Performance Evaluation of Rapid Test for Schistosoma Mansoni among School Aged Children in Mwanga District Council, Kilimanjaro Tanzania.

Background: Schistosomiasis is an acute and chronic tropical disease caused by trematodes of the genus Schistosoma. It is a disease of public health concern and mostly affects developing countries of the tropics. According to WHO burden of the disease is as high as 80-85%, principally in sub-Saharan Africa. Although the majority of the infection is often linked with morbidity, it also results in considerable death. The overall annual mortality rate might exceed 200,000 people in Africa due to different complications of urinary and intestinal Schistosomiasis. Children are at a greater risk of acquiring the infection as well as reinfection, and this might cause growth retardation, anemia and low school performance. Objective: The study aimed at determining the prevalence of Schistosoma mansoni, associated factors and evaluating the performance of Point of Care Circulating Cathodic Antigen comparison (POC-CCA) against a routine method (formal Ether) of detection methods among school aged children at Mwanga District Council, Kilimanjaro Tanzania. Methodology: This was a cross sectional study conducted from April - June 2019 in Mwanga District Council. A minimum of 288 primary school children in Mwanga District were enrolled. Random sampling technique was used to select the participants. Interviews were conducted with study participants followed by single stool and urine sample collection. formal-ether concentration technique, urine dipstick and Point of Care Circulating Cathodic Antigen (POC-CCA) were used for stool and urine analysis. Data were entered and cleaned by using SPSS Version 20. Descriptive statistics were summarised using frequency and proportion for categorical variables and mean and standard dispersion for continuous variables. Logistic regression was used to identify independent factors associated with schistosomiasis. Any association with P value <.05 was considered significant. Results: A total of 288 participants were enrolled. The mean age of participants was 9.8 (±2.4) years. The prevalence of Schistosoma mansoni among the 288 students was 7.3% by formal ether method and 80.4% by POC-CCA. Social demographic characteristics, and hygiene practice assessed were not associated with Schistosoma mansoni in this study. Water source was statistically significantly associated with the prevalence of Schistosoma mansoni. Conclusion: The prevalence of Schistosoma mansoni among school aged children is low by using formal-ether concentration technique (routine method). The annual projects of deworming might have helped decrease the endemicity of the infection. This is due to regular deworming project as recommended by WHO. Despite various efforts which are done to deworm, school aged children are still at risk of acquiring infection, due to poor hygienic practice especially from water sources.

Prevalence and patterns of HIV drug resistance in patients with suspected virological failure in North-Western Tanzania.

BACKGROUND: More than 15 million people in sub-Saharan Africa receive ART. Treatment failure is common, but the role of HIV drug resistance in treatment failure is largely unknown because drug resistance testing is not routinely done. This study determined the prevalence and patterns of HIV drug resistance in patients with suspected virological failure. MATERIALS AND METHODS: A single high viral load of >1000 viral RNA copies/mL of plasma at any point during ART was considered as suspected virological failure. HIV-1 RNA was extracted from plasma samples of these patients using the QIAamp Viral RNA kit. The protease and part of the RT regions of the HIV pol gene were characterized. RESULTS: Viral load was determined in 317 patients; 64 (20.2%) had suspected virological failure. We successfully genotyped 56 samples; 48 (85.7%) had at least one major resistance-associated mutation (RAM). Common mutations in RT were M184V (75%), T215Y (41.1%), K103N (39.3%), M41L (32.1%), D67DN (30.3%), G190A (28.6%) and A98G (26.8%). No RAMs were detected in ART regimens based on a ritonavir-boosted PI. CONCLUSIONS: The Tanzanian national guidelines define 'virological failure' as two consecutive viral load measurement results, at 3 month intervals, above the WHO threshold (1000 copies/mL). Here, we show that a single viral load above the WHO threshold is associated with high rates of RAMs. This suggests that a single high viral load measurement could be used to predict virological failure and avoid delays in switching patients from first-line to higher genetic barrier second-line regimens.

Perioperative serum albumin as a predictor of adverse outcomes in abdominal surgery: prospective cohort hospital based study in Northern Tanzania.

BACKGROUND: Albumin is an important protein that transports hormones, fatty acids, and exogenous drugs; it also maintains plasma oncotic pressure. Albumin is considered a negative active phase protein because it decreases during injuries and sepsis. In spite of other factors predicting surgical outcomes, the effect of pre and postoperative serum albumin to surgical complications can be assessed by calculating the percentage decrease in albumin (delta albumin). This study aimed to explore perioperative serum albumin as a predictor of adverse outcomes in major abdominal surgeries. METHODS: All eligible adult participants from Kilimanjaro Christian Medical Centre Surgical Department were enrolled in a convenient manner. Data were collected using a study questionnaire. Full Blood Count (FBP), serum albumin levels preoperatively and on postoperative day 1 were measured in accordance with Laboratory Standard Operating Procedures (SOP). Data was entered and analyzed using STATA version 14. Association and extent of decrease in albumin levels as a predictor of surgical site infection (SSI), delayed wound healing and death within 30 days of surgery was determined using ordinal logistic regression models. In determining the diagnostic accuracy, a Non-parametric Receiver Operating Curve (ROC) model was used. We adjusted for ASA classification, which had a negative confounding effect on the predictive power of the percent drop in albumin to adverse outcomes. RESULTS: Sixty one participants were studied; the mean age was 51.6 (SD16.3), the majorities were males 40 (65.6%) and post-operative adverse outcomes were experienced by 28 (45.9%) participants. In preoperative serum albumin values, 40 (67.8%) had lower than 3.4 g/l while 51 (91%) had postoperative albumin values lower than 3.4 g/l. Only 15 (27.3%) had high delta albumin with the median percentage value of 14.77%. Delta albumin was an independent significant factor associated with adverse outcome (OR: 6.68; 95% CI: 1.59, 28.09); with a good predictive power and area under ROC curve (AUC) of 0.72 (95% CI 0.55 0.89). The best cutoff value was 11.61% with a sensitivity of 76.92% and specificity of 51.72%. CONCLUSION: Early perioperative decreases in serum albumin levels may be a good, simple and cost effective tool to predict adverse outcomes in major abdominal surgeries.