Cryptosporidium, enterocytozoon, and cyclospora infections in pediatric and adult patients with diarrhea in Tanzania.
Cryptosporidiosis, microsporidiosis, and cyclosporiasis were studied in four groups of Tanzanian inpatients: adults with AIDS-associated diarrhea, children with chronic diarrhea (of whom 23 of 59 were positive [+] for human immunodeficiency virus [HIV]), children with acute diarrhea (of whom 15 of 55 were HIV+), and HIV control children without diarrhea. Cryptosporidium was identified in specimens from 6/86 adults, 5/59 children with chronic diarrhea (3/5, HIV+), 7/55 children with acute diarrhea (0/7, HIV+), and 0/20 control children. Among children with acute diarrhea, 7/7 with cryptosporidiosis were malnourished, compared with 10/48 without cryptosporidiosis (P < .01). Enterocytozoon was identified in specimens from 3/86 adults, 2/59 children with chronic diarrhea (1 HIV+), 0/55 children with acute diarrhea, and 4/20 control children. All four controls were underweight (P < .01). Cyclospora was identified in specimens from one adult and one child with acute diarrhea (HIV-). Thus, Cryptosporidium was the most frequent and Cyclospora the least frequent pathogen identified. Cryptosporidium and Enterocytozoon were associated with malnutrition. Asymptomatic fecal shedding of Enterocytozoon in otherwise healthy, HIV children has not been described previously. (+info)
Can vector control play a useful supplementary role against bancroftian filariasis?
A single campaign of mass treatment for bancroftian filariasis with diethylcarbamazine (DEC) in Makunduchi, a town in Zanzibar, United Republic of Tanzania, combined with elimination of mosquito breeding in pit latrines with polystyrene beads was followed by a progressive decline over a 5-year period in the microfilarial rate from 49% to 3%. Evidence that vector control had contributed to this long-term decline was obtained by comparison with another town, Moga, where a DEC campaign was used without vector control and where resurgence of microfilariae could be observed 3-6 years after the campaign. In Zanzibar town, treatment of 3844 wet pit latrines and cesspits with polystyrene beads reduced the adult mosquito population in houses by about 65%. Supplementary treatment of open drains and marshes with Bacillus sphaericus produced little or no additional reduction compared to a sector of the town where only pit treatment with polystyrene was carried out. The cost and effort of achieving the 65% reduction in mosquito population could hardly be justified for its impact on filariasis alone, but its noticeable impact on biting nuisance might help to gain community support for an integrated programme. (+info)
Enteropathogenic bacteria in faecal swabs of young children fed on lactic acid-fermented cereal gruels.
The influence of consumption of a lactic acid-fermented cereal gruel togwa with pH < or = 4 on the presence of faecal enteric bacteria such as campylobacter, enterohaemorrhagic Escherichia coli (EHEC:O157), enterotoxigenic Escherichia coli (ETEC), salmonella and shigella was evaluated. Under 5 years old healthy children listed in an ascending order of age were alternatively assigned and given either a lactic-acid fermented cereal gruel togwa (test diet) or an unfermented cereal gruel uji (control diet) once a day for 13 consecutive days. The presence of the enteropathogens was examined in rectal swabs collected from the children at baseline (before feeding session started), on days 7 and 13, and additionally 14 days (follow-up day) after the feeding session had stopped. The swabs were cultured on to different optimal media for respective enteropathogen and confirmed by standard microbiological and serological methods. Campylobacter spp. dominated among the enteropathogens (62% out of total) followed by Salmonella spp., ETEC and Shigella spp. Children with isolated enteropathogens in the togwa group was significantly reduced (P < 0.001) from 27.6% at baseline to 7.8, 8.2 and 12.7% on days 7, 13 and follow-up day, respectively. The effect was more pronounced in those children taking togwa > 6 times during the study period. In the control group, there was a slight decrease from 16.7% at baseline to 11.4% on day 7 and 8.1% on day 13. On the follow-up day, enteropathogens were found in 22.6% of the children, which was significantly higher than in those children taking togwa > 6 times. We conclude, that regular consumption of togwa with pH < or = 4, once a day, three times a week may help to control intestinal colonization with potential diarrhoea-causing pathogens in young children. (+info)
Controlling schistosomiasis: the cost-effectiveness of alternative delivery strategies.
Sustainable schistosomiasis control cannot be based on large-scale vertical treatment strategies in most endemic countries, yet little is known about the costs and effectiveness of more affordable options. This paper presents calculations of the cost-effectiveness of two forms of chemotherapy targeted at school-children and compares them with chemotherapy integrated into the routine activities of the primary health care system. The focus is on Schistosoma haematobium. Economic and epidemiological data are taken from the Kilombero District of Tanzania. The paper also develops a framework for possible use by programme managers to evaluate similar options in different epidemiological settings. The results suggest that all three options are more affordable and sustainable than the vertical strategies for which cost data are available in the literature. Passive testing and treatment through primary health facilities proved the most effective and cost-effective option given the screening and compliance rates observed in the Kilombero District. (+info)
Employer's willingness to pay: the case for compulsory health insurance in Tanzania.
This article documents employers' expenditure on the arrangements for the health care of their employees in one of the least developed countries; Tanzania. The case for compulsory health insurance is considered in the light of the fact that only 3% of the population is employed in the formal sector and could be covered at first. It is shown from a survey of larger employers, outside government, that they were spending on average 11% of payroll on health care for their employees. This demonstrated their lack of satisfaction with the government health services. Nevertheless, those who could readily be covered by insurance were making considerable use of the more expensive government hospital services. It is argued that a compulsory health insurance scheme could be introduced for the formal sector of employment which would cover a wider range of health services at lower cost. The scheme would also have the desirable economic effect of lowering employers' labour costs while making it possible to improve the standards of the government health services. (+info)
Reducing maternal mortality in Kigoma, Tanzania.
An intervention programme aiming at a reduction of maternal deaths in the Regional Hospital, Kigoma, Tanzania, is analyzed. A retrospective study was carried out from 1984-86 to constitute a background for an intervention programme in 1987-91. The retrospective study revealed gross under-registration of data and clarified a number of potentially useful issues regarding avoidable maternal mortality. An intervention programme comprising 22 items was launched and the maternal mortality ratio was carefully followed in 1987-91. The intervention programme paid attention to professional responsibilities with regular audit-oriented meeting, utilization of local material resources, schedules for regular maintenance of equipment, maintenance of working skills by regular on-the-job training of staff, norms for patient management, provision of blood, norms for referral of severely ill patients, use of antibiotics, regular staff evaluation, public complaints about patient management, travel distance of all essential staff to the hospital, supply of essential drugs, the need of a small infusion production unit, the creation of culture facilities for improved quality of microbiology findings, and to efforts to stimulate local fund-raising. The results indicate that the maternal mortality ratio fell from 933 to 186 per 100,000 live births over the period 1984-91. Thus it is underscored that the problem of maternal mortality can be successfully approached by a low-cost intervention programme aiming at identifying issues of avoidability and focusing upon locally available problem solutions. (+info)
Quality of primary outpatient services in Dar-es-Salaam: a comparison of government and voluntary providers.
This study aimed to test whether voluntary agencies provide care of better quality than that provided by government with respect to primary curative outpatient services in Dar-es-Salaam. All non-government primary services were included, and government primary facilities were randomly sampled within the three districts of the city. Details of consultations were recorded and assessed by a panel who classed consultations as adequate, inadequate but serious consequences unlikely, and consultations where deficiencies in the care could have serious consequences. Interpersonal conduct was assessed and exit interviews were conducted. The study found that government registers of non-government 'voluntary' providers actually contained a high proportion of for-profit private providers. Comparisons between facilities showed that care was better overall at voluntary providers, but that there was a high level of inadequate care at both government and non-government providers. (+info)
The determinants of infant and child mortality in Tanzania.
This paper investigates the determinants of infant and child mortality in Tanzania using the 1991/92 Tanzania Demographic and Health Survey. A hazards model is used to assess the relative effect of the variables hypothesized to influence under-five mortality. Short birth intervals, teenage pregnancies and previous child deaths are associated with increased risk of death. The Government of the United Republic of Tanzania should therefore maintain its commitment to encouraging women to space their births at least two years apart and delay childbearing beyond the teenage years. Further, this study shows that there is a remarkable lack of infant and child mortality differentials by socioeconomic subgroups of the population, which may reflect post-independence health policy and development strategies. Whilst lack of socioeconomic differentials can be considered an achievement of government policies, mortality remains high so there is still a long way to go before Tanzania achieves its stated goal of 'Health for All'. (+info)