MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES

MUHAS RESEARCH AGENDA

MARCH 2021
List of Abbreviations

AIDS Acquired Immunodeficiency Syndrome

AMR Antimicrobial Resistance

AMU Antimicrobial Use

ART Anti-Retroviral Therapy

HIV Human Immunodeficiency Virus

HSSP Health Sector Strategic Plan

[Link] Mycobacterium Tuberculosis

MDR – TB Multi Drug Resistance Tuberculosis

MMR Maternal Mortality Rates

MoHCDGEC Ministry of Health, Community Development, Gender, Elderly

and Children

MSM Men Sex with Men

MUHAS Muhimbili University of Health and Allied Sciences

PLHIV People Living with HIV

RMNCA Reproductive,Maternal, New-born,ChildandAdolescentHealth

SDGS Sustainable Development Goals

TBT TB Preventive Therapy

THIS TanzaniaHIVImpactSurvey

TMDA Tanzania Medicines and Medical Devices Authority

UNAIDS United Nations Programme on HIV/AIDS

WHO World Health Organization

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Table of Contents
List of Abbreviations ................................................................................................................ i
Introduction............................................................................................................................... 1
Rationale................................................................................................................................... 2
Objectives of The Research Agenda ................................................................................... 2
Stakeholders ............................................................................................................................ 2
MUHAS Research Governance ............................................................................................ 3
Methodological Approach ...................................................................................................... 4
Research Themes ................................................................................................................... 4
Theme 1: HIV and AIDS ......................................................................................................... 5
Theme 2: Tuberculosis ........................................................................................................... 9
Theme 3: Malaria and Neglected tropical diseases......................................................... 12
Theme 4: Reproductive, Maternal, New-born, Child and Adolescent Health .............. 14
Theme 5: Non-Communicable Diseases (NCD) .............................................................. 18
Theme 6: Health systems research ................................................................................... 21
Theme 7: Social Determinants and Social Conditions of Health ................................... 24
Theme 8: Injuries................................................................................................................... 27
Theme 9: Emerging and Re-Emerging Infections ............................................................ 29
Theme 10: Oral Health ......................................................................................................... 31
Theme 11: Mental Health ..................................................................................................... 34
Theme 12: Pharmacovigilance and Rational use of Medicines ..................................... 36
Theme 13: Occupational Health and Safety ..................................................................... 38
Theme 14: Haematological Disorders................................................................................ 40
Theme 15: Traditional Medicines and Natural Products Development ........................ 45
Theme 16: Bioethics ............................................................................................................. 49
Theme 17: Drug Discovery and Formulation .................................................................... 51
Theme 18: Knowledge Management and Informatics ..................................................... 53

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Executive Summary

The Muhimbili University of Health and Allied Sciences (MUHAS) trains the largest
number of human resources for health in Tanzania, a responsibility it has shouldered
for almost sixty years. Apart from training health and allied personnel MUHAS, has
carried out a number of researches that have been instrumental in informing policy in
the areas of HIV and AIDS, Tuberculosis, malaria, reproductive health, nutrition,
health financing and other areas. These priority and key research areas engaged by
the MUHAS community for almost the past 10 years were guided by the enacted
research agenda. Given the update of the National Research Agenda and the rapidly
changing patterns of diseases/health conditions, there is great need and reason for
having a new and up to date MUHAS Research Agenda.

The University has taken a conscious effort to align itself with national initiatives for
development including Vision 2025, the National Strategy for Growth and Reduction
of Poverty and the implementation of the health-related Sustainable Development
Goals (SDGs). In this respect the University has identified strategic areas of
research that will be engaged by its faculty for the next 10 years to address the need
for generating results that will inform policy and therefore contribute to national
development initiatives. Through a consultative effort, the University has identified
eighteen (18) research themes to which it shall direct resources and efforts to ensure
tangible outputs for informing policy and for solving important national health
challenges. The research themes include:
Theme 1 HIV and AIDS
Theme 2 Tuberculosis
Theme3 Malaria and Neglected Tropical Diseases
Theme 4 Reproductive, Maternal, New-born, Child and Adolescent Health
Theme 5 Non-Communicable Diseases (NCD)
Theme6 Health Systems Research
Theme7 Social Determinants and Social Conditions of Health
Theme8 Injuries
Theme9 Emerging and Re-Emerging Infections
Theme 10 Oral Health
Theme 11 Mental Health
Theme12 Pharmacovigilance and Rational use of Medicines
Theme 13 Occupational Health and Safety
Theme 14 Haematological Disorders
Theme15 Traditional Medicines and Natural Products Development
Theme 16 Bioethics
Theme 17 Drug Discovery and Formulation

Theme 18 Knowledge Management and Informatics

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Introduction
The strengthening of the educational and health systems has been considered very
vital in attaining the development and are incorporated in such vision. Pertinent to
the health systems, the 2025 development vision for instance aims to attain some of
the following targets; reducing the child and maternal mortality rates, prevalence of
HIV/AIDS among pregnant women and promoting knowledge-based care among
health workers. As to implement the same vision, the revamping the education
sector/systems is considered of paramount importance as the rapidly changing
contemporary era is in high demand for innovative and highly technological and
scientific solutions. Thus, the Tanzania’s development agenda is guided by
aspirations that are articulated in the development vision.

The dynamics in health challenges encountered in everyday practices emanate from

the fact that, health conditions also evolve every now and then. This would then
imply that, there is growing need for researches that will address these
unprecedented situations and furthermore, the health professionals should possess
necessary research skills as well as be updated by the results from different
researches. Revamping of the health sector especially the higher learning institutions
is necessary for the expected outputs; highly skilled researchers with high quality
researches. In this context, the need for the Muhimbili University of Health and Allied
Sciences (MUHAS) to strengthen her engagement in essential health research is of
paramount importance in order to identify evidence-based solutions to priority health
problems, generate new knowledge, develop innovative and cost-effective
interventions for these problems and provide objective information for guiding
implementation of control and prevention strategies. In this way, MUHAS will be in
position to contribute to the reduction of non-income poverty that arises from poor
health.

The country is committed to her development vision as well as to other regional and
international vision and / or strategies including; The Health Sector Strategic Plan;
Sustainable Development Goals (SDGs) and Development Vision 2025 among
others. The University understands that, to achieve the health targets spelt out in
these policies, vision and strategies, there is a need to make concerted efforts and
initiate activities which are informed by research. In this way, the university may
carry on providing and contributing meaningful generated knowledge only if, some
research areas are prioritized by coming up with a revised/ updated and
implementable MUHAS research agenda. The revision of the outdated agenda is line
with the vision of the University to become a centre of excellence for training health
professionals, quality research and public service

MUHAS as a higher learning institution has the responsibility to contribute to the

creation and generation of knowledge through research. The number of research
projects conducted by the institution increases every year reflecting the dynamism of
the MUHAS community, the efforts invested by the institution and the local, regional
and international links the institution and her community are engaged in. The
University occupies a unique position in the Tanzanian society. The MUHAS outputs
over the last half century have offered distinguished services to Tanzania and
beyond. Research results emanating from research by MUHAS staff are used to
formulate many of the health policies.
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Impact of MUHAS Research on Policy

MUHAS is the first and the main health professionals training institution in Tanzania,
and currently it is responsible for an output of about 70% of health professionals
each year. Over the years of MUHAS existence, its faculty has been the pillars for
informing health policy in Tanzania and has made contributions in many areas of
health and allied sciences. Some of its recent contributions has been notable in
informing policy for Malaria and Neglected Tropical Diseases, HIV, Tuberculosis,
Non-Communicable Diseases, Nutrition, Immunization and Vaccine Development,
Injuries and trauma, among others. Such evidence generated from MUHAS have
also impacted global health, guidelines and policies.

Rationale
A research agenda is a time-bound plan and a focus on issues and ideas in a subset
of a defined field, which clearly defines specific identified research goals and the
organizing principles around which to work to achieve these goals.

The rationale for having a research agenda is to create a linkage among

stakeholders, both internal and external, in addressing research questions of priority
to societal needs and in so doing to achieve a focused and guided growth and
development. The Ministry of Health, Community Development, Gender, Elderly and
Children (MoHCDGEC) has released the updated version of National Health
Research Agenda and by this, researchers are required to engage in researches of
national interest. This has necessitated the need for revising the already outdated
MUHAS Research Agenda and thus ensuring all research activities conducted by the
institution are guided with a well-defined research agenda.

Objectives of The Research Agenda

1. To create centres of excellence that address critical health issues in Tanzania.

2. To build and manage multidisciplinary research consortia comprising MUHAS

faculty, students, and collaborators that address specific defined strategic
research goals.

3. To enhance communication and collaboration among stakeholders.

4. To inform and educate health research communities of the research needs

and elicit collaboration where appropriate.

5. To synthesize evidence-based knowledge products from health research for

policy development and decision making.

6. To stimulate the development of implementation plans that would identify

resources available and propose desirable sequencing and timing of research
support activities.

Stakeholders
Stakeholders and beneficiaries of the MUHAS research agenda include policy
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makers, Ministry of Health, Community Development, Gender, Elderly and Children,
Ministry of Education, Science and Technology, internal and external funding
agencies, research collaborators, students as well as researchers. The relationships
that the research agenda has with such stakeholders include the following:

1. This Research Agenda will be useful in guiding policy makers in implementing

the National Research Policy and formulating future policies.

2. MUHAS’ research agenda therefore among other things is expected to assist

the Ministry of Health Community Development Gender Elderly and Children
and other line ministries in addressing health problems in the country.

3. The Ministry of Education, Science and Technology oversees the conduct of

cost effective and appropriate research. MUHAS research agenda will be an
important document in guiding allocation of research resources to research
and in particular for public research institutions.

4. A considerable proportion of the current research conducted at MUHAS is

collaborative research. MUHAS research agenda therefore gives appropriate
information to prospective external researchers who would like to do research
in collaboration with MUHAS researchers.

5. MUHAS conducts research in line with the national and international needs.
While the MUHAS research agenda has taken the national research priorities
in it, a number of research themes are of global importance, that will ultimately
be of national importance with MUHAS involvement.

MUHAS Research Governance

MUHAS has a research dedicated Directorate of Research and Publications for
managing research and all sponsored programmes. The main function of the
Directorate is to provide a conducive environment for conducting research, ensure
responsible conduct of research, and provide pre-award and post-award support to
faculty, students and collaborators.

Under the directorate, there are two functional committees whose members are
appointed by the University Senate; Institution Intellectual Property Right
Management Committee (IIPRMC) and University Senate Research and
Publications Committee (SRPC). The latter is responsible for advising the Director of
Research and Publications (DRP) on all the research and dissemination activities at
MUHAS. This directorate has a dedicated Intellectual Property Right Unit (IPR) that
oversees the innovation and property rights of the innovators and scientists at
MUHAS and is governed by the IIPRMC.

Other research/projects functional units in the directorate include; Research

Development unit (RDU), Institution Review Board (IRB) and Office of Sponsored
Projects (OSP). Altogether and in collaboration with other units and the committees
oversee all research/projects development and grants acquisition activities through;
conducting trainings, symposia and conference, providing ethical guidance and
monitoring while managing both pre and post awards for research projects.

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Schools and Institutes have their respective Research and Publications Committees
and focal persons. These committees are responsible for coordinating research and
dissemination of research results at the unit levels. The focal persons of the schools
and institutes Research and Publications Committees are members of the University
SRPC and are therefore responsible for reporting implementation and progress of
the Schools` and Institutes` research activities to the University SRPC.

The operationalization of research at MUHAS is guided by a Research Policy.

Complementing these documents are a number of specific policies and guidelines
including, the IPR policy and guidelines, Research Chairs Policy, Policy on the use
of animals for research, Efforts compensation policy and guidelines, MUHAS
Research and Ethics Committee Standard Operating Procedures, Institution
overhead policy, conflict of interest policy, among others.

Methodological Approach
The Deputy Vice Chancellor-Academic Research and Consultancy appointed a five-
member team to formulate the University Research Agenda. The team prepared a
structured questionnaire which explored previous research done at MUHAS,
research gaps, and the suggested future research areas which were administered to
all principal investigators and University units. Presentations were made from
prominent MUHAS researchers and research themes were identified. A draft
research agenda was then developed and circulated to stakeholders at MUHAS for
inputs. Comments and inputs were consolidated into the first draft that was
discussed by the Senate Research and Publications Committee, Committee of
Deans and Directors, and recommended to the Senate for discussion and
recommendation to the University Council.

Research Themes

A total of eighteen research themes have been identified and will be discussed in
this document as the future MUHAS research themes. These are:
1. Theme 1: HIV and AIDS
2. Theme 2: Tuberculosis
3. Theme 3: Malaria and Neglected Tropical Diseases
4. Theme 4: Reproductive, Maternal, New-born, Child and Adolescent Health
5. Theme 5: Non-Communicable Diseases (NCD)
6. Theme 6: Health Systems Research
7. Theme 7: Social Determinants and Social Conditions of Health
8. Theme 8: Injuries
9. Theme 9: Emerging and Re-Emerging Infections
10. Theme 10: Oral Health
11. Theme 11: Mental Health
12. Theme 12: Pharmacovigilance and Rational use of Medicines
13. Theme 13: Occupational Health and Safety
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 14. Theme 14: Haematological Disorders
15. Theme 15: Traditional Medicines and Natural Products Development
16. Theme 16: Bioethics
17. Theme 17: Drug Discovery and Formulation
18. Theme 18: Knowledge Management and Informatics

Theme 1: HIV and AIDS

Background

The MUHAS HIV research seeks to contribute to the national, regional and
international response to the HIV epidemic by performing high quality science of
international standards. This agenda comes a time when a number of new
developments have occurred in the field:

 In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and

partners launched the 90–90–90 targets; the aim was to diagnose 90% of all
HIV-positive persons, provide antiretroviral therapy (ART) for 90% of those
diagnosed, and achieve viral suppression for 90% of those treated by 2020

 In 2015, the MoHCDGEC embarked on Health Sector Strategic Plan IV (HSSP

IV) (2015-2020) that is driven by Sustainable Development Goals (SDGs)

 In late 2015, based on new scientific findings, the World Health Organization
(WHO) recommended that everyone with HIV be offered ART as soon as they
are diagnosed.

 Recently UNAIDS has announced its-new fast-track strategy to end the AIDS
epidemic by 2030 by upgrading the three 90 targets to 95–95–95 targets.

These developments necessitate MUHAS, which is leading academic, research and

consultancy institution in the medical field, to refocus its strategies in providing
technical assistance to the government and its stakeholders, to providing universal
access to quality ART services to all citizens in need.

Situation analysis

Results of The Tanzania HIV Impact Survey (THIS), a household based national
survey, conducted between October 2016 and August show the annual incidence of
HIV among adults ages 15 to 64 years to be 0.29 percent (0.40 percent among
females and 0.17 percent among males), which corresponds to approximately
81,000 new cases of HIV annually among adults aged 15 to 64 years in Tanzania.

The prevalence of HIV among adults aged 15 to 64 years in Tanzania was

approximately 5.0 percent (6.5 percent among females and 3.5 percent among

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males), corresponding to approximately 1.4 million people living with HIV (PLHIV) in
the age group 15 to 64 years. Tanzania is a home to 5.8% of global adolescents
living with HIV. Prevalence of viral load suppression (VLS) among HIV-positive
adults ages 15 to 64 years in Tanzania was 52.0 percent (57.5 percent among
females and 41.2 percent among males).

With regards to PMTCT, although the percentage of pregnant women enrolled in

services reached 92% in 2019, poor retention rates among pregnant and lactating
mothers (67% and 83% respectively remain a challenge, contributing towards the
mother-to-child HIV infection rate of 11% in 2019 against the global target of 5%.
Early infant diagnosis uptake is also low (47%), and the paediatric antiretroviral
therapy (ART) coverage of 66% in 2019 lags behind the national target of achieving
90% coverage by 2022.

Gaps

Existing gaps include; data on short- and long-term effects of Dolutex and ART
particularly among clients of reproductive age; data on factors associated with and
effective strategies for increasing access, uptake and retention to HIV services
especially among vulnerable population; rising prevalence of pre-treatment and
acquired HIV drug resistance; stigma and discrimination particularly of HIV positive
key populations; timely diagnosis, referral and treatment for HIV among infants and
young children. Other identified gaps include; poor coordination of various HIV
services and their integration into other programs including NCDs; evidence based
management of HIV in comorbid with NCDs; novel HIV treatment and prevention
strategies including effective vaccines; reliable reporting mechanisms of the progress
towards attainment of the global 95-95-95 HIV global targets; low human resource
for HIV services and poor quality of HIV services particularly HIV testing that comply
with testing standards. Poor uptake of ART by children; ANC package and HIV test
by adolescents and retention in PMTCT programs.

Priority Research Areas

General

Research areas; exploring the best strategies for; achieving UNAIDS 95-95-95 targets in
Tanzania by 2030; increase access to a comprehensive package of quality health
and social services to the key and vulnerable populations in order to significantly
minimize the transmission of HIV and to reduce HIV-related mortality, morbidity,
stigma and discrimination; enhance screening, surveillance and monitoring of Non-
communicable diseases among PLHIV.

Other areas include; strengthening local HIV policies, guidelines and programs using
operational research; explore the costs and benefits of adopting new HIV treatment
guidelines.

Specific research areas:

HIV testing

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Areas including: the best interventions to ensure timely linkage between HIV diagnosis,
treatment and care, especially for infants and children; community-based interventions or
strategies to improve access to HIV services; factors which enable or hinder linkage to
care and timely HIV services, including initiation of ART; entry points other than
antenatal care for identifying undiagnosedHIV-positive infants and children in different
epidemic settings; strategies or interventions to improve access to and uptake of HIV
testing services for key and vulnerable populations; time and method of disclosure of
HIV test results to paediatric and adolescent patients; and how can we enhance the
success rate of community-based referral system in linking HIV positive people with
treatment centres.

Treatment

Areas including: mechanisms are novel and cost effective in determining safety,
efficacy, acceptability, pharmacokinetics and optimal dosing of existing and new
antiretroviral drugs and formulations; the long- and short-term effects of Dolutex
among women of reproductive age; strategies or interventions should be
employed to improve uptake and adherence to ART programme; strategies for
prevention and clinical management of co- infections, particularly enhancing
effective tuberculosis screening in Care and Treatment centres; optimal
Approaches to Screening and Treating Co- morbidities and Malnutrition; Impact of
HIV infection and ART on short- and long- term outcomes, in particular non-
communicable disease; research on point-of-care diagnostic kits should be
used for determining HIV drug resistance to prevent and limit the spread of HIV
drug resistance and improve treatment outcomes; How to reduce the short and
long-term ART-associated complications and its impact on adherence and ARV
resistance; barriers to ART access in Paediatric and Adolescents and Young
Women (AGYW) populations and adolescents; short-term and Long-term effects of
in utero ART Exposure on HIV-infected Infants, Children and Adolescents;
reasons for lost to follow-up among patients on antiretroviral treatment; the
challenges faced by parents and feasible solution with regard to administering
ARVs to children (children <5yrs); factors facilitate uptake, retention and
adherence and minimize treatment failure among children with HIV; how to ensure
resources for monitoring ART be optimized, e.g., use of targeted viral load.

Prevention

Areas including: the opportunities and challenges of HIV self-testing in achieving

UNAIDS 95-95-95 targets particularly among Adolescents Girls and Young
Women (AGYW) in Tanzania by 2030; operational, social cultural and behaviour
barriers to increasing access and scale up of evidence based preventive
interventions such as Voluntary Medical Male Circumcision (VMMC), PrEP and
PEP; the best and cost-effective strategies of increasing Early infant diagnosis and
reducing Lost to follow up in PMTCT settings; Prevention of MTCT using Oral
Nevirapine among Breast Fed infants of HIV positive mothers; and feasible and
cost-effective strategies to improve access and retention in PMTCT and entire
breastfeeding period.

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Theme 2: Tuberculosis
Background

Tuberculosis (TB) is the leading single infection killer worldwide and thus form one of
the targeted diseases in the Sustainable Development Goals (SDG). In the year
2018 alone, ten million people were estimated to have TB disease and 1.5 million
succumbed to the disease. More than 80% of the global burden of tuberculosis is
concentrated in 30 countries, namely, high TB burden countries, Tanzania inclusive.
To date, there is no effective vaccine to prevent occurrence of TB disease. The only
vaccine available, Bacillus Calmette-Guérin (BCG) was discovered in 1921 and
provides protection only against severe forms of TB such as childhood TB
meningitis. In response to reducing the disease burden SDG3 and the END-TB
strategy 2015 – 2035 has set some policies and milestones.

Situation analysis

Tanzania is one of the 30 high TB burden country with TB prevalence rate of

253/100,000 population and is believed to be among the top ten causes of deaths in
Tanzania. In the year 2019, Tanzania notified more than 80,000 cases
corresponding to 59% of the estimated annual TB cases. Despite high burden of TB
in Tanzania, it is estimated that the prevalence of Multi Drug resistant (MDR) TB is
less 1%. A larger portion of TB in mainly contributed by HIV co-infection which
accounts for about 28% of all TB cases notified in 2018 2. The growing burden of
non-communicable diseases particularly Diabetes Mellitus, malignancies as well as
immunosuppressive therapies present a new challenge to the current TB control
initiatives in place. Furthermore, Tanzania’s formal and informal mining industry
poses a risk of reversal of achieved milestones particularly for recurrent TB 3. Other
country specific context includes smoking and use of drugs of addiction that affect
adherence to TB treatment which consequently may threaten TB control in Tanzania.
A large proportion of pediatric TB cases remain undetected, or not reported because
of limited diagnostic ability, which pauses a challenge in this population.

In line with the Pillar three (3) of the END-TB strategy 2015 – 2035, intensified
research and innovation; MUHAS Tuberculosis Research Agenda seeks to
contribute to the national, regional and international response to Ending Tuberculosis
epidemic through innovative and high-quality scientific work of international
standards in line with national and international policies and strategies such as:
 END-TB strategy 2015 – 2035.
 Accelerated plan to find TB cases “2018 Find all treat all #EndTB”.
 Ministry of Health Community Development Gender Elderly and Children
(MoHCDGEC) Health Sector Strategic Plan IV (HSSP IV) 2015-2020.
 Ministry of Health Community Development Gender Elderly and Children
(MoHCDGEC) Health Sector Strategic Plan IV (HSSP V) 2020 -2025 (under
development).
 Ministry of Health Community Development Gender Elderly and Children
(MoHCDGEC) The National Health Research Agenda 2019 – 2024.

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Gaps

Identified gaps; screening programmes for animals TB (to minimize potential for
zoonosis TB) asymptomatic TB infected individuals, and factors associated with
missed or delayed diagnosis particularly among children; poor understanding on
factors associated with poor TB treatment particularly MDR TB; understanding on
contribution of one heal and test and slaughter for animals (cattle/buffaloes) to
minimize the potential for zoonotic tuberculosis; understanding of epidemiology and
short and long term TB (including MDR) and Non-Tuberculous mycobacterium
treatment health and non-health outcomes.

Other gaps; optimizing attention to nutrition (micro and macro) in management of TB;
optimizing TB management in special populations (mining industries, DM, elderly
patients); cost-effective diagnostic strategies for paediatric MDR and extrapulmonary
TB; access to drug susceptibility testing among patients on TB treatment; data on
patients’ related TB diagnostic and treatment costs for tracking one pillar of END TB
strategy, catastrophic patients costs; unavailable effective TB treatment and/ or
preventive vaccines; local evidence the effectiveness, acceptability and sustainability
of the newer TB preventive therapies (TPT) other than isoniazid; local evidence on
the effect of genetic composition to the disposition to allow optimization of new
antituberculosis drugs, Bedaquiline and Delamanid.

Priority Research Areas

General

Exploring the current epidemiological and social determinants for development of

active tuberculosis disease.

Specific Research Areas

Diagnosis: Areas including; Development and evaluation of new diagnostic tools

utilizing specimens other than sputum; determination of susceptibility and resistance
to anti TB drugs using molecular techniques; exploring factors for delayed/missed TB
diagnosis and developing mechanisms for early detection of TB sequalae and TB
among children.

Optimizing TB treatment and care: Areas including; development and evaluation

of treatment and preventive vaccines, existing and new drugs for TB (including those
targeting MDR-TB) and accompanying lung disease their pharmacogenomics,
pharmacodynamics and pharmacokinetics and determining factors associated with
their interaction with other drugs; surveillance and management of TB sequalae, TB
in children and those with concomitant NCDs comorbidities or at risk for occupational
exposure; establishing the association between Host Directed Therapies (HDT),
nutritional deficiencies and TB treatment outcomes; and assessment and
management of Malnutrition Inflammation Syndrome (MIS) among patients treated
for TB.

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Prevention: Areas including; Operational research on newer TB prevention
therapies (TPT) among different at-risk populations; cost-effective mechanisms for
preventing TB and/or its recurrence among at-risk populations (including healthcare
workers); effective strategies to explore and overcome challenges of initiating INH
and following up new-born of sputum positive mothers.

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Theme 3: Malaria and Neglected tropical diseases
Background

Setting priorities for health research is essential to maximize utilization of the meagre
resources allocated to health sector and is regarded as a key factor in an effort to
strengthen national health research systems.

This agenda comes at a time when a number of new developments have occurred in
the field:

 In 2015, the MoHCDGEC embarked on HSSP IV (2015-2020) that is driven

by Sustainable Development Goals (SDGs)

 Roll Back Malaria (RBM) Partnership’s second-generation global malaria

action plan, Action and Investment to Defeat Malaria (AIM) 2016-2030:

 Malaria-Free World and the World Health Organization’s (WHO’s) updated

Global Technical Strategy: 2016-2030

 The World Health Organization (WHO), issued Third Edition Guidelines for the
Treatment of Malaria, Geneva, Switzerland: WHO Press (2015)

 WHO Strategic plan, 2000, for Halting transmission of Lympatic filarias and
other neglected tropical diseases by the 2020

The MUHAS Malaria research seeks to contribute to the national, regional and
international response to the Malaria epidemic by performing high quality science of
international standards ensuring universal access to good quality malaria services to
Tanzanians.

Situation analysis

Malaria can easily be treated if patients seek services promptly and receive both a
test and treatment with recommended antimalarial. Although the 2017 Tanzania
Malaria Indicator Survey showed that three quarters of children with fever sought
advice or treatment, a smaller proportion (about 40%) sought treatment promptly
(within 24 hours) and were tested for [Link] current map of NTDs in Tanzania,
show that the larger part of the country is in pre- to elimination of specific NTDs,
however, transmission continues in “hot spots”. Tanzania is also witnessing global
warming and climate change with consequences on the dynamics of malaria and
dengue vectors.

Gaps

Identified gaps include; limited evidence on; safety and quality of readily available
antimalarial drugs, and malaria treatment outcomes particularly to individuals with
comorbidities; providing guidance on Mass Drug Administration (MDA) use in
moderate or high transmission settings; optimal strategies for blocking transmission
of schistosomiasis, lymphatic filariasis and trachoma, optimal antimalarial dosing
and alternative malaria prevention intervention (other than SP) in pregnant women;

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treatment failures, and effective malaria treatment and prevention vaccine; selection
of new technologies into interventions [Link] is paucity of data on the
influence of climatic factors on the dynamics of malaria and dengue vectors. Gaps
also exist in the drivers of continuity of transmission of both malaria and NTDs,
innovative diagnostics for monitoring continuity of transmission, and the best ways to
target interventions in the face of changing malaria and NTD epidemiology.

Other gaps; translation of research into practice and support evidence based and
sustainable policy decisions; burden and effects of non-falciparum malaria and
emergency of resistant malarial parasites; weakly established bioequivalence lab for
ascertaining drug bioavailability in patients; new and appropriate vector control tools
to create an evidence-base for scale up; poor performance of conventional tools to
detect malaria infections in pre-elimination settings.

Priority research Areas

General

Areas including; the prevalence and interaction of non-falciparum malaria (P. ovale,
P. malaria) with P. falciparum; effect of different disease conditions on
uncomplicated malaria treatment; malaria operational research programmes for
strengthening local malaria policies, guidelines and programmes; approaches to
accelerate translation and adoption of research findings into policies. The other
important area is identification and characterization of “hot spots” of malaria and
NTDs transmission, operational research to inform programs on the best ways to
target interventions for these diseases in pre- to elimination settings, coupled with
field trial of innovative diagnostics for monitoring and surveillance of malaria and
NTD in elimination settings.

Specific Research Areas

Prevention: Areas including; development and evaluation of existing and/or new

preventive and control measures like; mosquito vector control measures (ecology
manipulation included); combination preventive strategies both biomedical and
multipurpose prevention technologies; malaria vaccines; role of micro-nutrient
supplementation in malaria prevention among children. Other areas include;
potential for trial of RTS, S vaccine in children; exploring the utility of Health
Technologies Assessments (HTA) in selection of new antimalaria [Link]
NTDs, studies are required to exploit the role of integrating vectors and
environmental control with preventive chemotherapy as a means of interrupting
transmission.

Malaria and NTD testing: Areas including; evaluate the performance of innovative
diagnostics for NTDs/malaria detection and its differentials; exploring the effect of
pfhrp2 gene deletion on the performance of rapid malaria test (mRDTs); exploring
genetic and epigenetic contributions to severity of malaria.

Malaria and NTD Control: Potential research areas; develop and implement cost-
effective mechanisms for evaluating pharmacokinetics, pharmacodynamics and
acceptability of novel and existing antimalarial drugs and formulation including
artemisinin-based drugs used in Intermittent Preventive Treatment in Pregnancy

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(IPTp); evaluate and optimize the effectiveness of MDA in moderate and high
transmission settings and in eradication of NTD; determining optimal dose of
antimalarial for the treatment of malaria in pregnancy; explore best therapeutic
alternative to replace sulfadoxine-pyrimethamine (SP) for intermittent preventive
treatment of malaria in pregnancy; explore the potentials of; using multiple first line
drugs in combating drug resistance malaria; Health technologies assessments (HTA)
in the selection of new antimalarial interventions. Other potential research areas
include; strategies to improve uptake and adherence to artemisinin-based
combination therapy (ACT) programmes; evaluate costs and benefits of adopting
new malaria treatment guidelines.

Theme 4: Reproductive, Maternal, New-born, Child and

Adolescent Health
Background

Reproductive, Maternal, New-born, Child, and Adolescent (RMNCHA) Health is

central to the development of any country in terms of increasing equity and reducing
poverty and building social capital. The survival and well-being of mothers and
children are not only important in their own right but are also central to addressing
large broader, economic, social, and developmental challenges. The government of
Tanzania developed a National Road Map Strategic Plan to Improve Reproductive,
Maternal, New-born, Child, and Adolescent Health in Tanzania (2016–2020): One
Plan II. This mainly targets at reducing

1. MMR from 410 to 292 deaths per 100,000 live births

2. Neonatal mortality rate from 21 to 16 deaths per 1000 live births

3. Infant mortality rate from 45 to 25 deaths per 1000 live births and

4. Under-five mortality rate from 54 to 40 deaths per 1000 live births. The overall
goal is to accelerate reduction of preventable maternal, new-born, child and
adolescent morbidity and mortality in line with the National Developmental
Vision 2025.

The institutional research agenda under RMNCHA theme will be geared towards
achieving this goal. Although the high-impact interventions needed to prevent
maternal and child deaths have been known for some time, they fail to be
implemented at the necessary scale for global mortality reductions. The RMNCAH
interventions should be guided by evidenced-based intervention which is effective,
acceptable to families and communities, and affordable and sustainable to use
limited resources efficiently. Subsequently, research in RMNCAH will contribute
towards achievement of national strategies.

Situation analysis

The burden of reproductive health (RH) cancers in Tanzania is showing an upward

trend as reported by International Agency for Research on Cancer (IARC) that
cervical cancer with incidence rate (ASR) is 54.0 cases per 100,000 women.

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Mortality rate due to cervical cancer is 32.4 per 100,000, breast cancer is 9.7 per
100,000 for women and prostate cancer, 27.9 per 100,000.

While there was a 47% reduction of the maternal mortality ratio (MMR) between
1990 and 2010 (870 and 454 deaths per 100,000 live births respectively), Tanzania
did not make sufficient progress to attain its Millennium Development Goal (MDG) 5
of reducing MMR to 193 per 100,000 live births. There are broad gaps in births
assisted by skilled health professionals in rural and urban areas (55% and 87%
respectively). Male involvement in RMNCAH programs is low e.g., in Prevention of
mother-to-child transmission (PMTCT) program the data shows only 30% do come
for couple counselling with their partners.

The Tanzanian population is mostly young, the country is home to 12 million

adolescents (10-19 years), an age group expected to reach 30 million by 2050.
Adolescent sexual and reproductive healthcare is inadequate. Adolescents and
young people are vulnerable to unintended pregnancy, sexually transmitted
infections (STIs) including HIV. The percentage of women who have given birth or
are pregnant with their first child by the age of 18 has increased from 23% in 2010 to
27% in 2015. Teens and young people report that confidentiality is often not
respected, and services are expensive and not youth-friendly. Medication is also in
short supply.

The mortality rates for under-fives, infants and neonates are at 53, 36 and 20 per
1,000 live births, respectively. Although there has been a significant reduction more
cost-effective interventions are required to achieve The Sustainable Development
Goal (SDG) 3.2.1 to end preventable deaths of new-borns and under-5 children by
2030. Neonatal deaths alone account for 40% of all deaths among children under
age of 5 years. Malaria, pneumonia, diarrhoea, malnutrition, HIV and neonatal
conditions (Prematurity, Birth asphyxia and neonatal sepsis) account for 80% of all
childhood deaths, while these deaths are mostly due to preventable causes.

Gaps

Gaps were identified in the following areas; Maternal Nutrition including underweight,
overweight, and anaemia; early marriage, childbearing and gender-based violence
and sexual abuse; adolescent gynaecology, user friendly adolescent reproductive
health services; exclusive breast feeding in the 1st 6months and satisfaction with
quality of antenatal and postnatal health services; transport and referral system;
drugs and supplies; access to insurance schemes and informal payments; adequacy
of WASH provisions; utilization of quality improvement (QI) models for RMNCAH and
male involvement in RMNCAH and HIV health services; maternal and neonatal
mortality and persistent preventable and/ or treatable diseases such as malaria,
pneumonia, diarrhoea, HIV and neonatal conditions and efforts coordination against
these situations/conditions; implementation of maternal and perinatal death
surveillance and response (MPDSR) approaches; coverage of; basic
emergency obstetric and new-born care services; antenatal corticosteroids among
mothers delivering preterm infants; HIV early infant diagnosis and interventions to
reduce neonatal mortality.

Other identified gaps include; evidence for age specific sexual and reproductive
health services; innovation research for new treatments and diagnostic procedures in

15
reproductive health; fecundity and contraception: fertility, foetal losses, their causes,
prevention, contraception methods and use

Research Areas

Maternal and New-born health: Priority areas include; improving maternal and
neonatal outcomes through utilizing perinatal death audits; harnessing community
structures and practices, male involvement into care and enhancing development
and accessibility of quality care that encompasses; feasible interventions against
neonatal sepsis prevention and treatment; scaling up and timely uptake of;
corticosteroids by mothers in preterm labour; immediate kangaroto mother care,
early continuous positive airway pressure (CPAP) and surfactant therapy.
Importantly there is a growing emphasis of addressing maternal and new-born
nutrition especially in the first 1000 days of life. Other areas include; cost-effective
strategies to improve adherence to ANC package; sustain partograph use for labour
management; strategies for reducing overall neonatal mortality and mortality at
Neonatal Intensive Care Unit (NICU). Areas to also consider include; strategies to
improve referral systems; pre-referral management of maternal and neonatal
conditions; improving early initiation of exclusive breastfeed; pain assessment and
management in new-born; exploring impacts of midwifes on quality of care;
readiness of government and private facilities to provide quality EMONC Services.

Child health: Specific areas include; major social economic determinants of under-
five survival and effective strategies to improve their survival in the community and
facility settings; enhancing clinical and public health competencies in child care and
developing strategies to deliver lifesaving interventions including Integrated
Management of Childhood Illnesses (IMCI), immunization etc.; develop and evaluate
strategies to prevent and manage childhood diarrhoea, malnutrition, low birth weight
infants and their associated short and long term complications; enhancing
accessibility to ICU; evaluate long term outcomes of chronic diseases diagnosed at
infancy. Other specific research areas include; addressing the child nutritional
challenges including under nutrition, micronutrient deficiencies, and the growing
burden of overweight and obesity and their roles in the development and cognitive
functioning, early NCDs onset, and economic and social development.

Adolescent health: Potential areas include; develop and implementing community

and/ or school-based health programs for STI &HIV counselling and testing, HPV
vaccination, sex education and adolescent nutrition including obesity/overweight
prevention, anemia, and other micronutrients challenges; harnessing the potential
found in new technologies and systems in providing physical and virtual information,
treatment and referral; develop strategies to promote accessibility to family planning,
TB/HIV diagnostic and treatment services; develop and evaluate the capacity of
Primary health Care (PHC) workers in proving friendly adolescents care in
accordance to their age and education level; developing indicators for evaluating the
quality of adolescents care.

Reproductive health: Specific areas include; developing cost-effective strategies to

improve; coordination of efforts by different partners and sectors; documentation and
data accuracy in RMNCAH; gynaecological cancer screening; the use of modern
contraceptives, antenatal care, skilled birth attendants, PMTCT and postnatal care
particularly among vulnerable individuals; ensuring the incorporation of syphilis

16
testing and treatment in SRH and maternal services is optimized. Integrating
reproductive health and other health services such as nutrition, community health
interventions, immunization, management of other infectious diseases such as TB,
HIV, cancers, and mental health services.

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Theme 5: Non-Communicable Diseases (NCD)
Background

Non-communicable diseases (NCDs) are the leading cause of global mortality and
morbidity accounting for 70% of Disease Adjusted Life Years (DALYs) in 2019 with
ischemic heart diseases and stroke leading. Whereas compared to 1990’s there is
global increase in the magnitude of NCD, there is also shift of the burden more to the
developing countries. In 2019, 80% of the premature death had occurred in sub-
Saharan Africa. Intriguing is the fact that 70% of the NCDs associated deaths could
be preventable by controlling tobacco use, hazardous alcohol intake, health diets,
physical activities and environmental pollution. Due to this emergency situation,
there has been a call to action for controlling non-communicable diseases.
Furthermore, 8.4% of DALYs due to NCD are contributed by infectious diseases
such as [Link], human papilloma virus, hepatitis B and C viruses and post-
streptococcal disease; Central and Sub-Saharan Africa ranking second in the burden
of infectious causes of NCD.

Situation analysis

Tanzania has been greatly affected by the NCDs with an upward trend since 1990s.
The landmark key study in Tanzania reported alarming figures for community burden
of NCDs as well as risk factors. More than a quarter (26%) of the respondent in the
STEP study were either overweight and obesity. It is disheartening to see that the
malnutrition trends start early in schools. A recent study revealed the prevalence of
overweight (13.5%) and obesity (4.4%) to be 17.9% among secondary school
students who should otherwise be active in sports. The major drivers of obesity and
overweight have been reported to be physical inactivity worse in urban than in rural
areas. There seem to be a gender disparity in overweight and nutrition without well-
established determinants. On the other side, under nutrition is a recognized problem
in Tanzania both for under-five children as well as the elderly population segment.
Furthermore, nutritional needs of people living with HIV, those with chronic diseases
and disabilities, elderly and in infection such as TB have not been fully studied. In
sync with lifestyle changes, there has been a sharp increase in obesity and
sedentary life related diseases, such as Diabetes Mellitus (9%), hypertension (26%),
sleep related disorders and arthritis.

In the recent years Tanzania has also seen an increase life expectancy to 65 years
in 2020. Consequently, there has been a corresponding increase of diseases
associated with aging such as Alzheimer’s and other memory related diseases,
chronic neurological, musculoskeletal and respiratory diseases. On the other hand,
stroke has also been on the increase along with End Stage kidney disease requiring
renal replacement services. These services, are evolving there is need to optimize
the service as well as increase access. Research must seek to responds to such
needs.

There are many opportunity MUHAS research can tap into as its contribution to the
National Research agenda and health and well-being of Tanzanians; such as
creating evidence of cost effective and locally applicable interventions early
diagnosis, management and prevention of Non-communicable diseases. It is in this
spirit MUHAS research agenda for NCD is written.
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Gaps

Areas needing attention; NCDs surveillance, interventions monitoring and burden

assessment, systems and approaches; NCDs diagnostic, management and
monitoring capacity of the health system; pathophogenesis of NCDs, their
complications and timely management of both; risk factors and outcomes of NCDs
(including Albinism), NCDs’ complications and their respective
treatment/management approaches; determinants of NCDs such as micro and
macro nutritional disorders; impact of nutritional interventions among vulnerable
populations segments with chronic disease. Significant issues were also identified in
the following; multilevel, multisectoral and multispecialty cost-effective NCDs
prevention and management strategies; evidenced based optimized treatment and
long-term outcomes organs and tissues among transplant patients; drugs discovery
and evaluation; NCDs medicine regulations; financing for NCDs’ services.

Priority Research Areas

General Research Areas

Target areas include; to evaluate the effectiveness of the health systems in

prevention, timely detection and/ or referral, management and surveillance of NCDs;
establish the involvement of MUHAS and government in development and evaluation
of drugs and vaccines; establish the association between epidemiological,
environmental, socio-cultural as well as behavioural factors and development of
NCDs. In the context of Tanzania, nutritional transition with regards to NCDs also will
be an emphasis to ensure identification of the burden and risk factors of nutritional
disorders, interventions to address poor feeding practices and other modifiable risk
factors such as physical activities, salt intakes, fruits and vegetable consumptions,
early and timely diagnosis, and management thereof. Apart from the WHO best buys
for NCDs, efforts will be geared to identify Tanzanian’s best buys that can address
the NCDs burden.

Specific Research Areas

Diagnosis: Specific areas include; develop and evaluate cost-effective interventions

for screening, timely diagnosis and referral of patients with non-communicable
diseases including congenital diseases; explore the role of local and international
collaboration and specialists in establishing in-depth understanding of the risk
factors, aetiopathogenesis and burden of the various NCDs including Hypertensive
Heart Diseases, Diabetes Mellitus, Kidney Diseases, Congenital diseases,
Cardiovascular Diseases including stroke, Neoplasms, Chronic Respiratory
Diseases, and their related complications.

Treatment and monitoring: Potential areas include; formulate programs to monitor

and evaluate short-term and long-term outcomes (including on reproductive health

19
and quality of life in general) of both childhood and adulthood NCDs (malignancies
included) and their related management including transplantation, dialysis, surgery,
medications, rehabilitation etc.; develop and evaluate novel and existing
interventions against; micro and macro nutrient interventions among at risk
population segments (children, disabled, elderly); observed and reported NCDs and
their management related outcomes. Other potential research areas include;
discovery of novel drugs and therapies against NCDs and evaluate their
pharmacokinetics and pharmacodynamics, acceptability and overall efficacy against
the standard treatment.

Prevention: Target research areas include; develop and evaluate feasible and cost-
effective intervention programs against the commonest NCDs risk factors such as
smoking, unhealthy alcohol and diet consumption and physical inactivity; formulate
strategies to address factors associated with nutritional disease including (but not
limited to) those associated with gender disparities; implement and scaling up cost-
effective screening programs against infections associated with NCDs such as H.
pylori, human papilloma virus, Hepatitis B and C viruses and streptococcal infection.

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Theme 6: Health systems research
Background

For extended period of time, the concept of universal health coverage (UHC) has
surfaced on the global health agenda. The latter aims at leaving no one behind in
quest of access to quality health care services. To realize UHC it is prudent that
countries have in place resilient, responsive and inclusive health systems that are
accessible to all, irrespective of socio-economic or legal status, health condition or
any other factors. In its National Health Policy 2017, Tanzania aims to reach all
households with essential health services attaining the needs of the population,
adhering to objective quality standards and applying evidence-informed interventions
through resilient systems for health. However, Tanzania as for most of the Low-
Middle-Income Countries (LMICs) succumb sub-optimal performance of its health
systems enshrined in weak governance systems, shortage of adequately deployed
and retained health workforce, weak health care financing systems and fragmented
health information systems. Altogether affect the supplies of medicines, vaccines
and technologies and thus impinge the health care services delivery and
subsequently rendering the responsiveness and resilience of the health system in
Tanzania at verge.

To ensure the responsiveness and resilience of the health system in Tanzania,

strategies that address the chronic health workforce problems, weak health systems
governance, weak health information system and the chronic health care financing
challenges are needed. Therefore evidence-based interventions are needed now
than ever. In its development vision 2025, Tanzania advocates for quality livelihood
for all its people.

Situation Analysis

Post implementation reports of: The National Health Policy 2007, Health Sector
Strategic Plan III July 2009–June 2015, Health Sector Strategic Plan July 2015–June
2020 as documented by a series of Demographic Health Surveys (DHS) carried out
in Tanzania and other studies indicate existence of a weak health system in
Tanzania. The latter is explained by the low rate in improvement of the health
indicators than expected.

The latter indicators are attributed to chronic shortage of health workforce due to low
capacity of training, employing and retaining their workforce; fragmented health care
financing strategies that do not warrant financial protection to vulnerable populations
due to low coverage of pre-payment schemes, multiple unintegrated prepayment
schemes, out of pocket cost sharing and reliance on tax-based funded health
systems in countries that have low taxation base; weak health system governance
due to weak health system management capacity at all levels from national to district
level: and the existence of weak health management information systems attributed
tothe existence of many unintegrated health information systems, limited skills in
uptake and use of digital health information systems and paper-based health
information system mind-set oriented health workers.

Gaps

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Areas that are yet to be addressed adequately in the health systems include;
strategies to strengthening Health System governance, the role of community-based
health systems, approaches for strengthening health care financing systems through
alternative financing strategies to protect vulnerable populations, evidence-based
strategies in deployment, performance and retention of health workforce in rural and
remote areas, integration of the health information systems at all levels,
strengthening the logistic chain management system to ensure availability of
adequate, safe and of quality supplies at all levels.

Priority Research Areas

Health care financing: Specific research areas include; analysis of the effect of the
different financing mechanisms on services delivery (DHFF, basket fund etc),
Determine the effects of direct health facility financing coverage on realization of
universal health coverage, exploring and determining of contributors for low
enrolment of community members to insurance schemes, identification of strategies
to increase health insurance coverage to those population in the informal sector,
exploring alternative funding strategies for ensuring sustained health care financing
in Tanzania.

Health System governance: Specific research areas include; identification of

evidence-informed approaches on strengthening health system governance at all
levels, analyzing the role of public-private partnership in enhancing equity, access
and quality of health service provision, assessing the accountability mechanisms in
strengthening the health system governance, capacity building approaches in
strengthening health system management at all levels of the health system, identify
cost-effective approaches for strengthening health system governance at the district
level, and strengthening health system governance in gender mainstreaming and
health care equity.

Health workforce: Specific research areas include; identification of evidence-

informedstrategies for retention of human resources for health at the rural and
remote areas, analyze the role of task-sharing on addressing human resources for
crisis in Tanzania, explore strategies for improving health workforce performance at
all levels, analysis of the quality of health workforce training across all levels of the
health system, determine the adequacy of financial and non-financial incentives in
motivation and satisfaction of health workforce at all levels, explore evidence-
informed strategies for planning health workforce training and recruitment at all
levels and identifying approaches for the strengthening health workforce
management by ensuring availability of a robust health workforce database.

Health Information System: Specific research areas include; exploring the role of
digital technology in strengthening training, deployment and retention of human
resources for health, analyzing the role of digital technology in strengthening health
care financing strategies for improved health insurance coverage, exploring the
feasible mechanisms for integration of health information systems, analyze how the
digital health strategy can be used in improving health system governance and
accountability, the role of digital technology strategies in ensuring availability of real
time health workforce and health care services delivery data and analyzing the
contribution of health information system in the availability of medicine, supplies and
technologies.

22
Community-based health systems: Specific research areas include; exploring the
role of community-based health systems in promoting health systems
responsiveness and resilience, assess the role of community health system in health
promotion and disease prevention, exploring the mechanisms for strengthening the
integration of community health systems to the health care delivery system, analyze
the implementation of Community Based Health Workers (CBHC) policy guidelines,
device contextually feasible incentives to the community health workers and analyze
the role of stakeholders towards strengthening the community based health systems.

Cross-cutting issues:Specific Research areas include; Analysis of equity and

equity issues in health care services provision in Tanzania, analysis of access of
health care services to vulnerable and marginalized groups and analysis of the
quality of health care services quality from multiple lens approach.

23
Theme 7: Social Determinants and Social Conditions of Health
Background

For an extended period, the Bio-medical model concept has remained dominant in
the understanding of diseases. Most diseases have been conceptualised as an
outcome of the interaction between human beings and microorganisms like bacteria,
parasites, viruses etc. This concept was consolidated with the discovery of
antibiotics: sulpha and penicillin. The discovery of antibiotics, which came to be
known as miracle bullets to hit microorganisms, literally deleted from all main stream
health related literature the role of nonbacterial, nonparasitic etc., factors in the
causation of diseases. In the course of time, however, as the source of infectious
diseases got minimized through lesser human contact with microorganisms by
improved hygiene and better sanitation etc., ill-health and diseases are still
prevalent. The biomedical model, therefore, has been turned upside down and it is
walking on its head. It is incompetent in explaining contemporarily widespread
degenerative diseases like diabetes, renal diseases etc. It cannot explain
hypertension or cancers. As MacKeon reasoned early on in the 19 th century a return
to the environment is key in the understanding of diseases. This return is best
represented by the Devi circle. This circle posits that the source of all diseases and
ill-health is the social and natural environment i.e., the origin of diseases and ill-
health is social determinants – contaminated water; poor sanitation; cigarette
smoking; substance abuse; alcoholism; unbalanced diet; poor housing; life style etc.

Situation Analysis

Situation Analysis as regards Social Determinants and Social Conditions of Health:

as factors in diseases and ill-health: Representative examples are: NCDs, Life style,
Oral health, Eye health, and Parasitic diseases.

NCDs

Tanzania has an increasing trend of non-communicable diseases (NCDs)

characterizing an evident epidemiological transition. The burden of diabetes and
cardiovascular diseases such as hypertension are high in Tanzania. The prevalence
of diabetes in urban areas has increased from 5% in 2007 to 9% in 2012, while in
2012 a survey showed that the prevalence of hypertension was 26%. These
diseases are driven by lifestyle related risk factors, types of foods and eating, habits
using tobacco and tobacco products and alcohol consumption. It is evident that
patients from cancer, diabetes and cardiovascular and mental diseases that require
health services are increasing. Social determinants underlying these diseases
include limited public awareness, promotion, prevention and curative services. This
is aggravated by inadequate NCD experts, rehabilitative services, community
involvement in home-based care and palliative care for patients. Habits of healthy
eating and physical activities, especially among at-risk communities are worsening.
Early detection through regular medical examinations promotion efforts is limited.
Also, there is limited diagnosis of NCDs and interventions related to screening in
new-born and elderly, and enrolment into comprehensive care services. Independent
NCD clinics have not been well integrated into the health care system to enhance
accessibility and affordability. Increasing socio economic hardships may increase the
magnitude of mental ill health.
24
Life Style

Life style as a social determinant: Increasing misuse of alcohol is one of the

significant public health problems that often begins early in adult life and is
associated with a range of non-communicable health conditions. It is a major cause
of intentional and unintentional injuries; have adverse negative effects on the foetus,
increasing risk of development of certain types of cancer, physical and sexual
violence and increase in road accidents and injuries in Tanzania in recent years.

The number of people who develop cancer has been increasing among others
because of increased unhealthy life style habits, such as tobacco smoking and
alcohol intake. At present about 35,000 people develop cancer each year, and
recent forecasts suggested that by 2020 this number would increase by 50%. This
will cause increasing strain on already stretched health systems and resources.
Tobacco smoking is a major risk factor in developing cancer and the prevalence of
tobacco use is rising in Tanzania. From 2008 to 2012 the prevalence of tobacco
smoking jumped from 7.9% to 14.1%, and according to the latest data 28% of males
are smoking. About 80-90% of cancer patients are unable to access diagnostic and
treatment facilities and when they seek hospital care, about 75-80% of the patients
have cancer in advanced stages that cannot be cured.

Oral health

Dental diseases have increased due to changes in the system of life-style of people;
changes in food and drinks and low awareness of oral health issues in the
community due to lack of dentists. Furthermore, the services provided do not meet
the needs due to shortage of human resources and related commodity and in
addition, the few available are not accessible to many people particularly those
residing in the rural areas. There is limited community involvement and oral health
researches.

Sight and Social conditions

Majority of eye conditions causing blindness or visual impairment can either be

prevented or treated. However, eye health services are not available to a significant
proportion of the population, with the rural far more affected than urban. Eye
diseases are on the increase and hence triggering a burden to the health care
system. There have been limited availability of eye health commodities, skilled
human resource, equipment and infrastructure for provision of eye health services.

Parasitic diseases and Social conditions

Intestinal parasites such as Hookworm, Ascaris, Pinworms, Tapeworms are

widespread. About 60% of OPD diagnosis has been associated with poor sanitation
and hygiene practices. Water, sanitation, hygiene and food safety problems, which
are social determinants-remain of big concern in the country. Use of improved toilets

25
at household level is 35% only. 10.8% of the households still practice open
defecation.

Moreover, only 44% of health care facilities have a functioning toilet while 96% of
schools lack standard sanitary facilities. Only 35% of households perform water
treatment and about 32% of all health facilities have unsafe water supply. This has
partly been due to inadequate community-based enforcement and overlapping of
various laws and regulations; weak coordination among stakeholders dealing with
sanitation and hygiene issues. In urban areas only 50% of waste generated is
effectively managed leading to breeding grounds for mosquitos and hence the
widespread malaria. Involvement of community in disease surveillance has been
limited and inadequate.

Emergencies and epidemic outbreaks and Social determinants

Tanzania is still faced with inadequate hazards mitigation and preparedness,

response and recovery plans and strategies at all levels, comprehensive multi-
hazard preparedness, emergency capacity in terms of human and financial
resources, and lack of pre-hospital Emergency Medical Services (EMS).

Nutrition and Social determinants

Tanzania is facing a triple burden of nutritional disorders. The commonly affected

populations include children under the age of five, women of reproductive age,
elderly, adolescents, and those with chronic diseases. Such conditions include
undernutrition, micronutrients deficiencies, and overweight and obesity. Nutrition
disorders span from social demographic disadvantages and challenges. Studies on
social determinants of health and interventions thereof can help addressing the
burden of undernutrition, micronutrients deficiency and overweight/obesity in various
sub-populations.

Gaps

Gaps have been identified in; awareness on contribution of social determinants in

diseases development; inclusion of social determinants component in health science
training; utilizing available services in carrying out frequent medical examinations;
motivation, policies and infrastructure for physical exercises; preparedness for
epidemics and emergencies.

Priority Research Area

Specific research areas include; implement targeted intervention programs among

policy makers and general population to promote lifestyle modification and
awareness on social determinants of health; increase emphasis on developing
competent health professionals who understand the context of health conditions and
can manage them holistically while addressing the social determinants of health in
the care and management of diseases.

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Theme 8: Injuries
Background

Injuries have been becoming an important contributor to the national disease burden
due to rapidly transforming socioeconomically from rural-agrarian to urban-industrial
and commercial economy. As injuries occur on regular basis in the day-to-day
activities, two important categories of injury must be recognized. One has been
intentional incidents like attempted or actual suicide in which the former leads to
injuries while the late causes actual deaths. The second group which has been
broader in perspective has been unintentional injuries resulting from motor traffic
accidents, occupational causes, sporting activities, domestic activities and violence,
criminal violence and related causes. In this regard, injuries have been differentiated
from emergency disasters which occur incidentally from the changing economic
activities.

Situation Analysis

Tanzania has seen tremendous rise in motor traffic accidents lately. Major causes
being pedestrians against vehicles, passengers of conventional vehicles like buses,
three wheeled vehicles (Bajaji) and above all, two wheeled motorcycles (Bodaboda).

Road traffic injuries in Tanzania are an important public health problem,

predominantly in adult males. Road traffic accidents are now the leading cause of
permanent disability and mortality among those aged 10 to 50 years. A study of
mortuary based fatal injuries surveillance (FIS) system in rural and urban hospitals in
Tanzania (2010-2015) revealed that out of 2387 deaths, two-thirds, 1222 (68%) were
from unintentional courses, majority (51%) being due to road traffic injuries (RTI),
whereas suffocation from hanging has been the main mechanism in intentional
injuries. Guns and blunt objects were the weapons involved for the majority homicide
deaths.

Provision of health care services to people injured has been effective in most of
health facilities although there are some deviances. Pre-hospital care has been
almost non-existent and health care service deliveries at the health facilities have
been inadequate. Furthermore, the requirement of case notification to police station
before a victim is sent to hospital delays patients further and defeat the concept of
golden hour in emergency management of trauma patient. It has been logical to
believe therefore, that significant proportion of patients with severe injuries is dying
without medical care in Tanzania. There are limited capacities for both pre-hospital
and health care facilities to manage accidents.

Gaps

Challenges identified lie in the following; approaching intentional/unintentional

injuries as disease entities; effective and integrated national injuries prevention,
rescuing and surveillance systems; adequacy integration into the referral system of
pre-hospital injuries management; injuries care and rehabilitation services;
competencies of health care providers particularly at PHC in triaging, assessing and
management of injuries. Furthermore, evidence on risk factors for injuries and road
traffic accidents needs to be evaluated. These include state of mental health,

27
substance abuse, associations with chronic diseases and nutrition, poverty and other
social economic disadvantages.

Priority Research Areas

Target research areas include; research that geared to formulate proper

management of intentional and unintentional injuries and promote the recognition of
these conditions as true disease entities; enhance respectively the efficiency and
competencies of health systems and health care providers at all levels (primary to
national) in proper injuries management (including rehabilitation); strengthen pre-
referral management of injuries; establish efficient and effective joint local (village to
region) and national injuries prevention systems and surveillance. Moreover,
research is needed on understanding the contexts where injuries and road traffic
accidents occurs including individual risk factors such as demographic
characteristics, mental health challenges, family, societal, and population-wide
constructs. Interventions are also necessary to ensure those affected are re-
integrated to economic activities to cut-down life-long suffering and dependency.

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Theme 9: Emerging and Re-Emerging Infections
Background

Emerging diseases are those whose incidence in humans has increased in the past
two decades while re-emergence is the reappearance of a known disease after a
significant decline in [Link] magnitude of the problem is illustrated by the
appearance of several new pathogens causing disease of marked severity, such as
the human immunodeficiency virus (HIV) and other retroviruses, the Ebola virus and
currently, the Corona virus. Old pathogens such as cholera, dengue, hemorrhagic
fever etc., have re-emerged and are having considerable impact in many
communities and countries. The “highways” on which these infections travel at
supersonic speed traverse the world which has become globalized. The vehicle is
person-to-person transmission or vectors contact between animals and humans as
championed by One Health.

Situation Analysis

Emerging and re-emerging infections are a reality in Tanzania. These include for
example cholera, HIV/AIDS, Rift valley fever and currently COVI-19. The latest
outbreak of cholera was from 15 August 2015 through 7 January 2018, 33 421 cases
including 542 deaths were reported in all the 26 regions of the United Republic of
Tanzania. Children under five years old accounted for 11.4% of cases. The
HIV/AIDS outbreak occurred in the early 1980s and currently its prevalence is 5%. It
infects adults and children although adults are infected more. Rift valley fever has
been sporadic but there has been effective control. The latest of these emerging
diseases is the current COVID-19. Documentation of the later in Tanzania is poor.
Occasional deaths have been reported. Worldwide, however, it has affected all
countries. The most affected countries include the USA, Brazil, India, USSR and
Britain. The WHO estimates that 100,000 people are dying every week in the world.
To-date over two million people have died worldwide from COVID-19.

The emerging and re-emerging infections management under ideal situations

requires:

1. Strengthened infectious disease surveillance and response.

2. Improved methods for gathering and evaluating surveillance data.

3. Ensured use of surveillance data to inform public health practice and medical
treatment.

4. Strengthened local and global capacity to monitor and respond to emerging

infectious diseases in addressing specific problems and in implementing
measures for the prevention and control of emerging and re-emerging
infections.

5. Basic infrastructure in place where the surveillance is being done besides the
capacity to systematically collect, analyse, interpret and disseminate the
collected data.

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 6. Established national and regional infrastructures for early warning and rapid
response to infectious disease threats through laboratory enhancement and
multidisciplinary training programs.

7. Promoting further development of applied research in the areas of rapid

diagnosis, epidemiology and prevention.

8. Strengthened regional collaboration for effective implementation of prevention

and control strategies.

Existing Gaps

Among areas that demand close attention include; effective and decentralized
surveillance systems; health system and government preparedness particularly in
absence of development partners; understanding on the importance of effective and
collective communication approaches with communities during outbreaks; necessary
human and laboratory capacity; regional collaboration, multisectoral and
multidisciplinary approach in outbreaks research and management; understanding
the influence of globalization and changing national ecology to emerging and re-
emerging infections.

Priority Research Areas

Specific research areas include; establish the tole of national ecology, risk factors,
nature, and contexts on emerging and re-emerging infections; develop and evaluate
novel and existing emerging and re-emerging infections surveillance systems;
formulate strategies to strengthen national capacity to manage emerging and re-
emerging infections; enhance effective and efficient communications, reporting and
referral systems between the community and respective authorities during
outbreaks of emerging and/ or re-emerging infections.

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Theme 10: Oral Health
Background

The World Health Organization - Regional Oral Health strategy 2016-2025

advocates for Common Risk factor approach to managing oral disease and
conditions. The strategy aims to reduce the NCD burden and risk factors so as to
effectively prevent oral disease. The Tanzania NCD strategic plan 2016-20,
incorporated oral heath as an NCD, to strengthen preventive efforts through a
common risk factor approach. The WHO guides countries to periodically conduct
national oral heath surveys in order have data required for planning oral health
services, monitor oral disease trends and allow comparability across the nations.

The first (1982), second 2010) and third national surveys yielded findings that formed
a basis for: producing the national plan for oral health 1988-2002 and the national
policy guidelines for oral health 2002 leading to formulation of plan for the
rehabilitation and equipping dental clinics at all hospital levels in Tanzania; drafting
the Tanzania oral health strategic rolling plan for 2010-2015; addressing
psychosocial aspects of oral health whereby it was realized that half of the
participants had at least one oral impact, and distance as well as cost of treatment
hindered many Tanzanians to access dental services. These findings led to the
intensification of dental task shifting; whereby clinical officers were trained to render
emergency oral care at health centres and strategically placed dispensaries.
Likewise, village health workers, primary school teachers and reproductive and child
health workers were trained to be able to give oral health education.

Situation analysis

The Tanzania national oral health surveys as well as research conducted in the
country revealed that:
Dental caries:Dental caries experience among Tanzanian pre-schoolers is reported
being at higher levels than the school going children with average number of
decayed teeth ranging from 0.95 to 2.4 and prevalence ranging from 3.7 to 49.6%
and the experience increases exponentially with age. There is scarce information
regarding prevalence of dental caries among Tanzanian adults, few studies retrieved
indicate average score of decayed-missing and filled teeth ranging from 1.8 -3.8 also
increasing with age. Dental caries is the main reason for teeth loss and majority of
patients stay with untreated dental caries. It is more prevalent among urban dwellers,
well-off families and females.
Periodontal disease:Gingivitis is the commonest periodontal disease but limited
progression to periodontal pockets. Oral hygiene is largely unsatisfactory. Risk
factors for such diseases include age, sex, education, residence, plaque and
calculus. Tobacco smoking is also known to be associated with periodontal
diseases.
Malocclusion:Prevalence ranges from 26.9 % among 3-5year olds to 62-97.6 %
among 12-15 years (42–44). It has a significant impact on oral Health Related
Quality of Life. With advances in dental technology a lot is desired to be done to
attain aesthetically functional occlusion.

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Dental fluorosis: Dental fluorosis affects almost everybody (92-100%) in fluoride
endemic areas. The concern is not only the mottling of teeth which impacts on
aesthetics, it also makes teeth brittle and fracture. Dental fluorosis intervention is
almost an untouched area in Tanzania. Given the number of people affected, the
ministry of health requires data for planning interventions at both community and
clinic level.
Dental trauma:This is prevalent in Tanzania and most individuals walk with
untreated traumatized teeth. There is increase in motor traffic accidents, fractures of
skull and facial bones account for more than 40% of head and neck injuries.
Oral cancers: The prevalence of oral tumours is low with 12% being comprised of
tumours of odontogenic origin, with ameloblastomas being the most commonly seen
odontogenic tumours (incidence rate of 0.68 per million). Kaposi’s Sarcoma of
orofacial region are common due to HIV association.
Cleft-lip and palate:Hospital data shows incidence of 17 per 100,000 – 1:2000.
Enhancing oral health in school is a public health measure.

Gaps

Oral diseases are among the most common non-communicable diseases (NCDs)
that impact populations’ quality of life. Infectious diseases that manifest in oral cavity
are also prevalent and they affect people throughout their lifetime. Studies conducted
in Tanzania indicate a gradual increase of oral impacts from early childhood to
elderly. Reported prevalence of impacts is reported in 32.5% of the studied toddlers,
28-48% among school children, 51% among young adults, and among the elderly,
the prevalence ranges from 51.2% - 62.1%. Putting all age groups together; the
previous national pathfinder survey found a prevalence of 49.1% indicating
significant suffering among Tanzanians due to poor oral health. Treatment of oral
diseases causes a considerable economic burden on individuals, communities and
countries. On the same note there is unequal distribution of oral health professionals
causing most of the oral diseases to remain untreated in the remote areas. MUHAS
as a public institution, having the appropriate facilities for research and hosting
health professionals who are capable of conducting innovative research, is in the
right position to contribute to the reduction of oral disease burden.

Priority Research Areas

General

Potential research areas include; evaluate the costs and impacts of adopting Basic
Package of Oral Car; develop and evaluate cost-effective programs needed to
strengthen local oral health policies, guidelines and programs; formulate effective
strategies to increase accessibility to quality comprehensive oral health package.

Specific Research Areas

Diagnosis: Specific research areas include; explore novel approaches for

diagnosing malignant oral lesions; establish cost-effective community-based
interventions/strategies to improve access to oral health services; evaluate best
entry points for diagnosing oral lesions.

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Treatment: Potential areas include; formulate cost-effective strategies or
interventions for preventing, screening and treating oral diseases including the oral
manifestations of systemic diseases; deploy best strategies or interventions to
improve preventive dental visiting behaviour.

Delivery of Quality Services: Target research areas include; deploy cost-effective

strategies to improve accessibility to oral health services and factors impacting their
success; implement best strategies or interventions in providing and integrating oral
health care with other NCD programs; formulate and implement optimal strategies or
interventions to improve oral health outcomes in adolescents.

Prevention (Community Dentistry): Specific research areas include; formulate and

evaluate strategies to introduce and promote uptake of comprehensive oral health
preventive package; establish the efficacy, feasibility, and acceptability of Silver
Diamine Fluoride (SDF) for prevention of early childhood.

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Theme 11: Mental Health
Background

Tanzania has experienced increased prevalence of mental illness which often have
onset in young adulthood. It is estimated that at least 1% of the population suffer
from a mental illness at any given time. Common mental illnesses are often not
diagnosed or treated which have implications for lost productivity of both patients
and the extended family while seeking healing for prolonged time. Persistence of the
AIDS epidemic and its psychosocial ramifications, and increasing socio economic
hardships may increase the magnitude of mental ill health.

Tanzania, being one among the developing countries in the world, has an
astonishing shortage in mental healthcare. Access to mental health services is
restricted and this restriction, comes from a variety of factors, from limited healthcare
facilities providing integrated mental health services, lack of mental health care
providers (both non-specialized and specialized), limited infrastructure for mental
health services including space, frequent stock-out of antipsychotic drugs, and
inadequate health management information systems that allow for documentation of
mental disorders. While these factors may in part be a result of lack of funding;
human resource challenges may limit abilities to develop adequate district and
regional mental health service plans, effectively excluding such services from
budgetary requests. Furthermore, stigma towards mental disorders, those affected
and their caregivers, may effectively marginalize people with mental and substance
use disorders. Mental disorders include: depression, bipolar affective disorder,
schizophrenia and other psychoses, dementia, intellectual disabilities, personality
disorders, substance use disorders and developmental disorders including autism.
Mental health services and clinical research has the potential to inform development
and strengthening of existing packages for mental health services and care, and in
this way save lives, relieve significant distress and improve quality of life. Mental
health promotive and preventive research may also benefit the whole of our society
by generating psychosocial and economic benefits that contribute to thriving
communities built upon resilience, reduced levels of mental ill-health and less stigma
and discrimination.

Gaps: Gaps were identified in the following areas; accessibility of mental care at
community, primary-tertiary levels; integration of mental health services into primary
and secondary levels; mental health training for both specialized and non-specialized
health care workers; adequacy of human resource (including age specific i.e.,
children, adolescents, adults, elderly) for specialized mental health care teams e.g.,
psychiatric nurses, social workers, occupational therapists, clinical psychologists etc;
supportive treatment/rehabilitative facilities/infrastructure in health facilities and
rehabilitative centres; evidenced based treatment and rehabilitative practices e.g.,
occupational and psychological therapies in improving the quality of life.

Research Areas: Potential research areas include; burden of suicide and common
mental disorders among adolescents and adults in the community and primary levels
of care; establishing biopsychosocial determinants, protective and risk factors of
common and severe mental disorders in Tanzania; cost effective strategies for
integrating mental health services in the assessments and plan of care of clients

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(including those with chronic illnesses like DM, CKD, HIV/AIDs, Stroke etc.) that are
attended at OPD and RCH in all levels, primary to tertiary levels; characterize the
preparedness, mental health and resilience of children and uneducated individuals in
coping with developmental challenges in the society. Other research areas include;
design and implement impactful multilevel interventions against gender based
violence; harmonizing quality and nature of mental health care packages delivered at
different levels of care, from community to national levels; formulate cost-effective
and feasible diagnostic and treatment models/interventions against common mental;
strategies to strengthen the capacity for mental health services clinical practice and
research; evaluate and scale up measures against illicit and narcotics drugs in
Tanzania.

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Theme 12: Pharmacovigilance and Rational use of Medicines
Background

The World Health Organization (WHO) has defined Pharmacovigilance (PV) as “the
science and activities relating to the detection, assessment, understanding, and
prevention of adverse effects or any other possible drug-related problems.”1 The aim
of the PV system is to protect the public from medicines-related harm. Currently few
low- and middle-income countries have a well-functioning PV system to support the
timely identification, collection, and assessment of medicine-related adverse events.
On the other hand, rational use of medicines is the role of all health worker cadres
and is under the mandate of National and Hospital Therapeutic committees.

Situation Analysis

The PV system in Tanzania was introduced in 1989. The major purpose was to
monitor and provide relevant information about the safety of medicines. Since its
establishment, there have been a lot of interventions conducted to strengthen the
system such as development of tools like electronic reporting systems, sensitization
and training, establishment of PV zonal centres and active safety monitoring for
some selected medicines. The Pharmacovigilance regulations were also developed
and endorsed by the Minister responsible for Health, Community Development,
Gender, Elderly and Children (MoHCDGEC) in the year 2018. The regulations
require for mandatory reporting of all suspected adverse drug reaction by the
Marketing Authorization Holders, healthcare works and consumers.

Despite all these efforts, the PV system in Tanzania did not achieve all of its planned
goals due to inefficient functional regulatory and organizational structures, limited
funds, unclear roles and responsibilities of all stakeholders on ensuring medicinal
safety, ineffective active surveillance of Adverse Drug Reactions (ADRs),
disconnected databases, lack of sufficient Human Resources as well as lack of PV
relevant skills and competence among stakeholders

On the other hand, irrational prescribing and dispensing of medicines contributes to

poor treatment outcomes. Engaging a check and balance mechanisms for medicines
prescribed and dispensed is the role of clinicians and Pharmacists and the 2 must
work collaboratively to the quality management of patients. In most health facilities
there is reluctance to initially check culture sensitive or check existence of parasites
before an antibiotic or antimalarial drug is prescribed. This has led to overuse of
antibiotics and antimalarial drugs hence creating drug pressure that eventually leads
to drug resistance.

Gaps: Inadequacies were observed in the following areas; collaborative approaches

between clinicians and pharmacists in for addressing medical errors; integration of
various PV teams e.g., MDR TB PV team and general hospital PV team; PV trained
staff turnover and knowledge sharing from them; commitment by health facilities
leadership (e.g. hospital drugs and therapeutic committees) and HCWs in reporting
adverse drug reactions; performance of hospital therapeutic committees; linkage
between the TMDA and the potential PV stakeholders e.g., healthcare workers and

36
professionals, Public Health Programmes (PHPs), Marketing Authorization Holders
(MAHs); linkage of institutional and TMDA ADR databases.

A number of gaps were also identified in the following areas; promoting prescription
of medications (particularly antimalarials and antibiotics) after culture results or
confirmation of parasites; capacity to analyse aggregated safety information like
Periodic Safety Update Reports (PSUR) from MAH; PV curriculum or standalone
training in medical schools; inadequate awareness on PV among HCWs and
management; defined system for ADR risk management; units and focal persons at
MAH and health facilities for coordinating activities and liaising with TMDA; STG and
NHIF medication list related consequences information.

Priority Research Areas: Specific research areas include; institute effective tools
and training modules/curricula for PV particularly in training institutions; strategies to
strengthen; Hospital and National Therapeutic Committees; ADR reporting systems
and regulatory framework for PV; quality of adverse event reports transmitted to
TMDA, quality of information transmitted to Uppsala Drug safety Monitoring centre;
quality of patients’ care irrespective of the discrepancies reflected on STG and NHIF
medications lists; the linkage between TMDA and various PV stakeholders and
pharmacists and clinicians the magnitude of overprescribing and dispensing of
injections and antibiotics, the economical and health impact of polypharmacy

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Theme 13: Occupational Health and Safety
Background

Workers represent half of the world population and are the major contributors to
economic and social development. Most of them work under difficult and hazardous
conditions. In low- and middle-income countries, the number of workers who contract
occupational diseases and injuries is particularly high, with significant societal
consequences. However, most of these diseases and injuries could be prevented
through improved knowledge and education. Effective interventions can prevent and
avoid occupational hazards and protect workers' health. While industrial activity is
increasing dramatically in Tanzania, knowledge about Occupational Health (OH) is
poor. In addition, only a small minority of the workforce has access to occupational
health services, and the growing informal economy is often associated with
hazardous working conditions.

Situation Analysis

The Global plan of action 2008-2017” by World Health Organization concluded that
“All workers should be able to enjoy the highest attainable standard of physical and
mental health and favourable working conditions. The workplace should not be
detrimental to health and wellbeing. Primary prevention of occupational health
hazards should be given priority. According to information from the International
Labour Organization, more than 2.3 million people die of work-related accidents and
diseases every year and 317 million accidents occur due to workplace hazards
annually. Worldwide, occupational diseases continue to be the leading cause of
work-related deaths. According to ILO estimates, out of 2.34 million occupational
fatalities every year, only 321,000 are due to accidents. The remaining 2.02 million
deaths are caused by various types of work-related diseases, which correspond to a
daily average of more than 5,500 deaths. This is an unacceptable number. “Every
15 seconds, a worker dies from a work-related accident or disease”, ILO states. The
inadequate prevention of occupational diseases has profound negative effects not
only on workers and their families but also on society at large due to the tremendous
costs that it generates; particularly, in terms of loss of productivity and burdening of
social security systems.

In many developing countries, death rates among workers are five to six times those
in industrialized countries and work-related injuries and diseases are largely
undocumented. Global competition, growing labour market and rapid change in all
aspects of work creates an increasing need for labour protection, especially in
developing countries. MUHAS should take concrete steps to enhance capacity
towards preventing occupational diseases.

Gaps: Pitfalls have been observed in such areas as; adequacy and competency of
HRH for OSHA and WCF scaleup; estimating magnitude of occupational exposures
and diseases; establishing the clear relationship between exposures and diseases;
developing, implementing and evaluating effective interventions for workplaces
related health issues; studies on occupational exposures related to chronic
respiratory diseases.

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Priority Research Areas: Specific research areas include: characterizing health
workers’ exposure to chemicals (cleaning agents, disinfectants, natural rubber latex,
dust, pesticides) and infectious agents (TB, viral infections) as well as assessment of
the associated health effects; investigating the magnitude and risk factors for burnout
and other work-related psychosocial disorders; determining the appropriate
reference values for the interpretation of lung function data in the Tanzanian
population; characterising risk factors for low lung volumes in the Tanzanian
population; characterising workers exposure and associated adverse health effects
in various sectors such as artisanal and small-scale mining, agriculture, coffee
processing, cement production, ceramic and textile industries; quantitative exposure
measurements and biological monitoring of hazardous chemicals such as poly-
chlorinated pesticides (PCPs), biphenyls (PCBs) and persistent organic pollutants
(POP).

Other research specific areas include; design, implementation and evaluation of

novel and existing cost-effective strategies for reducing or controlling occupational
exposures and their associated health and non-health impacts; develop and evaluate
cost-effective diagnostic, treatment and rehabilitative models for work-related
diseases.

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Theme 14: Haematological Disorders
Background

Haematological conditions are common in Tanzania and affect individuals across the
age spectrum. The range of haematological conditions described in the country is
wide, encompassing acute and chronic as well as benign and malignant conditions.
Notable burden includes haemoglobinopathies such as Sickle Cell Disease (SCD),
disorders of haematopoiesis such as aplastic anaemia, nutritional and other forms of
anaemia, coagulation abnormalities such as haemophilia and malignancies such as
multiple myeloma, leukaemia and lymphomas.

Over the years, MUHAS has taken lead in advancing the basic, clinical, translational
and public health research on these diseases. Insights from these studies have
informed the magnitude, determinants of disease severity, treatment outcomes and
associated factors for select diseases. Currently, substantial progress is being made
in the country in the areas of diagnosis, curative and monitoring services for
haematological disorders, including enhancement of zonal blood transfusion services
as well as use of clotting factors and monoclonal antibodies for the treatment of
bleeding disorders and leukaemia, respectively. Preparations are also under way for
introduction of bone marrow transplant and gene therapy. As clinical care for these
diseases advances at both public and private healthcare settings in the country,
MUHAS needs to continue to be at the leading age of research intended to inform
these advancements.

Situation analysis

Sickle Cell Disease

SCD is one of the more extensively described haematological disorders in the

country. Currently, about 11,000 babies are estimated to be born with the condition
each year in Tanzania, ranking 5th globally (Piel F et al., PLOS Medicine, 2013).
Mortality due to SCD in Tanzania is high, especially during childhood where the
disease contributes 7% of all-cause mortality among children below 5 years of age
(Makani J et al., Trop Med Int Health, 2015). Over the past decade, concerted efforts
have been invested in research and care for SCD in Tanzania with significant input
from MUHAS. These have included development of an online SCD registry, paving
way for cohort studies and implementation research; training of healthcare workers
and researchers on SCD; development of the National SCD Management
Guidelines; inclusion of Hydroxyurea in the National Essential Drugs List, implying
coverage by the National Health Insurance Fund and pilot in-country compounding of
Hydroxyurea. Through intended for all infants in the country, the introduction of
pneumococcal conjugate vaccine-13 (PCV-13) through the National Programme on
Immunization since 2013 has had a particular benefit to individuals with SCD.

Aplastic Anaemia and Paroxysmal Nocturnal Haemoglobinuria

Aplastic anaemia (AA) is a rare disorder, and paroxysmal nocturnal haemoglobinuria

(PNH) is an ultra-rare disorder. The essence of AA is bone marrow failure (BMF): it
may be caused by a specific genetic abnormality, as in Fanconi anaemia; or it may
be acquired, mostly as a result of a T cell-mediated auto-immune process causing

40
damage to the haematopoietic stem cells (HSC). PNH is closely related to AA
because, when the target of the auto-immune attack is the glycosyl-phosphatidyl-
inositol (GPI) molecule, as it often is, then HSCs with a PIGA mutation that lack GPI
will have a selective advantage and will repopulate the bone marrow: thus, AA can
evolve to PNH.

In spite of its rarity, AA is well recognized at the Muhimbili National Hospital, with 30-
40 new cases diagnosed each year. We have provided evidence that the incidence
of AA may be higher in Tanzania than in Europe. We also have at least 5 cases of
PNH on record.

Haemophilia and other coagulation disorders

The congenital bleeding disorders haemophilia A and B are estimated to affect

between 1 in 10,000 (Merritt A.D et al, Publishing science group,1976) and 1 in
30,000 (Rosendaal F.R et al, Thromb Haemostasis journal,1990) males. The
complications of haemophilia, including severe, debilitating chronic joint disease and
infectious diseases transmitted through blood products, create large demands on
health care resources. However, little is known about the size and distribution of the
East African haemophilia population and even less is known about the rate of
complications from the disease or its treatment.

Haemophilia A (HA) is an X-linked recessive bleeding disorder caused by any of a

large number of mutations in the factor VIII (F8) gene encoding the coagulation
factor VIII (FVIII) protein (Goodeve A et al, SeminThrombHemost journal, 2008). This
is required for propagation of the intrinsic coagulation pathway and is the only gene
known to be associated with HA (Renault N et al, European journal of Human
Genetics, 2007). HA is the most common inherited bleeding disorder (after von
Willebrand disease) and in many populations its frequency in males is approximately
1:5000 to 1:10,000 (Scriver CR et al, McGraw-Hill, New York Publisher,1995).
According to the residual FVIII activity, HA is classified as severe (<1% FVIII activity;
-0.01 IU/mL), moderate (1%–5% FVIII activity; 0.01–0.05 IU/mL) or mild (5%–40%
FVIII activity; 0.05–0.40 IU/mL) (Goodeve A et al, SeminThrombHemost journal,
2008).

In Sub-Saharan African countries, data on genetics, inhibitors, prevalence and

causal haemophilia variants are scarce and this includes East African countries,
Tanzania being one of them whereby there is no any published studies evaluating
the prevalence of Haemophilia A, Factor 8 genetic mutations among patients with
HA, presence of FVIII inhibitors against infused factor concentrates and associated
risk factors.

Multiple Myeloma, Leukaemia and Lymphoma

Lymphoma is a cancer resulting from malignant transformation of lymphoid cells, and

is the 3rd most common malignancy in children after acute leukaemia and central
nervous system (CNS) tumours. Non-Hodgkin’s Lymphoma is the most common
haematological malignancy in Tanzania with a median age at diagnosis of 54 years.
The most common childhood malignancy in Sub-Saharan Africa is Burkitt’s
lymphoma. In Tanzania, Burkitt’s lymphoma constitutes 42% of all childhood

41
cancers (Kristin Schroeder et al, American Society of Clinical Oncology Journal,
2017).

Multiple Myeloma is a malignancy of the plasma cell and represents the second most
common haematological malignancy world-wide. Globally there are about 86,000
new cases diagnosed annually (Kazandijan D., Seminars in Oncology, 2016). In
Tanzania, approximately 30 patients are diagnosed with Multiple Myeloma every
year. This is probably an under-estimate as there are existing limitations with
availability and accessibility of diagnostic facilities as well as sub-optimal awareness
in the general public as is common for the vast majority of cancers. Multiple
Myeloma patients in Tanzania present at a relatively younger age – median age of
57 years compared to patients in the developed countries, where the median age is
70 years. About 16% of patients are less than 45 years of age (Leak S.A et al., PLoS
One, 2020).

Leukaemia is a term used to define cancer of the blood and bone marrow. It is
broadly subdivided into acute leukaemia and chronic leukaemia based on the
maturity level of the blood cells involved with further subdivisions based on the type
of cells involved. Leukaemia is the second most common haematological
malignancy constituting 27% of all haematological malignancies in Tanzania (Leak
S.A et al., PLoS One, 2020). Acute Myeloid Leukaemia (AML) is the most common
acute leukaemia in adults, whilst acute lymphoblastic leukaemia (ALL) is most
common in children. The Paediatric Oncology Network in Tanzania, in collaboration
with the Non-Governmental Organization ‘Tumaini La Maisha (TLM) has made
significant progress in research on acute leukaemia in children. Approximately 72%
of all acute leukaemia cases in children constitute ALL (Kersten E et al. Pediatric
Blood and Cancer, 2013). The Chronic Myeloid Leukaemia clinic at Ocean Road
Cancer Institute (ORCI) attends an average of 40 patients with confirmed CML every
week with the median age of 45 years – a much younger age compared to patients
in developed countries where the median age is 60 years. Imatinib, used for
treatment of CML, is freely available in Tanzania under sponsorship of Glivec
International Patient Assistance Programme since 2004. However, 75% of patients
treated with Glivec in Tanzania have a sub-optimal response. The median age of
CLL in Tanzania is 67 years, with a predominant male pre-ponderance (ratio 4:1)
(Nasser A. et al, Blood Advances, 2021)

Gaps

Sickle Cell Disease

Deficiencies were observed in the following areas; awareness of SCD among HCWs
and community; national New-born Screening (NBS) policy; understanding of the
basic mechanisms (genetic, proteomic) that influence expression of haemoglobin F,
vaccine reactivity and susceptibility to infection and end-organ damage in patients
with SCD in Tanzania; coverage of health insurance for patients with SCD,
resources for SCD care at health facilities; on oral/dental manifestation of SCD and/
or its treatment; guidelines on oral/dental management of patients with SCD; data on
the availability and acceptability of Hydroxyurea, folic acid, penicillin prophylaxis and
the various pain medications in SCD; appropriate recommendation for malaria
chemoprophylaxis in patients with SCD.

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Other identified gaps include; studies on the incidence and determinants of end-
organ damage in SCD; availability of advanced transfusion services (exchange
transfusion, extended cross-matching, cryoprecipitates); data on acceptability
(community and HCWs’ perception, costs) and preparedness for advanced therapy
for SCD

Aplastic Anaemia and Paroxysmal Nocturnal Haemoglobinuria

Regarding AA, our main gaps are not in diagnosis but in management. Most of our
patients have severe AA, and the current recommended therapeutic options are
either (a) intensive immunosuppressive treatment (IST) or (b) allogeneic bone
marrow transplantation (BMT). While steps are being taken for instituting BMT, both
options have requirements in common; provision of platelets by platelet apheresis;
improved microbiology support (prompt reports of cultures, diagnostic tests for
viruses); a broader spectrum of antibiotics; leukocyte retention filters when giving
blood products; supply of anti-thymocyte globulin (ATG)

For PNH we also need; panel of 3-4 antibodies for flow cytometry; exploration of
access to eculizumab; entering patients into clinical trials of new complement
blockers.

Haemophilia and other coagulation disorders

The identified gaps are in such areas as; awareness on bleeding disorders among
health care workers, policy makers and the community; data on disease
epidemiology among African countries and Tanzania; diagnostic capacity and
resources in various health facility levels; accessibility to standard of care treatment
(e.g., Factor concentrates & By-passing agents); supply of blood and blood products
for the management of bleeding disorders; national screening policy and registry;
data on the treatment outcomes with the available therapeutic agents; parents
support groups and educators (Psychologist/social worker); information on the
genetic risk factors of Tanzanian patients with bleeding disorders, community social
economic status and insurance coverage for patients with bleeding disorders.

Multiple myeloma, leukaemia and lymphomas

Identified areas with unaddressed/ partially addressed challenges include;

awareness of health care workers, policy makers and the community on blood
cancers; data on disease epidemiology; diagnostic capacity, screening and early
detection resources; accessibility to standard of care treatment; supply of blood and
blood products for the management of blood cancers; information on the genetic risk
factors and genetic landscape of Tanzanian patients with blood cancer; data on the
treatment outcomes with the available therapeutic agents.

Priority Research Areas

Sickle Cell Disease and other haemoglobinopathies

Basic and clinical sciences

Research specific areas; exploration on the molecular mechanisms that influence

expression of haemoglobin F, vaccine reactivity and susceptibility to infection and
43
end-organ damage in patients with SCD in Tanzania; incidence and risk factors for
end-organ damage in SCD (renal failure, avascular necrosis, chronic ulcers, visual
impairment, cardiomyopathy, hepatopathy stroke)

Public health, health systems, sustainability

Potential research areas; explore and influence the preparedness of the healthy
systems, patient communities and healthcare workers for the introduction of
advanced therapies for SCD in Tanzania; developing feasible and cost-effective
strategies that could influence public-private partnerships towards investment in care
for SCD at healthcare facilities; design, implement and evaluate approaches for
enhancing and sustaining knowledge and awareness on SCD among communities
and healthcare workers.

Aplastic Anaemia and Paroxysmal Nocturnal Haemoglobinuria

Basic and clinical sciences

Specific research areas; Characterization of clonal haematopoiesis in AA and PNH;

establish in patients with AA; long term outcomes (e.g., propensity to evolve to PNH
or AML) and their proper preventive and treatment models/interventions.

Public health, health systems, sustainability

Potential research areas; socio-economic background of patients with AA;

strengthen doctor/patient education to facilitate spotting AA in peripheral hospitals in
patients receiving recurrent blood transfusion; exploring provision of new therapeutic
agents, particularly eltrombopag

Haemophilia and other coagulation disorders

Basic and clinical sciences

Specific research areas; Haemophilia related clinical phenotypes, genetic mutations

and complications among patients in Tanzania; FVIII inhibitors associated
prevalence, genetic and non-genetic factors for their development.

Public health, health systems, sustainability

Potential research areas; burden of bleeding disorders in Tanzania; feasible and

cost-effective advocacy strategies for sustaining diagnostic services and increases
awareness among healthcare workers and general public on bleeding disorders.

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Multiple myeloma, leukaemia and lymphomas

Basic and clinical sciences

Target research areas; the genetic and mutation profiles of patients with blood
cancers; design, implement and evaluate clinical trials to validate newer diagnostic
approaches suitable in the low resource setting; genome Wide Association Studies
for blood cancer in the African population; haematological and genetic response to
therapeutic agents used for treatment of blood cancers.

Public health, health systems, sustainability

Target research areas; the incidence and burden of blood cancers in Tanzania;
effective intervention programs to create and sustain awareness in the general public
and among health care workers; apply and evaluate the role of patient-led versus
physician-led patient support groups; acceptable, feasible and effective approached
to understand and influence perception of palliative care among specialists attending
to patients with haematological malignancy; effective and efficient strategies to
sustain diagnostic services for patients with haematological malignancies.

Theme 15: Traditional Medicines and Natural Products

Development
Background

Currently Tanzania imports over 70% of its drug needs, with the major share coming in
from India. India has successfully embarked on the production of well-established
drugs, and given the advantage of cheap labour as compared to European drug
manufacturers, they have managed to supply cheap drugs to many countries around
the world. On the other hand, the Chinese are pioneer of formalizing traditional
medicine use and it has been prescribed parallel as western medicines in hospitals.

The government declared intention to facilitate local production of traditional medicine

through the meeting which was held in July in 2011 in Malabo, Equatorial Guinea,
whereby Heads of African states laid up plans to in-cooperate some traditional
medicines in the nation essential medicine list by 2020.

There is a growing international demand for new medicines and chemotherapeutic

agents from natural products, owing to the failure of synthetic chemists to deal with
challenges of new diseases. Some of the new diseases include HIV/AIDS, Human
Spongiform Encephalopathy, Ebola and others which do not have cure. The world is
also facing re-emergence of old diseases like tuberculosis with organisms being
resistant to drugs. The emergence of multidrug resistant parasites is a formidable
challenge of our times that demands new and effective solutions. Due to
developments in biotechnology such as human genome project, has opened up new
areas of research including identification of new drug targets which provide
opportunities for the development of new medicines from traditional medicines and

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natural products to deal with emerging and re-emerging diseases. The Institute of
Traditional Medicine views this as an opportunity to take up the challenge to lead
efforts to develop traditional medicines and natural product formulations and channel
them to industries for mass production.

Situation Analysis

Tanzania is estimated to have over 75,000 traditional healers with varying

specialities. The majority of healers are herbalists using mainly plants and a few
animal and mineral products. In addition, there are practices such as bone setting
and socio-cultural aspects which contribute to the healing practices of traditional
health practitioners. Tanzania has over 12,000 higher plant species, of which at least
a quarter have medicinal value. The Institute has so far documented nearly 2600
species with limited preliminary chemical and pharmacological work. It is, indeed,
true that some of plants growing in Tanzania are already proven to have medicinal
value and have a big market potential worldwide and can be exploited for local drug
production.
The Tanzania National Health Policy (2007) stipulates that research in traditional
medicines will focus on the identification of traditional remedies, screening of
traditional herbal and medicinal materials and assessing the efficacy and safety of
the products.
The role of traditional and alternative health care to Tanzanian people is significant.
It is estimated that about 60 per cent of the population use traditional and alternative
care system for their day-to-day health care. Traditional and alternative healing
services and conventional health services are complementary to each other.
Tanzania needs to take advantage of this new window of opportunity in its efforts to
build a strong and competitive economy as enshrined in the Development Vision
2025.

Research Areas
HIV and AIDS
Gaps
Lack of effective herbal products in management of HIV/AIDS and associated
opportunistic infections; Inadequate nutrition information to support management of
HIV/AIDS patients.
Priority research areas
Treatment: Areas including; develop and evaluate novel mechanisms for
determining pharmacokinetics, pharmacodynamics and acceptability of ARVs and
drugs and formulations for opportunistic infections that originate from traditional
medicine and natural products; optimal approaches for management of
malnutrition using traditional medicine and natural products.
Prevention: Specific areas include; the potential of traditional medicines and natural
products in the formulation of microbicides for prevention of new HIV infections.
Tuberculosis
Gaps

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Identified gaps include; unavailability of effective traditional medicines for TB
prevention and/or treatment and overwhelming anti TB Drug resistance
Priority research areas
TB treatment and care: The specific areas involve; development and evaluation of
the pharmacokinetics, pharmacodynamics and acceptability of traditional medicines
based new anti-tuberculosis drugs including formulations that target MDR-TB.
Malaria
Gaps
A number of areas with gaps include; scientific evidence on the safety and efficacy of
herbal products traditionally used in the treatment of malaria; emergency of malaria
parasites resistant to the currently available antimalarial; potential antimalarial
natural products and their mechanism of actions in malaria parasites clearance;
effective new and appropriate vector control tools to create an evidence-base for
scaling up.
Priority research questions/areas
Prevention: Areas including; development and evaluation of existing and/or new
preventive and control measures like; mosquito vector control measures (ecology
manipulation included); combination preventive strategies both biomedical and
multipurpose prevention technologies.
Malaria Treatment: Areas including; evaluate the pharmacokinetics,
pharmacodynamics, efficacy and safety of antimalarial herbal products; potential for
developing antimalarial drugs from the bioactive constituents of these herbal
products.
Reproductive, Maternal, and Adolescent Health
Gaps
Deficiencies identified include; low rates of exclusive breastfeeding at 6 months and
lack of evidence on the role of traditional medicines and natural products in fecundity
and contraception
Priority Research Areas
Target areas include; establish the acceptability, safety and efficacy of the existing
and new the traditional medicines and natural products for; contraception and
management of; infertility; reproductive tract infections including STIs; labor and
various pregnancy complications. Other potential areas include; harnessing the
potential of integrating various culturally relevant practices with routine reproductive
health care to enhance uptake of FP services and institutional deliveries.
Non-Communicable Diseases (NCD)
Gaps: The following were the identified gaps; Inadequate evidence on potential role
of traditional medicines and natural products in the prevention and management of
NCDs in Tanzania; inadequate regulation on the use of traditional medicines and
natural products in preventing and managing NCDs in Tanzania.
Priority research areas
General: Potential areas; streamlined feasible and cost-effective strategies for
discovery, development and evaluation of drugs and vaccines.

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Specific Research Areas
Treatment: Specific areas; develop and evaluate the acceptability, pharmacokinetics
and pharmacodynamics of novel traditional formulation and natural products for
management of NCDs.
Prevention: Particular areas; role of nutritional traditional medicines and natural
products in management of NCDs in Tanzania
Injuries
Gaps: Underappreciated role of traditional medicines and natural products in pre-
hospital injuries management; poorly documented traditional medicines and natural
products used in management of injuries
Priority research areas: Specific areas include; the role of traditional medicines and
natural products in both pre- hospital and in-hospital management of injuries (bone
setting, skin burns).
Emerging and Re-Emerging Infections
Gap: Lack of multidisciplinary approach and capacity that incorporate application of
traditional medicine in researching and managing emerging and re-emerging
infections
Priority research areas: Specific areas; role of traditional medicines in
management of emerging and re-emerging infections.
Documentation of traditional healing practices and Conservation of medicinal
plants
Gap: Inadequate documentation and conservation of useful medicinal plants and
traditional healing practices
Priority research Areas: Specific areas; indigenous healing practices relevant for
the development of traditional medicine; techniques for sustainable conservation of
medicinal plants.

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Theme 16: Bioethics
Bioethics – Research Oversight

Background

Tanzania is one of the countries in Africa that have managed to have a decentralized
research oversight system. Under the system, institutions are able to independently
oversee research activities (other than clinical research and research with foreign
elements) by their members. Researchers conducting clinical research and research
with foreign elements must be assessed and regulated at the national level in
addition to the institutional level. Despite having a well-coordinated decentralized
oversight system, there is anecdotal information showing that the system needs to
be improved both at institutional level and national level.

Situational Analysis

Due to high burden of disease in Africa, there have been an increase in research
conducted in the continent. Increase in the researchers conducted has not
necessarily been accompanied by improvement in research oversight in Africa.
Concerns are up as to the standard of oversight processes in Africa owing to the
increase in the number of researches conducted in Africa.

Research Areas

Specific research areas; the pitfalls for research oversight in Tanzania; challenges
facing and strategies to improve the operational environment of the national research
regulatory authorities in overseeing research; establish and evaluate mechanisms
and procedure for protecting vulnerable population/participants in research; feasible
mechanisms for returning research results to the community/participants; design and
implement ethical framework for reviewing and approving emergency
research/drugs.

Bioethics – Clinical Ethics

Background

Ethical issues are common in the clinical care. Tanzania being among the middle-
income country faces the shortage of human and medical resources when working
with patients. Shortage of Health care providers leads to poor implementation of
informed consent, patient centered care and proper privacy and confidentiality of
patients. These ethical challenges require institutional support to address them.
Ethical challenges that often arise in the patient-provider relationship in their day-to-
day work life with patients and families, such as truth-telling, disagreements over
treatment plans and patient distrust of local physicians and hospital staff, among
others needs to be addressed through hospital ethics committee. Medical team is
also going paperless with electronic medical record. Improved technology raises the
issue of physician patient relationship and patient confidentiality.

Situational Analysis

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Lack of hospital ethics committee in Tanzania results to health care providers and
patients to deal with ethical dilemma all alone. There are several ethical challenges
including patient autonomy and confidentiality and physician and nurses deals with
them on isolated foci leading to moral distress among health care providers.

Gaps: Areas identified to have challenges include; the confidentiality of patients’

electronic medical records; availability of hospital ethics committee which could help
mitigate ethical issues in hospitals; boundary between individual autonomy and
public good when implementing public health interventions; availability of palliative
care at the end of the life.

Research Areas

Potential research areas; ethical procedures for sharing patients’ electronic medical
records; the dynamics and challenges of implementing patient-centred care in
Tanzania; extent of moral distress among healthcare providers; mechanisms to
balance public good and individual autonomy; enhancing communication within and
among families and carers with terminal ill patients/people at the end of their life;
exploring and evaluating best ways and timing to offer needed emotional support by
patients, carers and families including one-on-one peer support, support groups, and
professional counselling; effective strategies for providing impactful training and
information to healthcare workers and families towards providing best care to the
dying loved ones.

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Theme 17: Drug Discovery and Formulation
Background

Recent decisions arrived at the World Trade Organization (WTO) forced developing
countries to enter into license agreements with innovator companies to manufacture
generic medicines. This means that medicines will be costly and beyond the reach of
citizens in developing countries like Tanzania. This creates the need for developing
countries to make their medicines. New medicines can be developed from natural
sources, chemical synthesis or structural modification of the available medicines.

Drug discovery and formulation are two related specializations that can allow new
medicinal products to be discovered and made into a suitable form and dosage for
treatment.

Drug discovery is an interdisciplinary approach that may involve the interaction of

fields of medicine, biotechnology and pharmacology, pharmacognosy and medicinal
chemistry in the process of discovering new candidate medications either by
identifying the active ingredient from traditional remedies or by screening large
chemical libraries of small synthetic molecules, natural products or extracts which
are typically screened in intact cells or whole organisms. The purpose is to identify
substances that have a desirable therapeutic effect. It requires scientists with diverse
and complementary skills, including medicinal chemistry, computational methods,
and expertise in bioscience, structural biology, and biophysics.

With the advance of sequencing technology and release of the human genome,
there is rapid cloning and synthesis of large quantities of purified proteins. This
practice allows the use of high throughput screening of large compounds libraries
against isolated biological targets hypothesized to be disease-modifying in a process
known as reverse pharmacology. Hits from these screens are then tested in cells
and then in animals for efficacy. In drug discovery, first screening hits are done,
medicinal chemistry and optimization of those hits follow to increase the affinity,
selectivity (to reduce the potential of side effects), efficacy/potency, metabolic
stability (to increase the half-life), and oral bioavailability. Once a compound that
fulfils all of these requirements has been identified, the development process can
continue, and with sheer luck, clinical trials are planned.

Pharmaceutical formulation is related to drug discovery in pharmaceutics, a process

in which different chemical substances, including the active drug, are combined to
produce a final medicinal product. This may include dosage formulation.

Drug formulation and formulations should seek a wide range of academic-industry

and clinical partnerships to progress the research.

MUHAS has departments that are responsible for screening natural products and
their formulation. In addition, there are experts in medicinal chemistry versed with the
screening of chemical hits, while biotechnology and bioinformatics and
pharmacology can help identify targets and bioavailability of the medicines.

Gaps: Areas with unaddressed issues include; efforts on and prioritization of

vaccines and newer drugs discovery in the era of emerging viral pandemics with high

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fatality rates; availability of opportunities for patenting potential natural extracts,
chemical hits, or drug targets;

Priority Research Areas: Specific research areas include; screening, evaluation

and formulation of known plants with medicinal values; development of food
supplement from medicinal plants of medicinal values for some common neglected
tropical illnesses; identification of chemical hits from the medicinal library of chemical
from local plants; identification of novel biological targets using higher throughputs
technologies; strategies to influence development of patentable priority medicines.

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Theme 18: Knowledge Management and Informatics

Background Information

Health information is essential for health scientists to create new knowledge and
advance evidence-based practice. Health Librarians are led by its association,
Association of Health Information Libraries in Africa (AHILA) which was founded with
the aim of improving provision of up to date and relevant health information; increase
access to knowledge created by health researchers and enhancing information
literacy skills among students, faculty and clinicians within health and biomedical
institutions. However, studies on the extent to which health sciences librarians are
engaged in research are outdated or limited in scope, having been conducted prior
to developments in evidence-based librarianship (EBL). Therefore, it was noted that
there is a need for the emergence of the information’s role of the health sciences
librarian, and information scientists which highlights the requirement of appraising
and evaluating the available information to be used in enhancing healthcare services
delivery; treating patient, using health information databases effectively in supporting
treatment and clinical decision making in order to reduce medical errors within the
health care settings.

Situation Analysis

In Tanzania, initiatives have been conducted via the Ministry of Health Development
Gender, Elderly and Children (MoHCDGEC) in ensuring that information is
packaged, accessed, disseminated and utilized through various channels for clinical
decision making. In the year 2018 AHILA in collaboration with the MoHCDGEC
joined hands with other stakeholders from health (Health Institutions, hospitals, and
Non-Governmental Organizations-NGO’s) and non-health institutions; Tanzania
Library Service Board (TLSB), National Council for Technical Education (NACTE) by
developing a curriculum for Health Information Scientists (HIS). The trained HIS
professionals are responsible to assist and enable doctors, nurses and clinicians to
organize, search, gather and access evidence-based information from their
respective health institutions, hospitals, research centers. The idea is to improve the
treatment and clinical care services by utilizing the best available evidence-based
information in order to reduce medical errors.

Gap:Gaps have been identified in following areas; searching techniques and

resources for systematic reviews research; competence skills in searching for health
information(Identifying and recognize reputable sources of health information to the
public); developing successful search strategies when information is needed;
awareness on the available and accessible sources of information including health
technology and other technologies for clinical decision making; adequacy of skills in
evaluating information sources; competent skills in using information in critical
thinking and solving problems (how to work with information and exploit the results;
fair use of health information ethically and legally (ethics and responsibilities on the
use of information); skills in writing for publications.

Priority Research Areas:Specific Research areas include; searching techniques

and resources for systematic reviews research; access to and use ofhealth
information in delivering health care services; information seeking behavior for
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students, faculty and clinicians; reliable sources of information to support health
care service delivery; researchers/clinicians using health information published by
researchers in solving community problems; the use of evidence-based information
to support clinical queries when treating patients; library in the 21 st Century;
librarians assist clinicians and practitioners to access the up to date evidence based
information; knowledge researchers are required to disseminate to the community for
improving the healthcare services:ethics and responsibilities on the use of
information.

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STATUS OF RESEARCH AGENDA
This is a revised version of the MUHAS Research Agenda. The original Research
Agenda was developed in 2012.
KEY STAKEHOLDERS
i. MUHAS faculty, Postgraduate students, adjunct faculty, research associates,
research
chairs, and other MUHAS affiliated personnel
ii. Associated hospitals (MUHAS Academic Medical Center, Muhimbili National
Hospital,
Muhimbili Orthopedics Institute, Ocean Road Cancer Institute)
iii. Development partners
iv. Funding Organizations
v. Adjunct staff
APPROVAL DETAILS
The university council shall approve the Research Agenda.
ENDORSEMENT DETAILS
The University Council approved the Research Agenda on the agenda item……. In
the minutes of the
Council meeting number ……………… on …………………….
RELATED LEGISLATION
MUHAS Charter of Incorporation, February 2007;4 (ii), (k), (q)
RELATED POLICIES
i. Research Policy guidelines (2020)
ii. Intellectual Property Rights Policy (2018)
iii. Institutional Animal Care and Use Policy and Procedures (2020)
EFFECTIVE DATE FOR THE RESEARCH AGENDA
Unless otherwise determined by the approving body, the research agenda shall
become effective from the
date it is approved by the University Senate.
NEXT REVIEW DATE
Three years after approval and when deemed necessary.
POLICY OWNER
Muhimbili University of Health and Allied Sciences Council.
POLICY AUTHOR
The Directorate of research and Publications of the University.
CONTACT PERSON
Director of Research and Publications, Muhimbili University of Health and Allied
Sciences, P.O. Box 65001, Dar es salaam, Tanzania. Email: drp@[Link]

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