Prevalence and risk factors for vaginal candidiasis among women seeking primary care for genital infections in Dar es Salaam, Tanzania

Objective: To determine the prevalence and risk factors for vaginal candidiasis (VC) among women seeking primary care for genital infections. Design: Cross-sectional study. Setting: Ilala Municipal Hospital in Dar es Salaam, Tanzania. Subjects: Four hundred and sixty four women presenting with complaints of genital infections. Results: Of the 464 women examined, 177 (38.1%) had abnormal vaginal discharge, 68(14.7%) had genital ulcers, 272 (58.6%) had genital pruritis, 18 (3.9%) had genital warts and 58 (12.5%) had chancre. The prevalencies of VC, bacterial vaginosis, HIV, T vaginalis, N. gonorrhoeae and syphilis were 45%, 48.4%, 22%, 93%, 1.5% and 4.3%, respectively. The occurrence of VC was positively associated with HIV, (OR=1.81, 95% CI (1.0-2.67), bacterial vaginosis; (OR=2.6, 95%CI (1.7-3.9), genital pruritis; (OR=1.8 1, 95%CI (1.2- 2.7) genital discharge; (OR=1.867, 95% (1.28-2.73) and negatively with T. vaginalis (OR=0.27, 95% CI (0.12 - 0.6), occupation (OR=0.65, 95%CI (0.35-0.86)) and with education (OR=0.43, 95% CI (0.11-0.73). There were increased but non-significant odds for VC in patients with syphilis (OR=1.6 95%CI (0.6-4.3) and venereal warts (OR=2.5 95% CI (0.92-6.8) VC was not associated with N. gonorrhoeae, genital ulcers, age at first intercourse, number of sexual partners, marital status or antibiotic usage. Conculsion: The high prevalence of vaginal candidiasis among women with genital infections should be taken into account when updating policies concerning syndromic management of sexually transmitted diseases. More gender specific approach to syndromic management of sexually transmitted infections in females should be considered. East African Medical Journal Vol.82(3) 2005: 139-14

Pediatric HIV care and treatment services in Tanzania: implications for survival.

BACKGROUND: Improving child survival for HIV-infected children remains an important health agenda. We present progress regarding care and treatment services to HIV infected children in Tanzania. METHODS: The National AIDS Control Programme Care and Treatment (CTC 2) database was used to obtain information of all children aged 0-14yearsenrolled in the HIV Care and Treatment Program between January 2011 and December 2014. We assessed eligibility for ART, time from enrolment to ART initiation, nutritional status, and mortality using Kaplan-Meier methods. RESULTS: A total of 29,531 (14,304 boys and 15,227 girls) ART-naive children aged 0-14 years were enrolled during the period, approximately 6700 to 8000 children per year. The male to female ratio was 48:50. At enrolment 72% were eligible for ART, 2-3% of children were positive for TB, and 2-4% were severely malnourished. Between 2011 and 2014, 2368 (8%) died, 9243 (31%) were Lost to Follow-up and 17,920 (61%) were on care or ART. The probability of death was 31% (95% CI 26-35), 43% (40-47), 52% (49-55) and 61% (58-64) by 1,2, 5 and 10 years of age, respectively. The hazard of death was greatest at very young ages (<2 years old), and decreased sharply by 4 years old. Children who were on ART had around 10-15% higher survival over time. CONCLUSIONS: Significant progress has been made regarding provision of paediatric HIV care and treatment in Tanzania. On average 7000 children are enrolled annually, and that approximately two thirds of children diagnosed under the age of 2 years were initiated on ART within a month. Provision of ART as soon as the child is diagnosed is the biggest factor in improving survival. However we noted that i) most children had advanced disease at the time of enrolment ii) approximately two-thirds of children were missing a baseline CD4 measurement and only 35% of children had either a CD4 count or percentage recorded, indicating limited access to CD4 testing services, and iii) 31% were lost to follow-up (LTFU). These challenges need to be addressed to improve early detection, enrolment and retention of HIV-infected children into care and improve documentation of services offered

Saliva as epidemiological tool for HIV surveillance in developing countries

Isolation of the human immunodeficiency virus (HIV) as saliva collected from HIV infected individuals and AIDS patients is sporadic, even with highly sensitive methods such as the polmerase chain reaction (PCR), and. has therefore a low utility in detecting HIV infection. On the other hand, IgG HIV antibodies persist in saliva after infection with the virus, and studies have shown a complete agreement between saliva and serum antibody testing in diagnosis of HIV infection. The same ELISA and Western blot (WB) kits used for testing sera can be used, with slight modifications, to screen and confirm HIV infection respectively. Thus confirmatory testing of blood samples should no longer be considered essential when HIV antibody is detected in saliva. The use of saliva for ariti-HIV screening appears to be attractive since specimen collection is simple, rapid, safe,. cheap and has better compliance compared with blood testing. Thus, saliva is recommended as an effective alternative to serum for mv surveillance programmes in developing countries

Cervico-facial necrotising fasciitis occurring with facial paralysis: case report

Necrotising fasciitis is a soft tissue infection, usually polymicrobial, characterised by necrosis of fascia and subcutaneous tissue. It frequently involves the groin, abdomen and extremities, but rarely involves the cemco-facial region. A case is presented of a 70-year old man who, following a futile attempt to extract a lower left first molar, developed a cervico-facial necrotising fasciitis with facial nerve paralysis. Bacteriological investigations revealed the presence of Klebsiella spp and viridans streptococci. It is emphasised that early detection of this disease followed by aggressive surgical debridement and antibiotic therapy are most important

Patients' satisfaction with dental care provided by public dental clinics in Dar es Salaam, Tanzania

Background: In Tanzania, patient satisfaction with dental services has received only minor attention.Objective: To assess patients' satisfaction with public dental health services in Dar es Salaam. Design: A cross-sectional study. Setting: Five public dental clinics randomly selected from a list of all the nine public dental clinics in Dar es Salaam.Subjects: Five hundred and sixteen consecutive patients, 193 males and 323 females aged between 12 and 77 years who, during the study period between July and November, 2002 were attending five dental clinics were randomly selected. Results: No significant differences in patients' satisfaction level (overall or for the specific studied items) were found in all the five public dental clinics. The answers to the specific sub-items, apart from time spent with doctor, were around the average with very few responses with a high ranking. Conclusions: Findings indicate a moderate level of patient satisfaction with dental care offered in public dental clinics in Dar es Salaam. Areas identified as needing improvement included; technical quality of care, interpersonal aspects and communication. East African Medical Journal Vol. 83(4) 2006: 98-10

Identification of Candida strains isolated from Tanzanian pregnant women with vaginal candidiasis

Objective: To identify Candida strains isolated from Tanzanian women (13 to 45 years) with vaginal candidiasis. Design: A cross-sectional study. Setting: Antenatal clinic in llala district hospital in Dar es Salaam, Tanzania from March 1998 to December 2000. Results: The identities of the 272 isolates tested with API Candida were: Candida albicans 180(66.2%), Candida tropicalis 13(4.7%), Candida glabrata 20(7.35%), Candida famata 6(2.2%), Candida parapsilosis 6 (2.2%) and Candida lusitaniae one (0.37%). API Candida could not speciate 43 (15.8%) isolates of these; two (0.7%) fell between C. albicans and C. tropicalis, 17(6.25%) C. Iusitaniael, C. guilliermondii/C. famata, 14(5.15%) C. krusei, C. inconspicua, and C. norvegensis and nine (3.3%) either C. parapsilosis, C. krusei, C. incospicua or Geotrichum spp. Four (1.5%) isolates had an assimilation pattern of Trichosporo spp, but were all germ tube positive and had morphological features on cornemeal agar that were consistent with C. albicans. API 20C AUX was used for testing 29 isolates and results showed: 11/29 (37.9%) C. albicans, 1/29 (3.4%) C. tropicalis, 4/29 (13.8%) C. glabrata, 1/29 (3.4%) C. parapsilosis, 1/29 (3.4%) C. famata, 1/29 (3.4%) C. lusitaniae, 1/29 (3.4%) C. colliculosa/C. magnoliae, 5/29(17.2%) C. albicans/ C. tropicals 2/29 (6.8%) C. norvegensis/C. parapsilosis, and 2/29(6.8%) C. kruseil/C. inconspicua. Results of 20 isolates identified by Randomly Amplified Polymorphic DNA (RAPID) technique showed a 95% agreement with API Candida and a 100% agreement with API 20C AUX. Conclusion: Although most (66.3%) of the species isolated from Dar es Salaam women with vaginal candidiasis were C. albicans, a considerable percentage (33.7%) were nonalbicans, mainly C. glabrata, C. krusei and C. tropicalis. The high prevalence of non-albicans Candida spp observed in this population may have therapeutic implications.East African Medical Journal Vol. 82(5) 2005: 226-23

Clinical predictors of HIV-1 infection among preschool children in Dar Es Salaam, Tanzania

Seroprevalence of HIV-1 infection was determined in children aged between eighteen months and five years, attending maternal and child health (MCH) clinics in Dar es Salaam, Tanzania. A total of 889 children were eligible for the study, however seven children could not be enrolled because their mothers/guardians absconded and blood could not be drawn from 21 children due to refusal of mothers/guardians and from another 12 children due to technical reasons. Therefore, the participation rate was 95.5%. Of the 849 children screened, 14 (1.65%) were found to have IgG anti HIV-1 antibodies in their sera. The main clinical features found in children with symptomatic HIV-1 disease were weight loss, generalized lymphadenopathy, recurrent fevers, and prolonged diarrhoea. The utility of clinical features suggestive of HIV-1 infection (according to CDC classification) in identifying HIV-1 infection in children was evaluated and found to have high sensitivity (100%), specificity (96.9%) and negative predictive value (100%), but a low positive predictive value (35%). Marked variations in progression to symptomatic phase were noted, whereby some relatively young children had progressed to symptomatic phase (CDC class P-2A), while some older children were still in the asymptomatic stage (CDC class P-1 C). None of the symptomatic HIV-1 infected children presented with neurological disease, severe opportunistic infections, or malignancies. Although reduced mid-upper arm circumference and weight-for-age were associated with HIV seropositivity, these clinical parameters had low positive predictive values compared to the CDC classification. | Serologic testing of 849 children 18 months-5 years of age attending the Lugalo and Mwananyamala maternal-child health clinics in Dar es Salaam, Tanzania, during May-August 1994 identified 14 cases (1.65%) of HIV infection. The sample represented 95.5% of children making mandatory monthly clinic visits during the 3-month study period. The main clinical symptoms in HIV-infected children were weight loss, generalized lymphadenopathy, recurrent fever, and prolonged diarrhea, all included in the Centers for Disease Control and Prevention (CDC) classification scheme. Children with symptomatic HIV infection were younger than those with asymptomatic infection. None of the children with symptomatic HIV infection presented with neurologic impairment, severe opportunistic infections, or cancers. The clinical features included in the CDC classification for HIV had a 100% sensitivity, a 96.9% specificity, and a 100% negative predictive value, but the positive predictive value was only 35%. Although the model with the best fit included mid-upper arm circumference less than 14 cm and a reduced weight-for-age (odds ratios, 3.8 and 1.9, respectively), the positive predictive values for these two factors were only 4.3% and 4.1%, respectively. The 1.65% HIV seroprevalence rate recorded in this community-based study is lower than the 2.4% rate estimated among newborns in Dar es Salaam, presumably because of high infant mortality and hospitalization among HIV-infected newborns. Use of a simplified version of the CDC classification of HIV infection in children is recommended for routine clinical use in Tanzania.link_to_subscribed_fulltex

Detection of anti-HIV-1 IgG antibodies in whole saliva by Gacelisa and Western Blot assays

The present study, based on 158 HIV seropositives and 167 HIV seronegatives, demonstrates that saliva collected with the Omni-SAL™device and tested with GACELISA (an IgG antibody capture ELISA) is an effective non-invasive alternative to serum for anti-HIV IgG antibody screening. The study also shows that a conventional serum Western blot kit can be used, with slight modifications, for confirmatory testing of saliva specimens. Collecting saliva with the Omni-SAL™ device had a very good acceptance rate among Tanzanian subjects, and although this diagnostic method is not yet known by the general public, 65% of the study participants preferred to give saliva instead of blood for HIV testing.link_to_subscribed_fulltex

Detection of anti-HIV-1 IgG antibodies in whole saliva by gacelisa and western blot assays.

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