Prevention of mother-to-child transmission of HIV in a refugee camp setting in Tanzania.

The objective of this article is to describe the results of a 2-year pilot programme implementing prevention of mother to child HIV transmission (PMTCT) in a refugee camp setting. Interventions used were: community sensitization, trainings of healthcare workers, voluntary counselling and HIV testing (VCT), infant feeding, counselling, and administration of Nevirapine. Main outcome measures include: HIV testing acceptance rates, percentage of women receiving post test counselling, Nevirapine uptake, and HIV prevalence among pregnant women and their infants. Ninety-two percent of women (n=9,346) attending antenatal clinics accepted VCT. All women who were tested for HIV received their results and posttest counselling. The HIV prevalence rate among the population was 3.2%. The overall Nevirapine uptake in the camp was 97%. Over a third of women were repatriated before receiving Nevirapine. Only 14% of male counterparts accepted VCT. Due to repatriation, parent's refusal, and deaths, HIV results were available for only 15% of infants born to HIV-infected mothers. The PMTCT programme was successfully integrated into existing antenatal care services and was acceptable to the majority of pregnant women. The major challenges encountered during the implementation of this programme were repatriation of refugees before administration of Nevirapine, which made it difficult to measure the impact of the PMTCT programme.

Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations.

Childhood obesity is a global epidemic and rising trends in overweight and obesity are apparent in both developed and developing countries. Available estimates for the period between the 1980s and 1990s show the prevalence of overweight and obesity in children increased by a magnitude of two to five times in developed countries (e.g. from 11% to over 30% in boys in Canada), and up to almost four times in developing countries (e.g. from 4% to 14% in Brazil). The goal of this synthesis research study was to develop best practice recommendations based on a systematic approach to finding, selecting and critically appraising programmes addressing prevention and treatment of childhood obesity and related risk of chronic diseases. An international panel of experts in areas of relevance to obesity provided guidance for the study. This synthesis research encompassed a comprehensive search of medical/academic and grey literature and the Internet covering the years 1982-2003. The appraisal approach developed to identify best practice was unique, in that it considered not only methodological rigour, but also population health, immigrant health and programme development/evaluation perspectives in the assessment. Scores were generated based on pre-determined criteria with programmes scoring in the top tertile of the scoring range in any one of the four appraisal categories included for further examination. The synthesis process included identification of gaps and an analysis and summary of programme development and programme effectiveness to enable conclusions to be drawn and recommendations to be made. The results from the library database searches (13,158 hits), the Internet search and key informant surveys were reduced to a review of 982 reports of which 500 were selected for critical appraisal. In total 158 articles, representing 147 programmes, were included for further analysis. The majority of reports were included based on high appraisal scores in programme development and evaluation with limited numbers eligible based on scores in other categories of appraisal. While no single programme emerged as a model of best practice, synthesis of included programmes provided rich information on elements that represent innovative rather than best practice under particular circumstances that are dynamic (changing according to population subgroups, age, ethnicity, setting, leadership, etc.). Thus the findings of this synthesis review identifies areas for action, opportunities for programme development and research priorities to inform the development of best practice recommendations that will reduce obesity and chronic disease risk in children and youth. A lack of programming to address the particular needs of subgroups of children and youth emerged in this review. Although immigrants new to developed countries may be more vulnerable to the obesogenic environment, no programmes were identified that specifically targeted their potentially specialized needs (e.g. different food supply in a new country). Children 0-6 years of age and males represented other population subgroups where obesity prevention programmes and evidence of effectiveness were limited. These gaps are of concern because (i) the pre-school years may be a critical period for obesity prevention as indicated by the association of the adiposity rebound and obesity in later years; and (ii) although the growing prevalence of obesity affects males and females equally; males may be more vulnerable to associated health risks such as cardiovascular disease. Other gaps in knowledge identified during synthesis include a limited number of interventions in home and community settings and a lack of upstream population-based interventions. The shortage of programmes in community and home settings limits our understanding of the effectiveness of interventions in these environments, while the lack of upstream investment indicates an opportunity to develop more upstream and population-focused interventions to balance and extend the current emphasis on individual-based programmes. The evidence reviewed indicates that current programmes lead to short-term improvements in outcomes relating to obesity and chronic disease prevention with no adverse effects noted. This supports the continuation and further development of programmes currently directed at children and youth, as further evidence for best practice accumulates. In this synthesis, schools were found to be a critical setting for programming where health status indicators, such as body composition, chronic disease risk factors and fitness, can all be positively impacted. Engagement in physical activity emerged as a critical intervention in obesity prevention and reduction programmes. While many programmes in the review had the potential to integrate chronic disease prevention, few did; therefore efforts could be directed towards better integration of chronic disease prevention programmes to minimize duplication and optimize resources. Programmes require sustained long-term resources to facilitate comprehensive evaluation that will ascertain if long-term impact such as sustained normal weight is maintained. Furthermore, involving stakeholders in programme design, implementation and evaluation could be crucial to the success of interventions, helping to ensure that needs are met. A number of methodological issues related to the assessment of obesity intervention and prevention programmes were identified and offer insight into how research protocols can be enhanced to strengthen evidence for obesity interventions. Further research is required to understand the merits of the various forms in which interventions (singly and in combination) are delivered and in which circumstances they are effective. There is a critical need for the development of consistent indicators to ensure that comparisons of programme outcomes can be made to better inform best practice.

Tuberculosis in a prison population in Mwanza, Tanzania (1994-1997).

SETTING: Bugando Medical Centre, a referral consultant hospital in the lake zone to which all inmates from Butimba prison are admitted and treated. OBJECTIVE: To determine the extent of open (smear-positive) tuberculosis and other types of tuberculosis among prisoners with tuberculosis. DESIGN: A retrospective cohort study. Case notes of 501 prisoners from January 1994 to December 1997 were retrieved and reviewed. RESULTS: The proportion of open tuberculosis in this study was high, with 204 prisoners (40.7%) having smear-positive tuberculosis. Co-infection was recorded in the majority of patients; HIV/AIDS was recorded in 25.9% of cases. The mean length of imprisonment at the time of diagnosis was 19 months. CONCLUSION: The proportion of open, smear-positive tuberculosis among prisoners admitted with tuberculosis is high. Intervention measures specifically targeting this population are urgently needed in order to contain tuberculosis disease in the prison population.

Epidemiology of injury patients at Bugando Medical Centre, Tanzania.

OBJECTIVE: To describe the epidemiologic characteristics of injury cases at Bugando Medical Centre. SETTING: Bugando Medical Centre, Mwanza, Tanzania. DATA SOURCES: Records, registries and case notes in the surgical wards and clinic, casualty, medical record department, radiology and theatre from January 1995 to December 1997. STUDY SAMPLE: Cases attended to at Bugando and diagnosed to have had an injury during the stated period. Only those whose records were complete and available were recruited in the study. DATA EXTRACTION: A special data sheet was used to collect the required information from the registries in surgical wards clinic, casualty, theatre, radiology and medical records. Data analysis was Dbase IV and SPSS (version 9.0). RESULTS: There were 3,590 cases of injury recorded at the centre of whom 3340 (93%) whose data were complete were available for analysis. Of the cases, 2,443 (73.1%) were males and 897 (26.9%) females while 252 (7.7%) were children under five years. The most affected age group were the 20-59 year category comprising of mostly males. The leading causes of injuries were falls, assault (28.7%) and motor traffic accidents (17.9%). Mortality was (2.2%) for all causes, and permanent disability was two per cent. The mean length of stay in hospital was 21 days (range: 1-321 days). CONCLUSION: A more comprehensive study isrecommended to determine risk factors and magnitude of the problem.

Injury registration in a developing country. A study based on patients' records from four hospitals in Dar es Salaam, Tanzania.

BACKGROUND: A recent study conducted in some parts of Tanzania has revealed that injuries rank as the third major leading cause of death among the adult population only after tuberculosis and HIV/AIDS. Critical to any injury prevention activities is a reliable surveillance system. Such a system may for instance be based on hospital registration of injuries. OBJECTIVES: The aim of this study was to evaluate available hospital records for the purpose of describing the epidemiology of injuries among inpatients in four hospitals in Dar es Salaam, Tanzania. METHODS: The study utilized patients' medical records for the year 1998. The final sample included 1098 cases from four hospitals. Data handling and analysis was performed using statistical software SPSS for windows version 10.0. Cross tabulations with Chi-square testing for independence, t-test for difference between means (independent groups) and one way analysis of variance was used. RESULTS: The age group 21 to 30 years formed the largest proportion of injury-related admissions. The male to female ratio was 2.3 to 1. The largest categories of injuries were road traffic injuries (43.7%), violence and assaults (23.5%), and falls (13.8%). Burns accounted for 6.5% of the cases. The following variables were routinely recorded in case notes: gender (100%), nature of injury/principal diagnosis (99.6%), body part injured (99.4%), and age (96.4%). CONCLUSIONS: There is a need for improving the way injuries are recorded in hospitals. Hospitals' records could provide a useful tool for monitoring injury preventive activities in developing countries like Tanzania.