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Postpartum care of hypertensive disorders of pregnancy (HDP) often extends only 6 weeks after delivery in low-income countries. This multicenter observational cohort study was conducted to determine 3-month postpartum outcomes of HDP in Tanzania. Of 309 consecutive women admitted to 3 public hospitals, five (1.7 %) died within 3 months. Of the remaining 304, 292 (94.5 %) returned for 3-month follow-up visit and 41.1 % (95 % CI: 35.6 %-46.9 %) had persistent postpartum hypertension. The strongest independent predictor of hypertension persistence was reduced eGFR at delivery (aOR = 2.1[1.01,4.4]). Postpartum follow-up should routinely be extended to 3 months in all women with HDP to diagnose hypertension and prevent cardiovascular disease.
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Hipertensão Induzida pela Gravidez , Pré-Eclâmpsia , Gravidez , Feminino , Humanos , Pré-Eclâmpsia/epidemiologia , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/epidemiologia , Tanzânia/epidemiologia , Período Pós-Parto , Estudos de CoortesRESUMO
BACKGROUND: The single-visit strategy, also known as the "screen-and-treat" approach, is widely used to screen for cervical cancer in low- and middle-income countries. The screen-and-treat approach leads to unnecessary or inadequate treatment. Thus, a study was conducted to determine the histopathological patterns of aceto-white lesions on visual inspection with acetic acid (VIA) in patients who underwent a Loop Electrosurgical Excision Procedure (LEEP) at Bugando Medical Centre between January 2016 and December 2020. METHOD: A 5-year retrospective cross-sectional case record review was conducted on 329 women who had LEEP at Bugando Medical Centre following a positive VIA cervical screening test. A standard data abstraction form was used to collect patient information. Missing client information records and LEEP without histopathological results were exclusion criteria. For statistical analysis, STATA version 15 was used; in descriptive statistics, frequency, mean, and standard deviation were used. The Chi2 and Fisher's exact tests were used to investigate the relationship between patient characteristics and histopathological patterns, and a P-value of 0.05 was considered statistically significant in multinomial models. RESULTS: This study looked at 329 patients who had LEEP following a VIA positive but were not eligible for cryotherapy. Our study participants had a mean age of 40 ± 8.2 SD. There were 203 (61.7%) patients with benign lesions, including 4 with schistosomiasis and 2 with cervical tuberculosis. The precancerous lesions were discovered in 100 cases (30.4%), and 26 (7.9%) already had invasive cervical cancer. Out of 100 patients with precancerous lesions, 58 (17.6%) and 42 (12.8%) have high- and low-grade squamous intraepithelial (HSIL and LSIL) lesions, respectively. The presence of a precancerous lesion was found to be associated with age 31-40 years (P-value 0.042) and HIV positivity (P-value 0.004). CONCLUSION: Most patients in this study had benign cervical lesions, which do not require LEEP treatment. Nonetheless, a considerable percentage of invasive cervical malignancies and rare benign diseases such as schistosomiasis and cervical tuberculosis were identified. A screen-and-treat approach within well-equipped tertiary hospitals like Bugando Medical Centre should explore alternative options instead of relying solely on straight LEEP.
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Lesões Pré-Cancerosas , Esquistossomose , Tuberculose , Neoplasias do Colo do Útero , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/cirurgia , Detecção Precoce de Câncer/métodos , Ácido Acético , Estudos Retrospectivos , Estudos Transversais , Eletrocirurgia/métodos , Tanzânia , Lesões Pré-Cancerosas/cirurgia , Esquistossomose/cirurgiaRESUMO
BACKGROUND: Rudimentary horn pregnancy is a rare life-threatening obstetric condition with clinical and sonographic presentation resembling that of an abdominal pregnancy. Preoperative diagnosis of advanced rudimentary horn pregnancy is difficult and cases are often identified incidentally during laparotomy for a presumed abdominal pregnancy. CASE PRESENTATION: We report a case of a 29-year-old African woman, gravida 2 para 1 at 28 weeks of gestation complaining of epigastric pain for 7 days with no other associated gastrointestinal or genitourinary symptoms. On examination, she had normal vital signs and an enlarged abdomen sized at 33 cm with unremarkable fetal lie and presentation. She had normal laboratory blood results with an ultrasound revealing an abdominal pregnancy of 28 weeks. The informed decision for conservative management was planned after informing of the benefit and risks of early termination versus conservative management, however, with worsening symptoms an emergency laparotomy had to be performed in which a left unruptured rudimentary horn pregnancy with a viable fetus was identified incidentally and delivery of the fetus followed by surgical excision of the horn was done. The postoperative period was uneventful, and the patient was discharged home with her newborn. CONCLUSION: Rudimentary horn pregnancy is very rare and often indistinguishable from an abdominal pregnancy in advanced gestation age. First trimester ultrasound is by far the only noninvasive sensitive diagnostic modality for rudimentary horn pregnancy. Laparotomy with horn excision remains the standard of care for advanced rudimentary horn pregnancy.
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Cavidade Abdominal , Gravidez Abdominal , Gravidez , Feminino , Recém-Nascido , Humanos , Adulto , Gravidez Abdominal/diagnóstico por imagem , Gravidez Abdominal/cirurgia , Útero , Diagnóstico Diferencial , Primeiro Trimestre da GravidezRESUMO
Introduction: Health system strengthening initiatives in low and middle-income countries are commonly hampered by limited implementation readiness. The Maximizing Engagement for Readiness and Impact (MERI) Approach uses a system "readiness" theory of change to address implementation obstacles. MERI is documented based on field experiences, incorporating best practices, and lessons learned from two decades of maternal, newborn, and child health (MNCH) programming in East Africa. Context: The MERI Approach is informed by four sequential and progressively larger MNCH interventions in Uganda and Tanzania. Intervention evaluations incorporating qualitative and quantitative data sources assessed health and process outcomes. Implementer, technical leader, stakeholder, and policymaker reflections on sequential experiences have enabled MERI Approach adaptation and documentation, using an implementation lens and an implementation science readiness theory of change. Key programmatic elements: The MERI Approach comprises three core components. MERI Change Strategies (meetings, equipping, training, mentoring) describe key activity types that build general and intervention-specific capacity to maximize and sustain intervention effectiveness. The SOPETAR Process Model (Scan, Orient, Plan, Equip, Train, Act, Reflect) is a series of purposeful steps that, in sequence, drive each implementation level (district, health facility, community). A MERI Motivational Framework identifies foundational factors (self-reliance, collective-action, embeddedness, comprehensiveness, transparency) that motivate participants and enhance intervention adoption. Components aim to enhance implementer and system readiness while engaging broad stakeholders in capacity building activities toward health outcome goals. Activities align with government policy and programming and are embedded within existing district, health facility, and community structures. Discussion: This case study demonstrates feasibility of the MERI Approach to support district wide MNCH programming in two low-income countries, supportive of health outcome and health system improvements. The MERI Approach has potential to engage districts, health facilities, and communities toward sustainable health outcomes, addressing intervention implementation gaps for current and emerging health needs within and beyond East Africa.
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Pessoal Administrativo , Governo , Criança , Recém-Nascido , Humanos , Fortalecimento Institucional , Família , Ciência da ImplementaçãoRESUMO
BACKGROUND: In Tanzania, maternal and newborn deaths can be prevented via quality facility-based antenatal care (ANC), delivery, and postnatal care (PNC). Scalable, integrated, and comprehensive interventions addressing demand and service-side care-seeking barriers are needed. OBJECTIVE: Assess coverage survey indicators before and after a comprehensive maternal newborn health (MNH) intervention in Misungwi District, Tanzania. METHODS: A prospective, single-arm, pre- (2016) and post-(2019) coverage survey (ClinicalTrials.gov #NCT02506413) was used to assess key maternal and newborn health (MNH) outcomes. The Mama na Mtoto intervention included district activities (planning, leadership training, supportive supervision), health facility activities (training, equipment, infrastructure upgrades), and plus community health worker mobilization. Implementation change strategies, a process model, and a motivational framework incorporated best practices from a similar Ugandan intervention. Cluster sampling randomized hamlets then used 'wedge sampling' protocol as an alternative to full household enumeration. Key outcomes included: four or more ANC visits (ANC4+); skilled birth attendant (SBA); PNC for mother within 48 hours (PNC-woman); health facility delivery (HFD); and PNC for newborn within 48 hours (PNC-baby). Trained interviewers administered the 'Real Accountability: Data Analysis for Results Coverage Survey to women 15-49 years old. Descriptive statistics incorporated design effect; the Lives Saved Tool estimated deaths averted based on ANC4+/HFD. RESULTS: Between baseline (n = 2,431) and endline (n = 2,070), surveys revealed significant absolute percentage increases for ANC4+ (+11.6, 95% CI [5.4, 17.7], p < 0.001), SBA (+16.6, 95% CI [11.1, 22.0], p < 0.001), PNC-woman (+9.2, 95% CI [3.2, 15.2], p = 0.002), and HFD (+17.2%, 95% CI [11.3, 23.1], p < 0.001). A PNC-baby increase (+6.1%, 95% CI [-0.5, 12.8], p = 0.07) was not statistically significant. An estimated 121 neonatal and 20 maternal lives were saved between 2016 and 2019. CONCLUSIONS: Full-district scale-up of a comprehensive MNH package embedded government health system was successfully implemented over a short time and associated with significant maternal care-seeking improvements and potential for lives saved.
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Saúde do Lactente , Serviços de Saúde Materna , Recém-Nascido , Feminino , Gravidez , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Tanzânia/epidemiologia , Estudos Prospectivos , Saúde Materna , Cuidado Pré-NatalRESUMO
Population-based intervention coverage data are used to inform the design of projects, programs, and policies and to evaluate their impact. In low- and middle-income countries (LMICs), household surveys are the primary source of coverage data. Many coverage surveys are implemented by organizations with limited experience or resources in population-based data collection. We developed a streamlined survey and set of supporting materials to facilitate rigorous survey design and implementation. The RADAR coverage survey tool aimed to 1) rigorously measure priority reproductive, maternal, newborn, child health & nutrition coverage indicators, and allow for equity and gender analyses; 2) use standard, valid questions, to the extent possible; 3) be as light as possible; 4) be flexible to address users' needs; and 5) be compatible with the Lives Saved Tool for analysis of program impact. Early interactions with stakeholders also highlighted survey planning, implementation, and analysis as challenging areas. We therefore developed a suite of resources to support implementers in these areas. The toolkit was piloted by implementers in Tanzania and in Burkina Faso. Although the toolkit was successfully implemented in these settings and facilitated survey planning and implementation, we found that implementers must still have access to sufficient resources, time, and technical expertise in order to use the tool appropriately. This potentially limits the use of the tool to situations where high-quality surveys or evaluations have been prioritized and adequately resourced.
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Saúde da Criança , Características da Família , Criança , Humanos , Recém-Nascido , Estado Nutricional , Pobreza , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Most (94%) of global maternal deaths occur in low- and middle-income countries due to preventable causes. Maternal health care remains a key pillar in improving survival. Antenatal care (ANC) guidelines recommend that pregnant women should be provided with information about postnatal care in the third trimester. However, the utilization of postnatal care services is limited in developing countries including Tanzania. The aim of this study was to investigate the practice of health care workers in providing information on postnatal care to pregnant women during antenatal care visits. METHODS: A cross sectional study was conducted among health care workers from 27 health facilities that offer reproductive and child health services in Busega district Northwest Tanzania. A simulated client approach was utilized to observe quality of practice among health care workers with minimal reporting bias (i.e., the approach allows observing participants at their routine practices without pretending). Selected pregnant women who were trained to be simulated clients from the community within facility catchment area attended antenatal care sessions and observed 81 of 103 health care workers. Data analyses were carried out using STATA 13. RESULTS: Only 38.73% (95% CI; 28.18-49.49%) of health care workers were observed discussing subtopics related to postnatal care during the ANC visit. Few health care workers (19.35%), covered all eight subtopics recommended in the ANC guidelines. Postnatal danger signs (33.33%) and exclusive breast feeding (33.33%) were mostly discussed subtopics by health care workers. Being a doctor/nurse/clinical officer is associated by provision of postnatal education compared to medical attendant, aOR = 3.65 (95% CI; 1.21-12.14). CONCLUSION: The provision of postnatal education during ANC visits by health care workers in this district was limited. This situation could contribute to the low utilization of postnatal care services. Health care workers need to be reminded on the importance of delivering postnatal education to pregnant women attending ANC clinic visits. On job training can be used to empower health care workers of different cadres to deliver postnatal health education during ANC visits. These efforts could increase women's utilization of postnatal care and improve outcomes for mothers and newborns.
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Serviços de Saúde Materna , Cuidado Pré-Natal , Criança , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Cuidado Pós-Natal , Gravidez , TanzâniaRESUMO
BACKGROUND: Evidence has shown that male involvement is associated with improved maternal health outcomes. In rural Tanzania, men are the main decision makers and may determine women's access to health services and ultimately their health outcomes. Despite efforts geared towards enhancing male participation in maternal health care, their involvement in antenatal care (ANC) remains low. One barrier that impacts men's participation is the fear and experience of social stigma. This study, builds on previous findings about men's perspectives in attending antenatal care appointments in Misungwi district in Tanzania, examining more closely the fear of social stigma amongst men attending ANC together with their partners. METHODS: Twelve individual interviews and five focus group discussions were conducted using semi-structured questionnaires with fathers and expectant fathers. In-depth interviews were conducted with health providers, volunteer community health workers and village leaders. Interviews were audiotaped, and transcripts were transcribed and translated to English. Transcripts were organized in NVivo V.12 then analyzed using thematic approach. RESULTS: Three main themes were found to create fear of social stigma for men: 1. Fear of HIV testing; 2. Traditional Gender Norms and 3. Insecurity about family social and economic status. CONCLUSION: Respondent's experiences reveal that fear of social stigma is a major barrier to attend ANC services with their partners. Attention must be given to the complex sociocultural norms and social context that underly this issue at the community level. Strategies to address fear of social stigma require an understanding of the real reasons some men do not attend ANC and require community engagement of community health workers (CHWs), government officials and other stakeholders who understand the local context.
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Pai/psicologia , Cuidado Pré-Natal/psicologia , Normas Sociais/etnologia , Estigma Social , Adulto , Humanos , Masculino , Pesquisa Qualitativa , População Rural , TanzâniaRESUMO
BACKGROUND: In 2017, roughly 540 women in Sub-Saharan Africa died every day from preventable causes related to pregnancy and childbirth. To stem this public-health crisis, the WHO recommends a standard continuity of maternal healthcare, yet most women do not receive this care. Surveys suggest that illiteracy limits the uptake of the recommended care, yet little is understood about why this is so. This gap in understanding why healthcare is not sought by illiterate women compromises the ability of public health experts and healthcare providers to provide culturally relevant policy and practice. This study consequently explores the lived experiences related to care-seeking by illiterate women of reproductive age in rural Tanzania to determine why they may not access maternal healthcare services. METHODS: An exploratory, qualitative study was conducted in four communities encompassing eight focus group discussions with 81 illiterate women, 13 in-depth interviews with illiterate women and seven key-informant interviews with members of these communities who have first-hand experience with the decisions made by women concerning maternal care. Interviews were conducted in the informant's native language. The interviews were coded, then triangulated. RESULTS: Two themes emerged from the analysis: 1) a communication gap arising from a) the women's inability to read public-health documents provided by health facilities, and b) healthcare providers speaking a language, Swahili, that these women do not understand, and 2) a dependency by these women on family and neighbors to negotiate these barriers. Notably, these women understood of the potential benefits of maternal healthcare. CONCLUSIONS: These women knew they should receive maternal healthcare but could neither read the public-health messaging provided by the clinics nor understand the language of the healthcare providers. More health needs of this group could be met by developing a protocol for healthcare providers to determine who is illiterate, providing translation services for those unable to speak Swahili, and graphic public health messaging that does not require literacy. A failure to address the needs of this at-risk group will likely mean that they will continue to experience barriers to obtaining maternal care with detrimental health outcomes for both mothers and newborns.
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Competência Cultural/psicologia , Acessibilidade aos Serviços de Saúde , Alfabetização/psicologia , Serviços de Saúde Materna , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Alfabetização/etnologia , Gravidez , Pesquisa Qualitativa , População Rural , TanzâniaRESUMO
BACKGROUND: Adolescent girls (10-19 years) are at increased risk of morbidity and mortality from pregnancy and childbirth complications, compared with older mothers. Low and middle-income countries, including Tanzania, bear the largest proportion of adolescent perinatal deaths. Few adolescent girls in Tanzania access antenatal care at health facilities, the reasons for which are poorly understood. METHODS: We conducted a qualitative thematic analysis study of the experiences of pregnant adolescents with accessing antenatal care in Misungwi district, Tanzania. We recruited 22 pregnant or parenting adolescent girls using purposive sampling, and conducted in-depth interviews (IDIs) about antenatal care experiences. IDI data were triangulated with data from eight focus group discussions (FGDs) involving young fathers and elder men/women, and nine key informant interviews (KIIs) conducted with local health care providers. FGDs, KIIs and IDIs were transcribed verbatim in Swahili. Transcripts were then translated to English and analysed using emergent thematic analysis. RESULTS: Four main themes emerged: 1) Lack of maternal personal autonomy, 2) Stigma and judgment, 3) Vulnerability to violence and abuse, and 4) Knowledge about antenatal care, and highlighted the complex power imbalance that underlies barriers and facilitators to care access at the individual, family/interpersonal, community, and health-systems levels, faced by pregnant adolescents in rural Tanzania. CONCLUSION: Adolescent antenatal care-seeking is compromised by a complex power imbalance that involves financial dependence, lack of choice, lack of personal autonomy in decision making, experiences of social stigma, judgement, violence and abuse. Multi-level interventions are needed to empower adolescent girls, and to address policies and social constructs that may act as barriers, thereby, potentially reducing maternal morbidity and mortality in Tanzania.
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Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa , Tanzânia , Adulto JovemRESUMO
BACKGROUND: Mens'attendance with their pregnant partners at facility-based antenatal care (ANC) visits is important for maternal and child health and gender equality yet remains uncommon in parts of rural Tanzania. This study examined men's perspectives on attending ANC with their pregnant partners in Misungwi District, Tanzania. METHODS: Twelve individual interviews and five focus group discussions were conducted using semi-structured questionnaires with fathers, expectant fathers, and in-depth interviews were done to health providers, volunteer community health workers, and village leaders. Interviews were recorded and transcribed in Swahili and later translated to English. The research team conducted thematic analysis to identify common themes among interviews. RESULTS: We identified two broad themes on the barriers to male attendance at facility-based ANC visits: (1) Perceived exclusion during ANC visits among men (2) Traditional gender norms resulting to low attendance among men. CONCLUSION: Attendance at health facility for ANC visits by men with their pregnant partners in the study areas were challenged by structural and local cultural norms. At the facility men were uncomfortable to sit with women due to lack of specific waiting area for men and that they perceived to be neglected. Local cultural norms demanded women to have secrecy in pregnancy while men perceived not to have a role of being with their partners during ANC visits.
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Cultura , Pai/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Atitude , Atenção à Saúde , Feminino , Grupos Focais , Papel de Gênero , Humanos , Recém-Nascido , Masculino , Saúde Materna/etnologia , Saúde Materna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pesquisa Qualitativa , População Rural , Fatores Socioeconômicos , TanzâniaRESUMO
OBJECTIVES: To describe a simulation-based rater training curriculum for Objective Structured Clinical Examinations (OSCEs) for clinician-based training for frontline staff caring for mothers and babies in rural Tanzania. BACKGROUND: Rater training for OSCE evaluation is widely embraced in high-income countries but not well described in low-income and middle-income countries. Helping Babies Breathe, Essential Care for Every Baby and Bleeding after Birth are standardised training programmes that encourage OSCE evaluations. Studies examining the reliability of assessments are rare. METHODS: Training of raters occurred over 3 days. Raters scored selected OSCEs role-played using standardised learners and low-fidelity mannikins, assigning proficiency levels a priori. Researchers used Zabar's criteria to critique rater agreement and mitigate measurement error during score review. Descriptive statistics, Fleiss' kappa and field notes were used to describe results. RESULTS: Six healthcare providers scored 42 training scenarios. There was moderate rater agreement across all OSCEs (κ=0.508). Kappa values increased with Helping Babies Breathe (κ=0.28-0.48) and Essential Care for Every Baby (κ=0.42-0.77) by day 3 of training, but not with Bleeding after Birth (κ=0.58-0.33). Raters identified average proficiency 50% of the time. CONCLUSION: Our study shows that the in-country raters in this study had a hard time identifying average performance despite moderate rater agreement. Rater training is critical to ensure that the potential of training programmes translates to improved outcomes for mothers and babies; more research into the concepts and training for discernment of competence in this setting is necessary.
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The educational pedagogy surrounding Helping Babies Breathe (HBB) has been transformative in going beyond a curriculum focused only on basic neonatal resuscitation; indeed, it created the framework for an educational program that has served as a model for replication for other impactful programs, such as the Helping Mothers Survive and other Helping Babies Survive curricula. The tenets of HBB include incorporation of innovative learning strategies such as small group discussion, skills-based learning, simulation and debriefing, and peer-to-peer learning, all of which begin the hard work of changing behaviors that may eventually affect health care systems. Allowing for adaptation for local resources and culture, HBB has catalyzed innovation in the development of simplified, pictorial educational materials, in addition to low-tech yet realistic simulators and adjunct devices that have played an important role in empowering health care professionals in their care of newborns, thereby improving outcomes. In this review, we describe the development of HBB as an educational program, the importance of field testing and input from multiple stakeholders including frontline workers, the strategies behind the components of educational materials, and the impact of its pedagogy on learning.
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Asfixia Neonatal/terapia , Ressuscitação/educação , Currículo , Humanos , Recém-NascidoRESUMO
Bartholin's gland abscess is the commonest worldwide reported abscess in gynaecological outpatient clinics; it has also been reported that Bartholin's gland abscess is three times more common in occurrences compared to Bartholin's gland cyst. It is more common in women who are at risk of acquiring sexually transmitted infections; however, other causes of infection should be investigated to exclude other causes of disease. We present the case of an 18-year-old female patient, a teenager of the reproductive age group, with the recurrent development of huge Bartholin's gland abscess in a period of one year. The marsupialization surgical technique of repair was performed successfully. She was discharged home and she was scheduled to visit STI's clinic where she was receiving regular screening for STI's and she was also given health education regarding preventive measures for STI's.
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BACKGROUND: Human parvovirus B19 (B19) infection has been associated with congenital infection which may result into a number of the adverse pregnancy outcomes. The epidemiology and the magnitude of B19 infections among pregnant women have been poorly studied in developing countries. This study was done to establish preliminary information about the magnitude of B19 among pregnant women attending antenatal clinics in the city of Mwanza, Tanzania. METHODS: A cross-sectional study was conducted between December 2014 and June 2015 among 258 pregnant women attending two antenatal clinics representing rural and urban areas in the city of Mwanza. Socio-demographic data were collected using structured data collection tool. Specific B19 IgM and IgG antibodies were determined using indirect enzyme linked immunosorbent assay kits (DRG Instruments GmbH, Germany). Data were analyzed using STATA version 11 software. RESULTS: The median age of study participants was 21 IQR (19-25) years. Of 253 pregnant women; 116(44.96%), 109(42.25%) and 33(12.79%) were in the first, second and third trimester respectively. The majority 168(66.4%) of women were from urban areas. Of 253 pregnant women, the overall prevalence of IgM was 83(32.8%) while that of IgG was 142(55.0%) among 258 women tested. A total of 50(19.4%) women were positive for both IgG and IgM indicating true IgM positive. History of baby with low birth weight (OR: 10, 95% CI: 1.82-58.05, P = 0.01) was independent predictor of B19 IgG seropositivity and being at the third trimester was protective (OR: 0.38, 95% CI: 0.16-0.92, P = 0.03). The IgG titers were found to decrease significantly as gestational age increases (Spearman's rho = -0.2939, p = 0.0004) CONCLUSION: More than a half of pregnant women in Mwanza city are B19 IgG sero-positive with about one third of these being B19 IgM seropositive. Further studies to determine the impact of B19 infections among pregnant women and their newborns are recommended in developing countries.
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Eritema Infeccioso/epidemiologia , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Parvovirus B19 Humano/imunologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Estudos Transversais , Eritema Infeccioso/sangue , Feminino , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Gravidez , Complicações Infecciosas na Gravidez/sangue , Trimestres da Gravidez/sangue , Prevalência , Estudos Soroepidemiológicos , Tanzânia/epidemiologia , Adulto JovemRESUMO
First described in 1925, giant condyloma acuminatum also known as Buschke-Löwenstein tumor (BLT) is a benign, slow-growing, locally destructive cauliflower-like lesion usually in the genital region. The disease is usually locally aggressive and destructive with a potential for malignant transformation. The causative organism is human papilloma virus. The most common risk factor is immunosuppression with HIV; however, any other cause of immunodeficiency can be a predisposing factor. We present a case of 33-year-old female patient, a known HIV patient on antiretroviral therapy for ten months. She presented with seven-month history of an abnormal growth in the genitalia that was progressive accompanied with foul smelling yellowish discharge and friable. Surgical excision was performed successfully. Pap smear of the excised tissue was negative. Despite being a rare condition, giant condyloma acuminatum is relatively common in HIV-infected patients.
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INTRODUCTION: Acute rubella virus infection in early pregnancy has been associated with poor pregnancy outcome ranging from spontaneous abortion, stillbirth and multiple birth defects known as Congenital Rubella Syndrome (CRS). Despite its importance the prevalence of acute rubella virus infections is not known among women with spontaneous abortion in most centres in developing countries. AIM: The present study was aimed to determine the seroprevalence of acute rubella infection among women with spontaneous abortion in Mwanza city. MATERIALS AND METHODS: A total of 268 women with spontaneous abortion were enrolled from four different hospitals in Mwanza city between November 2015 and April 2016. Blood samples were collected; sera were extracted and stored at -80°C until processing. Acute rubella virus infection was diagnosed by the detection of rubella specific IgM antibodies using indirect Enzyme Linked Immunosorbent Assay (ELISA) as per manufacturer's instructions. Data were analysed by using STATA version 11. RESULTS: The mean age of enrolled women was 26.3±5.6 years. The prevalence of acute rubella virus infection was found to be 9/268 (3.7%, 95% CI: 1-5). Only women residing in urban areas (AOR: 5.65, 95% CI: 1.15-27.77, p=0.035) were found to predict acute rubella virus infection among cases with spontaneous abortion in Mwanza city. CONCLUSION: About four out of hundred women residing in urban areas with spontaneous abortion in Mwanza are acutely infected with rubella virus highlighting the potential of this virus in contributing to poor pregnancy outcome in this setting.
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BACKGROUND: High risk (HR) human papilloma Virus (HPV) genotypes have been associated with cervical cancer. In Tanzania there is a limited data on the epidemiology of HPV and genotypes distribution among HIV infected women. Here we document varieties of HPV genotypes associated with cervical squamous intraepithelial lesions (SIL) among HIV- infected women at Bugando Medical Centre, Mwanza-Tanzania. METHODS: A cross sectional hospital based study involving HIV infected women was conducted between August and October, 2014. Exfoliated cells from ectocervix and endocervix were collected using cytobrush. HPV genotypes were detected using polymerase chain reaction (PCR) followed by sequencing using specific primers targeting broad range of HPV types. Cytology was done to establish squamous intraepithelial lesions. Log binomial regression analysis was done to establish risk ratios (RR) associated with HPV infection using STATA version 11. RESULTS: A total of 255 HIV infected women with mean age 39.2 ± 9.1 years were enrolled in the study. HPV DNA was detected in 138/255 (54.1 %, 95 % CI: 47-60) of HIV infected women. Twenty six genotypes were detected in various combinations; of these 17(65.3 %) were of HR genotypes. HR genotypes were detected in 124(48.6 %) of HIV infected women. Common HR genotypes detected were HPV-52(26), HPV-58(21), HPV-35(20) and HPV-16(14). The risk of being HPV positive was significantly higher among women with CD4 counts <100 (RR: 1.20, 95 % CI: 1.05-1.35, P = 0.006) and women with SIL (RR: 1.37, 95 % CI: 1.11-1.68, P = 0.005). CONCLUSION: Significant proportion of HIV infected women with low CD4 counts have various grades of cervical SIL associated with varieties of uncommon HR genotypes. There is a need to evaluate the effectiveness of the current vaccine in preventing cervical cancer in developing countries where HIV is endemic.
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BACKGROUND: Teratomas are a germ cell tumors composed of two or more tissues which originate from ectoderm, endoderm or mesoderm. These tumors commonly arise from the ovary although other extragonadal sites can be involved, especially in children. CASE PRESENTATION: We report a case of a 21-year-old female of Sukuma ethnicity from the northern region of Tanzania who presented with abdominal pain and distension, fever, and abnormal vaginal discharge for the previous three weeks. The patient was also lactating for the previous 8 months following cesarean section delivery. Pelvic ultrasound suggested pelvic abscess but after laparotomy and histological analysis of a bulky uterus removed a diagnosis of mature uterine teratoma was confirmed. CONCLUSION: Although it is rare, uterine teratoma should be considered in differential diagnosis to any patient with uterine mass even without typical radiological findings.
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BACKGROUND: About two thirds of patients with cervical cancer in Tanzania present with advanced tumor stage, leading to significant morbidity and mortality. We designed a study to determine the factors associated with the late tumour stage at presentation among patients with cervical cancer in Mwanza. METHODS: This cross-sectional study recruited women at Bugando Medical Centre (BMC) with histologically confirmed cervical cancer from November 2013 to April 2014. Patients were recruited serially until the sample size was reached. RESULTS: A total of 202 women with histologically confirmed cervical cancer were recruited. The mean age of the patients was 50.5 ± 13.3 years. The majority of patients (n = 129, 63.9%) were diagnosed with late stage disease (IIB-IVB). Patients also presented with severe anemia (n = 78, 38.6%), urinary tract infections (n = 74, 36.6%), hydronephrosis (n = 43, 21.2%), elevated serum creatinine levels (n = 33, 16.3%), vesicovaginal fistula (VVF), (n = 13, 6.4%), lung metastasis (n = 5, 2.4%), metastasis to the urinary bladder (n = 4, 1.9%), rectovaginal fistula (RVF) (n = 3, 1.4%), liver metastasis (n = 2, 0.9%) and hydroureter (n = 2, 0.9%). In multivariate logistic regression, factors associated with late stage at presentation were attending to alternative health practitioners and lack of personal initiative to seek care to formal health facilities (OR 2.3; 95% CI 1.2-4.2, p = 0.011 and OR 2.0; 95 % CI 1.0-3.8, p = 0.028) respectively. CONCLUSION: Communities should be sensitized to women's empowerment, provide community education on early symptoms of cervical cancer, and the importance of early hospital attendance.