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Minja EG, Mrimi EC, Mponzi WP, Mollel GJ, Lang C, Beckmann J, Gerber M, Pühse U, Long KZ, Masanja H, Okumu FO, Finda MF, Utzinger J. Prevalence and Determinants of Undernutrition in Schoolchildren in the Kilombero District, South-Eastern Tanzania. Trop Med Infect Dis 2024; 9:96. [PMID: 38787029 PMCID: PMC11125975 DOI: 10.3390/tropicalmed9050096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Childhood undernutrition is a major issue in low- and middle-income countries, affecting the health, well-being, and educational outcomes of schoolchildren. This study aimed to assess the prevalence and associated factors of stunting, wasting, and underweight among schoolchildren in peri-urban areas in the south-eastern part of Tanzania. A cross-sectional study was conducted involving 930 children aged 6-12 years from four primary schools from July to August 2019. The WHO Anthro Survey Analyzer was employed to estimate the prevalence of stunting, wasting, and underweight, while logistic regression analyses examined sociodemographic background, malaria infection, anaemia, anthropometric measures, and dietary diversity score as potential factors. The prevalence of stunting, wasting, underweight, overweight, and obesity was 11.8%, 4.3%, 3.9%, 11.1%, and 2.0%, respectively. Overall, 1.5% of the children had malaria, as determined by rapid diagnostic tests, and 0.4% had severe anaemia. Univariate analysis indicated higher odds of undernutrition among children aged 9-12 compared to their younger peers. Stunting was more common among children with low and medium dietary diversity. Anaemia was found in 11.2% of schoolchildren, and severe anaemia was associated with wasting. Multivariate analysis revealed that age and low dietary diversity were significantly associated with undernutrition. These findings emphasise the need for school-based health and nutrition programmes targeting children beyond the age of 5 to improve their nutritional status and mitigate potential adverse effects on health, cognition, and academic achievement. Regular assessment of the nutritional status of schoolchildren is warranted.
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Affiliation(s)
- Elihaika G. Minja
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania; (E.C.M.); (W.P.M.); (G.J.M.); (H.M.); (F.O.O.); (M.F.F.)
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; (K.Z.L.); (J.U.)
- Faculty of Medicine, University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland
| | - Emmanuel C. Mrimi
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania; (E.C.M.); (W.P.M.); (G.J.M.); (H.M.); (F.O.O.); (M.F.F.)
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; (K.Z.L.); (J.U.)
- Faculty of Medicine, University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland
| | - Winfrida P. Mponzi
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania; (E.C.M.); (W.P.M.); (G.J.M.); (H.M.); (F.O.O.); (M.F.F.)
| | - Getrud J. Mollel
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania; (E.C.M.); (W.P.M.); (G.J.M.); (H.M.); (F.O.O.); (M.F.F.)
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Christin Lang
- Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, CH-4052 Basel, Switzerland; (C.L.); (J.B.); (M.G.); (U.P.)
| | - Johanna Beckmann
- Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, CH-4052 Basel, Switzerland; (C.L.); (J.B.); (M.G.); (U.P.)
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, CH-4052 Basel, Switzerland; (C.L.); (J.B.); (M.G.); (U.P.)
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, CH-4052 Basel, Switzerland; (C.L.); (J.B.); (M.G.); (U.P.)
| | - Kurt Z. Long
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; (K.Z.L.); (J.U.)
- Faculty of Medicine, University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland
| | - Honorati Masanja
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania; (E.C.M.); (W.P.M.); (G.J.M.); (H.M.); (F.O.O.); (M.F.F.)
| | - Fredros O. Okumu
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania; (E.C.M.); (W.P.M.); (G.J.M.); (H.M.); (F.O.O.); (M.F.F.)
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow G12 8QQ, UK
- School of Life Science and Bioengineering, Nelson Mandela African Institution of Science & Technology, Arusha P.O. Box 447, Tanzania
| | - Marceline F. Finda
- Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania; (E.C.M.); (W.P.M.); (G.J.M.); (H.M.); (F.O.O.); (M.F.F.)
- School of Life Science and Bioengineering, Nelson Mandela African Institution of Science & Technology, Arusha P.O. Box 447, Tanzania
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; (K.Z.L.); (J.U.)
- Faculty of Medicine, University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland
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David A, Swalehe O, Habagusenga JDA, Banzimana S, Asingizwe D, Chacky F, Molteni F. Accessibility of malaria commodities in Geita District Council, mainland Tanzania: the experiences from healthcare providers and clients. J Pharm Policy Pract 2024; 17:2308611. [PMID: 38333577 PMCID: PMC10851820 DOI: 10.1080/20523211.2024.2308611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Background Access to essential malaria commodities is a cornerstone in malaria control. However optimal availability and access to essential malaria commodities remain a challenge in Tanzania. Therefore, this study aimed to explore the factors affecting the accessibility of malaria commodities in Tanzania. Methods This was a mixed-method cross-sectional study using both quantitative and qualitative approaches. Data were collected between February and March 2023 from health facilities, health facility staff, and patients. Results Availability of malaria commodities in government health facilities was 100% for all items while in the private and faith-based facilities, this ranged from 10% to 80%. The reasons for stockouts in Government facilities were related to delayed and inadequate quantity delivery while in private facilities the main reason was the lack of cash for procurement. Both private facilities' clients and healthcare providers concurred that most people do not access complete treatment due to the high costs of prescribed medicines and poor stocking levels. Conclusion The availability, hence the accessibility, of malaria commodities in private and faith-based health facilities is still sub-optimal. Logistic management needs to be improved to eliminate stockouts and malaria commodities high costs need a permanent solution.
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Affiliation(s)
- Anna David
- EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- National Malaria Control Programme, Ministry of Health, Dodoma, Tanzania
| | - Omary Swalehe
- Department of Business Studies, Mzumbe University, Dar es salaam, Tanzania
| | - Jean D’ Amour Habagusenga
- EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Stany Banzimana
- EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Domina Asingizwe
- EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Frank Chacky
- National Malaria Control Programme, Ministry of Health, Dodoma, Tanzania
| | - Fabrizio Molteni
- National Malaria Control Programme, Ministry of Health, Dodoma, Tanzania
- Swiss Tropical and Public Health Institute, Dar es Salaam, Tanzania
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Mwankuna CJ, Kiros F, Mariki EE, Mabiki FP, Malebo HM, Mdegela RH, Styrishave B. Optimization of HPLC-MS/MS method for determination of antimalarial adulterants in herbal products. ANAL SCI 2023; 39:407-416. [PMID: 36633808 DOI: 10.1007/s44211-022-00255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023]
Abstract
The use of herbal products is booming all over the world because of being believed as safer than conventional drugs and free of side effects. However, there are untrustworthy manufacturers who adulterate herbal products by adding conventional drugs which might eventually lead to microbial resistance and herb-to-drug interactions. There is a need to develop methods for detecting adulterants in herbal products. A high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method for simultaneous identification and determination of conventional antimalarials (chloroquine, quinine, sulfadoxine, pyrimethamine, mefloquine, lumefantrine, amodiaquine, artemisinin, dihydroartemisinin, artesunate and artemether) in herbal products was developed. Stable isotopically labelled compounds (artemether-d3, quindine-d3, and sulfadoxine-d3) were used as internal standards (ISs) for quantitative analysis. Extraction of analytes was performed using methanol: water: formic acid (90:10:0.1, v/v) and chromatographic separation was done in a gradient mode using mobile phase A: Ultrapure water containing 0.1% formic acid and 1 mM ammonium formate and mobile phase B: Acetonitrile/methanol (50:50) containing 0.1% formic acid and 1 mM ammonium formate. The calibration curves were linear (r2 ≥ 0.991) over the range of 0.001-0.3 µg mL-1 for all compounds. The limit of detection (LOD) ranged from 0.002 to 0.02 μg mL-1 while the limit of quantification (LOQ) ranged from 0.006 to 0.08 μg mL-1. Accuracy, expressed as recovery of spiked herbal products ranged from 52 to 128%. The precision, expressed as percent relative standard deviation (%RSD) at two concentration levels, ranged from 1.0 to 13.8%. The matrix effect expressed as the matrix factor (MF) ranged from 0.77 to 0.97. The developed method was used to identify and quantify conventional antimalarials in herbal product samples from Tanzania. Ten out of 50 herbal products were found to contain amodiaquine, sulfadoxine, pyrimethamine, mefloquine, dihydroartemisinin, artemether and lumefantrine. The developed method is considered a valuable tool for getting a better understanding of the adulteration of conventional antimalarials in herbal products.
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Affiliation(s)
- Christopher J Mwankuna
- Department of Chemistry and Physics, College of Natural and Applied Sciences, Sokoine University of Agriculture, P.O. Box 3038, Morogoro, Tanzania.
| | - Feven Kiros
- Toxicology Laboratory, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark Universitetsparken 2, DK-2100, Copenhagen, Denmark
| | - Eliapenda E Mariki
- Department of Chemistry and Physics, College of Natural and Applied Sciences, Sokoine University of Agriculture, P.O. Box 3038, Morogoro, Tanzania
| | - Faith P Mabiki
- Department of Chemistry and Physics, College of Natural and Applied Sciences, Sokoine University of Agriculture, P.O. Box 3038, Morogoro, Tanzania
| | - Hamisi M Malebo
- UNESCO National Commission of the United Republic of Tanzania, 7 Magogoni Street, P.O. Box 20384, Dar Es Salaam, Tanzania
| | - Robinson H Mdegela
- Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P.O. Box 3015, Morogoro, Tanzania
| | - Bjarne Styrishave
- Toxicology Laboratory, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark Universitetsparken 2, DK-2100, Copenhagen, Denmark
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The effect of sickle cell genotype on the pharmacokinetic properties of artemether-lumefantrine in Tanzanian children. Int J Parasitol Drugs Drug Resist 2022; 19:31-39. [PMID: 35617818 PMCID: PMC9133758 DOI: 10.1016/j.ijpddr.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
Abstract
Since there are inconsistent data relating to the effect of haemoglobinopathies on disposition of artemisinin antimalarial combination therapy, and none in sickle cell trait (SCT) or sickle cell disease (SCD), the aim of this study was to characterize the pharmacokinetic properties of artemether-lumefantrine (ARM-LUM) in children with SCD/SCT. Thirty-eight Tanzanian children aged 5–10 years with normal (haemoglobin AA; n = 12), heterozygous (haemoglobin AS; n = 14) or homozygous (haemoglobin SS; n = 12) sickle genotypes received six ARM-LUM doses (1.7 mg/kg plus 10 mg/kg, respectively) over 3 days. Sparse venous and mixed-capillary dried blood spot (DBS) samples were taken over 42 days. Plasma and DBS ARM and LUM, and their active metabolites dihydroartemisinin (DHA) and desbutyl-lumefantrine (DBL), were assayed using validated liquid chromatography-mass spectrometry. Multi-compartmental pharmacokinetic models were developed using a population approach. Plasma but not DBS concentrations of ARM/DHA were assessable. The majority (85%) of the 15 measurable values were within 95% prediction intervals from a published population pharmacokinetic ARM/DHA model in Papua New Guinean children of similar age without SCD/SCT who had uncomplicated malaria, and there was no clear sickle genotype clustering. Plasma (n = 38) and corrected DBS (n = 222) LUM concentrations were analysed using a two-compartment model. The median [inter-quartile range] LUM AUC0–∞ was 607,296 [426,480–860,773] μg.h/L, within the range in published studies involving different populations, age-groups and malaria status. DBS and plasma DBL concentrations correlated poorly and were not modelled. These data support use of the conventional ARM-LUM treatment regimen for uncomplicated malaria in children with SCT/SCD. Malaria remains a serious infection in children with sickle cell trait/disease. Artemether-lumefantrine (AL) is first-line therapy in this situation. There are no AL pharmacokinetic data in children with sickle cell disease/trait. AL disposition in Tanzanian children did not differ across sickle genotypes. Recommended AL treatment doses can be given regardless of sickle status.
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Adherence, Awareness, Access, and Use of Standard Diagnosis and Treatment Guideline for Malaria Case Management among Healthcare Workers in Meatu, Tanzania. J Trop Med 2020; 2020:1918583. [PMID: 32148524 PMCID: PMC7049437 DOI: 10.1155/2020/1918583] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background Effective case management is a vital component of malaria control and elimination strategies. However, the level of adherence to the malaria diagnostic test and treatment guideline is not known, particularly at Meatu district. Therefore, this study aimed at determining the adherence, awareness, access, and use of standard diagnosis and treatment guidelines among healthcare workers in Meatu district. Method This was a descriptive cross-sectional study, which enrolled a total of 196 healthcare workers in Meatu district. Healthcare workers were sampled purposively to reach the required sample size. A structured questionnaire was used for data collection. Results Generally, 189 (96.4%) were aware of malaria treatment guidelines, while 148 (75.5%) had access and 98 (50.0%) used malaria treatment guidelines. One hundred and seven (54.6%) of all the healthcare workers adhered strictly to the diagnosis and national treatment guidelines. Ten (5.1%) partially adhered to the guideline when choosing antimalarials without confirmed malaria cases. Nonadherence to the prescription of recommended antimalarial drugs and laboratory confirmation was 79 (40.3%). Conclusion Half of healthcare worker's adhere to malaria diagnostic test and treatment guidelines. Most the healthcare workers are aware of the malaria diagnostic test and treatment guidelines. Continued education and assessment of the personal attitudes towards malaria diagnostic test and treatment guidelines are recommended.
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Kilonzi M, Minzi O, Mutagonda R, Baraka V, Sasi P, Aklillu E, Kamuhabwa A. Usefulness of day 7 lumefantrine plasma concentration as a predictor of malaria treatment outcome in under-fives children treated with artemether-lumefantrine in Tanzania. Malar J 2020; 19:66. [PMID: 32046718 PMCID: PMC7014606 DOI: 10.1186/s12936-020-3150-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
Background Day 7 plasma lumefantrine concentration is suggested as a predictor for malaria treatment outcomes and a cut-off of ≥ 200 ng/ml is associated with day 28 cure rate in the general population. However, day 7 lumefantrine plasma concentration can be affected by age, the extent of fever, baseline parasitaemia, and bodyweight. Therefore, this study assessed the usefulness of day 7 lumefantrine plasma concentration as a predictor of malaria treatment outcome in under-fives children treated with generic or innovator drug-containing artemether-lumefantrine (ALu) in Tanzania. Methods This study was nested in an equivalence prospective study that aimed at determining the effectiveness of a generic ALu (Artefan®) in comparison with the innovator’s product (Coartem®). Children with uncomplicated malaria aged 6–59 months were recruited and randomized to receive either generic or innovator’s product. Children were treated with ALu as per World Health Organization recommendations. The clinical and parasitological outcomes were assessed after 28 days of follow up. PCR was performed to distinguish recrudescence and re-infections among children with recurrent malaria. Analysis of day 7 lumefantrine plasma concentration was carried out using a high-performance liquid chromatographic method with UV detection. Results The PCR corrected cure rates were 98.7% for children treated with generic and 98.6% for those treated with the innovator product (p = 1.00). The geometric mean (± SD) of day 7 plasma lumefantrine concentration was 159.3 (± 2.4) ng/ml for the generic and 164 (± 2.5) ng/ml for the innovator groups, p = 0.87. Geometric mean (± SD) day 7 lumefantrine plasma concentration between cured and recurrent malaria was not statistically different in both treatment arms [158.5 (± 2.4) vs 100.0 (± 1.5) ng/ml, (p = 0.28) for generic arm and 158.5 (± 2.3) vs 251.2 (± 4.2) ng/ml, (p = 0.24) for innovator arm]. Nutritional status was found to be a determinant of recurrent malaria (adjusted hazardous ratio (95% confidence interval) = 3(1.1–8.2), p = 0.029. Conclusion Using the recommended cut-off point of ≥ 200 ng/ml, day 7 plasma lumefantrine concentration failed to predict malaria treatment outcome in children treated with ALu in Tanzania. Further studies are recommended to establish the day 7 plasma lumefantrine concentration cut-off point to predict malaria treatment outcome in children.
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Affiliation(s)
- Manase Kilonzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania.
| | - Omary Minzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Ritah Mutagonda
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Vito Baraka
- Department of Research, National Institute of Medical Research, Tanga Centre, P O Box 5004, Tanga, Tanzania
| | - Philip Sasi
- Department of Clinical Pharmacology, School of Medicine, Muhimbili University of Health and Allied Sciences, P. O. BOX 6515, Dar es Salaam, Tanzania
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital-Huddinge, C1:68, SE-141 86, Stockholm, Sweden
| | - Appolinary Kamuhabwa
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
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Ngasala B, Bushukatale S. Evaluation of malaria microscopy diagnostic performance at private health facilities in Tanzania. Malar J 2019; 18:375. [PMID: 31771572 PMCID: PMC6880513 DOI: 10.1186/s12936-019-2998-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/11/2019] [Indexed: 12/04/2022] Open
Abstract
Background The World Health Organization (WHO) recommends use of parasitological diagnosis of malaria for all age groups in all malaria transmission settings. Many private health facilities rely on malaria microscopy for malaria diagnosis. However, quality of malaria microscopy is affected by number of factors including availability of skilled laboratory microscopists and lack of quality assurance systems in many malaria endemic countries. This study was carried out to assess quality of malaria microscopy in selected private health facilities in Tanzania. Methods A cross sectional study was conducted from August to September, 2017. A total of 40 private health laboratories in five regions were invited to participate in the study. Data were collected by distributing standardized pre-validated malaria slide-panels to each health facility. Sensitivity, specificity, and strength of agreement (with kappa score) were calculated to assess performance in detecting and quantification of Plasmodium species. Results Among the 40 health facilities, 31 (77.5%) returned their results to the reference centre (Muhimbili University of Health and Allied Sciences). Overall, the measures of malaria diagnostic accuracy were high, i.e. the sensitivity and specificity of malaria parasite detection by microscopy in the health facilities were 84.3% (95% CI 77–90) and 90.8% (95% CI 83.3–95.7), respectively. There was substantial agreement in parasite detection with (Kappa value: 0.74 (95% 0.65–0.83). However, only 17.8% (24 of 134) of blood slides were interpreted correctly at the health facilities in terms of parasite density counts. Conclusion Although there was substantial agreement between the private health microscopists and experienced microscopists in malaria parasite detection, there was poor performance in parasite counts. This calls for regular in-service training and external quality assessments at private health facilities to enhance the skills of private health facility microscopists in malaria microscopy.
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Affiliation(s)
- Billy Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. .,Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
| | - Samweli Bushukatale
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Mpimbaza A, Nayiga S, Ndeezi G, Rosenthal PJ, Karamagi C, Katahoire A. Understanding the context of delays in seeking appropriate care for children with symptoms of severe malaria in Uganda. PLoS One 2019; 14:e0217262. [PMID: 31166968 PMCID: PMC6550380 DOI: 10.1371/journal.pone.0217262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/08/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction A large proportion of children with uncomplicated malaria receive appropriate treatment late, contributing to progression of illness to severe disease. We explored contexts of caregiver delays in seeking appropriate care for children with severe malaria. Methods This qualitative study was conducted at the Children’s Ward of Jinja Hospital, where children with severe malaria were hospitalized. A total of 22in-depth interviews were conducted with caregivers of children hospitalized with severe malaria. Issues explored were formulated based on the Partners for Applied Social Sciences (PASS) model, focusing on facilitators and barriersto caregivers’promptseeking and accessing ofappropriate care. The data were coded deductively using ATLAS.ti (version 7.5). Codes were then grouped into families based on emerging themes. Results Caregivers’ rating of initial symptoms as mild illness lead to delays in response. Use of home initiated interventions with presumably ineffective herbs or medicines was common, leading to further delay. When care was sought outside the home, drug shops were preferred over public health facilities for reasons of convenience. Drug shops often provided sub-optimal care, and thus contributed to delays in access to appropriate care. Public facilities were often a last resort when illness was perceived to be progressing to severe disease. Further delays occurred at health facilities due to inadequate referral systems. Conclusion Communities living in endemic areas need to be sensitized about the significance of fever, even if mild, as an indicator of malaria. Additionally, amidst ongoing efforts at bringing antimalarial treatment services closer to communities, the value of drug shops as providers ofrationalantimalarialtreatment needs to be reviewed.
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Affiliation(s)
- Arthur Mpimbaza
- Child Health & Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Grace Ndeezi
- Department of Pediatrics & Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Philip J. Rosenthal
- Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Charles Karamagi
- Department of Pediatrics & Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
- Clinical Epidemiology Unit, Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Anne Katahoire
- Child Health & Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
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Finda MF, Moshi IR, Monroe A, Limwagu AJ, Nyoni AP, Swai JK, Ngowo HS, Minja EG, Toe LP, Kaindoa EW, Coetzee M, Manderson L, Okumu FO. Linking human behaviours and malaria vector biting risk in south-eastern Tanzania. PLoS One 2019; 14:e0217414. [PMID: 31158255 PMCID: PMC6546273 DOI: 10.1371/journal.pone.0217414] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/10/2019] [Indexed: 12/24/2022] Open
Abstract
To accelerate malaria elimination in areas where core interventions such as insecticide-treated nets (ITNs) are already widely used, it is crucial to consider additional factors associated with persistent transmission. Qualitative data on human behaviours and perceptions regarding malaria risk was triangulated with quantitative data on Anopheles mosquito bites occurring indoors and outdoors in south-eastern Tanzania communities where ITNS are already used but lower level malaria transmission persists. Each night (18:00h-07:00h), trained residents recorded human activities indoors, in peri-domestic outdoor areas, and in communal gatherings. Host-seeking mosquitoes were repeatedly collected indoors and outdoors hourly, using miniaturized exposure-free double net traps (DN-Mini) occupied by volunteers. In-depth interviews were conducted with household representatives to explore perceptions on persistent malaria and its control. Higher proportions of people stayed outdoors than indoors in early-evening and early-morning hours, resulting in higher exposures outdoors than indoors during these times. However, exposure during late-night hours (22:00h–05:00h) occurred mostly indoors. Some of the popular activities that kept people outdoors included cooking, eating, relaxing and playing. All households had at least one bed net, and 83.9% of people had access to ITNs. Average ITN use was 96.3%, preventing most indoor exposure. Participants recorgnized the importance of ITNs but also noted that the nets were not perfect. No complementary interventions were reported being used widely. Most people believed transmission happens after midnight. We conclude that insecticide-treated nets, where properly used, can still prevent most indoor exposures, but significant risk continues unabated before bedtime, outdoors and at communal gatherings. Such exposure is greatest for rural and low-income households. There is therefore an urgent need for complementary interventions, particularly those targeting outdoor-biting and are applicable for all people including the marginalised populations such as migratory farmers and fishermen. Besides, the differences in community understanding of ongoing transmission, and feedback on imperfections of ITNs should be considered when updating malaria-related communication and interventions.
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Affiliation(s)
- Marceline F. Finda
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- * E-mail:
| | - Irene R. Moshi
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - April Monroe
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania
- Johns Hopkins Center for Communication Programs, Baltimore, MD, United States of America
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
| | - Alex J. Limwagu
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Anna P. Nyoni
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Johnson K. Swai
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Halfan S. Ngowo
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Elihaika G. Minja
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Lea P. Toe
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Emmanuel W. Kaindoa
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Maureen Coetzee
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Braamofontein, South Africa
| | - Lenore Manderson
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Fredros O. Okumu
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow
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Gallay J, Pothin E, Mosha D, Lutahakana E, Mazuguni F, Zuakulu M, Decosterd LA, Genton B. Predictors of residual antimalarial drugs in the blood in community surveys in Tanzania. PLoS One 2018; 13:e0202745. [PMID: 30192770 PMCID: PMC6128528 DOI: 10.1371/journal.pone.0202745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 08/08/2018] [Indexed: 01/09/2023] Open
Abstract
Background Understanding pattern of antimalarials use at large scale helps ensuring appropriate use of treatments and preventing the spread of resistant parasites. We estimated the proportion of individuals in community surveys with residual antimalarials in their blood and identified the factors associated with the presence of the most commonly detected drugs, lumefantrine and/or desbutyl-lumefantrine (LF/DLF) or sulfadoxine-pyrimethamine (SP). Methods A cross-sectional survey was conducted in 2015 in three regions of Tanzania with different levels of malaria endemicity. Interviews were conducted and blood samples collected through household surveys for further antimalarial measurements using liquid chromatography coupled to tandem mass spectrometry. In addition, diagnosis and treatment availability was investigated through outlet surveys. Multilevel mixed effects logistic regression models were used to estimate odds ratios for having LF/DLF or SP in the blood. Results Amongst 6391 participants, 12.4% (792/6391) had LF/DLF and 8.0% (510/6391) SP in the blood. Factors associated with higher odds of detecting LF/DLF in the blood included fever in the previous two weeks (OR = 2.6, p<0.001), living in districts of higher malaria prevalence (OR = 1.5, p<0.001) and living in a ward in which all visited drug stores had artemisinin-based combination therapies in stocks (OR = 2.7, p = 0.020). Participants in older age groups were less likely to have LF/DLF in the blood (OR = 0.9, p<0.001). Factors associated with higher odds of having SP in the blood included being pregnant (OR = 4.6, p<0.001), living in Mwanza (OR = 3.9, p<0.001 compared to Mbeya), fever in the previous two weeks (OR = 1.7, p<0.001) and belonging to older age groups (OR = 1.2, p<0.001). Conclusion The most significant predictors identified were expected. History of fever in the past two weeks and young age were significant predictors of LF/DLF in the blood, which is encouraging. Antimalarial drug pressure was high and hence the use of recommended first-line drugs in combination with malaria Rapid Diagnostics Tests should be promoted to ensure appropriate treatment.
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Affiliation(s)
- Joanna Gallay
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Service and Laboratory of Clinical Pharmacology, University Hospital, Lausanne, Switzerland
- * E-mail:
| | - Emilie Pothin
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | | | | | - Blaise Genton
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Department of Community Health, University Hospital, Lausanne, Switzerland
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Zurovac D, Machini B, Kiptui R, Memusi D, Amboko B, Kigen S, Njiri P, Waqo E. Monitoring health systems readiness and inpatient malaria case-management at Kenyan county hospitals. Malar J 2018; 17:213. [PMID: 29843717 PMCID: PMC5975267 DOI: 10.1186/s12936-018-2364-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Change of severe malaria treatment policy from quinine to artesunate, a major malaria control advance in Africa, is compromised by scarce data to monitor policy translation into practice. In Kenya, hospital surveys were implemented to monitor health systems readiness and inpatient malaria case-management. METHODS All 47 county referral hospitals were surveyed in February and October 2016. Data collection included hospital assessments, interviews with inpatient health workers and retrospective review of patients' admission files. Analysis included 185 and 182 health workers, and 1162 and 1224 patients admitted with suspected malaria, respectively, in all 47 hospitals. Cluster-adjusted comparisons of the performance indicators with exploratory stratifications were performed. RESULTS Malaria microscopy was universal during both surveys. Artesunate availability increased (63.8-85.1%), while retrospective stock-outs declined (46.8-19.2%). No significant changes were observed in the coverage of artesunate trained (42.2% vs 40.7%) and supervised health workers (8.7% vs 12.8%). The knowledge about treatment policy improved (73.5-85.7%; p = 0.002) while correct artesunate dosing knowledge increased for patients < 20 kg (42.7-64.6%; p < 0.001) and > 20 kg (70.3-80.8%; p = 0.052). Most patients were tested on admission (88.6% vs 92.1%; p = 0.080) while repeated malaria testing was low (5.2% vs 8.1%; p = 0.034). Artesunate treatment for confirmed severe malaria patients significantly increased (69.9-78.7%; p = 0.030). No changes were observed in artemether-lumefantrine treatment for non-severe test positive patients (8.0% vs 8.8%; p = 0.796). Among test negative patients, increased adherence to test results was observed for non-severe (68.6-78.0%; p = 0.063) but not for severe patients (59.1-62.1%; p = 0.673). Overall quality of malaria case-management improved (48.6-56.3%; p = 0.004), both for children (54.1-61.5%; p = 0.019) and adults (43.0-51.0%; p = 0.041), and in both high (51.1-58.1%; p = 0.024) and low malaria risk areas (47.5-56.0%; p = 0.029). CONCLUSION Most health systems and malaria case-management indicators improved during 2016. Gaps, often specific to different inpatient populations and risk areas, however remain and further programmatic interventions including close monitoring is needed to optimize policy translation.
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Affiliation(s)
- Dejan Zurovac
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya. .,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
| | - Beatrice Machini
- National Malaria Control Programme, Ministry of Health, Nairobi, Kenya
| | - Rebecca Kiptui
- National Malaria Control Programme, Ministry of Health, Nairobi, Kenya
| | - Dorothy Memusi
- National Malaria Control Programme, Ministry of Health, Nairobi, Kenya
| | | | - Samuel Kigen
- National Malaria Control Programme, Ministry of Health, Nairobi, Kenya
| | | | - Ejersa Waqo
- National Malaria Control Programme, Ministry of Health, Nairobi, Kenya
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12
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Gallay J, Mosha D, Lutahakana E, Mazuguni F, Zuakulu M, Decosterd LA, Genton B, Pothin E. Appropriateness of malaria diagnosis and treatment for fever episodes according to patient history and anti-malarial blood measurement: a cross-sectional survey from Tanzania. Malar J 2018; 17:209. [PMID: 29784001 PMCID: PMC5963060 DOI: 10.1186/s12936-018-2357-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 05/14/2018] [Indexed: 12/28/2022] Open
Abstract
Background Monitoring the impact of case management strategies at large scale is essential to evaluate the public health benefit they confer. The use of methodologies relying on objective and standardized endpoints, such as drug levels in the blood, should be encouraged. Population drug use, diagnosis and treatment appropriateness in case of fever according to patient history and anti-malarials blood concentration was evaluated. Methods A cross-sectional survey took place between May and August 2015 in three regions of Tanzania with different levels of malaria endemicity. Interviews were conducted and blood samples were collected by dried blood spots through household surveys for further anti-malarial measurements. Appropriate testing when individuals attended care was defined as a patient with history of fever being tested for malaria and appropriate treatment as (i) having anti-malarial in the blood if the test result was positive (ii) having anti-malarial in the blood if the person was not tested, and (iii) no anti-malarial in the blood when the test result was negative. Results Amongst 6391 participants included in the anti-malarial analysis, 20.8% (1330/6391) had anti-malarial drug detected in the blood. Only 28.0% (372/1330) of the individuals with anti-malarials in their blood reported the use of anti-malarials within the previous month. Amongst all participants, 16.0% (1021/6391) reported having had a fever in the previous 2 weeks and 37.5% of them (383/1021) had detectable levels of anti-malarials in the blood. Of the individuals who sought care in health facilities, 69.4% (172/248) were tested and 52.0% (129/248) appropriately treated. When other providers were sought, 6% (23/382) of the persons were appropriately tested and 44.2% (169/382) appropriately treated. Overall, the proportion of individuals treated was larger than that being tested [47.3% (298/630) treated, 31.0% (195/630) tested]. Conclusion This study showed high prevalence of circulating anti-malarial drug in the sampled population. Efforts should be made to increase rapid diagnostic tests use at all levels of health care and improve compliance to test result in order to target febrile patients that are sick with malaria and reduce drug pressure. Objective drug measurements collected at community level represent a reliable tool to evaluate overall impact of case management strategies on population drug pressure.
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Affiliation(s)
- Joanna Gallay
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box 4002, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Service and Laboratory of Clinical Pharmacology, University Hospital, Lausanne, Switzerland.
| | | | | | | | | | | | - Blaise Genton
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Division of Infectious Diseases and Department of Community Health, University Hospital, Lausanne, Switzerland
| | - Emilie Pothin
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Musuva A, Ejersa W, Kiptui R, Memusi D, Abwao E. The malaria testing and treatment landscape in Kenya: results from a nationally representative survey among the public and private sector in 2016. Malar J 2017; 16:494. [PMID: 29268789 PMCID: PMC5740898 DOI: 10.1186/s12936-017-2089-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/27/2017] [Indexed: 11/15/2022] Open
Abstract
Background Since 2004, Kenya’s national malaria treatment guidelines have stipulated artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria, and since 2014, confirmatory diagnosis of malaria in all cases before treatment has been recommended. A number of strategies to support national guidelines have been implemented in the public and private sectors in recent years. A nationally-representative malaria outlet survey, implemented across four epidemiological zones, was conducted between June and August 2016 to provide practical evidence to inform strategies and policies in Kenya towards achieving national malaria control goals. Results A total of 17,852 outlets were screened and 2271 outlets were eligible and interviewed. 78.3% of all screened public health facilities stocked both malaria diagnostic testing and quality-assured ACT (QAACT). Sulfadoxine–pyrimethamine (SP) for intermittent preventive treatment in pregnancy was available in 70% of public health facilities in endemic areas where it is recommended for treatment. SP was rarely found in the public sector outside of the endemic areas (< 0.5%). The anti-malaria stocking private sector had lower levels of QAACT (46.7%) and malaria blood testing (20.8%) availability but accounted for majority of anti-malarial distribution (70.6% of the national market share). More than 40% of anti-malarials were distributed by unregistered pharmacies (37.3%) and general retailers (7.1%). QAACT accounted for 58.2% of the total anti-malarial market share, while market share for non-QAACT was 15.8% and for SP, 24.8%. In endemic areas, 74.9% of anti-malarials distributed were QAACT. Elsewhere, QAACT market share was 49.4% in the endemic-prone areas, 33.2% in seasonal-transmission areas and 37.9% in low-risk areas. Conclusion Although public sector availability of QAACT and malaria diagnosis is relatively high, there is a gap in availability of both testing and treatment that must be addressed. The private sector in Kenya, where the majority of anti-malarials are distributed, is also critical for achieving universal coverage with appropriate malaria case management. There is need for a renewed commitment and effective strategies to ensure access to affordable QAACT and confirmatory testing in the private sector, and should consider how to address malaria case management among informal providers responsible for a substantial proportion of the anti-malarial market share. Electronic supplementary material The online version of this article (10.1186/s12936-017-2089-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Anne Musuva
- Population Services Kenya (PS/Kenya), 2nd Floor, Wing B, Jumuia Place, Lenana Road, P.O. Box 22591-00400, Nairobi, Kenya
| | - Waqo Ejersa
- National Malaria Control Programme, Kenya KNH Grounds, P.O. Box 20750, Nairobi, Kenya
| | - Rebecca Kiptui
- National Malaria Control Programme, Kenya KNH Grounds, P.O. Box 20750, Nairobi, Kenya
| | - Dorothy Memusi
- National Malaria Control Programme, Kenya KNH Grounds, P.O. Box 20750, Nairobi, Kenya
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Nnko EJ, Kihamia C, Tenu F, Premji Z, Kweka EJ. Insecticide use pattern and phenotypic susceptibility of Anopheles gambiae sensu lato to commonly used insecticides in Lower Moshi, northern Tanzania. BMC Res Notes 2017; 10:443. [PMID: 28877733 PMCID: PMC5585946 DOI: 10.1186/s13104-017-2793-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 08/31/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Evidence of insecticide resistance has been documented in different malaria endemic areas. Surveillance studies to allow prompt investigation of associated factors to enable effective insecticide resistance management are needed. The objective of this study was to assess insecticide use pattern and phenotypic susceptibility level of Anopheles gambiae sensu lato to insecticides commonly used in malaria control in Moshi, northern Tanzania. METHODS A cross-sectional survey was conducted to assess insecticide usage pattern. Data was collected was through closed and open ended questionnaires The WHO diagnostic standard kit with doses of 0.1% bendiocarb, 0.05% deltamethrin, 0.75% permethrin and 4% DDT were used to detect knockdown time, mortality and resistance ratio of wild A. gambiae sensu lato. The questionnaire survey data was analyzed using descriptive statistics and one-way analysis of variance while susceptibility data was analysed by logistic regression with probit analysis using SPSS program. The WHO criteria was used to evaluate the resistance status of the tested mosquito populations. RESULTS A large proportion of respondents (80.8%) reported to have used insecticide mainly for farming purposes (77.3%). Moreover, 93.3% of household reported usage of long lasting insecticidal nets. The frequently used class of insecticide was organophosphate with chloropyrifos as the main active ingredients and dursban was the brand constantly reported. Very few respondents (24.1%) applied integrated vector control approaches of and this significantly associated with level of knowledge of insecticide use (P < 0.001). Overall knockdown time for A. gambiae s.l was highest in DDT, followed by Pyrethroids (Permethrin and deltamethrin) and lowest in bendiocarb. Anopheles gambiae s.l showed susceptibility to bendiocarb, increased tolerance to permethrin and resistant to deltamethrin. The most effective insecticide against the population from tested was bendiocarb, with a resistance ratio ranging between 0.93-2.81. CONCLUSION Education on integrated vector management should be instituted and a policy change on insecticide of choice for malaria vector control from pyrethroids to carbamates (bendiocarb) is recommended. Furthermore, studies to detect cross resistance between pyrethroids and organophosphates should be carried out.
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Affiliation(s)
- Elinas J. Nnko
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, P.O. Box 65011, Dar es Salaam, Tanzania
| | - Charles Kihamia
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, P.O. Box 65011, Dar es Salaam, Tanzania
| | - Filemoni Tenu
- National Institute for Medical Research, Amani Medical Research Centre, Muheza, P.O. Box 81, Tanga, Tanzania
| | - Zul Premji
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, P.O. Box 65011, Dar es Salaam, Tanzania
| | - Eliningaya J. Kweka
- Tropical Pesticides Research Institute, Division of Livestock and Human Health Disease Vector Control, Mosquito Section, P.O. Box 3024, Arusha, Tanzania
- Department of Medical Parasitology and Entomology, School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464 Mwanza, Tanzania
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