Magnitude and factors associated with injection site infections among underfives in a district hospital, northern Tanzania

Injections are among the major procedures in health care facilities which need to be handled under sterile conditions. Unsafe injections have been found to cause deaths due to its associated complications.  The burden of injection site infections is unknown in Tanzania. This study was designed to determine the burden of injection site infections and factors associated to it among underfives in a district hospital, northern Tanzania. This cross-sectional hospital-based study was conducted at Huruma Hospital in Rombo District, northern Tanzania from November to December 2013. This study included children of less than five years attending reproductive child health clinic for the routine immunization. Demographic data and clinical information were collected using pre-tested self-administered questionnaires, with both closed and open ended questions. A total of 200 underfives attending clinics for vaccination were recruited. Majority (n=125, 62.5%) were males. Out of 200 underfives, 60 (30%) were infants. Injection site infections were observed in 18 (9%, 95% CI: 5-12.9) of children; of whom 13 (72.2%) were females. Factors associated with injection site infections were female sex (OR 5.03, 95% CI; 1.58-18.71, P=0.001), severe malnutrition (OR 90, 95% CI; 9.5-398, p<0.001) and HIV infection (OR 21.5, 95% CI; 4.27-114.19, p<0.001). In conclusion, injection site infection rate is relatively high in this hospital and was associated with female sex, malnutrition and positive HIV status.  Proper care and follow up should be instituted when injections are given to this high risk group of underfives. 

Predictors of esophageal candidiasis among patients attending endoscopy unit in a tertiary hospital, Tanzania: a retrospective cross-sectional study

Background: Esophageal candidiasis is a common disease among patients with impaired cell mediated immunity. In the current study, we report esophageal candidiasis among patients with various co-morbidities attending the endoscopic unit at the Bugando Medical Centre.Methods: This retrospective study was conducted from June to September 2015. All data of the patients who attended the endoscopic unit between 2009 and 2014 were retrieved and analyzed.Results: A total of 622 patients who underwent oesophagogastroduodenoscopy were analyzed. A slight majority 334/622(53.7%) of patients were female. Out of 622 patients; 35(5.6%) had esophageal candidiasis. Decrease in age (OR 1.1, 95%CI; 1.0-1.1), female sex (OR 3.8, 95%CI; 1.1-13.1), drinking alcohol (OR 17.1, 95%CI; 4.9-58.9), smoking (OR 8.3, 95%CI; 1.7-41.0), antibiotic use (OR 5.7, 95%CI; 2.0-16.4), positive HIV status (OR 10.3, 95%CI; 4.6-6.0) and presence of peptic ulcer disease (OR 13.2, 95%CI; 3.5-49.0) independently predicted esophageal candidiasis.Conclusion: Patients with a history of drinking alcohol, smoking, use of antibiotics and those with chronic diseases such as peptic ulcers were at high risk of developing esophageal candidiasis. Further studies are needed to identify Candida spp. and their anti-fungal susceptibility for proper management of esophageal candidiasis in HIV and non-HIV individuals.Keywords: Esophagogastroduodenoscopy, esophageal candidiasis

Letter to the editor 2: Predictors of oesophageal candidiasis in persons with or without HIV infection

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Prevalence and Predictors of Dermatophyte Infections Among Primary School Children in Ilemela, Mwanza, Tanzania

Background: Dermatophytes are highly contagious organisms of public health importance, particularly among primary school children in the resource-limited settings with a prevalence of 10% to 20% in East Africa. Here, we report the prevalence and associated factors of dermatophyte infections among primary school children in Ilemela, Mwanza - Tanzania.   Methods: A cross-sectional study was conducted involving 323 children aged between 4 and 10 years from 10 randomly selected primary schools. The study was conducted between July 2017 and September 2017. Pretested interviewer-administered semi-structured questionnaire was used to collect relevant social-demographic information followed by clinical examination to establish the diagnosis of dermatophyte infections. Data were analysed using Stata version 13.   Results: The mean age of the study participants was 7.63±1.27 years, with the slightl majority (n=183, 56.7%) of participants being girls. The majority (n=277, 70.3%) of the study participants were from public schools. A total of 299 (92.6%) children reported using tap water at home. Using clinical diagnosis, 94 (29.1%) children had dermatophyte infections with 92 (97.9%) of them having tinea capitis. By multivariate logistic regression analysis: being a boy (odds ratio [OR] 1.98; 95% confidence interval [CI], 1.22 to 3.22; P=.01); using lake, river, or well water (OR 3.18; 95% CI, 1.36 to 7.38; P<.01); playing in a dusty environment (OR 2.65; 95% CI, 1.28 to 5.47; P<.01); playing with animals (OR 2.13; 95% CI, 1.28 to 3.56; P<.003); and having family members with dermatophyte infections (OR 10.56; 95% CI, 4.57 to 24.41; P<.001) predicted dermatophyte infections.   Conclusion: The prevalence of dermatophyte infection is high in the study population and is associated with poor hygiene. Improved hygiene will reduce the prevalence of dermatophyte infections among primary school children in low-income countries. Further studies to identify the species and susceptibility patterns of these dermatophytes are recommended to establish empirical treatment guidelines

Clinical presentation and precipitating factors of diabetic ketoacidosis among patients admitted to intensive care unit at a tertiary hospital in Mwanza, Tanzania

Background: Diabetic ketoacidosis (DKA), one of the common emergencies in patient with diabetes mellitus is associated with considerable morbidity and mortality.  This study aimed to determine clinical presentation and precipitating factors of DKA among patients admitted at Bugando Medical Centre (BMC) in north-western Tanzania.Methods: This study involved a retrospective review of hospital records of DKA patients admitted to intensive care unit at BMC during 2012. Data on demographics, precipitating factors, clinical presentation, duration of hospital admission and mortality were extracted and analysed.Results: Total records of 1,906 hospitalized patients in 2012 were reviewed. Of this, 29 (1.5%) had DKA. Of the 29 DKA patients, 18(62.1%) and 11 (37.9%) were males and females, respectively. Among them 21(72.4%) were known diabetics and 8(27.6%) were newly diagnosed to be diabetics. Twelve patients (41.1%) presented with polyuria, polydipsia and general body malaise. Eleven (37.9%) patients presented with loss of consciousness while 6(20.7%), 4(13.8%), 3(10.3%) and 1(3.4%) presented with vomiting, abdominal pain, Kussmaul’s breathing and coma, respectively. Nausea, weight loss and polyphagia each were presented by 2(6.9%) patients. The precipitating factors were infection 15 (51.7%), first presentation of diabetes mellitus 6 (20.7%), missed insulin injection 6 (20.7%) and co-morbid conditions 6 (20.7%). Four (13.8%), 1 (3.45%) and 1(3.45%) had stroke, chronic renal failure and hypertension, respectively. Among the DKA patients, 22 (75.9%) improved and were discharged, and 7 (24.1%) died.Conclusion: DKA occurred in about 1.5% of the patients admitted to ICU and it was a major cause of morbidity and mortality. The main precipitating factor was infection. Since the precipitating factors are preventable, health care providers should put emphasis in educating diabetic patients at the diabetes clinic to reduce morbidity and mortality in these patients

Prevalence and factor associated with over-the-counter use of antifungal agents’, in Mwanza City, Tanzania

Background: Misuse of antifungal both in clinics and agriculture has been associated with the increased trend of antifungal resistance. In Tanzania, there is limited information regarding the magnitude of antifungal obtained over the counter therefore this study was performed to determine the extent of over the counter (OTC) antifungal use and factors associated to it. Methods:  This was a cross sectional study involving patients buying antifungal agents from community pharmacies between May and July 2015 in Mwanza city, Tanzania. Data were collected by the investigator using interview guided questionnaire and analyzed using STATA version 11.Results: A total of 270 patients were enrolled and interviewed. The mean age was 30 years±12.  Majority of patients (59.6%) were female.   Out of 270 patients, 188(69.3%) had dermatophytes. A total of 150(55.6%, 95%CI 49.6-61) obtained antifungal OTC.  Of 150 patients received antifungal agents OTC, 64(42.3%) received more than one antifungal compared to only 11/120 (9.2%) of those with prescription p<0.001. Clotrimazole was the commonly prescribed antifungal while fluconazole was mostly obtained OTC. On univariate analysis, increase in age was found to be associated with the tendency of obtaining antifungal over the counter (OR 1.03, 95% CI 1.008-1.05, P<0.006).  Having skin fungal infections was the only predictor of obtaining antifungal agents OTC (OR 3.36, 95% CI 2.34-4.81, P<0.001).Conclusion: In Mwanza City, patients receive multiple antifungal agents over the counter and the practice is significantly more for the patients with skin fungal infections. There is a need for the advocacy on appropriate antifungal use so that associated impact of resistance development can be reduce

Predominance of Multi-resistant Gram-negative Bacteria Colonizing Chronic Lower Limb Ulcers (CLLUs) at Bugando Medical Center.

Infections, trauma, malignances and poorly controlled diabetes are common causes of chronic lower limb ulcerations in developing countries. Infected wound with multi-drug resistant bacteria usually are associated with increased morbidity and mortality. We report the distribution of bacteria pathogens colonizing the chronic lower limb ulcers and their drug susceptibility pattern from Bugando Medical Centre (BMC) a tertiary hospital in Tanzania. Three hundred non-repetitive wound swabs were aseptically collected from 300 patients with chronic lower limb ulcers using sterile swabs and processed following standard operative procedures. Isolates were identified using in house biochemical testing and in case of ambiguous confirmation was done using API 20NE and API 20E. Susceptibility was determined using disc diffusion test following clinical laboratory standard Institute guidelines (CLSI). Of 300 swabs from patients with chronic lower limbs ulcers, 201 (67.7%) had positive aerobic culture within 48 hours of incubation. Of 201 isolates, 180(89.6%) were gram-negative bacteria. Out of 180 gram negative bacteria, resistance was detected for ampicillin (95%, n = 171), amoxicillin/clavulanate (83.9%, n = 151), trimethoprim-sulphamethoxazole (78.9%, n = 142), ceftriaxone (46.7%, n = 84), ceftazidime (45.6%, n = 82), gentamicin (39.4%, n = 71), ciprofloxacin (17.8%, n = 32) and meropenem 28(15.6%, n = 25). A total of 41 (35%) of enterobacteriaceae were found to be extended spectrum beta-lactamases (ESBL) producers while of 18 Staphylococcus aureus, 8(44.4%) were found to be methicillin resistant Staphylococcus aureus (MRSA). There is high prevalence of ESBL and MRSA isolates in surgical wards at BMC. We recommend infection control and antibiotic stewardship programs in these wards to minimize spread of multi-resistant organisms

Asymptomatic malaria and associated factors among blood donors in Mwanza, Tanzania

Background: Blood transfusion saves life of patients with severe anaemia. However, blood transfusion can transmit blood-borne parasites. Despite malaria being endemic in Tanzania, there is limited information on asymptomatic malaria among blood donors. This study determined the prevalence and associated factors of asymptomatic malaria among blood donors at the Lake Zone Victoria Blood Transfusion Centre in Mwanza, Tanzania.Methods: A cross-sectional study was conducted between March and April 2016 among blood donors without any symptoms of malaria. During blood donation, samples were collected from each participant. Malaria parasites were detected microscopically from Giemsa stained thin and thick smears and by the use of malaria rapid diagnostic test (MRDT).Results: A total of 150 blood donors participated in this study. The median age of participants was 20 (IQR: 18-27) years. Malaria prevalence by microscopy was 5.3% (95% CI: 1.7-8.8) while by MRDT was 8% (95% CI: 3.6-12.3). Malaria mean parasite density was 12mps/200WBC. Only individuals who reported using mosquito nets were found to be protected from getting asymptomatic malaria on multivariate logistic regression analysis (OR: 0.04, 95% CI: 0.01-0.25, P<0.001).Conclusion: A considerable proportion of blood donors in Mwanza, Tanzania are infected with P. falciparum which poses a risk for transmission to blood recipients including malaria vulnerable groups like pregnancy woman and children. Screening donated blood for malaria parasites is recommended in malaria endemic areas to prevent possible fatal consequences

Knowledge, Attitude and Practices of Hand Hygiene among Students and Nurses Staff in Mwanza Tanzania: A Cross-Sectional Hospital-Based Study during Global COVID-19 Pandemic

Background: Hand hygiene (HH) is a critical component of infection prevention and control (IPC) which aims at preventing microbial transmission during patient care hence reducing the burden of healthcare associated infections (HCAIs). Information on the level of HH knowledge, attitudes and practices among healthcare workers (HCWs) from low- and middle-income countries is scarce. This study determined knowledge, attitude and practices of HH among students and staff nurses in Mwanza, Tanzania.Methods: This cross-sectional hospital-based study was conducted between August and October 2020 among student and staff nurses from 2health centres, 2district hospitals, 1regional referral hospital and 1zonal referral hospital. Self-administered pretested structured questionnaires were used for data collection. All data was transferred to Microsoft excel spreadsheet for cleaning and coding, then to STATA software version 13.0 for analysis.Results: A total of 726 nurses aged 18 to 59 years with median (IQR) age of 29(24-38) years were enrolled. About 3 quarters 76.4% (555/726) of nurses had good level of knowledge on HH as most of them 88.3% (641/726) had received rigorous IPC trainings during COVID-19 pandemic. About 42.0% (305/726) of the participants reported that, the action of HH was effortless. Majority of the participants, 81.1% (589/726) practiced hand washing more than hand rubbing routinely. Being a student nurse [OR: 0.30, 95%CI: 0.21-1.44, p<.001], working in inpatient department [OR: 0.38, 95%CI: 0.27-0.55, p<.001], high level of education i.e., degree and above [OR: 1.74, 95%CI: 1.36-2.24, p<.001] and having working experience of 5 years and above [OR: 2.41, 95%CI: 1.52-3.82, p<.001] was associated with being knowledgeable of HH.Conclusion: Majority of the participants had good level of knowledge on HH because they had received rigorous training on IPC, notably HH during the global COVID-19 pandemic

Factors associated with colonization of Streptococcus pneumoniae among under-fives attending clinic in Mwanza City, Tanzania

Background: Streptococcus pneumoniae is a known cause of severe invasive bacterial infection leading to morbidity and mortality among children in sub-Saharan Africa. Nasopharyngeal colonization of S. pneumoniae is a critical step towards invasive disease progression. The objective of this study was to investigate the magnitude of nasopharyngeal carriage of S. pneumoniae and its associated factors in Mwanza, Tanzania. Methods: Children underfives attending Reproductive and Child Health (RCH) clinics in Mwanza, Tanzania clinics were enrolled and investigated for nasopharyngeal carriage of S. pneumoniae.  Demographic and clinical data were collected using standardized data collection tool. Nasopharyngeal swabs were taken and processed as per standard laboratory procedures. S. pneumoniae isolates were identified using conventional methods. Antimicrobial susceptibility testing was performed using the disc diffusion method as described by Clinical Laboratory Standard Institute.Results: Among 350 children enrolled in the study, 172 (49.1) were females and 309 (88.3%) were below 2 years of age.  A total of 253 (72.3%) children had received at least one dose of pneumococcal vaccine (Prevanar 13) whereas 83 (23.7%) had used antibiotics at median duration of 5 days in the past 14 days.  Out of 350 underfives, 43 (12.3%) were found to carry S. pneumoniae in their nasopharynx. Children with chronic diseases and those at school were 3.4 and 4.4 times more at risk to be carriers of S. pneumoniae than their counterpart group (OR; 3.4 (CI(1.0-11.6) 95%, p=0.05) and OR; 4.4 (CI (1.2-15.7) 95%, p=0.023), respectively.  Number of children at home, positive HIV status and someone smoking showed association with S. pneumoniae carriage but the differences were not statistically significant. The resistance levels of S. pneumoniae to penicillin, co-trimoxazole and erythromycin were 40%, 88.2% and 41.7%, respectively. However all of the S. pneumoniae isolates were found to be 100% sensitive to ciprofloxacin.Conclusion: A high nasopharyngeal carriage of penicillin resistant S. pneumoniae is observed in Mwanza, Tanzania despite a good coverage of pneumococcal vaccination. The carriage is significantly associated with schooling and presence chronic diseases. Continuous surveillance of penicillin resistant strains coupled with serotyping of the isolates is highly recommended to determine the influence of the pneumococcal vaccination