Risk Factors of Surgical Site Infection at Muhimbili National Hospital, Dar es Salaam, Tanzania

Surgical site infection (SSI) is a common source of morbidity among operated patients. At Muhimbili National Hospital (MNH), studies indicate that the rate of SSI has been increasing over the past thirty years. The aim of this study was to determine the prevalence and factors associated with SSI among patients undergoing surgery at MNH. This was a hospital-based cross-sectional study. One hundred and eighteen patients who underwent surgical procedures in the surgical wards were recruited. Demographic information was obtained using standardised questionnaire, surgical sites were examined to determine infections, and case notes were reviewed for clinical information including surgical notes. Blood sample was collected for HIV serology. SSI occurred in 42 patients (35.6%). Wound class, abdominal surgeries, emergency procedures and HIV infection increased the risk of SSI. Superficial SSI was the most commonly observed type, 54.8%. Overall HIV prevalence in this study was 16.9% with a 5 times risk of developing SSI. Surgical site infection has remained a major Nosocomial infection in developing countries. Factors shown to be associated with increased risk are wound class, site and nature of surgery, and HIV infection. This study found higher prevalence of HIV infection among surgical patients

Risk factors for work-related asthma in health workers with exposure to diverse cleaning agents in two African health care settings

Background: Health workers (HWs) are exposed to a wide range of chemicals used for cleaning and disinfection. This has been largely attributed to the ever-increasing demand for effective cleaning and disinfection in hospital settings in an effort to prevent healthcare associated infections. Over the last two decades, there has been increasing evidence linking cleaning agents to adverse work-related health effects such as rhinitis, asthma and contact dermatitis. There is however little information on the specific cleaning agents and tasks associated with various asthma-related outcomes. Furthermore, limited information exists regarding exposure-response relationships between the frequency of exposure to specific cleaning agents and asthma-related outcomes. This study investigated the prevalence and risk factors for work-related asthma (WRA) among HWs exposed to diverse cleaning agents in two academic tertiary public hospitals in southern Africa - South Africa and Tanzania. Methods: A cross-sectional study of 699 HWs was conducted. Exposure assessment included systematic workplace observations, environmental sampling for aldehydes (orthophthalaldehyde-OPA, glutaraldehyde and formaldehyde) and urine biomonitoring for chlorhexidine. Environmental sampling for aldehydes was conducted more extensively in the South African hospital (SAH). A pilot sampling in the Tanzanian hospital (TAH) revealed very low detectable levels of OPA and glutaraldehyde and as a result extensive measurements were not done. In the SAH, a total of 269 full-shift passive personal samples were collected from 164 HWs randomly selected from 17 different clinical departments. Passive sampling used TraceAir® AT580 monitors (Assay Technology, Livermore, CA). Biomonitoring for chlorhexidine was only conducted in the SAH since none of the HWs in the TAH used chlorhexidine. For the health outcome assessment, a total of 697 HWs completed interviews using the ECRHS questionnaire adapted for occupational contexts, which contained in-depth information on asthma, as well as detailed information on tasks and chemicals used during the course of their work. Sera was successfully collected from 682 HWs and analysed for specific immunoglobulin E (sIgE) antibody reactivity to common aero-allergens (Phadiatop) and specific occupational allergens (NRL - Hevea brasiliensis (Hev b5, Hev b6.02), chlorhexidine and OPA). Methacholine challenge tests (MCT) were performed on all South African HWs (n=318), based on standard inclusion criteria. Spirometry, accompanied by a post-bronchodilator (post-BD) test was conducted on all Tanzanian HWs (n=329) and a small proportion (n=25) of South African HWs where MCT was contraindicated. All HWs from both hospitals (n=654) underwent fractional exhaled nitric oxide (FeNO) testing during the working day prior to spirometry. Results: The prevalence of current asthma was 10% (atopic asthma 6%, non-atopic asthma 4%), while 2% had WRA. The prevalence of atopy was 43%, with 4% of workers being sensitised to OPA, 2% to NRL and only 1% to chlorhexidine. Environmental sampling demonstrated that OPA was detectable in 6 (2%) samples, all samples (Geometric mean (GM) = 0.010 ppm) being higher than the ACGIH exposure limit (0.0001 ppm). Workers with detectable OPA were found to have a longer duration of OPA use (OR = 1.28; 95% CI: 1.10 – 1.50). Formaldehyde was detectable in 103 (38%) samples (GM = 0.005 ppm), with 1% of samples having levels higher than the NIOSH TWA exposure limit (0.016 ppm). Asthmarelated outcomes (increasing asthma symptom score and FeNO) demonstrated consistent positive associations with certain medical instrument cleaning agents (OPA, QACs and enzymatic cleaners) and tasks (pre-cleaning of medical instruments, changing sterilisation solutions and manual disinfection of medical instruments) as well as certain patient care activities (disinfection prior to procedures, cleaning/disinfecting wounds, application of wound dressing, usage of adhesives and adhesive removing solvents). A particularly pronounced dose-response relationship was observed between work-related ocular-nasal symptoms and medical instrument cleaning agents (OPA, glutaraldehdye, QACs, enzymatic cleaners, alcohols and bleach; OR range: 2.50 – 12.08) and tasks (OR range: 2.58 – 3.97). Furthermore, a strong association was observed between higher asthma symptom scores and use of more sprays than wipes for fixed surface cleaning activities (mean ratio = 3.00; 95% CI: 1.50 – 5.98). Conclusion: This study has demonstrated that detectable exposures to OPA are higher and more isolated to certain departments than the more widespread low-level formaldehyde exposures present throughout the hospitals. Furthermore, cleaning agents have replaced NRL as important causes for WRA in health settings. Finally, specific cleaning agents such as OPA, quaternary ammonium compounds and enzymatic cleaners associated with medical instrument cleaning/disinfection as well as patient care activities and the use of sprays for fixed surface cleaning, are important environmental risk factors for various asthma-related outcomes among HWs in health care settings

Prevalence of Depression and Its Relationship to Care Engagement among Men Living with HIV

Background: The study was focused on the prevalence of depression among men living with HIV, who are in HIV care, and assessed the relationship between depression and care engagement. Several factors have been associated with care engagement among people living with HIV, including depression, but also lack disclosure due to stigmatization, poor social support, high pill burden, poor knowledge of ART, as well as young or old age. However, little is known about how these risk factors play out in men, as most of literature have been directed on women. Objectives: To understand the prevalence of depression in men living with HIV, attending Mawenzi Care and Treatment Clinic, and the effect of depression on care engagement. Method: A cross-sectional survey was conducted in the Mawenzi CTClinic, in Moshi, Kilimanjaro, Tanzania. Adult men living with HIV, 18 years and above, were invited to participate. A composite, continuous scale was developed to measure care engagement. At the clinic participants were asked about their medication adherence, their clinic cards were also checked for their viral load. Self-reported medication adherence and viral load were combined to form the outcome variable or as an indicator of patient care engagement. A total of 203 participants were enrolled in the study, with a mean age of 48 years. Results: The prevalence of depression among men living with HIV was 47.8 %: 35.0 % had mild symptoms, 8.9% moderate symptoms, and 3.9% severe symptoms. There was an indirect relationship between predictors: stigma was associated with depression and depression was associated with care engagement. Conclusion: HIV-related stigma and depression should not be underestimated because of their association with each other. Symptoms of depression need to be treated early, to reduce their effects on care engagement and hence disease progression

Mathematical Modelling of Syphilis Transmission Dynamics: Impacts of Mass Media Report, Risky Sexual Behavior and Treatment

Abstract Syphilis is one of the deadly sexually-transmitted diseases. This paper studied the impacts of sexual behavior, mass media report and treatment of infected individuals on the dynamics of syphilis transmission. The analytical and numerical analyses of the model are presented. The disease free equilibrium of the model is both locally and globally asymptotic stable when the associated reproduction number is less than unity.  Analysis of the Reproduction number shows that it is not possible to control syphilis disease transmission if the rate of individuals practicing risky sexual behavior is high. Furthermore, the treatment of late (latent and tertiary) syphilis infection is beneficial to the infected individuals, but has no impact in the lowering of the reproduction number. This study suggests that the effective control strategy of syphilis must focus on lowering the number of individuals practicing risky sexual behavior and applying higher treatment rates for early syphilis infections. Furthermore, the media function should address the issues regarding safe sexual behavior. Keywords: Syphilis, sexually transmitted infection, Risky sexual behavior, Mass medi

Gatekeeping processes in content produced by Kenyan news content creators on Youtube

Gatekeeping is a crucial process in journalistic content production and especially news. This is because the information collected from various sources must be subjected to journalistic practices such as verification to establish authenticity before dissemination to audiences. The growing popularity of online media content and the desire to attract more followers means news content creators on YouTube could be conflicted on the key reason they are producing content for the platform. The study aimed to establish the gatekeeping process employed by Kenyan news content creators producing content on YouTube and whether decisions are in the public’s interest or lack thereof. This study was prompted by the emergence and proliferation of celebrity content producers, some of whom are associated with legacy media and the attendant brand association. They produce content for YouTube in an era of click baits to attract traction and advertisers. The study’s objectives were to examine the sourcing strategies employed by news content creators on YouTube, establish the extent to which the gatekeeping processes by YouTube news content creators guarantee editorial independence and public interest journalism and find out gatekeeping challenges YouTube journalists face in their public interest undertaking. The gatekeeping and networked gatekeeping theories were used for this study to explain the process of selecting news content. A qualitative approach was adopted anchored on exploratory research design. Eight content creators based in Nairobi, who produce news content on YouTube, participated in the study and were selected using a purposive sampling technique. Data collected was analysed thematically. The study established just like in mainstream media, gatekeeping applies in YouTube news content creation and distribution. However, the study also established that even though YouTube news content producers produce public interest content, their gatekeeping processes are not as rigorous as in mainstream media. The study recommends more research into other journalistic practices by Kenyan news content creators on YouTube

HIV Sero Status Disclosure and Associated Factors Among People Living with HIV/AIDS Attending a Care and Treatment Centre in Kisarawe District Hospital, Tanzania

It is estimated that about 1.4 million people in Tanzania are infected with HIV, with 90,000 being infected annually. Previous studies in Africa on HIV status disclosure have documented low rates of disclosure that vary between countries. Limited data indicates that the disclosure rate in Tanzania ranges from 16.7% to 55%. PLWHA have difficulties in disclosing their HIV status to others for fear of negative consequences. This attitude affects the tempo of HIV prevention. Disclosure of HIV positive status in Tanzania has been focused on various areas but its association with social cultural factors remains unclear. To assess the magnitude of HIV status disclosure and explore determinants of disclosure among people living with HIV/AIDS (PLWHA) attending care and treatment centre at Kisarawe District Hospital. Materials and methods: A cross- sectional study design was employed where both quantitative and qualitative data were collected from consenting PLWHA. Univariate, bivariate and multivariate analyses were performed using SPSS statistical software. A total of 402 PLWHA were recruited, among them, 132 (32.8%) were males. The mean age of the participants was 42.0 years (Standard deviation 9.9) with majority aged between 25-49. The overall disclosure rate to somebody was 98% while the disclosure to spouses was 56.3%. The greater number of study participants (43%) disclosed their status to five people and above. Males (74.2%) disclose more to their spouses than females (47.7%), (p<0.001). The main determinants of HIV status disclosure were gender (AOR 0.28; 95%CI 0.14-0.56) and receiving counseling (AOR 0.33; 95%CI: 0.10- 0.81). Qualitative findings also show that cultural beliefs and attitudes influence HIV status disclosure among PLWHA. Overall disclosure rate is high though relatively low among spouses. Male gender and counseling were the most important determinants of disclosure. Interventions that target women and expand counseling should be intensified.\u

Espèces nouvellement signalées pour la flore ptéridologique de la République Démocratique du Congo

Nous signalons la présence des espèces nouvellement reportées pour la flore Ptéridologique de la République Démocratique du Congo (RDC), découvertes lors de notre exploration dans la forêt des montagnes du Parc National de Kahuzi-Biega (PNKB), et indiquons leurs conditions écologiques et leurs distributions géographiques. La méthodologie utilisée est celle de traitement taxonomique d’herbier sur les observations macroscopique et microscopique, des analyses chorologique et écologique des spécimens récoltés au PNKB dans la zone des montagnes. Ces recherches ont conduit à signaler 22 espèces nouvelles pour la flore Ptéridologique de la RDC en général et du PNKB en particulier. Parmi ces espèces, la majorité sont Afromontagnardes africaines, certaines sont Plurirégionales africaines, tandis que Pteris repens et Triplophyllum varians montrent une large disjonction. Une espèce, Adiantum incisum, est Paléotropicale. Ces espèces vivent dans des endroits des milieux hydromorphes et humides, les autres sont exposées à la luminosité, tandis que certaines sont épilithes dans l’étage afro-subalpin. Les résultats obtenus montrent que la connaissance de la flore de la RDC reste encore fragmentaire malgré plus d’un siècle de multiples explorations et de récoltes végétales réalisées. © 2013 International Formulae Group. All rights reserved.Mots clés: Espèces nouvelles, Pteridophytes, RDC, flore d’Afrique Centrale