Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study.

BACKGROUND: Despite recent advances in management and preventive strategies, high rates of first line antibiotics treatment failure and case fatality for Severe Community Acquired Pneumonia (SCAP) continue to occur in children in low and middle-income countries. This study aimed to identify the predictors and outcome of first line antibiotics treatment failure among children under-five years of age with SCAP admitted at Bugando Medical Centre (BMC) in Mwanza, Tanzania. METHODS: The study involved under-five children admitted with SCAP, treated with first line antibiotics as recommended by WHO. Patients with treatment failure at 48 hours were shifted to second line of antibiotics treatment and followed up for 7 days. Generalized linear model was used to determine predictors of first line antibiotics treatment failure for SCAP. RESULTS: A total of 250 children with SCAP with a median age of 18 [IQR 9-36] months were enrolled, 8.4% had HIV infection and 28% had acute malnutrition. The percentage of first line antibiotics treatment failure for the children with SCAP was 50.4%. Predictors of first line treatment failure were; presentation with convulsion (RR 1.55; 95% CI [1.11-2.16]; p-value 0.009), central cyanosis (RR 1.55; 95% CI [1.16-2.07]; p-value 0.003), low oxygen saturation (RR 1.28; 95% CI [1.01-1.62]; p-value 0.04), abnormal chest X-ray (RR 1.71; 95% CI [1.28-2.29]; p-value <0.001), HIV infection (RR 1.80; 95% CI [1.42-2.27]; p-value 0.001), moderate acute malnutrition (RR 1.48; 95% CI [1.04-2.12]; p-value = 0.030) and severe acute malnutrition (RR 2.02; 95% CI [1.56-2.61]; p-value<0.001). Mortality in children who failed first line treatment was 4.8%. CONCLUSION: Half of the children with SCAP at this tertiary center had first line antibiotics treatment failure. HIV infection, acute malnutrition, low oxygen saturation, convulsions, central cyanosis, and abnormal chest X-ray were independently predictive of first line treatment failure. We recommend consideration of second line treatment and clinical trials for patients with SCAP to reduce associated morbidity and mortality.

Triple assessment as a preoperative diagnostic tool for breast cancer at Bugando Medical Centre in northwestern Tanzania.

The triple assessment in the pre-operative evaluation of breast cancer has been practiced in some hospitals in Tanzania. However, its validity and reliability has not been evaluated in any hospital in the country including the study area. This cross-sectional study was conducted at Bugando Medical Centre in northwestern Tanzania to determine the validity, reliability and applicability of triple assessment as an alternative to conventional open biopsy in the pre-operative diagnosis of breast cancer. A total of 212 female patients aged 35 years and above were studied. All patients underwent clinical evaluation, mammography and fine needle aspiration cytology. Histopathology was done to confirm the diagnosis. One hundred and twenty (56.6%) patients with a median age of 36 years had benign lesions and the remaining ninety-two (43.4%) with a median age of 47 years had breast cancer (P = 0.002). With triple assessment, 92 patients were diagnostic for malignancy and 120 benign, respectively confirmed by histopathology. The Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Accuracy were 100.0%. There were no false positive or false negative results. The Kappa statistic for the combination was 1.0 implying excellent agreement with histopathology. The majority of patients (59.9%) underwent triple assessment on the same day with results being available to the patient within 24 to 72 hours. The triple assessment is an accurate and quick method for the evaluation of breast cancer and can be applied as a safe alternative for open biopsy when it is concordant.