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. 2018 Feb;98(2):598-606.
doi: 10.4269/ajtmh.17-0125. Epub 2017 Dec 7.

Risk Factors for Human Brucellosis in Northern Tanzania

Shama Cash-Goldwasser  1   2 , Michael J Maze  3   2 , Matthew P Rubach  4   2 , Holly M Biggs  4 , Robyn A Stoddard  5 , Katrina J Sharples  6   7 , Jo E B Halliday  8 , Sarah Cleaveland  8 , Michael C Shand  8 , Blandina T Mmbaga  9   2   1 , Charles Muiruri  1 , Wilbrod Saganda  10 , Bingileki F Lwezaula  10 , Rudovick R Kazwala  11 , Venance P Maro  9   2 , John A Crump  9   3   1   4
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Risk Factors for Human Brucellosis in Northern Tanzania

Shama Cash-Goldwasser et al. Am J Trop Med Hyg. 2018 Feb.

Abstract

Little is known about the epidemiology of human brucellosis in sub-Saharan Africa. This hampers prevention and control efforts at the individual and population levels. To evaluate risk factors for brucellosis in northern Tanzania, we conducted a study of patients presenting with fever to two hospitals in Moshi, Tanzania. Serum taken at enrollment and at 4-6 week follow-up was tested by Brucella microagglutination test. Among participants with a clinically compatible illness, confirmed brucellosis cases were defined as having a ≥ 4-fold rise in agglutination titer between paired sera or a blood culture positive for Brucella spp., and probable brucellosis cases were defined as having a single reciprocal titer ≥ 160. Controls had reciprocal titers < 20 in paired sera. We collected demographic and clinical information and administered a risk factor questionnaire. Of 562 participants in the analysis, 50 (8.9%) had confirmed or probable brucellosis. Multivariable analysis showed that risk factors for brucellosis included assisting goat or sheep births (Odds ratio [OR] 5.9, 95% confidence interval [CI] 1.4, 24.6) and having contact with cattle (OR 1.2, 95% CI 1.0, 1.4). Consuming boiled or pasteurized dairy products was protective against brucellosis (OR 0.12, 95% CI 0.02, 0.93). No participants received a clinical diagnosis of brucellosis from their healthcare providers. The under-recognition of brucellosis by healthcare workers could be addressed with clinician education and better access to brucellosis diagnostic tests. Interventions focused on protecting livestock keepers, especially those who assist goat or sheep births, are needed.

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Figures

Figure 1.
Figure 1.
Study flow diagram for patients seeking care at Kilimanjaro Christian Medical Center and Mawenzi Regional Hospital in Moshi, Tanzania, 2012–2014.
Figure 2.
Figure 2.
Location by district of participants with and without brucellosis, Kilimanjaro Region, northern Tanzania, 2012–2014.
See this image and copyright information in PMC

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