A look back at the millenium development goal of reducing #maternal mortality - studies from 2004 and 2009 - African Population Studies Vol.19 No.12 & Journal of Postgraduate Medicine Vol.55 No.1

The Guardian recently published an article on a new report compiled by a number of health organizations such as WaterAID and WHO that calls for action on water sanitation and hygiene care that could greatly reduce maternal deaths in Africa. The article notes that goal number 5 of the United Nation's millenium goals between 1990 and 2015 was to reduce the maternal mortality ratio. The Guardian notes that although rates have been improving in some countries, low-income and middle-income countries have yet to succeed in reaching this goal. The Guardian notes that among these countries are Tanzania and South Sudan.

Several articles on Bioline have discussed this issue in relation to different countries. Among them is an article from ten years ago in African Population Studies vol.19 no.12 named: "Maternal and Child Health among the Urban Poor in Nairobi, Kenya" by Monica Magadi. This study takes a look at the health care provided to infants and their mothers in the slums of Nairobi, and Kenya. Magadi notes that although it is important to consider the care and quality of services provided to the infants and their mothers, their overall health prior is equally as important. Unfortunately, many of these deaths occur as a direct result of diseases and malnutrition from lack of services and necessities such as food, shelter, health care, nutrition and water sanitation. Diarrhea is also prevalent in Nairobi, especially for people living in slums. Only 53 per cent of slum residents have access to safe drinking water. In the three major slums in Nairobi, it was reported that most water does not go directly to their houses but instead is purchased from informal traders or taken from communal water points. These conditions make for poor health of both the children and their mothers, and Magadi notes that they require urgent attention.

Another article, "An autopsy study of maternal mortality: A tertiary healthcare perspective" by Panchabhai et al. in the Journal of Postgraduate Medicine vol.55 no.1, discusses this millenium goal in relation to India. Panchabhai et al. note that many maternal deaths in India are attributable to sepsis, infection and hemorrhage. This study evaluates the maternal deaths that occurred between January 1998 to December 2006. Tuberculosis, malaria and meningitis were amongst the cases of deaths.

These articles highlight the need for action to be taken in preventing more maternal deaths, particularly in developing countries.

You can find more articles on Bioline on maternal mortality here.

Predicting small mammal and flea abundance using landform and soil properties in a plague endemic area in Lushoto District, Tanzania - Tanzania Journal of Health Research Vol. 16 No. 3

Recently, the World Health Organization (WHO) has reported a concentrated outbreak of Bubonic Plague centred off the coast of Africa in Madagascar. While there are only 40 confirmed cases, WHO has stated that it has the potential of spreading rapidly, and that two cases have already been confirmed in the regions capital of Antananarivo. Since the population of Antananarivo is so dense, this creates a problematic situation for overall containment of the outbreak, creating higher than average risks of contraction and overall rapid spread of infection. 


Prior articles such as: "Predicting small mammal and flea abundance using landform and soil properties in a plague endemic area in Lushoto District, Tanzania" by Meliyo et al. have included studies related to the contraction of Bubonic Plague that may help gain more insight into the life cycle of this illness. More specifically, the purpose of this study was to investigate the correlations between landforms and associated soil properties, and small mammals and fleas in the West Usambara Mountains, Tanzania, to determine whether plague persistence in natural foci has a root cause in soils. 

The methods used in this study were of standard field surveys, paired with Geographical Information Systems (GIS) techniques, in order to examine landforms and soil characteristics. Soil samples were analyzed more closely in a laboratory for physico- chemical properties, and the small mammals were trapped on pre-established landform positions, for which they were identified at genus/species level. Fleas were then meticulously picked off the mammal and counted accordingly. 

It is important to note that the relation between landforms and soil data was done using ArcGIS Toolbox functions. Descriptive statistical analysis and the correlation between landforms, soils, small mammals, and fleas were gathered and established by the use a generalized linear regression model (GLM), operated in R statistics software. 

Results showed that landforms and soils influenced the abundance of small mammals and fleas and their overall spatial distribution and that the increase of overall population of small mammals and fleas increased with altitude and elevation. The landform-soil model shows that phosphorus found within the soil, slope and elevation were significant predictors in explaining abundance in small mammals. Fleas' abundance and spatial distribution were strongly linked and influenced by hill-shade, phosphorus, and base saturation. 

In summary, this study suggests that there is a strong correlation between landforms and soils, and small mammals and fleas' overall abundance and could help explain further the dynamics associated with bubonic plague in the region. 

For this journal and others from this issue, click here.

For more on the plague epidemic in Madagascar, click here. 

Cost of Illness Due to Typhoid Fever in Pemba, Zanzibar, East Africa - Journal of Health, Population and Nutrition Vol.32 No.3

Today we are featuring "Cost of Illness Due to Typhoid Fever in Pemba, Zanzibar, East Africa" by Riewpaiboon et al in Journal of Health, Population and Nutrition vol.32 no.3.

Typhoid fever is still an ongoing economic burden within Pemba, Zanzibar, East Africa and the purpose of this study was to estimate said cost associated with this illness. The method used was an incidence-based cost-of-illness analysis from a societal perspective, paying close attention to new episodes of confirmed cases of typhoid fever in patients from inpatient and outpatient hospitals between May 2010 and December 2010. 

The overall cost associated with this illness was both the sum of direct costs and the costs of productivity, or in more fluid economic terms, the opportunity cost of the time lost. The sum of these costs, when broken down more specifically, looks like this: 

direct costs covered treatment, travel, and meals, whereas productivity costs were the loss of income of patients and caregivers. The analysis itself consisted of 17 episodes of confirmed cases with the mean age of the patients was 23 years (range= 5-65, median= 22). Thirty-five percent were inpatients, with a mean timespan of 4.75 days of hospital stay (range=3-7, median= 4.50). 

The results of the study may be surprising: the mean cost for treatment of typhoid fever was care was US$ 21.97 at 2010 prices (US$ 1=1,430.50 Tanzanian Shilling─TSH), with the average societal cost being that of $154.47 per episode. However, the most dramatic expenditure is the overall cost of lost wages of $128.02 (83%). These results help contribute to the economic evaluation of vaccination of typhoid fever in Zanzibar, as well as other sub-Saharan African regions.

For this article and others from this issue, click here.

Patients who received analgesics intravenously were reported to have better post-operative pain management - Tanzania Journal of Health Research Vol.16 No.1

Vol.16 no.1 of the Tanzania Journal of Health Research is being featured on the blog today. 

This issue includes "Postoperative pain management outcomes among adults treated at a tertiary hospital in Moshi, Tanzania" by Masigati et al. This study examines the challenges and effects of post-operative pain when left untreated in patients at the Kilimanjaro Christian Medical Centre in Moshi, Tanzania from August 2011 to March 2012. Pain and satisfaction numerical rating scales were used to assess the satisfaction and post-operative pain of patients. These assessments occurred 24 hours and 48 hours after operation on 124 patients. Over 45% of patients reported to have experienced pain when resting, and 44% experienced pain during movement. Patients who received analgesics intravenously were reported to have better post-operative pain management than patients who received intramuscular analgesics.

This issue also includes "Knowledge and perception on tuberculosis transmission in Tanzania: Multinomial logistic regression analysis of secondary data" by Ismail & Josephat. Tuberculosis is an ongoing health concern in Tanzania and was declared a national public health emergency in 2006. Multinominal Logistic Regression analysis was used to measure the effect of knowledge of TB. Data from the 2007-2008 Tanzania HIV/AIDS national survey and the Malaria Indicator Survey. The results indicated that the higher the age and education, the higher knowledge of TB. The results also indicated that people in urban areas had higher TB knowledge than people in rural areas. People who owned a radio or telephone had greater knowledge than those who did not. The study concluded that socio-economic factors such as age, education and place of residence, as well as owning a telephone or radio, systematically affected knowledge of tuberculosis transmission.

For these articles and others from this issue, click here.

49% of patients with HIV were diagnosed with heart failure in this study -- Tanzania Journal of Health Research Vol.15 No.2

This is our third post on the latest updated issues of the Tanzania Journal of Health Research on Bioline. Today we are featuring vol.15 no.2.

This issue includes "Factors associated with, and echocardiographic findings of heart failure among HIV infected patients at a tertiary health care facility in Dar es Salaam, Tanzania" by Bakari et al. This study aims to unpack the factors associated with heart failure among patients with HIV, as well as examine the echocardiographic findings. The study was conducted at Muhimbili National Hospital, a tertiary care facility in Dar es Salaam, Tanzania. Patients with HIV who also had cardiac complaints between September 2009 and April 2010. 49% of patients were diagnosed with heart failure, which was confirmed by echocardiography. The most common causes of heart failure were hypertensive heart disease, pulmonary hypertension and dilated cardiomyopathy. The results indicated that heart failure was common among patients with HIV who also had cardiac complaints. The factors for heart failure were associated with both modifiable and non-modfiable factors.

This issue also includes "Comprehensive health workforce planning: re-consideration of the primary health care approach as a tool for addressing the human resource for health crisis in low and middle income countries" by Munga & Mwangu. This article includes a literature review of case studies of low- and middle-income countries and their use of the Primary Health Care and existing planning approaches toward the Human Resources for Health crisis. Data from Tanzania was also used in this study, as well as consultations with experts. This article also details a conceptual framework using Primary Health Care as its foundation. The article concludes that health workforce planning is not common in Human Resources for Health planning due to lack of knowledge, and that Human Resources for Health planning is important but cannot be used alone to ensure that the Human Resource Health crisis is eliminated.

You can find these articles and others from this issue here.

43% of 2136 adolescents reported to have seriously injured themselves -- Tanzania Journal of Health Research Vol.15 No.1

This is our second consecutive post on the Tanzania Journal of Health Research. Today we are featuring vol.15 no.1, which was updated on Bioline at the end of March 2014.

This issue includes "Knowledge, attitude and practices on family planning services among adolescents in secondary schools in Hai District, northern Tanzania" by Dangat & Njau. This study examines attitudes, knowledge and practices of family planning services among adolescents in 10 secondary schools in the Hai district in northern Tanzania. The study was conducted between April and June 2011 through a cross-sectional survey administered to 316 randomly selected students, of which the median age was 17 years old. The results indicated that about 71% of survey respondents said that family planning services should not be used by adolescents, and less than 6% of survey respondents had received family planning services in their lifetime.

This issue also includes "Self-inflicted serious injuries among adolescents in Zambia" by Muula et al. This study aims to uncover some of the factors and and prevalence of self-inflicted injuries among students in Zambia. The study was conducted using data from the 2004 Zambia Global School-Based Health Survey to assess the prevalence within the last 12 months. Out of 2136 adolescents who did the survey, more than 43% were reported to have seriously injured themselves. Of these adolescents, almost 12% reported to have serious injured themselves on purpose. Emotions associated with a history of self-inflicted injury included sadness, suicidal behaviour, alcohol use and marijuana use.

For these articles and others from this issue, click here.

Resistance to some TB drugs occurred only in new cases - Tanzania Journal of Health Research Vol.14 No.4

Today we are featuring the Tanzania Journal of Health Research. This is the second time we are featuring the journal on our blog--the first time it was featured was in former Bioline team member Esha's post on a Student Perspective of Immunization Delay in Nigerian Infants. The journal was first posted on Bioline in 2008, and since then Bioline has posted 270 of its articles. The journal was formerly called the Tanzania Health Research Bulletin and aims to examine and shed light on health research in Tanzania.

This is one of a series of posts on the journal we will be featuring in the next few days. Vol.14 no.4 was posted on Bioline in March 2014. This issue includes "Anti-tuberculosis drug resistance pattern among pulmonary tuberculosis patients with or without HIV infection in Mwanza, Tanzania" by Range et al. This article examines the drug-resistance of Tuberculosis in new and relapsed TB cases. For the study, drug susceptibility was tested using sputum culture positive isolates of Mycobacterium tuberculosis using four first-line TB drugs which consisted of rifampicin, isoniazid, ethambutol and streptomycin. HIV status and demographic information among other information was collected. The results indicated that 7.8% of the isolates, resistance in new cases of TB to least one of the drugs was 7.3% and resistance in relapsed cases of TB was 12.5%. Resistance to just isoniazid was high in both new and relapsed cases, at 45.5% and 50%, respectively. Resistance to solely rifampicin and streptomycin only occurred in new cases of TB.

This issue also includes "How rational are indications for emergency caesarean section in a tertiary hospital in Tanzania?" by Mdgela et al. This article looks at the reasons and the basis for the increase in emergency caesarean sections at Muhimbili National Hospital in Tanzania, and if practices following decisions of caesarean sections are followed. The study was carried out through examination of 345 women's files who had an emergency caesarean section. Some indicators included repeat caesarean sections, which was experienced by 30.2% of women, obstructed labour (14.4%) and foetal distress (13.6%).

For these articles and other articles from this issue, click here.