Donath Tarimo | Trinity College Dublin (original) (raw)

Papers by Donath Tarimo

PLOS ONE, Jan 12, 2023

Background Intestinal schistosomiasis is one of the most common neglected tropical diseases in Ta... more Background Intestinal schistosomiasis is one of the most common neglected tropical diseases in Tanzania. Despite massive praziquantel administration, data from Northern Tanzania have reported a prevalence of up to 93.2%. Because the disease is focal, depending on host, environmental and intermediate host factors, there is a need to acquire data in specific settings to better tailor interventions. Therefore, the study assessed the prevalence and factors associated with persistent transmission of intestinal schistosomiasis among school-age children in Busega district, Northern Tanzania. Methods A school-based cross-sectional study was conducted among 363 primary school children, randomly selected from school clusters in the Busega district. A single stool sample was collected from each child for S. mansoni ova and infection intensity examination using Kato-Katz. Factors related to intestinal schistosomiasis transmission were acquired through a questionnaire. A malacological survey was carried out to determine the Biomphalaria infectivity rate. Descriptive statistics and logistic regression analysis were conducted to analyse the association between schistosoma infection and factors related to transmission in this setting.

IJID regions, Sep 1, 2022

ObjectiveTo investigate the magnitude of urogenital schistosomiasis and determinants of transmiss... more ObjectiveTo investigate the magnitude of urogenital schistosomiasis and determinants of transmission among adolescents and young adults in Itilima district, Simiyu region, Northern Tanzania.MethodsA quantitative cross-sectional study was carried out using probability sampling strategies to select 433 secondary school students from five schools among the five wards of Itilima district, an area endemic for urogenital schistosomiasis. A self-administered structured questionnaire was used to gather data on determinants, and urine samples were examined for macrohaematuria and the presence of Schistosoma haematobium using the standard urine filtration technique. Data analysis was performed using descriptive statistics, Chi-squared test and logistic regression.ResultsThe overall prevalence rates of S. haematobium infection and macrohaematuria among adolescents and young adults were 15.9% and 3%, respectively, with the majority of individuals being lightly infected (85.5%). The determinants for urogenital schistosomiasis among the adolescents and young adults in Itilima district were: being in Form I [adjusted odds ratio (aOR) 2.42, 95% confidence interval (CI) 1.16–11.8; P=0.018]; being resident in Sasago ward (aOR 5.57, 95% CI 1.98–15.67; P=0.001) or Budalabujiga ward (aOR 2.99, 95% CI 1.04–8.56; P=0.042); having positive attitudes towards urogenital schistosomiasis (aOR 3.14, 95% CI 1.27–7.72; P=0.013); swimming in rivers (aOR 1.92, 95% CI 1.06–3.50; P=0.032); and urinating in water bodies (aOR 1.68, 95% CI 1.05–2.69; P=0.032).ConclusionsUrogenital schistosomiasis is prevalent among adolescents and young adults, and serves as a reservoir for transmission of S. haematobium. Preventive chemotherapy campaigns should be extended to adolescents and young adults, and integrated with regular screening, health education and an adequate water supply.

East Africa science, Mar 30, 2023

Background: Toxoplasma gondii (T. gondii) infection during pregnancy is associated with various c... more Background: Toxoplasma gondii (T. gondii) infection during pregnancy is associated with various complications for the mother and baby. In Tanzania, there is a paucity of data on exposure to T. gondii infection among pregnant women and the associated risk factors. Therefore, this study investigated the seroprevalence of T. gondii and associated factors among pregnant women attending antenatal care in Ilala Municipality, Dar es Salaam. Methods: A cross sectional study was carried out among 383 pregnant women attending antenatal health care. A five mL of blood sample was collected from each recruited pregnant woman, processed to obtain serum, and tested for the presence of IgG and IgM anti T. gondii specific antibodies. A structured questionnaire was used to gather information on the risk factors predisposing pregnant women to the infection. Data analysis was performed using descriptive statistics and logistic regression. Results: Of the 383 participants, 104 (27.2%) were positive for antibodies specific to T. gondii; 102 (26.63%) were positive only for IgG, and 2 (0.52%) were positive for both IgM and IgG antibodies. Significant risk factors for T. gondii

Afro-Egyptian Journal of Infectious and Endemic Diseases (Online), Oct 24, 2021

Conclusion: There was a low level of knowledge, poor attitude, and inappropriate practices toward... more Conclusion: There was a low level of knowledge, poor attitude, and inappropriate practices toward lymphoedema management in the Lindi district. This will have negative consequences on the lymphoedema management in the Lindi district, hence, the need for further public health education on LF management.

PubMed, Feb 1, 1998

A cross-sectional household survey was carried out in Kibaha district, Tanzania to obtain caretak... more A cross-sectional household survey was carried out in Kibaha district, Tanzania to obtain caretakers' knowledge on symptoms of childhood malaria in children under five years of age in relation to its management. A total of 1530 caretakers were interviewed, 620 (40.5%) reporting malaria attacks among their children in the last three months of which, 432 (70%) reported that the attacks were severe. Only 15.7% (68/432) of those reporting severe attacks could mention convulsions as symptoms of severe malaria, while fever and vomiting were mentioned as symptoms of severe malaria by 93.3% (403/432) and 52.3% (226/432) of the care-takers respectively. Higher level of education was significantly associated with knowledge of symptoms of severe malaria, also with promptness in taking management action. The fact that most of the caretakers reported fever and vomiting as symptoms of severe malaria, and hence the observed high proportion of reported severe malaria, implies that the communities under study do not perceive febrile convulsion as being a symptom of severe malaria. The implication of these findings on the control of malaria through treatment on demand are discussed.

PubMed, Oct 1, 2007

Objective: To appraise the prevalence of malaria and anaemia in antenatal mothers; and explore th... more Objective: To appraise the prevalence of malaria and anaemia in antenatal mothers; and explore the factors influencing coverage of intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) under operational conditions in the national programme for malaria control in pregnancy. Design: Descriptive cross-sectional survey. Setting: The reproductive and child health clinic in Kibaha district hospital, Tanzania SUBECTS: Pregnant mothers on routine antenatal visits Main outcome measures: Prevalence of malaria (peripheral parasitaemia) and anaemia, coverage of IPT with SP and the factors influencing coverage. Results: A total of 395 mothers were recruited; 27.3% had malaria. Moderate anaemia i.e. haemoglobin (Hb) level 8. -10.9 g/dl was detected in 56.7% of mothers; 34.2% had severe anaemia (Hb < 8.0 g/dl). Hb > 8.0 g/dl was strongly associated with negative parasitaemia while Hb < 8.0 gidl was strongly associated with positive parasitaemia. About a third (40.0%) of the mothers did not receive SP for IPT

Research Square (Research Square), Jul 8, 2022

Background Tanzania is currently undergoing an epidemiological transition for malaria transmissio... more Background Tanzania is currently undergoing an epidemiological transition for malaria transmission with some areas of the country having < 10% (hypoendemic) and other areas ≥ 10% malaria prevalence (mesoendemic). Hypoendemic areas on the continuum toward elimination require higher testing rates for fever cases and appropriate treatment. There is a lack of information about the quality of malaria case management in elimination settings in Tanzania mainland. This study examined the in uence of endemicity on the quality of malaria case management at health facilities. Methods An analytical cross-sectional study was conducted among health facilities in Tanzania mainland. Data were collected by the National Malaria Control Program using an assessment tool to monitor the quality of malaria case management at facilities from September 2017 to December 2018. Using standard quality factors, mean scores from facilities in the different endemicity regions were compared by a Student's t-test. Simple and multiple linear regression analyses were performed to determine the association between facility performance (score) and endemicity (mesoendemic vs. hypoendemic). Results Malaria case management data from 1713 health facilities (1425 public; 288 private), representing 21.3% of all facilities nationally, were available for analysis. Facilities located in mesoendemic regions scored higher compared to those in hypoendemic regions on the overall quality of services [difference in mean scores (d) = 2.52; (95% CI 1.12, 3.91)], site readiness [d̄ = 2.97; (95% CI 1.30, 4.61)], availability of malaria reference materials [ d̄ = 4.91; (95% CI 2.05, 7.76)], Health Management Information System tools [d̄ = 5.86; (95% CI 3.80, 7.92)] and patient satisfaction [d̄ = 6.61; (95% CI 3.75, 9.48)]. Facilities in hypoendemic regions scored lower than those in mesoendemic regions [β:-1.54; (95% CI-2.74,-0.53)]. Facilities in urban areas scored lower than those in rural areas [β:-1.56; (95% CI-2.76,-0.38)]. Facilities in regions with implementing partner support scored higher than those without [β: 7.92; (95% CI 6.26, 9.57)]. Conclusion Health facilities located in malaria mesoendemic regions overall scored higher compared to those in hypoendemic regions. There is a need to target improvement efforts in the lower performing facilities regardless of endemicity setting.

Tropical Medicine & International Health, Jun 28, 2022

East African journal of public health, 2013

Background: Tanzania has changed its malaria treatment policy twice; in the first change Sulfadox... more Background: Tanzania has changed its malaria treatment policy twice; in the first change Sulfadoxine - Pyrimethamine (SP) replaced chloroquine (CQ) in August 2001. In the second change Artemether –Lumefantrine (ALu) replaced SP in January 2007. It is not known how experiences with previous policies would influence the uptake the new policy. Objective: This study assessed malaria treatment practices in the transition from SP to ALu and the implications for the uptake of the new policy. Methods: Two months prior to change from SP to ALu a survey of randomly selected households (HHs) was carried out to explore the factors influencing malaria therapy choices and formulations of antimalarial drugs preferred. Perceptions on single versus multiple doses of antimalarial drugs, awareness on dosage calculation and compliance were also explored. Results : Two thirds of the respondents held the perceptions that childhood illness corresponding to malaria would require an antimalarial drug. However, about a quarter (24.3%) held the perception that childhood convulsion is not amenable by modern medicines. Half (50.7%) held the perception that high fever causes convulsions, however only a small percentage (5.8%) linked convulsions with severe malaria. SP was the most commonly available antimalarial drug (81.8%); followed by amodiaquine (35.4%), quinine (25.5%), artemisinin monotherapies (3.2%) and chloroquine (3.2%). The larger majority (85.9%) preferred antimalarial drugs syrup for children below 12 months old; about half (52.2%) also preferred syrup for children 1 – 5 years old. More than half (57.5%) preferred antimalarial drugs as tablets for older children and adults. Less than a quarter were aware that antimalarial drugs doses are calculated based on weight and age by about a half (48.5%). About three quarters (76.5%) were aware that SP is given as a single dose. About two thirds (63.8%) preferred antimalarial drugs as a single dose; only about a third (34.5%) preferred multiple dosages. Conclusions : For uncomplicated malaria, the community would seek antimalarial drugs while traditional medicines may initially be sought for severe malaria in the form of convulsions. Experiences with and preference of single SP dose may negatively influence compliance with multiple dose ALu therapy. The absence of ALu syrup formulation may negatively influence its acceptance for young children; while the absence of injectable formulation may negatively influence its acceptance to adult patients. Key words: malaria, community, policy changes, artemisinin based combination therapy, Tanzania

PubMed, Apr 1, 2007

Objective: To describe, from health workers (HWs) perspectives, the potential and actual barriers... more Objective: To describe, from health workers (HWs) perspectives, the potential and actual barriers to the implementation of the first change of policy from chloroquine (CQ) to Sulfadoxine / Sulfalane - Pyrimewthamine (SP) in preparation for the second change of policy to Artemisinin based Combination Therapies (ACTs). Methods: A descriptive cross-sectional survey of HWs using questionnaire interviews was carried out in public and private health facilities in Songea Urban district. The interview concerned awareness and knowledge on the commonly used antimalarial drugs as given in the new policy, focusing on SP use and the associated side effects as well as perceptions on the potency and safety of SP versus CQ and the perceived alternative antimalarial drugs to non-response or reaction to SP. Results: Awareness on the new policy was very high; 91.4% of HWs were aware that SP was the new drug. Although the majority of HWs (81.9%) reported using the new policy as soon as it was out, a significant percentage (76.2%) reported continued use of SP (P-value < 0.001). SP was perceived to have a low potency in that it was slow in fever clearance. A significant percentage (65.7%) of HWs reported a history of problems with SP use namely headaches and skin reactions. Quinine (QN) was significantly frequently mentioned as the perceived alternative drug to CQ (61.1%) and non-response (56.6%) or reaction (54.1%) to SP. Conclusion: Findings show that SP was generally not preferred by HWs, and they continued to use CQ despite the evidence that it was no longer effective indicating that. HWs tend to maintain perceptions based on their experiences with drugs currently in use. Pertinent information, education and behaviour change communication strategies related to the change from SP to ACT should focus on the fact that the previous drug is no longer effective so as to induce consistent use of the new drug.

BMC Pregnancy and Childbirth, Nov 27, 2019

Background: Tanzania adopted the revised World Health Organization policy in 2013 recommending a ... more Background: Tanzania adopted the revised World Health Organization policy in 2013 recommending a minimum of ≥3 doses of Intermittent Preventive Treatment during pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP) to protect against malaria. A study in Tanzania in 2014 reported low (9%) uptake. We investigated health workers knowledge about IPTp-SP and factors that influenced uptake of > 3 doses of IPTp-SP among pregnant women. Methods: We conducted a cross-sectional study in 2017 among post-delivery women and health care workers from nine randomly-selected public health facilities in three Districts of Arusha Region. Probability proportional to size methodology was used to determine number of participants per facility. We used a structured questionnaire to collect socio-demographic and obstetric data, information on doses of SP received, and knowledge of SP for IPTp. Health care workers were interviewed about their knowledge for IPTp-SP and challenges encountered in its uptake and use. Results: We interviewed 556 persons (median age 26 years, range 16-42 years) with the response rate of 99.3%. Of these, 484 (87.1%) had > 3 Antenatal Care (ANC) visits. A total of 402 (72.3%) were multigravida with 362 (65.1%) having given birth at least once. Of the 556 participants, 219 (39.4%) made their first ANC booking at < 17 weeks of pregnancy and 269 (48.4%) had received > 3 doses of SP-IPTp. Factors associated with uptake of > 3 doses of IPTp-SP included having secondary or higher education [Adjusted Odds Ratio (AOR) =1.6, 95%CI 1.1-2.4], attending ≥4 ANC visits [AOR = 3.1, 95%CI 2.1-4.6], having first antenatal booking at < 17 weeks [AOR = 1.8, 95%CI 1.4-2.3], and adequate knowledge on IPTp-SP [AOR = 2.7, 95%CI 1.9-3.9]. Among 36 health care workers interviewed, 29(80.6%) had adequate knowledge about IPTp-SP. SP was available in seven (87.5%) of the visited health facilities and was administered under Direct Observed Therapy (DOT) in six (75%) facilities. Health care workers reported that stock outs of SP was a challenge. Conclusions: Fewer than half of the women interviewed reported uptake of > 3 doses of IPTp-SP. That is below the Tanzania national target of 80%. Making > 4 ANC visits, having secondary or higher education, making an early first ANC visit and having adequate knowledge on IPTp-SP promoted uptake of > 3 doses. Further qualitative studies are needed to explore factors that might contribute to low uptake of SP.

IJID regions, Jun 1, 2023

Malaria Chemotherapy, Control & Elimination, 2014

A decline in malaria transmission is evident in malaria endemic areas of sub-Saharan Africa and i... more A decline in malaria transmission is evident in malaria endemic areas of sub-Saharan Africa and is likely to reduce the proportion of fevers due to malaria. Fever has been used as a predictor of malaria, however, the proportion of fevers due to malaria vary with prevalence such that low malaria infection prevalence might alter the accuracy of fever as a marker of malaria. This study examined the diagnostic accuracy and proportion of fevers attributable to malaria among under-fives in a cross-sectional survey carried out in Bagamoyo district, Tanzania from April-May 2012 during peak malaria transmission. Consecutive under-fives with and without history of fever were recruited; for each, fever was measured by digital thermometer, and two Giemsa stained thick and thin blood films taken for parasite count and species identification. Accuracy of fever for prediction of malaria was assessed by performance indices, microscopy as gold standard. Proportion of fevers attributable to malaria was computed by the odds ratio technique at 0.05 significance level.{Formatting Citation} Only 98 out of 925 (10.6%) under-fives had parasitaemia. Among under-fives with a history of fever, the fraction attributable to malaria was 71.4% [95%CI: 54.8-81.9]; in those with measured fever ≥ 37.5˚C, the fraction was 74.3% [95%CI: 61.8-82.7]. In bivariate and multivariate analyses, at 1001-10000 parasites/µl the attributable fraction was 66%, and 93% for parasitaemia>10000/µl. Fever was more likely to be due to malaria among infants<12 months than subsequent months. Despite the recorded decline in malaria infection prevalence, fever is highly likely to be due to malaria among under-fives with fever and malaria infection in peripheral blood. This observation highlights the need to scale up and maintain parasitological confirmation of malaria; and to look for other causes of fever.

Malaria Journal, Jul 22, 2016

Background: Prenatal exposure to Plasmodium falciparum affects development of protective immunity... more Background: Prenatal exposure to Plasmodium falciparum affects development of protective immunity and susceptibility to subsequent natural challenges with similar parasite antigens. However, the nature of these effects has not been fully elucidated. The aim of this study was to determine the effect of prenatal exposure to P. falciparum on susceptibility to natural malaria infection, with a focus on median time from birth to first clinical malaria episode and frequency of clinical malaria episodes in the first 2 years of life. Methods: A prospective birth cohort study was conducted in Rufiji district in Tanzania, between January 2013 and December 2015. Infants born to mothers with P. falciparum in the placenta at time of delivery were defined as exposed, and infants born to mothers without P. falciparum parasites in placenta were defined as unexposed. Placental infection was established by histological techniques. Out of 206 infants recruited, 41 were in utero exposed to P. falciparum and 165 infants were unexposed. All infants were monitored for onset of clinical malaria episodes in the first 2 years of life. The outcome measure was time from birth to first clinical malaria episode, defined by fever (≥37 °C) and microscopically determined parasitaemia. Median time to first clinical malaria episode between exposed and unexposed infants was assessed using Kaplan-Meier survival analysis and comparison was done by log rank. Association of clinical malaria episodes with prenatal exposure to P. falciparum was assessed by multivariate binary logistic regression. Comparative analysis of mean number of clinical malaria episodes between exposed and unexposed infants was done using independent sample t test. Results: The effect of prenatal exposure to P. falciparum infection on clinical malaria episodes was statistically significant (Odds Ratio of 4.79, 95 % CI 2.21-10.38, p < 0.01) when compared to other confounding factors. Median time from birth to first clinical malaria episode for exposed and unexposed infants was 32 weeks (95 % CI 30.88-33.12) and 37 weeks (95 % CI 35.25-38.75), respectively, and the difference was statistically significant (p = 0.003). The mean number of clinical malaria episodes in exposed and unexposed infants was 0.51 and 0.30 episodes/infant, respectively, and the difference was statistically significant (p = 0.038). Conclusions: Prenatal exposure to P. falciparum shortens time from birth to first clinical malaria episode and increases frequency of clinical malaria episodes in the first 2 years of life.

BMC Research Notes, Jun 21, 2016

Objective: Insecticides treated nets (ITNs) and intermittent preventive therapy with two doses of... more Objective: Insecticides treated nets (ITNs) and intermittent preventive therapy with two doses of sulfadoxinepyrimethamine (SP IPTp) are the cornerstone for malaria control in pregnancy. Despite the coverage of these interventions being high, it is not known whether they confer optimal protection time against malaria in pregnancy. This study investigated the timing and determinants of timely uptake of SP(IPTp) and ITNs and the pregnancy time protected. Methods: A health facility based cross-sectional study was carried out in Bukoba urban district from 16th April to 29 May 2013. Involving pregnant women and post natal mothers attending Reproductive and Child Health (RCH) clinics. Data on their socioeconomic background, pregnancy history and attendance to RCH, receipt of a voucher and acquisition of an ITN as well as SP for IPTp were collected. Their responses were validated from the records of antenatal cards. Data was analysed using SPSS computer program version 20. Results: A total of 530 mothers were recruited. The overall uptake of SP IPTp was 96 % and the uptake of two SP (IPTp) doses was 86 %. Timely uptake of 1st dose was predicted by early antenatal booking, [AOR 2.59; 95 % CI 1.51-4.46; P = 0.001], and the availability of SP at the facility [AOR 4.63; 95 % CI 2.51-8.54; P < 0.0001]. Uptake of 2nd dose was independent of any predictor factors. A total of 486 (91.6 %) women received ITNs discount vouchers at different gestational age and of these, less than a quarter (21.4 %) received timely. Timely receipt of discount voucher was highly predicted by early antenatal booking [AOR 200; 95 % CI 80.38-498; P < 0.0001]. Conclusion: Although there is a high coverage of SP IPTp and discount vouchers for ITNs, timely uptake and therefore optimal protection time depended on early antenatal booking, the availability of (SP IPTp) and discount voucher at the health facility.

Background Ulanga, an onchocerciasis-endemic district in Tanzania, has received preventive chemot... more Background Ulanga, an onchocerciasis-endemic district in Tanzania, has received preventive chemotherapy for onchocerciasis by community-directed treatment with ivermectin (CDTI). With CDTI, interruption of transmission could occur after 14-17 years, yet transmission persists even after 20 years. This may be due to high baseline endemicity and other factors that can lower coverage of CDTI, including poor knowledge of the disease and negative attitudes and perceptions towards CDTI. This study examined community knowledge, attitudes and perceptions towards onchocerciasis control and acceptability of the CDTI program in Ulanga. Methods A mixed methods cross-sectional study was carried out from June to July 2018. A quantitative questionnaire was administered to 422 household members in the community. This was complemented with qualitative in-depth interviews and focus group discussions. Results A majority (94.1%) of community members had heard of onchocerciasis. Only 15.4% had a high level of knowledge about onchocerciasis; about half (49.2%) had a low level of knowledge on the disease and CDTI. Negative attitudes and perceptions towards CDTI prevailed in nearly half of participants (46.2% and 44%, respectively). A majority (83.4%) of respondents agreed that they will take ivermectin, and 74.4% were willing to comply with treatment for 12 to 15 years to eliminate onchocerciasis. In focus group discussions, participants reported mistrust of the method of dose calculation, that affects the acceptability and use of ivermectin treatment. Conclusion Inadequate levels of knowledge, negative attitudes and perceptions have the potential to affect participation in CDTI. This may result in continual transmission of onchocerciasis.

Tropical Doctor, Aug 2, 2022

Background and aim: Persistent postsurgical pain (PPP) has been reported by patients following va... more Background and aim: Persistent postsurgical pain (PPP) has been reported by patients following various surgeries. Body contouring procedures are being performed more frequently, but no data are available regarding the effects of these procedures. Long-term disability occurring after performing "functional" procedures on healthy subjects is a particular concern. The aim of this study was to describe the risk factors, prevalence, characteristics, and effects of persistent pain after body contouring procedures. Methods: Patients who underwent body contouring surgery (e.g., abdominoplasty, lower body lift, medial thigh lift, brachioplasty, and abdominal liposuction) between January 1 2009 and December 31 2013 were included in this retrospective, monocentric cohort study. Pain evaluation was performed using a visual analog pain scale (VAS) and the Douleur Neuropathique 4 (DN4) questionnaire. Major risk factors previously identified in the literature were evaluated. Results: The study included 199 patients. Pain was reported by 42 patients (21%). Seventy-one percent (n Z 30) of these 42 patients presented with neuropathic pain. Risk factors that were significantly associated with PPP were acute postoperative pain (p Z 0.0003), medical history of bariatric surgery (p Z 0.002), longer period of hospitalization (p Z 0.04), depressive status during the operative period (p Z 0.03), substantial stress before surgery (p Z 0.03), and major complications after surgery (p Z 0.03). Conclusion: Persistent chronic pain is frequent after body contouring procedures. Preemptive approaches and early postoperative diagnosis are important measures that can be used to limit

East African journal of public health, 2005

A trial of SP versus CQ was carried out in a holoendemic area as part of the antimalarial drugs e... more A trial of SP versus CQ was carried out in a holoendemic area as part of the antimalarial drugs efficacy monitoring in Tanzania prior to policy change from chloroquine (CQ) to sulfadoxine-pyrimethamine (SP). The aim was to obtain comparable data as reports from one holoendemic area had shown an SP resistance > 25% past the level for change. Therefore using the WHO in vivo test guidelines, the efficacy of SP versus CQ for the treatment of uncomplicated malaria in children was assessed. Children with fever ≥37.5°C, haemoglobin > 5g/dl, mono P.falciparum infection 2000-250000 parasites /μl were recruited in the ratio of 1:2 (CQ: SP) to obtain a sample of 58 for CQ and 120 for SP. SP showed a very high efficacy (98.2% adequate clinical response) in contrast to CQ (37.7%). There were only 1.75% RII responses to SP, in contrast there were 43.7% RIII/II responses to CQ. The decline in parasite density was fast in SP, and the median survival time to parasites clearance was 2 days, 86.7% of the children being aparasitaemic on day3. SP was therefore highly efficacious in this area. The 1.8% clinical and 1.75% parasitological failure rates to SP observed in this area sharply contrasts the 34.0% clinical and 84.4% parasitological failures reported in Muheza emphasizing the need of comparable countrywide data for policy decisions.

East African journal of public health, Jan 17, 2007

Background: Drugs with long elimination half-lives such as Sulfadoxine-Pyrimethamine (SP) maintai... more Background: Drugs with long elimination half-lives such as Sulfadoxine-Pyrimethamine (SP) maintain sub-curative levels in blood for a long time such that in high malaria transmission areas, re-infecting parasites are continuously under selection pressure for resistant genotypes. Objective: To assess SP efficacy and post therapeutic in-vivo selection for Plasmodium falciparum dihydrofolate reductase (DHFR) and dihydropteroate synthetase (DHPS) mutations associated with SP resistance. Design: SP efficacy trial with prospective follow up for selection of parasites with DHFR and DHPS mutations at re-infection in the resistance selection period (RSP). Subjects: Children aged < 5 years attending the outpatient reproductive and child health clinic of Kibaha district hospital with uncomplicated malaria fulfilling the inclusion criteria for efficacy trials in holoendemic settings. Main outcome measures: Clinical & parasitological efficacy, pre-treatment and post-treatment prevalence of P.falciparum DHFR & DHPS mutations. Results: Very high (98.2%) clinical & parasitological cure rates. DHFR single, double or triple mutations occurred in 46.7% of pre-treatment infections; triple c108/51/59 & double c108/51 mutations being commonest. Few (15.9%) DHPS mutations occurred in pre-treatment infections at c436 and c437. DHFR & DHPS mutations were significantly higher in post-than pre-SP treatment parasites. In a Poisson regression analysis, DHFR mutations at c108, c51 & c59 and the exclusive c108/51/59 triple mutations were strongly associated with exposure to SP at re-infection. Conclusion: DHFR & DHPS mutations associated with SP resistance exist in P.falciparum infections in a background of high SP efficacy. Despite optimal dosage, in holoendemic areas, these mutations will be selected by SP at re-infection; cumulatively shortening the useful therapeutic life of SP due to resistance.

PLOS Neglected Tropical Diseases, Apr 20, 2022

The funders had no role in the study design, data collection, and analysis, decision to publish, ... more The funders had no role in the study design, data collection, and analysis, decision to publish, or preparation of the manuscript. Conclusion/Significance A moderate prevalence of S. haematobium was found among the under-fives conceivably with adverse health events. The infected under-fives could be a source of continuity for transmission in the community. An intervention that covers this group is necessary and should be complemented with regular screening, health education campaigns, and an adequate supply of safe water.