Retired Nurses Can Improve Retention in Prevention of Mother-to-Child Transmission Programmes

Background: The success of prevention of mother-to-child transmission (PMTCT) programmes depends on retention of mothers throughout the PMTCT cascade.   Methods: In a clinical trial of short-course combination antiretroviral therapy (cART) for PMTCT in Tanzania, senior nurses were employed to reduce the substantial loss-to-follow up (LTFU) rate.   Results: Following intervention, the relative risk (RR) of receiving a CD4 count result and antiretroviral therapy was 1.16 (95% confidence interval [CI], 1.05 to 1.27), the RR of delivery at clinic was 2.51 (95% CI, 2.06 to 3.06), the RR for reporting for follow-up at 6 to 8 weeks postpartum was 4.63 (95% CI, 3.41 to 6.27), and the RR for being retained until 9 months postpartum was 28.19 (95% CI, 11.81 to 67.28). No significant impact on transmission was found.   Conclusion: Significantly higher retention was found after senior nurses were employed. No impact on transmission was found. Relatively low transmission was found in both study arms

Possible causes of fever among patients with blood smear negative for malaria parasites at Bombo Regional Referral Hospital in Tanga, Tanzania

Background: Due to its diverse and non‐specific clinical presentations, malaria has been associated with most infections causing febrile illnesses. Despite being non-specific, clinical diagnosis is still the main method of malaria diagnosis in most health facilities in sub-Saharan Africa. This study aimed to establish the probable diagnoses among fever cases admitted at Bombo Hospital in north-eastern Tanzania.Methods: This study involved patients admitted in Medical and Paediatric wards with a clinical diagnosis of severe malaria but having negative blood smears (BS) for malaria parasites. Finger prick blood specimens were collected for blood smear microscopy and rapid diagnostic test. Blood and urine cultures were done for all specimens collected.  Some patients were also screened for HIV infection.Results: A total of 227 patients were recruited and the majority (62.1%) were under-five children. Out of the 227 blood specimens cultured, 25 (11.0%) grew different bacteria species. Staphylococcus aureus was the most frequent pathogen (68.0%), followed by S. pneumoniae (24.0%), Salmonella species (4.0%) and Streptococcus pyogenes (4.0%).  Only 7 (3.2%) out of 219 urine specimens cultured showed growth of Escherichia coli, Pseudomonas aeruginosa, S. aureus and Klebsiella pneumoniae. Of the 215 patients screened for HIV, 17 (7.9%) had positive reaction.Conclusion: The findings indicate that S. aureus and S. pneumoniae as the commonest bacteria isolates from blood and P. aeruginosa, S. aureus and K. pneumoniae from urine cultures. These bacteria and HIV should be considered as important contributors to febrile illness cases among patients found with negative BS for malaria parasites

Addressing the fear and consequences of stigmatization - a necessary step towards making HAART accessible to women in Tanzania: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Highly Active Antiretroviral Therapy (HAART) has been available free of charge in Tanga, Tanzania since 2005. However we have found that a high percentage of women referred from prevention of mother-to-child transmission services to the Care and Treatment Clinics (CTC) for HAART never registered at the CTCs. Few studies have focused on the motivating and deterring factors to presenting for HAART particularly in relation to women. This study seeks to remedy this gap in knowledge.</p> <p>Methodology</p> <p>A qualitative approach using in-depth interviews and focus group discussions was chosen to understand these issues as perceived and interpreted by HIV infected women themselves.</p> <p>Results</p> <p>The main deterrent to presenting for treatment appears to be fear of stigmatization including fear of ostracism from the community, divorce and financial distress. Participants indicated that individual counselling and interaction with other people living with HIV encourages women, who are disinclined to present for HAART, to do so, and that placing the entrance to the CTC so as to provide discrete access increases the accessibility of the clinic.</p> <p>Conclusion</p> <p>Combating stigma in the community, although it is essential, will take time. Therefore necessary steps towards encouraging HIV infected women to seek treatment include reducing self-stigma, assisting them to form empowering relationships and to gain financial independence and emphasis by example of the beneficial effect of treatment for themselves and for their children. Furthermore ensuring a discrete location of the CTC can increase its perceived accessibility.</p

Early Infant Diagnosis of HIV in Three Regions in Tanzania; Successes and Challenges.

By the end of 2009 an estimated 2.5 million children worldwide were living with HIV-1, mostly as a consequence of vertical transmission, and more than 90% of these children live in sub-Saharan Africa. In 2008 the World Health Organization (WHO), recommended early initiation of Highly Active Antiretroviral Therapy (HAART) to all HIV infected infants diagnosed within the first year of life, and since 2010, within the first two years of life, irrespective of CD4 count or WHO clinical stage. The study aims were to describe implementation of EID programs in three Tanzanian regions with differences in HIV prevalences and logistical set-up with regard to HIV DNA testing. Data were obtained by review of the prevention from mother to child transmission of HIV (PMTCT) registers from 2009-2011 at the Reproductive and Child Health Clinics (RCH) and from the databases from the Care and Treatment Clinics (CTC) in all the three regions; Kilimanjaro, Mbeya and Tanga. Statistical tests used were Poisson regression model and rank sum test. During the period of 2009 - 2011 a total of 4,860 exposed infants were registered from the reviewed sites, of whom 4,292 (88.3%) were screened for HIV infection. Overall proportion of tested infants in the three regions increased from 77.2% in 2009 to 97.8% in 2011. A total of 452 (10.5%) were found to be HIV infected (judged by the result of the first test). The prevalence of HIV infection among infants was higher in Mbeya when compared to Kilimanjaro region RR = 1.872 (95%CI = 1.408 - 2.543) p < 0.001. However sample turnaround time was significantly shorter in both Mbeya (2.7 weeks) and Tanga (5.0 weeks) as compared to Kilimanjaro (7.0 weeks), p=<0.001. A substantial of loss to follow-up (LTFU) was evident at all stages of EID services in the period of 2009 to 2011. Among the infants who were receiving treatment, 61% were found to be LFTU during the review period. The study showed an increase in testing of HIV exposed infants within the three years, there is large variations of HIV prevalence among the regions. Challenges like; sample turnaround time and LTFU must be overcome before this can translate into the intended goal of early initiation of lifelong lifesaving antiretroviral therapy for the infants

Patterns and trends of in-hospital mortality due to non-communicable diseases and injuries in Tanzania, 2006-2015.

BackgroundGlobally, non-communicable diseases (NCD) kill about 40 million people annually, with about three-quarters of the deaths occurring in low- and middle-income countries. This study was carried out to determine the patterns, trends, and causes of in-hospital non-communicable disease (NCD) and injury deaths in Tanzania from 2006-2015.MethodsThis retrospective study involved primary, secondary, tertiary, and specialized hospitals. Death statistics were extracted from inpatient department registers, death registers, and International Classification of Diseases (ICD) report forms. The ICD-10 coding system was used to assign each death to its underlying cause. The analysis determined leading causes by age, sex, annual trend and calculate hospital-based mortality rates.ResultsThirty-nine hospitals were involved in this study. A total of 247,976 deaths (all causes) were reported during the 10-year period. Of the total deaths, 67,711 (27.3%) were due to NCD and injuries. The most (53.4%) affected age group was 15-59 years. Cardio-circulatory diseases (31.9%), cancers (18.6%), chronic respiratory diseases (18.4%), and injuries (17.9%) accounted for the largest proportion (86.8%) of NCD and injuries deaths. The overall 10-year hospital-based age-standardized mortality rate (ASMR) for all NCDs and injuries was 559.9 per 100,000 population. It was higher for males (638.8/100,000) than for females (444.6/100,000). The hospital-based annual ASMR significantly increased from 11.0 in 2006 to 62.8 per 100,000 populations in 2015.ConclusionsThere was a substantial increase in hospital-based ASMR due to NCDs and injuries in Tanzania from 2006 to 2015. Most of the deaths affected the productive young adult group. This burden indicates that families, communities, and the nation at large suffer from premature deaths. The government of Tanzania should invest in early detection and timely management of NCDs and injuries to reduce premature deaths. This should go hand-in-hand with continuous efforts to improve the quality of health data and its utilization

Malaria among rice farming communities in Kilangali village, Kilosa district, Central Tanzania: prevalence, intensity and associated factors

Abstract Background Malaria remains the most important cause of morbidity and mortality in Tanzania. However, its prevalence varies from area to area depending on various ecological, socio-economic and health system factors. This study was carried out to determine malaria prevalence and associated factors among rice farming communities in the Kilangali village of Kilosa District in Central Tanzania. Methods A cross-sectional study was conducted in May 2015, involving randomly selected persons living in the six sub-villages of the Kilangali village, namely Mlegeni, Kisiwani, Makuruwili, Kwamtunga, Upogoroni and Chamwino. A finger prick blood sample was obtained for diagnosis of malaria infection using Giemsa-stained thick smears and a rapid malaria diagnostic test. Study participants were also screened for haemoglobin levels and a total of 570 children aged ≤ 12 years of age were examined for spleen enlargement using the palpation method. Results A total of 1154 persons were examined for malaria infection with mean age of 21.9 ± 19.69 years. The overall malaria prevalence was 14.2% and 17.5% based on microscopic examination and rapid diagnostic test, respectively. Plasmodium falciparum accounted for the majority (89%) of the malaria infections. The overall geometrical mean parasite density was 20.5 parasites/μL (95% CI: 14.6–28.8). Malaria prevalence and parasitaemia was highest among individuals living in the Mlegeni (23.9%) and Makuruwili (24.4%) sub-villages. Among the children examined for splenomegaly, 2.98% (17/570) had it. The overall prevalence of anaemia was 34.6%. Malaria infection was associated with the age groups of 1–10 years (aOR = 4.41, 95% CI: 1.96–9.93, P < 0.001) and 11–20 years (aOR = 6.68, 95% CI: 2.91–15.37, P < 0.001); and mild anaemia (aOR = 1.71, 95% CI: 1.11–2.62, P < 0.014) and moderate anaemia (aOR = 1.55, 95% CI: 1.01–2.39, P < 0.045). Conclusions Malaria was found at the study setting and its prevalence varied according to the demographic characteristics of the study participants and between sub-villages that are closely located

High Prevalence of Sexually Transmitted and Reproductive Tract Infections (STI/RTIs) among Patients Attending STI/Outpatient Department Clinics in Tanzania

We determined the prevalence and reported risk factors associated with sexually transmitted and reproductive tract infections (STI/RTIs) among patients who presented with genital symptoms in STI/outpatient department (OPD) clinics in two regional referral hospitals and six health centres in six regions in Tanzania. Methods: The patients were consecutively recruited, and the data collection was conducted in eight health care facilities from 2014 to 2016. Genital swabs were collected for the detection of the aetiological pathogens of STI/RTIs. Results: A total of 1243 participants were recruited in the study; the majority (1073, 86%) were women. The overall median age was 27.8. The prevalence of Neisseria gonorrhoeae was 25.7% (319/1243), with proportions of 50.9 and 21.5% for men and women, respectively, of Chlamydia trachomatis 12.9% (160/1241) and Mycoplasma genitalium 4.7% (53/1134). Unmarried men were more often likely to be infected with gonococcal infections as compared to their women counterparts (57.9 vs. 24.1%) p p = 0.01), but those reported to the regional referral hospitals were more likely to be infected with N. gonorrhoeae (OR = 2.5) and C. trachomatis (OR = 2.1) than those from the health centres (p p = 0.03), though VC was strongly inversely associated with an N. gonorrhoeae infection (p N. gonorrhoeae (51.1%) and C. trachomatis (23.3%) were found in the Dodoma and Dar es Salaam regions, respectively. M. genitalium (7.6%) was found to be the highest in Mwanza. Conclusion: We reported a high prevalence of STI/RTIs. The findings suggest that these infections are common and prevalent in STI/OPD clinics in six regions of Tanzania. We recommend surveillance to be conducted regularly to elucidate the true burden of emerging and classical STI/RTIs by employing modern and advanced laboratory techniques for the detection and monitoring of STI/RTIs in low- and high-risk populations, including the community settings

Antimicrobial Susceptibility Testing Patterns of <i>Neisseria gonorrhoeae</i> from Patients Attending Sexually Transmitted Infections Clinics in Six Regions in Tanzania

Antimicrobial resistance (AMR) is global health threat that is on the increase, and it has been adversely affecting the proper management of sexually transmitted infections (STI). Data on antimicrobial susceptibility testing patterns of N. gonorrhoeae are limited in local settings. We determined in vitro antimicrobial susceptibility and phenotypic profiles of N. gonorrhoeae isolated from STI/Outpatient Department (OPD) clinics. Minimum Inhibitory Concentrations (MIC) (µg/mL) were determined using E-Test and agar dilution methods for previously and currently recommended antimicrobial agents. A total of 164 N. gonorrhoeae isolates from urethral discharge and endocervical swabs were tested. The prevalence of resistant N. gonorrhoeae to tetracycline, norfloxacin, penicillin and ciprofloxacin were 98.6%, 82.2%, 84.3% and 75.6%, respectively. None of the isolates was resistant to kanamycin. Penicillinase producing N. gonorrhoeae (PPNG) was found to be 73.7%, with 56.7% and 43.3% observed among isolates from women and men, respectively. Tetracycline resistant-N. gonorrhoeae (TRNG) was found to be 34.0%, and QRNG with HLR to ciprofloxacin was 79.9%. The overall MDR-NG was 79.9%, and XDR-NG was 3.6%. MIC50 and MIC90 were 4.0 and 8.0 and 2.0 and 4.0 µg/mL for ciprofloxacin and norfloxacin, respectively. Dendrograms showed that 44 phenotypic groups are associated with a high rate of AMR among high MDR-NG and moderate XDR-NG isolates. The predominant groups of quinolone-resistant N. gonorrhoeae (QRNG)+PPNG (34.7%) and QRNG+PPNG+TRNG (32.9%) were observed among the isolates having HLR to ciprofloxacin. We reported a high prevalence of AMR (>90%) to previously recommended antimicrobials used for the treatment of gonorrhoea. Multidrug resistant N. gonorrhoeae (MDR-NG) was highly reported, and extensively drug resistant (XDR-NG) has gradually increased to the currently recommended cephalosporins including ceftriaxone and cefixime. Heterogeneous groups of QRNG+PPNG+ and QRNG+PPNG+TRNG were highly resistant to penicillin, tetracycline, ciprofloxacin and norfloxacin. A surveillance program is imperative in the country to curb the spread of AMR

High cure rates and tolerability of artesunate–amodiaquine and dihydroartemisinin–piperaquine for the treatment of uncomplicated falciparum malaria in Kibaha and Kigoma, Tanzania

Abstract Background The Tanzanian National Malaria Control Programme (NMCP) and its partners have been implementing regular therapeutic efficacy studies (TES) to monitor the performance of different drugs used or with potential use in Tanzania. However, most of the recent TES focused on artemether–lumefantrine, which is the first-line anti-malarial for the treatment of uncomplicated falciparum malaria. Data on the performance of other artemisinin-based combinations is urgently needed to support timely review and changes of treatment guidelines in case of drug resistance to the current regimen. This study was conducted at two NMCP sentinel sites (Kibaha, Pwani and Ujiji, Kigoma) to assess the efficacy and safety of artesunate–amodiaquine (ASAQ) and dihydroartemisinin–piperaquine (DP), which are the current alternative artemisinin-based combinations in Tanzania. Methods This was a single-arm prospective evaluation of the clinical and parasitological responses of ASAQ and DP for directly observed treatment of uncomplicated falciparum malaria. Children aged 6 months to 10 years and meeting the inclusion criteria were enrolled and treated with either ASAQ or DP. In each site, patients were enrolled sequentially; thus, enrolment of patients for the assessment of one artemisinin-based combination was completed before patients were recruited for assessment of the second drugs. Follow-up was done for 28 or 42 days for ASAQ and DP, respectively. The primary outcome was PCR corrected cure rates while the secondary outcome was occurrence of adverse events (AEs) or serious adverse events (SAEs). Results Of the 724 patients screened at both sites, 333 (46.0%) were enrolled and 326 (97.9%) either completed the 28/42 days of follow-up, or attained any of the treatment outcomes. PCR uncorrected adequate clinical and parasitological response (ACPR) for DP on day 42 was 98.8% and 75.9% at Kibaha and Ujiji, respectively. After PCR correction, DP’s ACPR was 100% at both sites. For ASAQ, no parasite recurrence occurred giving 100% ACPR on day 28. Only one patient in the DP arm (1.1%) from Ujiji had parasites on day 3. Of the patients recruited (n = 333), 175 (52.6%) had AEs with 223 episodes (at both sites) in the two treatment groups. There was no SAE and the commonly reported AE episodes (with > 5%) included, cough, running nose, abdominal pain, diarrhoea and fever. Conclusion Both artemisinin-based combinations had high cure rates with PCR corrected ACPR of 100%. The two drugs had adequate safety with no SAE and all AEs were mild, and not associated with the anti-malarials. Continued TES is critical to monitor the performance of nationally recommended artemisinin-based combination therapy and supporting evidence-based review of malaria treatment policies. Trial registration This study is registered at ClinicalTrials.gov, No. NCT0343171