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HIV, HPV, and Oral Health in Tanzania: A scoping review
(MedRxiv,, 2025-02-06) Semali,Innocent A.; Moshi,Mainen J.; Mwaiswelo, Richard O.; Mashalla,Yohana J.
Background There is an increased risk of human papillomavirus (HPV)-associated infections and malignancies among people living with HIV (PLHIV). However, there is limited literature exploring the intersection of HPV, HIV, and oral health in Tanzania and across sub-Saharan Africa. We reviewed the existing literature on the intersection of HIV, HPV, and oral health in Tanzania. Methods This was a scoping review with the search of key words representing HIV, HPV, oral health, and Tanzania. Since there were no studies that explored the intersection of HIV, HPV, and oral health in Tanzania, the search extended to include studies with the intersection between oral health and either HIV or HPV in Tanzania. Findings 44 studies were eligible for analysis. Only one of them explored the relationship between HPV and oral health, where 4 (6%) of adolescent schoolgirls were detected with HPV-DNA and the paper hinted at the possibility of HPV autoinoculation. There were no articles linking HPV vaccination and oral health. The remaining 43 (98%) studies explored the relationship between HIV and oral health. There has been an increase in oral manifestations in PLHIV in the last two decades, and highly active antiretroviral therapy has been protective against oropharyngeal candidiasis but had no significance on head and neck cancer. Single-dose fluconazole and 35% herbal antifungals were identified to be effective in treating oral candidiasis. No recent studies explored the different facets of dental care among PLHIV. Interpretation There are no studies exploring the intersection of HIV, HPV, and oral health in Tanzania. Future studies are needed to determine the burden and barriers of HPV-associated oral manifestations among PLHIV in Tanzania and across Sub-Saharan Africa.
The influence of survival strategies on access to healthcare services by the elderly in Bagamoyo district, Pwani Region, Tanzania
(African Journal of Emerging Issues, 2025) Ndossi,Godwin D.
Purpose of the Study: This study aimed to determine the influence of survival strategies on healthcare access for elderly individuals in Bagamoyo District, Pwani Region, Tanzania. Research Methodology: The study employed a pragmatic research philosophy with a mixed-method research design. Data were collected from 237 primary respondents, elderly aged 60 and above seeking healthcare services at the selected 14 health facilities, using multistage and random sampling, and purposive sampling techniques for the key informants. The methodology integrated quantitative surveys and qualitative approaches, including structured questionnaires, key informant interviews, and focus group discussions. Data analysis utilized descriptive and inferential statistical techniques, including multiple linear regression and thematic content analysis. Findings of the Study: The study identified that longer waiting times negatively impact healthcare utilization, and the quality of doctor-patient relationships plays a crucial role in accessing healthcare services. Family support was found to be inconsistent, with only 56.1% of respondents reporting consistent assistance. Conclusion: The study concludes that survival strategies significantly influence healthcare access for elderly individuals in Bagamoyo District. Recommendation: The study recommends a multifaceted approach to improving elderly healthcare access, including expanding health insurance coverage, implementing healthcare subsidies, streamlining service delivery, and enhancing doctor-patient relationships through specialized geriatric care training.
Factors Influencing Outcomes of Diabetic Foot Management: Retrospective Study at Mwananyamala Regional Referral Hospital.
(www.easpublisher.com, 2024-10-21) Kabalimu, Titus K.
Background: Diabetic foot ulcers (DFUs) contribute to significant morbidity and mortality worldwide, with the global prevalence of diabetes expected to rise to 12.2% by 2045, an increasing number of people are at risk for complications like DFUs, which affect 19% to 34% of diabetic patients. People with DFUs carry a 20% lifetime risk of limb amputation and mortalityrate of 50% to 70%. In Tanzania DFUs account for 41.9% of major limb amputations and mortality rate of 54%. Methods: A retrospective observational study aimed to investigate the clinical factors, and treatment modalities that influence the management outcomes of diabetic foot among patients attending Mwananyamala Regional Referral Hospital (MRRH). The study reviewed existing patient records. Results: A total of 143 participants were enrolled in the study, of which 94 (65.73%) were female. The participants had a mean age of 57 ± 13.9 years. And approximately half (50.35%) were married. Nearly, all patients, 140 (97.90%), underwent surgical treatment, nearly half (41.96%) had DFU Wagner Class 3 while most of participants (69.93%) had hypertension. The mean hospital stay was 9.2 days. In binary logistic regression model output, marital status, level of education, working diagnosis, surgical management, patient progress and number of readmissions were identified as determinants of the outcome (P-value < 0.05). Conclusion: This study identified key factors influencing diabetic foot outcomes, including gender, marital status, co-morbidities and ulcer grade. These findings underscore the importance of early diagnosis, targeted interventions, and comprehensive management to improve patient outcomes.
A radiological approach to ischemic stroke in a young adult non hypertensive patient
(EC Paediatrics, 2024-02-16) Kabalimu, Titus K.; Rutachunzibwa, Fred F.
Stroke is the second leading cause of death above the age of 60 years, and the fifth leading cause in people aged 15 to 59 years old as reported by the World Health Organization global burden of diseases [1]. Hypertension is the leading risk factor for stroke in Tanzania, and its early detection, treatment and management cannot be overemphasized. Previous studies in SSA have demonstrated that 45% of all strokes could be prevented by simply measuring and controlling blood pressure. It is notable that in Tanzania, stroke occurs at a much younger age with later presentation associated with devastating outcomes. Hospital-based studies have reported early mortality ranging from 30 - 60% [2]. Other related known modifiable risk factors for stroke, of which smoking, and hypercholesterolaemia have been mentioned [3]. HIV infection is a notable finding, and associated with an increase of five times in risk of stroke [3]. Stroke in the young is particularly tragic because of the potential to create long-term disability, burden on the victims, their families, and the community at large. Despite this, there is limited data on stroke in young adults, and its risk factors in Tanzania. Therefore, in this case study we determined important radiological investigation that can possibly establish the diagnosis to this young adult patient who presented with weakness on the left side at Kairuki Hospital.
Giant Bullae as a Great Mimicker of Pneumothorax in a symptomatic young adult Individual seen on CXR and CT chest
(EC Paediatrics, 2024-01-02) Rutachunzibwa, Fredy; Kajugusi, Julieth; Kabalimu, Titus K.
Giant pulmonary bulla (Vanishing Lung Syndrome) is a rare condition which is usually associated with male gender and smoking habits. Sometimes such patients may present with symptoms like chest pain while other patients may become asymptomatic. In this report we describe a patient with a giant pulmonary bulla occupying the whole right upper lobe inferiorly compressing the middle lobe and lower lobe with transmediastinal herniation at the level of the anterior junctional zone as per CT Chest, who had history of occasional attacks of lower right chest pain. Having diagnosed the patient in our facility, he was referred to another facility for possible bullectomy.
Kagera health and development survey 2004. Basic Information Document.
(World Bank, 2006) Semali, Innocent A.
The Kagera Health and Development Survey 2004 (KHDS 2004) took place in 2004 as a fifth round following on the four rounds of the baseline Kagera Health and Development Survey 1991-1994 (KHDS 91-94). The KHDS 2004 was designed to provide data to understand economic mobility and changes in living standards of the sample of individuals interviewed 10- 13 years ago. The KHDS 2004 attempted to reinterview all respondents ever interviewed in the KHDS 91-94. This entailed attempting to track these individuals, even if they had moved out of the village, region or country. This document is designed to give information to enable proper and effective use the KHDS 2004 data. Since much of the KHDS 2004 is based on the original baseline 1991-1994 KHDS, data users are encouraged to carefully review “User’s Guide to the Kagera Health and Development Survey Datasets.” (World Bank, 2004), which serves to complement this KHDS 2004 basic information document. For papers using the KHDS 2004 data, we recommend that this document be cited as follows: Beegle, Kathleen, Joachim De Weerdt, and Stefan Dercon. (2006). Kagera Health and Development Survey 2004 Basic Information Document. mimeo. The World Bank.
User’s guide to the Kagera health and development survey datasets. Development Research Group.
(The World Bank, 2004) Semali, Innocent A.
It has long been established that poverty worsens health. It has been more difficult to establish that poor health worsens poverty or that health improvements can stimulate economic growth. The AIDS epidemic has dramatically raised the mortality rate among adults in their most productive years in Sub-Saharan Africa. What will be the impact on poverty and human capital, in a region where incomes, schooling, and health status are already low? To answer this question and to contribute to improved design of cost-effective programs to deal with the impact on households, the Population and Human Resources Department and the Africa Technical Department of the World Bank jointly launched a research project on “The Economic Impact of Fatal Adult Illness from AIDS and Other Causes in Sub-Saharan Africa” in 1991.1 To measure the impact of adult mortality and morbidity on the welfare of individuals and households, the research project launched a longitudinal household survey, known as the Kagera Health and Development Survey (KHDS), in the Kagera region of Tanzania from 1991-94. This region of 1.9 million people, located on the western shore of Lake Victoria adjacent to Uganda and Rwanda and not far from Zaire, is at a political and economic crossroads that is also at the epicenter of the AIDS epidemic in East Africa. The first case of AIDS in Tanzania was identified in Kagera in 1983, and subsequent serological studies have found infection rates among adults as high as 24% in the regional capital of Bukoba in the late 1980s (Killewo and others 1990). The KHDS interviewed more than 800 households from nearly 50 communities in all five districts of Kagera. Households, community leaders, health facilities, schools, and market vendors were queried in 6-7 month intervals for up to four survey periods. Traditional healers were also interviewed once. Although the KHDS questionnaires were adapted from the World Bank’s Living Standards Measurement Study (LSMS) questionnaires, the KHDS was unique because it was fully longitudinal.2 The panel design offered the researchers the opportunity to measure the change in household consumption and assets between interviews, and thus, to estimate household saving or dissaving—key household-level coping mechanisms. This document describes the KHDS research design, sampling and survey organization, the questionnaires, and the basic structure of the data for researchers who wish to use the KHDS datasets. Copies of all questionnaires and the interviewer and supervisor manuals can be obtained from the Living Standards Measurement Study web site
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. …
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 resources
Reconciling attitudes and behavior in organic food retailing
(2000) Semali, Innocent A.
For organic food to reach the average consumer will require greater penetration into conventional supermarkets. Product placement can be expanded into more stores by altering attitudes that lower the probability of selling organic foods. This study identified significant factors in the retail decision to sell organic foods and quantifies the effects of retailer attitudes on behavior. We used a probit model to quantify the effect of customer demographics, store characteristics, manager characteristics, and profitability of organic retailing on the decision to sell organic foods. The model was based on interview data collected in Atlanta, Georgia from 66 retailers who sell organic foods and 21 who do not. Our research indicates that organic education programs can be a cost-effective way to expand market penetration without requiring changes in price or cost premiums. If properly composed and targeted, such programs can alter underlying attitudes and increase the probability of selling organic foods.
Risk sexual behaviors and consistent condom use among adults living with HIV/AIDS in Mtwara Urban District, Tanzania.
(East African Journal of Public Health, 2018) Semali, Innocent A.
Objective: People living with HIV/AIDS, aware or unaware of their sero-status, form the main source of HIV transmission. Risk sexual behaviors among HIV infected persons have been studied in different parts of the world, with considerable variations and contexts. Regular efforts to study their behaviors are imperative in the struggle to mitigate the HIV/AIDS epidemic. We set out to determine risk behaviors and condom use among people living with HIV/AIDS in Mtwara urban district in Tanzania. Methods: Through a systematic sampling method, we selected 240 adults living with HIV/AIDS attending care and treatment centres in Mtwara urban district. We used an interview schedule to collect data from the respondents after individual verbal consent. Multivariate logistic regression models were employed to assess correlates of condom use. Results: The mean age of respondents was 40.9 (±10.3 SD) years, and 164 (68.4%) were female. Majority were married or cohabiting and had primary education. Sexual debut was generally early, with 43.3% and 42.1% of female and male respondents respectively reporting sexual debut before 18 years. All respondents had multiple sexual partners prior to HIV diagnosis, while only 6.7% of female and 15.8% of male reported having multiple sex partnerships post diagnosis. Consistent condom use increased significantly post HIV diagnosis, from 9.2% to 35.4% (p< 0.0001) among female and from 8.1% to 25.8% (p=0.013) among male. Having post primary education increased the odds of using condom in the last sex (aOR 4.3, 95% CI: 1.1–17.5). Conclusion: People living with HIV/AIDS in Mtwara reduced number of sex partners significantly post HIV testing. Although the proportion using condom consistently post HIV diagnosis increased significantly, findings suggest that condom use in this population is not a common practice, leading to an increased risk of re-infection and infecting their partners. We therefore recommend for more research to document motivational factors for using condom especially among people diagnosed with HIV infection.
Associations and healers: Attitudes towards collaboration in Tanzania. In The professionalisation of African medicine
(Routledge, 2018) Semali, Innocent A.
The establishment of an effective organisation or association of healers may be considered as one step towards the professionalisation of traditional healers. In Tanzania there is no law which prohibits or governs the practice of traditional medicine. In Tanzania there have been a number of efforts to promote traditional medicine. The association (UWATA) attracted many traditional healers within the urban set-up, some of whom were not traditional healers but quacks, while others were opportunists. Many people have urged the incorporation or collaboration of traditional medicine with modern health care. In general, traditional healers have been eager to form associations but faced with leadership problems. Umoja wa Waganga Tanzania or Traditional Healers' Union of Tanzania managed to open a number of treatment centres in the country. Its members were always coming forward to display their talents to cure, and they organised several treatment sessions in a number of areas throughout the country.
Understanding the magnitude of occupational exposure to human immunodeficiency virus (HIV) and uptake of HIV post-exposure prophylaxis among healthcare workers in a rural district in Tanzania.
(Journal of Hospital Infection, 2017) Semali, Innocent A.
Background Occupational exposure to blood or other body fluids in healthcare settings puts healthcare workers (HCWs) at risk of acquiring human immunodeficiency virus (HIV) infection. It is estimated that between 200 and 5000 HIV infections are transmitted annually to HCWs worldwide. Use of post-exposure prophylaxis (PEP) has been documented to reduce the rate of HIV infection from workplace exposures by 81%. Aim To investigate the extent of occupational exposure to HIV infection during the period of 12 months before the survey and to identify factors associated with uptake of PEP services among HCWs. Methods We interviewed 221 HCWs from selected healthcare facilities in Kongwa, Tanzania. Data included occupational exposures to body fluids, knowledge and use of PEP. Findings Sixty (27.1%) of the HCWs had experienced exposures to blood and body fluids, of whom 71.7% (43/60) had needlestick injuries. Medical attendants were more frequently exposed, followed by nurses (31.7% and 28.6% respectively). Of the exposed HCWs, seven (11.7%) reported use of HIV PEP. Reporting of exposure [odds ratio (OR): 8.44; P = 0.016], knowledge of the HIV status of the source patient (OR: 42.19; P = 0.007) and awareness of PEP (OR: 12.72; P = 0.010) were significant predictors of PEP use. Conclusion Uptake of PEP services among HCWs remains low despite high rate of occupational exposures. Wider dissemination of HIV PEP guidelines and training of HCWs is required in Tanzania to ensure that HCWs have knowledge of, and prompt access to, PEP services.
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.
Cervical cancer prevention in Tanzania: Health services and health policy influences on a preventable cancer
(Research gate, 2010) Semali, Innocent A.
Background: Cervical cancer is the leading cause of cancer death among women in Tanzania. Fewer than 20% of women in Tanzania present for care when cervical cancer disease is in its early, preventable stages. Development of structural factors related to health policy and health services may alleviate disease mortality and morbidity. Methods: Fifty stakeholders from government, nongovernmental, and healthcare organizations including the Tanzanian Ministry of Health (MOH) completed semi-structured face-to-face interviews to determine existing health services for cervical cancer, and capacity for implementation of a community-based program to promote screenings. Each interview lasted approximately two hours and was comprised of individuals and teams of stakeholders. Qualitative data analyses were performed using NVivo software. Results: Qualitative themes were related to political will, health services infrastructure, and partnership building. Political will and public/private collaboration exists for the development of a program to facilitate screenings for cervical cancer. The MOH committed to improve health services by increasing capacity for cervical cancer screen and treat protocols. Additionally, a public/private team will develop a strategic plan for cervical cancer control and prevention to define specific health policies and screening recommendations. Conclusion: Increasing the capacity for cervical cancer screenings will improve reproductive health services for women. Additionally, the development of cervical cancer screening policies may decrease deaths and presentation of late stage disease. Cervical cancer prevention is a public health imperative for women in low resource settings. It is a preventable cancer and therefore a major social justice issue affecting women, their families and communities.
Total liver vitamin A reserves, determined with 13C2-retinol isotope dilution, are similar among tanzanian preschool children in areas with low and high vitamin A exposure
(The Journal of Nutrition, 2022) Ndossi, Godwin D.
Background In Tanzania, some districts have single vitamin A (VA) interventions and others have multiple interventions. There is limited information on total liver VA reserves (TLRs) among preschool children (PSC) in Tanzania. Objectives We assessed total body VA stores (TBSs) and TLRs among PSC living in 2 districts with low and high exposures to VA interventions using 13C-retinol isotope dilution. Methods A cross-sectional, health facility–based study was conducted in 2 districts with access to VA supplementation only (low exposure to VA interventions) or multiple interventions (high exposure to VA interventions) to determine TLRs in 120 PSC aged 36–59 months. A questionnaire was used to collect data. Height and weight were measured, and the prevalence of undernutrition was based on z-scores. Blood samples were collected for measurement of TBSs, TLRs, retinol, biomarkers of infection and inflammation, and hemoglobin. 13C2-retinyl acetate (1.0 μmol) was administered to each child after blood collection, and the second sample was taken 14 days later. Serum was analyzed with HPLC and gas chromatography-combustion-isotope ratio mass spectrometry. Mann-Whitney U test was used to compare medians of nonnormally distributed variables. Pearson χ2 test was used to assess associations between 2 categorical variables. Results Median TBSs differed between PSC from low-exposure (196 μmol; IQR, 120 μmol) and high-exposure (231 μmol; IQR, 162 μmol) intervention areas (P = 0.015). Median TLRs were 0.23 μmol/g liver (IQR, 0.14 μmol/g liver) and 0.26 μmol/g liver (IQR, 0.16 μmol/g liver) from low- and high-exposure areas, respectively, which did not significantly differ (P = 0.12). Prevalences of VA deficiency (VAD; ≤0.1 μmol/g liver) were 6.3% and 1.7% for PSC from low- and high-exposure areas, respectively. There was no significant difference in VAD (P = 0.25). No child had hypervitaminosis A (≥1.0 μmol/g liver). Conclusions TLRs in Tanzanian PSC from 2 districts did not differ between low and high exposures to VA interventions. The majority had adequate VA stores. VAD in the study area presented a mild public health problem.
Malaria prophylaxis in pregnancy:result from a field trial conducted in Kigoma urban district in western Tanzania
(Tanzania Public Health Association, 2001) Kabalimu, Titus K.
A randomized study field study was conducted to assess the effectiveness of the chemoprophylactic regiments during pregnancy in Kigoma urban district. The study objective was to assess the effectiveness of alternative strategies of malaria chemoprophylaxis on the reduction of malaria episodes and the prevalence of parasitaemia among pregnant women attending maternal and childbirth (MCH) clinics. Study intervention measures were intermittent and continuous malaria chemoprophylaxis using chloroquine and proguanil. The study was conducted at two randomly selected antenatal care clinics as part of routine antenatal care services. Consecutive eligible pregnant women having their first and second pregnancies (designated as primigravidae) were randomized to chloroquine (continuous and intermittent prophylaxis)and proguanil (paludrine). Women having three or more pregnancies (multigravidae) were randomized to chloroquine(intermittent prophylaxis and chemotherapy when ill) and proguanil. Proguanil (paludrine). Women having three or pregnancies (multigravidae) were randomized to chloroquine (intermittent prophylaxis and chemotherapy when ill) and proguanil. Proguanil (continuous) was the golden standard for prophylaxis in both groups. Baseline laboratory investigations (hemoglobin, blood slide for malaria parasites and stool) and other routine clinic measurements were recorded, and women found with any infection were treated and some were referred to the regional hospital. There were follow-up studies consisting of a series of measurements and recording of all parameters as baselines; for each woman during subsequent visits to the clinic until delivery. A total of 705 eligible women registering at the clinic participated in the study and 701 had baseline results recorded. At baseline 17.8% (N=701) had helminithic infection; 9.3% (N=701) had malaria parasitaemia, while 71.1% (N=578) had anemia. Results: After 4 visits to the antenatal clinic, parasitaemia was reduced to 1.3% (N=578), and anemia drastically reduced from 71.1% to only 14.5 (N=578) during the intervention with chemoprophylaxis. However, there was no significant difference in the occurrence of a few malaria episodes/ parasitaemia and anemia among women receiving continuous prophylaxis with pronguanil as compared to those getting either continuous or intermitted chloroquine prophylaxis. The conclusions made from the study are clear usefulness of chemoprophylaxis as a practice in reducing anemia and malaria parasitaemia during pregnancy. Secondly, the chemoprophylactic regimens tested in this study had similar effects in reducing malaria parasitaemia episodes and pronguanil showed better either outcome results, though the difference was not statistically significant. These results pose a dilemma as well as challenges in malaria control programmes in Tanzania and, indeed suggest that results obtained in malaria holoendemic areas may not be easily generalizable to other parts of Tanzania.
Opportunistic Infections and Associated Factors among HIV Infected Patients on anti-retroviral treatment at Bombo Hospital in Tanga Region, Tanzania
(African Journal of Health Sciences, 2022) Kabalimu, Titus K.; Sungwa, Edson.; ;
BACKGROUND A substantive number of People Living with HIV (PLHIV) develop Opportunistic Infections (OIs). The introduction of Anti-Retroviral Therapy (ART) in Tanzania led to a significant decline in opportunistic infections and a slower progression to AIDS, but OIs are still prevalent. This study was set to determine the magnitude of OIs and associated factors among HIV/AIDS patients on Anti-Retroviral Therapy (ART) attending care and treatment clinic at Bombo Regional Referral hospital, Tanga region. MATERIALS AND METHODS A cross‐sectional descriptive study was conducted on HIV/AIDS patients on ART attending Bombo Hospital in Tanga from July to October 2019. A non-probability, consecutive sampling technique was employed to obtain study participants. Data were collected using available data obtained from the patients’ files, hospital record books and interviews of study participants by using semi-structured questionnaires. Data were entered into the computer using Excel 2013, cleaned and analysed using Epi Info version 7.2.2.6. Any p-value of < 0.05, at a 95% confidence interval was regarded as statistically significant. RESULTS The study showed that out of the 360 participants, 126 cases (35.0%) of OIs were reported. Pulmonary Tuberculosis had the highest prevalence of 18.0% among PLHIV while other opportunistic Infections altogether contributed 17.0%. Late ART initiation (OR=10.9, 95% CI: 6.5 – 18.3, p-value <0.001), Poor drug adherence (OR=19, 95% CI: 9.0 – 39.7, p-value <0.001), female gender (69% vs. 31%), which was however, not statistically significant (p-value – 0.904), Informal and Primary School education (OR = 1.6, 95% CI: 1.1 – 1.6, p-value 0.04) being married (OR=2.1, 95% CI: 1.3 – 3.4, p – value 0.004) and widowed/widower (OR=7.7, 95% CI: 1.7 – 33.7, p – value 0.007) respectively were found to be associated with OIs to PLHIV. CONCLUSION The rate of OIs still high among PLHIV, Pulmonary Tuberculosis is the leading disease with 18.0% of all OIs symptomatic patients. Delay in ART initiation after positive test results, poor drug adherence and moderate malnutrition have been identified as major risk factors affecting 66.0%, 70.0%, 71%of PLWHA with OIs. We recommend early initiation of ART, Education on ART adherence and refilling of large quantities of ARV drugs to individuals working far from their homes.
A possible role for proguanil-dapsone against SP-resistant P.falciparum?
(East African Network for Monitoring Antimalaria Treatment, 2001) Mutabingwa, Theonest K.
A two-armed trial was conducted in July 2000 in 4 villages near Muheza, Tanga Region, in Tanzania, asymptomatic children with P.falciparum parasitaemia > 200/ul (Mutabingwa et al. 2001 Trans Roy Soc Trop Med Hyg 95: 433-438). In one of the arms 188 children were treated with sulfadoxine-pyrimethamine and only 14.3% showed parasite clearance at day 7 (16.1% at day 14). The SP batch used was checked for good quality and the low clearance rate is indicative of one of the worst levels of SP resistance yet recorded in Africa. SP resistance in this area has increased from about 20% in 1995 (Trigg et all 1997 Acta Trop 63: 1865-189) to 45% in 1998/9 (Mutabingwa et al 2001 Lancet 358: 1218-1233) and is now 86%
Influence of placental and peripheral malaria exposure in fetal life on cardiometabolic traits in adult offspring
(BMJ Open Diabetes Research and Care, 2022-03-13) Mutabingwa, Theonest K.
Introduction Fetal malaria exposure may lead to intrauterine growth restriction and increase the risk of developing diabetes and cardiovascular diseases in adulthood. We investigated the extent to which fetal peripheral and placental malaria exposure impacts insulin sensitivity and secretion, body composition and cardiometabolic health 20 years after in utero malaria exposure. Research design and methods We traced 101 men and women in Muheza district, Tanga region whose mothers participated in a malaria chemosuppression during a pregnancy study in 1989–1992. All potential participants were screened for malaria, hepatitis B and HIV to ascertain study eligibility. Seventy-six individuals (44 men, 32 women) were included in this cohort study. The participants underwent a thorough clinical examination including anthropometric measurements, ultrasound scanning for abdominal fat distribution, blood pressure, 75 g oral glucose tolerance test, an intravenous glucose tolerance test followed by a hyperinsulinemic euglycemic clamp and a submaximal exercise test. Results Offspring exposed to placental malaria during pregnancy had significantly higher 30-minute plasma post-glucose load levels, but no significant difference in peripheral insulin resistance, insulin secretion or other cardiometabolic traits compared with non-exposed individuals. Conclusions Using the state-of- the- art euglycemic clamp technique, we were unable to prove our a priori primary hypothesis of peripheral insulin resistance in young adult offspring of pregnancies affected by malaria. However, the subtle elevations of plasma glucose might represent an early risk marker for later development of type 2 diabetes if combined with aging and a more obesogenic living environment.

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