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The overall objective of this thesis was to develop building blocks essential for establishing a sustainable dairy goat breeding program in Tanzania. To fulfil this objective, three approaches were employed. This included field survey (paper I &II), simulation study (paper III) and on-farm experiment and lesson learnt (paper IV). The production systems optimization in paper I showed that dairy goat production brings assurance of less variation in production income in the long term compared to other production systems. However, to achieve this in Tanzania it is necessary to purchase more concentrate feed and implement goat breeding principles. Paper II found that of the 125 respondents, many (35.2%) keep dairy goats for milk production, as many as 30.6% to obtain offspring and sell them, and 24.1% of the respondents emphasized the value of manure. In the study areas, manure was sold to obtain income. High producing goats (33.7%), tolerance to diseases (20%), and high twinning ability (14%) were the most preferred traits by respondents. In addition, the farmers lack knowledge on selection, recording, and animal identification. Paper III found that testing between 20 and 30 bucks per year could lead to a good breeding program with acceptable level of accuracy under local conditions in Tanzania. Testing 30 bucks per year is recommended for Mgeta. Part of paper III also outlines elements necessary for breeding program sustainability. A schematic figure is included to illustrate how selection can be performed through progeny testing to fit current situation in Mgeta. The SWOT analysis in paper IV reveals that Tanzania has a potential for dairy goat development. Strengths are: good policy, presence of research and academic institutions, readiness of private sectors to participate in the dairy goat industry, availability of resources, and that many rural famers already own dairy goats. Weaknesses are: insufficient support from the government, low formal education of farmers, lack of clear breeding goals, and lack of sustainability of breeding selection programs established. These pull back progress in the dairy goat sector. However, there are several opportunities such that information towards solving the limitations are available. In Europe, for example, they seem to do better with animal breeding programs. Quality genetic materials from these successful programs can be accessed by other countries like Tanzania through markets, given that the policy allows. On these grounds in paper IV, occasional import of dairy goat semen for AI to use in a nucleus breeding herd is proposed. Both bucks and female offspring born in such a herd may be supplied to farmers. Quality dairy goats is already a business in Tanzania, hence participation of private sectors in the industry should be encouraged. The government and academic institutions may be watchdogs of what should be happening regarding dairy goats in the country. Threats may include change in policy regarding export/import of buck semen, farmers’ willingness to pay for price of quality bucks, and how quick the market for surplus milk is growing, and participation of milk processors and marketing of derived products. This thesis proposes possibilities of establishing dairy goat breeding program under small scale farms in Tanzania given that better on-farm recording systems including pedigree information is developed. Setting clear breeding goals with a few traits, e.g. milk yield and survival in this case, is recommended. Because of the various practical options and accessibility to new knowledge, it is necessary to revise breeding schemes from time to time. Lastly, this thesis raises the question; ”How many dairy goat breeds are needed in Tanzania?”. This can be a future TALIRI job. Det overordna målet for denne avhandlinga var å utvikla byggjesteinar som er essensielle for å etablera eit bærekraftig avlsprogram for mjølkegeit i Tanzania. For å nå dette målet, blei tre angrepsmåtar brukt: feltstudiar (artikkel I & II), simuleringsstudie (artikkel III) og utprøving i felt og kunnskapsinnsamling (artikkel IV). I arbeidet med å optimalisera produksjonssystemet (artikkel I) viste eg at mjølkeproduksjon fører til mindre variasjon i produksjonsinntekt på lang sikt enn andre produksjonssystem. Men for å oppnå dette i Tanzania bør ein kjøpa meir kraftfôr og nytta moderne avlsprinsipp. I artikkel II fann eg at av dei 125 respondentane, ville mange (35,2%) ha ei geit med høg mjølkeproduksjon. Så mange som 30,6% vil ha fleire avkom per geit (mange tvillingar), og 24,1% av respondentane understreka nytten av gjødsel frå geitene. I dei områda der respondentane blei intervjua blei gjødsel selt og utgjorde ei inntekt frå geitehaldet. Eigenskapar som ein ønskjer å endra var høgare mjølkeproduksjon (33,7%), sjukdomstoleranse (20%), og høgare tvillingfrekvens (14%). I tillegg mangla bøndene kunnskap om utval av avlsdyr, husdyrkontroll og individmerking. I artikkel III fann eg at testing av mellom 20 og 30 bukkar per år kan gje eit godt avlsprogram med akseptabel sikkerheit for å rekna ut avlsverdar. For Mgeta anbefaler vi testing av 30 bukkar per år. I artikkel III skisserte eg òg faktorar som er nødvendige for å få etablert eit varig avlsprogram. Eit skjema som illustrerer korleis eit avlsprogram med avkomsgransking av testbukkar i Mgeta kan gjennomførast er òg tatt med. SWOTanalysen i artikkel IV viser eg at Tanzania har potensiale for å utvikla mjølkeproduksjon på geit vidare. Styrkar i landet er ein god politikk, at det finst forskings- og akademiske institusjonar, at privat sektor er villig til å delta i sektoren, at fôrresursar finst, og at mange bønder alt eig mjølkegeiter. Svakhetar er at det ikkje er nok støtte frå regjeringa, bøndene har lite skulegang, mangel på klare avlsmål, og at avlstiltak ikkje varer. Dette bremsar framgangen i sektoren. Men løysingar på slike problem finst. I Europa, for eksempel, synest dei å lykkast med avlsprogram for husdyr. Genetisk kvalitetsmateriale frå desse vellykka programma kan andre land som Tanzania få del i ved kjøp, gitt at ein får løyve til det. Difor foreslår eg i artikkel IV sporadisk import av sæd for å bruka det i ein elitebuskap for mjølkegeit i Tanzania. Både bukkar og geitekje fødde i ein slik flokk kan seljast til bønder. Mjølkegeiter blir alt nå omsette i Tanzania og slike initiativ i privat sektor bør oppmuntrast. Offentleg sektor kan passa på kva som bør skje med mjølkegeiter i landet. Truslar kan vera endringar i politikken når det gjeld import av genetisk materiale, bønders vilje til å betala for verdifulle avlsdyr, kor raskt mjølkeomsetninga aukar og utvikling av meieri og omsetning av mjølkeprodukt. I denne avhandlinga foreslår eg mulege måtar å få til eit avlsprogram for mjølkegeit gjennom eit samarbeid mellom små mjølkeprodusentar i Tanzania. For å lukkast med dette må mjølkekontroll og individinformasjon innhentast på slike gardar. Klare avlsmål med få eigenskapar, for eksempel mjølkemengde og overleving, blir anbefalt. På grunn av kva som er praktisk mulig og tilgjengeleg kunnskap til ei kvar tid, er det nødvendig å revidere avlsprogram frå tid til anna. Til slutt reiser eg i avhandlinga spørsmålet: «Kor mange mjølkegeitrasar trengst i Tanzania?. Å svara på dette, kan vera ein jobb for forskarane som arbeider ved TALIRI. “Enhancing Pro-poor Innovation in Natural Resources and Agricultural Value Chains (EPINAV)” program supported by the Government of Norway at Sokoine University of Agriculture (SUA) (grant No.1.1/06)

Background A distinct serum metabonomic pattern has been previously revealed to be associated with various forms of liver disease. Here, we aimed to apply mass spectrometry to obtain serum metabolomic profiles from individuals with cholangiocarcinoma and benign hepatobiliary diseases to gain an insight into pathogenesis and search for potential early-disease biomarkers. Methods Serum samples were profiled using a hydrophilic interaction liquid chromatography platform, coupled to a mass spectrometer. A total of 47 serum specimens from 8 cholangiocarcinoma cases, 20 healthy controls, 8 benign disease controls (bile duct strictures) and 11 patients with hepatocellular carcinoma (as malignant disease controls) were included. Data analysis was performed using univariate and multivariate statistics. Results The serum metabolome disparities between the metabolite profiles from healthy controls and patients with hepatobiliary disease were predominantly related to changes in lipid and lipid-derived compounds (phospholipids, bile acids and steroids) and amino acid metabolites (phenylalanine). A metabolic pattern indicative of inflammatory response due to cirrhosis and cholestasis was associated with the disease groups. The abundance of phospholipid metabolites was altered in individuals with liver disease, particularly cholangiocarcinoma, but no significant difference was seen between profiles from patients with benign biliary strictures and cholangiocarcinoma. Conclusion The serum metabolome in cholangiocarcinoma exhibited changes in metabolites related to inflammation, altered energy production and phospholipid metabolism. This study serves to highlight future avenues for biomarker research in large-scale studies.

Tanzania has a goat population of about 24.8 million most of which belong to the Small East African breed distributed in almost all agro-ecological zones. The different goat populations and the production system in which they are raised are not well characterized depriving animal breeders useful information in designing and running improvement and conservation programs. Therefore, the study was conducted in all agro-ecological zones in Tanzania to characterize the indigenous goats and the production system in which they are raised. Data on animals were collected from 688 randomly selected adult female goats and for production system description; 220 households were interviewed. Analysis of variance and discriminant analysis were used on quantitative data, while frequency analysis was used on qualitative data. Income generation and meat production were the primary goat rearing objectives. More than 55% of respondents grazed their animals freely in communal lands where natural pasture was the chief feed resource. Mating was mainly uncontrolled with apron and castration being used by goat keepers as mating control methods. Common diseases were contagious caprine pleural pneumonia and helminthiasis. Feed shortage, prevalence of diseases, and water scarcity were the major goat production constraints. There were morphological variations between and within these goat populations, and based on quantitative data, the goats were categorized into two groups. High twinning was observed in Ujiji and Lindi goats and low for Sukuma. The dominant coat color was plain white in Pare, Gogo, Maasai, and Tanga. Other coat color patterns were mixed black and white for Sukuma, reddish-brown for Lindi, black and reddish-brown for Ujiji, and white and reddish-brown for Pwani and Maasai. High within population variation is observed which is important as it can be used as a basis for genetic improvement through selection.

Background Phenotypic diversity in urinary metabolomes of different geographical populations has been recognized recently. In this study, urinary metabolic signatures from Western (United Kingdom) and South-East Asian (Thai) cholangiocarcinoma patients were characterized to understand spectral variability due to host carcinogenic processes and/or exogenous differences (nutritional, environmental and pharmaceutical). Methods Urinary liquid chromatography mass spectroscopy (LC-MS) spectral profiles from Thai (healthy=20 and cholangiocarcinoma=14) and UK cohorts (healthy=22 and cholangiocarcinoma=10) were obtained and modelled using chemometric data analysis. Results Healthy metabolome disparities between the two distinct populations were primarily related to differences in dietary practices and body composition. Metabolites excreted due to drug treatment were dominant in urine specimens from cholangiocarcinoma patients, particularly in Western individuals. Urine from participants with sporadic (UK) cholangiocarcinoma contained greater levels of a nucleotide metabolite (uridine/pseudouridine). Higher relative concentrations of 7-methylguanine were observed in urine specimens from Thai cholangiocarcinoma patients. The urinary excretion of hippurate and methyladenine (gut microbial-host co-metabolites) showed a similar pattern of lower levels in patients with malignant biliary tumours from both countries. Conclusion Intrinsic (body weight and body composition) and extrinsic (xenobiotic metabolism) factors were the main causes of disparities between the two populations. Regardless of the underlying aetiology, biological perturbations associated with cholangiocarcinoma urine metabolome signatures appeared to be influenced by gut microbial community metabolism. Dysregulation in nucleotide metabolism was associated with sporadic cholangiocarcinoma, possibly indicating differences in mitochondrial energy production pathways between cholangiocarcinoma tumour subtypes. Mapping population-specific metabolic disparities may aid in interpretation of disease processes and identification of candidate biomarkers.

BackgroundIn 2017, roughly 540 women in Sub-Saharan Africa died every day from preventable causes related to pregnancy and childbirth. To stem this public-health crisis, the WHO recommends a standard continuity of maternal healthcare, yet most women do not receive this care. Surveys suggest that illiteracy limits the uptake of the recommended care, yet little is understood about why this is so. This gap in understanding why healthcare is not sought by illiterate women compromises the ability of public health experts and healthcare providers to provide culturally relevant policy and practice. This study consequently explores the lived experiences related to care-seeking by illiterate women of reproductive age in rural Tanzania to determine why they may not access maternal healthcare services.MethodsAn exploratory, qualitative study was conducted in four communities encompassing eight focus group discussions with 81 illiterate women, 13 in-depth interviews with illiterate women and seven key-informant interviews with members of these communities who have first-hand experience with the decisions made by women concerning maternal care. Interviews were conducted in the informant’s native language. The interviews were coded, then triangulated.ResultsTwo themes emerged from the analysis: 1) a communication gap arising from a) the women’s inability to read public-health documents provided by health facilities, and b) healthcare providers speaking a language, Swahili, that these women do not understand, and 2) a dependency by these women on family and neighbors to negotiate these barriers. Notably, these women understood of the potential benefits of maternal healthcare.ConclusionsThese women knew they should receive maternal healthcare but could neither read the public-health messaging provided by the clinics nor understand the language of the healthcare providers. More health needs of this group could be met by developing a protocol for healthcare providers to determine who is illiterate, providing translation services for those unable to speak Swahili, and graphic public health messaging that does not require literacy. A failure to address the needs of this at-risk group will likely mean that they will continue to experience barriers to obtaining maternal care with detrimental health outcomes for both mothers and newborns.

Background: In 2017, an estimated 540 women in Sub-Saharan Africa died every day from preventable causes related to pregnancy and childbirth. To stem this public-health crisis, the WHO recommends a maternal and neonatal health continuity of patient care, yet most women do not meet this recommendation. Surveys suggest that illiteracy limits uptake of the proposed maternal-newborn package, yet little is known about the association between illiteracy and healthcare seeking, particularly in rural regions of low-income countries. This knowledge gap compromises the ability of public health experts and healthcare providers to provide culturally relevant policy and practice. To begin to address this gap this study explores the experiences related to care-seeking by illiterate, pregnant women in rural Tanzania.Methods: A qualitative study was conducted in four communities encompassing eight focus group discussions with 81 illiterate women, 13 interviews with illiterate women of reproductive age and seven interviews with members of these communities perceived to have some influence on women’s decisions concerning perinatal care services. Themes were coded and their relative importance determined using frequency reports and cross-tabulations. Findings: Three key themes emerged, illiterate women (1) could not read their healthcare cards or public health messaging; (2) spoke the local language, not Swahili, the language used by healthcare providers, and (3) have endeavored to develop coping strategies to overcome these obstacles. In addition, health service providers are often unaware of who is illiterate.Recommendations: More health needs of this group could be met, in the short term, by developing a protocol for health service providers to determine who is illiterate, providing translation services for those unable to speak Swahili, and graphic public health messaging that does not require literacy. In the long term, this barrier may be addressed by ensuring that all Tanzanians receive a high-quality, formal education, supporting community health workers, and recruiting healthcare providers from rural areas. A failure of to address the needs of this at-risk group will likely mean that they will continue to experience barriers to achieving the recommended continuity of patient care with detrimental health outcomes for both mothers and newborns.

BACKGROUND While the effectiveness of Helping Babies Breathe (HBB) training in Tanzania has been reported, no published studies of Essential Care for Every Baby (ECEB) and Essential Care for Small Babies (ECSB) in this setting have been found. This study compared knowledge before and after HBB, ECEB and ECSB training in Tanzania. METHODS Training was provided to future facilitators (n=16) and learners (n=24) in Tanzania. Using standardized multiple-choice questions, knowledge was assessed pre- and post-HBB and ECEB courses for both learners and facilitators, while ECSB assessment was conducted with facilitators only. A >80% score was considered to be a pass. Paired t-tests were used for hypothesis testing. RESULTS Knowledge significantly improved for both facilitators and learners on HBB and ECEB (p

The forest sector plays a significant roles both directly and indirectly in Tanzania. In total 54% of the land area of mainland Tanzania is covered by different types of forests, the main ones being the miombo woodlands, woodland mosaics, mangrove and the tropical or rain forests with closed canopy. Forestry supports directly or indirectly other sectors including agriculture and tourism through provision of habitats for wildlife, water resources and catchments as well as maintaining hydrological balance and soil protection. It plays significant roles in biodiversity protection and recycling atmospheric gases, and provides construction materials, income and employment opportunities. Tanzania’s wood harvest volume is difficult to estimate, but according to FAO official statistics the country’s total annual harvest of wood in 2014 was about 40 mill m3 of which more than 93% was used for firewood or charcoal production. In Tanzania, more than 90% of the population use fuelwood (i.e. charcoal and firewood) as main source of energy. Most of this fuelwood is supplied from the miombo woodlands which covers about half of the forest area in mainland Tanzania. The country’s demand of forest products is strongly increasing due to substantial economic and population growth and increased urbanization. Currently the population growth is 2.7% p.a., the economic growth is 6.9% p.a. while the urban population growth is about 5% p.a. Such growth rates imply increasing pressure on forest lands and forestry. Charcoal and firewood are key products from the forest in Tanzania and are the country’s main fuels for cooking, with charcoal mainly used in urban areas. Production and consumption of charcoal and firewood play a significant role in enhancing the livelihoods of people, but may also lead to adverse environmental impacts. In Tanzania, large uncertainties exist about the present quantities of fuelwood consumed, as well as about the future integrated development of fuelwood demand and supply. The main objectives of this study are to improve the knowledge base regarding the present and future production and consumption of charcoal and firewood in Tanzania and their impacts on forest sustainability. More specifically, the thesis addresses the following research questions: Q1. What is the extent of land degradation and land rehabilitation potential in Tanzania? Q2. Which information do previous studies provide about charcoal and firewood production and consumption in Tanzania? Q3. What are the effects of price, income and household size on charcoal consumption in the three Tanzanian urban areas Dodoma, Morogoro and Mtwara? Q4. To what extent is it possible to: (i) develop a dynamic forest sector partial equilibrium model for mainland Tanzania which consistently links forestry data regarding tree species, forest growth and growing stock from about 32,000 single plots in Tanzania’s national forest inventory NAFORMA, with socio-economic data regarding the country’s present and future consumption and production of charcoal and firewood; and (ii) apply this model for analyzing how assumptions regarding population growth, urbanization rate and economic growth would influence the future consumption and production of firewood, charcoal and poles, forest resource use, and forest sustainability? In this thesis those questions are addressed in four papers, one for each question. Most efforts have been made in developing the quantitative model described in Q4, and issues related to theories of land-use or policy analyses are only briefly discussed. Below follows a summary of the papers and chapters 4 and 5 of the synopsis. Paper I aims at (i) assessing the potential for land rehabilitation in various regions of Tanzania based on new data from NAFORMA, and (ii) reviewing main experiences and economic results gained in previous land rehabilitation studies in the country. It is found that about 49% (43.3 mill ha) of the total land area in mainland Tanzania is under either light (43%, 37.7 mill ha), moderate (5%, 4.4. mill ha) or heavy (1.3%, 1.2 mill ha) erosion. These figures are substantial and imply large opportunities for land rehabilitation. The present land degradation is high, and parts of the degraded areas could be reforested, thus giving increased sustainable supply of forest and food products and maintaining environmental benefits, including increased carbon sequestration for global climate change mitigation. Very few economic studies are found on the benefits and costs of land rehabilitation in Tanzania, and new studies are highly needed in order to identify and prioritize among the potential rehabilitation activities. In Paper II, a review is presented of studies of charcoal production and consumption in Tanzania, and promising new research tasks are identified. Many interesting and valuable studies have been done, and it is clearly seen how important charcoal consumption and production are both in a social, ecological and economic perspectives. However, the results of the studies diverge a lot and most of the reviewed studies lack clear hypotheses and specifications of behavior theories to be used for developing realistic and testable hypotheses. It is found that more research is needed on factors effecting charcoal demand – like changes in prices, income and policies, and for that, using national household surveys is recommended. More research is also needed about tree regeneration (time and volumes) in miombo woodlands; how various forms of land ownerships influence miombo woodlands management; the possibilities and preferability in Tanzania of establishing forest plantations for producing charcoal; total and distributional impacts of policies related to production or consumption of fuelwood; climate gas emission impacts of charcoal production and consumption; development of bio-economic models which make possible consistent analyses of ex ante defined possible changes from the present socio-economic and policy situation. In Paper III, results are presented from a survey of 360 households in the three Tanzanian cities Dodoma, Morogoro and Mtwara about the impacts of income, charcoal prices and household size on the household per capita charcoal consumption. For the total sample, statistically significant elasticities for charcoal per capita consumption were found to be 0.03, -0.13 and -0.62 for respectively per capita income, charcoal price and household size. In the low income group, statistically significant elasticities for annual charcoal per capita demand were found to be -0.44 and -0.59 for respectively charcoal price and household size; in the middle income group only household size was found to be statistically significant with estimated elasticity -0.81; and in the high income group elasticities of 0.17 for per capita income and -0.44 for household size were found statistically significant. These results are based on small samples and should be viewed as exploratory results of value primarily as information for larger surveys. Paper IV has as primary objectives to develop a forest sector model which integrates wood supply from detailed forest data from Tanzania’s NFI (National Forest Inventory) NAFORMA with demand for wood products, and apply this model to evaluate sustainability impacts of the future production and consumption of firewood, charcoal and poles in mainland Tanzania. The developed model (TanzFor) is classified as an intertemporally optimized spatial equilibrium model, and links in an economic consistent framework supply and demand for fuelwood, poles and charcoal as well as forest industry products. The study is the first one applying this kind of model in Africa with data from a detailed NFI as NAFORMA and newly developed forest growth functions as basis for the wood supply. The model results show alarming negative impacts on forest growing stocks by the steadily increasing consumption of firewood and charcoal in Tanzania, mainly caused by high population growth, high urbanization rates, low utilization efficiencies in both charcoal production and consumption, and rather free access to forest land. Chapter 4 of the synopsis gives a more overall, perspectively oriented discussion of the results obtained in Papers I-IV, focusing on uncertainty, linkages between the four thesis papers, connections to land use theories, relevance of forest sector modeling in Tanzania, policy implications and future research. The following topics are mentioned as being among the most interesting ones for future research: Further use of the NAFORMA data in fuelwood analyses; provide more accurate data on the present and future consumption of charcoal and firewood; analyze wood supply impacts of various kinds of property right regimes and policy means; improving forest sector modelling in Tanzania both regarding data input quality and incorporation of land property/ownership specifications; applying the model in estimating GHG emission and impacts of climate change in the forest sector; using the model in estimating impacts of policy means. It is emphasized, however, that like all models TanzFor has weaknesses and is a simplification of real life conditions, and that all TanzFor model results should be interpreted with that in mind. In Chapter 5 it is concluded that the above mentioned four research questions Q1-Q4 have been addressed and new results obtained which clearly show that the current consumption of wood in Tanzania is not sustainable. Tanzania is experiencing high and increasing production and consumption of charcoal particularly in urban areas where charcoal is the main type of energy for cooking. The results in this thesis indicate that challenges of fuelwood production and consumption will remain large in Tanzania for quite some time if no measures are taken to make cooking energy substitutes to charcoal more reliable and affordable than at present, and the charcoal production more efficient.

Background and aims Understanding of the significant genetic risk factors for Cholangiocarcinoma (CC) remains limited. Polymorphisms in the natural killer cell receptor G2D (NKG2D) gene have been shown to increase risk of CC transformation in patients with Primary Sclerosing Cholangitis (PSC). We present a validation study of NKG2D polymorphisms in CC patients without PSC. Methods Seven common Single Nucleotide Polymorphisms (SNPs) of the NKG2D gene were genotyped in 164 non-PSC related CC subjects and 257 controls with HaploView. The two SNPs that were positively identified in the previous Scandinavian study, rs11053781 and rs2617167, were included. Results The seven genotyped SNPs were not associated with risk of CC. Furthermore, haplotype analysis revealed that there was no evidence to suggest that any haplotype differs in frequency between cases and controls (P > 0.1). Conclusion The common genetic variation in NKG2D does not correlate significantly with sporadic CC risk. This is in contrast to the previous positive findings in the Scandinavian study with PSC-patients. The failure to reproduce the association may reflect an important difference between the pathogenesis of sporadic CC and that of PSC-related CC. Given that genetic susceptibility is likely to be multifaceted and complex, further validation studies that include both sporadic and PSC-related CC are required.

Background Globally, eHealth has attracted considerable attention as a means of supporting maternal and perinatal health care. This article describes best practices, gains and challenges of implementing eHealth for maternal and perinatal health care in extremely remote and rural Tanzania. Methods Teleconsultation for obstetric emergency care, audio teleconferences and online eLearning systems were installed in ten upgraded rural health centres, four rural district hospitals and one regional hospital in Tanzania. Uptake of teleconsultation and teleconference platforms were evaluated retrospectively. A cross sectional descriptive study design was applied to assess performance and adoption of eLearning. Results In 2015 a total of 38 teleconsultations were attended by consultant obstetricians and 33 teleconferences were conducted and attended by 40 health care providers from 14 facilities. A total of 240 clinical cases mainly caesarean sections (CS), maternal and perinatal morbidities and mortalities were discussed and recommendations for improvement were provided. Four modules were hosted and 43 care providers were registered on the eLearning system. For a period of 18–21 months total views on the site, weekly conference forum, chatroom and learning resources ranged between 106 and 1,438. Completion of learning modules, acknowledgment of having acquired and utilized new knowledge and skills in clinical practice were reported in 43–89% of 20 interviewed health care providers. Competencies in using the eLearning system were demonstrated in 62% of the targeted users. Conclusions E-Health presents an opportunity for improving maternal health care in underserved remote areas in low-resource settings by broadening knowledge and skills, and by connecting frontline care providers with consultants for emergency teleconsultations.

This paper discusses selection in a dairy goat population for improved performance by conceptualizing it for a population in Tanzania. Seven strategies (5, 10, 20, 30, 50, 70, 100 test bucks) were simulated. A progeny test based selection breeding program fitting Mgeta (Morogoro, Tanzania) situation was optimized. The selection intensity, accuracy of prediction, and genetic gain of milk yield (kg) per day at heritability 0.1 and 0.2 are discussed. Use of natural mating for 1000 goats, in cooperating villages, were assumed. Three elite bucks were selected for breeding with 12% of the best females. Outlines of essential elements for a local sustainable dairy goat breeding program in Tanzania are included with a schematic figure showing selection steps for dairy goat breeding scheme fitting in Mgeta area. This study found that selection intensity gained when testing many bucks is more important for daily milk yield (DMY) (kg) genetic gain than the extra accuracy gained when testing fewer bucks. Mgeta has a mountainous terrain, small herd sizes per farmer and long distance from one cooperating village to another. Testing 30 bucks is practical for Mgeta. That gives relatively high (42% or 53%) accuracy of selection and genetic gain (2% or 2.6% for 0.1 or 0.2 heritability). The current results of estimated genetic gain are close to reported findings under other environments. Based on dairy goats of Norwegian breed in Tanzania, milked once daily, if 210 days of milking and an average of 1 litre milk yield is considered, the possible genetic gain per year in this program is equivalent to an increase of 4.2kg for 0.1 heritability and 5.5kg of milk per doe for 0.2 heritability of the trait. Such an increase in amount of milk due to a breeding program under the considered environment is promising. Collaborative efforts from farmers to consumers along the dairy goat market chain remain important elements to realize a sustainable high gain. The proposed breeding program may not be perfect in future because of practical options and accessibility to new knowledge. Thus, it becomes indispensable to revise breeding programs.

Dairy goats in Tanzania accounts for two percent of the 17 million goats in total. Toggenburg, Saanen, Norwegian, Anglo Nubian and French alpine are dominant exotic dairy breeds distributed in all regions of Tanzania but abundance in Manyara, Morogoro, Arusha and Kilimanjaro regions. Both public and private organizations have played in importing and distribution the exotic breeds in the country. For example, the collaboration between in Sokoine University of Agriculture (SUA) and Norwegian University of Life Sciences (NMBU) participated importing the Norwegian goat breed. The FARM Africa (Food and Agricultural Research Management) and HPI (Heifer Project International) responsible for Toggenburg and Saanen dairy breeds. The support with dairy goats has proven to be rather effective in improving food security and livelihood of people who owned them. Long term benefits of the goats can be realized if breeding principles are well considered e.g. reliable source of replacement breeding stock. As a step towards achieving that, a Strength, Weakness, Opportunity and Threats (SWOT) analysis of a dairy goat breeding program in Tanzania today were analysed in this paper. The analysis revealed potential possibilities for establishing sustainable dairy goat breeding program in the country. However, poor and unreliable records were the main hindrances for sustainable genetic improvement of goats in the country. Alternatively, this paper propose a simplified breeding plan that benefits from progress made elsewhere through occasional semen import for AI in one breeding nucleus herd in the country, multiplied by another unit/centre for distribution to clients. Key roles and risks of private and public institutions participating in implementing the breeding plan are highlighted.

Background Discriminatory metabolic profiles have been described in urinary 1 H nuclear magnetic resonance (NMR) spectroscopy studies of African patients with hepatocellular carcinoma (HCC). This study aimed to assess similarities in a UK cohort, where there is a greater etiological diversity. Methods Urine from cirrhosis and HCC patients was analyzed using a 600MHz 1 H NMR system. Multivariate analysis and median group MR spectra comparison identified metabolite alterations between groups. Metabolite identification was achieved through literature reference and statistical total correlation spectroscopy. Diagnostic accuracy was compared to serum alpha-fetoprotein (AFP). Results Of the 52 patients recruited, 13 samples from HCC and 25 from cirrhosis patients were selected. At 200IUmL −1 , diagnostic sensitivity of AFP was 27%. Multivariate analysis of urinary spectra generated diagnostic models with a sensitivity/specificity of 53.6%/96%. p-Cresol sulfate ( P =0.04), creatinine ( P =0.03), citrate ( P =0.21) and hippurate ( P =0.52) were reduced in the HCC patients. Carnitine ( P =0.31) and formate ( P =0.44) were elevated. Conclusion Diagnostic sensitivity was lower than previous African studies, but still outperformed serum AFP. Reduced creatinine, citrate and hippurate and elevated carnitine are comparable with the African studies. p-Cresol sulfate alteration is a novel finding and may indicate an altered sulfonation capacity of the liver in patients with HCC.

Increased occurrence of drought and dry spells during the growing season have resulted in increased interest in protection of tropical water catchment areas. In Mgeta, a water catchment area in the Uluguru Mountains in Tanzania, water used for vegetable and fruit production is provided through canals from the Uluguru South Forest Reserve. The clearing of forest land for cultivation in the steep slopes in the area is causing severe land degradation, which is threatening the water catchment area, livelihoods, and food security of the local communities, as well as the major population centers in the lowlands. In this paper, the economic performance of a traditional cropping-livestock system with East African (EA)-goats and pigs and extensive vegetable production is compared with a more sustainable and environmentally friendly crop-dairy goat production system. A linear programming (LP) crop-livestock model, maximizing farm income considering the environmental constraints in the area was applied for studying the economic performance of dairy goats in the production system. The model was worked out for the rainy and dry seasons and the analysis was conducted for a basic scenario representing the current situation, based on the variability in the 30 years period from 1982-2012, and in a scenario of both lower crop yields and increased crop variability due to climate change. Data obtained from a sample of 60 farmers that were interviewed using a questionnaire was used to develop and parameterize the model. The study found that in the steep slopes of the area, a crop-dairy goat system with extensive use of grass and multipurpose trees (MPTs) would do better than the traditional vegetable gardening with the EA goat production system. The crop-dairy goat system was superior both in the basic and in a climate change scenario since the yield variation of the grass and MPTs system was less affected compared to vegetable crops due to more tree cover and the use of perennial grasses. However, the goat milk production in the area was constrained by inadequate feeding and lack of an appropriate breeding program. Hence, farmers should enhance goat milk production by supplementing with more concentrate feed and by implementing goat-breeding principles. Moreover, policy measures to promote such a development are briefly discussed. Keywords: dairy goats, climate change, risk analysis, Tanzania, production system

Summary Background Chronic biochemical cholestasis has been shown to be associated with a fivefold increase in histologically advanced liver disease in patients receiving home parenteral nutrition. Aims To investigate prevalence of chronic biochemical cholestasis in home parenteral nutrition patients and examine factors influencing its occurrence. Methods Records of all patients receiving home parenteral nutrition for >6 months treated at a single centre were reviewed and plasma biochemistry recorded. Logistic regression analysis was employed to identify factors associated with prevalence of chronic biochemical cholestasis. Results Records of 113 patients were reviewed. The point prevalence of chronic biochemical cholestasis was 24%, increasing to 28% if patients receiving parenteral fluid and electrolytes only were excluded. In multivariate analysis, presence of colon in continuity was associated with a significantly lower prevalence of chronic biochemical cholestasis, while total parenteral calorie intake was associated with a higher prevalence of chronic biochemical cholestasis. No association was seen between small intestinal lengths or between parenteral lipid intake and chronic biochemical cholestasis in multivariate analysis. Conclusions Chronic biochemical cholestasis is common in patients receiving home parenteral nutrition. High parenteral calorie intake and lack of a colon in continuity with small intestine are independently associated with an increased risk of chronic biochemical cholestasis.

A rapid and highly sensitive point of care (PoC) lateral flow assay for phospholipase-A2 (PLA2) is demonstrated in serum through the enzyme-triggered release of a new class of biotinylated multi-armed polymers from a liposome substrate. Signal from the enzyme activity is generated by the adhesion of polystreptavidin coated gold nanoparticle networks to the lateral flow device, which leads to the appearance of a red test line due to the localised surface plasmon resonance (LSPR) effect of the gold. The use of a liposome as the enzyme substrate and multivalent linkers to link the nanoparticles leads to amplification of the signal as the cleavage of a small amount of lipids is able to release a large amount of polymer linker and adhesion of an even larger amount of gold nanoparticles. By optimising the molecular weight and multivalency of these biotinylated polymer linkers the sensitivity of the device can be tuned to enable naked-eye detection of 1 nM human-PLA2 in serum within 10 minutes. This high sensitivity enabled the correct diagnosis of pancreatitis in diseased clinical samples against a set of healthy controls using PLA2 activity in a point of care device for the first time.