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BackgroundThe first month of life is the most critical in a child’s heath because it is associated with the highest risk of adverse health outcomes. In Tanzania the risk of adverse health outcomes in preterm infants is five times higher compared to term infants.The objective of this study was to assess common adverse health outcomes and compare the risk of such outcomes between preterm and term infants, in Tanzania, within the first 28 days of life.MethodsThis was a case-control study involving preterm (cases) and term (controls) infants delivered at the Muhimbili National Hospital between August and October 2019 . About 222 pairs of cases and controls were reviewed for their medical records. Logistic regression was used to compare the risk of neonatal outcomes between the study groups. Statistical significance was achieved at P-value < 0.05 and 95% confidence interval.ResultsPreterm infants have an increased risk of mortality (OR = 7.2, 95% CI: 3.4-15.1), apnea (OR = 4.7, 95% CI: 3.4-15.1), respiratory distress syndrome (OR = 4.8, 95% CI: 3.2-7.3), necrotizing enterocolitis (OR = 5.5, 95% CI: 1.2-25.3), anemia (OR = 4.3 , 95% CI: 2.8-6.6), pneumonia (OR = 2.7, 95% CI: 1.6-4.6) and sepsis (OR = 2.6, 95% CI: 1.7-3.9) in the first month of life compared to term infants. No differences in the risk of intraventricular hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosus and jaundice were observed between preterm and term infants. ConclusionThe findings of this study informs the Tanzanian health sector about the most common and high risk neonatal outcomes in preterm infants. Additionaly, for promoting neonates' health, the health sector needs to consider preventing and treating the most common and high risk adverse neonatal outcomes in preterm infants.

Genetic modifiers underlying various sickle cell disease phenotypic expressions are largely unexplored in Africa due to lack of databases linking biospecimens with demographic and clinical data. The problem may be compounded by a complete lack of biorepositories in these settings. This article aims to document the physical verification of biospecimens stored in the biorepository and link them to patient clinical and demographic information to facilitate plans for genomic and related clinical research studies. We reviewed and updated the existing biorepository infrastructure at Muhimbili Sickle Cell Programme in Dar es Salaam, Tanzania. The database of archived biospecimens was updated with the location information of respective biospecimens following the physical verification of biospecimens and then mapping the patient demographic and clinical data with the biospecimen data using sickle cell patients’ demographic identifiers. Three freezers maintained at -80°C store a total of 74,079 biospecimens, of which 63,345 were from 5,159 patients registered in the Muhimbili Sickle Cohort from 2004 to 2016. Out of stored biospecimens, follow-ups were 46,915 (74.06%), control 8,067 (12.74%), admission 5,517 (8.71%) and entry 2,846 (4.49%). Of these registered patients, females were 2,521 (48.87%) and males were 2,638 (51.13%). The age distribution was 1 to 59 years, with those above 18 years being 577 (11.18%) and children 4,582 (88.82%) of registered patients. The notable findings during the process include a lack of automated biospecimen checks, laboratory information management system and standardization of equipment used, biospecimens not linked to clinical and demographic data, date format inconsistencies, lack of regular updating of a database on exhausted biospecimens and updates when biospecimens are moved between positions within freezers. Well-organized biorepository plays a crucial role in answering future research questions. Enforcing strict standard operating procedures and quality control standards will ensure that laboratory scientists and other users adhere to the best biospecimen management procedures.

Sickle cell disease is a genetic disease with a predisposition to infections caused by encapsulated organisms, especially Streptococcus pneumoniae. Pneumococcal vaccines and prophylactic penicillin have reduced the rate of this infection and mortality in sickle cell disease. However, implementation of these interventions is limited in Africa. The objectives of the study were to assess health care providers’ behaviors with the implementation of pneumococcal vaccination and penicillin prophylaxis and to identify barriers to their use. A 25-item online questionnaire was administered through SickleinAfrica: a network of researchers, and healthcare providers, in Ghana, Nigeria, and Tanzania, working to improve health outcomes of sickle cell disease in Africa. Data was collected and managed using the Research Electronic Data Capture (REDCap), tools and data analysis was done using STATA version 13 and R statistical software. Eighty-two medical practitioners responded to the questionnaire. Only 54.0 and 48.7% of respondents indicated the availability of published guidelines on sickle cell disease management and pneumococcal vaccine use, respectively, at their facilities. The majority (54.0%) perceived that the vaccines are effective but over 20.0% were uncertain of their usefulness. All respondents from Ghana and Tanzania affirmed the availability of guidelines for penicillin prophylaxis in contrast to 44.1% in Nigeria. Eighty-five percent of respondents affirmed the need for penicillin prophylaxis but 15.0% had a contrary opinion for reasons including the rarity of isolation of Streptococcus pneumoniae in African studies, and therefore, the uncertainty of its benefit. Lack of published guidelines on the management of sickle cell disease and doubts about the necessity of prophylactic measures are potential barriers to the implementation of effective interventions.

Background Monitoring patient’s clinical attendance is a crucial means of improving retention in care and treatment programmes. Sickle cell patients’ outcomes are improved by participation in comprehensive care programmes, but these benefits cannot be achieved when patients are lost from clinical care. In this study, patients are defined as loss to follow-up when they did not attend clinic for more than 9 months. Precise information on the retention rate and characteristics of those who are not following their clinic appointments is needed to enable the implementation of interventions that will be effective in increasing the retention to care. Method This was a retrospective study involving sickle cell patients registered in the Muhimbili Sickle Cohort in Tanzania. Descriptive and survival analysis techniques both non-parametric methods (Kaplan-Meier estimator and Log-rank test) and semi-parametric method (Cox’s proportional hazard model), were used. A p-value of 0.05 was considered significant to make an inference from the analysis. Results A total of 5476 patients were registered in the cohort from 2004 to 2016. Of these, 3350 (58.13%) were actively participating in clinics, while 2126 (41.87%) were inactive, of which 1927 (35.19%) were loss to follow-up. We used data from 2004 to 2014 because between 2015 and 2016, patients were referred to other government hospitals. From the survival analysis results, pediatric (HR: 14.29,95% CI: 11.0071–18.5768, p p p = 0.0039) or mean cell volume (HR: 4.28, (95% CI: 1.0260–1.0598, p Conclusion Loss to follow-up is evident in the cohort of patients in long term comprehensive care. It is, therefore, necessary to design interventions that improve patients’ retention. Suggested solutions include refresher training for health care workers and those responsible for patient follow-up on techniques for retaining patients and comprehensive transition programs to prepare patients who are moving from pediatric to adult clinics.

Background Adherence to antiretroviral therapy (ART) among key populations like human immunodeficiency virus (HIV)-positive People Who Inject Drugs (PWID) could be challenging, especially in low and middle-income countries (LMICs). Therefore we conducted this study to assess the adherence to ART among HIV-positive PWID attending three methadone clinics in Dar es Salaam, Tanzania. Methods A cross-sectional study was conducted at three methadone clinics in Dar es Salaam, Tanzania. Adherence to ART was measured by using pharmacy refill and patient self-report methods. Bivariate and multivariable logistic regression was performed to determine the association between dependent and independent variables. A p-value of less than 0.05 was considered to be statistically significant. Results Of the 180 participants, 97.2% recorded good adherence to ART as per the pharmacy refill method. However, only 66.1% of the PWID were found to adhere to ART based on the patient self-report method. Upon associating the self-report method with a viral load of1000 copies/mL, participants were 3.37 times more likely to have missed their ART dose at least once in the last three days before their refill visit compared to those with a viral load of1000 copies/mL [Adjusted Odds ratio; 3.37, 95% Confidence Interval (95% CI); 1.35 - 8.45, p = 0.009]. Conclusion The adherence to ART among HIV-infected PWID attending methadone clinics was high based on the pharmacy refill method but relatively much lower based on the patient self-report method. There was a strong correlation between viral load and the level of adherence measured by the patient self-report method.

Background The worldwide emergence of antibiotic-resistant bacteria threatens to overshadow the dramatic advances in medical sciences since the discovery of antibiotics. Antibiotic resistance has rendered some antibiotics obsolete, creating a reliance on synthetic drugs. In some instances, bacteria can be resistant to all antibiotics. The problem of antibiotic resistance is eminent in resource-limited countries like Tanzania, where systematic surveillance and routine susceptibility tests are rarely conducted. Therefore, this study aimed to investigate the magnitude of beta-lactamase-producing Gram-positive pathogens and Enterobacteriaceae with extended-spectrum beta-lactamase (ESBL) in Dar es Salaam, Tanzania. Methodology This multi-site cross-sectional study involved three private hospitals in Dar es Salaam, Tanzania. The study was conducted between July and September 2008. Bacterial isolates were collected, identified, and subjected to antibiotic-sensitivity testing against cephalosporins, including ceftriaxone, cefuroxime and cefotaxime, and clavulanic acid, which are antibiotics readily available on the Tanzanian market at the time of the study. The microdilution method was employed to determine beta-lactamase and ESBL production per the Clinical Laboratory and Standards Institute (CLSI) protocol. Cephalosporins, including ceftriaxone, cefuroxime and cefotaxime, the beta-lactamase inhibitor, and clavulanic acid, were serially diluted with concentrations ranging from 0.011 mg/ml to 200 mg/ml. Each of these antibiotics was subjected to sensitivity tests by determining the minimum inhibitory concentrations (MIC) of the clinical isolates of bacteria using a 96-well microdilution plate. Five microliters of bacterial suspension were inoculated into each well-containing 120µl of sterile Mueller-Hinton broth before incubation overnight. Results A total of 111 bacterial isolates were tested. Of the 111 tested bacterial isolates, 85 (76.6%) and 26 (23.4%) were Gram-negative and Gram-positive bacteria, respectively. Fifty-six clinical isolates (50.4%) were

Cockroaches are common pests in homes and hospitals. They cause allergic reactions in some individuals and are potential vectors for various infectious pathogens. The study investigated the extent to which hospital cockroaches act as vectors and reservoirs of medically important fungal pathogens on their external surfaces.Cockroaches were captured from the selected hospital locations including the burn unit, adult surgical wards, pediatric oncology wards, intern hostel kitchen, and the central kitchen of a national referral teaching hospital in Tanzania. Normal saline washings from the external surface of cockroaches were cultured on standard mycological media to facilitate isolation and identification of medically important molds and yeasts. The susceptibility ofA total of 69 cockroaches were captured from various hospital sites between February and April 2017. All cockroaches captured were shown to carry medically important fungi. A total of 956 medically important fungi were isolated; 554 (57.9%) were of Cockroaches from this hospital may act as reservoirs of medically important opportunistic fungi exhibiting resistance to fluconazole.

Patients with sickle cell disease (SCD) with high fetal haemoglobin (HbF) tend to have a lower incidence of complications and longer survival due to inhibition of deoxyhaemoglobin S (HbS) polymerisation by HbF. HbF-containing cells, namely F cells, are strongly influenced by genetic factors. We measured the percentage of F cells (Fcells%) in 222 patients with SCD to evaluate the association of (i) Fcells% with genetic HbF-modifier variants and (ii) Fcells% with haematological parameters. There was a different distribution of Fcells% in females compared to males. The association of the B-cell lymphoma/leukaemia 11A (BCL11A) locus with Fcells% (β = 8·238; P < 0·001) and with HbF% (β = 2·490; P < 0·001) was significant. All red cell parameters except for Hb and mean corpuscular Hb concentration levels in males and females were significantly different. The Fcells% was positively associated with mean cell Hb, mean cell volume and reticulocytes. To explain the significant gender difference in Fcells%, we tested for associations with single nucleotide polymorphisms on the X chromosomal region Xp22.2, where a genetic determinant of HbF had been previously hypothesised. We found in males a significant association with a SNP in FERM and PDZ domain-containing protein 4 (FRMPD4) and adjacent to male-specific lethal complex subunit 3 (MSL3). Thus, we have identified an X-linked locus that could account for a significant fraction of the Fcells% variation in patients with SCD.

The electronic Hospital management Information System (eHMIS) can improve care for vulnerable patients, help collect important disability and maternal health data, and improve the hospital’s overall data management. This study assessed the use of HMIS and factors influencing the usage and behavioral intentions to use the eHMIS at the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT). We investigated both clinical and non-clinical staff (n=69) using tablets and online surveys, with a rate of return of 71.9%. The ICT staff were also interviewed to supplement data from the survey. The survey questionnaire was guided by the updated Information System Success (ISS) model. Most health workers (81.2%) used the eHMIS several times a day to support different decision-making activities. The better educated personnel were more likely to enter data more effectively into eHMIS as compared to their counterparts. Among six predictors, self-efficacy positively influenced self-reported use and user satisfaction of HMIS, while service quality negatively affected self-reported use of eHMIS. The system quality positively influenced health workers to be satisfied with the eHMIS, and user satisfaction positively influenced continued usage intention of the eHMIS. Both user satisfaction and continued usage intention were positively related to individual impact of eHMIS. Individual impact had positive effects on organizational impact of eHMIS. This is a comprehensive study conducted in Tanzania regarding the implementation of eHMIS, and factors influencing post-adoptive use of HMIS to improve quality of care of women and people with disabilities.

Background: The pathophysiology of sickle cell disease (SCD) is complex and involves nitric oxide depletion, increased inflammation/adhesion molecules and vaso-occlusion in addition to the chronic hemolytic anemia. This pathophysiology results in systemic clinical complications including recurrent episodes of severe pain, stroke, acute chest syndrome (ACS) and an increased susceptibility to infection. SCD severity varies among individuals and fetal hemoglobin (HbF) is known as a major modulator of the disease. To date, hydroxyurea (HU) is a known intervention that acts by increasing HbF in individuals with SCD. The increase in HbF reduces the risk of ‘sickling’ events and improves clinical outcomes. This is the first study on the use of HU in individuals with SCA in Tanzania.Methods: A case-control study to determine the proportion, indications, clinical and laboratory outcomes of SCD patients with HU use was conducted at Muhimbili National Hospital in Dar Es Salaam, Tanzania.Results: Forty-two patients with Sickle cell anemia (SCA) on HU treatment and 32 patients with SCA not on HU treatment were enrolled. The proportion of HU use by individuals with SCA at Muhimbili National Hospital was 10 per 1000. The mean HbF % was 9.8 ± 2.4 vs 6.2 ±1.4 for controls (P

Background: Sickle cell disease (SCD) is a blood disorder caused by a point mutation on the beta globin gene resulting in the synthesis of abnormal hemoglobin. Fetal hemoglobin (HbF) reduces disease severity, but the levels vary from one individual to another. Most research has focused on common variants which differ across populations and hence do not fully account for HbF variation. Methods: We investigated rare and common genetic variants that influence HbF levels in 14 SCD patients to elucidate variants and pathways in SCD patients with extreme HbF levels (≥7.7% for high HbF) and (≤2.5% for low HbF) in Tanzania. We performed targeted next generation sequencing (Illumina_Miseq) covering exonic and other significant fetal hemoglobin-associated loci, including BCL11A, MYB, HOXA9, HBB, HBG1, HBG2, CHD4, KLF1, MBD3, ZBTB7A and PGLYRP1.Results: Results revealed a range of genetic variants, including bi-allelic and multi-allelic SNPs, frameshift insertions and deletions, some of which have functional importance. Notably, there were significantly more deletions in individuals with high HbF levels (11% vs 0.9%). We identified deletions with high HbF levels and frameshift insertions in individuals with low HbF. CHD4 and MBD3 genes, interacting in the same sub-network, were identified to have a significant number of pathogenic or non-synonymous mutations in individuals with low HbF levels, suggesting an important role of epigenetic pathways in the regulation of HbF synthesis. Conclusions: This study provides new insights in selecting essential variants and identifying potential biological pathways associated with extreme HbF levels in SCD using multiple genomic variants associated with HbF in SCD.

Introduction: In the twenty-first century, Human Immunodeficiency Virus (HIV) continues to be among the major public health problem globally. The disease is implicated to the result of the over 32 million deaths, and in 2018 the disease caused over 770,000 deaths globally. The disease can be transmitted from an HIV-positive pregnant woman to her child during pregnancy and childbirth about 15% - 20%, and 5% - 15% in breastfeeding. Awareness of HIV infection sexual risk behaviors and practices among male partners of pregnant mothers, therefore, plays a greater role in reducing new infection to them and the prevention of mother-to-child transmission of HIV. Methods: We conducted a retrospective case-control study involving randomly selected 314 pregnant women’s male partners attending PMTCT services in the Tabora Municipality for from September 2018 to August 2019. The enrolled study participants were randomly allocated to cases and controls and, SMS communication was sent twice weekly with 5 standard key messages from the PMTCT community guide and followed up. Results: The awareness that HIV infected mothers can transmit HIV infection in labor and during breastfeeding among their male partners was raised to 73.3% and 61.8% from 55.4% and 47.5% to study and control groups respectively following intervention. Similarly, men aged below 35 years from the study group showed an 18.3% change and a 35.4% change for those who were over 35 years old compared to the control. The difference was tested and found to be statistically significant with a p-value of 0.001 (relative risk of 0.11) and less than 0.001 (relative risk of 0.07) respectively at a 95% confidence interval. This indicates that following SMS communication intervention men from the study group were less likely to practice HIV infection sexual risk behavior compared to the control group.

As more HIV patients start combination antiretroviral therapy (cART), the emergence of HIV drug resistance (HIVDR) is inevitable. This will have consequences for the transmission of HIVDR, the success of ART, and the nature and trend of the epidemic. We recruited a cohort of 223 patients starting or continuing their first-line cART in Tanzania towards the end of the stavudine era in 2010. Patients were then followed for one year. Of those with a viral load test at baseline and follow-up time, 34% had a detectable viral load at the one-year endpoint. For 41 patients, protease and reverse transcriptase genotyping were successful. Eighteen samples were from cART-naïve patients, and 23 samples were taken under therapy either at baseline for cART-experienced patients or from follow-up samples for both cART–naïve and cART–experienced patients. The isolates were subtype A, followed by C and D in 41.5%, 22%, and 12.2% of the patients, respectively. No transmitted HIVDR was detected, as scored using the surveillance drug resistance mutations (DRMs) list. However, in 3 of the 18 samples from cART-naïve patients, the clinical Rega interpretation algorithm scored 44D or 138A as non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance-associated polymorphisms. The most observed nucleoside reverse transcriptase inhibitor (NRTI) mutation was 184V. The mutation was found in 16 patients, causing resistance to lamivudine and emtricitabine. Nineteen patients had NNRTI resistance mutations, the most common of which was 103N, observed in eight patients. These high levels of resistance call for regular drug resistance surveillance in Tanzania to inform the control of the emergence and transmission of HIVDR.

HIV drug resistance (HIVDR) is a complex problem with multiple interconnected and context dependent causes. Although the factors influencing HIVDR are known and well-studied, HIVDR remains a threat to the effectiveness of antiretroviral therapy. To understand the complexity of HIVDR, a comprehensive, systems approach is needed. Therefore, a local systems map was developed integrating all reported factors influencing HIVDR in the Dar es Salaam Urban Cohort Study area in Tanzania. The map was designed based on semi-structured interviews and workshops with people living with HIV and local actors who encounter people living with HIV during their daily activities. We visualized the feedback loops driving HIVDR, compared the local map with a systems map for Sub-Saharan Africa, previously constructed from interviews with international HIVDR experts, and suggest potential interventions to prevent HIVDR. We found several interconnected balancing and reinforcing feedback loops related to poverty, stigmatization, status disclosure, self-esteem, knowledge about HIVDR and healthcare system workload, among others, and identified three potential leverage points. Insights from this local systems map were complementary to the insights from the Sub-Saharan systems map showing that both viewpoints are needed to fully understand the system. This study provides a strong baseline for quantitative modelling, and for the identification of context-dependent, complexity-informed leverage points. ispartof: Pathogens vol:10 issue:12 ispartof: location:Switzerland status: published

Antimicrobial use (AMU) is one of the major drivers of emerging antimicrobial resistance (AMR). Surveillance of AMU, a pillar of AMR stewardship (AMS), helps devise strategies to mitigate AMR. This descriptive, longitudinal retrospective study quantified the trends in human antibiotic utilization between 2010 and 2016 using data on all antibiotics imported for systemic human use into Tanzania's mainland. Regression and time series analyses were used to establish trends in antibiotics use. A total of 12,073 records for antibiotics were retrieved, totaling 154.51Daily Defined Doses per 1,000 inhabitants per day (DID) with a mean (± standard deviation) of 22.07 (±48.85) DID. The private sector contributed 93.76%% of utilized antibiotics. The top-ranking antibiotics were amoxicillin, metronidazole, tetracycline, ciprofloxacin and cefalexin. The DDIs and percentage contribution of these antibiotics were 53.78 (34.81%), 23.86 (15.44), 20.53 (13.29), 9.27 (6.0) and 6.94 (4.49), respectively. The time series model predicted significant increase in utilization(p-value =0.002). The model forecasted that by 2022, the total antibiotics consumed would reach 89.6 DIDs, corresponding to a 13-fold increase compared to 2010. Government intervention to curb inappropriate antibiotic utilization to mitigate the rising threat of antibiotic resistance should focus on implementing AMS programs in pharmacies and hospitals in Tanzania.

IntroductionThe increase in antimicrobial consumption contributes to the emergence of antimicrobial resistance (AMR). Many studies have investigated the patterns of antibacterial consumption and antibacterial resistance. However, there is a paucity of data on the utilization of antivirals and antifungals in low and middle-income countries to serve as a baseline for monitoring and surveillance of AMR. Therefore, this study determined Tanzania’s systemic antifungal and antiviral utilization trends from 2010 to 2017, based on the Tanzania Medicines and Medical Devices Authority (TMDA) medicine importation archives.MethodologyAn analytical, longitudinal retrospective survey covering 2010 to 2017 was conducted. The study utilized the Anatomical Therapeutic and Chemical (ATC) classification and Defined Daily Dose (DDD) developed by the World Health Organization (WHO) Collaborating Centre for Drug Statistics and the WHO Collaboration Centre for International Drug Consumption Monitoring. Human medicine importation data were collected from TMDA headquarters and used to assess the systemic antiviral and antifungal consumption trends. The importation data included the date, generic name, strength, brand name, currency, quantity, ATC classification, supplier country, port of entry and product supplier. The data were cleaned, reorganized and analyzed. Reference was made to the latest revised DDD list to assign antifungals and antivirals to their respective ATC/DDDs and then adjusted to the population estimates from the National Bureau of Statistics of Tanzania.ResultsThere was a high proportion of systemic antivirals and antifungals utilization with 367.1 and 10.8 DDD per 1000 inhabitants per day (DID) respectively over eight years. In regression model, there was a significant increase in both antiviral (p-value = 0.043) and antifungal (p-value = 0.015) agents’ utilization trends in Tanzania in the study period. Fluconazole had the highest proportion of utilization for antifungals, followed by ketoconazole, itraconazole, miconazole and amphotericin B. For systemic antivirals, a high proportion was attributed to antiretrovirals used for HIV infections.ConclusionFindings from this study suggest an increase in the utilization of systemic antiviral and antifungal agents. These findings may be used to further benchmark utilization and AMR studies in Tanzania.

BackgroundWith increased livestock keeping, multiple prevailing infections, antimicrobial agents’ use and pattern in Tanzania, the development of antimicrobial resistance (AMR) becomes inevitable. Antibiotic-resistant pathogens have increasingly become a major challenge in human and animal medicine. Although inappropriate use of antibiotics in humans is the principal cause of resistance, antibiotic-resistant bacteria originating from animals contribute to the emergence and spread of these bacteria. Antibiotics help control a multitude of bacterial infections that are major causes of diseases in both animals and humans. Rational use in animals is crucial to control any development and transfer of AMR to humans. This study aimed to create quantitative evidence of animal antimicrobial usage patterns in Tanzania to serve as a baseline for surveillance of antimicrobial use and antimicrobial resistance control.MethodologyThis descriptive longitudinal retrospective study was conducted to explore the trend of veterinary-antibiotics consumed in the eight years, from 1st January 2010 to 31st December 2017 in Tanzania mainland. The data source was records of all antibiotics imported for veterinary use into Tanzania’s mainland according to the Tanzania Medicines and Medical Devices Authority (TMDA) records. The analysis employed the World Health Organization (WHO) Collaborating Centre for Drug Statistics Methodology using Anatomical Therapeutic and Chemical (ATC) classification. Regression and time series analysis was used to establish trends in antibiotics consumption.ResultsA total of 12,147,491 kg of antibiotics were consumed in Tanzania from 2010 to 2017. Tetracycline, sulfonamides and trimethoprim, quinolones, aminoglycosides, beta-lactams and antibacterial combinations were the most commonly used antibacterial agents in Tanzania. Tetracycline class topped the list with about 8,090,798 kg (66.6%) out of 12,147,491 kg total quantity of antimicrobials consumed. Non-significant, linear curve estimations and time series analysis indicate a decline in the quantities of veterinary antibiotics used in the eight years from 2010 to 2017.ConclusionsThis study suggests that tetracycline is the most used antibiotic class for veterinary medicine in Tanzania. The trend of antimicrobial use is generally decreasing compared to other countries in Africa. Even though some antibiotics have the lowest consumption rate, they are also prone to AMR, prompting follow-up by the relevant regulatory authorities.

BackgroundEven though the genomics technologies have grown to a large extent, Sub Saharan Africa countries have not entirely reaped the benefits due to the lack of enough capacity to use these technologies. The lack of documentation on existing bioinformatics capacity in these countries hinders the guidance on leveraging the resources and in the identification of areas for improvement. The main objective of this study was to map out the interest and capacity for conducting bioinformatics and related research in Tanzania. Our findings identify critical areas for skills and infrastructure development for bioinformatics research. The study is a cross-sectional, explorative, descriptive study, among Tanzanian researchers in public and private academic and research institutionsResultsOut of 84 respondents, 50 (59.5%) were males. More than half of these 44 (52.4%) were in the age between 26-32 years. The majority 41 (48.8%) were master's degree holders with at least one publication related to bioinformatics. Eighty (95.2%) were willing to join the bioinformatics network and initiative in Tanzania. The major challenge faced by 22 (26.2%) of respondents was the lack of training and skills. The most used resources for bioinformatics analyses were the BLAST, PubMed and GenBank. Most performed analyses include sequence alignment and phylogenetic, which was reported by 57 (67.9%) and 42 (50%) of respondents, respectively. The most frequently used statistical software packages were SPSS and R. A quarter of the respondents were conversant with computer programming.ConclusionEarly career and young scientists were the largest group of responders engaged in bioinformatics research and activities across surveyed institutions in Tanzania. The use of bioinformatics tools for analysis is still low, including basic analysis tools such as BLAST, GenBank, sequence alignment software, Swiss-prot and TrEMBL. There is also poor access to resources and tools for bioinformatics analyses. As a way to address the skills and resources gaps, we recommend various modes of training and capacity building of relevant bioinformatics skills and provision of infrastructure so as to improve bioinformatics capacity in Tanzania.

Background and Purpose— Widespread reductions in white matter integrity are associated with cognitive dysfunction in sickle cell anemia. Silent cerebral infarction (SCI), vasculopathy (VSC), and low hemoglobin concentration (Hb) are implicated; we aimed to determine independent contributions to microstructural white matter injury and whether white matter integrity differs across arterial territories. Methods— Sixty two children with sickle cell anemia aged 6 to 19 years were prospectively studied at Muhimbili National Hospital, Tanzania. SCI± and VSC± were identified on magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) scans by 2 neuroradiologists. Tract-based spatial statistics tested for voxel-wise differences in diffusion tensor imaging metrics (ie, fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity) between SCI± and VSC± groups, with correlations between diffusion tensor imaging metrics and Hb. In tract-based spatial statistics analyses, potentially mediating factors (ie, age, sex, as well as Hb, SCI, and/or vasculopathy) were covariates. Differences in mean diffusion tensor imaging metrics across regions of interest in arterial territories were explored. Results— Compared with SCI− patients (n=45), SCI+ patients (n=17) exhibited increased radial diffusivity in multiple regions; negative relationships were observed between mean diffusivity, axial diffusivity, and Hb ( P P Conclusions— SCI, vasculopathy, and Hb are independent risk factors, and thus treatment targets, for diffuse white matter injury in patients with sickle cell anemia. Exacerbation of hemodynamic stress may play a role.

Background: Monitoring of patient’s clinical attendance is one of the crucial means that is used to improve adherence to care and treatment among the Sickle Cell Disease (SCD) patients. Adherence to care has been shown to improve health outcomes in SCD patients. However, these benefits cannot be achieved when patients are lost to follow-up to care. Method : We analyzed data on loss to follow up to determine the patterns among sickle cell patients registered at Muhimbili Sickle Cell Cohort (MSC), in Dar es Salaam, Tanzania. Data was aggregated and analysed using R software and Microsoft Excel Spreadsheet. Survival analysis techniques, both non-parametric methods (Kaplan-Meier estimator and Log-rank test) and semi-parametric method (Cox’s proportional hazard model), were used. A p-value of 0.05 was considered significant to make a strong inference of the analysis. Results: 5476 SCD patients were registered at MSC from 2004 to 2016, 3350 (58.13%) were actively participating in clinics while, 2126 (41.87%) were inactive, out of which 35.19% were lost to follow-up. From the survival analysis results, patients who were between 5 to 17 years were more likely to be lost to follow-up than the rest with a hazard ratio of 2.65 times more than those who were above 18 years. Patients with mean cell volume above 77.73 fL and white blood cell above 15.73(10ˆ3/uL) were more likely to be loss to follow-up than those below average. Conclusion: Loss to follow-up is evident in a cohort of patients in long term comprehensive care follow-up. It is, therefore, necessary to design interventions that minimize its impacts. Suggested solutions might include training of the health care workers, more emphasis on newborn screening and advocacy to patients regarding the effect of loss to follow-up.

Background: Cerebral infarcts and vasculopathy in neurologically asymptomatic children with sickle cell anemia (SCA) have received little attention in African settings. This study aimed to establish the prevalence of silent cerebral infarcts (SCI) and vasculopathy and determine associations with exposure to chronic hemolysis, anemia, and hypoxia.Methods: We prospectively studied 224 children with SCA with transcranial Doppler (TCD), and magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). Regressions were undertaken with contemporaneous hemoglobin, reticulocyte count, mean prior hemoglobin, oxygen content, reticulocyte count, and indirect bilirubin.Results: Prevalence of SCI was 27% (61 of 224); cerebral blood flow velocity was abnormal (>200 cm/s) in three and conditional (>170Conclusions: SCI and vasculopathy on MRA are common in neurologically asymptomatic children with SCA living in Africa, even when TCD is normal. Children with vasculopathy on MRA are at increased risk of SCI. Longitudinal exposure to anemia, hypoxia, and hemolysis appear to be risk factors for vasculopathy.

HIV drug resistance (HIVDR) in Tanzania is a complex problem with many interconnected causes. Some important factors contributing to the selection of drug resistant viruses in people infected with HIV are stigma, poverty, poor health, illiteracy, and insufficient adherence to antiretroviral therapy. Several studies have suggested the implementation of peer support groups as a way to shift the workload associated with adherence support, antiretroviral therapy (ART) distribution, and HIV education away from the doctors to the people living with HIV (PLHIV) themselves. We conducted interviews with local PLHIV to investigate the desirability and feasibility of a peer support group in the Pasada and Kisarawe hospitals in Dar es Salaam, Tanzania. A standardized questionnaire was completed by 27 PLHIV in July and August 2017 at the time of a follow-up visit. In this cohort, major causes for missing a dose of ART are lack of support from family and friends and forgetfulness. Reasons for wanting to join a peer support group include psychological support, fighting stigma, and increasing education about their disease. Interestingly, several respondents linked HIV peer support to business support groups such as village community banks (VICOBA). These are informal microfinance groups meant to offer economic stability to individuals. As this link was made by PLHIV themselves, we suggest that it may be worthwhile to explore mixed financial and HIV peer support groups in which HIV education is provided for both HIV positive and negative members. Such groups may reduce the risk of infection and stigma and provide combined psychological, financial, and logistic support to PLHIV.

Challenge: A way to understand and instruct on best practices for delivering and accepting HIV drug treatments in Africa. This transdisciplinary team focused on the problem of continuously rising levels of HIV drug resistance in Africa that as a result can lead to increased rates of mortality and morbidity. The main source of the HIV drug resistance problem is believed to be insuf cient adherence to therapy. The challenge submitter suggested to explore whether improving the relationship between patient and health-care provider would be the next best step to improve adherence. However, after gathering knowledge from different sources, it was found that the burden on local doctors was already very high and would only increase in the coming years. A better relationship with the patient would be an extra burden on the time of health personnel. Instead, the team researched the feasibility of implementing peer support groups in Dar Es Salaam, Tanzania, as a possible way to increase patient adherence. With the creation of a questionnaire, a rst step was taken in researching the value and acceptability of peer support groups in combating problems with adherence in regions where time constraints on skilled health workers limit possible interventions. ispartof: Transdisciplinary Insights vol:1 issue:1 pages:9-32 status: Published online

Background: Urinary tract infection (UTI) is a common condition in children that recurs frequently. This study aimed to determine the prevalence of UTIs among children under five attending Bagamoyo District Hospital and determine its association with nutritional status. Methods: This was a cross-sectional study that enrolled 214 children under five years old attending Bagamoyo District Hospital in Tanzania. Midstream urine was collected in sterile conditions and bottles. Samples were transported to the laboratory to isolate bacteria using cysteine lactose electrolyte deficient (CLED) agar. Identification was undertaken using Gram staining, single iron agar test, sulfide-indole motility (SIM) test, and catalase and oxidase tests. A susceptibility test was done using the disc diffusion method. Anthropometric measurements were employed to assess malnutrition status and body mass index was determined using each child's weight and height. Results: Of the 214 children under five enrolled in the study, 123 (57.4%) were girls and 91 (42.6%) were boys. A total of 35 children were confirmed UTI-positive, making the prevalence 16.4%. Of positive children, 17 (7.9%) were girls and 18 (8.4%) were boys. The UTI prevalence was higher in boys than in girls but not statistically significant (p=0.244). Among the isolated uropathogens, Escherichia coli were common bacteria accounting for 65.7% of all isolates. The rate of other uropathogens isolated was Klebsiella spp. (17.1%), Pseudomonas spp. Proteus spp (11.4%) and (2.9%) and Staphylococci spp. (2.9%). The antibiogram of the isolated bacterial uropathogens showed high in-vitro resistance ranging from 90-95% to erythromycin, trimethoprim-sulfamethoxazole and ampicillin. Conclusion: The prevalence of UTI for children under five was 16.4%. The most common causative agent of UTI was Escherichia coli. There was no association between UTI status and malnutrition status of the children. High resistance to antibiotics calls for antimicrobial stewardship and surveillance to preserve antibiotics' effectiveness in treating uropathogens.

Nosocomial infections due to multidrug resistant Staphylococcus aureus are an important health problem worldwide. Antimicrobial resistance prolongs the duration of hospitalization, thereby increasing the cost of patient care. For a long time, methicillin was considered as drug of choice for treatment of penicillin-resistant staphylococcal infections. Emergence of methicillin resistance reduced the available options for treatment of nosocomial and community acquired S. aureus. Normally, such strains are only sensitive to glycopeptides such as vancomycin and teicoplanin. Recent reports show that methicillin resistant S. aureus (MRSA) have become multiply resistant to other drugs such as fluoroquinolones, trimethoprim-sulfamethoxazole (SXT), clindamycin or erythromicin and there are reports of vancomycin resistant strains from different parts of the world. The aim of this study was to determine the susceptibility patterns of Staphylococcus isolates from humans. Drug susceptibility testing of isolates was determined using the disk diffusion method. A total of 110 S. aureus (SA) and 23 coagulase negative staphylococcus (CoNS) isolates from human sources were studied. Both SA and CoNS isolates were completely sensitive to vancomycin. On one hand, there was a comparable high resistance for both SA and CoNS to penicillin G, augmentin and tetracycline. On the other hand, there was significantly high resistance to erythromycin (69.6%), SXT (69.6%), oxacillin (82.6%), ciprofloxacin (52.2%) and clindamycin (39.1%) among CoNS when compared with SA isolates (erythromycin 38.2%, SXT 38.2, oxacillin (33.6%), ciprofloxacin (26.4%), clindamycin 18.2%) with p values 0.0090, 0.0099, 0.0001, 0.0239 and 0.0483, respectively. These high levels of resistance, calls for continuous surveillance studies to monitor for S. aureus infections in the community and hospital settings and the emergence of vancomycin resistant isolates. Key words: Methicillin resistant, Staphylococcus aureus, methicillin resistant Staphylococcus aureus (MRSA), antibiotic susceptibility, vancomycin, coagulase negative staphylococci.

Background Prescription of antibiotics based on microbiological investigations is a commendable rational use of antibiotics and help in fighting the spread of resistance. Although shortage of microbiology laboratory is indicated to impair this practice but prescription without microbiological investigation has been reported even in settings with laboratory facilities. Methods Semi structured key informant interviews with 31 prescribing medical doctors in Dar es Salaam, Tanzania were conducted from January to June 2019. The purpose of the interviews was to obtain the insight into the prescriptions of antibiotics without microbiological investigations especially in hospitals with laboratory facilities. Results Majority of participants (26/31) were ready to prescribe antibiotics without microbiological investigations. In addition, a total of four major themes were identified as the basis for this practice; i) clinical condition of the patient ii) past experience with the clinical condition and/or patient iii) an intention to prevent the spread of infection and iv) patient’s history and physical examination were adequate to establish the management plan. Conclusion In recognition of the urgent need to improve antibiotic use in hospitals, this study highlights the need to implement hospital Antibiotic Stewardship Programs in Dar es Salaam, Tanzania.

Background: Inappropriate use of antibiotics has been reported to contribute to the emergence and increase of antimicrobial resistance (AMR) in the world. Enforcing the dispensing of antibiotics with prescription is a way to promote the rational use of antibiotics and preventing the development and spread of AMR. The pharmacist has the responsibility to supervise the dispensing of antibiotics in pharmacies and ensure its rational use. This study assessed pharmacists’ knowledge, attitude and practice regarding the dispensing of antibiotics without prescription in Tanzania. Methods: An online semi-structured questionnaire was designed, tested and shared with licensed pharmacists in Tanzania through an invitation link sent in their official WhatsApp groups. An SMS alternative was used contact list from the Pharmacy Council to administer the questionnaire to pharmacists not subscribed to WhatsApp. Study data were collected and managed using REDCap electronic data capture tools hosted at Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. Data were then downloaded and exported into Statistical Package for Social Sciences (SPSS) version 20 for data analysis; Chi-square test was used to test association for categorical data, where a p-value of less than 0.05 was considered statistically significant. Results : More than 75% of pharmacists had excellent knowledge about the legal requirements for dispensing antibiotics and of the AMR challenge. Of the interviewed pharmacists, seventy-four percent admitted to dispensing antibiotics without prescription in their daily practice. Notably, 85.7% of pharmacists with high education were more likely to dispense without prescription compared to 69.9% among bachelor holders (p-value = 0.028). The main reasons for administering antibiotics without prescription were the profitability nature of pharmacy business, a failure of the patient to get a prescription and a lack of stringent regulatory authorities. Penicillins, macrolides and fluoroquinolones were the classes of antibiotics mostly dispensed without a prescription. Conclusion : Even though pharmacists seem knowledgeable about AMR, they still dispense antibiotics without prescription in Tanzania. The regulatory authorities should make regular inspections in pharmacies to detect this malpractice. The community should be trained on the importance of taking laboratory tests before getting medications for their sickness by a qualified medical practitioner.

Background: Inappropriate use of antibiotics has been reported to contribute to the emergence and increase of antimicrobial resistance (AMR) in the world. Antibiotics are prescription-only medicines to be dispensed to a person with a legal prescription inscribed by a qualified medical practitioner. Enforcing the dispensing of antibiotics with prescription is a way to promote the rational use of antibiotics and preventing the development and spread of AMR. It is, therefore, the responsibility of a pharmacist to dispense or supervise the dispensing of antibiotics in pharmacies and ensure its rational use. This study aimed to assess pharmacists’ knowledge, attitude and practice regarding the dispensing of antibiotics without prescription in Tanzania. Methods: An online semi-structured questionnaire was designed, tested and shared with licensed pharmacists in Tanzania through an invitation link sent in their official WhatsApp groups. A list of names, contacts and emails of licensed pharmacists obtained from the Pharmacy Council was used to directly contact and request pharmacist to fill the questionnaire, in case the pharmacist contact was not on WhatsApp, a text SMS invitation was sent. Study data were collected and managed using REDCap electronic data capture tools hosted at Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. Data were then downloaded and exported into Statistical Package for Social Sciences (SPSS) version 20 for data analysis; Chi-square test was used to test association for categorical data, where a p-value of less than 0.05 was considered statistically significant. Results: More than 75% of pharmacists had excellent knowledge about the legal requirements for dispensing antibiotics and of the AMR challenge. Of the interviewed pharmacists, seventy-four percent admitted to dispensing antibiotics without prescription in their daily practice. The main reasons for administering antibiotics without prescription were the profitability nature of pharmacy business, a failure of the patient to get a prescription and lack of stringent regulatory authorities. Penicillins, macrolides and floroquinolones were the classes of antibiotics mostly dispensed without a prescription. Conclusion: The study shows that the dispensing of antibiotics without prescription is a common practice in Tanzania. The regulatory authorities should make regular inspections in pharmacies to detect this malpractice. The community should be trained on the importance of taking laboratory tests before getting medications for their sickness by a qualified medical practitioner.