The value of community technology workers for LPG use: A pilot in Shirati, Tanzania

Background Sustainable Development Goal (SDG) 7 calls for the adoption and continued use of clean-burning stoves by the 2.9 billion people relying on unclean fuels (both solid biomass and kerosene). However, to date, the clean cooking literature has found low rates of efficient stove adoption and continued use. This paper presents the application of a public health community engagement model to the use of clean cooking fuels. We implemented a pilot study with Community Technology Workers (CTWs) as a means to overcome maintenance, education, and behavioral barriers to clean fuel use in rural Tanzania. Methods The intervention was a free 6 kg Liquified Petroleum Gas (LPG) cylinder and stove coupled with education from a local technically trained CTW on LPG use. We evaluated the training, work, and impact of a CTW on LPG use on 30 randomly selected households from two villages in a rural district of Tanzania over a 1-year period. After an initial baseline survey, technically trained local CTWs educated the households on safe LPG use and conducted 34 follow up surveys over the next year on their cooking fuel use. Additionally, we conducted qualitative interviews with all households and a focus group with six of the households. Results The results from the mixed methods approach show that 80% of families (n = 24) consistently refilled their LPG cylinders and ~ 40% of households exclusively used LPG. Households reported appreciating the CTWs’ visits for providing education and maintenance support, giving them confidence to use LPG safely, reminding them to save for their cylinder, and providing a community driven effort to use clean fuel. Conclusions The findings demonstrate the feasibility of this type of community infrastructure model to promote and facilitate consistent LPG use, but suggest the need to couple this local support with financial mechanisms (e.g., a microsavings program). This model could be a mechanism to increase LPG use, particularly in rural, low-income areas.

Causes of death and associated factors over a decade of follow-up in a cohort of people living with HIV in rural Tanzania

Background Nearly half of HIV-related deaths occur in East and Southern Africa, yet data on causes of death (COD) are scarce. We determined COD and associated factors among people living with HIV (PLHIV) in rural Tanzania. Methods PLHIV attending the Chronic Diseases Clinic of Ifakara, Morogoro are invited to enrol in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO). Among adults (≥ 15 years) enrolled in 2005–2018, with follow-up through April 2019, we classified COD in comprehensive classes and as HIV- or non-HIV-related. In the subset of participants enrolled in 2013–2018 (when data were more complete), we assessed cause-specific mortality using cumulative incidences, and associated factors using proportional hazards models. Results Among 9871 adults (65% female, 26% CD4 count < 100 cells/mm3), 926 (9%) died, among whom COD were available for 474 (51%), with missing COD mainly in earlier years. The most common COD were tuberculosis (N = 127, 27%), non-AIDS-related infections (N = 72, 15%), and other AIDS-related infections (N = 59, 12%). Cardiovascular and renal deaths emerged as important COD in later calendar years, with 27% of deaths in 2018 attributable to cardiovascular causes. Most deaths (51%) occurred within the first six months following enrolment. Among 3956 participants enrolled in 2013–2018 (N = 203 deaths, 200 with COD ascertained), tuberculosis persisted as the most common COD (25%), but substantial proportions of deaths from six months after enrolment onwards were attributable to renal (14%), non-AIDS-related infections (13%), other AIDS-related infections (10%) and cardiovascular (10%) causes. Factors associated with higher HIV-related mortality were sex, younger age, living in Ifakara town, HIV status disclosure, hospitalisation, not being underweight, lower CD4 count, advanced WHO stage, and gaps in care. Factors associated with higher non-HIV-related mortality included not having an HIV-positive partner, lower CD4 count, advanced WHO stage, and gaps in care. Conclusion Incidence of HIV-related mortality was higher than that of non-HIV-related mortality, even in more recent years, likely due to late presentation. Tuberculosis was the leading specific COD identified, particularly soon after enrolment, while in later calendar years cardiovascular and renal causes emerged as important, emphasising the need for improved screening and management.

The Centres for Disease Control Light Trap (CDC LT) and The Human Decoy Trap (HDT) Compared to The Human Landing Catch (HLC) for Measuring Anopheles Biting in Rural Tanzania

BackgroundThe intensity of vector mosquito biting is an important measure for malaria epidemiology and control. The human landing catch (HLC) is an effective entomological surveillance tool, but is labour-intensive, expensive and raises safety issues. The Centres for Disease Control light trap (CDC LT) and the human decoy trap (HDT) are less costly and exposure-free alternatives. This study compared the CDC LT and HDT against the HLC for measuring Anopheles (An.) biting in rural Tanzania and assessed their suitability as HLC proxies.MethodsIndoor mosquito surveys using HLC and CDC LT and outdoor surveys using HLC and HDT were conducted in 2017 and in 2019 in Ulanga, Tanzania in 19 villages, with one trap per house per night. Species composition, sporozoite rates and the numbers of mosquitoes caught by different trap types were compared. Aggregating the data by village and month, the Bland-Altman approach was used to assess agreement. ResultsOverall, 66,807 Anopheles funestus and 14,606 An. arabiensis adult females were caught from 6,013 CDC LT, 339 indoor HLC, 136 HDT and 195 outdoor HLC collections. Overall, the CDC LT caught fewer malaria vectors than indoor HLC: An. arabiensis (Adjusted rate ratio (Adj.RR) =0.35 (95% confidence interval (CI):0.27-0.46)) and An. funestus (Adj.RR=0.63(95%CI:0.51-0.79)). HDT caught fewer malaria vectors than outdoor HLC: An. arabiensis (Adj.RR=0.04(95%CI:0.01-0.14)) and An. funestus (Adj.RR=0.10(95%CI:0.07-0.15)). The bias and variability of the ratios of geometric mean mosquitoes caught by CDC LT and HDT relative to HLC collections for the same village-month were dependent on mosquito densities. The relative efficacies of both CDC LT and HDT declined with mosquito abundance. The variability in the ratios was substantial for low HLC counts and decreased as mosquito abundance increased. CDCLT caught a higher proportion of infected An. arabiensis and An. funestus than HLC, and HDT caught no infected mosquitoes.ConclusionsIf caution is taken in appreciation of its limitations, the CDC LT is suitable for use in routine entomological surveys and may be preferable for measuring sporozoite rates for Afrotropical mosquitoes. Use of HLC is useful to estimate human exposure to mosquitoes for estimating Entomological Inoculation Rate (EIR). The present design of the HDT is not amenable for use to conduct large-scale entomological surveys.

Prevalence, incidence and predictors of renal impairment in persons with HIV receiving protease-inhibitors in rural Tanzania

Objective Ritonavir-boosted protease inhibitors (bPI) in people living with HIV (PLWH) have been associated with renal impairment. Limited data are available from rural sub-Saharan Africa. Methods Using data from the Kilombero and Ulanga Antiretroviral Cohort Study (KIULARCO) in rural Tanzania from 2005-01/2020, we assessed the prevalence of renal impairment (estimated glomerular filtration rate <60 mL/min/1.73m2) at the time of switch from first-line antiretroviral treatment (ART) to bPI-regimen and the incidence of renal impairment on bPI. We assessed risk factors for renal impairment using logistic and Cox regression models. Results Renal impairment was present in 52/687 PLWH (7.6%) at the switch to bPI. Among 556 participants with normal kidney function at switch, 41 (7.4%) developed renal impairment after a median time of 3.5 (IQR 1.6–5.1) years (incidence 22/1,000 person-years (95%CI 16.1–29.8)). Factors associated with renal impairment at switch were older age (adjusted odds ratio (aOR) 1.55 per 10 years; 95%CI 1.15–2.11), body mass index (BMI) <18.5 kg/m2 (aOR 2.80 versus ≥18kg/m2; 95%CI 1.28–6.14) and arterial hypertension (aOR 2.33; 95%CI 1.03–5.28). The risk of renal impairment was lower with increased duration of ART use (aOR 0.78 per one-year increase; 95%CI 0.67–0.91). The renal impairment incidence under bPI was associated with older age (adjusted hazard ratio 2.01 per 10 years; 95%CI 1.46–2.78). Conclusions In PLWH in rural sub-Saharan Africa, prevalence and incidence of renal impairment among those who were switched from first-line to bPI-regimens were high. We found associations between renal impairment and older age, arterial hypertension, low BMI and time on ART.