Nurses' knowledge, perceived challenges, and recommended solutions regarding premature infant care: A mixed method study in the referral and tertiary hospitals in Dar es salaam, Tanzania.

BACKGROUND: There has been an increase in preterm birth of about 2% in a span of 14 years (2000-2014) mainly from Asia and Sub-Saharan Africa. Nursing care is very crucial and a lack of knowledge of health care providers is a contributing factor to morbidity and mortality. With the increasing number and investment of preterm infants towards attaining sustainable development goals (SDG) 3.2, nurses' knowledge adequacy, challenges and solutions on their care needs to be affirmed. METHODS: A mixed method study was conducted between September 2020 to January 2021 in the neonatal units of four hospitals in Dar es Salaam. Self-administered structured questionnaire was used to assess adequacy of knowledge set at 50% or more for the three main domains 1) Essential newborn Care 2) Infection prevention and management 3) Special care and monitoring. A phenomenological design using a structured interview guide focused on challenges and recommended solutions in acquiring on-the- job training on the care of preterm infants. Quantitative data were analyzed using SPSS version 23 and qualitative data were thematically categorized. RESULTS: Out of 52 of nurses who participated and providing care to preterm infants; 48.1% came from a tertiary hospital, (84.6%) were females, only 28.8% aged more than 40 years and 23.1% had less than one year of experience. Overall, 55.8% of the nurses had never received on job training. Adequate knowledge among nurses was 94% on essential newborn care, 80.8% on infection prevention and management and 36.5% on special care and monitoring of preterm infants. Generally, immediate actions of helping baby breath (HBB) and cord care scored poorest. Components on special care and monitoring which had lowest scores included blood glucose monitoring, temperature monitoring and acceptable daily weight gain. Being more than 41 years old, a female nurse and working in the neonatal unit for at least 1-3 years were more likely to determine adequacy of knowledge on infection prevention and management. Lack of schedule and ways to identify those who require training were among the challenges mentioned in the focus group discussion. CONCLUSION: The findings demonstrate an urgent need of instilling knowledge, skills and competences among nurses providing preterm care in our hospitals. Most nurses had not attended training on the care of premature infant. Special care and monitoring were most poorly performed. The recommended solutions included continuous medical education (CME) for all nurses through hospital and government commitment and encourage mentorship within and between hospitals. Nurses who are female, older than 41 years and those with 1 to 3 years of experience should be considered when planning for CME and mentorship program on infection prevention and management.

Prevalence of iron deficiency and iron deficiency anaemia among children with congenital heart defects at tertiary hospitals in Dar es Salaam, Tanzania: a cross-sectional study.

Introduction: iron deficiency (ID) is the most prevalent nutritional problem worldwide with children being the most vulnerable. In children with congenital heart defect (CHD), ID may lead to iron deficiency anaemia (IDA) which carries a poor prognosis due to exacerbation of left ventricular dysfunction and heart failure. This study assessed the prevalence and factors associated with ID and IDA among children with CHD at Muhimbili National Hospital (MNH) and Jakaya Kikwete Cardiac Institute (JKCI) in Tanzania. Methods: a descriptive hospital-based cross-sectional study was conducted among 238 participants with echocardiography confirmed CHD presenting at MNH and JKCI. A structured questionnaire was used to collect demographic data and medical history. Anthropometric measurements were done and blood samples for evaluation of complete blood count, serum ferritin and C-reactive protein were collected. Descriptive statistics such as frequencies, percentages, median with interquartile range, were used to describe study participants. Comparison of continuous variables was performed using Student's t-test or Mann-Whitney U-test as appropriate and Chi-square (x2) test or Fisher's exact test for categorical variables to determine associations. Odds ratio (OR) with 95% confidence intervals (CI) were estimated to determine risk factors for iron deficiency and iron deficiency anaemia. All analyses were conducted using SPSS version 20 and p-value ≤0.05 was considered statistically significant. Results: characteristic of study participant majority 66.4% (n 158) were less than 60 month of age with nearly equal number of male 51.3%(122) to female 48.7% (n 116). The overall prevalence of anaemia among study participants was 47.5% (n 238) with mild, moderate and severe anaemia being 21.4%, 21.4% and 4.6% respectively. The prevalence of iron deficiency was 26.9% (n 64) and that of iron deficiency anaemia was 20.2% (n 48). Age below 5 years, cyanotic CHD, history of recent illness and less consumption of red meat were significantly associated with iron deficiency (ID) and iron deficiency anaemia (IDA). After controlling for independent variables, history of recent illness aOR 0.46, 95% CI 0.22-0.98 P 0.045 less frequent consumption of red meat aOR 0.11 95% CI 0.04-0.32 P <0.001 and cyanotic CHD aOR: 0.40, 95% CI 0.18-0.87; p 0.021, were associated with of iron deficiency similarly age below 5 years aOR 0.33 0, 95% CI 14-0.89 P 0.02 early weaning practices aOR 0.50 95% CI 0.23-0.97 P 0.050 less frequent consumption of red meat aOR 0.07 CI (0.02-0.24 p <0.01 were significantly associated with iron deficiency anaemia. Conclusion: nearly half of the children with CHD in this study had anaemia, more than a quarter had ID and one-fifth had IDA. Routine screening and management of both ID and IDA in children with CHD should be practised during weaning and throughout the childhood to prevent ventricular dysfunction further heart failure.

Transcranial Doppler and Magnetic Resonance in Tanzanian Children With Sickle Cell Disease.

Background and Purpose- We determined prevalences of neurological complications, vascular abnormality, and infarction in Tanzanian children with sickle cell disease. Methods- Children with sickle cell disease were consecutively enrolled for transcranial Doppler; those with slightly elevated (>150 cm/s), low (<50 cm/s) or absent cerebral blood flow velocity (CBFv) were invited for brain magnetic resonance imaging and magnetic resonance angiography. Results- Of 200 children (median age 9; range 6-13 years; 105 [2.5%] boys), 21 (11%) and 15 (8%) had previous seizures and unilateral weakness, respectively. Twenty-eight (14%) had elevated and 39 (20%) had low/absent CBFv, all associated with lower hemoglobin level, but not higher indirect bilirubin level. On multivariable analysis, CBFv>150 cm/s was associated with frequent painful crises and low hemoglobin level. Absent/low CBFv was associated with low hemoglobin level and history of unilateral weakness. In 49 out of 67 children with low/absent/elevated transcranial Doppler undergoing magnetic resonance imaging, 43% had infarction, whereas 24 out of 48 (50%) magnetic resonance angiographies were abnormal. One had hemorrhagic infarction; none had microbleeds. Posterior circulation infarcts occurred in 14%. Of 11 children with previous seizure undergoing magnetic resonance imaging, 10 (91%) had infarction (5 silent) compared with 11 out of 38 (29%) of the remainder ( P=0.003). Of 7 children with clinical stroke, 2 had recurrent stroke and 3 died; 4 out of 5 had absent CBFv. Of 193 without stroke, 1 died and 1 had a stroke; both had absent CBFv. Conclusions- In one-third of Tanzanian children with sickle cell disease, CBFv is outside the normal range, associated with frequent painful crises and low hemoglobin level, but not hemolysis. Half have abnormal magnetic resonance angiography. African children with sickle cell disease should be evaluated with transcranial Doppler; those with low/absent/elevated CBFv should undergo magnetic resonance imaging/magnetic resonance angiography.

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.

Seroprevalence of hepatitis B and C viral co-infections among children infected with human immunodeficiency virus attending the paediatric HIV care and treatment center at Muhimbili National Hospital in Dar-es-Salaam, Tanzania.

BACKGROUND: With increased availability of antibiotics and antifungal agents hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are becoming a cause for significant concern in HIV infected children. We determined the seroprevalence and risk factors for HBV and HCV among HIV infected children aged 18 months to 17 years, attending the Paediatric HIV Care and Treatment Center (CTC) at Muhimbili National Hospital (MNH) in Dar-es-Salaam, Tanzania. METHODS: Investigations included; interviews, physical examination and serology for HBsAg, IgG antibodies to HCV and alanine aminotransferase (ALT) levels. HIV serostatus and CD4 counts were obtained from patient records. RESULTS: 167 HIV infected children, 88(52.7%) males and 79(47.3%) females were enrolled. The overall prevalence of hepatitis co-infection was 15%, with the seroprevalence of HBV and HCV being 1.2% and 13.8%, respectively. Hepatitis virus co-infection was not associated with any of the investigated risk factors and there was no association between HBV and HCV. Elevated ALT was associated with hepatitis viral co-infection but not with ART usage or immune status. CONCLUSION: The high seroprevalence (15%) of hepatitis co-infection in HIV infected children attending the Paediatrics HIV CTC at the MNH calls for routine screening of hepatitis viral co-infection and modification in the management of HIV infected children.