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Newsletter of the National Institute for Medical Research

______________________Tanzania______________________

Volume 4, Issue 1, January 2011

NEW YEAR MESSAGE FROM THE DIRECTOR GENERAL Dear Directors and all NIMR Staff I thank you for your support and efficiency in implementing NIMR obligations of the year 2010, apart from the drawbacks which you have been experiencing. I would like to thank NIMR Management for your efforts to promote the “One NIMR” culture through teamwork and collaborative initiatives in doing research with other partners at local and international level.

As we have started this New Year 2011 and this third quarter, it’s a good time to look back, reflecting on where are we coming from, our achievements, challenges facing us and the way forwards of meeting these challenges as well as looking forwards to see what we still need to accomplish over this year. I am excited to see that throughout last year NIMR’s human resource capacity has been a fundamental part of the whole research capacity strengthening agenda, which has allowed us to address the country research priorities, develop strong scientific solutions and put them into practice. In 2010, the Institute has been growing in terms of size and scope to keep pace with the ever-changing environment and respond to challenges. We have been able to expand our staffs to 490 and transform our research approaches from a diseases specific approach to a current wider mandate that includes all health research at the local, regional, zonal and national levels. The institute has also been transforming and restructuring to perform its mandated functions more effectively and efficiently. At least 22 new staffs were employed last year in order to improve our institution’s human resource capacity. I welcome all new staff and those who won new promotions, and I am expecting a high level of technical support from you, cooperation and hardworking in fulfilling NIMR mandates and making our research initiatives a success. In this year, NIMR will continue with researches on malaria vaccine, HIV/AIDS trial vaccines, neglected tropical diseases, tuberculosis direct observed treatment, and other chronic diseases. The institute has been working very collaboratively with the Ministry of Health and Social Welfare in the implementation of the National Disease control and Management Program in the country. The institute has been collaborating at with Tanzania national programmes on malaria control, tuberculosis and leprosy and Aids Control. NIMR is also Secretariat of the National

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Neglected Tropical Diseases Programme. As you are aware, throughout 2010 NIMR has been in the fore front in publishing Tanzania Journal of Health Research, which comes out four times a year. Furthermore, our institution has successfully managed to promote its image and activities through various national events such as International Trade Fair (Sabasaba) and the National Farmers Day (Nanenane) through participation in exhibitions. NIMR has been coordinating these activities with high level of integrity to the extent of helping the Ministry of Health and Social Welfare to become an overall winner for the Nanenane 2010. At this glance let me strongly commend all NIMR staff for this efficiency based successes of the institute and I congratulate you for your active participation in celebrations to mark 30 th anniversary of our institution. NIMR 30th Anniversary Celebrations was an eye opener to Tanzanians as it has expanded their knowledge about institutional activities and the role played in improving health status of people through evidence based research. Dear Colleagues, where there is sustainable development the challenges are always at the back. Indeed, successes in these endeavours had been made possible due to the strong research collaborations with local as well as international research institutions. These research collaborations among institutions had enabled the Institute come up with evidence based results which have guided policy makers to make health reforms. Great institutional challenges ahead of us include the capacities to develop proposals which will attract more sources of fund, improve our human resource capacity in the field of administration and improve our infrastructures especially in some of our centres. Of recent, I have been appointed by His Excellency President Jakaya Mrisho Kikwete, to be the Director General of NIMR, I believe that behind this successes are the NIMR staff supports and contributions which catalyzed for a better output in the promotion of better health through research. Under this new phase of my leadership, the institute will continue establishing best techniques to rectify salary scales of staff, that every staff enjoys the advantage of working at NIMR. And at the outset I want to thank you all, especially those of you who are far from your homes, conducting researches in remote places. Thank you for all your hard work. I wish you all the very best for this year and the following final quarter to come. May the lord bless you and your families for the great successes for NIMR and your families.

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NIMR at 30: Three Decades of Health Research in Tanzania By Koleta Njelekela

Thirty years of existence of the National Institute for Medical Research is a major milestone which signifies maturity and a turning point in health research. The Director of Information Technology and Communication Dr. Leonard Mboera noted this observation in a book entitled NIMR at 30: History, Development, Achievements and Success Stories, officially launched during a symposium held on 20th October 2010. Dr. Mboera further elaborated areas of progress reached by NIMR in the last 30 years as expansion of research areas, strengthening in research capacity, research coordination and control and the improvement in administrative and financial structures related to managing research. Citing examples on institutional achievements, Dr. Mboera said mosquito behavioural studies conducted during the 1990s at Amani have contributed immensely on our knowledge on malaria and fiilariasis mosquitoes’ host-finding behaviour. “Mosquito host-seeking knowledge generated by Amani scientists provided the basis for the changes in mosquito trapping techniques using light traps that is used to monitor mosquitoes and determine the inoculation rates” he emphasized.

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The Permanent Secretary of the Ministry of Health and Social Welfare Ms. Blandina Nyoni (C) launching a book titled NIMR at 30: History, Development, Achievements and Success Stories, during NIMR 30th Anniversary in October, 2011. On her right is the Chair of NIMR Council Professor Samuel Maselle and NIMR Acting Director General Dr. Mwelecele Malecela

Amani Centre provided the first evidence that treated mosquito nets lower malaria transmission and thereafter strongly promoted treated net scale-up. The Centre also evaluated a number of pyrethroid treated materials that has including the currently long lasting insecticide treated nets. According to Dr. Mboera NIMR Amani has generally contributed in generating research evidence that informed scaling up the long lasting mosquito nets in Tanzania and other African countries. Clinical trials conducted by Amani Centre and other collaborators on antimalarial chemotherapy, supportive therapy in paediatric and epidemiological studies on causes of febrile illness have provided evidence based information useful for appropriate disease management for an overall goal of improving health in Tanzania and Africa at large. For instance, studies conducted by the Centre has contributed substantially in setting performance indicators for health sector reform in Tanzania; generated evidence that contributed to changing antimalarial drug policy from chloroquine to sulphadoxine pyremithamine and generating evidence to inform policy decisions on intermittent preventive treatment of malaria during pregnancy and in infants. The centre has also been involved in programmes evaluations such as Tanzania National Voucher Scheme on Mosquito nets for pregnant women and young children and monitoring the effect of the Tanzanian National Lymphatic Filariasis Elimination Programme; monitoring susceptibility of mosquitoes to insecticide used for treating bed nets, other materials as well as indoor residual spraying.

Dr. Robert Malima briefing the Permanent Secretary of the Ministry of Health and Social Welfare, Ms. Blandina Nyoni on the use of Mosquito Spheres in mosquito behavioural studies during the NIMR 30th Anniversary

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Another area which NIMR signifies maturity and a turning point in health research is the area of clinical trials of malaria vaccines by its Tanga Centre. In the past five years, three malaria vaccine trials (RTS,S Phase IIb, MSP3 Phase Ib and RTS,S Phase III) have been carried out by the Centre through Joint Malaria Programme. The vaccine trials received funding from PATH-MVI and MCTA. The findings of the trial showed that the RTS,S/ASO1E vaccine was safe and able to protect 53% of the children against malaria infection. The Director of NIMR Tanga Dr. Martha Lemnge projected that if the vaccine will be found safe and efficacious, it will eventually be endorsed by regulatory authorities for use in children under the national expanded programme on immunization and will likely to contribute towards malaria elimination. Over the period of 30 years, Mwanza Centre has expanded its research portfolio from research on schistosomiasis and intestinal helmith infections to research on the control of HIV and other sexually transmitted infections (STIs), malaria and tuberculosis. In recent year, Mwanza Centre has been involved in studies on the management of syphilis including rapid syphilis testing in antenatal care and its feasibility of integrating into prevention of mother-to-child transmission of HIV programmes in Tanzania. The Mwanza Centre Director, John Changalucha earlier noted that since the introduction of rapid syphilis test in September 2009 until June, 2010, a total of 40,201 pregnant women have been tested for syphilis and 11.4% were found infected with the syphilis germ. Of these, 92% were appropriately treated. Commenting on the impact of improved management of STIs on HIV transmission, Mr Changalucha said “studies involving 12000 participants conducted by Mwanza Centre between 1991 and 1994, showed that improved treatment of STIs reduced the incidence of HIV by 40%. These findings formed the bases for the establishment of the National Control Programme for Sexually Transmitted Diseases within the Ministry of Health and Social Welfare.

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Mbeya Medical Research Programme: Promoting Mobile Diagnostic and Training Service in Southern Highlands of Tanzania Mbeya Medical Research Programme (MMRP) was founded in 1996 when the Mbeya Regional Medical Office, Mbeya Referral Hospital and Department of Infectious Diseases and Tropical Medicine of the University of Munich (LMU) conducted small collaborative studies on HIV/AIDS in the southern highland regions of Tanzania. The first formal project was established under European Commission (EC) support in 2000. The US Military HIV Research Programme (USMHRP) joined MMRP in 2001 and collaboration with the National Institute of Medical Research (NIMR) started in 2004. The centre was officially inaugurated to become a NIMR collaborative centre by His Excellency, Dr. Jakaya Kikwete, the President of the United Republic of Tanzania on the 18 th October 2008. MMRP was gazetted as Mbeya Research Centre of the National Institute for Medical Research in November 2010. MMRP started the Mobile Diagnostic and Training Centre under a four (4) year EC funded Active Detection of Active Tuberculosis (ADAT) project in June 2007. The MDTC was established to facilitate early diagnosis of HIV/AIDS and tuberculosis in collaboration with the health facilities in the rural communities using modern laboratory equipment, hence shortening the diagnosis time and facilitate early treatment of the diseases. The diagnosed patients are therefore, immediately referred to the treatment centres. Other objectives include training of health facility workers within the communities served by the MDTC and ensure quality control of the laboratory services in the respective health facilities; and providing health education to the community members using video/film shows. After piloting in July 2009, the actual MDTC services started in October, 2009 in Mbeya Region. In 2010 the MDTC participated and provided services in 2 national events namely, Sabasaba and Nanenane exhibitions, in Dar es Salaam and Dodoma, respectively.

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Dr. Leonard Maboko (R) of MMRP, Ministry of Health and Social Welfare Permanent Secretary, Ms Blandina Nyoni (C), and Dr. Mwelecele Malecela (L) at the MMRP pavilion during the 30 th NIMR Anniversary

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Motorcycle injuries accounts 37.5% of all road traffic injuries in Mwanza, a study has revealed By Koleta Njelekela

Motorcycle injuries constituted a major but neglected public health problem accounting for 37.5% of all road traffic injuries seen at Bugando Medical Centre, in Mwanza region. A study on Motorcycle injuries as an emerging public health conducted in Mwanza City, in north western Tanzania has revealed. These statistics were obtained from a 2-year descriptive cross-sectional that involved motorcycle injuries among patients of all age groups who presented to the Accident and Emergency Department of Bugando Medical Centre between March 2009 and February 2010. An exclusive interview with the Principal Investigator, Dr. Phillipo Chalya, revealed that motorcyclists accounted for 55.2% for the majority of motorcycle injury patients at Bugando Medical Centre, followed by passengers (33.9%) and “pedestrians” who accounted 10.9% of the victims. Dr. Challya attributed to rise in motorcycle accidents and injuries in Mwanza City to over-speed, passengers and luggage overload, recklessness, indiscipline and lack of respect for other road users by the motorcyclists. “Other reasons include non-helmet use by riders and their passengers, lack of certified and valid licensing, poor regulation and law enforcement, underdeveloped infrastructures and underemployment and possible use of alcohol and drugs by motorcyclists” Dr. Challya added.

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A sharp rise in public transport costs in urban areas is contributing to the misuse of motorcycles as seen in the above photo captured recently in the city. In an effort to convince more drivers to strap on a helmet in Tanzania, there is a need to sensitize motorcyclists on “helmet wearing culture”. Motorcycle transport commonly known as “bodaboda” in Uganda and Kenya and ‘‘okada’’ in Nigeria, has recently become increasingly popular in Tanzania as a means of commercial transport. This can be due to the following reasons; they are a quick means of transport especially for short distances in cities and towns, they are efficient in mitigating traffic jam delays in the cities and they are available throughout the day and night hours. Dr. Challya further noted that despite the burden of the problem in Mwanza City, motorcycle injuries have not received the attention they deserve partly because of lack of local data, and the public policy responses to this epidemic have been muted at regional and national level. He said to establish prevention strategies and treatment protocols, comprehensive collaborative efforts are needed by all stakeholders to understand the magnitude of the problem, contributing factors, injury patterns and outcome of these patients. This article has been published as: in Tanzania Journal of Health Research, Vol 12 (4) October 2010 ===========================================

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Vaccination against tuberculosis boosts the chance of cure in TB patients A research scientist with NIMR Mwanza, Dr Jeremiah Kidola noted recently that the BCG vaccine (the vaccine against tuberculosis) which protects primarily against tuberculosis of the brain membranes and lungs in children has been shown to provide a varying degree of protection against tuberculosis of the lungs among adults. It was initially assumed that the protective effect of the TB vaccine lay in its ability to reduce TB of the lungs, and thus limit the ability of the bacteria to multiply and spread during the course of the disease. In his recent publication in Thorax (one of the most prestigious journals of chest diseases), Dr. Kidola said that until today the positive effects of the BCG vaccine are yet to be known with certainty. In his prospective study conducted recently in Tanzania with a sample of 546 tuberculosis patients, it was discovered that infected patients with a visible vaccination (BCG) scar, are 3 times more likely to be cured (within 2 months) than patients without a visible BCG scar during treatment. Previous studies have shown that patients who are still infected 2 months after the initiation of treatment run a high risk of relapsing. These findings emphasise the need for promoting early vaccination against tuberculosis as an important initiative for future TB control. BCG vaccine was first introduced in 1921 over 3 billion doses of vaccines have been administered in the fight against Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB). This article was published in Thorax 2010, 65, 1072-1076. =============================================

New Appointments DR. MWELECELE MALECELA

On 14th December 2010, His Excellency Dr. Jakaya Kikwete, the President of the United Republic of Tanzania, appointed Dr. Mwelecele Ntuli Malecela, Chief Research Scientist, to be the 3rd Director General of the National Institute for Medical Research. Before her new appointment, she was Director of Research Coordination and Promotion and Director of the Tanzania Lymphatic Filariasis Elimination Programmme of the Ministry of Health and Social Welfare. Dr. Malecela holds a BSc in Zoology from the University of Dar-es-salaam and an MSc and PhD in Parasitology from the University of London (London School of Hygiene and Tropical Medicine). Her area of specialization is filarial immunology specifically on filarial immune evasion mechanisms. Dr. Malecela has worked with the National institute for Medical Research for 23 years mainly in the field of Lymphatic Filariasis immunoepidemiology and in Health Systems and Policy research. Dr Malecela has been in the forefront of priority setting for health research activities in Tanzania where she facilitated the Tanzania National Health Research Priority Setting process in 1999 and revision of these priorities in 2005. Dr. Malecela has served on a number of international committees including The Technical Advisory Group of The Global Program to Eliminate Lymphatic Filariasis, The Mectizan Expert Committee and

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the advisory board of the Initiative on Public-Private Partnerships in Health (IPPPH). Mwele is currently a member of the WHO Strategic and Technical Advisory Committee for Neglected Tropical Diseases and a member of the Medicine in Need steering Committee on Innovation, Alliance and Translation Management (MITAM). Mwele is also an adjunct faculty member of the Public Health Sciences Institute of Morehouse College. DR. WILLIAM N. KISINZA

On 16th December 2010, the NIMR Council has appointed Dr. William Kisinza, Principal Research Scientist as the new Centre Director of the Amani Medical Research Centre. Dr. Kisinza takes over Dr. Stephen M. Magesa, who is currently on leave without pay. Before his new appointment, Dr. Kisinza was the Head of Amani Hill Research Station from (2007-2010). Kisinza is a PhD holder (Tropical Medicine-Epidemiology) and MSc in Medical Entomology & Parasitology from the Liverpool School of Tropical Medicine, University of Liverpool in the United Kingdom. He graduated a BSc (Hons) degree in Applied Microbiology, Zoology and Marine Biology in the faculty of science from the University of Dar es Salaam, Tanzania in 1995. Dr. Kisinza joined the National Institute for Medical Research in 1996 as a Research Scientist (Medical Entomology). Over 15 years has substantial experience in fieldwork covering entomological and parasitological research especially in appropriate technologies for vector control, vector ecology, insecticide resistance, epidemiology and molecular entomology of malaria vectors and Tick-Borne Relapsing Fever. He was in one of the leading group of researchers who discovered a new pathogenic Borrelia species that transmits tick-borne relapsing fever in Tanzania. He has published 30 scientific papers in peerreviewed journals. Dr. Kisinza is a member of several committees and boards both nationally and internationally, Tanzania Public Health Association, African Medical Entomological Association, and British Society for Parasitology, African Network on Vector Resistance, Innovative Vector Control Consortium, African Vector Control New Tool Consortium and Roll Back Malaria Vector Control Working Group. =================================

WHO IS WHO AT NATIONAL INSTITUTE FOR MEDICAL RESEARCH THRESIA ESTOMIH NKYA

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Theresia Nkya, Research Scientist, holds a BSc degree in Biology from the Texas Southern University and MSc in Parasitology and Medical Entomology from Muhimbili University of Health and Allied Sciences where she was the first and only graduate of that degree and was awarded a prize for best academic performance. Ms. Nkya joined the National Institute for Medical Research in 2007. She was posted to Amani Research Centre where she worked on Health Systems and Policy Research. She has participated in a multi country study on community directed intervention (CDI). Ms. Nkya is now on her PhD programme with Grenoble University and Kilimanjaro Christian Medical College. Her area of study is “Selection pressure influencing pyrethroid resistance in Anopheles gambiae� Ms. Nkya is a strong advocate of empowering women mainly in medical field. She is working into establishing a coalition of young women scientists in Tanzania focusing on health research. She expects that this initiative will bring more women into science research and opting them to apply higher positions in this field. ================================

CHACHA MANGA

Mr. Chacha Manga, Research Assistant (Public Health), joined the National Institute for Medical Research, Tabora Centre in 2006. He is a holder BA in Resource Assessment and Environment Management of University of Dar-es-Salaam and Master of Public Health (MPH) of the Kilimanjaro Christian Medical College Tumaini University. During his time with NIMR, Mr. Manga has carried out a number of studies on Sleeping Sickness, Malaria and HIV/AIDS. His recent MPH dissertation, Mr. Manga carried out an Assessment on the Quality of Malaria Microscope Slide Readings at District Hospital in Tanzania. Before joining NIMR, Mr. Manga worked with the National Environment Management CouncilTanzania as Environmental Management Officer (2001-2002). Mr. Manga is a member of Tanzania Public Health Association and Joint Environment Action Management. Currently, in addition to his research duties, he is providing free public health education to community living in Tabora. =============

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A total of 13 articles have been published in the Tanzania Journal of Health Research Volume 13, No. 1 of January 2011: 1. Reaching the poor through community-based distributors of contraceptives: experiences from Muheza district, Tanzania. Daudi Simba, Cordula Schuemer, Kate Forrester and Merriment Hiza 2. Prevalence of intestinal parasites in relation to CD4 counts and anaemia among HIV-infected patients in Benin City, Edo State, Nigeria. Frederick O. Akinbo, Christopher E. Okaka and Richard Omoregie 3. Smear positive pulmonary tuberculosis among HIV patients receiving Highly Active Antiretroviral Therapy in Dar es Salaam, Tanzania. Veneranda M. Bwana, Filemoni Tenu, Stephen M. Magesa and Sayoki G. Mfinanga 4. Tuberculosis-HIV co-infection among patients admitted at Muhimbili National Hospital in Dar es salaam, Tanzania. Pili Kamenju and Said Aboud 5. The role of HIV counselling and testing in sexual health behaviour change among undergraduates in Lagos, Nigeria. Onipede Wusu and Saturday Okoukoni 6. Anaemia among pregnant women in northern Tanzania: prevalence, risk factors and effect on perinatal outcomes. Sia E. Msuya, Tamara H. Hussein, Jacqueline Uriyo, Noel E. Sam and Babill Stray-Pedersen 7. Detecting adenosine triphosphatase 6 point mutations that may be associated with Plasmodium falciparum resistance to artemisinin: prevalence at baseline, before policy change in Uganda. Erasmus Kamugisha, Hakim Sendagire, Mark Kaddumukasa, Nizar Enweji and Fatemeh Gheysari 8. Performance of ParaHit and OptiMAL tests in the diagnosis of malaria in Mwanza, northwestern Tanzania. Simon N. Buhalata and Julius J. Massaga 9. Transmission intensity and malaria vector population structure in Magugu, Babati District in northern Tanzania. Charles Mwanziva, Jovin Kitau, Patrick K. Tungu, Clement N. Mweya, Humphrey Mkali, Chacha Ndege, Alex Sanga, Charles Mtabho, Charles Lukwaro, Salum Azizi, Joseph Myamba, Jaffu Chilongola, Stephen M. Magesa, Seif Shekalaghe and Franklin W. Mosha 10. A retrospective study of Human African Trypanosomiasis in three Malawian districts. John E. Chisi, Adamson S. Muula, Bagrey Ngwira and Stone Kabuluzi 11. Reducing therapeutic injection overuse through patients-prescribers Interaction Group Discussions in Kinondoni District, Dar es Salaam, Tanzania. Amos Y. Massele, Yohana J. Mashalla, I. Kayombo, J. Mwaiselage, Natu E. Mwamba and I. Kaniki 12. Aetiological spectrum, injury characteristics and treatment outcome of head injury patients at Bugando Medical Centre in north-western Tanzania. Phillipo L. Chalya, Emmanuel S. Kanumba, Joseph B. Mabula, Godfrey Giiti and Japhet M. Gilyoma 13. Recurrent, massive Kaposi’s sarcoma pericardial effusion presenting without cutaneous lesions in an HIV infected adult: a Case Report. Rodrick Kabangila, William Mahalu, Nestory Masalu, Hyasinta Jaka and Robert N Peck.

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NIMR Publications, October-December 2010 1) Kidola, J., PrayGod, G., Faurholt-Jepsen, D., Range, N., Andersen, A.B., Grewal, H.M.S. & Friis, H. (2010) BCG vaccination status may predict sputum conversion in patients with pulmonary tuberculosis: a new consideration for an old vaccine. Thorax 65, 1072-1076. 2) Aabye, M.G., Ruhwald, M., PrayGod, G., Jeremiah, K., Faurholt-Jepsen, M., Faurholt-Jepsen, D., Range, N., Friis, H., Changalucha, J., Andersen, A.B. & Ravn, P. (2010). Potential of interferon-yinducible protein in improving tuberculosis diagnosis in HIV-infected patients. European Respiratory Journal 36 (6(, 1488-1490. 3) Kitau, J., Pates,H., Rwegoshora, T.R., Rwegoshora, D., Matowo, J., Kweka, J., Kweka, E.J., Mosha, F.W., McKenzie, K. & Magesa, S.M. (2010) The effect of mosquito Magnet Liberty Plus trap on the human mosquito biting rate under semi-field conditions. Journal of the American Mosquito Control Association 26 (3), 287-294. 4) Mboera, L.E.G., Massaga, J.J., Munga, M.A., Mayala, B.K., Kahwa, A.M., Msovela, J., Shija, A., Mushi, A.K. & Kilale, A.M. (2010) Health Services Availability at Various Levels of the Health System in Tanzania. National Institute for Medical Research, Dar es Salaam, Tanzania 5) Mosha, J.F., Conteh, L., Tediosi, F., Gesase, S., Bruce, J., Chandramoha, D. & Gosling, R. (2010) Cost implications of improving malaria diagnosis: findings from north-eastern Tanzania. PLoS One 5 (1), e8707. 6) Range, N.S., Malenganisho, W., Temu, M.M., Changalucha, J., Magnussen, P., Krarup, H., Andersen, A.B. & Friis, H. (2010) Body composition of HIV-positive patients with pulmonary tuberculosis: a cross sectional study in Mwanza, Tanzania. Annals of Tropical Medicine and Parasitology 104, 81-90. 7) Tungu, P., Magesa, S., Maxwell, C., Malima, R., Masue, D., Sudi, W., Myamba, J., Pigeon, O. & Rowland, M. (2010) Evaluation of PermaNet 3.0 a deltamethrin-PBO combination net against Anopheles gambiae and pyrethroid resistant Culex quinquefasciatus mosquitoes: an experimental hut trial in Tanzania. Malaria Journal 9:21 NIMR Highlights is available at: www.nimr.or.tz ___________________________________________________________________________

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Newslater Jan 2011