National Institute for Medical Research

Bacterial wound infections contribute significantly to global mortality, with nearly half of contaminated wounds progressing to chronic states, which can result in amputations. In Tanzania, the situation is worsened by the misuse of antibiotics and the rise of drug-resistant bacteria, alongside patients' varied understanding of wound care management. This qualitative study explores patient knowledge, attitudes, and practices (KAP) regarding chronic wound infections in Tanzania. A sample of 15 patients was selected from both genders, representing a wide range of ages and wound severities. Semi-structured interviews were conducted in Swahili at the Tanga Regional Referral Hospital (TRRH) from October 2023 to April 2024. Interviews used open-ended questions on dietary habits, traditional medicine, medication adherence, and wound care practices. Social demographic data were collected to contextualize patient experiences. Interviews were audio-recorded, transcribed verbatim, and analyzed via Nvivo. Thematic analysis of the interviews identified six major themes: delays in treatment-seeking, inadequate wound management, reliance on ritual practices, poor eating behaviors, challenges in coping with chronic wounds, and inadequate healthcare services. Delays stemmed from misjudging wound severity and reliance on traditional healers. Financial constraints contributed to inadequate wound management, with many patients turning to traditional remedies. Nutritious food access was limited, primarily due to financial and availability constraints. Patients faced substantial physical, emotional, and financial burdens. Long wait times and inconsistent care were also major barriers to effective wound management. Chronic wound infections are exacerbated by systemic healthcare shortcomings and limited patient education. Insights from patient perspectives emphasizes the need for proper wound management, understanding of antimicrobial resistance (AMR), and addressing cultural beliefs and resource constraints. Patient-centered models can foster more effective and sustainable models of wound care in the community setting.

High blood pressure (BP) among adolescents is a growing public health problem known to persist into adulthood. However, there is a scarcity of longitudinal BP data in Sub‐Saharan Africa (SSA). We aimed to describe sex differences in BP trajectories and determine the incidence of high BP among 500 secondary school−attending adolescents enrolled in a 2‐year closed cohort study in urban Tanzania. We collected data across three time points, spaced at 12‐month intervals. Participants were defined as having high BP if they had elevated BP or hypertension as per the standard guideline. Overall, there was a significant decline in BP from enrollment to Year 1, possibly attributable to the white coat effect. Between Year 1 and Year 2, we found a steeper longitudinal BP increase, particularly in males. The incidence of high BP was 5.5 cases per 100 person‐years and was significantly higher in males and among underweight participants. We recommend integrating routine BP measurement in the existing adolescent health programs and tailoring cardiovascular preventive messages to address gender‐specific risk factors.

As the field of cultural evolution marks its fiftieth anniversary, it has an opportunity not only to evolve in theory and scope, but also in ethics of practice. This theme issue contributes to that shift by showcasing projects supported by the Cultural Evolution Society's Transformation Fund (CES-TF), which centred equity, diversity and inclusion (EDI). This opinion piece draws on our CES-TF projects, conducted across diverse cultural and geographical settings, to reflect on the challenges and possibilities of making cultural evolution-and human research more broadly-more just. We focus on three relational dimensions in which cultural evolution research can become more inclusive and equitable: fostering equitable cross-cultural research collaborations; building mutually beneficial researcher community collaborations; and cultivating supportive funding and institutional relationships. Our collective reflections, written by grant recipients and the CES-TF lead, emphasize that, while there is no universal model for ethical research, attending to positionality, power dynamics and diverse knowledge systems can foster responsible and impactful research. Striving to make the field more globally representative will enhance our capacity to critically reflect and improve, but real progress requires time, resources and structural reform, supported by institutions, funders and journals committed to embedding EDI at the core of research. This article is part of the theme issue 'Transforming cultural evolution research and its application to global futures'.

Abstract Purpose: Over 85% of the 400,000 new pediatric cancer diagnoses annually occur in low- and middle- income countries (LMICs), where limited awareness and inadequate health system capacity contribute to poor outcomes. Retinoblastoma (RB), the most common pediatric eye cancer, is curable if diagnosed early. However, in Tanzania, 70% of RB patients present with vision loss, and survival rates are <30%. This study aimed to pilot a multi-component education intervention to improve community awareness of RB. Methods: Culturally adapted media (posters, retinoblastoma education song, and in person community based education and screening event) were developed to address community knowledge gaps and retinoblastoma misconceptions. Messaging was iteratively refined using a learner verification process with input from a community advisory board. A pre-post study design surveyed 200 participants (50 case and 50 control before and after intervention) to assess community knowledge, attitudes, and screening uptake. Impact of media exposure was correlated with intervention outcomes. Results: The intervention group demonstrated a significant 60% increase (p<0.001) in knowledge scores after the intervention, while no change was observed in the control group. Favorable attitudes toward RB screening increased significantly from 32% to 100% (p<0.001) in the intervention group but remained unchanged in the control group. Screening uptake improved from 0% to 22% among participants in the intervention group, whereas no participants in the control group brought their children for screening. Among media formats, the radio program was the most impactful, with 76% of participants exposed, followed by 64% attending awareness events and 8% viewing community posters. Conclusion: A multi-component intervention combining radio-based education, community events, and provider training significantly improved RB awareness, attitudes, and early screening uptake in an LMIC setting. These findings underscore the importance of tailored educational strategies and healthcare capacity building in reducing childhood cancer disparities in resource-limited settings. Citation Format: Richard Mhone, Mastidia Maximillian, Erica Sanga, Ashish Khanchandani, Perpetua Hhary, Heronima Joas, Kristin Schroeder. Impact of Community Education Program for Retinoblastoma in Tanzania [abstract]. In: Proceedings of the 13th Annual Symposium on Global Cancer Research; 2025 Sep 16. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(12_Suppl):Abstract nr 5.

We previously described an increased incidence of HIV among individuals infected with Wuchereria bancrofti (WB). However, no host, parasite, or viral factors were reported as directly associated with the increase in HIV incidence in this group. To investigate this, we compared T cell phenotypes between WB+ and WB− women. Flow cytometry analysis of activation and differentiation markers on CD4 T cells, as well as HIV entry receptor CCR5 was performed on cervical and peripheral blood samples from 54 women living without HIV (WLWoH). Additionally, HPV testing was performed on their specimens and for 13 WLWH. WB infection was associated with a significantly increased frequency of CD3+γδ2+ T cells in the cervical mucosa (median 4.0% vs. 1.4%, p = 0.012). Contrary to our expectations, we found lower frequencies of CCR5 on total, memory and activated memory CD4 T cells in the WB+ group. However, differences diminished after accounting for age and site of recruitment. WB and HIV infections were associated with an increased likelihood of high-risk human papillomavirus (HR HPV) positivity. (WB status: odds ratio (OR) 4.1, p = 0.066; HIV status: OR 5.5, p = 0.068). Our findings suggest immunological mechanisms by which WB increases the risk for other infections, e.g., HIV and HR HPV, albeit independent of the CCR5 receptor.

BackgroundMalaria remains a significant public health challenge in sub-Saharan Africa (SSA), where vector control strategies, particularly insecticide-treated nets (ITNs) and indoor residual spraying (IRS), have played a critical role in reducing transmission. However, the emergence and spread of insecticide resistance among malaria vectors threatens to undermine these gains. In response, many countries in the region have developed national insecticide resistance management (IRM) plans. This study evaluates the adequacy and implementation of these plans in Cameroon, Côte d’Ivoire, and mainland Tanzania, aiming to identify key challenges and best practices, and to develop actionable recommendations applicable to these and other countries with similar contexts.MethodsA mixed-methods approach was employed, incorporating document reviews, epidemiological and entomological data analysis, and discussions with stakeholders and experts in 2023. The evaluation focused on the alignment of national IRM plans with national malaria control strategies, their operational effectiveness, and the ability to guide effective monitoring and management of insecticide resistance. The assessment was conducted before changes in the global aid funding landscape.ResultsEach country has developed a 5-year IRM plan; however, the plans for Côte d’Ivoire and mainland Tanzania were found to be outdated. While the plans align well with national malaria strategies and international guidelines, implementation has been hindered by inadequate domestic funding and heavy reliance on external donors. Sentinel site coverage for resistance monitoring remains limited, though ITN campaigns have increasingly adopted targeted approaches using varied net types based on local data. IRS is sparsely deployed, but where it is used, rotation of insecticides with differing modes of action is practiced. Despite existing strengths, such as subnational tailoring of interventions, major challenges persist, including inactive monitoring sites and limited data availability due to financial and logistical constraints. The assessment identified important recommended actions, including increased mobilization of domestic financing of resistance monitoring and management to offset shortfalls in external funding, updating of national IRM plans regularly by realistically aligning with available resources, and improved tailoring of effective vector control through high-quality and localized resistance and malaria risk data.ConclusionInsecticide resistance remains a significant threat to malaria control efforts across sub-Saharan Africa. Robust, adaptable IRM plans are essential to address this challenge. Case studies from Cameroon, Côte d’Ivoire, and mainland Tanzania reveal that such policy plans exist but implementation gaps, largely driven by funding shortages (a challenge that has increased since the study was completed), undermine the effectiveness of existing strategies. Strengthening domestic resource mobilization, enhancing multisectoral coordination, and investing in systematic entomological surveillance are critical to ensure evidence-based, sustainable vector control programmes.

Program adaptations or modifications are often necessary to suit local contexts, populations, and resources available. Despite the frequency with which program modifications are made in practice, they are rarely systematically recorded and reported comprehensively, particularly in the context of scale-up delivery led by implementers and in low- and middle-income countries. We use the FRAME framework to document the modifications of a parenting program called Parenting for Lifelong Health for Parents and Adolescents, locally known as Furaha Teens, which was delivered to over 30,000 families in Tanzania in 2020-2021. We draw on thematic analysis of 12 focus groups and 67 semi-structured interviews with program facilitators, coaches, coordinators, and managers (164 participants). Both proactive and reactive modifications were made to the program context and content. Proactive modifications included delivering the program as part of a wider package of services for families with adolescent girls, focused on HIV prevention, and adding HIV-related content. Both proactive and reactive modifications were made to make the material more acceptable to participants, such as by translating into local languages. Modifications to condense the number and frequency of sessions were reactively made by implementers to meet delivery timelines, particularly due to COVID-related closures. Study findings suggest that a range of program modifications may be required to scale programs to large cohorts as well as new contexts. To ensure successful delivery at scale, funders can support implementers in learning from the modifications and encouraging reflection on whether and how modifications affect program fidelity.

BackgroundDespite Antiretroviral Therapy (ART) progress, Human Immunodeficiency Virus (HIV) remains a major issue in Tanzania (4.65% prevalence). World Health Organization (WHO) introduced Enhanced Adherence Counselling (EAC) in 2016 to improve adherence, but many patients still struggle to suppress viral load after EAC.ObjectiveThis study evaluated the effectiveness of Enhanced Adherence Counselling for people living with HIV with unsuppressed viral load in Ilala, Dar es Salaam.MethodsA cross-sectional study was conducted in eight Ilala Care and Treatment Clinic (CTCs), selected using multistage sampling based on patient volume, for this study, patient volume was defined as the number of CTC clients, with high-volume facilities referring to those serving more than 1000 patients. Records of patients with unsuppressed viral load (≥1000 copies/mL) in 2023 were reviewed. Data were analysed in STATA SE 14 using descriptive, ordered, and multivariable logistic regression, with significance set at p < 0.05.ResultsOut of 361 people living with HIV with high viral load, 86.2% enrolled in EAC and 70.9% completed it. Among completers, 68.4% achieved viral suppression. Viral load suppression was significantly associated with age and initial viral load, with younger individuals being less likely to achieve suppression, while those with lower initial viral load (VL) had a higher likelihood of suppression. Median EAC initiation time was 27 days, with most completing it within 3months.ConclusionThe study reveals gaps in transitioning people living with HIV with unsuppressed viral load to EAC enrolment and completion, undermining EAC's effectiveness. While 68% viral load suppression among those who completed EAC is promising, low enrolment and retention into EAC may impact overall success. Further research is needed to explore barriers to full participation into EAC sessions and its impact on viral load suppression.

Late diagnosis and treatment of malaria increase the odds of severe disease by nearly 2.8 times, enhance transmission rates, compromise drug effectiveness, and trigger malaria outbreaks. No continent-wide estimates for malaria treatment delay exist. We estimate delay rates among African children treated for malaria between 2006 and 2022, using 177 nationally representative surveys. We found that 60% [95% UI 45.7–72.8] of treated children experienced >24 h of delay, while 29% [95% UI 18.9–41.2] faced delays exceeding 48 h, affecting 33 million and 16 million children, respectively. Spatiotemporal variability exists across Africa. Somalia has the highest (76% [95% UI 39.7–97.9]) and Tanzania has the lowest (35.3% [95% UI 11.5–53.8]) delay rates. Overall, initial improvements in treatment delay stagnated post-2015, but East Africa showed the most progress, while Central and West Africa experienced increases. Socioeconomic factors and residence influenced delays, with poorer and rural populations facing higher rates. These findings are vital for policymakers to enhance malaria case management, access to effective treatment, and reduce malaria mortality among children.