Tanzania Journal of Health Research

Laboratory-Confirmed Blood Stream Infections and Antimicrobial Resistance Pattern of Isolates from Febrile Pediatric Patients at Tertiary Hospital in Tanzania

Mon, 10 Jul 2023 00:00:00 +0000

Background: Bloodstream infection (BSI) is one of the major causes of morbidity and mortality among children in Low and Middle-Income Countries. Febrile illness in pediatric patients requires urgent management; detecting the causative agent provides valuable information for appropriate management thus prevent the emergence of antimicrobial resistance (AMR). This study aimed to determined the magnitude of BSI and antimicrobial susceptibility pattern (AST) of bacteria among febrile pediatric patients.

Method: A cross-sectional study involving febrile pediatric patients was conducted between January and May 2021 at a tertiary hospital in Dar es Salaam. Blood culture was performed in an automated system, isolates were identified using conventional biochemical tests and AST was performed.

Result: The proportion of laboratory-confirmed BSI was 12.3% (95% CI: 8.2–17.5), with pediatric intensive care unit (PICU) having the highest frequency (27%). S.aureus (38.5%) and K.pneumoniae (26.9%) were the predominant bacterial pathogens. Overall, resistance to common antibiotics was more than 50%. Majority of gram-negative bacteria (GNR) (56.3%) were resistant to meropenem. Sixty-percent of S. aureus were MRSA, 50% of GNR were Extended spectrum beta-lactamase (ESBL) producers, and 65.4% of the isolates were multi-drug resistant (MDR). Children admitted to PICU had 5 times more adjusted odds of having laboratory-confirmed BSI than children at other wards (aOR = 4.8, 95% CI, 1.5 –16.1, p =0.010).

Conclusion: Laboratory confirmed BSI was relatively high among febrile pediatric patients; significantly found in infants and those admitted to PICU. Most isolated bacteria were MDR calling for routine blood culture and AST for appropriate management of BSI.

Prevalence and identification of Bacteria responsible for Nosocomial infections in Boufarik Hospital, Algeria

Sara Boukert, Dahia Saidj, Fella Hamaidi, Razika Boukert Boukert — Mon, 10 Jul 2023 00:00:00 +0000

Introduction: Nosocomial infections are one of the most common causes of death in hospitals. This study is accomplished as part of the bacteriological control of the hospital environment in relation to the evolution of nosocomial infections.

Objective: To estimate the prevalence of germs isolated from the equipment in Boufarik Hospital, province of Blida, Algeria. This investigation allowed us to determine the frequency of germs present in hospital materials.

Results: A total of 717 samples from the operating rooms, with a prevalence of 19.64% (147/717) cases were positive and 80.35% (576/717) were negative. Our study found that Gram-positive cocci represent a rate of (15.76%) and they are the most predominant germs in nosocomial infections, followed by Gram-negative bacilli which are represented by a rate of (2.64%) distributed among the Gram-negative oxidative bacteria (1.53%) and Enterobacteriaceae (1.11%) in addition Coagulase-negative Staphylococci are the most isolated germs in operating rooms with a frequency of 78.17% distributed between Staphylococcus epidermidis (61.81%) and Staphylococcus saprophyticus (16.36%). In intensive care, rooms are also Staphylococci, divided between Coagulase-negative staphylococci (78.91%) and Staphylococus aureus (2.32%). The Antibiogram tests determined the capacity of isolated microbes from the hospital environment to resist different molecules of antibiotics. The results revealed the resistance of Enterobacteriaceae to B-lactams and very well the sensitivity of Pseudomonas to imipenemipe, Ciprofloxacin and the aminosides Tobramycins, Netilmicins and Amikacin. The Variance

Conclusion: Analysis indicates that there is no improvement in the disinfection procedure at Boufarik Hospital over three consecutive years.

Differentiated Services Delivery Model and its associated outcomes among people living with HIV in Tanzania: A cross-sectional study

Mon, 10 Jul 2023 00:00:00 +0000

Background: Differentiated Service Delivery Model (DSDM) is now increasingly recognised as an important and sustainable approach that could contribute significantly towards the UNAIDS 90-90-90 by 2020 and 95-95-95 by 2030 targets and ultimately an AIDS-free generation. It is a strategy in use to promote retention in HIV care and/or ART adherence. Thus, this study aimed to determine the outcomes of DSDM among people living with HIV in Tanzania.

Methods: A Cross-sectional analytical design was conducted in nine regions of Tanzania with low, moderate and high HIV prevalence in the period from January to March 2020. We employed both quantitative and qualitative methods for data collection and analysis. We conducted record reviews and in-depth interviews with key informants at national and facility levels. Their data was summarised and arranged in sub-themes and then analysed according to the specific objectives using Thematic Analysis. We further conducted a bivariate analysis using Chi-Square to assess the association between each outcome and explanatory variable. Unadjusted and adjusted analysis was conducted to determine predictors of unfavourable outcomes using binary logistics and Cox regression models.

Results: Data was collected from 50 health facilities comprising 15 (30.0%) hospitals, 22 (44.0%) health centres and 13 (26.0%) dispensaries. Record reviews were for different outcomes as follows; Mis-categorization (13,056 records), Missed appointments (62,222 records), Advanced HIV disease (29,995 records), and Attrition (62,222 records). Among the 320 unstable clients, the miscategorisation rate significantly decreased after DSDM's introduction, from 63% to 36% (p < 0.001). After the introduction of DSDM, more clients missed their appointments compared to the period before the introduction of DSDM (1.7% vs 0.8% respectively). Missed appointments were associated with an urban setting ( AOR=1.1; 95%CI 1.1-1.2) and older age of 50 years and more (AOR=1.2; 95%CI 1.1-1.4) compared to a rural setting and younger age of less than 15 years respectively. Furthermore, DSDM led to a decrease (from 56.3% to 48.6%) of those with advanced WHO stage (WHO clinical stage 3 or 4) among the first-time testers. Attrition among the clients was higher after the introduction of DSDM compared to that before DSDM (ARR=1.1; 95%CI 1.04-1.2). Contributors to attrition were those related to individuals and institutions, including beliefs in faith healing, fear of stigma and wrong interpretation of viral load monitoring results.

Conclusion: Decentralized Community-based ART model is a promising entry point to improved HIV/AIDS service delivery. Strategies are needed to harmonise the comprehensiveness and quality of services across facilities providing HIV services.

Keywords: DSDM, Adherence, HIV/AIDS, ART, outcome

Efficacy of Quality Protein Maize-based Supplementary Foods on Rehabilitating Undernourished Children

Elina Maseta, Theobald Mosha — Mon, 10 Jul 2023 00:00:00 +0000

Background: A study was conducted to evaluate the efficacy of quality protein maize-based composite supplementary foods in rehabilitating moderately underweight children.

Methods: This was a randomised longitudinal study to treat undernourished children. Two formulations were developed from quality protein maize: quality protein maize-soybeans-common beans and quality protein maize -soybeans-cowpeas. A control diet was made from conventional maize. Children with weight-for-age Z score ≥ -2 SD from the reference population were selected for either diet. A total of 132 children were fed on the diets for a period of 16 weeks.

Results: Quality protein maize-based diets had positive effects (p<0.05) on weight, height, weight-for-age, height-for-age, weight-for-height Z-scores and haemoglobin concentrations but not on mid-upper arm circumference. Children consuming conventional maize porridge progressively faltered in growth with weight-for-age decreasing from -1.9 to -2.1 SD, height-for-age from -2.0 to -2.9 SD, weight for height from -1.2 to -1.9 SD and haemoglobin levels from 10 to 9.9 (g/dL). The quality protein maize-soybeans-common beans diet had a higher potential to support growth than the other diets. Sixteen weeks of supplementation resulted in significant (p˂0.05) improvement in height, weight, weight-for-age, height-for-age, weight-for-height Z-scores and haemoglobin levels for children receiving quality protein maize-based composite diets.

Conclusion: It is concluded from the current study that, in areas affected by undernutrition, quality protein maize-based composite foods can be used for rehabilitating undernourished children.

Meta-Switch improved plasma lipid profile in male wistar rats fed with a high-fat diet better than curcuma longa ethanolic extract

Mon, 10 Jul 2023 00:00:00 +0000

Introduction: A high fat intake through a high-fat diet (HFD) has been linked to hyperlipidaemia. Hyperlipidaemia is an important risk factor for obesity, metabolic syndrome, atherosclerosis, insulin resistance and hypertension. Curcumin is a yellow pigment obtained from the rhizomes of Curcuma longa, commonly used as a spice and food colourant. Curcumin extract has been published to possess several biochemical benefits, including anti-tumour, anti-inflammatory, antioxidant, anti-carcinogenic and hypo-cholesterolaemic activities.

Methods and objectives: This study compared the effect of Meta-Switch (MS) and Curcuma longa ethanolic extract (CLEE) on lipid profiles in Wistar rats fed with HFD. Thirty (30) male Wistar rats were randomly classified into six (6) groups of five (5) rats each. Rats in Group I was fed a normal diet. Rats in Groups (II, III, IV, V and VI) were fed HFD for two (2) weeks. Rats in Group I and II were treated with distilled water. Group III, IV, and V rats were orally administered 1.5, 2.0, and 2.5g/Kg of CLEE for another 2 weeks. Group VI rats were orally administered 1g/Kg of MS supplement for 2 weeks. After 2 weeks, the animals were humanely sacrificed. Blood samples were collected in heparinized bottles to obtain plasma samples for the measurement of total cholesterol (Chol), triglycerides (Trig), high-density lipoprotein-cholesterol (HDL) and low-density lipoprotein-cholesterol (LDL).

Results: Group II rats fed with HFD had high plasma Chol, LDL, and Trig but low HDL levels compared to Control Group I and Groups II, III, IV, V and VI (p < 0.05, p < 0.01 or p < 0.001). However, Groups III, IV, V and VI rats administered with CLEE and MS, respectively, after HFD had a reverse of Group II rats with HFD alone, i.e. low plasma Chol, LDL, and Trig but high LDL levels compared to the Group II rats (p < 0.05, p < 0.01 or p < 0.001). The low plasma Chol, Trig and LDL and the high plasma HDL obtained were more in 2.5 g/Kg followed by 2.0 g/Kg and 1.5 g/Kg CLEE. The plasma LDL and HDL were lower and higher, respectively, in Group VI, administered with 1 g/Kg MS than those of Group V, administered with 2.5 g/Kg CLEE after HFD. HFD produced high plasma lipid profile in the Wistar rats. However, CLEE or MS supplements improved the plasma lipid profile after HFD in the rats. Nonetheless, MS produced a better improvement in the plasma lipid profile than CLEE in the rats.

Conclusion: Meta-Switch may be useful in reducing the plasma levels of total Chol, LDL, and Trig and improves the level of HDL in humans.

Linkage and Retention in HIV care: A cost-outcome analysis for different strategies in Tanzania

Mon, 10 Jul 2023 00:00:00 +0000

Background: Starting Antiretroviral Treatment (ART) on time and being retained in care reduces the risk of HIV transmission, impoverishment of chronic end-organ effects of untreated viremia, and an overall increase in life expectancy. This study aimed at establishing available strategies for linkage and retention of HIV clients as well as the costs associated with the strategy.

Method: A retrospective cross-sectional design was conducted in eight regions of Tanzania mainland. A total of 60 facilities and affiliated communities providing linkage and ART services were involved. Mixed methods of collecting data were used with comprehensive document review. Information collected was for the period between 1^st January to 31^st December 2019. Cost evaluation was based on both patient and provider perspectives.

Results: In general, 91% of the clients were successfully linked to care in each linkage strategy and overall cost per client linked was $14.0 across regions. Cost of facility strategy was $14.73 with personnel, commodities and supplies and training costs emerging as the cost drivers. Community strategy cost was lower ($11.89) than facility strategy ($14.73). Overall retention rate was 99% with no difference between retention strategies. Cost of retention per client in facilities without outreach services was $14.73 while in facilities with outreach the cost was $11.89 with personnel as the primary costs’ driver in both strategies. Of 1,039 participants involved, to establish patient incurred cost for retention to care. Females were 65.4% and 57.8% of participants were from rural settings. Clients incurred annual out-of-pocket payments was $12.06. Linkage per-client cost for community strategy was lower ($11.89) than using facility strategy ($14.73)

Conclusion: There is no difference in yield of HIV positive and overall percentage of clients successfully linked to care based on facility and community strategy. However, there is regional variations in terms of per client cost for HIV linkage and retention services with overall cost per client linked using facility strategy higher than the community strategy. Personnel cost is the main cost driver for linkage and retention costs.

Effect of thiazide diuretics on nitric oxide and some hormones linked to erectile function in hypertension

Mon, 10 Jul 2023 00:00:00 +0000

Background: Erectile dysfunction is inability of a man to achieve and maintain an erection for desired and satisfactory sexual intercourse. Thiazide diuretics had been reported to affect some body functions especially erectile function. This study therefore investigates the effect of thiazide diuretics on nitric oxide and hormones linked with erectile function in hypertensive patients on this drug.

Methods: The study includes 150 subjects with 50 hypertensive patients on thiazide diuretics management regime (group 1), 50 hypertensive patients not under any management regime (group 2) and 50 normotensive subjects (group 3) attending the Osun State Specialist Hospital, llesha Osun State. Nitric oxide was determined with spectrophotometric method while prolactin, estrogen and testosterone were determined by enzyme linked immunosorbent assay method.

Results: The mean serum levels of nitric oxide was significantly lower (p< 0.05) in hypertensive subjects not under any management regime (group 2) than in the healthy subjects (group 3) and the test subjects (group 1) respectively. Also, estrogen levels was significantly reduced (p<0.05) in hypertensive subjects using thiazide diuretics than in hypertensive subjects that has been left unmanaged; while both values are significantly lower than estrogen levels in healthy subjects. The result of the study also showed that the serum testosterone levels of hypertensive subjects under thiazide diuretics management plan were significantly lower (p< 0.05) than that of hypertensive subjects not on any medications and healthy subject. Finally, serum prolactin levels was significantly higher (p< 0.05) in hypertensive patients on thiazide diuretics regime and hypertensive patients not under any management regime than the mean value in normotensive subjects.

Conclusion: This study shows that thiazide diuretics has no effect on nitric oxide or estrogen levels in relations to erectile dysfunction while its effects on testosterone and prolactin levels can be related to the occurrence of erectile dysfunction in patients using thiazide diuretics as an antihypertensive regimen.

Understanding the implications of social and financial burdens of pulmonary tuberculosis on patients, survivors and their family caregivers on care seeking and treatment in Tanzania: Feedback from a qualitative study in Mbeya and Songwe regions

Mon, 10 Jul 2023 00:00:00 +0000

Introduction: Tuberculosis (TB) leads to the most common fatal infectious disease, having devastating public health and socio-economic consequences. Despite the national TB programme in Tanzania strategizing and supporting interventions to end TB, TB is still highly prevalent, suggesting a need for studying the reasons behind it and understanding what could be done to improve the situation. This paper presents findings from a qualitative study that explored the role of social and financial consequences faced by TB patients, survivors and their family caregivers in their strive to seek TB treatment.

Methodology: A cross-sectional qualitative study was conducted between October 2010 and March 2021 covering 18 patients, 12 survivors and 8 of their family caregivers who were identified using a purposive sampling technique to participate in face-to-face in-depth interviews. Data were transcribed, back-translated from Kiswahili to English and then interpreted iteratively using a thematic analysis approach after the initial analysis facilitated by the use of NVivo 12 software.

Results: All respondent categories shared experience of having faced difficulties in mobilizing money for expenditure on transport meals and soft drinks, besides the time lost while seeking care at formal health facilities. TB comorbidity with diabetes, hypertension and other communicable diseases was reported to intensify the time and financial cost burdens. Social costs such as stigma and isolation from socialization, associating TB symptoms with witchcraft were testified as contributing to treatment-seeking delays and resultant health and financial costs.

Conclusion: Structural barriers must be addressed to reduce costs and improve healthcare access, TB sensitization, and economic support for vulnerable families are also necessary to enhance TB treatment and care compliance and reduce the burden of disease in the communities

Safety of herbal preparations among COVID-19 patients in Tanzania: An observational prospective cohort study

Mon, 10 Jul 2023 00:00:00 +0000

Background: Different measures have been taken to treat and control the spread of COVID-19. One of these measures is the use of locally available herbal preparations. Despite their long-time use, still, information on their safety is scarce.

Methods: This observational cohort study was conducted from February to May 2021 among COVID-19 patients admitted at one of 12 (10 public and two private) health facilities in Tanzania. Participants were grouped into two - those who were using standard care alone and those who reported to be supplementing standard care with herbal preparations for the treatment of COVID-19. A review of medical records and interviews were done to obtain socio-demographic, clinical and laboratory information. All participants were followed up for 14 days.

Results: Half of the participants had normal hemoglobin levels at baseline and on day 14. Renal insufficiency was observed more among non-herbal users compared to herbal users (38.5% vs 21.8%) on day 7 (p = 0.04) and 54% vs 49% on day 14. Creatinine levels were significantly raised among non-herbal users than among herbal users at baseline (p = 0.002) and at day 14 (p = 0.045). There was no significant difference in INR level among both groups on day 7, however at day 14, the raise was more among non-herbal compared to herbal users (100% vs 20.5%).

Conclusion: There were no noticeable haematological, renal or liver parameters derangements among COVID-19 patients who used herbal preparations plus standard care compared to those who used standard care alone.

Histological microstaging of cutaneous malignant melanoma in black African patients: A Ugandan experience

Kahima J Kahima, Henry R Wabinga, Dan Wamala, Phillipo L Chalya — Mon, 10 Jul 2023 00:00:00 +0000

Background: Histological micro-staging has been widely studied in Western countries and found to be an independent prognostic factor in patients with cutaneous malignant melanoma (CMM). However, in developing countries such as Uganda, there is a paucity of literature regarding this subject. This study was conducted to document the histological micro-staging of CMM in Ugandan patients and relate this staging to the histological features of the tumour.

Methods: This was an analytical cross-sectional study using diagnosed CMM stored samples in the Department of Pathology, Makerere University. Two hundred and seventeen paraffin-embedded specimen blocks were retrieved, resectioned, stained, and examined microscopically and in micro stages. The tumor thickness and demographic features were assessed to determine the variation of Breslow’s thickness, demographic and histological features in patients with CMM.

Results: A total of 217 patients with CMM were studied. Out of these, 121 (55.8%) were females and 96(44.2%) were females. The age of the patients ranged from 23 to 83 years with a median of 53 years. The lower limb was the most frequent site of CMM found in 200(92.2%) patients. Epitheliod cells were the most common cell type accounting for 181 (83.3%) cases. The majority of cases (87.1%) had thick tumours. Tumor ulceration was noted in 163 (75.1%) cases. The majority of cases of CMM with ulceration had thick tumors accounting for 67.4% of cases. Mitotic figures were found in 83 (38.3%) cases. The Tumors’ lymphocytic infiltrations were reported in 197 (90.8%) cases. Lymphatic invasion was seen in 3(1.4%) cases and microsatellites were not seen in any case. There was a statistically significant association between the anatomical site of the tumor and sex (p = 0.043). Sex and tumor ulceration was found to be statistically significantly associated with Breslow’s tumor thickness (p < 0.05). No statistically significant difference was found between age, anatomical site mitotic figures, tumor lymphocytic infiltrations, lymphatic invasion and Breslow’s tumor thickness (p > 0.05).

Conclusion: This study demonstrated that CMM in the black Ugandan population shows a trend towards a relatively young age at diagnosis and is more prevalent in females affecting mostly the lower extremities. The majority of patients present late with thick, ulcerated tumors. We recommend that histological micro-staging is extremely important in in-patient prognostication and management and should therefore be included in all histological reports of CMM.

Plexiform neurofibromatosis: A case report

Oscar Lucas Kivike — Mon, 10 Jul 2023 00:00:00 +0000

Neurofibroma is a tumor of connective tissue of a nerve which can develop within a major or minor nerve anywhere in the body. Neurofibromatosis is a group of genetic disorders that affects the cell growth of neural tissues. Plexiform neurofibromatosis is a type which affects a nerve plexus. Is diffuse, locally invasive, deep and may be associated with bony erosion and pain. It is actually a neurofibromatosis type I.

It takes up to 30% of neurofibromatosis type I and mostly affects the maxillofacial region. 75% of patients who undergo surgical removal of the tumor are cured. The recurrence rate is 20%. Diagnosis is clinical, histopathology and genetic testing. Imaging investigations are X-rays, CT scans or MRIs. The treatment of choice for plexiform neurofibroma is surgery.

Cutaneous neurofibromas can be treated by laser therapy. Chemotherapy is used to treat malignant neurofibromas. We report a case of a 21 years old male patient who presented with left-sided facial swelling involving the eyelid, cheek and left ear. The swelling was painless and made the face deform with a protruding mass hanging. Imaging investigations show tumour infiltration to involve the inner structures and facial bony erosion. Surgical intervention was performed to remove the tumor.

Short-term outcome of patients with open tibial diaphysis fracture treated with external fixator at Muhimbili Orthopaedic Institute in Tanzania

Said Nondo — Mon, 10 Jul 2023 00:00:00 +0000

Background: Open fracture occurs when a fractured bone or its haematoma communicates with the external environment. Management of open tibia shaft fracture still poses great challenges to surgeons, due to its high incidence of postoperative complications. In Tanzania and other developing countries, the incidence of open fracture is increasing as the motorcycle becomes a public transport. Unlike in the past when falling from height particularly from trees, was the major cause of injuries in developing countries. Currently, road traffic accidents and interpersonal violence, including the use of various firearms contribute a high proportion. The external fixator is the recommended implant of choice in the treatment of open fractures especially with high contamination and extensive tissue damage despite its complications.

Objective: The study’s aim was to assess the short-term outcomes of a patient with an open tibial diaphysis fracture treated with an external fixator at Muhimbili Orthoepedic Institute.

Methodology: This was a hospital-based prospective descriptive study carried out for 12 months duration, from March 2016 to the end of Feb 2017 at Muhimbili Orthoepedic Institute.