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1. Implementation of distance learning IMCI training in rural districts of Tanzania

Author

Isangula, Kahabi, Ngadaya, Esther, Manu, Alexander, Mmweteni, Mary, Philbert, Doreen, Burengelo, Dorica, Kagaruki, Gibson, Senkoro, Mbazi, Kimaro, Godfather, Kahwa, Amos, Mazige, Fikiri, Bundala, Felix, Iriya, Nemes, Donard, Francis, Kitinya, Caritas, Minja, Victor, Nyakairo, Festo, Gupta, Gagan, Pearson, Luwei, Kim, Minjoon, Mfinanga, Sayoki, Baker, Ulrika, and Hailegebriel, Tedbabe Degefie

Published
2023
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2. Measuring workload for tuberculosis service provision at primary care level: a methodology

Author

Blok Lucie, van den Hof Susan, Mfinanga Sayoki G, Kahwa Amos, Ngadaya Esther, Oey Liesbeth, and Dieleman Marjolein

Subjects
Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

Abstract We developed and piloted a methodology to establish TB related work load at primary care level for clinical and laboratory staff. Workload is influenced by activities to be implemented, time to perform them, their frequency and patient load. Of particular importance is the patient pathway for diagnosis and treatment and the frequency of clinic visits. Using observation with checklists, clocking, interviews and review of registers, allows assessing the contribution of different factors on the workload.

Published
2012
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3. Health facility-based Active Management of the Third Stage of Labor: findings from a national survey in Tanzania

Author

Mfinanga Godfrey S, Kimaro Godfather D, Ngadaya Esther, Massawe Sirili, Mtandu Rugola, Shayo Elizabeth H, Kahwa Amos, Achola Ominde, Mutungi Alice, Knight Rod, Armbruster Deborah, Sintasath David, Kitua Andrew, and Stanton Cynthia

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background Hemorrhage is the leading cause of obstetric mortality. Studies show that Active Management of Third Stage of Labor (AMTSL) reduces Post Partum Hemorrhage (PPH). This study describes the practice of AMTSL and barriers to its effective use in Tanzania. Methods A nationally-representative sample of 251 facility-based vaginal deliveries was observed for the AMTSL practice. Standard Treatment Guidelines (STG), the Essential Drug List and medical and midwifery school curricula were reviewed. Drug availability and storage conditions were reviewed at the central pharmaceutical storage site and pharmacies in the selected facilities. Interviews were conducted with hospital directors, pharmacists and 106 health care providers in 29 hospitals visited. Data were collected between November 10 and December 15, 2005. Results Correct practice of AMTSL according to the ICM/FIGO definition was observed in 7% of 251 deliveries. When the definition of AMTSL was relaxed to allow administration of the uterotonic drug within three minutes of fetus delivery, the proportion of AMTSL use increased to 17%. The most significant factor contributing to the low rate of AMTSL use was provision of the uterotonic drug after delivery of the placenta. The study also observed potentially-harmful practices in approximately 1/3 of deliveries. Only 9% out of 106 health care providers made correct statements regarding the all three components of AMTSL. The national formulary recommends ergometrine (0.5 mg/IM) or oxytocin (5 IU/IM) on delivery of the anterior shoulder or immediately after the baby is delivered. Most of facilities had satisfactory stores of drugs and supplies. Uterotonic drugs were stored at room temperature in 28% of the facilities. Conclusion The knowledge and practice of AMTSL is very low and STGs are not updated on correct AMTSL practice. The drugs for AMTSL are available and stored at the right conditions in nearly all facilities. All providers used ergometrine for AMTSL instead of oxytocin as recommended by ICM/FIGO. The study also observed harmful practices during delivery. These findings indicate that there is a need for updating the STGs, curricula and training of health providers on AMTSL and monitoring its practice.

Published
2009
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4. The magnitude and factors associated with delays in management of smear positive tuberculosis in Dar es Salaam, Tanzania

Author

Ngadaya Esther, Mtandu Rugola, Kimaro Godfather, Kahwa Amos, Mutayoba Beatrice K, Mfinanga Sayoki G, Egwaga Said, and Kitua Andrew Y

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Objective To assess the magnitude and factors responsible for delay in TB management. Design A cross sectional hospital based survey in Dar es Salaam region, May 2006. Results We interviewed 639 TB patients. A total of 78.4% of patients had good knowledge on TB transmission. Only 35.9% had good knowledge on the symptoms. Patient delay was observed in 35.1% of the patients, with significantly (X2 = 5.49, d.f. = 1, P = 0.019) high proportion in females (41.0%) than in males (31.5%). Diagnosis delay was observed in 52.9% of the patients, with significantly (X2 = 10.1, d.f. = 1, P = 0.001) high proportion in females (62.1%) than in males (47.0%). Treatment delay was observed in 34.4% of patients with no significant differences among males and females. Several risk factors were significantly associated with patient's delays in females but not in males. The factors included not recognizing the following as TB symptoms: night sweat (OR = 1.92, 95% CI 1.20, 3.05), chest pain (OR = 1.62, 95% CI 1.1, 2.37), weight loss (OR = 1.55, 95% CI 1.03, 2.32), and coughing blood (OR = 1.47, 95% CI 1.01, 2.16). Other factors included: living more than 5 Km from a health facility (OR = 2.24, 95% CI 1.41, 3.55), no primary education (OR = 1.74, 95% CI 1.01, 3.05) and no employment (OR = 1.77, 95% CI 1.20, 2.60). In multiple logistic regression, five factors were more significant in females (OR = 2.22, 95% CI 1.14, 4.31) than in males (OR = 0.70, 95% CI 0.44, 1.11). These factors included not knowing that night sweat and chest pain are TB symptoms, a belief that TB is always associated with HIV infection, no employment and living far from a health facility. Conclusion There were significant delays in the management of TB patients which were contributed by both patients and health facilities. However, delays in most of patients were due to delay of diagnosis and treatment in health facilities. The delays at all levels were more common in females than males. This indicates the need for education targeting health seeking behaviour and improvement in health system.

Published
2008
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6. Factors Affecting the Availability of Essential Health Commodities in Tanzania with a Special Focus on the Tracer Commodities.

Author

Mathias, Sadock Peter, Isangula, Kahabi, Kahwa, Amos, Ngadaya, Esther, Kimaro, Godfather, Joachim, Catherine, Mpatwa, Mercy, Valimba, Richard, Kamora, Wema, Shayo, Sharon, Swai, Sylvia, Kibwana, Mfaume, Omari Sukari, Kagaruki, Gibson, Kagoma, Pius, Kapologwe, Ntuli, Simeo, Japhet, Msasi, Daudi, Mgaya, Yunus D., and Kadula, Remi

Abstract

Background: Access to essential health commodities is fundamental to healthcare system efficacy. These commodities are vital in delivering health services and form integral elements within the World Health Organization's strengthening framework, encompassing the six foundational building blocks. Regrettably, there has been a global increase in shortages and stockouts of essential health commodities in recent years. Objective: The study aimed to identify factors influencing the availability of essential health commodities throughout all levels of the supply chain in Tanzania. Methods: A cross-sectional convergent parallel mixed method study that employed both qualitative and quantitative data collection techniques was conducted. Quantitative data were analyzed using STATA version 16, while qualitative data were thematically analyzed. Results: Factors contributing to stockouts of essential commodities at the national level included increased demand, delayed shipments from donors, decreased funding commitments, delayed disbursement of funds, global shortages, inadequate governance, debt within the Medical Stores Department, donor dependency for vertical programme commodities, and long lead times by Medical Stores Department's suppliers. At the regional and district levels, such factors include a shortage of human resources, lack of electronic medical records, limited interoperability of information systems, poor quality of logistics data, inadequate use of data for decision-making, and poor inventory management. At the healthcare facility level, factors included; an overwhelming number of exempted clients, which reduces facility revenues. Conclusion: More efforts are still needed to address both the upstream and downstream challenges required to ensure sustainable access and availability of essential health commodities at service delivery points, as a pathway for improving health sector performance. [ABSTRACT FROM AUTHOR]

Published
2024
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7. Cryptococcal meningitis screening and community-based early adherence support in people with advanced HIV infection starting antiretroviral therapy in Tanzania and Zambia: an open-label, randomised controlled trial

Author

Mfinanga, Sayoki, Chanda, Duncan, Kivuyo, Sokoine L, Guinness, Lorna, Bottomley, Christian, Simms, Victoria, Chijoka, Carol, Masasi, Ayubu, Kimaro, Godfather, Ngowi, Bernard, Kahwa, Amos, Mwaba, Peter, Harrison, Thomas S, Egwaga, Saidi, and Jaffar, Shabbar

Published
2015
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8. Community-based HIV services during Differentiated Service Delivery Models: a cross-sectional survey from nine regions in Tanzania

Author

Mutalemwa, Prince, Eric, Frank, Ngadaya, Esther, Chagula, Albert, Masatu Bwana, Veneranda, Lubinza, Clara Lubinza, Kisoka, William, Mpondo, Bonaventura, Rwebembera, Anath, Mbata, Doris, Bakari, Mtumwa, Kagaruki, Gibson, Kimaro, Godfather, and Kahwa, Amos

Subjects
Community, HIV, CHWs, CBHS, services, Tanzania
Abstract

Introduction: To combat the HIV epidemic and reach the 90-90-90 goals, community-based HIV/AIDS services (CHBS) plays a great role. However, how well CHBS works in the era of adopting differentiated service delivery models for care and treatment has not been adequately evaluated. We hence assessed CBHS programs implemented by various partners with a focus on the coverage; program needs; linkage and referral process; consistent use of guidelines and training curricula and challenges faced by providers and clients. Methods: It was a cross-sectional study conducted in July 2020 in 9 regions using both quantitative and qualitative methods. Quantitative data were analyzed using STATA version 12 and qualitative data were managed using Thematic Content Analysis. Results: 26 implementing partners were offering CBHS in biomedical, behavioral, and structural areas. Their focus was on PLHIV, orphans, and key and vulnerable populations. The majority of PLHIV had a positive perception of different CBHS. Key factors in the perceived effectiveness of community HIV services were the consistent use and availability of guidelines and training curricula, standard operating procedures, and readiness of essential commodities and supplies. Out of 1391 PLHIV who were involved, 67.4% and 25.0% were tested at the health facility and communities respectively. About 69.8% were referred after confirming their seropositivity and forms were not given to about 57.5% when referred from health facilities to communities for CBHS. There was a deficit of 45% in health workers across different cadres, a deficit in all categories of supplies and equipment example the HIV test kit by 53.8%. Challenges for CBHS included financial hindrances, HIV-related stigma, and discrimination, distance to health facilities, and poor incentives for community health workers. Conclusion: it is important to address HIV-related stigma hence accelerating efforts to limit the spread of the HIV epidemic in the respective communities.

Published
2023

9. HIV treatment outcomes and their associated factors among adolescents and youth living with HIV in Tanzania

Author

Philbert, Doreen, Msovela, Judith, Burengelo, Dorica, Hassan, Frank Eric, Kitinya, Caritas, Soka, Grace, Kagaruki, Gibson, Donard, Francis N, Rwebembera, Anath, Silvan, Boniface, Rutaihwa, Mastidia, Sanga, Casiana, Mwombeki, Theresia, Wilfred, Amani, Senkoro, Mbazi, Kisoka, William, Mfinanga, Sayoki, Ngadaya, Esther, Kimaro, Godfather, and Kahwa, Amos

Subjects
Keywords: AYLHIV, ART clinical outcomes, Advanced HIV disease, Virological failure, ART switch
Abstract

Introduction: Despite improvements in access to Ante-Retroviral therapy in Tanzania, low ART initiation rate, low retention rate, lower viral load suppression, high loss to follow up and death rate among adolescents and youth living with HIV remain a challenge. This study was conducted to identify factors affecting HIV treatment outcomes among adolescents and youths. Methods: A cross-sectional study was done in seven regions in Tanzania. A total of 1124 in and out of school ALYHIV were interviewed using a semi-structured questionnaire. Results: A total of 1120(99.6%) participants were on ART. Of those who were on ART, 606 (53.9%) participants had advanced HIV disease, 423(37.6 %) had switched to the second line of ART and 1761(7.7%) had a virological failure. After adjusting for confounders, death of both parents (APR= 1.3, 95%CI: 1.01-1.8); regions with high HIV prevalence (APR= 1.7, 95%CI: 1.2-2.3) and taking ARVs for three years and less (APR= 2.2, 95%CI: 1.4-3.6) were associated to have advanced HIV. Additionally, HIV regional prevalence level, level of perception, adherence status, ARV storage and supervision of ART use were independently associated with Virological failure. Conclusion: This study has shown that despite an almost universal utilization of ART among adolescents and youth living with HIV unfavourable clinical ART outcomes such as advanced HIV disease, virological failure and ART switch to the second line remain a challenge, particularly among males and adolescents. Various factors at individual, community and health facility levels contribute to unfavorable ART clinical outcomes among AYLHIV. Therefore, an all-inclusive multidimensional and multi- stakeholders’ approach is needed to ensure the availability of sustainable, effective and quality care and treatment services prioritizing AYLHIV.&nbsp

Published
2023

10. Differentiated Services Delivery Model and its associated outcomes among people living with HIV in Tanzania: A cross-sectional study.

Author

Burengelo, Dorica, Kitinya, Caritas, Kagaruki, Gibson, Philbert, Doreen, Soka, Grace, Donard, Francis, Rwebembera, Anath, Maokola, Werner, Njau, Prosper, Silvan, Boniface, Rutaihwa, Mastidia, Mutalemwa, Prince, Minja, Victor, Mahende, Coline, Mfinanga, Sayoki, Ngadaya, Esther, Kimaro, Godfather, Kahwa, Amos, and Senkoro, Mbazi

Abstract

Introduction: Differentiated Service Delivery Models (DSDM), a strategy to promote retention in HIV care and/or ART adherence, is now increasingly recognized as an important and sustainable approach that could contribute significantly toward the UNAIDS 90-90-90 by 2020 and 95-95-95 by 2030 targets and ultimately an AIDS-free generation. This study was conducted to determine the outcomes of DSDM among people living with HIV in Tanzania. Methods: A Cross-sectional analytical design approach employing both quantitative and qualitative data collection methods was adopted in this study that was implemented in 9 regions of Tanzania. We conducted record reviews and in-depth interviews with key informants at national and facility levels where their data was summarized and arranged in sub-themes and then analyzed according to the specific objectives by using Thematic Analysis. We further conducted a bivariate analysis using Chi-Square to assess the association between each outcome and explanatory variable. Unadjusted and adjusted analysis was conducted to determine predictors of unfavourable outcomes using logistics regression models. Results: Data was collected from 50 health facilities comprising 15 (30.0%) hospitals, 22 (44.0%) health centres and 13 (26.0%) dispensaries. Record reviews were for different outcomes as follows; Mis-categorization (13,056 records), Missed appointments (62,222 records), Advanced HIV disease (29,995 records), and Attrition (62,222 records). Among the 320 unstable clients, the rate of miscategorization significantly decreased after the introduction of DSDM, from 63% to 36% (p < 0.001). After the introduction of DSDM, more clients missed their appointments compared to the period before the introduction of DSDM (1.7% vs 0.8% respectively). Missed appointments were associated with an urban setting ( AOR 1.1, 95% CI 1.1-1.2) and older age of 50 years and more (AOR 1.2, 95% CI 1.1-1.4) in comparison to a rural setting and younger age of fewer than 15 years respectively. Furthermore, DSDM led to a decrease (from 56% to 49%) of those with advanced WHO stage among the first-time testers. Attrition among the clients was higher after the introduction of DSDM compared to that before DSDM (ARR 1.1, 95% CI 1.04-1.2). Contributors to attrition were those related to individuals and institutions including beliefs in faith healing, fear of stigma and wrong interpretation of viral load monitoring results. Conclusion: Decentralized Community-based ART model is a promising entry point to improved HIV/AIDS service delivery. Strategies are needed to harmonise the comprehensiveness and quality of services across facilities providing HIV services. [ABSTRACT FROM AUTHOR]

Published
2023
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11. Linkage and Retention in HIV care: A cost-outcome analysis for different strategies in Tanzania.

Author

Hassan, Frank Eric, Grace Soka, Esther Ngadaya1, Kimambo, Happiness, Silvan, Boniface, Maokola, Werner, Senkoro, Mbazi, Donard, Francis, Omollo, Justin, Filbert, Doreen, Mfinanga, Sayoki, Kahwa, Amos, and Kimaro, Godfather

Abstract

Background: Starting Antiretroviral Treatment (ART) on time and being retained in care reduces the risk of HIV transmission, impoverishment of chronic end-organ effects of untreated viremia, and an overall increase in life expectancy. This study aimed at establishing available strategies for the linkage and retention of HIV clients as well as the costs associated with the strategy. Method: A retrospective cross-sectional design was conducted in eight regions of Tanzania mainland. A total of 60 facilities and affiliated communities providing linkage and ART services were involved. Mixed methods of collecting data were used with comprehensive document review. Information collected was for the period between 1st January to 31st December 2019. Cost evaluation was based on both patient and provider perspectives. Results: In general, 91% of the clients were successfully linked to care and the cost per client linked was $14.0 across regions. The cost of facility linkage strategy was $14.73 with personnel, commodities and supplies and training costs emerging as the cost drivers. The cost for client linkage to care using the community strategy was lower ($11.89) than the facility strategy ($14.73). The overall retention rate was 99% with no difference between retention strategies. The Cost of retention per client in facilities without outreach services was $14.73 while in facilities with outreach, the cost was $11.89. Personnel cost was the primary costs’ driver in both strategies. Of 1,039 participants involved, to establish patient incurred cost for retention to care. Females were 65.4% and 57.8% of participants were from rural settings. Clients incurred annual out-of-pocket payments was $12.06. Conclusion: There is no difference in the yield of the HIV-positive and overall percentage of clients successfully linked to care based on facility and community strategies. However, there is regional variations in terms of per-client cost for HIV linkage and retention services. The overall cost per client linked using the facility strategy was higher than the community strategy and personnel cost was the main cost driver in both linkage and retention costs. [ABSTRACT FROM AUTHOR]

Published
2023
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13. Implementation of distance learning IMCI training in rural districts of Tanzania

Author

Isangula, Kahabi, primary, Ngadaya, Esther, additional, Manu, Alexander, additional, Mmweteni, Mary, additional, Philbert, Doreen, additional, Burengelo, Dorica, additional, Kagaruki, Gibson, additional, Senkoro, Mbazi, additional, Kimaro, Godfather, additional, Kahwa, Amos, additional, Mazige, Fikiri, additional, Bundala, Felix, additional, Iriya, Nemes, additional, Donard, Francis, additional, Kitinya, Caritas, additional, Minja, Victor, additional, Nyakairo, Festo, additional, Gupta, Gagan, additional, Pearson, Luwei, additional, Kim, Minjoon, additional, Mfinanga, Sayoki, additional, Baker, Ulrika, additional, and Hailegebriel, Tedbabe Degefie, additional

Published
2022
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15. Knowledge and utilization of prevention of mother-to-child transmission of HIV services among pregnant women in Tanzania

Author

Ngadaya, Esther, primary, Shija, Angela, additional, Sindato, Calvin, additional, Kahwa, Amos, additional, Kimaro, Godfather, additional, Senkoro, Mbazi, additional, Mnaymbwa, Nicholaus, additional, Philibert, Doreen, additional, Mbilu, Togolai, additional, Mandara, Celina, additional, Shemtandulo, Ramadhani, additional, Mwinyeheri, Thomas, additional, Wilfred, Aman, additional, and Mfinanga, Sayoki, additional

Published
2021
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16. Antibiotic Susceptibility Patterns of Bacterial Isolates from Routine Clinical Specimens from Referral Hospitals in Tanzania: A Prospective Hospital-Based Observational Study

Author

Mnyambwa,Nicholaus P, Mahende,Coline, Wilfred,Amani, Sandi,Erica, Mgina,Nicodem, Lubinza,Clara, Kahwa,Amos, Petrucka,Pammla, Mfinanga,Sayoki, Ngadaya,Esther, Kimaro,Godfather, Mnyambwa,Nicholaus P, Mahende,Coline, Wilfred,Amani, Sandi,Erica, Mgina,Nicodem, Lubinza,Clara, Kahwa,Amos, Petrucka,Pammla, Mfinanga,Sayoki, Ngadaya,Esther, and Kimaro,Godfather

Abstract

Nicholaus P Mnyambwa,1 Coline Mahende,1 Amani Wilfred,1 Erica Sandi,1 Nicodem Mgina,2 Clara Lubinza,1 Amos Kahwa,1 Pammla Petrucka,3,4 Sayoki Mfinanga,1,3,5 Esther Ngadaya,1 Godfather Kimaro1 1National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania; 2Central Tuberculosis Reference Laboratory (CTRL), Dar es Salaam, Tanzania; 3School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania; 4University of Saskatchewan, Saskatoon, Canada; 5Department of Epidemiology and Statistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaCorrespondence: Nicholaus P MnyambwaNational Institute for Medical Research Muhimbili Research Centre, P. O. Box 447, Dar es Salaam, TanzaniaEmail lodnicho@gmail.comIntroduction: Antimicrobial resistance is one of the biggest threats of modern public health. Although sub-Saharan Africa is highly burdened with infectious diseases, current data on antimicrobial resistance are sparse.Methods: A prospective study was conducted between October 2018 and September 2019 to assess the antibiotic susceptibility patterns of clinical bacterial isolates obtained from four referral hospitals in Tanzania. We used standard media and Kirby-Bauer disc diffusion methods as per Clinical and Laboratory Standards Institute (CLSI) standards.Results: We processed a total of 2620 specimens of which 388 (14.8%) were culture-positive from patients with a median (IQR) age of 28 (12– 44) years. Of the positive cultures, 52.3% (203) were from females. Most collected specimens were ear pus 28.6% (111), urine 24.0% (93), wound pus 20.6% (80), stool 14.9% (58), and blood 8.3% (32). Predominant isolates were S. aureus 28.4% (110), E. coli 15.2% (59), P. aeruginosa 10.6% (41), P. mirabilis 7.0% (27), V. cholerae 01 Ogawa 6.2% (24), Klebsiella spp. 5.2% (20) and Streptococcus spp. 4.6% (18). Generally, the isolates exhibited a high level of resistance

Published
2021

18. Antibiotic Susceptibility Patterns of Bacterial Isolates from Routine Clinical Specimens from Referral Hospitals in Tanzania: A Prospective Hospital-Based Observational Study

Author

Mnyambwa, Nicholaus P, primary, Mahende, Coline, additional, Wilfred, Amani, additional, Sandi, Erica, additional, Mgina, Nicodem, additional, Lubinza, Clara, additional, Kahwa, Amos, additional, Petrucka, Pammla, additional, Mfinanga, Sayoki, additional, Ngadaya, Esther, additional, and Kimaro, Godfather, additional

Published
2021
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19. Contributions of the lay workers in providing home-based treatment adherence support to patients with advanced HIV/AIDS disease in low-income settings: Lessons learned from the field in Tanzania and Zambia

Author

Kimaro, Godfather Dickson, primary, Bottomley, Christian, additional, Kahwa, Amos, additional, Guinness, Lorna, additional, Kivuyo, Sokoine, additional, Simms, Victoria, additional, Ngowi, Bernard, additional, Chanda, Duncan, additional, Jaffar, Shabbar, additional, and Mfinanga, Godfrey S. Mfinanga Sayoki, additional

Published
2020
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20. PS-003: EVIDENCE-INFORMED POLICY MAKING: CHALLENGES AND OPPORTUNITIES

Author

Makanga, Michael, Beattie, Pauline, Breugelmans, Gabrielle, Nyirenda, Thomas, Bockarie, Moses, Tanner, Marcel, Volmink, Jimmy, Hankins, Catherine, Walzl, Gerhard, Chegou, Novel, Malherbe, Stephanus, Hatherill, Mark, Scriba, Thomas J., Zak, Daniel E., Barry, Clifton E., Kaufmann, Stefan H.E., Noor, Abdisalan, Strub-Wourgaft, Nathalie, Phillips, Patrick, Munguambe, Khátia, Ravinetto, Raffaella, Tinto, Halidou, Diro, Ermias, Mahendrahata, Yodi, Okebe, Joseph, Rijal, Suman, Garcia, Coralith, Sundar, Shyam, Ndayisaba, Gilles, Sopheak, Thai, Ngoduc, Thang, Loen, Harry Van, Jacobs, Jan, D'Alessandro, Umberto, Boelaert, Marleen, Buvé, Anne, Kamalo, Patrick, Manda-Taylor, Lucinda, Rennie, Stuart, Mokgatla, Boitumelo, Bahati, Prince, Ijsselmuiden, Carel, Afolabi, Muhammed, Mcgrath, Nuala, Kampmann, Beate, Imoukhuede, Egeruan, Alexander, Neal, Larson, Heidi, Chandramohan, Daniel, Bojang, Kalifa, Kasaro, Margaret Phiri, Muluka, Brenda, Kaunda, Kaunda, Morse, Jill, Westfall, Andrew, Kapata, Nathan, Kruuner, Annika, Henostroza, German, Reid, Stewart, Alabi, Abraham, Foguim, Francis, Sankarganesh, Jeyaraj, Bruske, Ellen, Mfoumbi, Arnault, Mevyann, Chester, Adegnika, Ayola, Lell, Bertrand, Kranzer, Katharina, Kremsner, Peter, Grobusch, Martin, Sabiiti, Wilber, Ntinginya, Nyanda, Kuchaka, Davis, Azam, Khalide, Kampira, Elizabeth, Mtafya, Bariki, Bowness, Ruth, Bhatt, Nilesh, Davies, Gerry, Kibiki, Gibson, Gillespie, Stephen, Lejon, Veerle, Ilboudo, Hamidou, Mumba, Dieudonné, Camara, Mamady, Kaba, Dramane, Lumbala, Crispin, Fèvre, Eric, Jamonneau, Vincent, Bucheton, Bruno, Büscher, Philippe, Chisenga, Caroline, Sinkala, Edford, Chilengi, Roma, Chitundu, Hellen, Zyambo, Zude, Wandeler, Gilles, Vinikoor, Michael, Emilie, Dama, Camara, Oumou, Mathurin, Koffi, Guiguigbaza-Kossigan, Dayo, Philippe, Büscher, Regassa, Fikru, Hassane, Sakande, Bienvenu, Somda Martin, Fabrice, Courtin, Ouédraogo, Elie, Kouakou, Lingue, Owusu, Michael, Mensah, Eric, Enimil, Anthony, Mutocheluh, Mohamed, Ndongo, Francis Ateba, Tejiokem, Mathurin Cyrille, Texier, Gaetan, Penda, Calixte, Ndiang, Suzie, Ndongo, Jean-Audrey, Guemkam, Georgette, Sofeu, Casimir Ledoux, Afumbom, Kfutwa, Faye, Albert, Msellati, Philippe, Warszawski, Josiane, Vos, Alinda, Devillé, Walter, Barth, Roos, Klipstein-Grobusch, Kerstin, Tempelman, Hugo, Venter, François, Coutinho, Roel, Grobbee, Diederick, Ssemwanga, Deogratius, Lyagoba, Frederick, Magambo, Brian, Kapaata, Anne, Kirangwa, Joseph, Nannyonjo, Maria, Nassolo, Faridah, Nsubuga, Rebecca, Yebra, Gonzalo, Brown, Andrew, Kaleebu, Pontiano, Nylén, Hanna, Habtewold, Abiy, Makonnen, Eyasu, Yimer, Getnet, Burhenne, Jürgen, Diczfalusy, Ulf, Aklillu, Eleni, Steele, Duncan, Walker, Richard, Simuyandi, Michelo, Beres, Laura, Bosomprah, Samuel, Ansumana, Rashid, Taitt, C., Lamin, J.M., Jacobsen, K.H., Mulvaney, S.P., Leski, T., Bangura, U., Stenger, D., Vries, Sophie De, Zinsou, Frejus Jeannot, Honkpehedji, J, Dejon, Jean Claude, Loembe, Marguerite Massinga, Bache, Bache, Pakker, Nadine, Leeuwen, Remko Van, Hounkpatin, Aurore Bouyoukou, Yazdanbakhsh, Maria, Bethony, Jeffrey, Hotez, Peter, Diemert, David, Bache, Bache Emmanuel, Fernandes, José F., Mba, Régis M Obiang, Kabwende, Anita L., Grobusch, Martin P., Krishna, Sanjeev, Kremsner, Peter G., Todagbe, Agnandji Selidji, Nambozi, Michael, Kabuya, Jean-Bertin, Hachizovu, Sebastian, Mwakazanga, David, Kasongo, Webster, Buyze, Jozefien, Mulenga, Modest, Geertruyden, Jean-Pierre, Gitaka, Jesse, Chan, Chim, Kongere, James, Kagaya, Wataru, Kaneko, Akira, Kabore, Naomie, Barry, Nouhoun, Kabre, Zachari, Werme, Karidia, Fofana, Aminata, Compaore, Daniel, Nikiema, Frederic, Some, Fabrice, Djimde, Abdoulaye, Zongo, Issaka, Ouedraogo, Bosco, Kone, Aminatou, Sagara, Issaka, Björkman, Anders, Gil, Jose Pedro, Nchinda, Godwin, Bopda, Alain, Nji, Nadesh, Ambada, Georgia, Ngu, Loveline, Tchadji, Jules, Sake, Carol, Magagoum, Suzanne, Njambe, Ghislain D., Lisom, Abel, Park, Chae Gyu, Tait, Dereck, Sibusiso, Hlatjwako, Manda, Olga, Croucher, Kristin, Westhuizen, Anja Van Der, Mshanga, Isaac, Levin, Jonathan, Nanvubya, Annet, Kibengo, Freddie, Jaoko, Walter, Pala, Pietro, Perreau, Matthieu, Namuniina, Annemarie, Kitandwe, Paul, Tapia, Gonzalo, Serwanga, Jennifer, Yates, Nicole, Fast, Pat, Mayer, Bryan, Montefiori, David, Tomaras, Georgia, Robb, Merlin, Lee, Carter, Wagner, Ralf, Sanders, Edward, Kilembe, William, Kiwanuka, Noah, Gilmour, Jill, Kuipers, Hester, Vooij, Dani, Chinyenze, Kundai, Priddy, Frances, Ding, Song, Hanke, Tom, Pantaleo, Giuseppe, Ngasala, Billy, Jovel, Irina, Malmberg, Maja, Mmbando, Bruno, Premji, Zul, Mårtensson, Andreas, Mwaiswelo, Richard, Agbor, Lenshina, Apinjoh, Tobias, Mwanza, Sydney, Chileshe, Justin, Joshi, Sudhaunshu, Malunga, Phidelis, Manyando, Christine, Laufer, Miriam, Dara, Antoine, Niangaly, Amadou, Sinha, Indranil, Brodin, David, Fofana, Bakary, Dama, Souleymane, Dembele, Demba, Sidibe, Bakary, Diallo, Nouhoum, Thera, Mahamadou, Wright, Karin, Gil, Jose, Doumbo, Ogobara, Baraka, Vito, Nabasumba, Carolyn, Francis, Filbert, Lutumba, Pascal, Mavoko, Hypolite, Alifrangis, Michael, Geertruyden, Jean-Pierre Van, Sissoko, Sekou, Sangaré, Cheick, Toure, Sekou, Sanogo, Kassim, Diakite, Hamadoun, Toure, Siaka, Doumbia, Diagassan, Haidara, Kadiatou, Julé, Amélie, Ashurst, Hazel, Merson, Laura, Olliaro, Piero, Marsh, Vicki, Lang, Trudie, Guérin, Philippe, Awuondo, Kennedy, Njenga, Daniel, Nyakarungu, Elizabeth, Titus, Pauline, Sutamihardja, Awalludin, Lowe, Brett, Ogutu, Bernhards, Billingsley, Peter, Soulama, Issiaka, Kaboré, Moïse, Coulibaly, Aboubacar, Ouattara, Maurice, Sanon, Souleymane, Diarra, Amidou, Bougouma, Edith, Ouedraogo, Alphonse, Sombie, Benjamin, Ouedraogo, Amidou, Kargougou, Désiré, Ouattara, Daouda, Issa, Nebie, Tiono, Alfred, Sirima, Sodiomon, Chaponda, Mike, Dabira, Edgard, Dao, François, Dara, Nianwalou, Sidibe, Bouran, Coulibaly, Moctar, Tolo, Allaye, Maiga, Hamma, Ouologuem, Nouhoum, Niangaly, Hamidou, Botchway, Felix, Wilson, Nana, Dickinson-Copeland, Carmen M, Adjei, Andrew A., Wilson, Michael, Stiles, Jonathan K., Hamid, Muzamil Abdel, Awad-Elgeid, Mona, Nasr, Awad, Netongo, Palmer, Kamdem, Séverin, Velavan, Thirumalaisamy, Lasry, Estrella, Diarra, Modibo, Bamadio, Amadou, Traore, Aliou, Coumare, Samba, Soma, Bahonan, Dicko, Yeyia, Sangare, Boubou, Tembely, Aly, Traore, Djibril, Haidara, Aboubecrin, Dicko, Alassane, Diawara, Elisabeth, Beavogui, Abdoul, Camara, Daouda, Sylla, Malick, Yattara, Mohamed, Sow, Amadou, Camara, Gnèpou Camara, Diallo, Saliou, Mombo-Ngoma, Ghyslain, Remppis, Jonathan, Sievers, Moritz, Manego, Rella Zoleko, Endamne, Lilian, Hutchinson, David, Held, Jana, Supan, Christian, Salazar, Carmen L. Ospina, Bonkian, Léa Nadège, Nahum, Alain, Sié, Ali, Abdulla, Salim, Cantalloube, Cathy, Djeriou, Elhadj, Bouyou-Akotet, Marielle, Mordmüller, Benjamin, Siribie, Mohamadou, Sirima, Sodiomon B., Ouattara, San Maurice, Coulibaly, Sam, Kabore, Jean Moïse, Amidou, Diarra, Tekete, Mamadou, Burhenne, Juergen, Traore, Oumar, Haefeli, Walter, Borrmann, Steffen, Kaboré, Naomie, Kabré, Zachari, Nikèma, Fréderic, Compaoré, Daniel, Somé, Fabrice, Djimdé, Abdoulaye, Ouédraogo, Jean, Chalwe, Victor, Miller, John, Diakité, Hamadoun, Greco, Beatrice, Spangenberg, Thomas, Kourany-Lefoll, Elly, Oeuvray, Claude, Mulry, Jim, Tyagarajan, Kamala, Magsaam, Bettina, Barnes, Karen, Hodel, Eva Maria, Humphreys, Georgina, Pace, Cheryl, Banda, C.G, Denti, Paulo, Allen, Elizabeth, Lalloo, David, Mwapasa, Victor, Terlouw, Anja, Mwesigwa, Julia, Achan, Jane, Jawara, Musa, Ditanna, Gian, Worwui, Archibald, Affara, Muna, Koukouikila-Koussounda, Félix, Kombo, Michael, Vouvoungui, Christevy, Ntoumi, Francine, Etoka-Beka, Mandingha Kosso, Deibert, Julia, Poulain, Pierre, Kobawila, Simon, Gueye, Nerly Gampio, Koukouikila-Koussounda, Felix, Seda, Brian, Kwambai, Titus, Jangu, Phelix, Samuels, Aaron, ter Kuile, Feike, Kariuki, Simon, Barry, Aissata, Bousema, Teun, Okech, Brenda, Egwang, Thomas, Corran, Patrick, Riley, Eleanor, Ezennia, Ifeoma, Ekwunife, Obinna, Muleba, Mbanga, Stevenson, Jennifer, Mbata, Keith, Coetzee, Maureen, Norris, Douglas, Moneke-Anyanwoke, Ngozi, Momodou, Jasseh, Clarke, Ed, Scott, Susana, Tijani, Adelani, Djimde, Moussa, Vaillant, Michel, Samouda, Hanen, Mensah, Victorine, Roetynck, Sophie, Kanteh, Ebrima, Bowyer, Georgina, Ndaw, Amy, Oko, Francis, Bliss, Carly, Jagne, Ya Jankey, Cortese, Riccardo, Nicosia, Alfredo, Roberts, Rachel, D'Alessio, Flavia, Leroy, Odile, Faye, Babacar, Cisse, Badara, Gerry, Stephen, Viebig, Nicola, Lawrie, Alison, Ewer, Katie, Hill, Adrian, Nebie, Issa, Tiono, Alfred B, Sanou, Guillaume, Konate, Amadou T, Yaro, Baptiste J, Sodiomon, Sirima, Honkpehedji, Yabo, Agobe, Jean Claude Dejon, Zinsou, Frejus, Mengue, Juliana, Richie, Thomas, Hoffman, Stephen, Nouatin, Odilon, Ngoa, Ulysse Ateba, Edoa, Jean R, Homoet, Andreas, Engelhon, Julie Englhon, Massinga-Louembe, Marguerite, Esen, Meral, Theisen, Michael, Sim, Kim Lee, Luty, Adrian Jf, Moutairou, Kabirou, Dinko, Bismarck, King, Elizabeth, Targett, Geoffrey, Sutherland, Colin, Likhovole, Clement, Ouma, Collins, Vulule, John, Musau, Susan, Khayumbi, Jeremiah, Okumu, Albert, Murithi, Wilfred, Otu, Jacob, Gehre, Florian, Zingue, Dezemon, Kudzawu, Samuel, Forson, Audrey, Mane, Morto, Rabna, Paulo, Diarra, Bassirou, Kayede, Salako, Adebiyi, Emmanuel, Kehinde, Aderemi, Onyejepu, Nneka, Onubogu, Catherine, Idigbe, Emmanuel, Ba, Awa, Diallo, Aissatou, Mboup, Souleymane, Disse, Kodjo, Kadanga, Gerard, Dagnra, Yaotse, Baldeh, Ignatius, Corrah, Tumani, Jong, Bouke De, Antonio, Martin, Musanabaganwa, Clarisse, Musabyimana, Jean Pierre, Karita, Etienne, Diop, Blondin, Nambajimana, Abidan, Dushimiyimana, Valentine, Karame, Prosper, Russell, Jim, Ndoli, Jules, Hategekimana, Theobald, Sendegeya, Augustin, Condo, Jeannine, Binagwaho, Agnes, Okonko, Iheanyi, Okerentugba, Phillip, Opaleye, Oluyinka, Awujo, Ezinwanne, Frank-Peterside, Nnenna, Moyo, Sikhulile, Kotokwe, Kenanao, Mohammed, Terence, Boleo, Coretah, Mupfumi, Lucy, Chishala, Samuel, Gaseitsiwe, Simani, Tsalaile, Lesedi, Bussmann, Herman, Makhema, Joseph, Baum, Marianna, Marlink, Richard, Engelbretch, Susan, Essex, Max, Novitsky, Vladimir, Saka, Emmanuel, Kalipalire, Zex, Bhairavabhotla, Ravikiran, Midiani, Dalitso, Sherman, Judith, Mgode, Georgies, Cox, Christophe, Bwana, Dickens, Mtui, Leah, Magesa, Daniel, Kahwa, Amos, Mfinanga, Godfrey, Mulder, Christiaan, Borain, Nick, Petersen, Lizette, Plessis, Julianne Du, Theron, Grant, Holm-Hansen, Carol, Tekwu, Emmanuel Mouafo, Sidze, Larissa Kamgue, Assam, Jean Paul Assam, Eyangoh, Sarah, Niemann, Stefan, Beng, Veronique Penlap, Frank, Matthias, Atiadeve, Samuel, Hilmann, Doris, Awoniyi, Dolapo, Baumann, Ralf, Kriel, Belinda, Jacobs, Ruschca, Kidd, Martin, Loxton, Andre, Kaempfer, Susanne, Singh, Mahavir, Mwanza, Winnie, Milimo, Deborah, Moyo, Maureen, Kasese, Nkatya, Cheeba-Lengwe, Maina, Munkondya, Stembiso, Ayles, Helen, Haas, Petra De, Muyoyeta, Monde, Namuganga, Anna Ritah, Kizza, Harriet Mayanja, Mendy, Alieu, Tientcheu, Leopold, Ayorinde, Abigail, Coker, Edward, Egere, Uzochukwu, Coussens, Anna, Naude, Celeste, Chaplin, George, Noursadeghi, Mahdad, Martineau, Adrian, Jablonski, Nina, Wilkinson, Robert, Ouedraogo, Henri Gautier, Matteelli, Alberto, Regazzi, Mario, Tarnagda, Grissoum, Villani, Paola, Sulis, Giorgia, Diagbouga, Serge, Roggi, Alberto, Giorgetti, Francesco, Kouanda, Seni, Bidias, Amel, Ndjonka, Dieudonné, Olemba, Clémence, Souleymanou, Arabo, Mukonzo, Jackson, Kuteesa, Ronald, Ogwal-Okeng, Jasper, Gustafsson, Lars L., Owen, Joel, Bassi, Peter, Gashau, Wadzani, Olaf, Klungel, Dodoo, Alexander, Okonkwo, Prosper, Kanki, Phyllis, Maruapula, Dorcas, Seraise, Boitumelo, Einkauf, Kevin, Reilly, Amanda, Rowley, Christopher, Musonda, Rosemary, Framhein, Anna, Mpagama, Stella, Semvua, Hadija, Maboko, Leonard, Hoelscher, Michael, Heinrich, Norbert, Mulenga, Lloyd, Kaayunga, Callistus, Davies, Mary-Ann, Egger, Matthias, Musukuma, Kalo, Dambe, Rosalia, Usadi, Benjamin, Ngari, Moses, Thitiri, Johnstone, Mwalekwa, Laura, Fegan, Greg, Berkley, James, Nsagha, Dickson, Munamunungu, Virginia, Bolton, Carolyn, Siyunda, Alice, Shilimi, Jacinta, Bucciardini, Raffaella, Fragola, Vincenzo, Abegaz, Teshome, Lucattini, Stefano, Halifom, Atakilt, Tadesse, Eskedar, Berhe, Micheal, Pugliese, Katherina, Castro, Paola De, Terlizzi, Roberta, Fucili, Luca, Gregorio, Massimiliano Di, Mirra, Marco, Zegeye, Teame, Binelli, Andrea, Vella, Stefano, Abraham, Loko, Godefay, Hagos, Rakotoarivelo, Rivo, Raberahona, Mihaja, Randriamampionona, Njary, Andriamihaja, Rabezanahary, Rasamoelina, Tahinamandranto, Cornet, Muriel, Randria, Mamy Jean De Dieu, Benet, Thomas, Vanhems, Philippe, Andrianarivelo, Mala Rakoto, Chirwa, Uchizi, Michelo, Charles, Hamoonga, Raymond, Wandiga, Steve, Oduor, Patience, Agaya, Janet, Sharma, Aditya, Cavanaugh, Sean, Cain, Kevin, Mukisa, John, Mupere, Ezekiel, Worodria, William, Ngom, Justice Trésor, Koro, Francioli, Godwe, Celestin, Adande, Clemence, Ateugieu, Romaric, Onana, Tatiana, Ngono, Annie, Kamdem, Yannick, Ngo-Niobe, Sara, Etoa, François-Xavier, Kanengoni, Muchineripi, Ruzario, Sithembile, Ndebele, Paul, Shana, Melody, Tarumbiswa, Fadzai, Musesengwa, Rosemary, Gutsire, Rutendo, Fisher, Kevin, Thyagarajan, Bargavi, Akanbi, Olusola, Binuyo, Michael, Ssengooba, Willy, Respeito, Durval, Mambuque, Edson, Blanco, Silvia, Mandomando, Inacio, Cobelens, Frank, Garcia-Basteiro, Alberto, Tamene, Ayele, Topp, Stephanie, Mwamba, Chanda, Padian, Nancy, Sikazwe, Izukanji, Geng, Elvin, Holmes, Charles, Sikombe, Kombatende, Hantuba, Cardinal, Czaicki, Nancy, Simbeza, Sandra, Somwe, Paul, Umulisa, Michele, Ilo, Jennifer, Kestelyn, Evelyne, Uwineza, Mireille, Agaba, Stephen, Delvaux, Therese, Wijgert, Janneke, Gethi, Dickson, Odeny, Lazarus, Tamandjou, Cynthia, Kaindjee-Tjituka, Francina, Brandt, Laura, Cotton, Mark, Nel, Etienne, Preiser, Wolfgang, Andersson, Monique, Adepoju, Abiola, Magana, Musa, Etsetowaghan, Andrew, Chilikwazi, Mutinta, Sutcliffe, Catherine, Thuma, Philip, Sinywimaanzi, Kathy, Matakala, Hellen, Munachoonga, Passwell, Moss, William, Masenza, Issa Sabi, Geisenberger, Otto, Agrea, Peter, Rwegoshora, France, Mahiga, Hellen, Olomi, Willyhelmina, Kroidl, Arne, Kayode, Gbenga, Amoakoh-Coleman, Mary, Ansah, Evelyn, Uthman, Olalekan, Fokam, Joseph, Santoro, Maria-Mercedes, Musolo, Chrissie, Chimbiri, Isabel, Chikwenga, Gloria, Deula, Ruth, Massari, Riccardo, Lungu, Agness, Perno, Carlo-Federico, Ndzengue, Georgia, Loveline, Ngu, Lissom, Abel, Flaurent, Tchouangueu, Sosso, Samuel, Essomba, Claudine, Kpeli, Grace, Otchere, Isaac, Lamelas, Araceli, Buultjens, Andrew, Bulach, Dieter, Baines, Sarah, Seemann, Torsten, Giulieri, Stefano, Nakobu, Zuliehatu, Aboagye, Samuel, Owusu-Mireku, Evelyn, Danso, Emelia, Hauser, Julia, Hinic, Vladimira, Pluschke, Gerd, Stinear, Timothy, Yeboah-Manu, Dorothy, Elshayeb, Ayman, Siddig, Marmar El, Ahmed, Abdel Azim, Hussien, Adil El, Kabwe, Mwila, Tembo, John, Chilukutu, Lophina, Chilufya, Moses, Ngulube, Francis, Lukwesa, Chileshe, Enne, Virve, Wexner, Hannah, Mwananyanda, Lawrence, Hamer, Davidson, Sinyangwe, Sylvester, Ahmed, Yusuf, Klein, Nigel, Maeurer, Markus, Zumla, Ali, Bates, Matthew, Beyala, Landry, Etienne, Guenou, Anthony, Njimbia, Benjamin, Azike, Ateudjieu, Jerome, Chibwe, Bertha, Ojok, David, Tarr, Christine Attia, Perez, Guillermo Martinez, Omeonga, Senga, Kibungu, Fanta, Meyer, Ana, Lansana, Peter, Mayor, Alfredo, Onyango, Peter, Loggerenberg, François Van, Furtado, Tamzin, Boggs, Liam, Segrt, Alexis, Dochez, Carine, Burnett, Rosemary, Mphahlele, M. Jeffrey, Miiro, George, Mbidde, Edward, Peshu, Norbert, Kivaya, Esther, Ngowi, Bernard, Kavishe, Reginald, Maowia, Mukhtar, Sandstrom, Eric, Ayuo, Elizabeth, Mmbaga, Blandina, Leisegang, Cordelia, Thorpe, Marie, Batchilly, Elizabeth, N'Guessan, Jean-Pierre, Kanteh, Dembo, Søfteland, Solrun, Sebitloane, Motshedisi, Vwalika, Bellington, Taylor, Myra, Galappaththi-Arachchige, Hashini, Holmen, Sigve, Gundersen, Svein Gunnar, Ndhlovu, Patricia, Kjetland, Eyrun Floerecke, Kombe, Francis, Toohey, Jacintha, Pienaar, Elizabeth, Kredo, Tamara, Cham, Pa Modou, Abubakar, Ismaela, Dondeh, Bai Lamin, Vischer, Nerina, Pfeiffer, Constanze, Burri, Christian, Musukwa, Kalo, Zürcher, Samuel, Mwandu, Temwani, Bauer, Sophie, Adriko, Moses, Mwaura, Peter, Omolloh, Kevin, Jones, Clarer, Malecela, Mwelecele, Hamidu, Buhari Adamu, Jenner, Tettevi Edward, Asiedu, Larbi John, Osei-Atweneboana, Mike, Afeke, Innocent, Addo, Phyllis, Newman, Mercy, Durnez, Lies, Eddyani, Miriam, Ammisah, Nana, Abas, Mona, Quartey, Maxwell, Ablordey, Anthony, Akinwale, Olaoluwa, Adeneye, Adeniyi, Ezeugwu, Sylvanus, Olukosi, Yetunde, Adewale, Babatunde, Sulyman, Medinat, Mafe, Margaret, Okwuzu, Jane, Gyang, Pam, Nwafor, Timothy, Henry, Uzoma, Musa, Bilkisu, Ujah, Innocent, Agobé, Jean Claude Dejon, Grau-Pujol, Berta, Sacoor, Charfudin, Nhabomba, Augusto, Casellas, Aina, Quintó, Llorenç, Subirà, Carme, Giné, Ricard, Valentín, Antònia, Muñoz, Jose, Nikiema, Marguerite, Ky-Ba, Absatou, Comapore, Kiswendsida Abdou Muller, Traore, Alfred, Sangare, Lassana, Oluremi, Adeolu, Michel, Mandro, Camara, Yaya, Sanneh, Bakary, Cuamba, Inocencia, Gutiérrez, Jose, Lázaro, Carlota, Mejia, Rojelio, Adedeji, Abimbola, Folorunsho, Sola, Demehin, Pelumi, Akinsanya, Bamidele, Cowley, Giovanna, Silva, Eunice Teixeira Da, Nabicassa, Meno, Barros, Pedrozinho Duarte Pereira De, Blif, Milena Mbote, Bailey, Robin, Last, Anna, Mahendradhata, Yodi, Gotuzzo, Eduardo, Nys, Kateljine De, Casteels, Minnes, Nona, Sylvie Kwedi, Lumeka, Kabwende, Todagbe, Agnandji, Djima, Mariam Mama, Ukpong, Morenike, Sagay, Atiene, Khamofu, Hadiza, Torpey, Kwasi, Afiadigwe, Evaristus, Anenih, James, Ezechi, Oliver, Nweneka, Chidi, Idoko, John, Muhumuza, Simon, Katahoire, Anne, Nuwaha, Fred, Olsen, Annette, Okeyo, Seth, Omollo, Raymond, Kimutai, Robert, Ochieng, Michael, Egondi, Thaddaeus, Moonga, Clement, Chileshe, Chisele, Magwende, George, Anumudu, Chiaka, Onile, Olugbenga, Oladele, Victoria, Adebayo, Adewale, Awobode, Henrietta, Oyeyemi, Oyetunde, Odaibo, Alexander, Kabuye, Emily, Lutalo, Tom, Njua-Yafi, Clarisse, Nkuo-Akenji, Theresa, Anchang-Kimbi, Judith, Mugri, Regina, Chi, Hanesh, Tata, Rolland, Njumkeng, Charles, Dodoo, Daniel, Achidi, Eric, Fernandes, José, Bache, Emmanuel B., Matakala, Kalumbu, Searle, Kelly, Greenman, Michelle, and Rainwater-Lovett, Kaitlin

Subjects
Abstracts of Poster Presentations, Abstracts of Oral Presentations, Author Index, Abstracts of Presentations in Plenary Sessions, Article, Abstracts of the Eighth Edctp Forum, 6–9 November 2016
Published
2017

21. Cryptococcal meningitis screening and community-based early adherence support in people with advanced HIV infection starting antiretroviral therapy in Tanzania and Zambia: a cost-effectiveness analysis

Author

Dickson Godfather, Kimaro, Guinness, Lorna, Tinevimbo Shiri, Sokoine Kivuyo, Chanda, Duncan, Bottomley, Christian, Chen, Tao, Kahwa, Amos, Hawkins, Neil, Mwaba, Peter, Sayoki Godfrey Mfinanga, Harrison, Thomas S, Shabbar Jaffar, and Niessen, Louis W

Published
2019
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22. Supply chain management of laboratory supportive services and its potential implications on the quality of HIV diagnostic services in Tanzania

Author

Kagaruki, Gibson B., Kamugisha, Mathias L., Kilale, Andrew M., Kamugisha, Erasmus, Rutta, Acleus S.M, Baraka, Vito, Mandara, Celine I., Magesa, Stephen M., Materu, Godlisten, Kahwa, Amos M., Madebe, Rashid, Massaga, Julius J., Lemnge, Martha M., Mboera, Leonard E.G., Ishengoma, Deus I., and Global Fund for AIDS, Tuberculosis and Malaria (Grant Number 2013/20).

Subjects
laboratory services, supply chain, diagnosis, HIV/AIDS, Tanzania
Abstract

Background: Reliable supply of laboratory supportive services contributes significantly to the quality of HIV diagnostic services. This study assessed the status of supply chain management of laboratory supportive services and its potential implications on the quality of HIV diagnostic services in selected districts of Tanzania.Methods: The study was conducted in 39 health facilities (HFs) from eight districts in four regions of Tanzania, namely Iringa, Mtwara, Tabora and Tanga. Facilities with care and treatment centres for HIV/AIDS patients were purposively selected for the study. The study utilized a quantitative method of data collection. A questionnaire was administered to heads of laboratories to obtain information on laboratory supply chain management.Results: A total of 39 health facilities (HF) were included in the study. This included 23 public and 16 private facilities. In 82% of the HFs, ordering of supplies was performed by the laboratory departments. The information commonly used to forecast requirements of the laboratories included the number of tests done (74.4%; n=29), current stock levels (69.2%; n=27), average monthly consumption (64.1%, n=25) and minimum and maximum stock levels (10.2%, n=4). Emergency orders were significantly common in public than private facilities (73.9% vs. 56.3%, p=0.004). Delivery of ordered supplies took 1 to 180 days with a significantly longer period for public than private facilities (32.5 vs. 13.1 days, p=0.044). Most of the public HFs ordered supplies from diverse sources compared to private facilities (68.2% vs. 31.8%).Conclusion: There was a weak inventory management system and delays in delivery of supplies in the majority of HFs, which are likely to impede quality of HIV care and treatment. Strengthening capacity for data management and ensure constant supply will potentially improve the quality of HIV diagnostic services.

Published
2018

23. Cryptococcal Meningitis Screening and Community-based Early Adherence Support in People With Advanced Human Immunodeficiency Virus Infection Starting Antiretroviral Therapy in Tanzania and Zambia: A Cost-effectiveness Analysis

Author

Kimaro, Godfather Dickson, primary, Guinness, Lorna, primary, Shiri, Tinevimbo, primary, Kivuyo, Sokoine, primary, Chanda, Duncan, primary, Bottomley, Christian, primary, Chen, Tao, primary, Kahwa, Amos, primary, Hawkins, Neil, primary, Mwaba, Peter, primary, Mfinanga, Sayoki Godfrey, primary, Harrison, Thomas S, primary, Jaffar, Shabbar, primary, and Niessen, Louis W, primary

Published
2019
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24. Cryptococcal Meningitis Screening and Community-based Early Adherence Support in People With Advanced Human Immunodeficiency Virus Infection Starting Antiretroviral Therapy in Tanzania and Zambia: A Cost-effectiveness Analysis.

Author

Kimaro, Godfather Dickson, Guinness, Lorna, Shiri, Tinevimbo, Kivuyo, Sokoine, Chanda, Duncan, Bottomley, Christian, Chen, Tao, Kahwa, Amos, Hawkins, Neil, Mwaba, Peter, Mfinanga, Sayoki Godfrey, Harrison, Thomas S, Jaffar, Shabbar, and Niessen, Louis W

Subjects
CONFIDENCE intervals, COST effectiveness, CRYPTOCOCCUS neoformans, HIV infections, MEDICAL screening, MENINGITIS, STATISTICAL sampling, T cells, ANTIRETROVIRAL agents, SOCIAL support, RANDOMIZED controlled trials, INDEPENDENT living, DESCRIPTIVE statistics
Abstract

Background A randomized trial demonstrated that among people living with late-stage human immunodeficiency virus (HIV) infection initiating antiretroviral therapy, screening serum for cryptococcal antigen (CrAg) combined with adherence support reduced all-cause mortality by 28%, compared with standard clinic-based care. Here, we present the cost-effectiveness. Methods HIV-infected adults with CD4 count <200 cells/μL were randomized to either CrAg screening plus 4 weekly home visits to provide adherence support or to standard clinic-based care in Dar es Salaam and Lusaka. The primary economic outcome was health service care cost per life-year saved as the incremental cost-effectiveness ratio (ICER), based on 2017 US dollars. We used nonparametric bootstrapping to assess uncertainties and univariate deterministic sensitivity analysis to examine the impact of individual parameters on the ICER. Results Among the intervention and standard arms, 1001 and 998 participants, respectively, were enrolled. The annual mean cost per participant in the intervention arm was US$339 (95% confidence interval [CI], $331–$347), resulting in an incremental cost of the intervention of US$77 (95% CI, $66–$88). The incremental cost was similar when analysis was restricted to persons with CD4 count <100 cells/μL. The ICER for the intervention vs standard care, per life-year saved, was US$70 (95% CI, $43–$211) for all participants with CD4 count up to 200 cells/μL and US$91 (95% CI, $49–$443) among those with CD4 counts <100 cells /μL. Cost-effectveness was most sensitive to mortality estimates. Conclusions Screening for cryptococcal antigen combined with a short period of adherence support, is cost-effective in resource-limited settings. [ABSTRACT FROM AUTHOR]

Published
2020
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27. Performance of health laboratories in provision of HIV diagnostic and supportive services in selected districts of Tanzania

Author

Ishengoma, Deus S., primary, Kamugisha, Mathias L., additional, Rutta, Acleus S. M., additional, Kagaruki, Gibson B., additional, Kilale, Andrew M., additional, Kahwa, Amos, additional, Kamugisha, Erasmus, additional, Baraka, Vito, additional, Mandara, Celine I., additional, Materu, Godlisten S., additional, Massaga, Julius J., additional, Magesa, Stephen M., additional, Lemnge, Martha M., additional, and Mboera, Leonard E. G., additional

Published
2017
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28. MOESM2 of Determinants of demand for condoms to prevent HIV infections among barmaids and guesthouse workers in two districts, Tanzania

Author

Mubyazi, Godfrey, Exavery, Amon, Filemoni Tenu, Massaga, Julius, Jovitha Rugemalila, Hamisi Malebo, Wiketye, Victor, Makundi, Emmanuel, Ikingura, Joyce, Adiel Mushi, Malekia, Sia, Abubakary Mziray, Ogondiek, John, Kahwa, Amos, Mwanaidi Kafuye, and Mwelecele Malecela

Subjects
virus diseases
Abstract

Additional file 2. A Structured Questionnaire for Data Collection from Condom Retailers on Determinants of the Demand for Condoms in Mpwapwa and Mbeya Rural Districts, Tanzania.

Published
2015
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29. The contributions of lay workers in providing home-based treatment adherence support to patients with AIDS in urban settings: Lessons from the field in Tanzania and Zambia.

Author

Kimaro, Godfather D., Bottomley, Christian, Kahwa, Amos, Guinness, Lorna, Kivuyo, Sokoine, Simms, Victoria, Ngowi, Bernard, Chanda, Duncan, Jaffar, Shabbar, and Mfinanga, Godfrey S.

Abstract

Introduction: In 2018, there were appropriately 20.6 million [18.2 million-23.2 million] people living with HIV in Eastern and Southern Africa, and an estimated 67% of them were on antiretroviral therapy (ART). A major challenge in the scale-up of ART services in Sub-Saharan Africa is the severe shortage of clinical staff. Methods: We conducted a randomised trial in Tanzania and Zambia to test an innovative intervention that involved the use of lay health workers and screening for cryptococcal meningitis and tuberculosis. Here we describe the model of care with a particular focus on the trained lay worker component. Lay workers carried out home visits to patients in the intervention arm to deliver antiretroviral drugs, provide adherence counselling, and conduct simple monitoring for treatment side effects and other medical conditions. Lay workers were responsible for referring patients with conditions that might require further medical attention as well as discouraging self-referral. A total of 1999 participants were enrolled in the trial. Lay workers were recruited through public advertisements. Results: Six lay workers were recruited in each country and trained for two weeks. Each lay worker was paid a monthly salary of US$ 487.61 in Zambia and US$ 524.61in Tanzania. They were also paid communication and transport expenses for home visits. The median number of visits per patient was 3 for Tanzania and 4 for Zambia. On average a lay worker was responsible for 72.3 patients in Tanzania and 94.5 in Zambia for 1 year. Referrals were made in 9% of the home visits and self-referral was discouraged in 64% of visits. Conclusion: The use of paid lay workers to provide HIV/AIDS services in urban settings where there is a shortage of clinical staff may help to identify ART related side effects/adverse reactions and prevent unnecessary referrals. [ABSTRACT FROM AUTHOR]

Published
2019
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30. Enhancing HIV status disclosure and partners’ testing through counselling in Tanzania

Author

IDINDILI, BONIPHACE, SELEMANI, MAJIGE, BAKAR, FAKIHI, THAWER, SUMAIYYA G., GUMI, ABDALLAH, MRISHO, MWIFADHI, KAHWA, AMOS M., MASSAGA, JULIUS J., IDINDILI, BONIPHACE, SELEMANI, MAJIGE, BAKAR, FAKIHI, THAWER, SUMAIYYA G., GUMI, ABDALLAH, MRISHO, MWIFADHI, KAHWA, AMOS M., and MASSAGA, JULIUS J.

Abstract

Background: In Tanzania HIV Testing and Counselling (HTC) is being implemented through voluntary counselling and testing (VCT), provider initiated counselling and testing (PITC) and work place counselling and testing (HTC). Within these programmes, HIV status disclosure is emphasized. However, among persons who test HIV positive, many do not disclose their status to their partners and social networks. However, data are lacking on the effectiveness of the different HTC strategies on HIV positive status disclosure. Objective: To investigate which of the three HIV Testing and Counselling (HTC) strategies: Voluntary Counselling and Testing (VCT), Provider Initiated Counselling and Testing (PITC) and work place Counselling and testing is associated with improved HIV-positive status disclosure in Eastern Tanzania. Methods: Structured interviews were conducted with 455 newly diagnosed HIV-positive clients at 6 HTC sites during enrolment and at three months follow-up to collect data on disclosure status. Results: We found that PITC strategy attended a relatively higher proportion of clients 182/455(40.1%) as compared to VCT 169/455 (37.1%) and work place HTC strategies 104/455(22.9%) respectively. Among clients, about one third 130/455(28.6%) were found to be HIV-positive. HIV status disclosure rates were variable and were in order of preference of disclosing to family members 86/130(66.2 %), followed by relatives 74/130(56.9%) and sexual partners 71/130(54.6%). A high proportion of participants 77/130(59.2%) experienced violence acts from sexual partners in form of stigma and discrimination, abuse, divorce and termination from employment. In the multivariate logistic regression, disclosure to sexual partners was associated with violence acts of about two times higher (Disclosure to Partners OR=1.89) when compared to the group that did not disclose to their partners. Conclusion: PITC strategy was found to result into higher rates of HIV positive status disclosure when compa

Published
2015

31. Determinants of demand for condoms to prevent HIV infections among barmaids and guesthouse workers in two districts, Tanzania

Author

Mubyazi, Godfrey M., primary, Exavery, Amon, additional, Tenu, Filemoni, additional, Massaga, Julius J., additional, Rugemalila, Jovitha, additional, Malebo, Hamisi M., additional, Wiketye, Victor, additional, Makundi, Emmanuel A., additional, Ikingura, Joyce K., additional, Mushi, Adiel K., additional, Malekia, Sia E., additional, Mziray, Abubakary, additional, Ogondiek, John W., additional, Kahwa, Amos, additional, Kafuye, Mwanaidi M., additional, and Malecela, Mwelecele N., additional

Published
2015
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34. Prevalence and Risk Factors of Metabolic Syndrome among Individuals Living with HIV and Receiving Antiretroviral Treatment in Tanzania

Author

Kagaruki, Gibson, primary, Kimaro, Godfather, additional, Mweya, Clement, additional, Kilale, Andrew, additional, Mrisho, Ray, additional, Shao, Amani, additional, Kalinga, Akili, additional, Kahwa, Amos, additional, Ngadaya, Esther, additional, Materu, Godlisten, additional, Mfinanga, Sayoki, additional, and Mayige, Mary, additional

Published
2015
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35. Genetic profile of Mycobacterium tuberculosis and treatment outcomes in human pulmonary tuberculosis in Tanzania

Author

MFINANGA, SAYOKI G.M., WARREN, ROB M., KAZWALA, RUDOVICK, KAHWA, AMOS, KAZIMOTO, THECLA, KIMARO, GODFATHER, MFAUME, SAID, CHONDE, TIMOTHY, NGADAYA, ESTHER, EGWAGA, SAID, STREICHER, ELIZABETH M., VAN PITTIUS, GEY N.C., MORKVE, ODD, CLEAVELAND, SARAH, MFINANGA, SAYOKI G.M., WARREN, ROB M., KAZWALA, RUDOVICK, KAHWA, AMOS, KAZIMOTO, THECLA, KIMARO, GODFATHER, MFAUME, SAID, CHONDE, TIMOTHY, NGADAYA, ESTHER, EGWAGA, SAID, STREICHER, ELIZABETH M., VAN PITTIUS, GEY N.C., MORKVE, ODD, and CLEAVELAND, SARAH

Abstract

Information on the different spoligotype families of Mycobacterium tuberculosis in Tanzania is limited, and where available, restricted to small geographical areas. This article describes the genetic profile of M. tuberculosis across Tanzania and suggests how spoligotype families might affect drug resistance and treatment outcomes for smear positive pulmonary tuberculosis patients in Tanzania. We conducted the study from 2006 to 2008, and the isolates were obtained from samples collected under the routine drug resistance surveillance system. The isolates were from specimens collected from 2001 to 2007, and stored at the Central and Reference Tuberculosis Laboratory. A total of 487 isolates from 23 regions in the country were spoligotyped. We were able to retrieve clinical information for 446 isolates only. Out of the 487 isolates spoligotyped, 195(40.0%) belonged to the Central Asian (CAS) family, 84 (17.5%) to the Latin American Mediterranean (LAM) family, 49 (10.1%) to the East-African Indian (EAI) family, and 33 (6.8%) to the Beijing family. Other isolates included 1 (0.2%) for H37Rv, 10 (2.1%) for Haarlem, 4 (0.8%) for S family, 58 (11.9%) for T family and 52 (10.7%) for unclassified. No spoligotype patterns were consistent with M. bovis. Regarding treatment outcomes, the cure rate was 80% with no significant variation among the spoligotype families. The overall level of MDR TB was 2.5% (3/121), with no significant difference among the spoligotype families. All Beijing strains (11.8%, 30/254) originated from the Eastern and Southern zones of the country, of which 80% were from Dar es Salaam. Isolates from the CAS and T families were reported disproportionately from the Eastern-Southern zone, and EAI and LAM families from the Northern-Lake zones but the difference was not statistically significant. Five isolates were identified as non-tuberculous Mycobacteria. In conclusion, M. tuberculosis isolates from pulmonary tuberculosis cases in Tanzania were classified mo

Published
2014

36. High prevalence of tuberculosis diagnosed during autopsy examination at Muhimbili National Hospital in Dar es Salaam, Tanzania

Author

KILALE, ANDREW M., KIMARO, GODFATHER D., KAHWA, AMOS M., CHILAGWILE, MABUBA, NGOWI, BERNARD J., MULLER, WILLIAM, CHANDE, HASSAN, MFINANGA, GODFREY S., HINDERAKER, SVEN G., KILALE, ANDREW M., KIMARO, GODFATHER D., KAHWA, AMOS M., CHILAGWILE, MABUBA, NGOWI, BERNARD J., MULLER, WILLIAM, CHANDE, HASSAN, MFINANGA, GODFREY S., and HINDERAKER, SVEN G.

Abstract

The primary aims of tuberculosis (TB) control programmes is early diagnosis and prompt treatment of infectious cases to limit transmission. Failure to diagnose and adequately treat TB could lead to premature death and unrecognized transmission of Mycobacterium tuberculosis . The proportion of missed TB cases has not been reported in Tanzania. The objective of this study was to quantify the number of cases of TB identified by autopsy. Deceased morbid bodies from Muhimbili National Hospital were involved. Retrieval of admission, diagnostic and other important records used to manage the patient after admission was done. Demographic information, site and type of disease, past medical history, chest x-ray report, clinical diagnosis and cause of death reported upon death certification were recorded. Lung tissues, lymphnodes and blood clots for HIV testing were collected. Biopsy tissues were processed through Ziehl Nielsen staining and examined by microscopy. The study involved 74 deceased individuals where 56 (75.7%) were males. Information for duration of seeking health care before death was available for 41(55.4%) subjects. Thirty-four (45.9%) cases received diagnosis before death. The main diagnoses were pneumonia 10(13.5%), heart failure 6(8.1%), AIDS-related illnesses 6 (6.8%) and malaria 5 (6.8%). The main clinical findings were wasting (51/74 (68.9%)) and abnormal fluid collection in different body cavities, 61(50.8%). In 24 out of 71(33.8%) biopsies acid fast bacilli (AFB) were detected. Records of lymphnodes examination were available in 63 cases and 22 of them had AFB. Twenty-two (34.9%) from the paratracheal and hilar lymphnodes were observed to have AFB. HIV was detected by ELISA in 19 (33.3%) out of 57 deceased, and 12 (63.2%) of the HIV positive deceased were co-infected with TB. Out of the 22 cases positive for AFB on tissue-biopsies 12 (54.5%) were HIV positive. There is a high number of TB cases diagnosed after death that could not be detected before they

Published
2014

37. Provision of free ARV in public facilities in Tanzania : do the poor benefit?

Author

Kahwa, Amos and Thiede, Michael

Subjects
Health Economics
Abstract

The impact of the HIV pandemic in Tanzania has been profound and has affected all sectors. Today, HIV/AIDS is recognized not only as a major public health concern but also as social, economic and development problem in Tanzania as in most in Sub-Saharan African countries. With a population of estimated 37 million, Tanzania has an estimated of 2.5 million people infected with human immunodeficiency virus (HIV). The availability of antiretroviral therapy (ART) which has been defined as the main form of treatment (yet not a cure) for HIV/AIDS showed to significantly prolong and improve quality of life of people infected with HIV. By and large, the entire range of antiretroviral drugs is available anywhere in the world through private channels. Where resources permit, the supply may be adequate and consistent. Through the public sector, however, and for low-income patients, the choice of drugs may be somewhat restricted. This has implications for decisions such as when to start therapy, which therapeutic regimens to use, and what to do when treatment fails. The situation requires difficult choices in priority setting, poses serious ethical issues and imposes on government the obligation to scale up programmes in ways that are ethically sound, equitable, beneficial and sustainable as possible (WHO 2004). However in Tanzania, there is no clear policy established on targeting or prioritising specific population groups in order to avoid decision making based on subjective or arbitrary criteria that may lead to discrimination. The aim of this study was to establish the socioeconomic status of those individuals who benefit most from the provision of free ARV in terms of utilisation in urban and rural settings. It also aimed to identify the criteria used in enrolment of patients for free ARV provision, the barriers for ARV provision and patient's perception on ARV.

Published
2007

39. Evaluation of the KEMRI Hep-cell II test kit for detection of hepatitis B surface antigens in Tanzania

Author

KILALE, ANDREW M., RANGE, NYAGOSYA S., NGOWI, PROSPER H., KAHWA, AMOS M., MFINANGA, SAYOKI G., KILALE, ANDREW M., RANGE, NYAGOSYA S., NGOWI, PROSPER H., KAHWA, AMOS M., and MFINANGA, SAYOKI G.

Abstract

Hepatitis B surface antigen (HBsAg) is one of the most important serological markers used to diagnose acute and chronic hepatitis B infection. The objective of the current evaluation was to assess the operational characteristics of the Kenya Medical Research Institute (KEMRI) Hep-cell II against an ELISA Exsym HBsAg in the detection of hepatitis B surface antigens. To evaluate the Hepcell II test, blood samples were collected from blood donors and processed for detection of HBsAg using Hep-cell II based on the test principle and procedure outlined by the manufacturer. ELISA Axsym HBsAg test was used as golden standard. Of the 400 samples tested, 287 (71.8%) were positive by Hep-cell test and 295 (73.8%) were positive by the ELISA Axsym. Hep-cell test had a sensitivity of 98.6% and specificity of 95.96%. Similar values of sensitivity and specificity of the Hep-cell test were obtained even when Bayesian Analysis Model was applied. The positive and negative predictive values of Hep-cell test were 98.61% and 95.96%, respectively. The positive and negative diagnostic likelihood ratios of Hep-cell test were 24.4% and 0.0145, respectively. In conclusion, the Hep-cell test is useful for detecting hepatitis B virus and the high likelihood ratio observed suggests that it may be useful in blood screening. However, it may be necessary to evaluate for cost-effectiveness and robustness in field conditions before the test is recommended for use.

Published
2013

40. APOPO’s tuberculosis research agenda: achievements, challenges and prospects

Author

BEYENE, NEGUSSIE, MAHONEY, AMANDA, COX, CHRISTOPHE, WEETJENS, BART, MAKINGI, GEORGE, MGODE, GEORGIES, DURGIN, AMY, KUIPERS, DIAN, JUBITANA, MAUREEN, EGWAGA, SAIDI, KAMARA, DEUS, LWILLA, FRED, MFINANGA, SAYOKI G., KAHWA, AMOS, MACHANG’U, ROBERT, KAZWALA, RUDOVICK, REITHER, KLAUS, KAUFMANN, STEFAN H.E., POLING, ALAN, BEYENE, NEGUSSIE, MAHONEY, AMANDA, COX, CHRISTOPHE, WEETJENS, BART, MAKINGI, GEORGE, MGODE, GEORGIES, DURGIN, AMY, KUIPERS, DIAN, JUBITANA, MAUREEN, EGWAGA, SAIDI, KAMARA, DEUS, LWILLA, FRED, MFINANGA, SAYOKI G., KAHWA, AMOS, MACHANG’U, ROBERT, KAZWALA, RUDOVICK, REITHER, KLAUS, KAUFMANN, STEFAN H.E., and POLING, ALAN

Abstract

This article describes Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) recent use of specially trained African giant pouched rats as detectors of pulmonary tuberculosis in people living in Tanzania. It summarizes the achievements and challenges encountered over the years and outlines future prospects. Since 2008, second-line screening by the rats has identified more than 2000 tuberculosis-positive patients who were missed by microscopy at Direct Observation of Treatment – Short Course centres in Tanzania. Moreover, data that are reviewed herein have been collected with respect to the rats’ sensitivity and specificity in detecting tuberculosis. Findings strongly suggest that scent-detecting rats offer a quick and practical tool for detecting pulmonary tuberculosis and within the year APOPO’s tuberculosis-detection project will be extended to Mozambique. As part of its local capacity building effort, APOPO hires and trains Tanzanians to play many important roles in its TB detection project and provides research and training opportunities for Tanzanian students.

Published
2013

41. Integrating public health research trials into health systems in Africa: individual or cluster randomisation?

Author

Simms, Victoria, primary, Matiku, Sode, additional, Ngowi, Bernard, additional, Chanda, Duncan, additional, Lesikari, Sokoine, additional, Bottomley, Christian, additional, Egwaga, Saidi, additional, Kahwa, Amos, additional, Guinness, Lorna, additional, Mwaba, Peter, additional, Mfinanga, Sayoki, additional, and Jaffar, Shabbar, additional

Published
2013
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44. APOPO’s tuberculosis research agenda: achievements, challenges and prospects

Author

Beyene, Negussie, primary, Mahoney, Amanda, additional, Cox, Christophe, additional, Weetjens, Bart, additional, Makingi, George, additional, Mgode, Georgies, additional, Durgin, Amy, additional, Kuipers, Dian, additional, Jubitana, Maureen, additional, Egwaga, Said, additional, Kamara, Deus, additional, Lwilla, Fred, additional, Mfinanga, Sayoki G., additional, Kahwa, Amos, additional, Machang'u, Robert, additional, Kazwala, Rudovick, additional, Reither, Klaus, additional, Kaufmann, Stefan H.E., additional, and Poling, Alan, additional

Published
2012
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45. Hypertension in Sub-Saharan Africa: Cross-Sectional Surveys in Four Rural and Urban Communities

Author

Hendriks, Marleen E., primary, Wit, Ferdinand W. N. M., additional, Roos, Marijke T. L., additional, Brewster, Lizzy M., additional, Akande, Tanimola M., additional, de Beer, Ingrid H., additional, Mfinanga, Sayoki G., additional, Kahwa, Amos M., additional, Gatongi, Peter, additional, Van Rooy, Gert, additional, Janssens, Wendy, additional, Lammers, Judith, additional, Kramer, Berber, additional, Bonfrer, Igna, additional, Gaeb, Esegiel, additional, van der Gaag, Jacques, additional, Rinke de Wit, Tobias F., additional, Lange, Joep M. A., additional, and Schultsz, Constance, additional

Published
2012
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46. Pouched Rats’ Detection of Tuberculosis in Human Sputum: Comparison to Culturing and Polymerase Chain Reaction

Author

Mahoney, Amanda, primary, Weetjens, Bart J., additional, Cox, Christophe, additional, Beyene, Negussie, additional, Reither, Klaus, additional, Makingi, George, additional, Jubitana, Maureen, additional, Kazwala, Rudovick, additional, Mfinanga, Godfrey S., additional, Kahwa, Amos, additional, Durgin, Amy, additional, and Poling, Alan, additional

Published
2012
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48. Genetic profile of Mycobacterium tuberculosis and treatment outcomes in human pulmonary tuberculosis in Tanzania.

Author

MFINANGA, SAYOKI G. M., WARREN, ROB M., KAZWALA, RUDOVICK, KAHWA, AMOS, KAZIMOTO, THECLA, KIMARO, GODFATHER, MFAUME, SAID, CHONDE, TIMOTHY, NGADAYA, ESTHER, EGWAGA, SAID, STREICHER, ELIZABETH M., VAN PITTIUS, GEY N. C., MORKVE, ODD, and CLEAVELAND, SARAH

Abstract

Information on the different spoligotype families of Mycobacterium tuberculosis in Tanzania is limited, and where available, restricted to small geographical areas. This article describes the genetic profile of M. tuberculosis across Tanzania and suggests how spoligotype families might affect drug resistance and treatment outcomes for smear positive pulmonary tuberculosis patients in Tanzania. We conducted the study from 2006 to 2008, and the isolates were obtained from samples collected under the routine drug resistance surveillance system. The isolates were from specimens collected from 2001 to 2007, and stored at the Central and Reference Tuberculosis Laboratory. A total of 487 isolates from 23 regions in the country were spoligotyped. We were able to retrieve clinical information for 446 isolates only. Out of the 487 isolates spoligotyped, 195(40.0%) belonged to the Central Asian (CAS) family, 84 (17.5%) to the Latin American Mediterranean (LAM) family, 49 (10.1%) to the East-African Indian (EAI) family, and 33 (6.8%) to the Beijing family. Other isolates included 1 (0.2%) for H37Rv, 10 (2.1%) for Haarlem, 4 (0.8%) for S family, 58 (11.9%) for T family and 52 (10.7%) for unclassified. No spoligotype patterns were consistent with M. bovis. Regarding treatment outcomes, the cure rate was 80% with no significant variation among the spoligotype families. The overall level of MDR TB was 2.5% (3/121), with no significant difference among the spoligotype families. All Beijing strains (11.8%, 30/254) originated from the Eastern and Southern zones of the country, of which 80% were from Dar es Salaam. Isolates from the CAS and T families were reported disproportionately from the Eastern-Southern zone, and EAI and LAM families from the Northern-Lake zones but the difference was not statistically significant. Five isolates were identified as non-tuberculous Mycobacteria. In conclusion, M. tuberculosis isolates from pulmonary tuberculosis cases in Tanzania were classified mostly within the CAS, LAM, and EAI and T families, while the Beijing family comprised about 7% isolates only. Consistently good treatment outcomes were recorded across these spoligotype families. The proportion of drug resistance strains was low. The findings also suggest variation of spoligotype families with varying geographical localities within the country, and identify this area for further research to confirm this finding. [ABSTRACT FROM AUTHOR]

Published
2014
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49. Factors Influencing Participation of Adults in Voluntary Medical Male Circumcision in Lindi Region, Tanzania.

Author

Mathias SP, Kahwa A, Kimaro G, Ngadaya E, Nchagwa H, Eric F, Mfinanga S, Mwombeki T, Kagaruki G, Mwenda L, Smeo J, Kapologwe N, Mathania M, and Russa D

Abstract

Background: Voluntary Medical Male Circumcision (VMMC) is a surgical procedure done by a qualified medical personnel using anesthesia. In Tanzania, there is a gap between adult men who are not circumcised and adolescents. This calls for a review of the current situation of VMMC services in the community at large in order to inform policymakers and stakeholders involved in the fight against HIV and other sexually transmitted diseases. The present study explored the factors influencing utilisation of VMMC services among adult males in Lindi Region, Tanzania., Materials and Methods: A cross-sectional study was conducted among adults male (15-49 years). Data were collected by using a structured modified measure evaluation quantitative Version 2 questionnaire using a Tablet/Android device with an Open Data Kit (ODK) application (Google Inc. California, USA)., Results: The socio-demographic set up of the study participants was mainly composed of males less than 30yrs, single, unemployed, with primary education as the highest level of study and of a Muslim faith. Majority of the respondents (92%) recommended circumcision to a male family member who is not yet circumcised. The study showed that improved sexual performance (81%), penile hygiene (97%) and circumcision as a modern civilization (96%) to be the key factors that motivated respondents' utilisation of VMMC services. However, only 20.6% of the respondents could barely say that VMMC is a surgical procedure done by qualified medical personnel under anaesthesia. The major reasons for recommending the utilisation of VMMC services to their family members were the VMMC usefulness in preventing STIs (48.9%), cultural practices and norms (31.5%), improved penile hygiene (17.4%) and religious reasons (2.2%)., Conclusion: VMMC is positively favoured by the local coastal communities of the Lindi region of Tanzania Mainland. Our findings may be inferred to reflect on the other neighbouring regions with similar sociocultural set ups such as Mtwara, Pwani, Rural Dar es Salaam and Tanga and the isles of Unguja and Pemba. Programs addressing VMMC may be well instituted in these local communities with high degree of favourability and success., (© The East African Health Research Commission 2023.)

Published
2023
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