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Globally, there have been calls for an integrated zoonotic disease surveillance system. This study aimed to assess human and animal health surveillance systems to identify opportunities for One Health surveillance platform in Tanzania. A desk review of policies, acts and strategies addressing disease surveillance that support inter-sectoral collaboration was conducted. A semi-structured questionnaire was administered to key informants from the two sectors. Databases with potential relevance for surveillance were assessed. One Health-focused policies, acts, strategic plans and guidelines emphasising inter-sectoral collaboration strengthening were in place. Stable systems for collecting surveillance data with trained staff to implement surveillance activities at all levels in both sectors were available. While the human surveillance system was a mix of paper-based and web-based, the animal health system was mainly paper-based. The laboratory information system existed in both sectors, though not integrated with the epidemiological surveillance systems. Both the animal and human surveillance systems had low sensitivity to alert outbreaks. The findings indicate that individual, organisational, and infrastructure opportunities that support the integration of surveillance systems from multiple sectors exist. Challenges related to data sharing and quality need to be addressed for the effective implementation of the platform. [ABSTRACT FROM AUTHOR]

An effective disease surveillance system is critical for early detection and response to disease epidemics. This study aimed to assess the capacity to manage and utilize disease surveillance data and implement an intervention to improve data analysis and use at the district level in Tanzania. Mapping, in-depth interview and desk review were employed for data collection in Ilala and Kinondoni districts in Tanzania. Interviews were conducted with members of the council health management teams (CHMT) to assess attitudes, motivation and practices related to surveillance data analysis and use. Based on identified gaps, an intervention package was developed on basic data analysis, interpretation and use. The effectiveness of the intervention package was assessed using pre-and post-intervention tests. Individual interviews involved 21 CHMT members (females = 10; males = 11) with an overall median age of 44.5 years (IQR = 37, 53). Over half of the participants regarded their data analytical capacities and skills as excellent. Analytical capacity was higher in Kinondoni (61%) than Ilala (52%). Agreement on the availability of the opportunities to enhance capacity and skills was reported by 68% and 91% of the participants from Ilala and Kinondoni, respectively. Reported challenges in disease surveillance included data incompleteness and difficulties in storage and accessibility. Training related to enhancement of data management was reported to be infrequently done. In terms of data interpretation and use, despite reporting of incidence of viral haemorrhagic fevers for five years, no actions were taken to either investigate or mitigate, indicating poor use of surveillance data in monitoring disease occurrence. The overall percentage increase on surveillance knowledge between pre-and post-training was 37.6% for Ilala and 20.4% for Kinondoni indicating a positive impact on of the training. Most of CHMT members had limited skills and practices on data analysis, interpretation and use. The training in data analysis and interpretation significantly improved skills of the participants. [ABSTRACT FROM AUTHOR]

This study compared the access and utilisation of health services in public and non-public health facilities in terms of quality, equity and trust in the Mbarali district, Tanzania. Interviews, focus group discussions, and informal discussions were used to generate data. Of the 1836 respondents, 1157 and 679 respondents sought healthcare services on their last visit at public or non-public health facilities, respectively. While 45.5% rated the quality of services to be good in both types of facilities, reported medicine shortages were more pronounced among those who visited public rather than non-public health facilities (OR = 1.7, 95% CI 1.4, 2.1). Respondents who visited public facilities were 4.9 times less likely than those who visited non-public facilities to emphasise the influence of cost in accessing and utilising health care (OR = 4.9, CI 3.9–6.1). A significant difference was also found in the provider–client relationship satisfaction level between non-public (89.1%) and public facilities (74.7%) (OR = 2.8, CI: 1.5–5.0), indicating a level of lower trust in the later. Revised strategies are needed to ensure availability of medicines in public facilities, which are used by the majority of the population, while strengthening private–public partnerships to harmonise healthcare costs. [ABSTRACT FROM PUBLISHER]

Background: Malaria is a complex health problem related to socio-economic and environmental factors that cut across a number of sectors. Establishing intersectoral linkages is important to facilitate joint efforts to address the problem at all levels. The objectives of this study were to explore key sectoral engagements in malaria control policy formulation and implementation, and to determine decision and policy makers' opinions about different sectoral activities that contribute to malaria transmission and control in Tanzania. Methods: This study included documentary review, self-administered interviews and group discussion. Interviews and group discussions involved key informants at district and national levels. The sectors involved were health, agriculture, environment, livestock, fisheries, education, works, irrigation, water resources, land development, forestry, and community development. Results: Institutions and organizations that were involved in the development of the previous and current National Malaria Strategic Plan (2007-2013 and 2013-2020) were the Ministries of Health and Social Welfare, Prime Minister's Office of Regional Administration and Local Government, Public universities and non-governmental organizations. All the individuals involved in the development of the plans were either medical or health professionals. According to key informants, sectoral activities identified to contribute to malaria transmission included farming systems, deforestation, fishing, nomadic pastoralism, household water storage, water resource development projects, road and house construction and mining. The lack of intersectoral approaches in malaria control programme included the facts that the Health Sector does not involve other sectors during planning and development of policy guidelines, differences in sectoral mandates and management culture, lack of a national coordinating framework and lack of budget for intersectoral activities. Conclusion: The current strategies for malaria control in Tanzania need to address socio-economic and development activities across sectors and emphasise the need for intersectoral collaboration. It is recommended that the future of malaria control strategies should, therefore, be broad based and intersectoral in planning and implementation. [ABSTRACT FROM AUTHOR]

Abstract: Background: In Sub-Saharan Africa, some individuals infected with malaria are also infected with helminths. However, the magnitude and distribution of such coinfections in relation to eco-systems remains poorly defined. This study was undertaken to determine the prevalence of Plasmodium falciparum and helminth coinfections among schoolchildren in relation to agro-ecosystems in Mvomero District, Tanzania. Methods: The agro-ecosystems were categorised as sugarcane, traditional flooding rice irrigation, improved non-flooding rice irrigation and savannah. Schoolchildren had their blood examined for P. falciparum and Wuchereria bancrofti; urine for Schistosoma haematobium and stool for intestinal helminths. Blood samples were also examined for haemoglobin concentration. Results: A total of 578 schoolchildren (mean age=7.96 years) were involved in the study. Overall, 60% of all schoolchildren had at least an infection of either P. falciparum, W. bancrofti, S. haematobium or hookworm. The highest prevalence of P. falciparum (75.3%), W. bancrofti (62.9%) and hookworm (24.7%) infections was observed among children in flooding rice irrigation ecosystem. P. falciparum + S. haematobium (10.9%) and P. falciparum + W. bancrofti (11.1%) were the most prevalent types of coinfection in the area. The highest prevalence of double parasitic infections was observed among children in the flooding rice irrigation ecosystems. The risk for acquiring coinfections of P. falciparum + W. bancrofti was significantly higher among children in the flooding rice irrigation ecosystem. Forty-five (7.8%) children were coinfected with three types of parasitic infections. The risk of acquiring triple infection among children from flooding rice irrigation was higher for P. falciparum + S. haematobium + W. bancrofti (p <0.001). Seven schoolchildren (1.2%) were found infected with four parasites and all were from the flooding rice irrigation ecosystem. Significantly high P. falciparum geometric parasite density was observed among children coinfected with either hookworms or W. bancrofti (p <0.001). On average, 17.8% (103/578) of the children had enlarged spleens. Over 3- and 4-folds increase in the risk of having an enlarged spleen were observed among children coinfected with P. falciparum + S. haematobium and P. falciparum + W. bancrofti, respectively. The overall prevalence of anaemia (<11.5g/dl) was 61.9% (358/578). Conclusion: Malaria–helminth coinfections are prevalent among schoolchildren in rural Tanzania and the pattern varies between agro-ecosystems. Results of this study suggest that integrated control of malaria and helminthes should be designed based on the local agro-ecosystems. [Copyright &y& Elsevier]

Abstract: This study was carried out to determine knowledge, perceptions and practices of farming communities on linkages between agriculture and malaria in Mvomero District in Tanzania. A total of 661 adult males and females were interviewed using a structured questionnaire. Most respondents (85.6%) were engaged in crop production. Significantly, a larger proportion (55.2%) of the respondents had primary school education (P <0.001). Majority (88.2%) respondents described malaria as the most important public health problem. However, only 48.2% of the respondents had high knowledge of malaria. The level of knowledge on malaria was associated with level of education of the respondent. Those who had attended at least primary school education were more knowledgeable that those without formal education. A significantly larger proportion (67%) of the respondents experienced most malaria episodes during the rainy season (P <0.001). Respondents with low knowledge on malaria experienced 2.3 times more malaria cases in their households than those with higher knowledge. Respondents with low knowledge preferred to seek care from health facilities (OR: 7.28) than those with high knowledge (OR: 0.15). Rice farming was significantly associated with malaria transmission compared to either maize or sugarcane farming (P <0.001). Cattle, sheep and goats were the domestic animals most frequently incriminated to create aquatic habitats for mosquito breeding. Householders with formal education (OR: 4.6, CI: 1.33–15.89, P-value=0.016) and higher knowledge (OR: 1.7, CI: 1.15–2.55, P-value=0.008) reported to incur large losses when having a malaria case than those without education/low knowledge. Majority (60.2%) of the respondent owned at least an insecticide treated mosquito net (ITN). Respondents with higher knowledge of malaria were likely to own at least an ITN than those with low knowledge (P <0.001). In conclusion, the knowledge on malaria and its linkage with agriculture among farming communities in Mvomero District is low. Malaria is a complex health problem and its control approach needs understanding of the environmental factors associated with agricultural practices. It therefore is important that education and communication messages on malaria targeting farming communities take into consideration local agricultural practices. [Copyright &y& Elsevier]

• Rift Valley fever virus (RVFV) seroprevalence was higher in cattle (18.6%) than in sheep, goats, or humans • RVFV seroprevalence in humans was similar in the three districts • RVFV seroprevalence in domestic ruminants varied among the three districts • Individuals involved in splitting carcasses had 12-fold higher odds of seropositivity • There was a positive association between RVFV seropositivity in animals and humans Data on Rift Valley fever virus (RVFV) prevalence in urban settings and pastoral areas of Tanzania are scarce. We performed a cross-sectional study of RVFV seroprevalence and determinants in humans and animals from Ilala, Rufiji, and Sengerema districts of Tanzania. Blood samples from the study participants were tested for anti-RVFV immunoglobulin G (IgG) antibodies using an enzyme-linked immunosorbent assay. Logistic regression was used to determine association between exposure risk practices and RVFV seropositivity. The study involved 664 humans, 361 cattle, 394 goats, and 242 sheep. The overall anti-RVFV IgG seroprevalence in humans and animals was 2.1% (95% confidence interval [CI] 0.01-0.04) and 9.5% (n = 95, 95% CI 0.08-0.12), respectively. Seroprevalence in humans in Rufiji, Ilala, and Sengerema was 3.0% (n = 225, 95% CI 0.01-0.06), 1.8% (n = 230, 95% CI-0.005- 0.04), and 1.4% (n = 209, 95% CI 0.01-0.04), respectively (P >0.05). Seroprevalence in animals in Sengerema, Rufiji, and Ilala was 12.1% (n = 40, 95% CI 0.09-0.16), 11.1% (n = 37, 95% CI 0.08-0.15), and 5.4% (n = 18, 95% CI 0.03-0.08), respectively (P = 0.006). Handling of carcasses increased the odds of RVFV seropositivity 12-fold (odds ratio 11.84, 95% CI 1.97-71.16). The study confirms previous occurrence of RVFV in multiple species in the study districts. Animal handling practices appear to be essential determinants of seropositivity. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to determine the seroprevalence and risk factors of chikungunya (CHIKV), dengue (DENV), and Zika (ZIKV) viruses in Tanzania. Methods: The study covered the districts of Buhigwe, Kalambo, Kilindi, Kinondoni, Kondoa, Kyela, Mvomero, and Ukerewe in Tanzania. Blood samples were collected from individuals recruited from households and healthcare facilities. An ELISA was used to screen for immunoglobulin G antibodies against CHIKV, DENV, and ZIKV. Results: A total of 1818 participants (median age 34 years) were recruited. The overall CHIKV, DENV, and ZIKV seroprevalence rates were 28.0%, 16.1%, and 6.8%, respectively. CHIKV prevalence was highest in Buhigwe (46.8%), DENV in Kinondoni (43.8%), and ZIKV in Ukerewe (10.6%) and Mvomero (10.6%). Increasing age and frequent mosquito bites were significantly associated with CHIKV and DENV seropositivity (P < 0.05). Having piped water or the presence of stagnant water around the home (P < 0.01) were associated with higher odds of DENV seropositivity. Fever was significantly associated with increased odds of CHIKV seropositivity (P < 0.001). Visiting mines had higher odds of ZIKV seropositivity (P < 0.05). Conclusions: These findings indicate that DENV, CHIKV, and ZIKV are circulating in diverse ecological zones of Tanzania. There is a need to strengthen the control of mosquito-borne viral diseases in Tanzania. [ABSTRACT FROM AUTHOR]

• Overall, 12.8% of the population in Tanzania had been exposed to viral hemorrhagic fevers • Highest seroprevalence (4.8%) was due to Rift Valley fever antibodies • Lowest seroprevalence (1.2%) was due to Marburg virus disease antibodies • Contact with wild animals and keeping goats were associated with Rift Valley fever seropositivity • Contact with bats was associated with Marburg virus disease seropositivity To determine the seroprevalence of selected zoonotic viral hemorrhagic fevers (VHFs) and their associated risk factors in Tanzania. Blood samples were collected from consenting outpatients and community members in eight districts selected from five ecological zones of Tanzania. Serum was harvested and tested for the presence of immunoglobulin G (IgG) and M (IgM) antibodies against Crimean-Congo hemorrhagic fever (CCHF), Ebola virus disease (EVD), Marburg virus disease (MVD), Rift Valley fever (RVF), and yellow fever (YF). The presence of IgM and IgG antibodies against CCHF, EVD, MVD, RVF, and YF was detected in 64 of 500 samples (12.8%). The prevalences of IgM and IgG antibodies to CCHF, EVD, MVD, RFV, and YF were 2.0%, 3.4%, 1.2%, 4.8%, and 1.4%, respectively. Contact with wild animals (OR = 1.2, CI = 1.3–1.6) and keeping goats (OR = 1.3, CI = 1.5–1.9) were significantly associated with RVF, while contact with bats (OR = 1.2, CI = 1.1–1.5) was associated with MVD. The findings of this study provide evidence of exposure to CCHF, EVD, MVD, RVF, and YF in Tanzania. Since most of these VHFs occurred without apparent clinical forms of the disease, these findings call for the need to strengthen the surveillance system and management of febrile illnesses in Tanzania. [ABSTRACT FROM AUTHOR]

This study was carried out to understand the role social determinants and health seeking behavior among rice farming and pastoral communities in Kilosa District in central Tanzania. The study involved four villages; two with rice farming communities while the other two with pastoral communities. In each village, heads of households or their spouses were interviewed to seek information on livelihoods activities, knowledge and practices on malaria and its preventions. A total of 471 individuals (males = 38.9%; females = 61.1%) were interviewed. Only 23.5% of the respondents had adequate knowledge on malaria. Fifty-six percent of the respondents could not associate any livelihood activity with malaria transmission. Majority (79%) of the respondents believed that most of fevers were due to malaria; this was higher among the pastoral (81.7%) than rice farming communities (76.1%) ( p = 0.038). Cases of fever were significantly higher in households with non-educated (31.2%) than educated respondents (21.5%). Women experienced significantly more episodes of fever than men ( p < 0.001). Of the total of 2606 individuals living in the households, 26.9% were reported to have had fever in the previous three months. Fever was reported more frequently among pastoral than rice farming communities ( p < 0.01). Of those who had fever, 36.6% were clinically diagnosed with malaria and 22.9% were confirmed to be infected with malaria. A combination of fever + convulsions or joint pains + headache was most frequently perceived to be malaria. Treatment seeking frequency differed by the size of the household and between rice farming and pastoral communities ( p = 0.05). In conclusion, education, sex, availability of health care facility and livelihood practices were the major social determinants that influence malaria acquisition and care seeking pattern in central Tanzania. Appropriate public health promotion should be designed to address the links of livelihoods and malaria transmission among rural farming communities in an ecohealth approach. [ABSTRACT FROM AUTHOR]