In recent years, increasingly high rates of cardiovascular diseases have been recorded in the Sey... more In recent years, increasingly high rates of cardiovascular diseases have been recorded in the Seychelles. A survey was performed to investigate the prevalence of cardiovascular risk factors in that population, which is shifting from its traditional habits to a westernized lifestyle. The Seychelles population is of predominantly black African origin. A sex-and age-stratified random sample of 1,309 subjects was drawn from 21,256 people aged 25-64 years. A response rate of 86% was achieved. The data showed a high prevalence of hypertension (25%) and cigarette smoking (54%) in men and a high prevalence of hypertension (20%) and obesity (21%) in women. Hypercholesterolemia (>6.5 mmol/1) was found in 9% of men and 15% of women. High density lipoprotein cholesterol levels (mean±SD) were higher in men (1.42±0.49 mmol/1) than in women (1J6±OJ4 mmol/1). High levels of lipoprotein (a) (mean±SD) were found both in men (319±362 ing/I) and women (328±415 mg/1). The high prevalence of cardiovascular risk factors identified in the Seychelles indicates a pressing current need for effective preventive strategies.
In a limited case controlled but molecular study in symptomatic Tanzanian children, we found that... more In a limited case controlled but molecular study in symptomatic Tanzanian children, we found that those who had not previously received Chroloquine treatment had a higher proportion of parasitaemia. There was also a higher proportion of pyrimetamine-resistant P. falciparum parasites among those who had not received any treatment. This finding is paradoxical and the reasons for this observation are suggested.
The last two decades has witnessed a disruption of socioeconomic , security and political foundat... more The last two decades has witnessed a disruption of socioeconomic , security and political foundation worldwide due to surging of health events arising at the ecosystem, animal and human interface. The unprecedent magnitude of these events has led to the adoption of One Health approach. Several theoretical definitions and an operational one were released to help common user to understand the approach. To provide evidence of the impact of implementing the One Health approach and to assess the process outputs, a definition of a One Health intervention is required. We are proposing a definition and characteristics of a One Health intervention which will complement the operational definition of the One Health approach by the One Health High-Level Expert Panel.
Background: Intermittent preventive treatment of malaria during pregnancy (IPTp) is a key interve... more Background: Intermittent preventive treatment of malaria during pregnancy (IPTp) is a key intervention in the national strategy for malaria control in Tanzania. SP, the current drug of choice, is recommended to be administered in the second and third trimesters of pregnancy during antenatal care (ANC) visits. To allow for a proper design of planned scaling up of IPT services in Tanzania it is useful to understand the IPTp strategy's acceptability to health managers, ANC service providers and pregnant women. This study assesses the knowledge, attitudes and practices of these groups in relation to malaria control with emphasis on IPTp services. Methods: 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. Results: 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
The bloodmeal of a mosquito that has fed on an individual with a malarial infection may contain t... more The bloodmeal of a mosquito that has fed on an individual with a malarial infection may contain the parasites gametocytes as well as antibodies from the human. If antibodies against the sexual stages of the parasite are present these can prevent the fertilization of the gametes or further development of the sporogonic stages in the mosquito thereby preventing the transmission of the parasite to another human. Such transmission-blocking immunity (TBI) has been observed in sera from the inhabitants of malaria-endemic areas (Mendis et al. 1997) and has been correlated with responses to the principle sexual-stage antigens of Plasmodium falciparum - Pfs230 (Graves et al. 1988) and epitopes I and III of Pfs48/45 (Roeffen et al. 1995b). In maternal sera collected in Ifakara Tanzania - an area of intense and perennial malarial transmission - the levels of antibodies against the asexual stages of P. falciparum were found to correlate positively with those in the corresponding cord sera (Kitua et al. 1996). Maternally-acquired antibodies protected the children in this setting against symptomatic malaria for the first 4 months of their lives after which there was a significant decline in the titres of these antibodies and a tandem increase in malaria-related morbidity. It is not yet known whether antibodies to the sexual stages of the parasite are also transferred from mothers to their newborns and if so whether the levels of these antibodies follow a similar pattern of decline in infants. In the present pilot study therefore the presence and development of TBI during the first 12 months of life were explored in infants living in Ifakara. (excerpt)
A study was carried out in six villages located at different altitudes in Mpwapwa district of cen... more A study was carried out in six villages located at different altitudes in Mpwapwa district of central Tanzania to determine malaria parasitaemia and transmission levels in villages with or without health care facilities. A total of 1119 schoolchildren (age= 5.9-12.3 years) were examined for malaria parasitaemia. Plasmodium falciparum was the predominant malaria species accounting for 92.8% of all species. The average malaria prevalence rate among schoolchildren was 25.8% (range 1.5-53.8%). The geometric mean parasite densities for P. falciparum was 361 (N= 286). Higher malaria prevalence was observed in villages at lower (<1000 m) than at intermediate (1000-1500m) or higher (>1500m) altitudes. Schoolchildren in areas with health care facilities were less at risk of acquiring malaria by 33.4% as compared with those living in areas without health facilities. Mean packed cell volume in schoolchildren was 38.5% (range= 35.2-41.0%). Splenomegaly was observed in 18.1% (0-40.2%) of the schoolchildren examined and it was higher among those in villages without health care facilities. Anopheles gambiae sensu lato was the only malaria vector found in the district and was found in all villages and at all altitudes. Sporozoite rate in An. gambiae s.l. ranged from 0-10.5%, with the lowland villages recording the highest rates. This study indicates that altitude and geographical accessibility to healthcare service are important determinants of malaria infection among rural communities in Tanzania.
Transactions of The Royal Society of Tropical Medicine and Hygiene, Feb 1, 1999
The force of infection and recovery rate for malaria in infants in a highly endemic area ofTanzan... more The force of infection and recovery rate for malaria in infants in a highly endemic area ofTanzania were analysed using polymerase chain reaction-restriction fragment length polymorphism genotyping of the Plasmodium falciparum msp2 locus in 99 paired blood samples. Overall, new genotypes were acquired at a rate of 0.064 per day, and the average duration of infections was estimated to be 23 d. The highest recovery rates were in children under 4 months of age. The higher susceptibility of infants to clinical malaria in comparison with older children, in areas of very high transmission, may be largely a consequence of the short duration of infections which precludes the establishment of concomitant immunity. The high turnover of infections also implies that infection prevalence and multiplicity approach an equilibrium even in very young children, and calls into question the use of infant conversion rates as a measure of transmission intensity.
Tropical Medicine & International Health, Aug 1, 2007
Children under one year of age in an area of intense and perennial Plasmodium falciparum transmis... more Children under one year of age in an area of intense and perennial Plasmodium falciparum transmission were followed up for one year to establish to what extent chronic, low parasitaemia was associated with severe anaemia. There was a significant increase in the prevalence of anaemia (PCV &lt; or = 25%) with increase in parasite density. PCV levels were related not only to concurrent parasite density but also decreased with densities measured one month previously. At any point in time, the mean PCV level in infants with low parasitaemia (&lt; 1000 parasites/microliter) was higher than that of infants with intermediate (1000-9999/microliter) and high parasite densities (&gt; or 10000/microliter). After the age of 7 months, infants with low parasite densities tend to recover, probably as a result of developing immunity. At the age of 12 months, they have similar PCV levels to infants with no detectable parasitaemia by microscopy. The maintenance of low parasite density appears crucial to the survival of infants in malaria endemic areas. The findings suggest that interventions which lower parasite densities in areas of intense transmission reduce the development of severe malarial anaemia and thus malaria-related mortality and morbidity in infants.
The paper summarizes the evolution of a biomedical field research station in Tanzania, establishe... more The paper summarizes the evolution of a biomedical field research station in Tanzania, established by a European institute, into a national health research and resource centre. The Swiss Tropical Institute Field Laboratory was founded in Ifakara in the Kilombero District in southeastern Tanzania in 1957. It has evolved into the Ifakara Centre, a national but peripherally located research centre involved in applied, operational and health systems research, training, and direct health sector support activities. Since 1991, the centre has been an affiliate of the National Institute for Medical Research in Tanzania. It has achieved an autonomous status and attracts frontline priority research and high quality research teams; the ongoing phase 3 malaria vaccine trial is a recent major activity. Starting from biomedical priorities in research and training, the centre has broadened its spectrum to include social science disciplines including economics. The major determinants for this development were (i) the long-term partnership between the executing agency in the north and the partners in the south at the national level, (ii) the support of this partnership by a long-term commitment of the major funding partners, (iii) the concept that local priorities form the basis of all activities, and (iv) the linking of research and training to public health action. The last two elements are considered to be crucial for the centre&#39;s multidisciplinary approach to health research and the support of public health in Tanzania and in eastern and southern Africa.
At the end of December 2019, the China public health authorities were informed on cases of unusua... more At the end of December 2019, the China public health authorities were informed on cases of unusual pneumonia detected in Wuhan City, mainland China. The causative agent was later identified to be a novel coronavirus (2019-nCoV) currently referred to as the severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). The World Health Organization declared the disease a public health emergency of international concern on 30 th January 2020 and named it Coronavirus disease 2019 (COVID-19) on 11 th February 2020. By 20 th April 2020, over 2.4 million cases of COVID-19 had been reported from 210 countries and territories worldwide. The rate at which COVID-19 spreads and the fact that asymptomatic individuals can transmit the disease has risen concerns on how to control the pandemic in resource-constrained countries. We conducted a review of literatures and summarized the key lessons to inform policy and decision makers on strategies necessary for an effective response during the pandemic. We recommend comprehensive implementation of the proposed approaches that encompass robust containment strategies and flexible transition to scaling up mitigation strategies.
East African health research journal, Nov 15, 2021
The emergence of COVID-19 highlights globalisation realties, where diseases may emerge from anywh... more The emergence of COVID-19 highlights globalisation realties, where diseases may emerge from anywhere and rapidly spread globally. Lessons emphasise the necessity for strengthening regional and global collaboration and coordination to allow rapid risk identification, resource mobilisation and joint actions. We report the experience of the Regional Action through Data (RAD) partnership in fostering regional cooperation and collaboration to use data for battling infectious diseases and the effects of COVID-19. The Partnership comprised;BoadReach company, The West African Health Organization (WAHO) and the Intergovernmental Authority on Development (IGAD); Duke University Global Health Centre and the Jembi Health Systems, South Africa. Main objective: To address the problem of limited used of data to drive performance in healthcare service delivery in sub-Saharan Africa; by changing how and why data is collected, analysed, and then used to achieve results. Specific objectives: 1. Regional level: To equip and empower IGAD and WAHO with evidence-based analytics to drive data use for evidence-based policy and program action in public health (regional level). 2. Patient-provider level: To deploy and implement a digital health solution for childhood vaccination services focused on mobile cross-border populations along the Uganda-Kenya border. Engagement approaches used included; meetings, workshops, technical working groups, establishing monitoring system and annual implementation revision. Targeted training and capacity building were conducted. All activities were built on existing systems and structures to strengthen ownership and sustainability. Regional level achievements: 1. Regional health data sharing and protection policy, 2. Strengthened regional health information platform. Patient provider level: Deployment of a cloud based digital health solution to enhance childhood access to vaccination services for cross border populations of Kenya and Uganda, 3. Both regions developed resource mobilisation plans for sustainability. RAD established the foundation for building trust and strengthening regional collaboration and coordination in health in Sub-Saharan Africa.
In recent years, increasingly high rates of cardiovascular diseases have been recorded in the Sey... more In recent years, increasingly high rates of cardiovascular diseases have been recorded in the Seychelles. A survey was performed to investigate the prevalence of cardiovascular risk factors in that population, which is shifting from its traditional habits to a westernized lifestyle. The Seychelles population is of predominantly black African origin. A sex-and age-stratified random sample of 1,309 subjects was drawn from 21,256 people aged 25-64 years. A response rate of 86% was achieved. The data showed a high prevalence of hypertension (25%) and cigarette smoking (54%) in men and a high prevalence of hypertension (20%) and obesity (21%) in women. Hypercholesterolemia (>6.5 mmol/1) was found in 9% of men and 15% of women. High density lipoprotein cholesterol levels (mean±SD) were higher in men (1.42±0.49 mmol/1) than in women (1J6±OJ4 mmol/1). High levels of lipoprotein (a) (mean±SD) were found both in men (319±362 ing/I) and women (328±415 mg/1). The high prevalence of cardiovascular risk factors identified in the Seychelles indicates a pressing current need for effective preventive strategies.
In a limited case controlled but molecular study in symptomatic Tanzanian children, we found that... more In a limited case controlled but molecular study in symptomatic Tanzanian children, we found that those who had not previously received Chroloquine treatment had a higher proportion of parasitaemia. There was also a higher proportion of pyrimetamine-resistant P. falciparum parasites among those who had not received any treatment. This finding is paradoxical and the reasons for this observation are suggested.
The last two decades has witnessed a disruption of socioeconomic , security and political foundat... more The last two decades has witnessed a disruption of socioeconomic , security and political foundation worldwide due to surging of health events arising at the ecosystem, animal and human interface. The unprecedent magnitude of these events has led to the adoption of One Health approach. Several theoretical definitions and an operational one were released to help common user to understand the approach. To provide evidence of the impact of implementing the One Health approach and to assess the process outputs, a definition of a One Health intervention is required. We are proposing a definition and characteristics of a One Health intervention which will complement the operational definition of the One Health approach by the One Health High-Level Expert Panel.
Background: Intermittent preventive treatment of malaria during pregnancy (IPTp) is a key interve... more Background: Intermittent preventive treatment of malaria during pregnancy (IPTp) is a key intervention in the national strategy for malaria control in Tanzania. SP, the current drug of choice, is recommended to be administered in the second and third trimesters of pregnancy during antenatal care (ANC) visits. To allow for a proper design of planned scaling up of IPT services in Tanzania it is useful to understand the IPTp strategy's acceptability to health managers, ANC service providers and pregnant women. This study assesses the knowledge, attitudes and practices of these groups in relation to malaria control with emphasis on IPTp services. Methods: 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. Results: 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
The bloodmeal of a mosquito that has fed on an individual with a malarial infection may contain t... more The bloodmeal of a mosquito that has fed on an individual with a malarial infection may contain the parasites gametocytes as well as antibodies from the human. If antibodies against the sexual stages of the parasite are present these can prevent the fertilization of the gametes or further development of the sporogonic stages in the mosquito thereby preventing the transmission of the parasite to another human. Such transmission-blocking immunity (TBI) has been observed in sera from the inhabitants of malaria-endemic areas (Mendis et al. 1997) and has been correlated with responses to the principle sexual-stage antigens of Plasmodium falciparum - Pfs230 (Graves et al. 1988) and epitopes I and III of Pfs48/45 (Roeffen et al. 1995b). In maternal sera collected in Ifakara Tanzania - an area of intense and perennial malarial transmission - the levels of antibodies against the asexual stages of P. falciparum were found to correlate positively with those in the corresponding cord sera (Kitua et al. 1996). Maternally-acquired antibodies protected the children in this setting against symptomatic malaria for the first 4 months of their lives after which there was a significant decline in the titres of these antibodies and a tandem increase in malaria-related morbidity. It is not yet known whether antibodies to the sexual stages of the parasite are also transferred from mothers to their newborns and if so whether the levels of these antibodies follow a similar pattern of decline in infants. In the present pilot study therefore the presence and development of TBI during the first 12 months of life were explored in infants living in Ifakara. (excerpt)
A study was carried out in six villages located at different altitudes in Mpwapwa district of cen... more A study was carried out in six villages located at different altitudes in Mpwapwa district of central Tanzania to determine malaria parasitaemia and transmission levels in villages with or without health care facilities. A total of 1119 schoolchildren (age= 5.9-12.3 years) were examined for malaria parasitaemia. Plasmodium falciparum was the predominant malaria species accounting for 92.8% of all species. The average malaria prevalence rate among schoolchildren was 25.8% (range 1.5-53.8%). The geometric mean parasite densities for P. falciparum was 361 (N= 286). Higher malaria prevalence was observed in villages at lower (<1000 m) than at intermediate (1000-1500m) or higher (>1500m) altitudes. Schoolchildren in areas with health care facilities were less at risk of acquiring malaria by 33.4% as compared with those living in areas without health facilities. Mean packed cell volume in schoolchildren was 38.5% (range= 35.2-41.0%). Splenomegaly was observed in 18.1% (0-40.2%) of the schoolchildren examined and it was higher among those in villages without health care facilities. Anopheles gambiae sensu lato was the only malaria vector found in the district and was found in all villages and at all altitudes. Sporozoite rate in An. gambiae s.l. ranged from 0-10.5%, with the lowland villages recording the highest rates. This study indicates that altitude and geographical accessibility to healthcare service are important determinants of malaria infection among rural communities in Tanzania.
Transactions of The Royal Society of Tropical Medicine and Hygiene, Feb 1, 1999
The force of infection and recovery rate for malaria in infants in a highly endemic area ofTanzan... more The force of infection and recovery rate for malaria in infants in a highly endemic area ofTanzania were analysed using polymerase chain reaction-restriction fragment length polymorphism genotyping of the Plasmodium falciparum msp2 locus in 99 paired blood samples. Overall, new genotypes were acquired at a rate of 0.064 per day, and the average duration of infections was estimated to be 23 d. The highest recovery rates were in children under 4 months of age. The higher susceptibility of infants to clinical malaria in comparison with older children, in areas of very high transmission, may be largely a consequence of the short duration of infections which precludes the establishment of concomitant immunity. The high turnover of infections also implies that infection prevalence and multiplicity approach an equilibrium even in very young children, and calls into question the use of infant conversion rates as a measure of transmission intensity.
Tropical Medicine & International Health, Aug 1, 2007
Children under one year of age in an area of intense and perennial Plasmodium falciparum transmis... more Children under one year of age in an area of intense and perennial Plasmodium falciparum transmission were followed up for one year to establish to what extent chronic, low parasitaemia was associated with severe anaemia. There was a significant increase in the prevalence of anaemia (PCV &lt; or = 25%) with increase in parasite density. PCV levels were related not only to concurrent parasite density but also decreased with densities measured one month previously. At any point in time, the mean PCV level in infants with low parasitaemia (&lt; 1000 parasites/microliter) was higher than that of infants with intermediate (1000-9999/microliter) and high parasite densities (&gt; or 10000/microliter). After the age of 7 months, infants with low parasite densities tend to recover, probably as a result of developing immunity. At the age of 12 months, they have similar PCV levels to infants with no detectable parasitaemia by microscopy. The maintenance of low parasite density appears crucial to the survival of infants in malaria endemic areas. The findings suggest that interventions which lower parasite densities in areas of intense transmission reduce the development of severe malarial anaemia and thus malaria-related mortality and morbidity in infants.
The paper summarizes the evolution of a biomedical field research station in Tanzania, establishe... more The paper summarizes the evolution of a biomedical field research station in Tanzania, established by a European institute, into a national health research and resource centre. The Swiss Tropical Institute Field Laboratory was founded in Ifakara in the Kilombero District in southeastern Tanzania in 1957. It has evolved into the Ifakara Centre, a national but peripherally located research centre involved in applied, operational and health systems research, training, and direct health sector support activities. Since 1991, the centre has been an affiliate of the National Institute for Medical Research in Tanzania. It has achieved an autonomous status and attracts frontline priority research and high quality research teams; the ongoing phase 3 malaria vaccine trial is a recent major activity. Starting from biomedical priorities in research and training, the centre has broadened its spectrum to include social science disciplines including economics. The major determinants for this development were (i) the long-term partnership between the executing agency in the north and the partners in the south at the national level, (ii) the support of this partnership by a long-term commitment of the major funding partners, (iii) the concept that local priorities form the basis of all activities, and (iv) the linking of research and training to public health action. The last two elements are considered to be crucial for the centre&#39;s multidisciplinary approach to health research and the support of public health in Tanzania and in eastern and southern Africa.
At the end of December 2019, the China public health authorities were informed on cases of unusua... more At the end of December 2019, the China public health authorities were informed on cases of unusual pneumonia detected in Wuhan City, mainland China. The causative agent was later identified to be a novel coronavirus (2019-nCoV) currently referred to as the severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). The World Health Organization declared the disease a public health emergency of international concern on 30 th January 2020 and named it Coronavirus disease 2019 (COVID-19) on 11 th February 2020. By 20 th April 2020, over 2.4 million cases of COVID-19 had been reported from 210 countries and territories worldwide. The rate at which COVID-19 spreads and the fact that asymptomatic individuals can transmit the disease has risen concerns on how to control the pandemic in resource-constrained countries. We conducted a review of literatures and summarized the key lessons to inform policy and decision makers on strategies necessary for an effective response during the pandemic. We recommend comprehensive implementation of the proposed approaches that encompass robust containment strategies and flexible transition to scaling up mitigation strategies.
East African health research journal, Nov 15, 2021
The emergence of COVID-19 highlights globalisation realties, where diseases may emerge from anywh... more The emergence of COVID-19 highlights globalisation realties, where diseases may emerge from anywhere and rapidly spread globally. Lessons emphasise the necessity for strengthening regional and global collaboration and coordination to allow rapid risk identification, resource mobilisation and joint actions. We report the experience of the Regional Action through Data (RAD) partnership in fostering regional cooperation and collaboration to use data for battling infectious diseases and the effects of COVID-19. The Partnership comprised;BoadReach company, The West African Health Organization (WAHO) and the Intergovernmental Authority on Development (IGAD); Duke University Global Health Centre and the Jembi Health Systems, South Africa. Main objective: To address the problem of limited used of data to drive performance in healthcare service delivery in sub-Saharan Africa; by changing how and why data is collected, analysed, and then used to achieve results. Specific objectives: 1. Regional level: To equip and empower IGAD and WAHO with evidence-based analytics to drive data use for evidence-based policy and program action in public health (regional level). 2. Patient-provider level: To deploy and implement a digital health solution for childhood vaccination services focused on mobile cross-border populations along the Uganda-Kenya border. Engagement approaches used included; meetings, workshops, technical working groups, establishing monitoring system and annual implementation revision. Targeted training and capacity building were conducted. All activities were built on existing systems and structures to strengthen ownership and sustainability. Regional level achievements: 1. Regional health data sharing and protection policy, 2. Strengthened regional health information platform. Patient provider level: Deployment of a cloud based digital health solution to enhance childhood access to vaccination services for cross border populations of Kenya and Uganda, 3. Both regions developed resource mobilisation plans for sustainability. RAD established the foundation for building trust and strengthening regional collaboration and coordination in health in Sub-Saharan Africa.
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Papers by KITUA ANDREW