Mantoux skin test reactivity among household contacts of hiv-infected and hiv un-infected patients with sputum smear positive TB in Dar Es Salaam, Tanzania

Objective: To compare the prevalence of Tuberculosis (TB) infection as demonstrated by a positive Mantoux skin test (MST) amonghousehold contacts of sputum smear positive (SSP) HIV infected and un-infected TB patients.Methods: A cross-sectional study of household contacts of patients with TB (index cases) attending Muhimbili National Hospital, andTB clinics of Infectious Disease Control Centre and Municipal hospitals in Dar es Salaam. Index cases with SSP-TB and aged „d18 years had their HIV serostatus determined by ELISA. Contacts of index cases aged „d1 year received intradermal protein-purified derivative (Mantoux test) and results were read after 72 hours. Infected contacts (MST-positive) received medical evaluation to exclude TB disease.Results: The overall prevalence of TB infection among contacts of HIV infected and un-infected index cases were 61.6% and 62.5%respectively, (OR 1.04 [95% CI 0.61 ¡V 1.76], p=0.887). Factors associated with an increased risk of TB infection among contacts ofboth HIV infected and un-infected index cases were: older age of contacts („d25 years), duration of living with index case prior to TBdiagnosis of „d 1 year, and sharing a room with index case. Infectiousness to their contacts was higher among female compared to male index cases.Conclusions: The proportion of household contacts of SSP PTB index cases with a positive MST was high and uninfluenced by theHIV serostatus of the index case. Efforts towards contact tracing and screening for TB among close contacts of SSP PTB patientsshould be enhanced

Prevalence, clinical characteristics and echocardiographic parameters of arrhythmias among patients with rheumatic heart disease attending Jakaya Kikwete Cardiac Institute: a prospective cohort study

Abstract Background Arrhythmia is a known complication of rheumatic heart disease (RHD). It is critical to recognize arrhythmias early on so that prompt preventative actions and vigilant monitoring may be considered while treating these patients. Aim This study aimed at determining the prevalence, clinical characteristics and echocardiographic parameters of arrhythmias among RHD patients attending Jakaya Kikwete Cardiac Institute (JKCI). Methodology Hospital-based cross-sectional study was conducted among 390 patients with an echocardiographic diagnosis of RHD aged 18years and above attending JKCI. Demographic and clinical information was documented. Echocardiography, a resting electrocardiography and 24 h ambulatory Holter monitoring electrocardiography were done. Chi square test was used to determine association between variables and those with a p value ≤ 0.2 were entered in a multivariate logistic regression analysis to determine the independent factors associated with arrhythmias. P value of  48 mm. Conclusion We found a high prevalence of arrhythmias among patients with RHD. The independent predictors of arrhythmias were left atrium dilatation and NYHA functional class III-IV. We recommend close monitoring for arrhythmias among RHD patients in sinus rhythm with higher NYHA functional class and dilated left atrium

Characterization of Non-Ischemic Dilated Cardiomyopathy in a Native Tanzanian Cohort: MOYO Study

Background: Non-ischemic dilated cardiomyopathy (NIDCM) is a common cause of heart failure with progressive tendency. The disease occurs in one in every 2,500 individuals in the developed world, with high morbidity and mortality. However, detailed data on the role of NIDCM in heart failure in Tanzania is lacking. Aim: To characterize NIDCM in a Tanzanian cohort with respect to demographics, clinical profile, imaging findings and management. Methods: Characterization of non-ischemic dilated cardioMyOpathY in a native Tanzanian cOhort (MOYO) is a prospective cohort study of NIDCM patients seen at the Jakaya Kikwete Cardiac Institute. Patients aged ≥18 years with a clinical diagnosis of heart failure, an ejection fraction of ≤45% on echocardiography and no evidence of ischemia were enrolled. Clinical data, echocardiography, electrocardiography (ECG), coronary angiography and stress ECG information were collected from February 2020 to March 2022. Results: Of 402 patients, n = 220 (54.7%) were males with a median (IQR) age of 55.0 (41.0, 66.0) years. Causes of NIDCM were presumably hypertensive n = 218 (54.2%), idiopathic n = 116 (28.9%), PPCM n = 45 (11.2%), alcoholic n = 10 (2.5%) and other causes n = 13 (3.2%). The most common presenting symptoms were dyspnea n = 342 (85.1%), with the majority of patients presenting with New York Heart Association (NYHA) Class III n = 195 (48.5%). The mean (SD) left ventricular ejection fraction (LVEF) was 29.4% (±7.7), and severe systolic dysfunction (LVEF <30%) was common n = 208 (51.7%). Compared with other forms of DCM, idiopathic DCM patients were significantly younger, had more advanced NYHA class (p < 0.001) and presented more often with left bundle branch block on ECG (p = 0.0042). There was suboptimal use of novel guidelines recommended medications ARNI n = 10 (2.5%) and SGLT2 2-inhibitors n = 2 (0.5%). Conclusions: In our Tanzanian cohort, the majority of patients with NIDCM have an identified underlying cause, and they present at late stages of the disease. Patients with idiopathic DCM are younger with more severe disease compared to other forms of NIDCM

Public knowledge of risk factors and warning signs of heart attack and stroke

Abstract Background Knowledge of the predisposing risk factors and prompt recognition of the warning signs for heart attack and stroke is fundamental in modification of lifestyle behaviors and an imperative precursor to health-seeking behavior. In view of an existing knowledge gap amidst increasing incidence of heart attack and stroke in Tanzania, we conducted this community-based cross-sectional study among residents of Dar es Salaam city. Results A total of 1759 respondents were enrolled in this study. The mean age was 45.4 years, females constituted over a half of participants and over two-thirds had attained at least secondary school education. Regarding risk factors, just over 2% of participants displayed satisfactory awareness and only stress was recognized by at least half of participants. With regard to warning signs, barely 1% of participants had satisfactory knowledge for either of the conditions while nearly three-quarters of participants failed to mention even a single warning sign for heart attack. Recognized by about two-thirds of respondents, sudden numbness or weakness in face, arm or leg was the most acknowledged stroke symptom; however, other symptoms were familiar to less than a third of participants. Although over a half of respondents acknowledged going to a hospital as their first resort, over one-tenth of respondents expressed inappropriate reactions towards heart attack and stroke victims. Old age, higher level of education, positive history of heart attack or stroke, high blood pressure and history of dyslipidemia showed association with both risk factors and warning signs knowledge during bivariate analyses. Conclusions Public knowledge of common risk factors and typical warning signs for heart attack and stroke was critically suboptimal. These findings herald an utmost need for public health efforts to increase community awareness of risk factors and typical signs of the two conditions to curb the rising prevalence and associated morbimortality

The Effect of HIV-Related Immunosuppression on the Risk of Tuberculosis Transmission to Household Contacts

Background. Coinfection with human immunodeficiency virus (HIV) may modify the risk of transmitting tuberculosis. Some previous investigations suggest that patients coinfected with HIV and tuberculosis are less likely to transmit infection, whereas others do not support this conclusion. Here, we estimated the relative risk of tuberculosis transmission from coinfected patients compared to HIV-negative patients with tuberculosis. Methods. Between September 2009 and August 2012, we identified and enrolled 4841 household contacts of 1608 patients with drug-sensitive tuberculosis in Lima, Peru. We assessed the HIV status and CD4 counts of index patients, as well as other risk factors for infection specific to the index patient, the household, and the exposed individuals. Contacts underwent tuberculin skin testing to determine tuberculosis infection status. Results. After adjusting for covariates, we found that household contacts of HIV-infected tuberculosis patients with a CD4 count ≤ 250 cells/L were less likely to be infected with tuberculosis (risk ratio = 0.49 [95% confidence interval,. 24-.96]) than the contacts of HIV-negative tuberculosis patients. No children younger than 15 years who were exposed to HIV-positive patients with a CD4 count ≤ 250 cells/L were infected with tuberculosis, compared to 22% of those exposed to non-HIV-infected patients. There was no significant difference in the risk of infection between contacts of HIV-infected index patients with CD4 counts \u3e 250 cells/L and contacts of index patients who were not HIV-infected. Conclusions. We found a reduced risk of tuberculosis infection among the household contacts of patients with active tuberculosis who had advanced HIV-related immunosuppression, suggesting reduced transmission from these index patients