Control of (Multi)Drug Resistance and Tuberculosis Incidence over 23 Years in the Context of a Well-Supported Tuberculosis Programme in Rural Malawi

Background

The rise in tuberculosis (TB) incidence following generalized HIV epidemics can overwhelm TB control programmes in resource-limited settings, sometimes accompanied by rising rates of drug resistance. This has led to claims that DOTS-based TB control has failed in such settings. However, few studies have described the effect of a sustained and well-supported DOTS programme on TB incidence and drug resistance over a long period. We present long-term trends in incidence and drug resistance in rural Malawi.

Methods

Karonga District in northern Malawi has an adult HIV prevalence of ∼10%. A research group, the Karonga Prevention Study, collaborates with the National Tuberculosis Programme to support core TB control activities. Bacteriological, demographic and clinical (including HIV status) information from all patients starting TB treatment in the District have been recorded since 1988. During that period isolates from each culture-positive TB patient were exported for drug sensitivity testing. Antiretroviral therapy (ART) has been widely available since 2005.

Results

Incidence of new smear-positive adult TB peaked at 124/100,000/year in the mid-90s, but has since fallen to 87/100,000/year. Drug sensitivity information was available for 95% (3132/3307) of all culture-positive cases. Initial resistance to isoniazid was around 6% with no evidence of an increase. Fewer than 1% of episodes involved a multi-drug resistant strain.

Discussion

In this setting with a generalised HIV epidemic and medium TB burden, a well-supported DOTS programme enhanced by routine culture and drug sensitivity testing may well have reduced TB incidence and maintained drug resistance at low levels.     

Diet and feeding patterns in the kipunji (<Emphasis Type="Italic">Rungwecebus kipunji</Emphasis>) in Tanzania’s Southern Highlands: a first analysis

The diet and feeding behaviour of the kipunji (Rungwecebus kipunji) was studied over 45 months, the first dietary analysis for this species. During 9498 h of direct observation of 34 kipunji groups, a list of 122 identified foodplants was recorded. The list represents 60 families, including 64 trees, 30 herbs, 9 climbers, 7 shrubs, 6 lianas, 3 grasses and 3 ferns. Kipunji were observed eating bark, young and mature leaves, ripe and unripe fruits, flowers, pith, seed pods, rhizomes, tubers, shoots and stalks. Invertebrates, fungi, moss, lichen, and soil were also eaten. Macaranga capensis var. capensis, an early successional tree, was the most commonly consumed species, with leaves, leaf stalks, pith, flowers and bark all eaten. We demonstrate that the kipunji is an omnivorous dietary generalist, favouring mature and immature leaves, ripe and unripe fruits and bark in similar proportions, with an almost comparable fondness for leaf stalks and flowers. Kipunji appear to be adaptable foragers able to modify their diet seasonally, being more folivorous in the dry season and more frugivorous in the wet. Whereas more ripe fruit is eaten in the wet season, the proportion of unripe fruit remains similar across the year. The proportion of mature leaves and pith increases throughout the dry season at the expense of ripe fruits and bark, and this may compensate nutritionally for the lack of available dry-season ripe fruits. Relatively more pith is eaten in the dry season, more stalks at the end of the dry and beginning of the wet seasons, and bark consumption increases as the rainfall rises.     

A Reassessment of the Population Size,Demography, and Status of Tanzania’s Endemic Kipunji Rungwecebus kipunji 13 Years on: Demonstrating Conservation Success

International Journal of Primatology - Long-term population data on endangered species are fundamental to measure conservation implementation objectively, but they are rare, especially in remote...     

Leopard abundance,distribution and food habits in the Mt. Rungwe–Kitulo landscape,Southern Tanzania

Between 2003 and 2010, 2178.5 km of transect was walked and 76 leopard scats counted in the Mt. Rungwe–Kitulo landscape. The number of scats per 10 km ranged between 0 and 0.83 in Mt Rungwe and between 0 and 1.41 in Kitulo. Leopards chiefly selected bamboo forest between 2500 and 2950 m asl. Some 126 interviews revealed that leopards were encountered more in the 1980s than latterly. Leopards used to attack livestock, but in the 1960s and 1970s, were heavily poisoned. We analysed 59 scats for undigested materials and compared them to a hair reference atlas. Some 135 different prey items were found, with an average of 2.3 items per scat. Some 14 samples were identified to species level and four to genus level. The average prey body weight was 5.9 kg. The diet was dominated by small mammals and rodent species up to 5.0 kg (59.57%) of biomass, followed by carnivores (29.14%), primate species (8.91%) and small rodents <1 kg (2.24%). The highest relative biomass consumed was prey classes of 1.1–5.0 kg (61.06%), followed by prey 5.1–50 kg (35.22%) and small rodents <1 kg (2.24%). The total absence of ungulate prey and conservation implications are discussed.