An eye for inequality: how trachoma relates to poverty in Tanzania and Vietnam.

Purpose: An important challenge for trachoma control strategies is to break the circle of poverty, poor hygiene and poor health by bringing its benefits to the poor. This article aims to assess to what extent trachoma is a disease of the poor, and trachoma services reach the poor in Tanzania and Vietnam.

Methods: Individual level data on trachoma prevalence (active trachoma and trichiasis) and utilization of trachoma-related services were collected in both countries in 2004.

Prevalence of trachoma in six districts of Kenya.

Objectives: To estimate the prevalence of active trachoma (TF) in children aged one to nine years and potentially blinding trachoma (TT) in adults aged 15 years and older in six known trachoma-endemic districts in Kenya.

Design: Community based survey.

Setting: Six known trachoma endemic districts in Kenya (Samburu, Narok, West Pokot, Kajiado Baringo and Meru North).

Simplification and improvement of height-based azithromycin treatment for paediatric trachoma.

Recent data showing that azithromycin is safe at higher dosages than previously documented provide an opportunity to explore several important improvements in the efficiency and effectiveness of height-based treatment of paediatric trachoma. The purpose of this study is to examine the feasibility of a single standardised schedule for application in any trachoma-endemic region. Data for 60813 children from Asia, North and sub-Saharan Africa were analysed.

Gender equity and trichiasis surgery in the Vietnam and Tanzania national trachoma control programmes.

Aims: To calculate the gender distribution of trichiasis cases in trachoma communities in Vietnam and Tanzania, and the gender distribution of surgical cases, to determine if women are using surgical services proportional to their needs.

Methods: Population based data from surveys done in Tanzania and Vietnam as part of the national trachoma control programmes were used to determine the rate of trichiasis by gender in the population. Surgical records provided data on the gender ratio of surgical cases.

Integration of trachoma control into primary health care: the Tanzanian experience.

Tanzania was among the first countries to launch a trachoma control program with support from the International Trachoma Initiative (ITI) using surgery, antibiotics, facial cleanliness, and environmental improvement (SAFE) strategy with azithromycin. More than one million children less than 10 years of age in Tanzania have active disease and an estimated 54,000 people have trichiasis. Since 2000, Tanzania has implemented major health sector reform that have been carried out in three phases in 114 districts.

Height as a proxy for weight in determining azithromycin treatment for paediatric trachoma.

Azithromycin (Zithromax, Pfizer Inc., New York, NY, USA) is effective in the control of blinding trachoma. Community-based azithromycin treatment is recommended by the World Health Organization as part of a multipronged strategy aimed at the global elimination of binding trachoma by the year 2020.

Costs of tuberculosis for households and health care providers in Dar es Salaam, Tanzania.

Objective: To assess the costs of tuberculosis at household level in Dar es Salaam and to compare them with the provider costs of the national tuberculosis control programme.

Design: Tuberculosis patients were found by active case searching within a routine census in three areas of Dar es Salaam, and by examining records for residents already receiving treatment. Costs at household level were evaluated through a cross-sectional household survey.

Validation of the Kiswahili version of the SF-36 Health Survey in a representative sample of an urban population in Tanzania.

The objective of this study was to assess the validity of a Kiswahili translation of the SF-36 Health Survey (SF-36) among an urban population in Tanzania, using the method of known-groups validation. People were randomly selected from a demographic surveillance system in Dar es Salaam. The representative sample consisted of 3,802 adults (15 years and older).

A Kiswahili version of the SF-36 Health Survey for use in Tanzania: translation and tests of scaling assumptions.

The objective of the study was to translate and adapt the SF-36 Health Survey for use in Tanzania and to test the psychometric properties of the Kiswahili SF-36. A cross-sectional study was conducted as part of a household survey of a representative sample of the adult population of Dar es Salaam, Tanzania. The IQOLA method of forward and backward translation was used to translate the SF-36 into Kiswahili.

The population biology and epidemiology of schistosome and geohelminth infections among schoolchildren in Tanzania.

A study of helminth infections was undertaken among 3244 schoolchildren from 28 schools in Morogoro Rural District, Tanzania. Schistosoma haematobium was the most common infection, followed by hookworms, Ascaris lumbricoides, S. mansoni, and Trichuris trichiura.

The use of morbidity questionnaires to identify communities with high prevalences of schistosome or geohelminth infections in Tanzania.

Parasitic infections were investigated in Morogoro Rural District, Tanzania, between October 1992 and June 1993. A total of 4589 schoolchildren (aged 7-17 years) from 30 primary schools was screened for infection with Ascaris lumbricoides, Trichuris trichiura, hookworms (3456 children only), Schistosoma mansoni and S. haematobium.

Utilisation of government and private health services in Dar es Salaam.

Following the liberalisation of medical practice in Tanzania since the early 1990's, and the introduction of user fees in public hospitals in 1993, a household survey evaluated utilisation of health care in Dar es Salaam. A sample of 6,589 inhabitants was interviewed in April 1995 by means of a two-stage cluster sampling technique. Of the respondents, 32% reported some use of health care within the previous two weeks.

Validation of reagent sticks in diagnosing urinary schistosomiasis in an urban setting.

In view of the established potential of reagent sticks for detecting haematuria, a pilot survey to validate their use in the diagnosis of urinary schistosomiasis in an urban setting was done at Kinyerezi primary school of Ilala district in Dar es salaam. From 404 pupils screened for the disease, 273 were positive for the eggs by microscopy (filtration method), giving a prevalence of 67.6% and 253 (92.

Quality of primary outpatient services in Dar-es-Salaam: a comparison of government and voluntary providers.

This study aimed to test whether voluntary agencies provide care of better quality than that provided by government with respect to primary curative outpatient services in Dar-es-Salaam. All non-government primary services were included, and government primary facilities were randomly sampled within the three districts of the city. Details of consultations were recorded and assessed by a panel who classed consultations as adequate, inadequate but serious consequences unlikely, and consultations where deficiencies in the care could have serious consequences.

The right objectives in health care planning.

In Dar es Salaam, United Republic of Tanzania, the traditional epidemiological approach to health service planning has been superseded by a process-oriented approach. The implications for managers are discussed below.

Perinatal mortality in rural Tanzania.

In 1987, as part of the World Health Organization's Inter-Health Programme, we carried out a noncommunicable diseases survey in six rural villages in Tanzania. Each women completed a questionnaire, part of which was concerned with obstetric history, and underwent a physical examination. Our findings of unacceptably high perinatal mortality and abortion rates are described below.

Coronary heart disease risk factors in sub-Saharan Africa: studies in Tanzanian adolescents.

Study Objective: To assess the level of cardiovascular risk factors in young people in sub-Saharan Africa living in rural and urban settings.

Design: Cross sectional survey of the population aged 15 to 19 years.

Setting: Eight rural Tanzanian villages in three regions, and two districts in Dar es Salaam.

Low prevalence of risk factors for coronary heart disease in rural Tanzania.

A community-based survey was used to assess the prevalence of risk factors for coronary heart disease (CHD) in rural Tanzanians. In all, 8581 subjects (3705 men, 4876 women) aged > or = 15 years in eight villages in three regions in rural Tanzania representing a range of socioeconomic deprivation were studied. The main outcome measures were serum cholesterol and triglyceride level, blood pressure and prevalence of dyslipidaemia, hypertension, smoking, overweight, impaired glucose tolerance (IGT) and diabetes; as well as ECG changes.

Prevalence and incidence of epilepsy in Ulanga, a rural Tanzanian district: a community-based study.

A random cluster sample survey of approximately 18,000 people in 11 villages was performed in Ulanga, a Tanzanian district with a population of approximately 139,000 people. Well-instructed fourth-year medical students and neurologic and psychiatry nurses identified persons with epilepsy using a screening questionnaire and sent them to a neurologist for detailed evaluation. Identified were 207 subjects (88 male, 119 female) with epilepsy; of these, 185 (89.

Is diabetes mellitus related to undernutrition in rural Tanzania?

Objective: To investigate the relation between undernutrition and diabetes.

Design: Survey of glucose tolerance in rural Tanzania.

Setting: Eight villages in three widely separated regions of Tanzania.

Study in Tanzania of impaired glucose tolerance. Methodological myth?

During a study of diabetes prevalence in six rural Tanzanian communities, a repeat oral glucose tolerance test (OGTT) was carried out in 514 subjects greater than or equal to 15 yr of age within 1 wk of an initial 75-g OGTT. In 498 subjects, blood glucose was measured 2 h after the glucose load on both occasions, and in 175 subjects, fasting blood glucose measurement was also repeated. Of the 498 subjects, 245 had normal glucose tolerance in the first test and were selected at random for further testing; 223 subjects had impaired glucose tolerance (IGT), and 30 had diabetic values.

No deterioration of oral glucose tolerance during pregnancy in rural Tanzania.

There is still controversy concerning the reference ranges for glucose tolerance tests in pregnancy. The WHO has recommended the universal use of the 75 g oral glucose load with 2-h post-load values of greater than 6.7 mmol l-1 to be considered impaired glucose tolerance (IGT) in the non-pregnant, and equivalent to gestational diabetes in the pregnant.

The value of questionnaires aimed at key informants, and distributed through an existing administrative system, for rapid and cost-effective health assessment.

The requirement for a careful interview set-up in the classical key-informant approach considerably limits its extension to a larger scale. However, the administration of simplified questionnaires entirely through an existing administrative system can provide an alternative approach and become a valuable tool for fast and cost-efficient community health assessment. This methodology relies on a well-structured and working administrative system, and is restricted to health problems that are well and distinctly perceived by community members.