Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-6 (of 6 Records) |
Query Trace: Mnzava T[original query] |
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Evaluation of an inexpensive handwashing and water treatment program in rural health care facilities in three districts in Tanzania, 2017
Davis W , Massa K , Kiberiti S , Mnzava H , Venczel L , Quick R . Water (Switzerland) 2020 12 (5) Unsafe water, sanitation, and hygiene (WASH) conditions in healthcare facilities (HCFs) can increase the risk of disease transmission, yet WASH coverage is inadequate in HCFs in most low-and middle-income countries. In September 2017, we conducted a baseline survey ofWASH coverage in 100 HCFs in three rural Tanzanian districts. Based on needs calculated from the baseline, we distributed handwashing and drinking water stations, soap, and chlorine solution; we repeated the survey 10 months later. The intervention improved coverage with handwashing stations (82% vs. 100%, p < 0.0001), handwashing stations with water (59% vs. 96%, p < 0.0001), handwashing stations with soap and water (19% vs. 46%, p < 0.0001), and handwashing stations with soap and water within 5 m of latrines (26% vs. 53%, p < 0.0001). Coverage of drinking water stations increased from 34% to 100% (p < 0.0001) HCFs with at least one drinking water station with free chlorine residual (FCR) > 0.2mg/ml increased from 6% to 36% (p < 0.0001), and in a sample of HCFs, detectable E. coli in stored drinking water samples decreased from 46% to 5% (p < 0.001). Although the program increased access to handwashing stations, drinking water stations, and safe drinking water in HCFs in rural Tanzania, modest increases in soap availability and water treatment highlighted persistent challenges. |
Assessing whether universal coverage with insecticide-treated nets has been achieved: is the right indicator being used
Koenker H , Arnold F , Ba F , Cisse M , Diouf L , Eckert E , Erskine M , Florey L , Fotheringham M , Gerberg L , Lengeler C , Lynch M , Mnzava A , Nasr S , Ndiop M , Poyer S , Renshaw M , Shargie E , Taylor C , Thwing J , Van Hulle S , Ye Y , Yukich J , Kilian A . Malar J 2018 17 (1) 355 BACKGROUND/METHODS: Insecticide-treated nets (ITNs) are the primary tool for malaria vector control in sub-Saharan Africa, and have been responsible for an estimated two-thirds of the reduction in the global burden of malaria in recent years. While the ultimate goal is high levels of ITN use to confer protection against infected mosquitoes, it is widely accepted that ITN use must be understood in the context of ITN availability. However, despite nearly a decade of universal coverage campaigns, no country has achieved a measured level of 80% of households owning 1 ITN for 2 people in a national survey. Eighty-six public datasets from 33 countries in sub-Saharan Africa (2005-2017) were used to explore the causes of failure to achieve universal coverage at the household level, understand the relationships between the various ITN indicators, and further define their respective programmatic utility. RESULTS: The proportion of households owning 1 ITN for 2 people did not exceed 60% at the national level in any survey, except in Uganda's 2014 Malaria Indicator Survey (MIS). At 80% population ITN access, the expected proportion of households with 1 ITN for 2 people is only 60% (p = 0.003 R(2) = 0.92), because individuals in households with some but not enough ITNs are captured as having access, but the household does not qualify as having 1 ITN for 2 people. Among households with 7-9 people, mean population ITN access was 41.0% (95% CI 36.5-45.6), whereas only 6.2% (95% CI 4.0-8.3) of these same households owned at least 1 ITN for 2 people. On average, 60% of the individual protection measured by the population access indicator is obscured when focus is put on the household "universal coverage" indicator. The practice of limiting households to a maximum number of ITNs in mass campaigns severely restricts the ability of large households to obtain enough ITNs for their entire family. CONCLUSIONS: The two household-level indicators-one representing minimal coverage, the other only 'universal' coverage-provide an incomplete and potentially misleading picture of personal protection and the success of an ITN distribution programme. Under current ITN distribution strategies, the global malaria community cannot expect countries to reach 80% of households owning 1 ITN for 2 people at a national level. When programmes assess the success of ITN distribution activities, population access to ITNs should be considered as the better indicator of "universal coverage," because it is based on people as the unit of analysis. |
Drivers of patient costs in accessing HIV/AIDS services in Tanzania
Mnzava T , Mmari E , Berruti A . J Int Assoc Provid AIDS Care 2018 17 2325958218774775 BACKGROUND: Patient costs pose a challenge in accessing antiretroviral therapy for people living with HIV in sub-Saharan Africa. The study aimed at identifying drivers for out-of-pocket (OOP) costs in Tanzania. METHODS: In 2009, 500 adult patients who attended 10 HIV clinics across 7 regions of Tanzania were asked about time and resources consumed to access HIV services. Bivariate and multivariate median regression models were used to determine the main drivers for OOP costs. RESULTS: Male and female patients have a median OOP costs of $40.37 and $28.01 per year, respectively ( P = .01). Males spend significantly more on travel ($26.51) than females ($19.68; P = .02). Living in rural areas and poor social economic status (SES) are associated with greater OOP costs ( P = .001) for both sexes. CONCLUSION: Poor SES and rural residence are main drivers of OOP costs. Patients are less likely to seek health care unless they are in dire need, leading to expensive services. |
Implications of insecticide resistance for malaria vector control with long-lasting insecticidal nets: a WHO-coordinated, prospective, international, observational cohort study
Kleinschmidt I , Bradley J , Knox TB , Mnzava AP , Kafy HT , Mbogo C , Ismail BA , Bigoga JD , Adechoubou A , Raghavendra K , Cook J , Malik EM , Nkuni ZJ , Macdonald M , Bayoh N , Ochomo E , Fondjo E , Awono-Ambene HP , Etang J , Akogbeto M , Bhatt RM , Chourasia MK , Swain DK , Kinyari T , Subramaniam K , Massougbodji A , Oke-Sopoh M , Ogouyemi-Hounto A , Kouambeng C , Abdin MS , West P , Elmardi K , Cornelie S , Corbel V , Valecha N , Mathenge E , Kamau L , Lines J , Donnelly MJ . Lancet Infect Dis 2018 18 (6) 640-649 BACKGROUND: Scale-up of insecticide-based interventions has averted more than 500 million malaria cases since 2000. Increasing insecticide resistance could herald a rebound in disease and mortality. We aimed to investigate whether insecticide resistance was associated with loss of effectiveness of long-lasting insecticidal nets and increased malaria disease burden. METHODS: This WHO-coordinated, prospective, observational cohort study was done at 279 clusters (villages or groups of villages in which phenotypic resistance was measurable) in Benin, Cameroon, India, Kenya, and Sudan. Pyrethroid long-lasting insecticidal nets were the principal form of malaria vector control in all study areas; in Sudan this approach was supplemented by indoor residual spraying. Cohorts of children from randomly selected households in each cluster were recruited and followed up by community health workers to measure incidence of clinical malaria and prevalence of infection. Mosquitoes were assessed for susceptibility to pyrethroids using the standard WHO bioassay test. Country-specific results were combined using meta-analysis. FINDINGS: Between June 2, 2012, and Nov 4, 2016, 40 000 children were enrolled and assessed for clinical incidence during 1.4 million follow-up visits. 80 000 mosquitoes were assessed for insecticide resistance. Long-lasting insecticidal net users had lower infection prevalence (adjusted odds ratio [OR] 0.63, 95% CI 0.51-0.78) and disease incidence (adjusted rate ratio [RR] 0.62, 0.41-0.94) than did non-users across a range of resistance levels. We found no evidence of an association between insecticide resistance and infection prevalence (adjusted OR 0.86, 0.70-1.06) or incidence (adjusted RR 0.89, 0.72-1.10). Users of nets, although significantly better protected than non-users, were nevertheless subject to high malaria infection risk (ranging from an average incidence in net users of 0.023, [95% CI 0.016-0.033] per person-year in India, to 0.80 [0.65-0.97] per person year in Kenya; and an average infection prevalence in net users of 0.8% [0.5-1.3] in India to an average infection prevalence of 50.8% [43.4-58.2] in Benin). INTERPRETATION: Irrespective of resistance, populations in malaria endemic areas should continue to use long-lasting insecticidal nets to reduce their risk of infection. As nets provide only partial protection, the development of additional vector control tools should be prioritised to reduce the unacceptably high malaria burden. FUNDING: Bill & Melinda Gates Foundation, UK Medical Research Council, and UK Department for International Development. |
Scale-up of integrated malaria vector control: lessons from Malawi
Chanda E , Mzilahowa T , Chipwanya J , Ali D , Troell P , Dodoli W , Mnzava AP , Ameneshewa B , Gimnig J . Bull World Health Organ 2016 94 (6) 475-80 PROBLEM: Indoor residual spraying and long-lasting insecticidal nets (LLINs) are key tools for malaria vector control. Malawi has struggled to scale up indoor residual spraying and to improve LLIN coverage and usage. APPROACH: In 2002, the Malawian National Malaria Control Programme developed guidelines for insecticide treated net distribution to reach the strategic target of at least 60% coverage of households with an LLIN. By 2005, the target coverage was 80% of households and the Global Fund financed the scale-up. The US President's Malaria Initiative funded the indoor residual spraying intervention. LOCAL SETTING: Malawi's entire population is considered to be at risk of malaria. Poor vector control, insecticide resistance in malaria vectors and insufficient technical and financial support have exacerbated the malaria burden. RELEVANT CHANGES: Between 2002 and 2012, 18 248 206 LLINs had been distributed. The coverage of at least one LLIN per household increased from 27% (3689/13 664) to 58% (1974/3404). Indoor residual spraying coverage increased from 28 227 to 653 592 structures between 2007 and 2011. However, vector resistance prompted a switch from pyrethroids to organophosphates for indoor residual spraying, which increased the cost and operations needed to be cut back from seven to one district. Malaria cases increased from 2 853 315 in 2002 to 6 748 535 in 2010, and thereafter dropped to 4 922 596 in 2012. LESSONS LEARNT: A single intervention-based approach for vector control may have suboptimal impact. Well-coordinated integrated vector management may offer greater benefits. A resistance management plan is essential for effective and sustainable vector control. |
Design of a study to determine the impact of insecticide resistance on malaria vector control: a multi-country investigation
Kleinschmidt I , Mnzava AP , Kafy HT , Mbogo C , Bashir AI , Bigoga J , Adechoubou A , Raghavendra K , Knox TB , Malik EM , Nkuni ZJ , Bayoh N , Ochomo E , Fondjo E , Kouambeng C , Awono-Ambene HP , Etang J , Akogbeto M , Bhatt R , Swain DK , Kinyari T , Njagi K , Muthami L , Subramaniam K , Bradley J , West P , Massougbodji A , Okê-Sopoh M , Hounto A , Elmardi K , Valecha N , Kamau L , Mathenge E , Donnelly MJ . Malar J 2015 14 282 BACKGROUND: Progress in reducing the malaria disease burden through the substantial scale up of insecticide-based vector control in recent years could be reversed by the widespread emergence of insecticide resistance. The impact of insecticide resistance on the protective effectiveness of insecticide-treated nets (ITN) and indoor residual spraying (IRS) is not known. A multi-country study was undertaken in Sudan, Kenya, India, Cameroon and Benin to quantify the potential loss of epidemiological effectiveness of ITNs and IRS due to decreased susceptibility of malaria vectors to insecticides. The design of the study is described in this paper. METHODS: Malaria disease incidence rates by active case detection in cohorts of children, and indicators of insecticide resistance in local vectors were monitored in each of approximately 300 separate locations (clusters) with high coverage of malaria vector control over multiple malaria seasons. Phenotypic and genotypic resistance was assessed annually. In two countries, Sudan and India, clusters were randomly assigned to receive universal coverage of ITNs only, or universal coverage of ITNs combined with high coverage of IRS. Association between malaria incidence and insecticide resistance, and protective effectiveness of vector control methods and insecticide resistance were estimated, respectively. RESULTS: Cohorts have been set up in all five countries, and phenotypic resistance data have been collected in all clusters. In Sudan, Kenya, Cameroon and Benin data collection is due to be completed in 2015. In India data collection will be completed in 2016. DISCUSSION: The paper discusses challenges faced in the design and execution of the study, the analysis plan, the strengths and weaknesses, and the possible alternatives to the chosen study design. |
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