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Seroprevalence of SARS-COV-2 Exposure among “High-Risk” Populations (Healthcare Workers, People Who Attend Markets, and School Children) in Zanzibar

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Advances in Infectious Diseases 2024年第1期14卷 34-55页

作者： Ame Masemo Solomon Mwakasungula Khamis Kheir Erick Mgina Nahya Khamis Irabi Kassim Bihila Bakar Khamis Salim Sarah Mswata Kibwana Omar Theckla Kazimoto Linzy Elton Honorati Masanja Mayassa Ally Zanzibar Health Research Institute Binguni Zanzibar Ifakara Health Institute Bagamoyo Tanzania National Institute for medical Research muhimbili centre Dar es Salaam Tanzania Binguni Public Health Laboratory Binguni Zanzibar Department of Microbiology Mnazi Mmoja Hospital Stone Town Zanzibar centre for Clinical Microbiology Royal Free Hospital Campus University College London London UK

In Zanzibar, from the start of the pandemic in March 2020 to the time of sampling in December 2020, SARS-CoV-2 seroprevalence data was limited. We conducted a seroprevalence study to evaluate the magnitude of SARS-CoV-2 exposure among healthcare workers, school children, and people who attended general markets in Zanzibar. The objectives of the study were to analyse the total antibodies from selected higher-risk population groups in order to determine magnitude in SARS CoV-2 exposure. Blood samples were collected from eligible and consented participants (adults and children), and their serum was analyzed for total antibodies against SARS-CoV-2 using ELISA. A questionnaire was used to collect participants’ demographic and clinical data. The overall SARS-CoV-2 seroprevalence across all age groups was 33%, and a higher seroprevalence was observed in the 40 - 49 years’ age group relative to other ages as well as in those who attended markets. A runny nose (18.8% of participants) was the most frequently reported SARS-CoV-2 infection-related symptom. Multivariable analysis showed significantly higher odds of infection in people living in urban districts. The findings provide insight into SARS-CoV-2 infection among school children, health workers, and people who attended markets in Zanzibar in the early stages of the pandemic. Exposure in these groups might have been influenced by infection and prevention strategies taken by the government, as well as shopping behavior, school overcrowding, and population density in urban settings. The study had methodological limitations, including cross-sectional design. Further, well-designed, longitudinal studies are recommended to understand exposure and transmission at a population level.

关键词： SARS-CoV-2 Seroprevalence Zanzibar ELISA COVID-19

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High prevalence of epilepsy in two rural onchocerciasis endemic villages in the Mahenge area,Tanzania,after 20 years of community directed treatment with ivermectin

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Infectious Diseases of Poverty 2018年第1期7卷 622-634页

作者： Bruno P.Mmbando Patrick Suykerbuyk Mohamed Mnacho Advocatus Kakorozya William Matuja Adam Hendy Helena Greter Williams H.Makunde Robert Colebunders National Institute for medical Research Tanga Research CentreTangaTanzania Global Health Institute University of AntwerpAntwerpBelgium muhimbili National Hospital Dar es SalaamTanzania Enhance Tanzania Foundation Dar es SalaamTanzania muhimbili University of Health and allied Sciences Dar es SalaamTanzania University of Texas medical Branch GalvestonTXUSA

Background:Epilepsy is a neurological disorder with a multitude of underlying causes,which may include infection with Onchocerca volvulus,the parasitic worm that causes human onchocerciasis.A survey carried out in 1989 revealed a high prevalence of epilepsy(1.02%overall,ranging from 0.51 to 3.71%in ten villages)in the Mahenge area of Ulanga district,an onchocerciasis endemic region in south eastern *** study aimed to determine the prevalence and incidence of epilepsy following 20 years of onchocerciasis control through annual community directed treatment with ivermectin(CDTI).Methods:The study was conducted in January 2017 in two suburban and two rural villages in the Mahenge ***-todoor household visits were carried out by trained community health workers and data assistants to screen for persons suspected of having epilepsy,using a standardised *** with suspected epilepsy were then interviewed and examined by a neurologist for case *** associated epilepsy was defined as epilepsy without an obvious cause,with an onset of seizures between the ages of 3-18 years in previously healthy *** each village,fifty males aged≥20 years were tested for onchocerciasis antibodies using an OV16 rapid test and were examined for presence of onchocerciasis *** aged 6-10 years were also tested using OV16 ***:5117 individuals(median age 18.5 years,53.2%female)from 1168 households were screened.244(4.8%)were suspected of having epilepsy and invited for neurological *** of epilepsy was 2.5%,with the rural villages having the highest rate(3.5%vs 1.5%),P<*** incidence of epilepsy was 111 cases(95%CI:73-161)per 100000 person-years,while that of onchocerciasis associated epilepsy was 131(95%CI:70-223).Prevalence of OV16 antibodies in adult males and among children 6-10 years old was higher in rural villages than in suburban villages(76.5%vs 50.6,and 42.6%vs 4.7%respectively),(P

关键词： Epilepsy Onchocerciasis Mahenge Tanzania

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Prevalence and Factors Associated with Burnout Syndrome among Resident Doctors at Tertiary Teaching Hospitals in Dar es Salaam, Tanzania

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International Journal of Clinical Medicine 2022年第1期13卷 36-49页

作者： Edwin Rwebugisa Lugazia Happiness Charles Sway Respicious Lwezimula Boniface Asha Abdullah muhimbili University of Health and Allied Sciences (MUHAS) Dar es Salaam Tanzania Jakaya Kikwete Cardiac Institute Dar es Salaam Tanzania muhimbili Orthopaedic Institute (MOI) Dar es Salaam Tanzania Injury Control centre Tanzania (ICCT) Dar es Salaam Tanzania

Introduction: Burnout syndrome is prevalent to a great extent among medical residents, and this can interfere with their training and patient management. However, the extent of the problem is still unknown in our setting. This study therefore aimed at determining prevalence and factors associated with burnout syndrome among resident doctors at tertiary teaching hospitals in Dar es Salaam, Tanzania. Method: A cross-sectional study of resident doctors was carried out in four teaching hospitals of muhimbili University of Health and Allied Sciences between January 2021 and March 2021. Participants were interviewed using a structured questionnaire and Maslach Burnout Inventory. Results: The study had 398 participants with a mean age of 35 ± 3.5 years. Overall burnout prevalence was 33.7%, as for the burnout dimensions, 205 (51.5%) respondents reported burnout in the dimension of emotional exhaustion (EE), 177 (44.5%) in the dimension of depersonalization (D), and 144 (36.2%) in the dimension of reduced personal accomplishment (RPA). Independent factors associated with burnout syndrome were: inadequate support from residency program supervisors (Odds Ratio (OR) 1.97, 95% CI: 1.23 - 3.14, p = 0.005), work-related family conflicts (Odds Ratio (OR) 3.2, 95% CI: 1.35 - 7.71, p = 0.008), stressful call perception (Odds Ratio (OR) 3.31, 95% CI: 1.90 - 5.76, p = 0.001) and each added year of study (Odds Ratio (OR) 3.46, 95% CI: 1.08 - 6.73, p = 0.009). Conclusion: Burnout is a problem among resident doctors in Tanzania. This could be addressed by directing preventive and intervention measures in the residency training program. Periodic assessment is also needed to mitigate factors associated with burnout among resident doctors.

关键词： Burnout Resident Doctors Emotional Exhaustion (EE) Depersonalization (DP) Reduced Personal Accomplishment (RPA)

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Onchocerciasis-associated epilepsy:another piece in the puzzle from the Mahenge mountains, southern Tanzania

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Infectious Diseases of Poverty 2019年第3期8卷 88-93页

作者： Christoph Kaiser Bruno P.Mmbando Joseph N.Siewe Fodjo Patrick Suykerbuyk Mohamed Mnacho Advocatus Kakorozya William Matuja Adam Hendy Helena Greter Williams H.Makunde Robert Colebunders Pediatric Practice Balzenbergstrasse 7376530 Baden-BadenGermany National Institute for medical Research Tanga Research CentreTangaTanzania Global Health Institute University of AntwerpAntwerpBelgium muhimbili National Hospital Dar es SalaamTanzania Enhance Tanzania Foundation Dar es SalaamTanzania muhimbili University of Health and allied Sciences Dar es SalaamTanzania University of Texas medical Branch GalvestonTXUSA

In a study from the onchocerciasis-endemic area of Mahenge in southern Tanzania,Mmbando et al.[Inf Dis Poverty.2018,7:64]demonstrate that in four selected villages the overall epilepsy prevalence was high,and significantly more elevated in the two villages of higher onchocerciasis endemicity compared to those of lower *** is replicating earlier findings from many other areas of tropical *** authors are also providing data indicating that in the Mahenge focus,the prevalence of nodding syndrome may be related to that of onchocerciasis in the same way as epilepsy in *** application of a clinical case definition for onchocerciasis-associated epilepsy(OAE)as used in the study of Mmbando et al.[Inf Dis Poverty.2018;7:64]faces some difficulties;indeed,its precision in discerning cases of OAE from epilepsy due to other etiologies is not known,and it does not allow for a specific diagnosis in the individual *** an operational surveillance tool for assessing the number of patients in the population could mean substantial advance for better estimating the burden of OAE,the proposed definition should be tried in different settings and its performance reviewed in the process.

关键词： epilepsy mountains Poverty

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Association between Taenia solium infection and HIV/AIDS in northern Tanzania: a matched cross sectional-study

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Infectious Diseases of Poverty 2016年第1期5卷 1022-1036页

作者： Veronika Schmidt Christian Kositz Karl-Heinz Herbinger Hélène Carabin Bernard Ngowi Ezra Naman Patricia P.Wilkins John Noh William Matuja Andrea Sylvia Winkler Department of Neurology University HospitalKlinikum rechts der IsarTechnical University Munich(TUM)Ismaninger Str.2281675 MunichGermany Department of Infectious Diseases and Tropical Medicine(DITM) Medical Center of the University of MunichMunichGermany Department of Biostatistics and Epidemiology University of Oklahoma Health Sciences CenterOklahoma CityUSA muhimbili medical Research centre National Institute for Medical Research(NIMR)Dar es SalaamTanzania HIV Care and Treatment centre Haydom Lutheran HospitalHaydomTanzania Division of Parasitic Diseases and Malaria Center for Global HealthCenters for Disease Control and Prevention(CDC)AtlantaUSA Department of Neurology Muhimbili University of Health and Allied SciencesDar es SalaamTanzania centre of Global Health University of OsloOsloNorway

Background:The frequency of Taenia solium,a zoonotic helminth,is increasing in many countries of sub-Saharan Africa,where the prevalence of the human immunodeficiency virus(HIV)is also ***,little is known about how these two infections *** aim of this study was to compare the proportion of HIV positive(+)and negative(−)individuals who are infected with Taenia solium(TSOL)and who present with clinical and neurological manifestations of cysticercosis(CC).Methods:In northern Tanzania,170 HIV+individuals and 170 HIV–controls matched for gender,age and village of origin were *** staging and serological tests for TSOL antibodies(Ab)and antigen(Ag)were ***(NCC)was determined by computed tomography(CT)using standard diagnostic *** manifestations were confirmed by a standard neurological *** addition,demographic,clinical and neuroimaging data were ***,CD4^(+)cell counts as well as information on highly active antiretroviral treatment(HAART)were ***:No significant differences between HIV+and HIV–individuals regarding the sero-prevalence of taeniosis-Ab(0.6%vs 1.2%),CC-Ab(2.4%vs 2.4%)and CC-Ag(0.6%vs 0.0%)were detected.A total of six NCC cases(3 HIV+and 3 HIV–)were detected in the group of matched *** individuals(1 HIV+and 1 HIV–)presented with headaches as the main symptom for NCC,and four with asymptomatic *** the HIV+group,TSOL was not associated with CD4+cell counts,HAART duration or HIV ***:This study found lower prevalence of taeniosis,CC and NCC than had been reported in the region to *** low level of infection may have resulted in an inability to find cross-sectional associations between HIV status and TSOL infection or *** sample sizes will be required in future studies conducted in that area to conclude if HIV influences the way NCC manifests itself.

关键词： Taenia solium Taeniosis Cysticercosis Neurocysticercosis HIV AIDS Co-infection Helminth Tapeworm Prevalence

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Postpartum Hemorrhage: Incidence, Causes and Maternal Outcomes at muhimbili National Hospital, Tanzania—A Retrospective Descriptive Hospital-Based Study

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Open Journal of Obstetrics and Gynecology 2023年第7期13卷 1244-1258页

作者： Rafiki Nickson Mjema Amani Idris Kikula Furaha August Fadhlun Alwy Al-Beity Ali Said Phineas F. Sospeter Nasra Batchu Benjamin Shayo Damian Jeremiah Ponsian P. Kunambi John Somi Patricia Swai Department of Obstetrics and Gynecology Muhimbili University of Health and Allied Sciences MUHAS Dar es Salaam Tanzania Department of Reproductive Maternal and Child Health Ministry of Health Dodoma Tanzania Department of Obstetrics and Gynecology Kilimanjaro Christian Medical Centre Moshi Kilimanjaro Tanzania Department of Obstetrics and Gynecology Baylor’s College Lilongwe Malawi Kilimanjaro Christian medical University College Moshi Kilimanjaro Tanzania

Worldwide obstetric hemorrhage remains the leading cause of maternal mortality, accounting for over one quarter of maternal deaths. Over half of these deaths occur in Sub-Saharan Africa with mortality rates of 500 - 1000 per 100,000 births, compared to approximately 5 - 10 in developed countries. Over decades in Sub Saharan Africa preventive measures and treatment protocols have been made to reduce maternal mortality caused by PPH. While rates of postpartum hemorrhage have continued to rise, there is a need to evaluate if its etiology and patterns have changed over time. Broad Objective: This study aims at describing trends in incidence, causes and maternal outcomes of Postpartum Hemorrhage at muhimbili National Hospital for a period of 7 years. Methodology: This is a retrospective descriptive hospital-based study that has included all cases of postpartum hemorrhage at muhimbili National Hospital, a tertiary hospital in Tanzania from 2014 to 2020. The data was analyzed using SPSS Version 26 and presented using frequency tables, figures and percentages. The trends of postpartum hemorrhage over time were determined using chi-square test and P-value where less than 0.05 was considered statistically significant. Results: Overall, the incidence of postpartum hemorrhage has been fluctuating over the years with minimum of 1.78% and maximum of 2.87% with no statistical significance. Out of 1113 enrolled cases of PPH, 422 (37.9%) were attributed to genital tears followed by uterine atony 285 (25.6%). A statistically significant increase in linear trend was observed in the postpartum hemorrhage cases due to uterine atony, uterine rupture and sub analysis on genital tears (cervical tear). Overall, there was a statistically significant change in trend of maternal outcomes throughout the years, with a P-value < 0.001 and likelihood of complications increasing over time. Conclusion: The trend in the incidence of postpartum hemorrhage has been fluctuating over the years during the

关键词： Postpartum Hemorrhage Incidence Causes Maternal Outcomes and Tanzania

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SUCCESSFUL CRANIOTOMY FOR MULTIPLE INTRACRANIAL HEMATOMAS

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中华医学杂志(英文版) 1984年第7期97卷 494-494页

作者： Wu Cheng-yuan Mlay SM Mhina RI Department of Neurosurgery Affiliated Hospital of Shandong Medical College Jinan China Department of Orthopedics and Trauma Muhimbili Medical Centre Dar es Salaam Tanzania

A patient with multiple intracranial hematomas, complicated by respiratory arrest, is presented. He was successfully treated by emergency craniotomy with removal or a large flap of the parietal bone for decompression.

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Identifying Training Needs in Pain Management—A Survey of Staff at a Tertiary Cancer Care centre

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Pain Studies and Treatment 2022年第2期10卷 9-20页

作者： Nazima Dharsee Mary Haule Genoveve Mlawa Theodora Lwanga Ocean Road Cancer Institute Dar es Salaam Tanzania muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania

Pain is one of the most common and distressing symptoms experienced by cancer patients and can cause significant physical and psychological complications for patients and their families. Adequate pain management requires an understanding of pain, its assessment, and the use of analgesics according to the WHO analgesic ladder;information that is often lacking in routine medical education. Understanding the level of knowledge, attitudes and practices of clinicians who treat cancer pain can help us prepare relevant educational programs to address this need. A cross-sectional descriptive study was conducted among randomly selected eligible clinical staff using self-administered questionnaires that contained close-ended and open-ended questions testing factual knowledge on pain, attitudes towards pain management, and practices related to pain management and opioid use. Results were analyzed using SPSS Version 28. Of 66 participants of this study, 78% were female and 65% were nurses. Only 10% had received any additional training in pain management. Knowledge on pain was found to be adequate in some areas, but deficient in others such as “types of pain” and “adjuvant drugs” (35% and 26% respectively). A significant proportion of responses (73%) showed incorrect attitudes towards pain and opioid use. Recommended practices such as prescribing laxatives with opioids were prevalent (72%), however using a tool to assess pain or the WHO ladder to prescribe analgesics was not as common. The results of this study show that despite being a key component of clinical care, pain management is not adequately understood by many clinicians. Gaps in knowledge, and incorrect attitudes could contribute to inadequate pain management for patients. This study provides valuable information for an educational workshop planned on pain management.

关键词： Pain Knowledge Training

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Dapagliflozin and Spironolactone Improved Clinical Symptoms and CV Outcomes in Patient with HF Preserved Ejection Fraction (HFpEF) in Hard-to-Reach Rural African Population: A Case Series

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Case Reports in Clinical Medicine 2022年第11期11卷 465-473页

作者： Dominick Mkombozi Raphael Abdu Hussein Mogella Elias Edrick Mtalemwa Beatrice Kabuka Internal Medicine Department St. Francis Referral Hospital Ifakara Tanzania Cardiology Department Heart and Lung Clinic St. Francis Referral Hospital Ifakara Tanzania Hematology Department Muhimbili National Hospital Dar Es salaam Tanzania Pathology Department Bugando Medical Centre Mwanza Tanzania Pathology Department St. Francis University College of Health and Allied Science Ifakara Tanzania

Objective: To observe the benefit of mineralocorticoid receptor antagonist and sodium-glucose co-transport 2 inhibitor (SGLT2 inhibitor) in heart failure preserved ejection (HFpEF) in rural Tanzania. Background and Result: The use of spironolactone and dapagliflozin was shown to be effective in improving the clinical outcome and reducing CV hospitalization rate and CV mortality in patients with heart failure preserved left ventricular ejection fraction (HFpEF). This is the case presentation of one patient with HFpEF with diastolic dysfunction grade 3, obesity grade 3, Type 2 Diabetes, and Atrial Fibrillation (permanent). In the case of a 76-year-old female after previous ineffective treatment, the initiation of Spironolactone and Dapagliflozin led to a rapid and marked improvement in the clinical conditions. Diastolic dysfunction was improved from stage III to stage I. Moreover, the initiation of spironolactone and dapagliflozin therapy avoided a referral for surgical intervention and interrupted a long series of hospitalizations for acute HF and prevented CV death. Conclusion: Based on our experience, we conclude that the treatment with spironolactone and dapagliflozin allows for better treatment optimization with a positive impact on the control of clinical outcomes and preventing CV death and CV hospitalization in HFpEF and related comorbidities in the African population, which is underrepresented in most of the trials.

关键词： HFpEF Spironolactone Dapagliflozin Africans Population

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Evaluation of Accuracy of Clinical Examination and MRI on Diagnosing Anterior Cruciate Ligament and Meniscal Tears in Comparison to Diagnostic Arthroscopy among Patients Attending at muhimbili Orthopedic Institute

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Open Journal of Orthopedics 2021年第12期11卷 353-370页

作者： Hellen Machagge Felix Mrita Mohamed Muhamedhussen Billy Haonga Cuthbert N. Mcharo muhimbili Orthopedic Institute Dar-es-Salaam Tanzania muhimbili University of Health and Allied Sciences Dar-es-Salaam Tanzania Ebrahim Haji Charitable Health centre Dar-es-Salaam Tanzania

Routine use of Magnetic Resonance Imaging (MRI) as screening test after clinical diagnosis for meniscal and/or anterior cruciate ligament (ACL) has a detrimental effect on patients in limited resourced countries. This study was done to compare accuracy of clinical examination and that of (MRI) on diagnosing meniscal and or (ACL) tears. Methodology: A cross-sectional-descriptive study was done on 57 knees of patients. Clinical examination, MRI and then diagnostic arthroscopy, as the gold standard, were done to all the cases. Results were recorded;the accuracies of MRI and clinical examination were evaluated and their results were compared. Results: Median age of patients was 40 years. Clinical examination had sensitivity of 93.62% and specificity of 40% for diagnosing meniscal tears;and sensitivity of 100%;and specificity of 97.67% for diagnosing ACL tear. MRI had sensitivity of 85.11%, and specificity of 40% for meniscal tear diagnosis and 71% and 100% respectively for ACL tear diagnosis. Diagnostic accuracy was 84.21% for meniscal and 98.24% for ACL tears by clinical examination and by MRI was<

关键词： MRI Clinical Examination Diagnostic Accuracy ACL Meniscal

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