Browsing by Author "Mtema, Z."

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Mobile phones as surveillance tools: Implementing and evaluating a large-scale intersectoral surveillance system for rabies in Tanzania
(PLOS Medicine, 2016-04-12) Mtema, Z.; Changalucha, J.; Cleaveland, S.; Elias, M.; Ferguson, M. H.; Halliday, J. E. B.; Haydon, D.T.; Jaswant, G.; Kazwala, R. R.; Killeen, G. F.; Lembo, T; Lushasi, K.; Malishee, A. D.; Mancy, R.; Maziku, M.; Mbunda, E. M.; Mchau, G. J. M.; Murray-Smith, R.; Rysava, K.; Said, K.; Sambo, M.; Shayo, E.; Sikana, L.; Townsend, S. E.; Urassa, H.; Hampson, K.
Surveillance is critical to manage preventative health services and control infectious diseases. Integrated surveillance involving public health, veterinary, and environmental sectors is urgently needed to effectively manage zoonoses and vector-borne diseases. However, most surveillance in low-income countries is paper-based, provides negligible timely feedback, is poorly incentivised, and results in delays, limited reporting, inaccurate data, and costly processing. • The potential of mobile technologies for improving health system surveillance has been demonstrated through small-scale pilots, but large-scale evaluations under programmatic implementation remain rare. • An intersectoral mobile-phone–based system was developed and implemented for rabies surveillance across southern Tanzania. Since 2011, the system has facilitated near realtime reporting of animal bites and human and animal vaccine use (almost 30,000 reports) by over 300 frontline health and veterinary workers across a catchment area of 150,000 km2 with >10 million inhabitants, improving data quality, timeliness, and completeness while reducing costs. • The surveillance system infrastructure is a platform that can be further developed to improve services and deliver health interventions; for example, generating automated personalized text messages (SMS) to alert patients to their vaccination schedules improved their compliance with regimens. Other interventions targeting patients and health workers can now be implemented easily. • The system has become an integrated, popular, and valuable tool across sectors, used routinely throughout southern Tanzania to evaluate the impacts of rabies control and prevention activities and to improve their management, directly informed by the experiences of frontline users. • We discuss challenges encountered during development and deployment, how we overcame these, and our recommendations for scaling up mobile-phone–based health (mHealth) interventions in low-income countries.
Progress towards rabies elimination from Pemba Island, Southern Tanzania.
(Online Journal of Public Health Informatics ., 2017) Lushasi, K. S.; Cleaveland, S.; Changalucha, J. J.; Haydon, D.; Kazwala, R.; Lembo, T.; Masoud, M.; Maziku, M.; Mchau, G.; Mtema, Z.; Omar, K.; Maganga, S.; Rysava, K.; Hampson, K.
Using active surveillance approaches to investigate the transmission dynamics of rabies on Pemba Island and across Southern Tanzania, whilst a large-scale dog vaccination program was underway1 , to gain a greater understanding of the dynamics of infection as the disease is driven towards elimination
Toward Elimination of Dog-Mediated Human Rabies: Experiences from Implementing a Large-scale Demonstration Project in Southern Tanzania
(Original research article., 2017) Mpolya, E. A; Lembo, T.; Lushasi, K.; Mancy, R.; Mbunda, E. M.; Makungu, S.; Maziku, M.; Sikana, L.; Jaswant, G.; Townsend, S.; Meslin, F. X.; Abela, B.; Ngeleja, C.; Changalucha, J.; Mtema, Z.; Sambo, M.; Mchau, G.; Rysava, K.; Nanai, A.; Kazwala, R.; Cleaveland, S.; Hampson, K.
A Rabies Elimination Demonstration Project was implemented in Tanzania from 2010 through to 2015, bringing together government ministries from the health and veterinary sectors, the World Health Organization, and national and international research institutions. Detailed data on mass dog vaccination campaigns, bite exposures, use of post-exposure prophylaxis (PEP), and human rabies deaths were collected throughout the project duration and project areas. Despite no previous experience in dog vaccination within the project areas, district veterinary officers were able to implement district-wide vaccination campaigns that, for most part, progressively increased the numbers of dogs vaccinated with each phase of the project. Bite exposures declined, particularly in the southernmost districts with the smallest dog populations, and health workers successfully transitioned from primarily intramuscular administration of PEP to intradermal administration, resulting in major cost savings. However, even with improved PEP provision, vaccine shortages still occurred in some districts. In laboratory diagnosis, there were several logistical challenges in sample handling and submission but compared to the situation before the project started, there was a moderate increase in the number of laboratory samples submitted and tested for rabies in the project areas with a decrease in the proportion of rabies-positive samples over time. The project had a major impact on public health policy and practice with the formation of a One Health Coordination Unit at the Prime Minister’s Office and development of the Tanzania National Rabies Control Strategy, which lays a roadmap for elimination of rabies in Tanzania by 2030 by following the Stepwise Approach towards Rabies Elimination (SARE). Overall, the project generated many important lessons relevant to rabies prevention and control in particular and disease surveillance in general. Lessons include the need for (1) a specific unit in the government for managing disease surveillance; (2) application of innovative data collection and management approaches such as the use of mobile phones; (3) close cooperation and effective communication among all key sectors and stakeholders; and (4) flexible and adaptive programs that can incorporate new information to improve their delivery, and overcome challenges of logistics and procurement.