1
|
Mwita JC, Francis JM, Pillay C, Ogah OS, Goshu DY, Agyekum F, Musonda JM, James MC, Tefera E, Kabo T, Ditlhabolo KI, Ndlovu K, Ayodele AY, Mkomanga WP, Chillo P, Damasceno A, Folson AA, Oyekunle A, Tebuka E, Kalokola F, Forrest K, Dunn H, Karaye K, Jean-Pierre FL, Oljira CF, Tadesse TA, Taiwo TS, Nwafor CE, Omole O, Anakwue R, Cohen K. Anticoagulation control among patients on vitamin K antagonists in nine countries in Sub-Saharan Africa. J Thromb Thrombolysis 2024; 57:613-621. [PMID: 38478250 PMCID: PMC11026180 DOI: 10.1007/s11239-023-02928-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 04/19/2024]
Abstract
Vitamin K antagonists (VKA) is the primary anticoagulant in most settings of Sub-Saharan Africa. Understanding the quality of anticoagulation services in the continent is vital in optimising the intended benefits. This study assessed the quality of anticoagulation and associated factors among VKA-treated patients in nine SSA countries. We conducted a retrospective cohort study of randomly selected patients on anticoagulation from 20 clinics in Botswana, the Democratic Republic of Congo, Ethiopia, Gambia, Ghana, Mozambique, Nigeria, Tanzania, and South Africa. Eligible participants were those on VKAs for at least three months and with at least four international normalised ratios (INR) results in 2019-2021. We report the proportion of INR values in the therapeutic range, time-in-therapeutic range (TTR) using the Rosendaal method, and the proportion of patients with TTR ≥ 65% (optimal anticoagulation). The mean age was 51.1(16.1) years, and 64.2% were women. The most common indications for VKA included venous thromboembolism (29.6%), prosthetic valves (26.7%) and atrial fibrillation/flutter (30.1%). We analysed 6743 INR tests from 1011 participants, and of these, 48.5% were sub-therapeutic, 34.1% therapeutic, and 17.4% were supratherapeutic relative to disease-specific reference ranges. TTR was calculated for 660 patients using 4927 INR measurements. The median (interquartile range [IQR]) TTR was 35.8(15.9,57.2) %. Optimal anticoagulation control was evident in 19.2% of participants, varying from 2.7% in Tanzania to 23.1% in Ethiopia. The proportion of patients with TTR ≥ 65% was 15,4% for prosthetic heart valves, 21.1% for venous thromboembolism and 23.7% for atrial fibrillation or flutter. Countries with universal health coverage had higher odds of optimal anticoagulation control (adjusted odds ratio (aOR) 1.79, 95% confidence interval [CI], 1.15- 2.81, p = 0.01). Patients on VKAs for different therapeutic indications in SSA had suboptimal TTR. Universal health coverage increased the odds of achieving TTR by 79%. The evidence calls for more intensive warfarin management strategies in SSA, including providing VKA services without out-of-pocket payments.
Collapse
Affiliation(s)
- Julius Chacha Mwita
- Department of Internal Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana.
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chriselda Pillay
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Okechukwu S Ogah
- Cardiology Unit, Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
| | - Dejuma Yadeta Goshu
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Francis Agyekum
- Department of Medicine, College of Health Sciences, Korlebu Teaching Hospital, University of Ghana, Ghana, Ethiopia
| | - John Mukuka Musonda
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Endale Tefera
- Department of Paediatrics and Adolescent Health, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Tsie Kabo
- Department of Internal Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Keolebile Irene Ditlhabolo
- Department of Family Medicine and Primary Care School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kagiso Ndlovu
- Department of Computer Science, University of Botswana, Gaborone, Botswana
| | - Ayoola Yekeen Ayodele
- Cardiology Unit, Department of Medicine, Federal Teaching Hospital, Gombe, Gombe State, Nigeria
| | - Wigilya P Mkomanga
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Pilly Chillo
- Department of Internal Medicine, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | | | | | - Anthony Oyekunle
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Erius Tebuka
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | | | - Helena Dunn
- MRC Unit The Gambia at LSHTM, Fajara, The Gambia
| | - Kamilu Karaye
- Department of Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Fina Lubaki Jean-Pierre
- Department of Family Medicine and Primary Care, The Protestant University of Congo, Kinshasa, Democratic Republic of the Congo
| | - Chala Fekadu Oljira
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamirat Assefa Tadesse
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Chibuike E Nwafor
- The University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Olufemi Omole
- Department of Family Medicine and Primary Care School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Raphael Anakwue
- Departments of Medicine, Pharmacology/Therapeutics, The University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Karen Cohen
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
2
|
Kilonzi M, Mutagonda RF, Mwakawanga DL, Mlyuka HJ, Mikomangwa WP, Kibanga WA, Marealle AI, Mallya B, Katabalo D, Sanga S, Kalokola F, Rwegasha J, Magambo R, Mmassy J, Kabissi S, Balati JA, Maduki P, Minzi OM, Kamuhabwa AAR. Establishment of clinical pharmacy services: evidence-based information from stakeholders. Hum Resour Health 2024; 22:6. [PMID: 38200603 PMCID: PMC10782669 DOI: 10.1186/s12960-023-00887-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024]
Abstract
High morbidity and mortality related to the use of drugs resulted in demand for clinical pharmacy services (CPS) globally. In developed countries, the evolution of pharmacists' role in direct patient care started in the 1960s. The participation of pharmacists in CPS has resulted in positive clinical, economic, and humanistic outcomes. In developing countries, efforts have started to ensure pharmacists are engaged in the provision of CPS. However, the efforts are hampered by poorly defined pharmacist career paths, financial constraints, and a lack of political willingness. In Tanzania, efforts started in 2008, in which CPS was introduced into the Bachelor of Pharmacy curriculum, followed by the initiation of a postgraduate program on hospital and clinical pharmacy in 2013. A regulation was released by the Tanzania Ministry of Health in 2020 to enforce pharmacists' engagement in providing CPS. In 2021, a project was launched in the country, aiming to strengthen the provision of CPS in public and faith-based hospitals by training on-job pharmacists. The project was implemented in phases, including stakeholders' engagement, baseline survey, training, and supportive supervision of the trained pharmacists. Therefore, this commentary aims to share what we experienced during project implementation, the achievements, challenges, and key lessons learned.
Collapse
Affiliation(s)
- Manase Kilonzi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania.
| | - Ritah F Mutagonda
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Dorkasi L Mwakawanga
- School of Nursing, Muhimbili University of Health and Allied Sciences, P. O. BOX 65001, Dar es Salaam, Tanzania
| | - Hamu J Mlyuka
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Wema A Kibanga
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Alphonce Ignace Marealle
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Bertha Mallya
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Deogratias Katabalo
- School of Pharmacy, Catholic University of Health and Allied Sciences, P. O. BOX 1464, Mwanza, Tanzania
| | - Sofia Sanga
- Department of Internal Medicine, Muhimbili National Hospital, P. O. BOX 65000, Dar es Salaam, Tanzania
| | - Fredrick Kalokola
- School of Medicine, the Catholic University of Health and Allied Sciences, P. O. BOX 1464, Mwanza, Tanzania
| | - John Rwegasha
- Department of Internal Medicine, Muhimbili National Hospital, P. O. BOX 65000, Dar es Salaam, Tanzania
| | - Rose Magambo
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - John Mmassy
- Christian Social Services Commission, P.O. BOX 9433, Dar es Salaam, Tanzania
| | - Sungwa Kabissi
- Christian Social Services Commission, P.O. BOX 9433, Dar es Salaam, Tanzania
| | - Josephine A Balati
- Christian Social Services Commission, P.O. BOX 9433, Dar es Salaam, Tanzania
| | - Peter Maduki
- Christian Social Services Commission, P.O. BOX 9433, Dar es Salaam, Tanzania
| | - Omary Mashiku Minzi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Appolinary A R Kamuhabwa
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| |
Collapse
|
3
|
Matuja SS, Ngimbwa J, Andrew L, Shindika J, Nchasi G, Kasala A, Paul IK, Ndalahwa M, Mawazo A, Kalokola F, Ngoya P, Rudovick L, Kilonzo S, Wajanga B, Massaga F, Kalluvya SE, Munseri P, Mnacho MA, Okeng'o K, Kimambo H, Manji M, Ruggajo P, Nagu T, Ahmed RA, Sheriff F, Mahawish K, Mangat H, Nguyen-Huynh MN, Saylor D, Peck R. Stroke characteristics and outcomes in urban Tanzania: Data from the Prospective Lake Zone Stroke Registry. Int J Stroke 2023:17474930231219584. [PMID: 38031727 DOI: 10.1177/17474930231219584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND Stroke is a second leading cause of death globally, with an estimated one in four adults suffering a stroke in their lifetime. We aimed to describe the clinical characteristics, quality of care, and outcomes in adults with stroke in urban Northwestern Tanzania. METHODS We analyzed de-identified data from a prospective stroke registry from Bugando Medical Centre in Mwanza, the second largest city in Tanzania, between March 2020 and October 2022. This registry included all adults ⩾18 years admitted to our hospital who met the World Health Organization clinical definition of stroke. Information collected included demographics, risk factors, stroke severity using the National Institutes of Health Stroke Scale, brain imaging, indicators for quality of care, discharge modified Rankin Scale, and in-hospital mortality. We examined independent factors associated with mortality using logistic regression. RESULTS The cohort included 566 adults, of which 52% (294) were female with a mean age of 65 ± 15 years. The majority had a first-ever stroke 88% (498). Premorbid hypertension was present in 86% (488) but only 41% (200) were taking antihypertensive medications before hospital admission; 6% (32) had HIV infection. Ischemic strokes accounted for 66% (371) but only 6% (22) arriving within 4.5 h of symptom onset. In-hospital mortality was 29% (127). Independent factors associated with mortality were severe stroke (adjusted odds ratio (aOR) = 1.81, 95% confidence interval (CI) = 1.47-2.24, p < 0.001), moderate to severe stroke (aOR = 1.49, 95% CI = 1.22-1.84, p < 0.001), moderate stroke (aOR = 1.80, 95% CI = 1.52-2.14, p < 0.001), leukocytosis (aOR = 1.19, 95% CI = 1.03-1.38, p = 0.022), lack of health insurance coverage (aOR = 1.15, 95% CI = 1.02-1.29, p = 0.025), and not receiving any form of venous thromboembolism prophylaxis (aOR = 1.18, 95% CI = 1.02-1.37, p = 0.027). CONCLUSION We report a stroke cohort with poor in-hospital outcomes in urban Northwestern Tanzania. Early diagnosis and treatment of hypertension could prevent stroke in this region. More work is needed to raise awareness about stroke symptoms and to ensure that people with stroke receive guidelines-directed therapy.
Collapse
Affiliation(s)
- Sarah Shali Matuja
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Joshua Ngimbwa
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Lilian Andrew
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Jemima Shindika
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Goodluck Nchasi
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Anna Kasala
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Innocent Kitandu Paul
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mary Ndalahwa
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Akili Mawazo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Patrick Ngoya
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Ladius Rudovick
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Semvua Kilonzo
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Bahati Wajanga
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Fabian Massaga
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Samuel E Kalluvya
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mohamed A Mnacho
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Kigocha Okeng'o
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Henrika Kimambo
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Mohamed Manji
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paschal Ruggajo
- Department of Curative Services, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Tumaini Nagu
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Rashid Ali Ahmed
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Faheem Sheriff
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Karim Mahawish
- Stroke Medicine Department, Counties Manukau Health, Auckland, New Zealand
| | - Halinder Mangat
- Division of Neurocritical Care, Department of Neurology, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Mai N Nguyen-Huynh
- Division of Research, The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Robert Peck
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
4
|
Mhagama D, Kilonzi M, Kunambi P, Buma D, Kalokola F, Ruggajo P, Mutagonda RF. Pharmacological management of hypertension and outcome among patients on hemodialysis at Muhimbili National Hospital, Tanzania: a cross-sectional study. Pan Afr Med J 2023; 46:67. [PMID: 38282776 PMCID: PMC10822098 DOI: 10.11604/pamj.2023.46.67.39778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/10/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction hypertension is prevalent among patients attending hemodialysis. However, published information on hypertension management among patients on hemodialysis in African countries is scarce. This study assessed antihypertensive medication prescribing patterns and blood pressure control among patients with hypertension on hemodialysis in Tanzania. Methods an analytical cross-sectional study was conducted at Muhimbili National Hospital in Dar es Salaam from April to June 2022. The study population consisted of patients with hypertension undergoing hemodialysis. Data on demographic, clinical characteristics and the antihypertensive medications used by the patients was collected using a structured questionnaire. Analysis was performed using Statistical Package for the Social Sciences software version 26. Uncontrolled pre-dialysis blood pressure determinants were assessed using a modified Poisson regression model. A p-value < 0.05 was considered statistically significant. Results out of 314 participants, the majority (68.2%, n= 214) were male, and the median age was 52 (interquartile range: 42, 60) years. Only 16.9% (n= 53) of patients had their pre-dialysis blood pressure controlled. The most frequent antihypertensive medications prescribed were calcium channel blockers (73.2%, n= 230). Patients with less than three dialysis sessions were 20% more likely to have uncontrolled blood pressure than those with three sessions in a week (adjusted prevalence ratio = 1.2). Conclusion most patients on hemodialysis with hypertension had poor blood pressure control, according to the study. Patients with hypertension should be strongly encouraged to adhere to at least three hemodialysis treatments to achieve optimal blood pressure control.
Collapse
Affiliation(s)
- Devis Mhagama
- Dodoma Christian Medical Center Trust, Dodoma, Tanzania
| | - Manase Kilonzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Peter Kunambi
- Department of Clinical Pharmacology, School of Biomedical Sciences, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deus Buma
- Department of Pharmacy, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Paschal Ruggajo
- Directorate of Curative Services, Ministry of Health, Dodoma, Tanzania
| | - Ritah Francis Mutagonda
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| |
Collapse
|
5
|
Kisigo GA, Mgeta F, Mcharo O, Okello E, Wajanga B, Kalokola F, Mtui G, Sundararajan R, Peck RN. Peer Counselor Intervention for Reducing Mortality and/or Hospitalization in Adults With Hypertensive Urgency in Tanzania: A Pilot Study. Am J Hypertens 2023; 36:446-454. [PMID: 37086189 PMCID: PMC10345467 DOI: 10.1093/ajh/hpad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/27/2023] [Accepted: 04/19/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Worldwide, people with hypertensive urgency experience high rates of hospitalization and death due to medication non-adherence. Interventions to improve medication adherence and health outcomes after hypertensive urgency are urgently needed. METHODS This prospective cohort assessed the effect of a peer counselor intervention-named Rafiki mwenye msaada-on the 1-year incidence of hospitalization and/or death among adults with hypertensive urgency in Mwanza, Tanzania. We enrolled 50 patients who presented with hypertensive urgency to 2 hospitals in Mwanza, Tanzania. All 50 patients received a Rafiki mwenye msaada an individual-level, time-limited case management intervention. Rafiki mwenye msaada aims to empower adult patients with hypertensive urgency to manage their high blood pressure. It consists of 5 sessions delivered over 3 months by a peer counselor. Outcomes were compared to historical controls. RESULTS Of the 50 patients (median age, 61 years), 34 (68%) were female, and 19 (38%) were overweight. In comparison to the historical controls, the intervention cohort had a significantly lower proportion of patients with a secondary level of education (22% vs. 35%) and health insurance (40% vs. 87%). Nonetheless, the 1-year cumulative incidence of hospitalization and/or death was 18% in the intervention cohort vs. 35% in the control cohort (adjusted Hazard Ratio, 0.48, 95% CI 0.24-0.97; P = 0.041). Compared to historical controls, intervention participants maintained higher rates of medication use and clinic attendance at both 3- and 6-months but not at 12 months. Of intervention participants who survived and remained in follow-up, >90% reported good medication adherence at all follow-up time points. CONCLUSION Our findings support the hypothesis that a peer counselor intervention may improve health outcomes among adults living with hypertensive urgency. A randomized clinical trial is needed to evaluate the intervention's effectiveness.
Collapse
Affiliation(s)
- Godfrey A Kisigo
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Frank Mgeta
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Onike Mcharo
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Elialilia Okello
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Bahati Wajanga
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Graham Mtui
- Department of Internal Medicine, Sekou Touré Referral Regional Hospital, Mwanza, Tanzania
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Robert N Peck
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| |
Collapse
|
6
|
Matuja SS, Mlay G, Kalokola F, Ngoya P, Shindika J, Ahmed RA, Tumaini B, Khanbhai K, Mutta R, Manji M, Sheriff F, Mahawish K. PREDICTORS OF 30-DAY MORTALITY AMONG STROKE PATIENTS ADMITTED AT A TERTIARY TEACHING HOSPITAL IN NORTHWESTERN TANZANIA: A PROSPECTIVE COHORT STUDY. J Stroke Cerebrovasc Dis 2023. [DOI: 10.1016/j.jstrokecerebrovasdis.2023.107007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
|
7
|
Kilonzi M, Mutagonda RF, Mlyuka HJ, Mwakawanga DL, Mikomangwa WP, Kibanga WA, Marealle AI, Mallya B, Katabalo D, Sanga S, Kalokola F, Rwegasha J, Magambo R, Mmassy J, Kabissi S, Balati JA, Maduki P, OmaryMashikuMinzi, Kamuhabwa AAR. Barriers and facilitators of integration of pharmacists in the provision of clinical pharmacy services in Tanzania. BMC Prim Care 2023; 24:72. [PMID: 36932338 PMCID: PMC10021921 DOI: 10.1186/s12875-023-02026-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/02/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Collaboration between medical doctors and nurses in the provision of healthcare services has been there for decades. The concept of clinical pharmacy services as a main goal for pharmacy practice is relatively new and is yielding more positive results for healthcare providers (HCPs), patients, and the health system. This study assessed barriers and facilitators toward the integration of pharmacists in the provision of CPS in Tanzania. METHODS A qualitative study was conducted in five tertiary hospitals representing Tanzania mainland. Ten (10) focus group discussions (FGDs) with 83 HCPs and 14 in-depth interviews (IDIs) with hospital administrators in referral hospitals were conducted between August and September 2021. The experienced qualitative researchers moderated the IDIs and FGDs, and all discussions were audio-recorded. Finally, the audios were transcribed verbatim, and analysis was done using a thematic approach. RESULTS Limited skills, lack of confidence, poor communication, inferiority, and superiority behaviors among HCPs were among the mentioned barriers. Shortage of pharmacists, lack of in-job training, standard operating procedures (SOPs), and guidelines were also mentioned. The study noted the high acceptability of CPS by other HCPs, the positive perception of pharmacists, and the recognition of CPS by the Tanzania Pharmacy Act and regulation. CONCLUSION The facilitators and barriers to the integration of pharmacists in the provision of CPS lie at the individual, health facility, and health system levels. Therefore, the study recommends in-job pharmacists training, fostering teamwork among HCPs, and development of CPS SoPs, and guidelines.
Collapse
Affiliation(s)
- Manase Kilonzi
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania.
| | - Ritah F Mutagonda
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - Hamu J Mlyuka
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - Dorkasi L Mwakawanga
- School of Nursing, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65001, Dar Es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - Wema A Kibanga
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - Alphonce Ignace Marealle
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - Bertha Mallya
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - Deogratias Katabalo
- School of Pharmacy, the Catholic University of Health and Allied Sciences, P. O. BOX 1464, Mwanza, Tanzania
| | - Sofia Sanga
- Department of Internal Medicine, Muhimbili National Hospital, P. O. BOX 65000, Dar Es Salaam, Tanzania
| | - Fredrick Kalokola
- School of Medicine, the Catholic University of Health and Allied Sciences, P. O. BOX 1464, Mwanza, Tanzania
| | - John Rwegasha
- Department of Internal Medicine, Muhimbili National Hospital, P. O. BOX 65000, Dar Es Salaam, Tanzania
| | - Rose Magambo
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - John Mmassy
- Christian Social Services Commission (CSSC), P.O BOX 9433, Dar Es Salaam, Tanzania
| | - Sungwa Kabissi
- Christian Social Services Commission (CSSC), P.O BOX 9433, Dar Es Salaam, Tanzania
| | - Josephine A Balati
- Christian Social Services Commission (CSSC), P.O BOX 9433, Dar Es Salaam, Tanzania
| | - Peter Maduki
- Christian Social Services Commission (CSSC), P.O BOX 9433, Dar Es Salaam, Tanzania
| | - OmaryMashikuMinzi
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - Appolinary A R Kamuhabwa
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| |
Collapse
|
8
|
Pham K, Mertelsmann A, Mages K, Kingery JR, Mazigo HD, Jaka H, Kalokola F, Changalucha JM, Kapiga S, Peck RN, Downs JA. Effects of helminths and anthelmintic treatment on cardiometabolic diseases and risk factors: A systematic review. PLoS Negl Trop Dis 2023; 17:e0011022. [PMID: 36827239 PMCID: PMC9956023 DOI: 10.1371/journal.pntd.0011022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/12/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Globally, helminth infections and cardiometabolic diseases often overlap in populations and individuals. Neither the causal relationship between helminth infections and cardiometabolic diseases nor the effect of helminth eradication on cardiometabolic risk have been reviewed systematically in a large number of human and animal studies. METHODS We conducted a systematic review assessing the reported effects of helminth infections and anthelmintic treatment on the development and/or severity of cardiometabolic diseases and risk factors. The search was limited to the most prevalent human helminths worldwide. This study followed PRISMA guidelines and was registered prospectively in PROSPERO (CRD42021228610). Searches were performed on December 10, 2020 and rerun on March 2, 2022 using Ovid MEDLINE ALL (1946 to March 2, 2022), Web of Science, Cochrane Library, Global Index Medicus, and Ovid Embase (1974 to March 2, 2022). Randomized clinical trials, cohort, cross-sectional, case-control, and animal studies were included. Two reviewers performed screening independently. RESULTS Eighty-four animal and human studies were included in the final analysis. Most studies reported on lipids (45), metabolic syndrome (38), and diabetes (30), with fewer on blood pressure (18), atherosclerotic cardiovascular disease (11), high-sensitivity C-reactive protein (hsCRP, 5), and non-atherosclerotic cardiovascular disease (4). Fifteen different helminth infections were represented. On average, helminth-infected participants had less dyslipidemia, metabolic syndrome, diabetes, and atherosclerotic cardiovascular disease. Eleven studies examined anthelmintic treatment, of which 9 (82%) reported post-treatment increases in dyslipidemia, metabolic syndrome, and diabetes or glucose levels. Results from animal and human studies were generally consistent. No consistent effects of helminth infections on blood pressure, hsCRP, or cardiac function were reported except some trends towards association of schistosome infection with lower blood pressure. The vast majority of evidence linking helminth infections to lower cardiometabolic diseases was reported in those with schistosome infections. CONCLUSIONS Helminth infections may offer protection against dyslipidemia, metabolic syndrome, diabetes, and atherosclerotic cardiovascular disease. This protection may lessen after anthelmintic treatment. Our findings highlight the need for mechanistic trials to determine the pathways linking helminth infections with cardiometabolic diseases. Such studies could have implications for helminth eradication campaigns and could generate new strategies to address the global challenge of cardiometabolic diseases.
Collapse
Affiliation(s)
- Khanh Pham
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, United States of America
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
| | - Anna Mertelsmann
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, United States of America
| | - Keith Mages
- Samuel J. Wood Library, Weill Cornell Medicine, New York, New York, United States of America
| | - Justin R. Kingery
- Department of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Humphrey D. Mazigo
- Department of Parasitology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Hyasinta Jaka
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Internal Medicine, Mwanza College of Health and Allied Sciences, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | | | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Robert N. Peck
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Jennifer A. Downs
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| |
Collapse
|
9
|
Matuja SS, Mlay G, Kalokola F, Ngoya P, Shindika J, Andrew L, Ngimbwa J, Ahmed RA, Tumaini B, Khanbhai K, Mutagaywa R, Manji M, Sheriff F, Mahawish K. Predictors of 30-day mortality among patients with stroke admitted at a tertiary teaching hospital in Northwestern Tanzania: A prospective cohort study. Front Neurol 2023; 13:1100477. [PMID: 36742055 PMCID: PMC9889987 DOI: 10.3389/fneur.2022.1100477] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
Background Stroke is the second leading cause of death worldwide, with the highest mortality rates in low- to middle-income countries, particularly in sub-Saharan Africa. We aimed to investigate the predictors of 30-day mortality among patients with stroke admitted at a tertiary teaching hospital in Northwestern Tanzania. Methods This cohort study recruited patients with the World Health Organization's clinical definition of stroke. Data were collected on baseline characteristics, the degree of neurological impairment at admission (measured using the National Institutes of Health Stroke Scale), imaging and electrocardiogram (ECG) findings, and post-stroke complications. The modified Rankin scale (mRS) was used to assess stroke outcomes. Kaplan-Meier analysis was used to describe survival, and the Cox proportional hazards model was used to examine predictors of mortality. Results A total of 135 patients were enrolled, with a mean age of 64.5 years. Hypertension was observed in 76%, and 20% were on regular anti-hypertensive medications. The overall 30-day mortality rate was 37%. Comparing patients with hemorrhagic and ischemic stroke, 25% had died by day 5 [25th percentile survival time (in days): 5 (95% CI: 2-14)] versus day 23 [25th percentile survival time (in days): 23 (95% CI: 11-30) (log-rank p < 0.001)], respectively. Aspiration pneumonia was the most common medical complication, occurring in 41.3% of patients. ECG abnormalities were observed in 54.6 and 46.9% of patients with hemorrhagic and ischemic stroke, respectively. The most common patterns were as follows: ST changes 29.6 vs. 30.9%, T-wave inversion 34.1 vs. 38.3%, and U-waves 18.2 vs. 1.2% in hemorrhagic and ischemic stroke, respectively. Independent predictors for case mortality were as follows: mRS score at presentation (4-5) [aHR 5.50 (95% CI: 2.02-15.04)], aspiration pneumonia [aHR 3.69 (95% CI: 1.71-13.69)], ECG abnormalities [aHR 2.28 (95% CI: 1.86-5.86)], and baseline stroke severity [aHR 1.09 (95% CI: 1.02-1.17)]. Conclusion Stroke is associated with a high 30-day mortality rate in Northwestern Tanzania. Concerted efforts are warranted in managing patients with stroke, with particular attention to individuals with severe strokes, ECG abnormalities, and swallowing difficulties to reduce early morbidity and mortality.
Collapse
Affiliation(s)
- Sarah Shali Matuja
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania,*Correspondence: Sarah Shali Matuja ✉
| | - Gilbert Mlay
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania,Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Patrick Ngoya
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Jemima Shindika
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Lilian Andrew
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Joshua Ngimbwa
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Rashid Ali Ahmed
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Basil Tumaini
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Khuzeima Khanbhai
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Reuben Mutagaywa
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mohamed Manji
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Faheem Sheriff
- Department of Neurology, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, United States
| | - Karim Mahawish
- Stroke Medicine Department, Counties Manukau Health, Auckland, New Zealand
| |
Collapse
|
10
|
Chen Y, Alphonce E, Mujuni E, Kisigo GA, Kingery JR, Makubi A, Peck RN, Kalokola F. Atrial fibrillation and mortality in outpatients with heart failure in Tanzania: a prospective cohort study. BMJ Open 2022; 12:e058200. [PMID: 35046009 PMCID: PMC8772409 DOI: 10.1136/bmjopen-2021-058200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE In recent years, the prevalence and mortality of heart failure (HF) and other associated cardiovascular diseases have doubled in sub-Saharan Africa (SSA). Studies in high-income countries indicate that HF with concurrent atrial fibrillation (AF) is linked to increased mortality. Our objective was to determine the incidence and clinical outcomes of AF among patients with HF in SSA. DESIGN A prospective cohort study using data collected between October 2018 and May 2020. SETTING Outpatient clinic at a tertiary hospital in Mwanza, Tanzania. PARTICIPANTS 303 adult participants (aged ≥18 years) with HF as defined by the European Society of Cardiology guidelines (2016) and 100 adults with HF as defined by clinical criteria alone were enrolled into the study. Patients with comorbid medical condition that had prognosis of <3 months (ie, advance solid tumours, advance haematological malignancies) were excluded. METHODS Participants were screened for AF, and their medical history, physical examinations and sociodemographic information were obtained. Multivariable logistic regression models were used to examine factors associated with AF incidence. Cox regression models were used to analyse 3-month mortality and its associated risk factors. RESULTS We enrolled 403 participants with HF (mean age 60±19 years, 234 (58%) female). The AF prevalence was 17%. In multivariable models, factors associated with AF were low income, alcohol consumption and longer duration of HF. At the end of the 3-month follow-up, 120 out of 403 (30%) participants died, including 44% (31/70) of those with AF. Higher heart rate on ECG, more severe New York Heart Association HF class, rural residence and anaemia were significantly correlated with mortality. CONCLUSION AF is common, underdiagnosed and is associated with significant mortality among outpatients with HF in Tanzania (HR 1.749, 95% CI 1.162 to 2.633, p=0.007). Our findings additionally identify tachycardia (>110 bpm, HR 1.879, 95% CI 1.508 to 2.340, p<0.001) as an easily measurable, high-impact physical examination finding for adverse outcomes in patients with HF.
Collapse
Affiliation(s)
- Yunchan Chen
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Emmanuel Alphonce
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Eva Mujuni
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Godfrey A Kisigo
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Justin R Kingery
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Abel Makubi
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Dar es Salaam, Tanzania, United Republic of
| | - R N Peck
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Fredrick Kalokola
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| |
Collapse
|
11
|
Lambert VJ, Kisigo GA, Nzali A, Laizer E, Paul N, Walshe L, Kalokola F, Okello ES, Sundararajan R, Mwakisole AH, Downs JA, Peck RN. Religious Leaders as Trusted Messengers in Combatting Hypertension in Rural Tanzanian Communities. Am J Hypertens 2021; 34:1042-1048. [PMID: 34022044 DOI: 10.1093/ajh/hpab080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hypertension is a growing public health emergency in rural sub-Saharan Africa. Based on the known influence of religious leaders in rural sub-Saharan Africa and our prior research, we explored perspectives of religious leaders on hypertension and potential strategies to improve hypertension control in their communities. METHODS We conducted 31 in-depth interviews with Christian (n = 17) and Muslim (n = 14) religious leaders in rural Tanzania. Interviews focused on religious leaders' perceptions of hypertension and how they could play a role in promoting blood pressure reduction. We used interpretative phenomenological analysis, a qualitative research method, to understand religious leaders' perspectives on, and experiences with, hypertension. RESULTS Three main themes emerged during analysis. First, we found that perceptions about causes, treatment, and complications of hypertension are influenced by religious beliefs. Second, religious beliefs can enable engagement with hypertension care through religious texts that support the use of biomedical care. Third, religious leaders are enthusiastic potential partners for promoting hypertension control in their communities. These themes were consistent between religion and gender of the religious leaders. CONCLUSIONS Religious leaders are eager to learn about hypertension, to share this knowledge with others and to contribute to improved health in their communities.
Collapse
Affiliation(s)
- Valencia J Lambert
- Center for Global Health, Weill Cornell Medicine , New York, New York , USA
| | - Godfrey A Kisigo
- Center for Global Health, Weill Cornell Medicine , New York, New York , USA
| | - Aneth Nzali
- Mwanza Christian College , Mwanza , Tanzania
| | | | - Ndalloh Paul
- Department of Medicine, Bugando Medical Centre , Mwanza , Tanzania
| | - Louise Walshe
- Center for Global Health, Weill Cornell Medicine , New York, New York , USA
| | | | - Elialilia S Okello
- Mwanza Intervention Trials Unit, National Institute for Medical Research , Mwanza , Tanzania
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine , New York, New York , USA
- Department of Emergency Medicine, Weill Cornell Medicine , New York, New York , USA
| | | | - Jennifer A Downs
- Center for Global Health, Weill Cornell Medicine , New York, New York , USA
- Department of Medicine, Bugando Medical Centre , Mwanza , Tanzania
| | - Robert N Peck
- Center for Global Health, Weill Cornell Medicine , New York, New York , USA
- Department of Medicine, Bugando Medical Centre , Mwanza , Tanzania
| |
Collapse
|
12
|
Kilonzo SB, Gunda DW, Majinge DC, Jaka H, Manyiri PM, Kalokola F, Mtui G, Shao ER, Bakshi FA, Stephano A. Seroprevalence of hepatitis B virus infection, anti-HCV antibodies and HIV and knowledge among people who use drugs attending methadone therapy clinic in Tanzania; a cross-sectional study. BMC Infect Dis 2021; 21:699. [PMID: 34289801 PMCID: PMC8296674 DOI: 10.1186/s12879-021-06393-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/07/2021] [Indexed: 12/24/2022] Open
Abstract
Background Methadone therapy clinics have been recently introduced in Tanzania, aiming at reducing risk behaviors and infection rates of viral hepatitis and HIV among people who use drugs. The objective of this study was to estimate the prevalence, associated factors and knowledge level of these conditions among people who use drugs attending a methadone clinic in Tanzania. Methods We enrolled 253 People who using drugs receiving Methadone therapy. Clinical data was retrospectively collected from the medical records and face-to face interviews were conducted to determine the behavioral risk factors and respondents’ knowledge on viral hepatitis and HIV. Results An overall seroprevalence of viral hepatitis (either hepatitis B surface antigen or anti-hepatitis C virus) was 6.3%, while that of hepatitis B virus mono infection was 3.5% and anti-hepatitis C antibodies was 3.5%. Seroprevalence of HIV was 12.6%. Viral hepatitis was strongly predicted by advanced age (> 35 years) (p = 0.02) and staying at Kirumba area (p = 0.004), and HIV infection was predicted by increased age (> 37 years) (p = 0.04) and female sex (p < 0.001). Regarding the knowledge of viral hepatitis, majority of the respondents were unaware of the transmission methods and availability of hepatitis B virus vaccines and only 17% were classified as well informed (provided ≥4 correct answers out of 7 questions). Good knowledge was highly predicted by higher education level of the individual (p = 0.001). Conclusions Despite the efforts to curb viral hepatitis and HIV infections through Methadone clinics, infection rates among people who use drugs are still high and the general knowledge on preventive measures is inadequate.
Collapse
Affiliation(s)
- Semvua B Kilonzo
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania. .,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania.
| | - Daniel W Gunda
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - David C Majinge
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - Hyasinta Jaka
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - Paulina M Manyiri
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - Grahame Mtui
- Department of Medicine, Sekou Toure Regional Referral Hospital, P.O Box 132, Mwanza, Tanzania
| | - Elichilia R Shao
- Department of Medicine Kilimanjaro Christian University College, P.O Box 2240, Moshi, Tanzania
| | - Fatma A Bakshi
- Department of Medicine, Aga Khan Hospital, P.O Box 2289, Dar es Salaam, Tanzania
| | - Alex Stephano
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania
| |
Collapse
|
13
|
Kingery JR, Goyal P, Hosalli R, Lee MH, Desderius B, Kalokola F, Makubi A, Fadhil S, Kapiga S, Karmali D, Kaminstein D, Devereux R, McNairy M, Johnson W, Fitzgerald D, Peck R. Human Immunodeficiency Virus-Associated Myocardial Diastolic Dysfunction and Soluble ST2 Concentration in Tanzanian Adults: A Cross-Sectional Study. J Infect Dis 2021; 223:83-93. [PMID: 32526008 PMCID: PMC7781450 DOI: 10.1093/infdis/jiaa328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/09/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aims of this study were (1) to compare the prevalence of myocardial diastolic dysfunction (DD) in antiretroviral therapy (ART)-naive people living with human immunodeficiency virus (PLWH) to human immunodeficiency virus (HIV)-uninfected adults in East Africa and (2) to determine the association between serum concentration of the cardiac biomarkers ST2 and DD. METHODS In this cross-sectional study, we enrolled PLWH and uninfected adults at a referral HIV clinic in Mwanza, Tanzania. Standardized history, echocardiography, and serum were obtained. Regression models were used to quantify associations. RESULTS We enrolled 388 ART-naive PLWH and 461 HIV-uninfected adults with an average age of 36.0 ± 10.2 years. Of PLWH in the third, fourth, and fifth decades of life, 5.0%, 12.5%, and 32.7%, respectively, had DD. PLWH had a higher prevalence of DD (adjusted odds ratio, 2.71 [95% confidence interval, 1.62-4.55]; P < .0001). PLWH also had a higher probability of dysfunction with one or fewer traditional risk factors present. Serum ST2 concentration was associated with dysfunction in PLWH but not uninfected participants (P = .04 and P = .90, respectively). CONCLUSIONS In a large population of young adults in sub-Saharan Africa, DD prevalence increased starting in the third decade of life. HIV was independently associated with dysfunction. Serum ST2 concentration was associated with DD in PLWH but not HIV-uninfected participants. This pathway may provide insight into the mechanisms of HIV-associated dysfunction.
Collapse
Affiliation(s)
- Justin R Kingery
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Parag Goyal
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- Division of Cardiovascular Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Rahul Hosalli
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Myung Hee Lee
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Bernard Desderius
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Abel Makubi
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Salama Fadhil
- Mwanza Intervention Trials Unit, London School of Hygiene and Tropical Medicine, Mwanza, Tanzania
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, London School of Hygiene and Tropical Medicine, Mwanza, Tanzania
| | - Dipan Karmali
- Division of General Internal Medicine, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Daniel Kaminstein
- Center for Ultrasound Education, Department of Emergency Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Richard Devereux
- Division of Cardiovascular Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Margaret McNairy
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Warren Johnson
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Daniel Fitzgerald
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Robert Peck
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, New York, USA
- Mwanza Intervention Trials Unit, London School of Hygiene and Tropical Medicine, Mwanza, Tanzania
| |
Collapse
|
14
|
Reis KG, Wilson R, Kalokola F, Wajanga B, Lee MH, Safford M, Peck RN. Hypertensive Urgency in Tanzanian Adults: A 1-Year Prospective Study. Am J Hypertens 2020; 33:1087-1091. [PMID: 32776154 DOI: 10.1093/ajh/hpaa129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/05/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hypertensive urgency is associated with a high risk for cardiovascular events and mortality in the United States and Europe, but data from low-income countries and interventions to improve outcomes are lacking. METHODS We conducted a 1-year prospective study of the prevalence and outcomes of hypertensive urgency (blood pressure (BP) ≥180 mm Hg/120 mm Hg without end-organ damage) in a busy outpatient clinic in Tanzania. RESULTS Of 7,600 consecutive adult outpatients screened with 3 unattended automated BP measurements according to standard protocol, the prevalence of hypertensive crisis was 199/7,600 (2.6%) (BP ≥180 mm Hg/120 mm Hg) and the prevalence of hypertensive urgency was 164/7,600 (2.2%). Among 150 enrolled patients with hypertensive urgency, median age was 62 years (54-68), 101 (67.3%) were women, and 53 (35%) were either hospitalized or died within 1 year. In a multivariate model, the strongest predictor of hospitalization/death was self-reported medication adherence on a 3 question scale (hazard ratio: 0.06, P < 0.001); 90% of participants with poor adherence were hospitalized or died within 1 year. CONCLUSIONS Patients with hypertensive urgency in Africa are at high risk of poor outcomes. Clinicians can identify the patients at highest risk for poor outcomes with simple questions related treatment adherence. New interventions are needed to improve medication adherence in patients with hypertensive urgency.
Collapse
Affiliation(s)
- Karl G Reis
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Mwanza Interventional Trials Unit (MITU), Mwanza, Tanzania
| | - Raymond Wilson
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Bahati Wajanga
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Myung-Hee Lee
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
| | - Monika Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Robert N Peck
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Mwanza Interventional Trials Unit (MITU), Mwanza, Tanzania
| |
Collapse
|
15
|
Kishimbo P, Sogone NM, Kalokola F, Mshana SE. Prevalence of gram negative bacteria causing community acquired pneumonia among adults in Mwanza City, Tanzania. Pneumonia (Nathan) 2020; 12:7. [PMID: 32775174 PMCID: PMC7409501 DOI: 10.1186/s41479-020-00069-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 06/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community acquired pneumonia (CAP) in adults is still a common and serious illness in the sub-Saharan Africa. Identification of the pathogens is crucial in the management of CAP. This study was done to determine the common bacterial pathogens, treatment outcomes and associated factors for microbiological confirmed CAP among adults attending the Bugando Medical Centre and Sekou Toure hospital in the city of Mwanza, Tanzania. METHODS This was a hospital based cross sectional study involving patients with community acquired pneumonia attending Bugando Medical Centre and Sekou Toure regional Hospital. Demographic and other data were collected using standardized data collection tool. Sputum culture was done followed by identification of the isolates and antibiotics susceptibility testing. RESULTS A total of 353 patients were enrolled in the study. Out of 353 sputum samples, 265(75%) were of good quality. Of 353 non-repetitive sputum cultures, 72/353 (20.4, 95% CI: 16.2-24.6) were positive for the bacterial pathogens with five patients having more than one pathogen. Good quality sputa had significantly higher yield of pathogenic bacteria than poor quality sputa (26.1% vs.3.4%, P = 0.001). The majority 64 (83.1%) of the isolates were gram negative bacteria. Common bacteria isolated were Klebsiella pneumoniae 23/77(29.9%), Streptococcus pyogenes 10/77 (13.0%), Pseudomonas aeruginosa 9/77 (11.7%) and Escherichia coli 7/77 (9.1%). Of 23 K. pneumoniae isolates, 20/23 (87.0%) were resistant to ceftriaxone. Resistance to ceftriaxone was found to be associated with prolongation of CAP symptoms (p = 0.009). CONCLUSION Gram negative bacteria resistant to ampicillin, amoxicillin/clavulanic acid and ceftriaxone were most frequently isolated bacteria among adults' patients with CAP attending BMC and Sekou Toure hospital. Routine sputum culture should be performed to guide appropriate treatment of CAP among adults in developing countries.
Collapse
Affiliation(s)
- Peter Kishimbo
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Nyambura Moremi Sogone
- National Health Laboratory Quality Assurance and Training Centre, Dar es Salaam, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Stephen E Mshana
- Department of Microbiology/Immunology, Weill Bugando School of Medicine, Mwanza, Tanzania
| |
Collapse
|
16
|
Kingery J, Damas E, Kalluvya S, Pirmohamed A, Goyal P, Hee Lee M, Kalokola F, Desdarius B, Peck R. Abstract 182: Left Ventricular Diastolic Dysfunction in HIV-infected ART-naive and HIV-negative Tanzanian Adults: A Cross-sectional Study. Circ Res 2019. [DOI: 10.1161/res.125.suppl_1.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
To compare the prevalence and associated factors of left ventricular diastolic dysfunction in HIV-infected, ART naïve and HIV-negative Tanzanian adults.
Methods:
A cross-sectional analysis of a longitudinal study including: 257 HIV-infected, ART naïve adults and 265 HIV-negative controls. Echocardiography and traditional risk factors were performed and determined by standard investigations. The primary outcome was prevalence of left ventricular diastolic dysfunction. Secondary outcomes were factors associated with and grade of dysfunction.
Results:
Compared to HIV-negative controls, HIV-infected, ART naïve adults had a 2-fold higher prevalence of diastolic dysfunction (OR=2.06 [1.16-3.66], p=0.01). Additionally, age, female sex, obesity and hypertension were significantly associated with dysfunction in HIV-negative adults; whereas, only age and hypertension were associated with dysfunction in HIV-infected adults. As compared to HIV-negative controls, significantly more HIV-infected, ART naïve adults had higher grade dysfunction (p=0.02) and more ventricular hypertrophy. HIV-infected adults with diastolic dysfunction also expressed higher levels of inflammatory cytokines including TNFa, IL6, IL8, IL33 and sST2 as compared to both HIV-negative and HIV-infected adults without dysfunction.
Conclusions:
HIV-infected Tanzanian adults have a 2-fold higher prevalence of left ventricular diastolic dysfunction in the period immediately following diagnosis and before ART initiation as compared to HIV-negative adults, and this dysfunction is of higher grade and is associated with myocardial hypertrophy. These data identify diastolic dysfunction in an international cohort in the immediate post-diagnosis, pre-ART period similar to that previously reported in the post-ART period in high-income countries. Additionally, traditional cardiovascular risk factors are not significantly associated with dysfunction in HIV-infected adults; however, cytokine patterns are present and may be important for risk stratification in this group. Therefore, studies delineating appropriate screening for this population are needed.
Collapse
Affiliation(s)
| | - Edmund Damas
- Weill Bugando Med Cntr, Mwanza, Tanzania, United Republic of
| | - Samuel Kalluvya
- Weill Bugando Med Cntr, Mwanza, Tanzania, United Republic of
| | | | | | | | | | | | | |
Collapse
|
17
|
Kilonzo SB, Gunda DW, Bakshi FA, Kalokola F, Mayala HA, Dadi H. Control of Hypertension among Diabetic Patients in a Referral Hospital in Tanzania: A Cross-Sectional Study. Ethiop J Health Sci 2018; 27:473-480. [PMID: 29217952 PMCID: PMC5615008 DOI: 10.4314/ejhs.v27i5.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Hypertension is common among diabetic patients. The co-existence of two conditions carries an excessive risk of severe complications and mortalities. Limited information exists on the determinants of poor hypertension control among these patients. We aimed at determining the prevalence and factors associated with poor hypertension control in these patients. Methods Data of diabetic patients who were also hypertensive attending an outpatient clinic from 1 August 2015 to 31 December 2015 at Bugando Medical Centre were retrospectively analyzed. Uncontrolled hypertension was defined as a blood pressure of ≥130mmHg and/or ≥80mmHg systolic and diastolic respectively. A designed questionnaire was used to collect data of patients. Continuous variables were summarized by median and interquartile ranges (IQR) and categorical variables were summarized by frequency and percentage. Logistic regression was used to find the predictors of uncontrolled hypertension. Results The majority of our study population were females, 161/295 (54.6%), and the median age was 57 years (IQR 50–64). The prevalence of hypertension was 206/295 (69.8%). A total of 174/206 (84.5%) patients had uncontrolled hypertension. This poor control was significantly associated with poor adherence to anti-hypertensives (OR 1.73[1.26–2.38] p=0.002), presence of any long-term complication (OR 3.19 [1.65–6.18] p=0.03) and overweight (BMI>24.9 Vs <24.9) (OR 1.68 [0.98–2.88], p=0.04). Under-prescription and ambiguous drugs combination was also observed. Conclusion The prevalence of poor hypertension control among diabetic patients in Tanzania is alarming. Most of the factors associated with this situation can be modified. The clinicians should advocate individualized management, continuous health education and adherence to the available guidelines.
Collapse
Affiliation(s)
- Semvua B Kilonzo
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza-Tanzania.,Department of Internal Medicine, Bugando Medical Centre, Mwanza-Tanzania
| | - Daniel W Gunda
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza-Tanzania.,Department of Internal Medicine, Bugando Medical Centre, Mwanza-Tanzania
| | - Fatma A Bakshi
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza-Tanzania.,Department of Internal Medicine, Bugando Medical Centre, Mwanza-Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza-Tanzania.,Department of Internal Medicine, Bugando Medical Centre, Mwanza-Tanzania
| | - Henry A Mayala
- Cardiovascular department, Jakaya Kikwete Cardiac Institute, Dar es Salaam-Tanzania
| | - Hollo Dadi
- Faculty of Undergraduate Studies, Weill School of Medicine, Mwanza-Tanzania
| |
Collapse
|
18
|
Kingery JR, Yango M, Wajanga B, Kalokola F, Brejt J, Kataraihya J, Peck R. Heart failure, post-hospital mortality and renal function in Tanzania: A prospective cohort study. Int J Cardiol 2017; 243:311-317. [PMID: 28522164 DOI: 10.1016/j.ijcard.2017.05.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 05/05/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine one-year, post-hospital mortality and the predictors of mortality in Tanzanian adults with heart failure (HF) compared to other admitted adults. METHODS In this prospective cohort study we consecutively enrolled medical inpatients admitted during a 3-month period, screened for HF and followed until 12 months after hospital discharge. Standardized history, physical examination, echocardiography and laboratory investigations were obtained during hospital presentation. The primary outcome was one-year post-discharge mortality. The secondary outcome was in-hospital mortality. Cox regression adjusted for age and sex was used. RESULTS During the study period, we enrolled 558 adults; 145 had HF and 107 of these survived until discharge. Patients with HF had a higher one-year post-hospital discharge mortality than all other diagnoses (62/107 (57.9%) vs 150/343 (43.7%), respectively, HR=1.57[1.13-2.18]). In-hospital mortality was similar. Markers of renal disease were more common in adults with HF (40/107 (37.4%) and were the strongest independent predictors of post-hospital mortality: low eGFR (HR=2.94[1.62-5.31]) and proteinuria (HR=2.03, [95%CI 1.13-3.66]). No patients discharged with the combination of low eGFR/proteinuria survived to the one-year endpoint. Of note, 79/145 (54.5%) of adults admitted with HF were newly diagnosed during hospital admission. CONCLUSIONS Over half of adults discharged with HF died within 12months after discharge. Adults with HF had higher post-hospital mortality compared to other medical inpatients. Markers of renal disease were the strongest predictor of this mortality. Innovative interventions are needed to reduce post-hospital mortality in adults with HF and should focus on those with renal disease.
Collapse
Affiliation(s)
- Justin R Kingery
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania; Division of Hospital Medicine, Department of Internal Medicine, Weill Cornell Medical College, New York City, USA; Center for Global Health, Department of Internal Medicine, Weill Cornell Medical College, New York City, USA.
| | - Missana Yango
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania
| | - Bahati Wajanga
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania
| | - Josef Brejt
- Division of Hospital Medicine, Department of Internal Medicine, Weill Cornell Medical College, New York City, USA
| | - Johannes Kataraihya
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania
| | - Robert Peck
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania; Division of Hospital Medicine, Department of Internal Medicine, Weill Cornell Medical College, New York City, USA; Center for Global Health, Department of Internal Medicine, Weill Cornell Medical College, New York City, USA
| |
Collapse
|
19
|
Maginga J, Guerrero M, Koh E, Holm Hansen C, Shedafa R, Kalokola F, Smart LR, Peck RN. Hypertension Control and Its Correlates Among Adults Attending a Hypertension Clinic in Tanzania. J Clin Hypertens (Greenwich) 2015; 18:207-16. [PMID: 26279168 DOI: 10.1111/jch.12646] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/30/2015] [Accepted: 07/05/2015] [Indexed: 12/19/2022]
Abstract
Hypertension control rates are low in sub-Saharan Africa. Population-specific determinants of blood pressure (BP) control have not been adequately described. The authors measured BP and conducted interviews to determine factors associated with BP control among adults attending a hypertension clinic in Tanzania. Three hundred adults were enrolled. BP was controlled in 47.7% of patients at the study visit but only 28.3% over three consecutive visits. Demographic and socioeconomic factors were not associated with control. Obesity and higher medication cost were associated with decreased control. Their effect was mediated through adherence. Good knowledge of (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.0-6.1; P=.047), attitudes towards (OR, 2.7; 95% CI, 1.0-7.1; P=.04), and practices concerning (OR, 5.4; 95% CI, 2.3-13.0; P<.001) hypertension were independently associated with increased control, even after adjusting for mediation through adherence. Good adherence had the strongest association with control (OR, 14.6; 95% CI, 5.8-37.0; P<.001). Strategies to reduce hypertension-related morbidity and mortality in sub-Saharan Africa should target these factors. Interventional studies of such strategies are needed.
Collapse
Affiliation(s)
- John Maginga
- School of Public Health, Catholic University of Health & Allied Sciences, Mwanza, Tanzania
| | | | - Eileen Koh
- Weill Cornell Medical College, Cornell University, New York, NY
| | - Christian Holm Hansen
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK.,Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Rehema Shedafa
- Department of Internal Medicine, Catholic University of Health & Allied Sciences, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Catholic University of Health & Allied Sciences, Mwanza, Tanzania
| | - Luke R Smart
- Department of Internal Medicine, Catholic University of Health & Allied Sciences, Mwanza, Tanzania.,Center for Global Health, Weill Cornell Medical College, New York, NY
| | - Robert N Peck
- Department of Internal Medicine, Catholic University of Health & Allied Sciences, Mwanza, Tanzania.,Center for Global Health, Weill Cornell Medical College, New York, NY
| |
Collapse
|
20
|
Kilewo C, Massawe A, Lyamuya E, Semali I, Kalokola F, Urassa E, Giattas M, Temu F, Karlsson K, Mhalu F, Biberfeld G. HIV counseling and testing of pregnant women in sub-Saharan Africa: experiences from a study on prevention of mother-to-child HIV-1 transmission in Dar es Salaam, Tanzania. J Acquir Immune Defic Syndr 2001; 28:458-62. [PMID: 11744835 DOI: 10.1097/00042560-200112150-00009] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to determine the acceptability of HIV counseling and testing and participation in a mother-to-child HIV-1 transmission intervention study using antiretroviral therapy in Dar es Salaam, Tanzania, one of the sites for the Joint United Nations Program on AIDS (UNAIDS) multicenter Petra trial. HIV testing was offered to all pregnant women who visited three prenatal clinics in Dar es Salaam before 34 weeks' gestation. Group or individual pretest counseling was performed by trained midwives. Laboratory diagnosis of HIV infection was based on two sequential anti-HIV enzyme-linked immunosorbent assays. Posttest counseling was given 2 weeks later to women who wished to know their HIV status. HIV testing was offered to a total of 10,010 pregnant women from June 1996 to May 1998, of whom 76.4% (7647 of 10,010) agreed to be tested. The prevalence of HIV-1 infection was 13.7% (1050 of 7647). Overall, 68.1% (5205 of 7647) returned for their results. Of the HIV-1-seropositive respondents, 27.4% (288 of 1050) agreed to participate in the Petra trial after fulfilling the eligibility criteria. Only 16.7% (48 of 288) of the enrolled women disclosed their positive HIV serostatus to their sexual partners. The main reasons for not disclosing the HIV serostatus were fear of stigma and divorce. Sixty percent (29 of 48) of the informed sex partners agreed to be tested for HIV and 69% (20 of 29) tested HIV seropositive. Pregnancy recurrence rate was 4.4 per 100 women years (18 pregnancies during 408 women years of follow-up) with 10 of 18 (55.6%) women not wanting to carry the pregnancy to term. In conclusion, this information is useful in planning intervention programs for prevention of mother-to-child HIV-1 transmission and it shows that improvements are required in counseling.
Collapse
Affiliation(s)
- C Kilewo
- Department of Obstetrics and Gynaecology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Kitundu J, Msengi A, Matee M, Fataki M, Kazimoto T, Mpembeni R, Mnubhi E, Kalokola F. Post-transfusion hepatitis C seroprevalence in Tanzanian children. Ann Trop Paediatr 2001; 21:343-8. [PMID: 11732153 DOI: 10.1080/07430170120093535] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In Tanzania, children with malaria-associated anaemia are frequently given blood transfusions, and donor blood is not screened for hepatitis C virus (HCV) infection. To determine the seroprevalence of HCV infection in Tanzanian children previously transfused with blood, 184 children (92 transfused, 92 not transfused) aged between 15 and 59 months matched for age and sex were screened for HCV antibodies by the particle agglutination test using Serodia anti-HCV (Fujirebio Inc., Japan). The overall prevalence of HCV infection was 7.1% (13/184). HCV seropositivity was 5.4% (5/92) among children with a history of blood transfusion and 8.6% (8/92) among the non-transfused. There was no significant difference in the prevalence of HCV infection between transfused and non-transfused children. None of the factors investigated, such as gender, the nutrition and HIV serostatus of the children and the marital and education status of their mothers, was associated with HCV seropositivity. Further studies are recommended to identify the factors associated with HCV infection in Tanzanian children.
Collapse
Affiliation(s)
- J Kitundu
- Departments of Paediatrics and Child Health, Muhimbili University College of Health Sciences, PO Box 65001, Dar es Salaam, Tanzania.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Kawo G, Karlsson K, Lyamuya E, Kalokola F, Fataki M, Kazimoto T, Kitundu J, Msaky H, Munubhi E, Ostborn A, Bredberg-Rådén U, Swai A, Mbise R, Msengi A, Mhalu F, Biberfeld G. Prevalence of HIV type 1 infection, associated clinical features and mortality among hospitalized children in Dar es Salaam, Tanzania. Scand J Infect Dis 2001; 32:357-63. [PMID: 10959642 DOI: 10.1080/003655400750044917] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The aim of this study was to determine the prevalence of HIV-1 infection, the clinical spectrum of HIV-1-associated conditions and HIV-1-associated mortality among children hospitalized in the medical paediatric wards at Muhimbili Medical Centre (MMC), Dar es Salaam, Tanzania. All children admitted to the medical paediatric wards of MMC between August 1995 and January 1996 were eligible for the study. Testing for HIV antibodies was done using 2 consecutive enzyme linked immunosorbent assays (ELISAs). ELISA-reactive samples from children aged 18 months and below were further tested by a recently developed heat-denatured p24 antigen assay. The prevalence of HIV-1 infection among the 2015 children studied was 19.2%. When present for 14 days or more, fever, cough, diarrhoea, ear discharge, oral ulcers and skin rash were all significantly more common in HIV-1-infected than in HIV-uninfected children (p < 0.001). In the multivariate analysis cough, ear discharge, oropharyngeal ulcers and skin rash were found to be the most important symptoms. Clinical signs found to be significantly associated with HIV-1 infection in the univariate analysis were wasting, stunting, hair changes, oral thrush, oropharyngeal ulcers, lymphadenopathy, lung consolidation and lung crepitations (p < 0.001). In the multivariate analysis, oral thrush, lung crepitations, cervical lymphadenopathy, wasting and inguinal lymphadenopathy were found to be the most important signs. The 3 most common diagnoses in HIV-1-infected children were acute respiratory infection (ARI) (39.4%), malnutrition (38.1%) and tuberculosis (19.3%), while in HIV-uninfected children they were malaria (47.0%), ARI (25.0%) and malnutrition (16.1%). The mortality rate was 21.4% in HIV-1-infected children and 8.4% in HIV-uninfected children (p < 0.001). In conclusion, the prevalence of HIV-1 infection among hospitalized children at the main hospital in Dar es Salaam was high and associated with high mortality. Many symptoms and signs are indicative of HIV-1 infection, but appropriate laboratory testing is required for diagnosis.
Collapse
Affiliation(s)
- G Kawo
- Department of Paediatrics, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|