Beyond malaria--causes of fever in outpatient Tanzanian children.

BACKGROUND: As the incidence of malaria diminishes, a better understanding of nonmalarial fever is important for effective management of illness in children. In this study, we explored the spectrum of causes of fever in African children. METHODS: We recruited children younger than 10 years of age with a temperature of 38°C or higher at two outpatient clinics--one rural and one urban--in Tanzania. Medical histories were obtained and clinical examinations conducted by means of systematic procedures. Blood and nasopharyngeal specimens were collected to perform rapid diagnostic tests, serologic tests, culture, and molecular tests for potential pathogens causing acute fever. Final diagnoses were determined with the use of algorithms and a set of prespecified criteria. RESULTS: Analyses of data derived from clinical presentation and from 25,743 laboratory investigations yielded 1232 diagnoses. Of 1005 children (22.6% of whom had multiple diagnoses), 62.2% had an acute respiratory infection; 5.0% of these infections were radiologically confirmed pneumonia. A systemic bacterial, viral, or parasitic infection other than malaria or typhoid fever was found in 13.3% of children, nasopharyngeal viral infection (without respiratory symptoms or signs) in 11.9%, malaria in 10.5%, gastroenteritis in 10.3%, urinary tract infection in 5.9%, typhoid fever in 3.7%, skin or mucosal infection in 1.5%, and meningitis in 0.2%. The cause of fever was undetermined in 3.2% of the children. A total of 70.5% of the children had viral disease, 22.0% had bacterial disease, and 10.9% had parasitic disease. CONCLUSIONS: These results provide a description of the numerous causes of fever in African children in two representative settings. Evidence of a viral process was found more commonly than evidence of a bacterial or parasitic process. (Funded by the Swiss National Science Foundation and others.).

Parallel evolution of facial stripe patterns in the Neolamprologus brichardi/pulcher species complex endemic to Lake Tanganyika.

Colour pattern diversity can be due to random processes or to natural or sexual selection. Consequently, similarities in colour patterns are not always correlated with common ancestry, but may result from convergent evolution under shared selection pressures or drift. Neolamprologus brichardi and Neolamprologus pulcher have been described as two distinct species based on differences in the arrangement of two dark bars on the operculum. Our study uses DNA sequences of the mitochondrial control region to show that relatedness of haplotypes disagrees with species assignment based on head colour pattern. This suggests repeated parallel evolution of particular stripe patterns. The complete lack of shared haplotypes between populations of the same or different phenotypes reflects strong philopatric behaviour, possibly induced by the cooperative breeding mode in which offspring remain in their natal territory and serve as helpers until they disperse to nearby territories or take over a breeding position. Concordant phylogeographic patterns between N. brichardi/N. pulcher populations and other rock-dwelling cichlids suggest that the same colonization routes have been taken by sympatric species and that these routes were affected by lake level fluctuations in the past.

Managing the Sick Child in the Era of Declining Malaria Transmission: Development of ALMANACH, an Electronic Algorithm for Appropriate Use of Antimicrobials.

OBJECTIVE: To review the available knowledge on epidemiology and diagnoses of acute infections in children aged 2 to 59 months in primary care setting and develop an electronic algorithm for the Integrated Management of Childhood Illness to reach optimal clinical outcome and rational use of medicines. METHODS: A structured literature review in Medline, Embase and the Cochrane Database of Systematic Review (CDRS) looked for available estimations of diseases prevalence in outpatients aged 2-59 months, and for available evidence on i) accuracy of clinical predictors, and ii) performance of point-of-care tests for targeted diseases. A new algorithm for the management of childhood illness (ALMANACH) was designed based on evidence retrieved and results of a study on etiologies of fever in Tanzanian children outpatients. FINDINGS: The major changes in ALMANACH compared to IMCI (2008 version) are the following: i) assessment of 10 danger signs, ii) classification of non-severe children into febrile and non-febrile illness, the latter receiving no antibiotics, iii) classification of pneumonia based on a respiratory rate threshold of 50 assessed twice for febrile children 12-59 months; iv) malaria rapid diagnostic test performed for all febrile children. In the absence of identified source of fever at the end of the assessment, v) urine dipstick performed for febrile children <2 years to consider urinary tract infection, vi) classification of 'possible typhoid' for febrile children >2 years with abdominal tenderness; and lastly vii) classification of 'likely viral infection' in case of negative results. CONCLUSION: This smartphone-run algorithm based on new evidence and two point-of-care tests should improve the quality of care of <5 year children and lead to more rational use of antimicrobials.

Curriculum innovation in teacher education : exploring conceptions among Tanzanian teacher educators

The focus of the study is to understand curriculum innovation from the perspective of Tanzanian teacher educators. It is argued that the deterioration of quality of education in schools is partly to be attributed to the way in which teachers are educated. Curriculum innovation is considered as an essential strategy for bringing about improvement in teacher education. Therefore, in 2000 a new curriculum was introduced; however, right from the inception the curriculum was criticised by teacher educators. The overall aim of the study is to investigate teacher educators’ conceptions of curriculum innovation. In the theoretical framework the main focus is on discussion about different curriculum approaches for teacher education and innovation. In order to achieve the aim of the study, a phenomenographic approach is employed. This approach is used in order to identify similarities and variation in educators’ conceptions of curriculum innovation. The empirical basis of the study consists of interviews with thirty teacher educators working in eight teachers’ colleges situated in various parts of Tanzania. The findings, in brief, reveal variation in teacher educators’ conceptions of the dominant domains of innovation. Two broad conceptions of teaching with six aspects are identified. Conceptions of educational studies are presented in four broad categories of description with four aspects. Similarly, in methodology subjects two conceptions are described with four aspects. On the integration of subject matter studies and subject methods, two broad conceptions are presented with six aspects. Conceptions of textbook prescription policy are characterised in two broad categories of description with four aspects. With the use of modules two broad conceptions are identified with six aspects. In addition, the study identifies four broad conceptions of future curriculum approaches with eight aspects. Looking across the categories of description, the results indicate that educators cope with innovation individually. Three character types of teacher educators are presented: loyal, creative and critical. Furthermore, four types of phenomena suggesting critical areas about teacher educators’ conceptions of innovation are described: educators’ prior educational background, technical factors, student teachers’ factors and shifting from teaching to learning. On the whole, educators express a number of frame factors in the process of change towards the aim of curriculum innovation. This indicates that the new curriculum (2000) is not implemented as intended by curriculum developers. Constraints to the implementation are presented and discussed in detail. From these findings, two models of educators’ stance towards curriculum innovation are presented and can be used as a framework for planning successful curriculum innovations and analysing practice in teachers’ colleges.

Quality enhancement in teacher education : Tanzanian teacher educators’ conceptions and experiences

The overall aim of this study was to investigate and examine teacher educators’ conceptions and experiences of quality of teacher education. The research interest therefore was two-fold: a) to deepen understanding of the concept quality and b) scrutinize experiences of teacher educators of quality enhancement. To achieve this ambition the study was conducted in the context of a newly established university college-based teacher education in Tanzania. Two research questions guided the study. The first focused on investigating how teacher educators conceived quality in the domain of teacher education and the second intended to explore teacher educators’ experiences of quality enhancement. The theoretical framework of the study centered on the concepts of teacher education, quality, and criteria for quality enhancement. Phenomenographic and phenomenological approaches under the main umbrella of qualitative research design were selected. Twenty five teacher educators participated in the study. Interviews were used for the collection of the data. The results of the first research question, in brief, indicate that teacher educators’ conceptions of quality are expressed in two main categories, namely, outstanding academic scholarship and adequate professional scholarship. Quality as outstanding academic scholarship was illustrated by two subcategories: excellence and positive transformation. While the former was composed of two aspects, the latter was demonstrated by three aspects. Quality as adequate professional scholarship was described in three sub-categories. The first was improved teaching competency, consisting of two aspects. The second was conscious research orientation, which is displayed by three aspects, and the last was enhancing the ability to reflect, represented by two aspects. The results of the second research question, which focused on exploring teacher educators’ experience of quality enhancement, were classified into two main categories of description: insufficient programs of teacher education and unsatisfactory professional development of teacher educators. From the two categories, the strengths, weaknesses, opportunities and challenges related to programs of educating teachers, particularly curriculum development and implementation, and the professional development of educators, were exposed. Since the ambition of conducting the study was to deepen the understanding by producing insight that would act as a platform for appraising and enhancing the quality of teacher education, the results hopefully can be used for the development of the quality of teacher education in Tanzania.

Forest cover and its change in Unguja Island, Zanzibar

Tropical forests are sources of many ecosystem services, but these forests are vanishing rapidly. The situation is severe in Sub-Saharan Africa and especially in Tanzania. The causes of change are multidimensional and strongly interdependent, and only understanding them comprehensively helps to change the ongoing unsustainable trends of forest decline. Ongoing forest changes, their spatiality and connection to humans and environment can be studied with the methods of Land Change Science. The knowledge produced with these methods helps to make arguments about the actors, actions and causes that are behind the forest decline. In this study of Unguja Island in Zanzibar the focus is in the current forest cover and its changes between 1996 and 2009. The cover and changes are measured with often used remote sensing methods of automated land cover classification and post-classification comparison from medium resolution satellite images. Kernel Density Estimation is used to determine the clusters of change, sub-area –analysis provides information about the differences between regions, while distance and regression analyses connect changes to environmental factors. These analyses do not only explain the happened changes, but also allow building quantitative and spatial future scenarios. Similar study has not been made for Unguja and therefore it provides new information, which is beneficial for the whole society. The results show that 572 km2 of Unguja is still forested, but 0,82–1,19% of these forests are disappearing annually. Besides deforestation also vertical degradation and spatial changes are significant problems. Deforestation is most severe in the communal indigenous forests, but also agroforests are decreasing. Spatially deforestation concentrates to the areas close to the coastline, population and Zanzibar Town. Biophysical factors on the other hand do not seem to influence the ongoing deforestation process. If the current trend continues there should be approximately 485 km2 of forests remaining in 2025. Solutions to these deforestation problems should be looked from sustainable land use management, surveying and protection of the forests in risk areas and spatially targeted self-sustainable tree planting schemes.

Changing teachers´ practices in regular schools enrolling children with visual impairment

The number of persons with visual impairment in Tanzania is estimated to over 1.6 million. About half a million of these persons are children aged 7-13. Only about 1% of these children are enrolled in schools. The special schools and units are too few and in most cases they are far away from the children’s homes. More and more regular schools are enrolling children with visual impairment, but the schools lack financial resources, tactile teaching materials and trained special education teachers. Children with visual impairment enrolled in regular schools seldom get enough support and often fail in examinations. The general aim of this study was to contribute to increased knowledge and understanding about how teachers can change their teaching practices and thus facilitate the learning of children with visual impairment included in regular classrooms as they participate in an action research project. The project was conducted in a primary school in a poor rural region with a high frequency of blindness and visual impairment. The school was poorly resourced and the average number of pupils per class was 90. The teachers who participated in the collaborative action research project were the 14 teachers who taught blind or visually impaired pupils in grades 4 and 6, in total 6 pupils. The action research project was conducted during a period of 6 months and was carried out in five cycles. The teachers were actively involved in all the project activities; identifying challenges, planning solutions, producing teaching materials, reflecting on outcomes, collaborating and evaluating. Empirical data was collected with questionnaires, interviews, observations and focus group discussions. The findings of the study show that the teachers managed to change their teaching practices through systematic reflection, analysis and collaboration. The teachers produced a variety of tactile teaching materials, which facilitated the learning of the pupils with visual impairment. The pupils learned better and felt more included in the regular classes. The teachers gained new knowledge and skills. They grew professionally and started to collaborate with each other. The study contributes to new knowledge of how collaborative action research can be conducted in the area of special education in a Tanzanian school context. The study has also relevance to the planning of school-based professional development programs and teacher education programs in Tanzania and in other low-income countries. The results also point at strategies which can promote inclusion of children with disabilities in regular schools.

Exploring the politics of intergroup accommodation in Kenya’s vernacular radios during the 2007/08 conflicts

Depuis des années, le Kenya avait donné l’impression d’être un pays relativement stable dans la région d’Afrique sub-saharienne, régulièrement secouée par les conflits, et un « centre » autour duquel la communauté internationale coordonne ses missions vers certains pays d’Afrique comme ceux faisant partie de la Région des Grandes Lacs (Burundi, Rwanda, Ouganda, République démocratique du Congo, Kenya et Tanzanie) et ceux de la Corne de l’Afrique (Kenya, Somalie, Éthiopie, Djibouti et Ouganda). Toutefois, les élections présidentielles très contestées en 2007 et les conflits qui se sont enchaînés ont entrainé de nombreuses préoccupations en ce qui concerne la stabilité du Kenya à l’ère de l’insécurité globale. Alors que le rétablissement de la paix continue, la coexistence entre groupes est toujours délicate car le Kenya compte au moins quarante-deux ethnies qui sont toutes distinctes les unes par rapport aux autres. Par ailleurs, l’ouverture d’une enquête judiciaire, par la Cour Pénale Internationale (CPI), contre quatre des six personnes présumées être les principaux auteurs des violences postélectorales de 2007/08, s’ajoute aux problèmes liés à la coexistence pacifique entre les différents groupes avant les prochaines élections. Cette thèse examine les politiques relatives à l’accommodation des différents groupes à travers les radios vernaculaires et comment ces politiques ont influencé les relations entre les groupes lors des conflits de 2007/08 au Kenya. Partant du constat qu’un conflit est un processus communicatif, elle intègre le concept d’encadrement médiatique à la théorie de Protracted Social Conflict (PSC) définie par Azar (1990) pour tracer non seulement les changements dans les discours d’encadrement de ces conflits, mais aussi pour illustrer les mutations des attitudes à l’égard des relations entre groupes survenues avant, durant et après ces conflits. Cette étude emploie principalement les méthodes qualitatives pour rassembler les données issues des trois régions au Kenya qui sont ethniquement et linguistiquement divergentes: Nyeri (la majorité Kikuyu), Kisumu (la majorité Luo) et Eldoret (la majorité Kalenjin). L’argument central de cette thèse est que l’encadrement des relations entre groupes, notamment lors des conflits, est soit différencié soit concerté dépendamment du stade auquel le conflit se manifeste. Alors que dans l’encadrement différencié, les discours médiatiques sont articulés de façon à ce que ceux-ci soient susceptibles d’entrainer une polarisation entre groupes, l’encadrement concerté décrit les discours médiatiques négociés de manière à ce que ceux-ci reflètent les valeurs partagées au travers des différents groupes, et donc sont susceptibles d’engendrer une coopération entre groupes. J’argumente que les changements dans le discours des radios vernaculaires prennent effet lorsque de nouveaux éléments sont ajoutés aux discours caractérisant un conflit déjà existant, et les « nouveaux significations » que ces éléments apportent à la compréhension du conflit en question. J’argumente également que le changement du l’encadrement différentiée à l’encadrement concerté (et vice-versa) dépende du degré de résonance de ces discours avec la population cible. De façon générale, cette étude suggère que le langage de diffusion et la proximité culturelle induisent l’encadrement entre groupes à travers les radios vernaculaires au Kenya. La force de cette thèse se trouve donc dans les perspectives analytiques qu’elle propose pour localiser les discours changeants lors des conflits, plus particulièrement dans les états multiethniques où les politiques d’accommodation entre les différents groupes demeurent toujours fragiles et conditionnelles.

Fauna en Tanzania.

Programa emitido el 27 de enero de 1995

Las ni??as, las ??ltimas : un estudio sobre el abandono escolar femenino en Kibosho Central (Tanzania)

Resumen basado en el de la publicaci??n

Emotional interactions and an ethic of care: caring relations in families affected by HIV and AIDS

In the context of global processes of economic restructuring, the HIV and AIDS epidemic and socio-cultural constructions of care, many women and young people in low-income households have been drawn into caring roles within the family. Drawing on the literature on an ethics of care, emotional geographies and embodiment, this paper examines the emotional dynamics of the caring process in families affected by HIV and AIDS. Based on the perspectives of both ‘caregivers’ and ‘care-receivers’ from research undertaken in Namibia, Tanzania and the UK, we examine the everyday practices of care that women and young people are engaged in and explore how emotions are performed and managed in caring relationships. Our research suggests caregivers play a crucial role in providing emotional support and reassurance to people with HIV, which in turn often affects caregivers' emotional and physical wellbeing. Within environments where emotional expression is restricted and HIV is heavily stigmatised, caregivers and care-receivers seek to regulate their emotions in order to protect family members from the emotional impacts of a chronic, life-limiting illness. However, whilst caregiving and receiving may lead to close emotional connections and a high level of responsiveness, the intensity of intimate caring relationships, isolation and lack of access to adequate resources can cause tensions and contradictory feelings that may be difficult to manage. These conflicts can severely constrain carers' ability to provide the ‘good care’ that integrates the key ethical phases in Tronto's (1993) ideal of the caring process.

Young caregivers in the context of the HIV/AIDS pandemic in sub-Saharan Africa

Against a background of rising adult mortality and morbidity in the context of the HIV/AIDS pandemic in sub-Saharan Africa, this paper provides both quantitative and qualitative evidence for the existence of a largely neglected group of young people with increased responsibility for caregiving. Using questionnaire surveys, focus groups, storyboards and in-depth interviews in three studies across Southern and Eastern Africa some young people in Lesotho, Tanzania and Zimbabwe are found to devote considerable time and energy to caring for sick members of their households. Examination of the tasks carried out by these youngsters finds them to be burdened beyond usual familial and societal expectations of children's 'normal' contributions to the reproduction of households via domestic chores and suchlike. It is concluded that these young people can be described as 'young carers'. The three studies are presented to illuminate different sociospatial aspects of caregiving by young people. First, using qualitative data from Lesotho the range of caring tasks young caregivers; perform for care recipients - usually a grandmother, parent, or sibling - is identified. Second, the impact caregiving responsibilities have on children's primary school attendance is examined using survey data from Tanzania. Third, the wider negative and positive impacts of caregiving including loss of friends and gaining of emotional maturity for young carers and their households is explored with in-depth individual interviews from Zimbabwe. Finally, suggestions are made for further research to deepen understanding of the geographies of caring within the context of the population geographies of the HIV/AIDS pandemic in sub-Saharan Africa and beyond. Copyright (c) 2006 John Wiley & Sons, Ltd.

Protecting developing countries' forests: enforcement in theory and practice

This paper relates the key findings of the optimal economic enforcement literature to practical issues of enforcing forest and wildlife management access restrictions in developing countries. Our experiences, particularly from Tanzania and eastern India, provide detail of the key pragmatic issues facing those responsible for protecting natural resources. We identify large gaps in the theoretical literature that limit its ability to inform practical management, including issues of limited funding and cost recovery, multiple tiers of enforcement and the incentives facing enforcement officers, and conflict between protected area managers and rural people's needs.