Publications by authors named "Rune Philemon"

39 Publications

Perforated Meckel's diverticulum in omphalocele in a newborn: A case report of an uncommon presentation from northern Tanzania.

Int J Surg Case Rep 2021 Aug 27;85:106246. Epub 2021 Jul 27.

Kilimanjaro Christian Medical University College, Faculty of Medicine, P O Box 2240, Moshi, Tanzania; Department of Pediatrics, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania.

Introduction And Importance: The concurrent existence of Omphalocele and Meckel's diverticulum is not unheard of but is relatively uncommon. A few cases of their coexistence have been reported. Due to the uncommon dual presentation, it is easy to delay or even miss the diagnosis, delaying management. Meckel's diverticulum should be considered if there is a bowel opening on an omphalocele.

Case Presentation: Herein we present a newborn male baby who was referred to us presenting with an omphalocele that was leaking faeces. The baby also had a cleft lip and palate. He was born at term to a 30-year-old mother whose pregnancy was otherwise normal. The fistulated omphalocele was surgically repaired, and the child continued to do well.

Clinical Discussion: Omphalocele and Meckel's diverticulum are both relatively rare congenital malformations that are uncommonly present together. Other congenital malformations can be associated; hence thorough investigations should be carried out when resources are available. The search for associated malformation should not delay the management of the pathology as it can have serious consequences on the health and outcome of the child.

Conclusion: Fistulation of Meckel's diverticulum on an Omphalocele is rare. Treatment involves surgical resection and repair. Though other co-morbidities should be investigated, investigation for cause and other co-morbidities should not delay surgery.
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http://dx.doi.org/10.1016/j.ijscr.2021.106246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339332PMC
August 2021

Bilateral Subdural Hematoma following Ventriculoperitoneal Shunt Insertion in a Ten-month Old Tanzanian Female with Congenital Hydrocephalus: An Uncommon Presentation.

East Afr Health Res J 2021 11;5(1):17-19. Epub 2021 Jun 11.

Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi-Tanzania.

There is an unmet need for the treatment of hydrocephalus in Tanzania. Thousands of newborns each year in the region are affected by this condition and access to care remains a challenge. While treatment options like cerebrospinal fluid diversion through ventriculo-peritoneal shunting are within the skill set of general surgeons, the potential complications represent an additional challenge. We present a 10-month-old Tanzanian female who developed bilateral-subdural hematomas after insertion of a ventriculoperitoneal shunt.
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http://dx.doi.org/10.24248/eahrj.v5i1.646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8291209PMC
June 2021

Contributing Factors and Outcome after Cryotherapy of Molluscum Contagiosum among Patients Attending Tertiary Hospital, Northern Tanzania: A Descriptive Prospective Cohort Study.

Dermatol Res Pract 2021 1;2021:9653651. Epub 2021 Jul 1.

Department of Dermatovenereology, Kilimanjaro Christian Medical University College, P. O. Box 2240, Moshi, Tanzania.

Background: Molluscum contagiosum (MC) is a benign infection caused by a member of the Poxviridae family, molluscum contagiosum virus (MCV). The contributing factors for MCV infection are different in different populations and study areas. Few studies have been conducted to determine the effectiveness of cryotherapy in the treatment of MC. The study's objectives were to determine contributing factors and outcome after cryotherapy of MC among patients attending a tertiary hospital in Northern Tanzania.

Methods: A hospital-based cohort study was conducted at the Regional Dermatology Training Centre (RDTC) from September 2018 to August 2019, involving all patients clinically diagnosed with MC. We used a consecutive sampling method to recruit study participants. We treated all participants with cryotherapy and assessed them after two weeks. Data were collected using a structured questionnaire and analyzed using Statistical Package for the Social Sciences (SPSS) software version 21.

Results: There were 49 patients with MC who agreed to participate in this study with a median age of 8 (IQR 3-22). We found 18.4% of patients with active atopic dermatitis (AD) had MC while those with a history of atopic diseases (Ad) were 32%, and 22.4% had a history of using immunosuppressive drugs. The clearance rate of cryotherapy on MC lesions was found to be 94%. Hypopigmentation was the commonest adverse effect.

Conclusion: The findings of this study show that AD and immunosuppression may be contributing to MC development. Based on the clearance rate results, cryotherapy has shown to be effective and may be used in the treatment of MC.
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http://dx.doi.org/10.1155/2021/9653651DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8266469PMC
July 2021

Do Women Enrolled in PMTCT Understand the Recommendations: A Case Study from Kilimanjaro.

Patient Prefer Adherence 2021 16;15:1301-1309. Epub 2021 Jun 16.

Institute of Public Health, Department of Epidemiology & Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.

Introduction: Prevention of mother-to-child transmission (PMTCT) remains a cornerstone of HIV prevention and control efforts. It is vital that the beneficiaries of PMTCT programs understand PMTCT recommendations, especially since their adherence to recommendations is key to successful PMTCT. There have been several major changes in PMTCT recommendations, and many women have encountered different recommendations. It is plausible that confusion has arisen as to what is currently recommended for successful PMTCT. This confusion can affect adherence to recommendations and hinder PMTCT efforts. However, little is known about how women enrolled in PMTCT understand the recommendations in the context of these frequent changes.

Aim: In this paper, we present our findings regarding how HIV-positive women enrolled in PMTCT in Kilimanjaro understand PMTCT recommendations pertinent to them.

Methods: From August 2019 to April 2020, we surveyed 521 mothers enrolled in PMTCT in seven districts in the Kilimanjaro region, Northern Tanzania. A pretested questionnaire was administered to consenting mothers. The questionnaire collected information on mothers' demographic characteristics, previous encounters with PMTCT, and knowledge of various PMTCT program elements, including medication duration, breastfeeding recommendations and infant HIV testing schedule. A logistic regression model was used to determine factors associated with good PMTCT knowledge among mothers.

Results: A total of 521 women were enrolled, the median score for the 19 items used to assess knowledge was 57.9%, and 64.9% scored above the median. Counselling on ART (OR=2.17, 95% CI 1.08-4.36) and counselling on breastfeeding during the ANC visits (OR=2.38, 95% CI 1.38-4.11) were the only factors that we found to be significantly associated with higher odds of good knowledge of PMTCT.

Conclusion: Even amongst mothers enrolled in PMTCT, poor understanding regarding key PMTCT recommendations prevails. There is a need to reassess the training modalities and look at ways to reinforce PMTCT messages to mothers.
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http://dx.doi.org/10.2147/PPA.S307847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216065PMC
June 2021

Ectopia cordis: A case report of pre-surgical care in resource-limited setting.

Int J Surg Case Rep 2021 Jun 12;83:105965. Epub 2021 May 12.

Kilimanjaro Christian Medical University College, Faculty of Medicine, P O Box 2240, Moshi, Tanzania; Department of Pediatrics, Kilimanjaro Christian Medical Center, P O Box 3010, Moshi, Tanzania.

Introduction And Importance: Ectopia cordis is a rare congenital malformation of thoracic midline fusion that presents as location of the heart outside the open chest cavity. This presents as a surgical emergency and demands early and specialized intervention. Particularly in resource-limited settings, where prenatal ultrasonography screening is not done, these children are often born in facilities without the capability of managing such conditions definitively, necessitating them to be referred to a specialized centre. At lower health facilities, the challenge is in ensuring that the child is kept stable and protected from infection until they can reach a centre with the facilities required for care. This report describes the management give to such a child until they were successfully handed over to a cardiac institute.

Case Presentation: We present a newborn male baby delivered at term to a mother from a low socio-economic background with his heart and abdominal viscera outside the thoracic and abdominal cavity. Despite presenting at a centre without cardiac surgery facilities or cardiologists, they were sustained until referral.

Clinical Discussion: Ectopia cordis is a rare congenital anomaly characterized by defect in the fusion of the anterior chest wall resulting in the abnormal extra-thoracic location of the heart. Five types exist; cervical type with worst prognosis, attempts can be made to re-locate the heart and close the thoracic defect surgically.

Conclusion: Even with limited resources, it is possible to provide the basic care necessary to sustain a child with this complex anomaly until definitive management can be provided.
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http://dx.doi.org/10.1016/j.ijscr.2021.105965DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141755PMC
June 2021

A giant choledochal cyst: A case reported from Tanzania.

Int J Surg Case Rep 2021 Apr 27;81:105829. Epub 2021 Mar 27.

Department of General Surgery, Kilimanjaro Christian Medical Center, P O Box 3010, Moshi, Tanzania; Kilimanjaro Christian Medical University College, P O Box 2240, Moshi, Tanzania. Electronic address:

Introduction: Choledochal cyst is a rare common bile duct malformation that usually presents in the pediatric group with abdominal pain, distension, and jaundice. The pathophysiology remains unclear for the cause, and surgery aims to restore biliary enteric drainage.

Case Presentation: We present a six-year-old female who presented with gradual abdominal distention associated with jaundice. Abdominal ultrasound was suggestive of choledochal cyst, and CT-scan confirmed the diagnosis. She was operated on successfully and fared well.

Conclusion: Choledochal cysts are a rare entity of common bile duct malformations and should be considered as a differential diagnosis in the pediatric age group. Diagnosis can be easily made by non-invasive and in-expensive radiologic modalities like ultrasonography in resource-limited settings.
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http://dx.doi.org/10.1016/j.ijscr.2021.105829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8050714PMC
April 2021

Medical management of induced and incomplete first-trimester abortion by non-physicians in low- and middle-income countries: A systematic review and meta-analysis of randomized controlled trials.

Acta Obstet Gynecol Scand 2021 04 18;100(4):718-726. Epub 2021 Mar 18.

Department of Clinical Research, University of Southern Denmark, Odense, Denmark.

Introduction: Unsafe abortion is the cause of a substantial number of maternal mortalities and morbidities globally, but specifically in low- and middle-income countries. Medical abortion methods provided by non-physicians may be a way to reduce the burden of unsafe abortions. Currently, only one systematic review comparing non-physicians with physicians for medical abortion exists. However, the review does not have any setting restrictions and newer evidence has since been published. Therefore, this review aims to evaluate the effectiveness, acceptability, and safety of first-trimester abortion managed by non-physicians compared with physicians in low- and middle-income countries.

Material And Methods: The databases PubMed, Cochrane Library, Global Health Library, and EMBASE were searched using a structured search strategy. Further, the trial registries clinicaltrials.gov and The International Clinical Trial Registry Platform were searched for published and unpublished trials. Randomized controlled trials comparing provision of medical abortion by non-physicians with that by physicians in low- or middle-income countries were included. Risk of bias was assessed using the Cochrane Risk of Bias tool. Trials that reported effect estimates on the effectiveness of medical methods on complete abortion were included in the meta-analysis. The protocol was prospectively registered in the PROSPERO database, ID: CRD42020176811.

Results: Six papers from four different randomized controlled trials with a total of 4021 participants were included. Two of the four included trials were assessed to have overall low risk of bias. Four papers had outcome data on complete abortion and were included in the meta-analyses. Medical management of first-trimester abortion and medical treatment of incomplete abortion were found to be equally effective when provided by a non-physician as when provided by a physician (risk ratio 1.00; 95% CI 0.99-1.01). Further, the treatment was equally safe, and women were equally satisfied when a non-physician provided the treatment compared with a physician.

Conclusions: Provision of medical abortion or medical treatment for incomplete abortion in the first trimester is equally effective, safe, and acceptable when provided by non-physicians compared with physicians in low- and middle-income countries. We recommend that the task of providing medical abortion and medical treatment for incomplete abortion in low- and middle-income countries should be shared with non-physicians.
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http://dx.doi.org/10.1111/aogs.14134DOI Listing
April 2021

Inequalities in stunting among under-five children in Tanzania: decomposing the concentration indexes using demographic health surveys from 2004/5 to 2015/6.

Int J Equity Health 2021 01 23;20(1):46. Epub 2021 Jan 23.

Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Tanzania.

Background: Child stunting is a global health concern. Stunting leads to several consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania from from 50% in 1991/92 to 34% in 2016 although the prevalence is still high (34%)Stunting varyies across socioeconomic determinants with a larger burden among the socioeconomic disadvantaged group. The reduction of inequalities in stunting is very crucial as we aim to reduce stunting to 28% by 2021 and hence attain zero malnutrition by 2030 under Sustainable Development Goal 2.2.This study aimed at determining the trend, contributing factors and changes of inequalities in stunting among children aged 3-59 months from 2004 to 2016.

Methods: Data were drawn from the Tanzania Demographic and Health Surveys. The concentration index (CIX) was used to quantify the magnitude of inequalities in stunting. The pooled Poisson regression model was used to determine the factors for stunting, decision criterion for significant determinants was at 5% level of significance. The CIX was decomposed using the Wagstaff and Watanabe decomposition methods., the percentage contribution of each factor to the toal concentration index was used to rank the factors for socioeconomic inequalities in stutning.

Results: Inequalities in stunting were significantly concentrated among the poor; evidenced by CIX = - 0.019 (p < 0.001) in 2004, - 0.018 (p < 0.001) in 2010 and - 0.0096 (p < 0.001) in 2015. There was insignificant decline in inequalities in stunting; the difference in CIX from 2004 to 2010 was 0.0015 (p = 0.7658), from 2010 to 2015/6 was - 0.0081 (p = 0.1145). The overall change in CIX from 2004 to 2015/6 was 0.00965 (p = 0.0538). Disparities in the distribution of wealth index (mean contribution > 84.7%) and maternal years of schooling (mean contribution > 22.4%) had positive impacts on the levels of inequalities in stunting for all surveyed years. Rural-urban differences reduced inequalities in stunting although the contribution changed over time.

Conclusion: Inequalities in stunting declined, differentials in wealth index and maternal education had increased contribution to the levels of inequalities in stunting. Reducing stunting among the disadvantaged groups requires initiatives which should be embarked on the distribution of social services including maternal and reproductive education among women of reproductive age, water and health infrastructures in remote areas.
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http://dx.doi.org/10.1186/s12939-021-01389-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7824937PMC
January 2021

Effectiveness of FIBEROPTIC phototherapy compared to conventional phototherapy in treating HYPERBILIRUBINEMIA amongst term neonates: a randomized controlled trial.

BMC Pediatr 2021 01 11;21(1):32. Epub 2021 Jan 11.

Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, P O Box 2240, Moshi, Tanzania.

Background: Neonatal jaundice is one of the most common problems in neonates. Effective treatment of jaundice requires therapeutic intervention with high quality phototherapy. Over recent years, several studies reported fiberoptic phototherapy to be less effective than conventional phototherapy in term neonates. Our study aimed to compare the effectiveness of fiberoptic phototherapy with a larger illuminated area and higher irradiance to conventional phototherapy methods.

Methods: This was a randomized controlled trial conducted at the Kilimanjaro Christian Medical Centre (KCMC). A total of 41 term neonates, less than 7 days of age with unconjugated hyperbilirubinemia were randomized. Thirteen (13) neonates were allocated to receive fiberoptic phototherapy, 13 to blue light conventional phototherapy and 15 to white light conventional phototherapy. Effectiveness was assessed by comparing the duration of phototherapy, bilirubin reduction rate and side effects of treatment. The data was analyzed with the independent t-test.

Results: The mean overall bilirubin reduction rate was comparable in the fiberoptic phototherapy group (0.74%/h) and the blue light conventional phototherapy group (0.84%/h), with no statistically significant difference (p-value 0.124). However, white light conventional phototherapy had a significantly lower mean overall bilirubin reduction rate (0.29%/h) as compared to fiberoptic phototherapy (p-value < 0.001). The mean treatment duration of phototherapy was 69 h, 68 h and 90 h in the fiberoptic, blue light conventional and white light conventional phototherapy groups respectively. Side effects such as loose stool and skin rash were noted in some participants who received conventional phototherapy. No side effects of treatment were noted in the fiberoptic phototherapy group.

Conclusion: The effectiveness of fiberoptic PT and blue light conventional PT were comparable in terms of bilirubin reduction rate and treatment duration, whereas fiberoptic phototherapy was more effective than white light conventional PT, with a significantly higher bilirubin reduction rate and shorter treatment duration. Fiberoptic phototherapy may mitigate side effects caused by conventional phototherapy.

Trial Registration: The Pan African Clinical Trial Registry, PACTR202004723570110 . Registered 22nd April 2020- Retrospectively registered.
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http://dx.doi.org/10.1186/s12887-020-02458-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7798326PMC
January 2021

A Report of a Large Axillary Cystic Hygroma (a.k.a Lymphangioma) in a Newborn from a Tertiary Hospital in Northern Tanzania.

Case Rep Surg 2020 17;2020:5624019. Epub 2020 Nov 17.

Department of General Surgery, Kilimanjaro Christian Medical Center, P O Box 3010, Moshi, Tanzania.

Introduction: Cystic hygroma is a rare condition of the lymphatic system that occurs mainly in children. They are found around the neck, axilla, inguinal, or thoracic regions. . A newborn female baby with a right-sided axillary mass since birth was admitted to our center. She was otherwise a healthy baby with noncontributory prenatal history. The mass was 12 cm in diameter and cystic. Wide excision of the mass was done, and histology confirmed cystic hygroma. Postoperatively, the baby did well clinically and was discharged.

Conclusion: Due to its rare incidence, reports and literature on management of cystic hygroma are few. A multidisciplinary approach is vital to yield the best prognosis for this rare condition.
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http://dx.doi.org/10.1155/2020/5624019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685843PMC
November 2020

Community engagement in COVID-19 prevention: experiences from Kilimanjaro region, Northern Tanzania.

Pan Afr Med J 2020 14;35(Suppl 2):146. Epub 2020 Aug 14.

Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, P. O. Box 2240, Moshi, Tanzania.

Prevention of exposure to the COVID-19 virus in the general population is an essential strategy to slow community transmission. This paper shares the experiences and challenges of community engagement in COVID-19 prevention in the Kilimanjaro region, Northern Tanzania implemented by our team from the Institute of Public Health (IPH), Kilimanjaro Christian Medical University College (KCMUCo) in collaboration with the COVID-19 response team in the Moshi Municipality. We conducted an education session with the COVID-19 response team and together brainstormed transmission hotspots and which interventions would be most feasible in their settings. The first hotspot identified was crowded local market spaces. Suggested interventions included targeted and mass public health education through the engagement of market opinion leaders, public announcements, and radio shows. We conducted participatory rural appraisal techniques to enable market vendors and clients to visualize two-meter distances and provided a prototype hand-washing facility that was foot operated. We found mass public health educational campaigns essential to inform and update the public about COVID-19 pandemic and to address rumors and misinformation, which hampers compliance with public health interventions. Coordinated efforts among stakeholders in the country are necessary to develop context-specific prevention and case management strategies following the national and international guidelines. Local ownership of recommended interventions is necessary to ensure compliance.
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http://dx.doi.org/10.11604/pamj.supp.2020.35.146.24473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608759PMC
November 2020

Prevalence of Ear Nose and Throat (ENT) Manifestations Among HIV Seropositive Patients at a Tertiary Hospital in Northern Tanzania: A Descriptive Cross-Sectional Study.

HIV AIDS (Auckl) 2020 16;12:425-429. Epub 2020 Sep 16.

Kilimanjaro Christian Medical Center Moshi (KCMC), Moshi, Tanzania.

Background: To date, HIV/AIDS remains a threat of the 21st century. The overall rate of new HIV infection continues to decline in several countries, but there is still a remarkable burden of disease seen in sub-Saharan Africa. Several studies observed that 70% to 90% of HIV-infected patients present with ear, nose and throat symptoms. The aim of this study was to identify the magnitude of ENT manifestations among HIV-infected patients attended HIV clinics at KCMC based on age, sex, and CD4 count.

Methods: This was a descriptive cross-sectional study conducted at KCMC hospital involving HIV-infected patients who attended HIV clinics from February to July 2018. Convenient sampling was employed to get study participants, and 200 patients were recruited in the study. Data were collected through a questionnaire from patients, and results were analyzed using SPSS version 20.

Results: Sixty-eight (34%) of 200 HIV-infected patients had ENT manifestations. The most affected age group was 0-9 years. ENT manifestations were more prevalent in females (23.5%) than in males (10.5%). Those with CD4 count less than 200cells/µL also it was a high prevalence (56.3%).

Conclusion: This study observed that one-third of the studied population had ENT manifestations. All medical practitioners should be aware of ENT manifestations in HIV-infected patients in order to assure early and appropriate intervention.
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http://dx.doi.org/10.2147/HIV.S260908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7502399PMC
September 2020

Association between Chronic Urticaria and Infection among Patients Attending a Tertiary Hospital in Tanzania.

Dermatol Res Pract 2020 1;2020:5932038. Epub 2020 Sep 1.

Department of Dermato-Venereology, Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Tanzania.

Background: Chronic urticaria (CU) is a common skin disease; however, its etiology is rarely recognized. Infection due to (. ) has been shown in some studies to play a significant role in the pathogenesis of CU.

Objective: This study was conducted to determine the association between CU and . infection among patients attending the Regional Dermatology Training Center, Northern Tanzania, from October 2018 to April 2019. . A matched case-control study that included 55 cases and 55 controls matched by age and sex was conducted. Data were collected through direct interviews, and the results of laboratory investigations were recorded in the extraction sheet. An enzyme-linked immunosorbent assay test was used to detect . antigen in the stool samples. Conditional logistic regression was used to measure the association between CU and . .

Results: The total number of participants in this study was 110 patients (55 cases and 55 controls), whereby the median age was 31 (IQR 27-45) among controls versus 34 (IQR: 22-46) years among the cases. Both cases and controls had the same number of females and males. There was no significant association between CU and baseline characteristics of the participants. There was an association between CU and . infection, such that subjects with CU had a higher number of positive . test (15/55 = 27%) versus controls (6/55 = 10.1%) ( = 0.0225). The adjusted odds of CU among patients who were positive for . were sixfolds higher (OR = 6.9; CI: 1.3-36.2; = 0.021) than those of patients who were negative for

Conclusion: There was a strong and significant association between CU and . infection. We recommend investigating for . in all cases of CU and conducting further trials on . eradication.
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http://dx.doi.org/10.1155/2020/5932038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482006PMC
September 2020

Recurrence rate of preterm birth and associated factors among women who delivered at Kilimanjaro Christian Medical Centre in Northern Tanzania: A registry based cohort study.

PLoS One 2020 14;15(9):e0239037. Epub 2020 Sep 14.

Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical College, Moshi, Tanzania.

Background: Preterm birth is a public health problem particularly in low- and middle-income countries especially in sub-Saharan Africa. It is associated with infant morbidity and mortality. Survivor of preterm suffers long term health consequences such as respiratory, hearing and visual problems as well as delivering preterm infants. Preterm birth also tends to recur in subsequent pregnancies. Little is known about recurrent rate of preterm birth and associated factors in Tanzania. This study aimed to determine the recurrence rate of preterm birth and associated factors among women who delivered at Kilimanjaro Christian Medical Centre (KCMC), in Northern Tanzania.

Methods: A historic cohort study was designed using maternally-linked data from KCMC medical birth registry. Women who delivered 2 or more singletons were included. A total of 5,946 deliveries were analysed. Recurrence of preterm birth and associated risk factors were estimated using multivariable log-binomial regression model with robust standard error to account for repeated births from the same mother.

Results: Overall recurrent rate of preterm birth was 24.4%. The recurrence of early preterm birth was higher compared to late preterm birth (26.2% vs. 24.2%). Similar pattern of recurrence was observed for spontaneous and medically indicated preterm birth (13.5% vs. 10.9%, respectively). Previous preterm birth (RR;1.85, 95% CI: 1.49, 2.31), preeclampsia (RR;1.46, 95% CI: 1.07, 2.00), long inter-pregnancy interval (RR;1.22, 95% CI: 1.01, 1.49) and clinical subtypes (RR = 1.37, 95% CI: 1.00, 1.86) were important predictors for recurrent preterm birth.

Conclusion: Recurrence of preterm birth remains higher in this population. The rate of preterm recurrence was dependent of gestational age and sub-clinical subtype. Other factors which were associated with recurrence of preterm birth were previous preterm birth, preeclampsia and long inter-pregnancy interval. Early identification of high risk women during prenatal period is warranted.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239037PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489548PMC
November 2020

Dyslipidemia in HIV-Infected Children and Adolescents on Antiretroviral Therapy Receiving Care at Kilimanjaro Christian Medical Centre in Tanzania: A Cross-Sectional Study.

Infect Dis (Auckl) 2020 26;13:1178633720948860. Epub 2020 Aug 26.

Department of Pediatric and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

Background: Worldwide prevalence of dyslipidemia in HIV-infected children on antiretroviral medications (ARVs) is rising due to extensive use of treatment during their entire lives. Dyslipidemia is the potential side effect of ARVs, especially in individuals taking protease inhibitors. The objective of this study was to determine the prevalence of dyslipidemia in HIV-infected children on ARVs receiving care at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania.

Methods: This was a cross-sectional hospital-based study conducted from September 2015 to May 2016 at KCMC. HIV-infected children and adolescents less than 17 years on ARVs for more than 6 months were enrolled. Blood samples were taken to determine levels of triglycerides (TGs), total cholesterol, lipoproteins (including low-density lipoprotein (LDL) and high-density lipoprotein (HDL)), CD4+ T cells, and viral load (VL). Anthropometric measurements were used to assess nutritional status. SPSS 20.0 was used for analysis. Logistic regression estimated odds ratio (OR) and 95% confidence interval (CI), and value <.05 was considered significant. Written consent was obtained from parents/guardians on behalf of their children and assent for older children.

Results: A total of 260 participants were included in the study; the median age at HIV diagnosis was 3 (interquartile range (IQR) = 1-6) years. The overall prevalence of dyslipidemia was 46.5% with hypercholesterolemia (⩾200 mg/dl) of 11.2%, HDL (<35 mg/dl) of 22.7%, LDL (⩾130 mg/dl) of 7.7%, and hyperglyceridemia (TG ⩾150 mg/dl) of 12.3%. Children aged between 6 and 12 years at HIV diagnosis had 2.7 times higher odds of developing dyslipidemia compared with younger age at diagnosis (OR = 2.7; 95% CI = 1.1-6.6). Patients with advanced (OR = 6.4; 95% CI = 1.5-27.1) or severe (OR = 9.8; 95% CI = 1.2-76.5) HIV-associated immunodeficiency at diagnosis had higher odds of developing dyslipidemia. Protease inhibitor use was associated with higher odds of developing dyslipidemia (OR = 3.1; 95% CI = 1.4-7.1).

Conclusion: Late diagnosis of HIV at 6 years of age or more, advanced, or severe immunosuppression, and the use of protease inhibitors were independent predictors of dyslipidemia in children on ARVs after 6 months of treatment, and with low HDL levels observed most commonly. Monitoring lipid profiles in children, especially those on protease inhibitors and with advanced/severe immunosuppression at diagnosis, may help in preventing future complications.
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http://dx.doi.org/10.1177/1178633720948860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453455PMC
August 2020

Gastric perforation resulting into pneumoperitoneum in a neonate: a case report.

J Surg Case Rep 2020 Aug 26;2020(8):rjaa298. Epub 2020 Aug 26.

Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.

Gastric perforation in a neonate is a rare surgical emergency in routine practice. The causes and predisposing factors for gastric perforation in a neonate vary from traumatic to benign conditions like inflammatory processes. Early detection, intensive care, stabilization and prompt surgery yield positive outcome. Early diagnosis is important for better prognosis. Simple investigation such as plain abdominal X-ray can adequately lead to the diagnosis by showing pneumoperinoneum. We present a 3-day-old neonate; born at term who presented with abdominal distension and vomiting. Plain abdominal X-ray revealed pneumoperitoneum. Emergency laparotomy was performed where a gastric perforation was found measuring 0.5 by 0.5 cm located on the anterior aspect of the stomach body near the pylorus. The baby underwent successful surgical intervention and recovered well.
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http://dx.doi.org/10.1093/jscr/rjaa298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449603PMC
August 2020

Factors influencing utilization of skilled birth attendant during childbirth in the Southern highlands, Tanzania: a multilevel analysis.

BMC Pregnancy Childbirth 2020 Jul 25;20(1):420. Epub 2020 Jul 25.

Department of Epidemiology and Biostatistics, Institute of Public Health, KCMUCo, Moshi, Tanzania.

Background: Use of skilled health provider (SBA) during and after childbirth has been reported to reduce maternal and newborn deaths; and is one of the key indicators monitored in Sustainable Development Goals (SDGs). Progress, levels and factors influencing utilization of SBA differ within and between countries. In Tanzania, SBA coverage stands at 64% while the national target is 80%; with wide variability between regions (42-96%). This study aimed at determining factors associated with utilization of skilled births providers during childbirth in Mbeya Region, Southern highlands, Tanzania.

Methods: This was a cross-sectional analytical study conducted in December 2015 to January 2016, in Mbeya Region. A total of 2844 women of reproductive age were enrolled, but only 1777 women who reported a live birth 5 years prior to the survey were included in this analysis. Multilevel logistic regression analyses were used to determine independent factors influencing utilization of SBA during childbirth. Random effects logistic model was used to assess the variability between clusters on the odds of using skilled birth attendants during delivery.

Results: In this setting, 81% of the women reported utilization of skilled births attendants during childbirth. ANC visits four times or more (aOR = 1.63-95% CI = 1.26, 2.10; p < 0.001) and having secondary education or higher (aOR = 2.16; 95% CI = 1.19-3.90; p = 0.011) were associated with increased SBA use during childbirth whereas having two (aOR = 0.51; 95% CI: 0.33-0.79; p = 0.003) or three children (aOR = 0.37; 95% CI: 0.27-0.58; p < 0.001) relative to one child, 30 to 60 min walking distance to the health facility (aOR = 0.66; 95% CI: 0.48-0.92; p = 0.012) and more than 1 h walking distance to the health facility (aOR = 0.43; 95% CI: 0.32-0.57; p < 0.001) compared to < 30 min; were associated with decreased SBA use during childbirth.

Conclusion: The proportion of births attended by skilled births attendants was high, but 19% of the women are still left behind. Concentrated efforts to improve utilization of SBA should be targeted to women with low education, with higher number of children, and with low frequency of ANC attendance. Furthermore, community and facility interventions addressing transport for pregnant women are needed. Qualitative study to explore the barriers of SBA use among the 19% who are not using skilled assistance during childbirth is needed.
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http://dx.doi.org/10.1186/s12884-020-03110-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382099PMC
July 2020

Treatment outcomes of Pumani bubble-CPAP versus oxygen therapy among preterm babies presenting with respiratory distress at a tertiary hospital in Tanzania-Randomised trial.

PLoS One 2020 30;15(6):e0235031. Epub 2020 Jun 30.

Kilimanjaro Christian Medical University College, Moshi, Tanzania.

Background: Respiratory distress syndrome (RDS) is the most common respiratory disease in premature babies and the major cause of morbidity and mortality among preterm babies. Effective treatment of these babies requires exogenous surfactant and/or mechanical ventilation but these are of limited availability in low and middle income countries. A cheaper, simpler and more accessible treatment for preterms with RDS called bubble-continuous positive airway pressure (bCPAP) has been reported to be effective in treating RDS in preterm babies with varying levels of effectiveness ranging from 42% to 85%. We aimed to implement and determine the efficacy of bCPAP and its immediate outcomes as compared to oxygen therapy in preterm babies presenting with respiratory distress at a tertiary hospital in Tanzania.

Method: A randomized control trial, conducted from December 2016 to May 2017, included all preterm babies admitted at the neonatal care unit presenting with signs of respiratory distress and meeting the inclusion criteria. The primary outcome was survival while the secondary outcomes were treatment duration, duration of hospital stay and treatment complications.

Results: A total of 824 babies were admitted in the neonatal care unit during the study period. Of these, 187 babies were preterm and 48 babies were recruited and randomized (25 bCPAP vs 23 oxygen). The overall survival to discharge for all eligible participants (n = 48) was 58.2% compared to those who adhered to treatment protocol (n = 45, 62.2%). Babies in the bCPAP group had higher survival (17/22; 77.3%) as compared to their counterparts in the oxygen therapy group (11/23; 47.8%). Babies treated with bCPAP had 52% lower risk of death (crude HR 0.48, 95% CI = 0.16-1.43) compared to babies receiving oxygen therapy. The median duration of treatment for babies in the oxygen therapy group was 2 (Range 0-16) days compared to 2 (Range 0-5) days in the bCPAP group. The median duration of hospital stay for babies receiving bCPAP was 14 (range 7-43) days. Nasal bleeding was commonly observed among babies in the bCPAP group as compared to those in the oxygen therapy group.

Conclusion: This study revealed that treatment with bCPAP had a 30% clinical improvement in survival to discharge. Our findings highlight the role of bCPAP in reducing neonatal mortality in resource limited settings but further adequately powered studies in this or similar settings are required.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235031PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326169PMC
September 2020

Seroprevalence, risk factors and comorbidities associated with infection amongst children receiving care at Kilimanjaro Christian Medical Center.

Afr Health Sci 2019 Dec;19(4):3208-3216

Kilimanjaro Christian Medical University College, Pediatrics.

Background: frequently causes gastritis and peptic ulcers, and affected children are at risk of developing gastric carcinoma later in adulthood.

Methods: This was a Hospital based cross sectional study. A total of 200 children aged 6 months to 14 years were enrolled. Study subjects were tested for using a standard serology rapid test measuring immunoglobulin G for . For risk factors, Chi-square tests were used to test for association and then, odds ratios and their corresponding 95% confidence intervals and p-values were computed using logistic regression.

Results: The overall seroprevalence of was 11.5%. The following factors were associated with H. pylori infection: Age group above 10 years, keeping a dog and household size. The independent predictors of were: Fathers' occupation, keeping a dog, indoor tap water, age group, household size and diabetes mellitus type 1..

Conclusion: The seroprevalence of antibodies was lower compared to most developing countries. Keeping a dog, household size, indoor tap water, fathers' occupation and diabetes mellitus type 1 were found to be independent predictors of presence of antibodies.
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http://dx.doi.org/10.4314/ahs.v19i4.44DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040322PMC
December 2019

Colorectal Cancer in Northern Tanzania: Increasing Trends and Late Presentation Present Major Challenges.

JCO Glob Oncol 2020 03;6:375-381

Kilimanjaro Christian Medical University College, Moshi, Tanzania.

Purpose: A trend of increasing incidence of colorectal cancer (CRC) has been observed in northern Tanzania. Studies have shown a six-fold increase in CRC in the past decade, with 90% of patients presenting in late stages, with resultant high morbidity and mortality rates. In this study, we aimed to document the burden of CRC in the northern zone of Tanzania from 1998 to 2018, focusing on patient presentation, clinical features, and treatment at a tertiary hospital.

Methods: Pathological and clinical records for all patients from 1998 to 2018 were identified and reviewed. Records of patients whose CRC was diagnosed histologically were retrospectively reviewed.

Results: Approximately 313 CRC cases were documented. The majority age group (29.1%) was between 50 and 64 years (mean [standard deviation], 54.28 [16.75] years). However, together, the age groups of patients younger than 50 years was 41.5% (n = 130). Of 174 patients with complete records, most (29.3%) were between 35 and 49 years of age. The median age was 52 (interquartile range, 40-67) years. Men accounted for 62.1% of patients and were mostly from the Kilimanjaro region. More than half (54.7%) presented > 3 months after symptom debut; 62.6% first sought care at lower-level health facilities. Most (64.9%) presented as emergencies, necessitating colostomy for fecal diversion as the initial surgical procedure in 60.3% of patients. Colonoscopy was performed for 38.6% of the study participants. Most tumors (72.7%) originated from the sigmoid and rectum. Adenocarcinoma was the most prevalent histologic type.

Conclusion: High proportions of young individuals with CRC pose great concern and a need for further appraisal. Furthermore, late emergency presentation and low colonoscopy rates highlights underlying system challenges and need for education campaigns.
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http://dx.doi.org/10.1200/JGO.19.00301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113073PMC
March 2020

Inter-pregnancy interval and associated adverse maternal outcomes among women who delivered at Kilimanjaro Christian Medical Centre in Tanzania, 2000-2015.

PLoS One 2020 6;15(2):e0228330. Epub 2020 Feb 6.

Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania.

Inter-pregnancy interval is an important determinant of both maternal and child health. Suboptimal inter-pregnancy interval has been associated with adverse maternal outcomes -including postpartum hemorrhage and hypertensive disorders, direct causes of maternal mortality. Both overall maternal mortality and the contribution of postpartum hemorrhage on maternal mortality have increased in Tanzania. If we are to achieve sustainable development goal (SDG) number 3.1 to reduce the global maternal mortality ration to less than 70 per 100,000 live births by 2030, it is highly important that such contributors are dealt with. This study aimed to determine the distribution and trends of inter-pregnancy interval and to deduce its association with adverse maternal outcomes among women who delivered at Kilimanjaro Christian Medical Centre (2000-2015).A retrospective cohort study was designed using Kilimanjaro Christian Medical Centre medical birth registry data for women who delivered from 2000 to 2015. Women with at least two births recorded in the registry were included. A total of 7,995 births from 6,612 mothers were analyzed. Anemia during pregnancy, post-partum hemorrhage and pre-eclampsia were adverse maternal outcomes of interest. Data analysis was performed using multivariable logistic regression models allowing for robust standard errors. Crude and adjusted odds ratio with their respective 95% confidence intervals were estimated. More than half (51.7%) of non-first births were born within sub-optimal IPI. The median IPI was 34 months (IQR: 33.5 months). The median IPI increased from 11 months in 2002 to 35 months in 2006 and plateaued until 2014, but it rose to 41.6 months in 2015. Median IPI was shorter in young women <20 years and in birth order seven and above (16 vs. 27 months, respectively). Short IPI was associated with lower risk of pre-eclampsia [aOR: 0.71, 95%CI: 0.52, 0.97] while long IPI was associated with lower risk of post-partum hemorrhage [aOR: 0.70, 95%CI: 0.52, 0.94]. This study found an association between long and short IPI with adverse maternal outcomes. Even though these results should be interpreted with caution based on the fact that the data was sampled from a referral hospital and hence there could be overrepresentation of women with maternal complications, our findings still warrant the importance of supporting modern family planning methods as a measure to improve IPI and thereby improve maternal outcomes as well.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228330PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004302PMC
April 2020

Two cases of Prune Belly Syndrome from Kagera Region Tanzania.

East Afr Health Res J 2020 26;4(1):20-25. Epub 2020 Jun 26.

Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.

Prune Belly Syndrome is a rare congenital disorder with unknown aetiology, consisting of a triad of abdominal muscle wall weakness, undescended testes, and urinary tract abnormalities. We are unaware of any preceding report of Prune Belly Syndrome in Tanzania, and here we describe two cases reported in Kagera region. The first case is a 2 month old boy with the triad of Prune Belly Syndrome along with pectus carinatum who died due to septicaemia. This case posed a diagnostic challenge at birth and during the natal period. Paucity of comprehensive knowledge of congenital malformations at the peripheral health facilities may have also contributed to the diagnostic challenge in the first place. The second case is a neonate who was referred to regional referral hospital where he was diagnosed with Prune Belly Syndrome at the age of four weeks. Because of limited capacity to manage congenital malformations at the regional referral hospital, he was referred to an urologist at the zonal referral hospital. However, inadequacies in supporting systems to the parents compounded care of the neonate with Prune Belly Syndrome. High index of Prune Belly Syndrome suspicion is needed in a resource limited setting in order to timely make diagnosis. There is also a need to strengthen institutional and individual's capacity for prenatal screening to detect congenital anomalies at an early stage of foetus development. Multidisciplinary management approach is necessary in order to improve the quality of life for patients with Prune Belly Syndrome. Psychosocial and medical support systems should be put in place in order to enhance preparedness for patient care in resource limited settings including equipping the referral hospital with different specialists and ensuring availability of basic investigations for patients.
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http://dx.doi.org/10.24248/eahrj.v4i1.630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279232PMC
June 2020

Isolated Pulmonary Hydatid Cyst: A Rare Presentation in a Young Maasai Boy from Northern Tanzania.

Case Rep Surg 2019 1;2019:5024724. Epub 2019 Oct 1.

Department of General Surgery, Kilimanjaro Christian Medical Center, PO Box 3010, Moshi, Tanzania.

Introduction: Hydatidosis is a parasitic manifestation caused by It is characterized by cystic lesions in the liver and lungs. Diagnosis is based on typical history and radiological measures.

Case Presentation: A four-year-old boy presented with a one-year history of dry cough and difficulty in breathing which was of gradual progression. Computed tomography of the chest revealed a large 11.7 cm × 8.6 cm × 11.0 cm cyst in the right hemithorax. The patient underwent thoracotomy and recovered well post procedure.

Conclusion: This case report highlights that large hydatid cysts can be surgically removed with good outcome and the importance of realizing that the disease is a burden to the public health and is much neglected.
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http://dx.doi.org/10.1155/2019/5024724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791237PMC
October 2019

Iron Depletion, Iron Deficiency, and Iron Deficiency Anaemia Among Children Under 5 Years Old in Kilimanjaro, Northern Tanzania: A Hospital-Based Cross-Sectional Study.

East Afr Health Res J 2019 30;3(1):42-47. Epub 2019 Jul 30.

Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

Background: Iron depletion results from reduced iron stores, and it is an early stage of disease progression before iron deficiency, which leads to iron deficiency anaemia (IDA). IDA is associated with delayed infant growth and development, diminished cognitive function, poor academic performance, decreased exercise tolerance, and impaired immune function. This study aimed to determine the prevalence of iron depletion and IDA and factors associated with low ferritin levels among children under 5-years-old receiving care at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania.

Methods: Under-5 children presenting at KCMC were successively enrolled and screened for iron depletion and IDA using complete blood count and serum ferritin levels. The generally accepted World Health Organization cut-off levels for normal haemoglobin (Hb) and ferritin level were used. Iron depletion, iron deficiency, and IDA prevalences were estimated in relation to the combination measures of haemoglobin, mean corpuscular volume, and ferritin levels. Dietary and sociodemographic characteristic of the children were recorded after parents or caretakers provided informed consent. Data analysis was conducted using SPSS version 21.0.

Results: A total of 303 children aged 2 to 59 months were enrolled in the study. Anaemia was detected in169 (55.8%) children. Children aged 2 to 12 months had a higher prevalence of anaemia (n=101, 60.1%). The overall prevalences of iron depletion, iron deficiency with no anaemia, and IDA were 2.6% (n=8), 9.6% (n=29), and 28.1% (n=84), respectively. Low ferritin levels were detected in 124 (40.9%) children. Drinking more than 500 ml of cow's milk per day was associated with an increased risk of anaemia (adjusted odds ratio [AOR] 5.6; 95% confidence interval [CI], 2.6 to 12.1) relative to those not drinking cow's milk. Children whose families had meals that included beef more than 3 times per week were less likely to have low ferritin (AOR 0.6; 95% CI, 0.3 to 1.3), though the difference was not significant.

Conclusion: The IDA prevalence among children in the Kilimanjaro area was high, with more than 50% of infants being anaemic. Drinking cow's milk was associated with an increased risk of IDA. Future community-based research is recommended to elucidate more details about iron deficiency in the general population.
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http://dx.doi.org/10.24248/EAHRJ-D-18-00017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279273PMC
July 2019

The prevalence of hepatitis B virus among HIV-positive patients at Kilimanjaro Christian Medical Centre Referral Hospital, Northern Tanzania.

Pan Afr Med J 2017 28;28:275. Epub 2017 Nov 28.

Department of Community Medicine, KCMC Hospital, Moshi, Tanzania.

Introduction: Human Immunodeficiency Virus (HIV) and hepatitis B virus are prevalent infections in sub-Saharan Africa, but information on the prevalence of co-infection is limited. This study aimed to determine seroprevalence and risk factors for hepatitis B virus infection among people living with HIV receiving care and treatment at Kilimanjaro Christian Medical Centre Referral Hospital in northern Tanzania.

Methods: This was a cross-sectional study conducted from March to June 2015 among people living with HIV (PLWHIV) aged 15 years and above attending the Care and Treatment Clinic for routine care at Kilimanjaro Christian Medical Centre. Systematic sampling was used to select the study participants. Information on socio-demographic data, sexual behaviour and medical history were collected using a questionnaire. Hepatitis B surface antigen was diagnosed using a rapid test. Descriptive statistics were used to summarize the data.

Results: A total of 300 PLWHIV consented to participate in this study, of whom 62% were female. Their ages ranged from 15-75 years, with a median age of 46 years (IQR of 39-53 years). The seroprevalence of hepatitis B surface antigen among people living with HIV was 2.3% (n=7/300). A history of blood transfusion was the only factor associated with hepatitis B surface antigen infection, while other socio-demographic and clinical factors showed no association.

Conclusion: Hepatitis B virus infection is infrequent among PLWHIV in this setting. Despite the prevalence, we recommend routine screening for hepatitis B surface antigen and other hepatitis B virus markers among PLWHIV in order to tailor antiretroviral regimens against hepatitis B virus.
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http://dx.doi.org/10.11604/pamj.2017.28.275.11926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989175PMC
June 2018

Prevalence and antimicrobial sensitivity pattern of urinary tract infection among children with cerebral palsy, Moshi, Tanzania.

Pediatric Health Med Ther 2018 8;9:59-65. Epub 2018 May 8.

Department of Pediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.

Background: Urinary tract infection (UTI) in children with cerebral palsy (CP) is a challenging yet common clinical condition. Children with CP bare the greatest risk of contracting UTI because of their difficulties in neuromotor control which lead to delay of bladder control, causing incomplete bladder emptying and urine retention.

Method: This was an analytical cross-sectional study that was conducted from September 2016 to March 2017 at Comprehensive Community Based Rehabilitation in Tanzania - Moshi and Kilimanjaro Christian Medical Centre Neurological Pediatrics Outpatient Clinic. All children who met the inclusion criteria were studied. Urine samples were collected at one point by catheterization, and urine dipstick and urine culture were done. Data were analyzed using SPSS version 20.

Results: A total of 99 children were enrolled in the study. The median age was 4 years (3-8 years); 53.5% were aged between 2 and 4 years. More than half were male. UTI was detected in 13.1% (n=13) of the children. Five causative agents of UTI were isolated, namely , , , , and . The two most common organisms, and , both had low sensitivity to ampicillin and co-trimoxazole while they were sensitive to ciprofloxacin and ceftriaxone.

Conclusion: UTI is a common finding among children with CP. and are the commonest causative agents and are sensitive to ciprofloxacin and ceftriaxone but have low sensitivity to ampicillin and co-trimoxazole.
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http://dx.doi.org/10.2147/PHMT.S159766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5947104PMC
May 2018

Risk factors for inappropriate blood requisition among hospitals in Tanzania.

PLoS One 2018 17;13(5):e0196453. Epub 2018 May 17.

Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.

Background: Blood is a critical aspect of treatment in life saving situations, increasing demand. Blood requisition practices greatly effect sufficient supply in blood banks. This study aimed to determine the risk factors for inappropriate blood requisition in Tanzania.

Methods: This was a cross sectional study using secondary data of 14,460 patients' blood requests from 42 transfusion hospitals. Primary data were obtained by using cluster-sampling design. Data were analysed using a two-level mixed-effects Poisson regression to determine fixed-effects of individual-level factors and hospital level factors associated with inappropriate blood requests. P-value <0.05 (2-tails) was considered statistically significant.

Results: Inappropriate requisition was 28.8%. Factors significantly associated with inappropriate requisition were; reporting pulse rate and capillary refill decrease the risk (RR 0.74; 95% CI 0.64, 0.84) and (RR 0.73; 95% CI 0.63, 0.85) respectively and the following increased the risk; having surgery during hospital stay (RR 1.22; 95% CI 1.06, 1.4); being in general surgical ward (RR 3.3; 95% CI 2.7, 4.2), paediatric ward (RR 1.8; 95% CI 1.2, 2.7), obstetric ward (RR 2.5; 95% CI 2.0, 3.1), gynaecological ward (RR 2.1; 95% CI 1.5, 2.9), orthopaedics ward (RR 3.8; 95% CI 2.2, 6.7). Age of the patient, pallor and confirmation of pre-transfusion haemoglobin level were also significantly associated with inappropriate requisition. Majority of appropriate requisitions within the wards were marked in internal medicine (91.7%) and gynaecological wards (77.8%).

Conclusions: The proportion of inappropriate blood requests was high. Blood requisition was determined by clinical and laboratory findings and the ward patients were admitted to. Adherence to transfusion guidelines is recommended to assure the best use of limited blood supply.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0196453PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5957429PMC
August 2018

Adherence to Exclusive Breastfeeding and Associated Factors in Mothers of HIV-Exposed Infants Receiving Care at Kilimanjaro Christian Medical Centre, Tanzania.

East Afr Health Res J 2018 1;2(1):33-42. Epub 2018 Apr 1.

Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.

Background: More than 90% of HIV in children occurs through mother-to-child transmission. Breastfeeding is one of several factors associated with transmission of HIV, and, because of this, infant feeding practice is one of the cornerstones in the effort to reduce HIV transmission in children. World Health Organization guidelines from 2012 recommend exclusive breastfeeding to all infants for first 6 months of life. However, many factors contribute to the adherence of mothers to exclusive breastfeeding (EBF) recommendations. The aim of this study was to determine what factors likely influence adherence to exclusive breastfeeding in mothers of HIV-exposed infants receiving care at Kilimanjaro Christian Medical Centre.

Methods: A cross-sectional hospital-based study was conducted from September 2012 to March 2013 at Kilimanjaro Christian Medical Centre in Moshi. All mothers of HIV-exposed infants aged 6 to 12 months receiving care at child-centred family care clinic who consented to participate in the study were included. Data were collected using a pretested structured questionnaire and analysed using SPSS version 16.0 statistical package.

Results: Of the 128 mothers of HIV-exposed infants enrolled in the study, 71 (55.5%) adhered to EBF for 6 months. No statistical significance was seen between adherence status and maternal characteristics in bivariate analysis (>.05). The mean age and standard deviation of initiating other foods by mothers who did not adhere was 3.32 months ± 1.24. Of 57 (44.5%) non-adherent mothers, one-tenth of them practised mixed breastfeeding and the rest stopped breastfeeding completely. Fear of postnatal transmission of HIV through breastfeeding and inadequate breast milk production were the most common reasons for non-adherence to EBF.

Conclusion: Adherence to the recommended duration for EBF by mothers to their HIV-exposed infants is still a challenge. Ongoing intensive feeding counselling and education on EBF may increase the number of mother who can adhere to EBF in our society.
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http://dx.doi.org/10.24248/EAHRJ-D-16-00365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279206PMC
April 2018

Prevalence, Aetiological Agents, and Antimicrobial Sensitivity Pattern of Bacterial Meningitis Among Children Receiving Care at KCMC Referral Hospital in Tanzania.

East Afr Health Res J 2018 1;2(1):1-9. Epub 2018 Apr 1.

Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

Background: Bacterial meningitis is an inflammation of the meninges that occurs in response to bacteria, causing a significant number of morbidity and mortality worldwide, especially in newborns and people living in low-income countries. Diagnosis of bacterial meningitis combines a high index of clinical suspicion and laboratory confirmation through cerebrospinal fluid (CSF) analysis. Despite antibiotic treatment, mortality remains high and many children end with long-term consequences, which include neurological deficits, hearing loss, and cognitive impairment.

Objective: To determine prevalence, aetiological agents, and antimicrobial sensitivity pattern among children aged less than 13 years with bacterial meningitis at Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania.

Methods: This was a hospital-based cross-sectional study carried out in the KCMC paediatric ward from December 2013 to May 2014 and from June 2015 to April 2016. In total, 161 children aged less than 13 years suspected of having meningitis were consecutively recruited. Each child submitted to a lumber puncture and CSF collected for microscopy, cultures, antimicrobial sensitivity testing, a latex agglutination test, and a polymerase chain reaction (PCR) test. PCR was run on 129 of the selected CSF samples. Data were collected using structured questionnaires and laboratory data sheet. Aetiological agents were identified, and antibiotic sensitivity was tested. Analyses were performed using SPSS version 20.0.

Results: Overall, 24 children had confirmation of having acute bacterial meningitis. Of the 161 participants, Gram stain and culture identified 4 (2.5%) children; whereas, of the 129 samples tested using the PCR, infection was confirmed in 24 (18.6%) children. (n=18) was the most common organism isolated followed by (n=3), (n=1), (n=1), and species (spp.) (n=1). With the exception of spp., the isolated organisms were sensitive to the following commonly used antibiotics: ampicillin, chloramphenicol, gentamycin, and cephalosporin.

Conclusion: PCR yielded more organisms. was the most common organism and was sensitive to the empirically used antibiotics for treatment of bacterial meningitis tested in our study.
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http://dx.doi.org/10.24248/EAHRJ-D-16-00358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279346PMC
April 2018

Prevalence and genotypes of Rotavirus among children under 5 years presenting with diarrhoea in Moshi, Tanzania: a hospital based cross sectional study.

BMC Res Notes 2017 Oct 30;10(1):542. Epub 2017 Oct 30.

Department of Pediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

Background: Diarrhoea is a main cause of morbidity and mortality in children under 5 responsible for approximately four billion cases and 1.1 million deaths annually. In developing countries, it causes two million deaths each year. The major causative organism responsible is Rotavirus which is responsible for one-third of hospitalizations with approximately 40% mortality.

Results: The prevalence of Rotavirus infection was 26.4% (73/277). The predominant strain of Rotavirus found was G1 21/73 (53.8%), followed by G8 9/73 (23.1%), G12 5/73 (12.8%), G9 3/73(7.7%) and G4 1/73 (2.6%). All serotypes identified were in children who had completed Rotavirus vaccination except for one who had G8 in whom the vaccine was introduced after they had completed immunizations.

Conclusion: The overall prevalence of rotavirus has reduced from 33.2% in 2009 to 26.4% in 2016. We have found G1 to be the predominant serotype as well as other circulating serotypes namely G4, G8, G9 and G12. Despite a reduction in prevalence, there is a need for further rotavirus surveillance in the region.
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http://dx.doi.org/10.1186/s13104-017-2883-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5661935PMC
October 2017
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