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In March 2023, a Marburg Virus Disease (MVD) outbreak was declared in Kagera region, Northwestern Tanzania. This was the first MVD outbreak in the country. We describe the epidemiological characteristics of MVD cases and contacts. The Ministry of Health activated an outbreak response team. Outbreak investigation methods were applied to cases identified through MVD standard case definitions and confirmed through reverse-transcriptase polymerase chain reaction (RT PCR). All identified case contacts were added into the contact listing form and followed up in-person daily for any signs or symptoms for 21 days. Data collected from various forms was managed and analyzed using Excel and QGIS software for mapping. A total of nine MVD cases were reported with eight laboratory-confirmed and one probable. Two of the reported cases were frontline healthcare workers and seven were family related members. Cases were children and adults between 1-59 years of age with a median age of 34 years. Six were males. Six cases died equivalent to a case fatality rate (CFR) of 66.7%. A total of 212 individuals were identified as contacts and two (2) became cases. The outbreak was localized in two geo-administrative wards (Maruku and Kanyangereko) of Bukoba District Council. Transmission during this outbreak occurred among family members and healthcare workers who provided care to the cases. The delay in detection aggravated the spread and possibly the consequent fatality but once confirmed the swift response stemmed further transmission containing the disease at the epicenter wards. The outbreak lasted for 72 days but as the origin is still unknown, further research is required to explore the source of this outbreak.

Marburg viral disease (MVD) is a highly infectious disease with a case fatality rate of up to 90%, particularly impacting resource-limited countries where implementing Infection Prevention and Control (IPC) measures is challenging. This paper shares the experience of how Tanzania has improved its capacity to prevent and control highly infectious diseases, and how this capacity was utilized during the outbreak of the MVD disease that occurred for the first time in the country in 2023. In 2016 and the subsequent years, Tanzania conducted self and external assessments that revealed limited IPC capacity in responding to highly infectious diseases. To address these gaps, initiatives were undertaken, including the enhancement of IPC readiness through the development and dissemination of guidelines, assessments of healthcare facilities, supportive supervision and mentorship, procurement of supplies, and the renovation or construction of environments to bolster IPC implementation. The official confirmation and declaration of MVD on March 21, 2023, came after five patients had already died of the disease. MVD primarily spreads through contact and presents with severe symptoms, which make patient care and prevention challenging, especially in resource-limited settings. However, with the use of a trained workforce; IPC rapid needs assessment was conducted, identifying specific gaps. Based on the results; mentorship programs were carried out, specific policies and guidelines were developed, security measures were enhanced, all burial activities in the area were supervised, and both patients and staff were monitored across all facilities. By the end of the outbreak response on June 1, 2023, a total of 212 contacts had been identified, with the addition of only three deaths. Invasive procedures like dialysis and Manual Vacuum Aspiration prevented some deaths in infected patients, procedures previously discouraged. In summary, this experience underscores the critical importance of strict adherence to IPC practices in controlling highly infectious diseases. Recommendations for low-income countries include motivating healthcare providers and improving working conditions to enhance commitment in challenging environments. This report offers valuable insights and practical interventions for preparing for and addressing highly infectious disease outbreaks through implementation of IPC measures.

Background From May 2018 to September 2022, the Democratic Republic of Congo (DRC) experienced seven Ebola virus disease (EVD) outbreaks within its borders. During the 10th EVD outbreak (2018–2020), the largest experienced in the DRC and the second largest and most prolonged EVD outbreak recorded globally, a WHO risk assessment identified nine countries bordering the DRC as moderate to high risk from cross border importation. These countries implemented varying levels of Ebola virus disease preparedness interventions. This case study highlights the gains and shortfalls with the Ebola virus disease preparedness interventions within the various contexts of these countries against the background of a renewed and growing commitment for global epidemic preparedness highlighted during recent World Health Assembly events. Main text Several positive impacts from preparedness support to countries bordering the affected provinces in the DRC were identified, including development of sustained capacities which were leveraged upon to respond to the subsequent coronavirus disease 2019 (COVID-19) pandemic. Shortfalls such as lost opportunities for operationalizing cross-border regional preparedness collaboration and better integration of multidisciplinary perspectives, vertical approaches to response pillars such as surveillance, over dependence on external support and duplication of efforts especially in areas of capacity building were also identified. A recurrent theme that emerged from this case study is the propensity towards implementing short-term interventions during active Ebola virus disease outbreaks for preparedness rather than sustainable investment into strengthening systems for improved health security in alignment with IHR obligations, the Sustainable Development Goals and advocating global policy for addressing the larger structural determinants underscoring these outbreaks. Conclusions Despite several international frameworks established at the global level for emergency preparedness, a shortfall exists between global policy and practice in countries at high risk of cross border transmission from persistent Ebola virus disease outbreaks in the Democratic Republic of Congo. With renewed global health commitment for country emergency preparedness resulting from the COVID-19 pandemic and cumulating in a resolution for a pandemic preparedness treaty, the time to review and address these gaps and provide recommendations for more sustainable and integrative approaches to emergency preparedness towards achieving global health security is now.

Background Tanzania faces high maternal and infant mortality rates, yet key service quality metrics remain underexamined, limiting targeted improvements. Star Rating Assessment (SRA), introduced in 2015, aims to improve primary health care (PHC) quality, including maternal and child health (MCH) services. This study analyses SRA data to assess the prevalence of PHC quality in MCH and its associated factors. Methods Data for this cross-sectional study were collected from November 2021 to March 2022 across 10 regions. The tool used included 12 MCH-related indicators, each comprising specific criteria. Facilities scoring ≥ 80% across these criteria were considered to meet MCH quality standards, which was the primary study outcome. A descriptive analysis of indicator performance was conducted, followed by multivariate logistic regression to assess characteristics associated with achieving the quality standard. Results are reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI). Results A total of 2,583 facilities assessed: 2,189 dispensaries (84.7%), 303 health centres (11.7%), and 91 district-level hospitals (3.5%). Only 280(10.8%) met the MCH quality standards. Maternal audit and review practices aligned with guidelines in 2,057 facilities (79.6%). Moderate adherence was observed for family planning guidelines (48.3%), accurate partogram completion (47.9%), and immunisation standards (46.3%). Major gaps included cervical cancer screening, offered by 199 facilities (7.7%), and essential obstetric medicines, available in 424 facilities (16.4%). Among 394 hospitals and health centres, only 60(15.2%) offered postnatal and essential newborn care with dedicated neonatal and Kangaroo Mother Care spaces. Compliance was higher in public, rural, and higher-level facilities. Nurse availability, functional management, and quality improvement teams were key predictors of MCH quality. Conclusion The quality of MCH services in Tanzania varies widely by facility type, ownership, nurse staffing, and management functionality. Targeted improvements in cervical cancer screening, emergency obstetric care, and newborn care are essential to raise overall MCH service standards.

ObjectiveIn December 2023, floods and landslides in Hanang District, Northern Tanzania, caused severe casualties, infrastructure damage, and community displacement. We describe the public health emergency response and lessons learnt during this disaster to guide future mitigations.MethodsRetrospective data collection during the disaster was made through quantitative (description of casualties) and qualitative (interviews and focus groups) approaches to provide insights into psychosocial support, coordination, and other response pillars. Microsoft Excel (2019) was used for quantitative data analysis, and MAX Qualitative Data Analysis was used to manage qualitative data.ResultsSoft tissue injuries, bruises, and lacerations were the most common (60.43%), with 87.77% of casualties recovering and a notable fatality rate of 12.23%. Mental health and psychosocial support reached over 3300 individuals, offering depression assessments and family reconnections. Establishing a dual-level public health response team and implementing the Incident Management System demonstrated the country’s response efficiency.ConclusionsThe public health emergency response to the 2023 floods and landslides in Hanang District was largely effective. This demonstrated strong coordination, capacity, and resilience of Tanzania health system; however, the fatality rate highlighted a need for further investment to improve future disaster prevention, preparedness, and response.