Is it time to reassess the categorization of disease burdens in low-income countries?

The classification of disease burdens is an important topic that receives little attention or debate. One common classification scheme, the broad cause grouping, is based on etiology and health transition theory and is mainly concerned with distinguishing communicable from noncommunicable diseases. This may be of limited utility to policymakers and planners.

Community-based monitoring of safe motherhood in the United Republic of Tanzania.

Objective: To examine the progress made towards the Safe Motherhood Initiative goals in three areas of the United Republic of Tanzania during the 1990s.

Methods: Maternal mortality in the United Republic of Tanzania was monitored by sentinel demographic surveillance of more than 77,000 women of reproductive age, and by prospective monitoring of mortality in the following locations; an urban site; a wealthier rural district; and a poor rural district. The observation period for the rural districts was 1992-99 and 1993-99 for the urban site.

Noncommunicable diseases in sub-Saharan Africa: where do they feature in the health research agenda?

There is no doubt that communicable diseases will remain the predominant health problem for the populations in sub-Saharan Africa, including adults, for the next 10-20 years. Concern has been expressed that the available resources to deal with this problem would be reduced by increasing the emphasis on noncommunicable diseases. The latter, however, already present a substantial burden because their overall age-specific rates are currently higher in adults in sub-Saharan Africa than in populations in Established Market Economies.

Stroke mortality in urban and rural Tanzania. Adult Morbidity and Mortality Project.

Background: Most data for stroke mortality in sub-Saharan Africa are hospital based. We aimed to establish the contribution of cerebrovascular disease to all-cause mortality and cerebrovascular disease mortality rates in adults aged 15 years or more in one urban and two rural areas of Tanzania.

Methods: Regular censuses of the three surveillance populations consisting of 307,820 people (125,932 aged below 15 years and 181,888 aged 15 or more) were undertaken with prospective monitoring of all deaths arising in these populations between June 1, 1992 and May 31, 1995.

Application of the new ADA criteria for the diagnosis of diabetes to population studies in sub-Saharan Africa. American diabetes association.

Aims: To examine the implications for epidemiological studies of the American Diabetes Association (ADA) recommendation that the fasting blood glucose at a lowered level becomes the main diagnostic test for diabetes on cross-sectional-based data from sub-Saharan Africa.

Methods: Data from 11 surveys conducted in rural, peri-urban and urban Cameroon (n = 1804), South Africa (n = 3799) and Tanzania (n = 10013) which measured fasting (ADA criteria) and 2-h blood glucose concentrations during a standard 75 g OGTT (old WHO criteria) were analysed.

Results: The prevalence of diabetes was higher in eight of the 11 surveys when applying the new ADA compared to the old WHO criteria.

Age specific prevalence of impairment and disability relating to hemiplegic stroke in the Hai District of northern Tanzania. Adult Morbidity and Mortality Project.

Objectives: To determine the age specific prevalence of impairment and disability relating to hemiplegic stroke in one rural area of Tanzania.

Methods: During the yearly house to house census of the study population of 148 135 (85 152 aged 15 and over) in August 1994, specific questions were asked to identify those who might be disabled from stroke. People thus identified were subsequently interviewed and examined by one investigator.

Diabetes mellitus as a cause of death in sub-Saharan Africa: results of a community-based study in Tanzania. The Adult Morbidity and Mortality Project.

The aim of this study was to determine the contribution of diabetes mellitus to all-cause mortality and diabetes mortality rates in adults 15 years and above living in one urban and two rural areas of Tanzania (Dar es Salaam, Hai and Morogoro Rural Districts). The three surveillance populations comprised 307,912 persons. Prospective monitoring of all deaths between 1 June 1992 and 31 May 1995 was carried out.

Outlook for survivors of childhood in sub-Saharan Africa: adult mortality in Tanzania. Adult Morbidity and Mortality Project.

Objective: To measure age and sex specific mortality in adults (15-59 years) in one urban and two rural areas of Tanzania.

Design: Reporting of all deaths occurring between 1 June 1992 and 31 May 1995.

Setting: Eight branches in Dar es Salaam (Tanzania's largest city), 59 villages in Morogoro rural district (a poor rural area), and 47 villages in Hai district (a more prosperous rural area).

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.

Schistosomiasis prevalence after administration of praziquantel to school children in Melela village, Morogoro region, Tanzania.

A study of the prevalence of schistosomiasis was carried out in 253 school children in Melela, Tanzania, one year after a single dose of praziquantel, 40 mg/kg body weight. The cure rate was 90.4%.

Assessment of process quality in Tanzanian primary care.

Process quality is the commonly used operational definition of health care quality. Its key components are technical and inter-personal skills, but most assessments undertaken in developing countries focus only on technical skills. This study from Tanzania used explicit observation checklists to review the process of providing antenatal, curative and nursing care in primary health units, assessing both technical and inter-personal skills.

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.

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.

Diabetes is not caused by cassava toxicity. A study in a Tanzanian community.

Objective: To test the hypothesis that consumption of cassava with liberation of cyanide causes diabetes in malnourished individuals.

Research Design And Methods: Glucose tolerance was assessed in two rural communities in Tanzania; in one (Nyambori), the main source of calories was cassava; and in the other (Uswaa), cassava was rarely eaten. Undernutrition was prevalent in both communities.

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.

Prevalence of diabetes and impaired glucose tolerance in rural Tanzania.

The prevalence of diabetes mellitus and impaired glucose tolerance (IGT) was assessed by use of WHO diagnostic criteria in 6299 Africans aged 15 years and above living in six villages in Tanzania. 0.87% (1.