Reporting systems and diagnostic capacities for Taenia Solium Cysicercosis/Taeniosis: The current status in selected regions of Tanzania

Abstract

Porcine cysticercosis and human neurocysticercosis/taeniosis are two forms of a zoonotic disease caused by Taenia solium tapeworm. There is a perceived inefficient diagnosis and reporting of both forms of this parasitic disease in Tanzania. The aim of this study was to identify the challenges associated with diagnosis and reporting of both forms of the parasitic disease in medical and veterinary sectors. A cross-sectional study was conducted in Babati, Mbulu, Kongwa, Mbinga and Nyasa districts located in three regions namely Manyara, Dodoma and Ruvuma using qualitative and quantitative research approaches. The districts were purposively chosen basing on the porcine cysticercosis (PC) prevalence equal or more than 12.0% obtained through tongue palpation. In depth interview was used to collect qualitative data involving medical and veterinary officers from district to national level. Officers in charge of Zonal Veterinary Investigation Center and Tanzania Veterinary Laboratory Agency found in Iringa and Arusha regions were included in qualitative data collection to capture their perceptions and the role the investigation centers and laboratories were playing in the reporting and diagnosis of porcine cysticercosis. The quantitative data were collected by administering structured questionnaire to 154 medical officers in primary health facilities and 110 meat inspectors. Taeniosis diagnosis capacity was assessed for availability of functioning laboratories and qualified laboratory technicians and clinicians in primary health facilities with ability to test and diagnose helminthosis including taeniosis. Respondents’ awareness and knowledge about T. solium tapeworm and T. solium cysticerci were assessed for their correct descriptions of the two forms of the tapeworm, tapeworm hosts and mode of human infection by the larval stage of the tapeworm. In addition, questions about pig slaughter slabs, transport facilitation to meat inspectors, qualification and number of meat inspectors were asked to meat inspectors. Information about availability of taeniosis and neurocysticercosis/epilepsy diagnostic facilities and challenges for PC diagnosis was also enquired from 33 medical and veterinary respondents. T. solium taeniosis, neurocysticercosis and PC reporting was assessed for availability of reporting data of both forms of the disease in medical and veterinary reporting systems. Disease reporting was assessed for the availability of reporting format, specific disease reported, report completeness, timeliness in report submission, means of sending the report and presence of reporting feedback. Quantitative data were analysed for proportions and Chi-square statistical test using Statistical Package for Social Science (SPSS). Content analysis for qualitative data was undertaken using ATLAS.ti software. Qualitative results based on ATLAS.ti revealed inadequate diagnostic facilities, laboratory personnel and clinicians to diagnose taeniosis in primary health facilities and inadequate CT scanners, MRI machines and physicians to diagnose neurocysticercosis/epileptic cases in secondary and tertiary health facilities. On the other hand, T. solium taeniosis and neurocysticercosis were not reportable diseases in the current medical disease surveillance and reporting system although the system was adequately facilitated. Inadequate facilitation of the general animal disease surveillance system particularly in the primary data collection hindered efficient PC reporting. The reports lacked completeness, always lately submitted and sometimes not submitted at all. Porcine cysticercosis diagnosis was challenged by availability of inadequate qualified meat inspectors, inadequate slaughter slabs and inadequate facilitation of routine meat inspection activities. Quantitative data revealed that only 33.8% of the visited primary health facilities had laboratories with capacity to diagnose helminthosis, 46.5% of respondents relied on patients’ history to diagnose taeniosis. Majority of meat inspectors (71.5%) scored above average in T. solium cysticerci standard description compared to 57.9% medical personnel who scored below average. On contrary, 61.2% of medical personnel scored above average in T. solium tapeworm description while 57.4% of meat inspectors scored below average. Officers in charge with clinical medical health profession correctly described T. solium cysticerci than those with other medical health professions (P<0.019) whereas officers in charge with less working experience were much more aware about T. solium cysticerci than those with more working experience (P<0.046). Large proportion of meat inspectors with professional background other than animal health were aware about T. solium tapeworm compared to those with animal health professional background (P<0.009). Medical disease surveillance and reporting system was adequately facilitated in terms of report preparation and submissions with 83.8% of respondents being able to submit reports timely and 43.8% capable of physically submitting the reports. Nevertheless, meat inspectors were inadequately facilitated in report preparation and submission, with 91.8% lacking abattoir disease surveillance forms and 41.8% unable to submit reports on time. It is concluded that T. solium cysticercorsis/taeniosis diagnosis and reporting is a challenge in both medical and veterinary sectors. In addition to that, both forms of the disease are not listed under the reportable diseases of the MoHCDGEC. Porcine cysticercosis was inadequately reported possibly due to inadequate facilitation to enable timely disease reporting as reflected by the general lack of the abattoir surveillance forms. A One Health approach is needed to bring together medical practitioners and veterinarians and both should be equipped with common understanding regarding the tapeworm biology including medical and social economic importance of the parasite. Common strategies should be put in place to enhance efficient surveillance and reporting of both forms of the disease in medical and veterinary sectors.