Search

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

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

Malaria transmission varies from one area to another and there are also local difference in time and space. The objective of the study was to determine the local variability of entomological parameters namely, mosquito abundance, human biting rate (HBR), sporozoite rate for Plasmodium falciparum and entomological inoculation rate (EIR). The study was carried out in Rufiji District south eastern Tanzania from October 2001 and September 2004. Adult mosquitoes were collected indoors by CDC light traps. PCR was employed to identify the species within the Anopheles gambiae complex. ELISA was used to determine the sporozoite rate. Over a three year sampling period a total of 64,875 female mosquitoes were caught using light-traps, and of these 28% were Anopheles gambiae complex, 25% An. funestus Giles, 1% An. pharoensis Theobald, 46% Culex species and the rest were Mansonia uniformis Theobald. Mosquito abundance and species composition varied seasonally, spatially and between years. Using PCR, three members of the Anopheles gambiae complex namely An. gambiae s.s. Giles (69%), An. arabiensis Paton (23%) and An. merus Dönitz (7%) were confirmed to occur in the study area. Plasmodium falciparum circumsporozoite antigen (CSA) rates were 3.5% for An. gambiae complex and 2.3% for An. funestus. The mean EIR ranged from 28-275 infective bites/person/year. Transmission indices varied over short distances, seasonally and between years. In conclusion, malaria transmission indices in the study area are one of the highest in Tanzania; and there is high variability of entomological parameters over a small geographical area.

Capacity building is considered a priority for health research institutions in developing countries to achieve the Millennium Development Goals by 2015. However, in many countries including Tanzania, much emphasis has been directed towards human resources for health with the total exclusion of human resources for health research. The objective of this study was to systematically investigate the capacity building process for the Tanzanian National Institute for Medical Research (NIMR) over a 30-year period and identify the challenges and opportunities in creating a critical mass of multi-disciplinary research scientists that is required for achieving the intended health benefits. A desk review of personnel database was conducted for information covering 1980-2009 on academic qualifications, training, research experience and research output. The current staff curriculum vitae (CV) were reviewed to gather information on researchers’ employment record, training, training support, area of expertise and scientific output. Interviews were conducted with a cross section of researchers on capacity development aspects using a self-administered questionnaire. In-depth interviews were also conducted with the current and former NIMR Management to seek information on capacity development challenges. A review was also done on staff personal files, annual reports, strategic plans and other occasional documents. A total of 163 CV were assessed; of these, 76.7% (125) were for Research Scientists (RS), 20.9% (34) Laboratory Technologists (LT) and 2.4% (4) for System Analysts. The Institute had 13 research scientists upon its establishment. Since 1980, NIMR has recruited a total of 185 Research Scientists. By 2009, NIMR had a total scientific workforce of 170 staff (RS= 82.4%; LT= 17.6%). Of the 140 RSs, 37 (26.4%) were first degree; 77 (55.5%) second degree while 26 (18.6%) were PhD degree holders. Of the total of 78 researchers interviewed, 55 (70.5%) indicated to have accessed postg

An entomological survey to determine resting behaviour and species composition of malaria vectors was carried out in Uyui District in western Tanzania in May 2009. Mosquitoes were collected using indoor resting catch, window exit trap and outdoor “bed-net” techniques. They mosquitoes were identified using morphological key and polymerase chain reaction (PCR). A total of 672 Anopheles gambiae sensu lato were collected. Of these, 661 (98.4%) were collected outdoor whereas few (1.6%) were collected indoor. The exit trap catch: mechanical aspirator catch ratio was 1:1.75. The overall indoor resting density of An. gambiae s.l. as determined by mechanical aspirator and exit trap was 0.7 and 0.5 mosquitoes per room, respectively. The overall density of the host-seeking as determined by bed net trap outdoor was 44.1 mosquitoes per person. A sample of 44 specimens taken randomly from morphologically identified An.gambiae s.l. population was further analyzed to species level using PCR techniques. Of these 44 specimens 26 (59%) and 18 (41%) were Anopheles arabiensis and Anopheles gambiae sensu stricto respectively. This study contributes to the understanding of the distribution of malaria vectors with respect to species composition and their resting behaviour that could contribute to vector control operations in western Tanzania. A longitudinal study considering dry and wet seasons is recommended to provide more information on the seasonal distribution, abundance and biting behaviour of malaria vectors in the study area.

Malaria transmission varies from one area to another and there are also local difference in time and space. The objective of the study was to determine the local variability of entomological parameters namely, mosquito abundance, human biting rate (HBR), sporozoite rate for Plasmodium falciparum and entomological inoculation rate (EIR). The study was carried out in Rufiji District south eastern Tanzania from October 2001 and September 2004. Adult mosquitoes were collected indoors by CDC light traps. PCR was employed to identify the species within the Anopheles gambiae complex. ELISA was used to determine the sporozoite rate. Over a three year sampling period a total of 64,875 female mosquitoes were caught using light-traps, and of these 28% were Anopheles gambiae complex, 25% An. funestus Giles, 1% An. pharoensis Theobald, 46% Culex species and the rest were Mansonia uniformis Theobald. Mosquito abundance and species composition varied seasonally, spatially and between years. Using PCR, three members of the Anopheles gambiae complex namely An. gambiae s.s. Giles (69%), An. arabiensis Paton (23%) and An. merus Dönitz (7%) were confirmed to occur in the study area. Plasmodium falciparum circumsporozoite antigen (CSA) rates were 3.5% for An. gambiae complex and 2.3% for An. funestus. The mean EIR ranged from 28-275 infective bites/person/year. Transmission indices varied over short distances, seasonally and between years. In conclusion, malaria transmission indices in the study area are one of the highest in Tanzania; and there is high variability of entomological parameters over a small geographical area.

Capacity building is considered a priority for health research institutions in developing countries to achieve the Millennium Development Goals by 2015. However, in many countries including Tanzania, much emphasis has been directed towards human resources for health with the total exclusion of human resources for health research. The objective of this study was to systematically investigate the capacity building process for the Tanzanian National Institute for Medical Research (NIMR) over a 30-year period and identify the challenges and opportunities in creating a critical mass of multi-disciplinary research scientists that is required for achieving the intended health benefits. A desk review of personnel database was conducted for information covering 1980-2009 on academic qualifications, training, research experience and research output. The current staff curriculum vitae (CV) were reviewed to gather information on researchers’ employment record, training, training support, area of expertise and scientific output. Interviews were conducted with a cross section of researchers on capacity development aspects using a self-administered questionnaire. In-depth interviews were also conducted with the current and former NIMR Management to seek information on capacity development challenges. A review was also done on staff personal files, annual reports, strategic plans and other occasional documents. A total of 163 CV were assessed; of these, 76.7% (125) were for Research Scientists (RS), 20.9% (34) Laboratory Technologists (LT) and 2.4% (4) for System Analysts. The Institute had 13 research scientists upon its establishment. Since 1980, NIMR has recruited a total of 185 Research Scientists. By 2009, NIMR had a total scientific workforce of 170 staff (RS= 82.4%; LT= 17.6%). Of the 140 RSs, 37 (26.4%) were first degree; 77 (55.5%) second degree while 26 (18.6%) were PhD degree holders. Of the total of 78 researchers interviewed, 55 (70.5%) indicated to have accessed postg

An entomological survey to determine resting behaviour and species composition of malaria vectors was carried out in Uyui District in western Tanzania in May 2009. Mosquitoes were collected using indoor resting catch, window exit trap and outdoor “bed-net” techniques. They mosquitoes were identified using morphological key and polymerase chain reaction (PCR). A total of 672 Anopheles gambiae sensu lato were collected. Of these, 661 (98.4%) were collected outdoor whereas few (1.6%) were collected indoor. The exit trap catch: mechanical aspirator catch ratio was 1:1.75. The overall indoor resting density of An. gambiae s.l. as determined by mechanical aspirator and exit trap was 0.7 and 0.5 mosquitoes per room, respectively. The overall density of the host-seeking as determined by bed net trap outdoor was 44.1 mosquitoes per person. A sample of 44 specimens taken randomly from morphologically identified An.gambiae s.l. population was further analyzed to species level using PCR techniques. Of these 44 specimens 26 (59%) and 18 (41%) were Anopheles arabiensis and Anopheles gambiae sensu stricto respectively. This study contributes to the understanding of the distribution of malaria vectors with respect to species composition and their resting behaviour that could contribute to vector control operations in western Tanzania. A longitudinal study considering dry and wet seasons is recommended to provide more information on the seasonal distribution, abundance and biting behaviour of malaria vectors in the study area.

Globally, tuberculosis-HIV co-infections are on the increase. In 2007, 15% (1.37 million) of the tuberculosis cases were HIV-positive tuberculosis (TB). This cross-sectional study was conducted in February 2009 to assess the effect of the level of CD4 lymphocyte counts on the development of smear positive pulmonary TB (PTB) among HIV patients before and after initiation of highly active antiretroviral therapy (HAART). A total of 155 HIV patients who were on HAART programme were enrolled and out of these 42 (27.1%) were smear positive PTB. Of the 42 PTB patients, 38 (90.5%) were also infected with HIV and were already at initiation of HAART. There was no association between the development of smear positive PTB and socio-demographic characteristics among HIV patients before and after HAART initiation (P>0.05). A larger proportion of HIV+PTB patients diagnosed before and after HAART initiation was found with CD4 lymphocyte count <200cells/µl. However, the difference was not statistically significant (P=0.092). Among HIV patients who were diagnosed to be smear positive PTB after HAART initiation, their CD4 lymphocyte counts at time of TB diagnosis was lower than their CD4 lymphocyte counts at time of HAART initiation. The four patients diagnosed with PTB after HAART initiation had mean CD4 lymphocyte counts at HAART initiation not statistically different from that at TB diagnosis (t=0.715, P=0.526).The median time period within which the diagnosis of smear positive PTB was made after HAART initiation was 22 weeksand the mean time was 66.75 weeks. These findings provide evidence that development of smear positive PTB after HAART initiation may occur at any level of CD4 lymphocyte count (P<0.05). This study was limited by the relatively small sample size, we therefore recommend more studies involving a larger sample size in order to estimate more accurately the effect of both level of CD4 lymphocyte count and HAART on the development of smear positive PTB among

A 1-year longitudinal study was conducted in Magugu in Babati district, northern Tanzania to determine malaria vector population structure and malaria transmission indices. Mosquitoes were sampled using the Centre for Disease Control (CDC) light traps. A total of 110,357 adult female mosquitoes were collected. Anopheles gambiae s.l. accounted 25% of the total female mosquito collected. Relatively fewer An. funestus were collected. Other mosquito species collected were An. pharoensis, An. coustani, An. maculipalpis, An. marshallii, Culex quinquefasciatus , Cx unnivittatus, Mansonia uniformis and Ma. africana. An analysis by Polymerase Chain Reaction revealed that An. arabiensis was the only member of the An. gambiae complex in the collected samples. The number of mosquito collected correlated with the increasing mean rainfall. Blood meal analysis showed a higher human enzymatic reaction among An. gambiae s.l. (63.5%) followed by An. funestus (42.9%). Bovine enzymatic reaction was higher among An. coustani (73.7%) followed by the An. pharoensis (66.7%). The Enzyme Linked Immunosorbent Assay (ELISA) was used to detect Plasmodium falciparum circumsporozoites proteins in 10,000 female Anopheles mosquitoes. Only two An. arabiensis were found to be infected. The entomological inoculation rate (EIR) was estimated at 0.51 infectious bites per person per year. This EIR was considered to be relatively low, indicating that malaria transmission in this area is low. Variability in mosquito blood meal shows availability of variety of preferred blood meal choices and impact of other factors inhibiting mosquito-human host contact.The study has provided information considered useful in the mapping of the vector distribution and population structure in the country. Such information is considered to be among the essential tools for planning malaria control interventions.

Globally, tuberculosis-HIV co-infections are on the increase. In 2007, 15% (1.37 million) of the tuberculosis cases were HIV-positive tuberculosis (TB). This cross-sectional study was conducted in February 2009 to assess the effect of the level of CD4 lymphocyte counts on the development of smear positive pulmonary TB (PTB) among HIV patients before and after initiation of highly active antiretroviral therapy (HAART). A total of 155 HIV patients who were on HAART programme were enrolled and out of these 42 (27.1%) were smear positive PTB. Of the 42 PTB patients, 38 (90.5%) were also infected with HIV and were already at initiation of HAART. There was no association between the development of smear positive PTB and socio-demographic characteristics among HIV patients before and after HAART initiation (P>0.05). A larger proportion of HIV+PTB patients diagnosed before and after HAART initiation was found with CD4 lymphocyte count <200cells/µl. However, the difference was not statistically significant (P=0.092). Among HIV patients who were diagnosed to be smear positive PTB after HAART initiation, their CD4 lymphocyte counts at time of TB diagnosis was lower than their CD4 lymphocyte counts at time of HAART initiation. The four patients diagnosed with PTB after HAART initiation had mean CD4 lymphocyte counts at HAART initiation not statistically different from that at TB diagnosis (t=0.715, P=0.526).The median time period within which the diagnosis of smear positive PTB was made after HAART initiation was 22 weeksand the mean time was 66.75 weeks. These findings provide evidence that development of smear positive PTB after HAART initiation may occur at any level of CD4 lymphocyte count (P<0.05). This study was limited by the relatively small sample size, we therefore recommend more studies involving a larger sample size in order to estimate more accurately the effect of both level of CD4 lymphocyte count and HAART on the development of smear positive PTB among

A 1-year longitudinal study was conducted in Magugu in Babati district, northern Tanzania to determine malaria vector population structure and malaria transmission indices. Mosquitoes were sampled using the Centre for Disease Control (CDC) light traps. A total of 110,357 adult female mosquitoes were collected. Anopheles gambiae s.l. accounted 25% of the total female mosquito collected. Relatively fewer An. funestus were collected. Other mosquito species collected were An. pharoensis, An. coustani, An. maculipalpis, An. marshallii, Culex quinquefasciatus , Cx unnivittatus, Mansonia uniformis and Ma. africana. An analysis by Polymerase Chain Reaction revealed that An. arabiensis was the only member of the An. gambiae complex in the collected samples. The number of mosquito collected correlated with the increasing mean rainfall. Blood meal analysis showed a higher human enzymatic reaction among An. gambiae s.l. (63.5%) followed by An. funestus (42.9%). Bovine enzymatic reaction was higher among An. coustani (73.7%) followed by the An. pharoensis (66.7%). The Enzyme Linked Immunosorbent Assay (ELISA) was used to detect Plasmodium falciparum circumsporozoites proteins in 10,000 female Anopheles mosquitoes. Only two An. arabiensis were found to be infected. The entomological inoculation rate (EIR) was estimated at 0.51 infectious bites per person per year. This EIR was considered to be relatively low, indicating that malaria transmission in this area is low. Variability in mosquito blood meal shows availability of variety of preferred blood meal choices and impact of other factors inhibiting mosquito-human host contact.The study has provided information considered useful in the mapping of the vector distribution and population structure in the country. Such information is considered to be among the essential tools for planning malaria control interventions.