6 research outputs found
Risk Factors for Anaemia Among HIV Infected Children Attending Care and Treatment Clinic at Muhimbili National Hospital in Dar es Salaam, Tanzania
There is paucity of data describing the risk factors for anaemia among HIV infected children in Tanzania. This cross sectional study was carried out to determine the contributing factors for anaemia among HIV-infected children attending Muhimbili National Hospital in Dar es Salaam. Both univariate and multivariate logistic regression analyses were performed to identify possible factors associated with anaemia in HIV-infected children. A total of 75 (44%) patients among 167 recruited HIV-infected children aged 6 months to 59 months of were found to be anaemic (Hg<11g/dl). Multivariate logistic regression demonstrated that not being on HAART (OR 3.40, 95%CI (1.20-9.60), having CD4% <25% (OR 2.30, 95%CI (1.20-34.60), having a history of tuberculosis (TB) (OR 3.23, 95%CI (1.10-9.70) and having hookworm infestation (OR 5.97, 95%CI (1.92-18.4) were independent risk factors for anaemia among HIV infected children. The analyses also showed that being HIV positive for ≥ 2.5 years resulted into a low risk of severe anaemia compared to being HIV positive for < 2.5 years. Taking multivitamins (OR 0.07, 95%, CI (0.020-0.30) and antihelminthics (OR 0.27, 95%CI (0.10-0.74) were also protective against anaemia in children. Similar factors (with exception of using antihelmintics) were associated with severe anaemia. In conclusion the factors associated with anaemia in HIV infected children were multifactorial in nature. Efforts to correct anaemia in HIV infected children should include use of HAART and treatment of infections such as TB and hookworms
Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses and syphilis infections among blood donors at the Muhimbili National Hospital in Dar Es Salaam, Tanzania
BACKGROUND: According to the latest Tanzanian National AIDS Control Programme (NACP) report a total of 147,271 individuals donated blood during the year 2002. However, blood safety remains an issue of major concern in transfusion medicine in Tanzania where national blood transfusion services and policies, appropriate infrastructure, trained personnel and financial resources are inadequate. Most of the donated blood is screened for HIV alone. METHODS: We determined among blood donors at Muhimbili National Hospital (MNH), the seroprevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B surface antigen (HBsAg) and syphilis by donor type, sex and age and to determine association, if any, in the occurrence of the pathogens. The sample included 1599 consecutive donors, 1424(89.1%) males and 175 (10.9%) females, who donated blood between April 2004 and May, 2005. Most of them 1125 (70.4%) were replacement donors and a few 474 (29.6%) voluntary donors. Their age (in years) ranged from 16 to 69, and most (72.2%) were between 20–39 years. RESULTS: Two hundred and fifty four (15.9%) of the donated blood had serological evidence of infection with at least one pathogen and 28 (1.8%) had multiple infections. The current seroprevalence of HIV, HBsAg, HCV and syphilis among blood donors at MNH in Dar es Salaam was found to be 3.8%, 8.8%, 1.5% and 4.7%, respectively. Respective seroprevalences among HIV seronegative blood donors were 8.7% for HBV, 1.6% for HCV and 4.6% for syphilis. The differences in the prevalence of HIV and syphilis infections between replacement and voluntary donors were statistically significant (P < 0.05). Syphilis was the only infection that occurred more frequently among HIV infected (12.1%) than non-infected (4.6%) blood donors (P < 0.05), and whose prevalence increased with age (X(2 )= 58.5 df = 5, P < 0.001). There were no significant sex differences in the occurrence of pathogens. Finally, there were significant associations in the occurrence of HBsAg and syphilis (OR = 2.2, 95% CI 1.1.-4.2) and HIV and syphilis (OR = 2.2, 95% CI 1.0–5.3). CONCLUSION: The high (15.9%) seroprevalence of blood-borne infections in blood donated at MNH calls for routine screening of blood donors for HBV, HCV, HIV and syphilis and for strict selection criteria of donors, with emphasis on getting young voluntary donors and for establishment of strict guidelines for blood transfusions
Mortality in Sickle Cell Anemia in Africa: A Prospective Cohort Study in Tanzania
Background: The World Health Organization has declared Sickle Cell Anemia (SCA) a public health priority. There are 300,000 births/year, over 75% in Africa, with estimates suggesting that 6 million Africans will be living with SCA if average survival reaches half the African norm. Countries such as United States of America and United Kingdom have reduced SCA mortality from 3 to 0.13 per 100 person years of observation (PYO), with interventions such as newborn screening, prevention of infections and comprehensive care, but implementation of interventions in African countries has been hindered by lack of locally appropriate information. The objective of this study was to determine the incidence and factors associated with death from SCA in Dar-es-Salaam.Methods and Findings: A hospital-based cohort study was conducted, with prospective surveillance of 1,725 SCA patients recruited from 2004 to 2009, with 209 (12%) lost to follow up, while 86 died. The mortality rate was 1.9 (95% CI 1.5, 2.9) per 100 PYO, highest under 5-years old [7.3 (4.8-11.0)], adjusting for dates of birth and study enrollment. Independent risk factors, at enrollment to the cohort, predicting death were low hemoglobin (= 102 mu mol/L) [1.7 (1.0-2.9); p = 0.044] as determined by logistic regression.Conclusions: Mortality in SCA in Africa is high, with the most vulnerable period being under 5-years old. This is most likely an underestimate, as this was a hospital cohort and may not have captured SCA individuals with severe disease who died in early childhood, those with mild disease who are undiagnosed or do not utilize services at health facilities. Prompt and effective treatment for anemia in SCA is recommended as it is likely to improve survival. Further research is required to determine the etiology, pathophysiology and the most appropriate strategies for management of anemia in SCA
Risk factors for anaemia among HIV infected children attending care and treatment clinic at Muhimbili National Hospital in Dar es Salaam, Tanzania
There is paucity of data describing the risk factors for anaemia among
HIV infected children in Tanzania. This cross sectional study was
carried out to determine the contributing factors for anaemia among
HIV-infected children attending Muhimbili National Hospital in Dar es
Salaam. Both univariate and multivariate logistic regression analyses
were performed to identify possible factors associated with anaemia in
HIV-infected children. A total of 75 (44%) patients among 167 recruited
HIV-infected children aged 6 months to 59 months of were found to be
anaemic (Hg<11g/dl). Multivariate logistic regression demonstrated
that not being on HAART (OR 3.40, 95%CI (1.20-9.60), having CD4%
<25% (OR 2.30, 95%CI (1.20-34.60), having a history of tuberculosis
(TB) (OR 3.23, 95%CI (1.10-9.70) and having hookworm infestation (OR
5.97, 95%CI (1.92-18.4) were independent risk factors for anaemia among
HIV infected children. The analyses also showed that being HIV positive
for ≥ 2.5 years resulted into a low risk of severe anaemia
compared to being HIV positive for < 2.5 years. Taking multivitamins
(OR 0.07, 95%, CI (0.020-0.30) and antihelminthics (OR 0.27, 95%CI
(0.10-0.74) were also protective against anaemia in children. Similar
factors (with exception of using antihelmintics) were associated with
severe anaemia. In conclusion the factors associated with anaemia in
HIV infected children were multifactorial in nature. Efforts to correct
anaemia in HIV infected children should include use of HAART and
treatment of infections such as TB and hookworms
Audit of clinical-laboratory practices in haematology and blood transfusion at Muhimbili National Hospital in Tanzania
In Tanzania, there is paucity of data for monitoring laboratory
medicine including haematology. This therefore calls for audits of
practices in haematology and blood transfusion in order to provide
appraise practice and devise strategies that would result in improved
quality of health care services. This descriptive cross-sectional study
which audited laboratory practice in haematology and blood transfusion
at Muhimbili National Hospital (MNH) aimed at assessing the
pre-analytical stage of laboratory investigations including laboratory
request forms and handling specimen processing in the haematology
laboratory and assessing the chain from donor selection, blood
component processing to administration of blood during transfusion. A
national standard checklist was used to audit the laboratory request
forms (LRF), phlebotomists’ practices on handling and assessing
the from donor selection to administration of blood during transfusion.
Both interview and observations were used. A total of 195 LRF were
audited and 100% of had incomplete information such as patients’
identification numbers, time sample ordered, reason for request,
summary of clinical assessment and differential diagnoses. The
labelling of specimens was poorly done by phlebotomists/clinicians in
82% of the specimens. Also 65% (132/202) of the blood samples delivered
in the haematology laboratory did not contain the recommended volume of
blood. There was no laboratory request form specific for ordering blood
and there were no guidelines for indication of blood transfusion in the
wards/clinics. The blood transfusion laboratory section was not
participating in external quality assessment and the hospital
transfusion committee was not in operation. It is recommended that a
referral hospital like MNH should have a transfusion committee to
provide an active forum to facilitate communication between those
involved with transfusion, monitor, coordinate and audit blood
transfusion practices as per national guidelines