Demographic and contextual infl uences in injury risk among adolescents in a low-income country setting: Results from a school-based survey in Tanzania

Objective: This study investigated the social, demographic and contextual factors associated with injury among adolescents in a low-income urban sub-Saharan African setting.Methods: Data on 2 176 adolescents aged 11–16 years were divided into three groups: Those that reported not being injured, those that had been injured once, and those that had been injured multiple times within a 12-month recall period. We conducted bivariate analyses to screen for associations with several social, demographic and contextual factors. Then a multinomial logistic regression was performed to examine associations while adjusting for covariates.Results: Within the recall period, 22.14% of participants reported one serious injury and 10.96% reported multiple injuries. Compared with non-injured participants, those injured two or more times were mainly male (relative risk ratio (RRR) = 1.71 [1.27–2.31]), younger (RRR = 0.77 [0.68–0.86]), depressed (RRR = 1.98 [1.43–2.74]) and had high rates of truancy (RRR = 2.56; CI = 1.71–3.84). A travel time of more than 30 minutes to and from school was also associated with increased rates of injury (RRR = 1.61; CI = 1.13–2.29).Conclusions: Injuries are an important source of morbidity among school-attending adolescents in Dar es Salaam. The findings support more research into the contextual factors that predispose adolescents to excessive injury in the region. School settings have the potential to provide safety education in the region.Keywords: injury, sub-Saharan Africa, urban setting, school healt

Early outcome of Mitral Valve replacement: Results from Chordal Preservation at Muhimbiba National Hospital, Tanzania

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Intrapartum fetal heart rate monitoring using a handheld Doppler versus Pinard stethoscope: a randomized controlled study in Dar es Salaam

Benjamin A Kamala,1,2 Hussen L Kidanto,3,4 Peter J Wangwe,2,5 Ingvild Dalen,3 Estomih R Mduma,3,6 Jeffrey M Perlman,7 Hege L Ersdal1,8 1Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; 2Department of Obstetrics and Gynecology, Muhimbili National Hospital, Dar es Salaam, Tanzania; 3Department of Research, Stavanger University Hospital, Stavanger, Norway; 4School of Medicine, Aga Khan University, Dar es Salaam, Tanzania; 5Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania; 6Department of Research, Haydon Lutheran Hospital, Manyara, Tanzania; 7Department of Pediatrics, Weill Medical College, New York, NY, USA; 8Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway Background: Fetal stethoscopes are mainly used for intermittent monitoring of fetal heart rate (FHR) during labor in low-income countries, where perinatal mortality is still high. Handheld Dopplers are rarely available and are dependent on batteries or electricity. The objective was to compare the Pinard stethoscope versus a new wind-up handheld Doppler in the detection of abnormal FHR. Materials and methods: We conducted a randomized controlled study at Muhimbili National Hospital, Tanzania, from April 2013 to September 2015. Women with gestational age ≥37 weeks, cephalic presentation, normal FHR on admission, and cervical dilatation <7 cm were included. Primary outcome was abnormal FHR detection (<120 or >160 beats/min). Secondary endpoints were time to delivery, mode of delivery, and perinatal outcomes. χ2, Fisher’s exact test, Mann–Whitney test, and logistic regression were conducted. Unadjusted and adjusted odds ratios were calculated with respective 95% confidence interval. Results: In total, 2,844 eligible women were assigned to FHR monitoring with Pinard (n=1,423) or Doppler (n=1,421). Abnormal FHRs were more often detected in the Doppler (6.0%) versus the Pinard (3.9%) arm (adjusted odds ratio =1.59, 95% confidence interval: 1.13–2.26, p=0.008). Median (interquartile range) time from abnormal FHR detection to delivery was comparable between Doppler and Pinard, ie, 80 (60,161) and 89 (52,165) minutes, respectively, as was the incidence of cesarean delivery (12.0% versus 12.2%). The incidence of adverse perinatal outcomes (fresh stillbirths, 24-hour neonatal admissions, and deaths) was similar overall; however, among newborns with abnormal FHR delivered vaginally, adverse outcomes were less incident in Doppler (7 of 43 births, 16.3%) than in the Pinard arm (10 of 23 births, 43.5%), p=0.021. Conclusion: Intermittent FHR monitoring using Doppler was associated with an increased detection of abnormal FHR compared to Pinard in a low-risk population. Time intervals from abnormal FHR detection to delivery were longer than recommended in both arms. Perinatal outcomes were better among vaginally delivered newborns with detected abnormal FHR in the Doppler arm. Keywords: fetal heart rate, perinatal outcomes, Pinard stethoscope, Dopple

Incidence of invasive salmonella disease in sub-Saharan Africa: a multicentre population-based surveillance study

Summary: Background: Available incidence data for invasive salmonella disease in sub-Saharan Africa are scarce. Standardised, multicountry data are required to better understand the nature and burden of disease in Africa. We aimed to measure the adjusted incidence estimates of typhoid fever and invasive non-typhoidal salmonella (iNTS) disease in sub-Saharan Africa, and the antimicrobial susceptibility profiles of the causative agents. Methods: We established a systematic, standardised surveillance of blood culture-based febrile illness in 13 African sentinel sites with previous reports of typhoid fever: Burkina Faso (two sites), Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar (two sites), Senegal, South Africa, Sudan, and Tanzania (two sites). We used census data and health-care records to define study catchment areas and populations. Eligible participants were either inpatients or outpatients who resided within the catchment area and presented with tympanic (≥38·0°C) or axillary temperature (≥37·5°C). Inpatients with a reported history of fever for 72 h or longer were excluded. We also implemented a health-care utilisation survey in a sample of households randomly selected from each study area to investigate health-seeking behaviour in cases of self-reported fever lasting less than 3 days. Typhoid fever and iNTS disease incidences were corrected for health-care-seeking behaviour and recruitment. Findings: Between March 1, 2010, and Jan 31, 2014, 135 Salmonella enterica serotype Typhi (S Typhi) and 94 iNTS isolates were cultured from the blood of 13 431 febrile patients. Salmonella spp accounted for 33% or more of all bacterial pathogens at nine sites. The adjusted incidence rate (AIR) of S Typhi per 100 000 person-years of observation ranged from 0 (95% CI 0–0) in Sudan to 383 (274–535) at one site in Burkina Faso; the AIR of iNTS ranged from 0 in Sudan, Ethiopia, Madagascar (Isotry site), and South Africa to 237 (178–316) at the second site in Burkina Faso. The AIR of iNTS and typhoid fever in individuals younger than 15 years old was typically higher than in those aged 15 years or older. Multidrug-resistant S Typhi was isolated in Ghana, Kenya, and Tanzania (both sites combined), and multidrug-resistant iNTS was isolated in Burkina Faso (both sites combined), Ghana, Kenya, and Guinea-Bissau. Interpretation: Typhoid fever and iNTS disease are major causes of invasive bacterial febrile illness in the sampled locations, most commonly affecting children in both low and high population density settings. The development of iNTS vaccines and the introduction of S Typhi conjugate vaccines should be considered for high-incidence settings, such as those identified in this study. Funding: Bill & Melinda Gates Foundation