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Vaccines have played a critical role in the response to the COVID-19 pandemic globally, and Tanzania has made significant efforts to make them available to the public in addition to sensitizing them on its benefit. However, vaccine hesitancy remains a concern. It may prevent optimal uptake of this promising tool in many communities. This study aims to explore opinions and perceptions on vaccine hesitancy to better understand local attitudes towards vaccine hesitancy in both rural and urban Tanzania. The study employed cross-sectional semi-structured interviews with 42 participants. The data were collected in October 2021. Men and women aged between 18 and 70 years were purposefully sampled from Dar es Salaam and Tabora regions. Thematic content analysis was used to categorize data inductively and deductively. We found that COVID-19 vaccine hesitancy exists and is shaped by multiple socio-political and vaccine related factors. Vaccine related factors included worries over vaccine safety (e.g., death, infertility, and zombie), limited knowledge about the vaccines and fear of the vaccine's impact on pre-existing conditions. Participants also found it paradoxical that mask and hygiene mandates are expected even after vaccination, which further exacerbated their doubts about vaccine efficacy and their hesitancy. Participants possessed a range of questions regarding COVID-19 vaccines that they wanted answered by the government. Social factors included preference for traditional and home remedies and influence from others. Political factors included inconsistent messages on COVID-19 from the community and political leaders; and doubts about the existence of COVID-19 and the vaccine. Our findings suggest that the COVID-19 vaccine is beyond a medical intervention, it carries with it a variety of expectations and myths that need to be addressed in order to build trust and acceptance within communities. Health promotion messages need to respond to heterogeneous questions, misinformation, doubts, and concerns over safety issues. An understanding of country-specific perspectives toward COVID-19 vaccines can greatly inform the development of localized strategies for meaningful uptake in Tanzania.

There is now extensive evidence on the optimal management of diabetes, offering the opportunity of improving the immediate and long-term quality of life of those with diabetes. Unfortunately such optimal management is not reaching many, perhaps the majority, of the people who could benefi t. Reasons include the size and complexity of the evidencebase, and the complexity of diabetes care itself. One result is a lack of proven cost-effective resources for diabetes care. Another result is diversity of standards of clinical practice. Guidelines are one part of a process which seeks to address those problems. Many guidelines have appeared internationally, nationally, and more locally in recent years, but most of these have not used the rigorous new guideline methodologies for identifi cation and analysis of the evidence. Many countries around the world do not have the resources, either in expertise or fi nancially, that are needed to develop diabetes guidelines. Also such a repetitive approach would be enormously ineffi cient and costly. Published national guidelines come from relatively resource-rich countries, and may be of limited practical use in less well resourced countries. In 2005 the fi rst IDF Global Guideline for type 2 diabetes was developed. This presented a unique challenge as we tried to develop a guideline that is sensitive to resource and costeffectiveness issues. Many national guidelines address one group of people with diabetes in the context of one healthcare system, with one level of national and health-care resources. This is not true in the global context where, although every health-care system seems to be short of resources, the funding and expertise available for health-care vary widely between countries and even between localities. Despite the challenges, we feel that we found an approach which is at least partially successful in addressing this issue which we termed ‘Levels of care’ (see next page). This guideline represents an update of the fi rst guideline and extends the evidence base by including new studies and treatments which have emerged since the original guideline was produced in 2005. Funding is essential to an activity of this kind. IDF is grateful to a diversity of commercial partners for provision of unrestricted educational grants. Fil: Aschner, Pablo. International Diabetes Federation Guideline Development Group; Bélgica Fil: Beck Nielsen, Henning. International Diabetes Federation Guideline Development Group; Bélgica Fil: Bennet, Peter. International Diabetes Federation Guideline Development Group; Bélgica Fil: Boulton, Andrew. International Diabetes Federation Guideline Development Group; Bélgica Fil: Colagiuri, Ruth. International Diabetes Federation Guideline Development Group; Bélgica Fil: Colagiuri, Stephen. International Diabetes Federation Guideline Development Group; Bélgica Fil: Franz, Marion. International Diabetes Federation Guideline Development Group; Bélgica Fil: Gadsby, Roger. International Diabetes Federation Guideline Development Group; Bélgica Fil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Cientifico Tecnológico La Plata. Centro de Endocrinologia Experimental y Aplicada (i); Argentina. Universidad Nacional de La Plata; Argentina. International Diabetes Federation Guideline Development Group; Bélgica Fil: Home, Philip. International Diabetes Federation Guideline Development Group; Bélgica Fil: McGill, Marg. International Diabetes Federation Guideline Development Group; Bélgica Fil: Manley, Susan. International Diabetes Federation Guideline Development Group; Bélgica Fil: Marshall, Sally. International Diabetes Federation Guideline Development Group; Bélgica Fil: Mbanya, Jean Claude. International Diabetes Federation Guideline Development Group; Bélgica Fil: Neil, Andrew. International Diabetes Federation Guideline Development Group; Bélgica Fil: Ramachandran, Ambady. International Diabetes Federation Guideline Development Group; Bélgica Fil: Ramaiya, Kaushik. International Diabetes Federation Guideline Development Group; Bélgica Fil: Roglic, Gojka. International Diabetes Federation Guideline Development Group; Bélgica Fil: Schaper, Nicolaas. International Diabetes Federation Guideline Development Group; Bélgica Fil: Siminerio, Linda. International Diabetes Federation Guideline Development Group; Bélgica Fil: Sinclair, Alan. International Diabetes Federation Guideline Development Group; Bélgica Fil: Snoek, Frank. International Diabetes Federation Guideline Development Group; Bélgica Fil: Van Crombrugge, Paul. International Diabetes Federation Guideline Development Group; Bélgica Fil: Vespasiani, Giacomo. International Diabetes Federation Guideline Development Group; Bélgica Fil: Viswanathan, Vijay . International Diabetes Federation Guideline Development Group; Bélgica

Background: The diagnosis of undescended testis/cryptorchidism is missed and ignored by most clinicians following tendency of not performing genital examination in children unless asked by parents. The male sexual differentiation and development is important for the normal reproductive life span. Similarly, risk of carcinoma of testis will be prevented, if early diagnosis of undescended testis (UDT) is made. To aim of the study was to determine the prevalence of undescended testis, its characteristics and associated risk factors among children underfive.Methods: This was a hospital-based cross sectional study that was conducted at the Reproductive and Child Health Clinic (RCHC) of the St. Francis Referral Hospital (SFRH) from October 2011 to May 2012. The district hospital is located in Ifakara, southeast Tanzania, a city of 49,528 people. Among the estimated 4500 under-five male children in the district attending the RCHC for routine services, 616 children were physically examined their genitalia after consent from their caretakers. Results: The prevalence of the undescended testis (UDT) was 2.1% (13/616) with 12 children having unilateral UDT and one child with bilateral UDT. About 85% of families of recruited children own durable assets. A small proportion of children, 6.8% (49/616) were of low birth weight and 2.6% (16/616) were born prematurely. Among mothers who had preeclampsia, only 2.4% (1/41) of the children had UDT and none of eclamptic mothers‟ children had UDT. None of the children with UDT had exhibited evidence of birth asphyxia. In case of mothers who had been smoking or exposed to second hand smoking 5.4% (33/616) and those who have been binge drinking alcohol, 0.6% (4/616) of their children had UDT. Among mothers exposed to herbs during pregnancy only 3.2% (1/31) had UDT. None of the mothers had gestational diabetes or existing diabetes mellitus prior to conception.Conclusion: The prevalence of UDT in this rural setting has a pattern similar to that observed in previous studies in other areas. Efforts should be done to do genital examination by all clinicians. The associated factors exist but no statistically significant association was found and a long term follow up study is needed.Key words: Cryptorchidism/undescended testis, underfives, Reproductive Child Health Clinic, small for gestation age.

Those involved in type 2 diabetes care must be puzzled by the lack of consensus on self-monitoring of blood glucose (SMBG) (1,2,3), especially in non–insulin-treated patients. This is reflected by wide between-country variation in reimbursement for glucose meters and strips. Balanced evaluation of available data is required; however, further trials are needed to provide robust evidence as to how and in which groups SMBG use is justified. Fil: Davis, T. M. E.. University of Western Australia. Fremantle Hospital; Australia Fil: Davis, W. A.. No especifíca; Fil: Farmer, A.. No especifíca; Fil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; Argentina Fil: Giorda,C.. No especifíca; Fil: Home, P.. No especifíca; Fil: Ji, L.. No especifíca; Fil: Johnson, J.. No especifíca; Fil: Karter, A. J.. No especifíca; Fil: Kolb, H.. No especifíca; Fil: Martin, S.. No especifíca; Fil: Mohan, V.. No especifíca; Fil: Nicolucci, A.. No especifíca; Fil: Porta, M.. No especifíca; Fil: Ramachandran, A.. No especifíca; Fil: Ramaiya, K. L.. No especifíca; Fil: Shah, J. H.. No especifíca; Fil: Shera, A.S.. No especifíca; Fil: Skei, S.. No especifíca; Fil: International SMBG Working Group. No especifíca

OBJECTIVES--To seek differences in the prevalence of diabetes mellitus and other coronary heart disease risk factors, and to identify factors associated with these differences within a Hindu Indian community. DESIGN--Population based cross sectional survey. SETTING--Dar-es-Salaam, Tanzania. SUBJECTS--Of 20 Hindu subcommunities categorised by caste in Dar-es-Salaam, seven were randomly selected. 1147 (76.7%) of 1495 subjects aged 15 or over participated. MAIN OUTCOME MEASURES--Blood glucose concentrations (fasting and two hours after oral glucose loading), serum total cholesterol and serum triglyceride concentrations, blood pressure, and height and weight. RESULTS--The subcommunities differed substantially in socioeconomic characteristics and lifestyle. Overall, 9.8% of subjects (109/1113) had diabetes, 17.0% (189/1113) impaired glucose tolerance, 14.5% (166/1143) hypertension, and 13.3% (151/1138) were obese. The mean fasting blood glucose concentration was 4.9 mmol/l, the blood glucose concentration two hours after oral loading (75 g) 6.0 mmol/l, the total cholesterol concentration 4.9 mmol/l, the serum triglyceride concentration 1.4 mmol/l, and body mass index (weight/height: kg/m2) 24.3. Systolic and diastolic blood pressures were 121 and 77 mm Hg respectively. There were important intercommunity differences even after standardisation for age, sex, and body mass index--for example, in mean fasting blood glucose concentration (range 4.5 (Jains) to 5.9 mmol/l (Patels)), serum total cholesterol concentration (range 4.5 (Jains) to 6.2 mmol/l (Suthars)), systolic blood pressure (range 110 (Limbachias) to 127 mm Hg (Bhatias)), and prevalences of diabetes (range 3.4% (3/87 Limbachias) to 18% (20/111 Navnats)) and hypertension (range 5.7% (5/87 Limbachias) to 19.4% (43/222 Bhatias). Variables which showed significant linear correlation with subcommunity variations were entered into a multiple regression model. Intercommunity variations persisted. The Limbachia and Jain communities had the lowest prevalence of and mean values for coronary heart disease risk factors and the Bhatia and Patel communities had the highest. CONCLUSIONS--In this series intercommunity variations in disease and risk factors might have been related to genetic, dietary, socioeconomic, and lifestyle differences but could not be explained by the characteristics studied. Studies of Indian subcommunities are warranted to confirm and extend these descriptive findings and explore the genetic basis of diabetes. Communities of Indian origin should not be perceived as homogeneous

With the changing distribution of infectious diseases, and an increase in the burden of non-communicable diseases, low- and middle-income countries, including those in Africa, will need to expand their health care capacities to effectively respond to these epidemiological transitions. The interrelated risk factors for chronic infectious and non-communicable diseases and the need for long-term disease management, argue for combined strategies to understand their underlying causes and to design strategies for effective prevention and long-term care. Through multidisciplinary research and implementation partnerships, we advocate an integrated approach for research and healthcare for chronic diseases in Africa.

Background Diabetes mellitus (DM) is one of the most burdensome chronic diseases and is associated with shorter lifetime, diminished quality of life and economic burdens on the patient and society as a result of healthcare, medication, and reduced labor market participation. We aimed to estimate the direct (medical and non-medical) and indirect costs of DM and compare them with those of people without DM (ND), as well as the cost predictors. Methods and findings Observational retrospective case–control study performed in Mali. Participants were identified and randomly selected from diabetes registries. We recruited 500 subjects with DM and 500 subjects without DM, matched by sex and age. We conducted structured, personal interviews. Costs were expressed for a 90-day period. Direct medical costs comprised: inpatient stays, ICU, laboratory tests and other hospital visits, specialist and primary care doctor visits, others, traditional practitioners, and medication. Direct non-medical costs comprised travel for treatment and paid caregivers. The indirect costs include the productivity losses by patients and caregivers, and absenteeism. We estimate a two-part model by type of service and a linear multiple regression model for the total cost. We found that total costs of persons with DM were almost 4 times higher than total cost of people without DM. Total costs were $77.08 and $281.92 for ND and DM, respectively, with a difference of $204.84. Conclusions Healthcare use and costs were dramatically higher for people with DM than for people with normal glucose tolerance and, in relative terms, much higher than in developed countries.