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BACKGROUND: Parkinson's disease (PD) is the second most common neurodegenerative disorder and, according to the Global Burden of Disease estimates in 2015, was the fastest growing neurological disorder globally with respect to associated prevalence, disability, and deaths. Information regarding the awareness, diagnosis, phenotypic characteristics, epidemiology, prevalence, risk factors, treatment, economic impact and lived experiences of people with PD from the African perspective is relatively sparse in contrast to the developed world, and much remains to be learned from, and about, the continent. METHODS: Transforming Parkinson's Care in Africa (TraPCAf) is a multi-faceted, mixed-methods, multi-national research grant. The study design includes multiple sub-studies, combining observational (qualitative and quantitative) approaches for the epidemiological, clinical, risk factor and lived experience components, as appropriate, and interventional methods (clinical trial component). The aim of TraPCAf is to describe and gain a better understanding of the current situation of PD in Africa. The countries included in this National Institute for Health and Care Research (NIHR) Global Health Research Group (Egypt, Ethiopia, Ghana, Kenya, Nigeria, South Africa and Tanzania) represent diverse African geographies and genetic profiles, with differing resources, healthcare systems, health and social protection schemes, and policies. The research team is composed of experts in the field with vast experience in PD, jointly led by a UK-based and Africa-based investigator. DISCUSSION: Despite the increasing prevalence of PD globally, robust data on the disease from Africa are lacking. Existing data point towards the poor awareness of PD and other neurological disorders on the continent and subsequent challenges with stigma, and limited access to affordable services and medication. This multi-site study will be the first of its kind in Africa. The data collected across the proposed sub-studies will provide novel and conclusive insights into the situation of PD. The selected country sites will allow for useful comparisons and make results relevant to other low- and middle-income countries. This grant is timely, as global recognition of PD and the public health challenge it poses builds. The work will contribute to broader initiatives, including the World Health Organization's Intersectoral global action plan on epilepsy and other neurological disorders. TRIAL REGISTRATION: https://doi.org/10.1186/ISRCTN77014546 .

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This study tested genetic microbial source tracking (MST) methods for identifying ruminant- (BacR) and human-associated (HF183/BacR287, BacHum) bacterial faecal contaminants in Ethiopia in a newly created regional faecal sample bank (n = 173). BacR performed well, and its marker abundance was high (100% sensitivity (Sens), 95% specificity (Spec), median log10 8·1 marker equivalents (ME) g-1 ruminant faeces). Human-associated markers tested were less abundant in individual human samples (median: log10 5·4 and 4·2 (ME + 1) g-1 ) and were not continuously detected (81% Sens, 91% Spec for BacHum; 77% Sens, 91% Spec for HF183/BacR287). Furthermore, the pig-associated Pig2Bac assay was included and performed excellent (100% Sens, 100% Spec). To evaluate the presence of MST targets in the soil microbiome, representative soil samples were tested during a whole seasonal cycle (n = 60). Only BacR could be detected, but was limited to the dry season and to sites of higher anthropogenic influence (log10 3·0 to 4·9 (ME + 1) g-1 soil). In conclusion, the large differences in marker abundances between target and non-target faecal samples (median distances between distributions ≥log10 3 to ≥log10 7) and their absence in pristine soil indicate that all tested assays are suitable candidates for diverse MST applications in the Ethiopian area.

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A study was conducted in Hanang District to assess potential for on-farm feedlot finishing of Tanzanian Shorthorn Zebu (TSHZ) in dry season using locally available feed resources. A total of 65 (2-3 years old, 150-250 kg LWT) steers were randomly distributed into two dietary treatments in three villages. The steers were finished either in feedlots using compounded diets or under free grazing in accordance with farmers' practice. Following 90 days of feeding, all steers were slaughtered for detailed carcass and meat quality assessment. Growth performance, carcass and meat quality of experimental animals were assessed to determine feedlot performance of TSHZ. Results show that average daily gain of feedlot-finished animals (620 g/day) was nearly three-fold higher (P = 0.042) than that of grazed steers (223 g/day). Feedlot-finished steers produced 28 kg (P = 0.001) heavier carcasses than grazed ones. Carcasses from feedlot-finished steers cooled slowly as they had higher (P = 0.001) temperatures than that of grazed ones at 45 min (33.1 vs. 30.5 °C) and 6 h (21.0 vs. 19.5 °C) post-mortem. Feedlot-finished steers produced beef with higher (P = 0.003) marbling scores (3.4) than grazed ones (2.4). As a result, beef from the feedlot-finished steers was more tender (P = 0.016) than that from grazed ones, and it required 13 N less force to shear. It is concluded that TSHZ responds positively to improved feeding with significant enhancement on carcass gain and meat quality. Use of diets compounded using agro-processing by-products, instead of whole grain, can lower the cost of finishing TSHZ steers significantly.

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OBJECTIVE: To examine the association between postpartum depression and child growth in a Tanzanian birth cohort. DESIGN: Prospective cohort study. SETTING: Moshi, Tanzania. POPULATION: Pregnant women over the age of 18 who sought antenatal care at two health clinics in Moshi, and the children they were pregnant with, were assessed for inclusion in this study. METHODS: The women were interviewed twice during pregnancy and three times after birth, the final follow up taking place 2-3 years postpartum. Signs of postpartum depression were assessed approximately 40 days postpartum with the Edinburgh Postnatal Depression Scale. MAIN OUTCOME MEASURES: Child growth was assessed with anthropometric measurements at 2-3 years of age and expressed as mean z-scores. RESULTS: In all, 1128 mother-child pairs were followed throughout the duration of the study. In total, 12.2% of the mothers showed signs of postpartum depression. Adjusted mean height-for-age z-score (HAZ) was significantly lower at 2-3 years follow up for children of mothers with postpartum depression than for children of mothers without (difference in HAZ: -0.32, 95% CI-0.49 to -0.15). Adjusted mean weight-for-height z-score (WHZ) was significantly increased for the children exposed to postpartum depression (difference in WHZ: 0.21, 95% CI 0.02-0.40), whereas there was no significant difference in adjusted weight-for-age z-score (WAZ; difference in WAZ: -0.04, 95% CI -0.20 to 0.12). CONCLUSIONS: We found that postpartum depressive symptoms predicted decreased linear height in children at 2-3 years of age and slightly increased weight-for-height. TWEETABLE ABSTRACT: Postpartum depression in Tanzanian mothers is associated with impaired child growth at 2-3 years of age.

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The detection and typing of Vibrio cholerae in natural aquatic environments encounter major methodological challenges related to the fact that the bacterium is often present in environmental matrices at very low abundance in nonculturable state. This study applied, for the first time to our knowledge, a whole-genome enrichment (WGE) and next-generation sequencing (NGS) approach for direct genotyping and metagenomic analysis of low abundant V. cholerae DNA (<50 genome unit/L) from natural water collected in the Morogoro river (Tanzania). The protocol is based on the use of biotinylated RNA baits for target enrichment of V. cholerae metagenomic DNA via hybridization. An enriched V. cholerae metagenome library was generated and sequenced on an Illumina MiSeq platform. Up to 1.8 × 107 bp (4.5× mean read depth) were found to map against V. cholerae reference genome sequences representing an increase of about 2500 times in target DNA coverage compared to theoretical calculations of performance for shotgun metagenomics. Analysis of metagenomic data revealed the presence of several V. cholerae virulence and virulence associated genes in river water including major virulence regions (e.g. CTX prophage and Vibrio pathogenicity island-1) and genetic markers of epidemic strains (e.g. O1-antigen biosynthesis gene cluster) that were not detectable by standard culture and molecular techniques. Overall, besides providing a powerful tool for direct genotyping of V. cholerae in complex environmental matrices, this study provides a 'proof of concept' on the methodological gap that might currently preclude a more comprehensive understanding of toxigenic V. cholerae emergence from natural aquatic environments.

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The aim of the experiment was to study the effect of feeding system on meat quality characteristics of Small East African (SEA) goats and their crosses with Norwegian (SEA×N) goats finished under small scale farming conditions. Twenty four castrated goats at the age of 18 months with live body weight of 16.7±0.54 kg from each breed (SEA and SEA×N) were distributed in a completely randomized design in a 2×3 factorial arrangement (two breed, and three dietary treatments). The dietary treatments were; no access to concentrate (T0), 66% access to ad libitum concentrate allowance (T66) and 100% access to ad libitum concentrate allowance with 20% refusal (T100) and the experimental period was for 84 days. In addition, all goats were allowed to graze for 2 hours daily and later fed grass hay on ad libitum basis. Daily feed intakes were recorded for all 84-days of experiment after which the animals were slaughtered. Feed intake of T100 animals was 536 g/d, which was 183 g/d higher than that of T66 group. Supplemented goats had significantly (p<0.05) better feed conversion efficiency. The SEA had higher (p<0.05) hot carcass weight (8.2 vs 7.9 kg), true dressing percentage (54.5 vs 53.3) and commercial dressing percentage (43.3 vs 41.6) compared to SEA×N. There was no significant difference (p>0.05) for dressing percentage and carcass conformation among supplemented goats except fatness score, total fat depots and carcass fat which increased (p<0.05) with increasing concentrate levels in the diet. Increasing level of concentrate on offer increased meat dry matter with subsequent increase of fat in the meat. Muscle pH of goats fed concentrate declined rapidly and reached below 6 at 6 h post-mortem but temperature remained at 28°C. Cooking loss and meat tenderness improved (p<0.05) and thawing loss increased (p<0.05) with ageing period. Similarly, meat tenderness improved (p<0.05) with concentrate supplementation. Shear force of muscles varied from 36 to 66, the high values been associated with Semimembranosus and Gluteobiceps muscles. The present study demonstrates that there are differences in meat quality characteristics of meat from SEA goats and their crosses with Norwegian breeds finished under small scale farming conditions in rural areas. Therefore, concentrate supplementation of goats of both breeds improves meat quality attributes.

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This study is set to match and compare results of the analysis of impacts of cost sharing on households with those on health-care providers in two selected districts in Tanzania. The setting is intended to establish and compare concurrently the impact of cost sharing on health-care utilization as viewed from both the providers and beneficiary households. The findings of the study indicate that quality of primary health care has improved as a result of the introduction of cost sharing. Attendance and hence utilization in health facilities has also increased. Mortality rate, at least for one district has not worsened. By implication then, cost sharing appears to have a positive impact on the provision of primary health care, except for a few cases that fail to consult because of the fees. An appropriately managed exemption facility is likely to eliminate the negative impact.

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The effects of epilepsy on children and their families, factors influencing the treatment and education gap and socio-cultural beliefs about epilepsy in children in rural sub-Saharan Africa are not clearly defined. We conducted a qualitative study, with 38 in-depth interviews and 2 focus group discussions with carers of children with epilepsy (CWE) in Tanzania. Discrimination, isolation and lack of hope were identified as major issues. Poor school attendance was attributed to learning difficulties, behavior problems, ongoing seizures and restricted school access. The treatment gap was related to misdiagnosis, preferential use of traditional treatment and cost of biomedical treatment. The hopes expressed for the future centered on access to treatment and education. Improved access to diagnosis, cost-effective treatment, sensitization of the community on epilepsy, collaborative care provision with traditional and faith healers and improved access to specialist schooling could improve the quality of life and future of CWE in this region.

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The difficulty of diagnosing HIV in infants is a major obstacle to early antiretroviral therapy (ART) in resource-limited settings. As serological tests are unreliable during the first 18 months of life, and the cost and complexity of polymerase chain reaction (PCR)-based assays limit their access in resource-limited settings, p24 antigen detection has emerged as an alternative diagnostic tool. In this study, the performance of an ultrasensitive p24 antigen assay on dried blood spots was evaluated under field conditions in rural Tanzania. Specimens were stored and shipped at tropical room temperature, and analysed within six weeks. In total, 27 consecutive children aged <18 months and exposed to vertical HIV transmission were enrolled. Overall sensitivity and specificity was 100% (95% confidence interval [CI], 47.8-100) and 95.5% (95% CI, 77.2-99.9), respectively. Our findings suggest that detection of p24 antigen on dried blood spots can be a reliable and feasible diagnostic tool for infant HIV infection in rural resource-limited settings.

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OBJECTIVE: Understanding the social-cultural aspects of epilepsy in sub-Saharan Africa will help to improve the situation of people with epilepsy (PWE) in this region. METHODS: This qualitative study comprised interviews with 41 PWE and their carers. Participants were identified from a large community-based epidemiological study of epilepsy conducted in 2009. RESULTS: Epilepsy was commonly ascribed to witchcraft and curses. Nearly all PWE demonstrated pluralistic care-seeking behavior, including the use of prayers and traditional healers alongside modern care. PWE reported discrimination as a result of their condition. The majority of PWE had suffered burns during seizures. CONCLUSIONS: Poor knowledge and strong cultural and religious beliefs characterize the experience of PWE in this population. Epilepsy-related stigma contributes to overall disease burden, and PWE face exclusion across major life domains. There is a need to educate communities and inculcate perceptions and attitudes that promote early detection of epilepsy and early care-seeking behavior.

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Effects of supplementing Small East African (SEA) goats with concentrate diets on fatty acids composition of minced meat, M. longissimus dorsi (LD) and omental fat were assessed using 23 animals (14.5 months old and 20.1 kg body weight). Goats were subjected to four levels of concentrate supplementation: ad libitum concentrate allowance (T100), 66% (T66), 33% (T33) and 0% (T0) of ad libitum concentrate allowance. All goats were slaughtered after 90 days of experimental period. Minced meat from concentrate-supplemented goats had higher (P<0.05) proportions of unsaturated fatty acids (UFA), monounsaturated fatty acids (MUFA) and desirable fatty acid (DFA) than that of non-supplemented ones (T0). Minced meat from T00 and T66 goats had similar proportions of polyunsaturated fatty acids (PUFA) and n-6 PUFA that were higher (P<0.05) than that of other dietary groups. There was limited variation in fatty acids composition of LD attributable to concentrate supplementation. Trans-vaccenic and linoleic acids were in higher (P<0.05) proportion in omental fat from concentrate-supplemented goats whereas margaric and arachidonic acids were in higher (P<0.05) proportion in omental fat from non-supplemented goats. Overall, LD was associated with PUFA, omental fat with saturated fatty acids (SFA), minced meat with MUFA. It is concluded that finishing SEA goats on concentrate diets will increase the proportion of DFA in meat from them. In addition, the proportion of PUFA in meat from such goats will peak at concentrate supplementation equivalent to 66% of their ad libitum intake. Consumers should avoid high intake of internal fat due to their richness in SFA.

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Six female Norwegian lambs (29kg body weight, 8 months old), six castrated Norwegian goats (27kg body weight, 10 months old) and six castrated Cashmere goats (20kg body weight, 8 months old) were used to study the relative potential of Norwegian lambs, Norwegian goats and Cashmere goats for meat production. Animals were fattened on silage and commercial concentrate before slaughter. Lamb meat had 4 % lower (P<0.05) proteins and 13% higher (P<0.05) fat content than goat meats. Moreover, m. longissimus dorsi samples from lambs were less red (a(∗)) (P<0.05) and had lower colour intensity (C) and wider hue angle (H) than that from goats. Meat from lambs and Cashmere goats had higher proportions of saturated fatty acids (SFA) (P<0.001), especially stearic acid and lower ones for total unsaturated fatty acids (TUFA) and monounsaturated fatty acids (MUFA) than the meat from Norwegian goats. Sensory panellists scored lamb meat fattier, juicier and more tender than goat meats. Meat from Cashmere goats scored highest (P<0.05) in whiteness, and lowest (P<0.05) in both colour tone and colour intensity. It is concluded that, since C18:0 was the main contributor of SFA in meat from Norwegian lamb and Cashmere goats, meats from them are nutritionally comparable to that from Norwegian goats. However, the higher proportion of SFA in Norwegian lambs and Cashmere goats may increase hardness of fat and being easily solidified upon cooling, may influence meat palatability.