Evaluation of Xpert® MTB/RIF and Ustar EasyNAT™ TB IAD for diagnosis of tuberculous lymphadenitis of children in Tanzania: a prospective descriptive study.

BACKGROUND: Fine needle aspiration biopsy has become a standard approach for diagnosis of peripheral tuberculous lymphadenitis. The aim of this study was to compare the performance of Xpert MTB/RIF and Ustar EasyNAT TB IAD nucleic acid amplification assays, against acid-fast bacilli microscopy, cytology and mycobacterial culture for the diagnosis of TB lymphadenitis in children from a TB-endemic setting in Tanzania. METHODS: Children of 8 weeks to 16 years of age, suspected of having TB lymphadenitis, were recruited at a district hospital in Tanzania. Fine needle aspirates of lymph nodes were analysed using acid-fast bacilli microscopy, liquid TB culture, cytology, Xpert MTB/RIF and EasyNAT. Latent class analysis and comparison against a composite reference standard comprising "culture and/or cytology" was done, to assess the performance of Xpert MTB/RIF and EasyNAT for the diagnosis of TB lymphadenitis. RESULTS: Seventy-nine children were recruited; 4 were excluded from analysis. Against a composite reference standard of culture and/or cytology, Xpert MTB/RIF and EasyNAT had a sensitivity and specificity of 58 % and 93 %; and 19 % and 100 % respectively. Relative to latent class definitions, cytology had a sensitivity of 100 % and specificity of 94.7 %. CONCLUSIONS: Combining clinical assessment, cytology and Xpert MTB/RIF may allow for a rapid and accurate diagnosis of childhood TB lymphadenitis. Larger diagnostic evaluation studies are recommended to validate these findings and on Xpert MTB/RIF to assess its use as a solitary initial test for TB lymphadenitis in children.

High prevalence of tuberculosis diagnosed during autopsy examination at Muhimbili National Hospital in Dar es Salaam, Tanzania.

The primary aims of tuberculosis (TB) control programmes is early diagnosis and prompt treatment of infectious cases to limit transmission. Failure to diagnose and adequately treat TB could lead to premature death and unrecognized transmission of Mycobacterium tuberculosis. The proportion of missed TB cases has not been reported in Tanzania. The objective of this study was to quantify the number of cases of TB identified by autopsy. Deceased morbid bodies from Muhimbili National Hospital were involved. Retrieval of admission, diagnostic and other important records used to manage the patient after admission was done. Demographic information, site and type of disease, past medical history, chest x-ray report, clinical diagnosis and cause of death reported upon death certification were recorded. Lung tissues, lymphnodes and blood clots for HIV testing were collected. Biopsy tissues were processed through Ziehl Nielsen staining and examined by microscopy. The study involved 74 deceased individuals where 56 (75.7%) were males. Information for duration of seeking health care before death was available for 41 (55.4%) subjects. Thirty-four (45.9%) cases received diagnosis before death. The main diagnoses were pneumonia 10 (13.5%), heart failure 6 (8.1%), AIDS-related illnesses 6 (6.8%) and malaria 5 (6.8%). The main clinical findings were wasting (51/74 (68.9%)) and abnormal fluid collection in different body cavities, 61 (50.8%). In 24 out of 71 (33.8%) biopsies acid fast bacilli (AFB) were detected. Records of lymphnodes examination were available in 63 cases and 22 of them had AFB. Twenty-two (34.9%) from the paratracheal and hilar lymphnodes were observed to have AFB. HIV was detected by ELISA in 19 (33.3%) out of 57 deceased, and 12 (63.2%) of the HIV positive deceased were co-infected with TB. Out of the 22 cases positive for AFB on tissue-biopsies 12 (54.5%) were HIV positive. There is a high number of TB cases diagnosed after death that could not be detected before they died. There is a need for increased awareness and to include post-mortem data in the annual statistics of TB for precise reporting of the magnitude of the TB burden in the country.

Assessment of women's knowledge and attitude towards carcinoma of the cervix in Ilala Municipality.

MAIN OBJECTIVE: To asses knowledge and attitudes of women towards carcinoma of the cervix in Ilala Municipality. METHODOLOGY: A community based cross-sectional study targeting all women in Ilala municipality. Therefore the sample size was 196 women but for the purpose of this study it was increased up to 201 women.A multistage random sampling procedure was used to select a representative sample. Permission was sought at all the appropriate levels in the form of oral as well as written consent.Only women who were willing to participate in the study were interviewed. A questionnaire was developed and data analysed using Epi info software was used to analyse data. Differences beween proportions found in different groups were tested for statistical significant using chi-squared test. RESULTS: A total of 210 women were interviewed. A number of respondents were in the age groups 21-30 and 31-40 years and 76.1% of the respondents were aware of carcinoma of the cervix. The most common mentioned risk factors were early marriage (37.1%) and multiparity (36%). Irregular vaginal bleeding was the most common symptom metioned (51.7%). Irrespective of the level of education 98%-100% of all respondents knew the importance of screening for carcinoma of the cervix. CONCLUSION: It was therefore concluded that women were aware of carcinoma of the cervix but the knowledge on this disease is still very low.

Prevalence of and factors associated with alcohol consumption in Temeke in August/September, 2002.

OBJECTIVE: To determine the prevalence of alcohol consumption in Temeke district by social demographic characteristics. METHODOLOGY: Population-based cross-sectional study was conducted in Temeke district involving persons above 15 years of age. We selected Keko ward for the study and simple random sampling procedure was used to select clusters of ten-cell leaders. All households in the selected ten-cell leaders were included in the study sample. The study was cleared by the Ethical Clearance Committee of the Muhimbili University of Health and Allied Sciences, Dar es Salaam. Chi-squared (chi2) test for contingency tables was used to assess statistical significance and the results were considered significant if p-value was less than 0.5. RESULTS: A total of 246 persons participated in the survey and of these 22% (54) were alcohol drinkers. The age group 25-35 years showed a high prevalence with a male preponderance. There was no difference in the drinking pattern between single and married subjects with 20.1% and 22% respectively. On education basis, 22.1% of primary school leavers drank alcohol. Teachers and businessmen drank alcohol more than other occupational groups with 33.3% and 25.6% respectively. Bad health effect was the most perceived alcohol related problem occurring in 65.4% of all the respondents. CONCLUSION: It was concluded that alcohol consumption was low in Temeke as compared to other regions and was seen more in males than females and bad health effect was the most perceived problem resulting from alcohol consumption. We recommend that similar studies should be done in other districts of Dar-es-Salaam to validate our findings.