Presentation and challenges in management of COVID-19 in sickle cell disease: case report.

Sickle cell has predominantly been a disease in the sub-Saharan Africa. There is scanty data in Africa and none in Tanzania regarding patients with sickle cell disease infected with COVID-19 especially in the paediatric group. This is concerning because a large population of children living with sickle cell disease are found in this part of the world where scarcity of resources also prevail. This is the first paediatric case of sickle cell disease and COVID-19 reported in Tanzania; highlighting the presentation and challenges faced in management. It is also the first case in literature describing secondary infection in a child with COVID-19 and underlying sickle cell disease. Our patient was a female child of African origin with underlying sickle cell disease who had recurrent admissions. She presented with cough, fever, chest and abdominal pain and was managed for acute chest syndrome and vaso-occlusive crisis. During the second admission, she developed respiratory distress, infection with COVID-19 was confirmed and managed accordingly. However, she was re-admitted due to bilateral arm pain and physical findings were suggestive of secondary respiratory bacterial infection. She was then started on a different treatment plan. Despite challenges faced in the management of the patient, the outcome was favourable. It is important to recognize the presentation of COVID-19 in children with sickle cell disease and challenges faced in management so that the epidemiologic characteristics, spectrum of the disease and its outcomes can be understood better in the context of sub-Saharan Africa.

SARS-CoV-2 precipitating a stroke in a child? A case report from Tanzania.

There is scanty data on overall pediatric presentations with COVID-19 in sub-Saharan Africa and none reported related to stroke. Management of acute stroke in children has been challenging due to delays in presentation and difficulties in deducing the exact etiology. This is the first such case of a stroke in a child with COVID-19 infection reported in Tanzania to the best of our knowledge. A six-and-a-half-year-old male child of Asian origin with no history of chronic illness presented to our facility with fever, rash, gastrointestinal symptoms and conjunctivitis. Subsequently, he developed headache, irritability, altered mentation, loss of speech, facial nerve palsy and hemiparesis. He was provisionally diagnosed with bacterial meningitis with a differential diagnosis of viral encephalitis and received standard treatment for the same. On further investigations, magnetic resonance imaging (MRI) of the brain showed ischemic infarct along the territory of left middle cerebral artery and given the history of the child´s exposure to a relative with COVID-19 infection, child underwent a nasopharyngeal swab for polymerase chain reaction testing which was negative but the serum IgG for COVID was positive. Despite the severe presentation initially, early detection and appropriate management resulted in survival, regained speech and motor function. Due to constraints in health care systems in sub-Saharan Africa, it is difficult to exhaust the diagnostics in order to narrow down the list of differentials in a child with stroke. This case is reported to further describe the diverse presentations of COVID-19 particularly in children which has been under-represented especially in sub-Saharan Africa. Attending physicians should have a high index of suspicion for SARS-CoV-2 as the etiology for exposed children presenting with neurological symptoms.

Residency training on the frontlines of the COVID-19 pandemic - a qualitative study from Tanzania.

INTRODUCTION: the Coronavirus Disease 2019 pandemic has affected residency training globally. The aim of this study was to understand how the pandemic affected teaching and learning in residency programs in low resource settings where residents and faculty were working on the front line treating patients with the disease. METHODS: this qualitative study enrolled residents and faculty from the Aga Khan University in Tanzania who were providing front line care during the pandemic. Purposeful sampling was used and data was collected using focus group discussions and in-depth interviews between August and September 2020. Analysis was done using qualitative content analysis. RESULTS: twelve residents and six faculty members participated in this study. Two main themes emerged. The first was: "New and unfamiliar teaching and learning experiences." Residents and faculty had to adapt to changes in the learning environment and the academic program. Residents had increased responsibilities, including providing front line care and working with reduced supervision. The second theme was: "Learning opportunities amidst crisis." There were opportunities to improve critical care and procedural skills. They also had opportunities to improve non-technical skills like teamwork and communication. CONCLUSION: residents and faculty had to adapt to changes in teaching and learning. Residents also had to take up additional responsibilities. Support systems are required to help them adapt to the changes and settle in their new roles. There were opportunities to learn new skills, and training should be restructured to maximize the use of these opportunities.

Vitamin D Levels in Malnourished Children under 5 Years in a Tertiary Care Center at Muhimbili National Hospital, Dar es Salaam, Tanzania-A Cross-sectional Study.

Objective: : To evaluate vitamin D levels/deficiency among malnourished children <5 years admitted at a tertiary care center, the Muhimbili National Hospital, Dar es Salaam, Tanzania. Children with malnutrition may have co-existing vitamin D deficiency (VDD), which may be severe. Methods: : Serum vitamin D and alkaline phosphatase were evaluated, and X-ray of the wrist was carried out on 134 children. Results: : VDD was found in 41 of 134 children (30.6%). The mean vitamin D level was 74.8 nmol/l. The mean alkaline phosphatase level was 176.6 U/l. Sixty-four (48%) children were found to have severe stunting, of whom 20 (31.2%) were vitamin D deficient. Marasmic children had higher odds of VDD compared with other forms of malnutrition. Conclusion: : The high prevalence of VDD in malnourished children underlines the need for active surveillance and aggressive management.