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Background: Despite blood transfusion being a lifesaving option, it may be associated with blood borne infections including human cytomegalovirus(HCMV). The World Health Organization recommends screening of blood products for HCMV before transfusion to pregnant women, neonates and immunocompromised patients. However, this is not routinely practised in many resource limited countries. Objective: This study aimed at determining seroprevalence of specific HCMV IgM antibodies among volunteered blood donors at the Lake Victoria zone blood transfusion centre Methods: A total of 228 sera from volunteered blood donors were analyzed using HCMV IgM µ capture enzyme linked immunosorbent assay as per manufacturer’s instructions. Data were analyzed by STATA version 13 Results: The median age of the study participants was 19 interquartile range (IQR): 18-23 years. The seroprevalence of specific HCMV IgM antibodies was found to be 23/228 (10.1%, 95% confidence interval (CI): 6-14. None of the factors was found to be associated with HCMV IgM seropositivity among blood donors. Conclusion: One out 10 blood donors in the Lake Victoria zone blood transfusion centre is acutely infected with HCMV. There is a need to consider screening of HCMV before blood transfusion particularly in resource limited countries where HCMV is endemic. Keywords: Human cytomegalovirus, Tanzania, blood transfusion.

Factor VII deficiency is a rare inherited disorder. Clinically the patient presents with bleeding tendencies. Diagnosis is made by prolonged prothrombin time, normal activated partial thromboplastin time and low functions factor VII assay or factor VII antigen. Therapy involves factor VII concentrates, recombinant factor VII, fresh frozen plasma and fibrinolytic inhibitors. We present a 6 years old boy with nose bleed for six months of whom prothrombin time was prolonged with functional factor VII assay of less than 1% confirming factor VII deficiency. He was managed with fresh frozen plasma, blood transfusion, tranexamic acid. Factor VII deficiency even though rare should be sought out in children presenting with bleeding. Keywords: Factor VII deficiency; coagulation; hemorrhage.

Introduction. Anaemia is a common problem in sub-Saharan Africa. While most literature has focused on children, women of childbearing age, and pregnant women, data for the elderly population are relatively scarce. Anaemia exhorts negative consequences to functional ability of elderly patients, both physically and cognitively. The purpose of this study was to determine the prevalence of anaemia, severity, and micronutrient deficiency status in the elderly hospitalized patients in Tanzania. Methods. A total of 156 hospitalized adults aged 60 years and above were enrolled in this study. A structured questionnaire was used to capture sociodemographic and clinical characteristics. Blood samples were collected, and a complete blood count, serum cobalamin, serum ferritin, and serum folate levels were measured to assess anaemia and micronutrient deficiency status in all participants who had anaemia. Results. The prevalence of anaemia was 79.5% (124/156) with severe anaemia in 33.9% (42/124) of participants, moderate anaemia in 42.7% (53/124) of participants, and 23.4% (29/124) of all participants had mild anaemia. Micronutrient deficiency was found in 14.5% (18/124) of all participants with anaemia. Combined deficiency (either iron and vitamin B12 deficiency or iron and folate deficiency) was the most common micronutrient deficiency anaemia with a frequency of 33.3% (6/18), followed by isolated iron and folate deficiencies at equal frequency of 27.8% (5/18) and vitamin B12 deficiency at 11.1% (2/18). Conclusion. The prevalence of anaemia in the hospitalized elderly population is high warranting public health attention and mostly present in moderate and severe forms. Micro-nutrient deficiency anaemia is common in this age group and is mostly due to combined micronutrient deficiency.

Background: Erythrocyte alloimmunisation can lead to complications such as delayed haemolytic transfusion reaction. Objective: This study investigated the prevalence of and risk factors for red blood cell alloimmunisation among multiply transfused sickle cell disease (SCD) patients in Mwanza City, Tanzania. Methods: From May 2017 to July 2017, this descriptive, cross-sectional, hospital-based study enrolled 200 participants with SCD who had received at least two units of blood in the previous year. Blood count was performed using a Sysmex haematology analyser. Antibody screening was done by the tube method using a panel of three screening cells with known antigenicity. Results: Of the 200 patients enrolled, 108 (54%) were female. The median age was 4.5 years (interquartile range [IQR] = 6), the median number of transfusions was 3 (IQR = 1), and the median pre-transfusion haemoglobin level was 6.6 g/dl (IQR = 2.7). Prevalence of alloimmunisation was 8.5% (17/200) with immunoglobulin G, and one patient developed cold immunoglobulin M antibodies. Blood groups reported were Rhesus C and E, Kell, Kidd and Duffy. There was no statistically significant association between the number of transfusions and the risk of alloimmunisation. Conclusion: The rate of alloimmunisation in multiply transfused SCD patients was 8.5% and higher than other studies in East Africa. Thus, there is a need for extensive red blood cell screening and matching to minimize alloimmunisation and risk of delayed haemolytic transfusion reaction, particularly in SCD and chronically transfused patients.

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.

Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease (SCD) with blood transfusion an integral part in its management. Red cell exchange (RCE) transfusion is usually regarded as preferable to top-up transfusion, because it reduces the proportion of Hemoglobin (Hb) S while at the same time avoiding circulatory overload. Despite its obvious benefits, RCE is underutilized, particularly in low-resource settings which may be due to scarcity of blood products and of expertise in carrying out exchange transfusion. We report on a young woman with SCD with severe ACS who responded promptly and dramatically to a RCE of only 0.95 L (instead of the recommended 1.4 L) and had in the end an HbS level of 48% (instead of the recommended level below 30%). Limited RCE resulted in significant clinical improvement. We suggest that limited RCE may be of benefit than no RCE in SCD patients with ACS, particularly in settings where RCE is not available.

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: There is limited information on clinical characteristics, diagnosis and response to therapy of patients with chronic myeloid leukaemia (CML) in Tanzania. This hospital-based retrospective and cross-sectional study was conducted to describe the clinical and laboratory characteristics, time to diagnosis and response to first line therapy with imatinib in Philadelphia chromosome positive CML.Methods: The study was conducted at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Participants were sequentially recruited from the outpatient clinic where a structured questionnaire was employed seeking details socio-clinical features of the disease. Haematology indices at baseline and at three months of treatment was obtained from patient’s medical records. Haematological response was determined at three months of imatinib use using leukaemia net definition.Results: Of 127 study participants, 63% were males. The mean (±standard deviation) age at diagnosis was 40 (±16) years, majority being in the third decade of life. Abdominal distention (88%) and symptoms of anaemia (84%) were the most frequent complaints. Splenomegaly (92%) and pallor (82.7%) were the common physical findings. The mean duration from consultation to diagnosis was 3(±0) weeks and mean duration from diagnosis to imatinib therapy initiation was 3 (±0.9) weeks. A total of 116 (91.3%) of patients had complete haematological response to imatinib therapy three months after therapy. There was significant decline in total white blood cell counts, basophils count, platelets and increase in haemoglobin at three months after imatinib therapy initiation.Conclusion: Majority of patients were young with clinical and laboratory findings of severe disease. Patients presented late to hospital and there was a considerable long time to reach a final diagnosis and yet haematological response was still achieved in majority of these patients with imatinib therapy. The elucidated clinical and laboratory findings should advocate early CML diagnosis and immediate referral to a tertiary hospital.

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: Sickle cell disease (SCD) describes a group of inherited red blood cell disorders. People with SCD have abnormal haemoglobin (Hb), called Hb S. In all forms of SCD, at least one of the two abnormal genes causes a person's body to make Hb S. In countries with limited resources, diagnostic technique should be simple and easy to perform with high sensitivity and specificity. METHODS: This study compared the paperbased sickle cell test and sodium metabisulfite sickling test using Hb electrophoresis as a gold standard. It was a crosssectional hospitalbased study which was conducted from July to October 2017 involving a total of 140 blood samples of under 10 years children presumed to have SCD. Blood samples in ethylenediaminetetraacetic acid anticoagulantcontaining vacutainers were used for SCD diagnosis by using paperbased and sodium metabisulfite sickling tests then confirmed by Hb electrophoresis as the gold standard. RESULTS: Blood specimens were from individuals aged 4 years ranged from 2 to 9 years. Slightly majority of blood specimens belonged to males, 54.3% (76/140) while the majority was from inpatients, 82.9% (116/140). Paperbased sickle cell test identified 46/140 (32.9%) Hb AA, 81/140 (57.9%) Hb, and 6/140 (4.3%) Hb AS. Sickling test identified 50/140 (35.7%) Hb AA and 87/140 (62.1%) Hb SS. Hb electrophoresis identified 50/140 (35.7%) Hb AA, 83/140 (59.3%) Hb SS, and 7/140 (5%) Hb AS. The paperbased sickle cell test had a sensitivity of 97.8% and specificity of 96.7% while the sickling test had the sensitivity of 96.7% and specificity of 100%. CONCLUSION: Paperbased sickle cell test was able to detect sickle cell carriers, Hb AS and shown high sensitivity and specificity; therefore, it can be used as a substitute for sickling test in countries with limited resource. However, paperbased sickle test is suitable for adults' population.