Biotypes of oral Candida albicans isolates in a Tanzanian child population

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Educating Enough Competent Health Professionals: Advancing Educational Innovation at Muhimbili University of Health and Allied Sciences, Tanzania.

Sarah MacFarlane and colleagues share their lessons engaging in educational reform and faculty development with the Muhimbili University of Health and Allied Sciences in Tanzania and the University of California San Francisco

Sources of Microbial Contamination of Local Herbal Medicines Sold on the Open Market in Dar es Salaam, Tanzania

Four hundred traditional herbalists operating in an open air market in Ilala, Dar es Salaam, Tanzania were interviewed using a questionnaire to establish the stage at which contamination takes place during the processesing of herbal medicine preparations. Among the interviewees, 82.0 % were true traditional medicine herbalists while the rest were vendors. Most of the practitioners had received primary school education while 17.0 % were illiterate. Seventy five percent of the herbalists displayed their medicines along the streets despite being aware of the potential hazards of microbial contamination at such locations. Of the true herbalists, 70 % personally processed the herbal medicines they sold. Most of these herbalists reported using boiled and cooled tap water in the preparation of liquid forms of the medicines. The containers in which the medicines were handled were washed using unboiled tap water and soap. Previous research has shown that the use of tap water in the processing of herbal medicines and exposure in the open market are possible sources of contamination. These results point to the need for educational intervention directed at traditional medicine practitioners to curb microbial contamination of herbal medicines.Keywords: Traditional herbalists, herbal medicine, microbial contaminationEast and Central African Journal of Pharmaceutical Sciences Vol. 12 (2009) 19-2

Biological Activities of Essential Oils from Plants Growing in Tanzania

Essential oils from eleven plant species belonging to the Asteraceae, Lamiaceae, Lauraceae and Myrothamnaceae families growing in Tanzania were screened for mosquito larvicidal and anti-candida activities, and were subjected to the brine shrimp lethality test. In the larvicidal and brine shrimp tests, the organisms were exposed to varying oil concentrations for 24 h, after which mortality was assessed. The anticandida activity was determined using the bioautography agar overlay method. All oils showed larvicidal activity with two Ocimum suave oil samples being the most active with LC50 values of 169.8 and 151.3 ppm. The same Ocimum suave oils also exhibited the highest brine shrimp mortality (LC50 4.0 and 12.6 ppm). Most of the oils showed anti-candida activity, with oils from Ocimum species being the most active compared to the others. Thus, Ocimum suave oils merit further investigation towards the development of safe and biodegradable larvicides. Furthermore, oils from Ocimum basilicum and Ocimum kilimandscharicum could offer useful alternatives for combating candidiasis, a common opportunistic infection in HIV/AIDS patients.Keywords: Ocimum species, larvicides, brine shrimp, Candida albicansEast and Central African Journal of Pharmaceutical Sciences Vol. 13 (2010) 85-9

Declining HIV-1 Prevalence and Incidence among Police Officers - A potential Cohort for HIV Vaccine Trials, in Dar es Salaam, Tanzania.

A safe effective and affordable HIV vaccine is the most cost effective way to prevent HIV infection worldwide. Current studies of HIV prevalence and incidence are needed to determine potentially suitable cohorts for vaccine studies. The prevalence and incidence of HIV-1 infection among the police in Dar es Salaam in 1996 were 13.8% and 19.6/1000 PYAR respectively. This study aimed at determining the current prevalence and incidence of HIV in a police cohort 10 years after a similar study was conducted. Police officers in Dar es Salaam, Tanzania were prospectively enrolled into the study from 2005 and followed-up in an incidence study three years later. HIV infection was determined by two sequential enzyme linked immunosorbent assays (ELISAs) in the prevalence study and discordant results between two ELISAs were resolved by a Western blot assay. Rapid HIV assays (SD Bioline and Determine) were used for the incidence study. A total of 1,240 police participated in the HIV prevalence study from August 2005 to November 2008. Of these, 1101 joined the study from August 2005-September 2007 and an additional 139 were recruited between October 2007 to November 2008 while conducting the incidence study. A total of 726 (70%) out of the 1043 eligible police participated in the incidence study.The overall HIV-1 prevalence was 65/1240 (5.2%). Females had a non-statistically significant higher prevalence of HIV infection compared to males 19/253, (7.5%) vs. 46/987 (4.7%) respectively (p = 0.07). The overall incidence of HIV-1 was 8.4 per 1000 PYAR (95% CI 4.68-14.03), and by gender was 8.8 and 6.9 per 1000 PYAR, among males and females respectively, (p = 0.82). The HIV prevalence and incidence among the studied police has declined over the past 10 years, and therefore this cohort is better suited for phase I/II HIV vaccine studies than for efficacy trials

Knowledge of Sexually Transmitted Diseases Management Among Pharmacists in Dar es Salaam Tanzania: A Case Study

This study was conducted to find out if pharmacists are conversant with the management of sexually transmitted diseases (STDs) and whether they use their knowledge appropriately in managing their clients with STDs syndromes. A comparison was made between community pharmacists who graduated before and after the introduction of STDs/HIV management program in the Faculty of Pharmacy, University of Dar es Salaam, Tanzania in 1992. The aim was also to find out if these pharmacists have attended any training on STDs management after their formal training, and whether they are able to make correct diagnosis and give the right drug(s) to their clients suffering from STDs. Self-administered questionnaires were distributed to eighty-seven pharmacists operating in Dar es Salaam. The response was 74.7% (n=65), with female to male ratio of 1:1.8. Of the responding pharmacists, 73.8% reported to have had formal training on STDs management during their undergraduate course. All pharmacists reported that they normally see clients at their pharmacies with complaints suggestive of STDs. All pharmacists were able to list three or more STDs. About 65% of post-curricula pharmacists were able to list one or more STDs causative agents. Ninety four and hundred percent of pre- and post-curricular pharmacists, respectively were found to give the right drug(s) for various STDs. Twenty seven percent post- and 64.7% pre-curricula pharmacists had attended training on STDs management since they graduated. (E & C Afr Jnl Pharm Sci: 2002 5(1): 3-7

Source of microbial contamination of natural therapeutically used locally prepared herbal medicines sold on the open market in Dar es Salaam, Tanzania

SUMMARY Four hundred (400) traditional herbalists (280 males and 120 females) in an open market in Ilala district were interviewed using a questionnaire to find out the stage at which contamination takes place during the processes of collection, preparation, storage and dispensing of their herbal drug preparations. Among the herbalists interviewed, 82.0% were true traditional herbalists while the rest were just venders of herbal medicinal preparations. Most of the TM practitioners were primary education leavers with only 17 % illiterate an indication that the majority could read and write. Seventy five percent of the herbalists displayed their drugs along most of the roads/streets although they knew the potential hazards of microbial contaminations at such locations. Of the true herbalists 70% were responsible for the collection of the herbal drugs from sources based on what they knew about the role of the drugs in the treatment of specific disease conditions. They subsequently prepared and dispensed them. Most of these herbalists reported using boiled and cooled tap water in the preparation of the liquid form of the drugs. The containers used for collection, preparation, storage and dispensing of the drug of the preparations were reportedly washed using unboiled tap water and soap. In a previous study the microbial contamination found in similar drug preparations constituted mainly of Coliform bacteria. Results from this ongoing research, has shown that boiled and unboiled tap water which was earlier found to be contaminated with Coliform bacteria, was used in cleaning the containers used for collection, storage and dispensing and eventually used in the process of preparation of the liquid form of drugs. It is therefore likely that the tap water used during the process of preparing the drugs, their storage and dispensing could be one source of contamination of the herbal drug preparations. These results indicate the need for an educational intervention directed to TM practitioner

Low specificity of determine HIV1/2 RDT using whole blood in south west Tanzania

Objective: To evaluate the diagnostic performance of two rapid detection tests (RDTs) for HIV 1/2 in plasma and in whole blood samples. Methods: More than 15,000 study subjects above the age of two years participated in two rounds of a cohort study to determine the prevalence of HIV. HIV testing was performed using the Determine HIV 1/2 test (Abbott) in the first (2006/2007) and the HIV 1/2 STAT-PAK Dipstick Assay (Chembio) in the second round (2007/2008) of the survey. Positive results were classified into faint and strong bands depending on the visual appearance of the test strip and confirmed by ELISA and Western blot. Results: The sensitivity and specificity of the Determine RDT were 100% (95% confidence interval = 86.8 to 100%) and 96.8% (95.9 to 97.6%) in whole blood and 100% (99.7 to 100%) and 97.9% (97.6 to 98.1%) in plasma respectively. Specificity was highly dependent on the tested sample type: when using whole blood, 67.1% of positive results were false positive, as opposed to 17.4% in plasma. Test strips with only faint positive bands were more often false positive than strips showing strong bands and were more common in whole blood than in plasma. Evaluation of the STAT-PAK RDT in plasma during the second year resulted in a sensitivity of 99.7% (99.1 to 99.9%) and a specificity of 99.3% (99.1 to 99.4%) with 6.9% of the positive results being false. Conclusions: Our study shows that the Determine HIV 1/2 strip test with its high sensitivity is an excellent tool to screen for HIV infection, but that – at least in our setting – it can not be recommended as a confirmatory test in VCT campaigns where whole blood is used

Early and efficient detection of Mycobacterium tuberculosis in sputum by microscopic observation of broth cultures.

Early, efficient and inexpensive methods for the detection of pulmonary tuberculosis are urgently needed for effective patient management as well as to interrupt transmission. These methods to detect M. tuberculosis in a timely and affordable way are not yet widely available in resource-limited settings. In a developing-country setting, we prospectively evaluated two methods for culturing and detecting M. tuberculosis in sputum. Sputum samples were cultured in liquid assay (micro broth culture) in microplate wells and growth was detected by microscopic observation, or in Löwenstein-Jensen (LJ) solid media where growth was detected by visual inspection for colonies. Sputum samples were collected from 321 tuberculosis (TB) suspects attending Bugando Medical Centre, in Mwanza, Tanzania, and were cultured in parallel. Pulmonary tuberculosis cases were diagnosed using the American Thoracic Society diagnostic standards. There were a total of 200 (62.3%) pulmonary tuberculosis cases. Liquid assay with microscopic detection detected a significantly higher proportion of cases than LJ solid culture: 89.0% (95% confidence interval [CI], 84.7% to 93.3%) versus 77.0% (95% CI, 71.2% to 82.8%) (p = 0.0007). The median turn around time to diagnose tuberculosis was significantly shorter for micro broth culture than for the LJ solid culture, 9 days (interquartile range [IQR] 7-13), versus 21 days (IQR 14-28) (p<0.0001). The cost for micro broth culture (labor inclusive) in our study was US $4.56 per sample, versus US$11.35 per sample for the LJ solid culture. The liquid assay (micro broth culture) is an early, feasible, and inexpensive method for detection of pulmonary tuberculosis in resource limited settings

Gastric Outlet Obstruction at Bugando Medical Centre in Northwestern Tanzania: A Prospective Review of 184 Cases.

Gastric outlet obstruction poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. There is a paucity of published data on this subject in our setting. This study was undertaken to highlight the etiological spectrum and treatment outcome of gastric outlet obstruction in our setting and to identify prognostic factors for morbidity and mortality. This was a descriptive prospective study which was conducted at Bugando Medical Centre between March 2009 and February 2013. All patients with a clinical diagnosis of gastric outlet obstruction were, after informed consent for the study, consecutively enrolled into the study. Statistical data analysis was done using SPSS computer software version 17.0. A total of 184 patients were studied. More than two-third of patients were males. Patients with malignant gastric outlet obstruction were older than those of benign type. This difference was statistically significant (p < 0.001). Gastric cancer was the commonest malignant cause of gastric outlet obstruction where as peptic ulcer disease was the commonest benign cause. In children, the commonest cause of gastric outlet obstruction was congenital pyloric stenosis (13.0%). Non-bilious vomiting (100%) and weight loss (93.5%) were the most frequent symptoms. Eighteen (9.8%) patients were HIV positive with the median CD 4+ count of 282 cells/μl. A total of 168 (91.3%) patients underwent surgery. Of these, gastro-jejunostomy (61.9%) was the most common surgical procedure performed. The complication rate was 32.1 % mainly surgical site infections (38.2%). The median hospital stay and mortality rate were 14 days and 18.5% respectively. The presence of postoperative complication was the main predictor of hospital stay (p = 0.002), whereas the age > 60 years, co-existing medical illness, malignant cause, HIV positivity, low CD 4 count (<200 cells/μl), high ASA class and presence of surgical site infection significantly predicted mortality ( p< 0.001). The follow up of patients was generally poor as more than 60% of patients were lost to follow up. Gastric outlet obstruction in our setting is more prevalent in males and the cause is mostly malignant. The majority of patients present late with poor general condition. Early recognition of the diagnosis, aggressive resuscitation and early institution of surgical management is of paramount importance if morbidity and mortality associated with gastric outlet obstruction are to be avoided