Risk factors associated with multidrug resistant tuberculosis among patients referred to Kibong’oto Infectious Disease Hospital in northern Tanzania

Background: Multidrug resistant tuberculosis (MDR-TB) remains is an important public health problem in developing world. We conducted this study to determine risk factors associated with MDR-TB and drug susceptibility pattern to second line drug among MDR TB patients in Tanzania.Methods: Unmatched case control study was conducted at Kibong’oto Infectious Diseases Hospital in Tanzania in 2014. A case was defined as any patient whose sputum yielded Mycobacterium tuberculosis that were resistance to at least rifampin (RFP) and isoniazid (INH) whereas control was defined as those sensitive to rifampin (RFP) + isoniazid (INH).  One morning sputum sample was collected from each study subject and cultured on Löwenstein-Jensen (LJ) media for M. tuberculosis. Drug susceptibility testing of isolated M. tuberculosis was done for rifampicin, isoniazid, kanamycin and ofloxacin. A semi-structured questionnaire was used to collect socio-demographic and risk factors information for MDR-TB. Results: A total of 102 cases and 102 controls were enrolled. The predominant age group was 31- 40 years, of whom cases and controls accounted for 38 (37.3%) and 35 (34.3%) of the study subjects, respectively. Majority of participants (69% cases and 71% control) were males and self-employed (62.7% cases and 84.4% controls). More than half (52%) and approximately a quarter (24.5%) of cases and control had HIV infection, respectively. About two-thirds of cases (62.7%) were cigarette smokers compared to controls (42.2%). Previous history of TB treatment accounted for approximately three folds in cases (72.5%) and only 24.5% in controls. Risk factors independently associated with MDR-TB were previous history of treatment with first line anti-TB (OR= 3.3, 95% CI 1.7-6.3), smoking (OR=1.9, 95% CI 1.0-3.5), contact with TB case (OR=2.7, 95% CI 1.4-5.1) and history of TB. All MDR TB isolates were sensitive to kanamycin and ofloxacin.Conclusion: MDR-TB among patients referred to Kibong’oto Infectious Diseases Hospital is associated with previous history of TB contact, smoking habit, and contact with TB case. All MDR TB isolates were sensitive to the tested second line drugs, Kanamycin and Ofloxacin

Socio-demographic determinants of dengue infection during an outbreak in Dar es Salaam City, Tanzania

AbstractBackground: In recent years, the eastern coast of Africa has witnessed a number of dengue outbreaks. This study was carried out to determine socio-demographic determinants of dengue infection during the 2014 outbreak in Dar es Salaam, Tanzania. Methods: Unmatched case-control analysis of secondary data from a cross-sectional dengue investigation in three districts of Dar es Salaam in June 2014 was conducted. Febrile patients seeking care at health facilities were recruited. Cases were serologically-confirmed dengue-positive while controls were serologically-confirmed dengue-negative patients. A questionnaire was used to collect sociodemographic information. The association between sociodemographic variables and dengue infection was examined using univariate analysis and multivariate logistic regression analysis. Results: A total of 81 cases and 281 controls were included in the analysis. Majority of the cases and controls were males (64.2% versus 54.1%; P=0.137) and were >15 years of age (88.9% versus 72.9%; P =0.003). Living in Kinondoni (aOR = 4.28; 95% CI: 1.74 - 10.53); being employed (aOR = 2.06; 95% CI: 1.06-4.04); having piped water at home (aOR = 2.63; 95% CI: 1.40 - 4.95) and a recent visit of health facility (aOR = 1.94; 95% CI: 1.11 - 3.38) were significantly associated with dengue infection.Conclusions: Dengue infection in Dar es Salaam varied between the three districts and was associated with being employed, having piped water at home and a recent visit to the health facility. These findings provide primary understanding of the influence of socio-demographic factors on dengue and may be used to develop appropriate preventive interventions

Factors associated with partners elicitation during HIV Index client´s testing in Dar es Salaam Region, Tanzania

Introduction: Identifying people exposed to HIV is critical towards achieving the UNAIDS 90-90-90 goals for HIV epidemic control. The first 90 in Tanzania is at 53% and yet factors for partner's elicitation to HIV care providers are poorly understood. The objective of this study was to determine predictors of partner's elicitation among index HIV positive clients. Methods: We conducted a cross-sectional study from January to March 2019 among HIV positive clients diagnosed within the previous 12 months within HIV care and treatment centers in Dar-es Salaam. A structured questionnaire was used to collect the indexes' partner such as including name, type and status of relationship, and location. Participants were asked to choose the preferred approach to notify partners. Using modified Poisson regression estimate prevalence ratios predictors were determined for variables at p< to 0.05. Results: A total of 438 HIV index clients, mean age 37yrs ±11 SD were identified. Of these, 243 (55.5%) provided partners information to HIV Testing and Care (HTC) provider. Predictors for partner elicitation were awareness of notification methods aPR 3.80, 95%CI 2.11-7.01; having privacy at initial HTC visit aPR 3.20 95%CI 1.30-7.40; awareness of partner's HIV status aPR 1.16, 95%CI 1.03-1.30 and having no fear of rejection by partner aPR1.52, 95%CI 1.23-1.88. However, being a female HIV index client was significantly associated with decreased likelihood of partner's elicitation aPR 0.87, 95% CI 0.80-0.95. Conclusion: There is a low elicitation rate of exposed partners by index clients. Awareness of notification approaches, confidentiality, having no fear of rejection by partner, and privacy during HTC services contribute to high partner elicitation. Promotion of community awareness on partner's notification approaches and HIV transmission dynamics, and provision of additional support networks for women improve elicitation outcomes are recommended

Aetiology and factors associated with bacterial diarrhoeal diseases amongst urban refugee children in Eastleigh, Kenya: A case control study

Introduction: Kenya is home to over 400 000 refugees from neighbouring countries. There is scanty information about diarrhoea amongst urban refugees in Kenya. Objectives: We investigated the enteric bacteria causing diarrhoea amongst urban refugee children and described the associated factors. Method: During the period of August–December 2010, urban refugee children between the ages of two and five who attended Eastleigh County Council Health Centre were enrolled into the study. Diarrhoeal cases were compared with age-matched children with no diarrhoea (controls). Stool specimens were collected and enteric bacteria isolated. A questionnaire was administered to identify risk factors. Results: A total of 41 cases and 41 controls were enrolled in the study. The age and country of origin were similar for cases and controls. The bacterial isolation rates amongst the cases were: non-pathogenic Escherichia coli 71%, Shigella dysenteriae 2.4%, Shigella flexneri 2.4%, Salmonella paratyphi 5%. For the controls, non-pathogenic E. coli 90% and enterotoxigenic E. coli (ETEC)2.4% were amongst the organisms isolated. All isolates were resistant to amoxicillin; resistance to other antibiotics varied by isolate type. Factors associated independently with diarrhoea included children not washing their hands with soap (aOR 5.9, p < 0.05), neighbour(s) having diarrhoea (aOR 39.8, p < 0.05), children not exclusively breastfed for their first 6 months (aOR 7.6, p < 0.05) and children eating food cooked the previous day (aOR 23.8, p = 0.002). Conclusions: Shigella species, Salmonella species and ETEC were found to be responsible for diarrhoea amongst the urban refugee children. Measures to control and guide the use of antibiotics are critical for the prevention of antibiotic resistance. Efforts to improve personal and domestic hygiene, including educational campaigns to promote appropriate handwashing, should be encouraged

Methicillin-resistant staphylococcus aureus (MRSA) colonization among Intensive Care Unit (ICU) patients and health care workers at Muhimbili national hospital, Dar Es Salaam, Tanzania, 2012

Introduction: methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as important nosocomial pathogens worldwide. S aureus may induce clinically manifested diseases, or the host may remain completely asymptomatic. Methods: a cross-sectional hospital-based study was conducted from October 2012 to March 2013 in two ICUs at MNH. Admitted patients and health care workers were enrolled in the study. Interviewer administered questionnaires; patient history forms, observation charts and case report forms were used to collect data. Swabs (nostrils, axillary or wounds) were collected. MRSA were screened and confirmed using cefoxitin, oxacillin discs and oxacillin screen agar. Antibiotic susceptibility was performed using Kirby-Bauer disk diffusion method. The risk factors for MRSA were determined using the logistic regression analysis and a p - value of &lt;0.05 was considered as statistically significant. Results: of the 169 patients and 47 health workers who were recruited, the mean age was 43.4 years ± SD 15.3 and 37.7 years ± (SD) 11.44 respectively. Among the patients male contributed 108 (63.9%) while in health worker majority 39(83%) were females. The prevalence of MRSA colonization among patients and health care workers was 11.83% and 2.1% respectively. All (21) MRSA isolates were highly resistant to penicillin and erythromycin, and 17 (85.7%) were highly sensitive to vancomycin. Being male (AOR 6.74, 95% CI 1.31-34.76), history of sickness in past year (AOR 4.89, 95% CI 1.82- 13.12), being sick for more 3 times (AOR 8.91, 95% CI 2.32-34.20), being diabetic (AOR 4.87, 95% CI 1.55-15.36) and illicit drug use (AOR 10.18, 95%CI 1.36-76.52) were found to be independently associated with MRSA colonization. Conclusion: a study identified a high prevalence of MRSA colonization among patients admitted in the ICU. MRSA isolates were highly resistant to penicillin and erythromycin. History of illegal drug use was highly associated with MRSA colonization.The Pan African Medical Journal 2015;2

Knowledge of obstetric danger signs among recently-delivered women in Chamwino district, Tanzania: a cross-sectional study

Abstract Background Low knowledge of danger signs has been shown to delay seeking obstetric care which leads to high maternal mortality and morbidity worldwide. In Tanzania about half of pregnant women are informed about obstetric danger signs during antenatal care, but the proportion of those who have full knowledge of these obstetric danger signs is not known. This study assessed the knowledge of obstetric danger signs and its associated factors among recently-delivered women in Chamwino District, Tanzania. Methods A community-based cross-sectional study was conducted in January 2014 in Chamwino District, Tanzania. A woman was considered knowledgeable if she spontaneously mentioned at least five danger signs in any of the three phases of childbirth (pregnancy, childbirth and postpartum) with at least one in each phase. Multistage cluster sampling was used to recruit study participants. Descriptive and bivariate analyses were conducted. Multivariable logistic regression analyses were performed to control for confounding and other important covariates. Results A total of 428 women were interviewed. The median age (IQR) was 26.5 (22–33) years. Only 25.2% of respondents were knowledgeable about obstetric danger signs during pregnancy, childbirth/labour and postpartum. Significant explanatory variables of being knowledgeable about obstetric danger signs were found to be maternal education (AOR = 1.96; 95% CI: 1.01, 3.82), maternal occupation (AOR = 2.23; 95% CI; 1.10, 4.52), spouse occupation (AOR = 2.10; 95% CI: 1.02, 4.32) and counseling on danger signs (AOR = 3.42; 95% CI: 1.36, 8.62) after controlling for the clustering effect, confounding and important covariates. Conclusion A low proportion of women was found to be knowledgeable about obstetric danger signs in Chamwino district. Therefore, we recommend the Ministry of Health to design and distribute the maternal health booklets that highlight the obstetric danger signs, and encourage antenatal care providers and community health workers to provide frequent health education about these danger signs for every pregnant woman in order to increase their level of knowledge about obstetric danger signs

Sero-prevalence and spatial distribution of Rift Valley fever infection among agro-pastoral and pastoral communities during Interepidemic period in the Serengeti ecosystem, northern Tanzania

Abstract Background In the past two decades, Rift Valley Fever (RVF) outbreaks have been reported twice in Tanzania, with the most recent outbreak occurring in 2006/07. Given the ecology and climatic factors that support mosquito vectors in the Serengeti ecosystem, we hypothesized a continued transmission of RVF virus (RVFV) during interepidemic periods. This study was carried out to determine sero-prevalence, spatial distribution and factors associated with RVF in at-risk agro-pastoral and pastoral communities in the Serengeti Ecosystem in northern Tanzania. Methods A cross sectional study was carried out to establish the general exposure to RVFV by detecting anti–RVFV IgG and anti–RVFV IgM using ELISA techniques. The health facilities where human subjects were blood sampled concurrent with interviews included Bunda District Designated Hospital, Wasso DDH, Endulen hospital, Arash, Malambo, Olbabal, and Piyaya dispenaries (Ngorongoro district) and Nyerere DDH (Serengeti district) respectively. In addition, human subjects from Lamadi ward (Busega district) were recruited while receiving medical service at Bunda DDH. We conducted logistic regression to assess independent risk factor and mapped the hotspot areas for exposure to RVFV. Results A total of 751 subjects (males = 41.5%; females = 58.5%) with a median age of 35.5 years were enrolled at out-patient clinics. Of them, 34 (4.5, 95%CI 3.3–6.3%) tested positive for anti–RVFV IgG. Of the 34 that tested positive for anti–RVFV IgG, six (17.6%) tested positive for anti–RVFV IgM. Odds of exposure were higher among pastoral communities (aOR 2.9, 95% C.I: 1.21–6.89, p < 0.01), and agro-pastoral communities residing in Ngorongoro District (aOR 1.8, 95% C.I 1.14–3.39, p = 0.03). Hotspot areas for exposure to RVFV were Malambo, Olbalbal and Piyaya wards in Ngorongoro district, and Lamadi ward in Busega district. Conclusions The study found both previous and recent exposure of RVFV in humans residing in the Serengeti ecosystem as antibodies against both IgG and IgM were detected. Detection of anti-RVF IgM suggests an ongoing transmission of RVFV in humans during inter-epidemic periods. Residents of Ngorongoro district were most exposed to RVFV compared to Bunda and Serengeti districts. Therefore, the risk of exposure to RVFV was higher among pastoral communities compared to farming communities

Addressing the workforce capacity for public health surveillance through field epidemiology and laboratory training program: the need for balanced enhanced skill mix and distribution, a case study from Tanzania

Introduction:&nbsp;skill mix refers to the range of professional development and competencies, skills and experiences of staff within a particular working environment that link with specific outcome while responding to client needs. A balanced skill-mix and distribution of core human resources is important to strengthen decision-making process and rapid responses. We analysed graduates´ information of the Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) between 2008-2016, distribution of skill-mix and the surveillance workforce-gaps within regions. Methods:&nbsp;trainees´ data of nine cohorts enrolled between 2008 and 2016 were extracted from the program database. Distribution by sex, region and cadres/profession was carried out. An indicator to determine enhanced-skill mix was established based on the presence of a clinician, nurse, laboratory scientist and environmental health officer. A complete enhanced skill-mix was considered when all four were available and have received FELTP training. Results:&nbsp;the TFELTP has trained 113 trainees (male=71.7%), originated from 17 regions of Tanzania Mainland (65.4% of all) and Zanzibar. Clinicians (34.5%) and laboratory scientists (38.1%) accounted for the most recruits, however, the former were widely spread in regions (83% vs. 56%). Environmental health officers (17.7%) were available in 39% of regions. The nursing profession, predominantly lacking (6.2%) was available in 22% of regions. Only two regions (11.7%) among 17 covered by TFELTP presented complete skill-mix, representing 7.7% of Tanzanian regions. Seven regions (41%) had an average of one trainee. Conclusion:&nbsp;the TFELTP is yet to reach the required skill-mix in many regions within the country. The slow fill-rate for competent and key workforce cadres might impede effective response. Strategies to increase program awareness at subnational levels is needed to improve performance of surveillance and response system in Tanzania

Field Epidemiology and Laboratory Training Program, Where Is the L-Track?

Background: Modifications of the Field Epidemiology Training Program (FETP) curricula to include a laboratory track (L-Track), to become Field Epidemiology and Laboratory Training Program (FELTP), began in 2004 in Kenya. The L-Track offered candidates training on laboratory competencies in management, policy, quality systems, and diagnostic methods as well as epidemiology, disease surveillance and outbreak response. Since then several FELTPs have discontinued the L-Track and instead offer all candidates, epidemiologists and laboratorians, a single FETP curriculum. Reasons for these changes are reported here.Methods: A questionnaire was sent to directors of 13 FELTP programs collecting information on the status of the programs, reasons for any changes, basic entry qualifications, source institutions and where residents were post enrollment or after graduation. Data from previous CDC internal assessments on FELTP L-Track was also reviewed.Results: Out of the 13 FELTPs included, directors from 10 FELTPs sent back information on their specific programs. The FELTPs in Kenya, Mozambique, Cameroon and Kazakhstan and Mali have discontinued a separate L-Track while those in Ghana, Georgia, Nigeria, Rwanda, and Tanzania continue to offer the separate L-Track. Reasons for discontinuation included lack of standardized curriculum, unclear strategies of the separate L-Track, and funding constraints. Two countries Kenya and Tanzania reported on the career progression of their graduates. Results show 84% (Kenya) and 51% (Tanzania) of candidates in the FELTP, L-Track were recruited from national/regional medical health laboratories. However post-graduation, 56% (Kenya) and 43% (Tanzania) were working as epidemiologists, program managers, program coordinators, or regulatory/inspection boards. Professional upward mobility was high; 87% (Kenya) and 73% (Tanzania) residents, reported promotions either in the same or in new institutions.Conclusions: The FELTP L-Track residents continue to offer critical contributions to public health workforce development with high upward mobility. While this may be a reflection of professional versatility and demand of the FELTP graduates, the move from core laboratory services underscores the challenges in filling and retaining qualified staff within the laboratory systems. Results suggest different strategies are needed to strengthen laboratory management and leadership programs with a clear focus on laboratory systems and laboratory networks to meet current and future clinical and public health laboratory workforce demands

Phenotypic and genetic characterization of vibrio cholerae O1 isolated from various regions of Kenya between 2007 and 2010

Introduction: Cholera, a disease caused by Vibrio cholerae O1 and O139 remains an important public health problem globally. In the last decade, Kenya has experienced a steady increase of cholera cases. In 2009 alone, 11,769 cases were reported to the Ministry of Public Health and Sanitation. This study sought to describe the phenotypic characteristics of the isolated V. cholerae isolates.Methods: This was a laboratory based cross-sectional study that involved isolates from different cholera outbreaks. Seventy six Vibrio cholerae O1 strains from different geographical areas were used to  represent 2007 to 2010 cholera epidemics in Kenya, and were characterized by serotyping, biotyping, polymerase chain r(PCR), pulsed-field gel electrophoresis (PFGE) and ribotyping along with antimicrobial susceptibility testing. Results: Seventy six Vibrio cholerae O1 strains from different geographical areas were used to represent 2007 to 2010 cholera epidemics in Kenya. Serotype Inaba was dominant (88.2%) compared to Ogawa.  The isolates showed varying levels of antibiotic resistance ranging from 100% susceptible to tetracycline, doxycycline, ofloxacin, azithromycin, norfloxacin and ceftriaxone to 100% resistant to furazolidone, trimethoprim-sulfamethoxazole, polymyxin-B and streptomycin. The isolates were positive for ctxA, tcpA (El Tor), rtxC genes and were biotype El Tor variant harboring classical ctxB gene. All the isolates were classified as cholera toxin (CT) genotype 1 as they had mutation in the ctxB at positions 39 and 68. All the isolates had genetically similar NotI PFGE and BglI ribotype patterns. The absence of any observed variation is consistent with a clonal origin for all of the isolates. Conclusion: Kenya experienced cholera numerous outbreak from 2007-2010. The clinical Vibrio cholerae O1 isolates from the recent cholera epidemic were serotypes Inaba and Ogawa, Inaba being the  predominant serotype. The Vibrio cholerae O1 strains were biotype El Tor variants that produce cholera toxin B (ctx B) of the classical type and were positive for ctxA, tcpA El Tor and rtxC genes.Key words: Cholera, characterization, Kenya, serotype, epidemics, pulsed-field gel electrophoresis