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Background: Early Infant Diagnosis (EID) of Human Immunodeficiency Virus (HIV) is one of the major interventions for HIV and AIDS in sub-Saharan Africa. However, the coverage is still lower than the recommended levels. The objective of this review was to systematically assess factors associated with accessibility of EID services in sub-Saharan Africa. Method: Scientific engines were searched from library catalogues and public databases. The review included free full text articles in English published from 1996 to 2015 and fitting to the objectives of the study. Results: A total of 1,039,715 results appeared on the databases after initial searching. Of these, 48 eligible articles were identified and reviewed. From 2004 to 2014, the proportion of HIV exposed infants who received a virological test within the first 2 months of life in sub-Saharan Africa varied from 3 to 58%, far below the 80% recommended level by the World Health Organization. EID services were not available in more than 30% of health facilities in most sub-Saharan African countries. Factors associated with accessibility of EID services included parents with low formal education level, maternal unemployment, geographical relocation, religious beliefs, lack of paternal support, insufficient awareness of HIV control and prevention services, poor compliance to prevention of mother to child transmission services, lack of general knowledge of HIV transmission, stigma and discrimination, inadequate human resource for health, weak infrastructure, inadequate supplies of laboratory materials and late feedback of HIV test results. Conclusions: Availability and accessibility of EID services in sub-Saharan Africa is still low despite the investment made during the past decade. Both individual and institutional factors affect the availability and accessibility of the services. It is important that these factors are urgently addressed to improve EID services.

Background: Rift Valley fever (RVF) is a mosquito-borne viral zoonotic disease. Rift Valley fever virus (RVFV) has been isolated from more than 40 species of mosquitoes from eight genera. This study was conducted to determine the abundance of potential mosquito vectors and their RVFV infection status in Ngorongoro District of northern Tanzania. Methods: Adult mosquitoes were collected outdoors using the CDC light traps baited with carbon dioxide in five randomly selected villages namely, Meshili, Malambo, Osinoni, Endulen and Nainokanoka. The study was carried out towards the end of rainy season in May 2013. The traps were set in proximity to potential breeding sites and cattle kraals. The collected mosquitoes were identified to genus and species using morphological keys. They were tested for RVFV RNA using real time reverse transcription-polymerase chain reaction (rRT-PCR). Results: A total of 2,094 adult mosquitoes belonging to three genera and nine species were collected. Most of them (87.5%) were collected in Meshili, followed by Malambo (8.2%) and Osinoni (4%) villages. No single mosquito was collected in Nainokanoka or Endulen. The nine species collected were Culex pipiens complex, Cx. antennatus , Cx. tigripes , Cx. annulioris , Cx. cinereus , Anopheles arabiensis , An. squamosus , An. pharoensis and Mansonia uniformis. No RVFV RNA was detected in the mosquito specimens. Conclusion: Various RVFV potential mosquito species were collected from the study villages. These mosquito vectors were heterogeneously distributed in the district suggesting a variation in RVF transmission risk in the study area.

Capacity building is considered a priority for health research institutions in developing countries to achieve the Millennium Development Goals by 2015. However, in many countries including Tanzania, much emphasis has been directed towards human resources for health with the total exclusion of human resources for health research. The objective of this study was to systematically investigate the capacity building process for the Tanzanian National Institute for Medical Research (NIMR) over a 30-year period and identify the challenges and opportunities in creating a critical mass of multi-disciplinary research scientists that is required for achieving the intended health benefits. A desk review of personnel database was conducted for information covering 1980-2009 on academic qualifications, training, research experience and research output. The current staff curriculum vitae (CV) were reviewed to gather information on researchers’ employment record, training, training support, area of expertise and scientific output. Interviews were conducted with a cross section of researchers on capacity development aspects using a self-administered questionnaire. In-depth interviews were also conducted with the current and former NIMR Management to seek information on capacity development challenges. A review was also done on staff personal files, annual reports, strategic plans and other occasional documents. A total of 163 CV were assessed; of these, 76.7% (125) were for Research Scientists (RS), 20.9% (34) Laboratory Technologists (LT) and 2.4% (4) for System Analysts. The Institute had 13 research scientists upon its establishment. Since 1980, NIMR has recruited a total of 185 Research Scientists. By 2009, NIMR had a total scientific workforce of 170 staff (RS= 82.4%; LT= 17.6%). Of the 140 RSs, 37 (26.4%) were first degree; 77 (55.5%) second degree while 26 (18.6%) were PhD degree holders. Of the total of 78 researchers interviewed, 55 (70.5%) indicated to have accessed postg

Food insecurity and malnutrition seriously impedes efforts to control HIV/AIDS in resource poor countries. This study was carried out to assess food security, and coping strategies among people living with HIV/AIDS (PLHIV) attending Care and Treatment Centre (CTC) in Dar es Salaam, Tanzania. A structured questionnaire was used to interview randomly selected adults (≥18 years) who were HIV positive who have just been eligible for anti-retroviral treatment (ART) in a CTC or one who has started ART but not more than four weeks has elapsed. A total of 446 (females=67.9%; males= 32.1%) people living with HIV/AIDS attending CTC were interviewed. About three quarters (73.1%) of the respondents were 25-44 years old and most (43.9%) were married. Two thirds (66.7%) of the respondents had primary school education. Seventy percent reported to have a regular income and 63.7% with a monthly income of less than US$ 154. More than half (52.2%) of the respondents were food insecure. Food insecurity was similar in both males (54.6%) and females (51.2%). However, food insecurity was least (48.2%) among those who were single and highest (57.7%) among those cohabiting. Low level of food insecurity was associated with having completed primary education (Adjusted OR=0.27; 95%CI, 0.09–0.82) and high income (>US$154) (OR=0.10; 95%CI, 0.01–0.67). Reporting two or less meals increased the likelihood of food insecurity (OR=4.2; 95% CI1.7-9.8). Low frequency of meals was significantly more prevalent (18.6%) among those ≥45 years than among 35–44 years old respondents (6.7%) (P=0.04). Borrowing money (55.8%) and taking less preferred foods (53.3%) were the most common coping strategies. In conclusion, food insecurity is a significant problem among people living with HIV in Dar es Salaam which might significantly affect compliance to care and support. The study suggests that counselling of PLHIV before anti-retroviral treatment programmes should devise special strategies targeting those with

High rate of maternal death is one of the major public health concerns in Tanzania. Most of maternal deaths are caused by factors attributed to pregnancy, childbirth and poor quality of health services. More than 80% of maternal deaths can be prevented if pregnant women access essential maternity care and assured of skilled attendance at childbirth as well as emergency obstetric care. The objective of this review was to analyse maternal mortality situation in Tanzania during the past 50 years and to identify efforts, challenges and opportunities of reducing it. This paper was written through desk review of key policy documents, technical reports, publications and available internet-based literature. From 1961 to 1990 maternal mortality ratio in Tanzania had been on a downward trend from 453 to 200 per 100,000 live births. However, from 1990’s there been an increasing trend to 578 per 100,000 live births. Current statistics indicate that maternal mortality ratio has dropped slightly in 2010 to 454 per 100,000 live births. Despite a high coverage (96%) in pregnant women who attend at least one antenatal clinic, only half of the women (51%) have access to skilled delivery. Coverage of emergence obstetric services is 64.5% and utilization of modern family planning method is 27%. Only about 13% of home deliveries access post natal check-up. Despite a number of efforts maternal mortality is still unacceptably high. Some of the efforts done to reduce maternal mortality in Tanzania included the following initiatives: reproductive and child survival; increased skilled delivery; maternal death audit; coordination and integration of different programs including maternal and child health services, family planning, malaria interventions, expanded program on immunization and adolescent health and nutrition programmes. These initiatives are however challenged by inadequate access to maternal health care services. In order to considerably reduce maternal deaths some of recommended

This paper reviews preparedness for containing and controlling emerging and re-emerging diseases drawing lessons from disease events that occurred in animal and human populations in the last five decades (1961-2011). A comprehensive analysis based on retrieval and analysis of grey and published literature as well as reported cases was carried out to document type and trend of occurrence of emerging and re-emerging infectious diseases in different parts of Tanzania. Overall, the majority of diseases reported in the country were viral in nature followed by bacterial diseases. The trend for the occurrence shows a number of new emerging diseases as well as re-occurrence of old diseases in both animal (domestic and wild) and human populations. In humans, the major disease epidemics reported in the last five decades include cholera, influenza A H1N1, plague and rubella. In animals, the major epidemic diseases reported were Contagious Bovine Pleuropneumonia, Contagious Caprine Pleuropneumonia, Peste des petits ruminants and Giraffe Ear and Skin Diseases. Some epidemics have been reported in both human and animal populations including Rift Valley fever and anthrax. The emergence of the ‘fit-for purpose’ approaches and technologies such as the discipline of One Health, use of participatory epidemiology and disease surveillance and mobile technologies offers opportunity for optimal use of limited resources to improve early detection, diagnosis and response to disease events and consequently reduced impact of such diseases in animal and human populations.

Rift Valley Fever (RVF) is an acute, mosquito-borne viral disease that has a significant global threat to humans and livestock. This review was conducted to provide comprehensive update on Rift Valley Fever (RVF) in Tanzania, with particular attention devoted to trend of occurrence, epidemiological factors, socioeconomic impact and measures which were applied to its control. Information presented in this paper was obtained through extensive literature review. RVF occurred for the first time in Tanzania in 1930. This was followed by periodic epidemics of 10-20 years i.e. 1947, 1957, 1977, 1997 and 2007. During the latest disease outbreak in 2007 (the expanded to cover wider area of the country) 52.4% (n=21) of regions in Tanzania mainland were affected and majority (72.7%, n=11) of the regions had concurrent infections in human and animals. Phylogenetic comparison of nucleotide and amimo acid sequences revealed different virus strains between Kenya and Tanzania. Epidemiological factors that were considered responsible for the previous RVF epidemics in Tanzania included farming systems, climatic factors, vector activities and presence of large population of ruminant species, animal movements and food consumption habits. The disease caused serious effects on rural people’s food security and household nutrition and on direct and indirect losses to livestock producers in the country. Psycho-social distress that communities went through was enormous, which involved the thinking about the loss of their family members and/or relatives, their livestock and crop production. Socially, the status of most livestock producers was eroded in their communities. Steps taken to combat epidemics included restriction of animal movements, ban of the slaughter of domestic ruminants and vaccination of livestock and health education.

Climate change (CC) has a number of immediate and long-term impacts on the fundamental determinants of human health. A number of potential human health effects have been associated either directly or indirectly with global climate change. Vulnerability to the risks associated with CC may exacerbate ongoing socio-economic challenges. The objective of this review was to analyse the potential risk and vulnerability in the context of climate-sensitive human diseases and health system in Tanzania. Climate sensitive vector- and water-borne diseases and other health related problems and the policies on climate adaptation in Tanzania during the past 50 years are reviewed. The review has shown that a number of climateassociated infectious disease epidemics have been reported in various areas of the country; mostly being associated with increase in precipitation and temperature. Although, there is no single policy document that specifically addresses issues of CC in the country, the National Environmental Management Act of 1997 recognizes the importance of CC and calls for the government to put up measures to address the phenomenon. A number of strategies and action plans related to CC are also in place. These include the National Biodiversity Strategy and Action Plan, the National Action Programme, and the National Bio-safety Framework. The government has put in place a National Climate Change Steering Committee and the National Climate Change Technical Committee to oversee and guide the implementation of CC activities in the country. Recognizing the adverse impacts of natural disasters and calamities, the government established a Disaster Management Division under the Prime Minister’s Office. Epidemic Preparedness and Response Unit of the Ministry of Health and Social Welfare is responsible for emergency preparedness, mostly disease outbreaks. However, specific climate changes associated with human health issues are poorly addressed in the MoHSW strategies and the national

We investigated mosquito sampling techniques with two types of traps and attractants at different time for trapping potential vectors for Rift Valley Fever virus. The study was conducted in six villages in Ngorongoro district in Tanzania from September to October 2012. A total of 1814 mosquitoes were collected, of which 738 were collected by CDC light traps and 1076 by Mosquito Magnet trapping technique. Of the collected mosquitoes, 12.46% (N= 226) were Aedes aegypti and Culex pipiens and 87.54% (N= 1588) were Culex pipiens complex. More mosquitoes were collected outdoors using Mosquito Magnets baited with octenol attractant, 36.38% (N=660) followed by indoor trapping using CDC light traps without attractant, 29.60% (N=537). Most of Ae. aegypti mosquitoes were collected outdoor using Mosquito Magnets, 95% (N=214) whereas Cx. pipiens complex were trapped both indoor using CDC light traps without attractant and outdoors using both CDC light traps baited with carbon dioxide (CO2) sachets and Mosquito Magnets. Analysis on the differences in abundance of mosquitoes trapped by different techniques using Generalized Linear Models was statistically significance at p-value < 0.05 for both species. Three hours mosquito collections show differing patterns in activity, most Ae. aegypti species were collected primarily during the first and last quarters of the day. Cx pipiens complex was active throughout the night, early evening and early morning then decreased markedly during the day time. The results presented in this paper emphasize the possibility of using Mosquito Magnets in order to efficiently capture these potential RVF vectors.

Male circumcision (MC) has been practiced worldwide for religious, cultural, social and medical reasons. Recent studies in Africa have indicated that MC to be highly protective against HIV transmission. However, incorporating MC in HIV/AIDS prevention programme will increase its demand in Tanzania where traditional male circumcision is common and the health care system is weak. The objective of this study was to determine the challenges and opportunities of involving traditional practitioners in scaling up safe MC in the context of HIV prevention in Tanzania. The study was conducted in Monduli, Bahi and Mkuranga districts of Tanzania. Both quantitative and qualitative methods were employed. Household survey involved community members from the selected villages. Indepth interviews involved traditional practitioners and key informants at national, district and facility levels. A total of 601 householders were interviewed. Most (71.4%) household respondents preferred traditional MC as it was part of their culture and tradition. A similar response was obtained from other respondents. It was mostly preferred because it was used as an initiation school, turning of boys to warriors and sense of social cohesion. Only 228 (37.9%) of the respondents were aware of the adverse events associated with MC. The most frequently mentioned adverse effects were severe bleeding (65.0%), delayed wound healing (17.5%) and wound sepsis (8.4%). The risk of acquiring HIV through male circumcision practice was poorly known among community members except medical respondents. Single unsterilized local surgical equipment was used to circumcise several initiates. It was observed that interference with traditional values associated with circumcision to be the main hindrance of linkage between traditional and conventional practitioners. On the other hand it was reported that there was no policy or guidelines on Traditional MC (TMC). Most of respondents supported the efforts to establish and promote

Although clinical trials on intermittent-preventive-treatment (IPT) for malaria in infants (IPTi) are underway in Africa following the notable benefit of IPT during pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP), evidence on the socio-economic determinants of the acceptability and viability of IPTi within infant clinic settings is inadequate. This paper reports a study on the acceptability of IPTi in two Tanzanian districts implementing IPTp using SP. Data were collected from 24 focus-groupdiscussions (FGDs) with pregnant-women and infants' mothers; interviews with 823 antenatal clients, 78 antenatal workers and 14 district health-managers among whom some also participated in FGDs. Qualitative findings indicated IPTi being appreciated among all the study population groups, considering the malaria situation. However, reservations were expressed about IPTi if SP is officially recommended. Skeptics pinpointed the sideeffects, lack of antipyretic-effect and the general treatment failures of the SP drug. Another concern was that IPTi may face operational challenges such as those currently facing IPTp implementation, including the shortage of essential supplies, poor health facility infrastructural conditions, and low numbers, skills and motivation of humanresources. Based on a hypothetical question eliciting the pregnant women's willingness to allow (WTA) their babies to receive SP for IPTi if officially SP was the drug of choice, logistic regression analysis of the data obtained indicated variations among the respondents within and between the districts about in the WTA their babies to receive IPTi-SP. In conclusion, IPTi has limited potential acceptability in the healthcare system if SP is recommended, and despite some of the respondents having expressed speculative concerns, there is need for strong public sensitization before and during IPTi implementation towards enhancement of community and frontline health-workers' compliance.

Introduction: Intermittent presumptive treatment (IPT) for malaria during pregnancy (IPTp) is advocated against malaria. Yet, concerns prevail regarding safety, efficacy, and costs of the recommended anti-malarial interventions in economic, social and multi-faceted health contexts. Objective: This chapter elucidates the views of frontline healthcare workers (HWs) and antenatal care (ANC) clients regarding feasibility of implementing anti-malarial drugs in formal healthcare settings of Tanzania, including the scaling-up IPTp delivery in attempt to attain higher population coverage. Emphasis is on efficacy, safety and cost issues related to SP for IPTp. Methods: Semi-structured interviews with HWs and pregnant women at ANC clinics and investigators' observations in the fields were conducted. Content analysis was done on qualitative information whereas quantitative data were analyzed using computer software programs. Results: The respondents expressed positive and negative attitudes towards IPTp currently in practice. The reported positives of IPTp were related to: sulfadoxine-pyrimethamine (SP) - a drug of choice being more efficacious than other anti-malarial drugs; easy deliverability in terms of users taking a full dose once; saving lives of women, fetuses and newborn babies; and un-bitter taste. The negatives include the: (i) perception about SP causing adverse treatment outcomes, this lowering users' adherence to treatment schedules, including directly observed treatment; (ii) perceived possible adverse reactions if SP is used by the users who take alcoholic drinks; (iii) increasing- parasites resistance to SP and HIV infections lowering public trust in SP; (iii) health facilities (HFs), especially the private ones facing SP shortages for free delivery, adding costs mainly to the service users and partly HWs who are forced to pay out of their pockets; (iv) HF-based IPTp services forcing pregnant women who reside far away to incur additional costs on re-visitin

Objective: To explore and identify gaps in knowledge and information communication at all levels of health delivery system in Tanzania. Methods: In-depth interviews and twelve Focus Group Discussions were conducted to capture information on the community knowledge on different health problems and the health information communication process. Interviews and discussions were also held with primary schoolchildren, traditional healers, health facility workers and district health management team members. Documentary review and inventory of the available health education materials at community, health facility and district levels, was made. Results: Major community health and health-related problems included diseases (61.6%), lack of potable water (36.5%), frequent famine (26.9%) and lack of health facility services (25.3%). Malaria, HIV/AIDS and diarrhoeal diseases were the leading causes of morbidity and mortality. Most of the health communication packages covered communicable diseases and their prevention. Health care facility was the main (91.6%) source of health information for most communities. Public meetings, radio and print materials were the most frequently used channels of health information communication. Major constraints in adopting health education messages included poverty, inappropriate health education, ignorance and local beliefs. Conclusion: This study has identified gaps in health knowledge and information communication in Tanzania. There is lack of adequate knowledge and information exchange capacities among the health providers and the ability to share that information with the targeted community. Moreover, although the information gets to the community, most of them are not able to utilize it properly because they lack the necessary background knowledge.