Tanzania Field Epidemiology and Laboratory Training Program
Dar es Salaam, East Africa | Tanzania, United Republic of
Main Specialties: Infectious Disease
Additional Specialties: infectious disease
Primary Affiliation: Tanzania Field Epidemiology and Laboratory Training Program - Dar es Salaam, East Africa , Tanzania, United Republic of
Pan African Medical Journal
Introduction: in 2014, Tanzania introduced the combined measles-rubella vaccine in the routine immunization schedule. Two doses of measles-rubella vaccine (MR1 and MR2) are recommended at 9 and 18 months, respectively. In 2015, MR2 coverage among eligible 18-month-old children in Tanzania was only 57%, lower than the WHO-recommended coverage (95%). During the same period Mtwara District Council (MDC) reported a coverage of 52% which is lower than the nation average. We determined factors associated with non-uptake of MR2 among children in MDC Tanzania.
Methods: we conducted a community-based cross-sectional survey using cluster sampling during January - April 2017 in MDC. Caretakers of children born during January 2014 - January 2015 and residing in MDC for the past three years were recruited. We interviewed participants and reviewed vaccination cards. Logistic regression modeling was employed to identify independent factors associated with uptake of MR2.
Results: of 1,000 children assessed, 558 (55.8%) were unvaccinated with MR2. Factors independently associated with non-uptake of MR2 included the caretaker being unaware of the ages for MR1 and MR2 administration [aOR=3.50; 95%CI 1.98-6.21; p<0.001], having MR2 vaccination services offered at the local vaccination station fewer than three days per week [aOR=1.50; 95%CI 1.42-5.59; p<0.001], not having the vaccine available during vaccination days [aOR=3.38; 95%CI 1.08-10.61; p<0.01], unwillingness of health workers to open multi-dose vaccine vials for a single child [aOR=3.80; 95% CI 2.12-6.79; p<0.001], and long waiting times for vaccination services [aOR=1.80; 95% CI 1.08-3.00; p<0.01].
Conclusion: more than half the children under five years in MDC were not vaccinated with MR2. Lack of caretaker knowledge about appropriate vaccination age, unavailability of vaccine, having insufficient numbers of children waiting to warrant multidose vial use, and long clinic waiting times were associated with MR2 non-uptake. The community should receive education about MR vaccine; we recommend thorough screening of children?s vaccination status at each clinic visit and provision of vaccine whenever possible. Vaccine distribution should be improved in MDC.
Front Public Health. 2018; 6: 264.
Frontiers in Public Health
Background: Modifications of the Field Epidemiology Training Program (FETP) curricula to include a laboratory track (L-Track), to become Field Epidemiology and Laboratory Training Program (FELTP), began in 2004 in Kenya. The L-Track offered candidates training on laboratory competencies in management, policy, quality systems, and diagnostic methods as well as epidemiology, disease surveillance and outbreak response. Since then several FELTPs have discontinued the L-Track and instead offer all candidates, epidemiologists and laboratorians, a single FETP curriculum. Reasons for these changes are reported here.
Methods: A questionnaire was sent to directors of 13 FELTP programs collecting information on the status of the programs, reasons for any changes, basic entry qualifications, source institutions and where residents were post enrollment or after graduation. Data from previous CDC internal assessments on FELTP L-Track was also reviewed.
Results: Out of the 13 FELTPs included, directors from 10 FELTPs sent back information on their specific programs. The FELTPs in Kenya, Mozambique, Cameroon and Kazakhstan and Mali have discontinued a separate L-Track while those in Ghana, Georgia, Nigeria, Rwanda, and Tanzania continue to offer the separate L-Track. Reasons for discontinuation included lack of standardized curriculum, unclear strategies of the separate L-Track, and funding constraints. Two countries Kenya and Tanzania reported on the career progression of their graduates. Results show 84% (Kenya) and 51% (Tanzania) of candidates in the FELTP, L-Track were recruited from national/regional medical health laboratories. However post-graduation, 56% (Kenya) and 43% (Tanzania) were working as epidemiologists, program managers, program coordinators, or regulatory/inspection boards. Professional upward mobility was high; 87% (Kenya) and 73% (Tanzania) residents, reported promotions either in the same or in new institutions.
Conclusions: The FELTP L-Track residents continue to offer critical contributions to public health workforce development with high upward mobility. While this may be a reflection of professional versatility and demand of the FELTP graduates, the move from core laboratory services underscores the challenges in filling and retaining qualified staff within the laboratory systems. Results suggest different strategies are needed to strengthen laboratory management and leadership programs with a clear focus on laboratory systems and laboratory networks to meet current and future clinical and public health laboratory workforce demands.
The Field Epidemiology Training Program (FETP) was initiated in 1975 as a competency-based training modeled on the Centers for Disease Control and Prevention (CDC's) Epidemic Intelligence Service (EIS) (1). The program trained epidemiologists in countries outside the USA, filling critical gaps in public health programs and remarkably enhancing global health security by increasing the capacity of national public health programs to rapidly detect and respond to public health emergencies. Significant global health security contributions by the graduates of the FETPs included detection of vaccine-type poliovirus in Dominican Republic and Haiti in 1991, Escherichia coli O157:H7 in Germany and measles outbreaks in Thailand among others (1, 2). The FETP became a significant mechanism to strengthen epidemiologic capacities globally and by 2016 ~50 countries had adopted it. During the same period, a recognition of emerging and re-emerging diseases as major public health threats led to the need to better integrate laboratory scientists in applied field epidemiology, outbreak response, and disease surveillance. The adoption of the revised International Health Regulations (IHR) in 2007 (3) further exposed gaps in the workforce critical for surveillance and effective response to public health emergencies which requires both epidemiologists and laboratorians to extensively work together. Collaborations between epidemiologists and laboratorians in public health emergences highlighted the need to have joint competency-based trainings, justifying adaptations of the FETP (4). As a result, the first Field Epidemiology and Laboratory Training Program (FELTP) was launched in Kenya in 2004. Laboratory scientists from the Ministry of Health were enrolled in the 2-year program. The FELTP curriculum added a unique laboratory track (L-Track) in addition to epidemiology, disease surveillance, and outbreak responses modules taken by all fellows. Laboratory fellows also took elective modules in laboratory management, quality systems, and diagnostic procedures, and had assignments to laboratory-based field locations (5). The strategic goal was that epidemiologists trained alongside laboratorians would gain mutual understanding of each other's disciplines and strengthen public health surveillance and response.
The FELTP laboratory fellows developed competencies through a range of field epidemiology and laboratory investigations of disease outbreaks. Between 2004 and 2005, both epidemiology and laboratory fellows in the Kenya FELTP participated in outbreak responses to aflatoxicosis, brucellosis, and cholera among others (5–7). In Tanzania, FELTP fellows jointly investigated and responded to cholera, anthrax and avian and H1N1 influenza outbreaks among others (8). In addition, FELTP graduates initiated and supported trainings for courses on disease surveillance critical in programs such as Integrated Disease Surveillance and Response (IDSR); further giving the FELTP core impetus within the ministries of health (9, 10). The apparent success of the Kenya FELTP led to establishment of similar programs across Africa and Central Asia by adding the L-Track to existing FETPs. By 2011, 20 countries had FELTP programs (Figure (Figure1),1), although some were implemented as regional programs e. g., Armenia, Azerbaijan, Ukraine (South Caucus), and Togo, Mali and Burkina Faso (West Africa Region).
Along with the successes however, these FELTP programs have faced major challenges. From the beginning, the curricula were highly variable among the implementing FELTP programs and difficulties arose in integrating the L-Track with the existing FETP curriculum. There were also variabilities in the nature of laboratory specific projects and shortages of qualified mentors and facilities in which the trainees complete their fellowships. No standardized curriculum was developed to cover the core competencies of laboratorians that were being trained together with field epidemiologists. Consequently, FELTP programs tailored the curriculum to their host country needs and capacities. For some programs this meant epidemiologists and laboratory scientists took several laboratory modules with graduates earning a Field Epidemiology degree or certificate. Other programs developed a separate L-Track as a subset of the FELTP with modules for management, policy, laboratory testing for outbreak response and disease surveillance. This was the approach in Kenya with graduates earning a Laboratory Management & Epidemiology degree (5). However, the L-Track of the FELTP lacked clear, systematic, and measurable indicators necessary to comprehensively evaluate and improve the programs (11).
The CDC and many partner FELTP programs have been acutely aware of some of the challenges facing the L-Track despite consensus on the importance of the program. In the evaluation of the FELTP “laboratory component,” workshops reviewing the program and related proposals have been undertaken by programs within CDC's Center for Global Health. One measurable outcome observed from the CDC reviews was that almost a quarter of the FELTP laboratory scientist graduates changed their career to field epidemiologists and thus inadvertently weakening the workforce they were meant to strengthen.
Our assessment combined a review of available documents referencing the status and challenges of the FELTP since its inception and a follow-up questionnaire and discussions that aimed to find out the current state of FELTP programs. With some FELTP programs rolling back L-Track but continuing to enroll laboratory scientists, our aim was to understand the status of the laboratorians in FELTP and profile how the trainees and graduates were fairing within the public health laboratory workforce. The results will inform strategies aimed at strengthening laboratory leadership and give direction to future proposals addressing the public health laboratory workforce.
A questionnaire entitled, the FELTP Laboratory Component Survey 2016, was developed to collect information on: (a) year of initial roll-out and current status of the program; (b) challenges or reasons for any roll-back; (c) if program was implemented for single country or at a regional level; (d) total number of FELTP L-Track residents recruited; (e) L-Track minimum qualifications; and (f) positions and institutions of affiliation of the laboratorian residents before recruitment and after graduation. Finally, the participants were given an opportunity to list the major achievements of the FELTP and state what they would change in the FELTP program. The questions were structured as open-ended or with a selection of answers based on the standard FELTP program.
The survey tool was developed in Monkey Survey (www.surveymonkey.com). Questions were designed after consultations on study designs and aim of the survey with all the co-authors. An initial questionnaire was developed and shared with 4 FELTP Resident Advisors (RA) in Georgia, Kazakhstan, Tanzania and Cameroon for validation. Follow-up phone calls and written feedback were used to make changes to the questionnaire before it was sent out to all Resident Advisors (RA) or FELTP point of contacts in FELTP programs. Countries also requested to share records on the training backgrounds, employment histories or any relevant information, in any format they had to track FELTP residents. Data was analyzed both as qualitatively and quantitatively and presented as individual FELTP country profiles. Follow-up phone call and email clarifications were done with FELTP RAs or points of contact. The CDC human subjects research office judged that the survey constituted routine public health activities and therefore did not involve human subjects research.
Out of questionnaires sent to FELTP directors in 13 FELTP programs, responses were received from Kenya, Ghana, Nigeria, Tanzania, Armenia/Azerbaijan/Georgia, Kazakhstan, Cameroon, Mozambique, Rwanda, and Mali as of August 2016, representing both national and regional programs. Very limited information was received from Mali, with the respondent indicating the country had residents trained previously in the regional program situated in Burkina Faso in 2011. In 2016, Mali started their own single country program. Since no specific numbers were received, the country's input were only included in Figure Figure22 below showing challenges with L-Track. From the remaining nine who submitted responses, only Tanzania and Kenya fully completed the questionnaire, including the detailed records of employment histories of all FELTP laboratorian enrollees and graduates. As five FELTP programs had rolled back FELTP programs at the time of the survey, data was only compared between FELTP programs where the specific questions had complete responses.
Nigeria represented the largest number of L-Track residents (total of 72) in FELTP and continues to offer the separate L-Track module (Table (Table1,1, below). Kenya, Ghana, and Tanzania had 40 and 38 and 37 L-Track residents respectively. Tanzania, another country with a large number of L-Track residents, had a high graduation rate at 73%. Mozambique, with a smaller cohort, also had a high graduation rate at 73%. Four FELTP programs, including Kenya which first implemented the L-Track module, have rolled back this program since 2014. Kazakhstan initiated the L-Track in 2012 but the program was halted in 2016. Cameroon and Mozambique also rolled back their separate L-Track in 2015 and 2016, respectively. Nigeria, Rwanda, and Tanzania have kept the original program with both Epi and L-Track components. Despite the L-Track roll back, there were no changes in eligibility and all continue to enroll laboratorians in addition to epidemiologists, medical professionals, veterinarians (where applicable) and other scientists who receive the same trainings that includes ~20% laboratory-related topics.
|Country (sourcing regions)||FELTP initiated||Laboratory track degree awarded||Number of cohorts enrolled||Total no. of “L” track FELTP enrolled||Total no. of “L” track FELTP enrolled to date (overall graduation rate%)||Lab track module (roll back)|
|Kenya (Tanzania, South Sudan, Ghana, Uganda)||2004||MSc (Lab Management and Epi)||10||40||20 (50%)||No (2010)|
|Ghana||2007||MPhil in Field Epi||9||38||23 (61%)||Yes|
|Tanzania||2008||MSc (Applied Epi and Lab Management)||8||37||27 (73%)||Yes|
|Nigeria||2008||MPH (Lab Management & Epi)||8||72||31 (43%)||Yes|
|Georgia (Armenia, Azerbaijan, Ukraine)||2009||Certificate (Non Academic)||n/a||n/a||n/a||Yes|
|Rwanda||2010||MSc (Applied Epi & Lab Management)||3||9||6 (67%)||Yes|
|Mozambique||2010||MSc (Applied Epi & Lab Management)||3||15||11 (73%)||No (2016)|
|Cameroon (DRC, CAR)||2011||MSc (Field Epi & Lab Management)||n/a||n/a||n/a||No (2015)|
|Mali (Togo, Burkina Faso, Niger)||2008||MPH (Field Epi and Lab Management)||n/a||n/a||n/a||No info|
|Kazakhstan (FELTP)||2012||Certificate (Non Academic)||2||6||4 (67%)||No 2016|
The initiation, and overall implementation of the FELTP L-Track program. All programs in Africa award a Master degree or its equivalent while programs in Caucuses are non-academic certificate programs. Data on approximate residents trained and status of the L-Track is also shown.
Fellows in eastern Africa graduated with a Master of Science degree in Laboratory Management and Epidemiology while the western African programs awarded Master of Philosophy or Masters in Public Health in Field or Applied Epidemiology and Laboratory Management (Table (Table1).1). The Kazakhstan and Central Asian programs are non-degree. Data regarding numbers of L-Track residents or graduates were not available for regional programs in Cameroon, Mali and Georgia.
For all FELTP programs, the basic academic qualification for fellows entering the L-Track was a bachelor's degree in laboratory sciences (or equivalent) as shown in Table Table22 below. In Ghana there was an indication those with diploma in laboratory sciences also qualify but the diploma training is a 3-year course in clinical laboratory post high school and thus would be functionally equivalent to a bachelor's degree in laboratory sciences. Those with Medical or Veterinary degrees or Masters degrees or higher are eligible in all implementing FELTP programs. However, there are differences in the work experience required to qualify for FELTP enrollment. This ranged from a high of 3–5 years in clinical or public health laboratory work experience (Kazakhstan and Tanzania) to no work experience necessary in Nigeria.
|Basic academic qualifications||BSc Lab Sciences, Diploma Lab Science||BSc Lab Sciences||BSc Lab Sciences||BSc Lab Sciences||BSc Lab Sciences||BSc Lab Sciences||BSc Lab Sciences|
|Work experience||1–2 years in Clinical/Public Health Laboratory||3–5 years in Clinical/Public Health Laboratory||At least 2 years in Clinical/Public Health Laboratory||1–2 years in Clinical/Public Health Laboratory||No work experience necessary||1–2 years in Clinical/Public Health Laboratory||3–5 years in Clinical/Public Health Laboratory|
The basic qualifications for admission to the FELTP L-Track Program both in academics and work experience. All require a degree in or Diploma in Laboratory sciences, Tanzania and Kazakhstan require at least 3 years work experience while no work experience in required in the Nigeria program.
Several respondents cited factors they considered major challenges which are either ongoing or contributed to the decision to roll back the separate L-Track curriculum (Figure (Figure2).2). Respondents cited a lack of a standardized curriculum for the laboratory module, describing it as “curriculum not viable” or “structural issues and is not serving its purpose” while others cited shortage of laboratorian applicants. Another recurring factor were budget restrictions and lack of sustainability options. A combination of some of these reasons and budget cuts affecting the whole FELTP program also resulted to some scaling back on the separate laboratory module. Most of the budgetary issues were linked to reductions in funding for programs such as Presidential Emergency Plan for AIDS Relief (PEPFAR) and Presidential Malaria Initiative (PMI), and other related international aid programs for public health.
Data from the FELTP programs with complete information indicated the bulk of residents were recruited from national public health laboratories or from the regional public health or clinical laboratories. Ghana had the largest proportion from regional public health laboratories and clinical laboratories (Figure (Figure3).3). Kenya and Tanzania had the widest range of institutions contributing to FELTP L-Track residents which in addition to Ministry of Health included research institutes, Ministry of Agriculture and Livestock, Ministry of Defense, universities and non-governmental organizations outside of the traditional public health laboratory network. In contrast, all the FELTP L-Track residents in Rwanda came from the national reference laboratory. In Kazakhstan, residents were equally divided from the national reference laboratory and regional laboratories.
FELTP programs continue to build their capacity by steadily enrolling laboratorians in their FELTP. Nigeria has the largest number of trainees (101). The graduation rate is low in Nigeria at 31%, but this is because of an upswing in recruitment in the last four cohorts. Kenya continues to enroll laboratorians in their FELTP, after rolling back the L-Track as does Mozambique and Ghana. Tanzania had more FELTP L-Track graduates than the trainees in the pipeline as shown in Figure Figure44.
A major concern for the FELTP L-Track has been the career trajectory of the graduates. Unfortunately, only Kenya and Tanzania provided the detailed data on where their residents were before and after enrollment into FELTP. Out of 40 so far enrolled in Kenya, complete data was provided for 39 FELTP Laboratory residents while Tanzania provided complete data for 37 residents. Prior to enrollment, the majority of residents in both Kenya and Tanzania were laboratory scientist working in either the national public health laboratories or in district or provincial hospital clinical laboratories. Areas of employment of residents showed diverse positions as seen in Table Table3.3. For the Tanzania cohorts, there were ~6 general categories of the positions prior to enrollment with the largest group comprising 65% laboratory scientists. This number of categories increased to 17 post-enrollment (Figure (Figure5A).5A). Similarly, in Kenya there were eight overall categories with the laboratory scientists making about 46% of the total. Conversely, Kenya post enrollment categories were double the pre-enrollment numbers at 16 (Figure (Figure5B).5B). It is unclear if the residents changed positions because of enrollment into the FELTP as some of them were yet to graduate.
|Resident positions & institutional mobility|
|Propotions||Kenya n = 39||Tanzania n = 37|
|At original institutions||62||30|
|PROMOTIONS POST FELTP ENROLLMENT|
The positions of residents in both Kenya and Tanzania, before and after enrollement into FELTP. There was a high movement between institutions in the Kenya residents but in both countries, residents reported moving to a higher position after enrollement.
While the Kenya and Tanzania cohorts exhibited this change in positions, analysis indicated 62% of the Kenyan cohort moved to a different institution while 70% in Tanzania were in the same institution post enrollment but largely within the public sector. However, there was a high level of upward mobility with both cohorts indicating an upward change in position at 87 and 73% in Kenya and Tanzania respectively as shown in Table Table33 below.
From the overall positions of the residents post-FELTP enrollment, a classification was made on possible areas of focus to assess the proportion of those who are still working directly in the laboratory services. Those considered to be working directly in the clinical and public health laboratory services included laboratory directors or deputies, laboratory managers, heads of laboratory units, quality officers, blood safety, scientists, and technologists in laboratories including in academics and research. Those considered not working directly in laboratory services included residents in program managements, field and training coordinators, local government management positions (counties, district councils), epidemiologists, FELTP Advisors, inspectors and bureau of standards managers. Others not considered directly in laboratory services were in NGOs and the private sector. Approximately 56% of residents in Kenya work in areas considered outside laboratory services while the corresponding number is much lower in Tanzania at 43%. A significant proportion of FELTP graduates in Kenya are working as laboratory coordinators with county governments or in international organizations including WHO, CDC, and African Field Epidemiology Network (AFENET). A small but significant number of L-Track were international students and data show they have also progressed to be: the head of national laboratory in Tanzania, the head of laboratories for the Ministry of Defense, and the laboratory inspector both in South Sudan, and program officer for laboratory quality assurance in the Uganda Central Public Health Laboratory. One graduate has joined the private sector while there was loss to follow up for another graduate. In Tanzania, one of the graduates was a clinical officer and rejoined the source institution (military hospital) in Zambia.
At the end of the questionnaire, respondents listed recommendations for changes in the FELTP L-Track. Recommendations included:
The introduction of FELTP, especially in Africa, has seen a paradigm shift in laboratory training in the era of emerging and re-emerging diseases, disease detection and integrated disease surveillance and an important enhancement in global health security by contributing to more rapid detection and control of public health emergencies. (12–14). The FELTP offers laboratorian skills that were hitherto neglected by the traditional academic trainings which offered little in laboratory management or competencies in integrated epidemiology, laboratory surveillance, confirmatory testing in disease outbreaks and data analyses (15). Despite the demand for skilled and competent laboratorians in public health systems, the lack of standardized curriculum or long-term strategies threaten the sustenance of the separate L-Track as is evident from the roll back from many FELTP programs. In response, countries are finding the middle ground for FELTP by continuing to recruit laboratorians into the training where laboratory related modules are covered in the same scope with epidemiologists, veterinarians and any other trainees. This is the case with other FET(L)P programs in Kenya, Cameroon, and Central Asia and South Caucus which even without the L-Track enroll laboratory scientists for training in applied or field epidemiology (16). Nigeria, Rwanda and Tanzania however continue to implement and expand the L-Track recruitments to the respective FELTP programs. Reports form AFENET also show Angola continues to enroll L-Track and the 2 cohorts of 20 residents comprised of 12 Epi and 8 L-Track (15).
The challenges facing the L-Track FELTP identified here were listed in previous evaluations done by CDC. The program has experienced structural problems some of which may be inherent in the respective countries laboratory systems. For example, majority of recruits to the L-Track within the FELTP were from either the national reference laboratories or the regional clinical laboratories which in themselves have significant challenges in their operation and management systems. It is worth noting that prior to 2004 when the first FELTP cohort was initiated in Kenya, medical laboratories in many developing countries were severally neglected with low standards, undefined or outdated policies and limited national government's funding (17). The L-Track has therefore operated in an era where national laboratory systems were starting to address systemic challenges including legal frameworks, mandates and standards for medical laboratories (18). The lack of clarity at the national laboratory systems level and sometimes absence of defined public health laboratories ultimately may contribute to some of the structural challenges in both the curriculum and career development. Some of these were highlighted in a previous review where lack of sufficient mentors, key capacities in laboratory settings, lack of infrastructure and supplies were identified as challenges to FELTP among others (CDC; internal presentation). In addition, with the bulk of funding for FELTP tied to clinical laboratory testing, alignment to the core competencies of field laboratory and epidemiology was difficult. As donor funds have decreased, FELTP has seen significant budget cuts disrupting programs as they search for alternative financing. Some FELTP programs such as in Nigeria however continue to expand their L-Track program representing a unique program with joint training for epidemiologists, public health laboratory scientists, and veterinary field epidemiologists.
Several FELTP programs indicated the curriculum was “not viable.” Further discussions revealed programs were still debating on what the L-Track aim was considering the tendency of turning laboratorians into epidemiologists or program managers. Indeed, our data indicate over 50% of the FELTP residents in Kenya are working as epidemiologists, program managers or coordinators while in Tanzania 43% are working as epidemiologist or program managers/coordinators. As the data shows most of this was through career changes and promotions, an indication of the ambiguity of the program in relation to the respective workforce development especially in strengthening public health systems, laboratory response to outbreaks and disease surveillance. Despite this limitation, the data suggests the FELTP graduates are in demand especially in program coordination and management. At least four graduates are working as FELTP RA or advisors for CDC, or AFENET while others have joined international organizations including WHO.
A growing number of residents have taken positions as county medical laboratory coordinators in Kenya or district council laboratory scientists in Tanzania. The devolutions of national governments to a more decentralized system is opening opportunities at local government levels for laboratory coordinators and manager to provide oversight on services, budgets, personnel, infrastructure, and trainings. These are senior positions in the current health services delivery system as they are members of county/regional Senior Health Management Teams (SHMTs). Their skills in clinical laboratories and competencies in field epidemiology and laboratory management afford them unique opportunities to oversee both diagnostic and surveillance services. However, while this may be a priority with the country's national health system, and an affirmation of the program's success, it is a drain to the public health laboratory systems that were targeted in the initial FELTP programs, reducing the number of highly qualified staff within laboratories. There are other laboratory training programs aiming at building competencies in laboratory quality management, or management and leadership, but these are mainly short term, specific program-oriented and often times aim for facility-based improvements, rather than national systems strengthening (19, 20).
A downside to this survey was the limited data available for analysis as most FELTP programs failed to complete the questionnaire in its entirety. There is also evidence that databases one on the positions of fellows before joining FELTP and post-graduation and career paths within the health sector is not always available. Individual country data and reports on career progression of their residents over time would inform on the significance of the programs but there are significant challenges in getting complete data. This information is important in the development of strategies to address the core needs within public health laboratory workforces to fill the demands in clinical laboratories and integrated disease surveillance. The recent Ebola outbreak in parts of West Africa has increased the demand for laboratorians competent in disease surveillance, management of outbreaks and overall leadership skills (13, 21). Such skills remain a significant gap in laboratories workforce despite the implementation of FELTP program.
In conclusion, there is still a lack of clarity in both structure and systems in countries regarding the L-Track of the FELTP. Confusion still lingers on graduates' career paths and their advancements within the respective ministries. The majority of responders indicated it would be preferable to have a more focused field laboratory management program with clear intersection and overlap with epidemiologists. This could be achieved through an independent in-service laboratory professional training program with strong links to FETP or a more robust autonomous laboratory training track within the umbrella of FELTP. A concerted effort should also focus on host countries reviewing their laboratory workforce policies to include FELTP and other areas in laboratorian career development programs that are aligned and reflect the current demand for skilled and competent laboratory scientists able to strengthen public and clinical laboratory systems.
The questionnaire and raw responses generated and/or analyzed during the current study are not publicly available as they are held as program reports but would be availed from the corresponding author on reasonable request. The summarized reports obtained are however inclusive in whole of all data obtained.
The CDC human subjects research office judged that the survey constituted routine public activities and therefore did not involve human subjects research. All respondents were contacted by phone and email and they responded to voluntarily participate in the Survey Monkey answers. All authors submitted a written consent to the contents and publication of this manuscript in its entirety. The results and draft manuscript was shared with all the participants as feedback. The manuscript was reviewed and cleared for publication by Centers for Disease Control and Prevention.
WG is the lead author and is accountable for data analyses and all other aspects of this manuscript. AH, MR, JM, LP, and AAA were key in the study design and drafting of the questionnaire. TG, AA, and DM contributed to the in depth data summary data of resident's positions used in this study. All authors contributed to final discussion in the manuscript and all approved the final version for submission to scientific publication.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
We are indebted to all who participated in the Monkey Survey, answered follow-up questions or sent clarifications: Bola Olayinka, Els Mathieu, Enock Karekezi, Eric Tongren, Ernest Kenu, and Tim Doyle. Special thanks to Ms Bongkoch Jetsawang, DGHP HETA Fellow (2016) for providing initial summaries of the questionnaires. We thank all those who have previously held discussions and the retreats cited here including Beth Skaggs, Thomas Rush, and Nykiconia Preacely.
|AFENET||African Field Epidemiology Network|
|CDC||Centers for Disease Control and Prevention|
|FETP||Field Epidemiology Training Program|
|FELTP||Field Epidemiology and Laboratory Training Program|
|IDR||Integrated Disease Surveillance and Response|
|IHR||International Health Regulations|
|PEPFAR||Presidential Emergency Plan for AIDS Relief|
|PMI||Presidential Malaria Initiative|
Authors:Ahmed Abade Rachel B Eidex Athanasia Maro Jean Gratz Jie Liu Ireen Kiwelu Buliga Mujaga Maria E Kelly Blandina T Mmbaga James J Gibson Fausta Mosha Eric R Houpt
Am J Trop Med Hyg 2018 06 29;98(6):1640-1642. Epub 2018 Mar 29.
University of Virginia, Charlottesville, Virginia.
Sero-prevalence and spatial distribution of Rift Valley fever infection among agro- pastoral and pastoral communities during Interepidemic period in the Serengeti ecosystem, northern Tanzania
BMC Infectious Diseases (2018) 18:276
BMC Infectious Diseases
In the past two decades, Rift Valley Fever (RVF) outbreaks have been reported twice in Tanzania, with the most recent outbreak occurring in 2006/07. Given the ecology and climatic factors that support mosquito vectors in the Serengeti ecosystem, we hypothesized a continued transmission of RVF virus (RVFV) during interepidemic periods. This study was carried out to determine sero-prevalence, spatial distribution and factors associated with RVF in at-risk agro-pastoral and pastoral communities in the Serengeti Ecosystem in northern Tanzania.
Authors:Loveness John Urio Joseph Asamoah Frimpong Innocent Semali Rogath Saika Kishimba Janneth Maridadi Mghamba Ahmed Abade Senga Sembuche Nsiande Lema Asha Khamis Ussi
The Pan African Medical Journal. 2018;30 (Supp 1):7. doi:10.11604/pamj.supp.2018.30.1.15265
Pan African Medical Journal
The investigation of foodborne outbreaks requires a multi-disciplinary set of skills. Frequently, foodborne-related outbreaks are poorly investigated due to lack of all required skills on the part of the investigators. This case study, based on a shellfish poisoning outbreak investigation conducted in Wete, Zanzibar in July 2015 by the Tanzania Field Epidemiology Training Program (TFETP), seeks to reinforce principles and skills in foodborne outbreak investigation. It is primarily intended for training public health practitioners in a classroom setting. Facilitating this case study should take approximately 3 hours.
Socio-demographic determinants of dengue infection during an outbreak in Dar es Salaam City, Tanzania
Authors:Neema Camara Billy Ngasala Germana Leyna Ahmed Abade Susan F. Rumisha Ndekya M. Oriyo Leonard E.G. Mboera
Journal Home > Vol 20, No 2 (2018)
Tanzania Journal of Health Research
Background: In recent years, the eastern coast of Africa has witnessed a number of dengue outbreaks. This study was carried out to determine socio-demographic determinants of dengue infection during the 2014 outbreak in Dar es Salaam, Tanzania. Methods: Unmatched case-control analysis of secondary data from a cross-sectional dengue investigation in three districts of Dar es Salaam in June 2014 was conducted. Febrile patients seeking care at health facilities were recruited. Cases were serologically-confirmed dengue-positive while controls were serologically-confirmed dengue-negative patients. A questionnaire was used to collect sociodemographic information. The association between sociodemographic variables and dengue infection was examined using univariate analysis and multivariate logistic regression analysis. Results: A total of 81 cases and 281 controls were included in the analysis. Majority of the cases and controls were males (64.2% versus 54.1%; P=0.137) and were >15 years of age (88.9% versus 72.9%; P =0.003). Living in Kinondoni (aOR = 4.28; 95% CI: 1.74 - 10.53); being employed (aOR = 2.06; 95% CI: 1.06-4.04); having piped water at home (aOR = 2.63; 95% CI: 1.40 - 4.95) and a recent visit of health facility (aOR = 1.94; 95% CI: 1.11 - 3.38) were significantly associated with dengue infection. Conclusions: Dengue infection in Dar es Salaam varied between the three districts and was associated with being employed, having piped water at home and a recent visit to the health facility. These findings provide primary understanding of the influence of socio-demographic factors on dengue and may be used to develop appropriate preventive interventions.
Cholera Mortality during Urban Epidemic, Dar es. Salaam, Tanzania, August 16, 2015-January 16, 20161.
Authors:McCrickard LS Massay AE Narra R Mghamba J Mohamed AA Kishimba RS Urio LJ Rusibayamila N Magembe G Bakari M Gibson JJ Eidex RB Quick RE.
Emerg Infect Dis. 2017 Dec;23(13). doi: 10.3201/eid2313.170529.
Emerging infectious Disease
Abstract In 2015, a cholera epidemic occurred in Tanzania; most cases and deaths occurred in Dar es Salaam early in the outbreak. We evaluated cholera mortality through passive surveillance, burial permits, and interviews conducted with decedents' caretakers. Active case finding identified 101 suspected cholera deaths. Routine surveillance had captured only 48 (48%) of all cholera deaths, and burial permit assessments captured the remainder. We interviewed caregivers of 56 decedents to assess cholera management behaviors. Of 51 decedents receiving home care, 5 (10%) used oral rehydration solution after becoming ill. Caregivers reported that 51 (93%) of 55 decedents with known time of death sought care before death; 16 (29%) of 55 delayed seeking care for >6 h. Of the 33 (59%) community decedents, 20 (61%) were said to have been discharged from a health facility before death. Appropriate and early management of cholera cases can reduce the number of cholera deaths.
Knowledge of obstetric danger signs among recently-delivered women in Chamwino district, Tanzania: a cross-sectional study.
BMC Pregnancy Childbirth 2017 Aug 29;17(1):276. Epub 2017 Aug 29.
Tanzania Field Epidemiology and Laboratory Training Programme (TFELTP), Dar Es Salaam, Tanzania.
Male partner involvement in the prevention of mother to child transmission of HIV infection in Mwanza Region, Tanzania
Pan Afr Med J. 2017 Jun 6;27:90. doi: 10.11604/pamj.2017.27.90.8901.
Pan Africa Medical Journal
INTRODUCTION: Globally, there are 3.3 million children < 15 years of age living with HIV infection. About 95% of HIV infected children have acquired infection from their mothers. Although new pediatric HIV infection in Tanzania has declined by 48% and Prevention of Mother to Child Transmission (PMTCT) coverage of highly active anti-retroviral therapy (HAART) has increased to 77%, the MTCT rate remains high (15%). Poor male partner involvement in PMTCT services is one of the factors contributing to reduced effectiveness of the PMTCT and hence failure to achieve the elimination of maternal to child transmission of HIV. This study examined the predictors of male involvement in PMTCT services in Mwanza Region, Tanzania from perspectives of the mother. METHODS: A cross sectional study involving selected health facilities was conducted in Mwanza urban from October 2013 through January 2014. HIV positive pregnant women attending ante-natal clinic (ANC) were interviewed using a semi structured questionnaire. Univariate analysis was used to describe the study respondents where bivariate and logistic regression was used to determine predictors of male involvement. RESULTS: A total of 300 HIV positive mothers attending ANC with the mean age of 27.5 + 5.6 were interviewed. Few mothers (24.7%) had their male partners involved in PMTCT. Predictors of male partner involvement in PMTCT were mothers being proactive (Adjusted Odds Ratio (AOR) 28.6; Confidence Interval (CI) 7-116), perceived partners knowledge on PMTCT (AOR 24.6, CI 5.9-102.8), exposure to TV/Radio announcements on PMTCT (AOR 4.6, CI 1.5-14) and married status of the mother (AOR 3.7, CI 1.5-9). Mothers who never wanted to be escorted by their male partners and busy partners were associated with reduced odds of male involvement into PMTCT (AOR 0.07, CI 0.007-0.68) and (AOR 0.46 CI 0.21-0.99) respectively. Male partner involvement was associated with 98% reduced odds of violence (Crude Odds Ratio 0.018 CI 0.002-0.14). CONCLUSION: Male partner involvement in PMTCT is still low in Mwanza Region. Proactive mothers, partner's knowledge on PMTCT and announcements from television/radio were the major facilitating factors for male involvement in PMTCT as perceived by mothers. Busy male partners and mothers who did not want to be escorted by their partners were a hindrance to male involvement in PMTCT services. These factors highlight the importance of women role in promotion of PMTCT male involvement.
Identification and antimicrobial resistance patterns of bacterial enteropathogens from children aged 0-59 months at the University Teaching Hospital, Lusaka, Zambia: a prospective cross sectional study.
Authors:Harriet Chiyangi John B Muma Sydney Malama Joel Manyahi Ahmed Abade Geoffrey Kwenda Mecky I Matee
BMC Infect Dis 2017 02 2;17(1):117. Epub 2017 Feb 2.
Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania.
Genetic Characterization of Vibrio cholerae O1 isolates from outbreaks between 2011 and 2015 in Tanzania.
Authors:Yazid Kachwamba A A Mohammed H Lukupulo L Urio M Majigo F Mosha M Matonya R Kishimba J Mghamba J Lusekelo S Nyanga M Almeida S Li D Domman S Y Massele O C Stine
BMC Infect Dis 2017 02 20;17(1):157. Epub 2017 Feb 20.
Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA.
Risk factors associated with multidrug resistant tuberculosis among patients referred to Kibong’oto Infectious Disease Hospital in northern Tanzania
Volume 18, Number 4, October 2016
Tanzania Journal of Health Research
Background: Multidrug resistant tuberculosis (MDR-TB) has remained an important public health problem in developing world. We conducted this study to determine risk factors associated with MDR-TB and drug susceptibility pattern to second line drug among MDR TB patients in Tanzania. Methods: From July to November 2014, Unmatched case control study was conducted at Kibong’oto Infectious Diseases Hospital in Tanzania. A case was defined as any patient whose sputum yielded Mycobacterium tuberculosis that were resistance to at least rifampin (RFP) and isoniazid (INH) whereas control was defined as those sensitive to rifampin (RFP) + isoniazid (INH). One morning sputum sample was collected from each study participant and cultured on Löwenstein-Jensen (LJ) media for M. tuberculosis. Drug susceptibility testing of isolated M. tuberculosis was done for rifampicin, isoniazid, kanamycin and ofloxacin. A semi-structured questionnaire was used to collect socio-demographic and risk factors information for MDR-TB. Results: A total of 102 cases and 102 controls were enrolled. The predominant age group was 31- 40 years, of whom cases and controls accounted for 38 (37.3%) and 35 (34.3%) of study participants, respectively. Majority of participants (69% cases and 71% control) were males and self-employed (62.7% cases and 84.4% controls). More than half (52%) and approximately a quarter (24.5%) of cases and control had HIV infection, respectively. About two-thirds of cases (62.7%) were cigarette smokers where by cigarette smoking was reported in 42.2% of controls. Previous history of TB treatment accounted for approximately three quarter (72.5%) and only 24.5% of cases and controls, respectively. Risk factors independently associated with MDRTB were previous history of treatment with first line anti-TB (OR= 3.3, 95% CI 1.7-6.3), smoking (OR=1.9, 95% CI 1.0-3.5), contact with TB case (OR=2.7, 95% CI 1.4-5.1) and history of TB. All MDR TB isolates were sensitive to kanamycin and ofloxacin. Conclusion: MDR-TB among patients referred to Kibong’oto Infectious Diseases Hospital is associated with previous history of TB contact, smoking habit, and contact with TB case. All MDR TB isolates were sensitive to the tested second line drugs, Kanamycin and Ofloxacin. Keywords: Tuberculosis, MDR-TB, risk factors, drug resistance, second line anti-TB, Tanzania
ACCURACY OF MALARIA DIAGNOSIS AND PRESCRIBING PATTERNS FOR FEBRILE UNDERFIVES IN AN AREA WITH DECLINING MALARIA BURDEN, NORTHEASTERN TANZANIA
Vol 6 | Issue 1 | 2016 | 41-47
Asian J of Pharm Sci & Tech
This study examined the accuracy of clinical diagnosis and rapid malaria diagnostic test (mRDT) for the prediction of malaria; and the patterns of prescription for febrile underfives in a setting with reduced malaria burden. A quantitative facility based study was carried among 510 febrile underfives attending in primary health facilities of Tanga city. For each underfives referred for laboratory malaria confirmation; fever was measured by a digital thermometer and finger prick blood samples taken for mRDT testing and microscopy. Results of mRDT were provided to the clinician for a prescription and type of drugs prescribed recorded. Accuracy of measured fever, clinical diagnosis and mRDT for the prediction of malaria was assessed by performance indices against microscopy. Influence of mRDT results on prescribing patterns was also assessed. A clinical malaria diagnosis had a very highly sensitivity (100% [95%CI: 87.0 – 100.0]) and negative predictive value (100.0% [95%CI: 98.7 –100.0]); but a relatively low specificity (74.0% [95%CI: 70.0 – 77.8]) and very low positive predictive value (21.0% [95%CI:15.1 – 28.4]). The mRDT retained very high sensitivity ≥ 95.0% (97.0% [95%CI: 84.2 – 99.5]), specificity was also high (93.9 % [95%CI: 91.4 – 95.9]) but below the WHO recommendation of ≥ 95%. Of the 162 receiving antimalarial, only 21.6% were mRDT positive while majority (78.4%) was mRDT negative. Of those receiving antibiotic, the large majority (93.0%) was mRDT negative probably representing an over prescription of antibiotics. The decline in malaria prevalence has altered the performance of mRDT to a specificity < 95% below the WHO recommendation. There was an over prescription of both antimalarial andantibiotics. Key words: Febrile underfives, Diagnostic accuracy, mRDT, Prescribing patterns, Tanzania.
Phenotypic and genetic characterization of Vibrio cholerae O1 isolated from various regions of Kenya between 2007 and 2010.
Authors:Njeru Mercy Ahmed Abade Mohamed Ng'ang'a Zipporah Goutam Chowdhury Gururaja Perumal Pazhani Thandavarayan Ramamurthy Hamadi I Boga Samuel M Kariuki Oundo Joseph
Pan Afr Med J 2014 4;19. Epub 2014 Sep 4.
Centre for Disease Control (CDC), Nairobi, Kenya.
Methicillin-resistant staphylococcus aureus (MRSA) colonization among Intensive Care Unit (ICU) patients and health care workers at Muhimbili national hospital, Dar Es Salaam, Tanzania, 2012
Pan Afr Med J. 2015 Jul 23;21:211. doi: 10.11604/pamj.2015.21.211.4207. eCollection 2015.
Pan African Medical Journal
INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as important nosocomial pathogens worldwide. S aureus may induce clinically manifested diseases, or the host may remain completely asymptomatic. METHODS: A cross-sectional hospital-based study was conducted from October 2012 to March 2013 in two ICUs at MNH. Admitted patients and health care workers were enrolled in the study. Interviewer administered questionnaires; patient history forms, observation charts and case report forms were used to collect data. Swabs (nostrils, axillary or wounds) were collected. MRSA were screened and confirmed using cefoxitin, oxacillin discs and oxacillin screen agar. Antibiotic susceptibility was performed using Kirby-Bauer disk diffusion method. The risk factors for MRSA were determined using the logistic regression analysis and a p - value of <0.05 was considered as statistically significant. RESULTS: Of the 169 patients and 47 health workers who were recruited, the mean age was 43.4 years ± SD 15.3 and 37.7 years ± (SD) 11.44 respectively. Among the patients male contributed 108 (63.9%) while in health worker majority 39(83%) were females. The prevalence of MRSA colonization among patients and health care workers was 11.83% and 2.1% respectively. All (21) MRSA isolates were highly resistant to penicillin and erythromycin, and 17 (85.7%) were highly sensitive to vancomycin. Being male (AOR 6.74, 95% CI 1.31-34.76), history of sickness in past year (AOR 4.89, 95% CI 1.82- 13.12), being sick for more 3 times (AOR 8.91, 95% CI 2.32-34.20), being diabetic (AOR 4.87, 95% CI 1.55-15.36) and illicit drug use (AOR 10.18, 95%CI 1.36-76.52) were found to be independently associated with MRSA colonization. CONCLUSION: A study identified a high prevalence of MRSA colonization among patients admitted in the ICU. MRSA isolates were highly resistant to penicillin and erythromycin. History of illegal drug use was highly associated with MRSA colonization. KEYWORDS: ICU; MRSA; colonization; prevalence
Post exposure prophylaxis following occupational exposure to HIV: a survey of health care workers in Mbeya, Tanzania, 2009-2010
Pan Afr Med J. 2015; 21: 32.
Pan African Medical Journal
Introduction Approximately, 1,000 HIV infections are transmitted annually to health care workers (HCWs) worldwide from occupational exposures. Tanzania HCWs experience one to nine needle stick injuries (NSIs) per year, yet the use of post-exposure prophylaxis (PEP) is largely undocumented. We assessed factors influencing use of PEP among HCWs following occupational exposure to HIV. Methods A cross-sectional study was conducted in Mbeya Referral Hospital, Mbozi and Mbarali District Hospitals from December 2009 to January 2010 with a sample size of 360 HCWs. Participants were randomly selected from a list of eligible HCWs in Mbeya hospital and all eligible HCWs were enrolled in the two District Hospitals. Information regarding risk of exposure to body fluids and NSIs were collected using a questionnaire. Logistic regression was done to identify predictors for PEP use using Epi Info 3.5.1 at 95% confidence interval. Results Of 291 HCWs who participated in the study, 35.1% (102/291) were exposed to NSIs and body fluids, with NSIs accounting for 62.9% (64/102). Exposure was highest among medical attendants 38.8% (33/85). Out of exposed HCWs, (22.5% (23/102) used HIV PEP with females more likely to use PEP than males. Reporting of exposures (OR=21.1, CI: 3.85-115.62) and having PEP knowledge (OR =6.5, CI: 1.78-23.99) were significantly associated with using PEP. Conclusion Despite the observed rate of occupational exposure to HCWs in Tanzania, use of PEP is still low. Effective prevention from HIV infection at work places is required through proper training of HCWs on PEP with emphasis on timely reporting of exposures. Keywords: Post exposure prophylaxis, health care workers, occupational exposure, HIV
Authors:Cosmas George Kauky Rogath Saika Kishimba Loveness John Urio Ahmed Mohammed Abade Janneth Maridadi Mghamba
Pan Afr Med J. 2015; 20: 438.
Pan African Medical Journal
Introduction The purpose of this study was to determine prevalence of helmet use among motorcyclists as one of the preventive measures for road traffic injuries. Methods A cross sectional observational survey was conducted in the 3 Districts (Kinondoni, Ilala and Temeke) that make Dar es Salaam. Tanzania. A standardized line-listing form and checklist were used to record the drivers and passengers use of helmet as observed by study investigators. Data for helmet use was collected on one weekday and one weekend day. Time for observation was during the rush hour in the morning, noon and evening. Then data were entered into Epi Info 3.5.1 analysis Results A total of 7,678 motorcycle drivers and 4,328 passengers observed in this study. Drivers were almost male (98.8%) and 73.2% of all passengers were males. The prevalence use of helmet use among motorcyclist's riders was 82.1% and among passengers was 22.5%. Proportion of helmet use in drivers and passengers observed were relatively similar during weekday and weekend day and time of observation. Conclusion This study showed the relative high helmet use among motorcyclist riders though very low in passengers. This study recommends increased community awareness on helmet use among passengers and enforcement and revival of road safety laws of passengers and motorcyclists on helmet use. Keywords: Prevalence, helmet, motorcycle, Tanzania
Evaluation of HIV antigen /antibody combination ELISAs for diagnosis of HIV infection in Dar Es Salaam, Tanzania
Pan Afr Med J. 2015; 20: 196.
Pan African Medical Journal
Introduction The aim of this study was to evaluate the performance of Enzygnost HIV Integral II antigen/antibody combination ELISAs in order to formulate HIV ELISA testing algorithms for the Ministry of Health and Social Welfare, Tanzania. Methods This was a laboratory-based evaluation of Enzygnost HIV Integral II Antibody/ Antigen, Murex HIV antigen/antibody and Vironostika HIV Uniform II antigen/antibody conducted between October 2011 and May 2012. Results A total of 600 blood samples were included in the evaluation. A total of 209/596 (35.1%) serum samples were confirmed HIV positive. Of these, the prevalence of HIV infection was 2.3% (3/130), 2.3% (3/127), 2.2% (3/139) and 100% (200/200) for VCT clients, ANC attendees, blood donors and CTC patients, respectively. Three hundred and eighty seven (64.9%) were HIV negative samples. Sensitivity was 100% (95% CI; 98.3-100%) for all the three HIV ELISAs. The specificity for the Enzygnost HIV Integral II and Murex was 100% (95% CI; 99.1-100%). The final specificity at repeat testing was 99.5% (95% CI; 98.2-99.9%) for Vironostika. Enzygnost HIV Integral II detected HIV infection seven days since first bleed. Conclusion Initial testing using either Vironostika or Murex HIV antigen/antibody combination ELISA followed by testing of reactive samples on the Enzygnost HIV Integral II gave a sensitivity and specificity of 100% with reduced window period. Combination of two HIV antigen/antibody combination ELISAs can be used as an alternative confirmatory testing strategy for screening of donated blood at the National and Zonal blood transfusion centres and in lab diagnosis of HIV infection. Keywords: HIV antigen/antibody combination ELISA′s, HIV infection, diagnosis
Authors:John Kiiru Ankur Mutreja Ahmed Abade Mohamed Racheal W Kimani Joyce Mwituria Robert Onsare Sanaya Jane Muyodi Gunturu Revathi Julian Parkhill Nicholas Thomson Gordon Dougan Samuel Kariuki
PLoS One 2013 16;8(9):e74829. Epub 2013 Sep 16.
Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
Authors:Anagha Loharikar Elizabeth Briere Maurice Ope Daniel Langat Ian Njeru Lucy Gathigi Lyndah Makayotto Abdirizak M Ismail Martin Thuranira Ahmed Abade Samuel Amwayi Jared Omolo Joe Oundo Kevin M De Cock Robert F Breiman Tracy Ayers Eric Mintz Ciara E O'Reilly
J Infect Dis 2013 Nov;208 Suppl 1:S69-77
Epidemic Intelligence Service, Office of Workforce and Career Development.
Authors:David Mutonga Daniel Langat David Mwangi Julia Tonui Mercy Njeru Ahmed Abade Zephania Irura Ian Njeru Melissa Dahlke
Aetiology and factors associated with bacterial diarrhoeal diseases amongst urban refugee children in Eastleigh, Kenya: A case control study
Authors:• Waqo G. Boru Gideon Kikuvi Jared Omollo Ahmed Abade Samuel Amwayi William Ampofo Elizabeth T. Luman Joseph Oundo
African Journal of Laboratory Medicine; Vol 2, No 1 (2013), 6 pages. doi: 10.4102/ajlm.v2i1.63
African Journal of Laboratory Medicine
Introduction: Kenya is home to over 400 000 refugees from neighbouring countries. There is scanty information about diarrhoea amongst urban refugees in Kenya. Objectives: We investigated the enteric bacteria causing diarrhoea amongst urban refugee children and described the associated factors. Method: During the period of August–December 2010, urban refugee children between the ages of two and five who attended Eastleigh County Council Health Centre were enrolled into the study. Diarrhoeal cases were compared with age-matched children with no diarrhoea (controls). Stool specimens were collected and enteric bacteria isolated. A questionnaire was administered to identify risk factors. Results: A total of 41 cases and 41 controls were enrolled in the study. The age and country of origin were similar for cases and controls. The bacterial isolation rates amongst the cases were: non-pathogenic Escherichia coli 71%, Shigella dysenteriae 2.4%, Shigella flexneri 2.4%, Salmonella paratyphi 5%. For the controls, non-pathogenic E. coli 90% and enterotoxigenic E. coli (ETEC)2.4% were amongst the organisms isolated. All isolates were resistant to amoxicillin; resistance to other antibiotics varied by isolate type. Factors associated independently with diarrhoea included children not washing their hands with soap (aOR 5.9, p < 0.05), neighbour(s) having diarrhoea (aOR 39.8, p < 0.05), children not exclusively breastfed for their first 6 months (aOR 7.6, p < 0.05) and children eating food cooked the previous day (aOR 23.8, p = 0.002). Conclusions: Shigella species, Salmonella species and ETEC were found to be responsible for diarrhoea amongst the urban refugee children. Measures to control and guide the use of antibiotics are critical for the prevention of antibiotic resistance. Efforts to improve personal and domestic hygiene, including educational campaigns to promote appropriate handwashing, should be encouraged.
Pan Afr Med J. 2013; 15: 109.
Pan Africa Medical Journal
Cholera is a disease caused by the bacterium Vibrio cholera and has been an important public health problem since its first pandemic in 1817. Kenya has had numerous outbreaks of cholera ever since it was first detected there during 1971. In August 2010 an outbreak of cholera occurred in Kuria West District spreading to the neighboring Migori District. We conducted an investigation in order to determine the magnitude of the problem and institute control measures. Methods In order to update the line lists we reviewed records in Migori and Kuria district hospitals and conducted active case search in the community between 30th August and 6th September 2010. Data was analyzed using Epi-Info 3.5.2. Results A total of 114 cases and with 10 deaths (Case Fatality Rate = 9%) were documented. The index case was an 80 years old woman from Mabera Division who had hosted a cultural marriage ceremony a day before the outbreak. The mean age of case patients was 34.5 years (Standard Deviation=23.4) with a range 5 to 80 years. Females accounted for 61.4% of cases; people aged 10-39 years accounted 46.9%, those 40-69 years accounted for 29.2% and those above 70 years accounted for 9.7% of the cases. Sixty percent of deaths occurred among patients aged 50 years and over, case fatality rate was highest in this age group (16.7%) followed by those aged 40-49 years (12.5%), 20-29 years (10%) and 10-19 years (4.8%). The outbreak was confirmed within 2 weeks of onset after one (16.7%) of the six samples taken tested positive for V. cholera (serotype Inaba). Conclusion High case fatality rate and late laboratory confirmation was noted in this outbreak. There was urgent need to capacity build the districts on cholera case management, outbreak management, and equip the Migori District Hospital laboratory to allow prompt confirmation
Authors:Ahmed Abade Mohamed Joseph Oundo Samuel M Kariuki Hamadi I Boga Shanaz K Sharif Willis Akhwale Jared Omolo Anyangu S Amwayi David Mutonga David Kareko Mercy Njeru Shan Li Robert F Breiman O Colin Stine
Emerg Infect Dis 2012 Jun;18(6):925-31
Field Epidemiology and Laboratory TrainingProgram, Nairobi, Kenya.
East Afr Med J. 2010 May;87(5):192-8.
East Africa Medical Journal
OBJECTIVE: Determine factors associated with syphilis among pregnant women. DESIGN: Cross-sectional study. SETTING: Antenatal clinics of Juba Teaching Hospital, Malakia National Health Insurance Centre and Munuki Primary Health Care Centre in Juba, Southern Sudan. SUBJECTS: Consenting pregnant women not on syphilis treatment. MAIN OUTCOME MEASURES: Socio-demographic and clinical data, knowledge and behavioural characteristics. RESULTS: Of the 231 pregnant women participants, 51 (22.1%) were positive for syphilis with the rapid plasma reagin test and 79 (34.2%) were positive with the treponema pallidum Haemagglutination assay. Risk factors for syphilis were: housewife (OR 2.808; P= 0.0116), abortion (OR 2.654; P= 0.0116) and partner travel (OR 2.149; P= 0.028). Attending antenatal clinic for previous pregnancy was protective (OR 0.281; P= 0.0004) for syphilis. CONCLUSIONS: This is the first study to determine the prevalence and associated factors in the three clinics in Juba, South Sudan. There is a high prevalence of syphilis in pregnant women attending the selected health facilities. Treponema Pallindum Haemagglulination Assay can be used as a field test for syphilis due to its high sensitivity and specificity. Health education, screening and treating positive expectant mothers can reduce the prevalence of syphilis.
Authors:• Shikanga OT1 Mutonga D Abade M Amwayi S Ope M Limo H Mintz ED Quick RE Breiman RF Feikin DR
Am J Trop Med Hyg. 2009 Dec;81(6):1085-90. doi: 10.4269/ajtmh.2009.09-0400
American Journal of Tropical Medicine and Hygiene
In 2008, a cholera outbreak with unusually high mortality occurred in western Kenya during civil unrest after disputed presidential elections. Through active case finding, we found a 200% increase in fatal cases and a 37% increase in surviving cases over passively reported cases; the case-fatality ratio increased from 5.5% to 11.4%. In conditional logistic regression of a matched case-control study of fatal versus non-fatal cholera infection, home antibiotic treatment (odds ratio [OR] 0.049; 95% CI: < 0.001-0.43), hospitalization (OR, 0.066; 95% CI, 0.001-0.54), treatment in government-operated health facilities (OR, 0.15; 95% CI, 0.015-0.73), and receiving education about cholera by health workers (OR, 0.19; 95% CI, 0.018-0.96) were protective against death. Among 13 hospitalized fatal cases, chart review showed inadequate intravenous and oral hydration and substantial staff and supply shortages at the time of admission. Cholera mortality was under-reported and very high, in part because of factors exacerbated by widespread post-election violence.
eamj. Vol 89, No 1 (2012)
East African Medical Journal
Objectives: To identify factors associated with Brucellosis in patients attending Terekeka Health Facility, Terekeka County, Central Equatoria State, Southern Sudan and to evaluate the utility of the rapid test kit Euracil®. Design: A facility based case-control study. Setting: Terekeka Health Facility, Terekeka County, Central Equatoria State, Southern Sudan. Subjects: Cases were patients presenting at the Terekeka Health Facility with clinical symptoms suggestive of Brucellosis and tested positive for Brucellosis by rapid antigen test while controls were selected from individuals attending Terekeka Health facility with health problems unrelated to brucellosis or febrile illness. Results: A total of fifty eight cases with clinical symptoms suggestive of and tested positive for Brucellosis by rapid antigen test presented. A total of 116 consented controls were recruited into the study. Males accounted for 52% of the cases and 53% of the controls. The mean age was 31 years for both groups. Cases without formal education were 84% while 40% had no source of income, 20% of the cases and 14% of the controls were cattle keepers while 5% of the cases and 13% of the controls were students. In multivariate analysis there were many factors associated with Brucellosis like consumption of raw meat, living with animals at the same place, raising of goats, farm cleaning contact, eating of aborted and wild animals. Logistic regression revealed two factors associated with the disease; consumption of raw milk (OR=3.9, P-value 0.001, 95% CI 1.6666 - 9.0700) was a risk factor while drinking boiled milk was protective (OR= 0.09, p- value 0.000, 95% CI, 0.1 - 0.2). Conclusions: The main age-groups affected were 20 – 30 years with males being affected more than females. Drinking of raw milk was significantly associated with Brucellosis while drinking boiled milk was protective. There should be active public health education on the benefits of boiling milk before consumption. Further studies to elucidate the extent and epidemiology of brucellosis in humans and animals in Southern Sudan are recommended.