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Search Results: 1 - 10 of 67528 matches for " Andrew Y Kitua "
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To what extent can traditional medicine contribute a complementary or alternative solution to malaria control programmes?
Graz Bertrand,Kitua Andrew Y,Malebo Hamisi M
Malaria Journal , 2011, DOI: 10.1186/1475-2875-10-s1-s6
Abstract: Recent studies on traditional medicine (TM) have begun to change perspectives on TM effects and its role in the health of various populations. The safety and effectiveness of some TMs have been studied, paving the way to better collaboration between modern and traditional systems. Traditional medicines still remain a largely untapped health resource: they are not only sources of new leads for drug discoveries, but can also provide lessons and novel approaches that may have direct public-health and economic impact. To optimize such impact, several interventions have been suggested, including recognition of TM's economic and medical worth at academic and health policy levels; establishing working relationships with those prescribing TM; providing evidence for safety and effectiveness of local TM through appropriate studies with malaria patients; spreading results for clinical recommendations and health policy development; implementing and evaluating results of new health policies that officially integrate TM.
Role of traditional healers in the management of severe malaria among children below five years of age: the case of Kilosa and Handeni Districts, Tanzania
Emmanuel A Makundi, Hamisi M Malebo, Paulo Mhame, Andrew Y Kitua, Marian Warsame
Malaria Journal , 2006, DOI: 10.1186/1475-2875-5-58
Abstract: A community cross-sectional study was conducted in Kilosa and Handeni Districts, involving four villages selected on the basis of existing statistics on the number of traditional health practitioners involved in the management of severe malaria. A total of 41 traditional health practitioners were selected using the snowballing technique, whereby in-depth interviews were used to collect information. Eight Focus Group Discussions (FGDs) involving traditional health practitioners, caregivers and community leaders were carried out in each district.Home management of fever involving sponging or washing with warm water at the household level, was widely practiced by caregivers. One important finding was that traditional health practitioners and mothers were not linking the local illness termed degedege, a prominent feature in severe malaria, to biomedically-defined malaria. The majority of mothers (75%) considered degedege to be caused by evil spirits.The healing process was therefore organized in stages and failure to abide to the procedure could lead to relapse of degedege, which was believed to be caused by evil spirits. Treatment seeking was, therefore, a complex process and mothers would consult traditional health practitioners and modern health care providers, back and forth. Referrals to health facilities increased during the Rectal Artesunate Project, whereby project staff facilitated the process after traditional medical care with the provision of suppositories. This finding is challenging the common view that traditional healers are an important factor of delay for malaria treatment, they actually play a pivotal role by giving "bio-medically accepted first aid" which leads to reduction in body temperature hence increasing chances of survival for the child. Increasing the collaboration between traditional healers and modern health care providers was shown to improve the management of severe malaria in the studied areas.Traditional health care is not necessarily a
The magnitude and factors associated with delays in management of smear positive tuberculosis in Dar es Salaam, Tanzania
Sayoki G Mfinanga, Beatrice K Mutayoba, Amos Kahwa, Godfather Kimaro, Rugola Mtandu, Esther Ngadaya, Said Egwaga, Andrew Y Kitua
BMC Health Services Research , 2008, DOI: 10.1186/1472-6963-8-158
Abstract: A cross sectional hospital based survey in Dar es Salaam region, May 2006.We interviewed 639 TB patients. A total of 78.4% of patients had good knowledge on TB transmission. Only 35.9% had good knowledge on the symptoms. Patient delay was observed in 35.1% of the patients, with significantly (X2 = 5.49, d.f. = 1, P = 0.019) high proportion in females (41.0%) than in males (31.5%). Diagnosis delay was observed in 52.9% of the patients, with significantly (X2 = 10.1, d.f. = 1, P = 0.001) high proportion in females (62.1%) than in males (47.0%). Treatment delay was observed in 34.4% of patients with no significant differences among males and females. Several risk factors were significantly associated with patient's delays in females but not in males. The factors included not recognizing the following as TB symptoms: night sweat (OR = 1.92, 95% CI 1.20, 3.05), chest pain (OR = 1.62, 95% CI 1.1, 2.37), weight loss (OR = 1.55, 95% CI 1.03, 2.32), and coughing blood (OR = 1.47, 95% CI 1.01, 2.16). Other factors included: living more than 5 Km from a health facility (OR = 2.24, 95% CI 1.41, 3.55), no primary education (OR = 1.74, 95% CI 1.01, 3.05) and no employment (OR = 1.77, 95% CI 1.20, 2.60). In multiple logistic regression, five factors were more significant in females (OR = 2.22, 95% CI 1.14, 4.31) than in males (OR = 0.70, 95% CI 0.44, 1.11). These factors included not knowing that night sweat and chest pain are TB symptoms, a belief that TB is always associated with HIV infection, no employment and living far from a health facility.There were significant delays in the management of TB patients which were contributed by both patients and health facilities. However, delays in most of patients were due to delay of diagnosis and treatment in health facilities. The delays at all levels were more common in females than males. This indicates the need for education targeting health seeking behaviour and improvement in health system.Tanzania is among countries with the high
A progressive declining in the burden of malaria in north-eastern Tanzania
Bruno P Mmbando, Lasse S Vestergaard, Andrew Y Kitua, Martha M Lemnge, Thor G Theander, John PA Lusingu
Malaria Journal , 2010, DOI: 10.1186/1475-2875-9-216
Abstract: Malaria prevalence and morbidity have been monitored in two villages in north-eastern Tanzania; a lowland village and a highland village from 2003 to 2008. Trained village health workers treated presumptive malaria with the Tanzanian first-line anti-malarial drug and collected blood smears that were examined later. The prevalence of malaria parasitaemia across years was monitored through cross-sectional surveys.The prevalence of malaria parasitaemia in the lowland village decreased from 78.4% in 2003 to 13.0% in 2008, whereas in the highland village, the prevalence of parasitaemia dropped from 24.7% to 3.1% in the same period. Similarly, the incidence of febrile malaria episodes in the two villages dropped by almost 85% during the same period and there was a marked reduction in the number of young children who suffered from anaemia in the lowland village.There has been a marked decline in malaria in the study villages during the past few years. This decline is likely to be due to a combination of factors that include improved access to malaria treatment provided by the trained village helpers, protection from mosquitoes by increased availability of insecticide-impregnated bed nets and a reduced vector density. If this decline in malaria morbidity is sustained, it will have a marked effect on the disease burden in this part of Tanzania.There have been previous efforts to eradicate or, if this was not possible, to eliminate malaria, but these ambitious goals have not been achieved in large parts of Africa [1-5] despite the development of effective tools, such as insecticide-impregnated bed nets (ITNs) and case management on demand; and malaria vaccines are being developed to complement the existing tools [6-9]. The performance of these tools can be monitored by careful surveillance of the malaria burden in a defined community before and after their deployment [10-12]. However, malaria transmission and the associated disease burden can fluctuate in the absence of any i
Cytophilic antibodies to Plasmodium falciparum Glutamate Rich Protein are associated with malaria protection in an area of holoendemic transmission
John PA Lusingu, Lasse S Vestergaard, Michael Alifrangis, Bruno P Mmbando, Michael Theisen, Andrew Y Kitua, Martha M Lemnge, Thor G Theander
Malaria Journal , 2005, DOI: 10.1186/1475-2875-4-48
Abstract: A six month longitudinal study was conducted in an area of holoendemic malaria transmission in north-eastern Tanzania, where the incidence of febrile malaria decreased sharply by the age of three years, and anaemia constituted a significant part of the malaria disease burden. Plasma antibodies to glutamate rich protein (GLURP) were analysed and related with protection against malaria morbidity in models correcting for the effect of age.The risk of febrile malaria episodes was reduced significantly in children with measurable anti-GLURP IgG1 antibodies at enrolment [adjusted odds ratio: 0.39 (95% CI: 0.15, 0.99); P = 0.047]. Interestingly, there was an inverse relationship between the plasma anti-GLURP IgG1 and IgG3 levels and the levels of parasitaemia at enrolment. However, anti-GLURP IgG2 and IgG4 levels were not associated with reduction in parasite density. Similarly, antibody levels were not associated with haemoglobin levels or anaemia risk.Cytophilic IgG1 and IgG3 antibodies against R0-GLURP may contribute to the control of parasite multiplication and reduction in febrile malaria incidence in children living in an area of intense malaria transmission.In areas of stable malaria transmission, immunity is acquired during childhood [1,2], and the protection is mainly mediated by antibodies directed against the blood stages of the parasite [3]. The relationship between malaria morbidity and antibody levels to malaria antigens has been analysed in several prospective longitudinal studies performed in different parts of Africa and Asia [4-9]. The Glutamate Rich Protein (GLURP) is a Plasmodium falciparum antigen, which has been studied extensively. It is a 220 kD protein expressed in the hepatic, asexual and sexual stages of the parasite life cycle [10]. The protein can be divided into an N-terminal non-repeat region (R25–500 or R0), a central repeat region (R1) and a C-terminal repeat region (R2) [11]. GLURP is a malaria vaccine candidate, which has undergone phase
Malaria morbidity and immunity among residents of villages with different Plasmodium falciparum transmission intensity in North-Eastern Tanzania
John PA Lusingu, Lasse S Vestergaard, Bruno P Mmbando, Chris J Drakeley, Caroline Jones, Juma Akida, Zacharia X Savaeli, Andrew Y Kitua, Martha M Lemnge, Thor G Theander
Malaria Journal , 2004, DOI: 10.1186/1475-2875-3-26
Abstract: A 6-month longitudinal study monitoring risk factors for anaemia and febrile malaria episodes was conducted among individuals aged below 20 years, residing in three villages of different altitude in areas of high, moderate and low malaria transmission intensity in North-Eastern Tanzania.The burden of anaemia and malarial fever fell mainly on the youngest children and was highest in the village with high transmission intensity. Although a considerable percentage of individuals in all villages carried intestinal worms, logistic regression models indicated that Plasmodium falciparum was the only significant parasitic determinant of anaemia. Interestingly, children who carried low-density parasitaemia at the start of the study had a lower risk of contracting a febrile malaria episode but a higher risk of anaemia during the study period, than children who were slide negative at this point in time.Young children living in the high transmission village carried a very high anaemia burden, which could be attributed to malaria. The overall incidence of febrile malaria was also highest in the high transmission village particularly among those under five years of age. These data suggest that in rolling back malaria, available resources in prevention programmes should primarily be focussed on young children, particularly those residing in areas of high malaria transmission.Plasmodium falciparum malaria remains an important public health problem in sub-Saharan Africa. To develop and assess the efficacy of control measures, it is important to obtain a better understanding of how the malaria disease burden is distributed among population groups and how this burden is affected by changes in malaria transmission intensity [1]. In areas of high malaria transmission infants and young children carry a very high disease burden [2], but protective immunity is developed in early childhood. Adults and older children are able to control parasitaemia and therefore only rarely suffer from mild
European and Developing Countries Clinical Trials Partnership (EDCTP): the path towards a true partnership
Mecky I Matee, Christine Manyando, Peter M Ndumbe, Tumani Corrah, Walter G Jaoko, Andrew Y Kitua, Herman PA Ambene, Mathieu Ndounga, Lynn Zijenah, David Ofori-Adjei, Simon Agwale, Steven Shongwe, Thomas Nyirenda, Michael Makanga
BMC Public Health , 2009, DOI: 10.1186/1471-2458-9-249
Abstract: EDCTP promotes collaborative research supported by multiple funding agencies and harnesses networking expertise across different African and European countries. EDCTP is different from other similar initiatives. The organisation of EDCTP blends important aspects of partnership that includes ownership, sustainability and responds to demand-driven research. The Developing Countries Coordinating Committee (DCCC); a team of independent scientists and representatives of regional health bodies from sub-Saharan Africa provides advice to the partnership. Thus EDCTP reflects a true partnership and the active involvement and contribution of these African scientists ensures joint ownership of the EDCTP programme with European counterparts.The following have been the major achievements of the EDCTP initiative since its formation in 2003; i) increase in the number of participating African countries from two to 26 in 2008 ii) the cumulative amount of funds spent on EDCTP projects has reached € 150 m, iii) the cumulative number of clinical trials approved has reached 40 and iv) there has been a significant increase number and diversity in capacity building activities.While we recognise that EDCTP faced enormous challenges in its first few years of existence, the strong involvement of African scientists and its new initiatives such as unconditional funding to regional networks of excellence in sub-Saharan Africa is envisaged to lead to a sustainable programme. Current data shows that the number of projects supported by EDCTP is increasing. DCCC proposes that this success story of true partnership should be used as model by partners involved in the fight against other infectious diseases of public health importance in the region.Tuberculosis, human immunodeficiency virus (HIV) and malaria cross paths in sub-Saharan Africa, the epicentre of the three infections. Although HIV/AIDS, tuberculosis (TB) and malaria are three treatable and preventable diseases, they are having a devastatin
Intermittent preventive treatment of malaria during pregnancy: a qualitative study of knowledge, attitudes and practices of district health managers, antenatal care staff and pregnant women in Korogwe District, North-Eastern Tanzania
Godfrey Mubyazi, Paul Bloch, Mathias Kamugisha, Andrew Kitua, Jasper Ijumba
Malaria Journal , 2005, DOI: 10.1186/1475-2875-4-31
Abstract: The study was conducted in February 2004, in Korogwe District, Tanzania. It involved in-depth interviews with the district medical officer (DMO), district hospital medical officer in charge and relevant health service staff at two peripheral dispensaries, and separate focus group discussions (FGDs) with district Council Health Management Team members at district level and pregnant women at dispensary and community levels.Knowledge of malaria risks during pregnancy was high among pregnant women although some women did not associate coma and convulsions with malaria. Contacting traditional healers and self-medication with local herbs for malaria management was reported to be common. Pregnant women and ANC staff were generally aware of SP as the drug recommended for IPTp, albeit some nurses and the majority of pregnant women expressed concern about the use of SP during pregnancy. Some pregnant women testified that sometimes ANC staff allow the women to swallow SP tablets at home which gives a room for some women to throw away SP tablets after leaving the clinic. The DMO was sceptical about health workers' compliance with the direct observed therapy in administering SP for IPTp due to a shortage of clean water and cups at ANC clinics. Intensified sensitization of pregnant women about the benefits of IPTp was suggested by the study participants as an important approach for improving IPTp compliance.The successful implementation of the IPTp strategy in Tanzania depends on the proper planning of, and support to, the training of health staff and sustained sensitization of pregnant women at health facility and community levels about the benefits of IPTp for the women and their unborn babies.Malaria continues to be a major public health burden in Tanzania, a country with the world's third largest population at risk of stable malaria, after Nigeria and the Democratic Republic of Congo [1]. About 35 million Tanzania's population are at risk, pregnant women and under five childr
Recognition, Perceptions and Treatment Practices for Severe Malaria in Rural Tanzania: Implications for Accessing Rectal Artesunate as a Pre-Referral
Marian Warsame, Omari Kimbute, Zena Machinda, Patricia Ruddy, Majaha Melkisedick, Thomas Peto, Isabela Ribeiro, Andrew Kitua, Goran Tomson, Melba Gomes
PLOS ONE , 2007, DOI: 10.1371/journal.pone.0000149
Abstract: Objectives Preparatory to a community trial investigating how best to deliver rectal artesunate as pre-referral treatment for severe malaria; local understanding, perceptions of signs/symptoms of severe malaria and treatment-seeking patterns for and barriers to seeking biomedical treatment were investigated. Methodology/Principal Findings 19 key informant interviews, 12 in-depth interviews and 14 focus group discussions targeting care-givers, opinion leaders, and formal and informal health care providers were conducted. Monthly fever episodes and danger signs or symptoms associated with severe malaria among under-fives were recorded. Respondents recognized convulsions, altered consciousness and coma, and were aware of their risks if not treated. But, these symptoms were perceived to be caused by supernatural forces, and traditional healers were identified as primary care providers. With some delay, mothers eventually visited a health facility when convulsions were part of the illness, despite pressures against this. Although vomiting and failure to eat/suck/drink were associated with malaria, they were not considered as indicators of danger signs unless combined with another more severe symptom. Study communities were familiar with rectal application of medicines. Conclusions/Significance Communities' recognition and awareness of major symptoms of severe malaria could encourage action, but perceptions of their causes and poor discrimination of other danger signs – vomiting and failure to feed – might impede early treatment. An effective health education targeting parents/guardians, decision-makers/advisors, and formal and informal care providers might be a prerequisite for successful introduction of rectal artemisinins as an emergency treatment. Role of traditional healers in delivering such medication to the community should be explored.
Creating an "enabling environment" for taking insecticide treated nets to national scale: the Tanzanian experience
Stephen M Magesa, Christian Lengeler, Don deSavigny, Jane E Miller, Ritha JA Njau, Karen Kramer, Andrew Kitua, Alex Mwita
Malaria Journal , 2005, DOI: 10.1186/1475-2875-4-34
Abstract: Tanzania has been involved for two decades in the research process for developing insecticide-treated nets as a malaria control tool, from testing insecticides and net types, to assessing their efficacy and effectiveness, and exploring new ways of distribution. Since 2000, the emphasis has changed from a project approach to that of a concerted multi-stakeholder action for taking insecticide-treated nets to national scale (NATNETS). This means creating conditions that make insecticide-treated nets accessible and affordable to all those at risk of malaria in the country. This paper describes Tanzania's experience in (1) creating an enabling environment for insecticide-treated nets scale-up, (2) promoting the development of a commercial sector for insecticide-treated nets, and (3) targeting pregnant women with highly subsidized insecticide-treated nets through a national voucher scheme. As a result, nearly 2 million insecticide-treated nets and 2.2 million re-treatment kits were distributed in 2004.National upscaling of insecticide-treated nets is possible when the programme is well designed, coordinated and supported by committed stakeholders; the Abuja target of protecting 60% of those at high risk is feasible, even for large endemic countries.Like most countries in sub-Saharan Africa, Tanzania carries a heavy malaria disease burden. It is estimated that 28 million citizens are exposed to the risk of stable malaria, resulting in 16 million clinical episodes per year and 100,000 child deaths – over 25% of total deaths [1]. In addition, malaria represents the leading cause of outpatient attendance for children and adults (38% and 32%, respectively) and the cost to health services is, therefore, considerable. The negative impact on the socio-economic development of the country is undoubtedly large. In order to address this enormous burden, Tanzania recently developed a national malaria medium-term strategic plan [1]. With regard to primary prevention, the emphasis has b
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