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Background. The severity of malaria infection depends on the host, parasite and environmental factors. Merozoite surface protein (msp) diversity determines transmission dynamics, P. falciparum immunity evasion, and pathogenesis or virulence. There is limited updated information on P. falciparum msp polymorphisms and their impact on artemether-lumefantrine treatment outcomes in Tanzania. Therefore, this study is aimed at examining msp genetic diversity and multiplicity of infection (MOI) among P. falciparum malaria patients. The influence of MOI on peripheral parasite clearance and adequate clinical and parasitological response (ACPR) was also assessed. Methods. Parasite DNA was extracted from dried blood spots according to the manufacture's protocol. Primary and nested PCR were performed. The PCR products for both the block 2 region of msp1 and the block 3 regions of msp2 genes and their specific allelic families were visualized on a 2.5% agarose gel. Results. The majority of the isolates, 58/102 (58.8%) for msp1 and 69/115 (60.1%) for msp2, harboured more than one parasite genotypes. For the msp1 gene, K1 was the predominant allele observed (75.64%), whereas RO33 occurred at the lowest frequency (43.6%). For the msp2 gene, the 3D7 allele was observed at a higher frequency (81.7%) than the FC27 allele (76.9%). The MOIs were 2.44 for msp1 and 2.27 for msp2 (p = 0.669). A significant correlation between age and multiplicity of infection (MOI) for msp1 or MOI for msp2 was not established in this study (rho = 0.074, p = 0.521 and rho = −0.129, p = 0.261 , respectively). Similarly, there was no positive correlation between parasite density at day 1 and MOI for both msp1 (rho = 0.113, p = 0.244) and msp2 (rho = 0.043, p = 0.712). The association between MOI and ACPR was not observed for either msp1 or mps2 (p = 0.776 and 0.296, respectively). Conclusions. This study reports high polyclonal infections, MOI and allelic frequencies for both msp1 and msp2. There was a lack of correlation between MOI and ACPR. However, a borderline significant correlation was observed between day 2 parasitaemia and MOI. [ABSTRACT FROM AUTHOR]

While on the street, HIV infection among street-connected children is a challenging issue due to the nature of transmission, distribution, and prevention. Lack of proper care and protection, insufficient knowledge of the danger of acquiring HIV, and insufficient or absence of health facilities serving street-connected children have left this vulnerable group engaging in high-risk behaviors exposing them to acquiring HIV. This cross-sectional study aimed at estimating the prevalence of HIV infection and its associated risk factors among street-connected children aged between 10 to17 years in Mwanza City. The study was granted ethical clearance all permissions and restrictions to work with street-connected children were adhered to. A total of 131 participants aged 10–17 years were recruited for interviews and HIV testing. Exact logistic regression was used to determine factors associated with having HIV. A total of 111 (85.0%) boys and 20 (15.0%) girls responded to the questionnaire, with the median age being 15years. The overall HIV prevalence was 12.2% (16/131). Street-children using condoms were less likely to be affected by HIV compared to those who were not using (OR = 0.24; 95% CI 0.04–0.97). Females had higher odds of HIV infection compared to males (OR = 5.24; 95% CI of 1.24–24.65). The study shows a significantly higher prevalence of HIV among street-connected children as compared to the general population. Therefore, there should be tailored reproductive and sexual health programs, with the provision of protective materials like condoms. [ABSTRACT FROM AUTHOR]

Background: The community practice towards disposal of expired and unused medications in spite of its adverse impact have been widely neglected in many developing countries. The available guidelines in Tanzania focus on the disposal of expired medications and cosmetics in hospitals and community pharmacies only. Aim: The aim of this study was to assess the disposal practice of expired and unused medications at household level in Mwanza city, north-western Tanzania. Methodology: The household based cross-sectional study was conducted among 359 randomly selected household members. Semi-structured questionnaires were used for interview during data collection and while STATA® version 13 was used for analysis. Results: Out 359 households visited, 252 (70.19%) had medications kept in their houses at the time of data collection. Among them, 10 (4.0%) households had kept medications at their houses because they were still continuing with treatment while 242 (96.0%) kept unused medications which were supposed to be discarded. The main reason for keeping unused or expired medications at home was uncompleted course of treatment (199 (82.20%) after feeling that they had recovered from illness. The main reason for discarding medications were recovering from illness (141(48.7%) and expiry (136 (46.9%). The major discarding practices for medications were disposing into domestic trashes (219 (75.5%) and pit latrines (45 (15.5%). Majority of respondents (273 (76%) were aware that improper disposal of expired medications are detrimental to human health and environment in general. Conclusion: Improper disposal of unused and expired medications at household level was a common practice in the study area. Tailor-made interventions by the Food and Drugs Authority (FDA) and other national as well as local stake holders are urgently needed to address the situation. [ABSTRACT FROM AUTHOR]

Background: Artemisinin based combination therapies (ACTs) have been a cornerstone in the treatment of malaria in the world. A rapid decline in dihydroartemisinin piperaquine (DHP) and artemether lumefantrine (ALU) efficacies has been reported in some parts of South East Asia, the historical epicenter for the antimalarial drug resistance. Prolonged drug use is associated with selection of resistant parasites due to exposure to inadequate drug levels hence effects on treatment outcomes in malaria. ALU and DHP are used as first line and alternative first line, respectively, in Tanzania. This study was carried in Igombe, Tanzania to assess the efficacies of ALU and DHP in routine treatment of uncomplicated malaria among children. Methods: This was a prospective study involving children up to 10 years and followed up for 28 and 35 days as per the WHO protocol, 2015 for monitoring antimalarial drug efficacy. The primary end points were crude and adjusted Adequate Clinical and Parasitological Response (ACPR), parasite clearance rate and reported adverse events. Results: A total of 205 children with uncomplicated malaria were enrolled. One hundred and sixteen participants were treated with ALU, while 89 participants were treated with DHP. Two participants in the ALU group were lost within the 24 h of follow-up. The PCR unadjusted ACPR was108 (94.7%) for ALU and 88 (98.9%) for DHP, while the PCR adjusted ACPR was 109(95.6%) and 88(98.9%) for ALU and DHP, respectively, at 28 day follow-up. No treatment failure was observed in both groups. Cumulative risk of recurrent parasitemia was similar in both groups (p = 0.32). Age and parasite density were strong predictors for persistent day 1 parasitemia (p = 0.034 and 0.026, respectively). Nausea and vomiting, abdominal pain and headache were the most clinical adverse events reported in both groups of patients. Conclusion: The present study shows that ALU and DHP are still efficacious after more than a decade of use with PCR corrected efficacies greater than 95% implying a failure rate less than 5% which is below the WHO minimum threshold requirement for recommendation of a change in the treatment policy. Both drugs were well tolerated with no major adverse events reported. [ABSTRACT FROM AUTHOR]