Road traffic injury on rural roads in Tanzania: measuring the effectiveness of a road safety program.

OBJECTIVE: Road traffic injuries (RTIs) are a major public health burden, especially in low- and middle-income countries. There is limited data on RTIs in low-volume, rural African settings. This study attempted to survey all individuals living in households within 200 m of two low-volume rural roads in Tanzania and to collect data on RTIs. METHODS: Local communities and users of the Bago to Talawanda road (intervention site) and Kikaro to Mihuga road (control site) were targeted and received an intensive program of road safety measures tailored using the crash characteristics of the baseline sample. Demographic data on all household members were collected, and those individuals who suffered an RTI in the previous 3 months had comprehensive information collected about the crash characteristics and the socioeconomic impact. The follow-up data collection occurred nine months after the baseline data were collected. RESULTS: The majority of crashes that caused an RTI involved a motorcycle (71%) and the majority of victims were male (82%) with an average age of 27. Injuries to the legs (55%) were most common and the average length of time away from normal activity was 27 (±33) days. RTI incidence at the intervention site increased during the course of the study (incidence before vs. incidence after) and was unchanged in the community control (incidence before vs. incidence after). CONCLUSION: The incidence of RTIs in the low-volume rural setting is unacceptably high and most commonly associated with motorcycles. The change in incidence is unreliable due to logistic restraints of the project and more research is needed to quantify the impact of various RTI prevention strategies in this setting. This study provides insight into road traffic injuries on low-volume rural roads, areas where very little research has been captured. Additionally, it provides a replicable study design for those interested in collecting similar data on low-volume rural roads.

Breast Cancer Knowledge, Beliefs, and Screening Practices among Women Seeking Care at District Hospitals in Dar es Salaam, Tanzania.

BACKGROUND: Limited disease awareness among women may impact breast cancer stage-at-diagnosis in Tanzania, reducing survival. This study assessed breast cancer knowledge, screening practices, and educational preferences among outpatients at Tanzanian government-supported hospitals. METHODS: A convenience sample of women was surveyed regarding (1) knowledge/beliefs of breast cancer etiology, risk factors, symptoms, treatment, (2) early detection knowledge/practice, and (3) educational preferences. RESULTS: Among 225 respondents, 98.2% knew of breast cancer; 22.2% knew someone affected by breast cancer. On average, 30% of risk factors and 51% of symptoms were identified. Most accepted one or more breast cancer myths. Among 126 aware of breast self-exam, 40% did not practice it; only 0.9% underwent regular clinical breast examinations despite 68% being aware of the procedure. Among treatments, 87% recognized surgery, 70% radiation, and fewer systemic therapy. Preferred educational sources were group sessions, television/radio, and meetings with breast cancer survivors. CONCLUSIONS: This work reveals incomplete breast cancer awareness among Tanzanian women and promises to inform development of user-focused educational resources.

Mathematical models and lymphatic filariasis control: monitoring and evaluating interventions.

Monitoring and evaluation are crucially important to the scientific management of any mass parasite control programme. Monitoring enables the effectiveness of implemented actions to be assessed and necessary adaptations to be identified; it also determines when management objectives are achieved. Parasite transmission models can provide a scientific template for informing the optimal design of such monitoring programmes. Here, we illustrate the usefulness of using a model-based approach for monitoring and evaluating anti-parasite interventions and discuss issues that need addressing. We focus on the use of such an approach for the control and/or elimination of the vector-borne parasitic disease, lymphatic filariasis.

Genetic differentiation in the African malaria vector, Anopheles gambiae s.s., and the problem of taxonomic status.

Of the seven recognized species of the Anopheles gambiae complex, A. gambiae s.s. is the most widespread and most important vector of malaria. It is becoming clear that, in parts of West Africa, this nominal species is not a single panmictic unit. We found that the internal transcribed spacer (ITS) of the X-linked rDNA has two distinct sequences with three fixed nucleotide differences; we detected no heterozygotes at these three sites, even in areas of sympatry of the two ITS types. The intergenic spacer (IGS) of this region also displays two distinct sequences that are in almost complete linkage disequilibrium with the distinct ITS alleles. We have designated these two types as S/type I and M/type II. These rDNA types correspond at least partly to the previously recognized chromosomal forms. Here we expand the geographic range of sampling to 251 individuals from 38 populations. Outside of West Africa, a single rDNA type, S/type I, corresponds to the Savanna chromosomal form. In West Africa, both types are often found in a single local sample. To understand if these findings might be due to unusual behavior of the rDNA region, we sequenced the same region for 46 A. arabiensis, a sympatric sibling species. No such distinct discontinuity was observed for this species. Autosomal inversions in one chromosome arm (2R), an insecticide resistance gene on 2L, and this single X-linked region indicate at least two genetically differentiated subpopulations of A. gambiae. Yet, rather extensive studies of other regions of the genome have failed to reveal genetic discontinuity. Evidently, incomplete genetic isolation exists within this single nominal species.