Factors associated with mortality among premature babies admitted at Bugando medical centre, Mwanza - Tanzania

Background: Prematurity, birth asphyxia and infections are the leading causes of neonatal mortality globally. This study was conducted to determine the mortality and associated factors among premature neonates at Bugando Medical Centre, Mwanza-Tanzania.Methods: One hundred and three premature neonates delivered at Bugando Medical Centre and other health facilities but referred to Bugando Medical Centre (BMC) were recruited for this study between February and May, 2012. Questionnaires were used to obtain clinical and demographic data from neonates and their mothers. Neonates were followed up for seven days to determine complications and mortality.Results: Neonatal mortality within seven days of life was noted to be 39.4% (39/99).At least one episode of hypothermia was noted in 43/99 (43.4%), 37/99 (37.4%) hadrespiratory distress syndrome and 32/99 (32.3%) had infection. Significantly higher mortality was noted in neonates born to younger mothers (p=0.02) and those with primary education level (p< 0.047). Mortality was significantly lower for twin neonates (p=0.001) and those delivered by caesarean section (p=0.013).Among the independent predictors of mortality noted in this study were extremely low birth weight (ELBW)[OR 24; 95% CI 4.6-125.8 (p < 0.01)] and presence of respiratory distress syndrome (RDS) [OR 31.5; 95% CI 6.5-152.6 (p < 0.001)].Conclusions: High mortality was noted among premature neonates in the first week of life. Maternal age, extremely low-birth weight and presence of RDS were noted to be predicators of mortality

Factors associated with mortality among premature babies admitted at Bugando medical centre, Mwanza - Tanzania

Background: Prematurity, birth asphyxia and infections are the leading causes of neonatal mortality globally. This study was conducted to determine the mortality and associated factors among premature neonates at Bugando Medical Centre, Mwanza-Tanzania.Methods: One hundred and three premature neonates delivered at Bugando Medical Centre and other health facilities but referred to Bugando Medical Centre (BMC) were recruited for this study between February and May, 2012. Questionnaires were used to obtain clinical and demographic data from neonates and their mothers. Neonates were followed up for seven days to determine complications and mortality.Results: Neonatal mortality within seven days of life was noted to be 39.4% (39/99). At least one episode of hypothermia was noted in 43/99 (43.4%), 37/99 (37.4%) had respiratory distress syndrome and 32/99 (32.3%) had infection. Significantly higher mortality was noted in neonates born to younger mothers (p=0.02) and those with primary education level (p< 0.047). Mortality was significantly lower for twin neonates (p=0.001) and those delivered by caesarean section (p=0.013). Among the independent predictors of mortality noted in this study were extremely low birth weight (ELBW) [OR 24; 95% CI 4.6-125.8 (p < 0.01)] and presence of respiratory distress syndrome (RDS) [OR 31.5; 95% CI 6.5-152.6 (p < 0.001)].Conclusions: High mortality was noted among premature neonates in the first week of life. Maternal age, extremely low-birth weight and presence of RDS were noted to be predicators of mortalit

Clostridium difficile infections among adults and children in Mwanza/Tanzania: is it an underappreciated pathogen among immunocompromised patients in sub-Saharan Africa?

Little is known regarding the epidemiology Clostridium difficile in developing countries. Fresh stool samples from patients with diarrhoea were cultured anaerobically. C. difficile was detected in nine (6.4%) of 141 (95% confidence interval 4.2–13.1), of which seven (77.8%) were from children. HIV infection, prolonged hospitalization and antibiotic use were independent factors associated with the occurrence of C. difficile in the gastrointestinal tract. Two of the toxigenic isolates were typed as ribotype 045, and the other two had unknown ribotype. All C. difficile isolates were susceptible to metronidazole, moxifloxacin and clarithromycin, while three isolates were resistant to clarithromycin. C. difficile may be an important pathogen causing diarrhoea in sub-Saharan Africa among immunocompromised patients

Social accountability in primary health care facilities in Tanzania: Results from Star Rating Assessment

Background Star Rating Assessment (SRA) was initiated in 2015 in Tanzania aiming at improving the quality of services provided in Primary Healthcare (PHC) facilities. Social accountability (SA) is among the 12 assessment areas of SRA tools. We aimed to assess the SA performance and its predictors among PHC facilities in Tanzania based on findings of a nationwide reassessment conducted in 2017/18. Methods We used the SRA database with results of 2017/2018 to perform a cross-sectional secondary data analysis on SA dataset. We used proportions to determine the performance of the following five SA indicators: functional committees/boards, display of information on available resources, addressing local concerns, health workers’ engagement with local community, and involvement of community in facility planning process. A facility needed four indicators to be qualified as socially accountable. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to determine facilities characteristics associated with SA, namely location (urban or rural), ownership (private or public) and level of service (hospital, health centre or dispensary). Results We included a total of 3,032 PHC facilities of which majority were dispensaries (86.4%), public-owned (76.3%), and located in rural areas (76.0%). On average, 30.4% of the facilities were socially accountable; 72.0% engaged with local communities; and 65.5% involved communities in facility planning process. Nevertheless, as few as 22.5% had functional Health Committees/Boards. A facility was likely to be socially-accountable if public-owned [AOR 5.92; CI: 4.48–7.82, p = 0.001], based in urban areas [AOR 1.25; 95% CI: 1.01–1.53, p = 0.038] or operates at a level higher than Dispensaries (Health centre or Hospital levels) Conclusion Most of the Tanzanian PHC facilities are not socially accountable and therefore much effort in improving the situation should be done. The efforts should target the lower-level facilities, private-owned and rural-based PHC facilities. Regional authorities must capacitate facility committees/boards and ensure guidelines on SA are followed

Respondent characteristics^b'*'.

Respondent characteristicsb'*'.</p

Women’s recommendations for interventions to address gender-based barriers.

Women’s recommendations for interventions to address gender-based barriers.</p

Standards for Reporting Qualitative Research (SRQR).

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