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1.
BMC Pediatr ; 21(1): 383, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479515

RESUMO

BACKGROUND: Jaundice is common among neonates and if untreated can lead to kernicterus. Diagnosing neonatal jaundice (NJ) using Kramer's method (visual assessment) is considered user-friendly in resource-limited areas. However, there are conflicting findings on reliability of the Kramer's method in the diagnosis of NJ, particularly of black descent. Therefore, study aimed to determine the accuracy of Kramer's method in comparison to the total serum bilirubin (TSB) test in the diagnosis of NJ among neonates of black descent in Tanzania. METHODS: A cross-sectional study was conducted between June and July 2020 at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania. A total of 315 neonates were recruited consecutively. In each neonate, jaundice was assessed using Kramer's method and TSB test. NJ A total of 315 neonates were recruited i. A 2 X 2 table was created for the determination of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (+LR/-LR), and diagnostic accuracy (effectiveness) of Kramer's method. Cohen kappa (κ) was used to analyze the agreement between Kramer's method and TSB. Association between independent variables and presence of jaundice were assessed using the chi-square test and the p < 0.05 was considered to be statistically significant. RESULTS: The prevalence of NJ was 49.8% by Kramer's method and 63.5% by TSB. The Sensitivity, Specificity, PPV, and NPV of Kramer's method were 70.5, 86.1, 89.8, and 62.6%, respectively. The +LR and -LR were 5.07 and 0.34, respectively. The diagnostic accuracy of Kramer's method was 76.1%. There was a moderate agreement between Kramer's method and TSB results (κ = 0.524, P<0.001). No significant relationship was observed between the independent variables and the presence of NJ. CONCLUSION: Kramer has a good positive predictive value. However, due to low sensitivity and NPV one cannot say that overall predictive ability is good. Also, clinical assessment by Kramer's method should not be used for screening of NJ. Further studies are needed to investigate the utility of other non-invasive techniques in detecting NJ among neonates of black descent.


Assuntos
Icterícia Neonatal , Bilirrubina , Estudos Transversais , Humanos , Recém-Nascido , Icterícia Neonatal/diagnóstico , Triagem Neonatal , Reprodutibilidade dos Testes , Tanzânia
2.
BMJ Open ; 11(9): e045807, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475146

RESUMO

INTRODUCTION: Achieving universal health coverage goal by ensuring access to quality health service without financial hardship is a policy target in many countries. Thus, routine assessments of financial risk protection, and equity in financing and service delivery are required in order to track country progress towards realising this universal coverage target. This study aims to undertake a system-wide assessment of equity in health financing and benefits distribution as well as catastrophic and impoverishing health spending by using the recent national survey data in Tanzania. We aim for updated analyses and compare with previous assessments for trend analyses. METHODS AND ANALYSIS: We will use cross-sectional data from the national Household Budget Survey 2017/2018 covering 9463 households and 45 935 individuals cross all 26 regions of mainland Tanzania. These data include information on service utilisation, healthcare payments and consumption expenditure. To assess the distribution of healthcare benefits (and in relation to healthcare need) across population subgroups, we will employ a benefit incidence analysis across public and private health providers. The distributions of healthcare benefits across population subgroups will be summarised by concentration indices. The distribution of healthcare financing burdens in relation to household ability-to-pay across population subgroups will be assessed through a financing incidence analysis. Financing incidence analysis will focus on domestic sources (tax revenues, insurance contributions and out-of-pocket payments). Kakwani indices will be used to summarise the distributions of financing burdens according to households' ability to pay. We will further estimate two measures of financial risk protection (ie, catastrophic health expenditure and impoverishing effect of healthcare payments). ETHICS AND DISSEMINATION: We will involve secondary data analysis that does not require ethical approval. The results of this study will be disseminated through stakeholder meetings, peer-reviewed journal articles, policy briefs, local and international conferences and through social media platforms.


Assuntos
Financiamento Pessoal , Financiamento da Assistência à Saúde , Estudos Transversais , Gastos em Saúde , Humanos , Tanzânia , Cobertura Universal do Seguro de Saúde
3.
BMC Health Serv Res ; 21(Suppl 1): 214, 2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34511104

RESUMO

BACKGROUND: Monitoring medically certified causes of death is essential to shape national health policies, track progress to Sustainable Development Goals, and gauge responses to epidemic and pandemic disease. The combination of electronic health information systems with new methods for data quality monitoring can facilitate quality assessments and help target quality improvement. Since 2015, Tanzania has been upgrading its Civil Registration and Vital Statistics system including efforts to improve the availability and quality of mortality data. METHODS: We used a computer application (ANACONDA v4.01) to assess the quality of medical certification of cause of death (MCCD) and ICD-10 coding for the underlying cause of death for 155,461 deaths from health facilities from 2014 to 2018. From 2018 to 2019, we continued quality analysis for 2690 deaths in one large administrative region 9 months before, and 9 months following MCCD quality improvement interventions. Interventions addressed governance, training, process, and practice. We assessed changes in the levels, distributions, and nature of unusable and insufficiently specified codes, and how these influenced estimates of the leading causes of death. RESULTS: 9.7% of expected annual deaths in Tanzania obtained a medically certified cause of death. Of these, 52% of MCCD ICD-10 codes were usable for health policy and planning, with no significant improvement over 5 years. Of certified deaths, 25% had unusable codes, 17% had insufficiently specified codes, and 6% were undetermined causes. Comparing the before and after intervention periods in one Region, codes usable for public health policy purposes improved from 48 to 65% within 1 year and the resulting distortions in the top twenty cause-specific mortality fractions due to unusable causes reduced from 27.4 to 13.5%. CONCLUSION: Data from less than 5% of annual deaths in Tanzania are usable for informing policy. For deaths with medical certification, errors were prevalent in almost half. This constrains capacity to monitor the 15 SDG indicators that require cause-specific mortality. Sustainable quality assurance mechanisms and interventions can result in rapid improvements in the quality of medically certified causes of death. ANACONDA provides an effective means for evaluation of such changes and helps target interventions to remaining weaknesses.


Assuntos
Confiabilidade dos Dados , Instalações de Saúde , Causas de Morte , Certificação , Humanos , Tanzânia/epidemiologia
4.
Malawi Med J ; 33(1): 59-64, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34422235

RESUMO

Background: Non-susceptibility of bacteria to antiseptic agents used for preoperative skin preparations threaten the effectiveness of prevention of surgical site infections. Data concerning susceptibility of multidrug resistant bacteria strains to antiseptic agents was limited at our setting. This study presents the susceptibility of extended spectrum ß-lactamases producing Klebsiella pneumoniae and Escherichia coli (with and without biofilm formation) to antiseptic agents used for preoperative skin preparations at zonal referral hospital in Mwanza, Tanzania. Methods: This cross-sectional descriptive study was conducted through July 2020. Presumptive extended spectrum beta-lactamase producing Klebsiella pneumoniae and Escherichia coli were recovered for this study. Disc combination method was used to confirm production of ESBL while tube method was used to detect biofilms formation. Then, isolates were tested for susceptibility towards 10% povidone iodine, 70% methylated spirit, 50% hydrogen peroxide (6% of industrial H2O2 diluted in equal volume with sterile distilled water) and 2% chlorhexidine. STATA software version 13.0 was used for data analysis. Results: A total of 31 presumptive ESBL producers were recovered and phenotypically confirmed, whereas 54.8% (n=17) were K. pneumoniae and 45.2% (n=14) were E. coli. Five (35.7%) E. coli and seven (41.2%) K. pneumoniae had positive biofilms test results. Four (12.9%) bacteria were non-susceptible to antiseptic agents used for preoperative skin preparations. However, none exhibited resistance towards 10% PVP-I. Conclusion: In this study we highlight the existence of multidrug resistant Gram-negative bacteria with resistance to antiseptic agents used for preoperative skin preparation at a zonal referral hospital in Mwanza, Tanzania.


Assuntos
Anti-Infecciosos Locais/farmacologia , Resistência a Múltiplos Medicamentos/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Klebsiella pneumoniae/efeitos dos fármacos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/genética , Bactérias/isolamento & purificação , Biofilmes , Estudos Transversais , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/isolamento & purificação , Testes de Sensibilidade Microbiana , Tanzânia
5.
Nat Commun ; 12(1): 4809, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34376689

RESUMO

Genomic surveillance of SARS-CoV-2 is important for understanding both the evolution and the patterns of local and global transmission. Here, we generated 311 SARS-CoV-2 genomes from samples collected in coastal Kenya between 17th March and 31st July 2020. We estimated multiple independent SARS-CoV-2 introductions into the region were primarily of European origin, although introductions could have come through neighbouring countries. Lineage B.1 accounted for 74% of sequenced cases. Lineages A, B and B.4 were detected in screened individuals at the Kenya-Tanzania border or returning travellers. Though multiple lineages were introduced into coastal Kenya following the initial confirmed case, none showed extensive local expansion other than lineage B.1. International points of entry were important conduits of SARS-CoV-2 importations into coastal Kenya and early public health responses prevented established transmission of some lineages. Undetected introductions through points of entry including imports from elsewhere in the country gave rise to the local epidemic at the Kenyan coast.


Assuntos
COVID-19/epidemiologia , COVID-19/virologia , Genoma Viral , SARS-CoV-2/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/transmissão , Criança , Pré-Escolar , Feminino , Variação Genética , Humanos , Lactente , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Filogenia , Saúde Pública , SARS-CoV-2/classificação , SARS-CoV-2/isolamento & purificação , Análise de Sequência , Tanzânia , Viagem , Adulto Jovem
6.
Afr Health Sci ; 21(Suppl): 44-50, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34447423

RESUMO

Background: The World Health Organization (WHO) developed the Safe Birth Checklist (SCC) to facilitate best practices in safe birthing practices. The SCC is utilizing existing evidence-based WHO guidelines and recommendations which has combined those into a single and practical bedside tool. The SCC is the first checklist-based intervention to target the prevention of maternal and neonatal deaths. Objective: The objective of this project was to pilot-test the World Health Organization Safe Childbirth Checklist with Maternity Regional Hospital in, Tanzania. Study Design and Methods: Retrospective analysis on 35 charts were completed to identify presence or absence of documentation aligned with evidenced based checklist items. Staff training, end user observations and focus group discussions were utilized to elicit feedback about the tool and the process. Descriptive statistics and manual content analysis were used to analyze the rate of uptake and ownership over the checklist. The Checklist is broken down into four sections or time points (that are considered natural pause points in the care of laboring women). The four different pause points are admission, delivery, post-partum, and discharge. Results: We trained 26 participants out of 32 staff how to use the SCC. Delivery time point had the lowest at SCC completion rate at 39% compared to discharge having the highest completion rate at 93%. There was variation in completion rate of the checklist items at each time point. Checklist items at the beginning of each time point were completed between 94% and 100% of the time with the latter checklist list items completed between 29% and 57% of the time. Conclusion: This project was able to identify facilitators and potential barriers to the successful uptake of the Safe Childbirth Checklist in Shinyanga Regional Hospital. Based on these findings, the MOH have opportunities to utilize those findings in the scale-up of the implementation of the checklist and future evaluation activities.


Assuntos
Lista de Checagem/estatística & dados numéricos , Parto Obstétrico/normas , Fidelidade a Diretrizes , Guias como Assunto , Adulto , Feminino , Humanos , Recém-Nascido , Parto , Segurança do Paciente , Gravidez , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Tanzânia , Organização Mundial da Saúde
7.
Artigo em Inglês | MEDLINE | ID: mdl-34444166

RESUMO

The 2016-2017 Tanzania HIV Impact Survey (THIS) reported the accomplishments towards the 90-90-90 global HIV targets at 61-94-87, affirming the need to focus on the first 90 (i.e., getting 90% of people living with HIV (PLHIV) tested). We conducted a patient-pathway analysis to understand the gap observed, by assessing the alignment between where PLHIV seek healthcare and where HIV services are available in the Shinyanga region, Tanzania. We used existing and publicly available data from the National AIDS Control program, national surveys, registries, and relevant national reports. Region-wide, the majority (n = 458/722, 64%) of THIS respondents accessed their last HIV test at public sector facilities. There were 65.9%, 45.1%, and 74.1% who could also access antiretroviral therapy (ART), CD4 testing, and HIV viral load testing at the location of their last HIV test, respectively. In 2019, the viral suppression rate estimated among PLHIV on ART in the Shinyanga region was 91.5%. PLHIV access HIV testing mostly in public health facilities; our research shows that synergies can be achieved to improve access to services further down the cascade in this sector. Furthermore, effective engagement with the private sector (not-for-profit and for-profit) will help to achieve the last mile toward ending the HIV epidemic.


Assuntos
Epidemias , Infecções por HIV , Testes Diagnósticos de Rotina , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , População Rural , Tanzânia/epidemiologia
8.
AIDS Patient Care STDS ; 35(8): 308-317, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34375138

RESUMO

In many low- and middle-income countries, community health workers (CHWs) support multiple aspects of HIV care, including patient education and counseling, adherence support, and re-engaging patients lost to care. In Tanzania, the Community-Based HIV Services program is a nationwide cohort of CHWs supporting HIV care engagement. We enrolled a prospective cohort study of 80 people initiating HIV care at two Tanzanian clinics and conducted baseline and 3-month follow-up assessments to examine the potential influence of CHW support and other factors on patient early self-reported medication adherence, depression, anxiety, attitudes about medication, and HIV stigma. The vast majority of participants reported maintaining strong antiretroviral therapy (ART) adherence during the study and endorsed beliefs that ART is beneficial for them. However, there was high occurrence of likely depression and anxiety disorders in the study sample. Patient contact with CHWs at the clinic was unexpectedly low; fewer than two-thirds of participants were informed about the CHW program and fewer than one-third ever met with a CHW. Among participants who met with a CHW, there was mixed feedback about the helpfulness of the program, and contact with a CHW did not improve medication adherence at 3-month follow-up. Male participants, those with likely depression, and those who lived further from the clinic were significantly more likely to experience adherence challenges. The study findings indicate that CHWs are currently underutilized to provide patient support and may not be producing observable benefits to patients in this setting, representing a missed opportunity to address patient challenges, including depression and anxiety.


Assuntos
Agentes Comunitários de Saúde , Infecções por HIV , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Adesão à Medicação , Saúde Mental , Estudos Prospectivos , Tanzânia/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-34444245

RESUMO

We conducted this study to investigate the isolation frequency and phenotypic antibiotic resistance pattern of Staphylococcus aureus isolated from rodents, chickens, humans, and household soils. Specimens were plated onto mannitol salt agar (Oxoid, Basingstoke, UK) and incubated aerobically at 37 °C for 24 h. Presumptive colonies of S. aureus were subjected to Gram staining, as well as catalase, deoxyribonuclease (DNAse), and coagulase tests for identification. Antibiotic susceptibility testing was performed by using the Kirby-Bauer disc diffusion method on Mueller-Hinton agar (Oxoid, Basingstoke, UK). The antibiotics tested were tetracycline (30 µg), erythromycin (15 µg), gentamicin (10 µg), ciprofloxacin (5 µg), clindamycin (2 µg), and amoxicillin-clavulanate (20 µg/10 µg). The S. aureus strain American Type Culture Collection (ATCC) 25,923 was used as the standard organism. We found that 483 out of 956 (50.2%) samples were positive for S. aureus. The isolation frequencies varied significantly between samples sources, being 52.1%, 66.5%, 74.3%, and 24.5%, respectively, in chickens, humans, rodents, and soil samples (p < 0.001). S. aureus isolates had high resistance against clindamycin (51.0%), erythromycin (50.9%), and tetracycline (62.5%). The overall prevalence of multidrug-resistant (MDR) S. aureus isolates was 30.2%, with 8.7% resistant to at least four different classes of antibiotics.


Assuntos
Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Animais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Galinhas , Humanos , Testes de Sensibilidade Microbiana , Roedores , Solo , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/veterinária , Staphylococcus aureus , Tanzânia
10.
Artigo em Inglês | MEDLINE | ID: mdl-34444324

RESUMO

Many adolescent girls and young women (AGYW) experience gender-based violence (GBV) in Tanzania and only few seek GBV health services following violence. The objectives of our study are (1) to evaluate knowledge of gender-based violence among AGYW, (2) to explore their perceptions of and experiences with GBV health service quality and (3) to evaluate access to comprehensive GBV services. This study employed an explanatory, sequential mixed methods design in two districts of Dar es Salaam, Tanzania (Kinondoni and Temeke). A quantitative cross-sectional survey among AGYW (n = 403) between 15-24 years old was performed to assess their knowledge of GBV as well as perceptions of and experiences with GBV health services. The quantitative data was complemented by 20 semi-structured in-depth interviews with participants. Out of 403 study participants, more than three quarters (77.9%) had moderate to good knowledge of how GBV is defined and what constitutes gender-based violence. However, few participants (30.7%, n = 124) demonstrated knowledge of GBV health services offered at local health facilities. For example, only 10.7% (n = 43) of participants reported knowledge of forensic evidence collection. Additionally, of 374 participants (93% of total participants) who reported to have received GBV education sessions, only 66% accessed GBV health services (n = 247) and about half of these (52.7%, n = 130) were satisfied with these services. The study indicated that-despite good knowledge about what constituted GBV-knowledge about the roles and availability of GBV health services was limited and utilization of GBV health services remained low. Coordinated actions need to be strengthened to reach AGYW who remain unaware of GBV health services offered at health facilities by improving GBV service quality, bettering interventions aimed at reducing GBV among AGYW in Tanzania, and scaling-up integrated service models, such as GBV one-stop centers.


Assuntos
Violência de Gênero , Adolescente , Adulto , Estudos Transversais , Feminino , Serviços de Saúde , Humanos , Percepção , Tanzânia , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-34444027

RESUMO

We conducted environmental surveillance of antimicrobial resistance (AMR) bacteria in the Msimbazi river basin in Tanzania to determine the occurrence of extended-spectrum ß-lactamase (ESBL)-producing, carbapenem resistant Enterobacteriaceae (CRE) and quinolone resistant Escherichia coli and Klebsiella spp. A total of 213 Enterobacteriaceae isolates were recovered from 219 samples. Out of the recovered isolates, 45.5% (n = 97) were Klebsiella pneumoniae and 29.6% (n = 63) were Escherichia coli. K. pneumoniae isolates were more resistant in effluent (27.9%) compared to the E. coli (26.6%). The E. coli had a higher resistance in river water, sediment and crop soil than the K. pneumoniae (35 versus 25%), respectively. Higher resistance in K. pneumoniae was found in nalidixic acid (54.6%) and ciprofloxacin (33.3%) while the E. coli isolates were highly resistant to ciprofloxacin (39.7%) and trimethoprim/sulfamethoxazole (38%). Resistance increased from 28.3% in Kisarawe, where the river originates, to 59.9% in Jangwani (the middle section) and 66.7% in Upanga West, where the river enters the Indian Ocean. Out of 160 E. coli and K. pneumoniae isolates, 53.2% (n = 85) were resistant to more than three classes of the antibiotic tested, occurrence being higher among ESBL producers, quinolone resistant and carbapenem resistant strains. There is an urgent need to curb environmental contamination with antimicrobial agents in the Msimbazi Basin.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos , Quinolonas , Antibacterianos/farmacologia , Ecossistema , Escherichia coli , Klebsiella pneumoniae , Testes de Sensibilidade Microbiana , Rios , Tanzânia , beta-Lactamases
12.
Lancet Glob Health ; 9(9): e1262-e1272, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34363766

RESUMO

BACKGROUND: Quality of care is consistently shown to be inadequate in health-care settings in many low-income and middle-income countries, including in private facilities, which are rapidly growing in number but often do not have effective quality stewardship mechanisms. The SafeCare programme aims to address this gap in quality of care, using a standards-based approach adapted to low-resource settings, involving assessments, mentoring, training, and access to loans, to improve clinical quality and facility business performance. We assessed the effect of the SafeCare programme on quality of patient care in faith-based and private for-profit facilities in Tanzania. METHODS: In this cluster-randomised controlled trial, health facilities were eligible if they were dispensaries, health centres, or hospitals in the faith-based or private for-profit sectors in Tanzania. We randomly assigned facilities (1:1) using computer-generated stratified randomisation to receive the full SafeCare package (intervention) or an assessment only (control). Implementing staff and participants were masked to outcome measurement and the primary outcomes were measured by fieldworkers who had no knowledge of the study group allocation. The primary outcomes were health worker compliance with infection prevention and control (IPC) practices as measured by observation of provider-patient interactions, and correct case management of undercover standardised patients at endline (after a minimum of 18 months). Analyses were by modified intention to treat. The trial is registered with ISRCTN, ISRCTN93644888. FINDINGS: Between March 7 and Nov 30, 2016, we enrolled and randomly assigned 237 health facilities to the intervention (n=118) or control (n=119). Nine facilities (seven intervention facilities and two control facilities) closed during the trial and were not included in the analysis. We observed 29 608 IPC indications in 5425 provider-patient interactions between Feb 7 and April 5, 2018. Health facilities received visits from 909 standardised patients between May 3 and June 12, 2018. Intervention facilities had a 4·4 percentage point (95% CI 0·9-7·7; p=0.015) higher mean SafeCare standards assessment score at endline than control facilities. However, there was no evidence of a difference in clinical quality between intervention and control groups at endline. Compliance with IPC practices was observed in 8181 (56·9%) of 14 366 indications in intervention facilities and 8336 (54·7%) of 15 242 indications in control facilities (absolute difference 2·2 percentage points, 95% CI -0·2 to -4·7; p=0·071). Correct management occurred in 120 (27·0%) of 444 standardised patients in the intervention group and in 136 (29·2%) of 465 in the control group (absolute difference -2·8 percentage points, 95% CI -8·6 to -3·1; p=0·36). INTERPRETATION: SafeCare did not improve clinical quality as assessed by compliance with IPC practices and correct case management. The absence of effect on clinical quality could reflect a combination of insufficient intervention intensity, insufficient links between structural quality and care processes, scarcity of resources for quality improvement, and inadequate financial and regulatory incentives for improvement. FUNDING: UK Health Systems Research Initiative (Medical Research Council, Economic and Social Research Council, UK Department for International Development, Global Challenges Research Fund, and Wellcome Trust).


Assuntos
Certificação , Instalações de Saúde/normas , Controle de Infecções/normas , Melhoria de Qualidade/organização & administração , Qualidade da Assistência à Saúde/estatística & dados numéricos , Organizações Religiosas , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Guias de Prática Clínica como Assunto , Setor Privado , Avaliação de Programas e Projetos de Saúde , Tanzânia
14.
Glob Health Action ; 14(1): 1927507, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34340643

RESUMO

BACKGROUND: Stroke causes great suffering and severe disability worldwide, and rehabilitation following a stroke seeks to restore lost functions. The extent to which stroke patients get access to rehabilitation in Tanzania is not well estimated, and drawing a current picture of the rehabilitation services for these persons is the first step in developing a more effective rehabilitation model in the country. OBJECTIVE: The objective of this study was to establish the characteristics of stroke and its rehabilitation at the Kilimanjaro Christian Medical Centre (KCMC), a consultant referral hospital in northern Tanzania. METHODS: This was a records-based descriptive study in which demographic, clinical, and rehabilitation information of stroke patients admitted to the KCMC between January 2012 and December 2015 was collected and audited. The means, percentages, and proportions were used to summarise the demographic, clinical, and rehabilitation patterns using SPSS version 24.0 software. The chi-squared statistic was used to examine the relationships between categorical variables, and a p-value<0.05 was considered statistically significant. RESULTS: Of the 17,975 patients admitted to the KCMC during the period of the study, 753 (4.2%) had suffered a stroke, with a mean age of 68.8 ± 16.4 years. The predominant cause of stroke was hypertension, which accounted for 546 (72.5%) patients. A total of 357 (47.4%) patients had various forms of rehabilitation during the admission to hospital. Following a discharge home 240 (31.9%) patients did not return to the hospital for the continuation of rehabilitation. CONCLUSION: Stroke patients at the KCMC lack access to rehabilitation therapies. Insufficient access to rehabilitation therapies may warrant the need to explore alternative approaches such as tele-rehabilitation technologies in Tanzania.


Assuntos
Hipertensão , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Hospitalização , Humanos , Pessoa de Meia-Idade , Encaminhamento e Consulta , Acidente Vascular Cerebral/epidemiologia , Tanzânia/epidemiologia
15.
Front Public Health ; 9: 604058, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34336749

RESUMO

Background: Pregnant women are vulnerable to iron deficiency due to the fact that more iron is needed primarily to supply the growing fetus and placenta and to increase the maternal red cell mass. Little is known on the factors associated with uptake of iron supplement during pregnancy. Methods: The study used data from the 2015 to 2016 Tanzania Demographic and Health Survey and Malaria Indicators Survey. A total of 6,924 women of active reproductive age from 15 to 49 were included in the analysis. Both univariate and multiple regression analyses were used to determine factors associated with uptake of iron supplement during pregnancy. Results: Majority of the interviewed women 5,648 (81.6%) always took iron supplement during pregnancy, while a total of 1,276 (18.4%) women never took iron supplement during pregnancy. After controlling for confounders, the predictors for uptake of iron supplement during pregnancy were early antenatal booking (adjusted odds ratio, AOR = 1.603 at 95% CI = 1.362-1.887, p < 0.001); rural residence (AOR = 0.711 at 95% CI = 0.159-0.526, p = 0.007); wealth index [rich (AOR = 1.188 at 95% CI = 0.986-1.432, p = 0.07)]-poor was the reference population; level of education [primary education (AOR = 1.187 at 95% CI = 1.013-1.391, p = 0.034)]-no formal education was the reference population; parity [para 2 to 4 (AOR = 0.807 at 95% CI = 0.668-0.974, p = 0.026), para 5 and above (AOR = 0.75 at 95% CI = 0.592-0.95, p = 0.017)], para 1 was the reference population; zones [mainland rural (AOR = 0.593 at 95% CI = 0.389-0.905, p = 0.015) and Unguja Island AOR = 0.63 at 95% CI = 0.431-0.92, p = 0.017]-mainland urban was the reference population; and current working status [working (AOR = 0.807 at 95% CI = 0.687-0.949, p = 0.009)]. Conclusion: The study revealed that, despite free access to iron supplement during pregnancy, there are women who fail to access the supplement at least once throughout the pregnancy. The likelihood to fail to access iron supplement during pregnancy was common among pregnant women who initiated antenatal visits late, were from poor families, had no formal education, reside in rural settings, had high parity, were from mainland rural, and were in working status. Interventional studies are recommended in order to come up with effective strategies to increase the uptake of iron supplement during pregnancy.


Assuntos
Ferro , Malária , Estudos Transversais , Demografia , Feminino , Humanos , Malária/tratamento farmacológico , Paridade , Gravidez , Tanzânia/epidemiologia
16.
Reprod Health ; 18(1): 170, 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372864

RESUMO

BACKGROUND: The use of a decision aid in clinical settings has been beneficial. It informs and educates patients about the available treatment options that can help them reduce decision-making conflicts related to feeling uninformed compared with routine care. There is a scarcity of published data about using a decision aid during family planning counseling with postpartum women focusing on long-acting reversible contraception in Tanzania. Therefore, we developed a "postpartum Green Star family planning decision aid" and assessed its feasibility. The study outcomes were practicality, usefulness, and acceptability perceived by pregnant adolescents and nurses/midwives. METHODS: We used an exploratory qualitative in-depth interview involving six nurses/midwives with three or more years of experience in family planning services and 12 pregnant adolescents aged 15-19 years. Purposive sampling was used to select the participants, and selection relied on the saturation principle of data collection. We used a semi-structured interview guide translated into the Kiswahili language. Data were transcribed and analyzed following inductive content analysis. RESULTS: The amount of information presented was just right, with the time of reading the data ranging from 20 min to 1 h. The study participants perceived the flow of information to be good, with small significant changes suggested. Kiswahili language was used and reported to be appropriate and well elaborated. However, a few words were told to be rephrased to reduce ambiguity. The nurses/midwives said that the decision aid included most of the vital information the participants wanted to know during their family planning counseling. Pregnant adolescents stated that the decision aid improved their knowledge and provided new details on the long-acting reversible contraception methods (intrauterine copper devices and implants) offered immediately after childbirth. The participants stated that the decision aid addressed long-acting reversible contraception methods' benefits and side effects and dispelled myths and misconceptions. The study participants considered the decision aid helpful in complementing the family planning counseling offered and improving pregnant adolescents' knowledge. CONCLUSION: The postpartum Green Star family planning decision aid was practical, useful, and acceptable in enhancing the objectivity of counseling about long-acting reversible contraception methods. It improved the knowledge of pregnant adolescents in Tanzania about the available contraception methods (i.e., the use of intrauterine copper devices and implants), which can be immediately used postpartum. Further research is needed to assess the effects of the decision aid on long-acting reversible contraception postpartum uptake among pregnant adolescents in Tanzania.


Assuntos
Serviços de Planejamento Familiar , Período Pós-Parto , Adolescente , Anticoncepção , Técnicas de Apoio para a Decisão , Estudos de Viabilidade , Feminino , Humanos , Gravidez , Tanzânia
17.
BMJ Open ; 11(8): e046125, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34446483

RESUMO

INTRODUCTION: Leprosy, or Hansen's disease, remains a cause of preventable disability. Early detection, treatment and prevention are key to reducing transmission. Post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) reduces the risk of developing leprosy when administered to screened contacts of patients. This has been adopted in the WHO leprosy guidelines. The PEP4LEP study aims to determine the most effective and feasible method of screening people at risk of developing leprosy and administering chemoprophylaxis to contribute to interrupting transmission. METHODS AND ANALYSIS: PEP4LEP is a cluster-randomised implementation trial comparing two interventions of integrated skin screening combined with SDR-PEP distribution to contacts of patients with leprosy in Ethiopia, Mozambique and Tanzania. One intervention is community-based, using skin camps to screen approximately 100 community contacts per leprosy patient, and to administer SDR-PEP when eligible. The other intervention is health centre-based, inviting household contacts of leprosy patients to be screened in a local health centre and subsequently receive SDR-PEP when eligible. The mobile health (mHealth) tool SkinApp will support health workers' capacity in integrated skin screening. The effectiveness of both interventions will be compared by assessing the rate of patients with leprosy detected and case detection delay in months, as well as feasibility in terms of cost-effectiveness and acceptability. ETHICS AND DISSEMINATION: Ethical approval was obtained from the national ethical committees of Ethiopia (MoSHE), Mozambique (CNBS) and Tanzania (NIMR/MoHCDEC). Study results will be published open access in peer-reviewed journals, providing evidence for the implementation of innovative leprosy screening methods and chemoprophylaxis to policymakers. TRIAL REGISTRATION NUMBER: NL7294 (NTR7503).


Assuntos
Hanseníase , Etiópia , Estudos de Viabilidade , Humanos , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Hanseníase/prevenção & controle , Moçambique , Tanzânia
18.
BMJ Open ; 11(8): e050881, 2021 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433607

RESUMO

INTRODUCTION: Critical care is essential in saving lives of those that are critically ill, however, provision of critical care can be costly and heterogeneous across lower-resource settings. This paper describes the protocol for a systematic review of the literature that aims to identify the reported costs and resources available for the provision of critical care and the forms of critical care provision in Tanzania. METHODS AND ANALYSIS: The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (MEDLINE, Embase and Global Health) will be searched to identify articles that report the forms of critical care, resources used in the provision of critical care in Tanzania, their availability and the associated costs. The search strategy will be developed from four key concepts; critical care provision, critical illness, resource use, Tanzania. The articles that fulfil the inclusion and exclusion criteria will be assessed for quality using the Reference Case for Estimating the Costs of Global Health Services and Interventions checklist. The extracted data will be summarised using descriptive statistics including frequencies, mean and median of the quantity and costs of resources used in the components of critical care services, depending on the data availability. This study will be carried out between February and November 2021. ETHICS AND DISSEMINATION: This study is a review of secondary data and ethical clearance was sought from and granted by the Tanzanian National Institute of Medical Research (reference: NIMR/HQ/R.8a/Vol. IX/3537) and London School of Hygiene and Tropical Medicine (ethics ref: 22866). We will publish the review in a peer-reviewed journal as an open access article in addition to presenting the findings at conferences and public scientific gatherings. PROSPERO REGISTRATION NUMBER: The protocol was registered with PROSPERO; registration number: CRD42020221923.


Assuntos
Cuidados Críticos , Projetos de Pesquisa , Estado Terminal/terapia , Humanos , Londres , Literatura de Revisão como Assunto , Tanzânia
19.
Trop Anim Health Prod ; 53(4): 438, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34402985

RESUMO

Several African swine fever (ASF) outbreaks in domestic pigs have been reported in Burundi and Malawi and whole-genome sequences of circulating outbreak viruses in these countries are limited. In the present study, complete genome sequences of ASF viruses (ASFV) that caused the 2018 outbreak in Burundi (BUR/18/Rutana) and the 2019 outbreak in Malawi (MAL/19/Karonga) were produced using Illumina next-generation sequencing (NGS) platform and compared with other previously described ASFV complete genomes. The complete nucleotide sequences of BUR/18/Rutana and MAL/19/Karonga were 176,564 and 183,325 base pairs long with GC content of 38.62 and 38.48%, respectively. The MAL/19/Karonga virus had a total of 186 open reading frames (ORFs) while the BUR/18/Rutana strain had 151 ORFs. After comparative genomic analysis, the MAL/19/Karonga virus showed greater than 99% nucleotide identity with other complete nucleotides sequences of p72 genotype II viruses previously described in Tanzania, Europe and Asia including the Georgia 2007/1 isolate. The Burundian ASFV BUR/18/Rutana exhibited 98.95 to 99.34% nucleotide identity with genotype X ASFV previously described in Kenya and in Democratic Republic of the Congo (DRC). The serotyping results classified the BUR/18/Rutana and MAL/19/Karonga ASFV strains in serogroups 7 and 8, respectively. The results of this study provide insight into the genetic structure and antigenic diversity of ASFV strains circulating in Burundi and Malawi. This is important in order to understand the transmission dynamics and genetic evolution of ASFV in eastern Africa, with an ultimate goal of designing an efficient risk management strategy against ASF transboundary spread.


Assuntos
Vírus da Febre Suína Africana , Febre Suína Africana , Doenças dos Suínos , Febre Suína Africana/epidemiologia , Vírus da Febre Suína Africana/genética , Animais , Burundi/epidemiologia , Surtos de Doenças/veterinária , Malaui/epidemiologia , Filogenia , Sus scrofa , Suínos , Tanzânia
20.
AIDS Res Ther ; 18(1): 55, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34446039

RESUMO

BACKGROUND: For over a decade, antiretroviral therapy (ART) in resource-limited countries was only recommended for patients with advanced HIV disease. We investigated this group of patients in order to determine any relationship between degree of immunosuppression during treatment initiation and the subsequent levels of inflammatory biomarkers, reservoir size and plasma marker of fungal translocation after achieving long-term virological control. METHODS: We analyzed 115 virally suppressed (female 83.5%) and 40 untreated (female 70%) subjects from Dar es Salaam, Tanzania. The size of HIV latent reservoir (proviral DNA copy) was determined using quantitative PCR. Inflammatory biomarkers; IL-6, IL-10, and soluble CD14 (sCD14), were measured using multiplex cytometric beads array. Antibody titers for Cytomegalovirus (CMV) and Epstein Barr virus (EBV), plasma level of 1-3-beta-D-Glucan (BDG) was measured using ELISA. High-sensitivity C-reactive protein (hsCRP) was measured using nephelometric method. RESULTS: The median age was 36 (IQR 32-44) and 47 (IQR 43-54) years in untreated and virally suppressed patients respectively. Median duration of treatment for virally suppressed patients was 9 years (IQR 7-12) and median baseline CD4 count was 147 cells/mm3 (IQR 65-217). Virally suppressed patients were associated with significantly lower plasma levels of IL-10, sCD14 and BDG (P < 0.05) when compared to untreated patients. However, plasma level of IL-6 was similar between the groups. Baseline advanced level of immunosuppression (CD4 < 100cells/cm3) was associated with significantly higher plasma level of IL-6 (P = 0.02), hsCRP (P = 0.036) and BDG (P = 0.0107). This relationship was not seen in plasma levels of other tested markers. Degree of baseline immunosuppression was not associated with the subsequent proviral DNA copy. In addition, plasma levels of inflammatory marker were not associated with sex, CMV or EBV antibody titers, treatment duration or regimen. CONCLUSIONS: Our data suggest that advanced immunosuppression at ART initiation is associated with severity of inflammation and elevated fungal translocation marker despite long term virological control. Further studies are needed to evaluate the potential increased burden of non-AIDS comorbidities that are linked to elevated inflammatory and fungal translocation markers as a result of the policy of HIV treatment at CD4 count < 200 cells/cm3 implemented for over a decade in Tanzania.


Assuntos
Infecções por Vírus Epstein-Barr , Infecções por HIV , Adulto , Biomarcadores , Feminino , Infecções por HIV/tratamento farmacológico , Herpesvirus Humano 4 , Humanos , Imunossupressão , Inflamação , Tanzânia
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