Pattern of childhood burn injuries and their management outcome at Bugando Medical Centre in Northwestern Tanzania

Burn injuries constitute a major public health problem and are the leading cause of childhood morbidity and mortality worldwide. There is paucity of published data on childhood burn injuries in Tanzania, particularly the study area. This study was conducted to describe the pattern of childhood burn injuries in our local setting and to evaluate their management outcome. A cross sectional study was conducted at Bugando Medical Centre (in Northwestern Tanzania) over a 3-year period from January 2008 to December 2010. Data was collected using a pre-tested coded questionnaire and statistical analyses performed using SPSS software version 15.0. A total of 342 burned children were studied. Males were mainly affected. Children aged = 2 were the majority accounting for 45.9% of cases. Intentional burn injuries due to child abuse were reported in 2.9% of cases. Scald was the most common type of burns (56.1%). The trunk was the most commonly involved body region (57.3%). Majority of patients (48.0%) sustained superficial burns. Eight (2.3%) patients were HIV positive. Most patients (89.8%) presented to the hospital later than 24 h. The rate of burn wound infection on admission and on 10th day were 32.4% and 39.8% respectively.Staphylococcus aureus were more common on admission wound swabs, with Pseudomonas aeruginosa becoming more evident after 10th day. MRSA was detected in 19.2% of Staphylococcus aureus. Conservative treatment was performed in 87.1% of cases. Surgical treatment mainly skin grafting (65.9%) was performed in 44 (12.9%) of patients. The overall average of the length of hospital stay (LOS) was 22.12 ± 16.62 days. Mortality rate was 11.7%. Using multivariate logistic regression analysis; age of the patient, type of burn, delayed presentation, clothing ignition, %TBSA and severity of burn were found to be significantly associated with LOS (P < 0.001), whereas mortality rate was found to be independently and significantly related to the age of the patient, type of burn, HIV positive with stigmata of AIDS, CD4 count, inhalation injury, %TBSA and severity of burn (P < 0.001). Childhood burn injuries still remain a menace in our environment with virtually unacceptable high morbidity and mortality. There is need for critical appraisal of the preventive measures and management principles currently being practiced

High Prevalence of Malaria in Zambezia, Mozambique: The Protective Effect of IRS versus Increased Risks Due to Pig-Keeping and House Construction

BACKGROUND: African countries are scaling up malaria interventions, especially insecticide treated nets (ITN) and indoor residual spraying (IRS), for which ambitious coverage targets have been set. In spite of these efforts infection prevalence remains high in many parts of the continent. This study investigated risk factors for malaria infection in children using three malaria indicator surveys from Zambezia province, Mozambique. The impact of IRS and ITNs, the effects of keeping farm animals and of the construction material of roofs of houses and other potential risk factors associated with malaria infection in children were assessed. METHODS: Cross-sectional community-based surveys were conducted in October of 2006, 2007 and 2008. A total of 8338 children (ages 1-15 years) from 2748 households were included in the study. All children were screened for malaria by rapid diagnostic tests. Caregiver interviews were used to assess household demographic and wealth characteristics and ITN and IRS coverage. Associations between malaria infection, vector control interventions and potential risk factors were assessed. RESULTS: Overall, the prevalence of malaria infection was 47.8% (95%CI: 38.7%-57.1%) in children 1-15 years of age, less than a quarter of children (23.1%, 95%CI: 19.1%-27.6%) were sleeping under ITN and almost two thirds were living in IRS treated houses (coverage 65.4%, 95%CI: 51.5%-77.0%). Protective factors that were independently associated with malaria infection were: sleeping in an IRS house without sleeping under ITN (Odds Ratio (OR)= 0.6; 95%CI: 0.4-0.9); additional protection due to sleeping under ITN in an IRS treated house (OR = 0.5; 95%CI: 0.3-0.7) versus sleeping in an unsprayed house without a ITN; and parental education (primary/secondary: OR = 0.6; 95%CI: 0.5-0.7) versus parents with no education. Increased risk of infection was associated with: current fever (OR = 1.2; 95%CI: 1.0-1.5) versus no fever; pig keeping (OR = 3.2; 95%CI: 2.1-4.9) versus not keeping pigs; living in houses with a grass roof (OR = 1.7; 95%CI: 1.3-2.4) versus other roofing materials and bigger household size (8-15 people: OR = 1.6; 95%CI: 1.3-2.1) versus small households (1-4 persons). CONCLUSION: Malaria infection among children under 15 years of age in Zambezia remained high but conventional malaria vector control methods, in particular IRS, provided effective means of protection. Household ownership of farm animals, particularly pigs, and living in houses with a grass roof were independently associated with increased risk of infection, even after allowing for household wealth. To reduce the burden of malaria, national control programs need to ensure high coverage of effective IRS and promote the use of ITNs, particularly in households with elevated risks of infection, such as those keeping farm animals, and those with grass roofs

Ethnobotanical study of some of mosquito repellent plants in north-eastern Tanzania

The use of plant repellents against nuisance biting insects is common and its potential for malaria vector control requires evaluation in areas with different level of malaria endemicity. The essential oils of Ocimum suave and Ocimum kilimandscharicum were evaluated against malaria vectors in north-eastern Tanzania. An ethnobotanical study was conducted at Moshi in Kilimanjaro region north-eastern Tanzania, through interviews, to investigate the range of species of plants used as insect repellents. Also, bioassays were used to evaluate the protective potential of selected plants extracts against mosquitoes. The plant species mostly used as repellent at night are: fresh or smoke of the leaves of O. suave and O. kilimandscharicum (Lamiaceae), Azadirachta indica (Meliaceae), Eucalyptus globules (Myrtaceae) and Lantana camara (Verbenaceae). The most popular repellents were O. kilimandscharicum (OK) and O. suave (OS) used by 67% out of 120 households interviewed. Bioassay of essential oils of the two Ocimum plants was compared with citronella and DEET to study the repellence and feeding inhibition of untreated and treated arms of volunteers. Using filter papers impregnated with Ocimum extracts, knockdown effects and mortality was investigated on malaria mosquito Anopheles arabiensis and Anopheles gambiae, including a nuisance mosquito, Culex quinquefasciatus. High biting protection (83% to 91%) and feeding inhibition (71.2% to 92.5%) was observed against three species of mosquitoes. Likewise the extracts of Ocimum plants induced KD90 of longer time in mosquitoes than citronella, a standard botanical repellent. Mortality induced by standard dosage of 30 mg/m2 on filter papers, scored after 24 hours was 47.3% for OK and 57% for OS, compared with 67.7% for citronella. The use of whole plants and their products as insect repellents is common among village communities of north-eastern Tanzania and the results indicate that the use of O. suave and O. kilimandscharicum as a repellent would be beneficial in reducing vector biting. The widespread use of this approach has a potential to complement other control measures

The dominant Anopheles vectors of human malaria in Africa, Europe and the Middle East: occurrence data, distribution maps and bionomic précis

<p>Abstract</p> <p>Background</p> <p>This is the second in a series of three articles documenting the geographical distribution of 41 dominant vector species (DVS) of human malaria. The first paper addressed the DVS of the Americas and the third will consider those of the Asian Pacific Region. Here, the DVS of Africa, Europe and the Middle East are discussed. The continent of Africa experiences the bulk of the global malaria burden due in part to the presence of the <it>An. gambiae </it>complex. <it>Anopheles gambiae </it>is one of four DVS within the <it>An. gambiae </it>complex, the others being <it>An. arabiensis </it>and the coastal <it>An. merus </it>and <it>An. melas</it>. There are a further three, highly anthropophilic DVS in Africa, <it>An. funestus</it>, <it>An. moucheti </it>and <it>An. nili</it>. Conversely, across Europe and the Middle East, malaria transmission is low and frequently absent, despite the presence of six DVS. To help control malaria in Africa and the Middle East, or to identify the risk of its re-emergence in Europe, the contemporary distribution and bionomics of the relevant DVS are needed.</p> <p>Results</p> <p>A contemporary database of occurrence data, compiled from the formal literature and other relevant resources, resulted in the collation of information for seven DVS from 44 countries in Africa containing 4234 geo-referenced, independent sites. In Europe and the Middle East, six DVS were identified from 2784 geo-referenced sites across 49 countries. These occurrence data were combined with expert opinion ranges and a suite of environmental and climatic variables of relevance to anopheline ecology to produce predictive distribution maps using the Boosted Regression Tree (BRT) method.</p> <p>Conclusions</p> <p>The predicted geographic extent for the following DVS (or species/suspected species complex*) is provided for Africa: <it>Anopheles </it>(<it>Cellia</it>) <it>arabiensis</it>, <it>An. </it>(<it>Cel.</it>) <it>funestus*</it>, <it>An. </it>(<it>Cel.</it>) <it>gambiae</it>, <it>An. </it>(<it>Cel.</it>) <it>melas</it>, <it>An. </it>(<it>Cel.</it>) <it>merus</it>, <it>An. </it>(<it>Cel.</it>) <it>moucheti </it>and <it>An. </it>(<it>Cel.</it>) <it>nili*</it>, and in the European and Middle Eastern Region: <it>An. </it>(<it>Anopheles</it>) <it>atroparvus</it>, <it>An. </it>(<it>Ano.</it>) <it>labranchiae</it>, <it>An. </it>(<it>Ano.</it>) <it>messeae</it>, <it>An. </it>(<it>Ano.</it>) <it>sacharovi</it>, <it>An. </it>(<it>Cel.</it>) <it>sergentii </it>and <it>An. </it>(<it>Cel.</it>) <it>superpictus*</it>. These maps are presented alongside a bionomics summary for each species relevant to its control.</p

Factors contributing to non-adherence to diabetes treatment among diabetic patients attending clinic in Mwanza City

Background: Non-adherence to the diabetes treatment regimen is possibly the most common reason for poor health outcomes among people with diabetes. The rates of non-adherence to diabetes regimen tasks are highly variable, but have significant consequences on diabetes outcomes and the effectiveness of treatments.Objective: The aim of this study was to determine the proportion (magnitude) of non-adherence and its contributing factors among diabetic patients attending clinics in Mwanza city. Specifically the study determined the relationship between non-adherence and various variables which are; alcohol use, knowledge on diabetes, its treatment and complication, travel distance to reach the clinic by patients and medication side effects.Results: A total of 272 diabetic patients attending two diabetes clinics in Mwanza city were interviewed. Of the respondents, 118(43.4%) were males. Their mean age was 51.22 (14.97 standard deviation). Among all respondents, 255 (93.8%) scored High level of knowledge on Diabetes and its treatment as compared with those with low knowledge making it not a significant contributor to non-adherence. Of the 272 patients, 77(28.3%) reported non-adherent. Alcohol use, medication side effects and distance travelled to reach the clinic were the significant contributors to non-adherence (p=0.001).Conclusion: Factors which were found contributing to non-adherence to diabetes treatment include: alcohol use, medication side effects and few clinics located far from most of patient. For improving adherence, availability of information with patients' perspectives about patients' expectations, needs and experiences in taking medication and about what might help them to become and remain adherent should be maintained.Keywords: - Diabetes; type 1 diabetes; type 2 diabetes; Medication; Non-adherenc

Storage of antimalarials at household level and associated factors in Kiromo ward, Bagamoyo Tanzania

Background: Malaria is a highly debilitating and frequently fatal disease of wide distribution. Improper drug storage and rampant self-medication are some of the factors that may contribute to an increase in the development of drug resistance by malaria parasites towards antimalarials. Objectives: To determine the extent of antimalarial drugs storage, sources and associated factors at household level at Kiromo ward in Bagamoyo, Coast region, Tanzania after the introduction of SP replacing chloroquine as first line. Methods: A total of 300 households from three villages making up Kiromo ward were included in this study. Swahili version of the questionnaire and a checklist were used in data collection. Results: Of the 300 households visited 25 (8.3%) were found to store antimalarials. The most commonly stored antimalarials were amodiaquine (30.8%) and quinine (34.6%). Most of these were in tablet form (76.9%). The source of these drugs was mostly from dispensaries. Kiromo was the only dispensary in the ward and others were outside the ward. These drugs were stored in special containers for safety. Frequent episodes of illness in the family were given as the most (56%) common reasons for drug storage in the families, followed by distance (20%). There was a statistically significant (

The Quality of Different Diclofenac Sodium Tablet Formulations Sold in Pharmacies in Tanzania

Objective: The objective of this study was to investigate the possible reasons for decreased anti- inflammatory and analgesic activities in patients using generic diclofenac sodium tablet formulations (50mg) in Dar es Salaam. Methodology: Different diclofenac sodium tablet products from different manufacturers were collected from twelve wholesale pharmacies with good storage conditions. In total 80 samples were collected, with a minimum of five samples from each wholesale pharmacy. In addition a survey on brands available and the pricing of different diclofenac formulations in 120 retail pharmacies was conducted. Analyses of the sampled tablet formulations were performed at the laboratory of Tanzania Food and Drug Athority. Both validated British and United States Pharmacopoeia methods were used to perform the analyses. Results: On visual appearance of tablets, 18% of the collected samples had cracks and white patches on the coat. Same number of samples could not meet the requirements for drug content and disintegration rates respectively, whereas, 27 % failed the dissolution rate tests. Voltaren® (Norvatis Pharma, Switzerland), the originator's product was the most expensive, less available and a less bought product. Vivian® (Lincoln Pharma, India) and Dyclomax® (Medreich Laboratories, India) were sold cheapest and were available in all pharmacies including those in the peripheral part of the city. Conclusion: Low anti- inflammatory and analgesic response reported by many patients with different pain conditions could be associated with the use of poor quality diclofenac sodium. Tanzania Medical Journal Vol. 23 (2) 2008: pp. 20-2