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Item Effect of cooking on the nutritive value of common food plants of Tanzania: Part 1—Vitamin C in some of the wild green leafy vegetables(Food Chemistry, 1983) Ndossi, Godwin D.The vitamin C (ascorbic acid) content of fresh and cooked material of sixteen varieties of wild leafy vegetables was estimated. In fresh leaves, the vitamin varied from 204 mg/100 g fresh weight in Moringa oleifera to 0·7 mg in Emilia javanica. When 20 mg samples were cooked in 400 ml of water, the vitamin C content decreased considerably. Losses observed ranged from 98·5% (Moringa oleifera) to nil (Emilia javanica). Smaller losses of the vitamin were observed when vegetable samples were cooked in 100 ml of water. Since most leafy vegetables are cooked prior to consumption, it is recommended that the vegetables are cooked in small amounts of water for short periods to minimise loss of vitamin C and that the cooking water be consumed if no bitter compounds are present.Item Response of plasmodium falciparum to chloroquine and quinine in hospital patients in Muheza,Tanzania(World Health Organization, 1984) Mutabingwa, Theonest K.The response of plasimodium falciparum to chloroquine when administered to malaria patients at a dosage of 25 mg base/kg body weight was studied in 104 indigenous case of malaria at Muheza Hospital in north eastern Tanzania.RII AND RIII grades of resistance to chloroquine were observed in 45.2% of all the case.A combination of quinine with sulfadoxine/pyrimethamine finally cleared the mult drug(chloroquine and quinine) resistant parasites.Item Chloroquine-resistant plasmodium falciparum at the Tanganyika planting company(TPC) sugar estate,moshi,Tanzania.(World Health Organization, 1985) Mutabingwa, Theonest K.From 1966 to 1978 the TPC maintained a mass malaria chemoprophylactic programme based on chloroquine.However after reports of treatment failure to 25 mg chloroquine base per kg body weight,the sensitivity of plasmodium falciparum to chloroquine at the TPC sugar estate near Moshi,northern Tanzania,was determined.In Vivo and In vitro test utilizing standard methods were carried out on semi-immune asymptomatic primary-school children whose ages ranged from 8 to 18 years,with a mean age of 12 years.These children were selected from a total of 746 school children who had been screen for malaria parasites and of whom 245(32.8%)were found to be to be positive.Item Chloroquine therapy still useful in the management of malaria during pregnancy in Muheza, Tanzania(Tropical and geographical medicine, 1991) Mutabingwa, Theonest K.In searching for effective malaria chemosuppressives during pregnancy in Muheza District--Tanzania, pregnant women are randomly given either 300 mg base chloroquine once weekly or 200 mg daily proguanil. Breakthroughs presenting with clinical malaria are treated with 25 mg base chloroquine/kg (25 CQ) over three days. Due to loss of malaria immunity during pregnancy and Muheza moderate levels and degrees of chloroquine resistance, the in vivo response to 25 CQ was monitored. Between March and May 1989, 49 women were treated resulting into 32 (65%) parasitological clearances and 17 (35%) failures within 7 days. Two of 17 failures (12%) exhibited RIII response and the remaining 15 (88%) had a favourable clinical response. Only 6 (19%) of 32 cleared patients either recrudesced or got reinfected during the three weeks follow up period. In addition to its safety and affordability, the observed drug efficacy during peak malaria transmission and inspite of prevailing resistance makes 25 CQ an ideal first line drug for the management of malaria during pregnancy.Item Measuring the Impact of Fatal Adult Illness in Sub-Saharan Africa(Measuring the Impact of Fatal Adult Illness in Sub-Saharan Africa., 1992) Semali, Innocent A.This paper describes the development and content of a household questionnaire designed to measure the economic impact of adult morbidity and mortality in an African country. The questionnaire is the main data collection instrument of the research project on "The Economic Impact of Fatal Adult Illness due to AIDS and Other Causes in Sub-Saharan Africa", conducted by a research team from the World Bank and the University of Dar es Salaam. The main objectives of the project are: (1) to measure the impact of fatal adult illness on individuals, households and communities; and (2) to estimate the costs and effects of alternative policies to assist the survivors. The household questionnaire was adapted from the questionnaire of the World Bank's Living Standards Measurement Survey (LSMS) to measure the well-being and coping behaviors of individuals and households in response to fatal illness among adults. Key innovations in the household questionnaire include: adaptation for a longitudinal research design, including "inter-wave" consistency checks; an expanded set of questions on acute and chronic illness and their costs; a module on the mortality of household members and relatives; a consumption module that allows for seasonality; and collection of more data at the individual level, to facilitate analysis of intra-household distribution of resourcesItem Some aspects of traditional birth attendants' practice in a rural area in Tanzania(Transactions of the Royal Society of Tropical Medicine and Hygiene, 1992) Semali, Innocent A.As a pre-intervention study to improve the safety of the practice of traditional birth attendants, all 29 attendants in one rural area in Tanzania were interviewed, using a pre-tested questionnaire seeking information on the instruments used, care of the umbilical cord, and how they dealt with problem cases. The results are presented and discussed in this paper.Item Measuring the Impact of Fatal Adult Illness in Sub-Saharan Africa; An Annotated Household Questionnaire Papers 90.(World Bank, 1992) Semali, Innocent A.This paper describes the developmentand content of a household questionnairedesignedto measurethe economicimpactof adultmorbidityand mortalityin an African country. The questionnaire is the main data collectioninstrumentof the research project on "The EconomicImpact of Fatal Adult Illness due to AIDS and Other Causes in Sub-SaharanAfrica", conductedby a research team from the WorldBank and the Universityof Dar es Salaam. The main objectivesof theproject are: (1) to measure the impactof fatal adult illnesson individuals,householdsand communities;and (2) to estimatethe costs and effects of alternativepoliciesto assist the survivors. The household questionnairewas adaptedfrom the questionnaireof the World Bank's Living Standards MeasurementSurvey (LSMS)to measurethe well-beingand copingbehaviorsof individuals and householdsin responseto fatal illnessamongadults. Key innovationsin the householdquestionnaire include: adaptationfor a longitudinalresearch design, including "inter-wave" consistencychecks; an expanded set of questionson acute and chronic illness and their costs; a module on the mortality of household membersand relatives; a consumptionmodule that allows for seasonality;and collectionof more data at the individuallevel, to facilitateanalysisof intra-householddistributionof resourcesItem Malaria in infants whose mothers received chemoprophylaxis: response to amodiaquine therapy(Tropical and geographical medicine, 1992) Mutabingwa, Theonest K.In October 1988, a project was implemented for assessing the malaria chemoprophylactic efficacy of weekly chloroquine (CQ) and daily proguanil (PROG) during pregnancy in Muheza-Tanzania. Resultant CQ and PROG-cohorts of infants were followed up for prompt diagnosis and treatment of malaria. Infections were primarily treated with 25 mg base amodiaquine/kg over 3 days. By September 1990, 49 and 60 infants from PROG and CQ cohorts respectively had completed one year follow up. Thirty-five (71%) infants of PROG and 44 (73%) for CQ-cohort were infected with malaria before 3 months of age. The one year mean infection episode rates were 7 (PROG-cohort) and 6.6 (CQ-cohort). Amodiaquine cleared 209 (80%) of PROG's total infections and 224 (81%) for CQ-cohort, and significantly reduced the infection load among clearance failures. Clearance failures had high pre-treatment parasite densities whilst post-treatment densities were higher in the CQ-cohort than PROG-cohort. Low malaria immunity and chloroquine's long residence time could explain these differences. We conclude that early infancy malaria is common and should always be suspected, looked for and adequately treated. Amodiaquine is better than chloroquine for malaria primary therapy during infancy and early childhood.Item Malaria chemosuppression during pregnancy IV. Its effects on the newborn's passive malaria immunity(Tropical and geographical medicine, 1993) Mutabingwa, Theonest K.The effect of malaria prophylaxis during pregnancy on the levels of cord blood anti-sporozoite antibodies was investigated in 203 newborns in Muheza, Tanzania. Mothers of 76 newborns had received prophylaxis with proguanil daily (PROG), 66 chloroquine once weekly (CQ), and 61 got a combination of the two drugs (CQ+PROG). Prophylaxis with PROG or CQ+PROG was more efficacious than with CQ. The mean antibody titres were comparable in all three groups, despite titres being significantly low in mothers of the CQ+PROG group. In 93% of 167 paired maternal-cord sera, maternal titres were higher than cord titres. The correlation between maternal and cord titres was low. Parity, placental malaria, and baby maturity showed little influence on titres. Titres of babies delivered by Caesarean section or whose placenta weighed between 0.75 and 1 kg were comparatively low. The first occurrence of a malaria parasitaemia in infants was independent of the levels of cord titres at birth. The results suggested that chemoprophylaxis as effective as PROG or CQ+PROG in holoendemic areas, insignificantly affects maternal-foetal transfer of anti-sporozoite antibodies, and that levels of these antibodies at birth do not modulate the first occurrence of infancy malaria parasitaemia. Interference with the maternal-foetal transfer of this antibody and possibly other component antibodies of passive immunity should not limit the selection of PROG or CQ+PROG for chemoprophylaxis.Item Malaria chemosuppression in pregnancy V. Placenta malarial changes among three different prophylaxis groups(Tropical and geographical medicine, 1993) Mutabingwa, Theonest K.The effect of malaria chemoprophylaxis during pregnancy on placenta malarial changes (PMCs) was investigated in 170 tissue sections. Women of 63 sections received daily proguanil (PROG), 61 once weekly chloroquine (CQ) and 46 the two drug combination (CQ+PROG). All were residents of a malaria hyperendemic area in Muheza District, Tanzania. Supervised prophylaxis started early in pregnancy till delivery. Parasitaemias and clinical episodes were detected early and radically treated. Overall, PMCs were mostly infrequent and light viz: fibrinous deposits (98%), fibrinoid necrosis (60%), leucocytic infiltrations (59%), macrophage containing pigment (16%), and malaria parasites (8%). The type, prevalence, and severity of the PMCs in the three prophylaxis groups were comparable. This was despite the fact that PROG and CQ+PROG were prophylactically more efficacious than CQ and despite the expectation that the prevalence and severity of the PMCs would be high in the CQ group. Prompt diagnosis and effective treatment of parasitaemias in this group contributed to the low prevalence and less severity. It is concluded that effective malaria chemoprophylaxis or prompt diagnosis and effective treatment of malaria parasitaemias have significant impact on the prevalence of PMCs. Due to various operational constraints in most developing countries, chemoprophylaxis remains the only feasible broad option for malaria control in pregnancy.Item Malaria chemosuppression in pregnancy. II. Its effect on maternal haemoglobin levels, placental malaria and birth weight.(Tropical and geographical medicine, 1993) Mutabingwa, Theonest K.The malaria prophylactic effects of chloroquine (CQ), proguanil (PROG), and chloroquine-proguanil combination (CQ+PROG) during pregnancy on maternal haemoglobin levels (Hb), placental malaria, and birth weight were assessed in Muheza, Tanzania. Within 2 months of prophylaxis, severe anaemia in primigravidae (PG) was reduced from 21% (22 cases) to 13% (13 cases). There was no positive effect in multigravidae (MG). Sustained increases in the mean Hb occurred in PG of the PROG and CQ+PROG groups. The mean Hb of PG of the CQ group decreased after an initial increase, possibly due to the selection of more and highly chloroquine-resistant strain(s). The mean birth weight of PG was highest in the CQ+PROG (2.89 kg) and least in the CQ group (2.71 kg). The CQ group had the highest low birth weight rate (LBW). The prevalence of placental malaria was highest in the CQ (28%) and lowest in the PROG group (12%). For all the prophylactic effects, PROG and CQ+PROG did not differ significantly. Thence, the deployment of CQ+PROG for prophylaxis would be unnecessary. Proguanil is a suitable alternative to chloroquine prophylaxis. Due to possible emergence of proguanil resistance, deployment of this drug should incorporate constant monitoring for resistance and the eventual prophylaxis efficacy. The search for other effective malaria control measures should continue.Item Malaria chemosuppression in pregnancy I. The effect of chemosuppressive drugs on maternal parasitaemia(Tropical and geographical medicine, 1993) Mutabingwa, Theonest K.A randomized prophylactic drug trial was conducted in a malaria holoendemic area, in the Muheza District of Tanzania. Of 327 pregnant women, 124 received proguanil (PROG), 113 chloroquine (CQ), 90 the proguanil and chloroquine combination (CQ+PROG). Prophylaxis was supervised. Chemosuppressive efficacy was measured through the incidence of malaria breakthrough parasitaemias and clinical episodes. Groups were comparable by age, parity, residential area, and enrollment gestational age. Compliance and drug bio-availability was good. The median breakthrough time of the first parasitaemia episode for primigravidae (PG) and multigravidae (MG) was significantly shorter for the CQ group (PG = 56, MG = 78 days) than in the PROG (PG = 97, MG = 112 days) and the CQ+PROG (PG = 138, MG = 140 days) groups. 56% of the CQ group experienced 2 or more clinical episodes compared to 19% (PROG) and 10% (CQ+PROG). PROG and CQ+PROG did not differ significantly. Parasite densities and in vitro tests suggested that CQ selected for more and highly resistant strain(s). Proguanil is suitable for prophylaxis. However, proguanil resistance should be monitored as well as controlled drug distribution and usage. Malaria control strategies other than chemoprophylaxis should be investigated.Item Malaria and pregnancy: Epidemiology, pathophysiology and control options(Acta Tropica, 1994) Mutabingwa, Theonest K.Extensive research on the epidemiology, pathophysiology, and control of malaria during pregnancy has led to new developments and some controversies. Meanwhile, malaria remains a major environmental factor causing serious pregnancy complications, whose incidence and severity depend on gestational age, parity, and the level of malaria endemicity. There is no cohesive explanation for pregnancy-related immunosuppression, though several pathophysiological hypotheses have been proposed. Furthermore, the emergence and rapid spread of chloroquine resistance has complicated the epidemiology, and the policy on alternative chemoprophylaxis. Chemoprophylaxis is probably the only available option for the control of malaria during pregnancy in Africa. However, the best delivery strategy still has to be established. Daily proguanil is the best chemoprophylactic drug at hand. Its deployment should include constant monitoring for the emergence of proguanil resistance, as well as controlled supervision of the distribution of the drug. New control options, such as the use of insecticide-impregnated bed nets, and intermittent targeted mass chemotherapy, require more operational research before they can be broadly recommended.Item Malaria chemosuppression during pregnancy. VI. Some epidemiological aspects of malaria in infants(Tropical and geographical medicine, 1994) Mutabingwa, Theonest K.The possible influence of maternal malaria prophylaxis on infancy malaria was assessed in 241 infants. Mothers of 91 infants (PROG-cohort), 99 infants (CQ-cohort) and 51 infants (CQ+PROG-cohort) had received prophylaxis with daily proguanil, once weekly chloroquine, and the two drug combination respectively. Blood smears of infants were examined for parasitaemia once fortnightly. Parasitaemias were treated with either amodiaquine, Fansidar, or Fansidar-quinine combination. In all cohorts, the incidence of malaria parasitaemias within 3 months of age was high (overall mean = 63%). Chloroquine released from its tissue bound form in the CQ and CQ+PROG-cohorts did not have significant chemosuppressive effects on the parasitaemias. Acknowledging that the CQ-prophylaxis group simulated the hypothetical control group, the cohorts similarity in the pattern of parasitaemias suggested that effective maternal malaria chemoprophylaxis during pregnancy did not significantly influence infancy malaria. A sharp rise in incidence around 3 months was indicative of the waning effect of passive immunity. Sole dependence on sub-optimal active immunity led to another sharp rise in incidence from 9 months onwards. The high incidence of infancy malaria parasitaemias calls for increased vigilance in their early detection and effective treatment. Social-cultural factors within the communities may constrain effective disease management.Item Self-medication with antimalarial drugs in Dar es Salaam, Tanzania(Tropical and geographical medicine, 1995) Kabalimu, Titus K.A hospital-based cross-sectional study was conducted in Dar es Salaam, Tanzania, using a questionnaire to assess the extent of self-medication with antimalarial drugs and malaria treatment-seeking behaviour among patients attending out-patient treatment at Mnazi mmoja dispensary. It was found that 15.3% of respondents admitted to having ever used malaria chemoprophylaxis while 8.0% reported to be current users of chemoprophylaxis. Among the current users of malaria chemoprophylaxis, some reported having used quinine and Fansidar. While 71.7% reported having treated themselves with home-kept antimalarial drugs for a suspected malaria fever, 14.7% consulted traditional healers. The data suggest the need for increasing public awareness on malaria and appropriate use of antimalarial drugs.Item Perception and utilisation of malaria prophylaxis among pregnant women in Dar es Salaam, Tanzania(East African medical journal, 1995) Kabalimu, Titus K.Knowledge, perception and utilisation of malaria prophylaxis were assessed among pregnant women attending antenatal care clinic in Dar es Salaam, Tanzania. Of the 301 women interviewed, 71.1% reported having used chloroquine prophylaxis while 28.9% did not. Women with high knowledge of malaria were more likely to use malaria prophylaxis than those with low knowledge. However, there was no significant association between knowledge of malaria and perceived effectiveness of the various methods of malaria control. Chloroquine side effects and perceived lack of protective effect against malaria were mentioned as causes of failure to use chloroquine prophylaxis. Fear of chloroquine-induced pruritus accounted for the largest proportion (49.4%) of women who reported having failed to use chloroquine prophylaxis. Occurrence of malaria episodes was reported to be similar among users and non-users of malaria prophylaxis probably due to inconsistent use of malaria prophylaxis and reduced chloroquine sensitivity of malaria parasites. It is suggested that, in addition to chemoprophylaxis, pregnant women should be encouraged to use bednets in combination with mosquito repellents throughout the course of pregnancy.Item A Profile of traditional healers in an area hard-hit by the AIDS Epidemic: Kagera region, Tanzania.(World Bank, 1995) Semali, Innocent A.Throughout Sub-Saharan Africa, traditional medical practitioners are often the most accessible source of medical care, particularly in rural areas where modern care is relatively scarce. …Item Chloroguanide metabolism in relation to the efficacy in malaria prophylaxis and the S‐mephenytoin oxidation in Tanzanians(Clinical Pharmacology & Therapeutics, 1996) Mutabingwa, Theonest K.S‐Mephenytoin and chloroguanide (proguanil) oxidation was studied in 216 Tanzanians. The mephenytoin S/R ratio in urine ranged from <0.1 to 1.16. The distribution was skewed to the right, without evidence of a bimodal distribution. Ten subjects (4.6%, 2.2% to 8.3%, 95% CI) with an S/R mephenytoin ratio >0.9, were arbitrarily defined as poor metabolizers of mephenytoin. The chloroguanide/cycloguanil ratio ranged from 0.82 to 249. There was a significant correlation between the mephenytoin S/R ratio and the chloroguanide/cycloguanil ratios (rs = 0.73; p < 0.00001). This indicates that cytochrome P4502C19 or CYP2C19 is a major enzyme that catalyzes the bioactivation of chloroguanide to cycloguanil. Chloroguanide is a pro‐drug, and hence a low CYP2C19 activity may lead to prophylactic failure caused by inadequate formation of cycloguanil. Fifty‐eight women who previously took either 200 mg chloroguanide daily (n = 26) or 200 mg chloroguanide daily plus 300 mg chloroquine weekly (n = 32) in a malaria chemoprophylaxis study showed that there was a significant correlation between the number of earlier breakthrough parasitemia episodes and the chloroguanide/cycloguanil ratio (rs = 0.30; p = 0.02). The breakthrough rate did not correlate with the S/R mephenytoin ratio. However, other factors, such as exposure to mosquitoes and sensitivity of the plasmodium to cycloguanil, are probably more important.Item Impact of a micronutrient dietary supplement on growth of school children in Tanzania(1998) Ndossi, Godwin D.There is increasing evidence that in deficient populations providing micronutrients may improve the growth of undernourished children. This has been shown with iron and zinc and may be due to the fact that this improves appetite and food intake. In Tanzania an investigation has been undertaken to evaluate the impact of a micronutrient dietary supplement on iron, vitamin A and iodine status of school age children. This was a randomized, double-blind, placebo-controlled trial. Reported here is an evaluation of the impact of this supplement on nutritional status using anthropometry. The subjects were 830 primary school children in Mpwapwa District. The supplement consists of 25 gm of a white powder in a sachet which is mixed with 200 ml. water to produce an orange-flavoured beverage. One serving provides 30 to 120% of RDA for 10 micronutrients including 3 minerals (iron, zinc, and iodine) and 7 vitamins (A, C, folate, niacin, thiamin, riboflavin and pyrodoxine). The children consumed one serving every school day attended over a period of 180 days. Children at the baseline found to have intestinal parasites received a dose of albendazole. As reported elsewhere, biochemical determinations showed that both iron and vitamin A status were poor in large numbers of children at the onset of the study. There was no significant difference in weight for age and height for age in the fortified and non-fortified group at the baseline. In multivariate analyses, treatment group was the strongest explanatory variable for incremental change in height and weight. The mean change in weight for the fortified group was 1.8 kg vs. 1.0 kg in the non-fortified group (p<.000). The mean change in height for the fortified group was 3.4 cm vs. 2.7 cm in the non-fortified group (p<.000). The supplement was very popular with children. School staff were pleased with the program. We conclude that this dietary supplement using physiological not medicinal doses of micronutrients can improve growth of schoolchildren and reduce malnutrition as well as improve iron and vitamin A status.Item Trial of a micronutrient dietary supplement to control vitamin A, iron and iodine deficiencies in Tanzania(Faseb Journal, 1998) Ndossi, Godwin D.The three main strategies used to control micronutrient deficiencies are food diversification, fortification, and consumption of medicinal supplements through the health care system. In Tanzania, a fourth strategy is currently being evaluated. A micronutrient fortified beverage supplement that provides nutrients in physiological doses, not megadoses, has been developed to control several deficiencies at the same time. The efficacy of the supplement was evaluated in a randomized, double-blind, placebo-controlled trial among 830 primary schoolchildren in Mpwapwa District, Dodoma Region. The supplement was packaged in individual serving sachets containing 25 gm net of a powder that when added to 200 ml of water produces a very palatable, orange-flavored drink. The serving provides between 30 and 120% of the RDA for vitamin A, iron, iodine, zinc, vitamin E, ascorbic acid, and several B vitamins. The children drank one serving every attended school day for a 6 month intervention period. At baseline, 44% of the children were anemic (Hb<12.0 g/dL) and 4 children with Bitot's spots were excluded from the study and treated. Participation in the study was excellent with a 91% retention rate. The mean incremental change in Hb, for those with an initial Hb <11.0g/dL, was 1.3g/dL and 0.14g/dL in the fortified and non-fortified group, respectively. At baseline, 21.4% of the fortified group and 20.6% of the non-fortified group had serum retinol levels <20 mg/dL. After 6 month intervention, serum retinol levels <20 mg/dL were nearly twice as prevalent in the non-fortified group as the fortified group (19.7% vs. 11.3%, respectively, p<.000). The supplement was highly acceptable and compliance was high. In this population where iron and vitamin A deficiency are prevalent, the beverage supplement was effective in improving nutritional status. Children who had lower hemoglobin and vitamin A status benefited more from the micronutrient fortified beverage.