High Prevalence of Tuberculosis among Adults with Fever Admitted at a Tertiary Hospital in North-western Tanzania

Tuberculosis is a leading cause of death in developing countries where HIV is endemic. This hospital based study was done to estimate the magnitude of pulmonary and extra-pulmonary tuberculosis and to determine predictors of tuberculosis among febrile adults admitted at Bugando Medical Centre (BMC), Mwanza, Tanzania. A total of 346 adults febrile patients admitted in medical wards were studied. Sputum for AFB microscopy and chest X-rays was used to diagnose tuberculosis. Clinical features were collected using standardized data collection tool. HIV testing and CD4 counts were determined. Data were analyzed using STATA version 11 software. Of 346 febrile adults patients 116 (33.5%) were diagnosed to have tuberculosis; of which 79 (68.1%) and 37 (31.9%) had pulmonary tuberculosis (PTB) and extra-pulmonary tuberculosis, respectively. Smear negative PTB were more common in HIV positive than in HIV negative patients (50% vs. 18.5%, p=0.007). Extra-pulmonary tuberculosis was more common in HIV positive patients than pulmonary tuberculosis (86.4% vs. 13.6%), p=0.0001). On multivariate logistic regression analysis the predictors of tuberculosis were; age above 35 years (OR =2.38, p=0.007), cardinal symptoms (OR=37, p<0.0001), pleural effusion (OR=24, p=0.0001), and HIV status (OR =3.2, p=0.0001). Of 79 patients with PTB, 48 (60.7%) were AFB smear positive and 31(39.3%) were AFB smear negative. HIV patients with smear negative tuberculosis had significantly lower CD4 count than HIV patients with smear positive tuberculosis (63.5 cells/μl versus 111.5 cells/μl) [Mann- Whitney test p=0.0431]]. No different in mortality was observed between patients with TB and those without TB admitted in BMC medical wards (28.5% vs. 23.0%, p= 0.1318). Tuberculosis is the commonest cause of fever among adults patients admitted at BMC and is predicted by age above 35 years, positive HIV status, cardinal PTB symptoms, and pleural effusion. Routinely TB screening is highly recommended among adults with fever, cough, night sweating and wasting in countries where HIV is endemic.\u

Acute Renal Failure in a Caucasian Traveler with Severe\ud Malaria: A Case Report

Acute renal failure (ARF) secondary to severe malaria is uncommon. We report a case of a patient visiting Africa for the first time presenting with malaria and ARF. There was complete recovery after hemodialysis. Early initiation of hemodialysis proves to be useful in restoration of renal function

Challenges and outcomes of haemodialysis among patients presenting with kidney diseases in Dodoma, Tanzania

Abstract Background Kidney Diseases contribute a significant proportion to the global burden of non-communicable diseases. Haemodialysis services as the main modality of renal replacement therapy in most resource limited countries is only available in few cities and at higher costs. The aim of this study was to determine the challenges and outcomes of patients who were on haemodialysis at the University of Dodoma (UDOM) haemodialysis unit in Tanzania. Methods In this retrospective study; we reviewed haemodialysis registers and charts of 116 patients dialyzed from January 2013 to June 2015 at The UDOM haemodialysis unit. Data were descriptively and inferentially analysed using Stata version 11 software. Results Of the 116 patients, 52 (44.9%) were male, and 38(32.8%) were married. Their median age was 45 years. Thirty-two (27.6%) had acute kidney injury, of them 26 (81.3%) patients had recovery of renal function after haemodialysis. Indications for hemodialysis were anuria (18), intoxications (14), electrolyte imbalance (9), uraemia (7) infections (6) and fluid overload (4). Eighty-four (72.4%) patients had End Stage Renal Diseases (ESRD), of which 37 (44.1%) absconded/lost to follow up, 15 (17.9%) died, 22 (26.2%) were referred to Muhimbili National Hospital (MNH), 12 for possible kidney transplant abroad after haemodialysis, and 10 (11.9%) were still attending our unit for haemodialysis. Residing outside Dodoma was predictive for poor outcomes while on haemodialysis (OR 5.2, 95% CI 3.2–8.6, p < 0.001). In addition the odds ratio for poor outcomes was 7.3 times for a patient ESRD (OR7.34, 95% CI 3.26–18.17, p < 0.001). Patients who had no National Health Insurance Fund (NHIF) coverage (OR 6.6, 95% CI 5.4–12.7, p < 0.001) also had higher odds of poor outcomes after starting haemodialysis. Conclusion Unavailability and high costs related to utilization of haemodialysis services among patients needing dialysis are the challenges for better outcomes. Therefore, haemodialysis and renal transplants services should be made easily available in regional referral hospitals at reasonable costs. In addition, members of the public should be educated on joining health insurance schemes and on making healthy life style choices for preventing chronic kidney disease and its progression

Prevalence and Risk Factors Associated With Chronic Kidney Disease Among Patients Presenting at a Haemodialysis Unit in Dodoma, Tanzania

Background: Chronic kidney disease (CKD) is a major public health problem worldwide, due to its epidemic proportions and the associated cardiovascular morbidity and mortality. However, data on the burden of CKD among patients attending hospitals in Tanzania are still limited. The aim of this study was to determine the prevalence and risk factors associated with CKD among patients presenting at the University of Dodoma (UDOM) haemodialysis unit in Tanzania. &nbsp; Methods: In this retrospective study, we reviewed data of 1,395 patients who presented at the UDOM haemodialysis unit from January 2013 to June 2015. Data were descriptively and inferentially analysed using Stata version 11.0. &nbsp; Results: From January 2013 to June 2015, a total of 1,395 patients presented at the UDOM haemodialysis unit with history of kidney disease. Of these patients, 1244 (89.2%) enrolled into this study, 651 (52.3%) of them were female. Almost two-thirds (n=792, 63.7%) of the patients were found to have CKD, 59.1% with an estimated glomerular filtration rate of &lt;60 mL/min/1.73 m2. Among those who had CKD, 347 (43.8%) had hypertension, 241 (30.4%) had diabetic mellitus, 79 (10.0%) had chronic glomerulonephritis, 70 (8.8%) had hypertension and diabetes mellitus, 38 (4.8%) had HIV/AIDS, and 17 (2.1%) had hepatitis B. The median serum creatinine level was 222 μmol/L (interquartile range [IQR] 126 to 317), urea level was 14.5 mmol/L (IQR 5 to 24), hemoglobin was 11.0 g/dL (IQR 6.2 to 15.7), and body mass index was 27.1 kg/m2&nbsp;(IQR 17.3 to 36.8). Obesity, diabetes mellitus, and systolic hypertension were associated with developing CKD (P&lt;.001). A total of 116 patients received haemodialysis during the study period. &nbsp; Conclusion: CKD was common among patients presenting in our hospital and is associated with high cardiovascular risk. To that end, patients should be thoroughly evaluated to identify and correct causes of their kidney disease, and efforts should be put in place for early detection and screening as well as advocacy on risk factors for CKD development in Tanzania