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Objective To explore and describe the perceptions of policy actors and practitioners on antimicrobial use and resistance in human and animal health in Tanzania. Methods This was an exploratory qualitative study, which involved semi-structured interviews with nine policy makers and 102 practitioners. Results Improved multisectoral collaboration and coordination among experts from the animal and human sectors, government will, improved infrastructures, existence of public awareness campaigns on appropriate use of antimicrobials and existence of antimicrobial stewardship were identified as strengths for the implementation of National Action Plan on Antimicrobial Resistance (NAP-AMR) in Tanzania. Despite these strengths, insufficient public awareness of AMR, limited community engagement and inadequate human resources were among the reported weaknesses. A number of opportunities for the implementation of NAP-AMR were also reported including the presence of integrated disease surveillance and response strategy in health sector and development of a coordinated surveillance system. Furthermore, the inadequate laboratory capacity and poor resource mobilization were identified as challenges facing the implementation of NAP-AMR. Conclusion The future policies of AMR need to capitalize on the identified strengths and opportunities as well as design interventions to improve public awareness of AMR and community engagement, deployment of adequate human resources and ensure adequate resource mobilization to meet AMR needs.

A Corrigendum has been published for this paper,click here. Tuberculosis (TB) is a devastating chronic debilitating infection that imposes a considerable negative impact on human health. The disease also affects the quality of livestock, wildlife and their products.Mycobacterium tuberculosis(M. tuberculosis) is the causative agent for human TB, whileMycobacterium bovis(M. bovis) predominantly causes TB in animals, though is also zoonotic. In Tanzania and other developing countries timely diagnosis of disease is hampered by poor access to appropriate capacity and technology to characterize the pathogen. This review explores the diverse methods available for the diagnosis and characterization of Mycobacterial species and strains isolated from both humans and animals in sub Saharan Africa. The review will identify knowledge gaps and highlight direction for future investigation of the interface TB risk, which could lead to a better regional control strategy. A systematic search of PubMed, Google and Google Scholar retrieved 716 published articles on TB and methods used with the aim of tracking the advancement in technology and to reflect where we are and what can best be done to improve the strategy for best control of the disease. The search terms included but not limited to“(Whole Genome Sequencing AND sub-Saharan Africa);(Diverse TB strains + Human +Animals) AND Tanzania + Africa + Sub-Saharan Africa;(Diverse TB strains + human+ animals) OR Tanzania + Africa + Sub-Saharan Africa)”. The review illustrates an advancement of technology from 1950s to 2000s with only 17.7% studies having been done using DNA-based methods and 81.3% being studies that used conventional methods. Most of the molecular studies cluster in the mid- to late 2000s which could be due to lack of expertise, slow adoption of technology or the high cost of running these valuable molecular tests. This overview on genotyping studies and trend in molecular studies highlights the need for more investment in this region of the world. An increased use of molecular methods will help in increasing the chances of detecting new TB strains in circulation and identifying potential risks for cross-transmission at humans-livestock-wildlife interface. A strengthened ability to detect and characterizes disease will better support country and regional control strategies.

Background: Cross-species tuberculosis (TB) transmission between humans and animals has been reported for quite a long time in sub-Saharan Africa. Because humans and animals coexist in the same ecosystem, exploring their potential for cross-species transmission and the impact the disease may have on the health of humans, animals, and their products is critical. Objectives: This study aimed to identify risk factors for transmission of TB (Mycobacterium tuberculosis) and to assess the potential for zoonotic TB (Mycobacterium bovis) transmission in the Serengeti ecosystem where humans and animals are in intense contact. Our aim is to create a base for future implementation of appropriate control strategies to limit infection in both humans and animals. Methodology: We administered a semi-structured questionnaire to 421 self-reporting patients to gather information on risk factors and TB occurrence. In a parallel study, researchers screened sputum smears using Ziehl–Neelsen staining and confirmed by mycobacterial culture. We then performed descriptive statistics (Pearson’s chi-square test) and logistic regression analysis to establish frequencies, association, and quantification of the risk factors associated with TB cases. Results: Our findings showed 44% (95% confidence interval [CI], 0.40-0.49) of the results were positive from sputum samples collected over a 1-year duration in areas with a high TB burden, particularly the Bunda district, followed by the Serengeti and Ngorongoro districts. Of the culture-positive patients who also had infections other than TB (43/187 patients), 21 (49%) were HIV positive. Contact with livestock products (odds ratio [OR] 6.0; 95% CI, 1.81-19.9), infrequent milk consumption (OR 2.5; 95% CI, 1.42-4.23), cigarette smoking (OR 2.9; 95% CI, 1.19-7.1.2), and alcohol consumption (OR 2.3; 95% CI, 1.22-4.23) were associated with a higher likelihood of TB infection. Conclusion: There was no evidence of direct cross-species transmission of either M tuberculosis or M bovis between humans and animals using the study methods. The absence of cross-species TB transmission could be due to limited chances of contact rather than an inability of cross-species disease transmission. In addition, not all people with presumptive TB are infected with TB, and therefore control strategies should emphasise confirming TB status before administering anti-TB drugs.

Summary Mycobacterium bovis, the causative agent of bovine tuberculosis (bTB), is a multihost pathogen of public health and veterinary importance. We characterized the M. bovis isolated at the human–livestock–wildlife interface of the Serengeti ecosystem to determine the epidemiology and risk of cross‐species transmission between interacting hosts species. DNA was extracted from mycobacterial cultures obtained from sputum samples of 472 tuberculosis (TB) suspected patients and tissue samples from 606 livestock and wild animal species. M. bovis isolates were characterized using spoligotyping and Mycobacterial Interspersed Repetitive Units‐Variable Tandem Repeats (MIRU‐VNTR) on 24 loci. Only 5 M. bovis were isolated from the cultured samples. Spoligotyping results revealed that three M. bovis isolates from two buffaloes (Syncerus caffer) and 1 African civet (Civettictis civetta) belonged to SB0133 spoligotype. The two novel strains (AR1 and AR2) assigned as spoligotype SB2290 and SB2289, respectively, were identified from indigenous cattle (Bos indicus). No M. bovis was detected from patients with clinical signs consistent with TB. Of the 606 animal tissue specimens and sputa of 472 TB‐suspected patients 43 (7.09%) and 12 (2.9%), respectively, yielded non‐tuberculous mycobacteria (NTM), of which 20 isolates were M. intracellulare. No M. avium was identified. M. bovis isolates from wildlife had 45.2% and 96.8% spoligotype pattern agreement with AR1 and AR2 strains, respectively. This finding indicates that bTB infections in wild animals and cattle were epidemiologically related. Of the 24 MIRU‐VNTR loci, QUB 11b showed the highest discrimination among the M. bovis strains. The novel strains obtained in this study have not been previously reported in the area, but no clear evidence for recent cross‐species transmission of M. bovis was found between human, livestock and wild animals.

In the Ngorongoro Conservation Area (NCA), Tanzania, where wildlife and livestock interaction is intense, greater potential for intra- and interspecies disease transmission is expected. We assessed the prevalence of bovine tuberculosis in African buffalo (Syncerus caffer) residing on the valley floor of the crater in the NCA. Apparently healthy animals were randomly selected from herds in nine sites of the Ngorongoro Crater. Syncerus caffer buffalo herds were located using very high-frequency radio-aided rangers positioned in various observation points around the crater in the NCA. A total of 102 African buffalo from 16 herds were immobilized from the ground using a cocktail of 4-10 mg etorphine hydrochloride (M99) and 60-150 mg azaperone tartrate. The M99 was reversed using 10-25 mg diprenorphine hydrochloride depending on age of animals. An interferon gamma assay was performed on harvested plasma samples using sandwich enzyme linked immunosorbent assay. Of the 102 animals sampled, two (2%) African buffalo tested positive for bovine tuberculosis. These results corroborate those of the skin test done recently in cattle in the NCA. The presence of bovine tuberculosis in livestock and wildlife suggested the possibility of cross-species transmission of the disease, indicating the need for appropriate intervention measures.

A simple and rapid liquid chromatography/tandem mass spectrometry (LC-MS/MS) method has been developed and validated for the simultaneous quantitation of Olanzapine and Fluoxetine in human plasma using Olanzapine-d3 and Fluoxetine-d5 HCl as internal standard (IS), respectively. After solid phase extraction of the plasma samples on Waters Oasis HLB Catridges, Olanzapine, Fluoxetine and IS were chromatographed on Thermo Hypersil Gold C18 (50 mm × 4.6 mmi.d., 5 μm) analytical column with isocratic elution using methanol: 2mM Ammonium acetate buffer (90:10). Quantitation was performed on a triple quadrupole mass spectrometer employing electrospray ionization technique and operating in multiple reaction monitoring (MRM) and positive ion mode with transitions at 313/256 for Olanzapine and 310/148 for Fluoxetine. The total chromatographic run time was 2.0 min and calibration curves were linear over the concentration range of 0.10-20.00 ng/mL for Olanzapine and 0.50-50.00 ng/mL for Fluoxetine. The method was validated for selectivity, sensitivity, recovery, linearity, accuracy and precision and stability studies. The recoveries obtained for the Olanzapine and its IS was ≥87% and Fluoxetine and its IS was ≥91%. Recoveries obtained were consistent and reproducible. Inter-batch and intra-batch coefficient of variation across three validation runs (LLOQ, LQC, MQC1, MQC and HQC) was less than 3.6 for Olanzapine and less than 5.2% for Fluoxetine. The method was successfully applied to a pharmacokinetic study of fixed dose combination of Olanzapine/Fluoxetine in healthy male volunteers.

Objective: To determine the prevalence and spectrum of helminths in free-ranging African buffaloes in Tanzania by a cross-sectional study. Methods: Faecal samples (n=1 23) from Arusha National Park and Ngorongoro Crater were examined for helminth eggs using sedimentation and floatation techniques during the period of March to June 2012. Results: Coprological examination revealed that 34.1% (n=42) of the buffaloes excreted nematodes and trematodes eggs and protozoan oocyst in their faces. The pattern of infection was either single or mixed. Single (52.4%) and concurrent infections with two, three, four and five parasites were recorded in 19.0%, 11.9%, 14.3% and 2.3% respectively of the cases. The nematode eggs encountered were those of Trichostrongylus sp. (20.3%), Oesophagostomum sp. (7.3%), Strongyle sp. (4.1%), Bunostomum sp. (4.1%), Ostertegia sp. (3.3%) and Toxocara sp. (2.4%). The trematode eggs encountered were those of Fasciola sp. (9.8%), Paramphistomum sp. (4.9%), Gastrothylax sp. (1.6%), Ornithobilharzia sp. (0.81%) and Fischoederius sp (0.81%). The protozoan oocyst recorded was that of Eimeria sp. (8.1%). Geographical location of buffaloes had significant influence on the prevalence of infection with Trichostrongylus (P=0.046) and Fasciola (P=0.001), and the mean prevalances in Arusha National Park are significantly higher than those in Ngorongoro Crater. Age had significant influence on infection with Fasciola (P=0.036), and juvenile recorded higher levels of infection than sub-adults. Health status, body condition score and sex-wise prevalence of helminths were not significant (P>0.05). Conclusions: This study indicates that helminths species are numerous and highly prevalent in the two protected areas and may be one of the contributing factors to lower buffalo productivity.

The aim of this study was to assess and characterize Mycobacterium tuberculosis complex (MTBC) genotypic diversity in Tanzania, as well as in neighbouring East and other several African countries. We used spoligotyping to identify a total of 293 M. tuberculosis clinical isolates (one isolate per patient) collected in the Bunda, Dar es Salaam, Ngorongoro and Serengeti areas in Tanzania. The results were compared with results in the SITVIT2 international database of the Pasteur Institute of Guadeloupe. Genotyping and phylogeographical analyses highlighted the predominance of the CAS, T, EAI, and LAM MTBC lineages in Tanzania. The three most frequent Spoligotype International Types (SITs) were: SIT21/CAS1-Kili (n = 76; 25.94%), SIT59/LAM11-ZWE (n = 22; 7.51%), and SIT126/EAI5 tentatively reclassified as EAI3-TZA (n = 18; 6.14%). Furthermore, three SITs were newly created in this study (SIT4056/EAI5 n = 2, SIT4057/T1 n = 1, and SIT4058/EAI5 n = 1). We noted that the East-African-Indian (EAI) lineage was more predominant in Bunda, the Manu lineage was more common among strains isolated in Ngorongoro, and the Central-Asian (CAS) lineage was more predominant in Dar es Salaam (p-value

Mycobacterium bovis, the causative agent of bovine tuberculosis (bTB), is a multihost pathogen of public health and veterinary importance. We characterized the M. bovis isolated at the human-livestock-wildlife interface of the Serengeti ecosystem to determine the epidemiology and risk of cross-species transmission between interacting hosts species. DNA was extracted from mycobacterial cultures obtained from sputum samples of 472 tuberculosis (TB) suspected patients and tissue samples from 606 livestock and wild animal species. M. bovis isolates were characterized using spoligotyping and Mycobacterial Interspersed Repetitive Units-Variable Tandem Repeats (MIRU-VNTR) on 24 loci. Only 5 M. bovis were isolated from the cultured samples. Spoligotyping results revealed that three M. bovis isolates from two buffaloes (Syncerus caffer) and 1 African civet (Civettictis civetta) belonged to SB0133 spoligotype. The two novel strains (AR1 and AR2) assigned as spoligotype SB2290 and SB2289, respectively, were identified from indigenous cattle (Bos indicus). No M. bovis was detected from patients with clinical signs consistent with TB. Of the 606 animal tissue specimens and sputa of 472 TB-suspected patients 43 (7.09%) and 12 (2.9%), respectively, yielded non-tuberculous mycobacteria (NTM), of which 20 isolates were M. intracellulare. No M. avium was identified. M. bovis isolates from wildlife had 45.2% and 96.8% spoligotype pattern agreement with AR1 and AR2 strains, respectively. This finding indicates that bTB infections in wild animals and cattle were epidemiologically related. Of the 24 MIRU-VNTR loci, QUB 11b showed the highest discrimination among the M. bovis strains. The novel strains obtained in this study have not been previously reported in the area, but no clear evidence for recent cross-species transmission of M. bovis was found between human, livestock and wild animals.

Background Non-tuberculous mycobacteria (NTM), which are ubiquitous micro-organisms occurring in humans, animals and the environment, sometimes receive public health and veterinary attention as opportunistic disease-causing agents. In Tanzania, there is limited information regarding the diversity of NTM species, particularly at the human-livestock-wildlife interface such as the Serengeti ecosystem, where potential for cross species infection or transmission may exist. Methods Mycobacterial DNA was extracted from cultured isolates obtained from sputum samples of 472 suspect TB patients and 606 tissues from wildlife species and indigenous cattle. Multiplex PCR was used to differentiate NTM from Mycobacterium tuberculosis complex (MTBC) members. NTM were further identified to species level by nucleotide sequencing of the 16S rRNA gene. Results A total of fifty five (55) NTM isolates representing 16 mycobacterial species and 5 isolates belonging to the MTBC were detected. Overall, Mycobacterium intracellulare which was isolated from human, cattle and wildlife, was the most frequently isolated species (20 isolates, 36.4%) followed by M. lentiflavum (11 isolates, 20%), M. fortuitum (4 isolates, 7.3%) and M. chelonae-abscessus group (3 isolates, 5.5%). In terms of hosts, 36 isolates were from cattle and 12 from humans, the balance being found in various wildlife species. Conclusion This study reveals a diversity of NTM species in the Serengeti ecosystem, some of which have potential for causing disease in animals and humans. The isolation of NTM from tuberculosis-like lesions in the absence of MTBC calls for further research to elucidate their actual role in causing disease. We are also suggesting a one health approach in identifying risk factors for and possible transmission mechanisms of the NTM in the agro-pastoral communities in the Serengeti ecosystem. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0616-y) contains supplementary material, which is available to authorized users.

BACKGROUND: Bovine tuberculosis (bTB) is a chronic debilitating disease and is a cause of morbidity and mortality in livestock, wildlife and humans. This study estimated the prevalence and risk factors associated with bovine tuberculosis transmission in indigenous cattle at the human-animal interface in the Serengeti ecosystem of Tanzania. RESULTS: A total of 1,103 indigenous cattle from 32 herds were investigated for the presence of bTB using the Single Intradermal Comparative Tuberculin Test. Epidemiological data on herd structure, management and grazing system were also collected.The apparent individual animal prevalence of tuberculin reactors was 2.4% (95% confidence interval (CI), 1.7 - 3.5%), whereas the true prevalence was 0.6% CI, 0.6 - 0.7% as indicated by a reaction to avian tuberculin purified protein derivatives (PPD) which is more than 4 mm greater than the reaction to avian tuberculin PPD. The results showed that 10.6% (117/1,103) showed non-specific reactions (atypical mycobacterium). The herd prevalence of 50% (16/32) was found. Tuberculin skin test results were found to be significantly associated with age, location, size of the household and animal tested. Of 108 respondents, 70 (64.8%) individuals had not heard about bovine tuberculosis at all. Thirty five percent (38/108) of respondents at least were aware of bTB. About 60% (23/38) of respondents who were aware of bTB had some knowledge on how bTB is spread. Eighty one percent (87/108) of respondents were not aware of the presence of bTB in wildlife. There is regular contact between cattle and wild animals due to sharing of grazing land and water sources, with 99% (107/108) of households grazing cattle in communal pastures. CONCLUSION: The study has demonstrated a high reported interaction of livestock with wildlife and poor knowledge of most cattle owners concerning bTB and its transmission pathways among people, livestock and wildlife. Although the overall proportion of animals with bTB is relatively low, herd prevalence is 50% and prevalence within herds varied considerably. Thus there is a possibility of cross transmission of bTB at wildlife-livestock interface areas that necessitates use of genetic strain typing methods to characterize them accurately.

Infectious diseases account for nearly 40% of the burden of human mortality and morbidity in low-income countries, of which 7% is attributable to zoonoses and 13% to recently emerging diseases from animals. One of the strategic approaches for effective surveillance, monitoring and control of infectious diseases compromising health in both humans and animals could be through a combination of multiple disciplines. The approach can be achieved through a joint effort from stakeholders comprising health professionals (medical and veterinary), social, economic, agricultural, environmental and other interested parties. With resource scarcity in terms of number of staff, skills and facility in low-income countries, participatory multi- sectoral and multidisciplinary approaches in limiting the burden of zoonotic diseases could be worthwhile. We review challenging issues that may limit the ‘One Health’ approach for infectious diseases surveillance in Tanzania with a focus on Health Policy and how best the human and animal health systems could be complemented or linked to suit the community in need for disease control under the theme’s context.