Aetiology, Antimicrobial Susceptibility and Predictors of\ud Urinary Tract Infection among Febrile Under-Fives at\ud Muhimbili National Hospital, Dar es Salaam-Tanzania

Urinary tract infection (UTI) is a common cause of fever in children and contributes to morbidity and mortality. This study aimed at determining prevalence, aetiology and antimicrobial susceptibility pattern of the isolates at Muhimbili National Hospital (MNH), Dar es Salaam- Tanzania. Demographic data were collected using a pretested questionnaire. 382 febrile children below five years admitted in the general paediatric wards were recruited. Urine specimens were obtained for urinalysis, culture and antimicrobial sensitivity testing. UTI was detected in 16.8% (64/382). Children who presented prolonged duration of fever (7 days or longer) were more likely to have UTI (p< 0.01). Duration of fever, positive leukocyte and nitrite tests were independent predictors of UTI. Isolated bacteria included Escherichia coli (39.1%), Klebsiella spp (31.2%), Staphylococcus epidermidis (6.2%), Staphylococcus aureus (4.7%) and Pseudomonas aeruginosa (4.7%). We observed high resistance of the isolated uropathogens to ampicillin (79.9%), co-trimoxazole (89%) and clavulanate-amoxillin (70.3%). Amikacin had the least resistance (12.5%) from the isolated pathogens

Validation of the MINI (DSM IV) Tool for the Assessment of Alcohol Dependence among Young People in Northern Tanzania Using the Alcohol Biomarker Phosphatidylethanol (PEth).

The alcohol dependence section of the Mini International Neuropsychiatric Interview questionnaire (MINI) has not been evaluated in young Africans. We applied the MINI in a cross-sectional study of 202 alcohol users from northern-Tanzania, aged 18-24 years (103 male casual workers and 99 students), and validated it against phophatidylethanol (PEth) at a cut-off suggesting heavy chronic alcohol use (≥0.30 µmol/L). Blood was assayed for PEth (16:0/18:1-subform) by liquid chromatography-tandem mass spectrometry. The MINI dependence criteria (≥3 positive responses) were met by 39% participants although their PEth levels were low. Contrary, many young people with high PEth levels were not classified as dependent. The sensitivity of the MINI ranged from 0% to 69% (female students and male workers, respectively) and specificity from 52% to 85% (workers and female students, respectively). The highest AUROC (0.68) occurred with a cut-off of ≥4 positive responses. A modified MINI with three affirmative responses to five questions increased specificity to 92%-97%; however, sensitivity remained low. The performance of the MINI in detecting dependence among young people from northern-Tanzania is unsatisfactory. Specificity was improved using a modified version but sensitivity remained low. An accurate tool for the diagnosis of alcohol dependence is needed for epidemiological and clinical purposes

Comparison of self-reported alcohol use with the alcohol biomarker phosphatidylethanol among young people in northern Tanzania.

BACKGROUND: The one-month Time Line Follow Back calendar (TLFB) and the Alcohol Use Disorders Identification Test (AUDIT) are used to collect self-reported alcohol intake data. We compared these instruments with the alcohol biomarker phosphatidylethanol (PEth) among young-people in northern Tanzania. METHODS: AUDIT and TLFB were applied in a cross-sectional study of 202 young people (18-24 years), who reported using alcohol during the past year (103 male casual labourers; 99 college students). We assayed whole blood for PEth 16:0/18:1, using liquid chromatography-tandem mass spectrometry. RESULTS: For both self-report methods, alcohol consumption was high, particularly among men (e.g. a median of 54 drinks per month in labourers), and about half of male students (48%) reported hazardous or harmful levels of drinking (AUDIT ≥8). Almost half (49%) of participants were PEth-positive (median concentration 0.03μmol/L). There were significant positive correlations between reported total alcohol intake and PEth concentration in males (Spearman's correlation rs=0.65 in college students and rs=0.57 in casual labourers; p<0.001). Self-reported use in the past month was a sensitive marker of having a positive PEth result (≥0.01μmol/L) with 89% of those with a PEth positive result reporting alcohol use, and this was similar in all groups. The proportion of those with AUDIT scores ≥8 and AUDIT-C scores ≥6 among those with a high cut-off positive PEth result (≥0.30μmol/L) ranged between 94 and 100%. CONCLUSION: TLFB and AUDIT are sensitive measures to detect heavy alcohol use among young-people in northern Tanzania. They can be used to identify young people who may benefit from alcohol-focused interventions

The Epidemiology of Alcohol Use and Alcohol Use Disorders among Young People in Northern Tanzania.

INTRODUCTION: Alcohol use is a global public health problem, including as a risk factor for HIV infection, but few data are available on the epidemiology of alcohol use and alcohol use disorders (AUD) among young people in sub-Saharan Africa. METHODS: We conducted a cross-sectional survey among 4 groups of young people aged 15-24 years old (secondary school students, college/university students, employees of local industries and casual labourers) in two regions (Kilimanjaro and Mwanza) of northern Tanzania. Using a multistage stratified random sampling strategy, we collected information on demographics, alcohol use, and behavioural factors. We screened severity of alcohol use using the Alcohol Use Disorder Identification Test (AUDIT) and estimated the quantity and frequency of alcohol consumption using the timeline-follow-back-calendar (TLFB) method. RESULTS: A total of 1954 young people were surveyed. The prevalence of reported alcohol use was higher among males (47-70% ever users and 20-45% current users) than females (24-54% ever users and 12-47% current users). Prevalence of use was substantially higher in Kilimanjaro than Mwanza region. In both regions, participants reported high exposure to alcohol advertisements, and wide alcohol availability. College students reported the highest prevalence of current alcohol use (45% among males; 26% among females) and of heavy episodic drinking (71% among males; 27% among females) followed by casual labourers. Males were more likely to have AUD (an AUDIT score ≥8) than females, with 11-28% of males screening positive for AUD. Alcohol use was associated with male gender, being in a relationship, greater disposable income, non-Muslim religion and a higher number of sexual partners. CONCLUSIONS: Alcohol use is a significant problem among young people in northern Tanzania. There is an urgent need to develop, pilot and deliver interventions to help young people delay initiation and reduce levels of harmful drinking, particularly among college students and casual labourers

Perceptions About Repeat HIV Testing in an Incidence Study: A Qualitative Study among a Potential Cohort for HIV Vaccine Trials in Dar es Salaam, Tanzania

Information regarding repeat HIV testing is useful in the conduct of HIV vaccine trials as potential trial participants are required to undergo repeat HIV testing. In an incidence study conducted in 2008 among 1042 Police Officers 30% of them did not participate in a repeat HIV test. This study was therefore conducted to explore perceptions on repeat HIV testing among members of the incidence study cohort that also served as a source of volunteers for subsequent HIV vaccine trials. This qualitative cross-sectional study was conducted in Dar es Salaam. The study included male and female Police Officers who were eligible to participate in the HIV incidence study. Participants were selected purposefully from eight Police stations out of the 32 stations. Data was collected using in-depth interviews and analysed qualitatively using the content analysis approach. A majority of participants were willing to undergo a repeat HIV test and stated that it was important to repeat an HIV test to confirm their health status, and hence continue protecting themselves. Participants who participated in a repeat HIV test as a part of incidence study reported that the repeat HIV testing process was acceptable because counselling was provided, testing was voluntary, there was trust in the health care providers and a freedom to choose where to test. Participants who did not repeat the HIV test held that repeat a HIV test was not necessary since they believed that the initial test was adequate. Others said that communication breakdown was the main cause as they weren't aware of the importance of a repeat HIV test. Fear of the test results was also mentioned as one of the reasons. The participants were eager to gain more knowledge about the importance of a repeat HIV test. In order to facilitate repeat HIV testing in potential cohorts for HIV vaccine trials, more information and education regarding the repeat HIV test is needed. It is also important to make sure that researchers are well informed on what study participants are supposed to know.\u

Evolution of Debris‐Flow Initiation Mechanisms and Sediment Sources During a Sequence of Postwildfire Rainstorms

Wildfire alters vegetation cover and soil hydrologic properties, substantially increasing the likelihood of debris flows in steep watersheds. Our understanding of initiation mechanisms of postwildfire debris flows is limited, in part, by a lack of direct observations and measurements. In particular, there is a need to understand temporal variations in debris-flow likelihood following wildfire and how those variations relate to wildfire-induced hydrologic and geomorphic changes. In this study, we use a combination of in situ measurements, hydrologic monitoring equipment, and numerical modeling to assess the impact of wildfire-induced hydrologic and geomorphic changes on debris-flow initiation during seven postwildfire rainstorms. We predict the impact of hillslope erosion on debris-flow initiation by combining terrestrial laser scanning surveys of a hillslope burned during the 2016 Fish Fire with numerical modeling of sediment transport throughout a 0.12-km(2) basin in southern California. We use measurements of sediment thickness within the channel to constrain numerical experiments and to assess the role of channel sediment supply on debris-flow initiation. Results demonstrate that debris flows initiated during rainstorms where hillslopes contributed minimally to the event sediment yield and suggest that large inputs of sediment from rill and gully networks are not essential for runoff-generated debris flows. Simulations suggest that both the gradual entrainment of sediment and the mass failure of channel bed sediment can increase sediment concentration to levels associated with debris flows. Finally, postwildfire debris-flow initiation appears closely linked to the same rainfall intensity-duration threshold despite temporal changes in the sediment source, initiation processes, and hydraulic roughness.U.S. Geological Survey (USGS) Landslide Hazards ProgramPublic domain articleThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Host shifts result in parallel genetic changes when viruses evolve in closely related species.

Host shifts, where a pathogen invades and establishes in a new host species, are a major source of emerging infectious diseases. They frequently occur between related host species and often rely on the pathogen evolving adaptations that increase their fitness in the novel host species. To investigate genetic changes in novel hosts, we experimentally evolved replicate lineages of an RNA virus (Drosophila C Virus) in 19 different species of Drosophilidae and deep sequenced the viral genomes. We found a strong pattern of parallel evolution, where viral lineages from the same host were genetically more similar to each other than to lineages from other host species. When we compared viruses that had evolved in different host species, we found that parallel genetic changes were more likely to occur if the two host species were closely related. This suggests that when a virus adapts to one host it might also become better adapted to closely related host species. This may explain in part why host shifts tend to occur between related species, and may mean that when a new pathogen appears in a given species, closely related species may become vulnerable to the new disease

Robotic-assisted Versus Open Technique for Living Donor Kidney Transplantation: A Comparison Using Propensity Score Matching for Intention to Treat

Living donor robotic-assisted kidney transplantation (RAKT) is an alternative to open kidney transplantation (OKT), but experience with this technique is limited in the United States. METHODS: A retrospective review of living donor kidney transplants performed between 2016 and 2018 compared RAKT with OKT with regard to recipient, donor, and perioperative parameters. A 1:1 propensity score matching was performed on recipient/donor age, sex, body mass index, race, preoperative dialysis, and calculated panel reactive antibodies. RESULTS: Outcomes of patient survival, graft survival, and postoperative complications were assessed for 139 transplants (47 RAKT and 92 OKT). Propensity score analysis (47:47) showed that RAKT recipients had longer warm ischemic times (49 versus 40 min; P \u3c 0.001) and less blood loss (100 versus 150 mL; P = 0.005). Operative time and length of stay were similar between groups. Postoperative serum creatinine was similar during a 2-y follow-up. Post hoc analysis excluding 4 open conversions showed lower operative time with RAKT (297 versus 320 min; P = 0.04) and lower 30-d (4.7% versus 23.4%; P = 0.02) and 90-d (7% versus 27.7%; P = 0.01) Clavien-Dindo grade ≥3 complications. CONCLUSIONS: Our findings suggest that RAKT is a safe alternative to OKT

Transitioning to Dolutegravir in a Programmatic Setting: Virological Outcomes and Associated Factors Among Treatment-Naive Patients With HIV-1 in the Kilombero and Ulanga Antiretroviral Cohort in Rural Tanzania.

BACKGROUND Virological outcome data after programmatic transition from non-nucleoside reverse transcriptase inhibitor (NNRTI)-based to dolutegravir (DTG)-based antiretroviral therapy (ART) regimens in sub-Saharan Africa (SSA) outside of clinical trials are scarce. We compared viral suppression and associated factors in treatment-naïve people living with HIV (PLHIV) starting DTG- based versus NNRTI-based ART. METHODS We compared virological suppression at 12 months, after treatment initiation in the two cohorts of participants aged ≥15 years, initiating DTG- and NNRTI-based ART. Drug resistance was assessed among participants with viremia ≥50 copies/mL on DTG. RESULTS Viral suppression was achieved for 165/195 (85%) and 154/211 (73%) participants in the DTG- and NNRTI- cohorts, respectively (P = 0.003). DTG-based ART was associated with >2 times the odds of viral suppression versus NNRTI-based ART (adjusted odds ratio, 2.10 [95% confidence interval {CI}, 1.12-3.94]; adjusted risk ratio, 1.11 [95% CI, 1.00-1.24]). HIV-1 genotypic resistance testing (GRT) before ART initiation was done in 14 of 30 viremic participants on DTG, among whom nucleoside reverse transcriptase inhibitor (NRTI), NNRTI, and protease inhibitors resistance was detected in 0 (0%), 2 (14%) and 1 (7%), respectively. No resistance was found in the 2 of 30 participants with available GRT at the time of viremia ≥50 copies/mL. CONCLUSIONS Virological suppression at 1 year was higher in participants initiating DTG- versus NNRTI-based ART. In those with viremia ≥50 copies/mL on DTG-based ART, there was no pretreatment or acquired resistance to the DTG co-administered NRTIs, although the number of samples tested was small