Pub Date : 2017-04-01Epub Date: 2017-04-08DOI: 10.4314/thrb.v19i2.3
Emmanuel Balandya, Teri Reynolds, Said Aboud, Stephen Obaro, Julie Makani
Background: Infection is an important cause of morbidity in children with sickle cell anaemia (SCA). However, little is currently known regarding the spectrum of adaptive immune derangement in SCA, especially of populations in Sub-Saharan Africa. In this study, we investigated the phenotype and activation status of T and B lymphocytes among children with SCA in Tanzania.
Methods: We compared 30 children with SCA aged 1-6 years in steady-state with 10 age-matched controls. We assessed white blood cell count, T and B lymphocyte phenotype and activation status using an automated haematology analyser and multiparameter Flow Cytometry.
Results: In children with SCA, the absolute lymphocyte, monocyte and granulocyte counts were all increased. There was also an increase in proportion of central/transitional memory (42.4% vs. 33.3%, p = 0.0100), effector memory (7.8% vs. 5.4%, p = 0.0086) and terminally differentiated (2.3% vs. 1.3%, p = 0.0355) CD4+ T cells as well as effector memory CD8+ T cells (21.3% vs. 11.5%, p = 0.0060) in children with SCA. In contrast, there was no difference in naïve, classical memory, atypical memory and IgM memory B-cells between the two groups. The level of activation of both T and B cells were comparable between children with and without SCA. Furthermore, we observed a significant inverse correlation between frequency of the effector memory CD8+ T cells and haematocrit (Spearman rho = -0.3859, p = 0.0352).
Conclusions: Children with SCA in Tanzania show an absolute increase in all leukocyte types, including lymphocytes, with skewing of both CD4+ and CD8+ T cells towards the memory phenotypes. These findings provide insights on the development of adaptive immunity which may have implications on vaccine responsiveness, allo-immunisation, auto-immune diseases and transplant immunology in children with SCA.
背景：感染是镰状细胞性贫血（SCA）患儿发病的一个重要原因。然而，目前人们对镰状细胞性贫血适应性免疫失调的范围知之甚少，尤其是撒哈拉以南非洲地区的人群。在这项研究中，我们调查了坦桑尼亚患有 SCA 的儿童中 T 淋巴细胞和 B 淋巴细胞的表型和活化状态：我们将 30 名 1-6 岁稳态 SCA 患儿与 10 名年龄匹配的对照组进行了比较。我们使用自动血液分析仪和多参数流式细胞仪评估了白细胞计数、T 淋巴细胞和 B 淋巴细胞表型及活化状态：结果：在患有自闭症的儿童中，淋巴细胞、单核细胞和粒细胞的绝对数量都有所增加。SCA患儿的中枢/过渡记忆（42.4% vs. 33.3%，p = 0.0100）、效应记忆（7.8% vs. 5.4%，p = 0.0086）和终末分化（2.3% vs. 1.3%，p = 0.0355）CD4+ T细胞以及效应记忆CD8+ T细胞（21.3% vs. 11.5%，p = 0.0060）的比例也有所增加。相比之下，两组儿童的幼稚、经典记忆、非典型记忆和 IgM 记忆 B 细胞没有差异。T细胞和B细胞的活化水平在患有和不患有SCA的儿童中相当。此外，我们还观察到效应记忆 CD8+ T 细胞的频率与血细胞比容之间存在明显的反相关性（Spearman rho = -0.3859，p = 0.0352）：结论：坦桑尼亚的 SCA 患儿显示出包括淋巴细胞在内的所有白细胞类型的绝对增加，CD4+ 和 CD8+ T 细胞向记忆表型倾斜。这些发现为适应性免疫的发展提供了见解，可能对SCA患儿的疫苗反应性、同种免疫、自身免疫性疾病和移植免疫学产生影响。
{"title":"Increased memory phenotypes of CD4+ and CD8+ T cells in children with sickle cell anaemia in Tanzania.","authors":"Emmanuel Balandya, Teri Reynolds, Said Aboud, Stephen Obaro, Julie Makani","doi":"10.4314/thrb.v19i2.3","DOIUrl":"10.4314/thrb.v19i2.3","url":null,"abstract":"<p><strong>Background: </strong>Infection is an important cause of morbidity in children with sickle cell anaemia (SCA). However, little is currently known regarding the spectrum of adaptive immune derangement in SCA, especially of populations in Sub-Saharan Africa. In this study, we investigated the phenotype and activation status of T and B lymphocytes among children with SCA in Tanzania.</p><p><strong>Methods: </strong>We compared 30 children with SCA aged 1-6 years in steady-state with 10 age-matched controls. We assessed white blood cell count, T and B lymphocyte phenotype and activation status using an automated haematology analyser and multiparameter Flow Cytometry.</p><p><strong>Results: </strong>In children with SCA, the absolute lymphocyte, monocyte and granulocyte counts were all increased. There was also an increase in proportion of central/transitional memory (42.4% <i>vs</i>. 33.3%, p = 0.0100), effector memory (7.8% <i>vs</i>. 5.4%, p = 0.0086) and terminally differentiated (2.3% <i>vs</i>. 1.3%, p = 0.0355) CD4+ T cells as well as effector memory CD8+ T cells (21.3% <i>vs</i>. 11.5%, p = 0.0060) in children with SCA. In contrast, there was no difference in naïve, classical memory, atypical memory and IgM memory B-cells between the two groups. The level of activation of both T and B cells were comparable between children with and without SCA. Furthermore, we observed a significant inverse correlation between frequency of the effector memory CD8+ T cells and haematocrit (Spearman rho = -0.3859, p = 0.0352).</p><p><strong>Conclusions: </strong>Children with SCA in Tanzania show an absolute increase in all leukocyte types, including lymphocytes, with skewing of both CD4+ and CD8+ T cells towards the memory phenotypes. These findings provide insights on the development of adaptive immunity which may have implications on vaccine responsiveness, allo-immunisation, auto-immune diseases and transplant immunology in children with SCA.</p>","PeriodicalId":39815,"journal":{"name":"Tanzania Journal of Health Research","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11361362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70663580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Mirambo, M. Mushi, Ley Shilewangwa, Caroline A. Minja, B. Kidenya, M. Majigo, S. Mshana
Insufficient supply of manufacture’s buffers/diluents in relation to the number of strips per kit has been found to have negative impact on patients’ results. Some laboratories personnel tend to use diluents from other rapid tests manufacturers such as Bioline, Unigold as well as malaria rapid diagnostic test (MRDT). This study aimed at evaluating the use of 0.01M phosphate buffered saline (PBS) as detection buffer for Alere Determine® HIV rapid test. This study was carried out at Bugando School of Medicine in Mwanza, Tanzania. A total of 300 whole blood specimens ; 150 HIV positive specimens from patients attending Care and Treatment Centreand 150 HIV negative specimens were retested for HIV status using Alere Determine® HIV rapid test employing normal Alere buffer and 0.01M PBS as buffer.Of the total specimens tested; 150 (100%) of HIV positive were positive by using both Alere buffer and 0.01M PBS while 150(100%) of HIV negative samples were negative by both Alere Determine® and 0.01M PBS. The agreement between 0.01M PBS and Alere Determine® buffer was 100%. The value of kappa indicates perfect agreement between 0.01M PBS and Alere Determine® buffer (100%). A 0.01M PBS is recommended as alternative detection buffer for Alere Determine® in cases of insufficient supply. Further investigation to evaluate the suitable buffer for other rapid tests for HIV and other diseases is recommended especially in resource limited settings.
{"title":"The use of 0.01M phosphate buffered saline as detection buffer for Alere Determine HIV rapid test in resource limited settings.","authors":"M. Mirambo, M. Mushi, Ley Shilewangwa, Caroline A. Minja, B. Kidenya, M. Majigo, S. Mshana","doi":"10.4314/THRB.V19I2.10","DOIUrl":"https://doi.org/10.4314/THRB.V19I2.10","url":null,"abstract":"Insufficient supply of manufacture’s buffers/diluents in relation to the number of strips per kit has been found to have negative impact on patients’ results. Some laboratories personnel tend to use diluents from other rapid tests manufacturers such as Bioline, Unigold as well as malaria rapid diagnostic test (MRDT). This study aimed at evaluating the use of 0.01M phosphate buffered saline (PBS) as detection buffer for Alere Determine® HIV rapid test. This study was carried out at Bugando School of Medicine in Mwanza, Tanzania. A total of 300 whole blood specimens ; 150 HIV positive specimens from patients attending Care and Treatment Centreand 150 HIV negative specimens were retested for HIV status using Alere Determine® HIV rapid test employing normal Alere buffer and 0.01M PBS as buffer.Of the total specimens tested; 150 (100%) of HIV positive were positive by using both Alere buffer and 0.01M PBS while 150(100%) of HIV negative samples were negative by both Alere Determine® and 0.01M PBS. The agreement between 0.01M PBS and Alere Determine® buffer was 100%. The value of kappa indicates perfect agreement between 0.01M PBS and Alere Determine® buffer (100%). A 0.01M PBS is recommended as alternative detection buffer for Alere Determine® in cases of insufficient supply. Further investigation to evaluate the suitable buffer for other rapid tests for HIV and other diseases is recommended especially in resource limited settings.","PeriodicalId":39815,"journal":{"name":"Tanzania Journal of Health Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43100711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Scolastica J. Swai, Damian J. Damian, Sarah Urassa, B. Temba, M. Mahande, R. Philemon, S. Msuya
Background: It is estimated that over ten percent of the 36.7 million people living with HIV (PLWHIV) globally, are those aged ≥50 years. The objective of this study was to determine the prevalence and risk factors for HIV among adult aged 50 years and above in Rombo district, northern Tanzania. Methods: This cross sectional study was conducted from April to June 2015 among older adults aged ≥50 year in Rombo district. Interviews were conducted to collect information on socio-demographic characteristics, reproductive and sexual health characteristics of the participants, knowledge on HIV transmission, prevention and risk perception and on awareness and knowledge on voluntary and counselling testing services. In addition, a blood sample was taken for HIV diagnosis. Results: A total of 600 people were enrolled. Their age ranged from 50 to 90 years with mean of 64.9 (±SD 10.3) years. The HIV prevalence was 1.7% (n=10) and it was higher among women (2.1%) than men (1.3%). Sixty-percent (n=350) were knowledgeable on HIV transmission and only 40% (n=216) on HIV prevention. In bivariate analysis, age of partner <50 years, ever use of condoms, poor knowledge on HIV prevention and perception of risk on HIV were significantly associated with HIV. However, only partner’s age of <50 years remained significant after controlling for confounders. Conclusion: HIV prevalence and overall knowledge on its transmission among older adults in this rural population were low. There is a need for strategies to improve HIV preventive knowledge and testing in this group in order to continue keeping the transmission at low levels.
{"title":"Prevalence and risk factors for HIV among people aged 50 years and older in Rombo district, Northern Tanzania","authors":"Scolastica J. Swai, Damian J. Damian, Sarah Urassa, B. Temba, M. Mahande, R. Philemon, S. Msuya","doi":"10.4314/THRB.V19I2.2","DOIUrl":"https://doi.org/10.4314/THRB.V19I2.2","url":null,"abstract":"Background: It is estimated that over ten percent of the 36.7 million people living with HIV (PLWHIV) globally, are those aged ≥50 years. The objective of this study was to determine the prevalence and risk factors for HIV among adult aged 50 years and above in Rombo district, northern Tanzania. Methods: This cross sectional study was conducted from April to June 2015 among older adults aged ≥50 year in Rombo district. Interviews were conducted to collect information on socio-demographic characteristics, reproductive and sexual health characteristics of the participants, knowledge on HIV transmission, prevention and risk perception and on awareness and knowledge on voluntary and counselling testing services. In addition, a blood sample was taken for HIV diagnosis. Results: A total of 600 people were enrolled. Their age ranged from 50 to 90 years with mean of 64.9 (±SD 10.3) years. The HIV prevalence was 1.7% (n=10) and it was higher among women (2.1%) than men (1.3%). Sixty-percent (n=350) were knowledgeable on HIV transmission and only 40% (n=216) on HIV prevention. In bivariate analysis, age of partner <50 years, ever use of condoms, poor knowledge on HIV prevention and perception of risk on HIV were significantly associated with HIV. However, only partner’s age of <50 years remained significant after controlling for confounders. Conclusion: HIV prevalence and overall knowledge on its transmission among older adults in this rural population were low. There is a need for strategies to improve HIV preventive knowledge and testing in this group in order to continue keeping the transmission at low levels.","PeriodicalId":39815,"journal":{"name":"Tanzania Journal of Health Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45036919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Studies from developed countries have shown that home monitoring and follow up of heart failure (HF) patients by use of phone calls is cost-effective as it reduces re-admission and improves patients’ clinical status. This intervention has however not been tested in resource poor countries including Tanzania, and there are questions as to whether it is applicable in such situations. This study was carried out to determine the applicability of structured telephone monitoring of HF patients discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods: All heart failure patients admitted at the hospital’s Cardiovascular Medicine Department between August and December 2014 were consecutively recruited. Information on their clinical and demographic characteristics was collected and their mobile phone numbers recorded. Patients were then contacted through their phones on day 7, 14 and 30 post discharge and inquiry on their clinical status was made. Results: A total of 164 HF patients were admitted during the study period, of these 4 declined to participate, 3 could not establish a phone number and 26 died before discharge leaving 131 (79.9%) for follow-up. The mean age was 45±19 years and 56.5% were women. The proportion of patients that could be contacted through mobile phones were 96.2%, 94.7% and 93.9% on day 7, 14 and 30 post discharge, respectively. Over 90% of the contacted patients gave valuable information regarding their clinical status. Conclusion: Majority of HF patients can be contacted and provide valuable clinical information through mobile phones within a month post discharge from the national hospital in Tanzania. Structured telephone monitoring could be used as a tool to follow up HF patients in a resource-poor country like Tanzania.
{"title":"Applicability of structured telephone monitoring to follow up heart failure patients discharged from Muhimbili National Hospital, Tanzania","authors":"Sabina Mmbali, P. Chillo","doi":"10.4314/THRB.V19I2","DOIUrl":"https://doi.org/10.4314/THRB.V19I2","url":null,"abstract":"Background: Studies from developed countries have shown that home monitoring and follow up of heart failure (HF) patients by use of phone calls is cost-effective as it reduces re-admission and improves patients’ clinical status. This intervention has however not been tested in resource poor countries including Tanzania, and there are questions as to whether it is applicable in such situations. This study was carried out to determine the applicability of structured telephone monitoring of HF patients discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods: All heart failure patients admitted at the hospital’s Cardiovascular Medicine Department between August and December 2014 were consecutively recruited. Information on their clinical and demographic characteristics was collected and their mobile phone numbers recorded. Patients were then contacted through their phones on day 7, 14 and 30 post discharge and inquiry on their clinical status was made. Results: A total of 164 HF patients were admitted during the study period, of these 4 declined to participate, 3 could not establish a phone number and 26 died before discharge leaving 131 (79.9%) for follow-up. The mean age was 45±19 years and 56.5% were women. The proportion of patients that could be contacted through mobile phones were 96.2%, 94.7% and 93.9% on day 7, 14 and 30 post discharge, respectively. Over 90% of the contacted patients gave valuable information regarding their clinical status. Conclusion: Majority of HF patients can be contacted and provide valuable clinical information through mobile phones within a month post discharge from the national hospital in Tanzania. Structured telephone monitoring could be used as a tool to follow up HF patients in a resource-poor country like Tanzania.","PeriodicalId":39815,"journal":{"name":"Tanzania Journal of Health Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49237284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Mushi, Benedictor Masewa, M. Jande, M. Mirambo, S. Mshana
Background: Misuse of antifungal both in clinics and agriculture has been associated with the increased trend of antifungal resistance. In Tanzania, there is limited information regarding the magnitude of antifungal obtained over the counter therefore this study was performed to determine the extent of over the counter (OTC) antifungal use and factors associated to it . Methods: This was a cross sectional study involving patients buying antifungal agents from community pharmacies between May and July 2015 in Mwanza city, Tanzania. Data were collected by the investigator using interview guided questionnaire and analyzed using STATA version 11. Results: A total of 270 patients were enrolled and interviewed. The mean age was 30 years±12. Majority of patients (59.6%) were female. Out of 270 patients, 188(69.3%) had dermatophytes. A total of 150(55.6%, 95%CI 49.6-61) obtained antifungal OTC. Of 150 patients received antifungal agents OTC, 64(42.3%) received more than one antifungal compared to only 11/120 (9.2%) of those with prescription p<0.001. Clotrimazole was the commonly prescribed antifungal while fluconazole was mostly obtained OTC. On univariate analysis, increase in age was found to be associated with the tendency of obtaining antifungal over the counter (OR 1.03, 95% CI 1.008-1.05, P<0.006). Having skin fungal infections was the only predictor of obtaining antifungal agents OTC (OR 3.36, 95% CI 2.34-4.81, P<0.001). Conclusion : In Mwanza City, patients receive multiple antifungal agents over the counter and the practice is significantly more for the patients with skin fungal infections. There is a need for the advocacy on appropriate antifungal use so that associated impact of resistance development can be reduced
{"title":"Prevalence and factor associated with over-the-counter use of antifungal agents, in Mwanza City, Tanzania","authors":"M. Mushi, Benedictor Masewa, M. Jande, M. Mirambo, S. Mshana","doi":"10.4314/THRB.V19I1.8","DOIUrl":"https://doi.org/10.4314/THRB.V19I1.8","url":null,"abstract":"Background: Misuse of antifungal both in clinics and agriculture has been associated with the increased trend of antifungal resistance. In Tanzania, there is limited information regarding the magnitude of antifungal obtained over the counter therefore this study was performed to determine the extent of over the counter (OTC) antifungal use and factors associated to it . Methods: This was a cross sectional study involving patients buying antifungal agents from community pharmacies between May and July 2015 in Mwanza city, Tanzania. Data were collected by the investigator using interview guided questionnaire and analyzed using STATA version 11. Results: A total of 270 patients were enrolled and interviewed. The mean age was 30 years±12. Majority of patients (59.6%) were female. Out of 270 patients, 188(69.3%) had dermatophytes. A total of 150(55.6%, 95%CI 49.6-61) obtained antifungal OTC. Of 150 patients received antifungal agents OTC, 64(42.3%) received more than one antifungal compared to only 11/120 (9.2%) of those with prescription p<0.001. Clotrimazole was the commonly prescribed antifungal while fluconazole was mostly obtained OTC. On univariate analysis, increase in age was found to be associated with the tendency of obtaining antifungal over the counter (OR 1.03, 95% CI 1.008-1.05, P<0.006). Having skin fungal infections was the only predictor of obtaining antifungal agents OTC (OR 3.36, 95% CI 2.34-4.81, P<0.001). Conclusion : In Mwanza City, patients receive multiple antifungal agents over the counter and the practice is significantly more for the patients with skin fungal infections. There is a need for the advocacy on appropriate antifungal use so that associated impact of resistance development can be reduced","PeriodicalId":39815,"journal":{"name":"Tanzania Journal of Health Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4314/THRB.V19I1.8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49622343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Escherichia coli is among the most common causes of diarrhoea in children below five years of age in developing countries. Diarrhoeal diseases rank the second most common cause of morbidity and mortality in developing countries. Here we report the magnitude of Shiga toxin-producing Escherichia coli (STEC) infection among underfives with diarrhoea in Mwanza, Tanzania. Methods: This study was carried out at Nyamagana and Sekou Toure hospitals in Mwanza, Tanzania. Between July, 2015 and March, 2016, children aged < 5 years with diarrhoea were included in the study. Demographics and relevant information were recorded. Stool specimens were cultured onto MacConkey and Salmonella-Shigella Agars. CHROMagar STEC was used to identify STEC. Antimicrobial susceptibility testing was performed to all pathogenic bacteria using disc diffusion method. Results : A total of 304 children were include in the study. The mean (±standard deviation) age of the enrolled children was 1.4 (±1.03) years. Out of 304 diarrhoea cases, 32 (10.5%) were positive for STEC and 12 (3.9%) were due to other pathogenic bacteria ( Salmonella and Shigella species.). Of 32 STEC isolates, 22 (68.8%) and 20 (62.5%) were resistant to amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole respectively and 3 (9.4%) were found to produce extended spectrum beta lactamases (ESBL). Use of water from wells (p=0.006) was found to be the predictor of the presence of pathogenic bacteria. Conclusion: Clinicians should consider STEC as the potential pathogens causing diarrhoea in the region. More than 60% of pathogenic bacteria were resistant to commonly prescribed antimicrobials like amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole. There is a need to emphasize on the provision of safe water, health education together with improvements in sanitation and personal hygiene as key strategies to reduce these infections.
{"title":"Prevalence and antimicrobial sensitivity of Shiga-toxin-producing Escherichia coli among underfives presenting with diarrhoea at hospitals in Mwanza City Tanzania.","authors":"N. Moremi, A. Othman, Bahati P. Msaki, S. Mshana","doi":"10.4314/THRB.V19I1.7","DOIUrl":"https://doi.org/10.4314/THRB.V19I1.7","url":null,"abstract":"Background: Escherichia coli is among the most common causes of diarrhoea in children below five years of age in developing countries. Diarrhoeal diseases rank the second most common cause of morbidity and mortality in developing countries. Here we report the magnitude of Shiga toxin-producing Escherichia coli (STEC) infection among underfives with diarrhoea in Mwanza, Tanzania. Methods: This study was carried out at Nyamagana and Sekou Toure hospitals in Mwanza, Tanzania. Between July, 2015 and March, 2016, children aged < 5 years with diarrhoea were included in the study. Demographics and relevant information were recorded. Stool specimens were cultured onto MacConkey and Salmonella-Shigella Agars. CHROMagar STEC was used to identify STEC. Antimicrobial susceptibility testing was performed to all pathogenic bacteria using disc diffusion method. Results : A total of 304 children were include in the study. The mean (±standard deviation) age of the enrolled children was 1.4 (±1.03) years. Out of 304 diarrhoea cases, 32 (10.5%) were positive for STEC and 12 (3.9%) were due to other pathogenic bacteria ( Salmonella and Shigella species.). Of 32 STEC isolates, 22 (68.8%) and 20 (62.5%) were resistant to amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole respectively and 3 (9.4%) were found to produce extended spectrum beta lactamases (ESBL). Use of water from wells (p=0.006) was found to be the predictor of the presence of pathogenic bacteria. Conclusion: Clinicians should consider STEC as the potential pathogens causing diarrhoea in the region. More than 60% of pathogenic bacteria were resistant to commonly prescribed antimicrobials like amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole. There is a need to emphasize on the provision of safe water, health education together with improvements in sanitation and personal hygiene as key strategies to reduce these infections.","PeriodicalId":39815,"journal":{"name":"Tanzania Journal of Health Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4314/THRB.V19I1.7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43291270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Despite of the recommendations to use population specific blood pressure (BP) references which consider time, ethnicity and environmental factors, there is limited information regarding BP profile among Tanzanians. This cross sectional study was done to determine casual BP profile among healthy volunteer students of the Catholic University of Health and Allied Sciences in Mwanza, Tanzania. Methods: Socio-demographic and lifestyle data were collected using questionnaires. Systolic BP (SBP) and diastolic BP (DBP) were measured using aneroid sphygmomanometer. Results: A total of 299 students (males=204; females=95) were involved in the study. Their mean age was 23.4 ± 0.2 years. SBP ranged from 82-150mmHg (mean= 115.7 ± 0.7mmHg) and DBP ranged from 44–100mmHg (mean= 71.9±0.6mmHg). Mean arterial pressure (MAP) was 86.5±0.5mmHg. Males had significantly higher BP than females; and BP was noticed to increase with increased age and body weight. Upper limits of the normal SBP and DBP calculated as mean + 2SDs and 95 th percentiles were 140.5mmHg and 138mmHg, respectively and for DBP were 91.8 mmHg and 90 mmHg, respectively. Conclusion : The observed upper limits of the distribution of normal BP for the age of the participants are higher than the World Health Organization recommended values. We recommend a larger study to determine BP among healthy Tanzanians to establish the normal values.
{"title":"Casual blood pressure among Tanzanian undergraduate students: need for re-defining population specific operational threshold between normotension and hypertension","authors":"N. Rashid, Haruna Dika","doi":"10.4314/THRB.V19I1.5","DOIUrl":"https://doi.org/10.4314/THRB.V19I1.5","url":null,"abstract":"Background: Despite of the recommendations to use population specific blood pressure (BP) references which consider time, ethnicity and environmental factors, there is limited information regarding BP profile among Tanzanians. This cross sectional study was done to determine casual BP profile among healthy volunteer students of the Catholic University of Health and Allied Sciences in Mwanza, Tanzania. Methods: Socio-demographic and lifestyle data were collected using questionnaires. Systolic BP (SBP) and diastolic BP (DBP) were measured using aneroid sphygmomanometer. Results: A total of 299 students (males=204; females=95) were involved in the study. Their mean age was 23.4 ± 0.2 years. SBP ranged from 82-150mmHg (mean= 115.7 ± 0.7mmHg) and DBP ranged from 44–100mmHg (mean= 71.9±0.6mmHg). Mean arterial pressure (MAP) was 86.5±0.5mmHg. Males had significantly higher BP than females; and BP was noticed to increase with increased age and body weight. Upper limits of the normal SBP and DBP calculated as mean + 2SDs and 95 th percentiles were 140.5mmHg and 138mmHg, respectively and for DBP were 91.8 mmHg and 90 mmHg, respectively. Conclusion : The observed upper limits of the distribution of normal BP for the age of the participants are higher than the World Health Organization recommended values. We recommend a larger study to determine BP among healthy Tanzanians to establish the normal values.","PeriodicalId":39815,"journal":{"name":"Tanzania Journal of Health Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4314/THRB.V19I1.5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43698940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Iddi, B. Francis, Hyasinta Jaka, M. Mirambo, M. Mushi
Background: Diabetic ketoacidosis (DKA), one of the common emergencies in patient with diabetes mellitus is associated with considerable morbidity and mortality. This study aimed to determine clinical presentation and precipitating factors of DKA among patients admitted at Bugando Medical Centre (BMC) in north-western Tanzania. Methods: This study involved a retrospective review of hospital records of DKA patients admitted to intensive care unit at BMC during 2012. Data on demographics, precipitating factors, clinical presentation, duration of hospital admission and mortality were extracted and analysed. Results: Total records of 1,906 hospitalized patients in 2012 were reviewed. Of this, 29 (1.5%) had DKA. Of the 29 DKA patients, 18(62.1%) and 11 (37.9%) were males and females, respectively. Among them 21(72.4%) were known diabetics and 8(27.6%) were newly diagnosed to be diabetics. Twelve patients (41.1%) presented with polyuria, polydipsia and general body malaise. Eleven (37.9%) patients presented with loss of consciousness while 6(20.7%), 4(13.8%), 3(10.3%) and 1(3.4%) presented with vomiting, abdominal pain, Kussmaul’s breathing and coma, respectively. Nausea, weight loss and polyphagia each were presented by 2(6.9%) patients. The precipitating factors were infection 15 (51.7%), first presentation of diabetes mellitus 6 (20.7%), missed insulin injection 6 (20.7%) and co-morbid conditions 6 (20.7%). Four (13.8%), 1 (3.45%) and 1(3.45%) had stroke, chronic renal failure and hypertension, respectively. Among the DKA patients, 22 (75.9%) improved and were discharged, and 7 (24.1%) died. Conclusion: DKA occurred in about 1.5% of the patients admitted to ICU and it was a major cause of morbidity and mortality. The main precipitating factor was infection. Since the precipitating factors are preventable, health care providers should put emphasis in educating diabetic patients at the diabetes clinic to reduce morbidity and mortality in these patients.
{"title":"Clinical presentation and precipitating factors of diabetic ketoacidosis among patients admitted to intensive care unit at a tertiary hospital in Mwanza, Tanzania","authors":"S. Iddi, B. Francis, Hyasinta Jaka, M. Mirambo, M. Mushi","doi":"10.4314/THRB.V19I1.6","DOIUrl":"https://doi.org/10.4314/THRB.V19I1.6","url":null,"abstract":"Background: Diabetic ketoacidosis (DKA), one of the common emergencies in patient with diabetes mellitus is associated with considerable morbidity and mortality. This study aimed to determine clinical presentation and precipitating factors of DKA among patients admitted at Bugando Medical Centre (BMC) in north-western Tanzania. Methods: This study involved a retrospective review of hospital records of DKA patients admitted to intensive care unit at BMC during 2012. Data on demographics, precipitating factors, clinical presentation, duration of hospital admission and mortality were extracted and analysed. Results: Total records of 1,906 hospitalized patients in 2012 were reviewed. Of this, 29 (1.5%) had DKA. Of the 29 DKA patients, 18(62.1%) and 11 (37.9%) were males and females, respectively. Among them 21(72.4%) were known diabetics and 8(27.6%) were newly diagnosed to be diabetics. Twelve patients (41.1%) presented with polyuria, polydipsia and general body malaise. Eleven (37.9%) patients presented with loss of consciousness while 6(20.7%), 4(13.8%), 3(10.3%) and 1(3.4%) presented with vomiting, abdominal pain, Kussmaul’s breathing and coma, respectively. Nausea, weight loss and polyphagia each were presented by 2(6.9%) patients. The precipitating factors were infection 15 (51.7%), first presentation of diabetes mellitus 6 (20.7%), missed insulin injection 6 (20.7%) and co-morbid conditions 6 (20.7%). Four (13.8%), 1 (3.45%) and 1(3.45%) had stroke, chronic renal failure and hypertension, respectively. Among the DKA patients, 22 (75.9%) improved and were discharged, and 7 (24.1%) died. Conclusion: DKA occurred in about 1.5% of the patients admitted to ICU and it was a major cause of morbidity and mortality. The main precipitating factor was infection. Since the precipitating factors are preventable, health care providers should put emphasis in educating diabetic patients at the diabetes clinic to reduce morbidity and mortality in these patients.","PeriodicalId":39815,"journal":{"name":"Tanzania Journal of Health Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4314/THRB.V19I1.6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42788205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Percutaneous injuries and mucocutaneous blood and other body fluids exposure are among the common hospital hazards affecting health care workers (HCWs) worldwide. These exposures pose risks of contracting infections such as Hepatitis B and C and Human Immunodeficiency viruses. This study aimed to determine the incidence and human factors associated with percutaneous injuries and splash exposures among healthcare workers in Kahama District, Tanzania. Methods : This descriptive cross sectional study was conducted in Kahama District of north-western Tanzania and involved randomly selected healthcare workers. Structured self-administered questionnaire was used to collect data between July and October 2015. Results: A total of 277 HCWs participated in the study. Among them 146 (53%) were nurses, 138 (14%) auxiliary staff 36 (13%), 32 (12%) laboratory personnel and 25 (9%) were doctors. The mean age was 37.4 years. Seventy-one percent of the participants had more than 10 years’ of working experience. About 59% of participants reported incidences of percutaneous injuries and mucocutaneous blood and other fluids exposures. About 90% of participants agreed to experience the incidences several times. While 60% disagreed with availability of personal protective gears, non-reporting of the cases was noted by 26% of participants. Majority (81%) disagreed with existence of infection prevention and control (IPC) guidelines and protocols. The main human factors associated with the percutaneous injuries and splash exposures included HCWs experience at work (71%), long working hours (29%), type of workplace (48%) and inadequate use of IPC guidelines and protocols (48%). Conclusion: More than half of participants reported incidents of percutaneous injuries and mucocutaneous blood and other body fluids in Kahama District of Tanzania. Adherence to universal precautions, training and reduction of long working hours are necessary in order to reduce infections from percutaneous injuries and exposures.
{"title":"Reported incidences and factors associated with percutaneous injuries and splash exposures among healthcare workers in Kahama District, Tanzania","authors":"R. Laisser, John F. Ng'home","doi":"10.4314/THRB.V19I1.4","DOIUrl":"https://doi.org/10.4314/THRB.V19I1.4","url":null,"abstract":"Background: Percutaneous injuries and mucocutaneous blood and other body fluids exposure are among the common hospital hazards affecting health care workers (HCWs) worldwide. These exposures pose risks of contracting infections such as Hepatitis B and C and Human Immunodeficiency viruses. This study aimed to determine the incidence and human factors associated with percutaneous injuries and splash exposures among healthcare workers in Kahama District, Tanzania. Methods : This descriptive cross sectional study was conducted in Kahama District of north-western Tanzania and involved randomly selected healthcare workers. Structured self-administered questionnaire was used to collect data between July and October 2015. Results: A total of 277 HCWs participated in the study. Among them 146 (53%) were nurses, 138 (14%) auxiliary staff 36 (13%), 32 (12%) laboratory personnel and 25 (9%) were doctors. The mean age was 37.4 years. Seventy-one percent of the participants had more than 10 years’ of working experience. About 59% of participants reported incidences of percutaneous injuries and mucocutaneous blood and other fluids exposures. About 90% of participants agreed to experience the incidences several times. While 60% disagreed with availability of personal protective gears, non-reporting of the cases was noted by 26% of participants. Majority (81%) disagreed with existence of infection prevention and control (IPC) guidelines and protocols. The main human factors associated with the percutaneous injuries and splash exposures included HCWs experience at work (71%), long working hours (29%), type of workplace (48%) and inadequate use of IPC guidelines and protocols (48%). Conclusion: More than half of participants reported incidents of percutaneous injuries and mucocutaneous blood and other body fluids in Kahama District of Tanzania. Adherence to universal precautions, training and reduction of long working hours are necessary in order to reduce infections from percutaneous injuries and exposures.","PeriodicalId":39815,"journal":{"name":"Tanzania Journal of Health Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4314/THRB.V19I1.4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41681431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background : Birth weight is one of the key predictor for survival, health and future development of a child. In developing countries data on birth weights are limited to obtain due to difficulties in keeping records especially among rural women. Maternal recall of birth weight can therefore become a useful source of birth weight data. This study was carried out to determine recall of birth weight and delivery complications among mothers in Unguja West District of Zanzibar. Methods : This cross-sectional study involve mothers who had children below five years of age. Pretested structured questionnaire was used to collect information on socio-demographic characteristics of the mother, age of the child, birth weight of the child and delivery complications. Other information was obtained from maternal antenatal clinic and child’s growth monitoring cards. Results : A total of 260 women were included in the study. The mean age of the mothers was 29 years, ranging from 17 to 45 years. More than half (62%) had attained secondary education and few had informal education (6.5%) or post-secondary education (12%). Majority of the mothers (85%) delivered at the health facility assisted by trained health care provider. Those who delivered at home (15%) were either assisted by a relative or Traditional Birth Attendant (TBA). Over three quarters (78.5%) of the mothers had birth weights of their children recorded in the postnatal care cards. Out of 38 children who were born at home, 87% (n = 33) were not weighed and there were 23 women (10.4%) who delivered at the hospital but their children’s weight were not recorded. Overall, 46 (20%) mothers could not correctly recall birth weights of their children where. There was strong correlation between recall and recorded birth weight (r 2 =0.79; p<0.01). Reported/recorded delivery complications were hypertension, excessive bleeding, low birth weight, episiotomy, anaemia and preeclampsia. Conclusion : Maternal recall can provide reliable information with regard to child’s birth weight and delivery complications. Health facility staff should measure child’s weight correctly, inform the mother and record in the child’s card in order to facilitate correct recall by the mothers.
{"title":"Accuracy of maternal recall of birth weight and selected delivery complications in Zanzibar","authors":"A. Mwanri, Faki Hamisi, P. Mamiro","doi":"10.4314/THRB.V19I4.4","DOIUrl":"https://doi.org/10.4314/THRB.V19I4.4","url":null,"abstract":"Background : Birth weight is one of the key predictor for survival, health and future development of a child. In developing countries data on birth weights are limited to obtain due to difficulties in keeping records especially among rural women. Maternal recall of birth weight can therefore become a useful source of birth weight data. This study was carried out to determine recall of birth weight and delivery complications among mothers in Unguja West District of Zanzibar. Methods : This cross-sectional study involve mothers who had children below five years of age. Pretested structured questionnaire was used to collect information on socio-demographic characteristics of the mother, age of the child, birth weight of the child and delivery complications. Other information was obtained from maternal antenatal clinic and child’s growth monitoring cards. Results : A total of 260 women were included in the study. The mean age of the mothers was 29 years, ranging from 17 to 45 years. More than half (62%) had attained secondary education and few had informal education (6.5%) or post-secondary education (12%). Majority of the mothers (85%) delivered at the health facility assisted by trained health care provider. Those who delivered at home (15%) were either assisted by a relative or Traditional Birth Attendant (TBA). Over three quarters (78.5%) of the mothers had birth weights of their children recorded in the postnatal care cards. Out of 38 children who were born at home, 87% (n = 33) were not weighed and there were 23 women (10.4%) who delivered at the hospital but their children’s weight were not recorded. Overall, 46 (20%) mothers could not correctly recall birth weights of their children where. There was strong correlation between recall and recorded birth weight (r 2 =0.79; p<0.01). Reported/recorded delivery complications were hypertension, excessive bleeding, low birth weight, episiotomy, anaemia and preeclampsia. Conclusion : Maternal recall can provide reliable information with regard to child’s birth weight and delivery complications. Health facility staff should measure child’s weight correctly, inform the mother and record in the child’s card in order to facilitate correct recall by the mothers.","PeriodicalId":39815,"journal":{"name":"Tanzania Journal of Health Research","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70663792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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