Background: Strengthening malaria control activities in Tanzania has dramatically declined human malaria infections. However, there is an increasing epidemiological shift in the burden on school-age children. The underlying causes for such an epidemiological shift remain unknown in this context. This study explored activities and behaviours that could increase the vulnerability of school-age children to transmission risk to provide insight into protection gap with existing interventions and opportunities for supplementary interventions. Methods: This cross-sectional study conducted twenty-four focus group discussions (FGDs) in three districts of Rufiji, Kibiti and Kilwa in south-eastern Tanzania. Sixteen FGDs worked with school-age children (13 to 18 years) separating girls and boys and eight FGDs with their parents in mixed-gender groups. A total of 205 community members participated in FGDs across the study area. Of them, 72 participants were parents, while 133 were school-age children (65 boys and 68 girls). Results: Routine domestic activities such as fetching water, washing kitchen utensils, cooking, and recreational activities such as playing and watching television and studying were the reported activities that kept school-age children outdoors early evening to night hours (between 18:00 and 23:00). Likewise, the social and cultural events including initiation ceremonies and livelihood activities also kept this age group outdoors from late evening to early night and sometimes past midnight hours. Parents migrating to farms from December to June, leaving behind school-age children unsupervised affecting their net use behaviour plus spending more time outdoors at night, and the behaviour of children sprawling legs and hands while sleeping inside treated bed nets were identified as potential risks to infectious mosquito bites. Conclusion: The risky activities, behaviours, and social events mostly occurring outdoors might increase school-age children’s vulnerability to malaria infections. The findings provide preliminary insight on potential risk factors for persisting transmission. Further studies to quantify the risk behaviour and activities are recommended to establish the magnitude and anticipated impact on supplementary control strategies to control infection in school-age children.

Malaria rapid diagnostic tests (mRDTs) have played an important role in the early detection of clinical malaria in an endemic area. While several mRDTs are currently on the market, the availability of mRDTs with high sensitivity and specificity will merit the fight against malaria. We evaluated the field performance of a novel One Step Malaria (P.f/P.v) Tri-line and One Step Malaria (P.f) rapid test kits in Pwani, Tanzania. In a cross-sectional study conducted in Bagamoyo and Kibiti districts in Tanzania, symptomatic patients were tested using the SD BIOLINE, One Step Malaria (P.f/P.v) Tri-line and One Step Malaria (P.f) rapid test kits, microscope, and quantitative Polymerase Chain Reaction (qPCR). An additional qPCR assay was carried out to detect Histidine-Rich Protein 2 (HRP-2) gene deletion on mRDT negative but microscope and qPCR positive samples. Microscope results confirmed by qPCR were used for analysis, where qPCR was used as a reference method. The sensitivity and specificity of One Step P.f/P.v Tri-line mRDTs were 96.0% (CI 93.5–97.7%) and 98.3% (CI 96.8–99.2%), respectively. One Step P.f mRDT had sensitivity and specificity of 95.2% (CI 92.5–97.1%) and 97.9% (CI 96.3–99.0%) respectively. Positive predictive value (PPV) was 97.6% (CI 95.4–98.7%) and negative predictive value (NPV) was 96.2% (CI 95.5–98.3%) for the One Step P.f/P.v Tri-line mRDTs respectively, while One Step P.f mRDT had positive predictive value (PPV) and negative predictive value (NPV) of 97.0% (CI 94.8–98.3%) and 96.7 (CI 94.9–97.9%) respectively. 9.8% (CI 7.84–11.76) of all samples tested and reported to be malaria-negative by mRDT had HRP-2 gene deletion. One Step Malaria P.f/P.v Tri-line and One Step Malaria P.f rapid test kits have similar sensitivity and specificity as the standard mRDT that is currently in the market, demonstrating the potential to contribute in the fight against malaria in endemic settings. However, the identified malaria parasites population with HRP-2 gene deletion pose a threat to the current mRDT usability in the field and warrants further investigations.

Women experiencing co-occurring forms of intimate partner violence (IPV; ie, physical, sexual, and/or psychological) often face more severe psychological and health consequences than those experiencing a single form. However, research on IPV co-occurrence in low- and middle-income countries (LMICs) remains limited. This study examines the prevalence of IPV co-occurrence in LMICs and its education-based inequalities. Data from the most recent Demographic and Health Surveys in 49 LMICs (2011–2023) were used. Our primary outcome was IPV co-occurrence, defined as a woman aged 15–49 ever experiencing any two or three forms of physical, sexual, or psychological IPV from her partner within the past year. We categorised IPV co-occurrence into four subtypes: co-occurrence of (1) physical and sexual IPV, (2) physical and psychological IPV, (3) sexual and psychological IPV, and (4) all three forms of IPV. We analysed the prevalence of IPV co-occurrence and its subtypes by women's education levels, calculating odds ratios to assess inequalities. Nonparametric restricted cubic splines were used to explore nonlinear relationships between education and IPV. The study included a total of 344,661 women. The weighted prevalence of IPV co-occurrence varied widely across countries—from 2.4% in Armenia to 38.9% in Papua New Guinea. Overall, women with no education were most at risk, experiencing an adjusted prevalence of 14.3% (95% CI: 13.3–15.2), compared to 11.8% (95% CI: 10.8–12.9) among those with primary education, 9.9% (95% CI: 9.3–10.6) for secondary education, and 5.3% (95% CI: 4.5–6.2) for higher education. The prevalence of IPV co-occurrence involving sexual IPV was highest among women with primary education, with 4.1% (95% CI: 3.4–4.8) reporting concurrent physical and sexual violence, compared to 1.5% (95% CI: 1.1–1.9) to 3.7% (95% CI: 3.2–4.1) among other education levels. IPV co-occurrence remains high, particularly among women with little or no education. Education-focused interventions are urgently needed to reduce IPV risk and its severe impact. However, the findings may be influenced by potential reporting biases and cross-country variability in IPV measurement methodologies, which may limit generalizability. The 10.13039/501100001809 China National Natural Science Foundation (Grant numbers 72203119) and The Research Fund, Vanke School of Public Health, 10.13039/501100004147 Tsinghua University .

Background: Estimating human exposure to mosquito vectors is crucial for the prediction of malaria transmission and intervention impact. The human landing catch method is frequently used to directly measure estimate exposure rates; however, there has been an increasing shift from this method to exposure-free alternatives, such as the mosquito electrocuting traps (MET) and other approaches. While these latter methods can provide robust and representative values of human exposure and mosquito density, they often still require a human volunteer, which poses logistical challenges. Additionally, in the case of the MET, the early MET prototype (METe) required human volunteers to wear protective clothing that could be uncomfortable. We investigated two alternative trapping approaches to address these challenges by comparing the performance of the METe prototype to: (i) a modified caged MET prototype that offers full protection to users (METc) and (ii) a barrier screen trap (BST) designed to passively sample (host-seeking and blood-fed) mosquitoes outdoors without requiring a human participant. Methods: The relative performance of the METe, METc and BST were evaluated in a 3 × 3 Latin square field experiment design conducted in south-eastern Tanzania over 12 nights of sampling. The outcomes of interest were the nightly catch of mosquitoes and biting time estimates. Results: The METc and BST caught similar numbers of An. arabiensis as the METe (relative ratio [RR] = 0.76, 95% confidence interval [CI]: 0.42–1.39, P = 0.38 and RR = 1.13, 95% CI: 0.63–2.04, P = 0.69, respectively). Similarly, the METc and BST caught similar numbers of Culex spp. as the METe (RR = 0.87, 95% CI: 0.62–1.22, P = 0.42 and RR = 0.80, 95% CI: 0.57–1.12, P = 0.199, respectively). All three trapping methods indicated a similar pattern of biting activity by An. arabiensis and Culex spp., characterized by biting starting in the early evening (18:00–22:00), peaking when people are typically sleeping (22:00–05:00) and dropping off drastically toward the morning (05:00–07:00). Conclusions: The modifications made to the METe design to improve user comfort and remove the need for protective clothing did not result in an underestimation of mosquito vector abundance nor misrepresentation of their biting time pattern. We recommend the METc for use over the METe design. Similarly, the BST demonstrated potential for monitoring malaria and filariasis vector densities in Tanzania. Graphical

Although studies on COVID-19 vaccine hesitancy are being undertaken widely worldwide, there is limited evidence in Tanzania. This study aims to assess the sociodemographic factors associated with COVID-19 vaccine hesitancy and the reasons given by unvaccinated study participants. We conducted a mixed-method cross-sectional study with two components—health facilities and communities—between March and September 2022. A structured questionnaire and in-depth interviews were used to collect quantitative and qualitative data, respectively. A total of 1,508 individuals agreed to participate in the survey and explained why they had not vaccinated against COVID-19. Of these participants, 62% indicated they would accept the vaccine, whereas 38% expressed skepticism. In a multivariate regression analysis, adult study participants 40 years and older were significantly more likely to report not intending to be vaccinated (adjusted odds ratio [AOR], 1.28; 95% CI, 1.01–1.61; P = 0.04) than youth and middle-aged study participants between 18 and 40 years. Furthermore, female study participants had a greater likelihood of not intending to be vaccinated (AOR, 1.51; 95% CI, 1.19–1.90; P = 0.001) than male study participants. The study identified fear of safety and short-term side effects, and lack of trust of the COVID-19 vaccine; belief in spiritual or religious views; and belief in local remedies and other precautions or preventive measures as the major contributors to COVID-19 vaccine hesitancy in Tanzania. Further empirical studies are needed to confirm these findings and to understand more fully the reasons for vaccine hesitancy in different demographic groups.

: Immunization has saved millions of lives globally from vaccine-preventable diseases. Childhood immunization is an effective public health strategy for decreasing morbidity and mortality among children in developing countries. Tanzania has one of the highest rates of coverage of routine child immunization among sub-Saharan African countries. However, obstacles to universal immunization still exist, particularly in rural areas of the country. Assessing routine immunization coverage is essential to inform vaccine policies and program implementation. This study aimed to assess routine immunization status and factors associated with its coverage among children aged 12–23 months. We conducted a cross-sectional, quantitative household survey in 31 regions with caretakers of children in Tanzania, where a total of 4,560 households were visited. Nationally, 85.5% of children aged 12–23 months had completed the full recommended course of vaccines. Overall, 14.5% of children aged 12–23 months did not complete routine immunization schedules in 2019. We found that factors associated with immunization coverage included having one to six family members, higher household wealth, the family’s head engaging in subsistence farming, caretakers’ age, children’s age, educational level, children with clinic cards, and children receiving the diphtheria, pertussis, tetanus–3 vaccine. The country is about to reach the vaccination coverage target set by the WHO and the United Nations Children Fund. Improving existing vaccination coverage and optimizing the use of recommended interventions are required. We strongly advise using the periodic micro-planning tool and satellite image technology, particularly in areas where immunization coverage is less than 80%.