East Africa Science

Dengue Virus and Blood Safety: A Mini-Review of Research Publications

Festus Mulakoli — 2023-03-30

The growing demand for donated whole blood and blood products to save lives has both health benefits and health risks for blood recipients at the same time. Dengue virus, a re-emerging viral disease poses a threat to blood safety, and it has spread to over 128 countries in the world. Several studies have documented transfusion-transmitted (TT) dengue, with the first cases being reported in China in 2002 and Singapore in 2008. To understand the magnitude and broader picture of the dengue virus and blood safety, we conducted a mini-review of published literature from the Scopus database. The review focused on the number of publications related to the dengue virus among blood donors. Using keywords ‘Dengue virus’ AND ‘Blood safety’, ‘ Dengue virus’ AND ‘Blood donors’ and ‘Emerging infectious diseases’ AND “Blood safety” were used to extract data from the Scopus database which was downloaded as a CSV Excel file covering a period 2004 to 2021. This was followed by a data-cleaning exercise and a descriptive analysis to generate the frequency of the number of publications. Most studies, as can be seen in the review, were concentrated in tropical regions of the world. Globally, South America and the Asian regions had the largest number of publications; while at the country level, Brazil and India had the highest number. More research output was witnessed during the years 2014 and 2018. The regions that experienced more frequent outbreaks of the disease, with the exception Africa, published most of the research work. Therefore, much more research work is needed to protect the safety of blood donors in Africa.

Use of Hair Samples for Monitoring of Antiretroviral Therapy Adherence

Philomena Chepkirui — 2023-03-30

Introduction: Measurement of antiretrovirals (ARVs) drug concentration in biological matrices such as blood and urine has been used previously for monitoring adherence. Unfortunately, they only reflect ARV doses taken within 1 to 2 days of sampling. Hair testing has become the most preferred tool to determine chronic exposure to some drugs, especially drugs of abuse, because of its long detection window. Objective: This study, evaluated the utility of hair samples in therapeutic drug monitoring (TDM) as an indicator of ART adherence. Methods: This study used nevirapine (NVP), an ARV integral component of the first line ART in Kenya, for many years. Matched hair and blood samples were obtained from 234 and 328 consenting HIV patients on first line ART with virologic failure (viral load >1000 copies/mL) and suppressed viral load (VL<1000 copies/mL) respectively. The ARV plasma and hair concentrations were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results: The calculated median; interquartile range (IQR) of NVP levels in hair and plasma samples were 36.8ng/ mL and 19.32ng/mL respectively. There was no significant difference between the level of NVP in hair and matched plasma samples (Wilcoxon signed rank test; Z = -0.93, P> 0.05). Conclusion: The study has demonstrated that analysis of ARV drugs in the hair can determine drug exposure as an alternative to conventional plasma drug analysis, especially in our settings where laboratory facilities and skilled personnel to do phlebotomy are few or lacking.

Seasonal Transmission Dynamics of Rift Valley Fever in Kilimanjaro Region, Tanzania

Kevin M Rwegoshola — 2023-03-30

Background: Rift Valley Fever (RVF) is a zoonotic disease that affects both animals and humans. Under reporting, misdiagnosis caused by the broad spectrum of symptoms presented by the disease, and limited access to rapid and accurate laboratory confirmation have led to an undefined burden of RVF. Reports are available that show the circulation of the virus during inter-epidemic periods, implying an endemic circulation of RVFV. This study aimed to determine RVFV transmission across annual seasons and demographic factors that are independently associated with exposure to RVFV.
Methodology: Repeated serosurveys were performed during the long rainy, short rainy, and dry seasons in Lower Moshi area of Moshi district, Kilimanjaro region from January to December 2020. The goal was to determine seroprevalence against RVFV antibodies in humans and factors associated with seropositivity. Detection of RVF antibody was performed by competitive Enzyme-Linked Immunosorbent Assays (cELISA) using serum samples. Stata statistical software version 15 was used for data analysis. Descriptive statistics was carried out, whereby categorical variables were summarised using frequencies and percentages. Numeric variables were summarised using median and interquartile range. Logistic regression was used to assess factors associated with RVF seropositivity.
Results: A total of 446 individuals were involved in the analysis. RVF seroprevalence was highest during rainy season (20.4%) and lowest in the dry season (4%). The overall annual seroprevalence of RVF was 12.8%. Season, participant age, and large number of residents in a given household were found to be significantly associated with RVF seropositivity (p<.05).
Conclusion: RVFV demonstrates an endemic circulation in Lower Moshi area of Kilimanjaro region, suggesting the site is a potential RVF hotspot. Based on this study’s findings, we recommend close surveillance of RVF in the study area and other areas with similar ecology in Tanzania as a means of preparedness for future unpredicted RVF outbreaks.

Facility-Based Cross-Sectional Survey on Aedes-Borne Diseases and Associated Symptoms among Febrile Patients During the 2019 Dengue Outbreak in Moshi Rural District, Tanzania

Robert Kaaya — 2023-03-30

Background: Diseases caused by Aedes-borne viruses, such as; dengue, chikungunya, and Zika are emerging and re- emerging in different parts of the world. Tanzania has experienced several dengue outbreaks since 2010. The present study aims to determine the seroprevalence and associated symptoms of dengue and chikungunya fever in the Moshi rural district during the 2019 dengue outbreak.
Methodology: A facility-based cross-sectional survey was conducted in 15 health facilities in the Moshi Rural district. A total of 397 participants with malaria-like symptoms were enrolled. Participants were screened for seropositivity towards dengue and chikungunya Immunoglobulin G and M (IgG and IgM) using ELISA-based kits.
Results: Out of 397 participants, 28 (7.1 %) and 8 (2.0%) were dengue IgM and IgG positive respectively. Chikungunya IgM positives were 34 (8.6%). The most commonly reported symptoms were; headache 189 (27.7%), joint pains 132 (19.4%) and muscle pain 106 (15.5%). Factors such as being a farmer and history of travelling to outside regions was associated with dengue IgM seropositivity (p<.05). Conclusion: Aedes-borne illnesses appear to be endemic in the area, with IgG antibodies against the Chikungunya virus being more prevalent among study participants. These results provide an understanding of arboviral diseases as well as provide an early warning signal on the risk of transmission in north Tanzania. The results inform the allocation of local
and national public health intervention to prevent future outbreaks.

Seroprevalence of Toxoplasma gondii and Associated Risk factors Among Pregnant Women Attending Antenatal Care in Ilala Municipality, Dar es Salaam, Tanzania

Mayala Lushina — 2023-03-30

Background: Toxoplasma gondii (T. gondii) infection during pregnancy is associated with various complications for the mother and baby. In Tanzania, there is a paucity of data on exposure to T. gondii infection among pregnant women and the associated risk factors. Therefore, this study investigated the seroprevalence of T. gondii and associated factors among pregnant women attending antenatal care in Ilala Municipality, Dar es Salaam.
Methods: A cross sectional study was carried out among 383 pregnant women attending antenatal health care. A five mL of blood sample was collected from each recruited pregnant woman, processed to obtain serum, and tested for the presence of IgG and IgM anti T. gondii specific antibodies. A structured questionnaire was used to gather information on the risk factors predisposing pregnant women to the infection. Data analysis was performed using descriptive statistics and logistic regression.
Results: Of the 383 participants, 104 (27.2%) were positive for antibodies specific to T. gondii; 102 (26.63%) were positive only for IgG, and 2 (0.52%) were positive for both IgM and IgG antibodies. Significant risk factors for T. gondii infection were maternal age of 34-39 years (AOR:3.71;95% CI:1.52-9.06), eating unwashed fruits (AOR:7.39;95% CI:3.99-13.66), not washing hand with soap after meat preparation (AOR:7.53; 95% CI:3.40-16.64), consumption of undercooked meat (AOR:3.75; 95% CI:1.95-7.21), and consumption of raw vegetable (AOR: 1.99; 95% CI: 1.04- 3.80). Cat ownership was not statistically significantly associated with toxoplasmosis (AOR:1.90; 95% CI: 0.89-4.08).

Conclusions: The seroprevalence of T. gondii infection (27.2%) indicates ongoing transmission, hence the need for regular screening during antenatal care and establishment of a control programme.

Iron Deficiency and Iron Deficiency Anemia Among Children 3 to 59 Months of Age in Kinondoni Municipal, Dar es Salaam: A Facility-Based Cross-Sectional Study

Joyce Mushi — 2023-05-23

Background: Iron deficiency with subsequent iron deficiency anemia is the most common micronutrient disorder in children below 5 years of age worldwide. The developing countries bear more weight on the problem as the result of multifactorial factors including but not limited to recurrent infections such as malaria, helminths infestation, and inadequate food security. However, its magnitude in children living in Kinondoni Municipal in Dar es salaam is not well understood. Therefore, the aim of this study was to determine the prevalence of anemia and how it is contributed by the presence ofiron deficiency among children between 3-59months of age in the above-mentioned setting.
Methods: A facility-based cross-section study was conducted among children 3-59months attending Reproductive and Child Health Services at Kairuki, Sinza Hospital, and Kambangwa dispensary. Children who met the criteria, their basic social demographic information, complete blood count and differentials as well as blood ferritin levels were collected to assess the level of anemia, erythrocytic indices, and iron deficiency. Data were analyzed using the Statistical Package of Social Sciences (SPSS version 22). The magnitude of anemia and iron deficiencies were presented in percentages, and the relationship between hemoglobin and blood ferritin was assessed using Spearman’s correlation test for two continuous variables. The p-value of less or equal to 0.05 was considered statistically significant.
Results: A total of 350 children were recruited for the study, 255 Children (72.9%) were anemic. Children below 24 months of age were more anemic compared to the older age group (X2 = 50, p <0.001). Furthermore, anemia was significantly associated with low ferritin levels (X2 = 65, p <0.001). Iron deficiency was found in 156 (44.6%) participants while iron deficiency anemia (low MCV, low ferritin, and low hemoglobin) was found in 138 (39.4%) participants. However, among 255 participants with anemia, 147(65.3%) had iron deficiency. There was a significant
positive correlation between hemoglobin and blood ferritin levels (Spearman’s correlation coefficient = 0.6; p<0.01.
Conclusion: Prevalence of anemia was high among children and was highly associated with younger age and iron deficiency. To overcome this problem, appropriate interventions such as massive promotion of breastfeeding, appropriate complementary feeding, and ensuring food security are warranted.

Hygiene Practices, Water Supply, Sanitation, and Childhood Diarrhoea in Resource-Poor Settings of Rural Central Tanzania: A Mixed-Method Study

Elpidius Rukambile — 2023-03-30

Diarrhoeal diseases are associated with high morbidity and mortality, especially in children less than five years of age in many low- and middle-income countries (LMICs). This cross-sectional convergence mixed-method study explored water, sanitation and hygiene challenges as the important contributors to childhood diarrhoea in rural Tanzania. The study involved questionnaire survey (N=340), key informant interviews (KII) (n=10) and eight focus group discussions (FDG) (n=61). Prevalence of diarrhoea was 22.2% and 18.7% in Sanza and Iwondo Wards, of Manyoni and Mpwapwa Districts respectively. Improved houses (iron roof and baked brick walls) were more common in Sanza, while 80% of the houses in both wards had earth floor. Water sources in dry period and frequency of sharing water sources with animal were significantly different between wards (P<.001). Boiling drinking water was uncommon, practised by only 5.2% and 8.6% of the households in Sanza and Iwondo, respectively. More than 95% of the households in both wards used traditional pit latrines, and latrine sharing was more common in Iwondo than in Sanza (P=.035).
The themes from KII and FGD were: knowledge of occurrence and causes of diarrhoea, water safety, hand-washing, availability of improved sanitation services, keeping chickens inside the house overnight, health effects associated with keeping chickens inside the house and knowledge of occurrence and causes of diarrhoea. Mixed methods analysis through merging data sets revealed poor community knowledge on the causes of childhood diarrhoea, ineffective hand washing, seasonal variation of drinking water sources and high human-chicken interactions. Prevention and control of gastrointestinal infections in resource-poor settings should promote the use of cheap and locally available resources and feasible practices in response to the existing challenges related to water and sanitation services, financial constraints, economic activities, and cultural practices.

Point Prevalence Survey and Patterns of Antibiotic Use at Kirinyaga County Hospitals, Kenya

Perpetua Wanjiku Karanja — 2023-03-30

Background: Antibiotics are useful in treating and managing infections in outpatient and inpatient care settings. However, irrational antibiotic use can lead to improper patient care, antimicrobial resistance, wastage of resources and sometimes even death. The pattern of antibiotic use varies from one medical practitioner to another, infection, patient, wards, country and region. The study was a conducted as a baseline to describe the prevalence and patterns of antibiotic use in Kirinyaga County hospitals.
Methodology: The study was a point prevalence survey of antibiotics use among patients admitted to four hospitals in Kirinyaga county and the study utilised the World Health Organization methodology for point prevalence survey of antibiotics in hospitals. Data were abstracted from patients’ files of patients who consented using a pretested tool. The data was exported to MS Excel for cleaning and analysed descriptively
Results: The prevalence of antibiotic use in the four hospitals in Kirinyaga county was 44.0% (95%CI 38.6-49.5%). Penicillins were the most prescribed antibiotic class at 29.1%, followed by cephalosporins at 23.0%. Ceftriaxone and metronidazole were the highest prescribed at 22.0% and 19.8%, respectively. Antibiotics were mainly prescribed for community-acquired infections at 58.2%, followed by surgical prophylaxis at 26.0%. Most patients (52.5%) received two antibiotics, predominantly benzylpenicillin and gentamicin, at 40.3%. The majority, 63.0%, of all antibiotics were administered parenterally. There was poor documentation of the administration of medicines on the treatment sheet.
Conclusion: There was a relatively high prevalence of antibiotic use, all prescribed empirically. Community acquired infections were the most common indication for antibiotics. There was extensive use World Health Organization “watch” category of antibiotics without microbiological tests. There is a need for antibiotic stewardship program to ensure judicial use of antibiotics.

Self-Medication Practice with Antimalarials and Associated Factors Among Undergraduate Health Science Students in North Western - Tanzania: A Cross-Sectional Study

Ambrose Haule — 2023-03-30

Background: Self-medication is a growing public health concern in developing and developed countries. Objective: This study was designed to assess the prevalence of self-medication practice among undergraduate health science students and to determine its concomitant factors.
Methods: This study was conducted in May 2021 among undergraduate health science students studying at the Catholic University of Health and Allied Sciences (CUHAS) in Mwanza, Tanzania. An analytical cross-sectional design was used in this study. Semi-structured questionnaires were used to collect information on the sociodemographic characteristics of respondents and to assess their anti-malarial self-medication practice.
Results: A total of 340 participants were recruited. The prevalence of self-medication with antimalarials was 55.9%. Among 190 students who ever used antimalarials without a prescription; the majority 143 (75.3%) obtained antimalarials from community drug outlets, and 116 (61.0%) used artemether-lumefantrine. The majority reported the emergence of acute illness (ie, no time to attend health facilities) 82 (43.2%) to be the major reason for self-medication. Students aged 25 years and above were more likely to use antimalarials without a prescription compared to students aged between 18 and 21 years, (aOR=2.99 (95% CI 1.24-0.7.22). Compared to first-year students, third-year (aOR=0.18 (95% CI 0.07-0.41), fourth-year (aOR=0.32 (95% CI 0.13-0.79), and fifth-year students (aOR=0.16 (95% CI 0.04-0.64) were significantly less likely to take antimalarials without a prescription.
Conclusion: The study found a high prevalence of self-medication with antimalarials among undergraduate health science students, emphasizing the need for strategies to promote the rational use of antimalarials. It is recommended to improve access to healthcare facilities and educate students about the risks associated with self-medication to reduce its prevalence.

Contamination of Automated Teller Machines Surfaces with Multi-drug Resistance Gram-negative Bacteria in Dar es Salaam, Tanzania

Regan Zenas Shayo — 2023-03-30

Background: In Tanzania, little is known about the proportion of Multi-drug resistance (MDR) Gram-negative bacteria contamination on Automated Teller Machine (ATMs) surfaces. The study aimed to determine the proportion of MDR Gram-negative bacteria contamination on ATMs surfaces, antimicrobial resistance patterns as well as associated factors.
Methodology: A cross-sectional study was conducted between January and March -2021 in Dar es Salaam, involving 298 ATMs. Cultures were performed on Mac-Conkey agar while antimicrobial susceptibility was done using the Kirby Bauer disc diffusion method with Klebsiella pneumoniae ATCC 700603 and Escherichia coli ATCC 25922 used as controls. Data analysis was done using STATA version 15.1. Chi-square and Modified Poisson regression was used to assess factors associated with MDR contamination. Data was presented as prevalence ratio (PR) and 95% Confidence Interval. A p-value of <.05 was considered statistically significant.

Results: More than half (55.4%) of ATMs in Dar es Salaam are contaminated with Gram negative bacteria, mostly by Klebsiella pneumoniae 18.5% (31/168). The highest level of resistance was observed against ampicillin (68.9%). About one-third (34.5%) of the isolates were MDR. About 35.7% were Extended-Spectrum Beta-Lactamases (ESBL) producers while 19.6% were quinolone/ fluoroquinolones-resistance. Risk factors for contamination of ATMs included highly populated location such as; Ubungo (PR adjusted = 3.62, 95%CI = 1.58-8.30, P=.002), Kigamboni (PR adjusted = 2.78, 95%CI = 1.20-6.42, P=.017), and Temeke (PR adjusted = 2.75, 95%CI = 1.04-3.72, P=.023), and less frequent cleaned ATMs (PR adjusted = 1.98, 95%CI = 1.04-3.73, P=.04).

Conclusions: More than half of ATMs in Dar es Salaam are contaminated with Gram-negative and one-third of them with MDR bacteria, especially those located in highly populated areas and those that are less frequently cleaned. This calls for interventional measures regarding public awareness of ATMs as potential vehicles for the transmission of infectious agents.

Establishment of Haematological Reference Values for Healthy Individuals Attending Ruhengeri Referral Hospital in Rwanda

Ally Dusabimana — 2023-03-30

Background: The Laboratory investigations are very important for reaching to definitive diagnosis of diseases orientation and thus enabling optimal patient management based on informed diagnoses. Decision, and these are very difficult to obtain in the absence of reference values. In many cases, laboratory diagnosis such as haematological analyses are dependent on pre-defined locally established reference values.
Objective of the study: The objective of this study was to describe ranges of haematological reference values for healthy individuals attending Ruhengeri referral Hospital in Rwanda
Methodology: The cross sectional study was carried out in Northern Province at Ruhengeri referral hospital from July 2018 to September 2018. Participants were 252 healthy individuals aged less than one year to 68 years. From each participant, 4mL of blood samples were collected using K3 EDTA containers, and then analysed by Sysmex XS-500i automated haematology analyser.
Results: Haemoglobin levels varied with age and sex. The level decreased with the increasing age, and males had high haemoglobin level than females (15.69g/dL versus 14.46g/dL). Minimum mean values of haematological parameters for study participants were slightly on the high side with narrow confidence intervals compared to the
Manufactured Sysmex values.
Conclusion: The findings may be used to define normal haematological values for Rwandan population and help physicians to better define haematological abnormalities in patients.

Evaluation of the Performance of Copper Sulphate and Hemocue Methods for Haemoglobin Estimation Among Blood Donors in Dar Es Salaam, Tanzania

Doreen Kamori — 2023-03-30

Background: The National Blood Transfusion Service (NBTS) in Tanzania uses the Copper Sulphate (CuSO4) gravimetric method to estimate hemoglobin (Hb) in blood donors. However, this and other point-of-care methods, including HemoCue, may provide false results. Therefore, this study aimed to evaluate the performance of CuSO4 and HemoCue methods for Hb estimation compared with automated haematology analyzer (AHA).
Methods: The cross-sectional study was conducted among (N=204) blood donors in Dar es Salaam. Capillary blood samples were obtained for Hb estimation by CuSO4 and HemoCue methods, 3 mls of venous blood were also collected for Hb quantification by AHA (gold standard), HemoCue and CuSO4 gravimetric method. Data were analyzed by Epi info 7.2.2.6, statistical significance was defined at a P value of <0.05, and kappa agreement was calculated.
Results: The median age of the study participants was 30 years (IQR: 20-39). The proportion of false eligible donors was 19.6%, and false deferral donors were 2.9% by the CuSO4 gravimetric method. The specificity, sensitivity, positive and negative predictive values, and Kappa agreement for CuSO4 were 28.6%, 95.9%, 78.0%, 72.7%, and 0.1, respectively. In contrast, the specificity, sensitivity, positive and negative predictive values, and Kappa agreement for HemoCue were 62.5%, 98.6%, 87.4%, 94.6%, and 0.63, respectively.
Conclusion: Our study revealed that the performance of the CuSO4 gravimetric method in Tanzania is relatively poor, with a high proportion of false eligible donors than the HemoCue method. These findings warrant further studies to evaluate the quality control measures for CuSO4 gravimetric method and explore alternative point-of-care methods for Hb estimation among blood donors in similar resource limited-settings.

Assessment of Biochemical Parameters of Graft Survivors Post Renal Transplantation at King Faisal Hospital in Rwanda

Edgard Sumbiri — 2023-03-30

Background: Chronic kidney disease (CKD) remains a public health concern of 21st century. Each year, over million people die from CKD resulting from the lack of proper diagnosis and treatment of this terrible disease of the urinary system. Non-communicable diseases (NCDs) cause roughly 60% of all deaths worldwide. There is insufficient data in Rwanda for the management of kidney diseases and other NCDs for all health facilities. Renal substitution therapy appears to be the best solution for long–suffering patients with end-stage renal illness who want to survive. The study’s purpose was to find out the serum creatinine and blood urea nitrogen (BUN) concentrations among kidney transplanted patients at King Faisal Hospital of Rwanda, and to show the consequences linked with the transplantation of kidney.
Methods: This was a retrospective study carried from November 2018 to December 2019. The data were collected from medical records at King Faisal Referral Hospital, and analysed with SPSS version 22.
Results: BUN and serum creatinine concentrations ranged from 77.4 to 93.5% and 67.8 to 87.1%, respectively. BUN levels that were abnormally high ranged from 3.2 to 19.4%, while creatinine levels that were abnormally high ranged from 6.5 to 29.0%. BUN and creatinine levels that were abnormally low, ranged from 0.0 to 6.5 and 3.2 to 9.7%, respectively. Diabetes mellitus affected 19.35% of the study population, hypertension affected 35.48%, and antibodymediated rejection affected 6.45%.
Conclusion: The slight change in biochemical parameters may be a problem after kidney transplantation. There should be a monitoring of biochemical parameters tests to prevent the post kidney transplantation complications.

Importance and Limitations of Healthcare Verification for Accelerating Implementation of Universal Health Coverage in Burundi

Alexandre Nimubona — 2023-03-30

Introduction: As one of the avenues for implementing universal health coverage, healthcare verification for financing health facilities is receiving increased attention. Verification is the process of ensuring that healthcare services provided to users meet the predetermined criteria for billing and payment. The objective of this article was to examine the Burundi health system practices in healthcare verification for financing health facilities in order to identify strengths, limitations, and potential solutions for more advancement in universal health coverage implementation.
Methods: A critical case study was used as the overall methodological approach and a narrative review design to draw conclusions about the case.
Results: The results show that verification helps visualise the country’s level of progression in implementation of universal health coverage. While it promotes efficiency in healthcare service reimbursement by allowing payment for quality care services, verification has proven to be a resilient function to fraud, abuse, and waste in the demand for, and supply of, healthcare services. However, verification has some limitations in terms of services and population targeting, and technical effectiveness of the verification team. The most important way identified for alleviating these limitations is to separate the demand for, and supply of, healthcare services.
Conclusions: More investments in research are required to recognise verification as an essential sub-function of health financing for universal health coverage implementation.