Muhimbili National Hospital Research Articles

Magnitude and associated factors of anti-retroviral therapy adherence among children attending HIV care and treatment clinics in Dar es Salaam, Tanzania.

The HIV pandemic continues to contribute significantly towards childhood mortality and morbidity. The up-scaling of the Anti-retroviral therapy (ART) access has seen more children surviving and sanctions great effort be made on ensuring adherence. Adherence is a dynamic process that changes over time and is determined by variable factors. This necessitates the urgency to conduct studies to determine the potential factors affecting adherence in our setting and therefore achieve the 90-90-90 goal of sustainable viral suppression. To assess the magnitude and associated factors of ART adherence among children (1-14 years) attending HIV care and treatment clinics during the months of July to November 2018 in Dar es Salaam. A cross-sectional clinic-based study, conducted in three selected HIV care and treatment clinics in urban Dar es Salaam; Muhimbili National Hospital (MNH), Temeke Regional Referral Hospital (TRRH), Infectious Disease Centre- DarDar Paediatric Program (IDC-DPP) HIV clinics during the months of July to November 2018. HIV-infected children aged 1-14 years who had been on treatment for at least six months were consecutively enrolled until the sample size was achieved. A structured questionnaire was used for data collection. Four-day self-report, one-month self-recall report and missed clinic appointments were used to assess adherence. Frequencies and percentages were used to describe categorical data. The odds ratio was used to analyse the possible factors affecting ART adherence Logistic regression models were used to determine the factors associated with ART adherence. Analysis was conducted using SPSS version 20.0 and p-value <0.05 were considered statistically significant. 333 participants were recruited. The overall good adherence (≥95%) was approximated to be 60% (CI-54.3-65.1) when subjected to all three measures. On multivariable logistic regression, factors associated with higher odds of poor adherence were found to be caregivers aged 17-25 years [AOR = 3.5, 95%CI-(1.5-8.4)], children having an inter-current illness [AOR = 10.8, 95%CI-(2.3-50.4)], disbelief in ART effectiveness [AOR = 5.495; 95%CI-(1.669-18.182)] and advanced clinical stage [AOR = 1.972; 95% CI-(1.119-3.484)]. The major reasons reported by caregivers for missing medications included forgetfulness (41%), high pill burden (21%), busy schedule (11%) and long waiting hours at the clinic (9%). In the urban setting of Dar es Salaam, ART adherence among children was found to be relatively low when combined adherence measures were used. Factors associated with poor ART adherence found were younger aged caregivers, and child intercurrent illness, while factors conferring good adherence were belief in ART effectiveness and lower HIV clinical stage. More attention and support should be given to younger aged caregivers, children with concomitant illness and advanced HIV clinical stages. Educating caregivers on ART effectiveness may also aid in improving adherence.

Women's experiences with hypertensive disorders of pregnancy from a national referral hospital in Tanzania: A qualitative study.

This study aimed to explore the experiences among postpartum women with hypertensive disorders of pregnancy, from pregnancy to admission at a referral hospital in Tanzania. This was a descriptive cross-sectional design with purposive sampling. Data were collected from semi-structured in-depth interviews with postpartum women diagnosed with hypertensive disorders and who were admitted to the maternity ward of Muhimbili National Hospital. Data were analyzed using NVivo software for qualitative content analysis. Fourteen women participated in interviews. Half were primipara and two-thirds had over four antenatal visits. Data analysis yielded four categories and 27 sub-categories. The four categories were: "I'm shocked; I thought I was normal," "The treatment journey," "What health care providers did and did not teach me," "I have a risky future; I hope health care providers can help me." Women regarded themselves going from being normal to having a risk through the process of experiencing their treatments. They did not expect to be admitted or referred to a major hospital and while they demanded more information and education, they also expressed appreciation for their health care providers. Education during pregnancy addressing their needs and level of understanding is recommended for improvement of early detection and access to the health service.

Expression of Ki67 as detected by MIB-1 and its association with histopathological high-risk factors among patients with retinoblastoma tumour: a cross-sectional study

ObjectivesThis study aims to investigate the expression of Ki67 in formalin-fixed paraffin-embedded tissue blocks from patients with a diagnosis of retinoblastoma tumour (RbT) as well as determining its association with...

Prevalence and barriers to male involvement in antenatal care in Dar es Salaam, Tanzania: A facility-based mixed-methods study.

BackgroundMen have traditionally not been fully involved in reproductive health care of their partners, and yet, they play a crucial role in family decision-making and therefore crucial key players in preventing poor pregnancy outcomes. This study aimed to assess prevalence and determinants of male participation in maternal health care and explore male partners’ perspective of their involvement in antenatal care at an urban tertiary referral facility.MethodsA mixed-methods study was conducted from October 2018 to January 2019 at Muhimbili National Hospital. A cross-sectional survey of 428 nursing mothers and two focus group discussions of male partners (n = 7 and n = 11) of women attending antenatal clinic and nursing mothers in the post-natal ward were performed. Using SPSS Ver. 23 (IBM, Chicago, IL), frequency distribution tables summarized demographic data and categories of male partners’ involvement in antenatal care. Focus group discussions included male partners of age from 24 to 55 years at their first to fifth experience of pregnancy and childbirth. Interviews were audio-recorded, and then transcribed and coded. Thematic analysis was applied.ResultsThe prevalence of male involvement in antenatal care was 69%. More than two-thirds of nursing mothers received physical, psychological and financial support from partners (76%) and attended four or more antenatal visits (85%). Five themes of male perspective of their involvement in antenatal care were generated, including: a) cultural norms and gender roles, b) ignorance of reproductive health service, c) factors outside their control, d) couple interaction and conflicts, and e) institutional obstacles.ConclusionThe prevalence of male partners’ involvement in antenatal care was relatively high. Men’s involvement in antenatal care depended on access to antenatal care education, standards of structure and process of antenatal service and how well their role was defined in the maternal health care system. Interactions and practice in society, employment sector and government health system should complement strategies to promote men’s involvement in maternal health.

Comparison of gross morphological and histological features of placenta between hypertensive and normotensive pregnant women attending Muhimbili National Hospital.

Background: Placenta is the vital fetomaternal organ that is responsible for the maintenance of the pregnancy and promotion of fetal growth and development. The optimal survival, growth, and development of the fetus correspond to the appropriate formation and development of the placenta. Hypertensive disorders of pregnancy exert a great impact on the placenta and reflect changes both morphological and histological.&#x0D; Objective: To compare the morphological and histological features of the placenta between hypertensive pregnant mothers and non-hypertensive pregnant mothers who attended Muhimbili National Hospital (MNH).&#x0D; Methods: A hospital-based cross-sectional study was conducted from June 2020 to August 2020 at Muhimbili National Hospital (MNH). A total of 80 placentas were studied morphologically and histologically, of which 40 placentas were from hypertensive pregnant mothers and 40 placentas were from normotensive pregnant mothers. In the morphological aspect shape, weight, the site of insertion of the umbilical cord, the number of cotyledons of each placenta and thickness of the placenta were noted. In the histological part, Neutral buffered formalin (NBF) was used the routine staining technique which was Hematoxylin and Eosin (H&amp;E) and a light microscope was used. The data were analyzed by using SPSS version 20 computer software and the results were summarized in means and proportions. ‘T-test’ and chi-square’ tests were used and the difference was statistically significant when the p-value&gt;0.05&#x0D; &#x0D; Results: The irregular shape of the placenta and marginal insertion of the umbilical cord were more in the hypertensive group and were statistically significant (p&gt;0.01). The mean placenta weight, mean placenta thickness and mean numbers of cotyledons were significantly less in a hypertensive group compared to the normotensive group (p&lt;0.01). A microscopic study of the placenta revealed the presence of fibrinoid necrosis, syntial knots, calcifications and villous hypoplasia in both normotensive and hypertensive group however these findings were significantly higher in the hypertensive group (p&gt;0.01).&#x0D; Conclusion: Hypertensive disorders of pregnancy (HDP) exert a profound impact on the placenta. Morphologically altering its dimensions and histologically fibrinoid necrosis, calcifications, syntial knots, and villous hypoplasia were significantly more in the hypertensive group than in the normotensive (p&gt;0.01).

Experiences and challenges of parents caring for children with attention-deficit hyperactivity disorder: A qualitative study in Dar es salaam, Tanzania

Attention-deficit hyperactivity disorder (ADHD) is the most common neurobehavioral childhood disorder. Children with ADHD are difficult to handle due to the symptoms causing great impairments such as inattention, hyperactivity compared to other childhood mental disorders. Having a child with ADHD is a stressful situation as it impacts the whole family. However, little is known about the experiences and challenges of parents caring for children with ADHD in low and middle-income countries such as Tanzania. Thus, this study explored the experiences and challenges of parents caring for children with ADHD in Dar es Salaam, Tanzania. We conducted a qualitative descriptive study involving 16 parents of children with ADHD at Muhimbili National Hospital (MNH). We used the purposive sampling technique to obtain the participants. In-depth interviews, using a semi-structured interview guide, were used to collect data. Audio-recorded data were transcribed, translated, and analysed using qualitative content analysis. Parents experienced difficulties in handling the children whose level of functioning was impaired due to abnormal and disruptive behaviour such as not being able to follow parental instructions. Psychological problems were also experienced due to caring demands exacerbated by lack of support and stigma from the community. Moreover, there were disruptions in family functioning and social interactions among family members due to the children's behaviour. Lastly, too much time and family resources spent to fulfil the needs of these children culminated into disruption in economic activities that negatively affected everyday life. Parents struggle to meet and cope with care demands posed by children with ADHD. The disruptive nature of ADHD symptoms presents a unique caring challenge different from those experienced with other childhood mental illnesses. To address these challenges, a collaborative approach among key stakeholders such as the government, health care professionals, and non-governmental organizations, is needed.

Psychological Distress Factors among Caregivers of Children Receiving Cancer Therapy, at Muhimbili National Hospital.

Psychological distress is a major problem among caregivers of patients with chronic illness such as cancer. Psychological distress in caregivers affects the provision of healthcare services. The aim of this study was to determine the magnitude and factors contributing to psychological distress among caregivers of children receiving cancer treatment at Muhimbili National Hospital. A cross sectional hospital-based study was done. Questionnaires were used to collect information on socio demographic characteristics and psychological support while Hopkins Symptoms Checklist 25 was used to determine psychological distress. The association between the socio demographic characteristics, psychological support and psychological distress was determined using logistic regression analysis (univariate and multivariate analysis) and p values of less than 0.05 were considered significant. Prevalence of psychological distress was 64 (66.7%) among 96 caregivers interviewed while the proportion of psychological support was 71 (74%.) The social demographic characteristics were not associated with psychological distress. Psychological support from family member was protective against psychological distress (p=0.025, OR=0.047, CI 0.003-0.686) while other means of psychological support and self-copying mechanism to psychological distress were not associated with psychological distress. The prevalence of psychological distress was high despite the high proportion of psychological support. Socio demographic characteristics had no association with psychological distress. Psychological support from family member was protective against psychological distress. Further studies are needed to assess the social cultural aspect, content and context of psychological support.

Predictors of Surgical Site Infections among Patients Undergoing Open Urological Surgery at a Tertiary Hospital, Tanzania: A Cross Sectional Study.

Surgical Site Infection (SSI) is one of the major hospital acquired infections, highly associated with prolonged hospitalisation, morbidity and mortality. In open urological surgeries, little is known on magnitude and factors associated with development of SSI. The intervention was a cross-sectional prospective observational study performed between August 2015 and March 2016 at Muhimbili National hospital (MNH), Dar es Salaam, Tanzania. Patients who underwent open urological surgery at MNH during the study period and met inclusion criteria were consecutively enrolled, and followed up for 30 days. Patients' and operative characteristics were recorded using standard structured questionnaires. Wound/pus swabs were collected from patients with clinical evidence of SSI for bacteriological processing. Data analysis was performed using SPSS version 20. Of 182 patients who underwent open urological surgery, 22% (40/182) developed SSI. Pre-operative urinary tract infection (aOR 9.73, 95%CI 3.93-24.09, p<.001) and contaminated wound class (aOR 24.997, 95%CI 2.58-242.42, p = .005) were independent predictors for development of SSI. Shaving within 30 hrs before surgical procedure was found to be protective for developing SSI (aOR 0.26, 95%CI 0.09-0.79, p=.02). Escherichia coli (20/40) was the most predominant pathogen in SSI followed by Klebsiella pneumoniae (7/40) and S. aureus (6/40). Gram-negative bacteria were highly resistant to ceftriaxone, gentamicin, amoxicillin-clavulanic acid and trimethoprimsulfamethoxazole. Surgical Site Infection was high in open urological interventions. Pre-operative urinary tract infection and contaminated wound class predicted SSI. Bacteria causing SSI were highly resistant to commonly used antibiotics.

Inhaler Non-Adherence, Associated Factors and Asthma Control among Asthma Patients in a Tertiary Level Hospital in Tanzania.

Inhaled medications including corticosteroids are the most effective long-term controller medicines for asthma-related chronic airway inflammation. Despite this fact, 30% to 70% of the uncontrolled asthma patients report non-adherence to their inhalers. This study investigated factors affecting inhaler non-adherence among outpatient asthma patients in Muhimbili National Hospital, Dar es Salaam Tanzania and related the level of inhaler adherence to the extent of asthma control. A cross-sectional hospital-based study was conducted among patients with bronchial asthma in the pulmonology clinic of Muhimbili National Hospital in Dar-es-salaam, Tanzania. Patients' demographic, clinical and socio-economic factors were collected using a structured questionnaire. Medication adherence was self-reported using a 10-item Test of Adherence to Inhalers (TAI) questionnaire. Adherence was gauged as good when the score was 50, intermediate (score 46-49) or poor (score ≤ 45). Asthma control was assessed using a 5-question Asthma Control Test (ACT). A score of ≥20 meant well controlled asthma while a score of ≤19 meant poorly controlled asthma. Patients' inhaler use technique was assessed using a 10-step checklist. Patient's technique was regarded correct when all the steps were performed correctly. Categorical data were summarised as proportions. Binary logistic regression was performed to identify factors associated with inhaler non-adherence. Significance level was set at p-value less than .05. A total of 385 asthma patients were enrolled in the study. Females were 206 (53.5%), 232(60.3%) were non-adherent to medications and 283(73.5%) had poorly controlled asthma. Lack of health insurance, fear of medication side effects, being too busy, having alternative medication for asthma and incorrect inhaler technique were significantly associated with non-adherence to inhalers, all p-values <.05. The magnitude of inhaler non-adherence and poorly controlled asthma were very high. Promoting adherence through patients' education on asthma and its management, emphasis on patients' insurance coverage and setting aside time to care for ones' self are fundamental in optimising asthma care and treatment.

Predictors and outcome of time to presentation among critically ill paediatric patients at Emergency Department of Muhimbili National Hospital, Dar es Salaam, Tanzania

BackgroundMortality among under-five children in Tanzania remains high. While early presentation for treatment increases likelihood of survival, delays to care are common and factors causing delay to presentation among critically ill children are unknown. In this study delay was defined as presentation to the emergency department of tertially hospital i.e. Muhimbili National Hospital, more than 48 h from the onset of the index illness.MethodologyThis was a prospective cohort study of critically ill children aged 28 days to 14 years attending emergency department at Muhimbili National Hospital in Tanzania from September 2019 to January 2020. We documented demographics, time to ED presentation, ED interventions and 30-day outcome. The primary outcome was the association of delay with mortality and secondary outcomes were predictors of delay among critically ill paediatric patients.Logistic regression and relative risk were calculated to measure the strength of the predictor and the relationship between delay and mortality respectively.ResultsWe enrolled 440 (59.1%) critically ill children, their median age was 12 [IQR = 9–60] months and 63.9% were males. The median time to Emergency Department arrival was 3 days [IQR = 1–5] and more than half (56.6%) of critically ill children presented to Emergency Department in > 48 h whereby being an infant, self-referral and belonging to poor family were independent predictors of delay. Infants and those referred from other facilities had 2.4(95% CI 1.4–4.0) and 1.8(95% CI 1.1–2.8) times increased odds of presenting late to the Emergency Department respectively. The overall 30-day in-hospital mortality was 26.5% in which those who presented late were 1.3 more likely to die than those who presented early (RR = 1.3, CI: 0.9–1.9). Majority died > 24 h of Emergency Department arrival (P-value = 0.021).ConclusionThe risk of in-hospital mortality among children who presented to the ED later than 48 h after onset of illness was 1.3 times higher than for children who presented earlier than 48 h. It could be anywhere from 10% lower to 90% higher than the point estimate. However, the effect size was statistically not significant since the confidence interval included the null value Qualitative and time-motion studies are needed to evaluate the care pathway of critically ill pediatric patients to identify preventable delays in care.

Predictors and outcome of cardiac arrest in paediatric patients presenting to emergency medicine department of tertiary hospitals in Tanzania

BackgroundThe survival of children who suffer cardiac arrest is poor. This study aimed to determine the predictors and outcome of cardiac arrest in paediatric patients presenting to an emergency department of a tertiary hospital in Tanzania.MethodologyThis was a prospective cohort study of paediatric patients > 1 month to ≤ 14 years presenting to Emergency Medicine Department of Muhimbili National Hospital (EMD) in Tanzania from September 2019 to January 2020 and triaged as Emergency and Priority. We enrolled consecutive patients during study periods where patients’ demographic and clinical presentation, emergency interventions and outcome were recorded. Logistic regression analysis was performed to identify the predictors of cardiac arrest.ResultsWe enrolled 481 patients, 294 (61.1%) were males, and the median age was 2 years [IQR 1–5 years]. Among studied patients, 38 (7.9%) developed cardiac arrest in the EMD, of whom 84.2% were ≤ 5 years. Referred patients were over-represented among those who had an arrest (84.2%). The majority 33 (86.8%) of those who developed cardiac arrest died. Compromised circulation on primary survey (OR 5.9 (95% CI 2.1–16.6)), bradycardia for age on arrival (OR 20.0 (CI 1.6–249.3)), hyperkalemia (OR 8.2 (95% CI 1.4–47.7)), elevated lactate levels > 2 mmol/L (OR 5.2 (95% CI 1.4–19.7)), oxygen therapy requirement (OR 5.9 (95% CI 1.3–26.1)) and intubation within the EMD (OR 4.8 (95% CI 1.3–17.6)) were independent predictors of cardiac arrest.ConclusionThirty-eight children developed cardiac arrest in the EMD, with a very high mortality. Those who arrested were more likely to present with signs of hypoxia, shock and acidosis, which suggest they were at later stage in their illness. Outcomes can be improved by strengthening the pre-referral care and providing timely critical management to prevent cardiac arrest.

Aetiology, antimicrobial susceptibility and outcome of children with sepsis, admitted at Muhimbili National Hospital, Dar es Salaam.

Introductionsepsis is defined as a systemic inflammatory host response syndrome (SIRS) to infection, commonly bacterial. The global prevalence of sepsis is 8.2% with a mortality rate of 25%, whilst in Tanzania the prevalence is 6.6%. Treatment of sepsis involves early initiation of antibiotics based on local sensitivity patterns. However, there is an increase in antimicrobial resistance to commonly used antibiotics. Hence to promote rational use of antibiotics, we aimed at establishing the etiology, local susceptibility patterns and outcome of children with sepsis aged 2 months to 15 years, admitted at Muhimbili National Hospital (MNH), Dar es Salaam.Methodsa hospital based prospective cross sectional study was conducted among 245 participants who were consecutively recruited. A standardized structured questionnaire was used to collect information. Blood cultures and complete blood counts were done. Antimicrobial susceptibility was also done on positive cultures using disc diffusion method. Data were analyzed using SPSS version 20. Frequencies and proportions were used to summarize categorical data, whilst median and interquartile range was used to summarize continuous data. Student T test was used to compare means of data which were normally distributed and the differences in proportions were tested using Chi square test or Fisher’s exact test. A p value of = 0.05 was considered to be statistically significant.Resultsthere was predominance of male participants (67.5%) with a median age was 2 years and an interquartile range (IQR) 10 months to 4 years. Culture positive sepsis was detected among 29.8% of the participants, and the common Gram-positive bacterial isolates were S. aureus (39.7%) Coagulase Negative Staphylococcus (CoNS) (35.6%) and Gram-negative isolates were E. coli (12.3%), Klebsiella spp (6.8%) and Pseudomonas aeruginosa (5.5%). All bacteria showed a high resistance to ampicillin (80%- 100%) followed by ceftriaxone (40 - 70%). All Pseudomonas aeruginosawere 100% resistant to ampicillin, gentamycin and ceftriaxone but were sensitive to amikacin. There was less than 40% resistance to co-amoxiclav, meropenem, ciprofloxacin, amikacin, and clindamycin. The overall case mortality rate from sepsis was 9.4%. Among children discharged 59.3% had prolonged hospital stay of more than 7 days. Age group 1 to 5 years, prior use of antibiotics, tachycardia, and leukocytosis were significantly associated with high mortality.Conclusionbacterial sepsis is prevalent at Muhimbili National Hospital contributing to 9.4% of mortality and a prolonged hospital stay of more than 7 days among 59.3% of the participants. Gram-positive bacteria were found to be predominant cause of sepsis, whereas both Gram-positive and Gram-negative bacteria had a high resistance to first and second line antimicrobials including: ampicillin, gentamycin, and ceftriaxone.

Clinical Presentations and Predictors of Severe Sickle Cell Disease among Patients Who Attended Muhimbili National Hospital Dar-Es Salaam, Tanzania: A Retrospective Study

Inherited hemoglobinopathies led by Sickle Cell Disease (SCD) are key contributors to the anaemia burden in Sub-Saharan Africa (SSA). In Tanzania, an estimated six out of one thousand newborns are born with SCD, making Tanzania the fourth country with the highest burden of SCD patients in the world and the third in Africa after Nigeria and the Democratic Republic of Congo (DRC) (Nigeria 85,000, Democratic Republic of Congo 42,000 and Tanzania 11,000).

Cochlear implantation and outcomes in a resource–limited setting: experience from Tanzania

Introduction: Cochlear Implant is a small medical electronic device that is surgically inserted partially in the cochlear (inner ear) to restore some hearing in patients with severe to profound hearing loss. Cochlear implantation is considered a rehabilitative measure of choice that positively impacts on the quality of life of patients.Objective: The objective was to describe the clinico-demographic characteristics of cochlear implantees and the outcomes of the intervention among the implantees at Muhimbili National Hospital (MNH) in Tanzania.Method: This was a hospital based cross-sectional study which involved a total of 39 patients who underwent cochlear implantation from July 2017 to May 2021 at MNH. Clinico-demographic characteristics and outcomes of the intervention among the implantees were collected using structured questionnaires and data were analysed using Statistical Package for Social Sciences Version 20. Results were then presented in frequency tables and figures.Results: This study recruited 39 patients with bilateral hearing loss with their ages ranging from 2 to 55 years. Their mean age was 4.7 years and median of 3 years. More than half, 24(61.5%) of implantees aged 2-3 years. Males predominated with male to female ratio of 1.2:1. Majority 37(94.9%) had pre lingual hearing loss and 36 (92.3 %) had bilateral profound sensorineural hearing loss. Ototoxicity was the commonest cause of hearing loss among the implantees contributing 16(41%) followed by birth asphyxia, 8(20.5%). A total of 37(94.9%) of these patients were implanted with a single cochlear device due to the high cost associated with this type of intervention.Conclusion: Cochlear implantation in limited resource settings is possible and cost effective if there is enough support from the government and other charitable organisations. The availability of rehabilitative services remains key for better outcome after cochlear implantation.

Referral challenges and outcomes of neonates received at Muhimbili National Hospital, Dar es Salaam, Tanzania.

Functional referral system including pre referral care, access to emergency transport and ensuring continuity of care between facilities is critical for improved newborn health outcome. The neonatal transport system is quite undervalued in many sub Saharan countries, Tanzania included. This study assessed the pre referral care, transport process, ambulance characteristics, admission clinical status and outcomes of referred neonates at Muhimbili National Hospital Upanga, a tertiary facility in Dar es Salaam, Tanzania. A descriptive cross sectional study with a longitudinal follow up was conducted from September 2020 to February 2021 including neonates referred to Muhimbili National Hospital. A structured questionnaire was used to collect demographic characteristics and transport factors including pre referral care extracted from the referral documents and through interviewing caregivers or escorting person/nurse. Ambulances were directly observed using a structured checklist on presence, absence and functionality of supportive equipment. All enrolled neonates had a clinical assessment at admission and 48 hours post admission to determine admission clinical status and 48 hours' clinical outcome as either survived/died. Out of the 348 neonates assessed during the study period, the median gestation age was 38 weeks (IQR 32, 39) with the mean birth weight of 2455 ± 938 g. Pre referral documentation showed that temperature was measured in 176 (57.1%), oxygen saturation and random blood glucose in only 143 (46.6%) and 116 (36.2%) neonates respectively. Ambulance was used as a means of transportation in 308 (88.5%) neonates. While no ambulance had an incubator only 7 (2.0%) neonates were kept on a Kangaroo Mother Care position. Monitoring enroute was done to only 94 (27%) of the transferred neonates with 169 (54.9%) of health care professionals escorting the neonates lacking training on essential newborn care. On arrival, 115 (33%) were hypothermic, 74 (21.3%) hypoxic, 30 (8.6%) with poor perfusion and 49 (14.1%) hypoglycemic. Hypothermic neonates had an increased chance of dying compared to those who were normothermic (OR = 2.09, 95% CI (1.05-4.20), p = 0.037). The chance of dying among those presenting with hypoxia was almost three times (OR = 2.88, 95%CI (1.44-5.74), p = 0.003) while those with poor perfusion was almost five times (OR = 4.76, 95%CI (1.80-12.58), p = 0.002). Additionally, neonates who had hyperglycemia (RBG > 8.3mmol/l) on arrival had a higher probability of dying compared to those who were euglycemic [(OR = 3.10, 95% CI (1.19-8.09) p = 0.021]. Overall mortality was 22.4% within 48 hours of admission and risk of dying increased as the presence of poor clinical status added on. Neonatal transportation in Dar es Salaam, Tanzania was observed to be challenging. Pre transfer care and monitoring during transportation was inadequate and this contributed to poor clinical status on admission. Hypothermia, hypoglycemia, hyperglycemia, hypoxia and poor perfusion on admission were associated with increased mortality. Effective referral network is needed for improved neonatal health outcomes. Pre referral supportive care, training of health care professionals, transportation with improved monitoring, clear communication protocol and referral documentation should be invested and effectively utilized.

Newborn Screening for Critical Congenital Heart Disease in a Low-Resource Setting; Research Protocol and Preliminary Results of the Tanzania Pulse Oximetry Study.

Background:Critical Congenital Heart Disease (CCHD) is the leading cause of early new-born mortality. Its early detection and intervention is crucial for the survival of affected new-born. Pulse Oximetry (POX) has shown to be one of the feasible, accurate and cost-effective tools in screening CCHD in developed nations, it is yet to be practiced and established as standard of care in a low-resource setting.Objectives:This paper reports on the research protocol and preliminary results of an ongoing study regarding the performance of POX in detecting CCHD in new-borns in a low resource setting. Secondary objectives include investigating the burdens of CCHD and outcome at 12 months of age.Methods:The Tanzanian Pulse Oximetry Study (TPOXS) is a prospective cohort study which plans to enrol 30,000 mothers and new-borns delivered at two referral hospitals in Tanzania. New-borns are offered POX test 12 hours after birth, those positively undergoes echocardiography examinations. Confirmed with CCHD are placed under observation for up to first birthday.Results:During a 5-months pilot period, a total of 1,592 infants at the Muhimbili National Hospital, received POX test .65% of them were post-caesarean section and 52% being male. Most babies delivered through Spontaneous Vertex Delivery (SVD) were promptly discharge and did not get screened. The detection-rate of CCHD was 2.5 per 1,000 live births (at 95% confidence interval [CI] 0.9 to 6.7 per 1000 live birth); with a POX false positive rate of 0.6%. Seven false-positive infants out of 10 were found to carry significant other neonatal conditions, including persistent pulmonary hypertension of the new-born, transient tachypnoeic and neonatal sepsis.Conclusion:This paper provides the protocol of the ongoing TPOXS with the preliminary results showing prevalence matching closely the global data. It shows acceptability of POX screening for CCHD in a well-prepared low resource setting.Highlight:This study addresses the utilization of pulse oximeter in detecting critical congenital heart disease (CCHD) in a low-resource setting (such as sub-Saharan African countries).

A Journey Undertaken by Families to Access General Surgical Care for their Children at Muhimbili National Hospital, Tanzania; Prospective Observational Cohort Study

BackgroundA majority of the 2 billion children lacking access to safe, timely and affordable surgical care reside in low-and middle-income countries. A barrier to tackling this issue is the paucity of information regarding children’s journey to surgical care. We aimed to explore children’s journeys and its implications on accessing general paediatric surgical care at Muhimbili National Hospital (MNH), a tertiary centre in Tanzania.MethodsA prospective observational cohort study was undertaken at MNH, recruiting patients undergoing elective and emergency surgeries. Data on socio-demographic, clinical, symptoms onset and 30-days post-operative were collected. Descriptive statistics and Mann–Whitney, Kruskal–Wallis and Fisher’s exact tests were used for data analysis.ResultWe recruited 154 children with a median age of 36 months. The majority were referred from regional hospitals due to a lack of paediatric surgery expertise. The time taken to seeking care was significantly greater in those who self-referred (p = 0.0186). Of these participants, 68.4 and 31.1% were able to reach a referring health facility and MNH, respectively, within 2 h of deciding to seek care. Overall insurance coverage was 75.32%. The median out of pocket expenditure for receiving care was $69.00. The incidence of surgical site infection was 10.2%, and only 2 patients died.ConclusionAlthough there have been significant efforts to improve access to safe, timely and affordable surgical care, there is still a need to strengthen children’s surgical care system. Investing in regional hospitals may be an effective approach to improve access to children surgical care.

Acute Kidney Injury in ICU: Prevalence andOutcome at Muhimbili National Hospital, Dar es Salaam, Tanzania

Acute Kidney Injury in ICU: Prevalence andOutcome at Muhimbili National Hospital, Dar es Salaam, Tanzania

Drug utilization pattern and adverse drug reactions of chemotherapy in pediatric patients at Muhimbili National Hospital, Tanzania.

Background: Cancer is a highly debilitating non-communicable disease and an essential contributor to the global burden of disease. Pediatric patients are highly exposed to multiple drugs for the management of cancer. Monitoring drug utilization patterns helps to provide feedback to healthcare providers to ensure the rational use of medicines; as a result, it increases the therapeutic efficacy and decreases the frequency and severity of adverse drug reactions (ADRs). Therefore, this study assessed the utilization pattern and ADRs of chemotherapy in pediatric patients at Muhimbili National Hospital (MNH). Methods: A descriptive cross-sectional study was conducted for three months from February to April 2021 in pediatric cancer patients undergoing chemotherapy at MNH. A total of 123 children diagnosed with cancer and on chemotherapy were enrolled in this study. Patients' socio-demographics, clinical information, chemotherapy status, prescribed medications, and prevalence of ADRs were collected. Descriptive statistics was used in data analysis, whereby frequency and proportions were used to summarize data. Results: Out of 123 patients, 62.6% were male. Most patients received an average of four anticancer drugs. Vincristine (55.3%) was the most used anticancer drug, followed by cytarabine (44.7%) and methotrexate (42.3%). The most used adjuvant drugs were ondansetron (30.9%), hydrocortisone (27.6%), and piperacillin/tazobactam (23.6%). The percentage of drugs prescribed from the Tanzania Essential Medicine List (TEML) and World Health Organization (WHO) list was 66.4% and 93%. Most (87%) of the patients reported having experienced ADRs whereby nausea and vomiting (45.8%), hair loss (33.6%), and neutropenia (32.7%) were more prevalent ADRs reported. Conclusions: This study found the drug prescribing pattern to be in line with the essential medicine list, but the average number of drugs prescribed was higher than recommended. ADRs were prevalent among pediatric cancer patients.

Bacteriological Profile and Predictors of Death Among Neonates With Blood Culture-Proven Sepsis in a National Hospital in Tanzania-A Retrospective Cohort Study.

BackgroundNeonatal sepsis is still a major cause of death and morbidity in newborns all over the world. Despite substantial developments in diagnosis, treatments, and prevention strategies, sepsis remains a common problem in clinical practice, particularly in low-resource countries.MethodsA retrospective cohort study of 238 neonates with positive blood culture-proven sepsis (in Muhimbili National Hospital) was conducted from January 2019 to December 2020. The outcomes of hospitalization were survival and death.ResultsIn total, 45.4% mortality resulted from 238 neonates who had sepsis exclusively based on blood culture positivity. A significant association was found between very low birth weight (VLBW), hyperglycemia, mechanical ventilation, and high neonatal mortality. Among the different clinical presentations of neonatal sepsis, lethargy, vomiting, and respiratory distress were found to be frequently associated with neonatal mortality. Furthermore, sepsis with Gram-negative bacteria and early-onset sepsis were also associated with high neonatal mortality. Of the 108 neonatal deaths, the largest proportion (40%) was observed with Staphylococcus aureus, and the remaining 38% was caused by Klebsiella, 14% by Escherichia coli, 5% by Pseudomonas, 4% by Acinetobacter, and 2% by Streptococcus. No neonatal deaths from Serratia infection were observed. The overall resistance of isolated organisms to the recommended first-line antibiotics was 84% for ampicillin and 71.3% for gentamicin. The resistance pattern for the recommended second-line antibiotics was 76.2% for ceftriaxone, 35.9% for vancomycin, and 17.5% for amikacin.ConclusionVLBW, early-onset sepsis, clinical and laboratory parameters like lethargy, vomiting, and hyperglycemia, sepsis with Gram-negative bacteria, and being on mechanical ventilation are strong predictors of death in neonatal sepsis. In addition, this study discovered extraordinarily high resistance to conventional antibiotics. These findings give light on the crucial aspects to consider in preventing this disease and poor outcomes.