The importance of Escherichia coli clonal complex 10 and ST131 among Tanzanian patients on antimicrobial resistance surveillance programs.

The objective of this study was to characterize antimicrobial resistance (AMR) of WHO priority 1 critical pathogen (extrapathogenic Escherichia coli (ExPEC), sequence types (STs), and ST131 clades from patients in Tanzania so as to guide specific antimicrobial therapies and preventive measures. A total of 143 ExPEC strains (128 from pregnant women with urinary tract infections and 15 from children with blood stream infections) were collected between March 2016 and October 2017. These were characterized into ST-fimH clones by a 7-single nucleotide polymorphism quantitative polymerase chain reaction (7-SNP qPCR) and gene sequencing, and to ST131 clades by multiplex PCR. The extended-spectrum beta-lactamases (ESBL) production was 16.1% (23/143), and was predominantly due to the blaCTX-M-15 (91.3%, n=21). ESBL production was significantly more among strains from children (53.3%) than pregnant women (11.7%) (OR (95%CI): 8.61 (2.73-27.15); p-value <0.001)). Approximately 61.5% (n=88) ExPEC were typed into their respective STs/CCs (87 by the 7-SNP qPCR and by an additional of one or two genes sequencing). The commonest STs/CCs among typeable strains were CC10 (28.4%, n=25), ST131 (18.2%, n=16), and ST38 (10.2%, n=9). The ST131 clades (C1 (4, 25.0%) and C2 (6, 37.5%)) were predominantly associated with fluoroquinolone resistance and ESBL production, respectively. Approximately 60.8% of ExPEC strains and all dominant clones were typed by the 7-SNP qPCR by additional sequencing. The multiplex clade PCR allowed linkage of the global clone ST131 with AMR phenotypes. These feasible and user-friendly molecular tools can be routinely used for surveillance programs in resource-limited settings.

Maternal healthcare services use in Mwanza Region, Tanzania: a cross-sectional baseline survey.

BACKGROUND: Improving maternal health by reducing maternal mortality/morbidity relates to Goal 3 of the Sustainable Development Goals. Achieving this goal is supported by antenatal care (ANC), health facility delivery, and postpartum care. This study aimed to understand levels of use and correlates of uptake of maternal healthcare services among women of reproductive age (15-49 years) in Mwanza Region, Tanzania. METHODS: A cross-sectional multi-stage sampling household survey was conducted to obtain data from 1476 households in six districts of Mwanza Region. Data for the 409 women who delivered in the 2 years before the survey were analyzed for three outcomes: four or more ANC visits (ANC4+), health facility delivery, and postpartum visits. Factors associated with the three outcomes were determined using generalized estimating equations to account for clustering at the district level while adjusting for all variables. RESULTS: Of the 409 eligible women, 58.2% attended ANC4+, 76.8% delivered in a health facility, and 43.5% attended a postpartum clinic. Women from peri-urban, island, and rural regions were less likely to have completed ANC4+ or health facility delivery compared with urban women. Education and early first antenatal visit were associated with ANC4+ and health facility delivery. Mothers from peri-urban areas and those who with health facility delivery were more likely to attend postpartum check-ups. CONCLUSION: Use of ANC services in early pregnancy influences the number of ANC visits, leading to higher uptake of ANC4+ and health facility delivery. Postpartum check-ups for mothers and newborns are associated with health facility delivery. Encouraging early initiation of ANC visits may increase the uptake of maternal healthcare services.

Treponema pallidum infection predicts sexually transmitted viral infections (hepatitis B virus, herpes simplex virus-2, and human immunodeficiency virus) among pregnant women from rural areas of Mwanza region, Tanzania.

BACKGROUND: Sexually transmitted infections (STIs) is a global health problem with increased risk and morbidities during pregnancy. This study investigated the magnitude of viral STIs among pregnant women from three rural hospitals/clinics providing antenatal care in Mwanza region, Tanzania. METHODS: Between February and May 2018, a total of 499 pregnant women were enrolled and tested for Human immunodeficiency virus (HIV), Herpes simplex virus-2 (HSV-2), Hepatitis B virus (HBV) and Hepatitis C virus (HCV) using rapid immunochromatographic tests and for syphilis using non-treponemal and treponemal antibody test. RESULTS: The median age of enrolled women was 25 (IQR: 22-31) years. Seventy eight (15.6, 95% CI: 12-18) of women tested had at least one sexually transmitted viral infection. Specific prevalence of HIV, HBV, HCV, HSV-2 IgG and HSV-2 IgM were found to be 25(5.0%), 29(5.8%), 2(0.4%), 188(37.7%) and 24(4.8%), respectively. The odds of having viral infection was significantly high among women with positive T. pallidum serostatus (adjusted odd ratio (aOR): 3.24, 95%CI; 1.2-85). By multivariable logistic regression analysis, history of STIs predicted HSV-2 IgM seropositivity (aOR: 3.70, 95%CI: 1.43-9.62) while parity (aOR: 1.23, 95%CI: 1.04-1.46) predicted HBV infection and syphilis positive results (aOR: 8.63, 95%CI: 2.81-26.45) predicted HIV infection. CONCLUSION: A significant proportion of pregnant women in rural areas of Mwanza region has at least one sexually transmitted viral infection which is independently predicted by positive T. pallidum serostatus. The strengthening and expansion of ANC screening package to include screening of STIs will ultimately reduce the viral STIs among pregnant women hence reduce associated morbidities and mortalities.

Investigation of household contacts of pulmonary tuberculosis patients increases case detection in Mwanza City, Tanzania.

BACKGROUND: Tuberculosis (TB) contact tracing is a key strategy for containing TB and provides addition to the passive case finding approach. However, this practice has not been implemented in Tanzania, where there is unacceptably high treatment gap of 62.1% between cases estimated and cases detected. Therefore calls for more aggressive case finding for TB to close this gap. We aimed to determine the magnitude and predictors of bacteriologically-confirmed pulmonary TB among household contacts of bacteriologically-confirmed pulmonary TB index cases in the city of Mwanza, Tanzania. METHODS: This study was carried out from August to December 2016 in Mwanza city at the TB outpatient clinics of Tertiary Hospital of the Bugando Medical Centre, Sekou-Toure Regional Hospital, and Nyamagana District Hospital. Bacteriologically-confirmed TB index cases diagnosed between May and July 2016 were identified from the laboratory registers book. Contacts were traced by home visits by study TB nurses, and data were collected using a standardized TB screening questionnaire. To detect the bacterioriologically-confirmed pulmonary TB, two sputum samples per household contact were collected under supervision for all household contacts following standard operating procedures. Samples were transported to the Bugando Medical Centre TB laboratory for investigation for TB using fluorescent smear microscopy, GeneXpert MTB/RIF and Löwenstein-Jensen (LJ) culture. Logistic regression was used to determine predictors of bacteriologically-confirmed pulmonary TB among household contacts. RESULTS: During the study period, 456 household contacts from 93 TB index cases were identified. Among these 456 household contacts, 13 (2.9%) were GeneXpert MTB/RIF positive, 18 (3.9%) were MTB-culture positive and four (0.9%) were AFB-smear positive. Overall, 29 (6.4%) of contacts had bacteriologically-confirmed pulmonary TB. Predictors of bacteriologically-confirmed pulmonary TB among household contacts were7being married (Odds ratio [OR], 3.3; 95% confidence interval [CI], 1.4-8.0; p = 0.012) and consuming less than three meals a day (OR, 3.7; 95% CI, 1.6-8.7; p = 0.009). CONCLUSIONS: Our data suggest that in Mwanza, Tanzania, seven in 100 contacts living in the same house with a TB patient develop bacteriologically-confirmed pulmonary TB. These results therefore underscore the need to implement routine TB contact tracing to control tuberculosis in high TB burden countries such as Tanzania.

Comparison of antimicrobial resistance patterns of ESBL and non ESBL bacterial isolates among patients with secondary peritonitis at Bugando Medical Centre, Mwanza - Tanzania.

BACKGROUND: Secondary peritonitis is a common surgical emergence with deadly outcomes when not timely and promptly intervened. The emergence of Extended spectrum beta lactamase producing bacteria (ESBL) poses treatment challenge at Bugando Medical Centre (BMC); hence a need to evaluate the magnitude of ESBL so as to guide specific therapy. METHODS: This was a cross sectional study conducted at BMC from May 2014 to April 2015 involving patients with secondary peritonitis. A questionnaire was used to collect patients' information. Peritoneal aspirate sample was collected intra-operatively and processed using standard operating procedures to identify bacteria species and their susceptibility profiles. RESULTS: The study involved 97 patients with the median age (IQR) of 32 (21-47) years, males were 62 (63.9 %) and about 27 (27.8 %) patients had co-morbid illnesses. The prevalence of ESBL among patients with secondary peritonitis was 23.7 % (23/97). Of 53 gram negative Enterobacteriaceae isolated, 47.2 % (25/53) were ESBL producers, with predominance of Escherichia coli 7 (28.0 %) and Klebsiella spp 5 (20.0 %). The ESBL isolates exhibited more resistance rates to trimethoprim sulfamethoxazole and ciprofloxacin compared to non ESBL isolates 96.0 % versus 60.7 %, p value = 0.003 and 16.0 % versus 0.0 %, p value = 0.043 respectively). All isolates were sensitive to meropenem. CONCLUSIONS: The prevalence of ESBL among patients with secondary peritonitis at BMC is high; with more resistance rates among ESBL compared to non ESBL isolates. There is a need for strengthen ESBL surveillance in this setting so as to guide specific therapy.

Barriers to access reproductive health care for pregnant adolescent girls: a qualitative study in Tanzania.

AIMS: In Tanzania, approximately 25% of adolescents give birth and 50% more become sexually active during adolescence. We hypothesised that reproductive health education and services for adolescent girls are inaccessible and conducted this study to gain insights into their perceptions of sexually transmitted infections (STIs) and barriers to reproductive health service utilisation in rural Mwanza, Tanzania. METHODS: We conducted nine focus groups among pregnant adolescents aged 15-20 years. Data were transcribed, translated and coded for relevant themes using NVivo10 software for qualitative data analysis. RESULTS: Most participants were aware of the dangers of STIs to themselves and their unborn babies, but did not perceive themselves as at risk of acquiring STIs. They viewed condoms as ineffective for preventing STIs and pregnancies and unnecessary for those in committed relationships. Stigma, long waiting times, and lack of privacy in the clinics discouraged adolescent girls from seeking reproductive health care. CONCLUSION: Reproductive health care for adolescent girls who are not pregnant is practically nonexistent in Tanzania. Healthcare access for pregnant young women is also limited. Targeted changes to increase clinic accessibility and to provide reproductive health education to all rather than only pregnant women have the potential to address these gaps.

Reactive nitrogen budgets in human-nature coupling system in lakeside area with insufficient data - A case study of Mwanza, Tanzania.

Nitrogen (N) is an essential nutrient element for life, and also a major element involved in the composition of greenhouse gases, surface water pollutants, air pollutants, etc. Quantifying and evaluating the nitrogen budget of a region is very important for effectively controlling the nitrogen discharge and scientifically managing the nitrogen cycle. In this paper, the urban Rural Complex N Cycling (URCNC) model was used to analyze the nitrogen budget of Mwanza region, a typical lakeside area with insufficient data, and the nitrogen flow process of livestock subsystem, cropland subsystem, human subsystem and landfill subsystem was clearly described and the nitrogen input sources of atmospheric subsystem and surface water subsystem were clarified. And the results demonstrated: (1) the cropland subsystem was the subsystem with the largest nitrogen flux, and the input, output and accumulation of nitrogen were 33,116 t of N, 31,925 t of N and 1191 t of N, respectively. Livestock subsystem was the second largest subsystem of nitrogen flux, and the input, output and accumulation of nitrogen were 31,013 t, 30,183 t and 830 t, respectively. The nitrogen flux of the human subsystem was also large, and the nitrogen input, output and accumulation were 17,905, 17,125 and 780 t, respectively. The nitrogen input, output and accumulation of the landfill subsystem were 3700 t, 770 t and 2930 t, respectively. (2) 8093 t of N, 6864 t of N, 3959 t of N, and 758 t of N emitted into the atmospheric subsystem from the livestock subsystem, cropland subsystem, human subsystem, and landfill subsystem, respectively. (3) The total Nr input of surface water subsystem increased from 18,545 t of N in 2010 to 20,174 t of N in 2020, with an increase of 8.78 % in the past decade. It was estimated that by 2030, the total Nr input of the surface water subsystem would reach 24,946 t of N with an increase of 23.65 % compared with 2020. The livestock subsystem was the largest source, the cropland subsystem was the second largest source and human subsystem was an important source. (4) Population growth, economic development and urbanization are the main nitrogen driving factor. (5) Technology and policy together have important contributions to the reduction of nitrogen pollution in surface water.

Knowledge and Attitude of Healthcare Providers on Managing Pre-Eclampsia and Eclampsia During Antenatal Care in Mwanza Region-Tanzania.

Background: Pre-eclampsia and eclampsia are the second-leading causes of maternal death. Health care providers have a critical role in preventing and managing these conditions. Lack of knowledge among healthcare providers on managing pre-eclampsia and eclampsia has been reported in other parts of Tanzania, but more information is needed in other parts of the country so as to design appropriate targeted interventions. Hence, this study assessed the knowledge and attitude of healthcare providers on the management of pre-eclampsia and eclampsia in the Mwanza region of Tanzania. Method: A facility-based analytical cross-sectional study was conducted from April to May 2022 among 157 health care providers in the Mwanza region. A simple random sampling method was used to select districts and dispensaries, while a census method was used to recruit health care providers. A self-administered questionnaire was used for data collection. A descriptive statistics analysis was used to determine the distribution of background information of healthcare providers. Inferential statistics were used to determine the association between variables by using a chi-square test and logistic regression. A statistically significant variable in the final model was declared with a 95% confidence interval and a p-value of 0.05. Results: The study results showed that only 40 (25%) of healthcare providers had adequate knowledge and 56.69% had positive attitude towards the management of pre-eclampsia and eclampsia. Knowledge was predicted by having more years of working experience (1-5 years) (AOR: 0.12, 95% CI 0.03-0.53, p-value 0.005) and working in a health center (AOR: 4.58, 95% CI 1.14-18.36, p-value 0.023). For attitude, no variable was significantly associated with it. Conclusion: The study showed that the majority of the participants had inadequate knowledge of the management of pre-eclampsia or eclampsia, despite the positive attitude they possessed. This implies that HCP may be struggling to identify the signs and symptoms of the condition in pregnant women, and this could lead to delays in diagnosis despite believing that it is important to early diagnose the condition. To address this issue, it's crucial to invest in continuing medical education and training programs for healthcare providers to update their knowledge.

Scenario analysis of phosphorus flow in food production and consumption system in the Mwanza region, Tanzania.

Since the mineral, phosphorus (P), has dual properties of being limited resources for use, and being a pollutant for studying sustainable management of anthropogenic P flows in wetlands and soils, currently P receives the highest interests among researchers around the world. This study has successfully mapped P flows for a reference year (2017) and a future year (2030) using different scenarios of food production and consumption system (hereafter 'system') in the Mwanza region (Tanzania). The results showed that the total P input and output for 2017 alone were 9770 t and 7989 t, respectively. However, as high as 1781 tP accumulated in the system and the potentially recyclable P found, is yet to be recovered due to economic reasons and the lack of market. The main anthropogenic P input to the system occurred via imported feed, fertilizer, and crop food, accounting for about 99.72 % of the total input flow. The output was comprised of animal products exported with 3428 tP, and various P-contained wastes which were lost to water bodies with 4561tP. Analysis of the 2030 scenario showed that setting P management objectives from different perspectives such as the total P budget balance, potential recyclable P, and P emission, can help develop differentially preferred management strategies and measures in the Mwanza region. The combination of diet change, precision feeding, and integrated waste management practices presents the best prospects for decreasing P budget and losses, and the amount of P that can be potentially recovered from the system. We propose a package of integrated P management measures for the Mwanza region. Given the similarity of regional socio-economic development background around the Lake Victoria basin, the model can be used to guide the study of anthropogenic P flow analysis in other areas along the shore of Lake Victoria (Africa).

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.

Seropositivity of Leptospira spp. Antibodies among Febrile Patients Attending Outpatient Clinics in Mwanza, Tanzania: Should It Be Included in Routine Diagnosis?

Leptospirosis is a zoonotic neglected tropical disease with a worldwide distribution caused by the pathogenic spirochetes of the genus Leptospira. Despite being a widespread disease in tropical regions, it has never been considered in the routine diagnostic panel for febrile patients. This study determined seropositivity and factors associated with Leptospira antibodies among febrile adult patients in Mwanza, Tanzania. The cross-sectional study involving 296 febrile patients attending different outpatient clinics in Mwanza region was conducted between May and July 2019. Detection of Leptospira serovars antibodies was done using a microscopic agglutination test (MAT). Descriptive analysis was done using STATA version 13. The median age of the febrile patients was 32 (IQR: 24-45 years). Out of 296 patients, 36 (12.16%, 95%CI: 8-15) were seropositive for Leptospira antibodies. Common circulating serovars were Sokoine 28 (9.45%), followed by Lora 12 (4.05%) and Grippotyphosa 2 (0.67%). In the multivariable logistic regression analysis, the odds of being Leptospira seropositive were significantly higher with increased age (aOR: 1.03, 95%CI 1.00-1.07, p = 0.03). About one tenth of febrile patients in Mwanza were seropositive for Leptospira antibodies and this was significantly associated with age. With the decline of malaria fever in endemic areas, other causes of febrile illness like Leptospiral spp. should be considered in the routine diagnostic panel for febrile patients.

Treponema pallidum infection among women with macerated stillbirth in Mwanza Tanzania: an underestimated tragedy in Tanzania.

Background: Treponema pallidum is one of the commonest cause of stillbirths world-wide. This study investigated the magnitude of T. pallidum among women with macerated stillbirth in Mwanza, Tanzania. Methods: A cross-sectional study involving 301 women with macerated stillbirths attending selected health facilities in the region of Mwanza was conducted between October-2017 and March-2018. Detection of T. pallidum was done using venereal diseases research laboratory (VDRL) and T. pallidum hemagglutination test (TPHA). Data were analyzed by the STATA version 13. Results: The median age of the enrolled women was 27 (IQR: 22 - 34) years. Eighteen (6.0%, 95% CI: 3.0-8.0) of women were T. pallidum seropositive. Seropositivity of T. pallidum was significantly higher among women residing in rural areas than urban areas (p=0.010), and among HIV seropositive than HIV seronegative women (p=0.036). By multivariable regression analysis, the odds of being T. pallidum seropositive were significantly high among women with positive HIV serostatus (OR: 3.9, 95% CI: 1.2-14.1, p=0.036) and those residing in rural areas (OR: 5.6, 95% CI: 1.5-20.3, p=0.010). Conclusion: Seropositivity of T. pallidum is higher among women with macerated stillbirth than in normal pregnant women as previously reported which calls for the need to improve screening services in rural areas of Tanzania.

High Seroprevalence of SARS-CoV-2 in Mwanza, Northwestern Tanzania: A Population-Based Survey.

The transmission of the SARS-CoV-2 virus, which causes COVID-19, has been documented worldwide. However, the evidence of the extent to which transmission has occurred in different countries is still to be established. Understanding the magnitude and distribution of SARS-CoV-2 through seroprevalence studies is important in designing control and preventive strategies in communities. This study investigated the seropositivity of the SARS-CoV-2 virus antibodies in the communities of three different districts in the Mwanza region, Tanzania. A household cross-sectional survey was conducted in September 2021 using the modified African Centre for Disease and Prevention (ACDC) survey protocol. A blood sample was obtained from one member of each of the selected households who consented to take part in the survey. Immunochromatographic rapid test kits were used to detect IgM and IgG SARS-CoV-2 antibodies, followed by descriptive data analysis. Overall, 805 participants were enrolled in the study with a median age of 35 (interquartile range (IQR):27-47) years. The overall SARS-CoV-2 seropositivity was 50.4% (95%CI: 46.9-53.8%). The IgG and IgM seropositivity of the SARS-CoV-2 antibodies was 49.3% and 7.2%, respectively, with 6.1% being both IgG and IgM seropositive. A history of runny nose (aOR: 1.84, 95%CI: 1.03-3.5, p = 0.036), loss of taste (aOR: 1.84, 95%CI: 1.12-4.48, p = 0.023), and living in Ukerewe (aOR: 3.55, 95%CI: 1.68-7.47, p = 0.001) and Magu (aOR: 2.89, 95%CI: 1.34-6.25, p= 0.007) were all independently associated with SARS-CoV-2 IgM seropositivity. Out of the studied factors, living in the Ukerewe district was independently associated with IgG seropositivity (aOR 1.29, CI 1.08-1.54, p = 0.004). Twenty months after the first case of COVID-19 in Tanzania, about half of the studied population in Mwanza was seropositive for SARS-CoV-2.

Predominance of Other Pathogenic Bacteria among Presumptive Tuberculosis Cases Attending Tuberculosis Clinics in Mwanza, Tanzania: A Cross-Sectional Laboratory-Based Study.

This study was designed to determine the prevalence and co-infection of Mycobacterium tuberculosis and other pathogenic bacteria among presumptive cases of tuberculosis (TB) at selected hospitals in Mwanza, Tanzania. GeneXpert and conventional bacteriological culture and sensitivity were used for the detection of TB and other pathogenic bacteria, respectively. STATA version 13.0 was used for data analysis. The median (IQR) age of participants was 33 (19−51) years with males forming more than half (i.e., 59% (158/264)) of the participants. Microscopically, 29.5% (78/264) of the patients had polymorphonuclear leucocytes in the sputum samples. Approximately 7.2% (19/264), 16.3% (43/264), and 1.1% (3/264) of participants had TB, other pathogenic bacteria, and co-infections, respectively. One sample had growth of two other bacteria, resulting in a total of 44 isolated bacteria with the predominance of Gram-negative bacteria at 75.0% (33/44). The predominant species isolated was the Klebsiella pneumoniae complex at 52.3% (23/44). Overall, 27.3% (9/33) of GNB were resistant to third-generation cephalosporins, while Gram-positive bacteria were more resistant to erythromycin at 63.6% (7/11). Good quality sputa had a significantly higher yield of pathogenic bacteria than poor quality sputa (37.2% vs. 7.5%, p < 0.001). Presumptive TB cases were predominantly infected with other pathogenic bacteria than M. tuberculosis. Therefore, other pathogenic bacteria should be considered when attending presumptive TB cases to ensure favorable treatment outcomes.

High prevalence of sexually transmitted infections among asymptomatic women opting for the intrauterine contraceptive device use in Mwanza, Tanzania: An urgent call for control interventions.

Objective: Placement of intrauterine contraceptive device (IUCD) in asymptomatic woman infected with sexually transmitted infection (STIs) can lead to pelvic inflammatory diseases (PID) and infertility if not well treated. The current study investigated the magnitude of sexually transmitted infections among women opting for IUCD use in the city of Mwanza, Tanzania. Methods: A cross-sectional study involving 150 asymptomatic women was conducted from August to December 2017. Detection of Chlamydia trachomatis antigen from endocervical swabs was done using immunochromatographic rapid tests while sera were used for detection of Treponema pallidum, human immunodeficiency virus (HIV) and herpes simplex virus Type 2 (HSV-2) antibodies. Results: The overall prevalence of STIs was 45/150 (30%, 95% CI: 22-37) while that of individual STIs were 27.3%, 5.3%, and 2.6% for C trachomatis, T pallidum, and HSV-2, respectively. History of dysuria (aOR 6.6; 95% CI 2.3-18.8; p < 0.001) and history of STIs (aOR 4.6; 95%CI 1.0-20.8; p = 0.049) independently predicted presence of STIs. Conclusions: Prevalence of STIs among women opted for IUCD use in the city of Mwanza, Tanzania is alarmingly high and is predicted by past history of dysuria and history of partner's STIs, calling for the need of screening of the STIs among high-risk women in low- and middle-income countries (LMICs) opting for IUCD use.

Healthcare Providers' Experiences With a Clinical Mentorship Intervention to Improve Reproductive, Maternal and Newborn Care in Mwanza, Tanzania.

Introduction: There is increasing evidence suggesting that clinical mentorship (CM) involving on-the-job training is one of the critical resources-friendly entry points for strengthening the knowledge and skills of healthcare providers (HCPs), which in turn facilitate the delivery of effective reproductive, maternal, and newborn health (RMNH) care. The article explores the experiences of HCPs following participation in the CM program for RMNH in eight districts of Mwanza Region in Tanzania. Materials and Methods: A qualitative descriptive design employing data from midterm project review meetings and Key Informant Interviews (KIIs) with purposefully selected HCPs (mentors and mentees) and District Medical Officers (DMOs) during endline evaluation were employed. Interview data were managed using Nvivo Software and analyzed thematically. Results: A total of 42 clinical mentors and master mentors responded to a questionnaire during the midterm review meeting. Then, a total of 17 KIIs were conducted with Mentees (8), Mentors (5), and DMOs (4) during endline evaluation. Five key themes emerged from participants' accounts: (i) the topics covered during CM visits; (ii) the benefits of CM; (iii) the challenges of CM; (iv) the drivers of CM sustainability; and (iv) suggestions for CM improvement. The topics of CM covered during visits included antenatal care, neonatal resuscitation, pregnancy monitoring, management of delivery complications, and infection control and prevention. The benefits of CM included increased knowledge, skills, confidence, and change in HCP's attitude and increased client service uptake, quality, and efficiency. The challenges of CM included inadequate equipment for learning and practice, the limited financial incentive to mentees, shortage of staff and time constraints, and weaker support from management. The drivers of CM sustainability included the willingness of mentees to continue with clinical practice, ongoing peer-to-peer mentorship, and integration of the mentorship program into district health plans. Finally, the suggestions for CM improvement included refresher training for mentors, engagement of more senior mentors, and extending mentorship beyond IMPACT catchment facilities. Conclusion: CM program appears to be a promising entry point to improving competence among HCPs and the quality and efficiency of RMNH services potentially contributing to the reduction of maternal and neonatal deaths. Addressing the challenges cited by participants, particularly the equipment for peer learning and practice, may increase the success of the CM program.

Predominance of Acinetobacter spp., Harboring the blaIMP Gene, Contaminating the Hospital Environment in a Tertiary Hospital in Mwanza, Tanzania: A Cross-Sectional Laboratory-Based Study.

Data on colonization and hospital contamination of carbapenem-resistant Gram-negative bacteria (CR-GNB) are limited in low- and middle-income countries. We designed this study to determine the prevalence and co-existence of carbapenemase genes among CR-GNB isolated from clinical, colonization, and hospital environmental samples at a tertiary hospital in Mwanza, Tanzania. The modified Hodge test (MHT), the combined disk test (CDT), and the double-disk synergy test (DDST) were used for the phenotypic detection of carbapenemases. A multiplex PCR assay was used to detect blaIMP and blaKPC, and a singleplex PCR assay was used to detect blaOXA-48. Data were analyzed by STATA version 13.0. Overall, 68.8% (44/64) of the CR-GNB had at least one phenotype by phenotypic methods, whereby 60.9% (39/64) were both CDT and DDST positive and 31.3% (20/64) were MHT positive. A total of 23/64 (35.9%) had at least one of the genes tested with the predominance of blaIMP (91.3%; 21/23). In addition, 47.7% (21/44) of the CR-GNB phenotypes had at least one gene. Around 47.8% (11/23) of the CR-GNB carried multiple genes encoding for carbapenem resistance, with the maximum co-existence of blaIMP/blaKPC/blaOXA-48 (45.5%; 5/11). The majority of carbapenem-resistant genes were detected in Acinetobacter spp. (82.6%; 19/23) and isolated from bed swabs (69.6%; 16/23). Acinetobacter spp. carrying the blaIMP gene predominantly contaminated the hospital environment. Therefore, we recommend routine decontamination of inanimate hospital surfaces, including patient beds.

Gastrointestinal Tract Colonization Rate of Extended-Spectrum Beta-Lactamase-Producing Gram-Negative Bacteria and Associated Factors Among Orthopaedic Patients in a Tertiary Hospital in Tanzania: Implications for Infection Prevention.

BACKGROUND: The dual burden of road traffic accidents and antimicrobial resistance in orthopaedic infections is challenging already strained health-care systems. Limited information exists in Tanzania on antimicrobial resistance surveillance to delineate the potential sources of multi-drug-resistant bacteria for specific mitigation strategies among orthopaedic patients. METHODS: A longitudinal study was conducted at Bugando Medical Centre in Mwanza city between January and May 2020. It involved the collection of rectal swabs/stools, hand swabs, and environmental sampling to identify extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacteria. Participants' data were collected using a structured questionnaire and analysed to determine factors associated with ESBL colonization among index orthopaedic patients and correlates with other ESBL sources using OR (95% CI) and a cut-off p-value of ≤0.05. RESULTS: We found that 47.2% (125/265) of index patients, 77.8% (14/18) of neighbouring patients, 8.3% (2/24) of health-care workers, 72.2% (13/18) of non-medical caregivers, and 31.4% (27/86) of samples taken from the hospital environment had ESBL producers. Escherichia coli and Klebsiella spp. predominated among participants and Acinetobacter spp. predominated in the environmental samples. Patients with open fractures had increased odds of being colonized with ESBL producers [OR (95% CI): 2.08 (1.16-3.75); p=0.015]. The floor below patients' beds was commonly contaminated; however, the odds of environmental contamination decreased on the third round of sampling [OR (95% CI: 0.16 (0.04-0.67); p=0.012], apparently as a result of parallel infection prevention and control responsive measures against coronavirus disease 2019 (COVID-19). CONCLUSION: We found a high occurrence of ESBL colonization among participants and in the environmentat this tertiary hospital. The importance of routine ESBL surveillance among orthopaedic patients with open fractures on admission and strengthened decontamination of health-care premises is reiterated.

Existence of Similar Leptospira Serovars among Dog Keepers and Their Respective Dogs in Mwanza, Tanzania, the Need for a One Health Approach to Control Measures.

This study investigated seroepidemiology of Leptospira serovars among the dog keepers and their dogs in the city of Mwanza, Tanzania. A total of 205 dog keepers and 414 dogs were tested for Leptospira antibodies using a microscopic agglutination test (MAT). The median age of the dog keepers was 26 (inter quartile range (IQR): 17-40) years and median duration of keeping dogs was 36 (IQR: 24-120) months. The seropositivity of Leptospira antibodies was (33/205 (16.1%, 95% CI: 11.0-21.1) among dog keepers and (66/414 (15.9%, 95% CI: 12.4-19.4) among dogs, p = 0.4745. Among the serovars tested (Sokoine, Grippotyphosa, Kenya, Pomona and Hebdomadis), the most prevalent serovar was Sokoine in both dog keepers and their dogs (93.9% (31/33) vs. and 65.1% (43/66), p = 0.009). Thirty-one out of thirty-three seropositive dog keepers (93.9%) had dogs positive for Leptospira antibodies with 28 (84.9%) having similar serovars with their respective seropositive dogs. Having tertiary education (AOR: 0.24, 95% CI: 0.07-0.84, p = 0.026) independently protected individuals from being Leptospira seropositive. More than three quarters of dog keepers had similar serovars as their dogs, necessitating one health approach to control measures in endemic areas.

Methicillin resistant Staphylococcus aureus causing osteomyelitis in a tertiary hospital, Mwanza, Tanzania.

BACKGROUND: Culture results of fluid/pus from sinuses or open wound are not reliable in establishing the causative agent of osteomyelitis due to the high chances of contamination of superficial contaminants. Bone fragments obtained during surgery have been recommended as ideal sample to establish pathogens causing osteomyelitis. This study investigated pathogens causing osteomyelitis among patients undergoing orthopedic surgical treatment at Bugando Medical Centre. METHODS: A cross-sectional hospital-based study was conducted from December 2017 to July 2018 among 74 patients with osteomyelitis who underwent surgical treatments at Bugando Medical Centre, Mwanza, Tanzania. Bone fragments were collected using sterile 10 ml of in-house prepared brain heart infusion broth (Oxoid, UK) during surgery. Specimens were processed according to standard operating procedures within an hour of collection. Data were analyzed using STATA 13.0. RESULTS: The median age of study participants was 12 with inter quartile range of 8-20 years. The majority 45 (60.8%) of participants were male. All 74 non-repetitive bone fragment specimens had positive culture, of which 17 had dual growth of bacteria resulting to 91 bacterial isolates. Out of 91 isolates, 63 (85.1%) were Staphylococcus aureus (S. aureus) of which 18 (28.6%) were confirmed to be methicillin resistant Staphylococcus aureus strains. Fever was significantly associated with Staphylococcal osteomyelitis (100% vs. 79.6%, p = 0.029). CONCLUSION: About one third of cases of Staphylococcal osteomyelitis in the current study were caused by methicillin resistant Staphylococcus aureus. There is a need of tailoring antibiotic management of osteomyelitis based on culture and sensitivity results for the better treatment outcome of the patients.