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Background: Congenital Rubella Syndrome (CRS) is among the causes of infant mortality and lifelong disability due to severe birth defects. There has been an increasing number of neonates born with congenital abnormalities suggesting CRS, at the same time the rubella seroprevalence among pregnant mothers and healthy school children in the northwestern Tanzania has been noted to be alarmingly high. This study aimed to determine prevalence of rubella antibodies and associated factors among infants suspected to have CRS. Methods: This cross-sectional study included 174 infants aged ≤ 12 months with at least one clinical features of CRS. The study was conducted between Septembers 2017and March 2018 at Bugando Medical Centre, a consultant teaching hospital in North Western Tanzania. Collection of Social demographic and other relevant information was done hand in hand with screening for clinical symptoms suggestive of CRS and Blood samples were collected. Indirect enzyme-linked immunosorbent assay (ELISA) Test were conducted on collected sera to test for specific Rubella IgM and IgG antibodies. Results: The majority of enrolled infants were below 1 year of age; of these 83 (47.7%) were neonates and only 13.2% had received MR vaccine. Out of these, 111 (63.8%, 95%CI: 56.6-70.9) were IgG Rubella seropositive whereas none was IgM Rubella seropositive. In multivariate logistic regression analysis being neonate was the only factor that independently predicted rubella IgG seropositivity (OR 2.3; 95% CI 1.2 – 4.4; p=0.012) Conclusion: A significant proportion children (

Background: Severe maternal outcome is a complementary indicator of maternal health services. In absence of the patient’s testimony, reviews of maternal deaths alone often fail to provide critical details from the victim’s perspective. Combining maternal near misses and maternal deaths as two indicators for maternal health inform of severe maternal outcomes is designed to bridge this gap. Methods: A crossectional study conducted between November 2021 and May 2022, included 287 women admitted with obstetric-related conditions. Sub-Saharan Africa (SSA) maternal near-miss tool was used to identify women with maternal near-miss. Descriptive statistics were used to evaluate obstetric characteristics and severe maternal outcome indicators. Factors associated with SMO were tested using chi-square and fishers exact test with a p-value Results: A total of 287 women were enrolled in this study, from whom 175(60.9%) had severe maternal outcomes (SMO) in form of 138(78.9%) maternal near-miss and 37(21.1%) maternal deaths with a total of 3,071 recorded live birth. A calculated severe maternal outcome ratio of 56.9 per 1000 live births, a maternal near-miss ratio of 44.9 per 1000 live births, a mortality index of 0.21, and the maternal mortality ratio of 1204 per 100,000 live births were obtained. Referral from other health facilities {OR 6.1, 95% CI [2.38 – 16.0]} p-value Conclusion: This is the first study of its kind across the northeastern zone of Tanzania. The above national average maternal mortality rate, a higher mortality index, a lower maternal near miss to maternal mortality ratio, and a high SMO ratio seen in this study indicates inadequacies in the health care system across different levels of care. Delay in receiving intervention for more than 30 minutes, referral from other health facilities, and admission to intensive care units are highly associated with a SMO event. SMO studies offer a better understanding of healthcare system challenges than studying maternal deaths alone.

Background Acute febrile diseases transmitted by mosquitos are a diagnostic challenge for pediatricians working Sub-Sahara-Africa. Misclassification due to the lack of rapid, reliable diagnostic tests leads to the overuse of antibiotics and antimalarials. Methods Between April 2016 and March 2018, 751 children presenting with acute fever and suspected of having malaria were examined at healthcare facilities located in Mwanza Region, Tanzania. Sociodemographic data and medical histories were obtained. The sensitivity and specificity of blood smear microscopy and malaria rapid diagnostic tests were compared to multiplex-RT-PCR-ELISA. Results One hundred thirty-seven of 698 (19.6%) pediatric patients meeting the inclusion criteria and presenting with acute fever had Plasmodium falciparum infections confirmed by PCR. 22,8% received antibiotics and 22,6% antimalarials prior to admission. No evidence of arboviral infections was found. Blood smear microscopy exhibited 33.3% sensitivity and 93.2% specificity. Malaria Rapid Test NADAL® provided 86.6% sensitivity and 98.2% specificity in detecting acute malaria infections. Only 7.2% of malaria-negative children received antimalarials at Sengerema Designated District Hospital when treatment was guided by the results of the rapid test. Conclusions Misclassification and premedication of non-malarial, febrile illnesses contribute to the emergence of antimalarial and antimicrobial resistance. Rapid, reliable diagnostic tests could reduce the number of antimalarial prescription significantly. This occurred when Malaria Rapid Tests were incorporated into the clinical routine and the results were translated into adequate treatment.

Antimicrobial resistance is a global health threat and there is an urgent need to manage antibiotic use to slow its development. However, antimicrobial stewardship interventions in low- and middle-income countries (LMIC) have been limited in terms of their resourcing, feasibility and effectiveness in the face of greater challenges in child mortality. We sought to gather together examples of antibiotic use problems faced by clinicians in LMIC, many of which are unique to these settings, and real-world antimicrobial stewardship solutions identified, with the goal of learning broader lessons that might be applicable across LMIC.

Background and Objectives: Candida colonization in neonates with low birth weight is reported to be the first step for invasive candidiasis. This study was designed to describe the patterns of Candida spp. colonizing neonates with low birth weight in Mwanza, Tanzania to provide baseline information for future studies in this field. Methodology: The hospital based cross sectional study was conducted between January 2019 and April 2019 among neonates with low birth weight. Clinical and social demographic data were collected using interview guide questionnaire. Oral and umbilical rectal swabs were collected on the first and seventh day of life to assess Candida spp. colonization status. Data were analyzed using STATA version 13 following the study objectives. Results: A total of 320 neonates with median body weight of 1600 [IQR 1000 - 2000] grams were enrolled. Prevalence of Candida spp. colonization on either oral, umbilical or rectum was 16.2% (52/320). A total of 34 (10.6%) and 41 (12.8%) neonates were colonized by Candida spp. on the first day and seventh day of life, respectively. Of 34 neonates colonized on the first day of life, 23 (67.7%) were still being colonized on the seventh day. Candida albicans 38 (73.1%), was the predominant species detected followed by Candida glabrata 10 (19.2%). Conclusion: The prevalence of Candida spp. colonization among neonates with low birth weight is within the reported range and is mainly due to Candida albicans. Future studies are highly needed to explore the role of colonization and subsequent Candida spp. infections.

Introduction: Rotavirus infection is a leading cause of severe diarrhea culminating to dehydration among children under five years of age. Understanding trends and factors that could assist towards devising effective preventive strategies of Rotavirus infection beyond vaccination is crucial. Objectives: This study was done in an attempt to determine the prevalence and associated factors of Rotavirus infection among vaccinated children aged between 6 weeks and 24 months admitted with acute diarrhea Mwanza, Tanzania. Material and Methods: Across sectional study involving vaccinated children aged 6 weeks to 24 months was conducted in three selected hospitals from July 2017 to January 2018. Socio-demographic and other relevant clinical information were collected using a standardized data collection tool adopted from WHO Rotavirus surveillance tool. Rotavirus infection from the stool was detected using an enzyme immunoassay. Data were analyzed using STATA version 13. Results: A total of 301 vaccinated children with acute diarrhea with a median age of 12 [IQR: 8 - 17] months were enrolled. Nine (3.0%) and 292 (97.0%) had received one dose and two doses of Rotavirus vaccine, respectively. The prevalence of Rotavirus infection was 74 (24.6%) [95% CI: 20.0 - 29.8]. Independent predictors of Rotavirus infection were: dry season (OR 6.9; 95% CI: 2.9 - 16.0; p - 4.2; p = 0.043) and vomiting (OR 3.6; 95% CI 1.1 - 12.6; p = 0.045). Children with Rotavirus infection had a significantly shorter hospital stay than those without Rotavirus infection (3 [2 - 4] days versus 3 [3 - 5] days; p = 0.0297). Conclusions: The prevalence of Rotavirus infection has declined among vaccinated children in Mwanza, Tanzania with significant decrease in the hospital stay. Dry seasons, three or more children indwelling in the same house and vomiting were independent predictors of Rotavirus infection. There is a need to sustain the coverage of rotavirus vaccination in low-income countries in order to significantly reduce associated morbidity and mortality.

Objectives Acute mosquito-borne febrile diseases pose a threat to children in the Sub-Saharan-Africa with ∼272 000 children dying worldwide from malaria in 2018. Although the awareness for malaria in this area has increased due to improved health education, the apparent decline of actual malaria cases has not affected clinical practice significantly. This study collected clinical and epidemiologic data of children presenting with acute febrile diseases in order delineate their diagnostic and therapeutic management. Methods A hospital-based cross-sectional clinical study was conducted at the Sekou Toure Regional Referral Hospital in Tanzania. Children between 1 month and 12 years of age with an axillary temperature ≥ 37.5°C were recruited from August 2016 to December 2016. Children received full clinical examination. In addition, file data about diagnostics and treatment were collected and malaria rapid diagnostic tests (mRDTs) were performed. Confirmatory malaria polymerase chain reaction was performed from dry blood spots. Results From 1381 children presented in the pediatric outpatient department, 133 met the inclusion criteria. Out of 133 febrile children, 10.5% were malaria positive. Treatment data indicate the prescription of antimalarials in 35.3% and antibiotics in 63.9% of the children with an overlap of 24.1% receiving both. Despite a negative mRDT, 36 patients received antimalarials. Conclusions The findings of this study confirm a significant decline of malaria cases in the Lake Victoria region. The discrepancy between the valuable results provided by mRDTs and the high prescription rates of antibiotics and antimalarials call for an enforced diagnostic and therapeutic algorithm. LAY SUMMARY The aim of the study was to take a closer look at reported cases of febrile diseases in the Lake Victoria region and assess the relationship between clinical as well as diagnostic findings and the resulting therapeutic concept. Based on these findings the prescription rate of antimalarial and antibiotic drugs was analyzed. The results showed an overall high prescription rate of antimalarials and antibiotics in both diagnosed malaria cases and cases with diagnosed bacterial infections. Not only with regards to the possible side effects of these medications but also keeping in mind the apparent misuse of resources this practice poses a serious burden to the health care system in this low resource country.

To determine the regional- and district-level newborn prevalence of sickle cell trait and disease, and the prevalence of haemoglobin variants and genetic modifiers of sickle cell disease, in the nine regions of north-western United Republic of Tanzania.We repurposed dried blood spot samples from children (aged 0-24 months) born to mothers living with human immunodeficiency virus (HIV), collected as part of the HIV Early Infant Diagnosis programme, for sickle cell diagnosis. We performed isoelectric focusing to determine whether samples had normal haemoglobin, sickle cell trait, sickle cell disease or a rare haemoglobin variant. We shipped samples diagnosed as disease or variant to Cincinnati Children's Hospital in the United States of America for deoxyribonucleic-acid-based analyses to determine the prevalence of α-thalassaemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency or fetal haemoglobin genetic modifiers.We analysed a total of 17 200 specimens during February 2017-May 2018. We observed a prevalence of sickle cell trait and disease of 20.3% (3492/17 200) and 1.2% (210/17 200), respectively. District-level trait varied from 8.6% (5/58) to 28.1% (77/274). Among confirmed sickle cell disease specimens, we noted 42.7% (61/143) had 1-gene deletion and 14.7% (21/143) had 2-gene deletion α-thalassaemia trait. We documented G6PD AOur calculated prevalence is twice as high as previously reported and reinforces the need for enhanced sickle cell diagnostic services. Our district-level data will inform public health policy, allowing screening and disease-modifying hydroxyurea therapy to be focused on high-prevalence areas, until universal newborn screening is available.Déterminer la prévalence de la drépanocytose et du trait drépanocytaire chez les nouveau-nés, ainsi que la prévalence de variants d'hémoglobine et de modificateurs génétiques de la drépanocytose dans les neuf régions du nord-ouest de la République-Unie de Tanzanie.Nous avons réutilisé des échantillons de gouttes de sang séché provenant d'enfants (âgés de 0 à 24 mois) nés de mères atteintes du virus de l'immunodéficience humaine (VIH), prélevés dans le cadre du programme de diagnostic précoce de l'infection à VIH chez le nourrisson pour détecter une éventuelle drépanocytose. Nous avons procédé à une focalisation isoélectrique pour savoir si les échantillons présentaient une hémoglobine normale, un trait drépanocytaire, une drépanocytose ou un variant d'hémoglobine rare. Ensuite, nous avons envoyé les échantillons identifiés comme porteurs de la maladie ou d'un variant à l'hôpital pour enfants de Cincinnati, aux États-Unis, afin d'analyser l'acide désoxyribonucléique et de mesurer la prévalence d'une α-thalassémie, d'un déficit en glucose-6-phosphate déshydrogénase (G6PD) ou de modificateurs génétiques de l'hémoglobine fœtale.Nous avons étudié 17 200 spécimens au total entre février 2017 et mai 2018. Nous avons observé une prévalence de 20,3% (3492/17 200) pour la drépanocytose, et de 1,2% (210/17 200) pour le trait drépanocytaire. D'un district à l'autre, la présence du trait variait de 8,6% (5/58) à 28,1% (77/274). Nous avons constaté que 42,7% (61/143) des spécimens chez qui une drépanocytose avait été confirmée étaient privés d'un gène, et 14,7% (21/143) de deux gènes du trait α-thalassémique. Enfin, nous avons répertorié un déficit en G6PD ALa prévalence que nous avons calculée est deux fois supérieure aux chiffres mentionnés précédemment, et souligne la nécessité d'instaurer de meilleurs services de diagnostic de la drépanocytose. Nos données réparties par district fourniront des informations en matière de politique de santé publique, afin que le dépistage et le traitement modificateur de la maladie, à base d'hydroxyurée, se concentrent sur les zones de forte prévalence jusqu'à ce qu'un dépistage universel des nouveau-nés soit disponible.Determinar la prevalencia de la enfermedad y del rasgo de las células falciformes en los recién nacidos a nivel regional y de distrito, y la prevalencia de las variantes de hemoglobina y de los modificadores genéticos de la drepanocitosis en las nueve regiones del noroeste de la República Unida de Tanzania.Se reutilizaron las muestras de las manchas de sangre seca de los niños (de 0 a 24 meses de edad) nacidos de madres que padecían el virus de la inmunodeficiencia humana (VIH); estas muestras se obtuvieron a través del programa de Diagnóstico precoz del VIH en niños para diagnosticar las células falciformes. Se aplicó la técnica del enfoque isoeléctrico para determinar si las muestras tenían hemoglobina, rasgos de células falciformes, drepanocitosis normales o una variante de hemoglobina poco frecuente. Se enviaron muestras diagnosticadas como enfermedad o variante al Hospital Infantil de Cincinnati (Cincinnati Children's Hospital) en los Estados Unidos de América para analizarlas a base de ácido desoxirribonucleico y así determinar la prevalencia de talasemia α, de deficiencia de glucosa-6-fosfato deshidrogenasa (G6PD, por sus siglas en inglés) o de modificadores genéticos de hemoglobina fetal.Se analizaron un total de 17 200 muestras entre febrero de 2017 y mayo de 2018. Se observó una prevalencia del rasgo de las células falciformes y de la drepanocitosis del 20,3 % (3492/17 200) y del 1,2 % (210/17 200), respectivamente. El rasgo a nivel de distrito varió del 8,6 % (5/58) al 28,1 % (77/274). Se observó que en las muestras de drepanocitosis confirmadas, el 42,7 % (61/143) presentaba la eliminación de un gen y el 14,7 % (21/143) la eliminación de dos genes en el rasgo de talasemia α. Se registró una deficiencia de G6PD A- en el 19,2 % (14/73) de los varones.La prevalencia que se calcula aquí es el doble de la que se notificó anteriormente y refuerza la necesidad de mejorar los servicios para el diagnóstico de la drepanocitosis. Estos datos a nivel de distrito contribuirán a la política de salud pública, ya que permitirán que los cribados y la terapia con hidroxicarbamida que modifica la enfermedad se centren en las zonas de alta prevalencia, hasta que se disponga de un cribado universal de los recién nacidos.الغرض تحديد معدل انتشار سمات ومرض الخلايا المنجلية لدى حديثي الولادة على مستوى الأقاليم والمناطق، وانتشار متغيرات الهيموجلوبين والمعدلات الجينية لمرض فقر الدم المنجلي، في المناطق التسع الواقعة شمال غرب جمهورية تنزانيا المتحدة. الطريقة قمنا بإعادة استخدام عينات بقع الدم المجففة من الأطفال (من حديثي الولادة إلى 24 شهرًا) المولودين لأمهات مصابات بفيروس نقص المناعة البشرية (HIV)، والتي تم جمعها كجزء من برنامج التشخيص المبكر لفيروس نقص المناعة البشرية للرضع، لتشخيص مرض الخلايا المنجلية. أجرينا تركيزًا متساوي الجهد الكهربائي لتحديد ما إذا كانت العينات تحتوي على هيموجلوبين طبيعي، أو سمة للخلايا المنجلية، أو مرض الخلايا المنجلية، أو أحد المتغيرات النادرة للهيموجلوبين. كما قمنا بشحن عينات تم تشخيصها على أنها مصابة بالمرض أو أحد المتغيرات، إلى مستشفى سينسيناتي للأطفال في الولايات المتحدة الأمريكية، لإجراء تحليلات باستخدام حمض الديوكسي ريبونيوكليك لتحديد مدى انتشار كل من ثلاسيميا ألفا، أو النقص في نازع هيدروجين الجلوكوز 6 فوسفات (G6PD)، أو المعدلات الوراثية للهيموجلوبين الجنيني. النتائج قمنا بتحليل إجمالي 17200 عينة خلال الفترة من فبراير/شباط 2017 إلى مايو/أيار 2018. ولاحظنا انتشار سمة ومرض الخلايا المنجلية بنسبة 20.3% (3492/17200)، و1.2% (210/17200)، على الترتيب. تنوعت السمات على مستوى المناطق من 8.6% (5/58) إلى 28.1% (77/274). ولاحظنا من بين عينات مرض الخلايا المنجلية المؤكد، أن 42.7% (61/143) قد عانت من حذف جين واحد، و14.7% (21/143) عانت من حذف جينين من سمة ألفا ثلاسيميا. وكما بتوثيق النقص في G6PD A في 19.2% (14/73) من الذكور. الاستنتاج إن معدل الانتشار الذي قمنا باحتسابه هو ضعف ما تم الإبلاغ عنه سابقًا، ويعزز الحاجة إلى خدمات محسنة لتشخيص مرض الخلايا المنجلية. ستؤدي البيانات على مستوى المقاطعات لدينا إلى توجيه سياسة الصحة العامة، مما يسمح لكل من الفحص والمعالجة باستخدام هيدروكسي اليوريا المعدل للأمراض، بالتركيز على المناطق ذات الانتشار المرتفع، حتى يتوفر فحص شامل لحديثي الولادة.确定坦桑尼亚联合共和国西北九个地区，新生儿镰状细胞性状和镰状细胞疾病的患病率，以及血红蛋白变体和镰状细胞疾病遗传修饰因子的患病率。.作为 HIV 早期婴儿诊断计划的一部分，我们将携带人类免疫缺陷病毒 (HIV) 的母亲所生婴儿（0-24 个月）的干血斑样本重新用于诊断镰状细胞。我们对其实施等电聚焦，以确定样本的血红蛋白是否正常、是否具有镰状细胞性状、镰状细胞疾病或罕见的血红蛋白变体。我们将诊断出患有疾病或变异的样本运送到美国辛辛那提儿童医院，进行脱氧核糖核酸分析，以确定α地中海贫血、6-磷酸葡萄糖脱氢酶 (G6PD) 缺失症或胎儿血红蛋白遗传修饰因子的患病率。.我们在 2017 年 2 月至 2018 年 5 月期间共分析了 17200 个样本。我们观察到镰状细胞性状和镰状细胞疾病的患病率分别为 20.3％ (3492/17 200) 和 1.2％ (210/17 200)。区级镰状细胞性状患病率则从 8.6% (5/58) 到 28.1% (77/274) 不等。在确诊的镰状细胞疾病样本中，我们发现 42.7% (61/143) 具有 1 基因缺失型 α 地中海贫血性状，14.7% (21/143) 具有 2 基因缺失型 α 地中海贫血性状。我们注意到 19.2% (14/73) 的男婴患有 G6PD A–缺乏症。.我们计算得出的患病率是先前报道的两倍，这凸显了加强镰状细胞诊断服务的必要性。我们的区级数据将为公共卫生政策提供信息，从而确保在新生儿普查之前，对高发地区集中展开筛查和疾病修饰羟基脲疗法。.Определить на национальном уровне и на уровне районов распространенность среди новорожденных носительства признака серповидно-клеточной анемии и самого этого заболевания, а также распространенность вариантов гемоглобина и генетических модификаторов серповидно-клеточной анемии в девяти регионах на северо-западе Объединенной Республики Танзания.Для диагностики серповидно-клеточной анемии авторы использовали взятые методом высушивания пятна образцы крови детей в возрасте от 0 до 24 месяцев, чьи матери живут с вирусом иммунодефицита человека (ВИЧ); эти образцы были собраны в рамках программы ранней диагностики ВИЧ у детей. Для определения наличия в образцах нормального гемоглобина, носительства признака серповидно-клеточной анемии, собственно серповидно-клеточной анемии или редкого варианта гемоглобина использовался метод изоэлектрической фокусировки. Образцы, которые были диагностированы как соответствующие проявлениям заболевания или как содержащие вариантный гемоглобин, были направлены в Детскую больницу Цинциннати, США, для проведения ДНК-анализа с целью определения распространенности в них α-талассемии, дефицита глюкозо-6-фосфат-дегидрогеназы (Г6ФД) или наличия генетических модификаторов фетального гемоглобина.Авторы проанализировали 17 200 образцов в период с февраля 2017 г. по май 2018 г. Носительство признака серповидно-клеточной анемии было обнаружено в 20,3% случаев (3492 из 17 200 образцов), а серповидно-клеточная анемия — в 1,2% (210 из 17 200 образцов). Наличие признака в разных районах варьировалось от 8,6% (5 из 58 образцов) до 28,1% (77 из 274 образцов). Среди образцов с подтвержденным диагнозом серповидно-клеточной анемии в 42,7% случаев (61 из 143) наблюдался признак α-талассемии с делецией 1 гена и в 14,7% (21 из 143) — с делецией 2 генов. Дефицит Г6ФД был зафиксирован у 19,2% (14 из 73) мальчиков.Рассчитанная авторами распространенность заболевания вдвое превышает опубликованные ранее значения и еще раз указывает на необходимость укрепления и расширения услуг по диагностике СКА. Полученные данные по районам станут основой для выработки политики в области общественного здравоохранения, которая бы позволяла сосредоточить скрининговое обследование и лечение гидроксимочевиной (изменяющее течение заболевания) в областях с высоким распространением заболевания до тех пор, пока не станет возможным всеобщее скрининговое обследование новорожденных.

Background Malaria and acute bacterial meningitis (ABM) are the leading infectious causes of febrile encephalopathy in malaria endemic settings. The clinical distinction of the two conditions is complicated by overlap in clinical features. Objective To determine the clinical predictors for malaria, ABM and treatment outcome in febrile children aged 2 months to 12 years with altered mentation at two tertiary hospitals in Northwestern Tanzania. Methods Prospective study of 103 children to document demographic data and physical examination findings, such as level of consciousness and meningeal irritations. Laboratory results for cerebrospinal fluid, hemoglobin, malaria and HIV were also evaluated. Results Age >60 months and hemoglobin ≤5 g/dl were independent predictors of malaria; (p = 0.013 and 0.004, respectively). HIV infection was the only predictor of meningitis, p = 0.037, and mortality was high if the diagnosis was unconfirmed. Conclusions Children with febrile encephalopathy are more likely to have malaria than ABM if they have severe anemia.

BackgroundAfrica has the highest rates of child mortality. Little is known about outcomes after hospitalization for children with very severe anemia.ObjectiveTo determine one year mortality and predictors of mortality in Tanzanian children hospitalized with very severe anemia.MethodsWe conducted a prospective cohort study enrolling children 2-12 years hospitalized from August 2014 to November 2014 at two public hospitals in northwestern Tanzania. Children were screened for anemia and followed until 12 months after discharge. The primary outcome measured was mortality. Predictors of mortality were determined using Cox regression analysis.ResultsOf the 505 children, 90 (17.8%) had very severe anemia and 415 (82.1%) did not. Mortality was higher for children with very severe anemia compared to children without over a one year period from admission, 27/90 (30.0%) vs. 59/415 (14.2%) respectively (Hazard Ratio (HR) 2.42, 95% Cl 1.53–3.83). In-hospital mortality was 11/90 (12.2%) and post-hospital mortality was 16/79 (20.2%) for children with very severe anemia. The strongest predictors of mortality were age (HR 1.01, 95% Cl 1.00–1.03) and decreased urine output (HR 4.30, 95% Cl 1.04 – 17.7).ConclusionsChildren up to 12 years of age with very severe anemia have nearly a 30% chance of mortality following admission over a one year period, with over 50% of mortality occurring after discharge. Post-hospital interventions are urgently needed to reduce mortality in children with very severe anemia, and should include older children.

Malaria remains common in sub-Saharan Africa, but it is frequently over-diagnosed and over-treated in hospitalized children. HIV is prevalent in many malaria endemic areas and may delay parasite clearance and increase mortality among children with malaria. This prospective cohort study enrolled children with suspected malaria between 3 months and 12 years of age hospitalized at two referral hospitals in Tanzania. Both a thick blood smear (BS) and a malaria rapid diagnostic test (mRDT) were performed. If discordant results were obtained, PCR was performed for Plasmodium falciparum. Malaria was confirmed if two out of three tests were positive. Malaria parasite densities were determined for two consecutive days after diagnosis and treatment of malaria. All participants were tested for HIV. Among 1492 hospitalized children, 400 (26.8%) were enrolled with suspected malaria infection. There were 196/400 (49.0%) males, and the median age was 18 [9-36] months. BS was positive in 95/400 (23.8%), and mRDT was positive in 70/400 (17.5%), with moderate agreement (Kappa=0.598). Concordant results excluded malaria in 291/400 (72.8%) and confirmed malaria in 56/400 (14.0%). PCR performed on 53 discordant results confirmed malaria in 1/39 of the BS-positive/mRDT-negative cases, and 6/14 of the BS-negative/mRDT-positive cases. The prevalence of confirmed malaria was 63/400 (15.8%). In multivariable logistic regression, malaria was associated with HIV (OR 3.45 [1.65-7.20], p=0.001). Current breastfeeding (OR 0.25 [0.11-0.56], p=0.001) and higher hemoglobin (OR 0.70 [0.60-0.81], p

Tanzania has the third highest number of infants in the world born annually with sickle cell disease (SCD). Tanzania lacks a national newborn screening program, and a large majority of the clinical care, resources, and research for SCD are located in the coastal city of Dar es Salaam. Previous

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. peerReviewed

Background Sub-Saharan Africa has the highest rates of child mortality worldwide. Little is known about post-hospital outcomes after an index hospitalization for older children. We determined 12-month post-hospital mortality rate and identified factors associated with higher mortality. Methods In this prospective cohort study, we enrolled children 2–12 years of age admitted to the pediatric wards of two public hospitals in northwestern Tanzania. Participants or proxies were contacted at 3, 6 and 12 months post-hospitalization. The primary outcome measured was mortality. Factors associated with mortality were determined using Cox regression analysis. Results A total of 506 participants were enrolled. In-hospital mortality rate was 7.7% (39/506). Of the 467 participants discharged, the post-hospital mortality rate was 10.1% (47/467). Sickle cell disease (Hazard Ratio (HR) 3.32, 95% CI 1.44–7.68), severe malnutrition (HR 3.19, 95% CI 1.18–8.57), neurologic diseases (HR 3.51, 95% CI 1.35–9.11), heart disease (HR 7.11, 95% CI, 2.89–17.51), cancer (HR 11.79, 95% CI 4.95–28.03), and septic shock (HR 4.64, 95% CI 1.42–15.08) had higher association with mortality compared to other diagnoses. The risk factors significantly associated with mortality included older age (HR 1.01, 95% CI 1.00–1.08), lower hemoglobin level (HR 0.83, 95% CI 0.76–0.90), lower Glasgow Coma Scale (HR 0.66, 95% CI 0.59–0.74), history of decreased urine output (HR 2.87, 95% CI 1.49–5.53), higher respiratory rate (HR 1.02, 95% CI 1.00–1.03), estimated glomerular filtration rate less than 60 ml/min/1.73m2 (binary) (HR 1.84, 95% CI 1.10–3.10), and lower oxygen saturation (HR 0.96, 95% CI 0.92–0.99). Conclusions Post-hospital mortality is disturbingly high among children 2–12 years of age in Tanzania. Post-hospital interventions are urgently needed especially for older children with chronic illnesses.

Both anemia and sickle cell disease (SCD) are highly prevalent across sub-Saharan Africa, and limited resources exist to diagnose these conditions quickly and accurately. The development of simple, inexpensive, and accurate point-of-care (POC) assays represents an important advance for global hematology, one that could facilitate timely and life-saving medical interventions. In this prospective study, Robust Assays for Point-of-care Identification of Disease (RAPID), we simultaneously evaluated a POC immunoassay (Sickle SCAN™) to diagnose SCD and a first-generation POC color-based assay to detect anemia. Performed at Bugando Medical Center in Mwanza, Tanzania, RAPID tested 752 participants (age 1 day to 20 years) in four busy clinical locations. With minimally trained medical staff, the SCD POC assay diagnosed SCD with 98.1% sensitivity and 91.1% specificity. The hemoglobin POC assay had 83.2% sensitivity and 74.5% specificity for detection of severe anemia (Hb ≤ 7 g/dL). Interobserver agreement was excellent for both POC assays (r = 0.95–0.96). Results for the hemoglobin POC assay have informed the second-generation assay design to be more suitable for low-resource settings. RAPID provides practical feasibility data regarding two novel POC assays for the diagnosis of anemia and SCD in real-world field evaluations and documents the utility and potential impact of these POC assays for sub-Saharan Africa.

BACKGROUND Monovalent rotavirus vaccine (RV1) was introduced in Tanzania in January 2013 under the Reach Every Child initiative, to be given at ages 6 and 10 weeks. We used the sentinel hospital rotavirus surveillance system to examine the rotavirus detection rate before and after vaccine introduction and estimate vaccine effectiveness. METHODS Before vaccine introduction, rotavirus surveillance was established at two mainland hospitals; children admitted for acute diarrhea were eligible for enrollment and stools were tested for rotavirus antigen. We compared the rotavirus positivity rate in the pre-vaccine period (Tanga Hospital, 2009 and 2011; Bugando Medical Centre, 2012) to that from post-introduction years, 2014-2015. In 2013, surveillance was established at 9 additional hospitals. We examined rotavirus positivity among infants at these sites for 2014-2015. We obtained vaccine records and calculated vaccine effectiveness at 3 sites using case-test-negative control design. RESULTS At Tanga Hospital, the rotavirus positivity rate among infants was 41% (102/251) pre-vaccine and 14% (28/197) in post-vaccine years (rate ratio: 0.35 [95% CI 0.22-0.54]). At Bugando, the positivity rate was 58% (83/143) pre-vaccine, and 18% (49/277) post-introduction (rate ratio 0.30 [95% CI 0.210.44]). Results were similar among children

Globally, women experience a disproportionate burden of disease and death due to inequities in access to basic health care, nutrition, and education. In the face of this disparity, it is striking that leadership in the field of global health is highly skewed towards men and that global health organizations neglect the issue of gender equality in their own leadership. Randomized trials demonstrate that women in leadership positions in governmental organizations implement different policies than men and that these policies are more supportive of women and children. Other studies show that proactive interventions to increase the proportion of women in leadership positions within businesses or government can be successful. Therefore, the authors assert that increasing female leadership in global health is both feasible and a fundamental step towards addressing the problem of women's health. In this Perspective, the authors contrast the high proportion of young female trainees who are interested in academic global health early in their careers with the low numbers of women successfully rising to global health leadership roles. The authors subsequently explore reasons for female attrition from the field of global health and offer practical strategies for closing the gender gap in global health leadership. The authors propose solutions aimed to promote female leaders from both resource-wealthy and resource-poor countries, including leadership training grants, mentorship from female leaders in global professions, strengthening health education in resource-poor countries, research-enabling grants, and altering institutional policies to support women choosing a global health career path.

Introduction. Based on sparse historical data, Tanzania ranks fourth globally for the estimated number of annual births with sickle cell disease. Northwest Tanzania is projected to have an especially high burden of sickle cell disease, but no contemporary surveillance data exist to verify this projection. We designed a large prospective study to determine the prevalence of both sickle cell trait and sickle cell disease in northwest Tanzania. Additional objectives included an analysis of two known genetic modifiers of sickle cell disease [alpha thalassemia trait and glucose-6-phosphate dehydrogenase (G6PD) deficiency], as well as genetic variants affecting fetal hemoglobin (HbF) expression and characterization of hemoglobin variants. Methods. The Tanzania Sickle Surveillance Study (TS3) is a prospective cross-sectional study to determine the prevalence of sickle cell trait and disease in an area projected to be at high risk. Dried blood spots (DBS) from all children born to HIV-infected mothers in the 9 regions across northwest Tanzania were collected by the HIV Early Infant Diagnosis (EID) program and transported to a central laboratory at Bugando Medical Centre, a teaching and consultancy hospital in Mwanza. DBS were tested by isoelectric focusing and scored as normal, trait, disease, or variant. Samples scored as disease or variant were retested for confirmation, and then frozen for subsequent genetic analysis. In the US, genomic DNA was extracted from each DBS, and sickle cell disease status was confirmed by PCR and TaqMan genotyping. All confirmed samples were then analyzed for alpha thalassemia trait (rightward -3.7 gene deletion) using quantitative real time PCR, and for G6PD deficiency using three real time PCR probes to distinguish A and B G6PD isoforms, to identify the G6PD A- variant, and to confirm the sex, respectively. Single nucleotide polymorphisms within 3 quantitative trait loci [BCL11A, the HBS1L-MYB intergenic polymorphism (HMIP) region, and the gamma-globin promoter XmnI site] that modify baseline HbF were analyzed using TaqMan genotyping. DBS with hemoglobin variants were investigated for the presence of common variants found in East Africa. Results. Between February 2017 and May 2018, a total of 232 IEF gels were completed by local staff in Tanzania. Among EID samples from children Conclusion. The prevalence of sickle cell trait and disease among infants in northwest Tanzania is very high, exceeding 20% trait and 1.2% disease. Regional prevalence data paired with region-specific crude birth rates predict 10,055 births annually in the northwest regions, more than doubling previous estimates. Concomitant alpha thalassemia trait and G6PD deficiency are frequently co-inherited and may affect the phenotype, as well as common genetic modifiers of HbF expression. Our detailed genetic analysis of a geographically representative surveillance cohort provides a foundation for future targeted screening and the introduction of hydroxyurea for treatment of sickle cell disease in northwest Tanzania. Disclosures Ware: Bristol Myers Squibb: Other: Research Drug Donation; Addmedica: Other: Research Drug Donation; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees; Agios: Membership on an entity's Board of Directors or advisory committees; Nova Laboratories: Membership on an entity's Board of Directors or advisory committees; CSL Behring: Membership on an entity's Board of Directors or advisory committees; Novartis: Other: DSMB.

Background Severe malnutrition has been known to increase susceptibility and severity of infections. Bacteremia in malnourished children has been found to increase morbidity and mortality especially if is due to multidrug resistant bacteria. Here, we report the prevalence of bacteremia among children under 5 years of age and the antibiotic susceptibility pattern of the isolates; the information that can be used by clinicians to guide on the empirical antibiotic treatment. Findings A total of 402 malnourished children were investigated for bacteremia. The median age of enrolled children were 17 (IQR 12–31) months. Severe malnutrition was observed in 19.1% of malnourished underfives. The point prevalence of bacteremia among malnourished children was 56/402 (13.9%; 95% CI 10.3–17.3). The prevalence of bacteremia was significantly higher among severely malnourished children than in children with moderate/mild malnutrition (18.0 vs. 10.7%, P = 0.03). Mortality was significantly associated with bacteremia among severely malnourished children (OR 2.77, 95% CI 1.02–6.98, P = 0.02). Pseudomonas spp. 20/56 (35.7%) were the most frequent isolates while Staphylococcus aureus and Streptococcus pneumoniae were isolated in 8/56 (14.2%) and 5/56 (8.9%) respectively. Rates of resistance for gram negative bacteria were; ampicillin (100%), amoxicillin/clavulanic acid (85.7%), gentamicin (23.8%), ceftriaxone (23.8%), ceftazidime (23.8%) meropenem (4.7%) and ciprofloxacin (2.4%). methicillin resistant S. aureus strains were confirmed in 4/8 (50%) of S. aureus isolates and 60% of S. pneumoniae isolates were resistant to 1 µg oxacillin. Conclusion Bacteremia due to multi drug resistant isolates is common among severely malnourished children under 5 years of age. There is a need to review empirical antibiotic treatment coupled with antibiotic stewardship to prevent mortality and morbidity of severely malnourished children under 5 years of age.

Leadership positions in global health are greatly skewed toward men; the imbalance is more pronounced in low- and middle-income countries (LMICs). The under-representation of women in leadership is a threat to gender equality, and also impacts the improvement of women's health outcomes globally. In this perspectives piece, we assert that the promotion and retention of women in global health leadership has a ripple effect that can achieve improvement in global health outcomes. We present pragmatic, actionable solutions to promote and retain female global health leaders in this field.Les positions de dirigeant dans la santé du monde sont largement orientées vers les hommes et ce déséquilibre est encore plus prononcé dans les pays à revenu faible et moyen. La sous-représentation des femmes en termes de dirigeant menace l'égalité des genres et a également un impact sur l'amélioration de l'état de santé des femmes dans le monde. Dans cette perspective, nous affirmons que la promotion et la rétention des femmes au sein du leadership de la santé dans le monde a un effet d'entraînement qui peut aboutir à une amélioration de l'état de santé dans le monde. Nous présentons des solutions pragmatiques et réalisables pour promouvoir et retenir des leaders féminins en matière de santé dans le monde.Los puestos directivos en materia de salud mundial se asignan de manera desproporcionada a los hombres; este desequilibrio es aun más notorio en los países de ingresos bajos y medianos. La subrepresentación de las mujeres en los cargos de responsabilidad pone en peligro la equidad entre los hombres y las mujeres y tiene además repercusiones en los resultados de salud de las mujeres en el mundo. En el presente artículo de opinión, se sostiene que promover a las mujeres a las funciones directivas relacionadas con la salud mundial y facilitar su permanencia en ellas genera una reacción en cadena que puede dar lugar a mejores resultados de salud a escala mundial. Se proponen soluciones viables y prácticas encaminadas a estimular la presencia de las mujeres en los cargos de responsabilidad en materia de salud mundial y a respaldar su permanencia en esta actividad.

Upper airway obstruction (UAO) due to adenotonsillar hypertrophy represents one of the rare causes of pulmonary hypertension in children. We report a case of adenotonsillar hypertrophy, managed at pediatric and otorhinolaryngology departments in Bugando Medical Centre (BMC), northwestern Tanzania, with complete remission of symptoms of pulmonary hypertension following adenotonsillectomy. A 17-month-old boy presented with difficulty breathing, dry cough, and noisy breathing since 1 year. He had facial and lower limb oedema with a pan systolic murmur at the tricuspid area, fine crepitations, and tender hepatomegaly. A grade II tonsillar hypertrophy and hypertrophied adenoids were seen on nasal and throat evaluation. A 2D-echocardiography showed grossly distended right atrium and ventricle, dilated pulmonary artery, and grade III tricuspid regurgitation. His final diagnosis was severe pulmonary hypertension with right-sided heart failure due to adenotonsillar hypertrophy. He had complete remission of cardiopulmonary symptoms after adenotonsillectomy and had normal control echocardiography six and twelve months after surgery. Children with symptoms of upper airway obstruction and cardiopulmonary involvement could benefit from routine screening for pulmonary hypertension. Adenotonsillectomy should be considered for possible complete remission of both UAO and cardiopulmonary symptoms.

Tanzania ranks third in Africa for the estimated number of annual births with sickle cell disease, but these estimates are based on sparse data from small studies reported over the past 50 years. A recently completed surveillance study from Uganda documented substantial variation in the prevalence of sickle cell trait and disease across the country. Tanzania lacks a national newborn screening program, and no contemporary multi-regional screening of infants has been undertaken. We designed and conducted a prospective study to determine the prevalence of sickle cell trait and disease by region and district in northwest Tanzania, where the prevalence of sickle cell is thought to be highest. The study used existing public health infrastructure while building local capacity for accurate diagnosis of sickle cell disease. Secondary objectives included characterization of hemoglobin variants and exploration of associations between sickle cell trait, sickle cell disease, malaria, and HIV. The Tanzania Sickle Surveillance Study (TS3) is a prospective cross-sectional study of HIV-exposed infants born in 9 regions across the Lake Zone of northwest Tanzania. In Tanzania, the HIV early infant diagnosis (EID) program collects dried blood spots (DBS) from all children born to HIV-infected mothers. DBS are transported to a central laboratory for prompt detection of HIV vertical transmission. In northwest Tanzania, the DBS are transported to Bugando Medical Centre, a teaching and consultancy hospital in Mwanza, where they are tested for HIV and then stored on-site, and thus available for further testing. Isoelectric focusing (IEF) equipment was donated to Bugando Medical Centre along with reagents and supplies. Two laboratory staff were trained by a board certified hematologist, and then attended a two day seminar by the IEF manufacturer. One pediatrician completed a 2-month observership at Cincinnati Children's Hospital. All DBS samples were tested by IEF using appropriate controls. Completed gels were scored independently by two Tanzanian staff members as normal, disease, trait, variant, or uninterpretable. DBS samples scored as disease or variant were repeated for confirmation and preserved for later genotyping. Regular Skype calls were convened with US-based collaborators to improve quality and interpretation. HIV test results were obtained from the local EID program. Between February 2017 and May 2018, 232 IEF gels were completed by the local staff. After children >24 months of age were excluded to obtain a more accurate newborn prevalence, the median age of children tested was 52 days (IQR 41-93 days), and a total of 17,278 unique DBS samples were scored. The quality of laboratory testing was extremely high with only 20 samples scored as uninterpretable and 54 with missing results, and the primary analysis was performed on the 17,204 remaining samples. The overall prevalence of sickle cell trait and disease in the entire cohort was 20.3% and 1.2%, respectively, with a 0.1% prevalence of hemoglobin variants. This corresponds to an allelic frequency of 0.114 for the sickle gene mutation and demonstrates perfect Hardy-Weinberg equilibrium. No HbC or other common beta-globin variants were identified. Geospatial mapping revealed some variation across regions, with sickle trait ranging from 16.6% to 22.5% and disease ranging from 0.5% to 1.5%. Analysis of individual districts with >100 samples revealed wider geographic variability, with sickle trait ranging from 15.2% to 27.8% and disease ranging from 0.0% to 4.3%. Co-morbidity between HIV and sickle cell disease was analyzed to compare it with the effect on mortality previously observed in Uganda. The prevalence of sickle cell disease was the same among HIV-infected and HIV-negative children (1.2%), suggesting no difference in mortality. The prevalence of sickle cell trait and disease among infants born in northwest Tanzania is very high, exceeding 20% trait and 1.2% disease. All regions in the Lake Zone are affected possibly due to lack of immigration to the area and similar environmental exposures. Targeted newborn screening can be started in high prevalence districts, using existing public health infrastructure with minimal start-up cost and training. Future work will evaluate the correlation between historical malaria prevalence and sickle cell prevalence, and identify hemoglobin variants. Disclosures Ware: Addmedica: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squibb: Research Funding; Agios: Other: advisory board; Global Blood Therapeutics: Other: advisory board; Biomedomics: Research Funding; Nova Laboratories: Consultancy.

BACKGROUND: Malnutrition is a major public health problem in developing countries including Tanzania, contributing up to 50 % of under-five mortality. East Africa region was among the three United Nations (UN) subregions with the highest prevalence of stunting in 2011. In resource limited countries, the available little resources in hospitals are likely to be used focusing the primary clinical problem that led to admission of children leaving moderate and mild malnutrion unattended. This work was conducted to determine the prevalence of under-nutrition and risk factors associated with severe malnutrition among undernourished children aged 6–60 months admitted to Bugando Medical Centre (BMC) paediatric wards. METHOD: This was a hospital-based cross sectional study where by 720 children were screened in order to determine their nutritional status. Data were collected through measurement of weight/length or height, mid upper arm circumference (MUAC) and interpretation was done using Z-score (mild malnutrition ≤1SD, moderate malnutrition ≤2SD and severe malnutrition ≤3SD). The socio-demographic data were obtained using a questionnaire that was completed by interviewing children’s parents/caregiver. RESULTS: Out of 720 screened children, 402 (55.8 %) were undernourished. Severe malnutrition was found in 178 (24.7 %) children and among these 97 (54.5 %) had marasmus. Risk factors associated with severe malnutrition were children with age less than 2 years, lack of vaccination, taking unbalanced diet, low maternal education and single parent, with p-value (

Background Anaemia is a major public health problem in developing countries, contributing significantly to morbidity and mortality amongst children under-five years of age. About 43 % of under-fives are anaemic worldwide, and two-thirds reside in sub-Saharan Africa. Even where blood transfusion is available for treatment there is still a significant case fatality rate ranging between 6 and 18 %. This study aimed to determine the prevalence and morphological types of anaemia, as well as factors associated with severe anaemia in under-five children admitted at Bugando Medical Centre (BMC). Methods This was a hospital-based, cross-sectional study conducted between November 2012 and February 2013. Selected laboratory investigations were done on children admitted to BMC. Anaemia was defined using WHO criteria. Results A total of 448 under-five children were recruited into the study. The overall prevalence of anaemia was 77.2 % (346/448) with mild, moderate and severe anaemia being 16.5, 33 and 27.7 % respectively. Microcytic hypochromic anaemia was detected in 37.5 % of the children with anaemia. Of 239 children with moderate and severe anaemia, 22.6 % (54/239) had iron deficiency anaemia based on serum ferritin level less than12 μg/ml. The factors associated with severe anaemia included unemployment of the parent, malaria parasitaemia and presence of sickle haemoglobin. Conclusion The prevalence of anaemia among under-five children admitted at BMC was high. Iron deficiency anaemia was the most common type. Factors associated with severe anaemia were unemployment among caretakers, malaria parasitaemia and presence of sickle haemoglobin.

Background Infections are common complications occurring in malnourished childrenas a result of impaired immunity. Urinary tract infections (UTI) have been found to be the commonest cause of fever in normal children in developing countries. However, data regarding UTI among malnourished children is limited because in most of time severe and moderately malnourished children are afebrile despite significant bacteriuria. Methods A total of 402 malnourished underfives were enrolled. Demographic and other clinical characteristics were collected using standardized data collection tool. Urine specimens were cultured and interpreted according to standard operating procedures. Data were analyzed using STATA version 11. Results Out of 402 malnourished underfives, 229 (56.9 %) were male. The median age in months was 17 (IQR; 12–31). Of 402 malnourished underfives, 83 (20.3 %) had significant bacteriuria of gram negative enteric bacteria. Escherichia coli 35/84 and Klebsiella pneumonia 20/84 were predominant bacteria isolated. More than 37 % of isolates were resistant to third generation cephalosporins with all of them exhibiting extended spectrum beta lactamase (ESBL) phenotype. Rates of resistance to ampicillin, amoxillin/clavulanic acid, gentamicin and ciprofloxacin were 82/84 (98.7 %), 47/55 (85.4 %), 45/84 (57.8 %) and 9/84 (10.8 %) respectively. Decrease in age and increase in lymphocytes count were independent factors on multivariate logistic regression analysis found to predict UTI (p

Background Limited data document sexually transmitted infections (STIs) among pregnant adolescents in sub-Saharan Africa, where prenatal screening typically includes only HIV and syphilis. Given that HIV incidence in this population is among the world9s highest, we sought to assess the prevalence and factors associated with STIs in a population of rural pregnant adolescents in Tanzania. Methods We enrolled 403 pregnant adolescent girls from 10 antenatal clinics near Mwanza, Tanzania. Girls answered structured interviews about sexual health and risk factors and were tested for six common STIs. Results 199 girls (49.4%) had at least one STI. Herpes Simplex Virus- Type 2 was most prevalent (139 girls, 34.5%), followed by trichomoniasis (54 girls, 13.4%), chlamydia (46 girls, 11.4%), gonorrhoea (27 girls, 6.7%), syphilis (21 girls, 5.2%) and HIV (30 girls, 4.7%). Of note, 53/199 (26.6%) of girls with laboratory-proven STIs were asymptomatic. On multivariable analysis, the presence of any STI was associated with being in a long-term (as opposed to short-term) relationship (OR=2.6 (1.4 to 4.9) p=0.004), younger age at first sexual debut (OR=0.9 per year (0.8 to 0.99), p=0.034), increasing age difference between the girl and her partner (OR=1.1 (1.0 to 1.1) per year, p=0.03) and history of prior pregnancy (OR=1.6 (1.0 to 2.6), p=0.04). Conclusions STIs affected half of rural pregnant adolescents in Tanzania. Our work demonstrates the urgent need to incorporate routine STI testing into antenatal care in Tanzania to prevent morbidity and mortality in young girls and their babies. We also identify behavioural and demographic risk factors that can be used to target interventions to those at highest risk.

AIMS: In Tanzania approximately 25% of adolescents give birth and 50% more become sexually active during adolescence. We hypothesised that reproductive health education and services for adolescent girls are inaccessible and conducted this study to gain insights into their perceptions of sexually transmitted infections (STIs) and barriers to reproductive health service utilisation in rural Mwanza Tanzania. METHODS: We conducted nine focus groups among pregnant adolescents aged 15-20 years. Data were transcribed translated and coded for relevant themes using NVivo10 software for qualitative data analysis. RESULTS: Most participants were aware of the dangers of STIs to themselves and their unborn babies but did not perceive themselves as at risk of acquiring STIs. They viewed condoms as ineffective for preventing STIs and pregnancies and unnecessary for those in committed relationships. Stigma long waiting times and lack of privacy in the clinics discouraged adolescent girls from seeking reproductive health care. CONCLUSION: Reproductive health care for adolescent girls who are not pregnant is practically nonexistent in Tanzania. Healthcare access for pregnant young women is also limited. Targeted changes to increase clinic accessibility and to provide reproductive health education to all rather than only pregnant women have the potential to address these gaps.

We analyzed stool samples from underfives with gastroenteritis for rotavirus infection between January 2010 and June 2011. A total of 393 stool specimens were examined for rotavirus infection using enzyme-linked immunosorbent assay (ELISA). Hundred selected positive specimens were genotyped using multiplex polymerase chain reaction. Out of 393 underfives, 194 (49.4%) had rotavirus infection, with 96.9% of infected underfives being

Background Extended spectrum beta-lactamase producing bacteria (ESBL) are common causes of neonatal sepsis worldwide. Neonatal sepsis due to ESBL is associated with increased morbidity and mortality at Bugando Medical Centre (BMC). Due to limited information on the sources of these ESBL strains at BMC, this study was conducted to evaluate the existence, magnitude and transmission of ESBL from post-delivery women to neonates at BMC, Mwanza-Tanzania. Results A cross-sectional study was conducted at obstetrics and neonatal wards from May to July 2013, involving post-delivery women and their neonates. Rectal swabs were collected and processed to identify the ESBL strains and their antimicrobial susceptibility patterns. Patients’ data were obtained using a standardized data collection tool. We enrolled 113 women and 126 neonates with mean age of 26.5 ± 5.5 years and median gestation age [IQR] of 39 [35–40] weeks respectively. The prevalence of ESBL carriage among women and neonates were 15% (17/113) and 25.4% (32/126) respectively. The acquisition of ESBL isolates among neonates on day 1, day 3 and day 7 were 60.0% (21/35), 25.7% (9/35) and 14.3% (5/35) respectively. There was no phenotypic similarity between ESBL strains from women and their respective neonates, suggesting other sources of transmission. Neonates given antibiotics were more likely to carry ESBL than those not given [100% (32/32) versus 86% (81/94), p = 0.018]. Conclusion The carriage rate of ESBL strains among post-delivery women and neonates at BMC is high. Our findings suggest that neonates acquire these strains from sources other than post-delivery women and more than half acquire them on the first day of life. More studies are recommended to further explore the sources of ESBL strains among neonates.