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Mloka D, Tarimo E, Mselle L, Mshana S, Sirili N, Rogathi J, Msuya L, Rugarabamu P, Mteta A, Moshi M, Kwesigabo G, Lyamuya E, Bartlett J, Martin-Holland J, O'Sullivan P, Macfarlane S, Kaaya E. The process of harmonizing competency-based curricula for medicine and nursing degree programmes: A Multi-institutional and multi-professional experience from Tanzania. Med Teach 2023; 45:740-751. [PMID: 36622865 DOI: 10.1080/0142159x.2022.2158066] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In many low- and middle-income countries, there seems to be a mismatch between graduate skills and healthcare industry requirements due to variability in curricula. With the current increased global demand for competent health profession graduates, harmonizing competency-based curricula (CBC) is necessary to address this mismatch. This paper describes how three health professions training universities in Tanzania and their two long-standing United States partners embarked on developing harmonized CBC for undergraduate medicine and nursing degrees. The main goal of the activity was to develop templates to harmonize curricula that would support graduates to acquire mandatory national Graduate Minimum Essential Competencies (GMEC) irrespective of the institution of their training. The paper describes the processes of engaging multiple institutions, the professions of medicine and nursing and various stakeholders to develop mandatory curricula generic competencies, creating milestones for assessing competencies, training faculty at each of the three partnering institutions in curriculum delivery and assessments, resulting in the adoption of the curricula by the University leadership at each institution. Ultimately the Tanzania Commission for Universities (TCU) a regulatory body required all schools of medicine and nursing in the country to adopt the curricula, thus creating a harmonized national standard for teaching medicine and nursing beginning October 2022.
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Affiliation(s)
- Doreen Mloka
- Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Edith Tarimo
- Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lillian Mselle
- Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stephen Mshana
- Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Nathaniel Sirili
- Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jane Rogathi
- Community Health Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Levina Msuya
- Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Pascahilis Rugarabamu
- Anatomy and Histology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Alfred Mteta
- Surgery, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Mainen Moshi
- Biological and Preclinical Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gideon Kwesigabo
- Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eligius Lyamuya
- Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - John Bartlett
- Global Health and Nursing, Duke University, Durham, United States of America
| | - Judy Martin-Holland
- Physiological Nursing, University of San Francisco California, San Francisco, United States of America
| | - Patricia O'Sullivan
- Office of Research and Development in Medical Education, University of San Francisco California, San Francisco, United States of America
| | - Sarah Macfarlane
- Global Health Sciences, University of San Francisco California, San Francisco, United States of America
| | - Ephata Kaaya
- Pathology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Maina J, Mwaniki J, Mwiti F, Kiiru S, Katana J, Wanja F, Mukaya J, Khasabuli O, Asiimwe B, Gillespie S, Stelling J, Mshana S, Holden M, Sabiiti W, Kiiru J. Evaluation of the diagnostic performance of the urine dipstick test for the detection of urinary tract infections in patients treated in Kenyan hospitals. Access Microbiol 2023; 5:acmi000483.v3. [PMID: 37424559 PMCID: PMC10323778 DOI: 10.1099/acmi.0.000483.v3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/10/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Culture is the gold-standard diagnosis for urinary tract infections (UTIs). However, most hospitals in low-resource countries lack adequately equipped laboratories and relevant expertise to perform culture and, therefore, rely heavily on dipstick tests for UTI diagnosis. Research gap In many Kenyan hospitals, routine evaluations are rarely done to assess the accuracy of popular screening tests such as the dipstick test. As such, there is a substantial risk of misdiagnosis emanating from inaccuracy in proxy screening tests. This may result in misuse, under-use or over-use of antimicrobials. Aim The present study aimed to assess the accuracy of the urine dipstick test as a proxy for the diagnosis of UTIs in selected Kenyan hospitals. Methods A hospital-based cross-sectional method was used. The utility of dipstick in the diagnosis of UTIs was assessed using midstream urine against culture as the gold standard. Results The dipstick test predicted 1416 positive UTIs, but only 1027 were confirmed positive by culture, translating to a prevalence of 54.1 %. The sensitivity of the dipstick test was better when leucocytes and nitrite tests were combined (63.1 %) than when the two tests were separate (62.6 and 50.7 %, respectively). Similarly, the two tests combined had a better positive predictive value (87.0 %) than either test alone. The nitrite test had the best specificity (89.8 %) and negative predictive value (97.4 %) than leucocytes esterase (L.E) or both tests combined. In addition, sensitivity in samples from inpatients (69.2 %) was higher than from outpatients (62.7 %). Furthermore, the dipstick test had a better sensitivity and positive predictive value among female (66.0 and 88.6 %) than male patients (44.3 and 73.9 %). Among the various patient age groups, the dipstick test's sensitivity and positive predictive value were exceptionally high in patients ≥75 years old (87.5 and 93.3 %). Conclusion Discrepancies in prevalence from the urine dipstick test and culture, the gold standard, indicate dipstick test inadequacy for accurate UTI diagnosis. The finding also demonstrates the need for urine culture for accurate UTI diagnosis. However, considering it is not always possible to perform a culture, especially in low-resource settings, future studies are needed to combine specific UTI symptoms and dipstick results to assess possible increases in the test's sensitivity. There is also a need to develop readily available and affordable algorithms that can detect UTIs where culture is not available.
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Affiliation(s)
- John Maina
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - John Mwaniki
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Franklin Mwiti
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Susan Kiiru
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Japhet Katana
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Fredrick Wanja
- Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Osborn Khasabuli
- Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | | | - John Stelling
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephen Mshana
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Matthew Holden
- University of St Andrews, School of Medicine, St Andrews, UK
| | - Wilber Sabiiti
- University of St Andrews, School of Medicine, St Andrews, UK
| | - John Kiiru
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
- Ministry of Health, Nairobi, Kenya
| | - HATUA consortium
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
- Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
- Kentyatta National Hospital, Nairobi, Kenya
- Makerere University, Kampala, Uganda
- University of St Andrews, School of Medicine, St Andrews, UK
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Ministry of Health, Nairobi, Kenya
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Mboowa G, Sserwadda I, Bulafu D, Chaplain D, Wewedru I, Seni J, Kidenya B, Mshana S, Joloba M, Aruhomukama D. Transmission Dynamics of Antimicrobial Resistance at a National Referral Hospital in Uganda. Am J Trop Med Hyg 2021; 105:498-506. [PMID: 34181567 DOI: 10.4269/ajtmh.20-1522] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/28/2021] [Indexed: 11/07/2022] Open
Abstract
Reliable data on antimicrobial resistance (AMR) transmission dynamics in Uganda remains scarce; hence, we studied this area. Eighty-six index patients and "others" were recruited. Index patients were those who had been admitted to the orthopedic ward of Mulago National Referral Hospital during the study period; "others" included medical and non-medical caretakers of the index patients, and index patients' immediate admitted hospital neighbors. Others were recruited only when index patients became positive for carrying antimicrobial-resistant bacteria (ARB) during their hospital stay. A total of 149 samples, including those from the inanimate environment, were analyzed microbiologically for ARB, and ARB were analyzed for their antimicrobial susceptibility profiles and mechanisms underlying observed resistances. We describe the diagnostic accuracy of the extended-spectrum β-lactamase (ESBL) production screening method, and AMR acquisition and transmission dynamics. Index patients were mostly carriers of ESBL-producing Enterobacteriaceae (PE) on admission, whereas non-ESBL-PE carriers on admission (61%) became carriers after 48 hours of admission (9%). The majority of ESBL-PE carriers on admission (56%) were referrals or transfers from other health-care facilities. Only 1 of 46 samples from the environment isolated an ESBL-PE. Marked resistance (>90%) to β-lactams and folate-pathway inhibitors were observed. The ESBL screening method's sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 50%, 90%, and 100%, respectively. AMR acquisition and transmission occurs via human-human interfaces within and outside of health-care facilities compared with human-inanimate environment interfaces. However, this remains subject to further research.
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Affiliation(s)
- Gerald Mboowa
- Department of Immunology and Molecular Biology, College of Health Sciences, School of Biomedical Sciences, Makerere University, Kampala, Uganda.,African Center of Excellence in Bioinformatics and Data Intensive Sciences, The Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Ivan Sserwadda
- Department of Immunology and Molecular Biology, College of Health Sciences, School of Biomedical Sciences, Makerere University, Kampala, Uganda
| | - Douglas Bulafu
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Duku Chaplain
- Clinical Microbiology Laboratory, Mulago National Referral Hospital, Kampala, Uganda.,Clinical Microbiology Laboratory, Mbarara University Teaching Hospital Mbarara, Uganda
| | - Izale Wewedru
- Clinical Microbiology Laboratory, Mulago National Referral Hospital, Kampala, Uganda
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania
| | - Benson Kidenya
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania
| | - Stephen Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania
| | - Moses Joloba
- Department of Immunology and Molecular Biology, College of Health Sciences, School of Biomedical Sciences, Makerere University, Kampala, Uganda.,Department of Medical Microbiology, College of Health Sciences, School of Biomedical Sciences, Makerere University, Kampala, Uganda
| | - Dickson Aruhomukama
- Department of Immunology and Molecular Biology, College of Health Sciences, School of Biomedical Sciences, Makerere University, Kampala, Uganda.,Department of Medical Microbiology, College of Health Sciences, School of Biomedical Sciences, Makerere University, Kampala, Uganda
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Huth PFB, Addo M, Daniel T, Groendahl B, Hokororo A, Koliopoulos P, Mshana S, Pretsch L, Schmidt C, Zuechner A, Gehring S, Kayange N. Extensive Antibiotic and Antimalarial Prescription Rate among Children with Acute Febrile Diseases in the Lake Victoria Region, Tanzania. J Trop Pediatr 2021; 67:6133215. [PMID: 33575804 DOI: 10.1093/tropej/fmaa135] [Citation(s) in RCA: 4] [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] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Acute mosquito-borne febrile diseases pose a threat to children in the Sub-Saharan-Africa with ∼272 000 children dying worldwide from malaria in 2018. Although the awareness for malaria in this area has increased due to improved health education, the apparent decline of actual malaria cases has not affected clinical practice significantly. This study collected clinical and epidemiologic data of children presenting with acute febrile diseases in order delineate their diagnostic and therapeutic management. METHODS A hospital-based cross-sectional clinical study was conducted at the Sekou Toure Regional Referral Hospital in Tanzania. Children between 1 month and 12 years of age with an axillary temperature ≥ 37.5°C were recruited from August 2016 to December 2016. Children received full clinical examination. In addition, file data about diagnostics and treatment were collected and malaria rapid diagnostic tests (mRDTs) were performed. Confirmatory malaria polymerase chain reaction was performed from dry blood spots. RESULTS From 1381 children presented in the pediatric outpatient department, 133 met the inclusion criteria. Out of 133 febrile children, 10.5% were malaria positive. Treatment data indicate the prescription of antimalarials in 35.3% and antibiotics in 63.9% of the children with an overlap of 24.1% receiving both. Despite a negative mRDT, 36 patients received antimalarials. CONCLUSIONS The findings of this study confirm a significant decline of malaria cases in the Lake Victoria region. The discrepancy between the valuable results provided by mRDTs and the high prescription rates of antibiotics and antimalarials call for an enforced diagnostic and therapeutic algorithm. LAY SUMMARY The aim of the study was to take a closer look at reported cases of febrile diseases in the Lake Victoria region and assess the relationship between clinical as well as diagnostic findings and the resulting therapeutic concept. Based on these findings the prescription rate of antimalarial and antibiotic drugs was analyzed. The results showed an overall high prescription rate of antimalarials and antibiotics in both diagnosed malaria cases and cases with diagnosed bacterial infections.Not only with regards to the possible side effects of these medications but also keeping in mind the apparent misuse of resources this practice poses a serious burden to the health care system in this low resource country.
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Affiliation(s)
- Philipp Florian Brixius Huth
- Department of Infectiology and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Marylyn Addo
- Department of Infectiology and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Tim Daniel
- Center of Pediatric and Adolescent Medicine, Johannes Gutenberg-University Medical Center, 55131 Mainz, Germany
| | - Britta Groendahl
- Center of Pediatric and Adolescent Medicine, Johannes Gutenberg-University Medical Center, 55131 Mainz, Germany
| | - Adolfine Hokororo
- Department of Pediatric and Child Health, Bugando Medical Centre/Catholic University of Health and Allied Sciences, P.o. Box 1370 Mwanza, Tanzania
| | - Philip Koliopoulos
- Center of Pediatric and Adolescent Medicine, Johannes Gutenberg-University Medical Center, 55131 Mainz, Germany
| | - Stephen Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences (CUHAS), Mwanza, Tanzania
| | - Leah Pretsch
- Center of Pediatric and Adolescent Medicine, Johannes Gutenberg-University Medical Center, 55131 Mainz, Germany
| | - Christian Schmidt
- Department of Pediatric and Adolescent Medicine, 46535 Dinslaken, Germany
| | - Antke Zuechner
- Department of Pediatric and Child Health, Bugando Medical Centre/Catholic University of Health and Allied Sciences, P.o. Box 1370 Mwanza, Tanzania
| | - Stephan Gehring
- Center of Pediatric and Adolescent Medicine, Johannes Gutenberg-University Medical Center, 55131 Mainz, Germany
| | - Neema Kayange
- Department of Pediatric and Child Health, Bugando Medical Centre/Catholic University of Health and Allied Sciences, P.o. Box 1370 Mwanza, Tanzania
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Iddi S, Malindisa E, Shija M, Msemwa B, Silago V, Mirambo M, Mshana S. A 0.85% saline as alternative detection buffer for SD-Bioline HIV rapid test in resource limited setting. Pan Afr Med J 2020; 37:241. [PMID: 33552359 PMCID: PMC7847209 DOI: 10.11604/pamj.2020.37.241.24234] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/23/2020] [Indexed: 11/11/2022] Open
Abstract
Accuracy in the diagnosis is a key step to identify HIV infected individuals for appropriate management. Insufficient supply of manufacturer´s buffers in relation to the number of strips per kit has negative impact on patient´s results hence improper patient´s management. In resource limited settings, some laboratory staff use different substitute buffers which has never been validated on their reliability. This study aimed at comparing the performance of 0.85% saline and SD-Bioline manufacturer´s buffer in detection of HIV antibodies. A total of 220 whole blood specimens: 110 HIV positive specimens from patients attending care and treatment center (CTC) and 110 HIV negative specimens from blood donors were re-tested for HIV status using SD-Bioline HIV rapid test using manufacturer´s buffer and 0.85% saline separately. Data and laboratory results were recorded in Microsoft excel sheet followed by analysis using STATA version 13. For all tested samples, the level of agreement between 0.85% saline and manufacturer´s buffer was 98.64% (kappa=0.9727). The value of kappa indicates very good agreement between 0.85% saline and manufacturer´s buffer. In incidents where manufacturer´s buffer is not sufficient, 0.85% saline can give reliable results. Further studies to evaluate the suitable buffer for other rapid tests for HIV and other diseases are recommended especially in resource limited settings.
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Affiliation(s)
- Shabani Iddi
- Department of Physiology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Evangelista Malindisa
- Department of Physiology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Musa Shija
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Betrand Msemwa
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mariam Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Stephen Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Mushi M, Jonathan E, Mirambo M, Mshana S. Prevalence and Predictors of Dermatophyte Infections Among Primary School Children in Ilemela, Mwanza, Tanzania. East Afr Health Res J 2019. [DOI: 10.24248/eahrj.v3i1.600] [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: 11/20/2022] Open
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