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Background: Diabetic ketoacidosis (DKA), one of the common emergencies in patient with diabetes mellitus is associated with considerable morbidity and mortality. This study aimed to determine clinical presentation and precipitating factors of DKA among patients admitted at Bugando Medical Centre (BMC) in north-western Tanzania. Methods: This study involved a retrospective review of hospital records of DKA patients admitted to intensive care unit at BMC during 2012. Data on demographics, precipitating factors, clinical presentation, duration of hospital admission and mortality were extracted and analysed. Results: Total records of 1,906 hospitalized patients in 2012 were reviewed. Of this, 29 (1.5%) had DKA. Of the 29 DKA patients, 18(62.1%) and 11 (37.9%) were males and females, respectively. Among them 21(72.4%) were known diabetics and 8(27.6%) were newly diagnosed to be diabetics. Twelve patients (41.1%) presented with polyuria, polydipsia and general body malaise. Eleven (37.9%) patients presented with loss of consciousness while 6(20.7%), 4(13.8%), 3(10.3%) and 1(3.4%) presented with vomiting, abdominal pain, Kussmaul’s breathing and coma, respectively. Nausea, weight loss and polyphagia each were presented by 2(6.9%) patients. The precipitating factors were infection 15 (51.7%), first presentation of diabetes mellitus 6 (20.7%), missed insulin injection 6 (20.7%) and co-morbid conditions 6 (20.7%). Four (13.8%), 1 (3.45%) and 1(3.45%) had stroke, chronic renal failure and hypertension, respectively. Among the DKA patients, 22 (75.9%) improved and were discharged, and 7 (24.1%) died. Conclusion: DKA occurred in about 1.5% of the patients admitted to ICU and it was a major cause of morbidity and mortality. The main precipitating factor was infection. Since the precipitating factors are preventable, health care providers should put emphasis in educating diabetic patients at the diabetes clinic to reduce morbidity and mortality in these patients.

Background: Blood transfusion saves life of patients with severe anaemia. However, blood transfusion can transmit blood-borne parasites. Despite malaria being endemic in Tanzania, there is limited information on asymptomatic malaria among blood donors. This study determined the prevalence and associated factors of asymptomatic malaria among blood donors at the Lake Zone Victoria Blood Transfusion Centre in Mwanza, Tanzania. Methods: A cross-sectional study was conducted between March and April 2016 among blood donors without any symptoms of malaria. During blood donation, samples were collected from each participant. Malaria parasites were detected microscopically from Giemsa stained thin and thick smears and by the use of malaria rapid diagnostic test (MRDT). Results: A total of 150 blood donors participated in this study. The median age of participants was 20 (IQR: 18-27) years. Malaria prevalence by microscopy was 5.3% (95% CI: 1.7-8.8) while by MRDT was 8% (95% CI: 3.6-12.3). Malaria mean parasite density was 12mps/200WBC. Only individuals who reported using mosquito nets were found to be protected from getting asymptomatic malaria on multivariate logistic regression analysis (OR: 0.04, 95% CI: 0.01-0.25, P<0.001). Conclusion: A considerable proportion of blood donors in Mwanza, Tanzania are infected with P. falciparum which poses a risk for transmission to blood recipients including malaria vulnerable groups like pregnancy woman and children. Screening donated blood for malaria parasites is recommended in malaria endemic areas to prevent possible fatal consequences.

Background: Misuse of antifungal agents both in clinics and agriculture has been associated with the increased trend of antifungal resistance. In Tanzania, there is limited information regarding the magnitude of antifungal obtained over the counter. This study was therefore, conducted to determine the extent of over the counter (OTC) antifungal use and factors associated to it. Methods: This was a cross-sectional study involving patients buying antifungal agents from community pharmacies between May and July 2015 in Mwanza city, Tanzania. Data were collected by the investigator using interview guided questionnaire. Results: A total of 270 patients were enrolled and interviewed. The mean age was 30±12 years. Majority of patients (59.6%) were females. Of the 270 patients, 188 (69.3%) had dermatophytes. A total of 150 (55.6%, 95%CI 49.6-61) obtained antifungal OTC. Of 150 patients who received antifungal agents OTC, 64 (42.3%) received more than one antifungal agents compared to only 9.2% (11/120) of those with prescription (p<0.001). Clotrimazole was the commonly prescribed antifungal agent while fluconazole was mostly obtained OTC. On univariate analysis, increase in age was found to be associated with the tendency of obtaining antifungal agents over the counter (OR 1.03, 95% CI 1.008-1.05, P<0.006). Having skin fungal infections was the only predictor of obtaining antifungal agents OTC (OR 3.36, 95% CI 2.34-4.81, P<0.001). Conclusion: In Mwanza City, patients receive multiple antifungal agents over the counter and the practice is significantly more for those with skin fungal infections. There is a need for the advocacy on appropriate use of antifungal agent to reduce the associated impact of resistance development.

Injections are among the major procedures in health care facilities which need to be handled under sterile conditions. Unsafe injections have been found to cause deaths due to its associated complications. The burden of injection site infections is unknown in Tanzania. This study was designed to determine the burden of injection site infections and factors associated to it among underfives in a district hospital, northern Tanzania. This cross-sectional hospital-based study was conducted at Huruma Hospital in Rombo District, northern Tanzania from November to December 2013. This study included children of less than five years attending reproductive child health clinic for the routine immunization. Demographic data and clinical information were collected using pre-tested self-administered questionnaires, with both closed and open ended questions. A total of 200 underfives attending clinics for vaccination were recruited. Majority (n=125, 62.5%) were males. Out of 200 underfives, 60 (30%) were infants. Injection site infections were observed in 18 (9%, 95% CI: 5-12.9) of children; of whom 13 (72.2%) were females. Factors associated with injection site infections were female sex (OR 5.03, 95% CI; 1.58-18.71, P=0.001), severe malnutrition (OR 90, 95% CI; 9.5-398, p<0.001) and HIV infection (OR 21.5, 95% CI; 4.27-114.19, p<0.001). In conclusion, injection site infection rate is relatively high in this hospital and was associated with female sex, malnutrition and positive HIV status. Proper care and follow up should be instituted when injections are given to this high risk group of underfives.

Insufficient supply of manufacture’s buffers/diluents in relation to the number of strips per kit has been found to have negative impact on patients’ results. Some laboratories personnel tend to use diluents from other rapid tests manufacturers such as Bioline, Unigold as well as malaria rapid diagnostic test (MRDT). This study aimed at evaluating the use of 0.01M phosphate buffered saline (PBS) as detection buffer for Alere Determine® HIV rapid test. This study was carried out at Bugando School of Medicine in Mwanza, Tanzania. A total of 300 whole blood specimens; 150 HIV positive specimens from patients attending Care and Treatment Centreand 150 HIV negative specimens were retested for HIV status using Alere Determine® HIV rapid test employing normal Alere buffer and 0.01M PBS as buffer.Of the total specimens tested; 150 (100%) of HIV positive were positive by using both Alere buffer and 0.01M PBS while 150(100%) of HIV negative samples were negative by both Alere Determine® and 0.01M PBS. The agreement between 0.01M PBS and Alere Determine® buffer was 100%. The value of kappa indicates perfect agreement between 0.01M PBS and Alere Determine® buffer (100%). A 0.01M PBS is recommended as alternative detection buffer for Alere Determine® in cases of insufficient supply. Further investigation to evaluate the suitable buffer for other rapid tests for HIV and other diseases is recommended especially in resource limited settings.

In developing countries there is no routine screening of hepatitis B virus (HBV) infection among pregnant women resulting into limited data on its magnitude. The objective of this study was to determine the prevalence and risk factors associated with active HBV infection among pregnant women attending antenatal clinic (ANC) in Mwanza City, Tanzania. A total of 211 pregnant women were serially enrolled between May and July 2014. Hepatitis B surface antigen (HBsAg) was determined using a rapid Immuno-chromatographic assay. The median age of the study population was 23 years (IQR 20-29years). Of 211 pregnant women, 61.6% (130/211) were multigravidae. Eight (3.8%) of the pregnant women were positive with HBsAg. There was a significant difference in prevalence between primigravidae and multigravidae (0.8% vs. 8.6%, p=0.017). Active hepatitis B infection among pregnant women in Mwanza city is low and associated with multigravidity. Despite low prevalence of acute hepatitis B infection routine screening of HBsAg and anti HBsAg antibodies, coupled with the vaccination of those at risk should be introduced to prevent hepatitis B infection complications.

Toxoplasmosis is a major cause of morbidity and mortality among patients with advanced HIV disease. However, there is limited data on the magnitude of toxoplasmosis among HIV patients with immunological treatment failure. Therefore, this study was designed to determine the seroprevalence of specific Toxoplasma gondii IgG antibodies among HIV/AIDS patients attending Bugando Medical Centre in Mwanza, Tanzania. Immunological treatment failure was defined using the World Health Organization (WHO) criteria and specific T.gondii IgG antibodies were determined using indirect enzyme linked immunosorbent (ELISA). A total of 178 non-repetitive sera from HIV/AIDS patients were analyzed. The mean age of study participants was 38.5±11.3 years. Majority of study participants were males 120 (67.42%). Out of 178 patients, 38 (21.34%) were diagnosed to have immunological failure. T.gondii specific IgG antibodies were found in 26 (68.4%) of the patients with immunological failure compared to 46 (32.86%) of those without immunological failure (OR: 4.42, CI: 2.05-9.55; p<0.001). The seroprevalence of T.gondii infection is high among patients with immunological treatment failure and place them at a high risk of T. gondii encephalitis necessitating sustained trimethoprim-sulfamethaxazole prophylaxis to prevent reactivation.

Background: Since the introduction of prevention of mother to child transmission (PMTCT) in Tanzania, HIV infection rates have been reduced in different regions across the country. However, there is limited published data from the Lake Victoria zone of Tanzania regarding the effectiveness of various regimens used for PMTCT. This study was done to assess the effectiveness of antiretroviral therapy in preventing mother to child transmission of HIV Methods: Infants aged ≤18 months born to HIV positive mothers undertaking PMTCT programme and those with no intervention program from Mara, Kagera, Mwanza and Shinyanga were tested for HIV-1 DNA polymerase chain reaction (PCR). Data were analysed using STATA version 10.0 to assess factors associated with outcome. Results: A total of 1,005 study subjects were enrolled in the study. Of these 55% (554/1005) were females. Majority (82.6%; 830/1005) of the infants studied were aged 1-6 months. The median age of the infant studied was 3 months (IQR 2-4). Out of 1005 non-repetitive samples; 61(6.1%) were HIV-1 DNA PCR positive. Positive dried blood spots (DBS) rates by region were 6.4%, 5.9%, 5.6% and 5.1% in Mwanza, Mara, Kagera and Shinyanga, respectively. During pregnancy interventions, the positive rate for women with no therapy was 12.6% and for zidovudine alone was 5.4% while for triple antiretroviral therapy was 0.5%. Women who were in highly active antiretroviral therapy (HAART) during pregnancy had significantly lower positive rate than those without HAART treatment (p=0.001). Of 755 infants who received nevirapine, 3.9% were DBS positive compared to 12.8% of those who didn’t receive nevirapine (p=0.001). Conclusion: The use of antiretroviral therapy in the PMTCT programme is effective in reducing HIV transmission from mother to child.

Background: Streptococcus pneumoniae is a known cause of severe invasive bacterial infection leading to morbidity and mortality among children in sub-Saharan Africa. Nasopharyngeal colonization of S. pneumoniae is a critical step towards invasive disease progression. The objective of this study was to investigate the magnitude of nasopharyngeal carriage of S. pneumoniae and its associated factors in Mwanza, Tanzania. Methods: Children underfives attending Reproductive and Child Health (RCH) clinics in Mwanza, Tanzania clinics were enrolled and investigated for nasopharyngeal carriage of S. pneumoniae. Demographic and clinical data were collected using standardized data collection tool. Nasopharyngeal swabs were taken and processed as per standard laboratory procedures. S. pneumoniae isolates were identified using conventional methods. Antimicrobial susceptibility testing was performed using the disc diffusion method as described by Clinical Laboratory Standard Institute. Results: Among 350 children enrolled in the study, 172 (49.1) were females and 309 (88.3%) were below 2 years of age. A total of 253 (72.3%) children had received at least one dose of pneumococcal vaccine (Prevanar 13) whereas 83 (23.7%) had used antibiotics at median duration of 5 days in the past 14 days. Out of 350 underfives, 43 (12.3%) were found to carry S. pneumoniae in their nasopharynx. Children with chronic diseases and those at school were 3.4 and 4.4 times more at risk to be carriers of S. pneumoniae than their counterpart group (OR; 3.4 (CI(1.0-11.6) 95%, p=0.05) and OR; 4.4 (CI (1.2-15.7) 95%, p=0.023), respectively. Number of children at home, positive HIV status and someone smoking showed association with S. pneumoniae carriage but the differences were not statistically significant. The resistance levels of S. pneumoniae to penicillin, co-trimoxazole and erythromycin were 40%, 88.2% and 41.7%, respectively. However all of the S. pneumoniae isolates were found to be 100% sensitive to

Pseudomonas spp. and Klebsiella pneumoniae are common causes of serious health care associated infections (HCAIs) worldwide. The treatment options for infections caused by multi-drug resistant (MDR) organisms are limited to tigecycline and carbapenems. A total of 172 isolates of multi-drug resistant Pseudomonas spp and extended-spectrum β- (ESBL) producing Klebsiella pneumoniae isolated from clinical specimens at the Bugando Medical Centre were tested for their in vitro susceptibility to piperacillin-tazobactam 100/10μg using disc diffusion test as recommended by Clinical Laboratory Standard Institute (CLSI). Out of 59 multi-drug resistant Pseudomonas spp, 54 (92.0%) were susceptible to piperacillin-tazobactam while of 113 ESBL producing Klebsiella pneumoniae, 55 (48.7%) were susceptible to piperacillin-tazobactam 100/10μg. Also, 20 (34.0%) of the Pseudomonas spp were both ESBL producers and susceptible to piperacillin-tazobactam 100/10μg. A significant proportion of Pseudomonas spp isolates from clinical specimens in our setting are susceptible to piperacillin/tazobactam. This study shows that piperacillin-tazobactam offer a better option to clinicians for the treatment of health care associated infections due to Pseudomonas spp. and ESBL producing Klebsiella pneumoniae in our setting and other health facilities where these organisms are of significance.