{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:52:00Z","timestamp":1784098320928,"version":"3.55.0"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T00:00:00Z","timestamp":1647993600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"deltas afrique one-aspire","award":["Afrique One-ASPIRE\/DEL-15-008"],"award-info":[{"award-number":["Afrique One-ASPIRE\/DEL-15-008"]}]},{"DOI":"10.13039\/501100000268","name":"biotechnology and biological sciences research council","doi-asserted-by":"publisher","award":["BB\/L018845"],"award-info":[{"award-number":["BB\/L018845"]}],"id":[{"id":"10.13039\/501100000268","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nBrucellosis is listed as one of six priority zoonoses in Tanzania\u2019s One Health strategic plan which highlights gaps in data needed for the surveillance and estimation of human brucellosis burdens. This study collected data on current testing practices and test results for human brucellosis in Arusha region, northern Tanzania.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nRetrospective data were extracted from records at 24 health facilities in Arusha region for the period January 2012 to May 2018. Data were captured on: the test reagents used for brucellosis, procurement and testing protocols, the monthly number of patients tested for brucellosis and the monthly number testing positive. Generalised linear mixed models were used to evaluate relationships between health facility characteristics and the probability that brucellosis testing was conducted in a given month, and the proportion of individuals testing positive.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nFour febrile Brucella<\/jats:italic> agglutination tests were used widely. The probability of testing for brucellosis in a given month was significantly associated with an interaction between year of testing and facility ownership. Test probability increased over time with more pronounced increases in privately owned as compared to government facilities. The proportion of individuals testing positive for brucellosis was significantly associated with facility type and district, with individuals tested in hospitals in Meru, Monduli and Ngorongoro districts more likely to test positive.<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nFebrile Brucella<\/jats:italic> agglutination tests, known for their poor performance, were the mainstay of brucellosis testing at health facilities in northern Tanzania. The study indicates that historical data on human brucellosis in Arusha and other regions are likely to provide an inaccurate measure of true disease burden due to poor performance of the tests used and variation in testing practices. Measures to address these identified shortcomings could greatly improve quality of testing and surveillance data on brucellosis and ultimately inform prevention and control of this priority disease.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0265612","type":"journal-article","created":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T17:31:16Z","timestamp":1648056676000},"page":"e0265612","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Brucellosis testing patterns at health facilities in Arusha region, northern Tanzania"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0560-5565","authenticated-orcid":true,"given":"AbdulHamid Settenda","family":"Lukambagire","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Mkulima","family":"Shirima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damas Davis","family":"Shayo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coletha","family":"Mathew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard B.","family":"Yapi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher Julius","family":"Kasanga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blandina Theophile","family":"Mmbaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudovick Reuben","family":"Kazwala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1329-9035","authenticated-orcid":true,"given":"Jo E. B.","family":"Halliday","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,3,23]]},"reference":[{"key":"pone.0265612.ref001","article-title":"National Strategy for Prevention and Control of Brucellosis in Humans and Animals 2018\u20132023","author":"The United Republic of Tanzania (URT)","year":"2018","journal-title":"Prime Minist Off"},{"key":"pone.0265612.ref002","article-title":"The United Republic of Tanzania One Health Strategic Plan 2015\u20132020","author":"United Republic of Tanzania (URT), United States Department of Defense (DoD), Defense Threat Reduction Agency (DTRA), Cooperative Threat Reduction (CTR), Cooperative Biological Engagement Program (CBEP)","year":"2015","journal-title":"Dar es Salaam"},{"key":"pone.0265612.ref003","first-page":"7","article-title":"Etiology of Severe Non-malaria Febrile Illness in Northern Tanzania: A Prospective Cohort Study","author":"JA Crump","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0265612.ref004","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-020-62849-4","article-title":"Prevalence and speciation of acute brucellosis in febrile patients from a pastoralist community of Tanzania","volume":"10","author":"FR Bodenham","year":"2020","journal-title":"Sci Rep"},{"key":"pone.0265612.ref005","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.4269\/ajtmh.2012.12-0327","article-title":"Brucellosis among hospitalized febrile patients in northern Tanzania","volume":"87","author":"AJ Bouley","year":"2012","journal-title":"Am J Trop Med Hyg"},{"key":"pone.0265612.ref006","article-title":"Guidelines for Surveillance of Prioritized Zoonotic Diseases for Human and Animal Health in the United Republic of Tanzania","author":"United Republic of Tanzania(URT)","year":"2018","journal-title":"Gov Rep. Dar es Salaam"},{"key":"pone.0265612.ref007","first-page":"1","article-title":"Monitoring and evaluation of integrated disease surveillance and response in selected districts in Tanzania","volume":"9","author":"SF Rumisha","year":"2007","journal-title":"Tanzan Health Res Bull"},{"key":"pone.0265612.ref008","first-page":"1","article-title":"Integrated disease surveillance and response (IDSR) in Malawi: Implementation gaps and challenges for timely alert","volume":"13","author":"TSJ Wu","year":"2018","journal-title":"PLoS One"},{"key":"pone.0265612.ref009","article-title":"Streamlining and strengthening the Disease Surveillance System in Tanzania: Disease Surveillance System review, asset mapping, gap analysis, and proposal of strategies for streamlining and strengthening disease surveillance.","author":"BM Nkowane","year":"2019"},{"key":"pone.0265612.ref010","first-page":"34","article-title":"Trends of human brucellosis in pastoralist communities based on hospital records during 2013\u20132016 in Ngorongoro District, Tanzania","volume":"32","author":"HE Nonga","year":"2017","journal-title":"Tanzania Vet J"},{"key":"pone.0265612.ref011","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1472-6963-14-91","article-title":"An in-depth, exploratory assessment of the implementation of the National Health Information System at a district level hospital in Tanzania","volume":"14","author":"MC Wilms","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"pone.0265612.ref012","volume-title":"World Health Organization","author":"Food and Agriculture Organization of the United Nations, World Health Organization, World Organisation for Animal Health","year":"2006"},{"key":"pone.0265612.ref013","first-page":"1","author":"Center for Disease Control and Prevention","year":"2017","journal-title":"Brucellosis Reference Guide: Exposures, Testing and Prevention"},{"key":"pone.0265612.ref014","first-page":"1","volume-title":"Monograph series","author":"GG Alton","year":"1975"},{"key":"pone.0265612.ref015","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1097\/QCO.0b013e3283638104","article-title":"Brucellosis in low-income and middle-income countries","volume":"26","author":"PM Rubach","year":"2014","journal-title":"Curr Opin Infect Dis"},{"key":"pone.0265612.ref016","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1093\/trstmh\/try033","article-title":"Incidence of human brucellosis in the Kilimanjaro Region of Tanzania in the periods 2007\u20132008 and 2012\u20132014","volume":"112","author":"M Carugati","year":"2018","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pone.0265612.ref017","first-page":"135","article-title":"Risk factors for human brucellosis in northern Tanzania","volume":"19","author":"S Cash-Goldwasser","year":"2017","journal-title":"Am J Trop Med Hyg"},{"key":"pone.0265612.ref018","first-page":"1","article-title":"Performance characteristics and costs of serological tests for brucellosis in a pastoralist community of northern Tanzania","author":"SA Lukambagire","year":"2021","journal-title":"Nat Sci Reports"},{"key":"pone.0265612.ref019","first-page":"44","article-title":"Predictors of specific anti-Brucella antibodies among humans in agro-pastoral communities in Sengerema district, Mwanza, Tanzania: The need for public awareness","author":"EB Mngumi","year":"2016","journal-title":"Trop Med Health"},{"key":"pone.0265612.ref020","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4314\/thrb.v17i4.2","article-title":"Brucellosis serology as an alternative diagnostic test for patients with malaria-like symptoms","volume":"17","author":"K Orsel","year":"2015","journal-title":"Tanzan J Health Res"},{"key":"pone.0265612.ref021","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pntd.0005508","article-title":"Poor performance of the rapid test for human brucellosis in health facilities in Kenya","volume":"11","author":"WA de Glanville","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0265612.ref022","first-page":"1","article-title":"Hospital-based evidence on cost-effectiveness of brucellosis diagnostic tests and treatment in Kenyan hospitals","volume":"891","author":"L Alumasa","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0265612.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-020-5057-2","article-title":"Development and upgrading of public primary healthcare facilities with essential surgical services infrastructure: A strategy towards achieving universal health coverage in Tanzania","volume":"20","author":"NA Kapologwe","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"pone.0265612.ref024","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.1186\/1472-6963-13-S2-S6","article-title":"The Tanzania Connect Project: A cluster-randomized trial of the child survival impact of adding paid community health workers to an existing facility-focused health system","volume":"13","author":"K Ramsey","year":"2013","journal-title":"BMC Health Serv Res"},{"key":"pone.0265612.ref025","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.afjem.2012.06.002","article-title":"The state of emergency medicine in the United Republic of Tanzania","volume":"2","author":"BA Nicks","year":"2012","journal-title":"African J Emerg Med"},{"key":"pone.0265612.ref026","first-page":"1","article-title":"Appreciating local variations in standardising health care data collection processes and tools: A case of health management information system in Tanzania","volume":"2","author":"MH Mahundi","year":"2018","journal-title":"E J Info Sys Dev Ctries"},{"key":"pone.0265612.ref027","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12879-020-4873-7","article-title":"Seroprevalence of Brucella infection and associated factors among pregnant women receiving antenatal care around human, wildlife and livestock interface in Ngorongoro ecosystem, Northern Tanzania. A cross-sectional study","volume":"20","author":"R Makala","year":"2020","journal-title":"BMC Infect Dis"},{"key":"pone.0265612.ref028","volume-title":"The epidemiology of human brucellosis in the context of zoonotic diseases in Tanzania","author":"JS Kunda","year":"2005"},{"key":"pone.0265612.ref029","article-title":"The epidemiology of brucellosis in animals and humans in Arusha and Manyara regions of Tanzania","author":"SM Gabriel","year":"2005","journal-title":"The University of Glasgow. The University of Glasgow"},{"key":"pone.0265612.ref030","article-title":"The role of livestock keeping in human brucellosis trends in livestock keeping communities in Tanzania","author":"GM Shirima","year":"2010","journal-title":"Tanzan J Health Res"},{"key":"pone.0265612.ref031","first-page":"5","article-title":"Quantifying risk factors for human brucellosis in Rural Northern Tanzania","author":"K John","year":"2010","journal-title":"PLoS One"},{"key":"pone.0265612.ref032","author":"Pastoralists Indigenous Non-Governmental Organization\u2019s Forum (PINGO)","year":"2016","journal-title":"Socio-Economic Contributions of Pastoralism as a Livelihood System in Tanzania: Case of Selected Pastoral Districts in Arusha, Manyara and Dar Es Salaam Regions. Arusha, Tanzania"},{"key":"pone.0265612.ref033","volume-title":"Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) 2015\u201316","author":"Ministry of Health, Community Development","year":"2016"},{"key":"pone.0265612.ref034","doi-asserted-by":"crossref","first-page":"e0009049","DOI":"10.1371\/journal.pntd.0009049","article-title":"High incidence of human brucellosis in a rural Pastoralist community in Kenya, 2015","volume":"15","author":"P Munyua","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0265612.ref035","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0161576","article-title":"Prioritization of zoonotic diseases in Kenya, 2015","volume":"11","author":"P Munyua","year":"2016","journal-title":"PLoS One"},{"key":"pone.0265612.ref036","article-title":"Streamlining and strengthening the Disease Surveillance System in Tanzania: Disease Surveillance System review, asset mapping, gap analysis, and proposal of strategies for streamlining and strengthening disease surveillance","author":"BM Nkowane","year":"2019","journal-title":"Dar es Salaam"},{"key":"pone.0265612.ref037","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1038\/nprot.2014.064","article-title":"Antigen-specific activation and cytokine-facilitated expansion of naive, human CD8+ T cells","volume":"9","author":"M Wolfl","year":"2015","journal-title":"Nat Protoc"},{"key":"pone.0265612.ref038","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v084.i06","article-title":"tmap: Thematic Maps in R","volume":"84","author":"M. Tennekes","year":"2018","journal-title":"J Stat Softw"},{"key":"pone.0265612.ref039","author":"National Bureau of Statistics T","year":"2012","journal-title":"Tanzania National Bureau of Statistics 2012 housing census"},{"key":"pone.0265612.ref040","volume-title":"R: A language and environment for statistical computing","author":"R Core Team","year":"2020"},{"key":"pone.0265612.ref041","first-page":"1","volume-title":"Package \u201cDHARMa\u201d Title Residual Diagnostics for Hierarchical (Multi-Level \/ Mixed) Regression Models","author":"F Hartig","year":"2021"},{"key":"pone.0265612.ref042","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1586\/eri.11.55","article-title":"Implications of laboratory diagnosis on brucellosis therapy","volume":"9","author":"S Al Dahouk","year":"2011","journal-title":"Expert Rev Anti Infect Ther"},{"key":"pone.0265612.ref043","first-page":"10","article-title":"Laboratory diagnostics market in East Africa: A survey of test types, test availability, and test prices in Kampala, Uganda","author":"LF Schroeder","year":"2015","journal-title":"PLoS One"},{"key":"pone.0265612.ref044","article-title":"President\u2019s Malaria I Nitiative Tanzania Malaria Operational Plan FY 2018","author":"URT PMI, USAID, Centers for Disease Control and Prevention (CDC)","year":"2018","journal-title":"Dar es Salaam"},{"key":"pone.0265612.ref045","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ofid\/ofx237","article-title":"Human Brucellosis in Rural Uganda: Clinical Manifestations, Diagnosis, and Comorbidities at Kabale Regional Referral Hospital, Kabale, Uganda","volume":"4","author":"KD Dieckhaus","year":"2017","journal-title":"Open Forum Infect Dis"},{"key":"pone.0265612.ref046","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0105276","article-title":"Determinants of patients\u2019 choice of provider in accessing brucellosis care among pastoral communities adjacent to Lake Mburo National Park in Kiruhura District, Uganda","volume":"9","author":"C Kansiime","year":"2014","journal-title":"PLoS One"},{"key":"pone.0265612.ref047","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1111\/j.1863-2378.2008.01175.x","article-title":"Human Brucellosis: Seroprevalence and Risk Factors Related to High Risk Occupational Groups in Tanga Municipality, Tanzania","volume":"56","author":"ES Swai","year":"2009","journal-title":"Zoonoses Public Health"},{"key":"pone.0265612.ref048","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0196799","article-title":"Multisectoral prioritization of zoonotic diseases in Uganda, 2017: A One Health perspective","volume":"13","author":"M Sekamatte","year":"2018","journal-title":"PLoS One"},{"key":"pone.0265612.ref049","article-title":"Frontline health workers\u2019 awareness and use of E-based technology to enhance reporting of human brucellosis in rural setting in Tanzania","author":"JB Mligo1","year":"2021","journal-title":"BMC One Heal Outlook"},{"key":"pone.0265612.ref050","first-page":"1","article-title":"Brucellosis Diagnosis: Performance, Reporting and Costs of Frontline Tests","volume":"1","author":"A Lukambagire","year":"2021","journal-title":"Tanzania Public Heal Bull"},{"key":"pone.0265612.ref051","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.prevetmed.2018.01.005","article-title":"A systematic review of current immunological tests for the diagnosis of cattle brucellosis","volume":"151","author":"MJ Ducrotoy","year":"2018","journal-title":"Prev Vet Med"},{"key":"pone.0265612.ref052","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.actatropica.2016.10.004","article-title":"How do you get the Rose Bengal Test at the point-of-care to diagnose brucellosis in Africa? The importance of a systems approach","volume":"165","author":"MJ Ducrotoy","year":"2017","journal-title":"Acta Trop"},{"key":"pone.0265612.ref053","article-title":"Tanzania Service Provision Assessment","author":"Ministry of Health and Social Welfare (MoHSW) [Tanzania Mainland], Ministry of Health (MoH) [Zanzibar], (NBS) NB of S, Statistician(OCGS) O of the CG, International I","year":"2015","journal-title":"Dar es Salaam"},{"key":"pone.0265612.ref054","doi-asserted-by":"crossref","first-page":"2330","DOI":"10.1016\/j.socscimed.2006.06.003","article-title":"Outpatient process quality evaluation and the Hawthorne Effect","volume":"63","author":"K Leonard","year":"2006","journal-title":"Soc Sci Med"}],"updated-by":[{"DOI":"10.1371\/journal.pone.0344498","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000}}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0265612","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T17:32:46Z","timestamp":1648056766000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0265612"}},"subtitle":[],"editor":[{"given":"Aleksandra","family":"Barac","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,3,23]]},"references-count":54,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0265612","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,23]]}}}