Hypertension in people living with HIV on combined antiretroviral therapy in rural Tanzania.

Exposure to anti-retroviral therapy in HIV infection has been associated with hypertension, but whether and to what extent HIV-related factors and anti-retroviral treatment contribute to hypertension is not well defined; in addition, data are particularly scarce in Sub-Saharan Africa. Aim of the study was to investigate prevalence and awareness of hypertension in a cohort of people living with HIV (PLWHIV) on anti-retroviral therapy in rural Tanzania, and to identify possible predictors of hypertension. A cross-sectional study on hypertension in PLWHIV was conducted at Tosamaganga District Hospital, Iringa Region, Tanzania. Subjects on anti-retroviral therapy, age 26-80 years and with monthly attendance to the HIV clinic, were considered eligible. A total number of 242 patients were included in the analysis. Sixty-two subjects (26%) had hypertension, the majority (77%) of them not aware of the condition and/or not on treatment. Older age, higher BMI and lower baseline T-CD4 count were predictors of hypertension at multivariate analysis. The results of the study suggest that hypertension screening should become part of ordinary care of PLWHIV in Tanzania, particularly in subjects with more severe immunosuppression. Leveraging already existing HIV services could be an option to prevent the burden of non-AIDS complication and related deaths.

Use of traditional and complementary medicines by cancer patients at a national cancer referral facility in a low-income country.

OBJECTIVE: The aim of this study was to describe use of traditional and complementary medicines (T&CM) and associated factors among patients with cancer. METHODS: We conducted a cross-sectional study at the Uganda Cancer Institute (UCI) involving patients with selected solid tumours. Independent variables included age, sex, marital status, cancer site and stage. Main outcome variables were use and disclosure of use of T&CM. RESULTS: The majority of participants were women (n = 352; 81.9%). Breast cancer (n = 312; 71.9%) was the predominant cancer type. 55.4% of participants (n = 240) self-reported use of T&CM. Among them, 68.3% (140/205) reported using them to treat/cure cancer, 35.6% (72/202) for strengthening the immune system and 31.2% (63/202) for management of pain. Patients with advanced stage cancers were more likely to be users compared with those in stage one. The majority (81.9%, 195/238) of T&CM users did not disclose use to their healthcare professionals. The main reasons for nondisclosure included lack of inquiry by clinicians (79.6%, 117/147) and fear of disapproval and/or rebuke (11.6%, 17/147). CONCLUSION: Use of T&CM by patients with cancer under biomedical care is common but often undisclosed to the healthcare professionals.

A new use for an old tool: maternity waiting homes to improve equity in rural childbirth care. Results from a cross-sectional hospital and community survey in Tanzania.

Limited quality of childbirth care in sub-Saharan Africa primarily affects the poor. Greater quality is available in facilities providing advanced management of childbirth complications. We aimed to determine whether Maternity Waiting Homes (MWHs) may be a tool to improve access of lower socio-economic women to such facilities. Secondary analysis of a cross-sectional hospital survey from Iringa District, Tanzania was carried out. Women who delivered between October 2011 and May 2012 in the only District facility providing comprehensive Emergency Obstetric Care were interviewed. Their socio-economic profile was obtained by comparison with District representative data. Multivariable logistic regression was used to compare women who had stayed in the MWH before delivery with those who had accessed the hospital directly. Out of 1072 study participants, 31.3% had accessed the MWH. In multivariable analysis, age, education, marital status and obstetric factors were not significantly associated with MWH stay. Adjusted odds ratios for MWH stay increased progressively with distance from the hospital (women living 6-25 km, OR 4.38; 26-50 km, OR 4.90; >50 km, OR 5.12). In adjusted analysis, poorer women were more likely to access the MWH before hospital delivery compared with the wealthiest quintile (OR 1.38). Policy makers should consider MWH as a tool to mitigate inequity in rural childbirth care.

Where do the rural poor deliver when high coverage of health facility delivery is achieved? Findings from a community and hospital survey in Tanzania.

INTRODUCTION: As part of maternal mortality reducing strategies, coverage of delivery care among sub-Saharan African rural poor will improve, with a range of facilities providing services. Whether high coverage will benefit all socio-economic groups is unknown. Iringa rural District, Southern Tanzania, with high facility delivery coverage, offers a paradigm to address this question. Delivery services are available in first-line facilities (dispensaries, health centres) and one hospital. We assessed whether all socio-economic groups access the only comprehensive emergency obstetric care facility equally, and surveyed existing delivery services. METHODS: District population characteristics were obtained from a household community survey (n = 463). A Hospital survey collected data on women who delivered in this facility (n = 1072). Principal component analysis on household assets was used to assess socio-economic status. Hospital population socio-demographic characteristics were compared to District population using multivariable logistic regression. Deliveries' distribution in District facilities and staffing were analysed using routine data. RESULTS: Women from the hospital compared to the District population were more likely to be wealthier. Adjusted odds ratio of hospital delivery increased progressively across socio-economic groups, from 1.73 for the poorer (p = 0.0031) to 4.53 (p<0.0001) for the richest. Remarkable dispersion of deliveries and poor staffing were found. In 2012, 5505/7645 (72%) institutional deliveries took place in 68 first-line facilities, the remaining in the hospital. 56/68 (67.6%) first-line facilities reported ≤100 deliveries/year, attending 33% of deliveries. Insufficient numbers of skilled birth attendants were found in 42.9% of facilities. DISCUSSION: Poorer women remain disadvantaged in high coverage, as they access lower level facilities and are under-represented where life-saving transfusions and caesarean sections are available. Tackling the challenges posed by low caseloads and staffing on first-line rural care requires confronting a dilemma between coverage and quality. Reducing number of delivery sites is recommended to improve quality and equity of care.

Accuracy of indirect haemagglutination and western blot assays for the detection of anti-Schistosoma antibodies in non-severe febrile patients in two Tanzanian hospitals.

BACKGROUND: The diagnosis of schistosomiasis is usually based on clinical data associated with the detection of eggs in stool, urine, and/or rectal and bladder biopsy specimens. However antibody detection can be useful to indicate Schistosoma infection in those for whom eggs cannot be demonstrated. The aim of this study was to assess the seroprevalence of schistosomiasis and to evaluate the accuracy of indirect haemagglutination (IHA) and Western blot (WB) assays for the detection of anti-Schistosoma antibodies in 2 peripheral hospitals of the United Republic of Tanzania. METHODS: Between February and March 2007 blood samples were collected from 297 non-severe febrile outpatients who attended Chake Chake Hospital, Pemba Island and Tosamaganga Hospital, Iringa region in Tanzania. The samples were processed for Schistosoma antibodies by IHA and WB assays in Italy. RESULTS: Two hundred and sixty-two of 297 patients were schistosomiasis antibody-positive by IHA (88.2%). Of 142 patients positive by IHA, only 22 (12.4%) cases were confirmed by WB assay. The WB assay confirmed all 35 negative cases previously identified by IHA. The seroprevalence of Schistosoma at Chake Chake Hospital was lower than in Tosamaganga Hospital (9/97, 9.3% vs 13/80, 16.2%). CONCLUSIONS: Schistosomiasis is endemic in Tanzania, being more prevalent on the mainland than on Pemba Island. The implications of this study are of public health relevance and suggest the need for increased efforts in large-scale chemotherapy-based morbidity control programmes, integrated with those for other soil-transmitted helminthiases, in these 2 peripheral areas of the United Republic of Tanzania.

Seroprevalence of dengue infection: a cross-sectional survey in mainland Tanzania and on Pemba Island, Zanzibar.

OBJECTIVE: Evidence available to date indicates that dengue viruses 1, 2, and 3 could be among the causes of acute fever in eastern Africa. Recently, four reports on dengue infection in travelers and residents have raised concerns over the occurrence of dengue fever in mainland Tanzania and in Zanzibar. The objective of this study was to provide seroprevalence data on dengue infection in Tanzania. METHODS: This study was conducted in 2007 at two peripheral hospitals, one on Pemba Island, Zanzibar and one in Tosamaganga, Iringa Region, mainland Tanzania. Two hundred and two consecutive febrile outpatients were studied for antibodies and viral RNA to assess the circulation of dengue virus in Tanzania. RESULTS: A seroprevalence of 7.7% was found on Pemba Island and of 1.8% was found in Tosamaganga. No acute cases and no previous infections among patients under 11 years of age were detected. CONCLUSION: These findings provide the first baseline data on dengue seroprevalence in the country. No recent dengue virus circulation in Tanzania and in the Zanzibar archipelago up until the early 1990s is reported.

Accuracy of malaria diagnosis by microscopy, rapid diagnostic test, and PCR methods and evidence of antimalarial overprescription in non-severe febrile patients in two Tanzanian hospitals.

The study was aimed to evaluate the malaria over/underdiagnosis and over/underprescription of antimalarial drugs. Between February and March 2007 blood samples were collected from 336 non-severe febrile outpatients attended in two peripheral Tanzanian hospitals. Microscopy and a rapid diagnostic test (RDT) were done locally and the accuracy evaluated by qualitative polymerase chain reaction (PCR) for Plasmodium spp. The testing was performed at National Institute for Infectious Diseases Lazzaro Spallanzani (INMI), Rome, Italy. As a result of PCR, we identified 26 malaria cases out of 336 (7.7%) patients. Microscopy and RDT accuracies were 93.5% and 97.6%, respectively. Overprescription and underdiagnosis rates were 29.3% and 30.8%, respectively. On-field training, clinical management of febrile illness, and malaria microscopy in remote settings should be considered.