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Sado K, Keenan K, Manataki A, Kesby M, Mushi MF, Mshana SE, Mwanga JR, Neema S, Asiimwe B, Bazira J, Kiiru J, Green DL, Ke X, Maldonado-Barragán A, Abed Al Ahad M, Fredricks KJ, Gillespie SH, Sabiiti W, Mmbaga BT, Kibiki G, Aanensen D, Smith VA, Sandeman A, Sloan DJ, Holden MTG. Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance: A study of urinary tract infection patients in Kenya, Tanzania and Uganda. PLOS Glob Public Health 2024; 4:e0002709. [PMID: 38363770 PMCID: PMC10871516 DOI: 10.1371/journal.pgph.0002709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/17/2023] [Indexed: 02/18/2024]
Abstract
Antibacterial resistance (ABR) is a major public health threat. An important accelerating factor is treatment-seeking behaviour, including inappropriate antibiotic (AB) use. In many low- and middle-income countries (LMICs) this includes taking ABs with and without prescription sourced from various providers, including health facilities and community drug sellers. However, investigations of complex treatment-seeking, AB use and drug resistance in LMICs are scarce. The Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA) Consortium collected questionnaire and microbiological data from adult outpatients with urinary tract infection (UTI)-like symptoms presenting at healthcare facilities in Kenya, Tanzania and Uganda. Using data from 6,388 patients, we analysed patterns of self-reported treatment seeking behaviours ('patient pathways') using process mining and single-channel sequence analysis. Among those with microbiologically confirmed UTI (n = 1,946), we used logistic regression to assess the relationship between treatment seeking behaviour, AB use, and the likelihood of having a multi-drug resistant (MDR) UTI. The most common treatment pathway for UTI-like symptoms in this sample involved attending health facilities, rather than other providers like drug sellers. Patients from sites in Tanzania and Uganda, where over 50% of patients had an MDR UTI, were more likely to report treatment failures, and have repeat visits to providers than those from Kenyan sites, where MDR UTI proportions were lower (33%). There was no strong or consistent relationship between individual AB use and likelihood of MDR UTI, after accounting for country context. The results highlight the hurdles East African patients face in accessing effective UTI care. These challenges are exacerbated by high rates of MDR UTI, suggesting a vicious cycle of failed treatment attempts and sustained selection for drug resistance. Whilst individual AB use may contribute to the risk of MDR UTI, our data show that factors related to context are stronger drivers of variations in ABR.
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Affiliation(s)
- Keina Sado
- University of St Andrews, St Andrews, United Kingdom
| | | | | | - Mike Kesby
- University of St Andrews, St Andrews, United Kingdom
| | - Martha F. Mushi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Joseph R. Mwanga
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | | | - Joel Bazira
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - John Kiiru
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Xuejia Ke
- University of St Andrews, St Andrews, United Kingdom
| | | | | | | | | | | | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gibson Kibiki
- Africa Excellence Research Fund, London, United Kingdom
| | | | - V. Anne Smith
- University of St Andrews, St Andrews, United Kingdom
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Meaney PA, Hokororo A, Ndosi H, Dahlen A, Jacob T, Mwanga JR, Kalabamu FS, Joyce CL, Mediratta R, Rozenfeld B, Berg M, Smith ZH, Chami N, Mkopi N, Mwanga C, Diocles E, Agweyu A. Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains. BMJ Open 2024; 14:e077834. [PMID: 38309746 PMCID: PMC10840034 DOI: 10.1136/bmjopen-2023-077834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/09/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment. The objectives of this study were to (1) assess implementation success with use of in-person support and nudging strategy and (2) describe baseline provider knowledge and metacognition. METHODS 6-month observational study at one zonal hospital and three health centres in Mwanza, Tanzania. To assess implementation success, we used the Reach, Efficacy, Adoption, Implementation and Maintenance framework and to describe baseline provider knowledge and metacognition we used Howell's conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity. RESULTS aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centres. Median clinical experience was 4 years (IQR 1-9) and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD ±17%). Providers averaged 78% (SD ±31%) completion of initial learning and 7% (SD ±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% (IQR: 38%-63%), unconscious-incompetence 32% (IQR: 23%-42%), conscious-incompetence 7% (IQR: 2%-15%), and unconscious-competence 2% (IQR: 0%-3%). Higher baseline conscious-competence (OR 31.6 (95% CI 5.8 to 183.5)) and being a nursing officer (aOR: 5.6 (95% CI 1.8 to 18.1)), compared with medical officer, were associated with initial learning completion or persistent activity. CONCLUSION aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalisation is needed.
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Affiliation(s)
- Peter Andrew Meaney
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Critical Care, Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, California, USA
| | - Adolfine Hokororo
- Pediatrics and Child Health, Bugando Consultant and Referral Hospital, Mwanza, Tanzania
- Pediatrics and Child Health, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | - Hanston Ndosi
- Pediatrics and Child Health, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | - Alex Dahlen
- New York University Division of Biostatistics, New York, New York, USA
| | | | - Joseph R Mwanga
- Epidemiology, Biostatistics, and Behavioural Sciences School of Public Health, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | | | - Christine Lynn Joyce
- Critical Care, Cornell University Department of Pediatrics, New York, New York, USA
| | - Rishi Mediratta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Marc Berg
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Critical Care, Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, California, USA
| | - Zachary Haines Smith
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Neema Chami
- Pediatrics and Child Health, Bugando Consultant and Referral Hospital, Mwanza, Tanzania
- Pediatrics and Child Health, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | - Namala Mkopi
- Pediatric Critical Care, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Enock Diocles
- Nursing, Mwanza College of Health and Allied Sciences, Mwanza, Tanzania
| | - Ambrose Agweyu
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Institute, Nairobi, Kenya
- London School of Hygiene & Tropical Medicine, London, UK
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Olamijuwon E, Keenan K, Mushi MF, Kansiime C, Konje ET, Kesby M, Neema S, Asiimwe B, Mshana SE, Fredricks KJ, Sunday B, Bazira J, Sandeman A, Sloan DJ, Mwanga JR, Sabiiti W, Holden MTG. Treatment seeking and antibiotic use for urinary tract infection symptoms in the time of COVID-19 in Tanzania and Uganda. J Glob Health 2024; 14:05007. [PMID: 38236690 PMCID: PMC10795859 DOI: 10.7189/jogh.14.05007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Background There is still little empirical evidence on how the outbreak of coronavirus disease 2019 (COVID-19) and associated regulations may have disrupted care-seeking for non-COVID-19 conditions or affected antibiotic behaviours in low- and middle-income countries (LMICs). We aimed to investigate the differences in treatment-seeking behaviours and antibiotic use for urinary tract infection (UTI)-like symptoms before and during the pandemic at recruitment sites in two East African countries with different COVID-19 control policies: Mbarara, Uganda and Mwanza, Tanzania. Methods In this repeated cross-sectional study, we used data from outpatients (pregnant adolescents aged >14 and adults aged >18) with UTI-like symptoms who visited health facilities in Mwanza, Tanzania and Mbarara, Uganda. We assessed the prevalence of self-reported behaviours (delays in care-seeking, providers visited, antibiotics taken) at three different time points, labelled as 'pre-COVID-19 phase' (February 2019 to February 2020), 'COVID-19 phase 1' (March 2020 to April 2020), and 'COVID-19 phase 2' (July 2021 to February 2022). Results In both study sites, delays in care-seeking were less common during the pandemic than they were in the pre-COVID phase. Patients in Mwanza, Tanzania had shorter care-seeking pathways during the pandemic compared to before it, but this difference was not observed in Mbarara, Uganda. Health centres were the dominant sources of antibiotics in both settings. Over time, reported antibiotic use for UTI-like symptoms became more common in both settings. During the COVID-19 phases, there was a significant increase in self-reported use of antibiotics like metronidazole (<30% in the pre-COVID-19 phase to 40% in COVID phase 2) and doxycycline (30% in the pre-COVID-19 phase to 55% in COVID phase 2) that were not recommended for treating UTI-like symptoms in the National Treatment Guidelines in Mbarara, Uganda. Conclusions There was no clear evidence that patients with UTI-like symptoms attending health care facilities had longer or more complex treatment pathways despite strict government-led interventions related to COVID-19. However, antibiotic use increased over time, including some antibiotics not recommended for treating UTI, which has implications for future antimicrobial resistance.
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Affiliation(s)
- Emmanuel Olamijuwon
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Katherine Keenan
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Martha F Mushi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Catherine Kansiime
- School of Public Health, College of Health Sciences, Makerere University Kampala, Uganda
| | - Eveline T Konje
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mike Kesby
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Stella Neema
- Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
| | - Benon Asiimwe
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stephen E Mshana
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kathryn J Fredricks
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Benjamin Sunday
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joel Bazira
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alison Sandeman
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Derek J Sloan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Joseph R Mwanga
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Wilber Sabiiti
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | - CARE Consortium
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- School of Public Health, College of Health Sciences, Makerere University Kampala, Uganda
- Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
- School of Medicine, University of St Andrews, St Andrews, UK
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Ndaki PM, Mwanga JR, Mushi MF, Konje ET, Fredricks KJ, Kesby M, Sandeman A, Mugassa S, Manyiri MW, Loza O, Keenan K, Mwita SM, Holden MTG, Mshana SE. Practices and motives behind antibiotics provision in drug outlets in Tanzania: A qualitative study. PLoS One 2023; 18:e0290638. [PMID: 37651424 PMCID: PMC10470936 DOI: 10.1371/journal.pone.0290638] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
Dispensing antibiotics without prescription is among the major factors leading to antimicrobial resistance. Dispensing of antibiotics without prescription has negative impact at the individual and societal level leading to poor patient outcomes, and increased risks of resistant bacteria facilitated by inappropriate choice of antibiotics doses/courses. Antimicrobial resistance is a global public health threat which is projected to cause 10 million deaths by 2050 if no significant actions are taken to address this problem This study explored the practices and motives behind dispensing of antibiotics without prescription among community drug outlets in Tanzania. Finding of this study provides more strategies to antibiotics stewardship intervention. In-depth interviews with 28 drug dispensers were conducted for three months consecutively between November 2019 and January 2020 in 12 community pharmacies and 16 Accredited Drug Dispensing Outlets (ADDOs) in the Mwanza, Kilimanjaro and Mbeya regions of Tanzania. Transcripts were coded and analyzed thematically using NVivo12 software. Majority of dispensers admitted to providing antibiotics without prescriptions, selling incomplete courses of antibiotics and not giving detailed instructions to customers on how to use the drugs. These practices were motivated by several factors including customers' pressure/customers' demands, business orientation-financial gain of drug dispensers, and low purchasing power of patients/customers. It is important to address the motives behind the unauthorized dispensing antibiotics. On top of the existing regulation and enforcement, we recommend the government to empower customers with education and purchasing power of drugs which can enhance the dispensers adherence to the dispensing regulations. Furthermore, we recommend ethnographic research to inform antibiotic stewardship interventions going beyond awareness raising, education and advocacy campaigns. This will address structural drivers of AMR such as poverty and inadequate government health services, and the disconnect between public messaging and/or policy and the public itself.
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Affiliation(s)
- Pendo M. Ndaki
- Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Joseph R. Mwanga
- Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Martha F. Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Eveline T. Konje
- Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kathryn Jean Fredricks
- Department of Geography and Sustainable Development, University of St Andrews, St Andrews, United Kingdom
| | - Mike Kesby
- Department of Geography and Sustainable Development, University of St Andrews, St Andrews, United Kingdom
| | - Alison Sandeman
- Department of Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Stella Mugassa
- Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Msilikale W. Manyiri
- Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Olga Loza
- Department of Geography and Sustainable Development, University of St Andrews, St Andrews, United Kingdom
| | - Katherine Keenan
- Department of Geography and Sustainable Development, University of St Andrews, St Andrews, United Kingdom
| | - Stanley M. Mwita
- School of Pharmacy, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Matthew T. G. Holden
- School of Pharmacy, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Meaney P, Hokororo A, Ndosi H, Dahlen A, Jacob T, Mwanga JR, Kalabamu FS, Joyce C, Mediratta R, Rozenfeld B, Berg M, Smith Z, Chami N, Mkopi NP, Mwanga C, Diocles E, Agweyu A. Feasibility of an Adaptive E-Learning Environment to Improve Provider Proficiency in Essential and Sick Newborn Care in Mwanza, Tanzania. medRxiv 2023:2023.07.11.23292406. [PMID: 37502852 PMCID: PMC10370233 DOI: 10.1101/2023.07.11.23292406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Introduction To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment (AEE). The objectives of this study were to 1) assess implementation success with use of in-person support and nudging strategy and 2) describe baseline provider knowledge and metacognition. Methods 6-month observational study at 1 zonal hospital and 3 health centers in Mwanza, Tanzania. To assess implementation success, we used the RE-AIM framework and to describe baseline provider knowledge and metacognition we used Howell's conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity. Results aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing, and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centers. Median clinical experience was 4 years [IQR 1,9] and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD±17%). Providers averaged 78% (SD±31%) completion of initial learning and 7%(SD±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% [IQR:38-63%], unconscious-incompetence 32% [IQR:23-42%], conscious-incompetence 7% [IQR:2-15%], and unconscious-competence 2% [IQR:0-3%]. Higher baseline conscious-competence (OR 31.6 [95%CI:5.8, 183.5) and being a nursing officer (aOR: 5.6 [95%CI:1.8, 18.1]), compared to medical officer) were associated with initial learning completion or persistent activity. Conclusion aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning, and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalization is needed.
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Affiliation(s)
- Peter Meaney
- Stanford University School of Medicine, Palo Alto, CA
| | - Adolfine Hokororo
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Hanston Ndosi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Alex Dahlen
- Stanford University School of Medicine, Palo Alto, CA
| | | | - Joseph R Mwanga
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Florence S Kalabamu
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
- Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Christine Joyce
- Cornell University School of Medicine, New York, New York USA
| | | | | | - Marc Berg
- Stanford University School of Medicine, Palo Alto, CA
- Area9 Lyceum, Boston, Massachusetts, USA
| | - Zack Smith
- Stanford University School of Medicine, Palo Alto, CA
| | - Neema Chami
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Namala P Mkopi
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Castory Mwanga
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Enock Diocles
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Ambrose Agweyu
- KEMRI-Wellcome Trust Research Programme, Kenya
- London School of Hygiene and Tropical Medicine, London, UK
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Keenan K, Fredricks KJ, Al Ahad MA, Neema S, Mwanga JR, Kesby M, Mushi MF, Aduda A, Green DL, Lynch AG, Huque SI, Mmbaga BT, Worthington H, Kansiime C, Olamijuwon E, Ntinginya NE, Loza O, Bazira J, Maldonado-Barragán A, Smith VA, Decano AG, Njeru JM, Sandeman A, Stelling J, Elliott A, Aanensen D, Gillespie SH, Kibiki G, Sabiiti W, Sloan DJ, Asiimwe BB, Kiiru J, Mshana SE, Holden MTG. Unravelling patient pathways in the context of antibacterial resistance in East Africa. BMC Infect Dis 2023; 23:414. [PMID: 37337134 PMCID: PMC10278291 DOI: 10.1186/s12879-023-08392-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 06/09/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND A key factor driving the development and maintenance of antibacterial resistance (ABR) is individuals' use of antibiotics (ABs) to treat illness. To better understand motivations and context for antibiotic use we use the concept of a patient treatment-seeking pathway: a treatment journey encompassing where patients go when they are unwell, what motivates their choices, and how they obtain antibiotics. This paper investigates patterns and determinants of patient treatment-seeking pathways, and how they intersect with AB use in East Africa, a region where ABR-attributable deaths are exceptionally high. METHODS The Holistic Approach to Unravelling Antibacterial Resistance (HATUA) Consortium collected quantitative data from 6,827 adult outpatients presenting with urinary tract infection (UTI) symptoms in Kenya, Tanzania, and Uganda between February 2019- September 2020, and conducted qualitative in-depth patient interviews with a subset (n = 116). We described patterns of treatment-seeking visually using Sankey plots and explored explanations and motivations using mixed-methods. Using Bayesian hierarchical regression modelling, we investigated the associations between socio-demographic, economic, healthcare, and attitudinal factors and three factors related to ABR: self-treatment as a first step, having a multi-step treatment pathway, and consuming ABs. RESULTS Although most patients (86%) sought help from medical facilities in the first instance, many (56%) described multi-step, repetitive treatment-seeking pathways, which further increased the likelihood of consuming ABs. Higher socio-economic status patients were more likely to consume ABs and have multi-step pathways. Reasons for choosing providers (e.g., cost, location, time) were conditioned by wider structural factors such as hybrid healthcare systems and AB availability. CONCLUSION There is likely to be a reinforcing cycle between complex, repetitive treatment pathways, AB consumption and ABR. A focus on individual antibiotic use as the key intervention point in this cycle ignores the contextual challenges patients face when treatment seeking, which include inadequate access to diagnostics, perceived inefficient public healthcare and ease of purchasing antibiotics without prescription. Pluralistic healthcare landscapes may promote more complex treatment seeking and therefore inappropriate AB use. We recommend further attention to healthcare system factors, focussing on medical facilities (e.g., accessible diagnostics, patient-doctor interactions, information flows), and community AB access points (e.g., drug sellers).
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Affiliation(s)
- Katherine Keenan
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK.
| | - Kathryn J Fredricks
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | - Mary Abed Al Ahad
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | - Joseph R Mwanga
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mike Kesby
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | - Martha F Mushi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Dominique L Green
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | - Andy G Lynch
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | - Sarah I Huque
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Hannah Worthington
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | - Emmanuel Olamijuwon
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | - Olga Loza
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | | | - VAnne Smith
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | - Arun Gonzales Decano
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | - Alison Sandeman
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | - Alison Elliott
- London School of Hygiene & Tropical Medicine, London, UK
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Institute, Entebbe, Uganda
| | | | - Stephen H Gillespie
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | - Wilber Sabiiti
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | - Derek J Sloan
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | - John Kiiru
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Stephen E Mshana
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Matthew T G Holden
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
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Maganga JK, Campbell CH, Angelo T, Mosha J, Mwanga JR, Kinung’hi SM. Test-Treat-Track-Test-Treat Strategy for Control of Schistosomiasis in Two Low-Prevalence Villages in Northwestern Tanzania. Am J Trop Med Hyg 2023; 108:1167-1174. [PMID: 37160273 PMCID: PMC10540130 DOI: 10.4269/ajtmh.22-0442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 03/05/2023] [Indexed: 05/11/2023] Open
Abstract
Mass drug administration of praziquantel becomes a less attractive strategy for elimination of schistosomiasis in low-prevalence areas due to cost implications and low treatment compliance. We aimed to determine the feasibility of a Test-Treat-Track-Test-Treat (5T) strategy in two low-prevalence villages; the 5T strategy has been successfully implemented in diseases such as malaria. A total of 200 school children aged 6-12 years were randomly selected from two schools and tested for Schistosoma mansoni infection using the point-of-care circulating cathodic antigen test. Schistosoma mansoni-positive children, referred to as first-generation cases (FGCs), were tracked and treated including up to five members of their families. Second-generation cases, identified by the FGCs as their close, non-relative contacts, were also tracked, tested, and treated, including up to five members of their families. The prevalence of schistosomiasis among screened FGCs was 16.5% (33/200) in both villages. Twenty-four FGCs were included in the study. Prevalence among 94 contacts of FGCs was 46.8% (44/94). The proportion was higher in Muda than Bulunga village (61.2% versus 31.1%, χ2 = 10.6611, P = 0.005). Prevalence among SGCs and their contacts was 37.5% (9/24) and 47.1% (49/104), respectively. Overall, the 5T strategy identified 102 additional cases out of 222 tracked from FGCs, 95% of whom were treated, at a total time of 52 hours. Our data demonstrate the potential of the 5T strategy in identifying and treating additional cases in the community and hence its practicality in schistosomiasis control in low-prevalence settings at relatively low time and resources investment.
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Affiliation(s)
- Jane K. Maganga
- National Institute for Medical Research, Mwanza Center, Mwanza, Tanzania
| | - Carl H. Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Teckla Angelo
- National Institute for Medical Research, Mwanza Center, Mwanza, Tanzania
| | - Justina Mosha
- National Institute for Medical Research, Mwanza Center, Mwanza, Tanzania
| | - Joseph R. Mwanga
- Department of Epidemiology, Biostatistics and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Msemwa B, Mushi MF, Kidenya B, Okamo B, Keenan K, Sabiiti W, Miyaye DN, Konje ET, Silago V, Mirambo MM, Mwanga JR, Gillespie S, Maldonado-Barragan A, Sandeman A, Holden M, Mshana SE. Urogenital pathogens in urine samples of clinically diagnosed urinary tract infected patients in Tanzania: A laboratory based cross-sectional study. IJID Reg 2023; 7:170-175. [PMID: 37069922 PMCID: PMC10105482 DOI: 10.1016/j.ijregi.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
Background Urogenital pathogens such as Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis have been reported to cause pyuria, however they are not routinely cultured from urine samples of patients clinically diagnosed to have urinary tract infections (UTI). In this study, pathogen specific PCR was done to identify the urogenital pathogens in the urine samples among clinically diagnosed UTI patients with negative routine urine culture. Methods A cross-sectional study was conducted involving 227 archived urine samples from clinically diagnosed UTI patients with positive leucocyte esterase but negative urine culture results. The urogenital pathogens were detected using pathogen specific singleplex PCR. Data were cleaned and analyzed using STATA version 15. Results The median age of patients was 31[IQR 23 - 51] years and the majority (174, 76.7%) were females. Two thirds of patients had history of antibiotic use two weeks prior to recruitment (154, 67.8%). A total of 62(27.3%) urine samples were positive for at least one urogenital pathogen. Of 62 positive samples, 9 had two urogenital pathogens and 1 had three urogenital pathogens. The most predominant urogenital pathogen detected was Neisseria gonorrhoeae 25(34.2%) and Trichomonas vaginalis 24(32.9%). Being female (aOR 2.4; 95% CI: 1.04 - 5.49; p-value 0.039) and having history of using antibiotics in the past two weeks (aOR 1.9; 95%CI: 1.04 - 3.60; p-value 0.036) was independently associated with the presence of urogenital pathogens. Conclusion More than a quarter of female patients with clinical symptoms of UTI and routine urine culture negative results were infected with urogenital pathogens mainly Neisseria gonorrhoeae and Trichomonas vaginalis. Further research with a larger sample set in a range of settings is required to understand the implications of these finding generally.
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Affiliation(s)
- Betrand Msemwa
- Department of Medical Laboratory Sciences, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Martha F Mushi
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Benson Kidenya
- Department of Biochemistry and Molecular biology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Bernard Okamo
- Department of Biochemistry and Molecular biology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Katherine Keenan
- Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Wilber Sabiiti
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Donald N Miyaye
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462 Mwanza
| | - Eveline T Konje
- Department of Epidemiology and Biostatistics, and Behavioral Sciences, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Vitus Silago
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Joseph R Mwanga
- School of Public Health, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | | | | | - Alison Sandeman
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Mathew Holden
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
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9
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Olamijuwon E, Konje E, Kansiime C, Kesby M, Keenan K, Neema S, Asiimwe B, Mshana SE, Mushi MF, Loza O, Sunday B, Sandeman A, Sloan DJ, Benitez-Paez F, Mwanga JR, Sabiiti W, Holden MTG. Antibiotic dispensing practices during COVID-19 and implications for antimicrobial resistance (AMR): parallel mystery client studies in Uganda and Tanzania. Antimicrob Resist Infect Control 2023; 12:10. [PMID: 36774512 PMCID: PMC9919751 DOI: 10.1186/s13756-022-01199-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 12/07/2022] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Over-the-counter antibiotic access is common in low-and-middle-income countries and this may accelerate antimicrobial resistance. Our study explores critical aspects of the drug seller-client interaction and antibiotic dispensing patterns for simulated COVID-19 symptoms during the pandemic in two study sites in Tanzania and Uganda, countries with different government responses to the pandemic. METHODS Research assistants posing as clients approached different types of drug sellers such as pharmacies (Pharms), drug shops (DSs), and accredited drug dispensing outlets (ADDOs) in Mwanza, Tanzania (nPharms = 415, nADDOs = 116) and Mbarara, Uganda (nPharms = 440, nDSs = 67), from June 10 to July 30, 2021. The mystery clients held no prescription and sought advice for simulated COVID-19 symptoms from the drug sellers. They documented the quality of their interaction with sellers and the type of drugs dispensed. RESULTS Adherence to COVID-19 preventive measures and vigilance to COVID-19 symptoms was low in both sites but significantly higher in Uganda than in Tanzania. A higher percentage of drug sellers in Mbarara (Pharms = 36%, DSs = 35%, P-value = 0.947) compared to Mwanza (Pharms = 9%, ADDOs = 4%, P-value = 0.112) identified the client's symptoms as possibly COVID-19. More than three-quarters of drug sellers that sold prescription-only medicines in both Mbarara (Pharms = 86%, DSs = 89%) and Mwanza (Pharms = 93%, ADDOs = 97%) did not ask the MCs for a prescription. A relatively high percentage of drug sellers that sold prescription-only medicines in Mwanza (Pharms = 51%, ADDOs = 67%) compared to Mbarara (Pharms = 31%, DSs = 42%) sold a partial course without any hesitation. Of those who sold antibiotics, a higher proportion of drug sellers in Mbarara (Pharms = 73%, DSs = 78%, P-value = 0.580) compared to Mwanza (Pharms = 40% ADDOs = 46%, P-value = 0.537) sold antibiotics relevant for treating secondary bacterial infections in COVID-19 patients. CONCLUSION Our study highlights low vigilance towards COVID-19 symptoms, widespread propensity to dispense prescription-only antibiotics without a prescription, and to dispense partial doses of antibiotics. This implies that drug dispensing related to COVID-19 may further drive AMR. Our study also highlights the need for more efforts to improve antibiotic stewardship among drug sellers in response to COVID-19 and to prepare them for future health emergencies.
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Affiliation(s)
- Emmanuel Olamijuwon
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, KY16 9AL, UK.
| | - Eveline Konje
- grid.411961.a0000 0004 0451 3858Department of Biostatistics and Epidemiology, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Catherine Kansiime
- grid.11194.3c0000 0004 0620 0548School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mike Kesby
- grid.11914.3c0000 0001 0721 1626School of Geography and Sustainable Development, University of St Andrews, St Andrews, KY16 9AL UK
| | - Katherine Keenan
- grid.11914.3c0000 0001 0721 1626School of Geography and Sustainable Development, University of St Andrews, St Andrews, KY16 9AL UK
| | - Stella Neema
- grid.11194.3c0000 0004 0620 0548Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
| | - Benon Asiimwe
- grid.11194.3c0000 0004 0620 0548Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stephen E. Mshana
- grid.411961.a0000 0004 0451 3858Department of Microbiology, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Martha F. Mushi
- grid.411961.a0000 0004 0451 3858Department of Microbiology, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Olga Loza
- grid.11914.3c0000 0001 0721 1626School of Geography and Sustainable Development, University of St Andrews, St Andrews, KY16 9AL UK
| | - Benjamin Sunday
- grid.33440.300000 0001 0232 6272Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alison Sandeman
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St Andrews, St Andrews, KY16 9AL UK
| | - Derek J. Sloan
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St Andrews, St Andrews, KY16 9AL UK
| | - Fernando Benitez-Paez
- grid.11914.3c0000 0001 0721 1626School of Geography and Sustainable Development, University of St Andrews, St Andrews, KY16 9AL UK
| | - Joseph R. Mwanga
- grid.411961.a0000 0004 0451 3858Department of Biostatistics and Epidemiology, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Wilber Sabiiti
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St Andrews, St Andrews, KY16 9AL UK
| | - Matthew T. G. Holden
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St Andrews, St Andrews, KY16 9AL UK
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Solile L, Nyanza EC, Mwanga JR, Shangali DL. Challenges in accessing health care and socio-protection services among children living and working in streets in northwestern Tanzania: A qualitative study. PLOS Glob Public Health 2023; 3:e0001916. [PMID: 37195932 DOI: 10.1371/journal.pgph.0001916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/24/2023] [Indexed: 05/19/2023]
Abstract
The escalating number of Children Living and Working in Streets (CLWS) in Tanzania has become one of the neglected Public Health issues. It is of more concern that, most of the CLWS hardly have access to health care and socio-protection services as a result, increase their vulnerability to infections and engagement in risky behaviors such as early unprotected sex. Currently, efforts by Civil Society Organizations (CSOs) to work with and assist CLWS in Tanzania are promising. To explore the role of CSOs, preventing barriers and existing opportunities in enhancing the access to health care and socio-protection services among CLWS in Mwanza city, northwestern Tanzania. A phenomenological approach was used to explore a full understanding of the individual, organizational, and social context factors on the role, prevailing barriers, and opportunities CSOs play in enhancing access to health care services and socio-protection among CLWS. Majority of CLWS were males, rape was commonly reported among CLWS. Individual CSOs are involved in resources mobilization, provision of basic life skills, education on self-protection, and mobilization of health care services to CLWS who depend on donations from public passersby. Some CSOs went as far as to develop community-based initiatives that give CLWS and home-bound children, access to health care and protection services. Older CLWS sometimes compromise the young ones from getting proper health care services by taking and/or sharing medication prescribed to them. This could be leading to incomplete dosing when ill. Moreover, health care workers were reported to have negative attitudes towards CLWS. Limited access to health and social protection services put CLWS lives at risk, calling for immediate intervention. Self-medication and incomplete dosage are a norm among this marginalized and unprotected population. Individual Civil Society Organizations attempt to address the needs of CLWS with a lot of barriers from the community and the health care system. It is time for the CSOs attempting to assist the CLWS to get support from the authorities and other people to aid this vulnerable population.
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Affiliation(s)
- Lilian Solile
- Department of Environmental, Occupational Health and GIS, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Elias C Nyanza
- Department of Environmental, Occupational Health and GIS, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Joseph R Mwanga
- Department of Epidemiology, Behavioral Sciences and Biostatistics, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Dorice L Shangali
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
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11
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Green DL, Keenan K, Fredricks KJ, Huque SI, Mushi MF, Kansiime C, Asiimwe B, Kiiru J, Mshana SE, Neema S, Mwanga JR, Kesby M, Lynch AG, Worthington H, Olamijuwon E, Abed Al Ahad M, Aduda A, Njeru JM, Mmbaga BT, Bazira J, Sandeman A, Stelling J, Gillespie SH, Kibiki G, Sabiiti W, Sloan DJ, Holden MTG. The role of multidimensional poverty in antibiotic misuse: a mixed-methods study of self-medication and non-adherence in Kenya, Tanzania, and Uganda. Lancet Glob Health 2023; 11:e59-e68. [PMID: 36521953 DOI: 10.1016/s2214-109x(22)00423-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Poverty is a proposed driver of antimicrobial resistance, influencing inappropriate antibiotic use in low-income and middle-income countries (LMICs). However, at subnational levels, studies investigating multidimensional poverty and antibiotic misuse are sparse, and the results are inconsistent. We aimed to investigate the relationship between multidimensional poverty and antibiotic use in patient populations in Kenya, Tanzania, and Uganda. METHODS In this mixed-methods study, the Holistic Approach to Unravelling Antimicrobial Resistance (HATUA) Consortium collected data from 6827 outpatients (aged 18 years and older, or aged 14-18 years and pregnant) with urinary tract infection (UTI) symptoms in health-care facilities in Kenya, Tanzania, and Uganda. We used Bayesian hierarchical modelling to investigate the association between multidimensional poverty and self-reported antibiotic self-medication and non-adherence (ie, skipping a dose and not completing the course). We analysed linked qualitative in-depth patient interviews and unlinked focus-group discussions with community members. FINDINGS Between Feb 10, 2019, and Sept 10, 2020, we collected data on 6827 outpatients, of whom 6345 patients had complete data; most individuals were female (5034 [79·2%]), younger than 35 years (3840 [60·5%]), worked in informal employment (2621 [41·3%]), and had primary-level education (2488 [39·2%]). Antibiotic misuse was more common among those least deprived, and lowest among those living in severe multidimensional poverty. Regardless of poverty status, difficulties in affording health care, and more familiarity with antibiotics, were related to more antibiotic misuse. Qualitative data from linked qualitative in-depth patient interviews (n=82) and unlinked focus-group discussions with community members (n=44 groups) suggested that self-medication and treatment non-adherence were driven by perceived inconvenience of the health-care system, financial barriers, and ease of unregulated antibiotic access. INTERPRETATION We should not assume that higher deprivation drives antibiotic misuse. Structural barriers such as inefficiencies in public health care, combined with time and financial constraints, fuel alternative antibiotic access points and treatment non-adherence across all levels of deprivation. In designing interventions to reduce antibiotic misuse and address antimicrobial resistance, greater attention is required to these structural barriers that discourage optimal antibiotic use at all levels of the socioeconomic hierarchy in LMICs. FUNDING UK National Institute for Health Research, UK Medical Research Council, and the Department of Health and Social Care.
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Affiliation(s)
- Dominique L Green
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Katherine Keenan
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK.
| | - Kathryn J Fredricks
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Sarah I Huque
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Martha F Mushi
- Department of Microbiology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Benon Asiimwe
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - John Kiiru
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Stephen E Mshana
- Department of Microbiology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Stella Neema
- Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
| | - Joseph R Mwanga
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mike Kesby
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Andy G Lynch
- School of Mathematics and Statistics, University of St Andrews, St Andrews, UK; School of Medicine, University of St Andrews, St Andrews, UK
| | - Hannah Worthington
- School of Mathematics and Statistics, University of St Andrews, St Andrews, UK
| | - Emmanuel Olamijuwon
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Mary Abed Al Ahad
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | | | | | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi Tanzania
| | - Joel Bazira
- Department of Microbiology, Mbarara University, Mbarara, Uganda
| | - Alison Sandeman
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | | | | | - Wilber Sabiiti
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Derek J Sloan
- School of Medicine, University of St Andrews, St Andrews, UK
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12
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Ndaki PM, Mushi MF, Mwanga JR, Konje ET, Mugassa S, Manyiri MW, Mwita SM, Ntinginya NE, Mmbaga BT, Keenan K, Sabiiti W, Kesby M, Benitez-Paez F, Sandeman A, Holden MTG, Mshana SE. Non-prescribed antibiotic dispensing practices for symptoms of urinary tract infection in community pharmacies and accredited drug dispensing outlets in Tanzania: a simulated clients approach. BMC Prim Care 2022; 23:287. [PMID: 36402956 PMCID: PMC9675131 DOI: 10.1186/s12875-022-01905-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 11/08/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Antibiotic dispensing without prescription is a major determinant of the emergence of Antimicrobial Resistance (AMR) which has impact on population health and cost of healthcare delivery. This study used simulated clients describing UTI like symptoms to explore compliance with regulation, variations in dispensing practices and drug recommendation, and quality of seller-client interaction on the basis of the gender of the client and the type of drug outlets in three regions in Tanzania. METHOD A total of 672 Accredited Drug Dispensing Outlets (ADDOs) and community pharmacies were visited by mystery clients (MCs). The study was conducted in three regions of Tanzania namely Kilimanjaro (180, 26.79%), Mbeya (169, 25.15%) and Mwanza (323, 48.07%) in March-May 2020. During data collection, information was captured using epicollect5 software before being analyzed using Stata version 13. RESULTS Overall, 89.43% (CI: 86.87-91.55%) of drug sellers recommended antibiotics to clients who described UTI like symptoms but held no prescription and 58.93% were willing to sell less than the minimum recommended course. Female clients were more likely than male to be asked if they were taking other medications (27.2% vs 9.8%), or had seen a doctor (27.8% vs 14.7%), and more likely to be advised to consult a doctor (21.6% vs 9.0%); pharmacies addressed these issues more often than ADDOs (17.7% vs 13.2, 23.9% vs 16.6%, 17.7 vs 10.9% respectively). Sellers recommended 32 different drugs to treat the same set of symptoms, only 7 appear in the Tanzanian Standard Treatment Guidelines as recommended for UTI and 30% were 2nd and 3rd line drugs. ADDO sellers recommended 31 drug types (including 2nd and 3rd line) but had permission to stock only 3 (1st line) drugs. The most commonly suggested antibiotics were Azithromycin (35.4%) and ciprofloxacin (20.5%). Azithromycin was suggested more often in pharmacies (40.8%) than in ADDOs (34.4%) and more often to male clients (36.0%) than female (33.1%). CONCLUSION These findings support the need for urgent action to ensure existing regulations are adhered to and to promote the continuing professional development of drug sellers at all outlet levels to ensure compliance with regulation, high quality service and better antibiotic stewardship.
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Affiliation(s)
- Pendo M. Ndaki
- grid.411961.a0000 0004 0451 3858Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Martha F. Mushi
- grid.411961.a0000 0004 0451 3858Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Joseph R. Mwanga
- grid.411961.a0000 0004 0451 3858Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Eveline T. Konje
- grid.411961.a0000 0004 0451 3858Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Stella Mugassa
- grid.411961.a0000 0004 0451 3858Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Msilikale W. Manyiri
- grid.411961.a0000 0004 0451 3858Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Stanley M. Mwita
- grid.411961.a0000 0004 0451 3858School of Pharmacy, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Nyanda E. Ntinginya
- grid.416716.30000 0004 0367 5636National Institute for Medical Research, Mbeya Medical Research Centre, P.O. Box 2410, Mbeya, Tanzania
| | - Blandina T. Mmbaga
- grid.412898.e0000 0004 0648 0439Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical University College, P.O. Box 2236, Moshi, Tanzania
| | - Katherine Keenan
- grid.11914.3c0000 0001 0721 1626Geography and Sustainable Development, University of St Andrews, North Street, St Andrews, KY16 9AL UK
| | - Wilber Sabiiti
- grid.11914.3c0000 0001 0721 1626Division of Infection and Global Health, School of Medicine, University of St Andrews, North Street, St Andrews, KY16 9AL UK
| | - Mike Kesby
- grid.11914.3c0000 0001 0721 1626Geography and Sustainable Development, University of St Andrews, North Street, St Andrews, KY16 9AL UK
| | - Fernando Benitez-Paez
- grid.11914.3c0000 0001 0721 1626Geography and Sustainable Development, University of St Andrews, North Street, St Andrews, KY16 9AL UK
| | - Alison Sandeman
- grid.11914.3c0000 0001 0721 1626Division of Infection and Global Health, School of Medicine, University of St Andrews, North Street, St Andrews, KY16 9AL UK
| | - Matthew T. G. Holden
- grid.11914.3c0000 0001 0721 1626Division of Infection and Global Health, School of Medicine, University of St Andrews, North Street, St Andrews, KY16 9AL UK
| | - Stephen E. Mshana
- grid.411961.a0000 0004 0451 3858Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
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13
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Lo NC, Bezerra FSM, Colley DG, Fleming FM, Homeida M, Kabatereine N, Kabole FM, King CH, Mafe MA, Midzi N, Mutapi F, Mwanga JR, Ramzy RMR, Satrija F, Stothard JR, Traoré MS, Webster JP, Utzinger J, Zhou XN, Danso-Appiah A, Eusebi P, Loker ES, Obonyo CO, Quansah R, Liang S, Vaillant M, Murad MH, Hagan P, Garba A. Review of 2022 WHO guidelines on the control and elimination of schistosomiasis. Lancet Infect Dis 2022; 22:e327-e335. [PMID: 35594896 DOI: 10.1016/s1473-3099(22)00221-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 01/13/2023]
Abstract
Schistosomiasis is a helminthiasis infecting approximately 250 million people worldwide. In 2001, the World Health Assembly (WHA) 54.19 resolution defined a new global strategy for control of schistosomiasis through preventive chemotherapy programmes. This resolution culminated in the 2006 WHO guidelines that recommended empirical treatment by mass drug administration with praziquantel, predominately to school-aged children in endemic settings at regular intervals. Since then, school-based and community-based preventive chemotherapy programmes have been scaled-up, reducing schistosomiasis-associated morbidity. Over the past 15 years, new scientific evidence-combined with a more ambitious goal of eliminating schistosomiasis and an increase in the global donated supply of praziquantel-has highlighted the need to update public health guidance worldwide. In February, 2022, WHO published new guidelines with six recommendations to update the global public health strategy against schistosomiasis, including expansion of preventive chemotherapy eligibility from the predominant group of school-aged children to all age groups (2 years and older), lowering the prevalence threshold for annual preventive chemotherapy, and increasing the frequency of treatment. This Review, written by the 2018-2022 Schistosomiasis Guidelines Development Group and its international partners, presents a summary of the new WHO guideline recommendations for schistosomiasis along with their historical context, supporting evidence, implications for public health implementation, and future research needs.
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Affiliation(s)
- Nathan C Lo
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, CA, USA.
| | | | - Daniel G Colley
- Department of Microbiology, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, USA
| | | | - Mamoun Homeida
- Academy of Medical Sciences and Technology, Khartoum, Sudan
| | - Narcis Kabatereine
- Accelerating Resilient, Innovative, and Sustainable Elimination of NTDs, Vector Control Division, Kampala, Uganda
| | | | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Nicholas Midzi
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Francisca Mutapi
- Institute of Immunology and Infection Research, Tackling Infections to Benefit Africa Partnership, University of Edinburgh, Edinburgh, UK
| | - Joseph R Mwanga
- Department of Epidemiology, Biostatistics and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Reda M R Ramzy
- National Nutrition Institute, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt
| | - Fadjar Satrija
- School of Veterinary Medicine and Biomedicine, IPB University, Bogor, Indonesia
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Joanne P Webster
- Department of Pathobiology and Population Science, Royal Veterinary College, University of London, London, UK
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China; School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Paolo Eusebi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Eric S Loker
- Department of Biology, University of New Mexico, Albuquerque, NM, USA
| | - Charles O Obonyo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Song Liang
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Michel Vaillant
- Competence Centre for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, NY, USA
| | - Paul Hagan
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Amadou Garba
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
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14
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Ndomba ALM, Laisser RM, Konje ET, Mwanga JR, Mshana SE. Life with an Indwelling Urinary Catheter: Experiences from Male Patients Attending the Urology Clinic at a Tertiary Hospital in Northwestern Tanzania-A Qualitative Study. Nurs Rep 2022; 12:791-803. [PMID: 36412796 PMCID: PMC9680475 DOI: 10.3390/nursrep12040077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022] Open
Abstract
Experiences from patients living with a long-term indwelling urinary catheter (IUC) at home among men attending urology clinics have not been reported. Evidence-based information on such experiences is important for improving nursing care in low- and middle-income countries such as Tanzania. Using a descriptive phenomenological qualitative research design, we observed two main themes: "Adjustments to positive living with a catheter at home", denoting that social interaction and psychological and spiritual support are important to positively live with the catheter, and "The home environment influences negative or positive living", considering intimacy and altered body image to significantly influence the ability to practice sex, leading to wives' self-sacrifice. Respondents experienced difficulties in living with a long-term IUC at home due to a lack of information from healthcare professionals on how to manage their catheters and urine bags. In adjusting to positive or negative living with a catheter at home, respondents had to figure out strategies to minimize psychological and emotional trauma and hasten the adjustment process. A clear guideline or checklist is needed to ensure that all important information is provided by health professionals at the time of discharge and during subsequent visits to patients on how to care for the catheter insertion sites and help them adjust to living with a long-term IUC.
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Affiliation(s)
- Asteria L. M. Ndomba
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Bugando Area, Mwanza P.O. Box 1464, Tanzania
- Correspondence: ; Tel.: +255-755-435-470
| | - Rose M. Laisser
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Bugando Area, Mwanza P.O. Box 1464, Tanzania
| | - Eveline T. Konje
- Department of Biostatistics, Epidemiology and Behavioral Sciences, Catholic University of Health and Allied Sciences, Bugando Area, Mwanza P.O. Box 1464, Tanzania
| | - Joseph R. Mwanga
- School of Public Health, Catholic University of Health and Allied Sciences, Bugando Area, Mwanza P.O. Box 1464, Tanzania
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando Area, Mwanza P.O. Box 1464, Tanzania
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15
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Ndaki PM, Mushi MF, Mwanga JR, Konje ET, Ntinginya NE, Mmbaga BT, Keenan K, Sabiiti W, Kesby M, Benitez-Paez F, Sandeman A, Holden MTG, Mshana SE, Hatua Consortium. Dispensing Antibiotics without Prescription at Community Pharmacies and Accredited Drug Dispensing Outlets in Tanzania: A Cross-Sectional Study. Antibiotics (Basel) 2021; 10:1025. [PMID: 34439074 PMCID: PMC8389015 DOI: 10.3390/antibiotics10081025] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
Worldwide, antimicrobial resistance is increasing rapidly and is associated with misuse of antimicrobials. The HATUA study (a broader 3-country study) investigated the antibiotic dispensing practices of pharmaceutical providers to clients, particularly the propensity to dispense without prescription. A cross-sectional study using a 'mystery client' method was conducted in 1148 community pharmacies and accredited drugs dispensing outlets (ADDO) in Mwanza (n = 612), Mbeya (n = 304) and Kilimanjaro (n = 232) in Tanzania. Mystery clients asked directly for amoxicillin, had no prescription to present, did not discuss symptoms unless asked [when asked reported UTI-like symptoms] and attempted to buy a half course. Dispensing of amoxicillin without prescription was common [88.2, 95%CI 86.3-89.9%], across all three regions. Furthermore, the majority of outlets sold a half course of amoxicillin without prescription: Mwanza (98%), Mbeya (99%) and Kilimanjaro (98%). Generally, most providers in all three regions dispensed amoxicillin on demand, without asking the client any questions, with significant variations among regions [p-value = 0.003]. In Mbeya and Kilimanjaro, providers in ADDOs were more likely to do this than those in pharmacies but no difference was observed in Mwanza. While the Tanzanian government has laws, regulations and guidelines that prohibit antibiotic dispensing without prescription, our study suggests non-compliance by drug providers. Enforcement, surveillance, and the provision of continuing education on dispensing practices is recommended, particularly for ADDO providers.
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Affiliation(s)
- Pendo M Ndaki
- Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania
| | - Martha F Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania
| | - Joseph R Mwanga
- Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania
| | - Eveline T Konje
- Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania
| | - Nyanda E Ntinginya
- Mbeya Centre, National Medical Research Institute, Mbeya P.O. Box 2410, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2236, Tanzania
| | - Katherine Keenan
- Geography and Sustainable Development Department, University of St. Andrews, St. Andrews KY16 9AL, UK
| | - Wilber Sabiiti
- Division of Infection and Global Health, School of Medicine, University of St. Andrews, St. Andrews KY16 9AL, UK
| | - Mike Kesby
- Geography and Sustainable Development Department, University of St. Andrews, St. Andrews KY16 9AL, UK
| | - Fernando Benitez-Paez
- Geography and Sustainable Development Department, University of St. Andrews, St. Andrews KY16 9AL, UK
| | - Alison Sandeman
- Division of Infection and Global Health, School of Medicine, University of St. Andrews, St. Andrews KY16 9AL, UK
| | - Matthew T G Holden
- Division of Infection and Global Health, School of Medicine, University of St. Andrews, St. Andrews KY16 9AL, UK
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania
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16
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Asiimwe BB, Kiiru J, Mshana SE, Neema S, Keenan K, Kesby M, Mwanga JR, Sloan DJ, Mmbaga BT, Smith VA, Gillespie SH, Lynch AG, Sandeman A, Stelling J, Elliott A, Aanensen DM, Kibiki GE, Sabiiti W, Holden MTG. Protocol for an interdisciplinary cross-sectional study investigating the social, biological and community-level drivers of antimicrobial resistance (AMR): Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA). BMJ Open 2021; 11:e041418. [PMID: 34006022 PMCID: PMC7942251 DOI: 10.1136/bmjopen-2020-041418] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 01/14/2021] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a global health threat that requires urgent research using a multidisciplinary approach. The biological drivers of AMR are well understood, but factors related to treatment seeking and the social contexts of antibiotic (AB) use behaviours are less understood. Here we describe the Holistic Approach to Unravel Antibacterial Resistance in East Africa, a multicentre consortium that investigates the diverse drivers of drug resistance in urinary tract infections (UTIs) in East Africa. METHODS AND ANALYSIS This study will take place in Uganda, Kenya and Tanzania. We will conduct geospatial mapping of AB sellers, and conduct mystery client studies and in-depth interviews (IDIs) with drug sellers to investigate AB provision practices. In parallel, we will conduct IDIs with doctors, alongside community focus groups. Clinically diagnosed patients with UTI will be recruited from healthcare centres, provide urine samples and complete a questionnaire capturing retrospective treatment pathways, sociodemographic characteristics, attitudes and knowledge. Bacterial isolates from urine and stool samples will be subject to culture and antibiotic sensitivity testing. Genomic DNA from bacterial isolates will be extracted with a subset being sequenced. A follow-up household interview will be conducted with 1800 UTI-positive patients, where further environmental samples will be collected. A subsample of patients will be interviewed using qualitative tools. Questionnaire data, microbiological analysis and qualitative data will be linked at the individual level. Quantitative data will be analysed using statistical modelling, including Bayesian network analysis, and all forms of qualitative data analysed through iterative thematic content analysis. ETHICS AND DISSEMINATION Approvals have been obtained from all national and local ethical review bodies in East Africa and the UK. Results will be disseminated in communities, with local and global policy stakeholders, and in academic circles. They will have great potential to inform policy, improve clinical practice and build regional pathogen surveillance capacity.
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Affiliation(s)
- Benon B Asiimwe
- School of Biomedical Sciences, Makerere University, Kampala, Uganda
| | - John Kiiru
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Stella Neema
- College of Humanities and Social Science, Makerere University, Kampala, Uganda
| | - Katherine Keenan
- Geography and Sustainable Development, University of St Andrews, St Andrews, Fife, UK
| | - Mike Kesby
- Geography and Sustainable Development, University of St Andrews, St Andrews, Fife, UK
| | - Joseph R Mwanga
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Derek J Sloan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - V Anne Smith
- School of Biology, University of St Andrews, St Andrews, UK
| | | | - Andy G Lynch
- School of Medicine, University of St Andrews, St Andrews, UK
- School of Mathematics and Statistics, University of St Andrews, St Andrews, UK
| | - Alison Sandeman
- School of Medicine, University of St Andrews, St Andrews, UK
| | - John Stelling
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alison Elliott
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Immunomodulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Institute, Kampala, Uganda
| | - David M Aanensen
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Cambridge, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Wilber Sabiiti
- School of Medicine, University of St Andrews, St Andrews, UK
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17
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Ndomba ALM, Laisser RM, Kidenya BR, Kohi TW, Mwanga JR, Mshana SE. Prevalence and indications of long-term indwelling urinary catheter among out-patients attending urology clinic at a tertiary hospital in Northwestern Tanzania. Afr J Urol 2021. [DOI: 10.1186/s12301-021-00140-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Abstract
Background
People living with long-term indwelling urinary catheterization at home are increasing globally. Few studies on prevalence have been done globally and none in Sub-Saharan Africa. This study investigated the prevalence and indications of long-term indwelling urinary catheterization (IUC) at home in Northwestern Tanzania and to determine the reasons for staying long with an indwelling urinary catheter after diagnosis of benign prostatic hypertrophy was confirmed.
Methods
This was a cross-sectional study conducted at urology clinic at Bugando Medical Centre, a referral hospital in the Northwestern Zone of Tanzania. The study population included 2112 patients attending the urology clinic from December 2016 to September 2017 with different conditions. From this population, 202 out-patients living with a long-term IUC either suprapubic or urethral were conveniently selected. A review of hospital records of these 202 out-patients was done using a pre-tested checklist. Patients were interviewed to collect additional information. Data were analyzed using STATA version 13(college station, Texas). Descriptive statistics were used for categorical variable, whereas median [inter quartile range (IQR)] was used for continuous variables.
Results
The prevalence of out-patients living at home with an IUC was 9.6% (202/2112), CI (8.4–10.8). Age ranged from 18 to 95 years with the median age of 69 [IQR 61–77] years. Males 195(96.5%) formed the majority of participants. A total of 111 (54.9%) had catheters for ≥ six weeks and 123 (60.9%) had their catheters changed at least once. Common indications were benign prostatic hypertrophy (BPH), 129 (63.9%) and urethral stricture 34 (16.8%). Reasons for the long stay with an IUC at home, especially for those without National Health Insurance Fund (NHIF) 49(94.2%) were endless appointments 23(52.3%), no money to pay for surgery 9(20.5%) and medical conditions 7 (16%). Only 3(0.1%) were under NHIF and were treated promptly.
Conclusion
Prevalence of long-term IUC in Northwestern Tanzania is high. Improved health care system is required to lower the high prevalence of long-term IUC at home through training of more urologists and these patients to be under the scheme of NHIF.
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18
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Mwanga JR, Kinung'hi SM, Mosha J, Angelo T, Maganga J, Campbell CH. Village Response to Mass Drug Administration for Schistosomiasis in Mwanza Region, Northwestern Tanzania: Are We Missing Socioeconomic, Cultural, and Political Dimensions? Am J Trop Med Hyg 2021; 103:1969-1977. [PMID: 32901610 PMCID: PMC7646777 DOI: 10.4269/ajtmh.19-0843] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Praziquantel (PZQ)-based mass drug administration (MDA) is the main approach for controlling schistosomiasis in endemic areas. Interventions such as provision and use of clean and safe water, minimizing contacts with infested water, disposal of human waste in latrines, and snail control provide additional key interventions to break the transmission cycle and could complement and perhaps sustain the benefits of MDA. However, all interventions deployed need to be accepted by the targeted communities. A qualitative study was conducted to examine factors that might differentiate villages which did not show a substantial decrease in Schistosoma mansoni prevalence despite repeated, high treatment coverage referred to as “persistent hotspot (PHS) villages” from villages which showed a substantial decrease in prevalence referred to as “responding (RES) villages.” A convenient sample of adults was drawn from eight villages. Thirty-nine key informants were interviewed and 16 focus groups were held with a total of 123 participants. Data were analyzed manually using a thematic content approach. In both PHS and RES villages, schistosomiasis was not considered to be a priority health problem because of its chronic nature, lack of knowledge and awareness, and poverty among study communities. Persistent hotspot villages exhibited poor leadership style, lack of or insufficient social engagement, little or lack of genuine community participation, little motivation, and commitment to schistosomiasis control compared with RES villages where there were commitment and motivation to fight schistosomiasis. We support the view of scholars who advocate for the adoption of a biosocial approach for effective and sustainable PZQ-based MDA for schistosomiasis control.
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Affiliation(s)
- Joseph R Mwanga
- Department of Epidemiology, Biostatistics and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Safari M Kinung'hi
- National Institute of Medical Research (NIMR), Mwanza Center, Mwanza, Tanzania
| | - Justina Mosha
- National Institute of Medical Research (NIMR), Mwanza Center, Mwanza, Tanzania
| | - Teckla Angelo
- National Institute of Medical Research (NIMR), Mwanza Center, Mwanza, Tanzania
| | - Jane Maganga
- National Institute of Medical Research (NIMR), Mwanza Center, Mwanza, Tanzania
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases (CTEGD), University of Georgia, Athens, Georgia
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19
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Kittur N, Campbell CH, Binder S, Shen Y, Wiegand RE, Mwanga JR, Kinung'hi SM, Musuva RM, Odiere MR, Matendechero SH, Knopp S, Colley DG. Discovering, Defining, and Summarizing Persistent Hotspots in SCORE Studies. Am J Trop Med Hyg 2020; 103:24-29. [PMID: 32400365 PMCID: PMC7351310 DOI: 10.4269/ajtmh.19-0815] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) conducted large field studies on schistosomiasis control and elimination in Africa. All of these studies, carried out in low-, moderate-, and high-prevalence areas, resulted in a reduction in prevalence and intensity of Schistosoma infection after repeated mass drug administration (MDA). However, in all studies, there were locations that experienced minimal or no decline or even increased in prevalence and/or intensity. These areas are termed persistent hotspots (PHS). In SCORE studies in medium- to high-prevalence areas, at least 30% of study villages were PHS. There was no consistent relationship between PHS and the type or frequency of intervention, adequacy of reported MDA coverage, and prevalence or intensity of infection at baseline. In a series of small studies, factors that differed between PHS and villages that responded to repeated MDA as expected included sources of water for personal use, sanitation, and hygiene. SCORE studies comparing PHS with villages that responded to MDA suggest the potential for PHS to be identified after a few years of MDA. However, additional studies in different social-ecological settings are needed to develop generalizable approaches that program managers can use to identify and address PHS. This is essential if goals for schistosomiasis control and elimination are to be achieved.
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Affiliation(s)
- Nupur Kittur
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Ye Shen
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia
| | - Ryan E Wiegand
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph R Mwanga
- Department of Epidemiology, Biostatistics and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Safari M Kinung'hi
- Mwanza Research Centre, National Institute of Medical Research, Mwanza, Tanzania
| | - Rosemary M Musuva
- Neglected Tropical Diseases Unit, Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Maurice R Odiere
- Neglected Tropical Diseases Unit, Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Sultani H Matendechero
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
| | - Stefanie Knopp
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Daniel G Colley
- Department of Microbiology, University of Georgia, Athens, Georgia.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
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20
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Kapesa A, Basinda N, Nyanza EC, Monge J, Ngallaba SE, Mwanga JR, Kweka EJ. Malaria Morbidities Following Universal Coverage Campaign for Long-Lasting Insecticidal Nets: A Case Study in Ukerewe District, Northwestern Tanzania. Res Rep Trop Med 2020; 11:53-60. [PMID: 32801989 PMCID: PMC7406376 DOI: 10.2147/rrtm.s248834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background Surveillance of the clinical morbidity of malaria remains key for disease monitoring for subsequent development of appropriate interventions. This case study presents the current status of malaria morbidities following a second round of mass distribution of long-lasting insecticidal nets (LLINs) on Ukerewe Island, northwestern Tanzania. Methods A retrospective review of health-facility registers to determine causes of inpatient morbidities for every admitted child aged <5 years was conducted to ascertain the contribution of malaria before and after distribution of LLINs. This review was conducted from August 2016 to July 2018 in three selected health facilities. To determine the trend of malaria admissions in the selected facilities, additional retrospective collection of all malaria and other causes of admission was conducted for both <5- and >5-year-old patients from July 2014 to June 2018. For comparison purposes, monthly admissions of malaria and other causes from all health facilities in the district were also collected. Moreover, an LLIN-coverage study was conducted among randomly selected households (n=684). Results Between August 2016 and July 2018, malaria was the leading cause of inpatient morbidity, accounting for 44.1% and 20.3% among patients <5 and >5 years old, respectively. Between October 2017 and January 2018, the mean number of admissions of patients aged <5 years increased 2.7-fold at one health center and 1.02-fold for all admissions in the district. Additionally, approximately half the households in the study area had poor of LLIN coverage 1 year after mass distribution. Conclusion This trend analysis of inpatient morbidities among children aged <5 years revealed an upsurge in malaria admissions in some health facilities in the district, despite LLIN intervention. This suggests the occurrence of an unnoticed outbreak of malaria admissions in all health facilities.
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Affiliation(s)
- Anthony Kapesa
- Department of Community Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Namanya Basinda
- Department of Community Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Elias C Nyanza
- Department of Environmental and Occupational Health and GIS, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Joshua Monge
- Department of Health, Ukerewe District Council, Mwanza, Tanzania
| | - Sospatro E Ngallaba
- Department of Epidemiology, Biostatisticsand Behavioural Sciences, School of Public Health, Catholic University of Health Sciences and Allied Sciences, Mwanza, Tanzania
| | - Joseph R Mwanga
- Department of Epidemiology, Biostatisticsand Behavioural Sciences, School of Public Health, Catholic University of Health Sciences and Allied Sciences, Mwanza, Tanzania
| | - Eliningaya J Kweka
- Department of Parasitology and Medical Entomology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.,Division of Livestock and Human Disease Vector Control, Tropical Pesticides Research Institute, Arusha, Tanzania
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Angelo T, Kinung’hi SM, Buza J, Mwanga JR, Kariuki HC, Wilson S. Community knowledge, perceptions and water contact practices associated with transmission of urinary schistosomiasis in an endemic region: a qualitative cross-sectional study. BMC Public Health 2019; 19:703. [PMID: 31174505 PMCID: PMC6554870 DOI: 10.1186/s12889-019-7041-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 05/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In an effort to complement the current chemotherapy based schistosomiasis control interventions in Shinyanga district, community knowledge, perceptions and water contact practices were qualitatively assessed using focus group discussions and semi structured interviews involving 271 participants in one S. haematobium prevalent community of Ikingwamanoti village, Shinyanga district, Northwestern, Tanzania. METHODS In October, 2016 we conducted 29 parent semi structured interviews and 16 focus group discussions with a total of 168 parent informants. Adult participants were conveniently selected from three sub-villages of Butini, Miyu, and Bomani of Ikingwamanoti village, Shinyanga district. In March, 2017, a total of 103 children informants participated in 10 focus group discussions and 20 semi structured interviews, administered to children from standard four, five, six and seven attending Ikingwamanoti Primary School. Note taking and digital recorders were used to collect narrative data for thematic analysis of emergent themes. RESULTS Among participants, 75% parents and 50% children considered urinary schistosomiasis as a low priority health problem. Of the informants, 70% children and 48.3% parents had misconceptions about the cause, modes of transmission and control of schistosomiasis demonstrating gaps in their biomedical knowledge of the disease. Assessment of treatment seeking behavior for urinary schistosomiasis revealed a combination of traditional and modern health care sectors. However, modern medicines were considered effective in the treatment of urinary schistosomiasis. Lack of alternative sources of water for domestic and recreational activities and unhygienic water use habits exposed community members to high risk of acquiring urinary schistosomiasis. CONCLUSION Use of Schistosoma haematobium contaminated water sources for daily domestic and recreational use facilitated contraction of urinary schistosomiasis among community members in Shinyanga district. People's perceptions of urinary schistosomiasis as a less priority health problem promoted persistence of the disease. Future efforts to control urinary schistosomiasis should take into account integrated approaches combining water, sanitation and hygiene, health education, alternative sources of clean and safe water to facilitate behavior change.
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Affiliation(s)
- Teckla Angelo
- Department of Global Health and Bio-Medical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology (NM-AIST), P. O. Box 447, Arusha, Tanzania
- National Institute for Medical Research (NIMR), Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Safari M. Kinung’hi
- National Institute for Medical Research (NIMR), Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Jorum Buza
- Department of Global Health and Bio-Medical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology (NM-AIST), P. O. Box 447, Arusha, Tanzania
| | - Joseph R. Mwanga
- National Institute for Medical Research (NIMR), Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Henry Curtis Kariuki
- Kenya Methodist University, School of Medicine and Health Sciences, P. O. Box 267, Meru, Kenya
| | - Shona Wilson
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP UK
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Mwanga JR, Kaatano GM, Siza JE, Chang SY, Ko Y, Kullaya CM, Nsabo J, Eom KS, Yong TS, Chai JY, Min DY, Rim HJ, Changalucha JM. Improved Perceptions and Practices Related to Schistosomiasis and Intestinal Worm Infections Following PHAST Intervention on Kome Island, North-Western Tanzania. Korean J Parasitol 2015; 53:561-9. [PMID: 26537035 PMCID: PMC4635831 DOI: 10.3347/kjp.2015.53.5.561] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/30/2015] [Accepted: 09/30/2015] [Indexed: 11/23/2022]
Abstract
Schistosomiasis and intestinal worm infections are widespread diseases of public health importance in Tanzania. A study on perceptions and practices related to schistosomiasis and intestinal worm infections was undertaken among a community population of Kome Island in Sengerema District, north-western Tanzania, where intestinal schistosomiasis and intestinal worm infections are endemic. Schistosomiasis and intestinal worm-related perceptions and practices were assessed before and 3 years after implementation of a participatory hygiene and sanitation transformation (PHAST) intervention as a control measure. Data were obtained from baseline and post-intervention knowledge, attitudes, and practices (KAP) questionnaire surveys conducted twice in 2009 and 2012 among 82 individuals aged ≥15 years. We found significant increases in respondents’ knowledge of the cause, transmission, symptoms, health consequences, and prevention of schistosomiasis and intestinal worm infections after PHAST intervention. The increase in respondents’ knowledge on almost all aspects of the said infections was translated into actions to control schistosomiasis and intestinal worm infections. This has not been achieved by chance, but due to well-designed and locally-adapted PHAST intervention. We conclude that despite criticisms, PHAST approach is still useful in empowering communities to control water, sanitation, and hygiene related infectious diseases such as schistosomiasis and intestinal worm infections.
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Affiliation(s)
- Joseph R Mwanga
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Godfrey M Kaatano
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Julius E Siza
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Su Young Chang
- Good Neighbors International, Tanzania Western Chapter, P.O. Box 367, Mwanza, Tanzania
| | - Yunsuk Ko
- Good Neighbors International, Tanzania Western Chapter, P.O. Box 367, Mwanza, Tanzania
| | - Cyril M Kullaya
- Good Neighbors International, Tanzania Western Chapter, P.O. Box 367, Mwanza, Tanzania
| | - Jackson Nsabo
- Good Neighbors International, Tanzania Western Chapter, P.O. Box 367, Mwanza, Tanzania
| | - Keeseon S Eom
- Department of Parasitology, Medical Research Institute and Parasite Resource Bank, Chungbuk National University School of Medicine, Cheongju 28644, Korea
| | - Tai-Soon Yong
- Department of Environmental Medical Biology, Institute of Tropical Medicine and Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jong-Yil Chai
- Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Duk-Young Min
- Department of Immunology and Microbiology, Eulji University School of Medicine, Daejeon 34824, Korea
| | - Han-Jong Rim
- Department of Parasitology, College of Medicine, Korea University, Seoul 02841, Korea
| | - John M Changalucha
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
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Mwanga JR, Kaatano GM, Siza JE, Chang SY, Ko Y, Kullaya CM, Nsabo J, Eom KS, Yong TS, Chai JY, Min DY, Rim HJ, Changalucha JM. Improved Socio-Economic Status of a Community Population Following Schistosomiasis and Intestinal Worm Control Interventions on Kome Island, North-Western Tanzania. Korean J Parasitol 2015; 53:553-9. [PMID: 26537034 PMCID: PMC4635828 DOI: 10.3347/kjp.2015.53.5.553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/30/2015] [Accepted: 09/30/2015] [Indexed: 12/05/2022]
Abstract
Research on micro-level assessment of the changes of socio-economic status following health interventions is very scarce. The use of household asset data to determine wealth indices is a common procedure for estimating socio-economic position in resource poor settings. In such settings information about income is usually lacking, and the collection of individual consumption or expenditure data would require in-depth interviews, posing a considerable risk of bias. In this study, we determined the socio-economic status of 213 households in a community population in an island in the north-western Tanzania before and 3 year after implementation of a participatory hygiene and sanitation transformation (PHAST) intervention to control schistosomiasis and intestinal worm infections. We constructed a household 'wealth index' based housing construction features (e.g., type of roof, walls, and floor) and durable assets ownership (e.g., bicycle, radio, etc.). We employed principal components analysis and classified households into wealth quintiles. The study revealed that asset variables with positive factor scores were associated with higher socio-economic status, whereas asset variables with negative factor scores were associated with lower socio-economic status. Overall, households which were rated as the poorest and very poor were on the decrease, whereas those rated as poor, less poor, and the least poor were on the increase after PHAST intervention. This decrease/increase was significant. The median shifted from -0.4376677 to 0.5001073, and the mean from -0.2605787 (SD; 2.005688) to 0.2605787 (SD; 1.831199). The difference in socio-economic status of the people between the 2 phases was highly statistically significant (P<0.001). We argue that finding of this study should be treated with caution as there were other interventions to control schistosomiasis and intestinal worm infections which were running concurrently on Kome Island apart from PHAST intervention.
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Affiliation(s)
- Joseph R Mwanga
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Godfrey M Kaatano
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Julius E Siza
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Su Young Chang
- Good Neighbors International, Tanzania Western Chapter, P.O. Box 367, Mwanza, Tanzania
| | - Yunsuk Ko
- Good Neighbors International, Tanzania Western Chapter, P.O. Box 367, Mwanza, Tanzania
| | - Cyril M Kullaya
- Good Neighbors International, Tanzania Western Chapter, P.O. Box 367, Mwanza, Tanzania
| | - Jackson Nsabo
- Good Neighbors International, Tanzania Western Chapter, P.O. Box 367, Mwanza, Tanzania
| | - Keeseon S Eom
- Department of Parasitology, Medical Research Institute and Parasite Resource Bank, Chungbuk National University School of Medicine, Cheongju 28644, Korea
| | - Tai-Soon Yong
- Department of Environmental Medical Biology, Institute of Tropical Medicine and Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jong-Yil Chai
- Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Duk-Young Min
- Department of Immunology and Microbiology, Eulji University School of Medicine, Daejeon 35233, Korea
| | - Han-Jong Rim
- Department of Parasitology, College of Medicine, Korea University, Seoul 02841, Korea
| | - John M Changalucha
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
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Kaatano GM, Siza JE, Mwanga JR, Min DY, Yong TS, Chai JY, Ko Y, Chang SY, Kullaya CM, Rim HJ, Changalucha JM, Eom KS. Integrated Schistosomiasis and Soil-Transmitted Helminthiasis Control over Five Years on Kome Island, Tanzania. Korean J Parasitol 2015; 53:535-43. [PMID: 26537032 PMCID: PMC4635827 DOI: 10.3347/kjp.2015.53.5.535] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/30/2015] [Accepted: 09/30/2015] [Indexed: 11/23/2022]
Abstract
Integrated control strategies are important for sustainable control of schistosomiasis and soil-transmitted helminthiasis, despite their challenges for their effective implementation. With the support of Good Neighbors International in collaboration with National Institute of Medical Research, Mwanza, Tanzania, integrated control applying mass drug administration (MDA), health education using PHAST, and improved safe water supply has been implemented on Kome Island over 5 years for controlling schistosomiasis and soil-transmitted helminths (STHs). Baseline surveys for schistosomiasis and STHs was conducted before implementation of any integrated control strategies, followed by 4 cross-sectional follow-up surveys on randomly selected samples of schoolchildren and adults in 10 primary schools and 8 villages, respectively, on Kome islands. Those follow-up surveys were conducted for impact evaluation after introduction of control strategies interventions in the study area. Five rounds of MDA have been implemented from 2009 along with PHAST and improved water supply with pumped wells as other control strategies for complementing MDA. A remarkable steady decline of schistosomiasis and STHs was observed from 2009 to 2012 with significant trends in their prevalence decline, and thereafter infection rate has remained at a low sustainable control. By the third follow-up survey in 2012, Schistosoma mansoni infection prevalence was reduced by 90.5% and hookworm by 93.3% among schoolchildren while in adults the corresponding reduction was 83.2% and 56.9%, respectively. Integrated control strategies have successfully reduced S. mansoni and STH infection status to a lower level. This study further suggests that monitoring and evaluation is a crucial component of any large-scale STH and schistosomiasis intervention.
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Affiliation(s)
- Godfrey M Kaatano
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Julius E Siza
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Joseph R Mwanga
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Duk-Yong Min
- Department of Immunology and Microbiology, Eulji University School of Medicine, Daejeon 35233, Korea
| | - Tai-Soon Yong
- Department of Environmental Medical Biology, Institute of Tropical Medicine and Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jong-Yil Chai
- Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Yunsuk Ko
- Good Neighbors International, Tanzania Western Chapter, P.O. Box 367, Mwanza, Tanzania
| | - Su Young Chang
- Good Neighbors International, Tanzania Western Chapter, P.O. Box 367, Mwanza, Tanzania
| | - Cyril M Kullaya
- Good Neighbors International, Tanzania Western Chapter, P.O. Box 367, Mwanza, Tanzania
| | - Han-Jong Rim
- Department of Parasitology, College of Medicine, Korea University, Seoul 02841, Korea
| | - John M Changalucha
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Keeseon S Eom
- Department of Parasitology, Medical Research Institute and Parasite Resource Bank, Chungbuk National University School of Medicine, Cheongju 28644, Korea
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Webster BL, Webster JP, Gouvras AN, Garba A, Lamine MS, Diaw OT, Seye MM, Tchuem Tchuenté LA, Simoonga C, Mubila L, Mwanga JR, Lwambo NJ, Kabatereine NB, Lange CN, Kariuki C, Mkoji GM, Rollinson D, Stothard JR. DNA 'barcoding' of Schistosoma mansoni across sub-Saharan Africa supports substantial within locality diversity and geographical separation of genotypes. Acta Trop 2013; 128:250-60. [PMID: 22935316 DOI: 10.1016/j.actatropica.2012.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 08/08/2012] [Accepted: 08/10/2012] [Indexed: 11/25/2022]
Abstract
Schistosoma mansoni is a widespread human helminth and causes intestinal schistosomiasis in 54 countries, mainly across Africa but also in Madagascar, the Arabian Peninsula and the neotropics. The geographical range of this parasite relies on the distribution of certain species of freshwater pulmonate snails of the genus Biomphalaria. Whilst S. mansoni is known to exhibit high population diversity the true extent of this diversity is still to be fully elucidated as sampling of this taxon progressively accrues. Here a DNA 'barcoding' approach is taken using sequence analysis of a 450bp region within the mitochondrial cox1 gene to assess the genetic diversity within a large number of S. mansoni larval stages collected from their natural human hosts across sub-Saharan Africa. Five hundred and sixty one individual parasite samples were examined from 22 localities and 14 countries. Considerable within-species diversity was found with 120 unique haplotypes splitting geographically into five discrete lineages. The highest diversity was found in East Africa with samples forming three of the five lineages. Less diversity was found in the Far and Central Western regions of Africa with haplotypes from the New World showing a close affinity to the Far Western African S. mansoni populations supporting the hypothesis of a colonisation of South America via the West African slave trade. The data are discussed in relation to parasite diversity and disease epidemiology.
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26
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Mwanga JR, Lwambo NJS, Rumisha SF, Vounatsou P, Utzinger J. Dynamics of people's socio-economic status in the face of schistosomiasis control interventions in Ukerewe district, Tanzania. Acta Trop 2013; 128:399-406. [PMID: 23333229 DOI: 10.1016/j.actatropica.2013.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 11/27/2012] [Accepted: 01/08/2013] [Indexed: 11/19/2022]
Abstract
There is a paucity of research on micro-level assessment of the dynamics of socio-economic status following health interventions. The use of household asset data to determine wealth indices is a common procedure for estimating socio-economic position in low-income countries. Indeed, in such settings information about income is usually lacking and the collection of individual consumption or expenditure data would require in-depth interviews, posing a considerable risk of bias. In this study, we determined the socio-economic status of 159 households in a village in north-western Tanzania before and 1 year after participatory hygiene and sanitation transformation (PHAST) intervention to control schistosomiasis. We constructed a household 'wealth index' based on durable assets ownership (e.g. bicycle and radio) and household characteristics dealing with ownership of land and house construction features (e.g. type of walls and roof). We employed principal components analysis and classified households into wealth quintiles. The study revealed that asset variables with positive factor scores were associated with higher socio-economic status, whereas asset variables with negative factor scores were associated with lower socio-economic status. Overall, households which were rated as the poorest and very poor were on the decrease, whereas those rated as poor, less poor and the least poor were on the increase after PHAST intervention. This decrease/increase was significant. The median shifted from -0.761 to -0.448, and the mean from -0.204 (standard deviation (SD) 1.924) to 0.193 (SD 2.079) between pre- and post-intervention phases. The difference in socio-economic status of the people comparing the pre- and post-intervention phases was highly statistically significant (p<0.001). This observation was confirmed by a multinomial model with a random effect on the households. We argue that significant changes in the socio-economic status observed in our study are attributable to the PHAST intervention, despite other sporadic interventions against schistosomiasis.
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Affiliation(s)
- Joseph R Mwanga
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania.
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Mwanga JR, Lwambo NJ. Pre- and post-intervention perceptions and water contact behaviour related to schistosomiasis in north-western Tanzania. Acta Trop 2013; 128:391-8. [PMID: 23058736 DOI: 10.1016/j.actatropica.2012.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 09/23/2012] [Accepted: 09/30/2012] [Indexed: 12/12/2022]
Abstract
Schistosomiasis is a widespread disease of public health importance in Tanzania requiring concerted efforts to control it. A study on schistosomiasis-related perceptions and water contact behaviour was undertaken in one community population of Hamuyebe village in Ukerewe district, north-western Tanzania, where intestinal schistosomiasis is endemic before and 2 years after implementation of a participatory hygiene and sanitation transformation (PHAST) intervention. Data were obtained from baseline and post-intervention knowledge, attitudes and practices (KAP) questionnaire surveys conducted between 2008 and 2010 among 157 individuals aged 15 years and above. The surveys were further complemented by structured observations of human-water contact activities. We found significant increases in respondents' knowledge of the cause, transmission, symptoms and health consequences of schistosomiasis after the intervention. The reported treatment seeking and preventive practices were congruous with the actual (observed) behaviour. Frequency, duration and timing of water contacts also decreased significantly after the intervention and took into consideration the fact that those activities which need larger body surface exposure, for a long period and at an appropriate time when cercarial densities are high (i.e. around noon) are important for the transmission of schistosomiasis. We conclude that PHAST intervention has succeeded in effecting positive changes in peoples' perceptions and attitudes towards water. As a result, knowledge obtained from the said intervention was translated into actions to prevent schistosomiasis. Studies on knowledge, attitudes and practices coupled with structured observations should be part of the integrated approach for the control of schistosomiasis.
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Mosha FF, Wambura M, Mwanga JR, Mosha JF, Mshana G, Changalucha J. Readiness of health facilities to deliver safe male circumcision services in Tanzania: a descriptive study. Healthc Low Resour Settings 2013. [DOI: 10.4081/hls.2013.e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Assessing the readiness of health facilities to deliver safe male circumcision services is more important in sub-Saharan Africa because of the inadequacy state of health facilities in many ways. The World Health Organization recommends that only facilities equipped with available trained staff, capable to perform at least minor surgery, able to offer minimum MC package and appropriate equipment for resuscitation, and compliant with requirements for sterilization and infection control should be allowed to deliver safe circumcision services. A cross-sectional study using quantitative data collection technique was conducted to assess the readiness of the health facilities to deliver safe circumcision services in selected districts of Tanzania. All hospitals, health centres and 30% of all dispensaries in these districts were selected to participate in the study. Face-toface questionnaires were administered to the heads of the health facilities and to health practitioners. Overall, 49/69 (59%) of the facilities visited provided circumcision services and only 46/203 (24%) of the health practitioners performed circumcision procedures. These were mainly assistant medical officers and clinical officers. The vast majority – 190/203 (95%) – of the health practitioners require additional training prior to providing circumcision services. Most facilities – 63/69 (91%) – had all basic supplies (gloves, basin, chlorine and waste disposal) necessary for infection prevention, 44/69 (65%) provided condoms, HIV counselling and testing, and sexuallytransmitted infections services, while 62/69 (90%) had the capability to perform at least minor surgery. However, only 25/69 (36%) and 15/69 (22%) of the facilities had functioning sterilization equipment and appropriate resuscitation equipment, respectively. There is readiness for roll out of circumcision services; however, more practitioners need to be trained on circumcision procedures, demand forecasting. Sterilization equipment for infection prevention and resuscitation equipment should also be made available.
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Mashauri FM, Kinung'hi SM, Kaatano GM, Magesa SM, Kishamawe C, Mwanga JR, Nnko SE, Malima RC, Mero CN, Mboera LEG. Impact of indoor residual spraying of lambda-cyhalothrin on malaria prevalence and anemia in an epidemic-prone district of Muleba, north-western Tanzania. Am J Trop Med Hyg 2013; 88:841-9. [PMID: 23458959 DOI: 10.4269/ajtmh.12-0412] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The Government of Tanzania introduced indoor residual spraying (IRS) in Muleba district in north-western Tanzania after frequent malaria epidemics. Malaria parasitological baseline and two cross-sectional follow-up surveys were conducted in villages under the IRS program and those not under IRS to assess the impact of IRS intervention. After two rounds of IRS intervention there was a significant reduction of malaria parasitological indices in both two villages. In IRS villages overall, parasitemia prevalence was reduced by 67.2%, splenomegaly was reduced by 75.8%, whereas anemia was reduced by 50.5%. There was also a decline of malaria parasite density from 896.4 at baseline to 128.8 at second follow-up survey. Similarly, there was also a reduction of malaria parasitological indices in non-IRS villages; however, parasitological indices in IRS villages remained far below the levels in non-IRS villages. The reduction of malaria parasitological indices in non-IRS villages might have been contributed by interventions other than IRS.
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Affiliation(s)
- Fabian M Mashauri
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania.
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Mwanga JR, Mshana G, Kaatano G, Changalucha J. "Half plate of rice to a male casual sexual partner, full plate belongs to the husband": findings from a qualitative study on sexual behaviour in relation to HIV and AIDS in northern Tanzania. BMC Public Health 2011; 11:957. [PMID: 22202562 PMCID: PMC3296677 DOI: 10.1186/1471-2458-11-957] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 12/28/2011] [Indexed: 11/10/2022] Open
Abstract
Background A thorough understanding of the contexts of sexual behaviour of the people who are vulnerable to HIV infection is an important component in the battle against AIDS epidemic. We conducted a qualitative study to investigate perceptions, attitudes and practices of sexually active people in three districts of northern Tanzania with the view of collecting data to inform the formulation of appropriate complementary interventions against HIV and AIDS in the study communities. Methods We conducted 96 semi-structured interviews and 48 focus group discussions with sexually active participants (18-60 years of age) who were selected purposively in two fishing and one non-fishing communities. Results The study revealed a number of socio-economic and cultural factors which act as structural drivers of HIV epidemic. Mobility and migration were mentioned to be associated with the risk of HIV acquisition and transmission. Sexual promiscuous behaviour was common in all study communities. Chomolea, (a quick transactional sex) was reported to exist in fishing communities, whereas extramarital sex in the bush was reported in non-fishing community which was predominantly Christian and polygamous. Traditional practices such as Kusomboka (death cleansing through unprotected sex) was reported to exist. Other risky sexual behaviour and traditional practices together with their socio-economic and cultural contexts are presented in details and discussed. Knowledge of condom was low as some people mistook them for balloons to play with and as decorations for their living rooms. Acute scarcity of condoms in some remote areas such as vizingani (fishing islands) push some people to make their own condoms locally known as kondomu za pepsi using polythene bags. Conclusions HIV prevention efforts can succeed by addressing sexual behaviour and its socio-economic and cultural contexts. More innovative, interdisciplinary and productive structural approaches to HIV prevention need to be developed in close collaboration with affected communities and be closely related to policy-making and implementation; to go beyond the limited success of traditional behavioural and biomedical interventions to particularly address the underlying social and structural drivers of HIV risk and vulnerability in the study communities.
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Affiliation(s)
- Joseph R Mwanga
- National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania.
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Mwanga JR, Wambura M, Mosha JF, Mshana G, Mosha F, Changalucha J. Policy environment and male circumcision for HIV prevention: findings from a situation analysis study in Tanzania. BMC Public Health 2011; 11:506. [PMID: 21708046 PMCID: PMC3141465 DOI: 10.1186/1471-2458-11-506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 06/28/2011] [Indexed: 11/10/2022] Open
Abstract
Background Male circumcision (MC) has been shown to be effective against heterosexual acquisition of HIV infection and is being scaled up as an additional strategy against HIV in several countries of Africa. However, the policy environment (whether to formulate new specific policy on MC or adapts the existing ones); and the role of various stakeholders in the MC scale up process in Tanzania was unclear. We conducted this study as part of a situation analysis to understand the attitudes of policy makers and other key community and health authority decision makers towards MC, policy and regulatory environment, and the readiness of a health system to accommodate scaling up of MC services. Methods We conducted 36 key informants' interviews with a broad range of informants including civil servants, religious leaders, cultural and traditional gatekeepers and other potential informants. Study informants were selected at the national level, regional, district and community levels to represent both traditionally circumcising and non-circumcising communities. Results Study informants had positive attitudes and strong beliefs towards MC. Key informants in traditionally non-circumcising districts were willing to take their sons for medically performed MC. Religious leaders and traditional gatekeepers supported MC as it has been enshrined in their holy scripts and traditional customs respectively. Civil servants highlighted the need for existence of enabling policy and regulatory environment in the form of laws, regulations and guidelines that will ensure voluntary accessibility, acceptability, quality and safety for those in need of MC services. Majority of informants urged the government to make improvements in the health system at all levels to ensure availability of adequate trained personnel, infrastructure, equipment, and supplies for MC scale up, and insisted on the involvement of different MC stakeholders as key components in effective roll out of medically performed MC programme in the country. Conclusions Findings from the situation analysis in Tanzania have shown that despite the absence of a specific policy on MC, basic elements of enabling policy environment at national, regional, district and community levels are in place for the implementation of MC scale up programme.
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Wambura M, Mwanga JR, Mosha JF, Mshana G, Mosha F, Changalucha J. Acceptability of medical male circumcision in the traditionally circumcising communities in Northern Tanzania. BMC Public Health 2011; 11:373. [PMID: 21605433 PMCID: PMC3112418 DOI: 10.1186/1471-2458-11-373] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 05/23/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data from traditionally circumcising communities show that non-circumcised males and those circumcised in the medical settings are stigmatised. This is because traditional circumcision embodies local notions of bravery as anaesthetics are not used. This study was conducted to assess the acceptability of safe medical circumcision before the onset of sexual activity for HIV infection risk reduction in a traditionally circumcising community in Tanzania. METHODS A cross-sectional study was conducted among males and females aged 18-44 years in traditionally circumcising communities of Tarime District in Mara Region, North-eastern Tanzania. A face-to-face questionnaire was administered to females to collect information on the attitudes of women towards circumcision and the preferred age for circumcision. A similar questionnaire was administered to males to collect information on socio-demographic, preferred age for circumcision, factors influencing circumcision, client satisfaction, complications and beliefs surrounding the practice. RESULTS Results were available for 170 males and 189 females. Of the males, 168 (98.8%) were circumcised and 61 (36.3%) of those circumcised had the procedure done in the medical setting. Of those interviewed, 165 (97.1%) males and 179 (94.7%) females supported medical male circumcision for their sons. Of these, 107 (64.8%) males and 130 (72.6%) females preferred prepubertal medical male circumcision (12 years or less). Preference for prepubertal circumcision was significantly associated with non-Kurya ethnic group, circumcision in the medical setting and residence in urban areas for males in the adjusted analysis. For females, preference for prepubertal circumcision was significantly associated non-Kurya ethnic group and being born in urban areas in the adjusted analysis. CONCLUSIONS There is a shift of preference from traditional male circumcision to medical male circumcision in this traditionally circumcising population. However, this preference has not changed the circumcision practices in the communities because of the community social pressure. Male circumcision national program should take advantage of this preference of medical male circumcision by introducing safe and affordable circumcision services and mobilising communities in a culturally sensitive manner to take up circumcision services.
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Affiliation(s)
- Mwita Wambura
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Joseph R Mwanga
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Jacklin F Mosha
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Gerry Mshana
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Frank Mosha
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - John Changalucha
- National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania
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Kaatano GM, Mashauri FM, Kinung'hi SM, Mwanga JR, Malima RC, Kishamawe C, Nnko SE, Magesa SM, Mboera LEG. Patterns of malaria related mortality based on verbal autopsy in Muleba District, north-western Tanzania. ACTA ACUST UNITED AC 2010; 11:210-8. [PMID: 20734701 DOI: 10.4314/thrb.v11i4.50185] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Reliable malaria related mortality data is important for planning appropriate interventions. However, there is scarce information on the pattern of malaria related mortality in epidemic prone districts of Tanzania. This study was carried out to determine malaria related mortality and establish its trend change over time in both epidemic and non-epidemic areas of Muleba District of north-western Tanzania. A verbal autopsy survey was conducted to obtain data on all deaths of individuals who died in six randomly selected villages from 1997 to 2006. Relatives of the deceased were interviewed using a standardized questionnaire. Communicable diseases accounted for about two thirds (61.9%) of deaths among > or =5 years individuals and 84.8% in < or =5 years. Non-communicable diseases accounted for 28.9% and 14.1% deaths in > or =5 years and < or =5 years, respectively. Malaria was the leading cause of deaths in all age groups (40.3%) and among children <5 years (73.8%). Infants accounted for about two third (64.5%) of all malaria related deaths in children <5 years. Peak of malaria proportional mortality was highest during malaria epidemics. Most of the malaria-related deaths in this group were among 1-12 months (64.5%) followed by 13-24 months (20.9%), and 25-59 months (14.8%). Cerebral malaria accounted for 18.9% (N=32) of death related to malaria in all age groups; 12.1% (17/141) were in under-five, 42.9% (6/14) were in 5-14 years and 64.3% (9/14) in 15-70 years old. More than half of malaria related deaths (61.0%) in <5 years children were associated with severe anaemia followed by diarrhoeal disease (24.1%), cerebral malaria (12.5%) and respiratory infection (8.5%) as common conditions. The majority of the deceased caretakers first sought treatment at health facilities within 24hr of the onset of illness. Significantly a higher proportion of caretakers of the underfives in the epidemic area sought treatment within 24hr than in non-epidemic area (39.3% vs. 18.5%; P = 0.0385). In conclusion, malaria accounts for majority of deaths in Muleba district, with substantial proportion being attributed to malaria epidemics.
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Affiliation(s)
- G M Kaatano
- National Institute for Medical Research, Mwanza Research Centre, P.O. Box 1462, Mwanza, Tanzania.
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Kinung'hi SM, Mashauri F, Mwanga JR, Nnko SE, Kaatano GM, Malima R, Kishamawe C, Magesa S, Mboera LEG. Knowledge, attitudes and practices about malaria among communities: comparing epidemic and non-epidemic prone communities of Muleba district, North-western Tanzania. BMC Public Health 2010; 10:395. [PMID: 20602778 PMCID: PMC2910681 DOI: 10.1186/1471-2458-10-395] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 07/05/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Muleba district in North-western Tanzania has experienced malaria epidemics in recent years. Community knowledge, attitudes and practices are important in enhancing disease control interventions. This study investigated determinants of malaria epidemics in the study area in relation to household knowledge, attitudes and practice on malaria. METHODS A community based cross-sectional survey involving 504 study participants was conducted between April and June 2007 using a structured questionnaire focusing on knowledge, attitudes and practices of community members in epidemic and non-epidemic villages about malaria transmission, signs and symptoms, treatment, prevention and control. Multivariate logistic regression analysis was used to assess determinants of malaria epidemics. RESULTS A total of 504 respondents (males = 36.9%) were interviewed. Overall, 453 (90.1%) mentioned malaria as the most important disease in the area. Four hundred and sixty four respondents (92.1%) knew that malaria is transmitted through mosquito bite. A total of 436 (86.7%), 306 (60.8%) and 162 (32.1%) mentioned fever, vomiting and loss of appetite as major symptoms/signs of malaria, respectively. Of those interviewed 328 (65.1%) remembered the recent outbreak of 2006. Of the 504 respondents interviewed, 296 (58.7%) reported that their households owned at least one mosquito net. Three hundred and ninety seven respondents (78.8%) knew insecticides used to impregnate bed nets. About two thirds (63.3%) of the respondents had at least a household member who suffered from malaria during the recent epidemic. During the 2006 outbreak, 278 people (87.2%) sought treatment from health facilities while 27 (8.5%) obtained drugs from drug shops and 10 (3.1%) used local herbs. Logistic regression analysis showed that household location and level of knowledge of cause of malaria were significant predictors of a household being affected by epidemic. CONCLUSIONS Residents of Muleba district have high level of knowledge on malaria. However, this knowledge has not been fully translated into appropriate use of available malaria interventions. Our findings suggest that household location, ineffective usage of insecticide treated nets and knowledge gaps on malaria transmission, signs and symptoms, prevention and control predisposed communities in the district to malaria epidemics. It is important that health education packages are developed to address the identified knowledge gaps.
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Affiliation(s)
- Safari M Kinung'hi
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Fabian Mashauri
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Joseph R Mwanga
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Soori E Nnko
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Godfrey M Kaatano
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Robert Malima
- National Institute for Medical Research, Amani Centre, P. O. Box 81, Muheza, Tanzania
| | - Coleman Kishamawe
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Stephen Magesa
- National Institute for Medical Research, Amani Centre, P. O. Box 81, Muheza, Tanzania
| | - Leonard EG Mboera
- National Institute for Medical Research, Headquarters, P.O. Box 9653, Dar-Es-Salaam, Tanzania
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Temu MM, Changalucha JM, Mosha FF, Mwanga JR, Siza JE, Balira R. Community knowledge, attitude and practice towards sexually transmitted diseases and HIV infection in Biharamulo and Muleba districts in Kagera Region, Tanzania. ACTA ACUST UNITED AC 2009; 10:213-9. [PMID: 19402582 DOI: 10.4314/thrb.v10i4.45076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study was conducted to determine knowledge, attitude and practice towards Sexually Transmitted Diseases and HIV infections among communities in Biharamulo and Muleba districts, Kagera Tanzania. A total of 915 study participants were recruited and most of them (96.3%) knew that there are diseases which could be transmitted through sexual contact. Seventy one percent of participants thought STDs could be acquired through sharing a towel while fifty percent thought HIV could be transmitted through insect bites. Eighty five percent of school pupils who participated in the study reported to have been taught about AIDS and less than 30% on sex and pregnancy. Sixty three percent of study participants were of the opinion that a girl or woman should not refuse to have sex after being given a gift, and having sex with an elder partner was thought to be acceptable by almost fifty percent of participants. Over 50% percent of interviewees thought a girl or woman should not refuse to have sex with their friends. Although 99% of interviewees reported to have ever heard about condoms, only 28% reported to have ever used them irrespective of been affordable. Most schoolboys and about 50% of schoolgirls reported to have experienced sex by the time of the study. Thirty eight percent of girls reported to have first sex at the age of 14 years. Nine percent of the participants who reported to have experienced sex were forced to do so. Knowledge regarding STDs and HIV/AIDS was high among participants, but a sizeable proportion report misconception on transmission of STDs/HIV such as through sharing a towel and insect bites. Therefore it is recommended that S&RH intervention programme should address these misconceptions in order to match knowledge and practice, and achieve the intended objectives.
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Affiliation(s)
- M M Temu
- National Institute for Medical Research, Mwanza Research Centre, P.O. Box 1462, Mwanza, Tanzania.
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Mwanga JR, Magnussen P, Mugashe CL, Gabone RM, Aagaard-Hansen J. SCHISTOSOMIASIS-RELATED PERCEPTIONS, ATTITUDES AND TREATMENT-SEEKING PRACTICES IN MAGU DISTRICT, TANZANIA: PUBLIC HEALTH IMPLICATIONS. J Biosoc Sci 2004; 36:63-81. [PMID: 14989532 DOI: 10.1017/s0021932003006114] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A study on perceptions, attitudes and treatment-seeking practices related to
schistosomiasis was conducted among the Wasukuma in the rural Magu district of Tanzania at the
shore of Lake Victoria where Schistosoma haematobium and mansoni infections are endemic. The study applied in-depth interviews, focus group discussions and a questionnaire survey among adults and primary school children. The perceived symptoms and causes were incongruous with the biomedical perspective and a number of respondents found schistosomiasis to be a shameful disease. Lack of diagnostic and curative services at the government health care facilities was common, but there was a willingness from the biomedical health care services to collaborate with the traditional healers. Recommendations to the District Health Management Team were: that collaboration between biomedical and traditional health care providers should be strengthened and that the government facilities’ diagnostic and curative capacity with regard to schistosomiasis should be upgraded. Culturally compatible health education programmes should be developed in collaboration with the local community.
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Affiliation(s)
- J R Mwanga
- National Institute for Medical Research, Mwanza Centre, PO Box 1462, Mwanza, Tanzania
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