Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 11 de 11
Filtrar
1.
J Pediatr ; 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33516678

RESUMO

We conducted a pilot study to determine the effectiveness of a linkage to care intervention with social workers to improve 12-month post-hospital mortality for children in Tanzania with sickle cell disease. Comparison was done with a historical cohort. Mortality was 6.7% in the interventional cohort compared with 19.2% (adjusted Hazard Ratio, 0.26; 95% CI, 0.08-0.83).

2.
Bull World Health Organ ; 98(12): 859-868, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33293746

RESUMO

Objective: To determine the regional- and district-level newborn prevalence of sickle cell trait and disease, and the prevalence of haemoglobin variants and genetic modifiers of sickle cell disease, in the nine regions of north-western United Republic of Tanzania. Methods: We repurposed dried blood spot samples from children (aged 0-24 months) born to mothers living with human immunodeficiency virus (HIV), collected as part of the HIV Early Infant Diagnosis programme, for sickle cell diagnosis. We performed isoelectric focusing to determine whether samples had normal haemoglobin, sickle cell trait, sickle cell disease or a rare haemoglobin variant. We shipped samples diagnosed as disease or variant to Cincinnati Children's Hospital in the United States of America for deoxyribonucleic-acid-based analyses to determine the prevalence of α-thalassaemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency or fetal haemoglobin genetic modifiers. Findings: We analysed a total of 17 200 specimens during February 2017-May 2018. We observed a prevalence of sickle cell trait and disease of 20.3% (3492/17 200) and 1.2% (210/17 200), respectively. District-level trait varied from 8.6% (5/58) to 28.1% (77/274). Among confirmed sickle cell disease specimens, we noted 42.7% (61/143) had 1-gene deletion and 14.7% (21/143) had 2-gene deletion α-thalassaemia trait. We documented G6PD A- deficiency in 19.2% (14/73) of males. Conclusion: Our calculated prevalence is twice as high as previously reported and reinforces the need for enhanced sickle cell diagnostic services. Our district-level data will inform public health policy, allowing screening and disease-modifying hydroxyurea therapy to be focused on high-prevalence areas, until universal newborn screening is available.

3.
Pediatr Blood Cancer ; 67(11): e28620, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32803850

RESUMO

BACKGROUND/OBJECTIVES: Sickle cell disease (SCD) is an important, hidden cause of childhood mortality worldwide. It is most prevalent in sub-Saharan Africa where national newborn screening programs remain unavailable and most children in rural areas are never diagnosed. We conducted a study at a rural district hospital in northern Tanzania to determine the birth prevalence and community awareness of SCD and to determine the feasibility of using point-of-care testing to enroll newborns in a new SCD clinic for ongoing treatment. DESIGN/METHODS: We screened infants at Shirati KMT hospital for SCD using HemoTypeSC, an inexpensive point-of-care test. Infants who screened positive were enrolled in the SCD clinic and instructed to return at 6-12 weeks for confirmatory testing, counseling, and preventive care. RESULTS: A total of 999 newborns were screened from February to September 2019. Among these, 31.6% (315/999) had sickle cell trait and 3.9% (39/999) had SCD. No hemoglobin C was detected. Very few parents knew their own sickle cell status (0.3%). At 5 months after completion, 12 infants from the screening study and 30 additional children had been seen at the SCD clinic for ongoing counseling and care. CONCLUSIONS: Birth prevalence of SCD in rural Tanzania is extremely high and community awareness is low. Newborn point-of-care testing enhances case finding and enables early enrollment in preventive care for SCD, even in rural sub-Saharan Africa with minimal laboratory capacity. SCD-specific clinical services implemented at the district hospital level could expand access to many children and significantly reduce early SCD morbidity and mortality.

4.
J Community Genet ; 11(3): 253-268, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32415570

RESUMO

In an effort to explore new knowledge and to develop meaningful collaborations for improving child health, the First Pan African Workshop on Newborn Screening was convened in June 2019 in Rabat, Morocco. Participants included an informal network of newborn screening stakeholders from across Africa and global experts in newborn screening and sickle cell disease. Over 150 attendees, representing 20 countries, were present including 11 African countries. The agenda focused on newborn screening rationale, techniques, system development, implementation barriers, ongoing research, and collaborations both globally and across Africa. We provide an overview of the workshop and a description of the newborn screening activities in the 11 African countries represented at the workshop, with a focus on sickle cell disease.

5.
PLoS One ; 14(6): e0214563, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220109

RESUMO

BACKGROUND: Africa has the highest rates of child mortality. Little is known about outcomes after hospitalization for children with very severe anemia. OBJECTIVE: To determine one year mortality and predictors of mortality in Tanzanian children hospitalized with very severe anemia. METHODS: We conducted a prospective cohort study enrolling children 2-12 years hospitalized from August 2014 to November 2014 at two public hospitals in northwestern Tanzania. Children were screened for anemia and followed until 12 months after discharge. The primary outcome measured was mortality. Predictors of mortality were determined using Cox regression analysis. RESULTS: Of the 505 children, 90 (17.8%) had very severe anemia and 415 (82.1%) did not. Mortality was higher for children with very severe anemia compared to children without over a one year period from admission, 27/90 (30.0%) vs. 59/415 (14.2%) respectively (Hazard Ratio (HR) 2.42, 95% Cl 1.53-3.83). In-hospital mortality was 11/90 (12.2%) and post-hospital mortality was 16/79 (20.2%) for children with very severe anemia. The strongest predictors of mortality were age (HR 1.01, 95% Cl 1.00-1.03) and decreased urine output (HR 4.30, 95% Cl 1.04-17.7). CONCLUSIONS: Children up to 12 years of age with very severe anemia have nearly a 30% chance of mortality following admission over a one year period, with over 50% of mortality occurring after discharge. Post-hospital interventions are urgently needed to reduce mortality in children with very severe anemia, and should include older children.


Assuntos
Anemia/epidemiologia , Hospitalização/estatística & dados numéricos , Anemia/mortalidade , Causas de Morte , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Mortalidade , Prevalência , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Tanzânia/epidemiologia
6.
Pediatr Blood Cancer ; 65(1)2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28766840

RESUMO

BACKGROUND: Worldwide, hemoglobinopathies affect millions of children. Identification of hemoglobin disorders in most sub-Saharan African countries is delayed until clinical signs of the disease are present. Limited studies have been conducted to understand their prevalence and clinical presentation among newborns in resource-limited settings. METHODOLOGY: This was a prospective cohort study. Newborns (aged 0-7 days) at two hospitals in Northwestern Tanzania were enrolled and followed prospectively for 6 months. Clinical and laboratory information were collected at baseline. Participants were screened for hemoglobinopathies using high-performance liquid chromatography. Clinical and laboratory follow-up was performed at 3 and 6 months for those with hemoglobinopathies as well as a comparison group of participants without hemoglobinopathies. RESULTS: A total of 919 newborns were enrolled. Among these, 1.4% (13/919) had sickle cell anemia or Hb S/ß0 -thalassemia (Hb FS), and 19.7% (181/919) had sickle cell trait or Hb S/ß+ thalassemia (Hb FAS). Furthermore, 0.2% (two of 919) had ß+ -thalassemia. Red cell indices compared between Hb FS, Hb FAS, and Hb FA were similar at baseline, but hemoglobin was lower and red cell distribution width was higher in children with Hb FS at 3- and 6-month follow-up. Febrile episodes were more common for children with Hb FS at 3- and 6-month follow-up. CONCLUSION: The prevalence of sickle cell disease among neonates born in Northwestern Tanzania is one of the highest in the world. Newborn screening is needed early in life to identify neonates with hemoglobinopathies so that clinical management may commence and morbidity and mortality related to hemoglobinopathies be reduced.


Assuntos
Anemia Falciforme/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Adulto , Anemia Falciforme/sangue , Feminino , Seguimentos , Humanos , Recém-Nascido , Doenças do Recém-Nascido/sangue , Masculino , Prevalência , Estudos Prospectivos , Tanzânia/epidemiologia
7.
Ann Hematol ; 97(2): 239-246, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29147848

RESUMO

Both anemia and sickle cell disease (SCD) are highly prevalent across sub-Saharan Africa, and limited resources exist to diagnose these conditions quickly and accurately. The development of simple, inexpensive, and accurate point-of-care (POC) assays represents an important advance for global hematology, one that could facilitate timely and life-saving medical interventions. In this prospective study, Robust Assays for Point-of-care Identification of Disease (RAPID), we simultaneously evaluated a POC immunoassay (Sickle SCAN™) to diagnose SCD and a first-generation POC color-based assay to detect anemia. Performed at Bugando Medical Center in Mwanza, Tanzania, RAPID tested 752 participants (age 1 day to 20 years) in four busy clinical locations. With minimally trained medical staff, the SCD POC assay diagnosed SCD with 98.1% sensitivity and 91.1% specificity. The hemoglobin POC assay had 83.2% sensitivity and 74.5% specificity for detection of severe anemia (Hb ≤ 7 g/dL). Interobserver agreement was excellent for both POC assays (r = 0.95-0.96). Results for the hemoglobin POC assay have informed the second-generation assay design to be more suitable for low-resource settings. RAPID provides practical feasibility data regarding two novel POC assays for the diagnosis of anemia and SCD in real-world field evaluations and documents the utility and potential impact of these POC assays for sub-Saharan Africa.


Assuntos
Anemia Falciforme/diagnóstico , Anemia/diagnóstico , Colorimetria/métodos , Hemoglobinas/metabolismo , Testes Imediatos , Adolescente , Anemia/sangue , Anemia Falciforme/sangue , Criança , Pré-Escolar , Colorimetria/economia , Feminino , Humanos , Imunoensaio , Lactente , Recém-Nascido , Masculino , Variações Dependentes do Observador , Estudos Prospectivos , Sensibilidade e Especificidade , Tanzânia , Adulto Jovem
8.
J Trop Pediatr ; 64(6): 479-487, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-29244176

RESUMO

Parvovirus B19 (B19) can cause transient aplastic crisis and lead to acute severe anemia. This study investigated the relationship between B19 and anemia among children <5 years old in the city of Mwanza, Tanzania. An enzyme immunoassay was used to detect B19 IgM- and IgG-specific antibodies among children with various categories of anemia according to the World Health Organization (WHO) guidelines. A total of 265 children with median age of 28.5 months (interquartile range 18-39.5) were investigated. Eighty-six children (32.5%) had severe anemia. B19-specific IgM and IgG antibodies were detected in 24 (9%) and 46 (17.4%) children, respectively. Low hemoglobin (Hb) level (p = 0.031), Plasmodium falciparum infection (p = 0.001) and residing in rural areas (p = 0.025) independently predicted B19 IgM seropositivity. Acute B19 infection decreased Hb level by 1.1 g/dl (p = 0.003). In malaria endemic areas, acute B19 infections should be considered among children with severe anemia from rural areas.


Assuntos
Anemia/complicações , Anemia/virologia , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Infecções por Parvoviridae/complicações , Parvovirus B19 Humano/imunologia , Parvovirus B19 Humano/isolamento & purificação , Anemia Aplástica/epidemiologia , Anemia Aplástica/virologia , Anticorpos Antivirais/sangue , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Técnicas Imunoenzimáticas , Lactente , Recém-Nascido , Masculino , Infecções por Parvoviridae/imunologia , Reação em Cadeia da Polimerase , Tanzânia
9.
Hematology ; 21(4): 248-256, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26868490

RESUMO

OBJECTIVES: Tanzania has the third highest birth rate of sickle cell anaemia (SCA) in Africa, but few studies describe severity of complications or available treatments, especially in Northwest Tanzania around Lake Victoria where the sickle gene is most prevalent. This is a report of the spectrum of clinical disease and range of interventions available at Bugando Medical Centre (Bugando) in Northwest Tanzania in Africa. METHODS: A cross-sectional study was carried out in Bugando between 1 August 2012 and 30 September 2012. Children (<15 years old) with SCA attending Bugando were sequentially enrolled. A trained research assistant completed a Swahili questionnaire with the parent or guardian of each participant concerning demographic information, clinical features of disease, and treatments received. RESULTS: Among the 124 participants enrolled, the median age was 6 years (interquartile range [IQR] 4-8.5), and only 13 (10.5%) were < 3 years old. Almost all participants (97.6%) had a prior history of a vaso-occlusive episode, 83 (66.9%) had prior acute chest syndrome, and 21 (16.9%) had prior stroke. In the preceding 12 months, 120 (96.8%) had been hospitalized, and a vaso-occlusive episode was the most common reason for hospitalization (35.5%). Prescriptions for folic acid (92.7%) and malaria prophylaxis (84.7%) were common, but only one had received a pneumococcal vaccine, and none had received hydroxyurea or prophylactic penicillin. CONCLUSION: Children with SCA receiving care in Tanzania are diagnosed late, hospitalized frequently, and have severe complications. Opportunities exist to improve care through wider access to screening and diagnosis as well as better coordination of comprehensive care.


Assuntos
Síndrome Torácica Aguda , Ácido Fólico/administração & dosagem , Hospitalização , Acidente Vascular Cerebral , Doenças Vasculares , Síndrome Torácica Aguda/complicações , Síndrome Torácica Aguda/epidemiologia , Síndrome Torácica Aguda/terapia , Criança , Pré-Escolar , Feminino , Humanos , Malária/complicações , Malária/epidemiologia , Malária/prevenção & controle , Masculino , Vacinas Pneumocócicas/administração & dosagem , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Tanzânia/epidemiologia , Doenças Vasculares/epidemiologia , Doenças Vasculares/etiologia , Doenças Vasculares/terapia
10.
Tanzan J Health Res ; 13(2): 114-8, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25566608

RESUMO

Early diagnosis and prompt treatment is the recommended management for febrile illness among underfives. However, improper home management may be the cause of delay in seeking professional health care. This cross-sectional study was conducted at the outpatient department of Buzuruga Health Centre in Mwanza, Tanzania and involved 372 children < 5 years of age. Socio-demographic data of caregivers and children, type and source of treatment, and duration of fever were recorded. A total of 283 (76.1%) febrile underfives had received different types of treatment at home, before presenting at the hospital. The majority received antipyretics (204; 72.1%), and only a few (31; 10.9%) received antimalarials. The major sources of drugs were local drug stores (270; 94.7%). Duration of fever > 1 day (OR = 2.69; 95% CI: 1.95-3.70; P < 0.001), low grade fever (OR = 4.37, 95% CI: 2.60-7.35; P < 0.001) and fever accompanied with other major complaints (OR = 1.14, 95% CI: 1.05 - 1.23; P = 0.002) were significantly associated with prompt home medication before presenting to the health centre. In logistic regression analysis, duration of fever, low-grade fever and the presence of other symptoms remained significant predictors to receive antimalarial and or antipyretic drugs. In conclusion, home treatments with antipyretics and antimalarials in preschool children are common in Mwanza. Management of fevers may be improved by educating caregivers on community standard case definition of malaria while emphasizing the importance of early seeking of health facility services.


Assuntos
Antimaláricos/administração & dosagem , Antipiréticos/administração & dosagem , Assistência Domiciliar , Malária/tratamento farmacológico , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Malária/epidemiologia , Masculino , Tanzânia/epidemiologia
11.
Tanzan J Health Res ; 12(4): 299-301, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24409638

RESUMO

Plasmodium falciparum malaria and intestinal helminth infections are among the most common infections in the tropics and they share the same spatial distribution. The objective of this study was to explore the association between infections with intestinal helminths and P. falciparum infection as single helminth infections or co-infections among school children. A cross-sectional study was conducted among 400 school children in Nyamtongo, Sengerema District in Tanzania. The study involved examination of single stool and finger prick blood samples for intestinal helminths and malaria parasites. A Kato-Katz technique was employed to screen for intestinal helminths and Giemsa stained thin and thick blood smears were used to screen for malaria parasites. The results of logistic regression model adjusted for age and sex indicated no association between P. falciparum and S. mansoni (OR= 0.749, 95%CI 0.418-1.344), P. falciparum and hookworm (OR= 0.885, 95%CI 0.489-1.605) and P. falciparum and co-infection of S. mansoni and hookworm (OR=0.859, 95%CI 0.422-1.745). Using multinomial regression model adjusted for age and sex, no association was observed between P. falciparum with Schistosoma mansoni [Ratio of Relative Risk (RRR) = 0.651, 95% Confidence Interval (CI) 0.331-1.363] and hookworm (RRR=0712, CI 0.280-1.765). Similarly, no association was observed between co-infections of S. mansoni + hookworm (RRR=0.635, CI 0.268-1.504) with P. falciparum infection. Coinfections of S. mansoni, hookworm and P. falciparum among school children is common in the Nyamatongo ward, Sengerema District. We recommend prospective longitudinal studies to elucidate the interactions of malaria and helminths and its health impact in risk groups.


Assuntos
Helmintíase/complicações , Enteropatias/complicações , Enteropatias/parasitologia , Malária Falciparum/complicações , Criança , Coinfecção , Estudos Transversais , Feminino , Helmintíase/epidemiologia , Humanos , Enteropatias/epidemiologia , Malária Falciparum/epidemiologia , Masculino , Tanzânia/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...