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57 Tanzanian children aged 6-25 months hospitalized with acute diarrhea were grouped according to whether there was clinical evidence of systemic infection (SI) (n = 35) or not (n = 22). Serum acute phase proteins were measured in samples taken within 48 hours of admission. Means for C-reactive protein (CRP) and serum amyloid A (SAA) were significantly higher in children with SI compared to those without (geometric means (95% confidence interval); CRP mg/l: 22.1 (13.6-35.5) vs. 7.4 (4.4-12.4); SAA mg/l: 12.2 (6.8-22.1) vs. 4.9 (2.5-9.7)). Levels of alpha1-acid glycoprotein were similar in both groups (1.16 g/l (0.95-1.43) vs. 1.04 g/l (0.83-1.29) respectively). CRP >or= 30 mg/l had a positive predictive value of 95% and specificity of 96% for correctly identifying SI but a low sensitivity (51%) and negative predictive value (55%). Clinical outcome of diarrhea was worse in children with SI: more needed intravenous fluids (23% vs. 5%) the duration of diarrhea was longer (59.4 vs. 34.2 h) and mortality was higher (6% vs. 0%). APPs were not found to be useful markers of systemic illness in acute diarrhea in this population. (authors)

Bacteraemia is a leading cause of morbidity in sickle cell anaemia (SCA), but information from studies in Africa is limited. We evaluated 890 admissions from 648 SCA patients at a tertiary hospital in Tanzania. Bacteraemia was present in 43 admissions (4·8%); isolates included Staphylococcus aureus (12/43; 28%), non-Typhi Salmonella (9/43; 21%), Streptococcus pneumoniae (3/43; 7%) and Salmonella Typhi (2/43; 5%). Compared to SCA patients without bacteraemia, SCA patients with bacteraemia had significantly lower haemoglobin [71 g/l vs. 62 g/l, odds ratio 0·72 (95% confidence interval 0·56-0·91), P < 0·01]. Further exploration is needed of the relationship between anaemia and bacterial infections in SCA in Africa.

In Tanzania, children with malaria-associated anaemia are frequently given blood transfusions, and donor blood is not screened for hepatitis C virus (HCV) infection. To determine the seroprevalence of HCV infection in Tanzanian children previously transfused with blood, 184 children (92 transfused, 92 not transfused) aged between 15 and 59 months matched for age and sex were screened for HCV antibodies by the particle agglutination test using Serodia anti-HCV (Fujirebio Inc., Japan). The overall prevalence of HCV infection was 7.1% (13/184). HCV seropositivity was 5.4% (5/92) among children with a history of blood transfusion and 8.6% (8/92) among the non-transfused. There was no significant difference in the prevalence of HCV infection between transfused and non-transfused children. None of the factors investigated, such as gender, the nutrition and HIV serostatus of the children and the marital and education status of their mothers, was associated with HCV seropositivity. Further studies are recommended to identify the factors associated with HCV infection in Tanzanian children.

Background:The World Health Organization has declared Sickle Cell Anemia (SCA) a public health priority. There are 300,000 births/year, over 75% in Africa, with estimates suggesting that 6 million Africans will be living with SCA if average survival reaches half the African norm. Countries such as United States of America and United Kingdom have reduced SCA mortality from 3 to 0.13 per 100 person years of observation (PYO), with interventions such as newborn screening, prevention of infections and comprehensive care, but implementation of interventions in African countries has been hindered by lack of locally appropriate information. The objective of this study was to determine the incidence and factors associated with death from SCA in Dar-es-Salaam.Methods and Findings:A hospital-based cohort study was conducted, with prospective surveillance of 1,725 SCA patients recruited from 2004 to 2009, with 209 (12%) lost to follow up, while 86 died. The mortality rate was 1.9 (95%CI 1.5, 2.9) per 100 PYO, highest under 5-years old [7.3 (4.8-11.0)], adjusting for dates of birth and study enrollment. Independent risk factors, at enrollment to the cohort, predicting death were low hemoglobin (

Objectives: To compare indications for lumbar puncture and ndings of cerebrospinal uid examination in children admitted at Muhimbili National Hospital (MNH) in Dar-es-salaam, Tanzania and Kili District Hospital (KDH) in Kenya Study design: A descriptive, cross-sectional hospital based study. Setting: Paediatric wards of Muhimbili National Hospital (MNH) in Dar es Salaam and Kili District Hospital (KDH) in Kenya. Results: Overall, 8,741 paediatric admissions were recorded in the two hospitals; (Muhimbili = 6,228; Kili = 2,513). Of these, 607 (6.9%) had an LP performed; 154 out 6,228 (2.5%) from MNH and 453 out of 2,513 (18.0%) at KDH. The most common indications for lumbar puncture at MNH were convulsions (61.4%), neck sti ness (14.3%) and prostration (17%), whereas at KDH were convulsions (56.3%), neck sti ness (7.3%) and prostration (22.1%). The bacterial isolates were rarely (2.3%) obtained on culture at both hospitals. Streptococcus pneumonae and Salmonella species were the commonest causes of pyogenic meningitis. Conclusion & recommendations: Lumbar punctures are performed less frequently at Muhimbili than Kili Hospital. Pneumoccocus and Salmonella species are the commonest causes of pyogenic meningitis. Strategies should be put in place to improve the rates of lumbar puncture at MNH and the isolation of bacterial pathogens from cerebrospinal fluid cultures in both hospitals. Other possible causes for meningitis such as viruses need to be investigated.

Approximately 280 000 children are born with sickle cell anemia (SCA) in Africa annually, yet few survive beyond childhood. Falciparum malaria is considered a significant cause of this mortality. We conducted a 5-year prospective surveillance study for malaria parasitemia, clinical malaria, and severe malarial anemia (SMA) in Dar-es-Salaam, Tanzania, between 2004 and 2009. We recorded 10 491 visits to the outpatient clinic among 1808 patients with SCA and 773 visits among 679 patients without SCA. Similarly, we recorded 691 hospital admissions among 497 patients with SCA and 2017 in patients without SCA. Overall, the prevalence of parasitemia was lower in patients with SCA than in patients without SCA both at clinic (0.7% vs 1.6%; OR, 0.53; 95% CI, 0.32-0.86; P = .008) and during hospitalization (3.0% vs 5.6%; OR, 0.46; 95% CI, 0.25-0.94; P = .01). Furthermore, patients with SCA had higher rates of malaria during hospitalization than at clinic, the ORs being 4.29 (95% CI, 2.63-7.01; P < .001) for parasitemia, 17.66 (95% CI, 5.92-52.71; P < .001) for clinical malaria, and 21.11 (95% CI, 8.46-52.67; P < .001) for SMA. Although malaria was rare among patients with SCA, parasitemia during hospitalization was associated with both severe anemia and death. Effective treatment for malaria during severe illness episodes and further studies to determine the role chemoprophylaxis are required.

Background Different groups of viruses have been shown to be responsible for acute diarrhea among children during their first few years of life. Epidemiological knowledge of viral agents is critical for the development of effective preventive measures, including vaccines. Methods In this study we determined the prevalence of the four major enteropathogenic viruses – rotavirus, norovirus, adenovirus and astrovirus – was determined in 270 stool samples collected from children aged 0 – 60 months who were admitted with diarrhea in four hospitals in Dar es Salaam, Tanzania, using commercially available ELISA kits. In addition, the molecular epidemiology of group A rotavirus was investigated using reverse transcriptase multiplex polymerase chain reaction (RT-PCR). Results At least one viral agent was detected in 87/270 (32.2%) of the children. The prevalence of rotavirus, norovirus, adenovirus and astrovirus was 18.1%, 13.7%, 2.6% and 0.4%, respectively. In most cases (62.1%) of viruses were detected in children aged 7–12 months. The G and P types (VP7 and VP4 genotypes respectively) were further investigated in 49 rotavirus ELISA positive samples. G9 was the predominant G type (81.6%), followed by G1 (10.2%) and G3 (0.2%). P[8] was the predominant P type (83.7%), followed by P[6] (0.4%) and P[4] (0.2%). The following G and P types were not detected in this study population; G2, G4, G8 G10, P[9], P[10] and P[11]. The dominating G/P combination was G9P[8], accounting for 39 (90.7%) of the 43 fully characterized strains. Three (6.1%) of the 49 rotavirus strains could not be typed. Conclusion Nearly one third of children with diarrhea admitted to hospitals in Dar es Salaam had one of the four viral agents. The predominance of rotavirus serotype G9 may have implication for rotavirus vaccination in Tanzania.

Lumbar puncture (LP) is an important diagnostic tool for investigating neurological conditions/diseases. This study was carried out to compare the indications for lumbar puncture and findings of cerebrospinal fluid examination in children admitted to Muhimbili National Hospital (MNH) in Dar-es-salaam, Tanzania and Kilifi District Hospital (KDH) in Kenya. Records of all children admitted to the paediatric wards of the two hospitals from 1st November 2004 to 30th April 2005 with suspected central nervous system infections and had LPs performed were analysed. Overall, 8,741 paediatric admissions were recorded in the two hospitals (Muhimbili = 6,228; Kilifi= 2,513). Of these, 607 (6.9%) had a LP performed; 154 out 6,228 (2.5%) in MNH and 453 out of 2,513 (18.0%) in KDH. LPs were performed less frequently in Muhimbili than in Kilifi Hospital. The most common indications for LP at MNH were convulsions (62.5%), neck stiffness (14.3%) and prostration (17%), whereas at KDH were convulsions (56.3%), neck stiffness (7.3%) and prostration (22.1%). The bacterial isolates were rarely (23%) obtained on culture at both hospitals. Streptococcus pneumonaie and Salmonella species were the commonest causes of pyogenic meningitis. In conclusion, the rate of LP performance in the two hospitals is low. There is need therefore to improve the rates of LP and the isolation of bacterial pathogens from cerebrospinal fluid cultures. Other possible causes for meningitis such as viruses need to be investigated. Keywords : lumbar puncture, cerebro-spinal fluid, children, infections, Tanzania, Kenya Tanzania Health Research Bulletin Vol. 8(1) 2006: 7-10

There is a strong relationship between diarrhoea, malnutrition, and intestinal integrity. To investigate the effect of different dietary-treatment on intestinal permeability during acute diarrhoea, 87 Tanzanian children aged 6-25 months were recruited to this study when admitted to hospital.Children with acute diarrhoea were rehydrated and then randomly assigned to one of three dietary treatment groups: a conventional low-energy density porridge, a high-energy density amylase digested porridge (AMD), or a high-energy density amylase digested and then fermented porridge (FAD). Lactulose/mannitol permeability tests were performed on admission, at 3 days, and at follow-up 2 and 4 weeks after discharge. The lactulose/mannitol (L/M) ratios were compared between dietary treatment groups and to a group of age-matched, healthy control subjects.Children with diarrhoea had higher L/M ratios (geometric mean 0.85, 95% CI 0.68-1.05) compared with control subjects (0.14, 0.12-0.17) on admission. There was a significant difference in the change in L/M ratio between admission and 3 days between dietary treatment groups in favour of the FAD group (p0.05).Dietary treatment and intestinal damage at admission explain 13.5% of the variation in L/M ratio, but when age at admission and age at weaning are included as covariants, 21.9% is explained. FAD porridge seems to be more effective in the treatment of intestinal permeability than AMD or conventional porridge. Urinary lactose concentrations in spot urine samples taken prior to the permeability test were also measured. There was a significant correlation with the L/M ratio (correlation coefficient = 0.62, p0.001).The effect of three dietary treatments on intestinal permeability during acute diarrhea was compared in 86 Tanzanian children 6-25 months of age admitted to Muhimbili Medical Center's Pediatric Diarrhea Treatment Unit in Dar es Salaam in 1992. 55 children (64%) had received foods other than breast milk during the first week of life. After rehydration, children were randomly assigned to receive a conventional low-energy density porridge (n = 33), a high-energy density amylase digested (AMD) porridge (n = 28), or AMD porridge followed by fermented amylase digested (FAD) porridge (n = 25). Lactulose/mannitol (L/M) permeability tests were performed at admission, after 3 days, and at 2 and 4 weeks after hospital discharge. Children with diarrhea had higher L/M ratios (geometric mean, 0.85; 95% confidence interval (CI), 0.68-1.05) at admission than the 30 age-matched healthy controls (mean, 0.14; 95% CI, 0.12-0.17). The L/M ratio of study children fell over time and approached values recorded among healthy controls by the first follow-up visit. The change in L/M ratio between admission and day 3 of hospitalization was significantly greater in the FAD group (89%) than the conventional or AMD groups (44% and 75%, respectively). Dietary treatment and intestinal damage at admission explained 13.5% of the variation in this L/M ratio, while age at admission and age at weaning explained an additional 8.4%. These findings suggest that a porridge that has been both amylase digested and fermented effectively repairs mucosal damage through trophic effects on intestinal epithelium and should be administered to children with acute diarrhea to prevent malnutrition.

Amylase from germinating cereal grains enables the preparation of porridge with a higher energy density than conventional weaning foods. This food can be combined with fermentation which inhibits pathogen growth. These food technologies are inexpensive can be implemented at the household level and are therefore particularly appropriate for use in developing countries. In a controlled clinical trial 75 children aged 6-25 months admitted to hospital with acute diarrhea were rehydrated and then randomly allocated to three corn porridge dietary groups: conventional amylase-digested (AMD) and fermented and amylase-digested (FAD). The study diets were given ad libitum five times daily and all intakes except breast milk were weighed. Mean daily energy intakes over 4 days in the conventional AMD and FAD groups respectively were 32.4 (95% CI 28.7-36.6) 46.0 (CI 39.6-53.4) and 37.3 (CI 31.8-43.9) kcal/kg/day. The energy intake in the AMD group was 42% higher than the conventional group (p = 0.003). There were no significant differences between the groups for duration of diarrhea frequency of stooling or vomiting. Starch digestion using amylase from germination is an effective way of improving energy intake in children with acute diarrhea. (authors)

Background This study aimed to determine the age-specific aetiologic agents of diarrhoea in children aged less than five years. The study also assessed the efficacy of the empiric treatment of childhood diarrhoea using Integrated Management of Childhood Illness (IMCI) guidelines. Methods This study included 280 children aged less than 5 years, admitted with diarrhoea to any of the four major hospitals in Dar es Salaam. Bacterial pathogens were identified using conventional methods. Enzyme Linked Immunosorbent Assay (ELISA) and agglutination assay were used to detect viruses and intestinal protozoa, respectively. Antimicrobial susceptibility was determined using Kirby-Bauer disk diffusion method. Results At least one of the searched pathogens was detected in 67.1% of the cases, and mixed infections were detected in 20.7% of cases. Overall, bacteria and viruses contributed equally accounting for 33.2% and 32.2% of all the cases, respectively, while parasites were detected in 19.2% patients. Diarrhoeagenic Escherichia coli (DEC) was the most common enteric pathogen, isolated in 22.9% of patients, followed by Cryptosporidium parvum (18.9%), rotavirus (18.1%) and norovirus (13.7%). The main cause of diarrhoea in children aged 0 to 6 months were bacteria, predominantly DEC, while viruses predominated in the 7-12 months age group. Vibrio cholerae was isolated mostly in children above two years. Shigella spp, V. cholerae and DEC showed moderate to high rates of resistance to erythromycin, ampicillin, chloramphenicol and tetracycline (56.2-100%). V. cholerae showed full susceptibility to co-trimoxazole (100%), while DEC and Shigella showed high rate of resistance to co-trimoxazole; 90.6% and 93.3% respectively. None of the bacterial pathogens isolated showed resistance to ciprofloxacin which is not recommended for use in children. Cefotaxime resistance was found only in 4.7% of the DEC. Conclusion During the dry season, acute watery diarrhoea is the most common type of diarrhoea in children under five years in Dar es Salaam and is predominantly due to DEC, C. parvum, rotaviruses and noroviruses. Constant antibiotic surveillance is warranted as bacteria were highly resistant to various antimicrobial agents including co-trimoxazole and erythromycin which are currently recommended for empiric treatment of diarrhoea.