Anaemia among HIV infected children attending care and treatment clinic at Muhimbili National Hospital, Dar es Salaam - Tanzania

Introduction: Anaemia is common among HIV infected patients; causes of anaemia in these patients are multifactorial. Anemia is noted as one of important predictors of outcome in HIV infected patients. Tis study was carried out to determine the prevalence of anaemia among HIV infected children attending HIV clinic at Muhimbili National Hospital.Methods: A cross-sectional study was carried out and 240 HIV infected children attending HIV clinic at MNH were recruited. Structured questionnaire was used to obtain socio-demographic characteristics. Laboratory tests were performed for each participant to determine haemoglobin level, mean cell volume, mean corpuscular haemoglobin concentration, white blood cells and CD4 count and percent.Results: Hundred and thirty three (55.4%) of recruited participants were males, 219 (91.2%) were using antiretroviral drugs and 129 (53%) were using stavudine, lamivudine and nevirapine combination. Mean haemoglobin level was 10.9 ± 1.4 g/dl and mean CD4 was 1118.3 ± 656.1 cell/mm3 while mean CD4 percent was 31.1 ± 10 %. Prevalence of anaemia was 78.8% (189/240), anaemia was noted to be more prevalent among younger participants (<5 years) p=0.012. Participants using ART and those high CD4 percent (25%) had lower proportion of anaemic patients as compared to participants who were not using ART and those with low CD4 percent although the difference was not statistically significant.Conclusions: Prevalence of anaemia was noted to be high and was more prevalent among younger participants; there is a need to screen for anaemia in HIV infected children attending for clinic in our setting

Neonatal sepsis at Muhimbili National Hospital, Dar es Salaam, Tanzania; aetiology, antimicrobial sensitivity pattern and clinical outcome

Abstract Background Neonatal sepsis contributes significantly to morbidity and mortality among young infants. The aetiological agents as well as their susceptibility to antimicrobial agents are dynamic. This study determined aetiology, antimicrobial susceptibility and clinical outcome of neonatal sepsis at Muhimbili National Hospital. Methods Three hundred and thirty neonates admitted at the Muhimbili National Hospital neonatal ward between October, 2009 and January, 2010 were recruited. Standardized questionnaires were used to obtain demographic and clinical information. Blood and pus samples were cultured on MacConkey, blood and chocolate agars and bacteria were identified based on characteristic morphology, gram stain appearance and standard commercially prepared biochemical tests. Antimicrobial sensitivity testing was performed for ampicillin, cloxacillin, gentamicin, amikacin, cefuroxime and ceftriaxone on Mueller Hinton agar using the Kirby Bauer diffusion method. Results Culture proven sepsis was noted in 24% (74/330) of the study participants. Isolated bacterial pathogens were predominantly Staphylococcus aureus, Klebsiella spp and Escherichia coli. Klebsiella spp 32.7% (17/52) was the predominant blood culture isolate in neonates aged below seven days while Staphylococcus aureus 54.5% (12/22) was commonest among those aged above seven days. Staphylococcus aureus was the predominant pus swabs isolate for both neonates aged 0–6 days 42.2% (98/232) and 7–28 days 52.3% (34/65). Resistance of blood culture isolates was high to ampicillin 81.1% (60/74) and cloxacillin 78.4% (58/74), moderate to ceftriaxone 14.9% (11/74) and cefuroxime 18.9% (14/74), and low to amikacin 1.3% (1/74). Isolates from swabs had high resistance to ampicillin 89.9% (267/297) and cloxacillin 85.2 (253/297), moderate resistance to ceftriaxone 38.0% (113/297) and cefuroxime 36.0% (107/297), and low resistance to amikacin 4.7% (14/297). Sepsis was higher in neonates with fever and hypothermia (p=0.02), skin pustules (p Conclusions Staphylococcus aureus was predominant isolate followed by Klebsiella and Escherichia coli. There was high resistance to ampicillin and cloxacillin. Mortality rate due to neonatal sepsis was high in our setting. Routine antimicrobial surveillance should guide the choice of antibiotics for empirical treatment of neonatal sepsis.</p