COVID-19 pandemic on malaria transmission potential in malaria-endemic countries in Africa. METHODS: We present a data-driven method to quantify the extent to which the COVID-19 pandemic, as well as various non-pharmaceutical interventions (NPIs), could lead to the change of malaria transmission potential in 2020. First, we adopt a particle Markov Chain Monte Carlo method to estimate epidemiological parameters in each country by fitting the time series of the cumulative number of reported COVID-19 cases. Then, we simulate the epidemic dynamics of COVID-19 under two groups of NPIs: (1) contact restriction and social distancing, and (2) early identification and isolation of cases. Based on the simulated epidemic curves, we quantify the impact of COVID-19 epidemic and NPIs on the distribution of insecticide-treated nets (ITNs). Finally, by treating the total number of ITNs available in each country in 2020, we evaluate the negative effects of COVID-19 pandemic on malaria transmission potential based on the notion of vectorial capacity. RESULTS: We conduct case studies in four malaria-endemic countries, Ethiopia, Nigeria, Tanzania, and Zambia, in Africa. The epidemiological parameters (i.e., the basic reproduction number [Formula: see text] and the duration of infection [Formula: see text]) of COVID-19 in each country are estimated as follows: Ethiopia ([Formula: see text], [Formula: see text]), Nigeria ([Formula: see text], [Formula: see text]), Tanzania ([Formula: see text], [Formula: see text]), and Zambia ([Formula: see text], [Formula: see text]). Based on the estimated epidemiological parameters, the epidemic curves simulated under various NPIs indicated that the earlier the interventions are implemented, the better the epidemic is controlled. Moreover, the effect of combined NPIs is better than contact restriction and social distancing only. By treating the total number of ITNs available in each country in 2020 as a baseline, our results show that even with stringent NPIs, malaria transmission potential will remain higher than expected in the second half of 2020. CONCLUSIONS: By quantifying the impact of various NPI response to the COVID-19 pandemic on malaria transmission potential, this study provides a way to jointly address the syndemic between COVID-19 and malaria in malaria-endemic countries in Africa. The results suggest that the early intervention of COVID-19 can effectively reduce the scale of the epidemic and mitigate its impact on malaria transmission potential.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Malaria/epidemiology , Malaria/therapy , COVID-19/transmission , COVID-19/virology , Ethiopia/epidemiology , Humans , Malaria/transmission , Markov Chains , Nigeria/epidemiology , Pandemics , SARS-CoV-2/isolation & purification , Syndemic , Tanzania/epidemiology , Zambia/epidemiology
15.
Pan Afr Med J ; 35(Suppl 2): 125, 2020.
Article in English | MEDLINE | ID: covidwho-962480

ABSTRACT

INTRODUCTION: the current COVID-19 pandemic has occasioned the increased adoption of telemedicine. This study reports the uptake and trend of a new teleconsultation service in a Tanzanian hospital. METHODS: this is a retrospective observational study that profiled requests for teleconsultations and uptake of the service between April 1, 2020, and June 30, 2020. RESULTS: two hundred and eighteen telephone inquiries were received over the 3 months. One hundred and sixteen (53.2%) individuals followed through with the teleconsultations. Paediatric (38.8%) and Internal medicine (32.8%) were the subspecialties with the highest number of teleconsultations. In a frame of 3 months, teleconsultation uptake was highest in May and lowest in June. CONCLUSION: there was a steady rise and a rapid fall in requests and uptake of teleconsultation services over the period under evaluation. Lack of insurance coverage for teleconsultations was a significant barrier. We propose a re-education and reiteration of the benefits of telemedicine to all stakeholders. This is important for the current era and beyond.


Subject(s)
COVID-19/therapy , Delivery of Health Care/trends , Remote Consultation/statistics & numerical data , SARS-CoV-2 , Tertiary Care Centers , COVID-19/epidemiology , Humans , Retrospective Studies , Tanzania/epidemiology
16.
Pan Afr Med J ; 35(Suppl 2): 146, 2020.
Article in English | MEDLINE | ID: covidwho-946296

ABSTRACT

Prevention of exposure to the COVID-19 virus in the general population is an essential strategy to slow community transmission. This paper shares the experiences and challenges of community engagement in COVID-19 prevention in the Kilimanjaro region, Northern Tanzania implemented by our team from the Institute of Public Health (IPH), Kilimanjaro Christian Medical University College (KCMUCo) in collaboration with the COVID-19 response team in the Moshi Municipality. We conducted an education session with the COVID-19 response team and together brainstormed transmission hotspots and which interventions would be most feasible in their settings. The first hotspot identified was crowded local market spaces. Suggested interventions included targeted and mass public health education through the engagement of market opinion leaders, public announcements, and radio shows. We conducted participatory rural appraisal techniques to enable market vendors and clients to visualize two-meter distances and provided a prototype hand-washing facility that was foot operated. We found mass public health educational campaigns essential to inform and update the public about COVID-19 pandemic and to address rumors and misinformation, which hampers compliance with public health interventions. Coordinated efforts among stakeholders in the country are necessary to develop context-specific prevention and case management strategies following the national and international guidelines. Local ownership of recommended interventions is necessary to ensure compliance.


Subject(s)
Betacoronavirus , Communicable Disease Control/organization & administration , Community Participation , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Hand Disinfection/instrumentation , Health Education/methods , Health Education/organization & administration , Humans , Intersectoral Collaboration , Leadership , Mass Media , Mobile Applications , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Private Facilities , Public Health , Rural Population , SARS-CoV-2 , Stakeholder Participation , Tanzania/epidemiology
17.
J Biol Dyn ; 14(1): 748-766, 2020 12.
Article in English | MEDLINE | ID: covidwho-842271

ABSTRACT

The outbreak of COVID-19 was first experienced in Wuhan City, China, during December 2019 before it rapidly spread over globally. This paper has proposed a mathematical model for studying its transmission dynamics in the presence of face mask wearing and hospitalization services of human population in Tanzania. Disease-free and endemic equilibria were determined and subsequently their local and global stabilities were carried out. The trace-determinant approach was used in the local stability of disease-free equilibrium point while Lyapunov function technique was used to determine the global stability of both disease-free and endemic equilibrium points. Basic reproduction number, R 0 , was determined in which its numerical results revealed that, in the presence of face masks wearing and medication services or hospitalization as preventive measure for its transmission, R 0 = 0.698 while in their absence R 0 = 3.8 . This supports its analytical solution that the disease-free equilibrium point E 0 is asymptotically stable whenever R 0 < 1 , while endemic equilibrium point E ∗ is globally asymptotically stable for R 0 > 1 . Therefore, this paper proves the necessity of face masks wearing and hospitalization services to COVID-19 patients to contain the disease spread to the population.


Subject(s)
Betacoronavirus , Coronavirus Infections/transmission , Models, Biological , Pandemics , Pneumonia, Viral/transmission , Basic Reproduction Number , COVID-19 , Computer Simulation , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Disease Susceptibility , Endemic Diseases/prevention & control , Endemic Diseases/statistics & numerical data , Humans , Masks/statistics & numerical data , Mathematical Concepts , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Tanzania/epidemiology
19.
Lancet Glob Health ; 8(6): e780-e789, 2020 06.
Article in English | MEDLINE | ID: covidwho-186479

ABSTRACT

BACKGROUND: As coronavirus disease 2019 (COVID-19) spreads, weak health systems must not become a vehicle for transmission through poor infection prevention and control practices. We assessed the compliance of health workers with infection prevention and control practices relevant to COVID-19 in outpatient settings in Tanzania, before the pandemic. METHODS: This study was based on a secondary analysis of cross-sectional data collected as part of a randomised controlled trial in private for-profit dispensaries and health centres and in faith-based dispensaries, health centres, and hospitals, in 18 regions. We observed provider-patient interactions in outpatient consultation rooms, laboratories, and dressing rooms, and categorised infection prevention and control practices into four domains: hand hygiene, glove use, disinfection of reusable equipment, and waste management. We calculated compliance as the proportion of indications (infection risks) in which a health worker performed a correct action, and examined associations between compliance and health worker and facility characteristics using multilevel mixed-effects logistic regression models. FINDINGS: Between Feb 7 and April 5, 2018, we visited 228 health facilities, and observed at least one infection prevention and control indication in 220 facilities (118 [54%] dispensaries, 66 [30%] health centres, and 36 [16%] hospitals). 18 710 indications were observed across 734 health workers (49 [7%] medical doctors, 214 [29%] assistant medical officers or clinical officers, 106 [14%] nurses or midwives, 126 [17%] clinical assistants, and 238 [32%] laboratory technicians or assistants). Compliance was 6·9% for hand hygiene (n=8655 indications), 74·8% for glove use (n=4915), 4·8% for disinfection of reusable equipment (n=841), and 43·3% for waste management (n=4299). Facility location was not associated with compliance in any of the infection prevention and control domains. Facility level and ownership were also not significantly associated with compliance, except for waste management. For hand hygiene, nurses and midwives (odds ratio 5·80 [95% CI 3·91-8·61]) and nursing and medical assistants (2·65 [1·67-4·20]) significantly outperformed the reference category of assistant medical officers or clinical officers. For glove use, nurses and midwives (10·06 [6·68-15·13]) and nursing and medical assistants (5·93 [4·05-8·71]) also significantly outperformed the reference category. Laboratory technicians performed significantly better in glove use (11·95 [8·98-15·89]), but significantly worse in hand hygiene (0·27 [0·17-0·43]) and waste management (0·25 [0·14-0·44] than the reference category. Health worker age was negatively associated with correct glove use and female health workers were more likely to comply with hand hygiene. INTERPRETATION: Health worker infection prevention and control compliance, particularly for hand hygiene and disinfection, was inadequate in these outpatient settings. Improvements in provision of supplies and health worker behaviours are urgently needed in the face of the current pandemic. FUNDING: UK Medical Research Council, Economic and Social Research Council, Department for International Development, Global Challenges Research Fund, Wellcome Trust.


Subject(s)
Ambulatory Care Facilities , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Guideline Adherence/statistics & numerical data , Infection Control/standards , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , COVID-19 , Cross-Sectional Studies , Humans , Tanzania/epidemiology
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