Predictors of CD4+ lymphocyte count among HIV-Seropositive and HIV-Seronegative pregnant women in Dar Es Salaam, Tanzania

Objective: To determine the predictors of CD4+ lymphocyte count among pregnant women in Dar es Salaam, Tanzania.Methods: Between 04/1995 and 03/1997, HIV-seropositive (n=1,027) and HIV- seronegative (n=280) pregnant women were interviewed to obtain socio-demographic characteristics. Later, blood samples was collected for determination of T-lymphocyte subsets and other haematological indices.Results: CD4+ lymphocyte count was significantly higher among HlV-seronegative women (mean=770 cells/mm3, standard deviation (SD)=232 cells/mm3) than HIV-seropositive women (mean=422 cells/mm3, SD=205 cells/mm3). Most HIV-seropositive women were asymptomatic, in WHO clinical stage 1 (84.3%). Among HIV-seropositive women, total white blood count (WBC) and erythrocyte sedimentation rate (ESR) remained significantly correlated with CD4+ after adjusting for other predictors in multivariate analyses. For women of average age 25 years, the CD4+ lymphocyte count increased by about 16 cells/mm3 for each increment of 1000 WBC cells/mm3, while each 10 mm/hr increase in ESR was associated with areduction of CD4+ lymphocyte count of about 8 cells/mm3.Conclusion: These results show that simple and inexpensive haematological indices cannot be recommended for use as alternative measures of HIV-related immunosuppression in this population of mainly asymptomatic women

Patterns of sexually transmitted infections in adolescents and youth in Dar es Salaam, Tanzania

BACKGROUND: Syndromic management of STIs has been advocated as simplified and cheap approach. Youth have been reported to be at increased risk of acquiring STIs which can facilitate HIV transmission. We have investigated the relationship between the syndromic management and specific aetiology diagnosis and its relationship with HIV infection and health seeking behaviour among youth attending a reproductive health clinic in Dar es Salaam, Tanzania. METHODS: Between September 1998 and February 1999 among 1895 adolescents and youth below 25 years seen in the clinic 199 (10.5%) were randomly selected and consented to participate in the study. A standard questionnaire was administered. Blood and vaginal or urethral specimens were taken and investigated for STI causative agents. RESULTS: Among a total of 199 studied adolescents and youth 22.6 % were teenagers, with fewer females 17.8% than males; 27.5% (p < 0.018). 20.8% of the females compared to 11.5% in males were HIV infected. Genital discharge was the most common complaint which was reported in 54.1% of male and 63.4 % of female patients. All males with gonorrhoea and four out of five with Chlamydia were given appropriate treatment with syndromic management, while 28% women with gonorrhoea or Chlamydia received appropriate treatment by syndromic management. All patients found with active syphilis by serology had not complained of genital ulcers and would not have been assigned to syndromic treatment for syphilis at the initial visit. CONCLUSION: The burden of STIs in this youth population is large indicating that youth are at increased risk of STIs and will certainly require youth friendly clinics. There is a need to refine the current syndromic management guidelines

Risky sexual practices among youth attending a sexually transmitted infection clinic in Dar es Salaam, Tanzania

\ud Youth have been reported to be at a higher risk of acquiring STIs with significant adverse health and social consequences. Knowledge on the prevailing risky practices is an essential tool to guide preventive strategies. Youth aged between 18 and 25 years attending an STI clinic were recruited. Social, sexual and demographic characteristics were elicited using a structured standard questionnaire. Blood samples were tested for syphilis and HIV infections. Urethral, high vaginal and cervical swabs were screened for common STI agents. A total of 304 youth were studied with mean age of 21.5 and 20.3 years for males and females respectively. 63.5% of youth were seeking STI care. The mean age of coitache was 16.4 and 16.2 years for males and females respectively. The first sexual partner was significantly older in females compared to male youth (23.0 vs 16.8 years) (p < 0.01). 93.2% of male youth reported more than one sexual lifetime partner compared to 63.0% of the females. Only 50% of males compared to 43% of females had ever used a condom and fewer than 8.3% of female youth used other contraceptive methods. 27.1% of pregnancies were unplanned and 60% of abortions were induced. 42.0% of female youth had received gifts/money for sexual favours. The HIV prevalence was 15.3% and 7.5% for females and males respectively. The prevalence of other STIs was relatively low. Among male youth, use of alcohol or illicit drugs was associated with increased risk of HIV infection. However, the age of sexual initiation, number of sexual partners or the age of the first sexual partner were not associated with increased risk of being HIV infected. Most female youth seen at the STI clinic had their first sexual intercourse with older males. Youth were engaging in high risk unprotected sexual practices which were predisposing them to STIs and unplanned pregnancies. There is a great need to establish more youth-friendly reproductive health clinics, encourage consistent and correct use of condoms, delay in sexual debut and avoid older sexual partners in females.\u

Sexual practices among unmarried adolescents in Tanzania

\ud Sexual activities are increasingly changing from the cultural point of view what they used to be. Knowledge of these practices among adolescents may be a basis to create awareness among adolescents on practices that involve risks. This study aims to assess sexual practices among unmarried adolescents in Tanzania. A cross-sectional survey was conducted among in-school and out-of-school but unmarried adolescents aged 10 to 19 in five locations in Tanzania. A questionnaire was used to collect information and to characterize sexual practices among these adolescents. About 32% of adolescents reported being sexually active; a higher proportion being males than females. The only inquired and reported sexual practices include vaginal sex, masturbation, oral and anal sex. About 15% of sexually active adolescents reported having multiple sexual partners. Significantly more males reported having multiple partners than females. Nearly 42% of sexually active adolescents reported having used a condom during most recent sexual act. Females reported older partners at first sexual act. Adolescents experience several sexual practices that include penetrative and non-penetrative. More males reported being sexually active than females. Despite adolescents reporting having multiple sexual partners, reported condom use during the most recent sexual act was low. We advocate for a more enhanced approach of reproductive health education that includes safer sex to adolescents without forgetting those in-schools.\u

Determination of vertical transmission rate of Hepatitis B Virus infection in Dar es Salaam, Tanzania

The objectives of this study were to determine the vertical transmission rate of hepatitis B virus (HBV) infection and the socio-demographic factors associated with its transmission in pregnant women (PW). The subjects were pregnant women who presented for delivery in the prenatal wards and their newborns at Muhimbili Medical Centre, Mwananyamala, Ilala and Temeke Hospitals in Dar es Salaam between April and December 1995. Women who consented to participate in the study were interviewed according to a questionnaire established for this purpose. Sera were taken from all study subjects and subjected to testing for hepatitis B surface antigen (HBsAg). Babies who were HBsAg negative at birth but born of HBsAg positive mothers were re-tested at the ages of 3 and 6 months. Of the 1540 PW studied, 54 (3.5%) were HBsAg positive and they gave birth to 54 infants. Of the 54 infants, three (5.5%) were excluded from the study for various reasons. Two of the 51 infants (3.9%) were HBsAg positive at birth and four (7.9%) at three months. Hence, the vertical transmission rate was 11.8%. Frequent injections in the past were found to be significantly associated with increased risk for HBV infection in the mothers (Fisher's exact test: p = 0.001). We conclude that the vertical transmission rate is high (11.8%) and that the transmission occurs before birth and within 3 months after delivery. It is recommended that apart from introducing vaccination for under-fives, the vaccination should also be extended to PW as part of routine antenatal care. Keywords: Hepatitis B virus infection, vertical transmission, pregnant women, Tanzania Tanzania Medical Journal Vol. 19 (1) 2004: pp

An Audit Report on Bacterial Meningintis among Children Admitted at Muhimbili National Hospital, Dar es Salaam, Tanzania

Background: This is a preliminary report of the ongoing paediatric bacterial meningitis surveillance at Muhimbili National Hospital, Dar es Salaam, Tanzania. The World Health Organization (WHO AFRO) introduced this initiative to countries in the African region. The report covers the period beginning October 2001 up to December 2004. Methodology: All patients suspected to have acute bacterial meningitis were registered and a sample of cerebral spinal fluid (CSF) was taken from each patient and subjected to standard laboratory investigations. Results: A total of 16350 children were admitted during this period and, out of these, 1529 (9.6%) were suspected to have bacterial meningitis. CSF was collected from 84% of the children suspected of suffering from bacterial meningitis. While Bacteria were isolated from 5.6% of these samples, bacteria isolation rate from turbid CSF(96 samples) was 72.9%. The commonest isolates were Klebsiella species (26%), Streptococcus pneumoniae (22%), Haemophilus influenzae (13%), Salmonella species (9.1%) and E. coli (6.5%). N. meningitidis was not isolated during the three year period. Of all children with suspected bacterial meningitis, 61% were in the first 12 months of life while 3.8% of them were aged 36 months and above. H. influenzae was not observed to cause disease after the age of three years while Streptococcus pneumoniae continued to cause disease up to the age of 60 months (5years). Whereas Klebsiela spp, S. pneumoniae and H. influenzae contributed to 22.5% death rate each to the total meningitis death burden, H. influenzae had the highest microbial agent-specific mortality rate (90%), followed by E. coli (80%), and Salmonella spp. (66%). About 52.5% of the deaths occurred in the first 5 months of life and the overall disease case mortality rate was 51.9%. Conclusion: The low bacteria isolation rate could be attributed to the prior use of antibiotics and the use of human blood agar instead of sheep's blood agar for the isolation of H. influenzae. The high frequency of Klebsiella spp causing meningitis has not been frequently reported in Africa. The results of this study further confirm that there is no consistent pattern of microorganisms causing meningitis in tropical Africa. Recommendation: The high mortality rate observed in this study supports the need to introduce the H. influenzae and S. pneumoniae vaccines in our routine immunization schedules. There is a necessity of looking for factors contributing to this high death rate. Tanzania Medical Journal Vol. 22 (1) 2007: pp. 5-

Sexual behaviour among youths at high risk for HIV-1 infection in Dar es Salaam, Tanzania

Objectives: To investigate sex specific sexual behaviour in youths visiting a youth clinic for sexual and reproductive health in Dar es Saalam. Methods: A questionnaire was administered to a random sample of youths between 10 and 24 years of age attending the youth health clinic in Dar es Saalam. The clinical investigation included testing for syphilis and HIV-1 antibodies Results: 1423 youths attended the clinic between September 1997 and August 1998. The study population comprised 213 (53.5%) males and 185 (46.5%) females. 97 (24.4%) were below 20 years. The mean age at coitarche was 16.5 and 17.0 years of age for males and females, respectively. The coitarche was involuntary in 15 females (8.6%). 49.5% males reported more than five lifetime partners compared with 14.1% for females (p<0.0001). Males reported recent partners to be 2.5 years younger, while females reported them to be 5.0 years older. No contraceptive use was reported by 29.7% of the males and 40.3% of females. 52.7% females had been pregnant and 26 (14.1%) reported induced abortions. Genital discharge was found in 69.5% and 73.9% and GUD in 36.6% and 27.1% of males and females respectively. 12 males (5.9%) and 43 females (24.6%) were found to be HIV-1 infected. 13.8% of the females with only one lifetime partner were HIV-1 infected compared with 40.9% with more than five partners (p = 0.028). Conclusions: Many youths in Dar es Salaam engage in sexual behaviours that put them at risk of unwanted pregnancies and STIs including HIV infection. Female youths were more likely to contract HIV infection than males. In African urban areas youth oriented clinics can have a pivotal role in HIV/STI prevention and control Key Words: youth; sexual behaviour; HI

Prevalence of, and risk factors for, HSV-2 antibodies in sexually transmitted disease patients, healthy pregnant females, blood donors and medical students in Tanzania and Norway.

The prevalence of specific HSV-2 antibodies was studied in Tanzanian and Norwegian sexually transmitted disease (STD) patients (1095) and non-STD patients (488). Correlates to demographic and behavioural factors were evaluated. Seropositivity was determined by the non-commercial peptide-55 enzyme-linked immunoassay. The prevalence of HSV-2 antibodies was 70% in Tanzanian and 17% in Norwegian STD patients, 35% in Tanzanian blood donors and pregnant women, and 4, 7 and 14% in Norwegian medical students, blood donors and pregnant women respectively. A higher HSV-2 prevalence was associated with female sex, increasing age, previous STDs, history of genital HSV infection, coitarchal age (age at first intercourse) <15 years and HIV seropositivity. Compared to previous data, the prevalence of HSV-2 antibodies in Tanzanian STD patients has increased remarkably. In Norwegian STD patients our results are consistent with, or lower than, the prevalence previously reported in Western Europe. Demographic rather than behavioural factors were associated with higher prevalence of HSV-2 antibodies in STD patients

Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania

BACKGROUND: In HIV-1-infected women, poor micronutrient status has been associated with faster progression of HIV-1 disease and adverse birth outcomes. We assessed the effects of vitamin A and multivitamins on birth outcomes in such women.METHODS: In Tanzania, 1075 HIV-1-infected pregnant women at between 12 and 27 weeks' gestation received placebo (n=267), vitamin A (n=269), multivitamins excluding vitamin A (n=269), or multivitamins including vitamin A (n=270) in a randomised, double-blind, placebo-controlled trial with a 2x2 factorial design. We measured the effects of multivitamins and vitamin A on birth outcomes and counts of T lymphocyte subsets. We did analyses by intention to treat.RESULTS: 30 fetal deaths occurred among women assigned multivitamins compared with 49 among those not on multivitamins (relative risk 0.61 [95% CI 0.39-0.94] p=0.02). Multivitamin supplementation decreased the risk of low birthweight (&lt;2500 g) by 44% (0.56 [0.38-0.82] p=0.003), severe preterm birth (&lt;34 weeks of gestation) by 39% (0.61 [0.38-0.96] p=0.03), and small size for gestational age at birth by 43% (0.57 [0.39-0.82] p=0.002). Vitamin A supplementation had no significant effect on these variables. Multivitamins, but not vitamin A, resulted in a significant increase in CD4, CD8, and CD3 counts.INTERPRETATION: Multivitamin supplementation is a low-cost way of substantially decreasing adverse pregnancy outcomes and increasing T-cell counts in HIV-1-infected women. The clinical relevance of our findings for vertical transmission and clinical progression of HIV-1 disease is yet to be ascertained.PIP: Poor micronutrient status has been associated, in HIV-positive women, with faster progression of HIV disease and adverse birth outcomes. This randomized, double-blind, placebo-controlled study assessed the effects of vitamin A and multivitamins on birth outcomes in 1075 HIV-positive pregnant women at 12-27 weeks' gestation from Dar es Salaam, Tanzania. There were no differences in baseline plasma vitamin concentrations between groups. 267 women received a placebo, 269 were given vitamin A, 269 were administered a multivitamin excluding vitamin A, and 270 received a multivitamin including vitamin A. There were 30 fetal deaths in the group of women who received multivitamins (with and without vitamin A) compared with 49 among those not given multivitamins (relative risk (RR), 0.61; 95% confidence interval (CI), 0.39-0.94). Multivitamin supplementation decreased the risk of low birth weight (2500 g) by 44% (RR, 0.56; 95% CI, 0.38-0.82), of preterm birth (prior to 34 weeks gestation) by 39% (RR, 0.61; 95% CI, 0.38-0.96), and of small size for gestational age at birth by 43% (RR, 0.57; 95% CI, 0.39-0.82). Vitamin A had no significant effect on these variables. Multivitamins, but not vitamin A, were associated with significant increases in CD4, CD8, and CD3 counts. The clinical relevance of multivitamin supplementation for vertical transmission of HIV and the progression of disease remain unknown. However, these results indicate such supplementation is a low-cost means of substantially decreasing adverse pregnancy outcomes and increasing T cell counts in HIV-infected women. The observed beneficial effects of multivitamins on birth outcomes may have been mediated through improved maternal immune status