Prescribing patterns of antimicrobials according to the WHO AWaRe classification at a tertiary referral hospital in the southern highlands of Tanzania.

Background: Antimicrobial consumption continues to rise globally and contributes to the emergence and spread of antimicrobial resistance. This study aimed to evaluate antimicrobial prescribing patterns in a selected tertiary hospital in Tanzania. Methods: This cross-sectional study was conducted for one year (September 2021-September 2022) at Mbeya Zonal Referral Hospital, a public hospital in the southern highlands zone of Tanzania. Data on clinical diagnosis, laboratory tests, prescribed antimicrobials, and prescribers' designations were collected through a custom eMedical system, aligning antimicrobials with the WHO's 2021 AWaRe classification. Descriptive analysis was performed to assess the pattern of antimicrobial prescriptions. Results: Of 2,293 antimicrobial prescriptions, 62.41% were ACCESS, 37.42% were WATCH, and 0.17% fell in the RESERVE categories. Metronidazole, accounting for 23.8%, was the most commonly prescribed antimicrobial. More than 50% of the ACCESS and WATCH prescriptions were justified by laboratory diagnosis and were predominantly prescribed by clinicians. A very small proportion of prescriptions (<1%) were informed by culture and sensitivity (C/S) testing. The Paediatric department had the majority of WATCH prescriptions (72.2%). Conclusion: The prescribing patterns at the study hospital generally align with WHO AWaRe guidelines, potentially mitigating antimicrobial resistance. Nevertheless, the scarcity of culture and sensitivity testing is a concern that warrants targeted improvement.

In vitro performance of cost differentiated ceftriaxone brands against Escherichia coli: insights from a tertiary referral hospital in Mbeya, Tanzania.

Background: In Tanzania, ceftriaxone is one of the most commonly prescribed antibiotics. However, there is quite a significant variation in cost for numerous ceftriaxone brands, leading to the perception that pricier options are more effective. Yet, limited empirical data support this perception. Methods: Five ceftriaxone brands with a wide price range were tested in vitro against a ceftriaxone-sensitive Escherichia coli clinical isolate using microdilution and spectrophotometry. Brands were evaluated across a spectrum of concentrations. Bacterial growth inhibition was measured using optical density. Analysis of variance was used to compare the bacterial optical densities among the brands. Results: All brands were comparable at all tested concentrations, with peak inhibition above 1.95 mg/L. Conclusions: Despite significant price disparities, low-cost and high-cost ceftriaxone brands demonstrated similar in vitro performance against E. coli. This challenges the notion that higher-priced options offer better performance. Further, in vivo studies are recommended to validate these findings.

Surgical tumour excision of pleomorphic adenoma of submandibular salivary gland: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Pleomorphic adenoma is a benign tumour commonly found in salivary glands and surgical excision is the preferred treatment. CASE PRESENTATION: This case report describes a 37-year-old male patient who was psychologically affected, socially stigmatised and economically jeopardised, underwent successful surgical excision of a pleomorphic adenoma in the submandibular gland. The procedure involved making a lower submandibular incision through the skin, followed by blunt dissection to approach the tumour, where the whole gland was involved and excised. Haemostasis was achieved through compression, transfixing, and under-running sutures. The patient recovered well without any complications and was discharged with a good outlook. CLINICAL DISCUSSION: Proper diagnosis and using proper surgical techniques is essential to ensure favourable outcomes. Early diagnosis and prompt management of pleomorphic adenoma are crucial to prevent complications and improve the patient's quality of life. CONCLUSION: Surgical tumour excision is a safe and effective treatment for pleomorphic adenoma in the submandibular gland. Successful surgery has significant changes in the quality of life of the patient.

Attitude and practice of secondary school students towards voluntary counselling and testing in Mwanza, North-West Tanzania.

OBJECTIVES: Voluntary Counselling and Testing (VCT) has become popular in many parts of the world, especially in Africa, for people to learn about their HIV status and get motivation for positive sexual behaviour change. Our study explored the attitude and practice of secondary school students towards VCT. METHODS: A cross-sectional descriptive study was conducted in Magu, Mwanza, North-West Tanzania. Recorded information included sex, factors promoting or hindering VCT attendance, reasons why attending VCT is necessary, awareness of VCT locations and source of information. RESULTS: Of the 340 students interviewed, 93.2 % knew that VCT was necessary and had reasons such as getting Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) education, checking HIV status and getting advice if found to be HIV positive. The majority (74.4 %) knew the location of the VCT centres. However, only 20.3 % made use of the VCT services. Those who did not use VCT services had reasons such as time limitations, believing they were not infected and fear of being labelled HIV positive. CONCLUSIONS: Our study shows that most secondary school students know that VCT is necessary and the locations of the VCT centres, but only a few use VCT services. More effort should be put into educating students and society on the importance of using VCT services.

Neglected massive multinodular goiter during pregnancy with dyspnea and successful normal delivery: A case report.

Key Clinical Message: Prompt coordinated care enables vaginal delivery for severe goiter-induced airway compression in late pregnancy when expectant management is precluded. Abstract: Long-standing neglected multinodular goiter rarely causes life-threatening airway compression in late pregnancy. Most cases report cesarean delivery to relieve respiratory distress. Vaginal birth may also be possible, but the evidence is limited. A 30-year-old woman with a 7-year goiter history developed severe dyspnea at 34 weeks gestation. Despite the risks, labor was induced by urgent decompression. She vaginally delivered a premature but healthy infant. Her breathing improved after delivery. She later underwent an uncomplicated thyroidectomy. With careful selection and monitoring, vaginal delivery can be considered for goiter-induced respiratory compromise when expectant management is precluded. This case demonstrates successful urgent decompression and favorable maternal-fetal outcomes are possible with a coordinated approach despite the high-risk scenario.

Assessing knowledge, attitude and practice towards prostate cancer screening among males in Southwest Tanzania: A cross-sectional study.

BACKGROUND: Prostate cancer is common among men, and awareness can reduce associated deaths. Low knowledge of prostate cancer screening and wrong perceptions about prostate cancer leads to poor screening practices. Our study assessed knowledge, attitude and practice towards prostate cancer screening among male adults at Mbeya Zonal Referral Hospital. METHODS: This hospital-based cross-sectional study used a random sampling technique to select men attending the hospital. Data was collected using a questionnaire on socio-demographic characteristics, personal and familiar medical history of prostate cancer, knowledge about prostate cancer and its screening. Data analysis was done using SPSS version 23. RESULTS: One hundred and thirty-two (132) men participated in the study. Participants ranged from 18 to 75 years, with a mean age of 41.57. This study found that while 72% of respondents had heard of prostate cancer, only 43.9% had knowledge of prostate cancer screening. Age was associated with prostate cancer screening knowledge (COR = 1.03, 95% CI: 1.01-1.54, p < 0.001). Only 29.5% of respondents had a positive attitude toward prostate cancer screening. A small percentage (16.7%) had been tested for prostate cancer, but the majority (89.4%) were willing to be screened in the future. CONCLUSION: The study found that while most men in the study area had a basic understanding of prostate cancer, only a small percentage had a favourable knowledge of prostate cancer screening, with a low positive perception of screening. The study highlights the need to increase awareness of prostate cancer screening in Tanzania.

Factors Associated with Male Partner Involvement in Maternity Care in Mbeya, Tanzania.

Background: Male partner involvement in maternity care is critical to improving neonatal and maternal health by reducing maternal mortality, particularly in settings where males play a significant role in decision-making. This study aimed to assess factors associated with male partners involvement in maternity care in Mbeya, Tanzania. Methods: A community-based cross-sectional study was conducted among men in Mbeya City, Tanzania, from April to June 2021. A semi-structured questionnaire was used to collect information from participants. Male involvement level was measured as low, moderate or high. X2 test and multinomial logistic regression models were applied to determine association between male involvement levels and related factors. Results: A total of 201 males participated in the study. The overall level of male involvement during antenatal care, labour and delivery and postnatal care indicated that 44 (21.7%) had a high level of involvement, 116 (58%) had a moderate level of involvement and 41 (20.3%) had a low level of involvement. Demographic and health facilities factors indicated a significant association with male partner level of participation (P<.001). The likelihood of a man accompanying the partner was significantly associated with staff attitude and the time spent at the health facility (AOR 1.726 at 95% CI 1,394-2.136 P<.001). Conclusions: Findings indicated a generally moderate level of male partner involvement as a critical concern that can accelerate the decline in maternal mortality and improve maternal health. Enhancing the male-friendliness of health facilities in terms of infrastructure, organisation of services and staff attitudes, as well as educating the community, particularly men, to sensitise them to the negative attitudes toward male participation in maternity care, can increase male participation.

Field evaluation of the novel One Step Malaria Pf and Pf/Pv rapid diagnostic tests and the proportion of HRP-2 gene deletion identified on samples collected in the Pwani region, Tanzania.

Background: Malaria rapid diagnostic tests (mRDTs) have played an important role in the early detection of clinical malaria in an endemic area. While several mRDTs are currently on the market, the availability of mRDTs with high sensitivity and specificity will merit the fight against malaria. We evaluated the field performance of a novel One Step Malaria (P.f/P.v) Tri-line and One Step Malaria (P.f) rapid test kits in Pwani, Tanzania. Methods: In a cross-sectional study conducted in Bagamoyo and Kibiti districts in Tanzania, symptomatic patients were tested using the SD BIOLINE, One Step Malaria (P.f/P.v) Tri-line and One Step Malaria (P.f) rapid test kits, microscope, and quantitative Polymerase Chain Reaction (qPCR). An additional qPCR assay was carried out to detect Histidine-Rich Protein 2 (HRP-2) gene deletion on mRDT negative but microscope and qPCR positive samples. Microscope results confirmed by qPCR were used for analysis, where qPCR was used as a reference method. Results: The sensitivity and specificity of One Step P.f/P.v Tri-line mRDTs were 96.0% (CI 93.5-97.7%) and 98.3% (CI 96.8-99.2%), respectively. One Step P.f mRDT had sensitivity and specificity of 95.2% (CI 92.5-97.1%) and 97.9% (CI 96.3-99.0%) respectively. Positive predictive value (PPV) was 97.6% (CI 95.4-98.7%) and negative predictive value (NPV) was 96.2% (CI 95.5-98.3%) for the One Step P.f/P.v Tri-line mRDTs respectively, while One Step P.f mRDT had positive predictive value (PPV) and negative predictive value (NPV) of 97.0% (CI 94.8-98.3%) and 96.7 (CI 94.9-97.9%) respectively. 9.8% (CI 7.84-11.76) of all samples tested and reported to be malaria-negative by mRDT had HRP-2 gene deletion. Conclusion: One Step Malaria P.f/P.v Tri-line and One Step Malaria P.f rapid test kits have similar sensitivity and specificity as the standard mRDT that is currently in the market, demonstrating the potential to contribute in the fight against malaria in endemic settings. However, the identified malaria parasites population with HRP-2 gene deletion pose a threat to the current mRDT usability in the field and warrants further investigations.

A case report of a reverse sural flap for posterior ankle soft-tissue defect following an injury in a patient from Tanzania.

In the treatment and management of severe wounds, microsurgical repair remains the gold standard. However, it is difficult to transfer free tissue from a Tanzanian perspective due to donor site morbidity, longer operational times, bulky forms, recipient vessel stress, sophisticated surgical expertise, and high costs of the equipment. Meanwhile, the reverse sural flap has been considered as the ultimate tissue restoration technique. This study reviews a case of a 35-year-old man who was admitted at Mbeya Zonal Referral Hospital in the Department of Orthopaedics, Trauma, and Neurosurgery in Mbeya, Tanzania. The patient had a 9-day injury to the rear of his right ankle due to a cut he suffered after tripping over a toilet seat in the washroom. After the diagnosis, the plan involved surgical debridement, tendon repair, and reverse sural flap rotation. Despite the difficult working environment requiring advanced learning experience, our patient fully recovered after 3 weeks. Proving that reverse sural flap is one of the few available possibilities in the protection of vital structures such as bone or tendons, in the distal areas of the leg, ankle, and foot especially when the medical treatment facility lacks a strong microsurgery team and equipment.

Climate Influence on Emerging Risk Areas for Rift Valley Fever Epidemics in Tanzania.

Rift Valley Fever (RVF) is a climate-related arboviral infection of animals and humans. Climate is thought to represent a threat toward emerging risk areas for RVF epidemics globally. The objective of this study was to evaluate influence of climate on distribution of suitable breeding habitats for Culex pipiens complex, potential mosquito vector responsible for transmission and distribution of disease epidemics risk areas in Tanzania. We used ecological niche models to estimate potential distribution of disease risk areas based on vectors and disease co-occurrence data approach. Climatic variables for the current and future scenarios were used as model inputs. Changes in mosquito vectors' habitat suitability in relation to disease risk areas were estimated. We used partial receiver operating characteristic and the area under the curves approach to evaluate model predictive performance and significance. Habitat suitability for Cx. pipiens complex indicated broad-scale potential for change and shift in the distribution of the vectors and disease for both 2020 and 2050 climatic scenarios. Risk areas indicated more intensification in the areas surrounding Lake Victoria and northeastern part of the country through 2050 climate scenario. Models show higher probability of emerging risk areas spreading toward the western parts of Tanzania from northeastern areas and decrease in the southern part of the country. Results presented here identified sites for consideration to guide surveillance and control interventions to reduce risk of RVF disease epidemics in Tanzania. A collaborative approach is recommended to develop and adapt climate-related disease control and prevention strategies.

Climate Change Influences Potential Distribution of Infected Aedes aegypti Co-Occurrence with Dengue Epidemics Risk Areas in Tanzania.

BACKGROUND: Dengue is the second most important vector-borne disease of humans globally after malaria. Incidence of dengue infections has dramatically increased recently, potentially due to changing climate. Climate projections models predict increases in average annual temperature, precipitation and extreme events in the future. The objective of this study was to assess the effect of changing climate on distribution of dengue vectors in relation to epidemic risk areas in Tanzania. METHODS/FINDINGS: We used ecological niche models that incorporated presence-only infected Aedes aegypti data co-occurrence with dengue virus to estimate potential distribution of epidemic risk areas. Model input data on infected Ae. aegypti was collected during the May to June 2014 epidemic in Dar es Salaam. Bioclimatic predictors for current and future projections were also used as model inputs. Model predictions indicated that habitat suitability for infected Ae. aegypti co-occurrence with dengue virus in current scenarios is highly localized in the coastal areas, including Dar es Salaam, Pwani, Morogoro, Tanga and Zanzibar. Models indicate that areas of Kigoma, Ruvuma, Lindi, and those around Lake Victoria are also at risk. Projecting to 2020, we show that risk emerges in Mara, Arusha, Kagera and Manyara regions, but disappears in parts of Morogoro, Ruvuma and near Lake Nyasa. In 2050 climate scenario, the predicted habitat suitability of infected Ae. aegypti co-occurrence with dengue shifted towards the central and north-eastern parts with intensification in areas around all major lakes. Generally, model findings indicated that the coastal regions would remain at high risk for dengue epidemic through 2050. CONCLUSION/SIGNIFICANCE: Models incorporating climate change scenarios to predict emerging risk areas for dengue epidemics in Tanzania show that the anticipated risk is immense and results help guiding public health policy decisions on surveillance and control of dengue epidemics. A collaborative approach is recommended to develop and adapt control and prevention strategies.

The Risk of Dengue Virus Transmission in Dar es Salaam, Tanzania during an Epidemic Period of 2014.

BACKGROUND: In 2010, 2012, 2013 and 2014 dengue outbreaks have been reported in Dar es Salaam, Tanzania. However, there is no comprehensive data on the risk of transmission of dengue in the country. The objective of this study was to assess the risk of transmission of dengue in Dar es Salaam during the 2014 epidemic. METHODOLOGY/PRINCIPAL FINDINGS: This cross-sectional study was conducted in Dar es Salaam, Tanzania during the dengue outbreak of 2014. The study involved Ilala, Kinondoni and Temeke districts. Adult mosquitoes were collected using carbon dioxide-propane powered Mosquito Magnet Liberty Plus traps. In each household compound, water-holding containers were examined for mosquito larvae and pupae. Dengue virus infection of mosquitoes was determined using real-time reverse transcription polymerase chain reaction (qRT-PCR). Partial amplification and sequencing of dengue virus genome in infected mosquitoes was performed. A total of 1,000 adult mosquitoes were collected. Over half (59.9%) of the adult mosquitoes were collected in Kinondoni. Aedes aegypti accounted for 17.2% of the mosquitoes of which 90.6% were from Kinondoni. Of a total of 796 houses inspected, 38.3% had water-holding containers in their premises. Kinondoni had the largest proportion of water-holding containers (57.7%), followed by Temeke (31.4%) and Ilala (23.4%). The most common breeding containers for the Aedes mosquitoes were discarded plastic containers and tires. High Aedes infestation indices were observed for all districts and sites, with a house index of 18.1% in Ilala, 25.5% in Temeke and 35.3% in Kinondoni. The respective container indices were 77.4%, 65.2% and 80.2%. Of the reared larvae and pupae, 5,250 adult mosquitoes emerged, of which 61.9% were Ae. aegypti. Overall, 27 (8.18) of the 330 pools of Ae. aegypti were positive for dengue virus. On average, the overall maximum likelihood estimate (MLE) indicates pooled infection rate of 8.49 per 1,000 mosquitoes (95%CI = 5.72-12.16). There was no significant difference in pooled infection rates between the districts. Dengue viruses in the tested mosquitoes clustered into serotype 2 cosmopolitan genotype. CONCLUSIONS/SIGNIFICANCE: Ae. aegypti is the main vector of dengue in Dar es Salaam and breeds mainly in medium size plastic containers and tires. The Aedes house indices were high, indicating that the three districts were at high risk of dengue transmission. The 2014 dengue outbreak was caused by Dengue virus serotype 2. The high mosquito larval and pupal indices in the area require intensification of vector surveillance along with source reduction and health education.

Inter-epidemic abundance and distribution of potential mosquito vectors for Rift Valley fever virus in Ngorongoro district, Tanzania.

BACKGROUND: Rift Valley fever (RVF) is a mosquito-borne viral zoonosis that primarily affects ruminants but also has the capacity to infect humans. OBJECTIVE: To determine the abundance and distribution of mosquito vectors in relation to their potential role in the virus transmission and maintenance in disease epidemic areas of Ngorongoro district in northern Tanzania. METHODS: A cross-sectional entomological investigation was carried out before the suspected RVF outbreak in October 2012. Mosquitoes were sampled both outdoors and indoors using the Centre for Disease Control (CDC) light traps and Mosquito Magnets baited with attractants. Outdoor traps were placed in proximity with breeding sites and under canopy in banana plantations close to the sleeping places of animals. RESULTS: A total of 1,823 mosquitoes were collected, of which 87% (N=1,588) were Culex pipiens complex, 12% (N=226) Aedes aegypti, and 0.5% (N=9) Anopheles species. About two-thirds (67%; N=1,095) of C. pipiens complex and nearly 100% (N=225) of A. aegypti were trapped outdoors using Mosquito Magnets. All Anopheles species were trapped indoors using CDC light traps. There were variations in abundance of C. pipiens complex and A. aegypti among different ecological and vegetation habitats. Over three quarters (78%) of C. pipiens complex and most (85%) of the A. aegypti were trapped in banana and maize farms. Both C. pipiens complex and A. aegypti were more abundant in proximity with cattle and in semi-arid thorn bushes and lower Afro-montane. The highest number of mosquitoes was recorded in villages that were most affected during the RVF epidemic of 2007. Of the tested 150 pools of C. pipiens complex and 45 pools of A. aegypti, none was infected with RVF virus. CONCLUSIONS: These results provide insights into unique habitat characterisation relating to mosquito abundances and distribution in RVF epidemic-prone areas of Ngorongoro district in northern Tanzania.

Simulation modelling of population dynamics of mosquito vectors for rift valley Fever virus in a disease epidemic setting.

BACKGROUND: Rift Valley Fever (RVF) is weather dependent arboviral infection of livestock and humans. Population dynamics of mosquito vectors is associated with disease epidemics. In our study, we use daily temperature and rainfall as model inputs to simulate dynamics of mosquito vectors population in relation to disease epidemics. METHODS/FINDINGS: Time-varying distributed delays (TVDD) and multi-way functional response equations were implemented to simulate mosquito vectors and hosts developmental stages and to establish interactions between stages and phases of mosquito vectors in relation to vertebrate hosts for infection introduction in compartmental phases. An open-source modelling platforms, Universal Simulator and Qt integrated development environment were used to develop models in C++ programming language. Developed models include source codes for mosquito fecundity, host fecundity, water level, mosquito infection, host infection, interactions, and egg time. Extensible Markup Language (XML) files were used as recipes to integrate source codes in Qt creator with Universal Simulator plug-in. We observed that Floodwater Aedines and Culicine population continued to fluctuate with temperature and water level over simulation period while controlled by availability of host for blood feeding. Infection in the system was introduced by floodwater Aedines. Culicines pick infection from infected host once to amplify disease epidemic. Simulated mosquito population show sudden unusual increase between December 1997 and January 1998 a similar period when RVF outbreak occurred in Ngorongoro district. CONCLUSION/SIGNIFICANCE: Findings presented here provide new opportunities for weather-driven RVF epidemic simulation modelling. This is an ideal approach for understanding disease transmission dynamics towards epidemics prediction, prevention and control. This approach can be used as an alternative source for generation of calibrated RVF epidemics data in different settings.

Comparison of sampling techniques for Rift Valley Fever virus potential vectors, Aedes aegypti and Culex pipiens complex, in Ngorongoro District in northern Tanzania.

We investigated mosquito sampling techniques with two types of traps and attractants at different time for trapping potential vectors for Rift Valley Fever virus. The study was conducted in six villages in Ngorongoro district in Tanzania from September to October 2012. A total of 1814 mosquitoes were collected, of which 738 were collected by CDC light traps and 1076 by Mosquito Magnet trapping technique. Of the collected mosquitoes, 12.46% (N = 226) were Aedes aegypti and 87.54% (N = 1588) were Culex pipiens complex. More mosquitoes were collected outdoors using Mosquito Magnets baited with octenol attractant, 36.38% (N =660) followed by indoor trapping using CDC light traps without attractant, 29.60% (N = 537). Most of Ae. aegypti mosquitoes were collected outdoor using Mosquito Magnets, 95% (N = 214) whereas Cx. pipiens complex were trapped both indoor using CDC light traps without attractant and outdoors using both CDC light traps baited with carbon dioxide (CO2) sachets and Mosquito Magnets. Analysis on the differences in abundance of mosquitoes trapped by different techniques using Generalized Linear Models was statistically significance at p-value < 0.05 for both species. Three hours mosquito collections show differing patterns in activity, most Ae. aegypti species were collected primarily during the first and last quarters of the day. Cx pipiens complex was active throughout the night, early evening and early morning then decreased markedly during the day time. The results presented in this paper emphasize the possibility of using Mosquito Magnets in order to efficiently capture these potential RVF vectors.

Transmission intensity and malaria vector population structure in Magugu, Babati District in northern Tanzania.

A 1-year longitudinal study was conducted in Magugu in Babati district, northern Tanzania to determine malaria vector population structure and malaria transmission indices. Mosquitoes were sampled using the Centre for Disease Control (CDC) light traps. A total of 110,357 adult female mosquitoes were collected. Anopheles gambiae s.1. accounted 25% of the total female mosquito collected. Relatively fewer An. funestus were collected. Other mosquito species collected were An. pharoensis, An. coustani, An. maculipalpis, An. marshallii, Culex quinquefasciatus, Cx unnivittatus, Mansonia uniformis and Ma. africana. An analysis by Polymerase Chain Reaction revealed that An. arabiensis was the only member of the An. gambiae complex in the collected samples. The number of mosquito collected correlated with the increasing mean rainfall. Blood meal analysis showed a higher human enzymatic reaction among An. gambiae s.1. (63.5%) followed by An. funestus (42.9%). Bovine enzymatic reaction was higher among An. coustani (73.7%) followed by the An. pharoensis (66.7%). The Enzyme Linked Immunosorbent Assay (ELISA) was used to detect Plasmodium falciparum circumsporozoites proteins in 10,000 female Anopheles mosquitoes. Only two An. arabiensis were found to be infected. The entomological inoculation rate (EIR) was estimated at 0.51 infectious bites per person per year. This EIR was considered to be relatively low, indicating that malaria transmission in this area is low. Variability in mosquito blood meal shows availability of variety of preferred blood meal choices and impact of other factors inhibiting mosquito-human host contact. The study has provided information considered useful in the mapping of the vector distribution and population structure in the country. Such information is considered to be among the essential tools for planning malaria control interventions.