The spectrum of dermatological disorders among primary school children in Dar es Salaam

\ud Dermatologic disorders are common in many countries but the spectrum varies greatly. Many studies have reported a significant burden of skin diseases in school children. The objective of this study was to determine the current spectrum of dermatological disorders in primary school children in Dar es Salaam city. Primary school children were recruited by multistage sampling. Detailed interview, dermatological examination and appropriate laboratory investigations were performed. Data was analyzed using the 'Statistical Package for Social Sciences' (SPSS) program version 10.0 and EPI6. A p-value of < 0.5 was significant. A total of 420 children were recruited (51% males; mean age 11.4 ± 2.8 years; range 6-19 years). The overall point prevalence of any skin disorder was 57.3% and it was 61.9% and 52.6% in males and females respectively (p = 0.05). Infectious dermatoses accounted for 30.4% with superficial fungal infections (dermatophytoses and pityriasis versicolor) being the commonest (20%). Dermatophytoses were diagnosed in 11.4% (48/420); the prevalence in males and females being 12.6% and 10.1% respectively (p = 0.41) and higher (21.8%) in the age-group 6-10 years (p = 0.045). Fungal cultures were positive in 42/48 children (88%). All three dermatophyte genera were isolated. Tinea capitis was the commonest disease among culture-positive dermatophytoses (30/42; 71.4%) with an overall prevalence of 7.1% (30/420) followed by tinea pedis (11/42; 26.1%) whose overall prevalence was 2.6%. Microsporum canis was common in tinea capitis (14/30; 46.7%) followed by Trichophyton violaceum (6/30; 20%). Trichophyton rubrum was common in tinea pedis (5/11; 45.5%). Thirty six children (8.6%) had pityriasis versicolor which was more prevalent (6/27; 22.l2%) in the age group 16-19 years (p = 0.0004). The other common infectious dermatoses were pyodermas (4%) and pediculosis capitis (3.6%). Common non-infectious dermatoses were: acne vulgaris (36.4%), non-specific dermatoses (10.7%), non-specific ulcers (5%) and atopic eczema (2.6%). Rare conditions (prevalence < 1%) included: vitiligo, alopecia areata and intertrigo. The majority of the affected children (67.2%) did not seek any medical assistance. Skin disorders are common in primary school children; infectious dermatoses are still rampant and many children do not seek medical assistance.\u

Sanitary practices and occurrence of zoonotic conditions in cattle at slaughter in Morogoro Municipality, Tanzania: implications for public health

As meat consumption is increasing worldwide to cover for protein demands, also raise concerns and challenges regarding meat hygiene and safety. The current one year follow up study aimed at investigating on sanitary practices and occurrence of zoonotic conditions, during post-mortem examination, in cattle at slaughter in Morogoro Municipality abattoir. Sanitary practices were assessed through direct observation where as routine post-mortem inspection procedures were employed to detect zoonotic conditions in cattle at slaughter. During the study period a total of 30,713 cattle were slaughtered and inspected at the abattoir. Results revealed poor hygienic practices at the level of abattoir surrounding, the slaughter operation area, personnel as well as meat vans. Whole carcasses, lungs, livers, hearts and heads were condemned due to zoonotic conditions at rates of 0.026%, 1.96%, 1.61%, 0.02% and 0.21% respectively. Bovine tuberculosis, Cysticercus bovis cysts, fasciolosis and hydatidosis were the responsible zoonotic conditions for the condemnations. Bovine tuberculosis was a leading zoonotic cause of condemnations accounting for 95.7% of lungs and 100% of all head and carcass condemnations. Cysticercus bovis cysts were ranking the second in serving as causes of condemnations closely followed by fasciolosis and lastly hydatidosis. Occurrence of disease conditions with zoonotic implication in cattle at slaughter, meant for human consumption, may pose significant economic and public health risks to especially disaster-prone marginalized communities. Thus, there is a need to introduce appropriate control measures of livestock diseases to minimize the rate of infection; and eventually reduce economic losses and safeguard public health

Risk factors for mortality among patients admitted with upper gastrointestinal bleeding at a tertiary hospital: a prospective cohort study

Abstract Background Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency, which is potentially fatal. Proper management of UGIB requires risk-stratification of patients which can guide the type and aggressiveness of management. The aim of this was study was identify the causes of UGIB and factors that increase the risk of mortality in these patients. Methods This was a prospective cohort study conducted over a period of seven months at a tertiary hospital. Adults admitted with UGIB were included in the study. Demographic data, laboratory parameters and endoscopic findings were recorded. Patients were then followed up for 60 days to identify the occurrence of mortality. Chi-square tests and cox-regression was used to determine association between risk factors and mortality in the bivariate and multivariate analysis, respectively. Results A total of 170 patients with UGIB were included. Males accounted for the majority (71.2%). Median age of the study population was 40.0 years. Chronic liver disease was present in 30.6% of study patients. The most common cause of UGIB among the 86 patients who underwent endoscopy was oesophageal varices (57%), followed by peptic ulcer disease (18%) and gastritis (10%). Mortality occurred in 57 patients (33.5%) and was significantly higher in patients with high white blood cell count (HR 2.45, p 0.011), raised serum alanine aminotransferase (HR 4.22, p 0.016), raised serum total bilirubin (HR 5.79, p 0.008) and lack of an endoscopic procedure done (HR 4.40, p <0.001). Rebleeding was reported in 12 patients (7.1%) and readmission due to UGIB in 4 patients (2.4%) Conclusions Oesophageal varices was the most common cause of UGIB. One-third of patients admitted with upper gastrointestinal bleeding died within 60 days of admission, signifying a high burden. Rebleeding and readmission rates were low. A high WBC count, raised serum ALT, raised serum total bilirubin and a lack of endoscopy were independent predictors of mortality. These findings can be used to risk-stratify patients who may benefit from early and more aggressive management

Hepatitis B vaccination coverage among healthcare workers at national hospital in Tanzania: how much, who and why?

Abstract Background Hepatitis B vaccination for healthcare workers (HCWs) is a key component of the WHO Hepatitis B Elimination Strategy 2016–2021. Data on current hepatitis B vaccine coverage among health care workers in Sub-Saharan Africa are scarce, but these data are vital for effective programming. We assessed the proportion of HCWs vaccinated for hepatitis B and the factors associated with adequate vaccination coverage at a national hospital in Tanzania. Methods A descriptive cross-sectional study was conducted among consenting healthcare workers between 30th July and 30th September 2015. Vaccination histories were obtained through self-administered questionnaires. Means and proportions were used to summarize the data. Student’s t and chi-squared tests were used as appropriate. Logistic regression was used to determine the factors associated with vaccination. Results A total of 348 HCWs were interviewed, of whom 198 (56.9%) had received at least one dose of hepatitis B vaccination, while only 117 (33.6%) were fully vaccinated. About half of the 81 HCWs with partial vaccination (49.4%) had missed their subsequent vaccination appointments. Among unvaccinated HCWs, 14 (9.3%) had either HBV infection or antibodies against HBV infection upon pre-vaccination screening. However, the remaining participants were not vaccinated and did not know their immune status against HBV. Nearly all respondents (347, 99.3%) had heard about the hepatitis B viral vaccine. The following reasons for non-vaccination were given: 98 (65.3%) reported that they had not been offered the vaccine; 70 (46.7%) observed standard precautions to ensure infection prevention and 60 (41.3%) blamed a low level of awareness regarding the availability of the hepatitis B vaccine. Conclusion The current vaccination coverage among practicing healthcare workers at Muhimbili National Hospital is low, despite a high level of awareness and the acceptance of the vaccine. Expedited and concerted efforts to scale vaccine uptake should include improved access to the vaccine, especially for newly recruited HCWs. The extension of the study to private healthcare settings and lower-level facilities would be useful

Sanitary practices and occurrence of zoonotic conditions in cattle at slaughter in Morogoro Municipality, Tanzania: implications for public health

As meat consumption is increasing worldwide to cover for protein demands, also raise concerns and challenges regarding meat hygiene and safety. The current one year follow up study aimed at investigating on sanitary practices and occurrence of zoonotic conditions, during postmortem examination, in cattle at slaughter in Morogoro Municipality abattoir. Sanitary practices were assessed through direct observation where as routine post-mortem inspection procedures were employed to detect zoonotic conditions in cattle at slaughter. During the study period a total of 30,713 cattle were slaughtered and inspected at the abattoir. Results revealed poor hygienic practices at the level of abattoir surrounding, the slaughter operation area, personnel as well as meat vans. Whole carcasses, lungs, livers, hearts and heads were condemned due to zoonotic conditions at rates of 0.026%, 1.96%, 1.61%, 0.02% and 0.21% respectively. Bovine tuberculosis, Cysticercus bovis cysts, fasciolosis and hydatidosis were the responsible zoonotic conditions for the condemnations. Bovine tuberculosis was a leading zoonotic cause of condemnations accounting for 95.7% of lungs and 100% of all head and carcass condemnations. Cysticercus bovis cysts were ranking the second in serving as causes of condemnations closely followed by fasciolosis and lastly hydatidosis. Occurrence of disease conditions with zoonotic implication in cattle at slaughter, meant for human consumption, may pose significant economic and public health risks to especially disaster-prone marginalized communities. Thus, there is a need to introduce appropriate control measures of livestock diseases to minimize the rate of infection; and eventually reduce economic losses and safeguard public health