Suchergebnisse

BACKGROUND: Mosquito-borne viral infections have in recent years, become a public health threat globally. This review aimed to provide an overview of the ecological and epidemiological profiles of mosquito-borne viral infections in the Democratic Republic of the Congo (DRC). METHODS: A search of literature was conducted using Google Scholar, PubMed and the WHO website using the following keywords: "Democratic Republic of the Congo", "Zaire", "Belgian Congo" and either of the following: "mosquito-borne virus", "arbovirus", "yellow fever", "dengue", "chikungunya", "West Nile", "Rift Valley fever", "O'nyong'nyong", "Zika", "epidemiology", "ecology", "morbidity", "mortality". Published articles in English or French covering a period between 1912 and October 2018 were reviewed. RESULTS: A total of 37 articles were included in the review. The findings indicate that the burden of mosquito-borne viral infections in DRC is increasing over time and space. The north-western, north-eastern, western and central regions have the highest burden of mosquito-borne viral infections compared to south and eastern highland regions. Yellow fever, chikungunya, dengue, Zika, Rift Valley fever, West Nile and O'nyong'nyong have been reported in the country. These mosquito-borne viruses were found circulating in human, wildlife and domestic animals. Yellow fever and chikungunya outbreaks have been frequently reported. Aedes aegypti and Ae. simpsoni were documented as the main vectors of most of the mosquito-borne viral infections. Heavy rains, human movements, forest encroachment and deforestation were identified as drivers of mosquito-borne viruses occurrence in DRC. CONCLUSIONS: Mosquito-borne viral infections are becoming common and a serious public health problem in DRC. In the current context of climate change, there is urgent need to improve understanding on ecological and epidemiology of the diseases and strengthen surveillance systems for prompt response to epidemics in DRC.

Background: Fair processes in decision making need the involvement of stakeholders who can discuss issues and reach an agreement based on reasons that are justifiable and appropriate in meeting people's needs. In Tanzania, the policy of decentralization and the health sector reform place an emphasis on community participation in making decisions in health care. However, aspects that can influence an individual's opportunity to be listened to and to contribute to discussion have been researched to a very limited extent in low-income settings. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. We draw on the principle of fairness as outlined in the deliberative democratic theory. Methods: The study was carried out in the Mbarali District of Tanzania. A qualitative study design was used. In-depth interviews and focus group discussion were conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. Results: The study findings indicate a substantial influence of gender, wealth, ethnicity and education on health care decision-making processes. Men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. Conclusions: Existing challenges related to individuals' influence of decision making processes in health care need to be addressed if greater participation is desired. There is a need for increased advocacy and a strengthening of responsive practices with an emphasis on the right of all individuals to participate in decision-making processes. This simultaneously implies an emphasis on assuring the distribution of information, training and education so that individuals can participate fully in informed decision making. ; publishedVersion

BACKGROUND: Policy decisions for malaria control are often difficult to make as decision-makers have to carefully consider an array of options and respond to the needs of a large number of stakeholders. This study assessed the factors and specific objectives that influence malaria control policy decisions, as a crucial first step towards developing an inclusive malaria decision analysis support tool (MDAST). METHODS: Country-specific stakeholder engagement activities using structured questionnaires were carried out in Kenya, Uganda and Tanzania. The survey respondents were drawn from a non-random purposeful sample of stakeholders, targeting individuals in ministries and non-governmental organizations whose policy decisions and actions are likely to have an impact on the status of malaria. Summary statistics across the three countries are presented in aggregate. RESULTS: Important findings aggregated across countries included a belief that donor preferences and agendas were exerting too much influence on malaria policies in the countries. Respondents on average also thought that some relevant objectives such as engaging members of parliament by the agency responsible for malaria control in a particular country were not being given enough consideration in malaria decision-making. Factors found to influence decisions regarding specific malaria control strategies included donor agendas, costs, effectiveness of interventions, health and environmental impacts, compliance and/acceptance, financial sustainability, and vector resistance to insecticides. CONCLUSION: Malaria control decision-makers in Kenya, Uganda and Tanzania take into account health and environmental impacts as well as cost implications of different intervention strategies. Further engagement of government legislators and other policy makers is needed in order to increase funding from domestic sources, reduce donor dependence, sustain interventions and consolidate current gains in malaria. ; The Global Environment Facility (GEF), the UN Environment ...

Despite global awareness of the key factors surrounding antimicrobial resistance (AMR), designing and implementing policies to address the critical issues around the drivers of AMR remains complex to put into practice. We identified prevalent narratives and framing used by epistemological communities involved in the response to AMR in Tanzania, interrogated how this framing may inform policymaking, and identified interventions that could be tailored to the groups believed responsible for AMR. We interviewed 114 key informants from three districts and analysed transcripts line by line. Our results suggest that many different groups help drive the spread of AMR in Tanzania and need to be involved in any effective response. Human health is currently perceived as driving the response, while other domains lag behind in their efforts. For AMR programmes to be successful, all sectors need to be involved, including civil society groups, community representatives, and those working in communities (e.g., primary care physicians). However, current plans and programmes largely fail to include these viewpoints. The perceived presence of political will in Tanzania is a significant step towards such a response. Any strategies to tackle AMR need to be tailored to the context-specific realities, taking into account constraints, beliefs, and power dynamics within countries.

Despite global awareness of the key factors surrounding antimicrobial resistance (AMR), designing and implementing policies to address the critical issues around the drivers of AMR remains complex to put into practice. We identified prevalent narratives and framing used by epistemological communities involved in the response to AMR in Tanzania, interrogated how this framing may inform policymaking, and identified interventions that could be tailored to the groups believed responsible for AMR. We interviewed 114 key informants from three districts and analysed transcripts line by line. Our results suggest that many different groups help drive the spread of AMR in Tanzania and need to be involved in any effective response. Human health is currently perceived as driving the response, while other domains lag behind in their efforts. For AMR programmes to be successful, all sectors need to be involved, including civil society groups, community representatives, and those working in communities (e.g., primary care physicians). However, current plans and programmes largely fail to include these viewpoints. The perceived presence of political will in Tanzania is a significant step towards such a response. Any strategies to tackle AMR need to be tailored to the context-specific realities, taking into account constraints, beliefs, and power dynamics within countries.

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

The Government of Tanzania introduced indoor residual spraying (IRS) in Muleba district in north-western Tanzania after frequent malaria epidemics. Malaria parasitological baseline and two cross-sectional follow-up surveys were conducted in villages under the IRS program and those not under IRS to assess the impact of IRS intervention. After two rounds of IRS intervention there was a significant reduction of malaria parasitological indices in both two villages. In IRS villages overall, parasitemia prevalence was reduced by 67.2%, splenomegaly was reduced by 75.8%, whereas anemia was reduced by 50.5%. There was also a decline of malaria parasite density from 896.4 at baseline to 128.8 at second follow-up survey. Similarly, there was also a reduction of malaria parasitological indices in non-IRS villages; however, parasitological indices in IRS villages remained far below the levels in non-IRS villages. The reduction of malaria parasitological indices in non-IRS villages might have been contributed by interventions other than IRS.

Tanzania launched its first National Action Plan (NAP) on antimicrobial resistance (AMR) in 2017 to reduce the burden of AMR in the country and contribute to the global response. We aimed to analyze the implementation of the NAP on AMR in Tanzania using the governance framework. In-depth interviews were conducted with human and animal health practitioners and national-level policy actors. We adapted Chua's AMR governance framework to analyze the development and implementation of the NAP in Tanzania. Implementation of the NAP has realized several achievements, including: (i) the establishment of a functioning Multi-Sectoral Coordinating Committee for coordinating the implementation of AMR activities; (ii) existence of governance structure; (iii) establishment of human and animal surveillance sites; (iv) creation of AMR awareness in the community and (v) availability of guidelines at the health facility level to ensure AMR stewardship. However, some dimensions of the governance areas, including reporting and feedback mechanisms, accountability, transparency and sustainability of AMR plans, are not effectively implemented. Addressing these challenges should involve strengthening the collaboration of the different sectors involved at different NAP implementation levels by careful planning and coordination, and provision of adequate resources to ensure sustainability.

Despite slow reductions in the annual burden of active human tuberculosis (TB) cases, zoonotic TB (zTB) remains a poorly monitored and an important unaddressed global problem. There is a higher incidence in some regions and countries, especially where close association exists between growing numbers of cattle (the major source of Mycobacterium bovis ) and people, many suffering from poverty, and where dairy products are consumed unpasteurised. More attention needs to be focused on possible increased zTB incidence resulting from growth in dairy production globally and increased demand in low income countries in particular. Evidence of new zoonotic mycobacterial strains in South Asia and Africa (e.g. M. orygis), warrants urgent assessment of prevalence, potential drivers and risk in order to develop appropriate interventions. Control of M. bovis infection in cattle through detect and cull policies remain the mainstay of reducing zTB risk, whilst in certain circumstances animal vaccination is proving beneficial. New point of care diagnostics will help to detect animal infections and human cases. Given the high burden of human tuberculosis (caused by M. tuberculosis) in endemic areas, animals are affected by reverse zoonosis, including multi-drug resistant strains. This, may create drug resistant reservoirs of infection in animals. Like COVID-19, zTB is evolving in an ever-changing global landscape. ; the European and Developing Countries Clinical Trials Partnership (EDCTP2) pro- gramme which is supported under Horizon 2020, the European Union's Framework Programme for Research and Innovation. icddr, b is grateful to the Governments of Bangladesh, Canada, Sweden and the UK for providing core/unrestricted support. AZ is in receipt of a National Institutes of Health Research (NIHR) senior investigator award and the PANDORA-ID-NET. ; http://www.elsevier.com/locate/ijid ; hj2022 ; Veterinary Tropical Diseases

Tanzania launched its first National Action Plan (NAP) on antimicrobial resistance (AMR) in 2017 to reduce the burden of AMR in the country and contribute to the global response. We aimed to analyze the implementation of the NAP on AMR in Tanzania using the governance framework. In-depth interviews were conducted with human and animal health practitioners and national-level policy actors. We adapted Chua's AMR governance framework to analyze the development and implementation of the NAP in Tanzania. Implementation of the NAP has realized several achievements, including: (i) the establishment of a functioning Multi-Sectoral Coordinating Committee for coordinating the implementation of AMR activities; (ii) existence of governance structure; (iii) establishment of human and animal surveillance sites; (iv) creation of AMR awareness in the community and (v) availability of guidelines at the health facility level to ensure AMR stewardship. However, some dimensions of the governance areas, including reporting and feedback mechanisms, accountability, transparency and sustainability of AMR plans, are not effectively implemented. Addressing these challenges should involve strengthening the collaboration of the different sectors involved at different NAP implementation levels by careful planning and coordination, and provision of adequate resources to ensure sustainability.

Soon after the novel coronavirus, SARS-CoV-2 (2019-nCoV), was first identified in a cluster of patients with pneumonia (Li et al., 2020), in the Chinese city of Wuhan on 31 December 2019, rapid human to human transmission was anticipated (Hui et al., 2020). The fast pace of transmission is wreaking havoc and stirring media hype and public health concern (Ippolito et al., 2020) globally. When the World Health Organization (WHO) declared the disease, (now officially named COVID-19) a Public Health Emergency of International Concern (PHEIC) on 31st January 2020 (WHO, 2020a), the Director General Dr Tedros Ghebreyesus justified the decision by stating that WHOs greatest concern was the potential for the virus to spread to countries with weaker health systems. Repeated outbreaks of other preventable emerging and re-emerging infectious diseases with epidemic potential have taken their toll on the health systems of many African countries. The devastating 2014–2016 Ebola Virus Epidemic (WHO, 2020b) in West Africa, demonstrated how ill-prepared the affected countries were to rapidly identify the infection and halt transmission (WHO, 2020d, Largent, 2016, Hoffman and Silverberg, 2018, Omoleke et al., 2016). Similarly, the smoldering remnants of the 2018–19 Ebola Virus outbreak in the Democratic Republic of Congo, have demonstrated even for health services with considerable experience of dealing with a certain emerging pathogen, geography and sociopolitical instability, can hamper the response (Aruna et al., 2019).