During the night of Wednesday the 30th May 2018, the town of Marwa, Ruvu Mferejini and Ruvu Jiungeni in SAME District, Kilimanjaro Region, Tanzania, was severely hit by overflow of river Ruvu and Nyumba ya Mungu Dam. On this night an overflow caused displacement of households, interrupted communication, swept away termed animals and crop fields. According to the RVA done by two members of ACT Tanzania Forum (ELCT and TCRS), the overflow caused floods that displaced 450 Households that had a range of between 10 to 20 persons in each household making a total number of 5,780 homeless people.
Since not all infrastructural limitations can be tackled at once, we recommend an explicit focus on workplace and personal safety, fully prioritizing these and changing the organisational outlook that safety outside the hospital walls are not important. Certain issues such as safe handling of blood, night transport, and safe housing were persistently noted. Moreover, given the centrality of the community to health workers motivation to stay in post, a more interactive health services and community self-management model may improve workers relationships with community members.
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.
Patients who knew that TB can be spread from person to person by coughing/sneezing were defined as having 'good' knowledge on the transmission. Patients who selected cough plus two other symptoms (from the following: fever, chest pain, shortness of breath, night sweating, loss of body weight, coughing blood) were defined as having 'good' knowledge of TB symptoms.
Generally 78.4% (423/540) of patients interviewed had a good knowledge on transmission of TB. Only 35.9% (188/524) had good knowledge on the symptoms of TB disease. For instance, only a number of them recognized night sweat 54.8% (284/518), chest pain 30.6%(159/519), shortness of breath 27.6% (143/519), loss of body weight 26.6% (138/519) and coughing up sputum stained with blood 6.7% (35/519) as TB symptoms. However, most of them were aware of cough 87.5% (454/519) and fever 74.4% (386/519) as symptoms of TB. In terms of treatment, 97.4% (531/545) of patients interviewed believed that TB can be cured by medicines (Table 2).
Multivariate analysis on the risk factors for patients delay according to sex is shown in table 4. Several risk factors were higher and significantly associated with patient's delay in females than in males. These factors included: not recognizing the following as symptoms of TB: chest pain (OR = 1.62, 95% CI 1.11, 2.37), night sweating (OR = 1.92, 95% CI 1.20, 3.05), weight loss (OR = 1.55, 95% CI 1.03, 2.32) and coughing blood (OR = 1.47, 95% CI 1.01, 2.16).
The final model on multiple risks had the following variables: poor knowledge on night sweat, chest pain, having no employment, residing > 5 km from a nearby health facility with DOTS services and a belief that TB is always associated with HIV infection. The multiple risks for the five risks factors for patient delay was significantly higher in females (OR = 2.22, 95%CI 1.14, 4.31) than in males (OR = 0.70, 95% CI 0.44, 1.11).
Adult mosquitoes were collected by battery operated CDC light traps (Model 512; John W. Hock Gainesville, USA) in May-July 2011, during the peak mosquito season. Five houses with poor mosquito proofing measures were selected for this purpose in each of the four study wards. During the first week, mosquitoes were collected from Mchikichini and Chanika wards (i.e. 10 light traps) for 5 nights. The following week the exercise was repeated in Vingunguti and Ukonga wards, and so on, until all wards had been sampled for 3 weeks (i.e. total of 15 sampling nights with 5 traps from each ward). All persons sleeping in the collection room were provided with a 2-mm-mesh polyester un-impregnated bed net and the light trap was placed beside one of the occupied bed nets . Traps were switched on at 18:00 hours and off the next morning at 06:00 hours. Caught mosquitoes were transferred to paper cups covered with netting material. Cotton pads soaked in 10% glucose were placed on top of the cups for feeding the mosquitoes. The cups were transported to the laboratory in a cool box. Live mosquitoes were anaesthetized with diethyl ether, the catch was sorted and the mosquitoes identified on morphological characteristics. Live female mosquitoes were dissected under 20x magnification [14, 33]. Wings and legs were removed before head, thorax and abdomen were separated, placed in drops of saline and examined for filarial worms. The mosquitoes were scored as parous or nulliparous after examination of the tracheoles of their ovaries.
A total of 12096 vector mosquitoes were caught in the light traps (Table 7). The great majority were Cx. quinquefasciatus (99.0%), followed by a few An. gambiae (0.9%) and An. funestus (0.1%). The two anophelines were almost exclusively found in the most peripheral ward of Chanika. The mosquito density, measured as numbers caught per trap night, was highest in the most central ward of Mchikichini, and lowest in Chanika. Of the 4522 dissected mosquitoes, none had infective larvae and only one Cx. quinquefasciatus had immature filarial larval stages (one L1 larva and one L2 larva). The majority of dissected Cx. quinquefasciatus in all wards were nulliparous (overall 61%).
The smears were fixed in cold acetone at 4°C for 10 minutes and dried at room temperature (RT) for 10 minutes. After Tris-Buffered Saline (TBS) rehydration, blocking of endogenous peroxidase activity with hydrogen peroxide (H2O2) was done for 30 minutes at RT. Normal Horse Serum (NHS) diluted at 1:20 was then applied for 30 minutes at RT. The excess NHS was wiped off and slides incubated over night at 4°C with primary antibodies [mouse monoclonal anti-human p53 (clone DO-7) (Dako, Glostrup, Denmark)]. After TBS washing slides were then processed and mounted as previously described [15, 16].
This was done as previously described [15, 16]. Five microns (5 μ) thick sections were placed in xylene over night for deparafinization, and hydrated in descending grades of ethanol to distilled water. Antigen retrieval was achieved by heating sections to boiling in Citrate Buffer at pH 6.0 in a microwave oven for 10 minutes and sections then allowed to cool to RT. The remainder of the procedure was done as described above and previously [15, 16].
Twenty five males and 26 females randomly selected Haya adults from Muleba and Kagera urban districts of Kagera region were interviewed. Seven male and three female elders of Haya tribe and senene collectors were selected using snow ball sampling due to their distinct knowledge of local culture and senene. Senene collectors who were found at the senene collection points during the night were also interviewed. These experts were interviewed mainly to validate the findings and provide additional clarification around some of some beliefs and indigenous technologies outlined by interviewees. Information was collected through face to face interviews using questionnaires administered in Swahili. The study was of an ethnographic nature with interviews focused on perceptions, cultures and beliefs, indigenous technologies in harvesting, processing and preservation, and shelf-life as well as traditions towards senene consumption. Senene prices and nutrition knowledge among senene consumers were also collected through the questionnaires. In addition to the interviews, observations on harvesting, cooking and traditional processing of senene was carried out at the homestead, farms and wild fields. To document some of the traditional practices, photos of the insects, traditional traps and senene markets were taken. Samples of senene were collected from the fields and markets for identification and inventorying.
The prevalence of stunting among children under 5 [3,13,37,43] by the district level was downloaded from the Food and Agriculture Organization (FAO; ). Subnational HIV prevalence [3,13] for people aged 15 to 49 (reference year 2007) was downloaded from the Joint United Nations Programme on HIV/AIDS (UNAIDS; ). To convert these two prevalence datasets into continuous surfaces we used a dasymetric mapping approach . All analyses were done in ESRI ArcGIS 10.1 (ESRI, Redlands, CA).
Information on the current location of refugee settlements [46,47] was obtained from the United Nations High Commissioner for Refugees (UNHCR; ). A global map of accessibility ( ) that shows the travel time in hours to urban centers was gathered from the Joint Research Center (JRC) of the European Commission (EC), and used as a proxy for access to health facilities [27,36,46]. Donor aid for health-related projects [46,48] was acquired from the World Bank ( ). We obtained a grid with rural extents [25,27,36] from Moderate Resolution Imaging Spectroradiometer (MODIS) 500-m satellite data [49,50]. Moreover, a gridded surface showing the spatial distribution of Plasmodium falciparum entomological inoculation rate (EIR) was downloaded from the Malaria Atlas Project website  as a hazard/disease indicator. Lastly, a layer representing estimated levels of Plasmodium falciparum malaria endemicity was acquired from the same website and used as an input (dependent variable) for the regression model, as well as to validate the final malaria risk surface. 2b1af7f3a8