Center In Tanzania Research Articles

Antiretroviral Therapy in Children Less Than 24 Months of Age at Pediatric HIV Centers in Tanzania: 12-Month Clinical Outcomes and Survival.

Without antiretroviral therapy (ART), approximately one-half of HIV-infected infants will die by two years. In 2010, the World Health Organization (WHO) recommended that all HIV-infected infants < 24 months be initiated on ART regardless of their clinical/immunologic status. However, there remains little published data detailing cohorts of infants on ART in Sub-Saharan Africa. This study describes baseline characteristics and 12 month outcomes of a cohort of HIV-infected children < 24 months of age at pediatric HIV centers in Mwanza and Mbeya, Tanzania. Retrospective chart review. children < 24 months of age, initiated on ART at Baylor Children s Foundation Tanzania clinics, between March-December 2011. Baseline: Ninety-three children were initiated on ART at a median age of 13.4 months. Sixty-seven percent had severe immunosuppression and 31.5% had severe malnutrition. Seventy-three patients were still in care at 12 month follow-up, there were four (4.3%) deaths, five (5.4%) patients transferred, and 11 (11.8%) loss to follow-up. Average CD4% was 32.7 (p < 0.001). Ninety percent of patients were WHO treatment stage I (p < 0.001). Eighty-six percent had normal nutritional status (p < 0.001). Our cohort of HIV infected children < 24 months initiated on ART did well clinically at 12 month outcomes despite being severely immunocompromised and malnourished at baseline. Nevirapine based regimens had good 12 month clinical outcomes, regardless of maternal exposure. Loss to follow-up rate was high for our cohort, demonstrating the need to develop strong mechanisms to counteract this.

Radiation Needs In Pediatric Oncology in the Lake Region Of Tanzania

Abstract 32 Background: The majority of new pediatric cancer diagnoses are made in resource-poor countries where survival rates range from 5-25%, compared with 80% in high-resource countries. A key component of treatment includes radiation therapy, but access is extremely limited in East Africa. This study estimates the potential clinical benefit of radiation therapy for pediatric oncology patients at Bugando Medical Centre (BMC), a tertiary referral center in the lake zone of Tanzania, one of two cancer treatment centers in Tanzania. Methods: Study design is a retrospective review of recorded hospital admissions and clinic visits to the oncology department at BMC from January 2010-December 2014. The indication for radiation therapy was extrapolated from contemporary SIOP and COG protocols. The benefits of radiotherapy, both for curative and palliative intent, were estimated based on age, diagnosis and stage at presentation by two radiation oncologists. Results: A total of 221 pediatric patients were identified. The most common recorded diagnoses were Burkitt lymphoma (n=36), other non-Hodgkin lymphoma (n=33), Wilms tumor (n=32), acute leukemia (n=28) and retinoblastoma (n=23). Treatment received included chemotherapy only for 163 patients (74%), surgery only for 5 patients (2%), and a combination of chemotherapy and surgery for 30 patients (14%). No patients received radiation therapy due to lack of availability at our center. For 77 patients (35%), staging information was insufficient and the potential benefit of radiation therapy could not be determined. Of the remaining 144 cases, radiation could have been included in the treatment plan for 49 patients (34%, 95% CI 26-42%). Of these, 41 patients (84%, 95% CI 74-94%) could have been treated with curative intent and 8 patients (16%, 95% CI 6-26%) could have benefitted from palliative radiation therapy. Conclusion: Radiation therapy is an essential treatment modality for pediatric cancer but has limited availability in East Africa. In our population, roughly one third of presenting patients would have benefitted from radiation as part of their treatment. Most patients who would benefit from radiation therapy would be treated with curative intent. Introducing radiation has the potential to significantly improve pediatric cancer outcomes in the lake zone of Tanzania. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

Clinicopathological pattern of benign breast diseases among female patients at a tertiary health institution in Tanzania

Background: Benign breast diseases are a neglected entity in developing countries despite the fact that they constitute the majority of breast complaints. There is a paucity of published information regarding benign breast diseases in Tanzania. This study describes our experience in the management of benign breast diseases outlining the clinicopathological pattern and treatment modalities of these diseases in our local setting.Methods: This prospective descriptive study was conducted between November 2009 and March 2013 at Bugando Medical Centre in Tanzania on female patients aged 10 years and above presenting with benign breast diseases.Results: A total of 346 female patients with benign breast diseases were studied. The majority of patients, 255 (73.7%) were younger than 30 years. Breast lump was the most frequent presentation in 67.6% of patients. Fibroadenoma 95 (60.0%) was the most frequently diagnosed benign breast disease followed by fibrocystic changes (19.0%). Out of 295 patients who had histopathological examination, 64 (21.7%) had proliferative lesions. Of these, 18 (28.1%) had proliferative lesions with atypia while 46(71.9%) had proliferative lesions without atypia. Eight (2.6%) patients were HIV positive with the median CD 4+ count of 258 cells/μl. The majority of patients, 295(85.2%) underwent surgical treatment of which lumpectomy was the most common procedure performed. Conclusion: Benign breast diseases are more common than malignancies in our environment and occur mainly in young women less than 30 years of age and were mostly fibroadenoma and fibrocystic change. Though premalignant lesions of proliferative lesions with atypia were less common in this study, it is advisable that all cases of breast lesions should be carefully evaluated to exclude possibility of breast cancer.

Factors Associated with Repeat Blood Donation at the Northern Zone Blood Transfusion Centre in Tanzania.

Background and Objective. The aim of this study was to determine factors associated with repeat blood donation. Methods. This was a cross-sectional study carried out among blood donors aged 18–65 years in northern Tanzania. The questionnaire was administered among 454 participants through the phone. Results. Of the 454 participants, the proportion of repeat donation was 63.9%. In the backward logistic regression analysis, the significant predictors were living in Arusha which had lower odds of repeat donation compared to those living in Kilimanjaro. Knowledge of time interval between donations increased odds of repeating donations. High intention increased odds of repeat donation compared to low intention. Altruistic score had minor effect on increasing odds of repeating donation. Conclusion. Repeat blood donation is affected by proximity of donating site, awareness of the blood donation interval, intention to donate, and experience on previous donation. We recommend continuous education concerning blood donors and donation among health workers and society as a whole; this will create awareness on motivational factors for repeat donations.

Estimation of indices of health service readiness with a principal component analysis of the Tanzania Service Provision Assessment Survey.

BackgroundService Provision Assessment (SPA) surveys have been conducted to gauge primary health care and family planning clinical readiness throughout East and South Asia as well as sub-Saharan Africa. Intended to provide useful descriptive information on health system functioning to supplement the Demographic and Health Survey data, each SPA produces a plethora of discrete indicators that are so numerous as to be impossible to analyze in conjunction with population and health survey data or to rate the relative readiness of individual health facilities. Moreover, sequential SPA surveys have yet to be analyzed in ways that provide systematic evidence that service readiness is improving or deteriorating over time.MethodsThis paper presents an illustrative analysis of the 2006 Tanzania SPA with the goal of demonstrating a practical solution to SPA data utilization challenges using a subset of variables selected to represent the six building blocks of health system strength identified by the World Health Organization (WHO) with a focus on system readiness to provide service. Principal Components Analytical (PCA) models extract indices representing common variance of readiness indicators. Possible uses of results include the application of PCA loadings to checklist data, either for the comparison of current circumstances in a locality with a national standard, for the ranking of the relative strength of operation of clinics, or for the estimation of trends in clinic service quality improvement or deterioration over time.ResultsAmong hospitals and health centers in Tanzania, indices representing two components explain 32 % of the common variance of 141 SPA indicators. For dispensaries, a single principal component explains 26 % of the common variance of 86 SPA indicators. For hospitals/HCs, the principal component is characterized by preventive measures and indicators of basic primary health care capabilities. For dispensaries, the principal component is characterized by very basic newborn care as well as preparedness for delivery.ConclusionsPCA of complex facility survey data generates composite scale coefficients that can be used to reduce indicators to indices for application in comparative analyses of clinical readiness, or for multi-level analysis of the impact of clinical capability on health outcomes or on survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1203-7) contains supplementary material, which is available to authorized users.

Cost-effectiveness of live oral attenuated human rotavirus vaccine in Tanzania

BackgroundGlobally, diarrhoea is the second leading cause of morbidity and mortality, responsible for the annual loss of about 10% of the total global childhood disease burden. In Tanzania, Rotavirus infection is the major cause of severe diarrhoea and diarrhoeal mortality in children under five years. Immunisation can reduce the burden, and Tanzania added rotavirus vaccine to its national immunisation programme in January 2013. This study explores the cost effectiveness of introducing rotavirus vaccine within the Tanzania Expanded Programme on Immunisation (EPI).MethodsWe quantified all health system implementation costs, including programme costs, to calculate the cost effectiveness of adding rotavirus immunisation to EPI and the existing provision of diarrhoea treatment (oral rehydration salts and intravenous fluids) to children. We used ingredients and step down costing methods. Cost and coverage data were collected in 2012 at one urban and one rural district hospital and a health centre in Tanzania. We used Disability Adjusted Life Years (DALYs) as the outcome measure and estimated incremental costs and health outcomes using a Markov transition model with weekly cycles up to a five-year time horizon.ResultsThe average unit cost per vaccine dose at 93% coverage is US$ 8.4, with marked difference between the urban facility US$ 5.2; and the rural facility US$ 9.8. RV1 vaccine added to current diarrhoea treatment is highly cost effective compared to diarrhoea treatment given alone, with incremental cost effectiveness ratio of US$ 112 per DALY averted, varying from US$ 80–218 in sensitivity analysis. The intervention approaches a 100% probability of being cost effective at a much lower level of willingness-to-pay than the US$609 per capita Tanzania gross domestic product (GDP).ConclusionsThe combination of rotavirus immunisation with diarrhoea treatment is likely to be cost effective when willingness to pay for health is higher than USD 112 per DALY. Universal coverage of the vaccine will accelerate progress towards achievement of the child health Millennium Development Goals.

Survival and its determinants of Kaposi sarcoma in Tanzania: Retrospective study.

e20607 Background: Kaposi Sarcoma is the most common sarcoma and second most prevalent cancer seen in Tanzania. Its affect all age groups and strongly associated with AIDS. Little is known about disease/patients characteristics and survivorship in our settings, therefore this study expected to determine patients survival and its associated factors in Tanzania. Methods: Retrospective descriptive study using structured questionnaires. Patients with Kaposi Sarcoma diagnosed and treated at Ocean Road Cancer Institute, the only cancer care center in Tanzania were followed-up retrospectively using their hospital records and mobile phone communication system, with 199 patients included in the study. Descriptive, Bi-variate Analysis, Ordinal Regression, Life Tables and Kaplan Meier survival analysis as well as SPSS 16.0 and Log rants validity test were used during data analysis. Results: Mean age at KS diagnosis was 40 ± 12.012 yrs, with male (42.60 ± 12.6 yrs) population older than female ( 35.1 ± 9.7 yrs) . Patients waited 30 ± 120 days after diagnosis before start of treatment. Male : Female ratio was 1.6:1, with radiotherapy (82%) found to be most preferred modality of treatment. Skin (87.3%) was most primary organ affected followed by oral cavity (12.2%). Median and average survival of KS patients were 8 ± 0.613 months and 15.863 ± 1.407 months respectively. Primary organ affected and patient residence found significantly to influence survival while age, sex, treatment modality, hemoglobin level, time taken waiting for treatments found to be insignificant survival predictors. Serum white cell and platelets counts have not shown to influence survival with HIV found to affect 90% of Kaposi Sarcoma patients. Conclusions: Social demographic features, overall and median survival of patients with Kaposi Sarcoma in Tanzania, is closely related to other countries with similar settings but the latter two were significantly low compared to developed countries; This might be caused by differences in disease profile, late presentation, poor diagnostic and treatment resources seen in Tanzania compared with other settings.

A seminar on gardens for the health of the skin

This is a report on a seminar held on January 12, 2013, at the Regional Dermatology Training Centre in Tanzania, sponsored by the International Society of Dermatology as part of its Taskforce Program for Skin Care for All: Community Dermatology. There were four themes: (i) Gardens attached to health centers increase their attractiveness and result in increased attendance and, thus, increase the utilization of effective skin care interventions. Literature on the positive effect of greenery surrounding health centers on health and the environment is reviewed. (ii) Adding an expert on agriculture to the staff of health centers in Rwanda has provided nutrition and safe medicines. (iii) In southern India, these interventions are channeled through the empowerment of tribal women in an area noted for anxiety due to unemployment in the tea and forestry industry. The gardens are used for teaching about nutrition and herbal medicines, and the women are further attracted by childcare facilities. (iv) Measuring barrier function defects gives early warning of malnutrition of the skin after damage by trauma or by ultraviolet radiation. Higher cost research techniques may help to provide the science required to produce its evidence base. In conclusion, Gardens for health should be adopted as policy by skin care providers.

Pre ART attrition and its associated factors in care and treatment centres in Tanzania 2010-2011

Pre ART attrition and its associated factors in care and treatment centres in Tanzania 2010-2011

Applying the theory of planned behavior to explain geospatial data sharing for urban planning and management: cases from urban centers in Tanzania

This paper illustrates the potential use of the theory of planned behavior as a guiding framework for understanding intentions and behavior in geospatial data sharing in Tanzania. A structured questionnaire survey, was constructed and sent to local governments as well as academic and private organizations that are major producers and/or users of geodata. The questionnaire covered issues of how collection of geodata is financed, management of geospatial data, and compatibility of spatial data-sets. The theory was found to be generally effective in accounting for intentions to share geospatial data in Tanzania (p < .01). Results show potential for data sharing between local governments and other organizations in Tanzania, and it is suggested that creating awareness among spatial data stakeholders and the establishment of a spatial data infrastructure policy framework will speed up geospatial data sharing.

Labour management and Obstetric outcomes among pregnant women admitted in latent phase compared to active phase of labour at Bugando Medical Centre in Tanzania

BackgroundInterventions given to women admitted in latent or active phase of labor may influence the outcomes of labor and ameliorate complications which can affect the mother and fetus. Labour management, maternal and fetal outcomes among low risk women presenting both in latent phase and active phase of labour in Tanzania have not recently been explored.MethodsThis was a descriptive cross-sectional study. It was done from February to April 2013. Case notes were collected serially until the sample size was reached. A structured checklist was used to extract data. Data was analyzed using SPSS version 17. A p < 0.05 was considered significant at 95% confidence interval.ResultsFive hundred case notes of low risk pregnant women were collected, half of each presented in latent phase and active phase of labour. Key interventions including augmentation with oxytocin, artificial rupture of membranes and caesarean section were significantly higher in the latent phase group than the active phase group 84(33.6%) versus 52(20.8%) p < 0.05; 96(38.6%) versus 56(22.4%) p < 0.05 and 87(34.8%) versus 60(24.0%) p < 0.05 respectively. Spontaneous vertex delivery was higher among pregnant women admitted initially in active phase than in latent phase groups 180(72.0%), versus 153(61.2%) p > 0.01). There were more women in the active phase group who sustained genital tract tear and postpartum haemorrhage than in the latent phase group 101(18.6%), versus 38(15.6%) p < 0.01 and 46(18.4%), versus 17(6.6%) p < 0.05 respectively.ConclusionsPregnant women admitted at BMC in latent phase of labour are subjected to more obstetric interventions than those admitted in the active phase. There is need to produce guidelines on management of women admitted in latent phase of labour at BMC to reduce the risk of unnecessary interventions.

The Social Dimension of Sustainable Development: Social Inclusion in Tanzania’s Urban Centres

One of the challenges confronting cities in the developing world is social exclusion and marginalization of the poor. This has been observed in terms of large scale informalities in settlements growth, employment and livelihood activities. Inadequate infrastructure, diminishing access to basic services and livelihood opportunities are increasingly precipitating social exclusion in cities. In Tanzania, the policy shift from social welfare to liberal economies is contributing to marginalization and subsequently, exclusion of poor households in accessing basic services. This paper discusses the social dimension of sustainability viewed from social inclusion point of view. Eight major urban centres in Tanzania are being examined. The data collection methods included household interviews, review of documents, workshops and group discussion. Results show that with the exception of access to education and health services, cities are poorly performing in terms of access to water supply, income versus cost of living, employment, services to the handicapped and ownership of properties by sex. Quality of life elements such as sanitation and urban informality also remains below average. While informality in cities accounted for 66 percent (in terms of built up areas), access to onsite potable accounted for only 36.9 percent. On the bases of these findings, it is recommended that strategies such as cross subsidization and addressing informalities should be developed and implemented with a view to ensuring social inclusion in cities.

Risks, precipitants and clinical presentation of gastro-oesophageal reflux disease at the Kilimanjaro Christian medical centre in Tanzania [corrected

IntroductionRisk factors and precipitants of gastro-oesophageal disease (GERD) differ widely in communities. We conducted an observational study to describe these risks, precipitants and clinical presentation of GERD patients at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania.MethodsWe consecutively recruited 92 GERD patients who were referred for endoscopy at KCMC from March to November 2008. By using structured questionnaire we enquired: risk factors, precipitants and symptoms of GERD and upper gastrointestinal endoscopic findings. Their upper gastrointestinal endoscopic findings were as well documented.ResultsThe mean (± SD) age of the study population was 47.32 (±17) years. Reported symptoms included water brash (37%), dyspepsia (6%), chronic cough (11%) and hemoptysis (5%). More than half (56%) of the patients surveyed identified food precipitants for their GERD symptoms. Triggers of GERD symptoms were boiled beans 19%, spicy food 11%, sour/fermented meals 10%, roasted tomato 9%, silver cyprinid fish (dagaa) 5%, beans with cooked green banana (matoke) 2% and fermented milk 1%. Most of the studied patients had normal body mass index (52%), and 25% admitted to be consuming alcohol though they didn't associate it with their GERD symptoms. The most common endoscopy finding was “loose lower oesophageal sphincter” (85%).ConclusionMost GERD patients referred for endoscopy at KCMC were found to have water brash and “loose lower oesophageal sphincters” as described by endoscopists to denote mechanical abnormality of the lower oesophageal sphincter. GERD symptoms were precipitated by common locally available food and spices.

Challenges in managing paediatric osteomyelitis in the developing world: analysis of cases presenting to a tertiary referral centre in Tanzania.

The literature on paediatric osteomyelitis in the developing world is scarce, and there have been calls for further characterisation of its epidemiology and the identification of factors that limit effective management in order to guide local service delivery. Our centre is a hospital serving a population of 11 million people in Tanzania. We identified patients <18 years admitted between 1 st January 2008 and 31 st December 2010 with a diagnosis of osteomyelitis through a search of admission logbooks. Patient notes were reviewed for information regarding the nature of the presentation, treatment given and outcome, with the primary outcome measure being recurrence of infection at follow-up. A total of 63 patients were identified, notes available for 55: 40 males and 15 females, mean age of 11 years. The most common sites were the tibia and femur with other sites including the skull, humerus and foot. At presentation, 8 cases were categorised as acute, 5 as acute with X-ray changes, 40 as chronic localised and 2 as chronic systemic.A total of 11 patients were treated with antibiotics only, 11 with incision and drainage and 30 with surgical debridement. Bacterial cultures were available in 11 cases. all Staphylococcus aureus tested were gentamicin-sensitive, but at least one patient had S. aureus resistant to cloxacillin, erythromycin, co-trimoxazole, tetracycline or a combination of these. Of 29 patients attending follow-up, 20 made a full recovery and 9 developed recurrence of infection. Eight out of nine with recurrence had time from symptom onset to presentation of >3 months. Twelve out of 13 with a time from symptom onset to presentation of <2 months did not develop recurrence. This is, to the best of our knowledge, the second largest study of paediatric osteomyelitis in the developing world. Major challenges facing this centre include a lack of availability of bacterial cultures and failure to attend follow-up. Delayed presentation of osteomyelitis to our centre is associated with recurrence of infection.

The implementation of an external quality assurance method for point- of- care tests for HIV and syphilis in Tanzania

BackgroundExternal quality assurance (EQA) programmes, which are routinely used in laboratories, have not been widely implemented for point-of- care tests (POCTs). A study was performed in ten health centres in Tanzania, to implement the use of dried blood spots (DBS) as an EQA method for HIV and syphilis (POCTs).MethodDBS samples were collected for retesting at a reference laboratory and the results compared to the POCT results obtained at the clinic. In total, 2341 DBS samples were collected from 10 rural health facilities over a period of nine months, of which 92.5% were correctly collected and spotted.ResultsThe EQA method was easily implemented by healthcare workers under routine conditions in Northern Tanzania. For HIV, 967 out of 972 samples (99.5%) were concordant between DBS and POCT results. For syphilis, the sensitivity of syphilis tests varied between clinics with a median of 96% (25th and 75th quartile; 95-98%). The specificity of syphilis POCT was consistent compared to laboratory based test using DBS, with a median of 96% (25th and 75th quartiles; 95-98%).ConclusionOverall, the quality of testing varied at clinics and EQA results can be used to identify clinics where healthcare workers require remedial training, suggesting the necessity for stringent quality assurance programmes for POC testing. As Tanzania embarks on scaling up HIV and syphilis testing, DBS can be a useful and robust tool to monitor the quality of testing performed by healthcare workers and trigger corrective action to ensure accuracy of test results.

Occupational injuries and fatalities in a tanzanite mine: Need to improve workers safety in Tanzania.

IntroductionWork related injuries are common, and the mining industry accounts for a significant proportion of these injuries. Tanzania is among the countries with high rates of mining injuries, nevertheless pre-hospital care is almost non existant and health care service deliveries are poor. This study sought to identify factors associated with injuries and fatalities among miners in Mererani, Tanzania.MethodsA Cross - Sectional study of miners who sustained injuries and seen at Mererani health centre between January 2009 and May 2012.ResultsIn the selected period 248 injury patients were seen. All were males, and 54% were between 18 - 30 years age-group. Almost all (98.7%) didn’t use protective gears at work, and worked for more than 12 hours daily. Falling rocks were the leading cause of injury (18.2%), and majority sustained multiple injuries (33%). Of the patients seen, 41.3% died. The following were more likely to die than others; Primary education (p = 0.04), Less than 5 years work experience (p = 0.000), unintentional injuries (p = 0.000), fall injuries (p = 0.000) and sustaining multiple injuries (p = 0.000).ConclusionThe burden of injuries and fatalities demonstrated in this study, point to the need for implementation and monitoring of the use of safety equipment and operating procedures of the mines by government and other regulatory authorities. Initiation of pre hospital care at the mines and improved emergency medical service delivery at health centers in Tanzania.

Nutritional Deficiencies and Food Insecurity Among HIV-infected Children in Tanzania

Poor nutrition has been associated with impaired immunity and accelerated disease progression in HIV-infected children. The aim of this study was to quantify the levels of nutrient intake in HIV-infected children and compare these to standard recommendations. We surveyed HIV-infected Tanzanian children enrolled in a pediatric care program that provided routine nutritional counseling and vitamin supplementation. We obtained anthropometric measurements and determined 24-hour macronutrient and micronutrient intakes and food insecurity. Values were compared to recommended nutrient intakes based on age and gender. We interviewed 48 pairs of children and their caregiver(s). The age of the child ranged from 2-14 years; median age 6 and 60% female. The median weight-for-height z-score for children ≤ 5 years was 0.69 and BMI-for-age z-scores for children >5 was -0.84. Macronutrient evaluation showed that 29 (60%) children were deficient in dietary intake of energy; deficiency was more common in older children (p=0.004). Micronutrient evaluation shows that over half of study subjects were deficient in dietary intake of vitamin A, vitamin D, vitamin E, thiamine, riboflavin, niacin, folate, vitamin B12, and calcium. Food insecurity was reported by 20 (58%) caregivers. The diets of many HIV-infected children at a specialized treatment center in Tanzania do not meet recommended levels of macro-and micro-nutrients. Food insecurity was a contributory factor. Enhanced dietary counseling and provision of macro- and micro-nutrient supplements will be necessary to achieve optimal nutrition for most HIV-infected children in resource-poor regions.

Improved services to enrollees into an HIV rural care and treatment center in Tanzania

Better quality of services is essential for the sustainability of HIV programs, in particular in rural Sub-Saharan Africa, to support the increasing number of individuals treated with combination antiretroviral therapy (cART). However, longitudinal data from rural care and treatment centers (CTC) are scarce. The objective was to assess trend in quality of care for HIV infected persons before start of combination antiretroviral therapy (pre-ART). A retrospective analysis of pre-ART registers and patient's files of 1950 patients enrolled in the Bagamoyo CTC in Tanzania between 2008 and 2010 analyzing was conducted; with parameters including year of enrollment, gender, age, CD4 cell count and WHO clinical stage at time enrollment. We noted a significant increase by 20% of total patients who had CD4 cell count performed from 69% (n=457) in 2008, 83% (n=493) 2009 to 89% (n=616) 2010 (X2= 87.014, P2= 14.945, P2= 85.028, P3. Efforts must be undertaken for more HIV testing and timely referral of HIV-infected patients to CTC.

APOPO's tuberculosis research agenda: achievements, challenges and prospects.

This article describes Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) recent use of specially trained African giant pouched rats as detectors of pulmonary tuberculosis in people living in Tanzania. It summarizes the achievements and challenges encountered over the years and outlines future prospects. Since 2008, second-line screening by the rats has identified more than 2000 tuberculosis-positive patients who were missed by microscopy at Direct Observation of Treatment--Short Course centres in Tanzania. Moreover, data that are reviewed herein have been collected with respect to the rats' sensitivity and specificity in detecting tuberculosis. Findings strongly suggest that scent-detecting rats offer a quick and practical tool for detecting pulmonary tuberculosis and within the year APOPO's tuberculosis-detection project will be extended to Mozambique. As part of its local capacity building effort, APOPO hires and trains Tanzanians to play many important roles in its TB detection project and provides research and training opportunities for Tanzanian students.

Characterization of Symptoms Immediately Preceding Eclampsia

To characterize the symptoms that immediately precede eclamptic seizures. We did a prospective observational study of all women admitted to a single center in Tanzania between May 1, 2007 and April 30, 2008 who had an eclamptic seizure. During their admission they were asked a uniform set of questions related to symptoms preceding the seizure. There were 3,267 deliveries and 46 cases of eclampsia (1.4%). Neurologic symptoms (headache [80%] with or without visual disturbance [45%]) were the most common prodrome symptoms, regardless of degree of hypertension or whether the seizure occurred antepartum or postpartum. Twenty percent of women with eclampsia reported no neurologic symptoms before seizure. Neurologic symptoms commonly precede eclampsia. A minority of patients with eclampsia (17%) had no prodromal symptoms before their eclamptic seizure. Premonitory symptoms may provide an early warning of imminent eclampsia.