No abstract

The effectiveness of traps baited with (5R,6S)-6-acetoxy-5-hexadecanolide (the synthetic oviposition pheromone) and grass infusions in sampling a population of gravid Culex quinquefasciatus Say was conducted in Muheza, Northeast Tanzania. A counterßow geometry (CFG) trap baited with pheromone and set outdoors, adjacent to a pit latrine building, collected more gravid Cx. quinquefasciatus than a CDC trap baited with pheromone and operated without light. Inside pit latrine buildings, signiÞcantly more gravid Cx. quinquefasciatus were collected in a CFG trap-baited with pheromone or grass infusion than in traps baited with tap water. CFG traps baited with either grass infusion or pheromone and set outdoors, away from known breeding sites, caught signiÞcantly more gravid Cx. quinquefasciatus than traps baited with tap water. CFG traps baited with pheromone ϩ grass infusion caught signiÞcantly more gravid Cx. quinquefasciatus than CFG traps baited with either grass infusion or pheromone. In both cases, the proportion of gravid mosquitoes increased as traps were moved away from a natural emergence site. More gravid Cx. quinquefasciatus were collected in a pheromone-baited CFG trap than were egg rafts deposited in a jar with pheromonetreated water. It is concluded that CFG traps baited with oviposition attractants can be used effectively to sample gravid Cx. quinquefasciatus.

Although critical for good case management and the monitoring of health interventions, the health-laboratory services in sub-Saharan Africa are grossly compromised by poor infrastructures and a lack of trained personnel, essential reagents and other supplies. The availability and quality of diagnostic services in 37 health laboratories in three districts of the Tanga region of Tanzania have recently been assessed. The results of the survey, which involved interviews with health workers, observations and a documentary review, revealed that malaria accounted for >50% of admissions and out-patient visits. Most (92%) of the laboratories were carrying out malaria diagnosis and 89% were measuring haemoglobin concentrations but only one (3%) was conducting culture and sensitivity tests, and those only on urine and pus samples. Only 14 (17%) of the 84 people found working in the visited laboratories were laboratory technologists with a diploma certificate or higher qualification. Sixteen (43%) of the study laboratories each had five or fewer types of equipment and only seven (19%) had more than 11 types each. Although 11 (30%) of the laboratories reported that they conducted internal quality control, none had standard operating procedures (SOP) on display or evidence of such quality assurance. Although malaria was the main health problem, diagnostic services for malaria and other diseases were inadequate and of poor quality because of the limited human resources, poor equipment and shortage of supplies. If the health services in Tanga are not to be overwhelmed by the progressively increasing burden of HIV/AIDS, malaria, tuberculosis and other emerging and re-emerging diseases, more funding and appropriate policies to improve the availability and quality of the area's diagnostic services will clearly be required.

User charges in public health facilities are aimed at improving efficiency and quality of health services. In Africa, evidence about their effect on patient attendance and community health-seeking behaviour are mixed. This paper reports a study of the effect of user charges on revenue collection, quality of services and people's health-seeking behaviour in relation to malaria in Korogwe district, Tanzania. Data were collected through focus-group discussions with community members, interviewing community leaders and health workers, field observations and review of patient registers. Generally, there was no distinct difference in the trends of patient attendances before and after user fee introduction. Public awareness about cost-sharing policy was high, but had low appreciation in the administration of exemptions and waivers. Shortage of drugs, laboratory facilities, and inhospitality of nurses lowered their confidence in the user-fee system. Autonomy to collect and prioritize expenditure of user-fee revenue at the health-facility level was appreciated by community leaders and health workers who, however, had reservations with funds being held at the district level and delays by the DMO's office in approving budgets submitted in request for expenditure of such revenues. Thus, despite the potential of user charges for revenue mobilization, problems with their administration lowers public confidence in the user-fee system improving quality and accessibility of services to the poor.

Abstract. An in vivo drug sensitivity study was conducted in Magoda village in northeastern Tanzania to evaluate the usefulness of polymerase chain reaction (PCR)-based genotyping of Plasmodium falciparum parasites to distinguish between re-infection and treatment failure. The study tested P. falciparum susceptibility to a combination of sulfadoxine/pyrimethamine (Fansidar; F. Hoffmann La Roche, Basel, Switzerland). Blood samples were collected before treatment and on days 7, 14, or 28 post-treatment in 51 asymptomatic children, of which 26 could not clear parasitemia within seven days post-treatment. Among the remaining 25 children who had no detectable parasites on day 7, only five remained parasite negative up to day 28. Primary and recrudescent P. falciparum parasites were analyzed by PCR using family specific primers for merozoite surface protein-1 (MSP-1), MSP-2, and glutamate-rich protein (GLURP). All samples contained multiple P. falciparum infections. For all children with recrudescent P. falciparum, common alleles were detected in both the primary and recrudescent samples. However, in no child were the exact same alleles detected in both samples, indicating that probably at least some of the recrudescing parasites originated from new infections. The study demonstrates the general usefulness of PCR genotyping technique in distinguishing re-infections from true recrudescences following therapeutic drug treatment.