Flexible kinship: caring for AIDS orphans in rural Lesotho

HIV/AIDS has devastated families in rural Lesotho, leaving many children orphaned. Families have adapted to the increase in the number of orphans and HIV‐positive children in ways that provide children with the best possible care. Though local ideas about kinship and care are firmly rooted in patrilineal social organization, in practice, maternal caregivers, often grandmothers, are increasingly caring for orphaned children. Negotiations between affinal kin capitalize on flexible kinship practices in order to legitimate new patterns of care, which have shifted towards a model that often favours matrilocal practices of care in the context of idealized patrilineality.     

Experience of initiating collaboration of traditional healers in managing HIV and AIDS in Tanzania

Given the increased use of traditional medicines, possibilities that would ensure its successful integration into a public health framework should be explored. This paper discusses some of the links between biodiversity and traditional medicine, and addresses their implications to public health. We explore the importance of biodiversity and ecosystem services to global and human health, the risks which human impacts on ecosystems and biodiversity present to human health and welfare.     

Impact of Community-Based Larviciding on the Prevalence of Malaria Infection in Dar es Salaam,Tanzania

Background

The use of larval source management is not prioritized by contemporary malaria control programs in sub-Saharan Africa despite historical success. Larviciding, in particular, could be effective in urban areas where transmission is focal and accessibility to Anopheles breeding habitats is generally easier than in rural settings. The objective of this study is to assess the effectiveness of a community-based microbial larviciding intervention to reduce the prevalence of malaria infection in Dar es Salaam, United Republic of Tanzania.

Methods and Findings

Larviciding was implemented in 3 out of 15 targeted wards of Dar es Salaam in 2006 after two years of baseline data collection. This intervention was subsequently scaled up to 9 wards a year later, and to all 15 targeted wards in 2008. Continuous randomized cluster sampling of malaria prevalence and socio-demographic characteristics was carried out during 6 survey rounds (2004–2008), which included both cross-sectional and longitudinal data (N = 64,537). Bayesian random effects logistic regression models were used to quantify the effect of the intervention on malaria prevalence at the individual level. Effect size estimates suggest a significant protective effect of the larviciding intervention. After adjustment for confounders, the odds of individuals living in areas treated with larviciding being infected with malaria were 21% lower (Odds Ratio = 0.79; 95% Credible Intervals: 0.66–0.93) than those who lived in areas not treated. The larviciding intervention was most effective during dry seasons and had synergistic effects with other protective measures such as use of insecticide-treated bed nets and house proofing (i.e., complete ceiling or window screens).

Conclusion

A large-scale community-based larviciding intervention significantly reduced the prevalence of malaria infection in urban Dar es Salaam.     

Roles of traditional medicine and traditional healers for rabies prevention and potential impacts on post-exposure prophylaxis: A literature review

IntroductionGlobally, traditional medicine is widely used to treat a variety of injuries and illnesses, including dog bites, and exposures that are risky for rabies. However, efficacy of most traditional remedies used for rabies prevention or treatment has not been demonstrated in controlled trials or proven in community-based surveys.MethodsSix databases were searched including the terms rabies, traditional treatment, traditional remedy, traditional therapy, traditional medicine, and medicinal treatment to review traditional remedies used in the prevention and treatment of rabies. In addition, published literature of rabies transmission dynamics was used to estimate statistical likelihood of dog bite victims developing rabies to provide clarity as to why traditional healers have a high apparent success rate when preventing death from rabies in victims bitten by suspected rabid dogs.ResultsLiterature review yielded 50 articles, including three controlled experiments, that described use of traditional remedies for rabies prevention and treatment. Traditional remedies for rabies ranged from plant- or animal-based products to spiritual rituals; however, only a few controlled mice trials were conducted, and none of these trials demonstrated efficacy in preventing or treating rabies. Risk of dying from rabies after a bite from a dog with unknown rabies status is low, 1.90% (0.05%-29.60%). Therefore, traditional healers had a 98.10% (70.40%-99.95%) apparent success rate in preventing death from suspected rabid dog bites despite inefficaciousness of herbal remedies.ConclusionThere was no universal plant species or route of administration that was consistently used for rabies prevention or treatment across countries. No traditional remedy was efficacious in the prevention or treatment of rabies in randomized controlled experiments. Understanding the cultural context under which traditional remedies are used may facilitate collaboration of traditional healers with the modern medical system to ensure timely and appropriate use of proven therapies for prevention and clinical management of rabies.     

How beliefs in traditional healers impact on the use of allopathic medicine: In the case of indigenous snakebite in Eswatini

Snakebite is a major public health problem in Eswatini and serious envenomations can be responsible for considerable morbidity and mortality if not treated correctly. Antivenom should be administered in hospital in case of adverse reactions and any delays due to distance, transport, costs, antivenom availability and cultural beliefs can be critical. Myths and superstition surround snakes, with illness from snakebite considered a supernatural phenomenon best treated by traditional medicine since healers can explore causes through communication with the ancestors. Traditional consultations can cause significant delays and the remedies may cause further complications. Four rural focus group discussions were held in varying geographical regions to establish why people may choose traditional medicine following snakebite. The study revealed four themes, with no apparent gender bias. These were ‘beliefs and traditions’, ‘logistical issues’, ‘lack of knowledge’ and ‘parallel systems’. All snakes are feared, regardless of geographical variations in species distribution. Deep-seated cultural beliefs were the most important reason for choosing traditional medicine, the success of which is largely attributed to the ‘placebo effect’ and positive expectations. Collaboration and integration of the allopathic and traditional systems assisted by the regulation of healers and their methods could improve future treatment success. The plight of victims could be further improved with more education, lower costs and improved allopathic facilities.     

Bioconversion of lignocellulosic waste from selected dumping sites in Dar es Salaam,Tanzania

The poor management of solid wastes in Tanzania urban centers is a chronic problem that has increasingly become a source of environmental pollution. Bioconversion offers a cheap and safe method of not only disposing these wastes, but also it has the potential to convert lignocellulosic wastes into usable forms such as reducing sugars that could be used as food. This paper reports a preliminary study on the physical characteristics, acid pretreatment, saccharification by cellulase from Trichoderma reesei and fermentation by Saccharomyces cerevisiae of the lignocellulosic component of the solid wastes collected from various dumping sites located in Kinondoni Municipality, Dar es Salaam city. The results showed that overall, the lignocellulosic component constitute about 50% of solid wastes dumped in the study areas. Maximum production of reducing sugars was obtained after 6 h of saccharification while highest concentrations of bioethanol were achieved after 48 h of fermentation. Microbial bioconversion of lignocellulose component yielded up to 21% bioethanol.     

Initiation of healers in Ethiopia: a case study

The aim of this study is to see how healers are initiated in Ethiopia. The paper also describes the position of traditional healers in the current situation of Ethiopia. It is found out that most of spiritual healers believed that they are selected by divine power or spirit. The selections are manifested by a single or a combination of ways namely: through dream, escaping mortal accident, and miraculous healing from chronic illnesses. However, secular healers got the initiation through apprenticeship. It is noted that in many cases "spirit selected healers" could also undergo apprenticeship.     

A first insight into the genetic diversity of Mycobacterium tuberculosis in Dar es Salaam, Tanzania, assessed by spoligotyping

Background  

Tanzania has a high tuberculosis incidence, and genotyping studies of Mycobacterium tuberculosis in the country are necessary in order to improve our understanding of the epidemic. Spoligotyping is a potentially powerful genotyping method due to fast generation of genotyping results, high reproducibility and low operation costs. The recently constructed SpolDB4 database and the model-based program 'spotclust' can be used to assign isolates to families, subfamilies and variants. The results of a study can thus be analyzed in a global context.     

Knowledge and practice of traditional healers in oral health in the Bui Division, Cameroon

Background

The extraction of the teeth by traditional healers in Cameroon is an established cultural practice in the central region of the Cameroon. Traditional healers (TH) use herbs and crude un-sterilized instruments and tools for the tooth extraction procedure. The present study investigates the knowledge and practices of traditional healers regarding tooth extraction and the management of its complications.

Methods

A cross sectional design utilizing semi-structured questionnaires was used to collect the data from traditional healers and their patients.

Results

Sixteen traditional healers (TH) were interviewed. All were male and the majority were between 25-35 years old. The most important reason given for the removal of a tooth was "if it has a hole". All reported using herbs to control bleeding and pain after extractions. Only 20% used gloves between patients when extracting a tooth and just over a third (31.3%) gave post-operative instructions. Eighty seven percent managed complications with herbs and 62.5% reported that they would refer their patients to a dentist whenever there are complications. Only a third (31.3%) was familiar with the basic anatomy of a tooth and more than half (56.3%) reported that tooth extractions are the only treatment for dental problems. One hundred and fifty patients were interviewed with a mean age of 29 years. More than two thirds were in the 21-30 year age group and just over half were male. Sixty six percent reported that they visited the TH because it is cheap, 93.3% were satisfied with the treatment they received while 95.3% reported said they never had a problem after an extraction.

Conclusions

Tooth extractions using medicinal plants is well established in Lekie division, Cameroon. Infection control during extraction is not the norm. Traditional healers are willing to co-operate with oral health workers in improving the oral health of their patients. Mutual cooperation, collaboration and integrating TH into primary oral health care services need to be increased.     

A tool box for operational mosquito larval control: preliminary results and early lessons from the Urban Malaria Control Programme in Dar es Salaam, Tanzania

Background

As the population of Africa rapidly urbanizes, large populations could be protected from malaria by controlling aquatic stages of mosquitoes if cost-effective and scalable implementation systems can be designed.

Methods

A recently initiated Urban Malaria Control Programme in Dar es Salaam delegates responsibility for routine mosquito control and surveillance to modestly-paid community members, known as Community-Owned Resource Persons (CORPs). New vector surveillance, larviciding and management systems were designed and evaluated in 15 city wards to allow timely collection, interpretation and reaction to entomologic monitoring data using practical procedures that rely on minimal technology. After one year of baseline data collection, operational larviciding with Bacillus thuringiensis var. israelensis commenced in March 2006 in three selected wards.

Results

The procedures and staff management systems described greatly improved standards of larval surveillance relative to that reported at the outset of this programme. In the first year of the programme, over 65,000 potential Anopheles habitats were surveyed by 90 CORPs on a weekly basis. Reaction times to vector surveillance at observations were one day, week and month at ward, municipal and city levels, respectively. One year of community-based larviciding reduced transmission by the primary malaria vector, Anopheles gambiae s.l., by 31% (95% C.I. = 21.6–37.6%; p = 0.04).

Conclusion

This novel management, monitoring and evaluation system for implementing routine larviciding of malaria vectors in African cities has shown considerable potential for sustained, rapidly responsive, data-driven and affordable application. Nevertheless, the true programmatic value of larviciding in urban Africa can only be established through longer-term programmes which are stably financed and allow the operational teams and management infrastructures to mature by learning from experience.     

Movement among healers in Sri Lanka: A case study of a sinhalese patient

Sinhalese patients in Sri Lanka have a variety of practitioners to choose from in seeking treatment for illness. These include: Ayurvedic physicians, Western physicians, and ritual practitioners. This paper traces the movement of a single patient seeking treatment for pissu (madness) from a number of healers. It is suggested that this movement of the patient among a variety of treatment systems allows a fluidity of diagnosis which prevents any one explanatory system from dominating her perception of her illness. It is also argued that treatments are linked by an underlying continuity of process, in which the personal antecedents of the illness are reinterpreted in terms of public representations of affliction and in which all treatments phrase illness most basically in terms of excess and imbalance.This paper was originally represented to an Anthropology Department colloquium at the University of Massachusetts, Boston, in the fall of 1977. I would like to thank the following people for reading and commenting on an earlier version of the paper: H. L. Seneviratne, Brenda Beck, David Landy, Nancy Waxler, Arthur Kleinman, Charles Ducey, Daniel Brown, John McCreery, and Allan Meyers.     

Plants used in traditional medicine by hayas of the Kagera region,Tanzania

This paper provides a brief account of 31 plants associated with herbal remedies among the Hayas, a tribe of Kagera region, Tanzania. Reports from informants were obtained during field studies in June 1987. For each species are given the botanical name, vernacular name, collection number, locality, habit, dis-tribution and medical uses. The data are compared with information from literature for medical uses, and listed isolated constituents and pharmacological effects. The Hayas have had a rich herbal folklore, but this is fading due to increasing acculturation and depletion of plant cover.     

Prospective study of incidence of juvenile diabetes mellitus over 10 years in Dar es Salaam,Tanzania.

OBJECTIVE--To ascertain the annual incidence of diabetes requiring treatment with insulin in children and adolescents aged 0-19 years in Dar es Salaam, Tanzania, during a 10 year period from 1 January 1982 to 31 December 1991. DESIGN--Prospective registration at a major urban hospital of all patients with newly diagnosed diabetes who were resident in Dar es Salaam. SETTING--Muhimbili Medical Centre, Dar es Salaam, Tanzania. PATIENTS--86 patients: 45 male, 41 female. RESULTS--The annual incidence of juvenile diabetes for both sexes was 1.5 per 100,000 population aged 0-19 years (95% confidence interval 1.3 to 1.7). Incidence per 100,000 population per year increased with age: 0.6 (0.0 to 0.13) in the age group 0-4 years, 0.5 (0.3 to 0.7) at 5-9 years, 2.2 (1.8 to 2.6) at 10-14 years, and 3.4 (2.9 to 3.9) at 15-19 years. CONCLUSION--Juvenile diabetes mellitus is fairly rare in sub-Saharan Africa. If environmental factors such as infection and material deprivation were important determinants of insulin dependent diabetes in Africans, as they may be in Europeans, much higher rates would have been expected unless genetic factors possibly exert a protective role. The eightfold greater incidence in African Americans than in Tanzanians may be related to greater genetic admixture in African Americans with people from countries in Europe with a high incidence.     

Identifying Programmatic Gaps: Inequities in Harm Reduction Service Utilization among Male and Female Drug Users in Dar es Salaam,Tanzania

Introduction

Current estimates suggest an HIV prevalence of 42% among people who inject drugs (PWIDs) in Dar es Salaam, while HIV prevalence is estimated to be 8.8% among the general population in the city. To address the HIV epidemic in this population, the government of Tanzania began establishing HIV prevention, treatment and care services including outreach and medication assisted treatment (MAT) for PWIDs in 2010. We assessed gender inequities in utilization of outreach and MAT services and evaluated differences in HIV risk behaviors between female and male PWIDs.

Materials and Methods

Routine outreach data between December 2010 to mid-August 2012 and baseline data on clients enrolling in methadone from February 2011 to August 2012 were utilized. Binomial regression was used to estimate adjusted relative risk estimates comparing females to males.

Results

From December 2010 to August 2012, 8,578 contacts were made to drug users; among them 1,898 were injectors. A total of 453 injectors were eligible and referred to MAT, of which, 443 enrolled in treatment. However, regarding total outreach contacts, outreach to PWID, referral to MAT and enrollment in MAT, 8% or less of drug users accessing services were women. In contrast, weighted estimations from surveys suggest that 34% of PWIDs are female, and this approximation is similar to recent population size estimations. Overall, 43% of traditional outreach workers conducting outreach with drug users were female. Though reporting higher levels of condom usage, female PWID were more likely to report multiple sex partners, anal sex, commercial sex work and struggle under a higher burden of addiction, mental disorders and abuse.

Conclusions

Services have not been mobilized adequately to address the clear needs of females who inject drugs. A clear and urgent need exists for women-centered strategies that effectively engage female PWID into HIV prevention services.     

The diet of the edible cockle Anadara antiquata L. (Bivalvia,Arcidae) in Dar es Salaam,Tanzania, during the northeast monsoons

The diet of the cockle Anadara antiquata L. was studied along Dar es Salaam coast during the N-E Monsoon season. No zooplankton were found in the 80 cockle guts examined. 27 phytoplankton genera were identified, an indication of wide phytophagy. Members of classes Bacillariophyceae, Chlorophyceae, Pyrophyceae and Prasnophyceae were very prevalent in the diet. Scenedesmus, Chlamydomonas, Palmeria, Exuviella, and Coscinodiscus showed the highest recurrence frequencies per gut.