Application of community-based and integrated strategy to reduce malaria disease burden in southern Tanzania:the study protocol of China-UK-Tanzania pilot project on malaria control

Background:During the past six decades,remarkable success on malaria control has been made in China.The major experience could be shared with other malaria endemic countries including Tanzania with high malaria burden.Especially,China’s 1-3-7 model for malaria elimination is one of the most important refined experiences from many years’efforts and key innovation measures for malaria elimination in China.Methods:The China-UK-Tanzania pilot project on malaria control was implemented from April,2015 to June,2018,which was an operational research with two communities receiving the proposed interventions and two comparable communities serving as control sites.The World Health Organization"Test,Treat,Track"(WHO-T3)Initiative,which calls for every suspected case to receive a diagnostic test,every confirmed case to be treated,and for the disease to be tracked,was integrated with Chinese experiences on malaria control and elimination for exploration of a proper model tailored to the local settings.Application of China’s 1-3-7 model integrating with WHO-T3 initiative and local resources aiming at reducing the burden of malaria in terms of morbidity and mortality by 30%in the intervention communities in comparison with that at the baseline survey.Discussion:The China-UK-Tanzania pilot project on malaria control was that at China’s first pilot project on malaria control in Africa,exploring the feasibility of Chinese experiences by China-Africa collaboration,which is expected that the strategies and approaches used in this project could be potential for scaling up in Tanzania and African countries,and contribute to the acceleration of malaria control and elimination in Africa.

Distinct clinical characteristics and helminth co-infections in adult tuberculosis patients from urban compared to rural Tanzania

Background:Differences in rural and urban settings could account for distinct characteristics in the epidemiology of tuberculosis(TB).We comparatively studied epidemiological features of TB and helminth co-infections in adult patients from rural and urban settings of Tanzania.Methods:Adult patients(≥18 years)with microbiologically confirmed pulmonary TB were consecutively enrolled into two cohorts in Dar es Salaam,with~4.4 million inhabitants(urban),and Ifakara in the sparsely populated Kilombero District with~400000 inhabitants(rural).Clinical data were obtained at recruitment.Stool and urine samples were subjected to diagnose helminthiases using Kato-Katz,Baermann,urine filtration,and circulating cathodic antigen tests.Differences between groups were assessed byχ2,Fisher’s exact,and Wilcoxon rank sum tests.Logistic regression models were used to determine associations.Results:Between August 2015 and February 2017,668 patients were enrolled,460(68.9%)at the urban and 208(31.1%)at the rural site.Median patient age was 35 years(interquartile range[IQR]:27-41.5 years),and 454(68%)were males.Patients from the rural setting were older(median age 37 years vs.34 years,P=0.003),had a lower median body mass index(17.5 kg/m2 vs.18.5 kg/m2,P<0.001),a higher proportion of recurrent TB cases(9%vs.1%,P<0.001),and in HIV/TB co-infected patients a lower median CD4 cell counts(147 cells/μl vs.249 cells/μl,P=0.02)compared to those from urban Tanzania.There was no significant difference in frequencies of HIV infection,diabetes mellitus,and haemoglobin concentration levels between the two settings.The overall prevalence of helminth co-infections was 22.9%(95%confidence interval[CI]:20.4-27.0%).The significantly higher prevalence of helminth infections at the urban site(25.7%vs.17.3%,P=0.018)was predominantly driven by Strongyloides stercoralis(17.0%vs.4.8%,P<0.001)and Schistosoma mansoni infection(4.1%vs.16.4%,P<0.001).Recurrent TB was associated with living in a rural setting(adjusted odds ratio[aOR]:3.97,95%CI:1.16-13.67)and increasing age(aOR:1.06,95%CI:1.02-1.10).Conclusions:Clinical characteristics and helminth co-infections pattern differ in TB patients in urban and rural Tanzania.The differences underline the need for setting-specific,tailored public health interventions to improve clinical management of TB and comorbidities.

Evaluation of Malaria Standard Microscopy and Rapid Diagnostic Tests for Screening—Southern Tanzania,2018–2019

Summary What is already known about this topic?Microscopy is the gold standard for parasitological confirmation,but the accuracy of microscopic diagnosis is influenced by the skill of the technicians.An alternative is the immunologic-based malaria rapid diagnostic tests(mRDTs).What is added by this report?Our study evaluated standard microscopy in health system(SMHS)and mRDTs for focused screening and treatment of malaria(FSAT)in Southern Tanzania.We showed that mRDTs were more sensitive than local SMHS for diagnosing malaria infection.What are the implications for public health practices?Malaria rapid diagnostic tests can be useful as an alternative to SMHS for FSAT in the local context of Tanzania.