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Abstract Marburg viral disease (MVD) is a highly infectious disease with a case fatality rate of up to 90%, particularly impacting resource-limited countries where implementing Infection Prevention and Control (IPC) measures is challenging. This paper shares the experience of how Tanzania has improved its capacity to prevent and control highly infectious diseases, and how this capacity was utilized during the outbreak of the MVD disease that occurred for the first time in the country in 2023. In 2016 and the subsequent years, Tanzania conducted self and external assessments that revealed limited IPC capacity in responding to highly infectious diseases. To address these gaps, initiatives were undertaken, including the enhancement of IPC readiness through the development and dissemination of guidelines, assessments of healthcare facilities, supportive supervision and mentorship, procurement of supplies, and the renovation or construction of environments to bolster IPC implementation. The official confirmation and declaration of MVD on March 21, 2023, came after five patients had already died of the disease. MVD primarily spreads through contact and presents with severe symptoms, which make patient care and prevention challenging, especially in resource-limited settings. However, with the use of a trained workforce; IPC rapid needs assessment was conducted, identifying specific gaps. Based on the results; mentorship programs were carried out, specific policies and guidelines were developed, security measures were enhanced, all burial activities in the area were supervised, and both patients and staff were monitored across all facilities. By the end of the outbreak response on June 1, 2023, a total of 212 contacts had been identified, with the addition of only three deaths. Invasive procedures like dialysis and Manual Vacuum Aspiration prevented some deaths in infected patients, procedures previously discouraged. In summary, this experience underscores the critical importance of strict adherence to IPC practices in controlling highly infectious diseases. Recommendations for low-income countries include motivating healthcare providers and improving working conditions to enhance commitment in challenging environments. This report offers valuable insights and practical interventions for preparing for and addressing highly infectious disease outbreaks through implementation of IPC measures.

IntroductionIn March 2023, a Marburg Virus Disease (MVD) outbreak was declared in Kagera region, Northwestern Tanzania. This was the first MVD outbreak in the country. We describe the epidemiological characteristics of MVD cases and contacts.MethodsThe Ministry of Health activated an outbreak response team. Outbreak investigation methods were applied to cases identified through MVD standard case definitions and confirmed through reverse-transcriptase polymerase chain reaction (RT PCR). All identified case contacts were added into the contact listing form and followed up in-person daily for any signs or symptoms for 21 days. Data collected from various forms was managed and analyzed using Excel and QGIS software for mapping.ResultsA total of nine MVD cases were reported with eight laboratory-confirmed and one probable. Two of the reported cases were frontline healthcare workers and seven were family related members. Cases were children and adults between 1-59 years of age with a median age of 34 years. Six were males. Six cases died equivalent to a case fatality rate (CFR) of 66.7%. A total of 212 individuals were identified as contacts and two (2) became cases. The outbreak was localized in two geo-administrative wards (Maruku and Kanyangereko) of Bukoba District Council.ConclusionTransmission during this outbreak occurred among family members and healthcare workers who provided care to the cases. The delay in detection aggravated the spread and possibly the consequent fatality but once confirmed the swift response stemmed further transmission containing the disease at the epicenter wards. The outbreak lasted for 72 days but as the origin is still unknown, further research is required to explore the source of this outbreak.

Viral Haemorrhagic Fever Outbreak presents a significant public health threat, requiring a timely, robust, and well-coordinated response. This paper aims to describe the roles of the Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) graduates and residents in responding to Tanzania's first Marburg Viral Disease (MVD) outbreak. We performed a secondary data analysis using a range of documents, such as rosters of deployed responders and the TFELTP graduate and resident database, to count and describe them. Additionally, we conducted an exploratory textual analysis of field deployment reports and outbreak situational reports to delineate the roles played by the residents and graduates within each response pillar. A total of 70 TFELTP graduates and residents from different regions were involved in supporting the response efforts. TFELTP graduates and residents actively participated in several interventions, including contact tracing and follow up, sensitising clinicians on surveillance tools such as standard case definitions, alert management, supporting the National and Kagera Regional Public Health Emergency Operations Centres, active case search, risk communication, and community engagement, coordination of logistics, passenger screening at points of entry, and conducting Infection Prevention and Control (IPC) assessments and orientations in 144 Health Facilities. The successes achieved and lessons learned from the MVD response lay a foundation for sustained investment in skilled workforce development. FELTP Training is a key strategy for enhancing global health security and strengthening outbreak response capabilities in Tanzania and beyond.

The coronavirus disease pandemic has highlighted the need to establish and maintain strong infection prevention and control (IPC) practices, not only to prevent healthcare-associated transmission of SARS-CoV-2 to healthcare workers and patients but also to prevent disruptions of essential healthcare services. In East Africa, where basic IPC capacity in healthcare facilities is limited, the US Centers for Disease Control and Prevention (CDC) supported rapid IPC capacity building in healthcare facilities in 4 target countries: Tanzania, Ethiopia, Kenya, and Uganda. CDC supported IPC capacity-building initiatives at the healthcare facility and national levels according to each country’s specific needs, priorities, available resources, and existing IPC capacity and systems. In addition, CDC established a multicountry learning network to strengthen hospital level IPC, with an emphasis on peer-to-peer learning. We present an overview of the key strategies used to strengthen IPC in these countries and lessons learned from implementation.

Summary: Background: Compliance with infection prevention and control standard precautions (IPCSPs) remains a major challenge in many countries including Tanzania. Lack of compliance exposes healthcare workers (HCWs) and patients to a high risk of developing healthcare-associated infections (HAIs) including antimicrobial-resistant microorganisms which can contribute to the spread of antimicrobial resistance (AMR). This study investigated compliance with IPCSPs and associated factors among HCWs in public healthcare facilities (HFs) in Songwe Region, Tanzania between January and March 2021. Methods: A cross-sectional study was conducted in all 5 districts in Songwe Region, involved 400 HCWs from difference healthcare facilities (HFs) including dispensaries, health centres and hospitals. The Compliance with Standard Precautions scale (CSPS) tool developed by WHO was used. Descriptive and modified Poisson regression analysis was done. A P-value of less than 0.05 indicated statistical significance. Results: Only 22.5% (90/400) of HCWs had high compliance (above 80%) to IPCSPs. The majority of HCWs reported highest compliance on discarding used needles/sharps into sharps containers (94%), the lowest IPCSPs compliance was for the correct handling of spills, taking a shower after extensive splashing and not re-using disposable masks, 8%, 28.5% and 34% respectively. Attending IPC training or an IPC seminar in the previous year (ARR=2.97 [1.87–4.72] P

Abstract Background Healthcare associated infections (HAI) are estimated to affect up to 15% of hospital inpatients in low-income countries (LICs). A critical but often neglected aspect of HAI prevention is basic environmental hygiene, particularly surface cleaning and linen management. TEACH CLEAN is an educational intervention aimed at improving environmental hygiene. We evaluated the effectiveness of this intervention in a pilot study in three high-volume maternity and newborn units in Dar es Salaam, Tanzania. Methods This study design prospectively evaluated the intervention as a whole, and offered a before-and-after comparison of the impact of the main training. We measured changes in microbiological cleanliness [Aerobic Colony Counts (ACC) and presence of Staphylococcus aureus] using dipslides, and physical cleaning action using gel dots. These were analysed with descriptive statistics and logistic regression models. We used qualitative (focus group discussions, in-depth interviews, and semi-structured observation) and quantitative (observation checklist) tools to measure why and how the intervention worked. We describe these findings across the themes of adaptation, fidelity, dose, reach and context. Results Microbiological cleanliness improved during the study period (ACC pre-training: 19%; post-training: 41%). The odds of cleanliness increased on average by 1.33 weekly during the pre-training period (CI = 1.11–1.60), and by 1.08 (CI = 1.03–1.13) during the post-training period. Cleaning action improved only in the pre-training period. Detection of S. aureus on hospital surfaces did not change substantially. The intervention was well received and considered feasible in this context. The major pitfalls in the implementation were the limited number of training sessions at the hospital level and the lack of supportive supervision. A systems barrier to implementation was lack of regular cleaning supplies. Conclusions The evaluation suggests that improvements in microbiological cleanliness are possible using this intervention and can be sustained. Improved microbiological cleanliness is a key step on the pathway to infection prevention in hospitals. Future research should assess whether this bundle is cost-effective in reducing bacterial and viral transmission and infection using a rigorous study design.

Summary: Background: The WHO estimates 10–30% of hospital admissions are associated with poor infection prevention and control (IPC). There are no reliable data on IPC status in Tanzanian healthcare facilities; hence the Star Rating Assessment (SRA) was established to address this. This study compared the health facility performances on adherence to IPC principles using baseline and reassessment data of SRA. Methods: A retrospective analysis of data from eight randomly selected regions across Tanzania. Data was gathered from an SRA database in which records of baseline assessments (2015/16) and reassessments (2017/18) were documented. Each healthcare facility's ownership and service level were investigated as independent variables. Results: A total of 2,131 healthcare facilities at baseline and 2,185 at reassessment were analysed. Median adherence to IPC principles increased from 31% (IQR: 20%, 46%) to 57% (IQR: 41.4%, 73.2%) after interventions (p

The study was based on the contribution of vocational educational training to promoting self-employment in Tanzania in Morogoro Municipality. Specifically, the study determined the relevance of skills acquired and the skills actualized by Vocational Education and Training Authority (VETA) Graduates and the Constraints that hinder the VETA graduates from getting into selfemployment. This study was guided by a human capital theory which was propounded by Gary Becker and Theodore Schultz, in the 1950s and early 1960s. The theory states that "the more one invests in his/her education, the more returns one should receive in the form of earnings. Data were collected through questionnaires and interviews. Qualitative data were analyzed through content analysis and quantitative data were analyzed through descriptive analysis including index scale measurement. The findings indicated that selfemployed VETA graduates performed their duties to generate income for their livelihood. There were different specializations that VETA graduates had, some specialized in driving, however, they were not employed as drivers, and instead, they were self-employed as motorcycle drivers driving commercial motorcycles. The relevance of the skills acquired and the skills actualized was determined by the curriculum used and what was taught in colleges. Also, VETA students have higher expectations of getting employment after graduation. The study concluded that the skills acquired by the VETA graduates are the most likely to be the activities performed by VETA graduates in generating income for their family livelihood. It also concluded that VETA graduates experienced similar constraints when taught about self-employment. The government should make sure that the colleges have advanced and more current equipment to make sure students are well up-to-date with current technology. [ABSTRACT FROM AUTHOR]

The study is based focused on assessment of working conditions of secondary teachers' job motivation; teaching facilities in Bunda Town Council, Tanzania. The paper discusses the factors of motivation that can lead to teacher's job satisfaction, Data were collected through questionnaires, interview and documentary review. Qualitative data were coded and transcribed and subsequently analyzed thematically. With regard to quantitative data: descriptive analysis was done including index scale measurement. The findings of the study indicate that one of the motivation factors is to have autonomy in decision-making and be involved in decision-making when discussing about school affairs, it is in this sense, teachers can feel that they are accepted and recognized by the administration and the community at large. As such, teacher can be collaborative among themselves and collaborate with the school administration and make the school a better place to teach. The study concluded that, when teachers are given autonomy in decision making and involved in decision-making, they feel that they are accepted and recognized by the administration and the community at large. It was also concluded that, teachers can teach based on the current curriculum and hence students become updated. Teacher feels comfortable when they are teaching a manageable class. [ABSTRACT FROM AUTHOR]

The study aimed to examine the impact of teaching materials for pupils with mental disorders in public primary schools. The study employed a mixed approach and a case study design, and the social cognitive theory was used as a guiding tool. A sample size of 20 respondents was drawn from 30 populations through purposive and simple sampling technique. The data collection methods were through interviews, observation and questionnaire. Descriptive statistical analysis and content analysis were used to analyze the collected data. The study revealed that, there is shortage of teaching materials like text books, game puzzles, visual aids, audio visual, video visual and building blocks as indicated in selected four public primary school at Mvomero District Council, where each learner has different level of mental disorders. The study concludes that the government should provide a sufficient fund to these public primary schools so that pupils with mental disorders get better education services and conducive environment which will facilitate all teachers and pupils to improve teaching and learning process. [ABSTRACT FROM AUTHOR]

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