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1.  Intestinal schistosomiasis and geohelminths of Ukara Island, North-Western Tanzania: prevalence, intensity of infection and associated risk factors among school children 
Parasites & Vectors  2014;7(1):612.
Background
Schistosoma mansoni and soil-transmitted helminths (STH) are among the most prevalent and highly neglected tropical diseases in Tanzania. However, little is known on the distribution of these infections in rural settings, especially in the island areas on Lake Victoria. Identifying the local risk factors of S. mansoni and soil-transmitted helminths is one step towards understanding their transmission patterns and will facilitate the design of cost-effective intervention measures. The present study was therefore conducted to determine the prevalence, intensity of infection and risk factors associated with S. mansoni and soil-transmitted helminth infections among school children in Ukara Island.
Methods
This was a cross sectional study which enrolled 774 school children aged 4-15 years in 5 primary schools in Ukara Island, North-Western Tanzania. Single stool samples were collected, processed using the Kato Katz technique and examined for eggs of S. mansoni and geohelminths under a light microscope. A pre-tested questionnaire was used to collect socio-demographic information.
Results
Overall, 494/773 (63.91%, 95% CI; 45.19-90.36) of the study participants were infected with S. mansoni and the overall geometrical mean eggs per gram (GM-epg) of feaces were 323.41epg (95% CI: 281.09 – 372.11). The overall prevalence of soil-transmitted helminth (STH) was 6.73% (n = 52/773, 95% CI = 4.39 – 10.32) with the most prevalent species being hookworms, 5.69% (n = 44/773, 95% CI; 3.68 – 8.79). Location of school in the study villages (P < 0.0001), parent occupation, fishing (P < 0.03) and reported involvement in fishing activities (P < 0.048) remained significantly associated with the prevalence and intensity of S.mansoni infection.
Conclusion
Schistosoma mansoni infection is highly prevalent in the islands whereas the prevalence of soil-transmitted helminths is low. The risk of infection with S. mansoni and the intensity of infection increased along the shorelines of Lake Victoria. These findings call for the need to urgently implement integrated control interventions, starting with targeted mass drug administration.
Electronic supplementary material
The online version of this article (doi:10.1186/s13071-014-0612-5) contains supplementary material, which is available to authorized users.
doi:10.1186/s13071-014-0612-5
PMCID: PMC4297386  PMID: 25533267
Schistosoma mansoni; Soil-transmitted helminths; Ukara Island; North-Western Tanzania
2.  Co-infection with Schistosoma mansoni and Human Immunodeficiency Virus-1 (HIV-1) among residents of fishing villages of north-western Tanzania 
Parasites & Vectors  2014;7(1):587.
Background
Co-infection with S. mansoni and Human Immunodeficiency Virus-1 (HIV-1) has been described in sub-Saharan Africa. However, few community-based studies have been conducted to assess the association between the two diseases. The present study examined whether the infection with HIV-1 is associated with an altered susceptibility to S. mansoni infection by comparing the prevalence and intensity of S. mansoni infection among those infected and not infected with HIV-1. Any influence of HIV-1 associated immunodeficiency on the intensity of S. mansoni infection was also investigated.
Methods
A cross-sectional study was conducted among 1,785 randomly selected adults (aged 21–55 years) in fishing villages of north-western Tanzania. Single stool samples were obtained and examined for S. mansoni eggs using the Kato Katz technique. Finger prick and venous blood samples were collected for HIV-1 screening and CD4+ cell quantification. Demographic information was collected by questionnaire.
Results
Of the 1,785 individuals from whom complete data were obtained, 854 (47.85%, 95% CI; 40.46 – 56.57) were infected with S. mansoni and had a mean intensity of 183.21(95% CI; 165.61-202.70) eggs per gram of faeces (epg). A total of 125 individuals (6.29%, 95% CI 3.59-11.04) were infected with HIV-1 and only 40% (n=50) of them were co-infected with S. mansoni. No differences in prevalence of S. mansoni infection or intensities of infection, as estimated by egg count (epg), were observed between HIV-1 sero-positive individuals and HIV-1 negative individuals. In generalized regression models (adjusted for sex, age, occupation, residence and level of education), being infected with HIV-1 did not increase the risk (APR=1.01, 95%; 0.83-1.21, P=0.93) or intensity (AOR = 0.84, 95% CI; 0.56-1.25, P = 0.33) of S. mansoni infection. Among individuals co-infected with HIV-1 and S. mansoni infection, the intensity of infection (epg) was not associated (P = 0.21) or correlated (P = 0.13) with CD4+ cell counts.
Conclusion
Our findings suggest that HIV-1 infection may not have a major effect on S. mansoni infection or on the excretion of eggs from the co-infected individuals. However, further studies are needed to understand the biological interaction between HIV-1 and S. mansoni in a large cohort of co-infected individuals.
doi:10.1186/s13071-014-0587-2
PMCID: PMC4271490  PMID: 25511298
S. mansoni; HIV-1; Co-infection; Fishing villages; Risk factors; Tanzania
3.  Factors influencing the implementation of integrated management of childhood illness (IMCI) by healthcare workers at public health centers & dispensaries in Mwanza, Tanzania 
BMC Public Health  2014;14:277.
Background
Integrated Management of Childhood Illness (IMCI) was developed by the World Health Organization (WHO) and the United Nations International Children’s Fund (UNICEF) and aims at reducing childhood morbidity and mortality in resource-limited settings including Tanzania. It was introduced in 1996 and has been scaled up in all districts in the country. The purpose of this study was to identify factors influencing the implementation of IMCI in the health facilities in Mwanza, Tanzania since reports indicates that the guidelines are not full adhered to by the healthcare workers.
Methods
A cross-sectional study design was used and a sample size of 95 healthcare workers drawn from health centers and dispensaries within Mwanza city were interviewed using self-administered questionnaires. Structured interview was also used to get views from the city IMCI focal person and the 2 facilitators. Data were analyzed using SPSS and presented using figures and tables.
Results
Only 51% of healthcare workers interviewed had been trained. 69% of trained Healthcare workers expressed understanding of the IMCI approach. Most of the respondents (77%) had a positive attitude that IMCI approach was a better approach in managing common childhood illnesses especially with the reality of resource constraint in the health facilities. The main challenges identified in the implementation of IMCI are low initial training coverage among health care workers, lack of essential drugs and supplies, lack of onsite mentoring and lack of refresher courses and regular supportive supervision. Supporting the healthcare workers through training, onsite mentoring, supportive supervision and strengthening the healthcare system through increasing access to essential medicines, vaccines, strengthening supply chain management, increasing healthcare financing, improving leadership & management were the major interventions that could assist in IMCI implementation.
Conclusions
The healthcare workers can implement better IMCI through the collaboration of supervisors, IMCI focal person, Council Health Management Teams (CHMT) and other stakeholders interested in child health. However, significant barriers impede a sustainable IMCI implementation. Recommendations have been made related to supportive supervision and HealthCare system strengthening among others.
doi:10.1186/1471-2458-14-277
PMCID: PMC3987128  PMID: 24666561
Lower level health facilities; Integrated Management of Childhood Illness (IMCI); Council Health Management Team (CHMT); Factors influencing the implementation of IMCI
4.  Sero-positivity rate of rubella and associated factors among pregnant women attending antenatal care in Mwanza, Tanzania 
Background
Sero-positivity rates of the rubella virus among pregnant women vary widely throughout the world. In Tanzania, rubella vaccination is not included in the national immunization schedule and there is therefore no antenatal screening for this viral disease. So far, there are no reports on the sero-prevalence of rubella among pregnant women in Tanzania. As a result, this study was undertaken to establish the sero-positivity rate of rubella and rubella risk factors among pregnant women attending antenatal care clinics in Mwanza, Tanzania.
Methods
From November 2012 to May 2013 a total of 350 pregnant women were enrolled and their serum samples collected and analyzed using the AXSYM anti-rubella virus IgG/IgM-MEIA test. Demographic and clinical data were collected using a standardized data collection tool. Data analysis was done using STATA version 12.
Results
Of 342 pregnant women tested for rubella antibodies, 317 (92.6%) were positive for anti-rubella IgG while only 1 (0.3%) was positive for IgM. Higher sero-positivity rates were found in the age group of 25–44 years. Furthermore, it was observed that with each year increase in age, the risk of contracting rubella increases by 12% (OR = 1.12, 95% CI: 1.02-1.22, P = 0.019). Women involved in farming and business women were at a higher risk of contracting rubella infection compared to formally employed women (OR: 4.9, P = 0.011; OR 7.1, p = 0.003 respectively). In univariate analysis, the risk of contracting rubella virus infection was found to increase with gestational age with a statistical significance.
Conclusions
Sero-positivity rates of rubella are high in Mwanza and are significantly associated with an increase in age and being a farmer or a business woman. Screening of rubella and immunization of women at risk are highly recommended in this area with a high non-immune rate against rubella virus.
doi:10.1186/1471-2393-14-95
PMCID: PMC3975942  PMID: 24589180
Prevalence; Rubella; Pregnancy; Mwanza; Tanzania
5.  Bacteremia and resistant gram-negative pathogens among under-fives in Tanzania 
Background
Antibiotic resistance is one of the most serious public health concerns worldwide and is increasing at an alarming rate, making daily treatment decisions more challenging. This study is aimed at identifying local bacterial isolates and their antimicrobial susceptibility patterns to avoid irrational antibiotic use, especially in settings where unguided management occurs and febrile illnesses are predominant.
Material and methods
A hospital-based prospective cross-sectional study was conducted from September 2011 to February 2012. Febrile children were serially recruited and demographic and clinical data were collected using a standardized data collection tool. A blood culture was performed and identification of the isolates was undertaken using in-house biochemical tests. Susceptibility to common antibiotics was investigated using the disc diffusion methods.
Results
Of the 1081 children admitted during the study period, 317 (29.3%) met the inclusion criteria and were recruited, of whom 195 (61.5%) and 122 (38.5%) were male and female respectively. The median age was 18 months with an interquartile range of 9 to 36 months. Of the 317 children, 251 (79.2%) were below or equal to 36 months of age. The prevalence of bacteremia was 6.6%. A higher prevalence of bacteraemia was observed in children below 36 months than in those ≥ 36 months (7.5% vs. 3.0%, p = 0.001). Predictors of bacteraemia were an axillary temperature of >38.5 °C (OR =7, 95% CI = 2.2 - 14.8, p-value = 0.0001), a positive malaria slide (OR =5, 95% CI = 3.0 - 21.2, p-value = 0.0001) and a high neutrophils’ count (OR =21 95% CI = 5.6 - 84, p-value = 0.0001). Escherichia coli and Klebsiella pneumoniae accounted for 7 (33.3%) and 6 (28.6%) of all the isolates respectively. Others gram-negatives bacteria were Citrobacter spp 2 (9.5%), Enterobacter spp 1 (4.25%), Pseudomonas spp 2 (9.5%), Proteus spp 1 (4.25%) and Salmonella spp 1 (4.25%). These isolates were highly resistant to ampicillin (95%), co-trimoxazole (90%), tetracycline (90%), gentamicin (80%), augmentin (80%), chloramphenicol (65%), ceftriaxone (35%), cefotaxime (35%) ciprofloxacin (30%), amikacin (30%), ceftazidime (25%) and norfloxacine (10%).
Conclusion
Multi-resistant gram-negative bacteria are the commonest cause of bacteremia in under-fives attending the Bugando Medical Centre, Mwanza, Tanzania. A high body temperature, a positive malaria slide and a high absolute neutrophils’ count were all independent risk factors found to predict bacteremia. A higher mortality rate was observed in children with bacteraemia. Continuous epidemiological surveillance should be conducted so that a proper and effective antibiotics management can be instituted, especially in children with a high grade fever, a positive malaria slide and a high neutrophils’ count.
doi:10.1186/1824-7288-39-27
PMCID: PMC3665601  PMID: 23657136
6.  Epidemiology and interactions of Human Immunodeficiency Virus – 1 and Schistosoma mansoni in sub-Saharan Africa 
Human Immunodeficiency Virus-1/AIDS and Schistosoma mansoni are widespread in sub-Saharan Africa and co-infection occurs commonly. Since the early 1990s, it has been suggested that the two infections may interact and potentiate the effects of each other within co-infected human hosts. Indeed, S. mansoni infection has been suggested to be a risk factor for HIV transmission and progression in Africa. If so, it would follow that mass deworming could have beneficial effects on HIV-1 transmission dynamics. The epidemiology of HIV in African countries is changing, shifting from urban to rural areas where the prevalence of Schistosoma mansoni is high and public health services are deficient. On the other side, the consequent pathogenesis of HIV-1/S. mansoni co-infection remains unknown. Here we give an account of the epidemiology of HIV-1 and S. mansoni, discuss co-infection and possible biological causal relationships between the two infections, and the potential impact of praziquantel treatment on HIV-1 viral loads, CD4+ counts and CD4+/CD8+ ratio. Our review of the available literature indicates that there is evidence to support the hypothesis that S. mansoni infections can influence the replication of the HIV-1, cell-to-cell transmission, as well as increase HIV progression as measured by reduced CD4+ T lymphocytes counts. If so, then deworming of HIV positive individuals living in endemic areas may impact on HIV-1 viral loads and CD4+ T lymphocyte counts.
doi:10.1186/2049-9957-2-2
PMCID: PMC3707091  PMID: 23849678
Schistosoma mansoni; HIV-1; Co-infections; Immunological interactions; Deworming
7.  Epidemiology and control of human schistosomiasis in Tanzania 
Parasites & Vectors  2012;5:274.
In Tanzania, the first cases of schistosomiasis were reported in the early 19th century. Since then, various studies have reported prevalences of up to 100% in some areas. However, for many years, there have been no sustainable control programmes and systematic data from observational and control studies are very limited in the public domain. To cover that gap, the present article reviews the epidemiology, malacology, morbidity, and the milestones the country has made in efforts to control schistosomiasis and discusses future control approaches. The available evidence indicates that, both urinary and intestinal schistosomiasis are still highly endemic in Tanzania and cause significant morbidity.Mass drug administration using praziquantel, currently used as a key intervention measure, has not been successful in decreasing prevalence of infection. There is therefore an urgent need to revise the current approach for the successful control of the disease. Clearly, these need to be integrated control measures.
doi:10.1186/1756-3305-5-274
PMCID: PMC3549774  PMID: 23192005
Schistosomiasis; S. mansoni; S. Mansoni; epidemiology; morbidity; control; Tanzania
8.  Prevalence and predictors of urinary tract infection and severe malaria among febrile children attending Makongoro health centre in Mwanza city, North-Western Tanzania 
Background
In malaria endemic areas, fever has been used as an entry point for presumptive treatment of malaria. At present, the decrease in malaria transmission in Africa implies an increase in febrile illnesses related to other causes among underfives. Moreover, it is estimated that more than half of the children presenting with fever to public clinics in Africa do not have a malaria infection. Thus, for a better management of all febrile illnesses among under-fives, it becomes relevant to understand the underlying aetiology of the illness. The present study was conducted to determine the relative prevalence and predictors of P. falciparum malaria, urinary tract infections and bacteremia among under-fives presenting with a febrile illness at the Makongoro Primary Health Centre, North-Western Tanzania.
Methods
From February to June 2011, a cross-sectional analytical survey was conducted among febrile children less than five years of age. Demographic and clinical data were collected using a standardized pre-tested questionnaire. Blood and urine culture was done, followed by the identification of isolates using in-house biochemical methods. Susceptibility patterns to commonly used antibiotics were investigated using the disc diffusion method. Giemsa stained thin and thick blood smears were examined for any malaria parasites stages.
Results
A total of 231 febrile under-fives were enrolled in the study. Of all the children, 20.3% (47/231, 95%CI, 15.10-25.48), 9.5% (22/231, 95%CI, 5.72-13.28) and 7.4% (17/231, 95%CI, 4.00-10.8) had urinary tract infections, P. falciparum malaria and bacteremia respectively. In general, 11.5% (10/87, 95%CI, 8.10-14.90) of the children had two infections and only one child had all three infections. Predictors of urinary tract infections (UTI) were dysuria (OR = 12.51, 95% CI, 4.28-36.57, P < 0.001) and body temperature (40-41 C) (OR = 12.54, 95% CI, 4.28-36.73, P < 0.001). Predictors of P. falciparum severe malaria were pallor (OR = 4.66 95%CI, 1.21-17.8, P = 0.025) and convulsion (OR = 102, 95% CI, 10-996, P = 0.001). Escherichia coli were the common gram negative isolates from urine (72.3%, 95% CI, 66.50-78.10) and blood (40%, 95%CI, and 33.70-46.30). Escherichia coli from urine were 100% resistant to ampicillin, 97% resistant to co-trimoxazole, 85% resistant to augmentin and 32.4% resistant to gentamicin; and they were 100%, 91.2% and 73.5% sensitive to meropenem, ciprofloxacin and ceftriaxone respectively.
Conclusion
Urinary tract infection caused by multi drug resistant Escherichia coli was the common cause of febrile illness in our setting. Improvement of malaria diagnosis and its differential diagnosis from other causes of febrile illnesses may provide effective management of febrile illnesses among children in Tanzania
doi:10.1186/0778-7367-70-4
PMCID: PMC3415110  PMID: 22958592
Fever; Malaria; Urinary tract infection; Bacteremia; Under-fives; Tanzania

Results 1-8 (8)