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Background: Despite scaling up of HIV and treatment services to improve the outcome of people living with HIV, still a high proportion of patients seek out medical attention at late stages of the disease. This contributes to late initiation of ART and poor clinical outcome especially in sub Saharan Africa. The literature on magnitude of this problem in Tanzania is still scarce. This study aimed to determine the prevalence and associated factors of delayed HIV diagnosis in rural Tanzania. Methods: This was a cross sectional study, involving newly diagnosed adult HIV patients sent in for care and treatment linkage. Information regarding age, sex, WHO stage, type of opportunistic condition, HIV testing service and on diagnosis CD4 counts were all collected. On diagnosis CD4 counts <200cells/μl was coded as Late HIV diagnosis. The proportion of with Late HIV diagnosis was calculated and logistic regression modal was used to determine the degree of association of different variables at 95%CI. Results: In total 649 patients were included in this study. The median age of the study participants was 45.5 years most of them being females 396 (61.02%). The median CD4 count was 168 cells/μl and majority of our study participants 468 (72.11%) were in WHO clinical stage 3&4. Overall 385 (59.32%) were found to have Late HIV diagnosis where 303 (78.70%) had stage 3&4 AIDS defining illness (OR=2.2, p<0.001). Male patients were predominantly affected (OR=1.4, p=0.035), who were more likely to be tested following PITC service (OR=30, p<0.001). Conclusions: Late HIV diagnosis is prevalent in our setting with high prevalence of most of the stage 3&4 AIDS defining illnesses. Male patients are predominantly affected as late presenters. There is a need to strengthen and extend the available Provider Initiated Testing and Counselling activities to primary health care level.

Background: Tuberculosis (TB) is still an important cause of morbidity and mortality worldwide. Though it can effectively be treated, still a significant proportion of patients die on the course of their treatment. The objective of this study was to determine the outcome and risk factors of mortality among patients diagnosed with TB in a tertiary hospital in north-western Tanzania. Methods: A retrospective cross sectional study was done among all patients diagnosed with TB between January and December 2015 at Bugando Medical Centre. Information of demographic characteristics, smear positivity, haemoglobin concentration, HIV status, CD4 counts for HIV positive patients and treatment outcomes were collected and analysed. TB treatment outcomes as dead or alive were calculated and logistic regression was done to determine the factors associated with increased risk of death of patients on anti-TB treatment. Results: In total 701 patients were diagnosed with TB during the study period. Of these, 361 (51.5%) were males with a median age of 38 (IQR 27- 47) and 421 (60.06%) were younger than 40 years. Majority of the participants 409 (58.35%) had smear positive pulmonary tuberculosis and about half of patients (51.07%) tested positive for HIV. Of the enrolled patients 610 (87.02%) were alive at the end of TB treatment while 91 (12.98%) died in the course of treatment. The odds of deaths of patients on anti-TB treatment were strongly associated with male sex, HIV co infection and severe anaemia. Conclusion: The proportion of patients who die from TB treatment at BMC is high, with an increased risk of death among HIV co-infected, older than 40 years and severely anaemic patients. Improvement of strategies for early diagnosis and prompt treatment of TB patients will potentially improve treatment outcome.

Background: The prevalence and mortalities due to renal diseases is estimated to be high in sub-Saharan Africa. However, little is known about these conditions among the hospitalized adult-patients in Tanzania. The objective of this study was to determine the magnitude, associated factors and outcomes of renal dysfunction among the inpatients at Bugando Medical Centre in Mwanza, Tanzania. Method: An analytical cross-sectional study was used to determine the prevalence and predictors while prospective cohort design was employed to determine the outcomes. Demographic, clinical and laboratory data were collected from all adult inpatients. For those patients with initial estimated Glomerular Filtration Rate (eGFR) of <60ml/min/1.73m2, a repeat creatinine test was done after 3-months to diagnose the chronic kidney disease. Results: Out of 637 patients, 48.2% were females and the median age was 45 years. Twenty-eight percent of the study population had renal dysfunction. The prevalence of Chronic Kidney Disease was 69.5% (41/59). The odds of having renal dysfunction was strongly predicted by older age (p=0.009), female sex (p=0.004), heart failure (p<0.001), diabetes (p=0.04), decreased urine output (p<0.001) and proteinuria (p=0.004). Mortality, both in-hospital (3.23 [2.19–4.74], p<0.001) and at 1-month post-discharge (3.07[2.13-4.41], p<0.001) was found to be significantly higher in patients with renal dysfunction. Conclusions: This study has demonstrated a high prevalence of renal dysfunction and associated mortalities. This strongly emphasizes the need to increase awareness among clinicians in Tanzania on renal diseases so as to pro-actively screen, prevent, diagnose and provide early treatment of renal dysfunction among hospitalized patients.

Brugada syndrome is an autosomal-dominant arythmogenic genetic disorder associated with mutation in the SCN5A gene. We report a case of 3-month-old Tanzanian male who was admitted at Muhimbili National Hospital in Dar es Salaam, Tanzania with severe pneumonia, high fever and monomorphic ventricular tachycardia. The patient was treated with intravenous Amiodarone. In addition, oxygen, parenteral antibiotics, antipyretics and intravenous fluids were also given. About 2 hours and 20 minute later the child stabilized. An ECG obtained shortly after termination of ventricular tachycardia showed the typical J-point and coved ST elevation typical of Brugada type I pattern. To the best of our knowledge, this is the first paediatric case with Brugada-type ECG to be reported in Sub-Saharan Africa. This case emphasizes the need to increase awareness among clinicians of clinical and genetic arythmogenic disorders. Multiple ECGs during and after febrile disorders should be performed in children who exhibit extreme tachycardia or signs of cardiac failure.

Pulmonary hamartomas are the most common benign tumors of the lung. They are usually diagnosed incidentally while evaluating for other conditions. These tumors have been shown to be uncommon below the age of 25 years. We report a case of a 16-year-old male who presented with chronic chest pain and was histologically confirmed to have pulmonary hamartoma. The tumor was successfully resected. This is the first case of hamartoma to be reported in our country, and the atypical age at presentation together with the tumor’s position makes it more unique. In conclusion, although very rare, pulmonary hamartomas can occur in young age with the central location. Clinically, the presentation is usually non-specific and the diagnosis is mostly incidental while investigating other conditions. There is a need to increase awareness among clinicians on hamartomas to improve early treatment for this rare disease in the adolescents.