Prevalence of human immunodeficiency virus drug resistance and factors associated with high viral load among adolescents on antiretroviral therapy in Dar Es Salaam, Tanzania.

BACKGROUND: Resistance to antiretrovirals against human immunodeficiency virus (HIV) poses a threat to zero transmission of HIV by 2030. Few studies have been conducted on HIV drug resistance (HIVDR) mutations targeting adolescents. We determined the prevalence, pattern of HIVDR mutations, and factors associated with unsuppressed HIV viral load among adolescents on antiretroviral therapy (ART). METHODS: From March to June 2020, we conducted a cross-sectional study at the Infectious Disease Clinic in Dar es Salaam, Tanzania. HIV-1 viral load was tested using m2000rt Real-Time HIV-1 assay. A sample with a viral load equal or more than 1,000 copies/ml was tested for HIVDR mutations. We determined the factors associated with unsuppressed viral load using logistic regression. A p-value less than 0.05 was considered significant. RESULTS: We enrolled 131 participants with a median age (interquartile range) of 15 (13-18) years. Of all, 24(18.3%) had a viral load above 1000 copies/ml. HIVDR mutations were found in 19/24(68.4%). Mutation to protease inhibitors, nucleotide reverse transcriptase inhibitors, and non-nucleoside reverse transcriptase inhibitors were 1(5.2%), 9(47.4%), and 11(57.9%), respectively. Non-antiretroviral therapy and orphanages were independently associated with unsuppressed viral load. CONCLUSION: The prevalence of HIVDR and unsuppressed HIV viral load among adolescents are relatively high. The use of non-antiretroviral therapy and orphanage influenced the persistence of high viral load. Strategies for surveillance of HIVDR early warning signs should be devised among adolescents.

The pattern of rpoB gene mutation of Mycobacterium tuberculosis and predictors of rifampicin resistance detected by GeneXpert MTB/RIF assay in Tanzania.

INTRODUCTION: Antimicrobial resistance in Mycobacterium tuberculosis (MTB) poses a significant challenge to tuberculosis (TB) management worldwide. Rifampicin resistance (RR) has been associated with the rpoB gene mutation. No study was conducted in Tanzania to determine the commonest mutation. The inconsistent findings from various studies support the need to determine whether reported mutation patterns are applicable in our setting. We determined the frequency of rpoB gene mutation and factors associated with RR, which were detected using GeneXpert MTB/RIF assay. METHODS: We conducted a retrospective cross-sectional study involving data from the National Tuberculosis and Leprosy Program database from 2020 to 2022 for cases investigated using GeneXpert MTB/RIF assay. Descriptive analysis was performed to determine the frequency of categorical variables. The chi-square test and logistic regression analysis assessed the relationship between the independent variables and outcome. The 95% confidence interval and a significance level of p<0.05 were used to assess the strength of association. RESULTS: A total of 56,004 participants had a status of MTB and RR, where 38,705/56,004 (69.11%) were males. Probe E mutation (codon 529-533), 89/219 (40.64%) was predominant. Human immunodeficiency virus (HIV)-positive patients had a higher gene mutation, 134/10601 (1.26%) than HIV-negative, 306/45016 (0.68%) (p<0.001). Patients with both pulmonary and extra-pulmonary TB had about four times greater odds of developing rifampicin resistance (AOR 3.88, 95%CI: 1.80-8.32). RR was nearly nine times higher in previously treated patients than new patients (AOR 8.66, 95% CI: 6.97-10.76). HIV-positive individuals had nearly twice the odds of developing RR than HIV-negative individuals (AOR 1.91, 95%CI: 1.51-2.42). CONCLUSION: The rate of RR was lower compared to other studies in Tanzania, with probe E mutations the most prevalent. Patients with disseminated TB, HIV co-infection and those with prior exposure to anti-TB had more risk of RR. The findings highlight the need to strengthen surveillance of multidrug-resistant TB among high risk patients.

The prevalence of vertical transmission of human immunodeficiency virus and associated factors among exposed infants in Eastern Lake zone and Southern Highland of Tanzania: a cross-sectional study.

BACKGROUND: Globally, the rate of antiretroviral therapy coverage for pregnant women living with human immunodeficiency virus (HIV) increased by 38% between 2010 and 2015 but only by 2% between 2016 and 2020. OBJECTIVES: We aimed to determine the prevalence of vertical transmission of HIV among infants from mothers living with HIV and associated factors in the Eastern Lake Zone and Southern Highland of Tanzania from January to December 2022. METHODS: This retrospective cross-sectional study extracted data from the Open Laboratory Data Repository database collected from January to December 2022 at 93 health facilities. A total of 1,411 infants exposed to HIV from the Mbeya (851), Songwe (304), and Mara regions (256) were enrolled. RESULTS: The prevalence for vertical transmission of HIV was 2.48% (35/1411). We observed a non-significant difference in the prevalence of vertical transmission in children whose first test was done below six weeks of life (1.89%) and other age groups (2.52-2.62%) (p < 0.917). Children not given antiretroviral prophylaxis had eleven times higher odds of acquiring infection (AOR 11.39, 95% CI: 3.61-35.97). Mothers who were not on ART during pregnancy had three times the odds of transmitting HIV to their infants (AOR 3.03, 95%CI: 0.91-10.15). CONCLUSIONS: We found a low prevalence of vertical transmission of HIV compared to previous studies done in Tanzania. The use of ART prophylaxis for infants exposed to HIV is significantly associated with the low rate of HIV transmission.

Protocol for surveillance of antimicrobial-resistant bacteria causing community-acquired urinary tract infections in low-income countries.

The spread of drug-resistant bacteria into the community is an urgent threat. In most low-middle-income countries (LMICs) settings, community-acquired infection (CAI) is empirically treated with no data to support the choice of antibiotics, hence contributing to resistance development. Continuous antimicrobial resistance (AMR) data on community-acquired pathogens are needed to draft empirical treatment guidelines, especially for areas with limited culture and susceptibility testing. Despite the importance of addressing antibiotic-resistant pathogens in the community setting, protocols for the surveillance of AMR bacterial infections are lacking in most (LMICs). We present a protocol for surveillance of AMR in LMICs using urinary tract infection (UTI) as a proxy for CAI to enable users to quantify and establish the drivers of AMR bacteria causing UTI. The protocol intends to assist users in designing a sustainable surveillance program for AMR in the community involving children above two years of age and adults presenting to a primary health facility for healthcare. Implementation of the protocol requires initial preparation of the laboratories to be involved, surveillance areas, selection of priority bacteria and antimicrobials to be used, and the design of a coordinated sampling plan. Recruitment should occur continuously in selected health facilities for at least 12 months to observe seasonal trends of AMR. At least 10 mL of clean-catch mid-stream urine must be collected into 20 mL calibrated sterile screw-capped universal bottles lined with 0.2 mg boric acid and transported to the testing laboratory. Utilise the data system that generates standard reports for patient care to be shared internally and externally in the regions and the world through global platforms such as the Global Antimicrobial Resistance Surveillance System.

Bacterial aetiology, antimicrobial susceptibility patterns, and factors associated with urinary tract infection among under-five children at primary health facility, North-Western Tanzania.

BACKGROUND: Urinary tract infections (UTI) are common in under-five children, with significant consequences leading to bacteremia, dehydration, kidney scarring, and renal failure. The incidence of UTI varies with patients' demographics and geographic location. Limited studies have addressed UTI issues, particularly in children. We determined the proportion of UTI, bacterial aetiology, and antimicrobial susceptibility patterns and associated factors among under-five children at the district hospital between March and April 2023. METHODS: We conducted a cross-sectional study using a convenient non-probability sampling technique to collect urine samples from participants with signs and symptoms of UTI. Written informed consent was obtained from parents or guardians. We collected Participants' information using a pretested structured questionnaire. Urine samples were processed at the Regional Referral Hospital. All analyses were conducted using STATA version 15.0. We determined the factors associated with UTI using a modified Poisson model multivariable analysis of the modified Poisson model. The results were presented as a prevalence ratio and 95% confidence interval. The level of significance was specified at 0.05. RESULT: The study recruited 368 under-five children; 194 (52.7%) were males, and the median age (interquartile range) was 24 (13-36) months. Of all, 28.8% (95% CI-24.3-33.6) had culture-confirmed UTI. One hundred and six pathogens were isolated, the majority being Escherichia coli (E. coli), 37 (34.9%), and Staphylococcus aureus (S. aureus), 26 (24.5%). The susceptibility of E. coli to cefepime, piperacillin-tazobactam, nitrofurantoin, and meropenem ranged from 81.1% to 97.3%. S. aureus was most susceptible to nitrofurantoin (96.2%) and ciprofloxacin (92.3%). Multidrug resistance was observed in 33.0% of isolates. The proportion of Methicillin-resistant S. aureus and extended-spectrum beta-lactamases was 23.1% and 25%, respectively. UTI was observed more in patients presenting with vomiting, dysuria, and abdominal pain, patients below 24 months of age, nappy users, and uncircumcised males. CONCLUSION: Our study found a relatively high proportion of UTI among under-five children associated with vomiting, dysuria, abdominal pain, nappy use, and uncircumcision in males. The pathogens were least susceptible to (trimethoprim-sulfamethoxazole, gentamycin, ampicillin, and penicillin) the commonly used antibiotic. We advocate a thorough clinical analysis to detect the predictors of UTI and a periodic review of empirical treatment of UTI based on the antibiotic susceptibility pattern.

Polymicrobial bloodstream infections a risk factor for mortality in neonates at the national hospital, Tanzania: A case-control study.

BACKGROUND: Polymicrobial bloodstream infections (BSI) are difficult to treat since empiric antibiotics treatment are frequently less effective against multiple pathogens. The study aimed to compare outcomes in patients with polymicrobial and monomicrobial BSIs. METHODS: The study was a retrospective case-control design conducted at Muhimbili National Hospital for data processed between July 2021 and June 2022. Cases were patients with polymicrobial BSI, and controls had monomicrobial BSI. Each case was matched to three controls by age, admitting ward, and duration of admission. Logistic regression was performed to determine independent risk factors for in-hospital and 30-day mortality. RESULTS: Fifty patients with polymicrobial BSI and 150 with monomicrobial BSI were compared: the two arms had no significant differences in sex and comorbidities. The most frequent bacteria in polymicrobial BSI were Klebsiella pneumoniae 17% (17/100) and Enterobacter species 15% (15/100). In monomicrobial BSI, S. aureus 17.33% (26/150), Klebsiella pneumoniae 16.67% (25/150), and Acinetobacter species 15% (15/150) were more prevalent. Overall, isolates were frequently resistant to multiple antibiotics tested, and 52% (130/250) were multidrug resistance. The 30-day and in-hospital mortality were 33.5% (67/200) and 36% (72/200), respectively. On multivariable analysis, polymicrobial BSIs were independent risk factors for both in-hospital mortality (aOR 2.37, 95%CI 1.20-4.69, p = 0.01) and 30-day mortality (aOR 2.05, 95%CI 1.03-4.08), p = 0.04). In sub-analyses involving only neonates, polymicrobial BSI was an independent risk factor for both 30-day mortality (aOR 3.13, 95%CI 1.07-9.10, p = 0.04) and in-hospital mortality (aOR 5.08, 95%CI 1.60-16.14, p = 0.006). Overall, the median length of hospital stay post-BSIs was numerically longer in patients with polymicrobial BSIs. CONCLUSION: Overall, polymicrobial BSI was a significant risk for mortality. Patients with polymicrobial BSI stay longer at the hospital than those with monomicrobial BSI. These findings call for clinicians to be more aggressive in managing polymicrobial BSI.

High Seropositivity of Brucella melitensis Antibodies among Pregnant Women Attending Health Care Facilities in Mwanza, Tanzania: A Cross-Sectional Study.

Background: Brucellosis is one of the most prevalent zoonotic neglected tropical diseases across the globe. Brucella melitensis (B. melitensis), the most pathogenic species is responsible for several pregnancy adverse outcomes in both humans and animals. Here, we present the data on the magnitude of B. melitensis antibodies among pregnant women in Mwanza, Tanzania, the information that might be useful in understanding the epidemiology of the disease and devising appropriate control interventions in this region. Methodology. A hospital-based cross-sectional study involving pregnant women was conducted at two antenatal clinics in Mwanza between May and July 2019. The pretested structured questionnaire was used for data collection. Blood samples were collected aseptically from all consenting women followed by the detection of B. melitensis antibodies using slide agglutination test. Descriptive data analysis was done using STATA version 17. Results: A total of 635 pregnant women were enrolled with the median age of 25 (interquartile range (IQR): 16-48) years and median gestation age of 21 (IQR: 3-39) weeks. Seropositivity of B. melitensis antibodies was 103 (16.2 (95% CI:13.3-19.1)). On the multivariate logistic regression analysis, as the gestation age increases, the odds of being seropositive decreases (aOR:0.972 (95% CI: 0.945-0.999), P = 0.045). Furthermore, being a housewife (aOR:3.902 (95% CI:1.589-9.577), P = 0.003), being employed (aOR:3.405 (95% CI:1.412-8.208), P = 0.006), and having history of miscarriage (aOR:1.940 (95% CI:1.043-3.606), P = 0.036) independently predicted B. melitensis seropositivity among pregnant women in Mwanza. Conclusion: High seropositivity of B. melitensis was observed among employed and housewife pregnant women in Mwanza. This calls for the need of more studies in endemic areas that might lead to evidence-based control interventions.

WHO/INRUD prescribing indicators among tertiary regional referral hospitals in Dar es Salaam, Tanzania: a call to strengthen antibiotic stewardship programmes.

Background: Antibiotic prescribing should be guided by national essential medicines lists (NEMLs) and treatment guidelines; however, there are inadequate data on antibiotic utilization patterns in tertiary hospitals in Tanzania. This study aimed to determine antibiotic prescribing patterns in tertiary hospitals in Dar es Salaam, Tanzania. Methods: A retrospective cross-sectional study was conducted in three regional referral hospitals. About 200 prescription records from 2020 to 2022 were analysed at each hospital for prescribing patterns using WHO/ International Network of Rational Use of Drugs (INRUD) indicators (1993) and the AWaRe 2021 classification. Factors associated with receiving an antibiotic prescription were assessed using a logistic regression model. Facilities were ranked on prescribing practices using the index of rational drug prescribing (IRDP). Results: A total of 2239 drugs were prescribed, of which 920 (41.1%) were antibiotics. An average of 3.7 ±â€Š1.5 (optimal: 1.6-1.8) total medicines and 1.53 ±â€Š0.78 antibiotics were prescribed per patient. About 88.0% (528) of the prescriptions contained antibiotics (optimal: 20.0%-26.8%), while 78.2% (413) of all antibiotic prescriptions contained injections (optimal: 13.4%-24.1%). Furthermore, 87.5% (462) of the antibiotics were prescribed in generic names (optimal: 100%), while 98.7% (521) conformed to the NEML (optimal: 100%). Metronidazole was the most frequently prescribed antibiotic (39.2%; n = 134), followed by ceftriaxone (37.1%, n = 127) and amoxicillin/clavulanic acid (8.5%, n = 29). Conclusions: We found substantial empirical prescribing and overuse of antibiotics exceeding WHO recommendations. Antibiotic overuse varied across the hospitals. Being male, having underlying conditions such as diabetes mellitus, and/or being treated at Temeke hospital were associated with receiving an antibiotic prescription. We recommend strengthening antibiotic stewardship programmes in the studied facilities.

Bacterial Aetiology of Neonatal Sepsis and Antimicrobial Resistance Pattern at the Regional Referral Hospital, Dar es Salam, Tanzania; A Call to Strengthening Antibiotic Stewardship Program.

The diagnosis of neonatal sepsis in lower-income countries is mainly based on clinical presentation. The practice necessitates empirical treatment with limited aetiology and antibiotic susceptibility profile knowledge, prompting the emergence and spread of antimicrobial resistance. We conducted a cross-sectional study to determine the aetiology of neonatal sepsis and antimicrobial resistance patterns. We recruited 658 neonates admitted to the neonatal ward with signs and symptoms of sepsis and performed 639 automated blood cultures and antimicrobial susceptibility testing. Around 72% of the samples were culture positive; Gram-positive bacteria were predominantly isolated, contributing to 81%. Coagulase-negative Staphylococci were the most isolates, followed by Streptococcus agalactiae. Overall, antibiotic resistance among Gram-positive pathogens ranged from 23% (Chloramphenicol) to 93% (Penicillin) and from 24.7% (amikacin) to 91% (ampicillin) for Gram-negative bacteria. Moreover, about 69% of Gram-positive and 75% of Gram-negative bacteria were multidrug-resistant (MDR). We observed about 70% overall proportion of MDR strains, non-significantly more in Gram-negative than Gram-positive pathogens (p = 0.334). In conclusion, the pathogen causing neonatal sepsis in our setting exhibited a high resistance rate to commonly used antibiotics. The high rate of MDR pathogens calls for strengthening antibiotic stewardship programs.

Predominance of non-Candida albicans species oral colonisation among patients on anticancer therapy: findings from a cross-sectional study in Tanzania.

OBJECTIVES: This study aimed to determine the oral carriage prevalence of Candida species and identify factors associated with the carriage of Candida species among patients with cancer on treatment. DESIGN: A hospital-based cross-sectional study. SETTING: The study was conducted at a tertiary-level cancer hospital Ocean Road Cancer Institute (ORCI), Dar es Salaam, Tanzania. PARTICIPANTS: We enrolled 196 participants who consented to join the study. Oral swabs were collected from all participants and inoculated onto Sabouraud dextrose agar supplemented with 50 mg/mL gentamicin and 50 mg/mL chloramphenicol, and chromogenic agar for phenotypic identification of Candida species. PRIMARY OUTCOME: The study reported the high prevalence of oral carriage of Candida species among patients with cancer on treatment at the tertiary-level cancer hospital in Dar es Salaam, Tanzania. RESULTS: A total of 196 participants were enrolled in the study. The overall oral carriage of Candida species was 37.8% (74/196). The prevalence was higher among patients undergoing chemotherapy and radiotherapy (44.4%) than those in monotherapy (13.3% chemotherapy, 20% radiotherapy). Candida krusei was the most common isolated species, 48.6% (36/74). Head and neck (adjusted OR (aOR) 15.09, 95% CI 3.05 to 74.59, p=0.00), gastrointestinal (aOR 14.14, 95% CI 2.25 to 88.63, p=0.00) malignancies and diabetes (aOR 3.18, 95% CI 1.03 to 9.77, p=0.04) were factors independently associated with oral carriage of Candida species. CONCLUSION: The oral carriage of Candida species among patients with cancer receiving treatment at ORCI is high, mainly due to C. krusei species. This is alarming since C. krusei has intrinsic resistance to fluconazole, a common antifungal agent used to manage adult fungal infections. Therefore, efforts should be put into conducting regular check-ups for such opportunistic pathogens as they can lead to subsequent infections. Furthermore, studies conducted to determine the antifungal profile of the causative agents are warranted since different causative agents might have different profiles.

Aetiology of ear infection and antimicrobial susceptibility pattern among patients attending otorhinolaryngology clinic at a tertiary hospital in Dar es Salaam, Tanzania: a hospital-based cross-sectional study.

OBJECTIVES: To determine the aetiological pathogens causing ear infections and their antimicrobial susceptibility patterns among patients with ear complaints at a tertiary hospital in Dar es Salaam. DESIGN: Hospital-based cross-sectional study. SETTINGS: Otorhinolaryngology clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania. PARTICIPANTS: Patients presenting with signs and symptoms of ear infection. MAIN OUTCOME MEASURE: Bacteria and fungi isolated from ear swab specimens of patients presenting with signs and symptoms of ear infection; and antimicrobial susceptibility patterns of isolated bacteria. RESULTS: Two hundred and fifty-five participants were enrolled, with a median age of 31 years and an IQR of 15-49. Otitis externa was the predominant type of ear infection, accounting for 45.1%. We observed positive bacteria culture in 53.3% of study participants, in which 41% of isolates were obtained from patients with chronic suppurative otitis media. Moreover, Staphylococcus aureus (27.3%) and Pseudomonas aeruginosa (24.2%) were the most frequently isolated bacteria, while Candida spp, 12 (63.8%) and Aspergillus spp, 9 (36.2%) were the only isolated fungi. Furthermore, we report that 93% of isolated Enterobacterales were resistant to amoxicillin/clavulanic acid, and 73% were resistant to ceftazidime. In addition, we detected 34.4% extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) and 44.4% methicillin-resistance S. aureus (MRSA). We also found that 22% of the bacteria isolates were resistant to ciprofloxacin, a primary topical antibiotic used in managing ear infections. CONCLUSIONS: The findings from this study reveal that the leading aetiological agent of ear infection is bacteria. Furthermore, our findings show a significant proportion of ESBL-PE and MRSA-causing ear infections. Hence, detecting multidrug-resistant bacteria is crucial to improving ear infection management.

Predominance of Multidrug-Resistant Gram-Negative Bacteria on Contaminated Surfaces at a Tertiary Hospital in Tanzania: A Call to Strengthening Environmental Infection Prevention and Control Measures.

The spreading of multidrug resistance (MDR) strains in the hospital settings via contaminated surfaces have been increasingly reported where Gram-negative bacteria have been implicated in causing most nosocomial infections. This study aimed to determine the rate of contamination with multi-resistant gram-negative bacteria in the hospital environment. A cross-sectional study was conducted at Muhimbili National Hospital paediatric department, between July and August 2020. Non-repetitive surface swab samples were collected from predefined surfaces and medical device surfaces, and cultured on MacConkey agar with and without antibiotics. Isolates were identified using biochemical test and tested for antibiotic susceptibility using the Kirby-Bauer disk diffusion method. The rate of hospital contamination with Gram-negative bacteria across the Pediatrics units was 30%, with a high rate observed in oncology units (34.8%) and the malnutrition/diarrhoea ward (32.1%). Sink/washing basin had the highest frequency of bacterial contamination (74.2%). We observed a high rate of ESBL (32.5%), with Acinetobacter baumannii, Klebsiella pneumoniae, and E. coli being the predominant ESBL-producing Gram-negative bacteria, while carbapenemase-producing Gram-negative bacteria was detected at 22.8%. Highest resistance rates (63-100%) were observed against ceftriaxone and trimethoprim-sulfamethoxazole. Up to 51% of the Gram-negative bacteria showed resistant to meropenem. MDR strains were detected in 61.4% of Gram-negative bacteria isolated. In conclusion, we observed a high rate of MDR bacteria contaminating hospital surfaces. The higher rate of MDR calls for a need to strengthen infectious prevention control measures, including cleaning practices in the hospital environment, to reduce the risk of transmission of resistant strains to patients and healthcare workers.

Impaired fasting glucose levels among perinatally HIV-infected adolescents and youths in Dar es Salaam, Tanzania.

Objective: This study assessed impaired fasting glucose and associated factors among perinatally HIV-infected adolescents and youths in Dar es salaam Tanzania. Background: Impaired fasting glucose is a marker of heightened risk for developing type 2 diabetes among perinatally HIV-infected individuals. Therefore, identifying individuals at this stage is crucial to enable early intervention. Therefore, we assessed impaired fasting glucose (IFG) and associated factors among perinatally HIV-infected population in Dar es salaam Tanzania. Methods: A cross-sectional study was conducted among 152 adolescents and youth attending HIV clinic at Muhimbili National Hospital and Infectious Disease Centre from July to August 2020. Fasting blood glucose (>8 hours) was measured using one-touch selects LifeScan, CA, USA. We also examined C-Reactive Protein and interleukin-6 inflammatory biomarkers in relation to impaired fasting glucose (IFG). Associations between categorical variables were explored using Chi-square, and poison regression with robust variance was used to calculate the prevalence ratios. Results: Of the 152 participants, the majority were male (n=83[54.6%]), and the median age was 15(14-18) years. Overweight or obesity was prevalent in 16.4%, while more than one in ten (13.2%) had high blood pressure (≥149/90mmHg). All participants were on antiretroviral therapy (ART); 46% had used medication for over ten years, and about one in three had poor medication adherence. Among the recruited participants, 29% had impaired fasting glucose. The odds of IFG were two times higher in males compared to females (PR, 2.07, 95% CI 1.19 -3.59 p=0.001). Moreover, we found with every increase of Interleukin 6 biomarker there was a 1.01 probability increase of impaired fasting glucose (PR, 1.01, 95% CI 1.00 - 1.02 p=0.003). Conclusion: About one in three perinatally HIV-infected youths had impaired fasting glucose in Dar es Salaam, Tanzania, with males bearing the biggest brunt. Moreover, with every increase of 1.101 of the probability of having IFG increased. This calls for urgent measures to interrupt the progression to diabetes disease and prevent the dual burden of disease for this uniquely challenged population.

Herpes Simplex Virus Type 2 (HSV-2) and Cytomegalovirus (CMV) among Women with Macerated Stillbirth: A Cross-Sectional Hospital-Based Study from Mwanza, Tanzania.

Background: Stillbirth adversely affects pregnancy outcomes in low- and middle-income countries (LMICs). Viral infections have been implicated as one of the causes of stillbirths. Despite high rates of stillbirths and high viral prevalence in LMICs, there is limited information regarding their association. This study investigated the magnitude of herpes simplex 2 virus (HSV-2) and human cytomegalovirus (HCMV) among women with macerated stillbirth. Methods: A cross-sectional hospital-based study was conducted involving 279 women with macerated stillbirth between July and August 2018 at different health facilities in Mwanza, Tanzania. Detection of HSV-2 was done by immunochromatographic test while that of HCMV was done using enzyme-linked immunosorbent assay (ELISA). Descriptive data analysis was done using STATA version 13. Results: A total of 28 (10.04%, 95% CI: 6.8-13.9) tested positive for HSV-2 IgG antibodies with only 4 (1.43%, 95% CL: 0.3-2.8) testing positive for HSV-2 IgM antibodies. HCMV IgG antibodies were detected in 131 (77.98%, 95% CI: 71-84) of 168 women tested. By multivariate logistic regulation analysis, advanced age (OR: 0.93, 95% CI: 0.87-0.99, p = 0.025) was significantly associated with negative HSV-2 IgG antibodies. By log multinomial regression analysis, only urban residence (RRR.4.43: 95% CI 1.53-12.80, p = 0.006) independently predicted HCMV IgG seropositivity among women with stillbirth. Twenty-one (30.9%) of women with positive HCMV IgG antibodies had low avidity index (<40%) indicating recent infection. Conclusion: Significant proportion of women with macerated stillbirth residing in urban and with low age have HCMV and HSV antibodies, respectively. This calls for the need to consider introducing screening of these infections in the Tanzanian antenatal package and further studies to explore the role of these viruses in causing stillbirth in Tanzania.

Colonization of Extended-spectrum ß-lactamase producing Enterobacterales and meticillin-resistant S. aureus in the intensive care unit at a tertiary hospital in Tanzania: Implications for Infection control and prevention.

Background: Multi-drug resistant (MDR) bacteria pose a major global threat to public-health and are of particular concern to hospitalized intensive care unit (ICU) patients. This study aimed at addressing the burden of MDR and the associated factors at admission to ICU. Methods: This was a cross-sectional study conducted at the ICU of a tertiary hospital in Tanzania. Rectal and anterior nares swabs were collected within 48 hours of ICU admission to screen for extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) and meticillin-resistant Staphylococcus aureus (MRSA), respectively. Results: The proportion of fecal carriage for ESBL-PE at admission to ICU was 54.54% (95% CI, 47.52-61.39), and nasal carriage for MRSA was 9.32% (95%CI, 5.67-14.93). The nasal MRSA colonization (OR = 1.52) and fecal carriage for ESBL-PE (OR=1.38) were more likely in participants who had received antibiotics before ICU admission than not, but association was not statistically significant. Hospitalization for ≥2 days (OR=1.18) was associated with fecal carriage of ESBL-PE, though not statistically significant. Overall, 66% and 73.5% of patients received antibiotics before and upon admission to ICU, respectively. Ceftriaxone, metronidazole and meropenem were commonly prescribed antibiotics. More than 84% of Enterobacterales were resistant to ciprofloxacin and trimethoprim-sulfamethoxazole, and 2.90% were resistant to meropenem. MRSA isolates showed a high rate of resistance to gentamicin and erythromycin. Conclusion: MDR bacteria are common in patients admitted to ICU. To reduce the risk associated with MDR, we recommend use of simple screening methods to screen for MDR at ICU admission as part of infection control and prevention.

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.

Genetic relatedness, virulence factors and antibiotics susceptibility pattern of Vibrio cholerae isolates from various regions during cholera outbreak in Tanzania.

BACKGROUND: Cholera continues to cause morbidity and mortality in developing countries, including Tanzania. Since August 2015, Tanzania Mainland has experienced cholera outbreaks affecting 26 regions and a 1.6% case fatality rate. The current study determined the virulence factors, genetic relatedness and antimicrobial susceptibility patterns of the Vibrio cholerae isolated from different regions in Tanzania. METHODS: A cross-sectional study that involved the genetic characterization of V. cholerae isolates from eleven regions in Tanzania was carried out. There were 99 V. cholerae isolates collected between January 2016 and December 2017. The study perfomed a Multi-locus Variable-number tandem-repeat analysis for genetic relatedness and Mismatch Amplification Mutation Analysis polymerase chain reaction for analyzing toxin genes. All the isolates were tested for antimicrobial susceptibility using the Kirby Bauer disk diffusion method. Data were generally analyzed using Microsoft excel, where genetic relatedness was analyzed using eBurst software v3. RESULTS: All isolates were V. cholerae O1. Ogawa was the most predominant 97(98%) serotype. Isolates were genetically related with a small genetic diversity and were positive for ctxA, tcpA El Tor virulence genes. All isolates (100%) were sensitive to doxycycline, trimethoprim-sulphamethoxazole, tetracycline, ceftriaxone, and chloramphenicol, while 87.8% were sensitive to ciprofloxacin. A high resistance rate (100%) was detected towards erythromycin, nalidixic acid, amoxicillin, and ampicillin. CONCLUSION: The V.cholerae O1 serotypes Ogawa, El Tor variant predominantly caused cholera outbreaks in Tanzania with strains clonally related regardless of the place and time of the outbreak. Most of the isolates were susceptible to the antibiotic regimen currently used in Tanzania. The high resistance rate detected for the other common antibiotics calls for continuous antimicrobial susceptibility testing during outbreaks.

Prevalence of Glucose Metabolic Disorders and Associated Inflammatory Markers Among People Living with HIV in Sub-Saharan Africa.

Background: Glucose metabolic disorder (GMD) is closely related to inflammation among those living with HIV. However, there are extant studies regarding this phenomenon in sub-Saharan Africa (SSA) that bears the burden of HIV infection. Therefore, we assessed the associations between inflammation biomarkers and GMD on a cohort of HIV+ individuals in SSA. Methods: We conducted a cross sectional study at the largest (patient volume) HIV clinic in Tanzania from March to May 2018. Purposive sampling was used to identify 407 HIV+ patients on treatment. Data were collected using the World Health Organization (WHO) STEPwise approach for noncommunicable disease surveillance. Clinical and demographic variables were extracted from the medical chart. Fasting blood glucose and inflammatory markers [C-reactive protein (CRP), interleukin (IL)-6, IL-18, and soluble tumor necrosis factor receptor (sTNFR)-1, sTNFR-2] were measured. Bivariate and multivariate analysis was conducted to examine the association between the biomarkers and GMD. Results: GMD was present in 67.6% (n = 271). Among those with GMD, 44.5%, 38.4%, and 17.1% presented with impaired fasting glucose, impaired glucose tolerance, and diabetes mellitus, respectively. Being older (>55 years) and initiating smoking at an age >28 years was associated with GMD (P = 0.05). Engaging in moderate activity significantly reduced the risk of GMD (P = 0.04). Having a current CD4 count between 351 and 500 reduced the odds of GMD by 66.7% in comparison to clients with CD4 counts ≤350. Comparing the highest to the lowest quartile at the multivariate level, only CRP showed an independent significant association with GMD (adjusted odds ratio: 1.9; 95% confidence interval: 1.03-3.57). Despite a linear relationship, none of the other biomarkers showed a significant association with GMD. Conclusion: Our study shows that high CRP and low CD4 are important contributors to the prevalence of GMD. Even when controlling for confounding variables did not diminish the associations between GMD and CRP. These findings point to the importance of creating awareness, education, and screening for GMD in high-epidemic countries. More rigorous studies are needed to identify the manifestation of inflammation in HIV patients.

Seroprevalence and risk factors of Toxoplasmosis among HIV infected women of child-bearing age attending care and treatment clinics in Dar es Salaam, Tanzania.

Background: Toxoplasmosis in HIV-infected women of child-bearing age (HIV-WCB) increases the risk for congenital toxoplasmosis, leading to many complications. However, its magnitude is unknown in this population. Objectives: The study aimed to determine the prevalence and factors associated with toxoplasmosis among HIV-WCB. Methods: This was a cross-sectional study conducted from July to August 2020 among HIV- WCB attending care and treatment clinic (CTC) at Muhimbili National Hospital and Mnazi Mmoja hospital. Questionnaire and TORCH rapid test were used to obtain data and serological testing respectively. Data analysis was done using statistical package for social sciences (SPSS) version 20. Results: Overall, 29.7% of the study participants were positive for anti-T. gondii IgG, whereas none tested positive for IgM. Multivariate analysis showed that the probability of being infected with T. gondii increased by 57.1% for participants who consumed raw vegetables (p=0.005, aOR=0.43, 95%CI = 1.24-8.77). Other common risk factors such as undercooked meat consumption, source of drinking water, and cat ownership at home showed no association. Conclusion: A high number of HIV-WCB have not developed immunity to T. gondii in the study area. Introduction of routine screening during antenatal visits for pregnant women and further epidemiological studies are warranted in the country.

Bacterial vaginosis, the leading cause of genital discharge among women presenting with vaginal infection in Dar es Salaam, Tanzania.

BACKGROUND: Pathological vaginal discharge is a common complaint of women in reproductive age worldwide caused by various agents. The prevalence and etiologic agents vary depending on the population studied. Management of vaginal discharge in low-income countries, typically depend on the syndromic approach, which limits understanding the specific causative agents. We determined the proportion of bacterial vaginosis, candidiasis, and trichomoniasis among women with vaginal discharge at a regional referral hospital in Dar es Salaam, Tanzania. METHODS: We conducted a cross-sectional study between June and August of 2017 among nonpregnant women at Amana Regional Referral Hospital. Experienced staff performed physical examination to establish a clinical diagnosis, and collection of the high vaginal swab for microscopic examination. Descriptive statistics were performed to assess the characteristics of study participants and the proportion of vaginal infections. RESULTS: A total of 196 samples were collected, of all, 128 (65.3%) had either bacterial vaginosis, candidiasis, or trichomoniasis. Bacterial vaginosis was the leading infection at 33.2%, followed by candidiasis (19.4%) and trichomoniasis (13.3%). Laboratory confirmed vaginal infection were generally found more in age below 25, unmarried, and those employed or petty business. CONCLUSION: The proportion of bacterial vaginosis in women with vaginal discharge was relatively higher than others, and the presence of vaginal infection relate to socio-demographic characteristics. Further advanced studies are needed to understand the potential role of aetiologic agents in causing vaginal infections.