Ifakara

Researchers are evaluating World Visions 7-year intervention called Realizing Gender Equality, Attitudinal Change and Transformative Systems in Nutrition REACTS-IN, aimed at improving nutrition, nutrition-related rights, and gender equality for women, adolescent girls, and children under five years old in rural Bangladesh, Kenya, and Tanzania. This multi-sectoral approach integrates nutrition, water, sanitation, hygiene, and health system strengthening to improve access to quality, gender-responsive health services focusing on malnutrition prevention and treatment at the primary care level. The evaluation examines changes in child growth, dietary habits, womens empowerment, and equitable access to health services for nutrition and sexual and reproductive health, considering gender differences. The intervention includes nutrition-specific activities like school-based iron-folic acid supplementation for adolescent girls and nutrition-sensitive activities such as water, sanitation, and hygiene education, delivered through local health systems, schools, and communities. The evaluation compares intervention areas receiving these programs to comparison areas with no intervention but standard care available. Data will be collected at baseline, midpoint, and end-line from households, schools, and health facilities to assess changes over approximately five years. Participants will be surveyed on demographic, economic, and environmental factors, as well as knowledge and practices related to nutrition, hygiene, and sexual and reproductive health. Health staff and community leaders will provide qualitative data on gender-equitable service access. The primary outcomes measured include gender equality and child anthropometry changes, with additional outcomes covering maternal and child dietary practices, health service use, adolescent knowledge, and family planning. This evaluation spans about five years to capture the total impact of the intervention.

Researchers are evaluating how using lung ultrasound can help improve treatment decisions for children aged 2 months to 12 years who have symptoms of a lung infection. The study focuses on better identifying which children actually need antibiotics, aiming to reduce unnecessary antibiotic use that can cause health problems and contribute to antibiotic resistance. Lung infections are a leading cause of illness in children and are often treated with antibiotics even when caused by viruses, which do not respond to these drugs. Participants are randomly assigned to one of two groups one receiving routine care without additional testing, and the other receiving lung ultrasound examinations. In the ultrasound group, experts review images to guide doctors on whether antibiotics are needed, potentially reducing antibiotic prescriptions if the infection appears viral. The study excludes children who are very sick or have already taken antibiotics for more than two days. The study also evaluates lung ultrasounds role in diagnosing tuberculosis and other lung conditions. During the study, children are assessed at the start and followed up through day 29 or 8 weeks depending on the outcomes measured. This includes monitoring antibiotic use, clinical improvement, hospital admissions, adverse reactions, and diagnoses like tuberculosis. Researchers collect data through clinical exams, ultrasound imaging, and other tests as needed. The goal is to see if lung ultrasound can safely reduce antibiotic use without harming health outcomes, with careful safety monitoring throughout the study period.

Researchers are evaluating the effect of switching from angiotensin converting enzyme ACE inhibitors or angiotensin receptor blockers ARB to angiotensin-neprilysin inhibitors ARNI in adults with symptomatic heart failure with reduced ejection fraction HFrEF in rural Tanzania. Heart failure is a significant health issue in sub-Saharan Africa, with high mortality rates, and this study aims to assess the health status benefits and safety of sacubitrilvalsartan ARNI in this population where it has not been previously studied except in South Africa. Participants who have been on stable heart failure treatment with ACE inhibitors or ARBs, beta-blockers, and spironolactone for at least 3 months will switch to sacubitrilvalsartan after a 36-hour washout of ACE inhibitors. The dose will start at 50 mg twice daily for two weeks, increase to 100 mg twice daily for three weeks, and then to 200 mg twice daily. Beta blockers and spironolactone will continue, with diuretics adjusted as needed. The study period includes 10 months of follow-up with scheduled visits for assessments and medication adherence. During the study, participants will undergo baseline and follow-up evaluations including physical exams, questionnaires measuring health status Kansas City Cardiomyopathy Questionnaire, 6-minute walking tests, echocardiography, blood tests for biomarkers like brain natriuretic peptide BNP, and monitoring of vital signs. Medication adherence will be tracked by pill count and self-report. Safety and efficacy outcomes, including quality of life improvements, heart function, and hospitalization rates, will be measured over 10 months. Sacubitrilvalsartan will be provided free during the study, and transport costs for visits will be reimbursed.