Community Medicine
Permanent URI for this community
Browse
Browsing Community Medicine by Issue Date
Now showing 1 - 20 of 203
Results Per Page
Sort Options
Item Effect of cooking on the nutritive value of common food plants of Tanzania: Part 1—Vitamin C in some of the wild green leafy vegetables(Food Chemistry, 1983) Ndossi, Godwin D.The vitamin C (ascorbic acid) content of fresh and cooked material of sixteen varieties of wild leafy vegetables was estimated. In fresh leaves, the vitamin varied from 204 mg/100 g fresh weight in Moringa oleifera to 0·7 mg in Emilia javanica. When 20 mg samples were cooked in 400 ml of water, the vitamin C content decreased considerably. Losses observed ranged from 98·5% (Moringa oleifera) to nil (Emilia javanica). Smaller losses of the vitamin were observed when vegetable samples were cooked in 100 ml of water. Since most leafy vegetables are cooked prior to consumption, it is recommended that the vegetables are cooked in small amounts of water for short periods to minimise loss of vitamin C and that the cooking water be consumed if no bitter compounds are present.Item Response of plasmodium falciparum to chloroquine and quinine in hospital patients in Muheza,Tanzania(World Health Organization, 1984) Mutabingwa, Theonest K.The response of plasimodium falciparum to chloroquine when administered to malaria patients at a dosage of 25 mg base/kg body weight was studied in 104 indigenous case of malaria at Muheza Hospital in north eastern Tanzania.RII AND RIII grades of resistance to chloroquine were observed in 45.2% of all the case.A combination of quinine with sulfadoxine/pyrimethamine finally cleared the mult drug(chloroquine and quinine) resistant parasites.Item Chloroquine-resistant plasmodium falciparum at the Tanganyika planting company(TPC) sugar estate,moshi,Tanzania.(World Health Organization, 1985) Mutabingwa, Theonest K.From 1966 to 1978 the TPC maintained a mass malaria chemoprophylactic programme based on chloroquine.However after reports of treatment failure to 25 mg chloroquine base per kg body weight,the sensitivity of plasmodium falciparum to chloroquine at the TPC sugar estate near Moshi,northern Tanzania,was determined.In Vivo and In vitro test utilizing standard methods were carried out on semi-immune asymptomatic primary-school children whose ages ranged from 8 to 18 years,with a mean age of 12 years.These children were selected from a total of 746 school children who had been screen for malaria parasites and of whom 245(32.8%)were found to be to be positive.Item Chloroquine therapy still useful in the management of malaria during pregnancy in Muheza, Tanzania(Tropical and geographical medicine, 1991) Mutabingwa, Theonest K.In searching for effective malaria chemosuppressives during pregnancy in Muheza District--Tanzania, pregnant women are randomly given either 300 mg base chloroquine once weekly or 200 mg daily proguanil. Breakthroughs presenting with clinical malaria are treated with 25 mg base chloroquine/kg (25 CQ) over three days. Due to loss of malaria immunity during pregnancy and Muheza moderate levels and degrees of chloroquine resistance, the in vivo response to 25 CQ was monitored. Between March and May 1989, 49 women were treated resulting into 32 (65%) parasitological clearances and 17 (35%) failures within 7 days. Two of 17 failures (12%) exhibited RIII response and the remaining 15 (88%) had a favourable clinical response. Only 6 (19%) of 32 cleared patients either recrudesced or got reinfected during the three weeks follow up period. In addition to its safety and affordability, the observed drug efficacy during peak malaria transmission and inspite of prevailing resistance makes 25 CQ an ideal first line drug for the management of malaria during pregnancy.Item Measuring the Impact of Fatal Adult Illness in Sub-Saharan Africa; An Annotated Household Questionnaire Papers 90.(World Bank, 1992) Semali, Innocent A.This paper describes the developmentand content of a household questionnairedesignedto measurethe economicimpactof adultmorbidityand mortalityin an African country. The questionnaire is the main data collectioninstrumentof the research project on "The EconomicImpact of Fatal Adult Illness due to AIDS and Other Causes in Sub-SaharanAfrica", conductedby a research team from the WorldBank and the Universityof Dar es Salaam. The main objectivesof theproject are: (1) to measure the impactof fatal adult illnesson individuals,householdsand communities;and (2) to estimatethe costs and effects of alternativepoliciesto assist the survivors. The household questionnairewas adaptedfrom the questionnaireof the World Bank's Living Standards MeasurementSurvey (LSMS)to measurethe well-beingand copingbehaviorsof individuals and householdsin responseto fatal illnessamongadults. Key innovationsin the householdquestionnaire include: adaptationfor a longitudinalresearch design, including "inter-wave" consistencychecks; an expanded set of questionson acute and chronic illness and their costs; a module on the mortality of household membersand relatives; a consumptionmodule that allows for seasonality;and collectionof more data at the individuallevel, to facilitateanalysisof intra-householddistributionof resourcesItem Some aspects of traditional birth attendants' practice in a rural area in Tanzania(Transactions of the Royal Society of Tropical Medicine and Hygiene, 1992) Semali, Innocent A.As a pre-intervention study to improve the safety of the practice of traditional birth attendants, all 29 attendants in one rural area in Tanzania were interviewed, using a pre-tested questionnaire seeking information on the instruments used, care of the umbilical cord, and how they dealt with problem cases. The results are presented and discussed in this paper.Item Measuring the Impact of Fatal Adult Illness in Sub-Saharan Africa(Measuring the Impact of Fatal Adult Illness in Sub-Saharan Africa., 1992) Semali, Innocent A.This paper describes the development and content of a household questionnaire designed to measure the economic impact of adult morbidity and mortality in an African country. The questionnaire is the main data collection instrument of the research project on "The Economic Impact of Fatal Adult Illness due to AIDS and Other Causes in Sub-Saharan Africa", conducted by a research team from the World Bank and the University of Dar es Salaam. The main objectives of the project are: (1) to measure the impact of fatal adult illness on individuals, households and communities; and (2) to estimate the costs and effects of alternative policies to assist the survivors. The household questionnaire was adapted from the questionnaire of the World Bank's Living Standards Measurement Survey (LSMS) to measure the well-being and coping behaviors of individuals and households in response to fatal illness among adults. Key innovations in the household questionnaire include: adaptation for a longitudinal research design, including "inter-wave" consistency checks; an expanded set of questions on acute and chronic illness and their costs; a module on the mortality of household members and relatives; a consumption module that allows for seasonality; and collection of more data at the individual level, to facilitate analysis of intra-household distribution of resourcesItem Malaria in infants whose mothers received chemoprophylaxis: response to amodiaquine therapy(Tropical and geographical medicine, 1992) Mutabingwa, Theonest K.In October 1988, a project was implemented for assessing the malaria chemoprophylactic efficacy of weekly chloroquine (CQ) and daily proguanil (PROG) during pregnancy in Muheza-Tanzania. Resultant CQ and PROG-cohorts of infants were followed up for prompt diagnosis and treatment of malaria. Infections were primarily treated with 25 mg base amodiaquine/kg over 3 days. By September 1990, 49 and 60 infants from PROG and CQ cohorts respectively had completed one year follow up. Thirty-five (71%) infants of PROG and 44 (73%) for CQ-cohort were infected with malaria before 3 months of age. The one year mean infection episode rates were 7 (PROG-cohort) and 6.6 (CQ-cohort). Amodiaquine cleared 209 (80%) of PROG's total infections and 224 (81%) for CQ-cohort, and significantly reduced the infection load among clearance failures. Clearance failures had high pre-treatment parasite densities whilst post-treatment densities were higher in the CQ-cohort than PROG-cohort. Low malaria immunity and chloroquine's long residence time could explain these differences. We conclude that early infancy malaria is common and should always be suspected, looked for and adequately treated. Amodiaquine is better than chloroquine for malaria primary therapy during infancy and early childhood.Item Malaria chemosuppression in pregnancy I. The effect of chemosuppressive drugs on maternal parasitaemia(Tropical and geographical medicine, 1993) Mutabingwa, Theonest K.A randomized prophylactic drug trial was conducted in a malaria holoendemic area, in the Muheza District of Tanzania. Of 327 pregnant women, 124 received proguanil (PROG), 113 chloroquine (CQ), 90 the proguanil and chloroquine combination (CQ+PROG). Prophylaxis was supervised. Chemosuppressive efficacy was measured through the incidence of malaria breakthrough parasitaemias and clinical episodes. Groups were comparable by age, parity, residential area, and enrollment gestational age. Compliance and drug bio-availability was good. The median breakthrough time of the first parasitaemia episode for primigravidae (PG) and multigravidae (MG) was significantly shorter for the CQ group (PG = 56, MG = 78 days) than in the PROG (PG = 97, MG = 112 days) and the CQ+PROG (PG = 138, MG = 140 days) groups. 56% of the CQ group experienced 2 or more clinical episodes compared to 19% (PROG) and 10% (CQ+PROG). PROG and CQ+PROG did not differ significantly. Parasite densities and in vitro tests suggested that CQ selected for more and highly resistant strain(s). Proguanil is suitable for prophylaxis. However, proguanil resistance should be monitored as well as controlled drug distribution and usage. Malaria control strategies other than chemoprophylaxis should be investigated.Item Malaria chemosuppression during pregnancy IV. Its effects on the newborn's passive malaria immunity(Tropical and geographical medicine, 1993) Mutabingwa, Theonest K.The effect of malaria prophylaxis during pregnancy on the levels of cord blood anti-sporozoite antibodies was investigated in 203 newborns in Muheza, Tanzania. Mothers of 76 newborns had received prophylaxis with proguanil daily (PROG), 66 chloroquine once weekly (CQ), and 61 got a combination of the two drugs (CQ+PROG). Prophylaxis with PROG or CQ+PROG was more efficacious than with CQ. The mean antibody titres were comparable in all three groups, despite titres being significantly low in mothers of the CQ+PROG group. In 93% of 167 paired maternal-cord sera, maternal titres were higher than cord titres. The correlation between maternal and cord titres was low. Parity, placental malaria, and baby maturity showed little influence on titres. Titres of babies delivered by Caesarean section or whose placenta weighed between 0.75 and 1 kg were comparatively low. The first occurrence of a malaria parasitaemia in infants was independent of the levels of cord titres at birth. The results suggested that chemoprophylaxis as effective as PROG or CQ+PROG in holoendemic areas, insignificantly affects maternal-foetal transfer of anti-sporozoite antibodies, and that levels of these antibodies at birth do not modulate the first occurrence of infancy malaria parasitaemia. Interference with the maternal-foetal transfer of this antibody and possibly other component antibodies of passive immunity should not limit the selection of PROG or CQ+PROG for chemoprophylaxis.Item Malaria chemosuppression in pregnancy V. Placenta malarial changes among three different prophylaxis groups(Tropical and geographical medicine, 1993) Mutabingwa, Theonest K.The effect of malaria chemoprophylaxis during pregnancy on placenta malarial changes (PMCs) was investigated in 170 tissue sections. Women of 63 sections received daily proguanil (PROG), 61 once weekly chloroquine (CQ) and 46 the two drug combination (CQ+PROG). All were residents of a malaria hyperendemic area in Muheza District, Tanzania. Supervised prophylaxis started early in pregnancy till delivery. Parasitaemias and clinical episodes were detected early and radically treated. Overall, PMCs were mostly infrequent and light viz: fibrinous deposits (98%), fibrinoid necrosis (60%), leucocytic infiltrations (59%), macrophage containing pigment (16%), and malaria parasites (8%). The type, prevalence, and severity of the PMCs in the three prophylaxis groups were comparable. This was despite the fact that PROG and CQ+PROG were prophylactically more efficacious than CQ and despite the expectation that the prevalence and severity of the PMCs would be high in the CQ group. Prompt diagnosis and effective treatment of parasitaemias in this group contributed to the low prevalence and less severity. It is concluded that effective malaria chemoprophylaxis or prompt diagnosis and effective treatment of malaria parasitaemias have significant impact on the prevalence of PMCs. Due to various operational constraints in most developing countries, chemoprophylaxis remains the only feasible broad option for malaria control in pregnancy.Item Malaria chemosuppression in pregnancy. II. Its effect on maternal haemoglobin levels, placental malaria and birth weight.(Tropical and geographical medicine, 1993) Mutabingwa, Theonest K.The malaria prophylactic effects of chloroquine (CQ), proguanil (PROG), and chloroquine-proguanil combination (CQ+PROG) during pregnancy on maternal haemoglobin levels (Hb), placental malaria, and birth weight were assessed in Muheza, Tanzania. Within 2 months of prophylaxis, severe anaemia in primigravidae (PG) was reduced from 21% (22 cases) to 13% (13 cases). There was no positive effect in multigravidae (MG). Sustained increases in the mean Hb occurred in PG of the PROG and CQ+PROG groups. The mean Hb of PG of the CQ group decreased after an initial increase, possibly due to the selection of more and highly chloroquine-resistant strain(s). The mean birth weight of PG was highest in the CQ+PROG (2.89 kg) and least in the CQ group (2.71 kg). The CQ group had the highest low birth weight rate (LBW). The prevalence of placental malaria was highest in the CQ (28%) and lowest in the PROG group (12%). For all the prophylactic effects, PROG and CQ+PROG did not differ significantly. Thence, the deployment of CQ+PROG for prophylaxis would be unnecessary. Proguanil is a suitable alternative to chloroquine prophylaxis. Due to possible emergence of proguanil resistance, deployment of this drug should incorporate constant monitoring for resistance and the eventual prophylaxis efficacy. The search for other effective malaria control measures should continue.Item Malaria and pregnancy: Epidemiology, pathophysiology and control options(Acta Tropica, 1994) Mutabingwa, Theonest K.Extensive research on the epidemiology, pathophysiology, and control of malaria during pregnancy has led to new developments and some controversies. Meanwhile, malaria remains a major environmental factor causing serious pregnancy complications, whose incidence and severity depend on gestational age, parity, and the level of malaria endemicity. There is no cohesive explanation for pregnancy-related immunosuppression, though several pathophysiological hypotheses have been proposed. Furthermore, the emergence and rapid spread of chloroquine resistance has complicated the epidemiology, and the policy on alternative chemoprophylaxis. Chemoprophylaxis is probably the only available option for the control of malaria during pregnancy in Africa. However, the best delivery strategy still has to be established. Daily proguanil is the best chemoprophylactic drug at hand. Its deployment should include constant monitoring for the emergence of proguanil resistance, as well as controlled supervision of the distribution of the drug. New control options, such as the use of insecticide-impregnated bed nets, and intermittent targeted mass chemotherapy, require more operational research before they can be broadly recommended.Item Malaria chemosuppression during pregnancy. VI. Some epidemiological aspects of malaria in infants(Tropical and geographical medicine, 1994) Mutabingwa, Theonest K.The possible influence of maternal malaria prophylaxis on infancy malaria was assessed in 241 infants. Mothers of 91 infants (PROG-cohort), 99 infants (CQ-cohort) and 51 infants (CQ+PROG-cohort) had received prophylaxis with daily proguanil, once weekly chloroquine, and the two drug combination respectively. Blood smears of infants were examined for parasitaemia once fortnightly. Parasitaemias were treated with either amodiaquine, Fansidar, or Fansidar-quinine combination. In all cohorts, the incidence of malaria parasitaemias within 3 months of age was high (overall mean = 63%). Chloroquine released from its tissue bound form in the CQ and CQ+PROG-cohorts did not have significant chemosuppressive effects on the parasitaemias. Acknowledging that the CQ-prophylaxis group simulated the hypothetical control group, the cohorts similarity in the pattern of parasitaemias suggested that effective maternal malaria chemoprophylaxis during pregnancy did not significantly influence infancy malaria. A sharp rise in incidence around 3 months was indicative of the waning effect of passive immunity. Sole dependence on sub-optimal active immunity led to another sharp rise in incidence from 9 months onwards. The high incidence of infancy malaria parasitaemias calls for increased vigilance in their early detection and effective treatment. Social-cultural factors within the communities may constrain effective disease management.Item Self-medication with antimalarial drugs in Dar es Salaam, Tanzania(Tropical and geographical medicine, 1995) Kabalimu, Titus K.A hospital-based cross-sectional study was conducted in Dar es Salaam, Tanzania, using a questionnaire to assess the extent of self-medication with antimalarial drugs and malaria treatment-seeking behaviour among patients attending out-patient treatment at Mnazi mmoja dispensary. It was found that 15.3% of respondents admitted to having ever used malaria chemoprophylaxis while 8.0% reported to be current users of chemoprophylaxis. Among the current users of malaria chemoprophylaxis, some reported having used quinine and Fansidar. While 71.7% reported having treated themselves with home-kept antimalarial drugs for a suspected malaria fever, 14.7% consulted traditional healers. The data suggest the need for increasing public awareness on malaria and appropriate use of antimalarial drugs.Item A Profile of traditional healers in an area hard-hit by the AIDS Epidemic: Kagera region, Tanzania.(World Bank, 1995) Semali, Innocent A.Throughout Sub-Saharan Africa, traditional medical practitioners are often the most accessible source of medical care, particularly in rural areas where modern care is relatively scarce. …Item Perception and utilisation of malaria prophylaxis among pregnant women in Dar es Salaam, Tanzania(East African medical journal, 1995) Kabalimu, Titus K.Knowledge, perception and utilisation of malaria prophylaxis were assessed among pregnant women attending antenatal care clinic in Dar es Salaam, Tanzania. Of the 301 women interviewed, 71.1% reported having used chloroquine prophylaxis while 28.9% did not. Women with high knowledge of malaria were more likely to use malaria prophylaxis than those with low knowledge. However, there was no significant association between knowledge of malaria and perceived effectiveness of the various methods of malaria control. Chloroquine side effects and perceived lack of protective effect against malaria were mentioned as causes of failure to use chloroquine prophylaxis. Fear of chloroquine-induced pruritus accounted for the largest proportion (49.4%) of women who reported having failed to use chloroquine prophylaxis. Occurrence of malaria episodes was reported to be similar among users and non-users of malaria prophylaxis probably due to inconsistent use of malaria prophylaxis and reduced chloroquine sensitivity of malaria parasites. It is suggested that, in addition to chemoprophylaxis, pregnant women should be encouraged to use bednets in combination with mosquito repellents throughout the course of pregnancy.Item Chloroguanide metabolism in relation to the efficacy in malaria prophylaxis and the S‐mephenytoin oxidation in Tanzanians(Clinical Pharmacology & Therapeutics, 1996) Mutabingwa, Theonest K.S‐Mephenytoin and chloroguanide (proguanil) oxidation was studied in 216 Tanzanians. The mephenytoin S/R ratio in urine ranged from <0.1 to 1.16. The distribution was skewed to the right, without evidence of a bimodal distribution. Ten subjects (4.6%, 2.2% to 8.3%, 95% CI) with an S/R mephenytoin ratio >0.9, were arbitrarily defined as poor metabolizers of mephenytoin. The chloroguanide/cycloguanil ratio ranged from 0.82 to 249. There was a significant correlation between the mephenytoin S/R ratio and the chloroguanide/cycloguanil ratios (rs = 0.73; p < 0.00001). This indicates that cytochrome P4502C19 or CYP2C19 is a major enzyme that catalyzes the bioactivation of chloroguanide to cycloguanil. Chloroguanide is a pro‐drug, and hence a low CYP2C19 activity may lead to prophylactic failure caused by inadequate formation of cycloguanil. Fifty‐eight women who previously took either 200 mg chloroguanide daily (n = 26) or 200 mg chloroguanide daily plus 300 mg chloroquine weekly (n = 32) in a malaria chemoprophylaxis study showed that there was a significant correlation between the number of earlier breakthrough parasitemia episodes and the chloroguanide/cycloguanil ratio (rs = 0.30; p = 0.02). The breakthrough rate did not correlate with the S/R mephenytoin ratio. However, other factors, such as exposure to mosquitoes and sensitivity of the plasmodium to cycloguanil, are probably more important.Item Patient satisfaction with emergency oral health care in rural Tanzania(Community dentistry and oral epidemiology., 1998) Ntabaye, Moshi K.Emergency oral health care, as conceived in Tanzania, is an on‐demand service provided at a rural health center or dispensary by a Rural Medical Aide. The service includes: simple tooth extraction under local anesthesia, draining of abscesses, control of acute oral infection with appropriate drug therapy, first aid for maxillo‐facial trauma, and recognition of oral conditions requiring patient referral for further care at the district or regional hospital dental clinic. The objective of the present study was to describe patient satisfaction with emergency oral health care services in rural Tanzania and determine the relative importance of factors influencing patient satisfaction. The study was carried out as a cross‐sectional interview survey between April 1993 and May 1994 using a patient satisfaction questionnaire in rural villages in the Rungwe district of Tanzania. It included 206 patients aged 18 years or more who had received emergency oral health care between April 1993 and March 1994. Overall, 92.7% of the respondents re‐ported that they were satisfied with the service. Patients who were married, had no formal education and lived more than 3 km from the dispensary were more likely to be satisfied with treatment. In a logistic regression model, a good working atmosphere at the dispensary, a good relationship between care provider and patients (art of care) and absence of post‐treatment complications significantly influenced patient satisfaction with odds ratios of 10.3, 17.4 and 6.2, respectively.Item The impact of AIDS mortality on individual fertility: evidence from Tanzania(Mortality decline and reproductive change, 1998) Semali, Innocent A.During the European demographic transitions, fertility decline was often but not always preceded by an aggregate decline in mortality (Matthiessen and McCann, 1978). In sub-Saharan Africa, high levels of child mortality are thought to be an impediment to fertility decline. Caldwell et al. (1992), for example, suggest that a decline in infant mortality to levels below 70 per 1,000 may be a prerequisite for the onset of fertility decline, based on the experience of Botswana, Kenya, and Zimbabwe. Child mortality has declined and life expectancy increased in sub-Saharan Africa in recent decades, but the spreading AIDS epidemic threatens this progress. Nearly two-thirds of the 23 million people currently infected with human immunodeficiency virus (HIV) worldwide live in sub-Saharan Africa (UNAIDS data, cited in Ainsworth and Over, 1997). AIDS is fatal and is striking two key groups—sexually active adults who become infected through sexual relations and very young children who are infected from their mothers at birth or while breastfeeding. The impact of AIDS on mortality is difficult to measure, as vital registration systems in sub-Saharan Africa are subject to extensive underreporting (Stover, 1993). However, the U.S. Bureau of the Census predicts that the decline in African infant and child mortality will be stalled and reversed as a result of the AIDS epidemic (Way and Stanecki, 1994). Nicoll et al. (1994) predict that mortality of children under the age of 5 in severely affected urban areas will increase by one-third in eastern and central Africa and by as much as three-quarters in southern Africa, sharply diminishing the existing differentials in child mortality between urban and rural areas. Furthermore, levels of adult mortality in the age group 15-50 can be expected to double, triple, or even quadruple in some locales. What will be the impact of heightened mortality from AIDS on fertility in sub-Saharan Africa? There is remarkably little empirical evidence on this issue. In fact, demographic modelers of the impact of the AIDS epidemic commonly assume no fertility response to AIDS mortality. For example, The AIDS Epidemic and its Demographic Consequences (UN/WHO, 1991) presents seven mathematical models for the demographic consequences of the spread of HIV, none of which includes an individual fertility response. The World Bank's AIDS-adjusted population projections assume no interaction between HIV prevalence and fertility (Bos and Bulatao, 1992). In this chapter we review the channels through which we might expect both positive and negative fertility responses to the heightened mortality of the AIDS epidemic, summarize the evidence to date, and present new evidence of the response of individual fertility behavior to heightened mortality based on three data sets from Tanzania. In the next section we provide an overview of levels of HIV infection in sub-Saharan Africa and the relation between HIV infection and mortality. This is followed by a discussion of the channels through which heightened mortality from AIDS might induce changes in fertility. In the fourth section we present results of multivariate analysis of individual fertility using three data sets from Tanzania—two national and one from the severely affected Kagera region. The results suggest that, although there is evidence of a positive effect of heightened child mortality on fertility, adult mortality at the household and community level tends to be associated with lower individual fertility. These results are supported by an analysis of the effect of mortality on other indicators of fertility intentions, such as the desire for additional children and patterns of sexual behavior.