Risk factors for mortality among tuberculosis patients on treatment at Bugando Medical Centre in north-western Tanzania: a retrospective cross-sectional study

 Background: Tuberculosis (TB) is still an important cause of morbidity and mortality worldwide. Though it can effectively be treated, still a significant proportion of patients die on the course of their treatment. The objective of this study was to determine the outcome and risk factors of mortality among patients diagnosed with TB in a tertiary hospital in north-western Tanzania.Methods: A retrospective cross sectional study was done among all patients diagnosed with TB between January and December 2015 at Bugando Medical Centre. Information of demographic characteristics, smear positivity, haemoglobin concentration, HIV status, CD4 counts for HIV positive patients and treatment outcomes were collected and analysed. TB treatment outcomes as dead or alive were calculated and logistic regression was done to determine the factors associated with increased risk of death of patients on anti-TB treatment.Results: In total 701 patients were diagnosed with TB during the study period. Of these, 361 (51.5%) were males with a median age of 38 (IQR 27- 47) and 421 (60.06%) were younger than 40 years. Majority of the participants 409 (58.35%) had smear positive pulmonary tuberculosis and about half of patients (51.07%) tested positive for HIV. Of the enrolled patients 610 (87.02%) were alive at the end of TB treatment while 91 (12.98%) died in the course of treatment. The odds of deaths of patients on anti-TB treatment were strongly associated with male sex, HIV co infection and severe anaemia.Conclusion: The proportion of patients who die from TB treatment at BMC is high, with an increased risk of death among HIV co-infected, older than 40 years and severely anaemic patients. Improvement of strategies for early diagnosis and prompt treatment of TB patients will potentially improve treatment outcome

HIV-1 drug mutations in children from northern Tanzania

Objectives: In resource-limited settings, it is a challenge to get quality clinical specimens due to poor infrastructure for their collection, transportation, processing and storage. Using dried blood spots (DBS) might be an alternative to plasma for HIV-1 drug resistance testing in this setting. The objectives of this study were to determine mutations associated with antiretroviral resistance among children 400 copies/mL. Results: Genotypic resistance mutations were detected in 13 of 46 children (28%). HIV-1 genotypes were A1 (n = 27), C (n = 10), A/D (n = 4), D (n = 3) and CRF10_CD (n = 2). The median age was 12 weeks (IQR 6–28). The mean log10 viral load was 3.87 copies/mL (SD 0.995). All major mutations were detected in the reverse transcriptase gene and none in the protease gene region. The most frequent mutations were Y181C (n = 8) and K103N (n = 4), conferring resistance to non-nucleoside reverse transcriptase inhibitors. Conclusions: One-third of infants newly diagnosed with HIV in northern Tanzania harboured major drug resistance mutations to currently used antiretroviral regimens. These mutations were detected from DBS collected from the field and stored at room temperature. Surveillance of drug resistance among this population in resource-limited settings is warranted

HIV-1 drug mutations in children from northern Tanzania

Objectives: In resource-limited settings, it is a challenge to get quality clinical specimens due to poor infrastructure for their collection, transportation, processing and storage. Using dried blood spots (DBS) might be an alternative to plasma for HIV-1 drug resistance testing in this setting. The objectives of this study were to determine mutations associated with antiretroviral resistance among children 400 copies/mL. Results: Genotypic resistance mutations were detected in 13 of 46 children (28%). HIV-1 genotypes were A1 (n = 27), C (n = 10), A/D (n = 4), D (n = 3) and CRF10_CD (n = 2). The median age was 12 weeks (IQR 6–28). The mean log10 viral load was 3.87 copies/mL (SD 0.995). All major mutations were detected in the reverse transcriptase gene and none in the protease gene region. The most frequent mutations were Y181C (n = 8) and K103N (n = 4), conferring resistance to non-nucleoside reverse transcriptase inhibitors. Conclusions: One-third of infants newly diagnosed with HIV in northern Tanzania harboured major drug resistance mutations to currently used antiretroviral regimens. These mutations were detected from DBS collected from the field and stored at room temperature. Surveillance of drug resistance among this population in resource-limited settings is warranted

Seroprevalence of hepatitis B virus infection, anti-HCV antibodies and HIV and knowledge among people who use drugs attending methadone therapy clinic in Tanzania; a cross-sectional study

Background Methadone therapy clinics have been recently introduced in Tanzania, aiming at reducing risk behaviors and infection rates of viral hepatitis and HIV among people who use drugs. The objective of this study was to estimate the prevalence, associated factors and knowledge level of these conditions among people who use drugs attending a methadone clinic in Tanzania. Methods We enrolled 253 People who using drugs receiving Methadone therapy. Clinical data was retrospectively collected from the medical records and face-to face interviews were conducted to determine the behavioral risk factors and respondents’ knowledge on viral hepatitis and HIV. Results An overall seroprevalence of viral hepatitis (either hepatitis B surface antigen or anti-hepatitis C virus) was 6.3%, while that of hepatitis B virus mono infection was 3.5% and anti-hepatitis C antibodies was 3.5%. Seroprevalence of HIV was 12.6%. Viral hepatitis was strongly predicted by advanced age (\u3e 35 years) (p = 0.02) and staying at Kirumba area (p = 0.004), and HIV infection was predicted by increased age (\u3e 37 years) (p = 0.04) and female sex (p \u3c 0.001). Regarding the knowledge of viral hepatitis, majority of the respondents were unaware of the transmission methods and availability of hepatitis B virus vaccines and only 17% were classified as well informed (provided ≥4 correct answers out of 7 questions). Good knowledge was highly predicted by higher education level of the individual (p = 0.001). Conclusions Despite the efforts to curb viral hepatitis and HIV infections through Methadone clinics, infection rates among people who use drugs are still high and the general knowledge on preventive measures is inadequate

Multi-organ dysfunction in Sickle Cell Disease: a rare presentation and its management in resource-limited setting.

Introduction: Chronic end-organ damage among the sicklers is frequently diagnosed in Tanzania, but rarely involves multiple organs in a single patient. Case report: A 26-year-old Tanzanian black-sickler woman presented with features related to avascular necrosis of the right hip, left ventricular hypertrophy, pulmonary hypertension, Chronic Kidney Disease and Cholelithiasis. Despite the management given, her condition is still deteriorating. Conclusion: Prevention of these complications through screening and early diagnosis with a concurrent timely treatment should be advocated by all health-care provider

Suboptimal Blood Pressure Control, Associated Factors, and Choice of Antihypertensive Drugs among Type 2 Diabetic Patients at KCMC, Tanzania

Background. Hypertension (HTN) can be present in up to two-thirds of patients living with diabetes mellitus (DM). It is a risk factor for the development of diabetes as well as complications like coronary artery disease (CAD), nephropathy, retinopathy, and neuropathy. Hypertension is treatable, and the degree to which it is controlled determines the risk of development of cardiovascular diseases and other complications in a given individual patient. Even though antihypertensive drugs are available and issued to hypertensive diabetic patients, the rate of control of HTN is often inadequate. The aim of this study was to assess the prevalence of suboptimal blood pressure (BP) control, its associated factors, and the choice of antihypertensive drugs among type 2 DM patients at Kilimanjaro Christian Medical Centre (KCMC). Methods. A hospital-based cross-sectional study was conducted at the KCMC diabetes clinic from October 2018 to March 2019 among type 2 DM patients with HTN based on the inclusion criteria. Data were collected using structured questionnaires, and written informed consent was obtained. Suboptimal BP was defined as BP levels≥140/90 mmHg according to the American Diabetes Association guideline published in 2018. Data analysis was done using the Statistical Package for the Social Sciences (SPSS) version 25. Chi-square analysis was done to identify the independent predictors of BP control, and a p value of <0.05 was considered to be statistically significant. Results. The data of 161 participants was analysed; the mean age was 63.9±20.2 years, with the majority being females (67.1%). Despite all participants being on different classes of antihypertensives, 57.8% had suboptimal BP control. Among the participants with good BP control, 52.7% were on angiotensin-converting enzyme inhibitors (ACE-I). Poor diabetes control was observed in 50.1% participants as indicated by elevated glycated haemoglobin. Conclusion. This study demonstrated that BP control in type 2 DM patients was suboptimal in more than half of the participants. The study showed that the use of ACE-I or angiotensin II receptor blockers (ARBs) in the majority of DM patients has a good impact in the control of blood pressure. The early initiation of ACE-I or ARBs among the diabetic patients will improve the optimal BP control

ABO and Rhesus blood group distribution and frequency among blood donors at Kilimanjaro Christian Medical Center, Moshi, Tanzania

Abstract Objective This study aims to determine the distribution of blood groups and the demographic background of blood donors in a referral hospital in Northern Tanzania. Results The most common blood group was O (52.3%) and the least common was AB (3.18%). 97.7% of the blood donors were Rh positive and the rest were Rh negative. Most donors were young adults, representing the age group of 19–29. The majority of donors were male (88.1%) and the majority (90.8%) were replacement while the remainder was voluntary donors

HIV-1 Subtypes and treatment outcome among adults on Antiretroviral therapy at tertiary hospital in Moshi, Tanzania

Background: Human Immunodeficiency virus (HIV) is characterized by great genetic diversity due to its high mutations that occur during replication. Its infection also characterized by high rates of viral turnover and extensive viral diversity. This diverse has implication on disease progression, diagnostic strategies, vaccine development as well as treatment response to antiretroviral drugs.Methods: 63 HIV positive adults infected by different HIV-1 Subtypes at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania were studied. HIV-1 Subtypes were characterized using peptide ELISA representing HIV-1 subtypes A, B, C, D and E derived from consensus gp 120 V3 sequences. The CD4+T-lymphocyte cell counts were measured at baseline, six and twelve months using FACS Calliber (Becton Dickinson, San Jose, CA, USA).Results: HIV-1 Subtype A was the most prevalent (47.62%), followed by Subtype C (36.51%) and Subtype D (15.87%). Subtype D showed higher immunological and clinical failures as compared to subtype A and C with Hazard Ratio (H.R, 5.6) and 95% CI=1.3-5.2, P=0.02). After adjustment for sex, baseline CD4+ T Lymphocyte and clinical stage, the association remained the same.Conclusions: HIV-1 A was the most predominant followed by C and D was less predominant. HIV-1 D showed rapid progression of diseases with poor treatment outcomes relative to others subtypes. Keywords: HIV-1 diversity, immunological failure, ELISA, Peptides and immunodominant regio

Clinical Characteristics and Factors Associated with Heart Failure Readmission at a Tertiary Hospital in North-Eastern Tanzania

Introduction. Heart failure (HF) is characterized by frequent episodes of decompensation, leading to a high hospitalization burden. More than 50% of index hospitalizations for HF patients return within 6 months of discharge. Once the patient is readmitted, the risk of further disease progression and the mortality rate are increased. A lot of patients are readmitted due to factors such as poor medication adherence, infections, or worsening comorbidities. The aim of our study was to identify the inpatient burden of HF readmission and to identify the factors associated with early readmission. Methods. A hospital-based cross-sectional analytical study was conducted from November 2018 to April 2019 within the medical wards at Kilimanjaro Christian Medical Centre (KCMC), which is a teaching and referral hospital in north-eastern Tanzania. The study population included all patients with HF admitted within the medical ward. Data were collected using questionnaires and blood and radiological investigations, and analysis was done using Statistical Package for Social Science (SPSS) version 25. Chi-square test was used to compare proportions of categorical variables. Logistic regression was used to determine the likelihood for readmission, and p-value of <0.05 was considered to be statistically significant. Results. A total of 353 patients were identified with HF, of whom 136 (38.5%) had a previous admission. Of the 136 patients analysed, the mean age was 62.8 years (SD 17.1), and 86 (63.2%) were females. Within 30 days after discharge, 34 (25.0%) of the patients were readmissions. Factors for early readmission were unemployment (OR = 2.38, 95% CI = 1.02–5.54, p=0.043), poor medication adherence (OR = 3.87, 95% CI = 1.67–8.97, p=0.002), absence of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) (OR = 2.40, 95% CI = 1.09–5.31, p=0.030), and pleural effusion (OR 3.25, 95% CI = 1.44–7.32, p=0.004). Conclusion. Heart failure is a burden due to a large number of admissions and readmissions. Factors such as poor medication adherence and absence of adequate HF therapy, especially the absence of regimes containing ACEI or ARB, need to be targeted to reduce the number of readmissions. This will help reduce the risk of further decompensations, disease progression, and mortality rate