Masters Thesis
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.
Cystinet Africa Project