Tanzania HIV/AIDS and Malaria Indicator Survey 2007-2008

Data collection was carried out by 14 field teams, each consisting of one team leader, four female interviewers, one male interviewer, and one driver. Five senior staff members from NBS and OCGS-Zanzibar coordinated and supervised the fieldwork activities. Fieldwork on the Mainland started on 20 October 2007. Delay in obtaining ethical clearance for the Zanzibar fieldwork resulted in a delay in starting data collection in Zanzibar until 10 November 2007. Data collection took place over a four-month period, from 20 October 2007 to 22 February 2008. A quality control team periodically visited teams in the field to check their work and reinterview some households.

1.9 ANAEMIA, MALARIA, AND HIV TESTING
In addition to collecting information with the survey questionnaire, the THMIS also included anaemia and malaria testing for children under five (6-59 months) and HIV testing for adults age 15- 49. The protocol for the anaemia and HIV testing was based on the standard protocols employed in the MEASURE DHS project, adapted to achieve the objectives of the THMIS.

1.9.1 Anaemia Testing
In the THMIS, haemoglobin measurement for anaemia testing was performed in the field by a team member. Consent was obtained from the parent or guardian. The statement explained the purpose of the test, how the test would be administered, and advised the parent or guardian that the results would be available as soon as the test was completed. Finally, permission was requested for the test to be carried out. For haemoglobin measurement, capillary blood was usually taken from a finger of the children for whom consent had been obtained. A single-use, sterile lancet was used for this purpose. In cases where a child was very thin, a heel prick was used to obtain the sample.
The concentration of haemoglobin in the blood was measured using the HemoCue system. The results of the anaemia test were immediately provided for all eligible children tested. Levels of anaemia were classified as severe, moderate, or mild according to criteria developed by the World Health Organization (WHO). A brochure was provided on anaemia which included suggestions as to the steps (e.g., changes in diet) that could be taken in the event that a child was found to have some degree of anaemia. Parents/guardians of children who were found to be severely anaemic were advised to take the child to health facilities for further evaluation and management.

1.9.2 Malaria Testing
The rapid diagnostic test used in the 2007-08 THMIS is the Paracheck Pf™ device (Orchid Biomedical, India), which is based on the detection of P. falciparum-specific histidine-rich protein 2 (HRP2 Pf) in blood. The test has relatively high sensitivity and specificity and is deemed appropriate for clinical and epidemiologic assessment of malaria, especially placental malaria. Parents or responsible adults were advised about the malaria test result. If the child tested positive, he or she was provided with a full course of Artemether Lumefantrine (ALu or Coartem). Children who tested negative but had a fever in the past two weeks were also provided a full course of ALu. THMIS field staff explained to the parent or responsible adult that ALu is effective and should rid the child of fever and other symptoms in a few days. Parents/guardians were advised to take the child to a health professional for treatment immediately if, after taking ALu, the child still had high fever, fast or difficult breathing, was not able to drink or breastfeed, and became sicker or did not get better in two days.

1.9.3 HIV Testing
In the THMIS, HIV testing involved the collection of at least three blood spots from a finger prick on a special filter paper card. The testing was anonymous, i.e., it was conducted in such fashion that the results could not be linked to individual respondents. A unique random identification number (bar code) was assigned to each eligible respondent consenting to the testing. Labels containing the bar code were affixed to the filter paper card, the questionnaire, and a field tracking form at the time of the collection of the sample. No other identifiers were attached to the dried blood spot (DBS) sample. Because of the anonymous nature of the testing approach in the THMIS, it was not possible to provide information on the results from the HIV testing conducted during the THMIS.
The procedures that THMIS field staff followed to obtain informed consent from eligible individuals to collect DBS samples for the HIV testing were similar to those used for obtaining consent for the anaemia testing. The HIV testing consent statement explained the objective of the testing and how the DBS sample would be collected. Prospective subjects were informed that the testing process was anonymous and, therefore, their result would not be available to them, advised them of the availability of free voluntary counselling and testing services, and requested permission for the test to be carried out. Field staff also asked for consent to store the DBS samples for unspecified future tests.
After the survey team completed a cluster, all questionnaires, dried blood spot samples, and sample transmittal forms for the cluster were sent to the NBS for logging and checking prior to data entry. Blood samples were checked against the transmittal form and then forwarded to MUCHS Laboratory for testing. No identifying information other than the unique barcode label affixed at the time of the collection of the DBS sample accompanied the specimen to the laboratory