Physiology

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Acute respiratory symptoms among sisal workers in Tanzania
(Occupational Medicine, 2007-02-22) Mashalla, Yohana J.
Background Few studies have focused on respiratory health effects among sisal workers. Aim To report on the prevalence of acute respiratory symptoms among sisal processors. Methods We interviewed 163 dust-exposed brushing and decortication workers and 31 low-exposed security workers from six sisal estates in Tanzania using a modified symptom score questionnaire to determine the prevalence of acute respiratory symptoms during work. Groups were compared using chi-square tests, Fisher's exact tests, t-tests and logistic regression, adjusting for confounding factors. Results After the first working day of the week, 73% of the brushing workers reported dry cough, 66% sneezing, 65% productive cough, 63% running nose and 34% stuffy nose. Brushing workers had a significantly higher prevalence of these symptoms than decortication workers. Brushing and decortication workers had significantly more dry cough and sneezing than the control group of security workers, when adjusting for age, smoking, past respiratory diseases and residence. Conclusion Processors of sisal fibre have a high prevalence of acute respiratory symptoms. More detailed studies on work and health in sisal estates are needed, including exposure studies.
The adequacy of antenatal care services among slum residents in Addis Ababa, Ethiopia
(BMC pregnancy and childbirth, 2016-06-15) Mashalla, Yohana J.
Background: There are recent efforts made to eliminate inequalities in the utilisation of basic health care services. More emphasis is given for improvement of health in developing countries including maternal and child health. However, disparities for the fast-growing population of urban poor are masked by the urban averages. The aim of this paper is to report on the findings of antenatal care adequacy among slum residents in Addis Ababa, Ethiopia. Methods: This was a quantitative and cross-sectional community based study design which employed a stratified two-stage cluster sampling technique to determine the sample. Data was collected using structured questionnaire administered to 870 women aged 15–49 years. Weighted ‘backward selection’logistic regression models were employed to identify predictors of adequacy of antenatal care. Results: Majority of slum residents did not have adequate antenatal care services with only 50.3, 20.2 and 11.0 % of the slum resident women initiated antenatal care early, received adequate antenatal care service contents and had overall adequate antenatal care services respectively. Educational status and place of ANC visits were important determinant factors for adequacy of ANC in the study area. Women with secondary and above educational status were 2.7 times more likely to receive overall adequate care compared to those with no formal education. Similarly, clients of private healthcare facilities were 2.2 times respectively more likely to receive overall adequate antenatal care compared to those clients of public healthcare facilities. Conclusion: In order to improve ANC adequacy in the study area, the policy-making, planning, and implementation processes should address the poor adequacy of ANC among the disadvantaged groups in particular and the slum residents in general.
Advanced human immunodeficiency virus disease in Botswana following antiretroviral therapy rollout: incidence successful of and temporal trends in cryptococcal meningitis
(Clinical infectious diseases, 2017-05-13) Mashalla, Yohana J.
Background. Botswana has a well-developed antiretroviral therapy (ART) program that serves as a regional model. With wide ART availability, the burden of advanced human immunodeficiency virus (HIV) and associated opportunistic infections would be expected to decline. We performed a nationwide surveillance study to determine the national incidence of cryptococcal meningitis (CM), and describe characteristics of cases during 2000–2014 and temporal trends at 2 national referral hospitals. Methods. Cerebrospinal fluid data from all 37 laboratories performing meningitis diagnostics in Botswana were collected from the period 2000–2014 to identify cases of CM. Basic demographic and laboratory data were recorded. Complete national data from 2013–2014 were used to calculate national incidence using UNAIDS population estimates. Temporal trends in cases were derived from national referral centers in the period 2004–2014. Results. A total of 5296 episodes of CM were observed in 4702 individuals; 60.6% were male, and median age was 36 years. Overall 2013–2014 incidence was 17.8 (95% confidence interval [CI], 16.6–19.2) cases per 100 000 person-years. In the HIV-infected population, incidence was 96.8 (95% CI, 90.0–104.0) cases per 100 000 person-years; male predominance was seen across CD4 strata. At national referral hospitals, cases decreased during 2007–2009 but stabilized during 2010–2014. Conclusions. Despite excellent ART coverage in Botswana, there is still a substantial burden of advanced HIV, with 2013–2014 incidence of CM comparable to pre-ART era rates in South Africa. Our findings suggest that a key population of individuals, often men, is developing advanced disease and associated opportunistic infections due to a failure to effectively engage in care, highlight-ing the need for differentiated care models.
AFYA BORA CONSORTIUM FELLOWSHIP: a journey of success in Global Health Leadership Training
(African Health Sciences, 2021-05) Mashalla, Yohana J.
The afya bora fellowship in global health leadership: dual mentorship to strengthen the next generation of African health leaders
(Annals of Global Health, 2015-02) Mashalla, Yohana J.
Program/Project Purpose Mentorship is critical to develop effective leaders. The Afya Bora Fellowship in Global Health Leadership program, a consortium of four African and four U.S. universities formed in 2008, has incorporated a robust dual mentorship component into its training of over 70 fellows. Each Fellow was assigned two mentors to guide professional growth over the fellowship period. Here, we evaluate 39 Fellows’ experiences with their mentors between 2012 and 2014, and identify how these relationships prepare Fellows to lead major health programs in Botswana, Kenya, Tanzania, and Uganda. Structure/Method/Design As part of their 12-month training, Afya Bora Fellows participate in two 4.5 month experiential learning attachments in the African countries. The attachments take place at pre-accredited “attachment sites”, which include governmental (Ministries of Health) and non-governmental organizations (NGOs). Fellows were assigned a Primary Mentor, who is an academic member of the Fellowship Working Group, and a Site Mentor, who is a senior supervisor at the Fellow's attachment site. Mentors assist in providing support to each Fellow to achieve Fellowship objectives and personal goals, and to gain insight into the realities of building a successful career. Evaluations from the Fellows on both mentors were collected once after the first attachment site rotation (January) and again after the second rotation (June). Outcomes & Evaluation Content analysis of Fellow interview and journal data showed Fellows were positively impacted by their relationships with mentors. Key domains of mentor influence included relationship attributes (“friendship and support”), scientific knowledge and skills (“teaching/guiding me on how to conduct official research”), provision of feedback (“he gives constructive feedback to my work every time we meet”), career or other guidance (“she advised me to apply for a job...luckily I was taken for that position”), and professionalism (“keeps his word and time despite busy schedule”). Fellows reported some differences between Site and Primary Mentors. Primary Mentors were better able to provide emotional support for professional issues (“discussed culture shock/adjustment”) and encouragement for Fellows to go outside their comfort zone (“urged me to work tall and take up distinctive tasks...without fear/hesitation”). Site Mentors were better able to serve as an advocate for attachment site assignments (“prepared the ground for orientation, information, and technical assistance from her and other staff”). Going Forward Dual mentorship can provide a rich range of complementary skills and expertise that is valuable to Fellows, including modeling professional behaviors and teaching specific skills. This aspect of the Afya Bora Fellowship is of great value to participants and will continue for future cohorts. Funding The President's Emergency Program for AIDS Relief, Office of AIDS Research, and US Health Resources and Services Administration
The Afya Bora Fellowship: an innovative program focused on creating an interprofessional network of leaders in Global Health.
(Journal of the Association of American Medical Colleges, 2017-09) Mashalla, Yohana J.
Problem: Most current health professions education programs are focused on the development of clinical skills. As a result, they may not address the complex and interconnected nature of global health. Trainees require relevant clinical, programmatic, and leadership skills to meet the challenges of practicing in an increasingly globalized environment. Approach: To develop health care leaders within sub-Saharan Africa, the Afya Bora Consortium developed a one-year fellowship for medical doctors and nurses. Fellows from nine institutions in the United States and sub-Saharan Africa participate in 12 learning modules focused on leadership development and program management. Classroom-based training is augmented with an experiential apprenticeship component. Outcomes: Since 2011, 100 fellows have graduated from the program. During their apprenticeships, fellows developed projects beneficial to their development and to host organizations. The program has developed fellows’ skills in leadership, lent expertise to local organizations, and built knowledge in local contexts. Most fellows have returned to their countries of origin, thus building local capacity. U.S.-based fellows examine global health challenges from regional perspectives and learn from sub-Saharan African experts and peers. Next Steps: The Consortium provides ongoing support to alumni through career development awards and alumni network engagement with current and past fellow cohorts. The Consortium expanded from its initial network of five countries to six and continues to seek opportunities for geographical and institutional expansion.
Airflow limitation among workers in a labour-intensive coal mine in Tanzania.
(International archives of occupational and environmental health, 2007-01-23) Mashalla, Yohana J.
Objectives To describe the relationship between cumulative respirable dust and quartz exposure and lung functioning among workers in a labour-intensive coal mine. Methods The study population comprised 299 men working at a coal mine in Tanzania. Lung function was assessed using a Vitalograph alpha III spirometer in accordance with American Thoracic Society recommendations. Multiple linear regression models were developed to study the relationship between forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC and the cumulative dust or quartz exposure while adjusting for age, height and ever smoking. To evaluate trends for dose response, cumulative exposure concentrations for respirable dust and quartz were ranked and categorized in quartiles and the highest decile, with the first quartile as the reference group. Logistic regression models were used to determine odds ratios for FEV1/FVC < 0.7 and FEV1% < 80 for categories of cumulative dust or quartz exposure. Results The prevalence of FEV1/FVC < 0.7 among the workers was 17.3%. Workers in the development team (20.5%) had the highest prevalence of FEV1% < 80%. The estimates of the effects of cumulative exposure on FEV1/FVC were –0.015% per mg years m–3 for respirable dust and –0.3% per mg years m–3 for respirable quartz. In logistic regression models, the odds ratios for airway limitation (FEV1/FVC < 0.7) for the workers in the highest decile of cumulative dust and quartz exposure versus the referents were 4.36 (95% confidence interval: 1.06, 17.96) and 3.49 (0.92, 13.21), respectively. The upper 10% of workers by cumulative dust and quartz exposure also had higher odds ratios for predicted FEV1% < 80% than the reference group odds ratio: 10.38 (1.38, 78.13) and 14.18 (1.72, 116.59), respectively. The results must be interpreted with caution due to a possible healthy worker effect and selection bias. Conclusion Exposure to respirable coal mine dust was associated with airway limitation as measured by FEV1/ FVC and predicted FEV1%.
Anaemia, renal dysfunction and in-hospital outcomes in patients with heart failure in Botswana
(South African Medical Journal, 2018-01-01) Mashalla, Yohana J.
Background. Anaemia and renal dysfunction are associated with an increased morbidity and mortality in heart failure (HF) patients. Objective. To estimate the frequency and impact of anaemia and renal dysfunction on in-hospital outcomes in patients with HF. Methods. A total of 193 consecutive patients with HF admitted to Princess Marina Hospital, Gaborone, Botswana, from February 2014 to February 2015, were studied. Anaemia was defined as haemoglobin <13 g/dL for men and <12 g/dL for women. Renal dysfunction was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, calculated by the simplified Modification of Diet in Renal Disease formula. The in-hospital outcomes included length of hospital stay and mortality. Results. The mean (standard deviation (SD)) age was 54.2 (17.1) years and 53.9% of the patients were men. The overall median eGFR was 75.9 mL/min/1.73 m2 and renal dysfunction was detected in 60 (31.1%) patients. Renal dysfunction was associated with hypertension (p=0.01), diabetes mellitus (p=0.01) and a lower haemoglobin level (p=0.008). The mean (SD) haemoglobin was 12.0 (3.0) g/dL and 54.9% of the patients were anaemic. Microcytic, normocytic and macrocytic anaemia were found in 32.1%, 57.5% and 10.4% of patients, respectively. The mean (SD) haemoglobin level for males was significantly higher than for females (12.4 (3.3) g/dL v. 11.5 (2.5) g/dL; p=0.038). Anaemia was more common in patients with diabetes (p=0.028) and in those with increased left ventricular ejection fraction (p=0.005). Neither renal dysfunction nor anaemia was significantly associated with the length of hospital stay or in-hospital mortality. Conclusion. Anaemia and renal dysfunction are prevalent in HF patients, but neither was an independent predictor of length of stay or in-hospital mortality in this population. These findings indicate that HF data in developed countries may not apply to countries in sub- Saharan Africa, and call for more studies to be done in this region.
Antimicrobial utilization research and activities in Botswana, the past, present and the future
(Expert review of anti-infective therapy, 2019-09-23) Mashalla, Yohana J.
A number of activities are ongoing to reduce AMR in Botswana by improving antimicrobial utilization across all sectors. However, there is a need to share experiences. With the objective of sharing these, the second one day symposium was held in the University of Botswana in October 2018 involving both private and public hospitals. In Lenmed Bokamoso hospital, ESKAPE organisms were associated with 50- 90% of clinical infections; however, there was no correlation between healthcare associated infections (HAIs) and admission swab positivity with ESKAPE or ESBL isolates. Hang times, the time between a prescription and IV administration, were also discussed. At Nyangabwe Hospital, the prevalence of HAIs was 13.54%, 48.9% were laboratory confirmed of which 8.5% were blood stream infections (BSIs). The prevalence of different bacteria causing neonatal BSIs was also investigated. At Princess Marina Hospital, positive cultures were seen in 22.4% of blood cultures with contaminants comprising the majority. Several activities are ongoing in Botswana across sectors as a result of the findings and will be periodically reported to further improve antibiotic utilization
Assessment of prescribing practices at the primary healthcare facilities in Botswana with an emphasis on antibiotics: Findings and implications
(International journal of clinical practice, 2017-11-27) Mashalla, Yohana J.; ; Massele, Amos Y.
Background and Aims Inappropriate drug prescribing has increased especially in developing countries where systems for monitoring medicine use are not well developed. This increases the rate of antimicrobial resistance. The study aim was to assess the prescribing patterns among urban primary health facilities in Botswana to provide future guidance including developing future quality indicators. Methods Retrospective data from patients’ records between January and December 2013 in 19 clinics were collected in a cross-sectional study. The WHO/International Network for Rational Use of Drugs indicators were used to assess prescribing patterns in the study clinics. Results Average number of drugs per prescription was 2.8; 78.6% of the prescribed antibiotics were by International Non-proprietary Name and 96.1% complied with the Botswana Essential Drugs List. Overall rate of antibiotic prescribing was high (42.7%) with 14.7%, 5.9% and 1.3% of prescriptions having two, three and four antibiotics, respectively. Systemic antibiotics (JO1C) accounted for 45.4% of prescribed antibiotics of which amoxicillin accounted for 28.4% and metronidazole 14.4% of all antibiotic prescriptions. There was low use of co-amoxiclav (0.3% of all antibiotic prescriptions). Third generation cephalosporins and macrolides accounted for 9.8% and 6.2% of antibiotic prescriptions respectively, with no prescribing of fluoroquinolones. The majority of indications (87%) for antibiotic prescriptions were according to ICD classification. Conclusions While most indications for antibiotic prescriptions were based on signs and symptoms according to ICD, antibiotic prescribing rates were high with some conditions not requiring antibiotics because they are viral infections. There is a need to further improve prescribing practices through induction and training of in-service prescribers. An effective management tool for monitoring antibiotic prescribing practices at Primary Health Care facilities should be designed and implemented, including developing robust quality indicators.
Asthma prevalence, knowledge, and perceptions among secondary school pupils in rural and urban coastal districts in Tanzania.
(BMC public health, 2014-04-23) Mashalla, Yohana J.
Background: Asthma is a common chronic disease of childhood that is associated with significant morbidity and mortality. We aimed to estimate the prevalence of asthma among secondary school pupils in urban and rural areas of coast districts of Tanzania. The study also aimed to describe pupils’perception towards asthma, and to assess their knowledge on symptoms, triggers, and treatment of asthma. Methods: A total of 610 pupils from Ilala district and 619 pupils from Bagamoyo district formed the urban and rural groups, respectively. Using a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, a history of “diagnosed”asthma or the presence of a wheeze in the previous 12 months was obtained from all the studied pupils, along with documentation of their perceptions regarding asthma. Pupils without asthma or wheeze in the prior 12 months were subsequently selected and underwent a free running exercise testing. A ≥20% decrease in the post-exercise Peak Expiratory Flow Rate (PEFR) values was the criterion for diagnosing exercise-induced asthma. Results: The mean age of participants was 16.8 (±1.8) years. The prevalence of wheeze in the past 12 months was 12.1% in Bagamoyo district and 23.1% in Ilala district (p < 0.001). Self-reported asthma was found in 17.6% and 6.4% of pupils in Ilala and Bagamoyo districts, respectively (p < 0.001). The prevalence of exercise-induced asthma was 2.4% in Bagamoyo, and 26.3% in Ilala (P < 0.002). In both districts, most information on asthma came from parents, and there was variation in symptoms and triggers of asthma reported by the pupils. Non-asthmatic pupils feared sleeping, playing, and eating with their asthmatic peers. Conclusion: The prevalence rates of self-reported asthma, wheezing in the past 12 months, and exercise-induced asthma were significantly higher among urban than rural pupils. Although bronchial asthma is a common disease, pupils’perceptions about asthma were associated with fear of contact with their asthmatic peers in both rural and urban schools.
Availability of guidelines and policy documents for enhancing performance of practitioners at the Primary Health Care (PHC) facilities in Gaborone, Tlokweng and Mogoditshane, Republic of Botswana.
(Journal of Public Health and Epidemiology, 2016-05-13) Mashalla, Yohana J.
This study aimed to determine the profile and availability of policies and guidelines as reference documents at Primary Health Care (PHC) facilities in Gaborone and its surrounding in Botswana using the World Health Organisation/Drug Action programme (WHO/DAP) Questionnaire. The Questionnaire is a standard recommended by WHO and therefore was not piloted. All 20 PHC facilities were included in the study, however, data from 18 clinics was collected and analysed. The Matron from each PHC facility was asked to name and produce as evidence, guidelines and policy documents available as reference in his/her PHC facility. Data was entered in an Excel spread sheet and percentages, averages and frequencies were used to describe the profile and availability of the documents at each facility. Fifty two different documents were available at the facilities, 50% of them were on treatment and management of diseases. The remaining 50% were distributed between general information/policy, Ante-Natal Clinic, obstetrics and gynaecological care, and family planning. Except for guidelines for treating sexually transmitted diseases (86%), availability of the other guidelines and policy documents was low (56%) or less. Policy and guideline reference information for disease immunisation and prevention were available at 4 and 13% PHC, respectively. This low availability of such important instruments may be compromising patient care in the studied PHC facilities and should be addressed. While the Ministry of Health has produced many policy documents and guidelines as reference documents for PHC providers, none of the clinics had all the documents, raising questions on what is available at the facilities as reference and guide in the prescription practices. It is recommended that ministries of health and PHC workers should ensure that necessary reference documents are available at the facilities and staff should be trained and retrained on the use of such documents.
Beneficial Effects of Omega-3 Polyunsaturated Fatty Acids in Gestational Diabetes: Consequences in Macrosomia and Adulthood Obesity.
(Journal of diabetes research, 2015-04-16) Mashalla, Yohana J.
Omega-3 polyunsaturated fatty acids (PUFAs) are increasingly being used to prevent cardiovascular diseases, including diabetes and obesity. In this paper, we report data on the observed effects of omega-3 PUFA on major metabolic disorders and immune system disruption during gestational diabetes and their consequences on macrosomia.While controversies still exist about omega 3 PUFA effects on antioxidant status regarding the level of omega-3PUFA in diet supplementation, their lipid-lowering effects are unanimously recognized by researchers. Animal studies have shown that omega-3 PUFA contributes to the maintenance of the immune defense system by promoting the differentiation of T helper (Th) cell to a Th2 phenotype in diabetic pregnancy and by shifting the Th1/Th2 ratio from a deleterious pro inflammatory Th1 phenotype to a protective anti-inflammatory Th2 phenotype in macrosomia and in adulthood obesity that results from macrosomia at birth. Based on the available evidence, international nutritionalandfoodagenciesrecommendadministrationofomega-3PUFAastriglyceride-loweringagents,for the preventionof cardiovascular disease risk and during human pregnancy and lactation.Furthermore,studies targeting humans are still required to explore application of the fatty acids as supplement in the management of gestational diabetes and inflammatory and immune diseases.
Cardiovascular risk factors in Tanzania: A revisit.
(Acta tropica, 2001-03-09) Mashalla, Yohana J.
In this assessment of cardiovascular risk factors, we examined the prevalence of selected risk factors according to the World Health Organisation (WHO) CARDIAC Study protocol and compared them with a similar study conducted more than a decade ago. The survey was carried out in Dar es Salaam (D, urban), Handeni (H, rural) and Monduli (Mo, semi-nomadic area). Subjects aged 47–57 were recruited randomly for blood pressure and anthropometrical measurements, 24 h urine collection and blood sampling. A structured questionnaire was used to obtain dietary information. The 1998 survey studied 446 subjects, while the 1987 survey included 496 men and women. The measured weight, body mass index (BMI) and prevalence of obesity (BMI≥30 kg/m2) increased significantly among women in the 1998 survey in rural Handeni and urban Dar. The overall prevalence of obesity was higher for women in the most recent survey (22.8%, P<0.0001). Diastolic blood pressure (DBP) was higher in the most recent survey for women in Handeni. The overall prevalence of hypertension (blood pressure>160/95 mmHg, or antihypertensive drug use), rose to 41.1% in 1998, (P<0.001) for men and to 38.7% (P<0.05) for women. The mean total serum cholesterol and prevalence of hypercholesterolaemia increased significantly in the most recent survey in the three studied areas. The overall prevalence of hypercholestrolaemia (serum cholesterol>5.2 mmol/l) was higher in the 1998 survey for both men (21.8%, P<0.0001) and women (54.0%, P<0.0001). The mean HDL cholesterol increased significantly in the most recent survey, with a significant reduction in the mean atherogenic index, though these were still at higher levels (men 5.8, P<0.0001; women 5.1, P<0.0001 vs. 1987). A strong positive correlation was observed between blood pressure (SBP and DBP) and body mass index, total serum cholesterol and sodium to potassium ratio. These data suggest that for the past decade there has been an increase in the mean levels and prevalence of selected cardiovascular risk factors in Tanzania.
Cement Dust Exposure and Ventilatory Function Impairment: An Exposure– Response Study.
(Journal of occupational and environmental medicine, 2004-07) Mashalla, Yohana J.
We investigated cumulative total cement dust exposure and ventilatory function impairment at a Portland cement factory in Tanzania. All 126 production workers were exposed. The control group comprised all 88 maintenance workers and 32 randomly chosen office workers. Exposed workers had significantly lower forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow rate (PEF), FEV1/FVC, FVC%, FEV1% and PEF%, than controls adjusted for age, duration of employment, height, and pack-years. Cumulative total dust exposure was significantly associated with reduced FVC, forced expiratory volume in 1 second, and peak expiratory flow rate adjusted for age, height and pack-years. Cumulative total dust exposure more than 300 mg/m3 year versus lower than 100 mg/m3 years was significantly associated with increased risk of developing airflow limitation (odds ratio = 9.9). The current occupational exposure limit for total cement dust (10 mg/m3) appears to be too high to prevent respiratory health effects among cement workers.
Changing relationship between FEV1 and height during adolescence.
(East African medical journal, 1992-05-01) Mashalla, Yohana J.
Forced expired volume in one second (FEV1), body weight, standing and sitting height, and chest dimensions were measured in 962 male and 674 female subjects aged between 9 and 20 years. Standing height and body weight correlated best with ventilatory indices in boys. In girls, standing height, body weight and chest circumference correlated more or less equally with ventilatory indices. Regression analysis of logarithmically transformed FEV1 on standing height were done. In the boys, the correlation coefficient between In FEV1 and in height increased from 0.34 at 9 years to 0.77 at 13 years of age, while girls appear to have reached a peak by 12 years of age. The mean allometric constant was 3.109 and 3.032 for male and female subjects respectively. However, age-specific allometric constants increased in the boys from 2.846 to a peak value of 4.045 at 16 years of age. In the girls, the constant increased to a peak value of 4.5 a year earlier than in boys. The log-log plot of FEV1 against standing height was nonlinear, becoming more curvilinear with increasing height. These findings reflect changes in body proportions and shape during adolescence with lung growth lagging behind growth in standing height.
Changing the debate about health research for development.International health research awards recipients
(Journal of public health policy, 2004-12-10) Mashalla, Yohana J.
We represent ten groups of citizens and researchers from low- and middle-income countries who were recipients of International Health Research Awards (IHRA) presented at the Bangkok Conference on International Health Research for Development, 2000. The IHRA, funded by the Rockefeller Foundation and administered by the World Health Organization, recognized the need for us to find effective ways of solving our countries' health problems and acknowledged the special environmental constraints we face in conducting research and exploiting the results. We used this funding to explore alternative ways for harnessing largely untapped resources in our countries to generate and apply knowledge to improve people's health and address inequalities. In the Bangkok Declaration, we joined many others to express our commitment to research as a vital force for health of all of our people. Six of our ten projects explored, for particular themes or health topics, ways of extending the benefits of research to special groups or populations. Four more proposed specific approaches to consolidate national research policy and systems for allocating public research funds and managing research. From our collective reflection about what we have learned, we note ways in which our experiences represent change, particularly expansion of the traditional boundaries of research: –broadening the research agenda by adding new topics, more voices and more perspectives than has been the norm in our settings –expanding capacity to design and conduct research by preparing new groups of researchers to pose questions, design and carry out studies, and by engaging more partners and disciplines in addressing national priorities –extending dissemination of research results, especially by using websites and mass media to reach decision makers and broader segments of the public –encouraging uptake of research for policy and practice. We want research to improve the health of our societies' most disadvantaged groups and to engage them in the process. Our work benefited immeasurably from networks and other forms of collaboration that our grants helped to support—and supported to an extent that was unusual compared to other forms of research funding. We linked our national and regional collaborations to global efforts, but endeavored to do so without being driven or preempted by the latter. We are optimistic about the value of our experiences, but remain acutely aware of the unfinished agenda—an agenda that we incorporate into A CHALLENGE and A CALL for future action. We challenge ourselves, and others, to evaluate the effectiveness of our approaches to research for improving health systems and population health. We call on policy makers to adopt an evidence-based approach and to ensure that health systems are equipped to use rigorous research methods to embrace and analyze information from all participants. We close by asking donors and other international agencies for more flexible support so that we can benefit from global collaboration while maintaining our own priorities and building national and regional infrastructures to implement and evaluate new ways of doing research.
Comparison on treatment outcomes of patients enrolled on anti-retroviral therapy at different levels of the health-care system in a high HIV/AIDS setting.
(Europe PMC, 2023-01-01) Mashalla, Yohana J.
HIV/AIDS prevalence in Botswana is amongst the highest in the world and remains a significant public health problem. however, the introduction of anti-retroviral therapy (ART) lead to a significant reduction in morbidity and mortality. Decentralization of anti-retroviral therapy has improved access to treatment for people living with HIV. Treatment outcomes for patient initiated on treatment at different levels of care is unknown and this study seeks to compare treatment outcomes of patients enrolled on ART at different levels of the health care. This is a retrospective cross-sectional study that included review of data from January 2017 to December 2018. The study was conducted in 2 health districts in the country. Nine hundred and sixty (960) patient's record were included in analysis. More than half (63%) of patients were enrolled at primary care level while 37% were at tertiary level. Sixty one percent (n = 587) were female while 39% (n = 373) were males. There were no statistically significant differences in viral load suppression after 12 months of treatment between patients enrolled at tertiary level and primary care level, x2 = 0.75, p value = 0.56. Time to initiation was longer at tertiary (median = 126) compared to primary are level (median = 18), p < 0.001. We reccommend further decentralization of ART services to lower levels of the health care system to initiate PLWHIV early on treatment and improve their health outcomes and reduce transmission through treatment by prevention.
Coordinating health research to promote action: the Tanzanian experience.
(BMJ, 2000-09-30) Mashalla, Yohana J.
Developing countries carry 90% of the global burden of disease. Infections such as malaria and HIV are debilitating their economies by killing the young and economically productive workforce. Research is essential for health development, yet less than 10% of the annual global expenditure on health research is allocated to addressing developing countries' problems.1 Poor countries must face this challenge seriously. It is essential that they create strong national research infrastructures so that they can define priorities for health research priorities; influence national, regional, and global health agendas; and lobby for a more equitable allocation of resources. This paper discusses some of the barriers to establishing coordinated health research programmes in developing countries and describes how Tanzania has developed a new research model to try and overcome these.
Cutaneous leishmaniasis a neglected tropical disease: community knowledge, attitude and practices in an endemic area, Northwest Ethiopia
(BMC infectious diseases, 2019-10-16) Mashalla, Yohana J.
Background: Cutaneous leishmaniasis is one of the neglected tropical diseases in the Ethiopian highlands and studies on assessment of knowledge, attitude and practice of the community in endemic areas are scanty. The study aimed to assess the knowledge, attitude towards cutaneous leishmaniasis and treatment seeking practices in people living in the endemic highlands areas in the Northwest, Ethiopia and to provide evidence-based information to guide development of appropriate interventions to reduce the impact of cutaneous leishmaniasis on communities. Methods: Quantitative cross-sectional study was conducted in cutaneous leishmaniasis endemic districts (woredas) using a semi structured questionnaire. Households were randomly selected according to probability proportional to size of households in each enumeration area. Systematic random sampling of eligible households was based on the number of households recorded during listing of households. Descriptive statistics was used to describe numerical data, organise and summarise the data in a manner that gave meaning to the numerical form. Frequency tables were used to show descriptive analysis and regression analysis was used to determine correlation between variables. Results: Majority of respondents 321(78.7%) lived in rural areas, age ranged between 18 and 85 years and most were farmers. Illiteracy was high (47.6%) among respondents and majority 358(87.8%) had seen patients with CL. Less than quarter (21.6%) had heard about sand flies and knowledge on the peak transmission period was low (46.3%). About 192 (47.1%) of the respondents indicated disfiguring lesions were the major clinical presentations, less than half 55(27.5%) of urban residents believed CL was treatable compared to 145(72.5%) of rural residents (P < 0.001). Traditional medicines were indicated as best treatment option by 209(51.2%) compared to 114(27.9%) for modern treatment. Major factors influencing treatment options included accessibility to treatment facilities, distance and short duration of treatment. Participants expressed negative experiential attitude and perceived control towards modern treatment because of inaccessibility and distance from where modern treatment is provided. Conclusion: Priority should be given to primary prevention and appropriate awareness campaigns on lesion recognition. Information on modern treatment should be intensified.

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