Tertiary Hospital In Tanzania Research Articles

Breast cancer molecular subtype classification according to immunohistochemistry markers and its association with pathological characteristics among women attending tertiary hospitals in Tanzania

BackgroundBreast cancer immunohistochemistry is a biological characteristic of the tumour which has a role to diagnose molecular subtype, prognosticate and guide treatment and is categorised into 4 subtypes. Data in Tanzania was lacking and was based off data extrapolated from studies in Western Africa thus hypothesizing that women of African ancestry predominately develop Triple Negative Breast Cancer (TNBC). MethodsA retrospective cross-sectional study was carried out at two tertiary referral hospitals on participants who were recruited from the cancer registries from 2015 to 2022. Prevalence of each molecular subtype was determined and association between molecular subtype to demographic and pathological characteristics were evaluated. Predictors of molecular subtypes was then determined using logistic regression. ResultsTotal number of participants were 1214, median age was 50 (IQR: 41–61), median tumor size was 5 cm (IQR: 4–7) with lymph node positivity in 73.7 %. Immunohistochemistry studies showed estrogen, progesterone and Human Epidermal Growth Factor Receptor 2 (HER2) receptor positivity in 54.4 %, 34.4 % and 27.8 % of cases respectively. Molecular subtype classification prevalence for Luminal A was 21.17 % (95 % CI: 18.87–23.47), for Luminal B 35.75 % (95 % CI: 33.05–38.45), for HER2 enriched 11.86 % (95 % CI: 10.04–13.68) and for TNBC 31.22 % (95 % CI: 28.61–33.83). Significant association was seen between molecular subtype with age, tumor size, tumor grade and lymph node involvement. Predictors of Luminal tumors were larger tumor size (aOR 1.217, 95 % CI: 1.149–1.291) no lymph node involvement (aOR 0.429, 95 % CI: 0.313–0.589) while an advanced tumor grade reduced likelihood (aOR 0.041, 95 % CI: 0.011–0.019). ConclusionIn Tanzania Luminal B was most predominant subtype presenting at an earlier age and associated with more favorable pathological characteristics.

Clinical manifestations and treatment outcomes among hospitalised COVID-19 patients in tertiary hospitals in Tanzania, 2021–2022: a retrospective cohort study

BackgroundThere have been differential mortality rates from COVID-19 in different parts of the world. It is not clear whether the clinical presentation does also differ, thus the need for this...

Prevalence and patterns of multidrug-resistant bacteria isolated from sputum samples of patients with bacterial pneumonia at a tertiary hospital in Tanzania

BackgroundAntimicrobial resistance affects the treatment of several bacterial infections, including pneumonia. This subsequently increased the morbidity and mortality rates of patients with bacterial pneumonia, especially in resource-limited settings. In this study, we aimed to determine the patterns of multidrug-resistant (MDR) bacteria isolated from the sputum samples of patients with bacterial pneumonia attending a tertiary hospital in Tanzania.MethodologyA retrospective cross-sectional study was conducted. It involved reviewing the laboratory sputum data in the laboratory information system at Muhimbili National Hospital in Tanzania. The sputum samples were previously processed using standard methods (culture, Gram staining, and biochemical tests) to isolate and identify the bacteria. At the same time, antibiogram profiles were determined using antimicrobial susceptibility tests. Bacterial isolates that expressed MDR patterns were identified. Demographic information was collected from patients' medical records. We used the chi-square test to determine factors associated with MDR. A p-value < 0.05 was considered significant.ResultsWe retrieved and analysed 169 laboratory records of patients with a provisional clinical diagnosis of bacterial pneumonia confirmed in the microbiology laboratory. Nearly 98% of the records were from adult patients. The patients’ mean age was 48.3 years and 17.3 standard deviations. About 84% of the isolated bacteria were Gram-negative; the most predominant was Klebsiella pneumoniae (59/142; 41.5%). The predominant Gram-positive bacteria was Staphylococcus aureus (25/27; 92.6%). Furthermore, 80 out of 169 (47.3%) bacteria were MDR; Klebsiella pneumoniae (32.5%) was predominant. In addition, 50% of Staphylococcus aureus was methicillin resistance. MDR bacterial pneumonia was highly observed in patients admitted to the Intensive Care Unit (p < 0.05).ConclusionsAlthough our study was limited by variations in the number of bacterial isolates subjected to the same antibiotic drugs and a lack of information on risk factors such as occupation, smoking history, and marital status, we observed that a high proportion of bacterial pneumonia is caused by MDR Gram-negative bacteria in our local setting. These results inform the need to improve infection prevention control measures in hospitals to reduce the burden of MDR bacteria in our settings and other similar resource-limited settings.

Clinicopathological features and short-term surgical outcomes of early-onset versus late-onset colorectal cancer at a tertiary hospital in Tanzania: A retrospective-cohort study

BackgroundDespite the reported rising trend of early-onset CRC incidence globally, little is known about the clinical profile and primary CRC surgical outcome in Tanzania and sub-Saharan Africa. This study aimed to analyze the clinicopathological features and short-term surgical outcomes of early-onset CRC patients undergoing primary surgery. MethodologyThe patients who underwent primary CRC surgery and whose diagnosis was confirmed by histopathology were identified and reviewed from prospectively maintained medical records. Clinicopathological characteristics and short-term surgical outcomes were analyzed and compared between groups. ResultsA total of 225 patients were included in this study, there were 137 patients in the late-onset CRC group and 88 in the early-onset group. After a 1:1 ratio PSM, there were 86 patients in each group. The overall proportion of early-onset CRC patients was 39.1 %. With regards to baseline characteristics of gender, tumor stage, tumor location, and presenting symptoms, there was no significant difference between early-onset and late-onset CRC patient groups before and after propensity score Matching (PSM) analysis (p > 0.05). After PSM, Early-onset CRC patients had a significantly higher proportion of Signet-ring cell histology (p = 0.007) and a higher rate of overall postoperative complications, (p = 0.043). The multivariate analyses showed that early-onset CRC patients (p = 0.048, OR=2.14, 95 % CI=1.01–4.53) and emergency surgery (p = 0.011, OR=2.79, 95 % CI=1.27–6.13) were significant predictors of overall postoperative complications ConclusionEarly-onset CRC patients showed a significantly higher proportion of Signet-ring cell histology (poorly differentiated) and overall short-term postoperative complications. The early-onset CRC patients and emergency surgery were significant predictors of overall short-term postoperative complications

Occurrence of Pantoea agglomerans bloodstream infection in neonatal intensive care unit at tertiary hospital in Tanzania: antibiotic susceptibility profile and clinical outcome

BackgroundPantoea agglomerans (P. agglomerans) is an environmental gram-negative bacterium that rarely infects humans. P. agglomerans infections have never been reported in Tanzania. We investigated the occurrence of P. agglomerans bloodstream infections among neonates in the Intensive Care Unit (NICU) and their subsequent clinical outcome that occurred in 2019.MethodologyBlood samples were collected from neonates with sepsis. A total of 19 P. agglomerans were isolated from 17 infected neonates; two of the neonates had P. agglomerans isolated twice. A total of 14 patient files were retrieved from medical records.ResultsThe mean age of the infected neonates were 3.75 ± 7.95 days. Isolated P. agglomerans showed high sensitivity to the antibiotics particularly chloramphenicol (94.7%), piperacillin-tazobactam (94.7%) and meropenem (94.7%). The mortality rate was 71.4% with 35.7% of infected neonates dying before Antibiotic Susceptibility Test results for appropriate management. The Infection Prevention and Control (IPC) team shut the NICU for thorough decontamination which helped to stop the P. agglomerans occurrence.ConclusionsP. agglomerans occurrence at the NICU was an uncommon aetiology pathogen for neonatal sepsis associated with high rates of mortality despite high sensitivity to multiple antibiotics. This calls for the strengthening of infection control measures and introduction of surveillance for environmental pathogens capable of causing human infections.

Canal fitting and treatment outcomes of patients treated with sign fin nail at a Tertiary Hospital in Tanzania

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

Diagnostic correlation between plain radiographic and histopathology reports among patients with long bones tumours treated at a Tertiary Hospital in Tanzania

Background: Bone tumours are significant global health concern, with a rising number of new cases being diagnosed each year. The incidence of bone tumours has shown a significant increase in recent years, as evidenced by a 50% rise in new cases in 2020 alone. Early and accurate diagnosis is crucial for effective treatment and improved patient outcomes. The diagnosis of primary bone tumours is based on clinical, radiological and histopathological findings. Objective: This study aimed to determine the diagnostic correlation between plain radiographic and histopathological reports in diagnosing long bone tumours. Methods: A cross-sectional study was conducted between 2018 and 2021. Participants who underwent a histological examination for long bone tumours and met the inclusion criteria were enrolled. Relevant information was obtained from patient records then sensitivity, specificity, and accuracy of the plain radiograph were calculated with histopathology serving as the gold standard. Results: The study included 83 participants, the majority were aged 30 years old or younger. Forty six percent of the cases were malignant tumours while benign were 54%. Osteosarcoma was found to be the most common tumour type both by radiological and histological diagnosis and femur was the most commonly affected bone. Plain radiograph was found to have a sensitivity of 92.1%, specificity of 73.3% and accuracy of 82%. Conclusion: This study found a strong diagnostic correlation between plain radiographic and histopathology reports in patients with long bone tumours. This suggests that plain radiography can serve as a useful screening tool for long bone tumours in resource-limited settings, allowing for early and accurate preliminary diagnoses.

Herbal medicines use among HIV/AIDS patients on antiretroviral therapy and its influence on viral suppression and CD4 count: A survey at a tertiary hospital in Tanzania

ObjectivesThis study aimed to determine the magnitude of concurrent use of herbal medicines with ART, its associated factors and effect on viral load suppression and CD4 count among people living with HIV. Study designThis was a cross-sectional study involving 375 HIV positive patients on ART attending at care and treatment clinic (CTC). MethodsData were obtained through face-to-face interviews using pre-structured questionnaires and patient's files through a checklist. Adherence was assessed though pill count method while CD4 count and viral load suppression were assessed using the Tanzania National guidelines for the management of HIV and AIDS. Data were analysed using STATA version 15. Independent predictors for herbal medicine use or viral suppression were assessed using univariate and multivariate logistic regression. ResultsOut of 375 PLHIV, 132 (35%) reported to use herbal medicines concurrently with ART. Predictors for herbal medicines use were existence of chronic disease (OR = 4.53; CI = 1.87–10.95) (p = 0.001), male gender (OR = 0.57; CI = 0.35–0.93) (p = 0.02) and HIV clinical stage (OR = 1.71; CI = 0.99–2.94) (p = 005). PLHIV who used herbal medicines along with ART did not have a significantly higher chance of achieving viral suppression than PLHIV who did not use herbal medicines (OR = 1.42; CI = 0.71–2.82). There was no statistically significant difference on CD4 count (p = 0.8943) and viral load (p = 0.8612) between herbal medicines users and non-users. ConclusionThe utilization of herbal medicine among PLHIV on ART remains notably prevalent. Nonetheless, it is worth noting that despite the prevailing herbal medicine usage, there is no substantial effect on viral suppression. The primary determinants of the adoption of herbal medicines use were having chronic medical conditions and the stage of progression of the HIV infection.

Nutritional Status Among Head and Neck Cancer Patients, Tanzania

Background: Nutrition in cancer patients is a challenge as various mechanisms can lead to poor nutrition status, and this contributes to poor prognosis and quality of life. In developing countries, before one concludes that cancer is the culprit to malnutrition, one has to rule out access to food. The Head and Neck region is involved with the intake and initial processing of the food. Therefore, the presence of a tumor in any subsite directly affects nutritional status. Aim: This study aimed to establish nutritional adequacy among Head and Neck Cancer patients accessing services at a tertiary hospital in Tanzania. Method: The study was cross-sectional descriptive. Patients with head and neck cancer attended from 1st August 2022 to 31st January 2023 were recruited. Information about access to food was collected and nutrition was measured by anthropometric measurements and biochemical tests (serum albumin levels). After data collection, the correctness was checked by running frequency tables and analyzed by Statistical Package for the Social Sciences (SPSS) version 26. Results: The study involved a total of 113 participants aged from 15 to 93 years with a mean age of 51.81+/-17.439 years. There were 74 males and 39 females, making a ratio of 1.9:1. Most participants had laryngeal tumours (46%). 85.6% of patients had advanced disease, stage IV (52.2%).17% of patients had pre-existing dietary risk, and 36.3% had severe malnourishment at presentation. In this study,75% of patients with oropharyngeal tumours had malnutrition, followed by hypopharyngeal and nasopharyngeal tumours, each with 66.7%. Stage IV patients were severely malnourished (57.6%) which was statistically significant. Conclusion and recommendation: Laryngeal tumours are common in men and are related to advanced age. Most of the patients with Head and Neck Cancer (HNC) had severe malnourishment. Management of head and neck cancer should also address malnutrition which contributes to poor prognosis and quality of life.

Predictors of mortality among children at a tertiary hospital in Tanzania: a cohort study

BackgroundTanzania is among the countries in sub-Saharan Africa with the highest under-five mortality rate. The leading causes of mortality among these children include vaccine-preventable infections. Strategies for reducing under-five mortality in hospital settings require a good knowledge of driving factors, which are largely unknown in Tanzania. This study was conducted at Muhimbili National Hospital to determine mortality and its predictors among under-five admitted in the general paediatric wards.MethodsWe conducted a prospective cohort study among children aged between 1 and 59 months admitted in the paediatric wards at Muhimbili National Hospital from 2nd October 2017 to 13th April 2018. We recruited eligible children consecutively and followed them up until discharge or death. We calculated the mortality rate as the incidence density rate and determined the causes and predictors of mortality. We analyzed data to identify and quantify predictors of deaths and used Kaplan-Meir and Cox regression analyses to determine predictors of survival. A P-value of < 0.05 was considered statistically significant.ResultsWe recruited 925 children aged 1–59 months with a median age of 13 and (IQR) of (20) months, females constituted 40.8%. The overall mortality rate was 12.2% (95% CI: 10.2%-14.5%). We found septicaemia (27%), malnutrition (12%), congenital heart disease (12%), pneumonia (11%), and Human Immunodeficiency Virus infection (9%) to be leading causes of mortality. More deaths were observed at night, during the first 24 h of admission, and on weekends. Independent factors for mortality were found to be low wealth quintiles (lowest quintile (AOR = 4.0; 95% CI: 1.19–13.51), second quintile (AOR = 5.2; 95% CI: 1.65–16.69) and middle quintile (AOR = 3.6; 95% CI: 1.14–11.33), unconsciousness on admission (AOR = 18; 95% CI: 6.70–56.82), inability to feed (AOR = 5.7; 95% CI: 1.97–16.51), lethargy (AOR = 4.9; 95% CI: 2.32–10.40), severe wasting (AOR = 4.5; 95% CI: 2.49–8.10), and respiratory distress (AOR = 2.6; 95% CI: 1.40–4.97).ConclusionA high mortality rate was noted in this study and low wealth quantile, low parental education, and lack of health insurance were associated with high mortality. Patients had the highest risk of mortality within 24 h of admission, therefore it is important to raise awareness among clinicians regarding the need for improvement in the monitoring of patients, especially within 24 h of admission.

Angiographic characteristics of coronary artery disease in patients undergoing diagnostic coronary angiography at a tertiary hospital in Tanzania

BackgroundCoronary artery disease (CAD) is an important cause of global burden of disease. There is a paucity of data on the burden and risk factors for CAD in sub-Saharan Africa (SSA), despite the rising trends in the shared risk factors across regions. The recent introduction of cardiac catheterization laboratory services in SSA could shed light on the burden of CAD in the region. We aimed to assess the angiographic characteristics among patients undergoing diagnostic coronary angiography (CAG) at a single tertiary care hospital in Tanzania.MethodsThis study was a retrospective chart review. A total of 728 patients ≥ 18 years of age who underwent CAG from January 2020 to December 2022 were recruited into the study. Basic demographic variables, risk factors and clinical characteristics including CAG findings were obtained from the registry. In addition, CAG images were retrieved for assessment of angiographic features. The luminal vessel stenosis was assessed based on eyeballing and the degree of obstruction was agreed by two independent and experienced cardiologists. The coronary stenosis of ≥ 50% was considered significant for obstructive CAD. The study was approved by the local ethics committee.ResultsOf patients who were recruited into the study, 384 (52.23%) were female. The study participants had a mean age of 59.46 ± 10.83 standard deviation (SD) and mean body mass index (BMI) of 31.18 kg/m2. The prevalence of CAD of any degree was estimated at 24.43% (34.18% in male, 15.50% in female), while that of obstructive CAD was 18.27%. Forty six percent of those with obstructive CAD had multiple vessel disease (MVD). Nearly 77% of patients were found to have ≥ 50–70% luminal stenosis and while those with ≥ 70% luminal coronary artery stenosis constituted 56.65%. Right coronary artery (RCA) was the most commonly affected vessel, accounting for 36.84% when any vessel disease or 56% when single vessel disease were considered. Being 65 years or older and comorbidity with type 2 diabetes (T2D) were independent risk factors for developing CAD.ConclusionThere is a high prevalence of obstructive CAD among patients undergoing diagnostic CAG in Tanzania, with male gender preponderance and increasingly higher in older age, often with severe disease. A large, prospective study is needed to provide epidemiological and clinical data for developing a locally-relevant cardio-preventive strategy for CAD intervention in Tanzania.

Paranasal sinuses in patients with chronic rhinosinusitis,Tanzania

Introduction: Chronic rhinosinusitis is inflammation of the nasal cavity and paranasal sinuses that lasts for at least twelve weeks. Paranasal sinus variations account for various pathologies, including chronic rhinosinusitis. This study assessed the anatomical variations of paranasal sinuses among patients with chronic rhinosinusitis attending otorhinolaryngology services in a tertiary hospital in Tanzania.&#x0D; Method: This was a descriptive prospective cross-sectional study of 120 patients aged 15 years and above who fulfilled the Rhinosinusitis Task Force criteria. A structured checklist was used to collect socio-demographic characteristics and clinical presentations. Cone-beam computed tomography scan and the Lund-Mackay scoring system were used. Data analysis was done using SPSS version 26, and p-values &lt;0.05 were considered statistically significant.&#x0D; Results: A total of 120 patients were enrolled with a median age of 37 (IQR 27-52) years, with 40% aged 30-49 years. There were 65 (54.2%) males, and 55 (45.8%) females. Maxillary sinuses were affected in 85.8% of all patients with chronic rhinosinusitis. The overall proportion of anatomical variation was 53.3%, with concha bullosa, deviated nasal septum, Onodi cells, and septal spur being the most common, accounting for 40.6%, 25.0%, 23.4%, and 20.3%, respectively. Twenty-four patients with concha bullosa had chronic maxillary rhinosinusitis, with 14 (58.3%) having ipsilateral rhinosinusitis.&#x0D; Conclusion: Half of the patients had one or more paranasal sinus anatomical variations. The most common variants were concha bullosa followed by deviated nasal septum. Onodi cells and septal spurs were rarely identified. Most patients with concha bullosa had ipsilateral maxillary sinusitis.

Retrospective Analysis of Histopathological Reports of Salivary Gland Pleomorphic Adenomas in Tanzania.

Pleomorphic adenoma (PA) is the most common benign tumor representing about 80% of all salivary gland tumors. Despite this, there is limited documentation of the demographic information and pattern of PA in Tanzania. This study retrospectively determines the demographic information and the pattern of presentation of pleomorphic adenomas of the salivary gland among patients managed at a tertiary hospital in Tanzania. This was a retrospective study of histological results of salivary gland pleomorphic adenoma diagnosed between 2016 and 2021. The information gathered included the age and sex of the patient and the anatomical location. Data analysis was done using Statistical Package for the Social Sciences version 27 computer program. Out of 1824 reports of patients with oral and maxillofacial lesions retrieved from the archives of the department, 62 (3.4%) had the diagnosis of pleomorphic adenoma of the salivary glands. The patients' ages at diagnosis ranged from 7 to 72 years, with a mean age of 39.9 (SEM = 2.3) years. The male-to-female ratio of patients diagnosed with pleomorphic adenoma was 1:1. There were 31 (50%) cases of pleomorphic adenomas affecting major salivary glands. The palatal minor salivary glands were the most (n=31, 50%) affected followed by the parotid gland (n=16, 25.8%). Pleomorphic adenomas have no sex predilection, most of these lesions occur during the 3rd to 5th decade of life. The majority of pleomorphic adenomas occur in the palatal minor salivary glands.

A study protocol for predictors of post-discharge mortality among children aged 5-14 years admitted to tertiary hospitals in Tanzania: A prospective observational cohort study.

Globally, millions of children and adolescents die every year from treatable and preventable causes. Sub-Saharan Africa accounted for 55% of deaths of children aged 5-14 years in 2017. Despite this high burden, minimal effort has been directed toward reducing mortality among older children and adolescents in comparison to under-fives. Mortality rates of children post-discharge vary between 1-18% in limited-resource countries and are reported to exceed in-hospital mortality. In Tanzania, there is limited data regarding post-discharge mortality and its predictors among children aged 5-14 years. This study aims to determine the post-discharge mortality rate and its predictors among children aged 5-14 years admitted to pediatric wards at MNH, MOI, and JKCI. This will be a prospective observational cohort study that will be conducted among children aged 5-14 years admitted to pediatric wards at Muhimbili National Hospital, Jakaya Kikwete Cardiac Institue, and Muhimbili Orthopedic Institue in Dar-Es-Salaam, Tanzania. Data will be collected using a structured questionnaire and will include socio-demographic characteristics, clinical factors, and patients' outcomes. Post-discharge follow-up will be done at months 1, 2, and 3 after discharge via phone call. Data will be analyzed using SPSS version 23. The association of demographic, social economic, and clinical factors with the outcome of all causes, 3 months post-discharge mortality will be determined by Cox regression, and survival rates will be displayed through Kaplan-Meier curves. This study will determine post-discharge mortality among children aged 5-14 years and its predictors in Tanzania. This information is expected to provide baseline data that will be useful for raising awareness of clinicians on how to prioritize and plan a proper follow-up of children following hospital discharge. These data may also be used to guide policy development to address and reduce the high burden of older children and adolescent mortality and may be used for future studies including those aiming to develop prediction models for post-discharge mortality among older children and adolescents.

Clinical profile and outcomes of paediatric patients with acute seizures: a prospective cohort study at an urban emergency department of a tertiary hospital in Tanzania

ObjectiveChildren with seizures require immediate and appropriate intervention in the emergency department (ED). This study describes the clinical profile and outcome of paediatric patients with seizures at the ED in...

The Pattern of Admission, Clinical Characteristics, and Outcomes Among Patients Admitted to the Intensive Care Unit of a Tertiary Hospital in Tanzania: A 5-Year Retrospective Review

The Pattern of Admission, Clinical Characteristics, and Outcomes Among Patients Admitted to the Intensive Care Unit of a Tertiary Hospital in Tanzania: A 5-Year Retrospective Review

Prevalence of methicillin and clindamycin resistant Staphylococcus species at a tertiary hospital in Tanzania: Implications for antibiotic stewardship and infection management

Methicillin and clindamycin resistance (constitutive and inducible) pose a common clinical challenge in treating Staphylococcal infections. This cross-sectional study, conducted at Muhimbili National Hospital (MNH) in Tanzania from April to June 2023, to assess the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and clindamycin-resistant Staphylococcus (S.) species by using a cefoxitin disk (30 μg) and the D-test method as per CLSI 2022 guidelines. Of the 361 clinical samples, 125 (34.6%) were culture-positive. Among Staphylococcus spp., S. aureus was 6% (12/125), while 33.6% (42/125) were coagulase-negative staphylococci (CoNS). Among the isolated S. aureus, 75% were resistant to methicillin, while 66.7% of the CoNS were resistant to methicillin. Further, 92% (11/12) of the S. aureus isolates were resistant to erythromycin, and 50% (6/12) were resistant to clindamycin. Among the CoNS, 83% (35/42) were resistant to erythromycin, and 52% (22/42) were resistant to clindamycin. The proportion of inducible macrolides lincosamide streptogramin B resistance (iMLSB), constitutive macrolides lincosamide streptogramin B resistance (cMLSB), and macrolides lincosamide streptgramin B methicillin susceptible (MS) phenotypes among S. aureus isolates was 16.7%, 41.7%, and 33.3%, respectively, and among CoNS was 19%, 35.7%, and 28.6%, respectively. The overall prevalence of iMLSB and cMLSB phenotypes was 18.5% (10/54) and 37% (20/54), respectively. Comparatively, MRSA had more resistance to ciprofloxacin than methicillin-susceptible S. aureus (MSSA) (88.9% vs. 33.3% p = 0.027), while methicillin-resistant coagulase-negative staphylococci (MR-CoNS) had significantly higher resistance to gentamicin (35.7% vs. 7.1% p= 0.005), and trimethoprim-sulfamethoxazole (78.6% vs. 50% p=0.007) than methicillin-susceptible coagulase-negative staphylococci (MS-CoNS). The high prevalence of methicillin and inducible clindamycin resistance in this study points out a potential rise in treatment failures, prolonged hospitalization, and limited treatment options. Thus, emphasizes the importance of antibiotic stewardship and laboratory-guided antibiotic decisions. To address the growing challenge of antibiotic resistance in Tanzania, it is advisable to implement stringent public health measures, including monitoring antibiotic usage, conducting educational initiatives, and raising awareness among patients and healthcare professionals.

Prevalence of Age-Related Sensorineural Hearing Loss and Related Factors in Elderly Patients Attending Tertiary Hospital in Tanzania.

Age-related sensorineural hearing loss (SNHL), is a progressive, usually bilateral hearing loss that occurs in elderly. It is correctable using rehabilitative hearing devices, which can vastly improve the older person's quality of life. This study aimed to find out the prevalence and related factors of age-related sensorineural hearing loss among elderly patients in Tanzania. A total of 380 elderly patients who received Otorhinolaryngology (ORL) services at Muhimbili tertiary hospital were enrolled. Participants were screened for hearing loss and interviewed by the structured questionnaire followed by otoscopic examination and Pure tone Audiometry (PTA). This study included 182(47.9%) males, and 198 (52.1%) females. The prevalence of SNHL was 27.6%, males were mostly affected 57(31.3%) p = 0.574. Bilateral SNHL was found 90 (85.7%) p = 0.026, and the severity of age-related SNHL was found to increase as age increases. Sensorineural hearing loss among the elderly was prevalent, mostly bilateral, and the severity increases with age. Confounding factors such as hypertension, diabetes mellitus (DM), cigarette smoking, and ototoxic medication may have contributed. Elderly should be screened for hearing loss especially on the individuals with other co-morbidities for early diagnosis and management in order to improve the quality of life of the elderly.

Antibiotic use at a tertiary hospital in Tanzania: findings from a point prevalence survey

BackgroundIn Tanzania, data on antibiotic use at the patient level is scarce, and intervention measures to optimize antibiotic use and reduce antimicrobial resistance are rarely performed.ObjectivesTo describe antibiotic use at Muhimbili National Hospital.MethodsThis was a point prevalence survey on antibiotic use conducted at Muhimbili National Hospital in August-September 2022. The World Health Organization point prevalence survey data collection tool was used to collect patients’ information from the files. All patients admitted to the wards on the day of the survey were included.ResultsOverall, 47% (185/397) of admitted patients were on at least one antibiotic during the survey. All antibiotics prescribed were for empirical treatment and guideline compliance was low, at 45%. Of 185 patients who received antibiotics, the most common indication was community acquired infection (55%) and 36% had no documentation of the reasons for prescribing antibiotics. Almost 75% of the antibiotics were administered parenterally, with only 2% switching to oral route. Microbiological tests were performed in only 9 (5%) patients out of 185 and results were available for only one patient. Of all participants, 52% received two or more antibiotic in combination, with the combination ceftriaxone-metronidazole being most frequently prescribed, followed by the combination of ampicillin, cloxacillin, and gentamicin. For individual antibiotics, ceftriaxone was the most frequently prescribed antibiotic accounting for 28% (79/283), followed by metronidazole (24%) and amoxicillin-clavulanic acid (11%).ConclusionThe findings of a high prevalence of antibiotic use, inadequate use of bacterial culture, and frequent empiric antibiotic treatment suggests the need for strengthening diagnostic and antimicrobial stewardship programs. Furthermore, this study has identified areas for quality improvement, including education programs focusing on prescription practice.

Silicosis and silicotuberculosis among respiratory hospital admissions: A cross-sectional survey in northern Tanzania.

There is little evidence describing respiratory disease among 40.5 million small-scale miners worldwide. To describe the prevalence and clinical characteristics of adult respiratory inpatients with silicosis and silicotuberculosis in a tertiary hospital in Tanzania that serves a small-scale mining region. In this retrospective, cross-sectional survey, patient files from admissions between 2010 and 2020 were opportunistically selected and included if a respiratory diagnosis had been made. Of 223 patients with respiratory conditions, 32 (14.3%; 95% confidence interval (CI) 10.0 - 19.6) were diagnosed with silicosis and 17 (7.6%; 95% CI 4.5 - 11.9) with silicotuberculosis. Mining was the most frequent occupation in those with silicosis (n=15/32; 46.9%) and silicotuberculosis (n=15/17; 88.2%). Of those with silicosis or silicotuberculosis, 26/49 (53.1%) were aged <45 years. Our study suggests that silicosis and silicotuberculosis are common among male and female respiratory inpatients with occupational exposure. The study highlights the role of occupational exposures in respiratory disease in developing economies. What the study adds. This retrospective, cross-sectional survey describes the prevalence of silicosis and silicotuberculosis among adult respiratory inpatients admitted to a tertiary hospital in northern Tanzania. It is the first study to describe the prevalence and characteristics of respiratory inpatients with silicosis and silicotuberculosis in a small-scale mining region of Africa. A high prevalence of silicosis (14.3%) and silicotuberculosis (7.6%) was found. Patients were often aged <45 years, and the majority required oxygen therapy.Implications of the findings. The high prevalence of advanced silicosis and silicotuberculosis in miners presenting at a young age raises concerns about high occupational silica exposures and, importantly, suggests a need for community-based research, which our team is planning to undertake.