State University of Zanzibar

Background Methicillin-resistant Staphylococcus aureus (MRSA) is a formidable public scourge causing worldwide mild to severe life-threatening infections. The ability of this strain to swiftly spread, evolve, and acquire resistance genes and virulence factors such as pvl genes has further rendered this strain difficult to treat. Of concern, is a recently recognized ability to resist antiseptic/disinfectant agents used as an essential part of treatment and infection control practices. This study aimed at detecting the presence of pvl genes and determining the distribution of antiseptic resistance genes in Methicillin-resistant Staphylococcus aureus isolates through whole genome sequencing technology. Materials and methods A descriptive cross-sectional study was conducted across six regional referral hospitals-Dodoma, Songea, Kitete-Kigoma, Morogoro, and Tabora on the mainland, and Mnazi Mmoja from Zanzibar islands counterparts using the archived isolates of Staphylococcus aureus bacteria. The isolates were collected from Inpatients and Outpatients who attended these hospitals from January 2020 to Dec 2021. Bacterial analysis was carried out using classical microbiological techniques and whole genome sequencing (WGS) using the Illumina Nextseq 550 sequencer platform. Several bioinformatic tools were used, KmerFinder 3.2 was used for species identification, MLST 2.0 tool was used for Multilocus Sequence Typing and SCCmecFinder 1.2 was used for SCCmec typing. Virulence genes were detected using virulenceFinder 2.0, while resistance genes were detected by ResFinder 4.1, and phylogenetic relatedness was determined by CSI Phylogeny 1.4 tools. Results Out of the 80 MRSA isolates analyzed, 11 (14%) were found to harbor LukS-PV and LukF-PV, pvl-encoding genes in their genome; therefore pvl-positive MRSA. The majority (82%) of the MRSA isolates bearing pvl genes were also found to exhibit the antiseptic/disinfectant genes in their genome. Moreover, all (80) sequenced MRSA isolates were found to harbor SCCmec type IV subtype 2B&5. The isolates exhibited 4 different sequence types, ST8, ST88, ST789 and ST121. Notably, the predominant sequence type among the isolates was ST8 72 (90%). Conclusion The notably high rate of antiseptic resistance particularly in the Methicillin-resistant S. aureus strains poses a significant challenge to infection control measures. The fact that some of these virulent strains harbor the LukS-PV and LukF-PV, the pvl encoding genes, highlight the importance of developing effective interventions to combat the spreading of these pathogenic bacterial strains. Certainly, strengthening antimicrobial resistance surveillance and stewardship will ultimately reduce the selection pressure, improve the patient’s treatment outcome and public health in Tanzania.

Background Eclampsia is among the primary causes of maternal and perinatal morbidity and mortality in Zanzibar. Many women and men are not aware of the signs, symptoms and causes of eclampsia and may have different explanatory models. Therefore, this study aimed to describe the community understanding of pre-eclampsia, as a key stage to improve maternal and perinatal health in Unguja Island, Zanzibar. Methods A qualitative study design of six focus group discussions (FDGs) was performed using a focus group interview guide; 51 male and female respondents at three selected wards of Unguja Island, Zanzibar participated. Thematic analysis was applied using Qualitative data analysis (QDA Miner Lite software version 2.0.9). Results Overall participants demonstrated a lack of understanding regarding eclampsia. The majority of participants perceived that there are certain things related to eclampsia: Mjusi or Mdudu (devil/satanic), superstitious issues, tension/stress from partners, food consumption, eating slaughtered meat like chicken, cow and goat during pregnancy, nice smelling lotion, soap and perfumes have been stated to be the causes of eclampsia. Spiritual and traditional remedies were mentioned as a treatment for eclampsia, including herbs, makombe (written verses of the Qur’an) and steaming (smoked dry leaves). Local names of eclampsia used by the communities, in urban and rural areas are mjusi (lizard) or mdudu (bug), which means the devil enters a woman’s body, especially during pregnancy or within 42 days post-delivery. Conclusion Most participants had a lack of understanding of eclampsia and perceived that there are traditional and spiritual issues related to its causes, attributed risks and clinical presentation, which makes them rely more on traditional and spiritual treatments. Therefore, health educational programs in the community setting and at the antenatal clinics, aiming at improving knowledge and dismissing myths and misperceptions regarding eclampsia, are recommended in rural and urban areas of Unguja Zanzibar.

Background The blended learning (BL) approach to training health care professionals is increasingly adopted in many countries because of high costs and disruption to service delivery in the light of severe human resource shortage in low resource settings. The Covid-19 pandemic increased the urgency to identify alternatives to traditional face-to-face (f2f) education approach. A four-day f2f antenatal care (ANC) and postnatal care (PNC) continuous professional development course (CPD) was repackaged into a 3-part BL course; (1) self-directed learning (16 h) (2) facilitated virtual sessions (2.5 h over 3 days) and (3) 2-day f2f sessions. This study assessed the feasibility, change in healthcare providers’ knowledge and costs of the BL package in Nigeria, Tanzania, and Kenya. Methods A mixed methods design was used. A total of 89 healthcare professionals, were purposively selected. Quantitative data was collected through an online questionnaire and skills assessments, analyzed using STATA 12 software. Qualitative data was collected through key informant interviews and focus group discussions, analysed using thematic analysis. Results Majority of participants (86%) accessed the online sessions using a mobile phone from home and health facilities. The median (IQR) time of completing the self-directed component was 16 h, IQR (8, 30). A multi-disciplinary team comprising of 42% nurse-midwives, 28% doctors, 20% clinical officers and 10% other healthcare professionals completed the BL course. Participants liked the BL approach due to its flexibility in learning, highly educative/relevant content, mixing of health worker cadres and CPD points. Aspects that were noted as challenging were related to personal log-in details and network connectivity issues during the self-directed learning and facilitated virtual sessions respectively. Conclusion The blended learning approach to ANC-PNC in-service training was found to be acceptable, feasible and cost less to implement compared to face-to-face training approach in the study settings. The BL training approach was effective in improving the knowledge and skills of healthcare providers who participated in the training.

This paper presents one part of a larger, multidimensional study on the vulnerability of Zanzibar coastal communities to climate change and other stressors, focusing on water insecurity in two sites on the Zanzibar coast. Water security is composed of three components, namely water availability, water accessibility and the quality of available water. Findings from the study showed that water from wells is the major source of household water since tap water supply is often erratic. Farming systems are completely rain-fed, while some livestock owners use coral caves as the main source of water for their animals. Water quality is a major challenge along the coast as the majority of wells and coral caves in the study sites contain hard water with varying levels of salinity. A diversity of physical and social factors such as variability in water supply infrastructure, settlement structure, poverty, geology and geohydrology, variability in supply and poor water resource management adversely interact with local climate phenomena such as sea level rise, salt water incursion and drought to intensify water insecurity along the Zanzibar coast. Among the policy options to address these challenges would be to promote rainwater harvesting and increased utilisation of underground water for irrigation in the dry areas in order to increase agricultural production and reduce poverty.

Zanzibar, a low‐resource semiautonomous region of Tanzania, has an estimated prevalence of hepatitis B virus (HBV) infections of 3.6%. To assess the feasibility of care and treatment, a 5‐year hepatitis B demonstration project was implemented in Zanzibar during January 2017–December 2021, following the 2015 WHO HBV care and treatment guidelines. Participants included adults (aged ≥ 18 years) who tested positive for HBV surface antigen and tested negative for HIV and hepatitis C antibody. Participants were examined for clinical signs of liver disease and testing was conducted at baseline to assess treatment eligibility and every 6–12 months thereafter. Tenofovir disoproxil fumarate (TDF) was provided at no cost to treatment‐eligible participants. Clinical and laboratory data were analysed to assess improvement in proximal disease outcomes. Among 596 participants enrolled, the median age was 32 years (IQR 26–39) and 365 (61%) were male. Of those enrolled, 268 (45%) returned for ≥ 1 follow‐up visit, with a median of 511 days of follow‐up. Overall, 58 patients initiated treatment: 15 met treatment criteria based on liver cirrhosis alone; 13 by APRI > 1.5; among those with HBV DNA results, six met criteria based on HBV DNA levels and ALT activity; 24 met ≥ 2 criteria. Significant decreases in ALT activities, APRI scores and HBV DNA levels were observed among those treated. This hepatitis B care and treatment programme was demonstrated to be feasible in a low‐resource setting. Despite challenges, testing and linkage to care is critical to decrease the global burden of hepatitis B.

Background/Objectives: Despite efforts within the framework of the Sustainable Development Goal to end malnutrition by 2030, malnutrition and soil-transmitted helminth infections persist in sub-Saharan Africa. A significant barrier to success is the inadequate understanding of effective intervention methods. Most research on the gut microbiota’s role in health has been conducted in developed countries, leaving a critical gap in knowledge regarding low-income populations. This study addresses this gap by expanding research on the gut microbiota of underprivileged populations to help tackle these public health challenges. Methods: We employed 16S rDNA sequencing to assess the bacterial gut microbiota composition of 60 children (mean age: 26.63 ± 6.36 months) and their 58 mothers (mean age: 30.03 ± 6.31 years) in Pemba, with a focus on helminth infection and nutritional status. Results: Our differential abundance analysis identified bacterial taxa that were significantly negatively associated with both helminth infections and malnutrition, highlighting the potential for microbiota-directed interventions to address these health issues simultaneously. Notably, we identified Akkermansia, Blautia, Dorea, and Odoribacter as promising probiotic candidates for such interventions. In stunted children, positive co-occurrences were observed between Lactobacillus, Prevotella, and Bacteroides, while Escherichia/Shigella displayed negative co-abundance relationships with short-chain fatty acid (SCFA) producers in the gut microbiota. These findings suggest that administering Lactobacillus and SCFA-producing probiotics to children may foster the growth of beneficial bacteria like Prevotella and Bacteroides while reducing the relative abundance of Escherichia/Shigella, potentially enhancing overall health. Conclusions: This study underscores the importance of microbiota-directed interventions in children and women of reproductive age as promising strategies, alongside established approaches, for combating helminth infections and malnutrition in vulnerable populations.

Background The emergence of multidrug-resistant termed Methicillin-resistant Staphylococcus aureus (MRSA) strain, driven by the acquisition of resistance gene mecA imposes a substantial challenge in the treatment and control of their related infections. Although quinolones have historically been effective against both MRSA and methicillin-susceptible S. aureus (MSSA) strains, the rising resistance to quinolones among S. aureus isolates, particularly in MRSA, has severely curtailed their potency and further narrowed down the therapeutic options. This study aimed to determine the burden of MRSA among isolates, as well as their resistance profile, genotypic characterization, and molecular relatedness through the construction of a phylogenetic tree. Materials and methods Archived clinical S. aureus isolates from a descriptive, cross-sectional study involving six regional referral hospitals in Dodoma, Songea, Kigoma, Kitete, and Morogoro in the mainland Tanzania and Mnazi Mmoja in Zanzibar were analyzed. Bacterial identification was performed using both classical microbiology and whole genome sequencing on Illumina Nextseq 550 Sequencer. Species identification was done using KmerFinder 3.2, Multilocus Sequence Typing using MLST 2.0, SCCmec typing using SCCmecFinder 1.2, resistance genes using ResFinder 4.1, and phylogenetic relatedness using CSI Phylogeny 1.4. Results Out of the 140 isolates analyzed, 69 (49.3%) were identified as MRSA, with 57 (82.6%) exhibiting quinolone resistance. Conversely, 71 isolates were identified as MSSA, and none of them exhibited resistance to quinolones. Spa-typing revealed six spa types, with t355, t1476, and t498 being the most common. Moreover, all (69) MRSA were found to carry SCCmec type IV. The isolates exhibited 14 different sequence types (STs). Notably, ST152 was prevalent among MSSA (50 isolates, 70%), while ST8 was the predominant sequence type among MRSA (58 isolates, 84%). The antimicrobial resistance profile revealed at least three horizontally acquired resistance genes, with blaZ, dfrG, tet(K), and aac (6’)-aph (2’’) genes being highly prevalent. Conclusion There is a high genetic diversity among the S. aureus isolates existing in Tanzania regional hospitals, with a concerning burden of quinolone resistance among MRSA isolates. The diversity in resistance genes among MRSA lineages emphasizes the necessity for the development of sustainable antimicrobial stewardship and surveillance to support evidence-based guidelines for managing and controlling MRSA infections in both community and hospital settings.

BACKGROUND Wheat flour paste is a typical Chinese fermented food, valued for its distinct flavors and health benefits. However, evidence regarding volatile organic compounds (VOCs) in Chinese wheat flour paste is limited. This study aims to examine the effect of fermentation on the VOCs and their physicochemical properties. Chinese wheat flour paste fermented at different stages was characterized using headspace gas chromatography ion‐mobility spectrometry (HS‐GC‐IMS) with an electronic nose (E‐nose) and an electronic tongue (E‐tongue). RESULTS The results revealed that around 76 VOCs were found in Chinese wheat flour paste from all stages of fermentation. These included esters, alcohols, aldehydes, ketones, acids, furans, and pyrazines. The E‐tongue and E‐nose analyses also showed high responses for saltiness, umami, WIW, and W5S. The fermentation process changed the color of the wheat flour paste, and the taste, and smell parameters. Principal component analysis (PCA) showed that taste parameters were positively associated with the volatile flavor profile detected in wheat flour paste. Partial least squares discriminant analysis also identified 28 VOCs as distinct flavor metabolites across fermentation stages. CONCLUSION At the ‘after ripening’ (AR) and ‘sterilization’ (S) stages of wheat flour paste fermentation there were strong umami and salty flavors, with minimal sour and sweet notes in comparison with the other stages. These stages were characterized by elevated terpene concentrations, inorganic sulfides, and key flavor enhancers such as 2‐hexanol and propyl sulfide. Headspace gas chromatography ion‐mobility spectrometry and E‐nose technologies are recommended for a more precise assessment of volatile changes during fermentation. The findings indicate that the ‘sterilization’ stage of wheat flour paste fermentation is optimal for achieving the required flavor profile. © 2024 Society of Chemical Industry.

A coastal area is an area that is very exposed to sea level changes for a long period, especially during the Holocene. Three marine sediment cores (TRC 3 and TER16-GC13C) in the offshore area were analysed for radiocarbon (14C) and some geochemical elements (Na, Al, Ca, Fe, Li, Pb, Zn, and Ba) in response to the terrigenous- and marine-originated sediment changes of in East Coast Peninsula Malaysia (ECPM) during the Holocene epoch. Across three Holocene stages, geochemical elements show a distinct temporal pattern. The average concentrations of the studied metals were in decreasing order as follows: Al > Na > Ca > Fe > Pb > Zn > Li > Ba. Dominant terrigenous/marine origin was captured by the ratio Ca/Al and Ca/Fe in the early Holocene/late Holocene. The present study suggests that sea level transgression is the primary factor controlling the shifting of terrigenous- and marine-originated sediments in the ECPM.

Mpox, caused by the Monkeypox virus (MPXV), has emerged as a significant global public health concern, particularly affecting vulnerable populations. The recent outbreak in the Democratic Republic of the Congo (DRC) is the largest recorded, driven by the highly virulent clade 1 strain. Transmission has shifted from animal contact to primarily sexual contact among Key Populations (KPs) such as Sex Workers (SW) and Men who have Sex with Men (MSM). In Zanzibar, where HIV prevalence is significantly higher among Key Populations, People Living with Human Immunodeficiency Virus (PLHIV) are at increased risk of Mpox infection due to socioeconomic challenges and immunosuppression. Despite no reported cases in Zanzibar, the spread of Mpox in non-endemic areas highlights the need for proactive measures. Leveraging Zanzibar's strengthened public health infrastructure, key strategies include tailored awareness campaigns, improved vaccine access through existing COVID-19 vaccination models, healthcare infrastructure enhancement, and mental health support. These targeted actions aim to protect Zanzibar's most vulnerable populations and bolster preparedness against Mpox, emphasizing the importance of resource-appropriate interventions to mitigate potential outbreaks.

Aim This study aims to investigate international students’ perspectives on service quality and analyse factors contributing to the perceived service quality of the university health centre. Background International students are at increased risk of experiencing poor mental health, isolation from families and cultures, language barriers, financial stress and academic pressures. It is important that universities support international students to enable them to complete their degrees and reach their desired level of achievement and performance. One of the supports required by international students is the availability of healthcare services. Therefore, improving the quality of services to meet international students’ requirements, including healthcare services, is essential. Methods A three-phase exploratory sequential mixed methods design was used. Phase 1 aims to explore international students’ perceptions of primary healthcare quality by conducting in-depth interviews and focus group discussions. Data were analysed using thematic analysis. Phase 2 is to form questionnaire items based on the results of the qualitative study. The questionnaire is subject to pilot testing to measure validity and reliability. Phase 3 analyses factors influencing international students’ perceived primary healthcare service quality. Multiple regression was used to analyse factors contributing to the perceived service quality of international students. Findings The qualitative strand revealed five major themes representing the study participants’ thoughts about the quality of services in the university healthcare context. Perceived quality attributes identified in this study were primarily empathy, equity, effectiveness, efficiency and safety. The quantitative strand found that 35.57% of participants consider the perceived quality of the centre as good. The highest and lowest service quality attributes were related to safety and efficiency, with a score of 21.12 ± 3.58 and 19.57 ± 4.34, respectively. The multiple linear regression analyses showed that PhD students from Health Faculty and Scholarship awardees were significantly associated with the perceived quality of healthcare services. Thus, the university management needs to improve service quality considering the diversity of international students’ socio-demographic characteristics.

A prerequisite for learning is that instructions and other learning activities take place in a language that you understand. This may seem self-evident, but fact remains that most learners in Sub-Saharan Africa (SSA) are taught in a European second language (L2) that they are unfamiliar with. Frequently, the role of the home languages in the classrooms has been completely subtracted leading to very unfavourable learning situations for many pupils, something which in turn results in failures and early drop-out. The current paper takes up some of the challenges, dilemmas and consequences of current medium of instruction (MoI) policies as illustrated by theories and previous studies. Part 2 gives an outline of the analytical framework being developed under the Understanding project financed by the Swedish research Council. The purpose of the framework is to help reveal strengths, shortcomings and mismatches in current language-in-education policies. Focus lies on how different policy levels acknowledge the challenges involved in learning and teaching through a second language in SSA contexts. The model provides a systematic framework for explorations of how language-in-education policy outcomes (mis)match intentions. The framework, though adapted for SSA contexts, has direct relevance to the analysis of language-in-education polices in Western education systems.

This guideline will provide up-to-date, evidence-based recommendations on the safe use of non-biologic DMARDs, also called conventional synthetic DMARDs (csDMARD), across the full spectrum of autoimmune rheumatic diseases. The guideline will update the guideline published in 2017 and will be expanded to include people of all ages. Updated information on the monitoring of DMARDs and vaccinations will be included. The guideline will be developed using the methods and processes described in the British Society for Rheumatology’s ‘Creating clinical guidelines: our protocol’, updated 2023.

Zanzibar has always been both multilingual and multicultural even before colonial era. Despite about a half dozen languages being used in Zanzibar since that time, Kiswahili has dominated and overshadowed other languages in terms of use. As many Zanzibaris are Muslims, and Arabic language is the one which is largely used in Islamic practices, Kiswahili was written using the Arabic script. Many Zanzibaris were reluctant to attend formal schools because they were equated to Christianity. Evidence shows that the language situation of Zanzibar has changed drastically from colonial era to the current. During the colonial era languages such as Gujarati, Arabic, English and Kiswahili were used in several newspapers in Zanzibar and Tanzania Mainland in general whereas currently the only language used by newspaper in Zanzibar is Kiswahili, and for Tanzania Mainland Kiswahili and English are used. Currently Zanzibar opts for dual official language in that both Kiswahili and English are stipulated to enjoy official status. However, Kiswahili, the language which is used by people from all walks of life is largely used in administration, politics, legal matters and mass media. In the education domain, Kiswahili is used alongside English, while for Islamic religious practices, Kiswahili is used concurrently with Arabic.

This chapter provides an overview on the diversification of the sport tourism activities in Zanzibar and the need for the institutional arrangement to tap into the benefits and more sustainability brought in by the wide arrays of these activities. Specifically, the study sought to examine the sport tourism activities in the study areas and discuss both the social and environmental impact of these activities. The study was conducted in four Marine Conservation Areas located in Unguja Island of Zanzibar. These are Menai Bay Conservation area (MBCA), Mnemba Island and Chwaka bay Marine Conservation area (MIMCA), Changuu–Bawe Marine Conservation area (CHABAMCA), and Tumbatu Marine Conservation Area (TUMCA). Marine conservation Areas or Marine Protected Areas (MPAs) involve the protective management of natural areas according to pre-defined management objectives. MCAs/MPAs are conserved for a number of reasons, including economic resources, biodiversity conservation, and species protection. These areas were selected as most of the tourism, diving, snorkelling, swimming, diving, jet ski, kite surfing, kayak, yacht sailing and sunset dhow cruising, beach volleyball, beach soccer are taking place. The data used to inform this chapter was mainly from secondary sources, experiences in managing the marine conservation areas (MCAs), and interviews with actors in various sport tourism activities, tourists, fishers, and seaweed famers. The study revealed that there are various sport tourism activities that are practised in all MCAs. However, their popularity varies from one area to the others. For example, Jet Ski is more common in TUMCA compared with other MCA, while kitesurfing is predominantly in MBCA compared with others. The study also found that there are various challenges that are associated with the management of the sport tourism. For example, there are no guidelines or any kind of enforcement with regard to Jet Ski business which are attributable to the environmental and safety issues. Lastly, the study recommends more planning and coordination in sport tourism to exploit the potential of the business to achieve sustainable development.

The provision of education using information and communications technology (ICT) has been adopted by many institutions in Africa. The use of ICT is critical in knowledge-based societies, such as those in Zanzibar and Zimbabwe. COVID-19 has changed the way educational institutions do their business in a number of ways. This study looks at how the Midlands State University (MSU) and the State University of Zanzibar (SUZA) have each increased the use of ICT for teaching and learning as well as communication during the COVID-19 pandemic. It has become inevitable, during the current COVID-19 crisis, for educators to integrate ICT in their teaching and gradually replace traditional teaching methods with modern ones which are ICT-led. The main objective of this study is to find out how ICT has been integrated into the university systems during the COVID-19 crisis. This chapter also discusses the challenges and opportunities of using ICT in education and how its use impacts on communication during a crisis.

This study sought to explore techniques used in teaching practical skills to lower secondary school students in Kondoa District, Tanzania. The purposive and random sampling techniques were used to select 20 students and 10 teachers from two public schools. The study used a questionnaire, an interview schedule and focus group discussions as sources of data. Data was treated through descriptive statistics and the thematic approach. Based on the study findings, the study concluded that despite the fact that the ministry of education, science and technology highly advocated the use of Competency based Curriculum, the use of the approach was minimal due to limited instructional resources, limited time and large number of students in the classrooms. As a result, the use of the teacher centered approach dominated the teaching and learning sessions at the expense of demonstration, role play, group discussion and study tour learning strategies. The study recommends a need to provide regular seminars and workshops to teachers for them to realize the importance of applying the competence based approaches and to actually employ the same in the teaching and learning process.

Introduction Coral reefs as key ecosystems in Zanzibar are exposed to several anthropogenic and natural stressors. Methods The benthic composition and coverage of coral reefs were investigated on three data sets involving ten coral reefs monitored from 1992 to 2016. Firstly, we investigated differences in the reef composition using data from seven reefs in 2015. Secondly, we analyzed communities on three distinctive reefs (2010 to 2012) to understand the importance of seasons and reef zones (slope, crest and flat) on species abundance. Finally, we investigated long-term changes (1992 to 2016) of five reefs. Results Branching Porites and Acropora, and soft coral order Corallimorpharia, characterized sheltered reef communities. Soft corals and algal species characterized the reef communities exposed to strong hydrodynamic conditions, which also displayed greater cover of rocks and rubbles. The average dissimilarity between reefs ranged between 60% and 75%. The seasonal changes in community structure for reefs near Stone Town were mostly associated with soft coral Corallimorpharia. Indeed, the bare rock and algae distinguished the northern exposed reef from more sheltered reefs. Acropora was a key genus for the sheltered Chumbe reef, which explained between 14% and 18% of the dissimilarities among the three reefs. Hard corals covered between 40% and 70% in most years, with severe declines following El Niño events in 1998 and 2016. The dominating genus Acropora showed a strong decline from the late 1990s’ with signs of recovery at remote reefs compared to reefs closer to human residence. Discussion Our results highlight the importance of seasonality and spatial differences, reflecting differences in human impact and physical exposure and significant long-term changes in coral communities. Continued monitoring of reef health is essential to evaluate the success of ongoing management to sustain the reef services.