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Nadeem Kassam,1 Philip B Adebayo,1 Iris Martin Matei,1 Eric Aghan,2 Samina Somji,1 Samwel Paul Kadelya,1 Yasson Abha,1 Frank Elton Swai,2 Mangaro Mabusi,1 Kamran Hameed,1 Hanifa Mbithe,1 Alyyah Thawer,1 Mandela Charles Makakala,1 Fatma Amirali Bakshi,1 Harrison Chuwa,1 Masolwa Ng’wanasayi,1 Casmir M Wambura,1 Robert Sostenes Mvungi,1 James Orwa,3 Munish Sharma,4 George Udeani,5 Salim Surani5 1Department of Internal Medicine, Aga Khan Health Service, Dar-es-Salaam, Tanzania; 2Department of Family Medicine, Aga Khan University Medical College, Nairobi, Kenya; 3Department of Population Health, Aga Khan University Medical College, Nairobi, Kenya; 4Department of Medicine, Division of Pulmonology and Critical Care, Baylor Scott and White Medical Center, Temple, Texas, USA; 5Department of Pharmacy, A&M University, College Station, Texas, USACorrespondence: Nadeem Kassam, Department of Internal Medicine, Aga Khan Health Service, Dar-es-Salaam, Tanzania, Email Kassamnadeem2@gmail.comIntroduction: Despite the implementation of complex interventions, ICU mortality remains high and more so in developing countries. The demand for critical care in Sub-Saharan Africa is more than ever before as the region experiences a double burden of rising rates of non-communicable diseases (NCD) in the background battle of combating infectious diseases. Limited studies in Tanzania have reported varying factors associated with markedly high rates of ICU mortality. Investigating the burden of ICU care remains crucial in providing insights into the effectiveness and challenges of critical care delivery.Material and Methods: A single-center retrospective study that reviewed records of all medically admitted patients admitted to the ICU of the Aga Khan Hospital, Dar-es-Salaam, from 1st October 2018 to 30th April 2023. To define the population in the study, we used descriptive statistics. Patients’ outcomes were categorized based on ICU survival. Binary logistic regression was run (at 95% CI and p-value

Nadeem Kassam,1 Salim Surani,2 Kamran Hameed,3 Eric Aghan,4 Robert Mayenga,1 Iris Matei,1 Gijsberta Jengo,1 Fatma Bakshi,3 Hanifa Mbithe,3 James Orwa,5 George Udeani,2 Samina Somji3 1Department of Internal Medicine, Aga Khan Hospital, Mwanza, Tanzania; 2Department of Pharmacy, A&M University, College Station, TX, USA; 3Department of Internal Medicine, Aga Khan Hospital, Dar es Salaam, Tanzania; 4Department of Family Medicine Aga Khan University Medical College, Dar es Salaam, Tanzania; 5Department of Population Health, Aga Khan University, Nairobi, KenyaCorrespondence: Nadeem Kassam, Email Kassamnadeem2@gmail.comIntroduction: Atherosclerotic Cardiovascular Disease (ASCVD) is the leading cause of death worldwide. In Diabetics, ASCVD is associated with poor prognosis and a higher case fatality rate compared with the general population. Sub-Saharan Africa is facing an epidemiological transition with ASCVD being prevalent among young adults. To date, over 20 million people have been living with DM in Africa, Tanzania being one of the five countries in the continent reported to have a higher prevalence. This study aimed to identify an individual’s 10-year ASCVD absolute risk among a diabetic cohort in Tanzania and define contextual risk enhancing factors.Methods: A prospective observational study was conducted at the Aga Khan hospital, Mwanza, for a period of 8 months. The hospital is a 42-bed district-level hospital in Tanzania. Individuals 10-year risk was calculated based on the ASCVD 2013 risk calculator by ACC/AHA. Pearson’s chi-square or Fischer’s exact test was used to compare categorical and continuous variables. Multivariable analysis was applied to determine contextual factors for those who had a high 10-year risk of developing ASCVD.Results: The overall cohort included 573 patients. Majority of the individuals were found to be hypertensive (n = 371, 64.7%) and obese (n = 331, 58%) having a high 10-year absolute risk (n = 343, 60%) of suffering ASCVD. The study identified duration of Diabetes Mellitus (> 10 years) (OR 8.15, 95% CI 5.25– 14.42), concomitant hypertension (OR 1.82 95% CI 1.06– 3.06), Diabetic Dyslipidemia (OR 1.44, 95% CI 1.08– 1.92) and deranged serum creatinine (OR 1.03, 95% CI 1.02– 1.03) to be the risk enhancing factors amongst our population.Conclusion: The study confirms the majority of diabetic individuals in the lake region of Tanzania to have a high 10-year ASCVD risk. The high prevalence of obesity, hypertension and dyslipidemia augments ASCVD risk but provides interventional targets for health-care workers to decrease these alarming projections.Keywords: diabetes mellitus, Tanzania, factors, cardiovascular risk, primary prevention, ASCVD

Nadeem Kassam,1 Eric Aghan,2 Omar Aziz,1 Hanifa Mbithe,1 Kamran Hameed,1 Reena Shah,3 Salim Surani,4 James Orwa,5 Samina Somji1 1Internal Medicine, The Aga Khan Hospital, Dar es Salaam, Tanzania & Aga Khan University, Medical College, Dar-es- Salaam, Tanzania; 2Family Medicine, The Aga Khan Hospital, Dar es Salaam, Tanzania & Aga Khan University, Medical College, East Africa, Dar-es-Salaam, Tanzania; 3Infectious Disease & Internal Medicine, The Aga Khan University, Medical College, Nairobi, Kenya; 4Pulmonology & Internal Medicine, Texas a&m University, Texas A&M College Station, TX, USA; 5Population Health, Aga Khan University, Medical College, East Africa, Nairobi, KenyaCorrespondence: Nadeem Kassam Email nadeem.kassam@aku.eduBackground: The emergence of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. There has been paucity of data for hospitalized African patients suffering from COVID-19. This study aimed to identify factors associated with in-hospital mortality in patients suffering from COVID-19 in Tanzania.Methods: This was a single center, retrospective, observational cohort study in adult patients hospitalized with confirmed COVID-19 infection. Demographics, clinical pattern, laboratory and radiological investigations associated with increased odds of mortality were analyzed.Results: Of the 157 patients, 107 (68.1%) patients survived and 50 (31.8%) died. Mortality was highest in patients suffering with severe (26%) and critical (68%) forms of the disease. The median age of the cohort was 52 years (IQR 42– 61), majority of patients were male (86%) and of African origin (46%), who presented with fever (69%), cough (62%) and difficulty in breathing (43%). Factors that were associated with mortality among our cohort were advanced age (OR 1.07, 95% CI 1.03– 1.11), being overweight and obese (OR 9.44, 95% CI 2.71– 41.0), suffering with severe form of the disease (OR 4.77, 95% CI 1.18– 25.0) and being admitted to the HDU and ICU (OR 6.68, 95% CI 2.06– 24.6).Conclusion: The overall in-hospital mortality was 31.8%. Older age, obesity, the severe form of the disease and admission to the ICU and HDU were major risk factors associated with in-hospital mortality.Keywords: COVID-19, factors, hospital, mortality, Tanzania