Understanding Laboratory Methods and Their Impact on Antimicrobial Resistance Surveillance, at Muhimbili National Hospital, Dar es Salaam, Tanzania

The study sought to describe laboratory methods and blood culture procedures and their impact on antimicrobial resistance surveillance among nosocomial bacteria. We conducted a systematic audit of blood culture procedures and practices in the Department of Microbiology, Central Pathology Laboratory at Muhimbili National Hospital, between 19th and 23rd March 2012. A total of 25 -30 blood culture specimens were received each day as an indication of low volumes of blood culturing at this site. More blood culture requests came from the neonatal unit of the hospital, and were performed manually with high culture negative specimens. The laboratory performed antibiotic susceptibility testing as per the CLSI guidelines. No vancomycin resistance was ever reported at this site. All blood culture results were entered into the JEEVA laboratory information system, where results could be accessed by clinicians in the wards and data could be retrieved to assess patterns of antimicrobial resistance. Blood culture data entry system lacked quality control checks hence numerous errors and missing data were observed. Our results support the relevance of having improved laboratory procedures and good quality blood culture since surveillance of antimicrobial resistance primarily depends on good laboratory procedures, good quality and reliable blood culture data. This would essentially minimise imprecise estimates of rates of antimicrobial resistance at this hospital.

Investigation of Factors Affecting Preparedness of Reporting Adverse Drug Reactions among Nurses in Public and Private Hospitals in Dar Es Salaam, Tanzania

The current study assessed preparedness among nurses about reporting adverse drug reactions in public and private hospitals. Nurses in hospitals are among health providers very close to patients and are involved in the process of administering medications especially to inpatients. A cross sectional study was conducted among nurses in public and private hospitals in Dar es Salaam city in Tanzania to compare their preparedness on reporting adverse drug reactions (ADRs). A total of 384 nurses were involved in this study, of which 50% were drawn from public hospitals and 50% from private hospitals. Majority of respondents (75.25%) in public and 84.73% in private hospitals said they have not received any training about reporting ADRs. Of the few trained nurses, 85.43% and 96.55%, in public and private hospitals, respectively, said they have been trained in a seminar only once, after they started working as nurses. Respondents in public (19.17%) and private (32.8%) hospitals reported to stock ADRS forms (Yellow cards). Less than 50% of respondents agreed to have access to reference materials such as a text books named “Good Dispensing Practice” and a “List of Registered Medicines”. Further results showed more than two third of all respondents in private (74.25%) and public (73.5%) hospitals reported that lack of training affects the process of reporting ADRs in terms of ability and tendency. In this study we found training, availability of Yellow cards and presence of a focal person are among important contributing factors to preparedness of reporting ADRs among nurses in public and private hospitals.

Ocular Manifestations among HIV Infected Children in Ouagadougou, Burkina Faso

Ocular manifestations among HIV infected children are diverse and global incidence varies from 7% to 75%. At this age, eye lesions are often unnoticed because of the incapacity to express eye discomfort. The purpose of this study is to describe ocular manifestations among HIV-infected children and hence associated factors in the Department of Paediatrics at the Yalgado Ouédraogo Teaching Hospital. This was a cross-sectional descriptive and analytical study conducted between July 2014 and December 2014. A complete ophthalmic examination was systematically done to all HIV-positive children attending the clinic, as part of their routine medical visit. The most recent socio-demographic, clinical, biological and treatment data were registered. Seventy-nine children had an ocular examination and among them 92.4% were on ARV treatment. The incidence of ocular manifestations was 46.7%. Median age was 8 years old (interquartile 6 - 12 years old). Sex ratio was 1.3. The risk of ocular manifestations involvement among boys was twice than that of girls. More than half (59.5%) of children who had ocular problems had not expressed ocular discomfort. Ocular adnexal lesions were more common (35.4%) compared to eye segments (8.9%) lesions. Anterior segment and posterior segment lesions were statistically associated with immune system depression (p = 0.003 and 0.001). However, this relationship was not statistically significant (p = 0.15). Five out of seven children who had eye fundus lesions had CD4 count 3. Ocular manifestations were very common among HIV infected children in our context. Ophthalmic examination should be systematic at admission and regularly repeated during follow-up.

Dapagliflozin and Spironolactone Improved Clinical Symptoms and CV Outcomes in Patient with HF Preserved Ejection Fraction (HFpEF) in Hard-to-Reach Rural African Population: A Case Series

Objective: To observe the benefit of mineralocorticoid receptor antagonist and sodium-glucose co-transport 2 inhibitor (SGLT2 inhibitor) in heart failure preserved ejection (HFpEF) in rural Tanzania. Background and Result: The use of spironolactone and dapagliflozin was shown to be effective in improving the clinical outcome and reducing CV hospitalization rate and CV mortality in patients with heart failure preserved left ventricular ejection fraction (HFpEF). This is the case presentation of one patient with HFpEF with diastolic dysfunction grade 3, obesity grade 3, Type 2 Diabetes, and Atrial Fibrillation (permanent). In the case of a 76-year-old female after previous ineffective treatment, the initiation of Spironolactone and Dapagliflozin led to a rapid and marked improvement in the clinical conditions. Diastolic dysfunction was improved from stage III to stage I. Moreover, the initiation of spironolactone and dapagliflozin therapy avoided a referral for surgical intervention and interrupted a long series of hospitalizations for acute HF and prevented CV death. Conclusion: Based on our experience, we conclude that the treatment with spironolactone and dapagliflozin allows for better treatment optimization with a positive impact on the control of clinical outcomes and preventing CV death and CV hospitalization in HFpEF and related comorbidities in the African population, which is underrepresented in most of the trials.

Laryngopharyngeal reflux disease, prevalence and clinical characteristics in ENT department of a tertiary hospital Tanzania

Background:Laryngopharyngeal reflux disease(LPRD)is a condition with nonspecific symptoms and most of times patients present late with advanced disease which may pre-dispose to malignancy.The magnitude and clinical characteristics of this condition are not well known among patients attending Otorhinolaryngology services in Tanzania.Materials and methods:This was a hospital based descriptive cross sectional study,conducted in the wards and clinics of Otorhinolaryngology department of Muhimbili National Hospital.Patients with symptoms of Laryngopharyngeal reflux disease were included in the study.Data was collected using questionnaires and clinical examination forms,were processed and analysed by using SPSS.Results presented in frequency tables,cross tabulations and figures.Results:This study recruited 256 participants among them males were 131(51.2%).The mean age was(41.38±13.94)years.Prevalence of Laryngopharyngeal reflux disease was 18.4%without gender predilection.The commonest symptoms were globus sensation,hoarseness of voice and excessive urge to clear the throat with 95.7%,88.1%and 83.0%respectively while the most observed signs were thick endolaryngeal mucus,Vocal cord oedema and partial ventricular obliteration with 90.9%,88.6%and 72.7%respectively.Lying down less than two hours after meal and spices foods consumption were the leading risk factors.Hypertension and Diabetes Mellitus type 2 were the most prevalent co morbid conditions associated with Laryngopharyngeal reflux disease.Conclusion:The prevalence of Laryngopharyngeal reflux disease is high among patients attending Otorhinolaryngology services at Muhimbili national hospital.All patients with Laryngopharyngeal reflux disease related symptoms should get thorough evaluation for early diagnosis and treatment.

High prevalence of epilepsy in two rural onchocerciasis endemic villages in the Mahenge area,Tanzania,after 20 years of community directed treatment with ivermectin

Background:Epilepsy is a neurological disorder with a multitude of underlying causes,which may include infection with Onchocerca volvulus,the parasitic worm that causes human onchocerciasis.A survey carried out in 1989 revealed a high prevalence of epilepsy(1.02%overall,ranging from 0.51 to 3.71%in ten villages)in the Mahenge area of Ulanga district,an onchocerciasis endemic region in south eastern Tanzania.This study aimed to determine the prevalence and incidence of epilepsy following 20 years of onchocerciasis control through annual community directed treatment with ivermectin(CDTI).Methods:The study was conducted in January 2017 in two suburban and two rural villages in the Mahenge area.Door-todoor household visits were carried out by trained community health workers and data assistants to screen for persons suspected of having epilepsy,using a standardised questionnaire.Persons with suspected epilepsy were then interviewed and examined by a neurologist for case verification.Onchocerciasis associated epilepsy was defined as epilepsy without an obvious cause,with an onset of seizures between the ages of 3-18 years in previously healthy children.In each village,fifty males aged≥20 years were tested for onchocerciasis antibodies using an OV16 rapid test and were examined for presence of onchocerciasis nodules.Children aged 6-10 years were also tested using OV16 tests.Results:5117 individuals(median age 18.5 years,53.2%female)from 1168 households were screened.244(4.8%)were suspected of having epilepsy and invited for neurological assessment.Prevalence of epilepsy was 2.5%,with the rural villages having the highest rate(3.5%vs 1.5%),P<0.001.Overall incidence of epilepsy was 111 cases(95%CI:73-161)per 100000 person-years,while that of onchocerciasis associated epilepsy was 131(95%CI:70-223).Prevalence of OV16 antibodies in adult males and among children 6-10 years old was higher in rural villages than in suburban villages(76.5%vs 50.6,and 42.6%vs 4.7%respectively),(P<0.001),while overall prevalence of onchocerciasis nodules was 1.8%.Conclusions:This survey revealed a high prevalence and incidence of epilepsy in two rural onchocerciasis endemic villages in the Mahenge area.Despite 20 years of CDTI,a high prevalence of OV16 antibodies in children aged 6-10 years suggests on-going O.volvulus transmission.Reasons for the persistence of on-going parasite transmission in the Mahenge area need to be investigated.

Onchocerciasis-associated epilepsy:another piece in the puzzle from the Mahenge mountains, southern Tanzania

In a study from the onchocerciasis-endemic area of Mahenge in southern Tanzania,Mmbando et al.[Inf Dis Poverty.2018,7:64]demonstrate that in four selected villages the overall epilepsy prevalence was high,and significantly more elevated in the two villages of higher onchocerciasis endemicity compared to those of lower endemicity.This is replicating earlier findings from many other areas of tropical Africa.The authors are also providing data indicating that in the Mahenge focus,the prevalence of nodding syndrome may be related to that of onchocerciasis in the same way as epilepsy in general.The application of a clinical case definition for onchocerciasis-associated epilepsy(OAE)as used in the study of Mmbando et al.[Inf Dis Poverty.2018;7:64]faces some difficulties;indeed,its precision in discerning cases of OAE from epilepsy due to other etiologies is not known,and it does not allow for a specific diagnosis in the individual patient.Because an operational surveillance tool for assessing the number of patients in the population could mean substantial advance for better estimating the burden of OAE,the proposed definition should be tried in different settings and its performance reviewed in the process.