D-Dimer: Predictor of Postpartum Hemorrhage among Pre-Eclampsia at Kilimanjaro Christian Medical Centre

Background: Postpartum hemorrhage (PPH) is the major contributor to maternal mortality and morbidity worldwide as well as in Tanzania. Studies have shown Pre-eclampsia as a risk indicator for Postpartum hemorrhage and D-dimer tends to rise in women with pre-eclampsia. Few studies that have shown the association between D-dimer and PPH have been controversial and differ according to ethnicity and lifestyle. Hence there is no suitable reference interval for D-dimer in predicting Postpartum hemorrhage among women with pre-eclampsia. Broad Objective: This study aimed to assess the association, sensitivity, and specificity of D-dimer as a laboratory predictor of postpartum hemorrhage among women with pre-eclampsia at KCMC hospital. Methodology: This was a hospital-based analytical cross-sectional study conducted at KCMC Hospital in Northern Tanzania from September 2022 to March 2023. A total of 195 women with pre-eclampsia were included in this study. Plasma D-dimer levels were taken from women with pre-eclampsia pre-delivery. Haematocrit was compared before and after delivery, and a fall of 10% was considered as Postpartum hemorrhage together with clinical assessment of the patient. Participants were divided among those who had severe features and those who did not have severe features and were further categorized into those who had PPH and those who did not have PPH. Logistic regression was used to determine the association between D-dimer and PPH adjusting for other factors. The Receiver Operating Curve (ROC) was used to evaluate the predictive value. Results: Higher median D-dimer levels were seen among women who had PPH compared to those who had no PPH. D-dimer was seen to be associated with PPH, thus for every unit increase of µg/ml of D-dimer among women who had pre-eclampsia without severe features there was a 14% significant increase in the odds of having postpartum hemorrhage and a 45% significant increase of having postpartum hemorrhage among those who had pre-eclampsia with severe features. Furthermore, the cut-off point of a D-dimer level of 0.66 µg/ml significantly predicts postpartum hemorrhage with a sensitivity of 75% and specificity of 55%. For those who had no severe features the cut-off point was 0.53 µg/ml with a sensitivity of 95% and specificity of 53%, and for those who had severe features the cut-off point was 3.58 µg/ml with a sensitivity of 50% and specificity of 96%. Conclusion: D-dimer can be used to predict postpartum hemorrhage among pre-eclampsia, especially among those who have severe features. This shows that D-dimer has specificity in predicting PPH in women with pre-eclampsia and can be applied in clinical services to save women from maternal morbidity and mortality. Blood products such as fresh frozen plasma, platelets, and whole blood together with tranexamic acid should be readily available in women with pre-eclampsia especially those with severe features with a D-dimer level of 3.58 µg/ml and above during delivery as they are at high risk of developing PPH.

Abnormal Umbilical Doppler: Incidence and Neonatal Outcomes among Hypertensive Disorders in Pregnancy at KCMC: A Hospital-Based Prospective Cohort Study

Hypertensive disorders of pregnancy (HDP) are the most common maternal and perinatal health challenges. Globally, the incidence of HDP increased from 16.30 million to 18.08 million, with a total increase of about 10.9% from 1990 to 2019. Umbilical Doppler study in hypertensive disorders of pregnancy helps to predict neonatal outcomes and prevent neonatal and maternal morbidity and mortality. Objective: This study aims to determine the incidence of abnormal umbilical Doppler among hypertensive pregnant women, to identify the adverse neonatal outcomes associated with abnormal umbilical Doppler, and also to detect the diagnostic predictive values of umbilical Doppler to neonatal outcomes at KCMC. Material and methods: A hospital-based prospective cohort study included women with hypertensive disorders of pregnancy from the gestational age of 28 weeks and above, followed up to delivery during the study period from August 2022 to March 2023. Multivariate logistic regression analysis was used to determine the association between AUD and neonatal outcomes. Results: Out of 112 women with HDP, the incidence of abnormal umbilical Doppler was 38 (33.93%). Abnormal umbilical Doppler was associated with neonates with low birth weight aOR (95% of CI) of 4.52 (1.59 - 12.83) p = 0.005 and neonatal ICU admission 9.71 (2.90 - 32.43) p Conclusion: The incidence of abnormal umbilical Doppler is high in hypertensive disorders of pregnancy which is associated with an increase in neonatal low birth weight and neonatal ICU admissions, the sensitivity of abnormal umbilical Doppler in prediction of low birth weight and neonatal ICU admission is significant hence the routine use of umbilical Doppler assessment among hypertensive pregnant women is crucial.

Prevalence and Associated Factors of Hepatitis B Surface Antigen (HBsAg) among People Living with HIV (PLWHIV) Attending at CTC Mawenzi Regional Hospital Kilimanjaro, Northern Tanzania

Background: Human immunodeficiency virus (HIV) and hepatitis virus (HBV) coinfection are common due to shared modes of transmission between these viruses. Also studies have shown that HIV appears to be a risk factor for reactivation of hepatitis B in patients who have developed hepatitis B surface antibodies HBsAg which is considered as a marker of chronic HBV infection. The magnitude of HIV/HBV coinfection among people living with HIV in Tanzania is not well known. Objective: The aim of this study was to determine the prevalence and associated factors of HBsAg among HIV Positive Clients at CTC at Mawenzi Regional Hospital. Methods: It was a cross sectional study that included 100 HIV Positive CTC clients at Mawenzi Regional Hospital. Ethical clearance was obtained at KCMUCo ethical committee, structured questionnaires with closed-ended question were used to collect the information needed done by interviewing the person, blood sample was collected from median cubital vein and HBsAg Rapid Test Strips were used. Data processing and analysis were done using SPSS version 20. Results: Of 100 HIV patients, only 8 (8%) tested positively for HBsAg. There was a significant association between residence and HBV infection. People from rural areas had high prevalence compared to urban areas (OR 8.71, 95% CI: 1.029 - 73.66). Other social demographic and clinical characteristics in this study had no significant association with HBsAg positivity. Conclusion: Significant numbers of 8% HIV patients are HBsAg positive. HIV patients from rural residency are more likely to acquire HBV than Urban residents that showed significant association.

Postpartum Hemorrhage: Incidence, Causes and Maternal Outcomes at Muhimbili National Hospital, Tanzania—A Retrospective Descriptive Hospital-Based Study

Worldwide obstetric hemorrhage remains the leading cause of maternal mortality, accounting for over one quarter of maternal deaths. Over half of these deaths occur in Sub-Saharan Africa with mortality rates of 500 - 1000 per 100,000 births, compared to approximately 5 - 10 in developed countries. Over decades in Sub Saharan Africa preventive measures and treatment protocols have been made to reduce maternal mortality caused by PPH. While rates of postpartum hemorrhage have continued to rise, there is a need to evaluate if its etiology and patterns have changed over time. Broad Objective: This study aims at describing trends in incidence, causes and maternal outcomes of Postpartum Hemorrhage at Muhimbili National Hospital for a period of 7 years. Methodology: This is a retrospective descriptive hospital-based study that has included all cases of postpartum hemorrhage at Muhimbili National Hospital, a tertiary hospital in Tanzania from 2014 to 2020. The data was analyzed using SPSS Version 26 and presented using frequency tables, figures and percentages. The trends of postpartum hemorrhage over time were determined using chi-square test and P-value where less than 0.05 was considered statistically significant. Results: Overall, the incidence of postpartum hemorrhage has been fluctuating over the years with minimum of 1.78% and maximum of 2.87% with no statistical significance. Out of 1113 enrolled cases of PPH, 422 (37.9%) were attributed to genital tears followed by uterine atony 285 (25.6%). A statistically significant increase in linear trend was observed in the postpartum hemorrhage cases due to uterine atony, uterine rupture and sub analysis on genital tears (cervical tear). Overall, there was a statistically significant change in trend of maternal outcomes throughout the years, with a P-value < 0.001 and likelihood of complications increasing over time. Conclusion: The trend in the incidence of postpartum hemorrhage has been fluctuating over the years during the study period. The leading cause of postpartum hemorrhage was genital tears, followed by uterine atony with a significant increase in adverse maternal outcomes over the years. Continuous health education to medical personnel to improve timely and proper diagnosis of women in danger of PPH and timely referral, thus improve maternal morbidity and mortality.

Barriers in the Transition of Care for Heart Failure Patients Attending Clinics in Mwanza City, Tanzania

Introduction: Transition of care strategies have shown to improve quality of lives of heart failure patients, but it has little implemented in clinical settings. Objective: To evaluate context-specific perceived barriers and experiences of heart failure patients during their admission and after they were discharged from hospital. Methods: A cross-sectional qualitative study was conducted among 13 heart failure patients at two large referral hospitals in northwestern Tanzania. In-depth interviews among heart failure patients, in line with the Consolidated Criteria for Reporting Qualitative research checklist, were used to collect data. Interviews were audio recorded, transcribed, and translated into English. Results: Three key barriers were identified, as well as possible solutions that could improve the transition of care for heart failure patients. These include strengthening healthcare provider communications, organizing medication management, and assisting with follow-up appointments. Conclusion: The barriers identified are real and challenging in clinical resource- limited settings. Findings suggest they can be overcome when realistic and tailor-made interventions are in place.

Rare Case of Surviving Infant with Strawberry Yoghurt like Blood Diagnosed to Be Infantile Hypertriglyceridemia at 1 Month Old: A Case Report

Background: Hypertriglyceridemia in children means increased plasma fasting Triglyceride levels above the 95th percentile for age and sex. For children aged 0 to 9 years, a triglyceride level greater than or equal to 100 mg/dl is considered above the 95th percentile. Hypertriglyceridemia can be mild to borderline high, moderate to high, very high, severe and very severe (>2000 mg/dl). We present the case of a 1 month and 3 weeks old baby who presented with difficulty in breathing. It was accidentally found to have strawberry yoghurt like blood during phlebotomy, of which upon investigation had very high triglyceride levels of >2000 mg/dl. Case Presentation: 1 month and 3 weeks old female baby, admitted as referral from nearby health centre presenting with difficulty in breath, her blood sample was incidentally found to appear as strawberry yoghurt like. Clinically the infant had features suggestive of respiratory distress, with no other systemic abnormalities noted. Chest X-ray that was done had features of pneumonia. The working diagnosis on admission was Pneumonia, Electrolyte imbalance. The strawberry yoghurt like blood raised suspicions of hypertriglyceridemia. Our triglyceride levels in the infant were very high at 136 mmol/l (12,046 mg/dl). The patient was treated with IV antibiotics for pneumonia, electrolytes were corrected and Rosuvastatin was started. This patient improved remarkably and was discharged with Rosuvastatin. Lipid profile was followed up for 4 consecutive months in our outpatient clinic with a drastic drop in triglyceride and cholesterol. Conclusion: We report a case of infantile hypertriglyceridemia found accidentally during phlebotomy. Despite limited resource to evaluate further on primary cause of this condition as well as family’s poor economic status to seek further medical evaluation outside the country, this case report raises awareness on how to deal with this condition in a low resource setting. It also highlights the role of statins in the treatment of hypertriglyceridemia.

Perinatal Mortality and Associated Risk Factors among Singleton Babies in Unguja Island, Zanzibar

Background: Perinatal mortality is a major public health problem, particularly in developing countries where three quarters of neonatal deaths happen in the first week of life. Therefore, it is crucial to understand factors associated with perinatal mortality in order to design strategies and interventions that will improve newborn outcomes. Methods: A prospective cohort study was carried out, whereby pregnant women with gestational age ≥ 28 weeks were enrolled. Interviews were conducted during antenatal booking using structured questionnaire. Follow-up visits were made within 48 hours after delivery and on seventh day post delivery. Results: A total of 959 pregnant women were enrolled;38 were lost to follow-up prior delivery. The remaining 921 participants, resulting in PMR of 45.5 per 1000 births. Over half of the deaths were stillbirths (SBR 29.6 per 1000 births) and early neonatal deaths (ENMR 16.8 per 1000 live births). Using Generalized Linear Model (GLM), risk factors associated with perinatal mortality included: maternal age ≥ 35 years (ARR 3.0, 95% CI: 1.0 to 9.0), nulliparous women (ARR 4.2, 95% CI: 1.6 to 11.1), assisted vaginal delivery (ARR 5.1, 95% CI: 1.4 to 19.0), home delivery (ARR 3.3, 95% CI: 1.6 to 6.6), previous newborn death (ARR 4.0, 95% CI: 1.5 to 10.1), pregnancy-induced hypertension (ARR 4.8, 95% CI: 2.4 to 9.4), herbal use during labour (ARR 2.4, 95% CI: 1.2 to 5.1) and newborn asphyxia (ARR 5.9, 95% CI: 1.3 to 26.5). Conclusions: Perinatal mortality was found to be high in Zanzibar. Healthcare providers should pay special attention to women with pregnancy-induced hypertension and nulliparous women throughout pregnancy and delivery. However, home delivery and use of herbs during labour should be discouraged.

Determinants of Modern Contraceptive Use among Women of Reproductive Age in Tanzania: Evidence from Tanzania Demographic and Health Survey Data

Introduction: Tanzania is among of the African countries with high maternal and child mortality rates and fast growing population. It also has high fertility rate and a huge unmet need for family planning. Contraceptive use reported to avert more than 1 million maternal deaths in Sub-Saharan Africa due to decline in fertility rate and thus help to achieve MDG 4 and 5. Therefore, this study aimed to determine factors influencing modern contraceptive use among women aged 15 - 49 years in Tanzania. Methods: This was a secondary analysis of Tanzania Demographic Health Survey (TDHS), 2010. A total of 475 clusters (urban and rural) composed of 9663 households were selected. During the survey, a total of 10,139 women aged 15 - 49 years were interviewed about sexual and reproductive matters using a standardized questionnaire. We restricted our analysis to married/cohabiting women (n = 6412) responded for in individual records and domestic violence (n = 4471). Univariate and multiple logistic regression analyses were performed using Stata version 11.0. Odds ratios with 95% confidence intervals for determinants of modern contraceptive use were estimated. A P value of 5% (2 tails) was considered statistically significant. Results: Women empowerment (OR = 1.4;95% CI: 1.13 - 1.63), male-female age difference of less or equal to nine (OR = 1.6;95 CI: 1.01 - 2.66), and advice given at health care facilities on family planning (OR = 1.6;95 CI: 1.37 - 1.96) were predictors of modern contraceptive use. Woman sexual violence was not associated with modern contraceptive use. Conclusions: The predictors of modern contraceptive use in our study correspond with previous studies in low and middle income countries. Women empowerment, male-female age difference, and child desire were important predictors for modern contraceptive use. This highlights the need to promote contraceptive use among women of reproductive age.

Awareness and Factors Associated with Postpartum Modern Contraceptives Use among Women of Reproductive Age in Bukombe District, Geita Region

Introduction: Pregnancies that occur during the first year postpartum are more likely to be unplanned. This leads to an increased risk of adverse maternal and perinatal outcomes. However, modern contraceptive use during this period helps to reduce unplanned pregnancies and its associated adverse outcomes. There is scant data on postpartum contraceptives in pastoral communities in Tanzania. This study aimed to assess awareness and factors associated with postpartum modern contraceptives use among women of reproductive age in Bukombe District, Geita Region. Method: A community based cross-sectional study was conducted in a predominant pastoral community of Bukombe district in Geita region in north-western Tanzania from May-June 2018. A total of 511 postpartum women who were in their first year after child birth were studied. A multistage sampling technique was used to select study participants. Data analysis was performed using SPSS version 21. Multivariable logistic regression analysis was used to determine independent predictors of postpartum modern contraceptive use. Results: Most (97.3%) of the participants were aware about modern contraceptives. The prevalence of postpartum modern contraceptive use was 11.9%. The most frequent used contraceptive method was Implant 6.5%. Majority (75%) of women started to use the contraceptive at the first three months after delivery. Living in urban (AOR = 1.84, 95% CI: 1.20 - 3.79), business women’s (AOR = 2.34, 95% CI: 1.31 - 2.28), having last born aged 3 - 4 months (AOR = 3.30, 95% CI: 1.11 - 9.85) and menses resumption (AOR = 9.23, 95% CI: 3.60 - 23.72) were associated with postpartum modern contraceptive use. Fear of side effects, poor knowledge about contraceptives, husband restrictions, distance to health facility and availability of contraceptive were the barriers for use of contraceptive use. Conclusion: We found low uptake of postpartum modern contraceptive use in this population. Numerous factors were associated with modern contraceptive use. Therefore, health communication targeting this group is warranted to improve modern contraceptive uptake.

Evaluation of Mobile Electronic Devices in Detecting Optic Disc and Visual Field Parameters in Patients with Glaucoma at a Tertiary Hospital in Northeastern Tanzania

Background: Glaucoma is a serious public health problem since it causes visual impairment impacting social, mental and physical health of an individual. Diagnosis and management of glaucoma continue to be a challenge due to few qualified personnel and high cost of the equipment. The use of portable Eye Examination Kit such as Smartphone and tablets can be used in glaucoma screening for taking high-resolution fundus photos for optic disc and visual field parameters, respectively. This study was conducted to evaluate the applicability of mobile electronic device to detect optic disc and visual field parameters for glaucoma in a resource limited setting. Objective: To evaluate the applicability of mobile electronic devices to detect optic disc and visual field parameters for glaucoma. Methodology: Across-sectional study was conducted at KCMC Eye department from October 2018 to June 2019. Study included 140 participants attending eye clinic of which 67 had glaucoma and 73 without glaucoma. Clinical and socio-demographic data were collected using a structured questionnaire and analysed using Stata 15. Glaucoma examination was made on the right eye and photo comparison made between those with and without glaucoma. PEEK Smartphone fundus photo examination was compared with the gold standard machine (Slit Lamp Biomicroscopy), Amsler grid chart installed on a tablet (Microsoft surface, internal storage 256 GB, 2013) and contrast sensitivity compared with Humphrey field analyser (i series, model 740117434, Carl Zeiss Meditec). Results: The kappa (k) agreement between Slit lump biomicroscopy fundus view image and PEEK Smartphone concerning the optic disc measurement was 0.92 with sensitivity and specificity of 90.32% (95% CI: 80.12 - 96.37) and 93.59% (95% CI: 85.67 - 97.89) with a p < 0.001 respectively. An agreement between Amsler grid and Humphrey Field Analyser was 0.67 with sensitivity of 33.33% (95% CI: 20.76 - 47.92) and specificity of 86.52% (95% CI: 77.63 - 92.83) with a p < 0.005. An agreement for contrast sensitivity and Humphrey Field Analyser was 0.51 with sensitivity of 48.91% (95% CI: 38.3 - 59.56) and specificity of 54.17% (95% CI: 39.17 - 68.63) and p value of 0.729. Conclusion: PEEK Smartphone fundus image specificity was almost in perfect agreement compared with Amsler grid and Contrast sensitivity. The PEEK Smartphone fundus view optic disc parameter for vertical cup to disc ratio has a potential to enhance detection of glaucoma and thus improve its management in resource-limited settings.

Bacterial Isolates and Their Antibiotic Susceptibility Pattern among Patients with Infected Wounds Admited in Orthopaedic and Trauma Ward in Tertiary Care Hospital North-Eastern Tanzania

The hospital environment contributes to wound infections. Effects of such infections include prolonged hospitalization, increased morbidity, potential for antibiotics resistance and mortality due to sepsis. An updated knowledge of antibiotics susceptibility profiles of clinical isolates will assist both in choosing the most appropriate antibiotic treatment for wound infections and help in curbing the escalation of drug resistance. Cross sectional hospital based study, analysis of 125 pus samples collected from January 2018 to December 2020 was conducted. Identification and characterization of isolates were performed on the basis of Gram staining, microscopic characteristics, colony characteristic, and biochemical tests using standard microbiological methods. Antibiotic susceptibilities of bacterial isolates were determined by Kirby Bauer disc diffusion. A total of 125 pus samples were studied, 94 (75%) were from male patients, mean age was 38.5 (SD ± 19) years. Single bacterial isolates were recovered from 120 (96%) samples, 67 (53.6%) shows Multiple Drug Resistance (MDR) pattern, 74 (59.2%) were gram negative, the predominant organism isolated was Staphylococcus aureus 46 (36.8%). Gram negative isolates showed high resistance to ampicillin and cephalosporins. Gram positive isolates showed high resistance to erythromycin. Both gram positive and negative were found to be highly susceptible to gentamicin, amikacin, clindamycin, ciprofloxacin and amoxicillin/clavulanic acid. The study showed that Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli are the major bacteria isolated from pus samples. High proportion (53.6%) of the isolates was MDR. In the light of these findings, a change in antibiotic prescription policy is required at this hospital.

Trends and Factors Associated with Changes in Early Initiation of Breastfeeding: Analysis of the Tanzania Demographic and Health Surveys 2004-2016

Background: Despite WHO recommendations on the benefits of early initiation of breastfeeding for both the mother and child, only 53.5% of newborns in Tanzania are breastfed within the first hour of life. The trend for early initiation of breastfeeding shows little progress and Tanzania is still far behind reaching the global recommended rate of 70% of early initiation of breastfeeding. This study aims to determine trends and factors associated with changes in the early initiation of breastfeeding in Tanzania from 2004-2016. Methodology: This was an analytical cross-sectional study utilizing secondary data from the Tanzania Demographic and Health Surveys (TDHS) for the years 2004-2005, 2010, and 2015-2016. Data analysis was performed using Stata 15. Frequencies and proportions were used to summarize categorical variables. A Modified Poisson regression model was used to determine factors associated with the early initiation of breastfeeding. Multivariable Poisson decomposition analysis was used to assess factors associated with changes in the early initiation of breastfeeding across surveys. Results: Trends in early initiation of breastfeeding decreased from 59.53% in 2004/2005 to 46.72% in 2010, and then increased to 51.94% in 2015/2016. Only 5.9% of the overall change in early initiation of breastfeeding was contributed by the difference in characteristics such as mode of delivery and working status. The difference in coefficients contributed to a 94% decrease in early initiation of breastfeeding mostly due to a decrease in early initiation of breastfeeding among caesarean section delivery patients. Conclusion: The prevalence of early initiation of breastfeeding in Tanzania decreased between 2004 and 2016, then increased from 2010-2016. Interventions and health policies need to target factors that had significant effects on the early initiation of breastfeeding such as increasing health facility delivery and promoting the initiation of breastfeeding soon after caesarean section delivery.

The impact of out-of-pocket expenditures on missed appointments at HIV r care and treatment centers in Northern Tanzania

Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect expenditures made while accessing HIV care.The objective of this study was to examine the relationship between out-of-pocket(OOP)health expenditures and the likelihood of missing appointments.Method:Totally 618 PLHIV older than 18 years attending two HIV care and treatment centres(CTC)in Northern Tanzania were enrolled in the study.Clinic attendance and clinical characteristics were abstracted from medical records.Information on OOP health expenditures,demographics,and socio-economic factors were self-reported by the participants.We used a hurdle model.The first part of the hurdle model assessed the marginal effect of a one Tanzanian Shillings(TZS)increase in OOP health expenditure on the probability of having a missed appointment and the second part assessed the probability of having missed appointments for those who had missed an appointment over the study period.Results:Among these 618 participants,242(39%)had at least one missed clinic appointment in the past year.OOP expenditure was not significantly associated with the number of missed clinic appointments.The median amount of OOP paid was 5100 TZS per visit,about 7%of the median monthly income.Participants who were separated from their partners(adjusted odds ratio[AOR]=1.83,95%confidence interval[CZ]:1.11-8.03)and those aged above 50 years(AOR=2.85,95%CI:1.01-8.03)were significantly associated with missing an appointment.For those who had at least one missed appointment over the study period,the probability of missing a clinic appointment was significantly associated with seeking care in a public CTC(P=0.49,95%CI:0.88-0.09)and aged between>25-35 years(P=0.90,95%CI:0.11-1.69).Conclusion:Interventions focused on improving compliance to clinic appointments should target public CTCs,PLHIV aged between>25-35 years,above 50 years of age and those who are separated from their partners.

Postoperative Complications and Risk Factors among Women Who Underwent Caesarean Delivery from Northern Tanzania: A Hospital-Based Analytical Cross-Sectional Study

Introduction: Caesarean section (CS) causes some complications. We here attempted to determine the rate of CS complications, characterize their timing, and identify their risk factors among women delivered at Kilimanjaro Christian Medical Center (KCMC). Methods: Patients who underwent CS in KCMC were interviewed and analysed. Risk factors were expressed with Odds ratio (OR) and 95% CI. Results: Of 386 deliveries, 106 (27.5%) had one or more complications. Common early complications (24 - 72 hours after CS) were puerperal sepsis, anaesthesia-related complications, blood transfusion and ICU admission. Longer duration of surgery was significantly associated with all complications (aOR 2.90;95% CI: 1.02 - 8.50). Grand multiparity was significantly associated with blood transfusion (7.0;1.40 - 34.35) and PPH (6.4;1.5 - 24.24) while pre-operative anaemia was significantly associated with blood transfusion (4.34;1.90 - 9.45). Conclusion: Longer duration of surgery, grand multiparity and pre-operative anaemia are associated with complications. Physicians should be aware that these are risk factors for CS-complications.

Impact of Praziquantel on Schistosomiasis Infection and the Status of Proteinuria and Hematuria among School Children Living in Schistosoma mansoni-Endemic Communities in Northwestern Tanzania

The aim of the study was to assess the effect of praziquantel (PZQ) treatment on hematuria, proteinuria and the status of eGFR following treatment in school children infected with S. mansoni. A cohort study among 6 - 13 years old children was conducted in the Lake Zone region of Tanzania to assess S. mansoni infection using a circulating cathodic antigen (CCA), Kato Kartz while urine dipstick to screen for urine protein levels and red blood cells. A blood sample was taken for every child to determine creatinine levels and later a status of estimated glomerular filtration rate (eGFR). The prevalence of S. mansoni infection was 64%, 46%, and 24% at baseline, 6 months, and 1 year respectively using CCA test. There was a 62.5% reduction in S. mansoni infection from baseline (p S. mansoni using CCA test, reductions in proteinuria, and hematuria in school children in Tanzania. There was complete remission in eGFR < 90 ml/min/1.73 m2 from 3.9% to 0% at 6 months. This suggests that praziquantel is effective, but there is still a need for integrated strategies to minimize reinfections.

Nutritional Status, Feeding Practices and Factors Associated to Undernutrition among 6 to 59 Months of Age Orphans in the Arusha Region

Background: Orphans are potentially at greater risk of malnutrition because they are more likely to be extremely poor and receive less medical and social care. Children living in orphanages tend to be neglected and may be malnourished and they’re at risk of losing their full potential, with consequences to the child, nation and worldwide. Despite the nutritional concerns raised globally and in neighboring countries among these children, there exists an inadequate body of information about orphans’ nutritional status and feeding practices in Tanzania. This study aimed to assess the nutritional status, feeding practices and factors contributing to malnutrition among children aged 6 - 59 months in Arusha region orphanages, Tanzania. Study Objective: To assess the nutritional status, feeding practices and factors contributing to undernutrition among children aged 6 - 59 months in Arusha region orphanages, Tanzania. Methodology: This was an institution-based cross-sectional study conducted in selected orphanage Centre in the Arusha region. A representative sample size of 216 children aged 6 - 59 months in Arusha orphanages was selected to participate in the study. Multistaging sampling was used to select the study participants. Interviewer-administered questionnaires and anthropometric measurements were used during data collection. The data collected were entered, processed, and analyzed;continuous variables were summarized by use of mean and Standard deviation, while categorical variables were summarized by use of frequency, percentages and figures. Multivariable logistic regression was used to estimate the Odds Ratio with 95% CI and measure the strength of association between the outcomes with respect to selected independent variables. Variables with a p-value of less than 0.05 were considered statistically significant. Results: A total of 216 children from the orphanage Centre were involved in this study. Prevalence of Stunting, underweight and wasting among orphan children were 23.60%, 15.30% and 9.30%. The proportions of MDD and MMF were 89% and 99%. Children being on medication for any kind of illness during the survey (AOR: 7.9;95% CI: 1.95, 31.78), unmarried caregivers (AOR: 1.9;95% CI: 1.32, 10.86), fever 2 weeks before the survey (AOR: 2.9;95% CI: 1.09, 9.24) and orphanage Centre with more than 30 children (AOR: 1.8;95% CI: 1.08, 6.86) were found to be associated with undernutrition. Conclusion: In Arusha orphanages, the prevalence of stunting, underweight, and wasting among children exceeded WHO standards. Despite adequate feeding practices, the child’s illness, the number of children in the orphanage, and the marital status of caregivers were factors influencing the nutritional status of the orphans.

Bacteriological Profile, Antimicrobial Susceptibility Patterns and Predictors of Bacteremia in Neonates with Clinical Sepsis at KCMC Hospital, Northern Tanzania

Background: Despite a significant decline in neonatal deaths in the last 20 years (5 million in 1990 to 2.4 million in 2019), the risk of death is still high, especially in developing countries. In Tanzania, neonatal sepsis is the third leading cause of neonatal death, accounting for 25% of all deaths. The rising global threat of antimicrobial resistance and the rising burden of neonatal death due to neonatal sepsis have been of great concern and have delayed progress toward reaching SDG goal 3.2 by 2030. This study aims to determine the bacteriological profile, antibiotic susceptibility patterns, and predictors of bacteremia among neonates with clinical sepsis at KCMC Hospital in Northern Tanzania. Methodology: This study had a cross-sectional design conducted at KCMC Hospital, Northern Tanzania. The study population was neonates admitted to the neonatal unit at KCMC Hospital. Data were collected using questionnaires and blood cultures from neonates. Frequencies and proportions were used to summarize categorical variables, while continuous variables were summarized using mean and standard deviation. The frequencies and proportions of bacteria isolated and the antimicrobial susceptibility results were analyzed and compared using Pearson’s chi-square test and Fisher’s exact test where applicable. Modified Poisson regression model was used to determine factors associated with positive blood culture. Results: Out of 411 neonates with a clinical diagnosis of neonatal sepsis, 175 (42.9%) had positive blood cultures. Gram-positive bacteria were most frequently isolated at 52.3%, and gram-negative bacteria were 47.7%. Coagulase-negative Staphylococcus (30.7%) and Staphylococcus aureus (19.9%) were the predominant gram-positive isolates. Gram-negative isolates were Klebsiella spp 47 (26.7%), E. coli 10 (5.7%), and Citrobacter spp 10 (5.1%). The gram-positive isolates were sensitive to vancomycin, piperacillin/tazobactam, and ceftazidime, whereas the gram-negative were sensitive to amikacin, meropenem, and vancomycin. The study did not find statistically significant associations between clinical factors and positive blood cultures in bacteremia. Conclusion: Gram-positive bacteria are the dominant pathogens in early-onset and late-onset neonatal sepsis. High levels of resistance to ampicillin and ceftriaxone and moderate resistance to gentamycin were observed in both gram-positive and gram-negative bacteria. Gram-positive organisms exhibit better susceptibility rates to vancomycin and ciprofloxacin, while gram-negative micro-organisms are more sensitive to amikacin and meropenem. An effective initial treatment approach for neonatal sepsis would involve a combination of drugs.

Factors associated with changes in uptake of HIV testing among young women (aged 15–24) in Tanzania from 2003 to 2012

Background:This study explored the factors associated with changes in HIV testing uptake among young women in Tanzania,based on an analysis of data from the 2003–2004 Tanzania HIV/AIDS Indicator Survey,and the 2007–2008 and 2011–2012 Tanzania HIV/AIDS and Malaria Indicator Surveys.Methods:The study population consisted of young women aged 15–24 years at the time of the survey.Multivariate decomposition analysis was used to assess factors associated with changes in HIV testing uptake between the 2003–2004 and 2007–2008 surveys,and between the 2007–2008 and 2011–2012 surveys.Results:HIV testing uptake among the study population was 7%in 2003–2004,31%in 2007–2008 and 40%in 2011–2012.The time period of the survey had a substantial effect on the uptake of HIV testing independent of other covariates.The characteristics that were significantly associated with a higher chance of HIV testing uptake across the surveys were age(20–24),education level(primary and secondary),ever being married,having at least one lifetime sexual partner,having a sexually transmitted infection or associated symptoms,and receiving antenatal care.Conclusions:Changes in the study participants’characteristics in the 2003–2004 survey compared with the 2007–2008 survey were associated with a decrease in HIV testing uptake.Comparing the 2007–2008 survey with the 2011–2012 survey shows that the changes in the participants’characteristics contributed to 22%of the changes in HIV testing uptake,while 78%of the changes were attributed to coefficients.