Correction: The burden of respiratory conditions in the emergency department of Muhimbili National Hospital in Tanzania in the first two years of the COVID-19 pandemic: A cross sectional descriptive study.

[This corrects the article DOI: 10.1371/journal.pgph.0000781.].

Mobile application adjunct to the WHO basic emergency care course: a mixed methods study.

OBJECTIVES: The WHO developed a 5-day basic emergency care (BEC) course using the traditional lecture format. However, adult learning theory suggests that lecture-based courses alone may not promote long-term knowledge retention. We assessed whether a mobile application adjunct (BEC app) can have positive impact on knowledge acquisition and retention compared with the BEC course alone and evaluated perceptions, acceptability and barriers to adoption of such a tool. DESIGN: Mixed-methods prospective cohort study. PARTICIPANTS: Adult healthcare workers in six health facilities in Tanzania who enrolled in the BEC course and were divided into the control arm (BEC course) or the intervention arm (BEC course plus BEC app). MAIN OUTCOME MEASURES: Changes in knowledge assessment scores, self-efficacy and perceptions of BEC app. RESULTS: 92 enrolees, 46 (50%) in each arm, completed the BEC course. 71 (77%) returned for the 4-month follow-up. Mean test scores were not different between the two arms at any time period. Both arms had significantly improved test scores from enrolment (prior to distribution of materials) to day 1 of the BEC course and from day 1 of BEC course to immediately after BEC course completion. The drop-off in mean scores from immediately after BEC course completion to 4 months after course completion was not significant for either arm. No differences were observed between the two arms for any self-efficacy question at any time point. Focus groups revealed five major themes related to BEC app adoption: educational utility, clinical utility, user experience, barriers to access and barriers to use. CONCLUSION: The BEC app was well received, but no differences in knowledge retention and self-efficacy were observed between the two arms and only a very small number of participants reported using the app. Technologic-based, linguistic-based and content-based barriers likely limited its impact.

The burden of respiratory conditions in the emergency department of Muhimbili National Hospital in Tanzania in the first two years of the COVID-19 pandemic: A cross sectional descriptive study.

Globally, respiratory diseases cause 10 million deaths every year. With the COVID-19 pandemic, the burden of respiratory illness increased and led to significant morbidity and mortality in both high- and low-income countries. This study assessed the burden and trend of respiratory conditions among patients presenting to the emergency department of Muhimbili National Hospital in Tanzania and compared with national COVID-19 data to determine if this knowledge may be useful for the surveillance of disease outbreaks in settings of limited specific diagnostic testing. The study used routinely collected data from the electronic information system in the Emergency Medical Department (EMD) of Muhimbili National Hospital in Tanzania. All patients presenting to the EMD in a 2-year period, 2020 and 2021 with respiratory conditions were included. Descriptive statistics and graphical visualizations were used to describe the burden of respiratory conditions and the trends over time and to compare to national Tanzanian COVID-19 data during the same period. One in every four patients who presented to the EMD of the Muhimbili National Hospital had a respiratory condition- 1039 patients per month. Of the 24,942 patients, 52% were males, and the median age (IQR) was 34.7 (21.7, 53.7) years. The most common respiratory diagnoses were pneumonia (52%), upper respiratory tract infections (31%), asthma (4.8%) and suspected COVID-19 (2.5%). There were four peaks of respiratory conditions coinciding with the four waves in the national COVID-19 data. We conclude that the burden of respiratory conditions among patients presenting to the EMD of Muhimbili National Hospital is high. The trend shows four peaks of respiratory conditions in 2020-2021 seen to coincide with the four waves in the national COVID-19 data. Real-time hospital-based surveillance tools may be useful for early detection of respiratory disease outbreaks and other public health emergencies in settings with limited diagnostic testing.

Reaching further: Lessons from the implementation of the WHO Basic Emergency Care Course Companion App in Tanzania.

INTRODUCTION: The World Health Organization's (WHO's) Basic Emergency Care (BEC) course was developed to address training gaps in low- and middle-income countries (LMICs). Simultaneously, LMICs have experienced an unprecedented increase in the number of cell phone and internet users. We developed a mobile application adjunct to the BEC course (BEC app) and sought to assess the reach of the BEC app. METHODS: Forty-six BEC course participants, made up of doctors and nurses from three hospital sites in Tanzania, were given access to the BEC app with download instructions. Moderators tracked mobile access characteristics and barriers. This is a descriptive study outlining the implementation of the BEC app and associated findings from the process. RESULTS: Fewer than 10% of participants were able to independently download and use the application. The download process revealed three key barrier areas: accessibility (no smartphone, smartphone without charge, no access to data/WiFi to download app, increased cost of data), technical (outdated operating system, inconsistent access to data/WiFi to run the app, insufficient phone storage), and participant-related characteristics (variability in smartphone literary, language discordance, smartphone turnover). Of the 46 participants, 29 (63%) were able to download and use the BEC app successfully with moderator support. CONCLUSIONS: There is potential utility of mobile health in LMICs. However, barriers still exist to reaching the largest possible audience for these initiatives. The importance of app compatibility with a broad range of operating systems and limitation of the amount of data needed to download and use the app was underscored by our study. Moreover, creative solutions are needed to facilitate large-scale roll-outs of mobile health interventions, such as a distribution model that relies on super user and peer support rather than an individual moderator. Additional local perspectives on the download process and the utilisation and acceptance of the application post-implementation are needed.

Novel educational adjuncts for the World Health Organization Basic Emergency Care Course: A prospective cohort study.

INTRODUCTION: The World Health Organization's (WHO) Basic Emergency Care Course (BEC) is a five day, in-person course covering basic assessment and life-saving interventions. We developed two novel adjuncts for the WHO BEC: a suite of clinical cases (BEC-Cases) to simulate patient care and a mobile phone application (BEC-App) for reference. The purpose was to determine whether the use of these educational adjuncts in a flipped classroom approach improves knowledge acquisition and retention among healthcare workers in a low-resource setting. METHODS: We conducted a prospective, cohort study from October 2017 through February 2018 at two district hospitals in the Pwani Region of Tanzania. Descriptive statistics, Fisher's exact t-tests, and Wilcoxon ranked-sum tests were used to examine whether the use of these adjuncts resulted in improved learner knowledge. Participants were enrolled based on location into two arms; Arm 1 received the BEC course and Arm 2 received the BEC-Cases and BEC-App in addition to the BEC course. Both Arms were tested before and after the BEC course, as well as a 7-month follow-up exam. All participants were invited to focus groups on the course and adjuncts. RESULTS: A total of 24 participants were included, 12 (50%) of whom were followed to completion. Mean pre-test scores in Arm 1 (50%) were similar to Arm 2 (53%) (p=0.52). Both arms had improved test scores after the BEC Course Arm 1 (74%) and Arm 2 (87%), (p=0.03). At 7-month follow-up, though with significant participant loss to follow up, Arm 1 had a mean follow-up exam score of 66%, and Arm 2, 74%. DISCUSSION: Implementation of flipped classroom educational adjuncts for the WHO BEC course is feasible and may improve healthcare worker learning in low resource settings. Our focus- group feedback suggest that the course and adjuncts are user friendly and culturally appropriate.

Novel educational adjuncts for the World Health Organization Basic Emergency Care Course: a prospective cohort study

Introduction: The World Health Organization's (WHO) Basic Emergency Care Course (BEC) is a five day, inperson course covering basic assessment and life-saving interventions. We developed two novel adjuncts for the WHO BEC: a suite of clinical cases (BEC-Cases) to simulate patient care and a mobile phone application (BECApp) for reference. The purpose was to determine whether the use of these educational adjuncts in a flipped classroom approach improves knowledge acquisition and retention among healthcare workers in a low-resource setting. Methods: We conducted a prospective, cohort study from October 2017 through February 2018 at two district hospitals in the Pwani Region of Tanzania. Descriptive statistics, Fisher's exact t-tests, and Wilcoxon ranked-sum tests were used to examine whether the use of these adjuncts resulted in improved learner knowledge. Participants were enrolled based on location into two arms; Arm 1 received the BEC course and Arm 2 received the BEC-Cases and BEC-App in addition to the BEC course. Both Arms were tested before and after the BEC course, as well as a 7-month follow-up exam. All participants were invited to focus groups on the course and adjuncts. Results: A total of 24 participants were included, 12 (50%) of whom were followed to completion. Mean pre-test scores in Arm 1 (50%) were similar to Arm 2 (53%) (p=0.52). Both arms had improved test scores after the BEC Course Arm 1 (74%) and Arm 2 (87%), (p=0.03). At 7-month follow-up, though with significant participant loss to follow up, Arm 1 had a mean follow-up exam score of 66%, and Arm 2, 74%. Discussion: Implementation of flipped classroom educational adjuncts for the WHO BEC course is feasible and may improve healthcare worker learning in low resource settings. Our focus- group feedback suggest that the course and adjuncts are user friendly and culturally appropriate

Human immunodeficiency virus infection acquired through a traditional healer's ritual: a case report.

BACKGROUND: Globally, over 36 million people were infected with human immunodeficiency virus by the end of 2015. The Sub-Saharan African region home to less than one-fifth of the global population disproportionately harbors over two-thirds of the total infections and related deaths. Residents of Sub-Saharan Africa continue to face limited access to allopathic medicine and it is estimated that over 80% of primary health care needs in the region are met through traditional healing practices. It is known that some of these practices are performed in groups and the use of unsterilized instruments is common thus potentiating the transmission of human immunodeficiency virus. CASE PRESENTATION: A 29-year-old business woman of African origin residing in rural Tanzania presented at a screening event to confirm her human immunodeficiency virus status. Her past medical history was unremarkable and so were two past pregnancies. As per the antenatal clinic card for the second pregnancy, her human immunodeficiency virus serostatus was negative. She reported that she had been taken to a traditional healer to take an oath of remaining faithful during her husband's absence. The oath involved cutting of the healer's skin followed by hers using the same instrument. Approximately 4 months following this traditional ritual she developed a febrile illness accompanied by enlarged lymph nodes of her neck. She was investigated for malaria, typhoid fever, and urinary tract infection which were negative but she tested positive for human immunodeficiency virus. Owing to her disbelief regarding the human immunodeficiency virus status, she went to three other care and treatment clinics and the results remained similar. She denied any history of transfusion or extramarital affairs. She tested positive at the screening event and enzyme-linked immunosorbent assay for human immunodeficiency virus performed at our institution was reactive. Tenofovir, lamivudine, and efavirenz antiretroviral combination was initiated. CONCLUSIONS: Persistence of cultural norms involving exposure of bodily fluids and use of unsterilized instruments especially in the developing world remains a viable source of human immunodeficiency virus transmission especially in rural areas.

Bilateral ocular ischemia-induced blindness as a presenting manifestation of Takayasu arteritis: a case report.

BACKGROUND: Takayasu arteritis is a granulomatous panarteritis that predominantly affects the aorta and its major branches. The initial manifestations of this large-vessel vasculitis are usually nonspecific; however, as the disease progresses, typical symptoms of arterial occlusion, aneurysmal formation, and vascular pain become evident. Ischemic ocular complications of Takayasu arteritis which could lead to complete loss of vision are not uncommon and depend on the obliterated portion(s) of carotid(s), the intensity and rate of progression of ocular vascular insufficiency, and sufficiency of the collateral blood supply to the eye. CASE PRESENTATION: A 24-year-old woman of African descent with prior normal vision was referred to us with a 3-year history of gradual decline in visual acuity in both eyes and unintentional weight loss (17 kg) within the past 1 year. A physical examination revealed feeble brachial and radial arterial pulses on her left side. She had sinus tachycardia (136 beats/minute) and her blood pressure was 85/59 mmHg on her left and 134/82 mmHg on her right side. Bilateral microaneurysms, dot and blot hemorrhages, and multiple ischemic areas of retina together with neovascularization in her right eye were noted during a funduscopic examination. Computed tomography angiography of her thoracic and abdominal aorta revealed irregular narrowing with variable degrees of stenosis, tapering, and corrugated appearance. CONCLUSIONS: Despite its rarity, Takayasu arteritis significantly impairs a patient's quality of life and has a life-threatening potential. Early initiation of appropriate therapy could delay disease progression and reduce the associated complications.

Cardiorenal Anemia Syndrome and Survival among Heart Failure Patients in Tanzania: A Prospective Cohort Study.

BACKGROUND: Cardiorenal anemia syndrome (CRAS) is an evolving global epidemic associated with increased morbimortality and cost of care. The management of patients with CRAS remains a challenging undertaking worldwide and the lack of evidence-based clinical guidelines adds to the challenge. We aimed to explore the prevalence and survival rates of heart failure patients with CRAS in Tanzania. METHODS: We screened 789 patients and consecutively recruited 463 who met the inclusion criteria. Each participant underwent an interview, physical examination, anthropometric measurements, anemia, renal functions and echocardiographic assessment. All participants were followed until death or for up-to 180 days, whichever came first. Bivariate comparison and subsequent Cox proportional-hazards regression model were used to compare the CRAS and non-CRAS groups with respect to the primary end point. RESULTS: The mean age of participants was 46.4 ± 18.9 years, and 56.5% were women. Overall, 51.9% of participants had renal insufficiency, 72.8% were anemic and 44.4% had CRAS. During a mean follow-up of 103 ± 75 days, 57.8% of participants died. Patients with CRAS displayed a higher mortality rate (73.5%) compared to those free of CRAS (45.8%), (p < 0.001). During multivariate analysis in a cox regression model of 21 potential predictors of mortality; renal dysfunction (HR 1.9; 95% CI 1.0-3.5; p = 0.03), severe anemia (HR 1.8; 95% CI 1.0-3.1; p = 0.04), hyponatremia (HR 2.2; 95% CI 1.3-3.7; p = 0.004) and rehospitalization (HR 4.3; 95% CI 2.2-8.4; p < 0.001) proved to be the strongest factors. CONCLUSION: Cardiorenal anemia syndrome is considerably prevalent and is associated with an increase in mortality amongst patients with heart failure. In view of this, timely, aggressive and collaborative measures to improve renal functions and/or correct anemia are crucial in the management of CRAS patients. Furthermore, these findings call for guideline committees to revise and/or develop evidence-based recommendations for management of patients with CRAS.

Primary mediastinal large B cell lymphoma in a woman who is human immunodeficiency virus positive presenting with superior vena cava syndrome: a case report.

BACKGROUND: The risk of non-Hodgkin lymphoma is increased 200-fold in individuals seropositive for human immunodeficiency virus compared to those free from human immunodeficiency virus. Human immunodeficiency virus-associated non-Hodgkin lymphoma is known for its atypical presentation, aggressive ability, widespread involvement, poor response to chemotherapy, and high relapse potential which makes both the diagnosis and management a difficult undertaking especially in resource-poor settings. CASE PRESENTATION: We report a case of primary mediastinal large B cell lymphoma in a 46-year-old woman of African descent who is human immunodeficiency virus positive who presented with symptoms of superior vena cava syndrome. Her past medical history was remarkable for a 23-year history of systemic hypertension and a 10-year history of human immunodeficiency virus infection. A physical examination revealed an underweight woman with right-sided facial, neck, upper limb, and trunk swelling together with distended veins on her chest and abdomen draining downwards. A respiratory examination revealed a reduced chest expansion, stony dull percussion note, and absent breath sounds on her entire right side with a left-sided tracheal deviation. She had a CD4 count of 146 cells/µL. A chest X-ray revealed a homogenous opacification on her right side with a left-sided tracheal deviation while a computed tomography scan of her chest revealed a solid mass on her right side. An echocardiogram showed a huge well-circumscribed mass (4.6×3.3 cm) with spontaneous echocardiographic contrast compressing her heart inferiorly. She had severe pulmonary hypertension (right ventricular systolic pressure 58 mmHg) but preserved left ventricular systolic function, no thrombus was seen, and her pericardium was normal. A computed tomography angiography of her aorta ruled out an aortic aneurysm. Finally, she underwent mediastinoscopy and a direct biopsy of the mass was taken for histopathology. Hematoxylin and eosin staining demonstrated a dense lymphoid infiltrate of large malignant cells with pleomorphic nuclei in clusters, compartmentalized by fine bands of fibrosis, and frequent mitoses were present. A diagnosis of mediastinal large B cell lymphoma was reached. CONCLUSIONS: The presence of a mediastinal widening coupled with a history of unintentional yet significant weight loss in an individual who is human immunodeficiency virus seropositive should raise an index of suspicion for lymphomas and warrant aggressive investigations and timely management.

Semilobar holoprosencephaly in a 12-month-old baby boy born to a primigravida patient with type 1 diabetes mellitus: a case report.

BACKGROUND: Holoprosencephaly is a rare spectrum of cephalic disorders resulting from a failure or incomplete division of the embryonic forebrain into distinct cerebral hemispheres. It is the most common brain malformation with an incidence of 1:250 during embryogenesis; however, owing to the associated high rates of spontaneous abortion the incidence is 1:16,000 among live deliveries. Pathogenesis of holoprosencephaly is complex and heterogeneous involving genetic abnormalities, teratogenic exposures, and syndromic associations. Among the teratogenic exposures, maternal diabetes is a well-established risk factor associated with a 200-fold increased incidence of holoprosencephaly. CASE PRESENTATION: We report a case of a delayed diagnosis of semilobar holoprosencephaly in a 12-month-old baby boy of African descent who presented to us with a history of global developmental delay, erratic sleep patterns, and poor weight gain. He was born to a type 1 diabetes mellitus mother at 39+ weeks by emergency cesarean section due to fetal distress and breech presentation. The baby weighed 2315 g and had Apgar scores of 6/10 and 8/10 at 1 and 5 minutes respectively. A physical examination done at 12 months of age revealed a small-for-age child with a developmental age of 2 months. He had normal facies but a neurological examination revealed hypotonia in all four limbs. The rest of systemic examination was unremarkable. Hematological and biochemical investigations revealed normal findings except for iron deficiency anemia. The child also underwent magnetic resonance imaging of his brain which revealed distinctive features of semilobar holoprosencephaly. He was treated for iron deficiency anemia with Hemovit syrup (ferric ammonium citrate, folic acid, pyridoxine hydrochloride, cyanocobalamin, and zinc sulfate) 10 ml thrice daily, ferrous sulfate 10 mg once daily, folic acid 1 mg once daily, and multivitamin syrup 5 ml once daily. Furthermore, nutritional and genetic counseling was offered to his parents. CONCLUSIONS: In conclusion, although rare, holoprosencephaly is the commonest structural anomaly of the brain with a complex and multifactorial etiopathogenesis. It is prudent to diagnose it prenatally, classify its severity, and forge its prognosis so that parents are counseled early enough to make informed decisions especially where termination of pregnancy may be implicated.

Disseminated tungiasis in a 78-year-old woman from Tanzania: a case report.

BACKGROUND: Tungiasis is one of the neglected tropical diseases; it affects up to 40% of individuals living in societies with poor housing and sanitation standards. In endemic areas, Tunga infestation, which predominantly affects the periungual areas of the lower limbs in humans, is associated with considerable morbidity and poor quality of life. CASE PRESENTATION: A 78-year-old woman of African descent presented with pain, inflammation, suppuration, ulceration, and deformation of digits of all four limbs. She had a total of 1146 embedded sand fleas: 812 in lower limbs and 334 in her hands. She was febrile; her full blood count revealed pancytopenia and blood cultures were positive for Staphylococcus aureus and Streptococcus pyogenes isolates. Furthermore, she had severe hyponatremia. We applied 20% salicylated petroleum jelly followed by the manual removal of embedded sand fleas with a sterile needle. Intravenously administered piperacillin-tazobactam, topical ivermectin, ferrous sulfate, folic acid, tolvaptan, albendazole, multivitamins, and tetanus prophylaxis were instituted. She was discharged home after 16 days of hospitalization. CONCLUSIONS: Tungiasis is a neglected disease of concern in underprivileged societies that is preventable and curable. Early recognition and prompt treatment is crucial to prevent complications in this disease which may potentially mimic other conditions resulting in erroneous management.

A community-based study on prevalence and correlates of erectile dysfunction among Kinondoni District Residents, Dar Es Salaam, Tanzania.

BACKGROUND: Globally, erectile dysfunction burden (ED) is rising appreciably and it is projected to affect about 332 million men by the year 2025. This rise is attributable to the rising incidence of conditions associated with ED including obesity, diabetes, hypertension, coronary artery disease and depression. We conducted this community-based screening to elucidate on the prevalence of ED and its associated factors among men residing in an urban community in Tanzania. METHODS: We conducted a cross-sectional community-based study and interviewed 441 men aged at least 18 years. Diabetes and hypertension were defined as per the International Diabetes Federation (IDF) and the 7th Report of the Joint National Committee (JNC 7) respectively. The 5-item version of the International Index of Erectile Function (IIEF-5) Scale was used to assess for erectile dysfunction. Multivariate logistic regression analyses were performed to explore the factors associated with ED. RESULTS: The mean age was 47.1 years, 57.6 % had excess body weight, 8.2 % had diabetes and 61.5 % had high blood pressure. Overall, 24 % (106/441) of men in this study had some form of ED. Participants with age ≥55, positive smoking history, obesity, diabetes and hypertension displayed highest rates of ED in their respective subgroups. However, age ≥40 and diabetes were ultimately the strongest factors for ED after multivariate logistic regression analyses, (OR 5.0, 95 % CI 2.2-11.2, p < 0.001 and OR 5.3, 95 % CI 2.2-12.7, p < 0.001 respectively). CONCLUSION: Erectile dysfunction affects about a quarter of adult men living in Kinondoni district. Old age, obesity, smoking, hypertension and diabetes have the potential to increase the odds of ED up-to 5 times. In view of this, men with diabetes and hypertension should be offered screening services and treatment of ED as an integral component in their management.

Bilateral anomalous drainage of the posterior divisions of renal veins into the azygos venous system in a 20-year-old woman: a case report.

BACKGROUND: Renal vein anomalies are relatively infrequent and generally asymptomatic. Preoperative knowledge of such variants is, however, of paramount importance in several angiographic and surgical procedures including renal venography, renal vein sampling, spermatic embolization, and renal transplantation. Inadequate knowledge and failure to recognize such anatomic variations may lead to several operative hazards including hemorrhage, nephrectomy, and even death. CASE PRESENTATION: We report a case of bilateral anomalous drainage of the posterior divisions of renal veins into the azygos venous system in a 20-year-old woman of African descent from Tanzania who presented to us with a 12-year history of recurrent anemia. She had anemia, a positive sickling test, and hemoglobin electrophoresis revealed a sickle cell trait (AS). She underwent computed tomography angiography of her chest and abdomen to rule out the presence of arteriovenous malformations. Aortography findings were normal but venography results revealed features of tortuously dilated azygos and hemiazygos veins each receiving blood from its respective posterior division of renal vein. CONCLUSIONS: Although venous anomalies are relatively infrequent and generally lack a clinical significance, a thorough understanding of embryologic development and its associated errors is of immense importance in equipping angiographers and surgeons to select appropriate interventional/operative techniques, anticipate risks, and prevent intervention-related complications.

Isolated congenital complete heart block in a five-year-old seronegative girl born to a woman seropositive for human immunodeficiency virus: a case report.

BACKGROUND: Congenital complete heart block is a life-threatening condition which is highly associated with autoimmune and connective tissue disorders. Presence of maternal autoantibodies for associated conditions increases the risk of delivering a child with congenital complete heart block, however, less than a half of all women with such antibodies are symptomatic even after delivery. Mortality rate is highest during the neonatal period (45 %) and about two-thirds of all cases will require permanent pacing at some point in their lives. CASE PRESENTATION: We report a case of isolated complete heart block in a 5-year-old HIV-free girl of African descent born to an HIV-infected woman with no prior history of autoimmune disorders. She was referred to us with chief complaints of recurrent syncopal attacks and effort intolerance since birth. A physical examination was unremarkable except for her being small for her age (body mass index 16.3 kg/m2) and bradycardia. Her vital signs were within acceptable range with the exception of her pulse rate, which ranged between 22 and 34 beats/minute. An echocardiogram revealed a sinus bradycardia, otherwise a structurally normal heart. An electrocardiogram showed atrioventricular dissociation in keeping with third-degree atrioventricular block. The child underwent a permanent epicardial pacemaker insertion and has been symptom-free following pacing. CONCLUSIONS: Despite its infrequency and life-threatening potential, patients with congenital complete heart block have an excellent survival rate with timely diagnosis and intervention. An incidental detection of bradycardia in a fetus during routine obstetrical ultrasound examination should increase the index of suspicion for congenital complete heart block and warrant a screening for associated maternal autoantibodies.

Spontaneous Subdural Empyema Following a High-Parasitemia Falciparum Infection in a 58-Year-Old Female From a Malaria-Endemic Region: A Case Report.

Malaria remains a significant public health problem of the tropical world. Falciparum malaria is most prevalent in the sub-Saharan African region, which harbors about 90% of all malaria cases and fatalities globally. Infection by the falciparum species often manifests with a spectrum of multi-organ complications (eg, cerebral malaria), some of which are life-threatening. Spontaneous subdural empyema is a very rare complication of cerebral malaria that portends a very poor prognosis unless diagnosed and treated promptly. We report a case of spontaneous subdural empyema in a 58-year-old woman from Tanzania who presented with high-grade fever, decreased urine output, and altered sensorium.

Anomalous Origin of the Right Pulmonary Artery From the Ascending Aorta in a 10-Month-Old Child: A Case Report From Tanzania.

Anomalous origin of the right pulmonary artery from the ascending aorta is a rare congenital deformity associated with poor quality of life and reduced life expectancy. Without a corrective surgery, less than one third of cases will live to see their sixth month. We report a case of a 10-month-old male child from Tanzania who presented with a 6-month history of recurrent respiratory tract infections, mild effort intolerance, and failure to thrive.