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Background: There has been increasing evidence of the association between hyperuricemia and diabetes mellitus (DM). In the general population, hyperuricemia has been associated with pre-diabetes. In DM patients, hyperuricemia has been associated with poor outcomes. Objectives: The objective was to determine the proportion of hyperuricemia and associated factors among patients with type 2 DM in Mwanza, Tanzania. Design: This was a cross-sectional study. Methods: This study was conducted from January to March 2023 among patients with type 2 DM attending clinic at Bugando Medical Centre, Mwanza. Data was obtained from a structured questionnaire. Serum uric acid, HbA1c, lipid profile, and renal functions were analyzed. Analysis was done via STATA version 17. The primary outcome was the proportion of hyperuricemia among patients with type 2 DM, and logistic regression models were used to analyze associated factors. Results: Out of 360 patients, 59.7% were female. The median age was 61 years [IQR 57-68], and the median duration of DM was 5 years [IQR 3-9]. The mean HbA1c was 8.2 ± 2.5%, with 60% of patients having poor control. Most patients had hypertension (78.9%) and were overweight or obese (81.9%). The proportion of patients with DM and hyperuricemia was 44.4%, with mean serum uric acid levels among males and females of 410 ± 137 and 385 ± 119 µmol/L, respectively. We found that being female (P =.001), overweight (P =.021), or obese (P =.007), and having chronic kidney disease (P <.001) was associated with hyperuricemia among patients with type 2 DM. Conclusion: The burden of hyperuricemia among type 2 DM patients is quite high, and it is associated with female gender, high body mass index, lipids, and chronic kidney disease. This calls for regular screening of hyperuricemia in the population, and more studies are needed to establish the outcomes associated with hyperuricemia and create a treatment guideline. Plain Language Summary: High Uric Acid Levels and Associated Factors Among Patients with Diabetes in Northwestern Tanzania There has been association between high uric acid levels and diabetes, as high uric acid levels have been found in patients with early stages of diabetes, as well as related to complications and death. This study investigated 360 patients with diabetes and found that 44.4% had high uric acid levels. The study found that factors associated with high uric acid levels in patient with diabetes were females, overweight and obese patients, and patients with kidney disease. [ABSTRACT FROM AUTHOR]

Background: There is an increasing emphasis on promoting women's autonomy in reproductive decision-making, particularly given global efforts to increase contraceptive access and uptake. Scales to quantify autonomy have inconsistently included the effect of external influences and focused primarily on influences of partners. Objectives: This study aimed to gain greater depth in understanding how influences including and beyond a woman's partner affect her contraceptive decision-making, as well as how external influences can overlap and further complicate contraceptive decision-making. Design: A phenomenological, qualitative study in which in-depth interviews were conducted in three phases from May 2021 to February 2022 with women living in northwest Tanzania who had varying histories of contraceptive use or non-use. Methods: One-on-one, in-depth interviews were conducted in Swahili, the national language of Tanzania, by trained female interviewers. Interviews were digitally recorded, transcribed, translated into English, and independently coded by three investigators. Analysis was conducted using NVivo. The codes developed from the transcripts were grouped into overarching themes with supporting illustrative quotes. Results: A total of 72 women were interviewed. Partners were the most influential in women's family planning decision-making, followed by friends, relatives, community religious leaders, and healthcare providers. Out of the 52 women with a partner who had ever used family planning, 76.9% had discussed their desire to use family planning with their partner and nearly all reported strong pressures to use or not to use family planning from partners, family, and friends. Rarely, participants stated that they were devoid of any influence. Conclusion: In rural Tanzania, women's decision-making about family planning was highly impacted by external influences, including not only partners but also family, friends, and community. Indicators of women's reproductive autonomy and measurements of interventions to promote contraceptive use should incorporate measures of these external influences. [ABSTRACT FROM AUTHOR]

Background: Stroke is a second leading cause of death globally, with an estimated one in four adults suffering a stroke in their lifetime. We aimed to describe the clinical characteristics, quality of care, and outcomes in adults with stroke in urban Northwestern Tanzania. Methods: We analyzed de-identified data from a prospective stroke registry from Bugando Medical Centre in Mwanza, the second largest city in Tanzania, between March 2020 and October 2022. This registry included all adults ⩾18 years admitted to our hospital who met the World Health Organization clinical definition of stroke. Information collected included demographics, risk factors, stroke severity using the National Institutes of Health Stroke Scale, brain imaging, indicators for quality of care, discharge modified Rankin Scale, and in-hospital mortality. We examined independent factors associated with mortality using logistic regression. Results: The cohort included 566 adults, of which 52% (294) were female with a mean age of 65 ± 15 years. The majority had a first-ever stroke 88% (498). Premorbid hypertension was present in 86% (488) but only 41% (200) were taking antihypertensive medications before hospital admission; 6% (32) had HIV infection. Ischemic strokes accounted for 66% (371) but only 6% (22) arriving within 4.5 h of symptom onset. In-hospital mortality was 29% (127). Independent factors associated with mortality were severe stroke (adjusted odds ratio (aOR) = 1.81, 95% confidence interval (CI) = 1.47–2.24, p < 0.001), moderate to severe stroke (aOR = 1.49, 95% CI = 1.22–1.84, p < 0.001), moderate stroke (aOR = 1.80, 95% CI = 1.52–2.14, p < 0.001), leukocytosis (aOR = 1.19, 95% CI = 1.03–1.38, p = 0.022), lack of health insurance coverage (aOR = 1.15, 95% CI = 1.02–1.29, p = 0.025), and not receiving any form of venous thromboembolism prophylaxis (aOR = 1.18, 95% CI = 1.02–1.37, p = 0.027). Conclusion: We report a stroke cohort with poor in-hospital outcomes in urban Northwestern Tanzania. Early diagnosis and treatment of hypertension could prevent stroke in this region. More work is needed to raise awareness about stroke symptoms and to ensure that people with stroke receive guidelines-directed therapy. [ABSTRACT FROM AUTHOR]

Background: Detection of subclinical cryptococcal disease using cryptococcal antigen screening among HIV‐positive individuals presents a potential opportunity for prevention of both clinical disease and death if patients with detectable cryptococcal antigen are identified and treated pre‐emptively. Recently developed point‐of‐care cryptococcal antigen tests may be useful for screening, particularly in resource‐limiting settings, but few studies have assessed their utility. Methodology: The objectives of this study were to determine the prevalence and factors associated with cryptococcal antigenemia in HIV‐positive patients with CD4[sup.+] T‐cell counts ≤200 cells/µL who were initiating ART, and also to evaluate the utility of the point‐of‐care urine lateral flow assay (LFA) cryptococcal antigen test using two different diluents, compared to gold standard serum antigen testing, as a screening tool. Urine and serum of outpatients initiating antiretroviral therapy at two hospitals in Mwanza were tested for cryptococcal antigen, and demographic and clinical characteristics were obtained using structured questionnaires and patients’ files. Patients with asymptomatic cryptococcal antigenemia received oral fluconazole in accordance with World Health Organization recommendations. Results: Among 140 patients screened, 10 (7.1%) had asymptomatic cryptococcal antigenemia with a positive serum cryptococcal antigen. Four of these ten patients had CD4 counts between 100 and 200 cells/µL. The prevalence of cryptococcal antigen detected in urine using a standard (older) and a test (newer) diluent were 44 (31.4%) and 19 (13.6%), with Kappa coefficients compared to serum of 0.28 and 0.51 (p Conclusions: Our findings suggest that HIV‐positive outpatients with CD4 counts, Introduction Cryptococcus neoformans is one of the leading opportunistic infections in people living with HIV/AIDS in sub‐Saharan Africa [1–4]. It is estimated that 3% of HIV‐positive individuals in sub‐Saharan Africa [...]

Background: Schistosomiasis increases the risk of human immunodeficiency virus (HIV) acquisition in women by mechanisms that are incompletely defined. Our objective was to determine how the cervical environment is impacted by Schistosoma haematobium or Schistosoma mansoni infection by quantifying gene expression in the cervical mucosa and cytokine levels in cervicovaginal lavage fluid.Methods: We recruited women with and those without S. haematobium infection and women with and those without S. mansoni infection from separate villages in rural Tanzania with high prevalences of S. haematobium and S. mansoni, respectively. Infection status was determined by urine and stool microscopy and testing for serum circulating anodic antigen. RNA was extracted from cervical cytobrush samples for transcriptome analysis. Cytokine levels were measured by magnetic bead immunoassay.Results: In the village where S. haematobium was prevalent, 110 genes were differentially expressed in the cervical mucosa of 18 women with versus 39 without S. haematobium infection. Among the 27 cytokines analyzed in cervicovaginal lavage fluid from women in this village, the level of interleukin 15 was lower in the S. haematobium-infected group (62.8 vs 102.9 pg/mL; adjusted P = .0013). Differences were not observed in the S. mansoni-prevalent villages between 11 women with and 29 without S. mansoni infection.Conclusions: We demonstrate altered cervical mucosal gene expression and lower interleukin 15 levels in women with S. haematobium infection as compared to those with S. mansoni infection, which may influence HIV acquisition and cancer risks. Studies to determine the effects of antischistosome treatment on these mucosal alterations are needed. [ABSTRACT FROM AUTHOR]

HIV infection, a major health problem worldwide, has been reported to be prevalent in trauma patients, thus presents an occupational hazard to health care workers who care for these patients. The purpose of this study was to establish the prevalence of HIV among trauma patients in our setting and to compare the outcome of these patients who are HIV positive with those who are HIV negative. This was a descriptive cross sectional study involving trauma patients aged 11 years and above, admitted to the surgical wards of Bugando Medical Centre in Mwanza, Tanzania over a six-month period from October 2008 to March 2009. All eligible patients were consecutively enrolled in the study. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS computer software. A total of 250 trauma patients were recruited and studied. The mean age of the study population was 36.37±15.35. Males accounted for the majority (N=202; 80.8%) of the study population. The prevalence of HIV among trauma patients was 11.6%. Among the HIV positive patients, 26 (89.7%) were males and majority aged 31-40 years. Seventy two percent of HIV positive patients had CD4+ count of = 200 cells/µl. Overall length of hospital stays (LOS) ranged from 1 - 90 days with mean of 19.11 ± 15.84 days. Using multivariate logistic regression, injury severity score (ISS) (P=0.0026), revised trauma scores (RTS) (P= 0.002,), HIV seropositivity (P= 0.0012) and CD4+ count (P= 0.001) were significantly found to be associated with increased LOS. Mortality rate was 10.8% and was significantly associated with; the body region injured (P < 0.05), ISS (P = 0.026), RTS (P = 0.001), PTS (P= 0.01), HIV positivity (P= 0.0001) and CD4+ count (P= 0.035). HIV is prevalent among trauma patients in our setting. A substantial risk of exposure to HIV exists in health workers who care for these patients. Thus, all trauma health care workers in this region need to practice universal barrier precautions in order to reduce the risk of exposure to HIV infection. HIV positive patients with CD4+ count =200cells/µl have similar prognosis as HIV negative patients and therefore should be treated the same way. [ABSTRACT FROM AUTHOR]