Self-medication practices and predictors for self-medication with antibiotics and antimalarials among community in Mbeya City, Tanzania

Background: Self-medication with antimalarials and antibiotics is highly practiced worldwide particularly in developing countries including Tanzania. This study was carried out to determine self-medication practices with antimalarials and antibiotics, and as well as predictors for self-medication among urban communities of Mbeya in Tanzania.Methods: A cross sectional descriptive community survey was conducted in Mbeya City in the South-western highlands of Tanzania from April to June 2016. The study population comprised of adults participants aged 18 years and above. Face to face interviews were conducted using a structured pre-tested questionnaires. Data on self-medication practices and predictors of self-medication was assessed. Descriptive statistics and logistic regression analysis were used s to assess predictors associated with self-medication with either antibiotic or antimalarials.Results: A total of 300 individuals (mean age= 35.4 ± 13.4 years) were involved in the study. Prevalence of self-medication with either of the drugs, antibiotic only and antimalarial only was 55.7%, 19.7% and 19.0%, respectively. Participants who were employed had higher odds of self-medicating with antibiotics than students (OR=4.13, 95% CI: 1.14-14.96). Participants who kept medicines at home had lower odds of self-medicating with either antibiotic or antimalarial than those who do not keep. The main reason that was indicated for the self- medication was emergency illness. The main source of medicines was the private pharmacies.Conclusion: There is generally high self-medication practice among urban communities of Mbeya, Tanzania. Community awareness on the practice of self-medication and its implications especially on the harmful effects of self-medication that are less known. The self-medication rates with antibiotics and antimalarials are higher among urban communities of Mbeya, Tanzania. There is an urgent need for the government to enforce regulations on pharmacies dispensing medications, especially antibiotics, without prescriptions. Public education on the implication of self-medication is equally important to address to reduce self-medication with antibiotics and antimalarials among Tanzanian populations

Oral candida infection among HIV patients at Kilimanjaro Christian Medical Centre in northern, Tanzania

Background: Oral candidiasis has been a global health challenge especially in immunocompromised patients particularly with HIV infection. Though the incidence and prevalence of opportunistic infections have been reduced due to the use of anti-retroviral therapy (ART), oral candidiasis remains the most frequently HIV-associated oral lesion in Tanzania. This study aimed at determining the prevalence of oral candida infection in HIV positive patients and investigate the relationship between oral manifestations and the level of immunosuppression. Method: This study was carried out at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. The study included 314 HIV patients with complete clinical results records who were diagnosed with HIV and who were on ARV and attending the hospital for care and treatment. Results: Prevalence of oral candida was 42.0% (132/314). Age group 6-27 years accounted for half of the infections (49/98).  A significantly higher prevalence of candida infection  (66.7%; 24/36) was obseved among patients with <200 cells/µl than in those with 200-500 cells/µl or >500 cells/µl (Chi-square χ2=14.9, p=0.001). The mean CD4+T-cell counts in HIV patients infected with oral candida was lower (523±35) than patients without oral candida infection (645±31 cells/µl), (ANOVA, p= 0.009). The mean CD4+ T-cell count among HIV patients on ART and those not on ART was not statistically different. Conclusion: The prevalence of oral candida infection was significantly higher in patients with CD4+ cell counts less than 200 cells/µl

Antimicrobial resistance patterns of phenotype Extended Spectrum Beta-Lactamase producing bacterial isolates in a referral hospital in northern Tanzania

Background: Production of Extended Spectrum Beta-Lactamase (ESBL) by bacteria is a chronic problem in a health care set up. In order to have adequate information for treatment of bacterial infections especially ESBL producing isolates, it is crucial to understand the trends in the antibiotic-resistance pattern, occurrence and their geographical spread.  The objective of this study was to determine the antimicrobial resistance pattern among phenotype ESBL producing isolates in northern Tanzania.Methods: From July 2013 to January 2014, urine, pus and blood samples were collected from patients suspected to have bacterial infections at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. The isolates were identified based on standard laboratory procedures. Antimicrobial susceptibility tests were carried out using various antimicrobial discs as per the recommendations of Clinical Laboratory Standard Institute.Results: A total of 330 specimens were collected. They consisted of 46 urine, 264 pus (from wound) and 20 blood samples. Among isolated bacteria, ESBL producers were 29.7% (98) and non-producers were 70.5% (232).  Escherichia coli and Klebsiella pneumoniae were the most isolated bacteria and dominant ESBL producers.  ESBL production was highly associated with moderate condition at discharge and longer periods of admission. More than 60% of the ESBL producing E. coli were resistant to ceftazidime, cefpodoxime, cefotaxime, amoxycilin, ciprofloxacin, and gentamycin. More than 80% of ESBL producing K. pneumonia and Proteus mirabilis were resistant to ceftazidime and cefotaxime. Fifty four percent of ESBL producing K. pneumonia were resistant to gentamycin.Conclusion: This study shows that ESLB phenotypes among Gram-negative bacteria are common among patients attending a tertiary hospital in northern in Tanzania. The findings suggest that clinical microbiology laboratories should take into account the diagnosis of ESBL producers in order to define the degree of the problem so as to establish a proper treatment protocol

Practice and Prevalence of Antibiotic Self-Medication among Undergraduate Students at Kilimanjaro Christian Medical University College, Tanzania

Background: Antibiotic self-medication has been on the rise in different parts of the world. Antibiotic self-medication causes excessive antibiotic exposure to humans which is associated with many health risks including antibiotic resistance. The objective of this study was to assess practice and determine the prevalence of antibiotic self-medication among undergraduate students.Methodology: This was a descriptive cross-sectional study conducted at Kilimanjaro Christian Medical University College. A self-administered questionnaire was used to assess the practice and knowledge of antibiotic self-medication among undergraduate students. A total of 300 undergraduate students were purposively sampled. The association between categorical predictors and antibiotic self-medication waspresented as Odds Ratios (OR) with 95% Confidence Intervals (95% CIs) using logistic regression.Result: The prevalence of antibiotic self-medication among undergraduate students is 191(63.7%) with amoxicillin 103(53.9%) being the most used antibiotic for treatment of respiratory disorders 109(57.1%) and gastrointestinal disorders 50(26.2%). Pharmacy is the major source of antibiotics used for self-medication 165(86.4%). Delayed/queue in seeking hospitals services was the main reason for practicing antibiotic self-medication 74(38.7%).Conclusion: The study observed a high prevalence of antibiotic self-medication among undergraduate students. This calls for immediate implementation of public health programs aimed at increasing awareness of consequences that may results from antibiotic self-medication. At the policy-making level, there is an urgent need to legislate and enforce laws restricting access to antibiotics in Tanzania

Antibiotic use in Moshi Urban: A cross-sectional Study of Knowledge and Practices among Caretakers of Children in Kilimanjaro Tanzania

IntroductionAntibiotics are commonly accessed and used for the management of illness in children without a prescription. We investigated the caretaker’s knowledge and practices on antibiotics and antibiotics use to their children.MethodThis was the hospital-based cross-sectional study conducted from April to July 2017 in three facilities located in Moshi Municipality. A convenience sampling was employed to select for caretakers with their sick children at KCMC, Mawenzi hospital, and Longuo dispensary. Face-to-face interviews were conducted with 224 caretakers who had visited health facilities with their children seeking health care.ResultsThe majority (87.9%, 197/224) of all interviewed caretakers had good knowledge of the use of antibiotics. Irrespective of knowing that it is not safe to self-medicate a child with any antibiotics (95.1%, 213/224), most (61.6%, 138/224) caretakers practiced self-medication with the medicines. Having two children (aOR = 7.75, 95% CI: 1.89-31.67) and having three children (aOR=7.23, 95%CI: 1.08-48.51) were significantly associated with good knowledge of antibiotics.ConclusionThis study has revealed that caretakers in Moshi had a good knowledge of antibiotic use. However, despite such good knowledge, malpractices were observed. We call upon the use of media campaigns to advocate for the importance of the rational use of antibiotics and its effect on human health and the risk of antimicrobial resistance development.Rwanda J Med Health Sci 2021;4(3):347-35

10 Years of Environmental Change on the Slopes of Mount Kilimanjaro and Its Associated Shift in Malaria Vector Distributions.

INTRODUCTION: Malaria prevalence has declined in the Kilimanjaro region of Tanzania over the past 10 years, particularly at lower altitudes. While this decline has been related to the scale-up of long-lasting insecticidal nets to achieve universal coverage targets, it has also been attributed to changes in environmental factors that are important for enabling and sustaining malaria transmission. OBJECTIVES: Herein, we apply spatial analytical approaches to investigate the impact of environmental and demographic changes, including changes in temperature, precipitation, land cover, and population density, on the range of the major malaria vector species Anopheles arabiensis in two districts of Tanzania, situated on the southern slope of Mount Kilimanjaro. These models are used to identify environmental changes that have occurred over a 10-year period and highlight the implications for malaria transmission in this highland region. METHODS: Entomological data were collected from the Hai and Lower Moshi districts of Tanzania in 2001-2004 and 2014-2015. Vector occurrence data were applied alongside satellite remote sensing indices of climate and land cover, and gridded population data, to develop species distribution models for An. arabiensis for the 2004 and 2014 periods using maximum entropy. Models were compared to assess the relative contribution of different environmental and demographic factors to observed trends in vector species distribution in lowland and highland areas. RESULTS: Changes in land cover were observed in addition to increased population densities, increased warm season temperature, and decreased wetness at low altitudes. The predicted area and extent of suitable habitat for An. arabiensis declined across the study area over the 10-year period, with notable contraction at lower altitudes, while species range in higher altitude zones expanded. Importantly, deforestation and warmer temperatures at higher altitudes may have created stable areas of suitable vector habitat in the highlands capable of sustaining malaria transmission. CONCLUSION: We show that environmental changes have had an important influence on the distribution of malaria vector species in a highland area of northern Tanzania. Highland areas may be at continued risk for sporadic malaria outbreaks despite the overall range contraction of principal vector species at lower altitudes, where malaria transmission remains at low intensity

Prevalence of dengue and chikungunya virus infections in north-eastern Tanzania:a cross sectional study among participants presenting with malaria-like symptoms

BACKGROUND: In spite of increasing reports of dengue and chikungunya activity in Tanzania, limited research has been done to document the general epidemiology of dengue and chikungunya in the country. This study aimed at determining the sero-prevalence and prevalence of acute infections of dengue and chikungunya virus among participants presenting with malaria-like symptoms (fever, headache, rash, vomit, and joint pain) in three communities with distinct ecologies of north-eastern Tanzania. METHODS: Cross sectional studies were conducted among 1100 participants (aged 2–70 years) presenting with malaria-like symptoms at health facilities at Bondo dispensary (Bondo, Tanga), Hai hospital (Hai, Kilimanjaro) and TPC hospital (Lower Moshi). Participants who were malaria negative using rapid diagnostic tests (mRDT) were screened for sero-positivity towards dengue and chikungunya Immunoglobulin G and M (IgG and IgM) using ELISA-based kits. Participants with specific symptoms defined as probable dengue and/or chikungunya by WHO (fever and various combinations of symptoms such as headache, rash, nausea/vomit, and joint pain) were further screened for acute dengue and chikungunya infections by PCR. RESULTS: Out of a total of 1100 participants recruited, 91.2 % (n = 1003) were malaria negative by mRDT. Out of these, few of the participants (<5 %) were dengue IgM or IgG positive. A total of 381 participants had fever out of which 8.7 % (33/381) met the defined criteria for probable dengue, though none (0 %) was confirmed to be acute cases. Chikungunya IgM positives among febrile participants were 12.9 % (49/381) while IgG positives were at 3.7 % (14/381). A total of 74.2 % (283/381) participants met the defined criteria for probable chikungunya and 4.2 % (11/263) were confirmed by PCR to be acute chikungunya cases. Further analyses revealed that headache and joint pain were significantly associated with chikungunya IgM seropositivity. CONCLUSION: In north-eastern Tanzania, mainly chikungunya virus appears to be actively circulating in the population. Continuous surveillance is needed to determine the contribution of viral infections of fever cases. A possible establishment of arboviral vector preventive control measures and better diagnosis of pathogens to avoid over-treatment of other diseases should be considered. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-016-1511-5) contains supplementary material, which is available to authorized users

Mapping clusters of chikungunya and dengue transmission in northern Tanzania using disease exposure and vector data

Background: Dengue and chikungunya are mosquito-borne viral diseases that are of public health importance throughout the tropical and subtropical regions of the world. Seasonal variations in transmission of these viruses have been suggested owing to the ecology of their mosquito vectors. However, little is known about the epidemiology of the diseases Tanzania. To address this gap, seasonal community-based cross-sectional surveys were undertaken to identify potential clusters of transmission in Hai district in northern Tanzania.Methods: Epidemiological and entomological data from two cross-sectional surveys were used to examine the spatial pattern of dengue and chikungunya transmission. Six villages namely, Boma Ng’ombe, Magadini, Rundugai, Nshara and Kware were involved in the study. Serological measures of dengue and chikungunya virus infections were derived using enzyme-linked immunosorbent assays, and all participants were geo-referenced to the household level using a global positioning system. Potential clusters of individual exposed to dengue and chikungunya virus , as well as clusters of Aedes mosquitoes in the wet and dry seasons were detected using SaTScan. All significant clusters (with p≤0.05) were mapped using ArcGIS.Results: A large, widely dispersed cluster of chikungunya exposed individuals was detected spanning Rundugai and parts of Magadini villages (RR = 2.58,  p= 0.01), while no significant clustering was observed in the dry season. Spatial clusters of Aedes aegypti were detected in Rundugai in both the wet and dry seasons (RR = 2.56, p&lt; 0.001 and RR = 2.24, p=0.05, respectively). In the dry season a small cluster was also detected in Kware (RR = 2.25, p=0.05). No significant clusters of dengue were detected in both seasons.Conclusion: Clusters of chikungunya-exposed individuals and Aedes mosquitoes indicate on-going transmission of chikungunya virus in Hai district of northern Tanzania

Adherence, Awareness, Access, and Use of Standard Diagnosis and Treatment Guideline for Malaria Case Management among Healthcare Workers in Meatu, Tanzania

Background. Effective case management is a vital component of malaria control and elimination strategies. However, the level of adherence to the malaria diagnostic test and treatment guideline is not known, particularly at Meatu district. Therefore, this study aimed at determining the adherence, awareness, access, and use of standard diagnosis and treatment guidelines among healthcare workers in Meatu district. Method. This was a descriptive cross-sectional study, which enrolled a total of 196 healthcare workers in Meatu district. Healthcare workers were sampled purposively to reach the required sample size. A structured questionnaire was used for data collection. Results. Generally, 189 (96.4%) were aware of malaria treatment guidelines, while 148 (75.5%) had access and 98 (50.0%) used malaria treatment guidelines. One hundred and seven (54.6%) of all the healthcare workers adhered strictly to the diagnosis and national treatment guidelines. Ten (5.1%) partially adhered to the guideline when choosing antimalarials without confirmed malaria cases. Nonadherence to the prescription of recommended antimalarial drugs and laboratory confirmation was 79 (40.3%). Conclusion. Half of healthcare worker’s adhere to malaria diagnostic test and treatment guidelines. Most the healthcare workers are aware of the malaria diagnostic test and treatment guidelines. Continued education and assessment of the personal attitudes towards malaria diagnostic test and treatment guidelines are recommended

Factors and Causes of Puerperal Sepsis in Kilimanjaro, Tanzania: A Descriptive Study among Postnatal Women who Attended Kilimanjaro Christian Medical Centre

Background:&nbsp;Puerperal sepsis is the major cause of maternal morbidity and mortality worldwide. About 94% of maternal mortality occur in low and middle-income countries including Tanzania.Objective:&nbsp;To estimate the prevalence, document factors and causes of puerperal sepsis among postnatal women who attended postnatal care in Kilimanjaro Christian Medical Centre Hospital in the year 2015.Methodology:&nbsp;A descriptive cross-sectional study was carried out at Kilimanjaro Christian Medical Centre, Tanzania. A total of 183 medical records of attendance in 2015 were used for the study. Information about the isolated organism in culture was retrieved from the Laboratory Information System.Results:&nbsp;The prevalence of puerperal sepsis was 11.5% (21/183). The most common factors and causes of puerperal sepsis included caesarean section 66.7% (14/21), postpartum haemorrhage 57.1% (12/21), moderate to severe anaemia 61.9% (13/21), prolonged labour 76.2% (16/21) and bacterial infection 90.5% (19/21). The difference was significant at p&lt;.05. The most bacteria species isolated among women with puerperal sepsis was&nbsp;Staphylococcus spp&nbsp;50.0% (7/14),&nbsp;Escherichia&nbsp;28.6% (4/14) and&nbsp;Streptococcus spp&nbsp;21.4% (3/14).Conclusion:&nbsp;Puerperal sepsis is prevalent (11.5%) at Kilimanjaro Christian Medical Centre. Staphylococcus spp was found to be a predominant isolate which causes puerperal sepsis followed by&nbsp;E. coli and Streptococcus spp