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Objective To determine why health workers fail to follow integrated management of childhood illness (IMCI) guidelines for severely ill children at first-level outpatient health facilities in rural areas of the United Republic of Tanzania. Methods Retrospective and prospective case reviews of severely ill children aged < 5 years were conducted at health facilities in four districts. We ascertained treatment and examined the characteristics associated with referral, conducted follow-up interviews with parents of severely ill children, and gave health workers questionnaires and interviews. Findings In total, 502 cases were reviewed at 62 facilities. Treatment with antimalarials and antibiotics was consistent with the diagnosis given by health workers. However, of 240 children classified as having "very severe febrile disease", none received all IMCIrecommended therapies, and only 25% of severely ill children were referred. Lethargy and anaemia diagnoses were independently associated with referral. Most (91%) health workers indicated that certain severe conditions can be managed without referral. Conclusion The health workers surveyed rarely adhered to IMCI treatment and referral guidelines for children with severe illness. They administered therapy based on narrow diagnoses rather than IMCI classifications, disagreed with referral guidelines and often considered referral unnecessary. To improve implementation of IMCI, attention should focus on the reasons for health worker nonadherence.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español.

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Mangrove forest sediments produce significant amounts of methane, but the diversity of methanogenic archaea is not well known at present. Therefore, 16S rRNA gene libraries were made using archaea-specific primers and DNA extracted directly from Tanzanian mangrove sediment samples as a template. Analysis of sequence data showed phylotypes closely related to cultivated methylotrophic methanogenic archaea from the marine environment, or distantly related to acetoclastic and hydrogenotrophic methanogenic archaea. In an attempt to isolate relevant methanogenic archaea, we succeeded in obtaining a new mesophilic methylotrophic methanogenic archaeon (strain MM1) capable of utilizing methanol and methylated amines as the only substrates. Under optimum conditions, the cells of strain MM1 exhibited a high specific growth rate (mu) of 0.21+/-0.03 (i.e. doubling time of 3.2 h) on both methanol and trimethylamine. The 16S rRNA gene sequence of strain MM1 clustered with five environmental clones, indicating that MM1 is an important methanogenic methylotroph in mangrove sediments. Based on physiological and phylogenetic analyses, strain MM1 is proposed to be included in the species of Methanococcoides methylutens.