The burden of infections in burn patients at a tertiary hospital in Tanzania: microbial etiology, drug resistance Patterns, and patient outcomes

Patient's characteristics, management practices and outcome of re-laparotomies in a tertiary hospital in Tanzania

BackgroundLarge vessel ischemic strokes account for more than one-third of all strokes associated with substantial morbidity and mortality without early intervention. The incidence of large vessel occlusion (LVO) is not known in sub-Saharan Africa (SSA). Definitive vessel imaging is not routinely available in resource-limited settings.AimsWe aimed to investigate the burden and outcomes of presumed LVO among patients with ischemic stroke admitted to a large tertiary academic hospital in Tanzania.MethodsThis cohort study recruited all consenting first-ever ischemic stroke participants admitted at a tertiary hospital in Tanzania. Demographic data were recorded, and participants were followed up to 1 year using the modified Rankin Scale (mRS). A diagnosis of presumed LVO was made by a diagnostic neuroradiologist and interventional neurologist based on contiguous ischemic changes in a pattern consistent with proximal LVO on a non-contrast computed tomography head. We examined factors associated with presumed LVO using logistic regression analysis. Inter-observer Kappa was calculated.ResultsWe enrolled 158 first-ever ischemic strokes over 8 months with a mean age of 59.7 years. Presumed LVO accounted for 39.2% [95% confidence interval (CI) 31.6–47.3%] and an overall meantime from the onset of stroke symptoms to hospital arrival was 1.74 days. Participants with presumed LVO were more likely to involve the middle cerebral artery (MCA) territory (70.9%), p < 0.0001. Independent factors on multivariate analysis associated with presumed LVO were hypertension [adjusted odds ratio (aOR) 5.74 (95% CI: 1.74–18.9)] and increased waist-hip ratio [aOR 7.20 (95% CI: 1.83–28.2)]. One-year mortality in presumed LVO was 80% when compared with 73.1% in participants without presumed LVO. The Cohen's Kappa inter-observer reliability between the diagnostic neuroradiologist and interventional neurologist was 0.847.ConclusionThere is a high burden of presumed LVO associated with high rates of 1-year morbidity and mortality at a tertiary academic hospital in Tanzania. Efforts are needed to confirm these findings with definitive vessel imaging, promoting cost-effective preventive strategies to reduce the burden of non-communicable diseases (NCDs), and a call for adopting endovascular therapies to reduce morbidity and mortality.

BackgroundStroke mimics account for up to one-third of acute stroke admissions and are a heterogeneous entity which pose diagnostic challenges. Diagnosing such patients is however crucial to avoid delays in treatment and potentially harmful medication prescription. We aimed at describing the magnitude, clinical characteristics and short-term outcomes of stroke mimics in patients clinically diagnosed with a stroke.MethodsThis prospective study enrolled patients admitted with a World Health Organization clinical criteria for stroke at a tertiary hospital in Tanzania. Baseline data was collected and the simplified version of the FABS scale was used to determine its usefulness in predicting stroke mimics. The National Institute of Health Stroke Scale and Modified Rankin Scale were used to assess for admission stroke severity and outcomes respectively.ResultsAmong 363 patients with suspected stroke on admission, the final diagnosis was stroke mimics in 24 (6.6%) who had a mean age of 65.8 ± 15 years. Patients with stroke mimics were less likely to have cardiovascular risk factors for stroke including premorbid hypertension (7 (29.2%) vs 263 (77.6%), p < 0.001) and increased waist-hip ratio (9 (37.5%) vs 270 (79.6%) p < 0.001) for mimics and true strokes respectively. Clinical findings such as hypertension and the presence of cortical features in neurological examination occurred less in patients with stroke mimics. The simplified FABS score of ≥3 could identify patients with stroke mimics with a sensitivity and specificity of 38 and 80% respectively. The most common causes of mimics were brain tumors 6 (25%), meningoencephalitis 4 (16.7%) and epileptic seizures 3 (12.5%). The majority of patients with stroke mimics had severe disease on admission and the 30-day mortality in these patients was 54.5%.ConclusionsIn the present study, the proportion of stroke mimics among patients clinically diagnosed with stroke was 6.6% and brain tumors was a common etiology. Stroke mimics were less likely to have cardiovascular risk factors and cortical signs during evaluation. We recommend further studies that can help develop clinical scales used for predicting stroke mimics in an African population.

Background: Clindamycin is a reserved antibiotic used to treat infections caused by Gram-positive cocci; however, increasing bacterial resistance threatens its effectiveness. Routine antimicrobial susceptibility testing may fail to detect inducible macrolide-lincosamide-streptogramin B (iMLS B) resistance, which requires the double disc diffusion (D-test) for accurate identification. Therefore, this study aimed to use the D-test to determine the prevalence of inducible clindamycin resistance among Gram-positive cocci isolates from patients with bacterial infections at a tertiary hospital in Tanzania. Methods: A cross-sectional study was conducted among patients presenting with bacterial infections at Muhimbili National Hospital (MNH) in Tanzania from April to August 2022. Convenience sampling was used to include all eligible clinical specimens yielding Gram-positive cocci during the study period. All Gram-positive cocci isolated from the participants’ clinical specimens were subjected to antimicrobial susceptibility testing (AST) using the Kirby-Bauer disc diffusion method, and the D-test was performed to phenotypically detect iMLS B resistance. Demographic variables (age and sex), clinical specimen types, bacterial species, and antimicrobial resistance profiles were collected from patients’ records and laboratory results. Data were analyzed using Stata® Statistical Software version 15.1 (StataCorp LLC, College Station, TX, USA). Descriptive statistics were used to summarize the data, while the Chi-square test was used for analysis of categorical variables. A p-value &lt; 0.05 was considered statistically significant. Results: A total of 246 Gram-positive cocci isolates from clinical specimens were analyzed. The majority were Coagulase-negative Staphylococci (CoNS) 64.6%, followed by Staphylococcus aureus 30.1%. The prevalence of inducible clindamycin resistance was 25.2% (95% Confidence Interval (CI) [20.2%-30.9%]). Among the Staphylococcus aureus and CoNS isolates, 39.2% (95% CI [28.9%-50.6%]) and 20.8%(95% CI [15.2%-27.7%]) exhibited the iMLS B resistance phenotype, respectively. In addition, 63.5% of Staphylococcus aureus isolates were phenotypically confirmed as methicillin-resistant Staphylococcus aureus (MRSA), and 44.7% of these isolates demonstrated the iMLS B resistance phenotype. Furthermore, 75.6% (95% CI [69.9%-80.6%]) of the Gram-positive bacterial isolates were multidrug-resistant (MDR). Conclusions: The present study demonstrated that a substantial proportion of Gram-positive cocci isolates exhibited iMLS B resistance, and the prevalence of MDR was high. These findings highlight the importance of incorporating the D-test into routine antimicrobial susceptibility testing to guide appropriate antibiotic therapy for infections caused by Gram-positive cocci. Furthermore, the results provide baseline evidence for future surveillance studies and support the need for strengthened antimicrobial stewardship programs and continued research to monitor and control antibiotic resistance in resource-limited settings.

Background: Childhood undernutrition causes significant morbidity and mortality in low- and middle-income countries (LMICs). In Tanzania, the in-hospital prevalence of undernutrition in children under five years of age is approximated to be 30% with a case fatality rate of 8.8%. In Tanzania, the burden of undernourished children under five years of age presenting to emergency departments (EDs) and their outcomes are unknown. This study describes the clinical profiles and outcomes of this population presenting to the emergency department of Muhimbili National Hospital (ED-MNH), a large, urban hospital in Dar es Salaam, Tanzania.MethodsThis was a prospective descriptive study of children aged 1–59 months presenting to the ED-MNH over eight weeks in July and August 2016. Enrolment occurred through consecutive sampling. Children less than minus one standard deviation below World Health Organization mean values for Weight for Height/Length, Height for Age, or Weight for Age were recruited. Structured questionnaires were used to document primary outcomes of patient demographics and clinical presentations, and secondary outcomes of 24-h and 30-day mortality. Data was summarised using descriptive statistics and relative risks (RR).ResultsA total of 449 children were screened, of whom 34.1% (n = 153) met criteria for undernutrition and 95.4% (n = 146) of those children were enrolled. The majority of these children, 56.2% (n = 82), were male and the median age was 19 months (IQR 10–31 months). They presented most frequently with fever 24.7% (n = 36) and cough 24.0% (n = 35). Only 6.7% (n = 9) were diagnosed with acute undernutrition by ED-MNH physicians. Mortality at 24 h and 30 days were 2.9% (n = 4) and 12.3% (n = 18) respectively. A decreased level of consciousness with Glasgow Coma Scale below fifteen on arrival to the ED and tachycardia from initial vital signs were found to be associated with a statistically significant increased risk of death in undernourished children, with mortality rates of 16.1% (n = 23), and 24.6% (n = 35), respectively.ConclusionsIn an urban ED of a tertiary referral hospital in Tanzania, undernutrition remains under-recognized and is associated with a high rate of in-hospital mortality.

Objectives: Respiratory distress syndrome (RDS) is the most common respiratory disease in premature babies and the major cause of morbidity and mortality among preterm babies. We aimed to implement and determine the efficacy of bCPAP and its immediate outcomes as compared to oxygen therapy in preterm babies presenting with RDS at a tertiary hospital in Tanzania. Method: A randomized control trial included all premature babies admitted at the neonatal care unit presenting with signs of RDS. The primary outcome was survival while secondary outcomes were treatment duration, duration of hospital stay and treatment complications. Results: 48 preterm babies were enrolled and randomized (25 bCPAP vs 23 oxygen). After randomization, 3 babies were excluded leaving 45 babies (22 bCPAP vs 23 oxygen). The overall survival for all 48 participants was 58.5%. Babies in the bCPAP group had higher survival as compared to the oxygen group (77.8% vs 47.8%). Babies treated with oxygen therapy had a longer treatment duration (87 hours) as compared to babies receiving bCPAP (48 hours). Babies treated with bCPAP experienced a shorter hospital stay. Nasal bleeding was observed in babies who received bCPAP. Conclusion: Treatment with bCPAP improved survival by 30% and reduced the duration for RDS treatment when compared to treatment with oxygen therapy.

The World Health Organization (WHO) has prioritized collaboration with communities in its 2016 "End TB" implementation strategy. Acknowledging the difficulties that some communities face in gaining access to health facilities due to barriers such as stigma, discrimination, healthcare expenditure, transport and income loss, partnering with communities in the roll-out of community-based TB management activities is vital. The aim of this project was to make a contribution to promoting evidence-based practice with regards to the community-based management of multidrug-resistant tuberculosis (MDR-TB) at Kibong'oto National Infectious Disease Hospital, Tanzania, and thereby supporting improvements in patient outcomes and resource utilization. The project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) program to facilitate the collection of pre- and post-audit data. The Getting Research into Practice (GRiP) module was also used to analyze the potential barriers and for designing the final action plan. This project was conducted in three phases over a three-month period at the MDR-TB unit in a referral hospital in Northern Tanzania. The project showed that there were significant improvements in compliance rates in staff education and documentation of patients' suitability and preferences in receiving community-based care for MDR-TB. The compliance rate of criterion 2, which was already 100% at baseline, was slightly lower at follow-up. The project achieved significant improvements in the delivery of evidence-based practice with regards to community-based management of MDR-TB.

Predictors of post-operative complications following thyroid surgeries at a tertiary hospital in Tanzania

BackgroundProstate cancer is a common cancer among men globally and its treatment affects quality of life. Poor patients’ perception of prostate cancer services may lead to their late presentation for care, often presenting with the advanced stage of the disease. This may vary from one region to another.ObjectiveThis study, therefore, aimed to explore patients’ perceptions of the quality of care for prostate cancer in Tanzania.MethodsThis qualitative case study was conducted in five tertiary hospitals in Tanzania in November 2023. In-depth interviews were conducted with prostate cancer patients on treatment for not less than 6 months. Data on patients’ perception of prostate cancer, quality of prostate cancer services, and quality of life among prostate cancer patients were collected. Thematic analysis used a hybrid inductive and deductive reasoning approach through NVivo 14 software.ResultsA total of 17 interviews were conducted, resulting in four themes. These were perception of prostate cancer on the causes and diagnostic methods, delays of care leading to late presentation, perception of quality of life after treatment for prostate cancer recovery versus cancer progression, and quality of service in terms of organization of service delivery for prostate cancer at tertiary hospitals in Tanzania.ConclusionQuality of services for prostate cancer was well-perceived, especially communication for psychosocial support. A good perception of the quality of service was found to influence the uptake of prostate cancer services. Prostate cancer patients have mixed perceptions about the quality of life after treatment, which delays health seeking, leading to late presentation. Despite efforts in awareness campaigns through different platforms, more effort is needed in determining the causes of prostate cancer, the diagnostic/screening methods necessary for prostate cancer, timely health seeking, the available treatment options for prostate cancer, and the expected quality of life after treatment.

Renal dysfunction is one of the complications of malignancy which can be due to malignancy itself, treatment related and or other associated medical complications, which is associated with increased mortality among under five children in low-income countries. Despite the high mortality reported, studies on renal dysfunction in children with malignancy on chemotherapy are limited in low and middle-income settings. Therefore, the current study aimed to determine the prevalence, predictors and short-term outcomes of renal dysfunction among children aged 1 to less than 18 years with malignancy on chemotherapy at two tertiary hospitals in Tanzania. In this cross-sectional study with follow up component, a total of 142 children aged 1 to less than 18 years were enrolled during a 6 months’ time period at Muhimbili National Hospital and Benjamini Mkapa Hospital from December 2024 to May 2025. Socio-demographic, clinical and laboratory data were collected using a structured questionnaire. Estimated glomerular filtration rate was calculated using Revised Schwartz formula. Renal dysfunction was defined as urinary albumin-to-creatinine ratio > 30 mg/g and or Estimated Glomerular Filtration Rate of < 60 ml/min/1.73m2. Data analysis was done using SPSS version 27 and statistical significance was assumed for factors with p-value < 0.05. Out of 142 children, the overall prevalence of renal dysfunction was found to be 29.58%. Children with hematological malignancies were 6 times likely to experience renal dysfunction compared to those with solid malignancies APR 6.377[1.899,21.419] p = 0.0027 Similarly, the likelihood of Renal Dysfunction based on time of chemotherapy exposure among those within initial days of chemotherapy were 3.9 likely compared to those above 30 days APR3.918[1.230,12.483]p = 0.0209. Other variables, including, stage of malignancy, the use of combination therapy such as surgery and radiotherapy, did not show statistically significant associations with renal dysfunction. Renal dysfunction is common among children with malignancy on chemotherapy. It is associated with undetected and asymptomatic renal dysfunction with short-term complications. Further studies are needed to determine the burden of renal dysfunction among children with malignancy while on treatment as compared to those with malignancy prior to initiation of chemotherapy, focusing on timing of chemotherapy initiation for early prevention, detection and early treatment.

Background: Hypertensive retinopathy is a known marker of cardiovascular disease, and among unselected patients with chronic kidney disease (CKD) more severe retinopathy has been associated with lower estimated glomerular filtration rate (eGFR). This association has, however, not been widely studied among nondiabetic hypertensive patients with CKD, especially in sub-Saharan Africa. We aimed to determine the prevalence and severity of hypertensive retinopathy and its relationship with eGFR among nondiabetic CKD patients seen at Muhimbili National Hospital in Dar es Salaam, Tanzania.Methods: A hospital-based cross-sectional study was conducted among nondiabetic CKD adult (≥18 years) patients with hypertension. A structured questionnaire was used to record patients’ demographic characteristics and their cardiovascular risk profile. eGFR was calculated using the Modification of Diet in the Renal Disease (MDRD) equation and only patients with CKD stage 3 or more were enrolled in the study. Grading of retinopathy was done using the Keith–Wagener classification.Results: In total, 224 patients fulfilled the inclusion criteria and were enrolled. Their mean age was 45.8±14.1 years, and 59.4% were men. The proportions of patients with stage 3, 4, and 5 CKD were 21.4%, 19.6%, and 58.9%, respectively. Hypertensive retinopathy was present in 157 (70.1%) patients and the proportions with grade I, grade II, grade III, and grade IV retinopathy were 17.9%, 18.8%, 19.6%, and 13.8%, respectively. The severity of retinopathy increased with decreasing levels of eGFR, and in multivariate logistic regression analysis, factors found to be independently associated with ≥grade II hypertensive retinopathy were more severe CKD, higher hypertension grades, and alcohol use, all p<0.05.Conclusion: The prevalence of hypertensive retinopathy is high among nondiabetic CKD patients seen at a tertiary hospital in Tanzania and is independently associated with CKD severity. Retinopathy grade can be used as a marker of CKD severity among these patients.

Background: The Surgical Implant Generation Network (SIGN) Fin nail is a relatively newer design of intramedullary nails that eliminates the requirement for distal locking. While various factors influencing treatment outcomes with different nail designs have been extensively studied, limited research has focused on the specific implications of using the SIGN Fin nail. Objective: This study aimed to assess the relationship between Fin nail canal fitting and treatment outcomes in femur fractures treated with the SIGN Fin nail at Muhimbili Orthopaedics Institute. Methods: A cross-sectional study was conducted at a tertiary hospital in Tanzania. Patients who underwent femoral fracture fixation with SIGN Fin nails between January 2016 and December 2021 were recruited from the SIGN surgical database. Radiographic measurements were performed using radiant software, fracture union at one year was assessed using the mRUST score, and weight-bearing status at 6 weeks was obtained from patient records. Results: The mean canal diameter was 11.30±1.75 mm, and 82.2% had a canal fill of 80% or more. The reoperation rate was 5.9% (7/118). Although not statistically significant, patients with canal fill less than 80% had a higher rate of reoperation (p = 0.074). The union rate was 84.1% in this study, with a mean mRUST score of 9.4, and those patients with a canal fill of less than 80% were more likely to have nonunion at 1 year (p = 0.028). Pain on weight bearing at 6 weeks was reported by 42.9% (24/118) of participants, and this was significantly associated with canal fitting (p &lt; 0.001). Conclusion: The study found the degree of canal fitting of the Fin nail to be an important factor affecting the outcomes of femoral fractures treated with SIGN Fin nails. A higher degree of canal fill was associated with better pain outcomes and lower nonunion rates.

Background: Hip joint replacement surgery or total hip arthroplasty (THA) is an effective procedure for elderly patients. It can improve their quality of life and functionality while reducing the direct costs associated with arthritis. With increased THA procedures being performed on patients of different ages, it is essential to identify factors that may affect mortality for better patient care. Objective: This study aimed to identify the early mortality rate and potential risk factors among patients undergoing primary total hip replacement (THR) at a tertiary hospital in Tanzania. Methodology: This was a retrospective cohort study conducted from January 2020 to December 2021, which involved patients who had undergone THR. Result: The study involved 183 participants, 53.6% of which were male with a mean age of 55.9 ± 18.4 years. Early mortality (death before 3 months) was found to be 7%. Having hypertension and being seropositive for HIV were independent prognostic factors for survival. Hypertension was associated with an increased chance of death by 4.8 times. The likelihood of death was eleven times higher among participants who were HIV+. Conclusion: Hypertensive patients had an increased chance of death of five times more compared to those with no hypertension. HIV+ patients had an increased chance of death, up to eleven times higher with difference in disease profiles and HIV endemicity in our settings this calls for a different approach to THR.

Objectives: This study focuses on the critical "Justification and Optimization" principles of radiation protection during pediatric chest X-ray (CXR) examinations, the most common radiographic procedure, to reduce unnecessary ionizing radiation exposure and enhance safety protocols. Given that children are particularly vulnerable to the long-term biological effects of ionizing radiation, such as cancer and hereditary conditions, this research evaluates the application of these principles at a tertiary hospital in Tanzania. Methods: A hospital-based, cross-sectional study was conducted on 320 pediatric patients who underwent AP/PA CXR examinations over six months. The "justification" of CXR requests was assessed by comparing them with the "European Radiology and Nuclear Medicine Pediatric Imaging Referral Guideline." The "optimization" of radiation protection was evaluated using six radiographic criteria: X-ray beam projection, collimation, rotation, console exposure parameters, repeated examinations, and the use of thyroid and abdominopelvic shielding. The study used frequencies, percentages, measures of central tendencies, Pearson Chi-square test, logistic regression, t-tests, and ANOVA for data analysis, with significance set at p&lt;0.05, all conducted using SPSS version 29.0. Results: Among the 320 participants, 57.2% were male, with the majority aged 1-5 years (41.9%), and a mean age of 3.2 years ± 1.6. Clinically unjustified CXR requests accounted for 36.6%, predominantly from outpatient departments (82.9%). Optimization failures were observed in AP projection (79.7%), collimation (69.7%), and rotation (63.8%) of the exams, particularly in children under five years old. Additionally, 11.6% of the CXR exams were unnecessarily repeated, and 36.9% did not meet optimal console exposure settings. No thyroid or abdominopelvic shielding was used in any examination. Conclusion: The findings reveal that approximately one-third of pediatric CXR exams were unjustified, and many were conducted using suboptimal techniques, highlighting the urgent need to strengthen the implementation of justification and optimization principles in pediatric radiography.

BackgroundStroke burden in young adults is growing associated with unique risk factors and devastating outcomes. We aimed to investigate the magnitude, risk factors and outcomes of first ever stroke in young adults ≤45 years compared to older adults > 45 years.MethodsAll patients with a World Health Organization clinical definition of stroke at a tertiary hospital in Tanzania were enrolled. The National Institute of Health Stroke Scale and Modified Rankin Scale were used to assess admission stroke severity and outcomes respectively. Kaplan-Meier analysis was used to describe survival and Cox-proportional hazards model was used to examine predictors of fatality.ResultsWe enrolled 369 first ever stroke participants over 8 months. First strokes accounted for one quarter of the medical admissions in both younger and older groups, 123/484 {(25.4%) [95% CI 21.5–29.3%]} and 246/919 {(26.8%) [95% CI 23.9–29.6%]} respectively. Hemorrhagic stroke occurred in 47 (42.3%) vs 62 (27.2%) for the young and old respectively p = 0.005. Factors associated with stroke in the young were: a new diagnosis of hypertension in 33 (26.8%) vs 23 (9.3%) p < 0.001, HIV infection 12 (9.8%) vs 7 (2.8%) p = 0.005, use of hormonal contraception in females 33 (48.5%) vs 13 (9.4%) p < 0.001, elevated serum low density lipoproteins 28 (27.7%) vs 29 (16.4%) p = 0.024, hypercholesteremia 34 (31.2%) vs 40 (20.2%), p = 0.031, sickle cell disease 11 (9.7%) vs 9 (4.2%) p = 0.047 and thrombocytosis 12 (16.9%) vs 8 (5.6%) p = 0.007. The overall 30-day fatality rate was 215 (61.3%); 57 (49.1%) vs 158 (67.2%) in the young and old respectively. Independent predictors of fatality were: severe stroke {HR 10.35 (95% CI: 1.397–76.613)}, leukocytosis {HR 2.23 (95% CI: 1.448–3.419)} and fever {HR 1.79 (95% CI: 1.150–2.776)}.ConclusionsThere is a high burden of stroke in young adults that is coupled with a high 30-day fatality rate. Screening and management of hypertension is crucial in the prevention of stroke. More research is needed to identify factors which cause death, allowing the development of sustainable interventions to reduce early post stroke fatality in this group.