Prevalence and risk factors for obstructive sleep apnoea in Dar es Salaam, Tanzania

Background: Obstructive sleep apnoea (OSA) is a common cause of daytime sleepiness, a condition associated with accidents, antisocial behaviour, mood disturbances, cognitive dysfunctions and inefficiency at work. This study was carried out to determine the prevalence and risk factors for obstructive sleep apnoea in Dar es Salaam, Tanzania.Methods: Multistage random sampling of households was done. Eligible members were interviewed and underwent anthropometric measurements. Epiworth sleepiness scale was used to asses one’s likelihood of daytime sleepiness. OSA was defined as the presence of 2 of the following: symptoms of obstructive sleep apnoea, a Body Mass Index (BMI) ≥ 28 kg/ m² and a total Epworth score≥ 15.Results: A total of 1249 people were involved in the study. Of these, 65.2% were females. Night snoring was reported by 9.3% of the respondents. The prevalence of OSA was 11.5% (144/1249). OSA was significantly more common among females (12.9%) (p = 0.038) than males. OSA prevalence increased significantly with increasing age (p <0.001) and increasing BMI (p- value < 0.001).  Respondents with hypertension, central obesity and those who snored at night significantly presented with high prevalence of OSA, being 26.5%, 34% and 29.3%, respectively (p- value <0.001 for each). OSA was found in 26.3% of diabetics (p= 0.042). The odds of OSA were significantly higher among females, OR (95% CI) = 2.0 (1.2-3.2), among age group 45-54 years, OR (95% CI) = 2.2 (1.1-4.3), among those with central obesity OR (95% CI) = 3.4 (2.1- 5.4) and among night snorers OR (95% CI) = 2.8(1.7-4.6). Socio-economic status, cigarette smoking, alcohol consumption, hypertension and diabetes mellitus could not predict OSA.Conclusions: OSA is prevalent among residents of Dar es Salaam and significantly associated with age 45 years or older, female gender, high socioeconomic status, obesity and overweight and night snoring. Predictors of OSA were female sex, age above 45 years, central obesity, and night snoring. Clinicians should therefore actively look for OSA in patients with these characteristics.

Endobronchial Tuberculosis: A Rare Presentation

Endobronchial tuberculosis (EBTB) is an infection of the tracheobronchial tree by Mycobacterium tuberculosis. It is common among young females. Patient can present with fever, cough, wheeze, with or without any constitutional symptoms. It presents as a diagnostic dilemma, as patient sputum smear can be false negative. CT scan may or may not show any abnormality, or any endobronchial lesion. Bronchoscopy with bronchoalveolar lavage and biopsy offers the diagnostic choice. We hereby report a case of a young immunocompetent Asian female who was found to have endobronchial pathology, leading to diagnosis and timely therapy

Assessment of the Effects of Moderating Factors of Entrepreneurial Orientation on the Performance of SMEs in Tanzania

This conceptual study was conducted in order to assess the effects of the Moderating Factors of Entrepreneurial Orientation (EO) on the performance of SMEs in Tanzania. According to the literature EO refers to the strategy making process that provides organizations with the basis for entrepreneurial decisions and actions. The dimensions of EO are innovativeness, proactiveness, risk taking, competitive aggressiveness and autonomy. The need for firms to exercise EO has been widely recognized. In less developed countries like Tanzania where the growth rate of SMEs is very limited, the subject matter has not been fully exploited for firms to cope and understand the effects of EO on firm performance especially the SMEs. To the authors’ best knowledge there exists only a few studies in Tanzania on EO especially those looking at the  oderating factors and linking them to SMEs performance. According to the literature several moderating factors such as cultural orientation and organizational structure (internal factors), social economic factors and political and legal factors (external factors) have a contribution on the applicability of EO hence performance of SMEs. The study found out that the moderating factors have an effect on performance of SMEs. However there is a need for research to test the applicability of moderating factors of EO and firm performance in a Tanzanian context

Sensory evaluation of different preparations of cassava leaves from three species as a leafy vegetable

Cassava leaves are largely consumed in Africa and are among the top three African indigenous vegetables rich in nutrients. Leaves from bitter (Manihot utilissima), sweet (Manihot dulcis) and wild (Manihot glaziovii) species of cassava were cooked by boiling in salted (sodium bicarbonate and table salt) water with the addition of palm oil and ground-nut paste, following processing by “pounding”, “pounding and then drying” and, “drying and then pounding”. The drying was done in tunnel solar drier at temperature of 65°C on average. Nine samples (three species x three processing methods) were evaluated by 31 panelists, using a five point hedonic scale, where 5 = like very much and 1= dislike very much. Cassava species affected significantly (p = 0.0047; 0.0206) scoring for texture and overall acceptability, respectively, but not for colour, aroma and taste. Processing method highly significantly (p< 0.0001) affected all the sensory attributes scoring. Leaves from all three  species were liked as leafy vegetable, except when pounded after drying.Key words: Cassava leaves, cassava species, sensory characteristics, tunnel solar drying, processing methods, Rwanda

A Network and Repository for Online Laboratory based on Ontology

Our propose is to build a network of virtual laboratories and also use it as a global repository of online laboratory’s and experiences. This set of virtual and online laboratories can be “stored” in an “virtual closet”, and also the system will allow us to build new experiences and online laboratories, and store them is this “virtual closet”. With the drawing of this new standard we pretend define methods for storing and retrieving learning objects for remote laboratories. The objective of this standard is also define methods for linking learning objects to design and implement smart learning environments for remote online laboratories. The objects defined by this standard are, for example, interfaces for devices connected to user computers over computers networks and the devices themselves. They are also learning scenarios or collaboration tools for communications necessary to conduct an activity of practical online laboratory work, they will allow to design and implement mechanisms that make smart learning environment formed by the ad hoc aggregation of learning objects taking always into account the pedagogical context for their use. This will allow to easy design and implement the pedagogically driven remote laboratory environment and experiments as also is learning environments. The experiences and laboratories are build using the parts and separate components that we have in a separate “virtual closet” with parts, components, and already build experiences. To build this complex network we need to find a system that supports effectively this structure. This probably will be a enormous database of v-labs and independent elements, where will be possible sometimes to “recycle” some of the elements. For this structure we propose an Ontology because it allows to “re-use” the same element several times in many experiences, and provide a very detailed description of each kind of element through is classes and sub-classes.Com o apoio RAADRI

School violence, depression symptoms, and school climate: a cross-sectional study of Congolese and Burundian refugee children

Forcibly displaced children are at increased risk of violence and mental health disorders. In refugee contexts, schools are generally perceived as protective environments where children can build a sense of belonging and recover from trauma. Evidence shows that positive school climates can support student skills development and socio-emotional wellbeing and protect them against a host of adverse outcomes. However, schools are also places where children may experience violence, from both teachers and peers. Prevalence estimates of violence against children in humanitarian settings are scarce and evidence on the relationship between school climate and student outcomes in these contexts is non-existent. The aim of the study is to estimate the prevalence of school-based violence against children and to explore the association between perceptions of school climate and students’ experiences and use of violence and their depression symptoms. We relied on data from a cross-sectional survey of students and teachers in all primary and secondary schools in Nyarugusu Refugee Camp in Tanzania, conducted as part of a cluster randomised controlled trial, to compute prevalence estimates and used mixed logistic regression analysis to assess the association between school climate and students’ outcomes. We found that students in Nyarugusu experienced high levels of violence from both peers and teachers in both primary and secondary schools in the camp, with little difference between boys and girls. Nearly one in ten students screened positive for symptoms of depression. We found that opportunities for students and teachers to be involved in decision-making were associated with higher odds of violent discipline and teachers’ self-efficacy was a significant protective factor against student depression symptoms. However, generally, school-level perceptions of school climate were not associated with student outcomes after adjusting for potential confounders. Our findings suggest that interventions to prevent and respond to teacher and peer violence in schools and to support students’ mental health are urgently needed. Our results challenge the assumption that education environments are inherently protective for children and call for further investigation of norms around violence among students and teachers to better understand the role of school climate in refugee settings

Malaria surveillance and use of evidence in planning and decision making in Kilosa District, Tanzania

Background: Since 2001, Tanzania has been making concerted efforts to strengthen its Integrated Disease Surveillance and Response system. In this system, malaria is one of the priority diseases that are to be reported monthly. The objectives of this study were to (i) assess malaria surveillance system at facility and district levels to identify key barriers, constraints and priority actions for malaria surveillance strengthening; and (ii) to explore the use of evidence in health planning and decision making at these levels.Methods: The study was carried in Kilosa District in central Tanzania, during October 2012 and involved health facility workers and members of the district health management team. The existing information system on malaria was evaluated using a structured questionnaire and check list. Data collection also involved direct observations of reporting and processing, assessment of report forms and reports of processed data.Results: Three district officials and 17 health facility workers from both public and private health facilities were interviewed. Of the 17 informants, 15 were familiar with disease surveillance functions. A good percentage (47%, 8/17) received training on disease surveillance during the previous two years. Public transport and motorcycles were the main means of reporting epidemiological information from facility to district level. Most of the health facilities (93%, 14/15) faced difficulties in submitting reports due to lack of resources and feedback from the district authority. Analysis of malaria data was reported in 52.9% (9/17) of the facilities, but limited to malaria incidence per age groups. Challenges in data analysis included unavailability of compilation books; lack of computers; poor data storage; incomplete recording; lack of adequate skills for data analysis; and increase in workloads. Data at both facility and district levels were mainly used for quantification and forecasting of drug requirements.Conclusion: Malaria surveillance system in Kilosa district is weak and utilization of evidence for planning and decision making is poor. Capacity strengthening on data analysis and utilization should be given a priority at both facility and district levels of the health systems in Tanzania

Factors Influencing Medical Adherence of Clients in AIDS Project Worcester

What are the factors and barriers that lead to levels of adherence for those receiving treatment for those in the HIV/AIDS community through AIDS Project Worcester? Over the last few decades, the HIV/AIDS epidemic has undergone a visible shift. In particular, the demographics of HIV/AIDS infected persons have transitioned from mostly gay affluent, white males to women and men of various minority populations with lower resources and socioeconomic statuses. This trend has also been true for the Worcester community. Based in Worcester, Massachusetts, this research project seeks to identify patterns between the recent change in client demographics and the relation between client adherence at AIDS Project Worcester (APW). A group of student researchers from Clark University examined the barriers to complete adherence within HIV positive clients at APW. Qualitative research within APW revealed that self-efficacy combined with the ability and knowledge to navigate the mechanics of the health care system are the necessary antidote for clients to achieve 100% adherence

Clinical and Imaging Features of Adults with Recurrent Pulmonary Tuberculosis - A Prospective Case-Controlled Study

BACKGROUND: Recurrent pulmonary tuberculosis (RPTB) is a growing, important and neglected problem affecting treated TB patients and TB health services across the world, particularly in sub-Saharan Africa. Analyses and identification of differences in clinical features between recurrent PTB and newly diagnosed PTB may lead to improved management recommendations. METHODS: Between September 1st 2019 and January 31st 2020, we performed a prospective case controlled study of clinical and imaging features of patients with recurrent pulmonary tuberculosis and compared them with those of newly diagnosed PTB cases. Recurrent PTB was defined as a patient with bacteriologically confirmed active PTB who was previously successfully treated for PTB and was cured. A control was defined as a patient who presents for the first time with bacteriologically confirmed PTB. Clinical and radiological features were assessed and documented. Chi-square and t-test were used to test the difference between proportion and continuous data, respectively. Logistic regression analysis was done to determine factors associated with RPTB using SPSS version 23 software. RESULTS: A total of 312 patients with PTB were enrolled (104 RPTB cases and 208 newly diagnosed controls). Clinically hemoptysis was more common in RPTB compared to controls 28/104 (26.9%) vs 35/208 (16.8%), P = 0.036. Chest pain was significantly less common among patients with RPTB compared to controls 33 (31.7%) vs 92 (44.2%), P = 0.034. A higher proportion of RPTB presented with cavitation 34/104 (32.7%) compared to control 44/208 (21.2%) P = 0.027. The median score for lung pathology was higher among patients with RPTB (50) compared to controls (30); P = 0.001. Lung function of patients with RPTB at diagnosis of index TB were more likely to show mixed restrictive and obstructive pattern 36/104 (34.6%) compared to controls 31/208 (14.9%). p<0.001. Multivariate analysis showed that patients older than 45 years of age (adjusted odds ratio [aOR]: 3.59, 95% CI: 1.38 - 9.32), those with hemoptysis (aOR 1.96, 95% CI: 1.04 - 3.69) p=0.04) and fibrosis on chest x rays (aOR 2.18, 95% CI: 1.16 - 4.10) were significantly associated with recurrent PTB. CONCLUSIONS: Hemoptysis, lung parenchymal damage, and patients being older than 45 years of age are significant features of RPTB. Management should focus on risk factors for recurrence, and a more holistic model of care to prevent long term lung injury

A Qualitative Exploration of the Mental Health and Psychosocial Contexts of HIV-Positive Adolescents in Tanzania

Although 85% of HIV-positive adolescents reside in sub-Saharan Africa, little is known about the psychosocial and mental health factors affecting their daily well-being. Identifying these contextual variables is key to development of culturally appropriate and effective interventions for this understudied and high-risk population. The purpose of this study was to identify salient psychosocial and mental health challenges confronted by HIV-positive youth in a resource-poor Tanzanian setting. A total of 24 qualitative interviews were conducted with a convenience sample of adolescents aged 12–24 receiving outpatient HIV care at a medical center in Moshi, Tanzania. All interviews were audio-recorded, transcribed, and coded using thematic analysis. Psychosocial challenges identified included loss of one or more parents, chronic domestic abuse, financial stressors restricting access to medical care and education, and high levels of internalized and community stigma among peers and other social contacts. Over half of youth (56%) reported difficulties coming to terms with their HIV diagnosis and espoused related feelings of self-blame. These findings highlight the urgent need to develop culturally proficient programs aimed at helping adolescents cope with these manifold challenges. Results from this study guided the development of Sauti ya Vijana (The Voice of Youth), a 10-session group mental health intervention designed to address the psychosocial and mental health needs of HIV-positive Tanzanian youth