One Week Prevalence and Incidence of Diarrhea: Baseline Status of Cluster Randomised Controlled Trial of Nano Maji Filter System in Geita, Tanzania.

Background: We have developed Nano Maji (NMM) filter system for water treatment which is currently being evaluated in a definitive cluster randomised controlled trial. Objectives: This paper descriptively presents the baseline status of one-week incidence and prevelence of diarrhoea water, sanitation and hygiene and their determinants. Methods: Recruited households in the three villages of Geita district were allocated to either intervention (NNM filter system) or control (usual practice). The primary outcome of the trial is to reduce episodes of diarrhoea at 6 months post-randomisation. Secondary outcomes are to improve water, sanitation and hygiene (WASH) status. Although households were sampled, individuals living in the selected households are used as unit of analysis for estimation of prevalence and incidence of diarrhea. Results: A total of 1,281 individuals (1,070 above 5 years and 211 under the age of 5 year children) lived in 186 households (7 individuals per household). The reported one-week prevalence and incidence of diarrhea was 10.8% and 8.4% respectively. Children under the age of five years had high incidence (22.7%) of diarrhea than individuals aged 5 years and above (5.6%). Among under five children, boys had high incidence and prevalence of diarrhea than girls. Individuals with diarrhea were likely to live in poor household, not using safe water and toilet. Over 70% of households had unacceptable latrines 135 (72.7%) and poor water situation 138 (74.3%) in terms of practice of storing, treating and drawing water from storage container. Majority of respondents had limited knowledge on handwashing and rarely used soap when washing hands. Conclusion: Substantial proportion of individuals living in project areas are affected by diarrhea. Children below the age of five years are more affected than individuals aged five years and above. The baseline findings are representative of local status of WASH, and reflects the prevailing poor water, sanitation and hygiene status in rural areas of Tanzania. Trial approval number NIMR/HQ/R.8a/Vol. IX/3045.

A Qualitative Study of Perceived Risk of Occupational Exposure to HIV and Use of Post Exposure Prophylaxis Services Among Health-Care Workers in Tanzania.

BACKGROUND: Occupational exposure to HIV continues to present a risk of HIV infections to health-care workers (HCWs) in low-income countries. Since 2005, policies in Tanzania have been in place to guide the implementation of HIV/AIDS post-exposure prophylaxis (PEP) interventions in the workplace. However, little is known about how frontline HCWs experience and view these interventions. This study aimed to explore how HCWs perceive their HIV infection risk and capture their experiences of workplace HIV/AIDS interventions. METHODS: A descriptive qualitative design was used. Medical and nonmedical personnel from 2 hospitals in the Pwani and Dodoma regions of Tanzania participated in the study. We conducted 22 In-depth interviews (IDIs) with HCWs (heads of departments, hospital units, or sections). A content analysis approach was used. RESULTS: The HCWs perceived and reasoned that working in medical wards, incinerator units, dental units, obstetric wards, laundries, laboratories, and mortuaries exposed them to HIV acquisition risk. Many of the medically trained personnel reported that invasive procedures exposed them to some risk of HIV infection. Nonmedical personnel reported to be potentially exposed to HIV infection while incorrectly handling discarded needles and blades (sharps). Although most HCWs expressed awareness about the availability of postexposure prophylaxis (PEP), not all HCWs knew where to report and whom to contact in case of accidents. Ignorance about the implications of exposure to contaminated sharps hindered PEP use among certain cadres. Also, some PEP users were reported to experience side effects, but they were motivated to complete the doses to remain healthy. CONCLUSION: Occupational exposure to HIV infection remains a significant concern to HCWs, particularly among nonmedical cadres. Despite expressed awareness about infection prevention and control, the reporting channels and the strategies to promote recognition of the importance of using PEP services after exposure need to be strengthened.

Efficacy of standardized extract of Hibiscus sabdariffa L. (Malvaceae) in improving iron status of adults in malaria endemic area: A randomized controlled trial.

ETHNOPHARMACOLOGICAL RELEVANCE: Indigenous community of Mkuranga district have been using aqueous extract of H. sabdariffa L. for treating anemia. However, there have been neither safety nor efficacy studies to validate this medicinal product in anemia. AIM: The purpose of this study was to establish efficacy and safety of standardized aqueous extract of H. sabdariffa L. in anemic adults. MATERIALS AND METHODS: This was a randomized controlled clinical trial in which 130 adults' men and women aged 18-50 years were involved after meeting the inclusion criteria. Initially, standardized aqueous extract of H. sabdariffa L. was prepared using optimized extraction parameters. Stratified randomization was used to randomize participants into four fixed dose groups. The first group received oral dose of 1000ml while the 2nd group was randomized to receive 1500ml orally. The last two groups were given a dose of 2000ml of extract and 200mg ferrous sulphate tablet respectively. Primary endpoint was the actual change of iron status indicators at the end of 30 days follow up period as compared to those recorded at baseline. Adverse effects were assessed at every 10th day scheduled visit. In all arms, HB and hematopoietic parameters were measured using HemoCue hemoglobinometer® (HemoCue, Ängelholm, Sweden) and hematology analyzer® respectively at the trial site. Follow up was done for 30 days. A total of 82 participants were included for analysis. RESULTS: A standardized aqueous extract of H. sabdariffa L. did not improve iron status in anemic adults in malaria endemic region (P>0.005). However, there was evidence to support the safety of the extract for human consumptions as herbal supplement. Iron and organic acids contents of H. sabdariffa L. extract showed the potential of improving hematopoietic parameters. Studies with bigger sample size are therefore needed to establish the efficacy of the extract when concurrently used with malaria chemoprophylaxis in malaria endemic areas.

Biosocial Determinants of Persistent Schistosomiasis among Schoolchildren in Tanzania despite Repeated Treatment.

Schistosomiasis is a parasitic disease endemic to Tanzania and other countries of the global south, which is currently being addressed through preventive chemotherapy campaigns. However, there is growing recognition that chemotherapy strategies will need to be supplemented to sustainably control and eventually eliminate the disease. There remains a need to understand the factors contributing to continued transmission in order to ensure the effective configuration and implementation of supplemented programs. We conducted a cross-sectional questionnaire, to evaluate the biosocial determinants facilitating the persistence of schistosomiasis, among 1704 Tanzanian schoolchildren residing in two districts undergoing a preventive chemotherapeutic program: Rufiji and Mkuranga. A meta-analysis was carried out to select the diagnostic questions that provided a likelihood for predicting infection status. We found that self-reported schistosomiasis continues to persist among the schoolchildren, despite multiple rounds of drug administration.Using mixed effects logistic regression modeling, we found biosocial factors, including gender, socio-economic status, and water, sanitation, and hygiene (WASH)-related variables, were associated with this continued schistosomiasis presence. These findings highlight the significant role that social factors may play in the persistence of disease transmission despite multiple treatments, and support the need not only for including integrated technical measures, such as WASH, but also addressing issues of poverty and gender when designing effective and sustainable schistosomiasis control programs.

Prevalence, one week incidence and knowledge on causes of diarrhea: household survey of under-fives and adults in Mkuranga district, Tanzania.

BACKGROUND: Diarrhea is known to be the major cause of mortality in children aged less than five years old. Although mortality from diarrheal disease is decreasing globally, morbidity is not. The objectives of this study were to determine the prevalence of diarrhea among under-fives and assess knowledge on causes of diarrhea among adults in Mkuranga district Tanzania. METHODS: Interviews with heads of households and observations were the methods of data collection employed by this study. RESULTS: The prevalence of diarrhea in children below the age of five years as reported by heads of households was 6.1% and most affected were children in age groups 12-17 and 18-23 months (11.6% and 15.8% respectively; p-value 0.001). The rate of diarrhea incidence was 1 episode per 10 children per week. The mean duration of diarrhea illness was 1.7 days. Most under-fives had diarrhea for one (38.1%) or two (24%) days. Respondents in the 4th least poor quintile were more likely to have comprehensive knowledge on causes of diarrhea compared to respondents in the 1st poorest quintile. Male respondents were two times more likely to have comprehensive knowledge than female respondents. Respondents with comprehensive knowledge on causes of diarrhea were less likely to have poor hand-washing practice and more likely to have received water, hygiene and sanitation education. Under-fives in age group 12-17 months and those from households with reported poor hand washing practice were more likely to experience diarrhea episodes. CONCLUSION: Although prevalence of diarrhea reported in this study is low, the one week incidence is moderately high but less severe. Majority of household respondents had inadequate knowledge on causes of diarrhea and poor hand-washing practice. There is a need to provide WASH education to improve their knowledge on causes of diarrhea and hand washing practice.

Ethno-medicinal knowledge and plants traditionally used to treat anemia in Tanzania: a cross sectional survey.

ETHNOPHARMACOLOGICAL RELEVANCE: Indigenous communities have often served as rich repositories of empirical knowledge on medicinal plants used for anemia. Use of these plants need to be validated with respect to their efficacy and safety so as to provide scientific basis of their use. Quantifying presence of medicinal plants used for anemia treatment, validating indigenous knowledge and extent of its use in rural Mkuranga district, Tanzania is the main focus of this paper. METHODS: A cross sectional study conducted in May and December 2013 at Mkuranga District of Coastal region of Tanzania. Forty key informants including traditional healers, religious leaders, community members and healthcare workers were interviewed using semi structured questionnaire. Eight focus group discussions were also conducted. Both interviews and focus group discussion gathered data on socio-demographics, general knowledge of anemia and plants used to correct anemia. In a brief field visit, all plants mentioned during the interview were collected and later identified. Both NVivo 10 and STATA softwares were employed for statistical analysis. RESULTS: Out of 40 participants, 31 were traditional healers, majority were male (77.4%). Mean age of the participants was 55.7±15 years. About 45% had no any formal education and majority (80%) were married. Twenty eight plant species are used to treat anemia. Hibiscus sabdariffa was the most mentioned species. The species belongs to 24 families, with Euphorbiaceae (14.3%) having the largest number. Lawsonia inermis, Aloe sp, Uvaria acuminata, Parinari curatellifolia, Ozoroa reticulata, Manihot esculenta, Canthium sp and Afzelia quanzensis were the plant species in which their claimed use for anemia were novel. CONCLUSIONS: People in rural areas of Mkuranga district possess a rich traditional knowledge of medicinal plants species for anemia treatment. Researches on these plants showed promising anti-anemic activity. Analysis and documentation of this knowledge has not only helped the analysis and recognition of novel information, it also contributed to conserving it for future generations.

Estimated risk of HIV acquisition and practice for preventing occupational exposure: a study of healthcare workers at Tumbi and Dodoma Hospitals, Tanzania.

BACKGROUND: Healthcare workers (HCWs) are at risk of acquiring human immuno-deficiency virus (HIV) and other infections via exposure to infectious patients' blood and body fluids. The main objective of this study was to estimate the risk of HIV transmission and examine the practices for preventing occupational exposures among HCWs at Tumbi and Dodoma Hospitals in Tanzania. METHODS: This study was carried out in two hospitals, namely, Tumbi in Coast Region and Dodoma in Dodoma Region. In each facility, hospital records of occupational exposure to HIV infection and its management were reviewed. In addition, practices to prevent occupational exposure to HIV infection among HCWs were observed. RESULTS: The estimated risk of HIV transmission due to needle stick injuries was calculated to be 7 cases per 1,000,000 HCWs-years. Over half of the observed hospital departments did not have guidelines for prevention and management of occupational exposure to HIV infections and lacked well displayed health and safety instructions. Approximately, one-fifth of the hospital departments visited failed to adhere to the instructions pertaining to correlation between waste materials and the corresponding colour coded bag/container/safety box. Seventy four percent of the hospital departments observed did not display instructions for handling infectious materials. Inappropriate use of gloves, lack of health and safety instructions, and lack of use of eye protective glasses were more frequently observed at Dodoma Hospital than at Tumbi Hospital. CONCLUSIONS: The poor quality of the hospital records at the two hospitals hampered our effort to characterise the risk of HIV infection acquisition by HCWs. Greater data completeness in hospital records is needed to allow the determination of the actual risk of HIV transmission for HCWs. To further reduce the risk of HIV infection due to occupational exposure, hospitals should be equipped with sufficient personal protective equipment (PPE) and HCWs should be reminded of the importance of adhering to universal precautions.

Self-reported occupational exposure to HIV and factors influencing its management practice: a study of healthcare workers in Tumbi and Dodoma Hospitals, Tanzania.

BACKGROUND: Blood borne infectious agents such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immune deficiency virus (HIV) constitute a major occupational hazard for healthcare workers (HCWs). To some degree it is inevitable that HCWs sustain injuries from sharp objects such as needles, scalpels and splintered bone during execution of their duties. However, in Tanzania, there is little or no information on factors that influence the practice of managing occupational exposure to HIV by HCWs. This study was conducted to determine the prevalence of self-reported occupational exposure to HIV among HCWs and explore factors that influence the practice of managing occupational exposure to HIV by HCWs in Tanzania. METHODS: Self-administered questionnaire was designed to gather information of healthcare workers' occupational exposures in the past 12 months and circumstances in which these injuries occurred. Practice of managing occupational exposure was assessed by the following questions: RESULTS: Nearly half of the HCWs had experienced at least one occupational injury in the past 12 months. Though most of the occupational exposures to HIV were experienced by female nurses, non-medical hospital staff received PEP more frequently than nurses and doctors. Doctors and nurses frequently encountered occupational injuries in surgery room and labor room respectively. HCWs with knowledge on the possibility of HIV transmission and those who knew whom to contact in event of occupational exposure to HIV were less likely to have poor practice of managing occupational exposure. CONCLUSION: Needle stick injuries and splashes are common among HCWs at Tumbi and Dodoma hospitals. Knowledge of the risk of HIV transmission due to occupational exposure and knowing whom to contact in event of exposure predicted practice of managing the exposure. Thus provision of health education on occupational exposure may strengthen healthcare workers' practices to manage occupational exposure.

Changes in the quality of life of Tanzanian school children after treatment interventions using the Child-OIDP.

This study aimed to examine the evaluative properties of the Child Oral Impacts on Daily Performances (Child-OIDP) inventory and to estimate treatment-associated changes in the OIDP and self-reported oral health following atraumatic restorative treatment (ART) and oral health education (OHE). A total of 1,306 school attendees in Kilwa, Tanzania, completed the Child-OIDP inventory before, and 6 months after, treatment. The post-treatment questionnaire assessed change in perceived oral health. Complete baseline and follow-up data were obtained for 104, 117, and 1,085 participants who received, respectively, ART fillings (Group A), ART fillings and tooth extraction (Group B), and OHE only (Group C). The longitudinal validity, responsiveness, and treatment-associated changes were calculated using anova, effect sizes, and repeated general linear models (GLM). The follow-up prevalence was 73.8%. The mean changes in the OIDP total- and subscale scores were negative within those who reported 'worsened' oral health, and positive in subjects reporting 'improved' oral health. Effect sizes for the total OIDP score ranged from -0.2 within the category 'worsened' to 0.4 within the category 'improved'. Changes following treatment were more extensive in Group B compared with Groups A and C, and in Group C compared with Group A. The Child-OIDP showed promising evaluative properties and responsiveness to change following ART fillings, ART fillings and tooth extraction, and OHE.

Socio-demographic disparity in oral health among the poor: a cross sectional study of early adolescents in Kilwa district, Tanzania.

BACKGROUND: There is a lack of studies considering social disparity in oral health emanating from adolescents in low-income countries. This study aimed to assess socio-demographic disparities in clinical- and self reported oral health status and a number of oral health behaviors. The extent to which oral health related behaviors might account for socio-demographic disparities in oral health status was also examined. METHODS: A cross-sectional study was conducted in Kilwa district in 2008. One thousand seven hundred and forty five schoolchildren completed an interview and a full mouth clinical examination. Caries experience was recorded using WHO criteria, whilst type of treatment need was categorized using the ART approach. RESULTS: The majority of students were caries free (79.8%) and presented with a low need for dental treatment (89.3%). Compared to their counterparts in opposite groups, rural residents and those from less poor households presented more frequently with caries experience (DMT>0), high need for dental treatment and poor oral hygiene behavior, but were less likely to report poor oral health status. Stepwise logistic regressions revealed that social and behavioral variables varied systematically with caries experience, high need for dental treatment and poor self reported oral health. Socio-demographic disparities in oral health outcomes persisted after adjusting for oral health behaviors. CONCLUSIONS: Socio-demographic disparities in oral health outcomes and oral health behaviors do exist. Socio-demographic disparities in oral health outcomes were marginally accounted for by oral health behaviors. Developing policies and programs targeting both social and individual determinants of oral health should be an urgent public health strategy in Tanzania.

Dental pain, oral impacts and perceived need for dental treatment in Tanzanian school students: a cross-sectional study.

BACKGROUND: Dental caries, dental pain and reported oral problems influence people's oral quality of life and thus their perceived need for dental care. So far there is scant information as to the psychosocial impacts of dental diseases and the perceived treatment need in child populations of sub-Saharan Africa. OBJECTIVES: Focusing on primary school students in Kilwa, Tanzania, a district deprived of dental services and with low fluoride concentration in drinking water, this study aimed to assess the prevalence of dental pain and oral impacts on daily performances (OIDP), and to describe the distribution of OIDP by socio-demographics, dental caries, dental pain and reported oral problems. The relationship of perceived need estimates with OIDP was also investigated. METHODS: A cross-sectional study was conducted in 2008. A total of 1745 students (mean age 13.8 yr, sd = 1.67) completed an extensive personal interview and under-went clinical examination. The impacts on daily performances were assessed using a Kiswahili version of the Child-OIDP instrument and caries experience was recorded using WHO (1997) criteria. RESULTS: A total of 36.2% (41.3% urban and 31.4% rural, p < 0.001) reported at least one OIDP. The prevalence of dental caries was 17.4%, dental pain 36.4%, oral problems 54.1% and perceived need for dental treatment 46.8% in urban students. Corresponding estimates in rural students were 20.8%, 24.4%, 43.3% and 43.8%. Adjusted OR for reporting oral impacts if having dental pain ranged from 2.5 (95% CI 1.8-3.6) (problem smiling) to 4.7 (95% CI 3.4-6.5) (problem sleeping),--if having oral problems, from 1.9 (95% CI 1.3-2.6) (problem sleeping) to 3.8 (95% CI 2.7-5.2) (problem eating) and if having dental caries from 1.5 (95% CI 1.1-2.0) (problem eating) to 2.2 (95% CI 1.5-2.9) (problem sleeping). Students who perceived need for dental care were less likely to be females (OR = 0.8, 95% CI 0.6-0.9) and more likely to have impacts on eating (OR = 1.9, 95% CI 1.4-2.7) and tooth cleaning (OR = 1.6, 95% CI 1.6-2.5). CONCLUSION: Substantial proportions of students suffered from untreated dental caries, oral impacts on daily performances and perceived need for dental care. Dental pain and reported oral problems varied systematically with OIDP across the eight impacts considered. Eating and tooth cleaning problems discriminated between subjects who perceived need for dental treatment and those who did not.