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

The Effect of Capital Structure on Profitability of Listed Manufacturing Companies in Tanzania

Researcher used this study to measure the effect of capital structure on Performance of Public listed companies in DSE Tanzania using a panel data of six companies during the 5 year period, from 2009 to 2013 which created 30 observations. Panel data for the selected companies were generated and analyzed using fixed effect regression statistical technique to test the relationship between capital structure variables and return on asset and random effect used to test the relationship between capital structure variables and return on equity. Variable computations were conducted with the assistance of STATA computer software and the results of the study revealed the mixed results, a negative relationship revealed between debt to equity ratios and return on equity while Debt to asset ratios indicated a positive relationship with return on equity when random effect regression used. The overall results revealed that capital structure has a positive impact on company profitability while some of capital structure variables with combination of debt to equity indicated a negative relationship with company profit and other capital structure variables with combination of debt to assets indicated a positive relationship with company profit Correlation and regression models indicated a positive relationship between debt to assets ratios and company profit. In terms of ROE and ROA while only debt to equity ratios showed a negative relationship with ROE as indicated by both methods. The study recommends that managers of manufacturing companies should increase the reliance on short term debt to asset ratios as a source of finance because they have much influence on profit generation on both return on equity and return on assets. Debt to equity ratios were the only variables which indicated a negative relationship with company profit in terms of return on equity, for that case managements should reduce the use of these ratios although other remaining ratios has to be increased because they also indicated a positive relationship with all profitability ratio

Modelling and optimisation of water loss management strategies in a water distribution system: a case of Moshi Urban Water Supply and Sanitation Authority (MUWSA)

A Dissertation Submitted in Partial Fulfilment of the Requirements for the Degree of Master’s in Mathematical and Computer Sciences and Engineering of the Nelson Mandela African Institution of Science and TechnologyWater loss in water distribution systems (WDS) is a serious problem in developing countries. A lot of water is lost on its way from the sources before reaching the consumers due to leakage, illegal use, and theft of infrastructures among others. The effect of water loss in the WDS includes reduction of revenue, water shortage, disruption of water quality, and inflation of operation and maintenance cost of the water authorities. The control of water loss in the WDS is closely dependent on the commitment of the decision-makers, the strategies used and budget set for water loss management (WLM). This study presents a combined model of Multi-Criteria Decision Making (MCDM) and Integer Linear Programming (ILP) methods which may help decision-makers to prioritise and select the best strategies for WLM. The MCDM family methods; the MAVT, SMARTER, SAW, and COPRAS were used to evaluate and prioritize the strategies, while ILP was used to select the best strategies. Additionally, the study compared the SAW and COPRAS methods in prioritising and selecting the strategies. The data used were collected at MUWSA. The results show that the COPRAS and SAW methods rank the given alternatives differently while when integrated with the ILP technique, the formulated models select the same portfolios of alternatives. Thirteen alternatives which cost 97% of the total budgets set for WLM were selected. Furthermore, the ILP models showed robustness in selecting the portfolio of alternatives as they select the same alternatives despite the ranking of alternatives and change of weights of evaluation criteria. Finally, the study proposed the decision model framework which can be used by decisionmakers to evaluate and select the best strategies for WLM in WDS

Bacteria isolated from bloodstream infections at a tertiary hospital in Dar es Salaam, Tanzania – antimicrobial resistance of isolates

Objective. A bloodstream infection (BSI) is a life-threatening condition. We studied the causative agents of BSIs and antimicrobial susceptibility patterns of bacterial isolates at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods. A retrospective analysis of blood culture results obtained at MNH from January 2005 to December 2009 was done. Blood culture isolates judged to be clinically significant and antimicrobial susceptibility results of the bacteria were included. The frequencies and proportions of bacteria isolated and antimicrobial susceptibility results were analysed and compared using Pearson’s chi-square test and Fisher’s exact test where applicable, or the Mann-Whitney U-test. Results. A total of 13 833 blood cultures were performed. Bacterial pathogens were detected in 1 855 (13.4%), Gram-positive bacteria (1 523; 82.1%) being significantly more prevalent than Gramnegative bacteria (332; 17.9%) (p=0.008). The most common bacterial pathogens isolated were coagulase-negative staphylococci (CoNS) (1 250; 67.4%), S. aureus (245; 13.2%), Escherichia coli (131; 7%) and Klebsiella spp. (130; 7.0%). All bacteria isolated showed high resistance to penicillin G (70.6%), tetracycline (63.8%), cefotaxime (62.5%) and ampicillin (62.3%). Moderate to high resistance was seen against chloramphenicol (45.2%), erythromycin (35.0%), ciprofloxacin (29.3%), co-trimoxazole (25.0%) and gentamicin (23.5%). Of S. aureus isolates, 23.3% were resistant to methicillin. Conclusions. CoNS accounted for two-thirds of the bacterial pathogens isolated. High-level resistance was seen to first-line and inexpensive antimicrobial agents. Routine screening for extendedspectrum beta-lactamase production and methicillin resistance among Gram-negative rods and S. aureus from blood cultures should be instituted to monitor spread of multidrug-resistant isolates

Antimicrobial resistance among producers and non-producers of extended spectrum beta-lactamases in urinary isolates at a tertiary Hospital in Tanzania

<p>Abstract</p> <p>Background</p> <p>Published data on the existence and magnitude of extended spectrum beta-lactamase (ESBL) production in urinary pathogens in local setting is limited. The aim of the present study was to determine the prevalence of antimicrobial resistance and ESBL production among <it>Escherichia coli </it>and <it>Klebsiella spp </it>from urine samples in a tertiary hospital. This was a cross sectional study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania.</p> <p>Findings</p> <p>A total of 270 <it>E.coli </it>and <it>Klebsiella spp </it>urinary pathogens from children and adults isolated from January to March 2010 were included in the study. <it>E. coli </it>and <it>Klebsiella spp </it>isolates were tested for antimicrobial susceptibility by the Clinical and Laboratory Standard Institute's disc diffusion method. These isolates were further screened for ESBL phenotype using cefotaxime and ceftazidime discs. Isolates with reduced sensitivity were confirmed using ESBL E-test strips. Of 270 isolates, 138 (51.1%) were <it>E. coli </it>and 132 (48.9%) were <it>Klebsiella spp</it>. ESBL was detected in 122 (45.2%) of all the isolates. ESBL- producing <it>E. coli </it>strains were significantly more resistance to cotrimoxazole (90.7%), ciprofloxacin (46.3%) and nalidixic acid (61.6%) than strains that did not produce ESBL (p < 0.05). Similarly, ESBL- producing <it>Klebsiella spp </it>strains were significantly more resistance to cotrimoxazole (92.6%), ciprofloxacin (25.0%), nalidixic acid (66.2%), and gentamicin (38.2%) than strains that did not produce ESBL (P < 0.05). Multi-drug resistance was found to be significantly (<it>P </it>< 0.05) more in ESBL producing isolates (90.5%) than non ESBL producers (68.9%). The occurrence of ESBL was significantly higher among isolates from inpatients than outpatients [95 (50.5%) vs. 27(32.9%)] (p = 0.008). The occurrence of ESBL was significantly higher among isolates from children than in adults [84 (54.9%) vs. 38(32.5%)] (p < 0.001).</p> <p>Conclusions</p> <p>High prevalence of ESBL-producing <it>E. coli </it>and <it>Klebsiella spp </it>strains was found among inpatients and children. Most of the ESBL- producing isolates were multi-drug resistant making available therapeutic choices limited. We recommend continued antibiotic surveillance as well comprehensive multi-center studies to address the emerging problem of ESBL-associated infections in order to preserve the continued usefulness of most antimicrobial drugs. Further more conducting molecular studies will help to evaluate the various ESBL types.</p

Multi-Criteria Decision Making and Numerical Optimization Approaches for Optimizing Water Loss Management Strategies in Water Distribution System A case of Urban Water Supply and Sanitation Authorities in Tanzania

This research article published by Modern Education and Computer Science Press, 2019Water loss in water distribution systems (WDS) is a serious problem in Tanzania and the third world countries at large. A lot of water is lost on its way before reaching the consumers. This causes a shortage of water supply which leads to loss of revenues of the concerned water authorities. The control or reduction of water loss in the WDS is closely dependent on the commitment of the decision-makers and on the strategies and budget, they set for that purpose. This paper presents a combined model of Multi-Criteria Decision Making (MCDM) and Numerical optimization techniques which may help decision-makers to prioritize and select the best strategies to be used in the management of water loss in the WDS at Moshi Urban Water Supply and Sanitation Authority (MUWSA), Tanzania. The Multi-Criteria Decision Making family methods namely the Multi-Attribute Value Theory (MAVT), Simple Multi-Attribute Rating Technique Exploiting Ranks (SMARTER), and Complex Proportional Assessment (COPRAS) were used to evaluate and prioritize the strategies, whereas the Integer Linear Programming (ILP) technique a numerical optimization technique was used to select the best strategies or alternatives to be employed in water loss management. The results show that the most preferable alternative is replacement of dilapidated pipes while the least preferable alternative is network zoning. The model selects thirteen out of sixteen alternatives, which cost 97% (TZS 235.71 million) of the total budgets set by the water authority to form a portfolio of the best alternatives for water loss management. Furthermore, the model showed robustness as the selected portfolio of alternatives remained the same even when the weights of the evaluation criteria changed

Genetic diversity of circulating rotavirus strains in Tanzania prior to the introduction of vaccination

Background: Tanzania currently rolls out vaccination against rotavirus-diarrhea, a major cause of child illness and death. As the vaccine covers a limited number of rotavirus variants, this study describes the molecular epidemiology of rotavirus among children under two years in Dar es Salaam, Tanzania, prior to implementation of vaccination. Methods: Stool specimens, demographic and clinical information, were collected from 690 children admitted to hospital due to diarrhea (cases) and 545 children without diarrhea (controls) during one year. Controls were inpatient or children attending child health clinics. Rotavirus antigen was detected using ELISA and positive samples were typed by multiplex semi-nested PCR and sequencing. Results: The prevalence of rotavirus was higher in cases (32.5%) than in controls (7.7%, P,0.001). The most common G genotypes were G1 followed by G8, G12, and G4 in cases and G1, G12 and G8 in controls. The Tanzanian G1 variants displayed 94% similarity with the Rotarix vaccine G1 variant. The commonest P genotypes were P[8], P[4] and P[6], and the commonest G/P combination G1 P[8] (n = 123), G8 P[4] and G12 P[6]. Overall, rotavirus prevalence was higher in cool (23.9%) than hot months (17.1%) of the year (P = 0.012). We also observed significant seasonal variation of G genotypes. Rotavirus was most frequently found in the age group of four to six months. The prevalence of rotavirus in cases was lower in stunted children (28.9%) than in non-stunted children (40.1%, P = 0.003) and lower in HIV-infected (15.4%, 4/26) than in HIVuninfected children (55.3%, 42/76, P,0.001). Conclusion: This pre-vaccination study shows predominance of genotype G1 in Tanzania, which is phylogenetically distantly related to the vaccine strains. We confirm the emergence of genotype G8 and G12. Rotavirus infection and circulating genotypes showed seasonal variation. This study also suggests that rotavirus may not be an opportunistic pathogen in children infected with HIV

Bacteria isolated from bloodstream infections at a tertiary hospital in Dar es Salaam, Tanzania - antimicrobial resistance of isolates

Objective. A bloodstream infection (BSI) is a life-threatening condition. We studied the causative agents of BSIs and antimicrobial susceptibility patterns of bacterial isolates at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods. A retrospective analysis of blood culture results obtained at MNH from January 2005 to December 2009 was done. Blood culture isolates judged to be clinically significant and antimicrobial susceptibility results of the bacteria were included. The frequencies and proportions of bacteria isolated and antimicrobial susceptibility results were analysed and compared using Pearson’s chi-square test and Fisher’s exact test where applicable, or the Mann-Whitney U-test. Results. A total of 13 833 blood cultures were performed. Bacterial pathogens were detected in 1 855 (13.4%), Gram-positive bacteria (1 523; 82.1%) being significantly more prevalent than Gram-negative bacteria (332; 17.9%) (p=0.008). The most common bacterial pathogens isolated were coagulase-negative staphylococci (CoNS) (1 250; 67.4%), S. aureus (245; 13.2%), Escherichia coli (131; 7%) and Klebsiella spp. (130; 7.0%). All bacteria isolated showed high resistance to penicillin G (70.6%), tetracycline (63.8%), cefotaxime (62.5%) and ampicillin (62.3%). Moderate to high resistance was seen against chloramphenicol (45.2%), erythromycin (35.0%), ciprofloxacin (29.3%), co-trimoxazole (25.0%) and gentamicin (23.5%). Of S. aureus isolates, 23.3% were resistant to methicillin. Conclusions. CoNS accounted for two-thirds of the bacterial pathogens isolated. High-level resistance was seen to first-line and inexpensive antimicrobial agents. Routine screening for extended-spectrum beta-lactamase production and methicillin resistance among Gram-negative rods and S. aureus from blood cultures should be instituted to monitor spread of multidrug-resistant isolates

Optimisation of Water Loss Management Strategies: Multi-Criteria Decision Analysis Approaches

This research article published by the Journal of Mathematics and Informatics, 2020Water loss in the water distribution systems (WDS) is a challenge to many water authorities in the world but the problem is crucial in the less developed countries. The effect of water losses in the WDS includes the reduction in the revenue and availability of water, interruption in the quality of water, and inflation of the operation and maintenance cost of the water authorities. Using data from the Moshi Urban Water Supply and Sanitation Authority (MUWSA) Tanzania, an assessment of strategies used for water loss management (WLM) was carried out through an integrated model of Multi- Criteria Decision Making (MCDM) and Integer Linear Programming (ILP) which is an optimisation technique. The family of MCDM methods, Multi-Attribute Value Theory (MAVT), Simple Multi-Attribute Rating Technique Exploiting Ranks (SMARTER), and Simple Additive Weighting (SAW) were employed to assess and prioritise the strategies while the ILP was used to formulate a decision model. The model was used to select a portfolio of the best strategies. Sixteen strategies were identified. The results show that the comparison between the bulk meter and customers’ meter on detecting the physical or apparent losses was ranked as the best strategy in managing the loss while the network zoning was ranked as the worst strategy. The model selected thirteen out of sixteen strategies to form the portfolio of the best strategies to be employed by the MUWSA for water loss management. Furthermore, the model was found to be robust as the selected portfolio of strategies remained the same even when the weights of the criteria were changed. The developed model in this study will assist the decision-makers to assess, prioritise and choose the best strategies for reducing or controlling water loss in the distribution system

Surveillance of antimicrobial resistance at a tertiary hospital in Tanzania

BACKGROUND: Antimicrobial resistance is particularly harmful to infectious disease management in low-income countries since expensive second-line drugs are not readily available. The objective of this study was to implement and evaluate a computerized system for surveillance of antimicrobial resistance at a tertiary hospital in Tanzania. METHODS: A computerized surveillance system for antimicrobial susceptibility (WHONET) was implemented at the national referral hospital in Tanzania in 1998. The antimicrobial susceptibilities of all clinical bacterial isolates received during an 18 months' period were recorded and analyzed. RESULTS: The surveillance system was successfully implemented at the hospital. This activity increased the focus on antimicrobial resistance issues and on laboratory quality assurance issues. The study identified specific nosocomial problems in the hospital and led to the initiation of other prospective studies on prevalence and antimicrobial susceptibility of bacterial infections. Furthermore, the study provided useful data on antimicrobial patterns in bacterial isolates from the hospital. Gram-negative bacteria displayed high rates of resistance to common inexpensive antibiotics such as ampicillin, tetracycline and trimethoprim-sulfamethoxazole, leaving fluoroquinolones as the only reliable oral drugs against common Gram-negative bacilli. Gentamicin and third generation cephalosporins remain useful for parenteral therapy. CONCLUSION: The surveillance system is a low-cost tool to generate valuable information on antimicrobial resistance, which can be used to prepare locally applicable recommendations on antimicrobial use. The system pinpoints relevant nosocomial problems and can be used to efficiently plan further research. The surveillance system also functions as a quality assurance tool, bringing attention to methodological issues in identification and susceptibility testing