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Coaxum LA, Sakita FM, Mlangi JJ, Kweka GL, Tarimo TG, Temu GA, Kilonzo KG, Arthur D, Bettger JP, Thielman NM, Limkakeng AT, Hertz JT. Provider attitudes towards quality improvement for myocardial infarction care in northern Tanzania. PLOS Glob Public Health 2024; 4:e0003051. [PMID: 38574056 PMCID: PMC10994299 DOI: 10.1371/journal.pgph.0003051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 03/03/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Myocardial Infarction (MI) is a leading cause of death worldwide. In high income countries, quality improvement strategies have played an important role in increasing uptake of evidence-based MI care and improving MI outcomes. The incidence of MI in sub-Saharan Africa is rising, but uptake of evidence-based care in northern Tanzania is low. There are currently no published quality improvement interventions from the region. The objective of this study was to determine provider attitudes towards a planned quality improvement intervention for MI care in northern Tanzania. METHODS This study was conducted at a zonal referral hospital in northern Tanzania. A 41-question survey, informed by the Theoretical Framework for Acceptability, was developed by an interdisciplinary team from Tanzania and the United States. The survey, which explored provider attitudes towards MI care improvement, was administered to key provider stakeholders (physicians, nurses, and hospital administrators) using convenience sampling. RESULTS A total of 140 providers were enrolled, including 82 (58.6%) nurses, 56 (40.0%) physicians, and 2 (1.4%) hospital administrators. Most participants worked in the Emergency Department or inpatient medical ward. Providers were interested in participating in a quality improvement project to improve MI care at their facility, with 139 (99.3%) strongly agreeing or agreeing with this statement. All participants agreed or strongly agreed that improvements were needed to MI care pathways at their facility. Though their facility has an MI care protocol, only 88 (62.9%) providers were aware of it. When asked which intervention would be the single-most effective strategy to improve MI care, the two most common responses were provider training (n = 66, 47.1%) and patient education (n = 41, 29.3%). CONCLUSION Providers in northern Tanzania reported strongly positive attitudes towards quality improvement interventions for MI care. Locally-tailored interventions to improve MI should include provider training and patient education strategies.
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Affiliation(s)
- Lauren A. Coaxum
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Francis M. Sakita
- Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Jerome J. Mlangi
- Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Godfrey L. Kweka
- Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Tumsifu G. Tarimo
- Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Gloria A. Temu
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kajiru G. Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - David Arthur
- Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Janet P. Bettger
- Department of Health and Rehabilitation Sciences, Temple University, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Nathan M. Thielman
- Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Alexander T. Limkakeng
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Julian T. Hertz
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina, United States of America
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Mashauri HL, Makunga FJ, Luhwago EC, Ndale E, Kilonzo KG. Is it myocardial infarction? A case report of C7 cervical radiculopathy with cervical angina. SAGE Open Med Case Rep 2024; 12:2050313X231223434. [PMID: 38187813 PMCID: PMC10768626 DOI: 10.1177/2050313x231223434] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Cervical radiculopathy refers to the mechanical compression or inflammation of any of the cervical roots which lead to their dysfunction. Male sex, uncontrolled diabetes mellitus, manual labor-related occupation or activities are among the possible factors which can predispose or precipitate the occurrence of cervical radiculopathy. A 63 years old male presented with cervicogenic angina which was refractory to painkillers. C7 cervical radiculopathy might present with cervicogenic angina and pose a clinical diagnosis challenge given its similarity in clinical presentation with other clinical conditions like myocardial infarction. Clinicians should have a high index of suspicion to differentiate the two conditions. Nevertheless, ruling out firstly myocardial infarction and pulmonary embolism among patients presenting with chest pain is of clinical benefit in terms of morbidity and mortality of a patient. Furthermore, proper and timely physical examination should be emphasized to be conducted to every patient so as to avoid delayed diagnosis and management.
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Affiliation(s)
- Harold L Mashauri
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Department of Emergency Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Frank J Makunga
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Elisha C Luhwago
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Eliasa Ndale
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Kajiru G Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
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Maze MJ, Nyakunga G, Sakasaka PA, Kilonzo KG, Luhwago E, Chelangwa M, Crump JA, Kisonga RM, Madut DB, Rogath J, Sadiq A, Thiessen R, Rubach MP. Etiologic Investigation of Patients Diagnosed with Bacteriologically Unconfirmed Tuberculosis in Tanzania. Am J Trop Med Hyg 2023; 109:733-739. [PMID: 37604470 PMCID: PMC10551096 DOI: 10.4269/ajtmh.23-0023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/06/2023] [Indexed: 08/23/2023] Open
Abstract
Globally, half of patients with pulmonary tuberculosis (PTB) are diagnosed clinically without bacteriologic confirmation. In clinically diagnosed PTB patients, we assessed both the proportion in whom PTB could be bacteriologically confirmed by reference standard diagnostic tests and the prevalence of diseases that mimic PTB. We recruited adult patients beginning treatment of bacteriologically unconfirmed PTB in Moshi, Tanzania, in 2019. We performed mycobacterial smear, Xpert MTB/RIF Ultra, and mycobacterial culture, fungal culture, and bacterial culture on two induced sputum samples: fungal serology and computed tomography chest scans. We followed participants for 2 months after enrollment. We enrolled 36 (63%) of 57 patients with bacteriologically unconfirmed PTB. The median (interquartile range) age was 55 (44-67) years. Six (17%) were HIV infected. We bacteriologically confirmed PTB in 2 (6%). We identified pneumonia in 11 of 23 (48%), bronchiectasis in 8 of 23 (35%), interstitial lung disease in 5 of 23 (22%), pleural collections in 5 of 23 (22%), lung malignancy in 1 of 23 (4%), and chronic pulmonary aspergillosis in 1 of 35 (3%). After 2 months, 4 (11%) were dead, 21 (58%) had persistent symptoms, 6 (17%) had recovered, and 5 (14%) were uncontactable. PTB could be bacteriologically confirmed in few patients with clinically diagnosed PTB and clinical outcomes were poor, suggesting that many did not have the disease. We identified a high prevalence of diseases other than tuberculosis that might be responsible for symptoms.
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Affiliation(s)
- Michael J. Maze
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Gissela Nyakunga
- Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Kajiru G. Kilonzo
- Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | | | - John A. Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Deng B. Madut
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
| | | | - Adnan Sadiq
- Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Rennae Thiessen
- Radiology Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Matthew P. Rubach
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
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Sakita FM, O’Leary P, Prattipati S, Kessy MS, Kilonzo KG, Mmbaga BT, Rugakingira AA, Manavalan P, Thielman NM, Samuel D, Hertz JT. Six-month incidence of hypertension and diabetes among adults with HIV in Tanzania: A prospective cohort study. PLOS Glob Public Health 2023; 3:e0001929. [PMID: 37603550 PMCID: PMC10441788 DOI: 10.1371/journal.pgph.0001929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023]
Abstract
Data describing the incidence of hypertension and diabetes among people with HIV in sub-Saharan Africa remain sparse. In this study, adults with HIV were enrolled from a public clinic in Moshi, Tanzania (September 2020-March 2021). At enrollment, a survey was administered to collect information on comorbidities and medication use. Each participant's blood pressure and point-of-care glucose were measured. Baseline hypertension was defined by blood pressure ≥140/90 mmHg or self-reported hypertension at enrollment. Baseline diabetes was defined by self-reported diabetes or hyperglycemia (fasting glucose ≥126 mg/dl or random glucose ≥200 mg/dl) at enrollment. At 6-month follow-up, participants' blood pressure and point-of-care glucose were again measured. Incident hypertension was defined by self-report of new hypertension diagnosis or blood pressure ≥140/90 mmHg at follow-up in a participant without baseline hypertension. Incident diabetes was defined as self-report of new diabetes diagnosis or measured hyperglycemia at follow-up in a participant without baseline diabetes. During the study period, 477 participants were enrolled, of whom 310 did not have baseline hypertension and 457 did not have baseline diabetes. At six-month follow-up, 51 participants (95% CI: 38, 67) had new-onset hypertension, corresponding to an incidence of 33 new cases of hypertension per 100 person-years. Participants with incident hypertension at 6-month follow-up were more likely to have a history of alcohol use (90.2% vs. 73.7%, OR = 3.18, 95% CI:1.32-9.62, p = 0.008) and were older (mean age = 46.5 vs. 42.3, p = 0.027). At six-month follow-up, 8 participants (95% CI: 3, 16) had new-onset diabetes, corresponding to an incidence of 3 new cases of diabetes per 100 person-years. In conclusion, the incidence of elevated blood pressure and diabetes among Tanzanians with HIV is higher than what has been reported in high-income settings.
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Affiliation(s)
| | - Paige O’Leary
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Sainikitha Prattipati
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | | | | | | | - Preeti Manavalan
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Nathan M. Thielman
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Dorothy Samuel
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Julian T. Hertz
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Moorthy GS, Madut DB, Kilonzo KG, Lwezaula BF, Mbwasi R, Mmbaga BT, Ngocho JS, Saganda W, Bonnewell JP, Carugati M, Egger JR, Hertz JT, Tillekeratne LG, Maze MJ, Maro VP, Crump JA, Rubach MP. Antibacterial Utilization for Febrile Illnesses and Laboratory-Confirmed Bloodstream Infections in Northern Tanzania. Open Forum Infect Dis 2023; 10:ofad448. [PMID: 37663090 PMCID: PMC10468737 DOI: 10.1093/ofid/ofad448] [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] [Received: 06/08/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023] Open
Abstract
Background We describe antibacterial use in light of microbiology data and treatment guidelines for common febrile syndromes in Moshi, Tanzania. Methods We compared data from 2 hospital-based prospective cohort studies, cohort 1 (2011-2014) and cohort 2 (2016-2019), that enrolled febrile children and adults. A study team member administered a standardized questionnaire, performed a physical examination, and collected blood cultures. Participants with bloodstream infection (BSI) were categorized as receiving effective or ineffective therapy based upon antimicrobial susceptibility interpretations. Antibacterials prescribed for treatment of pneumonia, urinary tract infection (UTI), or presumed sepsis were compared with World Health Organization and Tanzania Standard Treatment Guidelines. We used descriptive statistics and logistic regression to describe antibacterial use. Results Among participants, 430 of 1043 (41.2%) and 501 of 1132 (44.3%) reported antibacterial use prior to admission in cohorts 1 and 2, respectively. During admission, 930 of 1043 (89.2%) received antibacterials in cohort 1 and 1060 of 1132 (93.6%) in cohort 2. Inpatient use of ceftriaxone, metronidazole, and ampicillin increased between cohorts (P ≤ .002 for each). BSI was detected in 38 (3.6%) participants in cohort 1 and 47 (4.2%) in cohort 2. Of 85 participants with BSI, 81 (95.3%) had complete data and 52 (64.2%) were prescribed effective antibacterials. Guideline-consistent therapy in cohort 1 and cohort 2 was as follows: pneumonia, 87.4% and 56.8%; UTI, 87.6% and 69.0%; sepsis, 84.4% and 61.2% (P ≤ .001 for each). Conclusions Receipt of antibacterials for febrile illness was common. While guideline-consistent prescribing increased over time, more than one-third of participants with BSI received ineffective antibacterials.
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Affiliation(s)
- Ganga S Moorthy
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Deng B Madut
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Kajiru G Kilonzo
- Kilimanjaro Christian Medical Centre-Duke University Collaboration, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | | | - Ronald Mbwasi
- Kilimanjaro Christian Medical Centre-Duke University Collaboration, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre-Duke University Collaboration, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | - James S Ngocho
- Kilimanjaro Christian Medical Centre-Duke University Collaboration, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | - Wilbrod Saganda
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | - John P Bonnewell
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Manuela Carugati
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph R Egger
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Julian T Hertz
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - L Gayani Tillekeratne
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael J Maze
- Centre for International Health, University of Otago, Dunedin, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Venance P Maro
- Kilimanjaro Christian Medical Centre-Duke University Collaboration, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | - John A Crump
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Matthew P Rubach
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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Sadiq AM, Kilonzo KG. Pattern of diseases and clinical outcomes in medical intensive care unit at a tertiary hospital in northeastern Tanzania: A three-year retrospective study. PLoS One 2023; 18:e0282269. [PMID: 36827317 PMCID: PMC9955624 DOI: 10.1371/journal.pone.0282269] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The availability of medical intensive care unit (MICU) services is limited, which is the main obstacle to providing optimal care to critically ill patients. Describing disease patterns and clinical outcomes will help make better use of the limited resources. This retrospective study was conducted to determine the pattern and outcome of MICU admissions to aid continuous quality improvement in obstetric care. MATERIALS AND METHODS This was a retrospective study conducted in a tertiary hospital in northeastern Tanzania. Data on participant characteristics were collected from patient records for all MICU admissions to identify the pattern of disease, length of stay, and clinical outcome from 1st January 2018 to 31st December 2020. Descriptive statistics were presented as frequencies, proportions, and tables. The odds ratio was generated for the relationship between MICU admission outcome and participant characteristics. A p-value <0.05 was considered statistically significant. RESULTS Of the 1425 patients analyzed, 780 (54.7%) were males. Most patients (61.5%) were admitted to the MICU from the emergency department. The overall mortality rate was 37.6%. Mortality was associated with being over 75 years old (OR 1.66, 95% CI 1.20-2.30, P 0.002), being transferred from the medical ward (OR 1.46, 95% CI 1.16-1.82, P 0.001), having a communicable disease (OR 2.63, 95% CI 1.98-3.50, P <0.001), and having cardiovascular disease (OR 1.46, 95% CI 1.14-1.86, P 0.002). CONCLUSION The overall mortality rate in the MICU was high. Elderly patients, transfers from the medical ward, and short ICU stays were significantly associated with the poor outcome of MICU patients. Further studies are needed to better appreciate the causes underlying MICU admission outcomes.
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Affiliation(s)
- Abid M. Sadiq
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- * E-mail:
| | - Kajiru G. Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
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Sakita FM, Prattipati S, Chick J, Samu LP, Maro AV, Coaxum L, Galson SW, Samuel D, Limkakeng AT, O'Leary PR, Kilonzo KG, Thielman NM, Temu G, Hertz JT. Six-month blood pressure and glucose control among HIV-infected adults with elevated blood pressure and hyperglycemia in northern Tanzania: A prospective observational study. PLoS One 2023; 18:e0285472. [PMID: 37155672 PMCID: PMC10166506 DOI: 10.1371/journal.pone.0285472] [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] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND People with HIV in sub-Saharan Africa are increasingly developing age-related comorbidities. The purpose of this prospective observational study was to describe 6-month outcomes among Tanzanians with HIV and elevated blood pressure or hyperglycemia under current care pathways. METHODS Adults presenting for routine HIV care were enrolled and underwent blood pressure and blood glucose measurements. Participants with abnormal blood pressure or glucose were referred for further care, as per current guidelines. Participants' blood pressure and point-of-care glucose were re-evaluated during their 6-month follow-up visit. Elevated blood pressure was defined as systolic ≥140 mmHg or diastolic ≥90 mmHg. Hyperglycemia was defined as fasting glucose ≥126 mg/dl or random glucose ≥200 mg/dl. An electrocardiogram was obtained at enrollment and at follow-up. Interim myocardial infarction and interim myocardial ischemia were defined as new pathologic Q waves and new T-wave inversions, respectively. RESULTS Of 500 participants, 155 had elevated blood pressure and 17 had hyperglycemia at enrolment. At 6-month follow-up, 7 (4.6%) of 155 participants with elevated blood pressure reported current use of an anti-hypertensive medication, 100 (66.2%) had persistent elevated blood pressure, 12 (7.9%) developed interim myocardial infarction, and 13 (8.6%) developed interim myocardial ischemia. Among 17 participants with hyperglycemia, 9 (56%) had persistent hyperglycemia at 6 months and 2 (12.5%) reported current use of an anti-hyperglycemic medication. CONCLUSIONS Interventions are needed to improve non-communicable disease care pathways among Tanzanians with HIV.
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Affiliation(s)
- Francis M Sakita
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Sainikitha Prattipati
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Jordan Chick
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Linda P Samu
- Health Department, Moshi Municipal Council, Moshi, Tanzania
| | | | - Lauren Coaxum
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Sophie W Galson
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | | | - Alexander T Limkakeng
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Paige R O'Leary
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Kajiru G Kilonzo
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Nathan M Thielman
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Gloria Temu
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Julian T Hertz
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
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Moorthy GS, Madut D, Kilonzo KG, Lwezaula B, Mbwasi R, Mmbaga B, Ngocho J, Saganda W, Officer C, Bonnewell JP, Carugati M, Egger JR, Hertz J, Maze MJ, Maro V, Crump JA, Rubach M. 1164. Antibacterial Utilization for Febrile Illnesses and Laboratory-Confirmed Bloodstream Infections in Northern Tanzania. Open Forum Infect Dis 2022. [PMCID: PMC9752995 DOI: 10.1093/ofid/ofac492.1001] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Antimicrobial resistance is an important cause of morbidity and mortality globally; low- and middle-income countries (LMICs) face an especially high burden. Ineffective antimicrobial prescriptions and use of broad-spectrum agents contribute to resistance. We describe antibacterial prescribing patterns in patients with febrile illnesses and bloodstream infections (BSI) in northern Tanzania. Methods We compared data from two hospital-based prospective cohort studies, cohort 1 (2011-2014) and cohort 2 (2016-2019), both enrolled febrile pediatric and adult inpatients in Moshi, Tanzania. Aerobic blood culture was obtained in all patients and standard methods were used to determine isolate antimicrobial susceptibility. To describe management of febrile illness, we analyzed antibacterial drug prescription prior to and after enrollment. Broad-spectrum antibacterials were categorized using published frameworks. Treatments were categorized as discordant if a blood culture isolate was not susceptible to the patient’s antibacterial regimen. We performed descriptive statistics and logistic regression to understand predictors of receiving an antibacterial. Results In total, 2,176 febrile inpatients were enrolled. Antibacterials were administered to 430 (42.0%) and 501 (45.1%) patients prior to enrollment, and 930 (89.1%) and 1,060 (93.6%) during admission in cohorts 1 and 2, respectively. Infancy and duration of fever were associated with higher antibacterial prescribing prior to enrollment (Table 2). Broad-spectrum antibacterials were administered to 548 (52.5%) in cohort 1 and 682 (60.2%) in cohort 2. Laboratory-confirmed bacteremia was detected in 87 (4%) patients. Susceptibility results were available in 73 patients; of these, 41 (56.2%) received discordant antibacterials.
![]() ![]() ![]() Conclusion Antibacterials were commonly administered for febrile illness in outpatient and inpatient settings; over half of patients received broad-spectrum antibacterials. A high proportion of patients with culture-positive BSI were treated with ineffective antimicrobials. Improved laboratory diagnostics for febrile illness, antimicrobial stewardship interventions, context-specific clinical guidelines, and provider education may improve prescribing practices. Disclosures Julian Hertz, MD, Roche Diagnostics: Grant/Research Support.
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Affiliation(s)
| | | | - Kajiru G Kilonzo
- Kilimanjaro Christian Medial University College, moshi, Kilimanjaro, Tanzania
| | | | - Ronald Mbwasi
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Blandina Mmbaga
- Kilimanjaro Christian Medical Centre, Tumaini University, Moshi, Kilimanjaro, Tanzania
| | - James Ngocho
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | | | - Clinical Officer
- Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro, Tanzania
| | | | | | | | | | - Michael J Maze
- University of Otago, Christchurch, Canterbury, New Zealand
| | - Venance Maro
- Kilimanjaro Christian Medical Centre, Tumaini University, Moshi, Kilimanjaro, Tanzania
| | - John A Crump
- University of Otago, Christchurch, Canterbury, New Zealand
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Sadiq AM, Njau RE, Kilonzo KG. Disease patterns and clinical outcomes of medical admissions at a tertiary hospital in Northern Tanzania: A retrospective observational study. Health Sci Rep 2022; 6:e983. [PMID: 36514325 PMCID: PMC9731290 DOI: 10.1002/hsr2.983] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/10/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Aims The burden of noncommunicable diseases is increasing in developing countries and in settings with an existing communicable burden. The study aim was to identify the disease pattern, length of stay, and clinical outcome of medical admissions. Methods A retrospective observational study of patients admitted to medical wards between 1st July 2019 and 30th June 2020, excluding those admitted for chemotherapy. The outcome measures were the pattern of disease, length of stay, and clinical outcome. Results A total of 3930 patients were analyzed. A total of 53.5% were males, and 42.9% were aged 51-75 years, with a median age of 57 years (IQR 41-71). A total of 41.3% had health insurance, 21.7% died, and the median length of stay was 6 days (IQR 4-9). Cardiovascular diseases were the most common diagnosis (26.8%) on admission and cause of death (27.9%). The common causes of death were stroke (15.1%), chronic kidney disease (11.1%), and heart failure (9.0%). Noninsured patients had a high mortality risk (odds ratios [OR] 1.67, 95% confidence interval [CI] 1.42-1.96), which was also seen among patients aged more than 75 years (OR 1.3, 95% CI 1.08-1.57), patients with communicable diseases (OR 1.44, 95% CI 1.23-1.68), and weekend admissions (OR 1.29, 95% CI 1.08-1.55). The 72-h admission window is critical due to a very high mortality risk (OR 3.03, 95% CI 2.58-3.56). Conclusion Cardiovascular diseases are the leading cause of hospital admissions and deaths in a tertiary hospital in Northern Tanzania. Lifestyle modification, health education, and community resources are needed to combat the growing burden of cardiovascular and renal disease.
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Affiliation(s)
- Abid M. Sadiq
- Department of Internal MedicineKilimanjaro Christian Medical CentreMoshiTanzania,Kilimanjaro Christian Medical University CollegeMoshiTanzania
| | | | - Kajiru G. Kilonzo
- Department of Internal MedicineKilimanjaro Christian Medical CentreMoshiTanzania,Kilimanjaro Christian Medical University CollegeMoshiTanzania
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10
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Howlett WP, Urasa SJ, Maro VP, Walker RW, Kilonzo KG, Howlett PJ, Dekker MCJ. Neurological disorders in Northern Tanzania: A 6-year prospective hospital-based case series. Afr Health Sci 2022; 22:269-284. [PMID: 36032440 PMCID: PMC9382522 DOI: 10.4314/ahs.v22i1.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The burden of neurological disorders is large and altered by the HIV epidemic. Objectives We describe the pattern of neurological disorders and their association with HIV infection in adult patients attending a consultant hospital in Northern Tanzania. Methods In this prospective cross-sectional study, we collected data on adult neurological referrals over a 6-year period between 2007-13. The odds of HIV infection, across neurological categories adjusted for age and sex, was calculated. Results Of 2037 participants, 54.8% were male and 45.2% were female. The median age of participants was 43 years. The results for HIV screening were available for 992/2037 (48.7%) patients, of whom 306 (30.8%) were seropositive. The most frequent neurological disorders were cerebrovascular disease (19.9%), paraplegia (13.6%), and peripheral neuropathies (8%). Taken together CNS infection accounted for 278/2037 (13.6%). The adjusted odds (aOR) of HIV infection was highest amongst infections; brain abscesses (aOR 107, 95% CI 35.1-470.4) and meningitis/encephalitis (aOR 40.1, 95% CI 13.6-172.9), but also raised in cerebrovascular disease, paraplegia, peripheral neuropathies, cranial nerve palsies, seizures, cerebllar disorders, movement disorders, motor neuron disease and headache. Conclusion The main pattern of neurological disorders in Northern Tanzania is presented. The odds of HIV infection was highest in CNS infections and in a wide range of non-communicable neurological disorders.
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Affiliation(s)
- William P Howlett
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
- Centre for International Health University of Bergen, Bergen Norway
| | - Sarah J Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Venance P Maro
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Richard W Walker
- Department of Medicine, North Tyneside General Hospital, Rake Lane, North Shields, Tyne, and Wear NE29 8NH
| | - Kajiru G Kilonzo
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Patrick J Howlett
- Royal Brompton and Harefield Hospital Trust Fulham Road, London, SW3 6HP
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Costales C, Crump JA, Mremi AR, Amsi PT, Kalengo NH, Kilonzo KG, Kinabo G, Lwezaula BF, Lyamuya F, Marandu A, Mbwasi R, Mmbaga BT, Mosha C, Carugati M, Madut DB, Nelson AM, Maze MJ, Matkovic E, Zaki SR, Maro VP, Rubach MP. Performance of Xpert Ultra nasopharyngeal swab for identification of tuberculosis deaths in northern Tanzania. Clin Microbiol Infect 2022; 28:1150.e1-1150.e6. [DOI: 10.1016/j.cmi.2022.03.027] [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] [Received: 10/09/2021] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 11/03/2022]
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12
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Bonnewell JP, Rubach MP, Madut DB, Carugati M, Maze MJ, Kilonzo KG, Lyamuya F, Marandu A, Kalengo NH, Lwezaula BF, Mmbaga BT, Maro VP, Crump JA. Performance Assessment of the Universal Vital Assessment Score vs Other Illness Severity Scores for Predicting Risk of In-Hospital Death Among Adult Febrile Inpatients in Northern Tanzania, 2016-2019. JAMA Netw Open 2021; 4:e2136398. [PMID: 34913982 PMCID: PMC8678687 DOI: 10.1001/jamanetworkopen.2021.36398] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Severity scores are used to improve triage of hospitalized patients in high-income settings, but the scores may not translate well to low- and middle-income settings such as sub-Saharan Africa. OBJECTIVE To assess the performance of the Universal Vital Assessment (UVA) score, derived in 2017, compared with other illness severity scores for predicting in-hospital mortality among adults with febrile illness in northern Tanzania. DESIGN, SETTING, AND PARTICIPANTS This prognostic study used clinical data collected for the duration of hospitalization among patients with febrile illness admitted to Kilimanjaro Christian Medical Centre or Mawenzi Regional Referral Hospital in Moshi, Tanzania, from September 2016 through May 2019. All adult and pediatric patients with a history of fever within 72 hours or a tympanic temperature of 38.0 °C or higher at screening were eligible for enrollment. Of 3761 eligible participants, 1132 (30.1%) were enrolled in the parent study; of those, 597 adults 18 years or older were included in this analysis. Data were analyzed from December 2019 to September 2021. EXPOSURES Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS) assessment, and UVA. MAIN OUTCOMES AND MEASURES The main outcome was in-hospital mortality during the same hospitalization as the participant's enrollment. Crude risk ratios and 95% CIs for in-hospital death were calculated using log-binomial risk regression for proposed score cutoffs for each of the illness severity scores. The area under the receiver operating characteristic curve (AUROC) for estimating the risk of in-hospital death was calculated for each score. RESULTS Among 597 participants, the median age was 43 years (IQR, 31-56 years); 300 participants (50.3%) were female, 198 (33.2%) were HIV-infected, and in-hospital death occurred in 55 (9.2%). By higher risk score strata for each score, compared with lower risk strata, risk ratios for in-hospital death were 3.7 (95% CI, 2.2-6.2) for a MEWS of 5 or higher; 2.7 (95% CI, 0.9-7.8) for a NEWS of 5 or 6; 9.6 (95% CI, 4.2-22.2) for a NEWS of 7 or higher; 4.8 (95% CI, 1.2-20.2) for a qSOFA score of 1; 15.4 (95% CI, 3.8-63.1) for a qSOFA score of 2 or higher; 2.5 (95% CI, 1.2-5.2) for a SIRS score of 2 or higher; 9.1 (95% CI, 2.7-30.3) for a UVA score of 2 to 4; and 30.6 (95% CI, 9.6-97.8) for a UVA score of 5 or higher. The AUROCs, using all ordinal values, were 0.85 (95% CI, 0.80-0.90) for the UVA score, 0.81 (95% CI, 0.75-0.87) for the NEWS, 0.75 (95% CI, 0.69-0.82) for the MEWS, 0.73 (95% CI, 0.67-0.79) for the qSOFA score, and 0.63 (95% CI, 0.56-0.71) for the SIRS score. The AUROC for the UVA score was significantly greater than that for all other scores (P < .05 for all comparisons) except for NEWS (P = .08). CONCLUSIONS AND RELEVANCE This prognostic study found that the NEWS and the UVA score performed favorably compared with other illness severity scores in predicting in-hospital mortality among a hospitalized cohort of adults with febrile illness in northern Tanzania. Given its reliance on readily available clinical data, the UVA score may have utility in the triage and prognostication of patients admitted to the hospital with febrile illness in low- to middle-income settings such as sub-Saharan Africa.
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Affiliation(s)
- John P. Bonnewell
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Matthew P. Rubach
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Programme in Emerging Infectious Diseases, Duke–National University of Singapore Medical School, Singapore
| | - Deng B. Madut
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Manuela Carugati
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Michael J. Maze
- Department of Medicine, University of Otago, Dunedin, New Zealand
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Kajiru G. Kilonzo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | - Furaha Lyamuya
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | | | | | | | - Blandina T. Mmbaga
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Venance P. Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | - John A. Crump
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Medicine, University of Otago, Dunedin, New Zealand
- Centre for International Health, University of Otago, Dunedin, New Zealand
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13
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Madut DB, Rubach MP, Bonnewell JP, Cutting ER, Carugati M, Kalengo N, Maze MJ, Morrissey AB, Mmbaga BT, Lwezaula BF, Kinabo G, Mbwasi R, Kilonzo KG, Maro VP, Crump JA. Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania. Trop Med Int Health 2021; 26:1668-1676. [PMID: 34598312 PMCID: PMC8639662 DOI: 10.1111/tmi.13683] [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] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In 2010, WHO published guidelines emphasising parasitological confirmation of malaria before treatment. We present data on changes in fever case management in a low malaria transmission setting of northern Tanzania after 2010. METHODS We compared diagnoses, treatments and outcomes from two hospital-based prospective cohort studies, Cohort 1 (2011-2014) and Cohort 2 (2016-2019), that enrolled febrile children and adults. All participants underwent quality-assured malaria blood smear-microscopy. Participants who were malaria smear-microscopy negative but received a diagnosis of malaria or received an antimalarial were categorised as malaria over-diagnosis and over-treatment, respectively. RESULTS We analysed data from 2098 participants. The median (IQR) age was 27 (3-43) years and 1047 (50.0%) were female. Malaria was detected in 23 (2.3%) participants in Cohort 1 and 42 (3.8%) in Cohort 2 (p = 0.059). Malaria over-diagnosis occurred in 334 (35.0%) participants in Cohort 1 and 190 (17.7%) in Cohort 2 (p < 0.001). Malaria over-treatment occurred in 528 (55.1%) participants in Cohort 1 and 196 (18.3%) in Cohort 2 (p < 0.001). There were 30 (3.1%) deaths in Cohort 1 and 60 (5.4%) in Cohort 2 (p = 0.007). All deaths occurred among smear-negative participants. CONCLUSION We observed a substantial decline in malaria over-diagnosis and over-treatment among febrile inpatients in northern Tanzania between two time periods after 2010. Despite changes, some smear-negative participants were still diagnosed and treated for malaria. Our results highlight the need for continued monitoring of fever case management across different malaria epidemiological settings in sub-Saharan Africa.
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Affiliation(s)
- Deng B Madut
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Matthew P Rubach
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - John P Bonnewell
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Pathology, Duke University, Durham, North Carolina, USA
| | - Elena R Cutting
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Manuela Carugati
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Michael J Maze
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Anne B Morrissey
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | | | - Grace Kinabo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Ronald Mbwasi
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kajiru G Kilonzo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | - Venance P Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | - John A Crump
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Centre for International Health, University of Otago, Dunedin, New Zealand
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14
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Madut DB, Rubach MP, Kalengo N, Carugati M, Maze MJ, Morrissey AB, Mmbaga BT, Lwezaula BF, Kilonzo KG, Maro VP, Crump JA. A prospective study of Escherichia coli bloodstream infection among adolescents and adults in northern Tanzania. Trans R Soc Trop Med Hyg 2021; 114:378-384. [PMID: 31820810 PMCID: PMC7197297 DOI: 10.1093/trstmh/trz111] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/09/2019] [Accepted: 10/18/2019] [Indexed: 11/14/2022] Open
Abstract
Background Characterization of the epidemiology of Escherichia coli bloodstream infection (BSI) in sub-Saharan Africa is lacking. We studied patients with E. coli BSI in northern Tanzania to describe host risk factors for infection and to describe the antimicrobial susceptibility of isolates. Methods Within 24 h of admission, patients presenting with a fever at two hospitals in Moshi, Tanzania, were screened and enrolled. Cases were patients with at least one blood culture yielding E. coli and controls were those without E. coli isolated from any blood culture. Logistic regression was used to identify host risk factors for E. coli BSI. Results We analyzed data from 33 cases and 1615 controls enrolled from 2007 through 2018. The median (IQR) age of cases was 47 (34–57) y and 24 (72.7%) were female. E. coli BSI was associated with (adjusted OR [aOR], 95% CI) increasing years of age (1.03, 1.01 to 1.05), female gender (2.20, 1.01 to 4.80), abdominal tenderness (2.24, 1.06 to 4.72) and urinary tract infection as a discharge diagnosis (3.71, 1.61 to 8.52). Of 31 isolates with antimicrobial susceptibility results, the prevalence of resistance was ampicillin 29 (93.6%), ceftriaxone three (9.7%), ciprofloxacin five (16.1%), gentamicin seven (22.6%) and trimethoprim-sulfamethoxazole 31 (100.0%). Conclusions In Tanzania, host risk factors for E. coli BSI were similar to those reported in high-resource settings and resistance to key antimicrobials was common.
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Affiliation(s)
- Deng B Madut
- Division of Infectious Diseases and International Health, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA.,Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC, 27710, USA
| | - Matthew P Rubach
- Division of Infectious Diseases and International Health, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA.,Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC, 27710, USA
| | | | - Manuela Carugati
- Division of Infectious Diseases and International Health, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA
| | - Michael J Maze
- Department of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.,Centre for International Health, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Anne B Morrissey
- Division of Infectious Diseases and International Health, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Tumaini University, PO Box 3010, Moshi, Tanzania
| | | | - Kajiru G Kilonzo
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Tumaini University, PO Box 3010, Moshi, Tanzania
| | - Venance P Maro
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Tumaini University, PO Box 3010, Moshi, Tanzania
| | - John A Crump
- Division of Infectious Diseases and International Health, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA.,Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC, 27710, USA.,Centre for International Health, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.,Kilimanjaro Christian Medical University College, Tumaini University, PO Box 3010, Moshi, Tanzania
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15
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Dekker MCJ, Mremi A, Kilonzo KG, Nyakunga G, Sakita F, Mvungi M, Urasa SJ, Masenga G, Howlett WP. Altitude-Related Disorders on Mount Kilimanjaro, Tanzania: Two-Year Survey in a Local Referral Center. Wilderness Environ Med 2021; 32:36-40. [PMID: 33431301 DOI: 10.1016/j.wem.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/03/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION A significant number of climbers on Mount Kilimanjaro are affected by altitude-related disorders. The aim of this study was to determine the main causes of morbidity and mortality in a representative cohort of climbers based on local hospital records. METHODS We conducted a 2-y retrospective chart review of all patients presenting to the main referral hospital in the region after a climb on Mount Kilimanjaro, including all relevant records and referrals for postmortem studies. RESULTS We identified 62 climbers who presented to the hospital: 47 inpatients and 15 outpatients. Fifty-six presented with high altitude illness, which included acute mountain sickness (n=8; 14%), high altitude pulmonary edema (HAPE) (n=30; 54%), high altitude cerebral edema (HACE) (n=7; 12%), and combined HAPE/HACE (n=11; 20%). The mean altitude of symptom onset ranged from 4600±750 m for HAPE to 5000±430 m for HAPE/HACE. The vast majority of inpatients (n=41; 87%) were improved on discharge. Twenty-one deceased climbers, most having died while climbing (n=17; 81%), underwent postmortem evaluation. Causes of death were HAPE (n=16; 76%), HAPE/HACE (n=3; 14%), trauma (1), and cardiopulmonary (1). CONCLUSIONS HAPE was the main cause of death during climbing as well as for hospital admissions. The vast majority of climbers who presented to hospital made a full recovery.
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Affiliation(s)
- Marieke C J Dekker
- Department of Medicine, Kilimanjaro Christian Medical Center, Moshi Kilimanjaro, United Republic of Tanzania.
| | - Alex Mremi
- Department of Pathology, Moshi Kilimanjaro, United Republic of Tanzania
| | - Kajiru G Kilonzo
- Department of Medicine, Kilimanjaro Christian Medical Center, Moshi Kilimanjaro, United Republic of Tanzania
| | - Gissela Nyakunga
- Department of Medicine, Kilimanjaro Christian Medical Center, Moshi Kilimanjaro, United Republic of Tanzania
| | - Francis Sakita
- Department of Emergency Medicine, Moshi Kilimanjaro, United Republic of Tanzania
| | - Mark Mvungi
- Department of Emergency Medicine, Moshi Kilimanjaro, United Republic of Tanzania
| | - Sarah J Urasa
- Department of Medicine, Kilimanjaro Christian Medical Center, Moshi Kilimanjaro, United Republic of Tanzania; Department of Administration, Moshi Kilimanjaro, United Republic of Tanzania
| | - Gileard Masenga
- Department of Administration, Moshi Kilimanjaro, United Republic of Tanzania
| | - William P Howlett
- Department of Medicine, Kilimanjaro Christian Medical Center, Moshi Kilimanjaro, United Republic of Tanzania
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Mbwete GW, Kilonzo KG, Shao ER, Chamba NG. Suboptimal Blood Pressure Control, Associated Factors, and Choice of Antihypertensive Drugs among Type 2 Diabetic Patients at KCMC, Tanzania. J Diabetes Res 2020; 2020:4376251. [PMID: 32775461 PMCID: PMC7391100 DOI: 10.1155/2020/4376251] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/17/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hypertension (HTN) can be present in up to two-thirds of patients living with diabetes mellitus (DM). It is a risk factor for the development of diabetes as well as complications like coronary artery disease (CAD), nephropathy, retinopathy, and neuropathy. Hypertension is treatable, and the degree to which it is controlled determines the risk of development of cardiovascular diseases and other complications in a given individual patient. Even though antihypertensive drugs are available and issued to hypertensive diabetic patients, the rate of control of HTN is often inadequate. The aim of this study was to assess the prevalence of suboptimal blood pressure (BP) control, its associated factors, and the choice of antihypertensive drugs among type 2 DM patients at Kilimanjaro Christian Medical Centre (KCMC). METHODS A hospital-based cross-sectional study was conducted at the KCMC diabetes clinic from October 2018 to March 2019 among type 2 DM patients with HTN based on the inclusion criteria. Data were collected using structured questionnaires, and written informed consent was obtained. Suboptimal BP was defined as BP levels ≥ 140/90 mmHg according to the American Diabetes Association guideline published in 2018. Data analysis was done using the Statistical Package for the Social Sciences (SPSS) version 25. Chi-square analysis was done to identify the independent predictors of BP control, and a p value of <0.05 was considered to be statistically significant. RESULTS The data of 161 participants was analysed; the mean age was 63.9 ± 20.2 years, with the majority being females (67.1%). Despite all participants being on different classes of antihypertensives, 57.8% had suboptimal BP control. Among the participants with good BP control, 52.7% were on angiotensin-converting enzyme inhibitors (ACE-I). Poor diabetes control was observed in 50.1% participants as indicated by elevated glycated haemoglobin. CONCLUSION This study demonstrated that BP control in type 2 DM patients was suboptimal in more than half of the participants. The study showed that the use of ACE-I or angiotensin II receptor blockers (ARBs) in the majority of DM patients has a good impact in the control of blood pressure. The early initiation of ACE-I or ARBs among the diabetic patients will improve the optimal BP control.
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Affiliation(s)
- Gabriel W. Mbwete
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kajiru G. Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Elichilia R. Shao
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Nyasatu G. Chamba
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Abstract
Although often underappreciated, a number of bacterial zoonoses are endemic in Africa. Of these, brucellosis, leptospirosis, Q fever, and rickettsioses are responsible for a substantial proportion of febrile illness among patients seeking hospital care. In this paper, we discuss the aetiology, epidemiology, clinical presentation, diagnosis, treatment and prevention of these bacterial zoonoses. To prevent and control bacterial zoonoses, strategies targeting both animals and humans are crucial. These may lead to better outcomes than strategies based exclusively on treatment of human infections. Such strategies are referred to as the 'One Health' approach; the collaborative effort of multiple disciplines to attain optimal health for people, animals and the environment.
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Affiliation(s)
- Manuela Carugati
- Duke University, Durham, USA and consultant, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Kajiru G Kilonzo
- Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - John A Crump
- University of Otago, Dunedin, New Zealand and adjunct professor of medicine, pathology and global health, Duke University, Durham, USA
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Carugati M, Zhang HL, Kilonzo KG, Maze MJ, Maro VP, Rubach MP, Crump JA. Predicting Mortality for Adolescent and Adult Patients with Fever in Resource-Limited Settings. Am J Trop Med Hyg 2019; 99:1246-1254. [PMID: 30226134 DOI: 10.4269/ajtmh.17-0682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Febrile illnesses are a major cause of mortality in sub-Saharan Africa. Early identification of patients at increased risk of death may avert adverse outcomes. We aimed to independently evaluate the performance of the Modified Early Warning Score, quick Sequential Organ Failure Assessment (qSOFA) score, and Integrated Management of Adolescent and Adult Illness (IMAI) emergency signs and severity criteria to predict in-hospital mortality among a prospective cohort of febrile patients in Tanzania. We evaluated 419 patients aged ≥ 10 years in the period 2007-2008. Of the 44 patients who died, 31 (70.5%) were human immunodeficiency virus (HIV) infected. On univariate analysis, in-hospital mortality was associated with HIV infection, oxygen saturation < 90%, respiratory distress, Glasgow Coma Scale < 15, neck stiffness, unconsciousness, convulsions, hemoglobin < 9 g/dL, absence of a systemic syndrome, and neurologic syndrome. A qSOFA score ≥ 2, the presence of at least one, two, or three IMAI emergency signs, and IMAI severe respiratory distress syndrome without shock were significantly associated with in-hospital mortality. The criterion "presence of at least one IMAI emergency sign" showed a good diagnostic accuracy, as highlighted by the high sensitivity, low negative likelihood ratio, and wide area under the receiver operating characteristics curve. The remaining scores showed a poor performance in predicting fatal outcomes in our study population. Further studies are needed to validate our findings and to derive early warning scores that have good clinical performance in settings throughout sub-Saharan Africa.
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Affiliation(s)
- Manuela Carugati
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Division of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Helen L Zhang
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | | | - Michael J Maze
- Centre for International Health, University of Otago, Dunedin, New Zealand.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Venance P Maro
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Matthew P Rubach
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - John A Crump
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina.,Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Centre for International Health, University of Otago, Dunedin, New Zealand.,Duke Global Health Institute, Duke University, Durham, North Carolina
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19
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Dekker MCJ, Kilonzo KG, Howlett WP, Guttman M, Cubo E. Inspiratory Myoclonus. Tremor Other Hyperkinet Mov (N Y) 2019; 9:625. [PMID: 30809420 PMCID: PMC6387828 DOI: 10.7916/3qs5-cv76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/17/2019] [Indexed: 12/01/2022]
Abstract
Background Movement disorders of respiration are rare and are restricted to a phase of the respiratory cycle. Phenomenology Shown The intermittent inspiratory myoclonus in this patient with post-anoxic encephalopathy is likely to be of brainstem origin. Educational Value Rare movement disorders can be identified even in remote areas of the world where access to neurological care is limited.
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Affiliation(s)
- Marieke C J Dekker
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, TZ
| | - Kajiru G Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, TZ
| | - William P Howlett
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, TZ
| | - Mark Guttman
- Department of Internal Medicine, Division of Neurology, University of Toronto, Toronto, CA
| | - Esther Cubo
- Neurology Department, Hospital Universitario Burgos, Burgos, SP
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20
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Shao ER, Mboya IB, Gunda DW, Ruhangisa FG, Temu EM, Nkwama ML, Pyuza JJ, Kilonzo KG, Lyamuya FS, Maro VP. Seroprevalence of hepatitis B virus infection and associated factors among healthcare workers in northern Tanzania. BMC Infect Dis 2018; 18:474. [PMID: 30241503 PMCID: PMC6151054 DOI: 10.1186/s12879-018-3376-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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] [Received: 12/06/2017] [Accepted: 09/06/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Hepatitis B virus infection is a global health problem with the highest prevalence in East Asia and Sub-Saharan Africa. The majority of infected people, including healthcare workers are unaware of their status. This study is aimed to determining seroprevalence of hepatitis B virus infection and associated factors among healthcare workers in northern Tanzania. METHODS This cross-sectional study included 442 healthcare workers (HCWs) from a tertiary and teaching hospital in Tanzania before the nationwide hepatitis B vaccination campaign in 2004. Questionnaire- based interviews were used to obtain detailed histories of the following: demographic characteristics; occupation risks such splash and needle stick injuries or other invasive procedure such as intravenous, intramuscular or subcutaneous injections; history of blood transfusion and surgeries, as well as HCWs'knowledge of HBV. Serological markers of HBV were done using Laborex HBsAg rapid test. Serology was done at zero months and repeated after six months ( bioscienceinternational.co.ke/rapid-test-laborex.html HBsAg Piazzale-milano-2, Italy [Accessed on November 2017]). Chi-square (χ2) tests were used to compare proportion of HBV infection by different HCWs characteristics. Multivariable logistic regression was used to determine factors associated with HBV infection. RESULTS A total of 450 surveys were sent out, with a 98.2% response rate. Among the 442 HCWs who answered the questionnaire, the prevalence of chronic hepatitis B virus infection was 5.7% (25/442). Only 50 (11.3%) of HCWs were aware of the HBV status. During the second HBsAg testing which was done after six months one participant sero-converted hence was excluded. Adjusted for other factors, history of blood transfusion significantly increased the odds of HBV infection (OR = 21.44, 95%CI 6.05, 76.01, p < 0.001) while HBV vaccine uptake was protective against HBV infection (OR = 0.06, 95%CI 0.02, 0.26, p < 0.001). The majority of HCWs with chronic HBV infection had poor to fare knowledge about HBV infection but this was not statistically significant when controlled for confounding. CONCLUSIONS Prevalence of HBV among health care workers was 5.7% which is similar to national prevalence. Although the response rate to take part in the study was good but knowledge on HBV infection among HCWs was unsatisfactory. History of blood transfusion increased risks while vaccine uptake decreased the risk of HBV infection. This study recommends continues vaccinating HCWs together with continues medical education all over the country. We also recommend documentation of vaccination evidence should be asked before employment of HCWs in order to sensitize more uptakes of vaccinations. Although we didn't assess the use of personal protective equipment but we encourage HCWs to abide strictly on universal protections against nosocomial infections.
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Affiliation(s)
- Elichilia R Shao
- Internal Medicine Department, Kilimanjaro Christian Medical Center, P.O.Box3010, Moshi, United Republic of Tanzania. .,Institute of Public Health, Community Health Department, Kilimanjaro Christian Medical University College, P.O.Box2240, Moshi, Tanzania. .,Better Human Health Foundation, P.O.Box1348, Moshi, Tanzania. .,Imagedoctors International, P.O.Box16341, Arusha, Tanzania.
| | - Innocent B Mboya
- Institute of Public Health, Community Health Department, Kilimanjaro Christian Medical University College, P.O.Box2240, Moshi, Tanzania
| | | | - Flora G Ruhangisa
- Internal Medicine Department, Kilimanjaro Christian Medical Center, P.O.Box3010, Moshi, United Republic of Tanzania.,Institute of Public Health, Community Health Department, Kilimanjaro Christian Medical University College, P.O.Box2240, Moshi, Tanzania
| | - Elizabeth M Temu
- Internal Medicine Department, Kilimanjaro Christian Medical Center, P.O.Box3010, Moshi, United Republic of Tanzania
| | - Mercy L Nkwama
- Internal Medicine Department, Kilimanjaro Christian Medical Center, P.O.Box3010, Moshi, United Republic of Tanzania
| | - Jeremia J Pyuza
- Internal Medicine Department, Kilimanjaro Christian Medical Center, P.O.Box3010, Moshi, United Republic of Tanzania.,Institute of Public Health, Community Health Department, Kilimanjaro Christian Medical University College, P.O.Box2240, Moshi, Tanzania
| | - Kajiru G Kilonzo
- Internal Medicine Department, Kilimanjaro Christian Medical Center, P.O.Box3010, Moshi, United Republic of Tanzania.,Institute of Public Health, Community Health Department, Kilimanjaro Christian Medical University College, P.O.Box2240, Moshi, Tanzania
| | - Furaha S Lyamuya
- Internal Medicine Department, Kilimanjaro Christian Medical Center, P.O.Box3010, Moshi, United Republic of Tanzania.,Institute of Public Health, Community Health Department, Kilimanjaro Christian Medical University College, P.O.Box2240, Moshi, Tanzania
| | - Venance P Maro
- Institute of Public Health, Community Health Department, Kilimanjaro Christian Medical University College, P.O.Box2240, Moshi, Tanzania
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van Zwetselaar M, Nyombi B, Sonda T, Kumburu H, Chamba N, Dekker MCJ, Kilonzo KG, Urasa SJ, Mmbaga BT. Aeromonas caviae mimicking Vibrio cholerae infectious enteropathy in a cholera-endemic region with possible public health consequences: two case reports. J Med Case Rep 2018; 12:71. [PMID: 29548295 PMCID: PMC5857081 DOI: 10.1186/s13256-018-1603-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 08/01/2017] [Accepted: 02/02/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Aeromonas species have been documented to yield false positive results in microbiological tests for Vibrio cholerae. They share many biochemical properties with Vibrio species, with which they were jointly classified in the family Vibrionaceae until genotypic information provided new insights. Aeromonas species are increasingly associated with gastrointestinal infections, albeit with great apparent variation in pathogenicity and virulence both between and within species of the genus. We report two cases with clinically mild cholera-like symptoms, at a time when a cholera outbreak was unfolding in other regions of the country (Tanzania). These are the first cases to be reported with Aeromonas mimicking cholera in our area. CASE PRESENTATION Two patients were admitted at the isolation unit designated by the Kilimanjaro Christian Medical Centre for emerging infectious diseases and provided informed consent about regular stool analysis and culture under the provisional diagnosis of gastroenteritis. The first patient was a 23-year-old black African woman with a 2-day history of watery diarrhea and vomiting associated with a temperature of 39.7 °C. The second patient was a 47-year-old black African woman with a 2-day history of diarrhea and vomiting with a temperature of 37.7 °C, and she was hemodynamically stable. Both patients were isolated in a specific area for infection control and treated with fluids and orally administered rehydration solution, ciprofloxacin, metronidazole, and paracetamol. Stool culture was done. The isolated colonies were reported as V. cholerae and transferred to the research laboratory of Kilimanjaro Clinical Research Institute for confirmation using whole genome sequencing. Microbiological testing determined colonies isolated from stool to be V. cholerae, and warranted the conclusion "presumptive cholera." Whole genome sequencing, however, established the presence of Aeromonas caviae rather than V. cholerae. CONCLUSIONS The co-existence of Aeromonas species with V. cholerae in cholera-endemic regions suggests the possibility that a proportion of suspected cholera cases may be Aeromonas infections. However, with close to no epidemiological data available on Aeromonas infection in cases of diarrhea and dysentery in Sub-Saharan Africa, it is not currently possible to establish the extent of misdiagnosis to any degree of certainty. Whole genome sequencing was shown to readily exclude V. cholerae as the etiological agent and establish the presence of Aeromonas species.
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Affiliation(s)
- Marco van Zwetselaar
- Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro United Republic of Tanzania
| | - Balthazar Nyombi
- 0000 0004 0648 072Xgrid.415218.bKilimanjaro Christian Medical Centre, Moshi, Kilimanjaro United Republic of Tanzania ,0000 0004 0648 0439grid.412898.eKilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Tolbert Sonda
- Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro United Republic of Tanzania ,0000 0004 0648 0439grid.412898.eKilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Happiness Kumburu
- Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro United Republic of Tanzania ,0000 0004 0648 0439grid.412898.eKilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Nyasatu Chamba
- 0000 0004 0648 072Xgrid.415218.bKilimanjaro Christian Medical Centre, Moshi, Kilimanjaro United Republic of Tanzania
| | - Marieke C. J. Dekker
- 0000 0004 0648 072Xgrid.415218.bKilimanjaro Christian Medical Centre, Moshi, Kilimanjaro United Republic of Tanzania
| | - Kajiru G. Kilonzo
- 0000 0004 0648 072Xgrid.415218.bKilimanjaro Christian Medical Centre, Moshi, Kilimanjaro United Republic of Tanzania ,0000 0004 0648 0439grid.412898.eKilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Sarah J. Urasa
- 0000 0004 0648 072Xgrid.415218.bKilimanjaro Christian Medical Centre, Moshi, Kilimanjaro United Republic of Tanzania ,0000 0004 0648 0439grid.412898.eKilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro United Republic of Tanzania ,0000 0004 0648 072Xgrid.415218.bKilimanjaro Christian Medical Centre, Moshi, Kilimanjaro United Republic of Tanzania ,0000 0004 0648 0439grid.412898.eKilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
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Kilonzo KG, Jones ESW, Okpechi IG, Wearne N, Barday Z, Swanepoel CR, Yeates K, Rayner BL. Disparities in dialysis allocation: An audit from the new South Africa. PLoS One 2017; 12:e0176041. [PMID: 28419150 PMCID: PMC5395209 DOI: 10.1371/journal.pone.0176041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 04/04/2017] [Indexed: 11/18/2022] Open
Abstract
End Stage Kidney Disease (ESKD) is a public health problem with an enormous economic burden. In resource limited settings management of ESKD is often rationed. Racial and socio-economic inequalities in selecting candidates have been previously documented in South Africa. New guidelines for dialysis developed in the Western Cape have focused on prioritizing treatment. With this in mind we aimed at exploring whether the new guidelines would improve inequalities previously documented. A retrospective study of patients presented to the selection committee was conducted at Groote Schuur Hospital. A total of 564 ESKD patients presented between 1 January 2008 and 31 December 2012 were assessed. Half of the patients came from low socioeconomic areas, and presentation was late with either overt uremia (n = 181, 44·4%) or fluid overload (n = 179, 43·9%). More than half (53·9%) of the patients were not selected for the program. Predictors of non-acceptance onto the program included age above 50 years (OR 0·3, p = 0·001), unemployment (OR 0·3, p<0·001), substance abuse (OR 0·2, p<0·001), diabetes (OR 0·4, p = 0·016) and a poor psychosocial assessment (OR 0·13, p<0·001). Race, gender and marital status were not predictors. The use of new guidelines has not led to an increase in inequalities. In view of the advanced nature of presentation greater efforts need to be made to prevent early kidney disease, to allocate more resources to renal replacement therapy in view of the loss of young and potentially productive life.
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Affiliation(s)
- Kajiru G. Kilonzo
- Division of Nephrology and Hypertension, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
- Internal Medicine Department, Kilimanjaro Christian Medical University College, Kilimanjaro, Moshi, Tanzania
| | - Erika S. W. Jones
- Division of Nephrology and Hypertension, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Ikechi G. Okpechi
- Division of Nephrology and Hypertension, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Nicola Wearne
- Division of Nephrology and Hypertension, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Zunaid Barday
- Division of Nephrology and Hypertension, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Charles R. Swanepoel
- Division of Nephrology and Hypertension, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Karen Yeates
- Department of Nephrology, Queen’s University, Kingston, Ontario, Canada
| | - Brian L. Rayner
- Division of Nephrology and Hypertension, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
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Shao ER, Joseph PM, Slootweg P, Mkwizu EW, Kilonzo KG, Mwasamwaja AO. Spontaneous oesophageal rupture: a diagnostic challenge in resource-limited setting. Oxf Med Case Reports 2015; 2015:314-6. [PMID: 26421158 PMCID: PMC4584513 DOI: 10.1093/omcr/omv048] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 07/05/2015] [Indexed: 11/13/2022] Open
Abstract
Spontaneous oesophageal rupture after swallowing a bolus of food is a very rare condition. In resource-limited settings, it is very challenging to diagnose this condition especially when its presentation is atypical. Its prognosis is very poor when diagnosis is delayed due to risk of mediastinitis. We report a case of 37-year-old man who was admitted to our hospital complaining of sudden onset of chest tightness and pain after a meal 8 h prior to admission. Urgent chest radiograph revealed right hydropneumothorax with collapsed lung. Water-seal drainage was established gushing 1200 ml of food materials. Definitive diagnosis of oesophageal rupture was reached after post-mortem.
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Affiliation(s)
- Elichilia R Shao
- Department of Internal Medicine , Kilimanjaro Christian Medical Center , Moshi , Tanzania ; Kilimanjaro Christian Medical University College , Moshi , Tanzania ; Image Doctors International , Arusha , Tanzania ; Better Human Health Foundation , Moshi , Tanzania
| | - Pantaleo M Joseph
- Department of Internal Medicine , Kilimanjaro Christian Medical Center , Moshi , Tanzania ; Kilimanjaro Christian Medical University College , Moshi , Tanzania
| | - Piet Slootweg
- Department of Pathology , Kilimanjaro Christian Medical Center , Moshi , Tanzania ; Department of Pathology , Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Elifuraha W Mkwizu
- Department of Internal Medicine , Kilimanjaro Christian Medical Center , Moshi , Tanzania ; Kilimanjaro Christian Medical University College , Moshi , Tanzania ; Better Human Health Foundation , Moshi , Tanzania ; Endoscopy Unit , Kilimanjaro Christian Medical Center , Moshi , Tanzania
| | - Kajiru G Kilonzo
- Department of Internal Medicine , Kilimanjaro Christian Medical Center , Moshi , Tanzania ; Kilimanjaro Christian Medical University College , Moshi , Tanzania ; Endoscopy Unit , Kilimanjaro Christian Medical Center , Moshi , Tanzania
| | - Amos O Mwasamwaja
- Department of Internal Medicine , Kilimanjaro Christian Medical Center , Moshi , Tanzania ; Kilimanjaro Christian Medical University College , Moshi , Tanzania ; Image Doctors International , Arusha , Tanzania ; Better Human Health Foundation , Moshi , Tanzania ; Endoscopy Unit , Kilimanjaro Christian Medical Center , Moshi , Tanzania
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Sheriff FG, Howlett WP, Kilonzo KG. Post-partum pituitary insufficiency and livedo reticularis presenting a diagnostic challenge in a resource limited setting in Tanzania: a case report, clinical discussion and brief review of existing literature. BMC Endocr Disord 2012; 12:4. [PMID: 22583510 PMCID: PMC3393611 DOI: 10.1186/1472-6823-12-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 05/14/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pituitary disorders following pregnancy are an important yet under reported clinical entity in the developing world. Conversely, post partum panhypopituitarism has a more devastating impact on women in such settings due to high fertility rates, poor obstetric care and scarcity of diagnostic and therapeutic resources available. CASE PRESENTATION A 37 year old African female presented ten years post partum with features of multiple endocrine deficiencies including hypothyroidism, hypoadrenalism, lactation failure and secondary amenorrhea. In addition she had clinical features of an underlying autoimmune condition. These included a history of post-partum thyroiditis, alopecia areata, livedo reticularis and deranged coagulation indices. A remarkable clinical response followed appropriate hormone replacement therapy including steroids. This constellation has never been reported before; we therefore present an interesting clinical discussion including a brief review of existing literature. CONCLUSION Post partum pituitary insufficiency is an under-reported condition of immense clinical importance especially in the developing world. A high clinical index of suspicion is vital to ensure an early and correct diagnosis which will have a direct bearing on management and patient outcome.
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