Mnazi Mmoja Hospital Research Articles

Predominance of multidrug-resistant Salmonella Typhi genotype 4.3.1 with low-level ciprofloxacin resistance in Zanzibar.

Typhoid fever is a common cause of febrile illness in low- and middle-income countries. While multidrug-resistant (MDR) Salmonella Typhi (S. Typhi) has spread globally, fluoroquinolone resistance has mainly affected Asia. Consecutively, 1038 blood cultures were obtained from patients of all age groups with fever and/or suspicion of serious systemic infection admitted at Mnazi Mmoja Hospital, Zanzibar in 2015-2016. S. Typhi were analyzed with antimicrobial susceptibility testing and with short read (61 strains) and long read (9 strains) whole genome sequencing, including three S. Typhi strains isolated in a pilot study 2012-2013. Sixty-three S. Typhi isolates (98%) were MDR carrying blaTEM-1B, sul1 and sul2, dfrA7 and catA1 genes. Low-level ciprofloxacin resistance was detected in 69% (43/62), with a single gyrase mutation gyrA-D87G in 41 strains, and a single gyrA-S83F mutation in the non-MDR strain. All isolates were susceptible to ceftriaxone and azithromycin. All MDR isolates belonged to genotype 4.3.1 lineage I (4.3.1.1), with the antimicrobial resistance determinants located on a composite transposon integrated into the chromosome. Phylogenetically, the MDR subgroup with ciprofloxacin resistance clusters together with two external isolates. We report a high rate of MDR and low-level ciprofloxacin resistant S. Typhi circulating in Zanzibar, belonging to genotype 4.3.1.1, which is widespread in Southeast Asia and African countries and associated with low-level ciprofloxacin resistance. Few therapeutic options are available for treatment of typhoid fever in the study setting. Surveillance of the prevalence, spread and antimicrobial susceptibility of S. Typhi can guide treatment and control efforts.

Detection of Biofilm Formation and Antibiotic Susceptibility in Escherichia coli Isolated from the Urine of Pregnant Women at Mnazi Mmoja Hospital, Zanzibar, Tanzania

Detection of Biofilm Formation and Antibiotic Susceptibility in Escherichia coli Isolated from the Urine of Pregnant Women at Mnazi Mmoja Hospital, Zanzibar, Tanzania

Staff Capacity and Management of Diabetic Patients at Mnazi Mmoja Hospital in the Urban District of Unguja, Zanzibar

Non-communicable diseases (NCDs) stand as a formidable global public health challenge, casting a shadow over populations and contributing significantly to global mortality rates. Among the primary culprits in this health crisis are cardiovascular diseases, diabetes, chronic respiratory diseases, and cancer. This study zeroes in on a critical facet of this challenge - the staff capacity and management of diabetic patients at Mnazi Mmoja Hospital in the Urban District of Unguja, Zanzibar. The urgency of this research is accentuated by the staggering statistic that approximately 415 million people worldwide are grappling with diabetes, catapulting it into the forefront of global health emergencies in the twenty-first century. In response to this pressing need, 205 questionnaires were distributed among diabetes health workers at Mnazi Mmoja Hospital, creating a comprehensive foundation for analysis. Employing statistical techniques with SPSS version 26, the study sought to unravel the intricate landscape of staff knowledge and the challenges faced in managing diabetic patients.
 The findings of the study paint a nuanced picture, revealing that 38.6% of the staff possessed specialized knowledge in managing diabetic patients, while 61.4% had general knowledge. Alarmingly, only 36.3% of diabetic health workers were available for the management of diabetic patients. The study sheds light on the multifaceted challenges faced by the staff, with issues related to equipment, drugs, support from relatives, psychotherapy treatment, and drug adherence and compliance all surfacing as significant concerns, reported by varying percentages. In the face of these challenges, the study underscores a compelling message: the critical importance of hospital management in recruiting staff with expertise in diabetic treatment and care. This strategic hiring approach is seen as a linchpin for ensuring the efficient and effective management of diabetic patients. Moreover, the study advocates for ensuring the availability of adequate equipment, medical supplies, and materials essential for investigating diabetes and its complications, such as diabetic foot, renal failure, and cardiovascular diseases. This comprehensive approach is deemed crucial for providing holistic care to patients grappling with the complexities of diabetes.

Assessing Factors Affecting Pharmaceutical Management Practices in Zanzibar Public Health Institutions: A case study of Mnazi Mmoja Hospital (MMH)

The study aimed to assess variables that affect pharmaceutical management practices in Zanzibar public health institutions, using Mnazi Mmoja Hospital (MMH) as a case study. Specifically, the research assessed how inventory management techniques, staff inventory control abilities, budgetary restrictions, and the regulatory environment that supports pharmaceutical management techniques all affected management practices. 150 respondents were selected using a purposive sampling technique, the study adopted a descriptive research design to establish the relationship between the studied variables. The quantitative data were descriptively analyzed and the results indicated that pharmaceutical inventory management practice scores were both positively related to regulatory framework budget constraints and inventory control systems. Pharmaceutical inventory management practice was influenced strongly by 0.965 in the presence of regulations and very lowly influenced by 0.047 and 0.028 for budget constraints and Inventory control systems. There was a negative low influence on pharmaceutical inventory management practice by 0.030 in inventory control skills. The study found that manual inventory control systems were used. There was dissatisfaction among users on the procured pharmaceutical products. The study concludes that a pharmaceutical inventory management system needs to be streamlined by introducing modern inventory control systems like barcode scanners and Radio Frequency Identification.

Quality of life and associated factors among infertile women attending infertility clinic at Mnazi Mmoja Hospital, Zanzibar

BackgroundWorldwide, it is estimated at least 50 million couples are affected by infertility with the prevalence of infertility being 16% in Tanzania. Psychological impact of infertility in patients negatively affects women’s Quality of Life (QoL) defined as a person`s perception of where they are in life in terms of culture and value in the emotional, mind-body, relational, social, environment and tolerability of treatment aspects. Poor Quality of Life is related to increased treatment discontinuation. The aim of this study was to determine the Quality of Life and associated factors among infertile women attending infertility clinic at Mnazi Mmoja Hospital, Zanzibar.MethodsA hospital based cross–sectional study was conducted among 340 infertile women attending infertility clinic at Mnazi Mmoja Hospital, Zanzibar. Data was collected using FertiQoL tool. The factors associated with Quality of Life using FertiQoL tool in infertile women were estimated in a multivariable linear regression model at 95% confidence interval and 5% level of significance.ResultsQuality of life of infertile women at Mnazi Mmoja infertility clinic was 70.6 ± 10.0 on a scale of 0 to 100. It increased significantly with increase in educational level (p = 0.009). Women with female individual causes on average had 5.07 (B=- 5.07, 95%CI: -7.78, -2.35) and women with individual and respective male partner causes of infertility had on average 4.95 (B= -4.95, 95% CI: -7.77, -2.12) respective decrease in the FertiQoL scores compared to those who had their male partner with problems as reason for infertility. There was an average 4.50 (B=-4.50, 95% CI: 2.30, 6.70) decrease in quality of life in women with secondary infertility compared to women with primary infertility. Every month increase in duration of infertility led to an average of 0.04 (B=-2.57, 95%CI: -0.07, -0.01) decrease in FertiQoL scores.ConclusionThe overall quality of life in this population was positively associated with level of education but negatively affected with reason for infertility, type of infertility and duration of infertility.

Biochemical Changes in Salivary pH and Its Correlation to Hemoglobin Levels, Calcium and Phosphate Ion Concentrations among Pregnant Women, Tanzania: A Cross-Sectional Study

Background: Surveys in Tanzania show that pregnant women have a significant burden of oral disease, although there is still little literature on the variation of their intraoral electrolytes. The present study investigated changes in salivary calcium (Ca2+), phosphate (PO43−), and hydrogen (H) ions during pregnancy and the correlation between salivary pH and hemoglobin levels. Methodology: A cross-sectional study involved sixty (60) pregnant women stratified by trimester and twenty (20) non-pregnant women attending an antenatal clinic at Mnazi Mmoja Hospital. Consecutive sampling was used, saliva was collected, and electrolyte levels were measured. Gestation age was the independent variable, whereas saliva pH and calcium and phosphate ion concentrations and hemoglobin levels were the dependent variables. Results: A difference in calcium concentration (z = −3.145, p = 0.001) and salivary pH (t = −2.49, p = 0.014) was observed between pregnant and non-pregnant women. Kruskal–Wallis tests for saliva Ca2+ and PO43− and ANOVA for saliva pH revealed differences in concentrations of saliva Ca2+, PO43−, and pH levels between trimester groups (saliva Ca2+ (H = 9.91, df = 3, p = 0.019), saliva PO43− (H = 12.36, df = 3, p = 0.006), saliva pH (F (3.76) = (16.42); p < 0.001)). Pearson’s correlation tests showed no association between salivary pH and hemoglobin levels. Conclusions: Pregnancy is associated with a reduction in saliva pH and saliva calcium levels with a progressive increase in the magnitude of reduction from the first trimester to the third trimester. Saliva phosphate reduction was noticed during the third trimester only and saliva pH levels were independent of hemoglobin levels.

Stepping Towards Improved Audit Quality: The Outcome of Caesarean Section Using the Robson Ten Group Classification System at Mnazi Mmoja Hospital, Zanzibar

Stepping Towards Improved Audit Quality: The Outcome of Caesarean Section Using the Robson Ten Group Classification System at Mnazi Mmoja Hospital, Zanzibar

Prevalence and Detection of Pharmaceuticals in Hospital Wastewater: A Case of Referral and District Hospitals in Zanzibar

Despite the great efforts taken by the developed and some developing countries in managing the release of pharmaceuticals from their primary sources to the environment; the pharmaceutical wastewater management in Zanzibar-Tanzania still has not received much attention as a bulk of pharmaceuticals and their metabolites are released to the environment without proper treatment. Therefore, this study has scrutinized the incidence of pharmaceuticals in wastewater released from the referral and district hospitals in Zanzibar, to ascertain the levels of pharmaceuticals present in hospital wastewater. Purposive sampling was implemented to collect a total of seventy-two (72) wastewater samples in a period of six months (March-August 2022). Samples were collected in the effluent of wastewater-streams (Mnazi Mmoja Hospital, MMH) and pit latrines (Kivunge District Hospital (KDH) and Makunduchi District Hospitals (MDH)). The pharmaceuticals in these samples were obtained via the solid phase extraction after which they were analyzed using the LC-tandem MS (Agilent 1,290 LC coupled to 6,460-triple quadrupole MS). The limit of detections (LODs) and limit of quantitations (LOQs) for the determination of pharmaceuticals were in the range of 0.021-0.037 μg L-1 and 0.033-0.059 μg L-1, respectively. The detected analytes belonged to antibiotics, anti-inflammatory, benzodiazepine, antipsychotic, antipyretic and anticonvulsant (anti-epileptic) drugs. Diclofenac (DIC), paracetamol (PCT), ciprofloxacin (CIP), sulfamethoxazole (SMZ) and azithromycin (AZM) were detected at higher concentrations (> 0.25 μg L-1) in wastewater samples collected from KDH and MDH. Lower concentrations of pharmaceuticals (< 0.10 µg L-1) were identified in MMH wastewater samples. These present findings provide estimable information on the incidence of pharmaceuticals in wastewater that can assist in strengthening the environmental strategies for the protection of marine and terrestrial life from pharmaceutical pollution in Zanzibar.

Healthcare Disparity in East African Island Hospital, A Neurological Perspective (P4-7.006)

<h3>Objective:</h3> To report on an International Medical Elective in East Africa, a disastrous capsized ferry accident, and the ensuing medical management with a focus on neurological care. <h3>Background:</h3> Medical student elective is an excellent opportunity to gain valuable cross-cultural experience and become familiar with different healthcare systems around the world. My experience was in Mnazi Mmoja hospital, a small referral hospital in Zanzibar. I participated in several services, including Paediatrics, Obstetrics, and Surgery. Lack of sufficient funding, deviation from standards of practice, and paternalistic mode of practice were especially evident during this international experience. Students who elect to spend time learning in developing countries must remain cognisant of their limitations and competencies. There is a need in developing countries for a more structured exchange program that would be mutually beneficial, with a particular focus on neurology exchange programs <h3>Design/Methods:</h3> Field report <h3>Results:</h3> During this elective time, I was witness to a capsized ferry accident where hundreds of people lost their lives. We were a group of medical students on an elective during this disaster. We were called upon to assist in the search and rescue mission and to provide immediate life support. Patients with traumatic brain injuries, convulsions, and other neurological presentations often did not receive adequate care due to insufficient personnel and equipment. A portion of the elective was spent on obstetrics service, during which we assisted with deliveries. Often there were several women on separate birthing tables; at times, there was a lack of adequate analgesia and aseptic procedures, contributing to both infant and maternal mortality. <h3>Conclusions:</h3> Medical electives in developing countries are an excellent opportunity to learn and gain exposure to the diverse, multicultural health system, which will be an asset in reducing unconscious biases in healthcare. To gain maximum benefits, a student must remain open-minded, vigilant, and professional throughout the experience. <b>Disclosure:</b> Dr. Kakawand has nothing to disclose.

Maternal perception of fetal movements: Views, knowledge and practices of women and health providers in a low-resource setting.

The study assessed perception, knowledge, and practices regarding maternal perception of fetal movements (FMs) among women and their healthcare providers in a low-resource setting. Semi-structured interviews, questionnaires and focus group discussions were conducted with 45 Zanzibar women (18 antenatal, 28 postpartum) and 28 health providers at the maternity unit of Mnazi Mmoja Hospital, Zanzibar, Tanzania. Descriptive and thematic analyses were conducted to systematically extract subthemes within four main themes 1) knowledge/awareness, 2) behavior/practice, 3) barriers, and 4) ways to improve practice. Within the main themes it was found that 1) Women were instinctively aware of (ab)normal FM-patterns and healthcare providers had adequate knowledge about FMs. 2) Women often did not know how to monitor FMs or when to report concerns. There was inadequate assessment and management of (ab)normal FMs. 3) Barriers included the fact that women did not feel free to express concerns. Healthcare providers considered FM-awareness among women as low and unreliable. There was lack of staff, time and space for FM-education, and no protocol for FM-management. 4) Women and health providers recognised the need for education on assessment and management of (ab)normal FMs. In conclusion, women demonstrated adequate understanding of FMs and perceived abnormalities of these movements better than assumed by health providers. There is a need for more evidence on the effect of improving knowledge and awareness of FMs to construct evidence-based guidelines for low resource settings.

The multidimensional impact of maternal near-miss on the lives of women in Zanzibar, Tanzania: a prospective, 1-year follow-up study

Severe maternal morbidity has been shown to have specific, long-term effects on health and wellbeing, such as daily functioning and mental health. This study aimed to multidimensionally assess the long-term impact of maternal near-miss complications in Zanzibar. A prospective cohort study was conducted in Zanzibar's referral hospital. Women with maternal near-miss complications were matched with controls. At 3, 6, and 12 months after hospital discharge, history was taken, blood pressure and haemoglobin levels were measured, and multiple validated questionnaires (WHOQOL-BREF, WHODAS2.0, Patient Health Questionnaire-9, Harvard Trauma Questionnaire-16) were administered assessing experienced quality of life and disability, and screening for depression and posttraumatic stress disorder. We included 223 women after maternal near-miss complications and 213 women controls. There was a high prevalence of hypertension at 6 and 12 months in both groups and significantly higher after a near-miss. The proportion of women with low quality of life, disability, depression, or posttraumatic stress disorder was not significantly different between the 2 groups. A poor outcome for at least 1 of these 3 health domains was more prevalent after a near-miss complication. In Zanzibar, women after maternal near-miss complications report similar but slower recovery to control participants in the assessed dimensions. Adaptation of perceptions on and coping mechanisms with daily reality might partly explain this. Hypertension has a high prevalence after childbirth and should be treated adequately to prevent recurrent obstetrical and cardiovascular complications. Blood pressure follow-up for all women who delivered at Mnazi Mmoja Hospital seemed justified.

Seroprevalence and risk factors of Toxoplasmosis among HIV infected women of child-bearing age attending care and treatment clinics in Dar es Salaam, Tanzania.

Toxoplasmosis in HIV-infected women of child-bearing age (HIV-WCB) increases the risk for congenital toxoplasmosis, leading to many complications. However, its magnitude is unknown in this population. Objectives: The study aimed to determine the prevalence and factors associated with toxoplasmosis among HIV-WCB. This was a cross-sectional study conducted from July to August 2020 among HIV- WCB attending care and treatment clinic (CTC) at Muhimbili National Hospital and Mnazi Mmoja hospital. Questionnaire and TORCH rapid test were used to obtain data and serological testing respectively. Data analysis was done using statistical package for social sciences (SPSS) version 20. Overall, 29.7% of the study participants were positive for anti-T. gondii IgG, whereas none tested positive for IgM. Multivariate analysis showed that the probability of being infected with T. gondii increased by 57.1% for participants who consumed raw vegetables (p=0.005, aOR=0.43, 95%CI = 1.24-8.77). Other common risk factors such as undercooked meat consumption, source of drinking water, and cat ownership at home showed no association. A high number of HIV-WCB have not developed immunity to T. gondii in the study area. Introduction of routine screening during antenatal visits for pregnant women and further epidemiological studies are warranted in the country.

Too busy to care? Analysing the impact of system-related factors on maternal mortality in Zanzibar’s Referral Hospital

This study analyses the contribution of system-related factors to maternal mortality in the low-resource setting of Mnazi Mmoja Hospital in Zanzibar, Tanzania. It is a retrospective cohort study including all maternal deaths (MD, n = 139) and maternal near-misses (MNM, n = 122) in Mnazi Mmoja Hospital with sufficient documentation during 2015 to 2018 (MD) and 2017 to 2018 (MNM). The number of admissions and surgical interventions per health care provider on the day of admission and the number of times vital signs were monitored per day were compared between MNM and MD cases using logistic regression. The mean number of times vital signs were monitored per day was associated with reduced odds of mortality (aOR 0.75, 95% CI 0.64–0.89), after adjustment for confounding factors such as severity of illness. The numbers of admissions or surgical procedures per health care provider were not associated with mortality. Concluding, the degree of monitoring of patients with life-threatening complications of pregnancy or childbirth is associated with the risk of mortality independent of the degree of severity. Preventing maternal mortality requires going beyond availability of essential interventions to tackle system-related factors that have a direct impact on the capacity to provide comprehensive care. Impact Statement What is already known on this subject? Root cause analyses of maternal deaths have identified many system-related factors, such as availability of health care providers, adequate training, and motivation to sustain high intensity monitoring (Madzimbamuto et al. 2014; Mahmood et al. 2018). What do the results of this study add? This is the first study to attempt to quantify the contribution of these system-related factors by comparing cases of maternal death with cases of maternal near-miss. We show that the degree of monitoring of patients with life-threatening complications is associated with the odds of mortality independent of the degree of severity. Even though this relation should not be regarded as causative, monitoring of vital signs can be seen as reflective of many system-related factors which hamper or facilitate comprehensive care. What are the implications of these findings for clinical practice and/or further research? This study helps increase general understanding of the factors leading to progression from severe disease to death in a high-volume low-income setting.

Bacterial Profile and Antibiogram of Pathogens Causing Surgical Site Infections at Mnazi Mmoja Hospital in Zanzibar, Tanzania

A hospital based cross sectional study was done to determine bacterial profile and antibiogram of pathogens causing surgical site infections at Mnazi Mmoja Hospital in Zanzibar, Tanzania. The study was conducted from May to July 2017. We enrolled a total of 121 patients who underwent different surgical procedures and met study inclusion criteria. Pus swabs were collected and cultured as per standard operating procedures. Bacterial identification was then performed using biochemical tests and Analytical Profile Index test for Enterobacteriaceae (API 20E). Antimicrobial drug susceptibility testing was performed using Kirby Bauer disc diffusion technique. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 21.0. Of 121 patients that were enrolled in the study, 75 (62%) developed surgical site infection (SSI). A total of 106 isolates were recovered from patients with positive culture results. The majority of the isolates, 92/106 (87%) were Gram-negative bacteria. The most predominant bacterium was Pseudomonas aeruginosa, 29/106 (27%) in all surgical Departments. Some of the isolated pathogens were multi-drug resistant (29/106; 27%), including Extended Spectrum Beta Lactamase (ESBL) producers (24/92; 26%), Methicillin Resistant Stahylococcus aureus (MRSA) (3/9; 33%) and Induced Clindamycin Resistance (ICR) strains (2/14; 14%). K. pneumoniae isolates showed the highest resistance towards most tested antibiotics (24.1-100%), and 24% of P. aeruginosa isolates were resistant to meropenem. In conclusion, P. aeruginosa was the most common isolated pathogen from patients with SSI in Zanzibar and the majority of the pathogens showed high resistance to commonly prescribed antimicrobial agents used in the hospital settings.

Influence of Leadership Styles on Quality Health Service Delivery at Mnazi Mmoja Hospital Zanzibar

The aim of the study was to assess the influence of transformational, transactional and democratic leadership styles on quality health service delivery at Mnazi Mmoja Hospital, Zanzibar. Bearing the importance of quality health service there is no doubt that leadership style could be integral in offering quality health service. Despite the efforts done to improve health service delivery, Zanzibar has not optimally achieved quality health service delivery. The study used transformational, transactional and democratic leadership styles to assess their influence on quality health service delivery. Cross-sectional research design which involved quantitative research approach was used. The quantitative analysis included mean, standard deviation and multiple linear regressions. A sample size of 317 was determined using stratified Sampling method. Multifactor Leadership Questionnaire, (MLQ) was used to collect data. The results found that transformational, transactional and democratic leadership styles impacted quality of health service delivery with 37.3%, 25.7% and 21.8% respectively. The study recommended the management of Mnazi Mmoja to put effort in practicing all aspects of transformational, transactional and democratic leadership styles in order to enhance delivery of quality health services.

Malaria prevalence and performance of diagnostic tests among patients hospitalized with acute undifferentiated fever in Zanzibar

BackgroundControl efforts in Zanzibar reduced the burden of malaria substantially from 2000 to 2015, but re-emergence of falciparum malaria has been observed lately. This study evaluated the prevalence of malaria and performance of routine diagnostic tests among hospitalized fever patients in a 1.5 years period in 2015 and 2016.MethodsFrom March 2015 to October 2016, paediatric and adult patients hospitalized with acute undifferentiated fever at Mnazi Mmoja Hospital, Zanzibar were included. The malaria prevalence, and performance of rapid diagnostic test (RDT) and microscopy, were assessed using polymerase chain reaction (PCR) as gold standard.ResultsThe malaria prevalence was 9% (63/731). Children under 5 years old had lower malaria prevalence (5%, 14/260) than older children (15%, 20/131, p = 0.001) and persons aged 16 to 30 years (13%, 15/119, p = 0.02), but not different from persons over 30 years old (6%, 14/217, p = 0.7). All cases had Plasmodium falciparum infection, except for one case of Plasmodium ovale. Ten malaria patients had no history of visiting mainland Tanzania. The RDT had a sensitivity of 64% (36/56) and a specificity of 98% (561/575), and microscopy had a sensitivity of 50% (18/36) and a specificity of 99% (251/254), compared to PCR. The malaria parasitaemia was lower in patients with false negative results on RDT (median 7 × 103 copies/µL, interquartile range [IQR] 2 × 103 – 8 × 104, p = 0.002) and microscopy (median 9 × 103 copies/µL, IQR 8 × 102 – 7 × 104, p = 0.006) compared to those with true positive RDT (median 2 × 105 copies/µL, IQR 3 × 104 – 5 × 105) and microscopy (median 2 × 105 copies/µL, IQR 6 × 104 – 5 × 105).ConclusionsThe study emphasizes that malaria was a frequent cause of febrile illness in hospitalized patients in Zanzibar in the years 2015-2016, particularly among school age children and young adults. We found evidence of autochthonous malaria transmission in Zanzibar. Compared to PCR, both RDT and microscopy had low sensitivity, and false negative results were associated with low parasitaemia. While low parasitaemia identified only by PCR in a semi-immune individual could be coincidental and without clinical relevance, clinicians should be aware of the risk of false negative results on routine tests.

Development of a clinical prediction model for perinatal deaths in low resource settings.

SummaryBackgroundMost pregnancy-related deaths in low and middle income countries occur around the time of birth and are avoidable with timely care. This study aimed to develop a prognostic model to identify women at risk of intrapartum-related perinatal deaths in low-resourced settings, by (1) external validation of an existing prediction model, and subsequently (2) development of a novel model.MethodsA prospective cohort study was conducted among pregnant women who presented consecutively for delivery at the maternity unit of Zanzibar's tertiary hospital, Mnazi Mmoja Hospital, the Republic of Tanzania between October 2017 and May 2018. Candidate predictors of perinatal deaths included maternal and foetal characteristics obtained from routine history and physical examination at the time of admission to the labour ward. The outcomes were intrapartum stillbirths and neonatal death before hospital discharge. An existing stillbirth prediction model with six predictors from Nigeria was applied to the Zanzibar cohort to assess its discrimination and calibration performance. Subsequently, a new prediction model was developed using multivariable logistic regression. Model performance was evaluated through internal validation and corrected for overfitting using bootstrapping methods.Findings5747 mother-baby pairs were analysed. The existing model showed poor discrimination performance (c-statistic 0·57). The new model included 15 clinical predictors and showed promising discriminative and calibration performance after internal validation (optimism adjusted c-statistic of 0·78, optimism adjusted calibration slope =0·94).InterpretationThe new model consisted of predictors easily obtained through history-taking and physical examination at the time of admission to the labour ward. It had good performance in predicting risk of perinatal death in women admitted in labour wards. Therefore, it has the potential to assist skilled birth attendance to triage women for appropriate management during labour. Before routine implementation, external validation and usefulness should be determined in future studies.FundingThe study received funding from Laerdal Foundation, Otto Kranendonk Fund and UMC Global Health Fellowship. TD acknowledges financial support from the Netherlands Organisation for Health Research and Development (grant 91617050).

Patients Satisfaction Toward Dental Health Services Offered at Mnazi- Mmoja Dental Clinic in Dar Es Salaam, Tamzania

Background: The success of an oral health service can be assessed by the degree of satisfaction/dissatisfaction of its patients. In Tanzania, patients’ satisfaction with dental services has received only minor attention. Objectives: To assess patient satisfaction with dental care among patients at Mnazi-Mmoja Dental clinic. Methodology: A cross sectional study conducted at Mnazi-mmoja dental clinic for two months to determine patients’ satisfaction with dental services offered at Mnazi-mmoja dental clinic. A total of 145 patients of different sex were the subjects during the time of study. The study included all the patients attended at Mnazi-mmoja dental clinic during the time of data collection who were aged from 18 to 65 years. Results: There were more female respondents than male (53.1% versus 46.9%) and majority (62.1%) of the respondents were young adults (between 18 and 35 years). Most (93.4%) respondents showed overall satisfaction with service offered. The level of education influenced the participants satisfaction, showing higher satisfactions among patients with primary educations and those without formal education while low satisfaction was among participants with secondary or higher-level education (96.3% and 51.6% respectively) (p ≤ 0.05). The rest of social-demographic characteristics did not significantly influence patients’ satisfaction. Conclusion: Patients were highly satisfied with dental services offered at Mnazi-mmoja Hospital. In addition, social-demographic factors were not associated with patients’ satisfaction except level of education.

Effect of Gender and Risk Factors in Complications of Type 2 Diabetic Mellitus among Patients Attending Diabetic Clinic in Mnazi Mmoja Hospital, Zanzibar

Diabetes type 2 (T2D) had caused the loss of millions of lives all over the world. About 50% of the patients with T2D die because of cardiovascular disease (CVD), primarily myocardial infarction and stroke. Many of the leading risk factors for CVD coexist and act synergistically to increase cardiovascular events. The purpose of this descriptive cross-sectional study was to determine the prevalence, patterns, and certain predictive factors in the complications of T2D patients attending diabetic clinics at Mnazi Mmoja hospital. A total of 138 respondents made up of 58 females and 80 males within the age brackets of 30-40, 41-50, 51 – 60, and 61 above were recruited for this study. Data were analysed and interpreted based on certain predictive factors and variables, including smoking, alcohol, excessive salt intake, lipid intake, sedentary lifestyle, family history of diabetes, and hypertension, on how they relate to the development of complications of type 2 diabetes. Pearson Chi-Square test was used to compare the levels of significances. Probability values of less or equal to 0.05 were accepted to be significant. The combination of salt intake, sedentary lifestyle, family history of diabetes, and lipid intake was the commonest risk factor for developing complications of T2D. However, alcohol and cigarette smoking had the most negligible impact on developing complications in T2D. The result also shows the patients between the age bracket of 30 and 40 have more risk factors for developing complications. The result showed no gender difference in the number of risk factors. There was a statistically significant association between some of the risk factors (smoking, alcohol, sedentary lifestyle, and salt intake) and the gender of respondents (p&lt;0.05). Males smoked (43.8%) and consumed alcohol (32.5%) than females, while females were prone to a sedentary lifestyle (63.8%) and consume salt (82.8%) than males. On the other hand, this research showed that the significant complication for both males and females are numbness, pain sensation, and dry skin (diabetic neuropathy). Gender and certain predictive risk factors like salt intake, sedentary lifestyle, and family history of diabetes, and lipid intake are fundamental parameters to be tackled to reduce the complications of type 2 diabetes mellitus. There is a greater need now for awareness of the risk factors through effective health promotion in Zanzibar. Also, secondary prevention through regular screening, early detection, and appropriate treatment of chronic complications could reduce the morbidity and mortality caused by diabetes mellitus.

Iodine status in women attending Mnazi Mmoja Hospital in Zanzibar: a matched case-control study

BackgroundIodine deficiency can have adverse health effects in all age groups affecting growth, development and cognitive functions as well as the incidence of goitre. Worldwide, the most important dietary source...