East Africa Science

Is it Time to Embark on Laparoscopic Daycare Surgery in Resource-Limited Settings? Perspectives from a Series of Laparoscopic Heller’s Myotomy and Fundoplication for Achalasia Cardia

Kitembo S. Kibwana — 2024-05-11

Background: In developing countries, delivering advanced surgical procedures presents a unique array of challenges and opportunities, including the potential to address the escalating demand for such procedures in resource-constrained settings. Based on insights gleaned from a case series, we highlight the potential of incorporating daycare practices for advanced laparoscopic surgeries in Lower- and Middle-Income Countries (LMICs).
Case Presentations: We report a case series of randomly selected patients who underwent laparoscopic Heller’s myotomy and fundoplication for achalasia cardia at Muhimbili National Hospital in Tanzania. We observed an uneventful postoperative in-hospital course marked by significant improvement within 24 hours following surgery. However, all cases had a relatively extended hospital stay; likely stemming from healthcare provider-, patient-, and facility-related factors.
Conclusion: Given the patient-centered, economic, operational efficiency, and resource utilization advantages associated with daycare laparoscopic surgery, adopting this method may prove appropriate for LMICs. Therefore, collaborative efforts from stakeholders are necessary for the integration of this practice into the healthcare systems of developing economies.

Odontogenic Infections in Pregnancy: Case Studies

Onesmo Augustino — 2024-03-29

Introduction: Globally, dental diseases in pregnancy have been reported to affect between 10% and 50% of pregnant women. In Tanzania, periodontal disease burden among pregnant women stands at 14.2%. Despite improvements in antenatal care (ANC) attendance, oral cavity examination is not part of the ANC package in Tanzania. Consequently, oral health evaluation receives little attention from healthcare providers during routine ANC, exacerbating the risk of dental complications during pregnancy.
Case studies Presentation: This report presents four distinct cases of dental issues leading to severe complications, including brain abscess, empyema thoracis, Ludwig’s angina, and maternal sepsis. A multidisciplinary approach was employed in managing these cases, tailoring interventions based on individual patient needs. While three cases resulted in positive maternal outcomes, one case experienced poor outcomes due to Ludwig’s angina. Unfortunately, perinatal deaths occurred in three cases, attributed to preterm delivery and intrauterine foetal demise, with only one case yielding a favourable perinatal outcome.
Conclusion: The reported case studies underscore the critical importance of integrating oral cavity evaluation into routine ANC to facilitate timely diagnosis and appropriate management, thereby reducing associated morbidity and mortality risks.

Concomitant Carcinoma of the Gallbladder and Incidental Gallstones, and Concurrent Gallbladder Cyst: A Case Report

Alex Mremi — 2024-03-29

Introduction: Gallbladder carcinoma is a malignant epithelial neoplasm of the gallbladder. The tumor is clinically aggressive, with an overall 5-year survival rate of < 10%. Cholelithiasis is a known and established risk factor. Up to 50% of gallbladder tumors are detected incidentally in routine cholecystectomy specimens due to the absence of gross abnormalities. Gallbladder carcinoma has several unusual presentations, one of which is an incidental pseudocyst with cholelithiasis and perforation. This unusual occurrence makes the index case unique.
Case presentation: We report a case of gallbladder cancer diagnosed by an emergency cholecystectomy, performed for acute cholecystitis caused by a pseudocyst. The patient underwent chemotherapy, and currently, 12 months have passed. The patient is doing well, without signs of recurrence or metastasis.
Conclusions: Systematic sampling of cystectomy specimens is therefore crucial to detecting incidental gallbladder adenocarcinomas.

Predictors of Unsuppressed Viral Load Among Children Below Five Years of Age Living with Human Immunodeficiency Virus Infection in Mwanza, Tanzania

Enock Diocles — 2024-03-29

Background: Children below five years of age have increased risk of unsuppressed viral load due to various socio-demographic and clinical factors. This study investigated the prevalence and predictors of unsuppressed viral load among HIV infected children below five years of age in Mwanza, Tanzania.
Methods: A cross sectional study involving 279 children below five years of age who were on antiretroviral therapy (ART) for at least six months was conducted in the care and treatment clinics (CTC), from December 2020 to April 2021.
Results: A total, 20 (7.2%, 95% CI; 4.2-10.2) had unsuppressed HIV viral load. The duration on ARVs less than 24 months (AOR 3.8, 95% CI: 1.2-12.0; P=.026), poor ARVs adherence in the past six months (AOR 5.7; 95% CI: 1.6-18.6; P=.004), severe or moderate malnutrition (AOR 3.3, 95% CI: 1.2-8.9; P=.020) and caregivers with no home supporters (AOR 4.4, 95% CI: 1.5-13.3; P=.008) independently predicted unsuppressed HIV viral load among children below five years of age.
Conclusions: More than 90% of children below the age of five years on ART had suppressed viral load. Short time on ARVs, moderate and severe malnutrition, poor ARV adherence and economic constrain among caregivers were found to predict unsuppressed viral load. These factors should be used to identify children at risk of unsuppressed viral load and provide tailored support.

Immunoglobulin G Responses to SARS-Cov-2 and Patterns of Adverse Vaccination Effects Among Health Care Workers in North-Eastern Tanzania: A Retrospective Longitudinal Study

Felix Anthony — 2024-03-29

Background: The global response to the COVID-19 has been largely successful due to widespread vaccination programs, which have resulted in significant clinical and socioeconomic achievements. Nonetheless, there is a significant information gap on the efficacy and safety of COVID-19 vaccines. Scientific data on basic immunological attributes of COVID-19 vaccines such as; duration of protection, and potential side effects associated with vaccination is inadequate, leading to high hesitancy rates towards vaccination. This study aimed at bridging these knowledge gaps and addressing these crucial issues.
Methods: This was a retrospective longitudinal study involving 273 health care workers (HCWs) from Kilimanjaro Christian Medical Centre, a referral zonal hospital in northern Tanzania, between August 2022 and February 2023. Immunoglobulin G concentrations were measured over a 21 months period post- COVID-19 vaccination using an indirect Enzyme Linked Immunosorbent Assay (ELISA). Data was analysed using STATA software version 15 (College Station, TX). Descriptive statistics was used to summarise the study participant’s characteristics and prevalence of antibodies against SARS-CoV-2. Kruskal-Wallis and Mann–Whitney U test were used to assess the differences between exposure variables and median SARS COV-2 IgG concentration. Logistic regression was used to determine association of independent variables with seroprevalence, using a p-value of .05 as the cut off for statistical significance.
Results: The study population of HCWs at the KCMC is strongly seropositive to COVID-19. Vaccinated individuals had a significantly higher median IgG concentration (137.5 IU/ml) than unvaccinated individuals (122.12 IU/ml) (p<.01). Individuals who received a booster vaccination dose showed a higher median IgG concentration (145.7 IU/ml) compared to those who received a single dose (137.5 IU/ml). Our findings identified two IgG concentration peaks at 5 months (136.17U/ml) and 17 months (146.4 IU/ml) post vaccination. These peaks align with the peaks in immune response following vaccination and natural exposure during the second COVID-19 wave, respectively. Regarding adverse effects, only a few HCWs reported side effects after vaccination, and these were not found to be associated with any specific host factors.
Conclusions: Majority of HCWs at KCMC were seropositive to COVID-19 during the study period. The combination of vaccination and natural exposure to SARS-CoV-2 contributed to the high seropositivity rate among HCWs in the study site. Vaccine related adverse effects were rare among recipients indicating a high degree of safety of the vaccines. Further studies are warranted to better understand and characterise immune responses in terms of longevity and the level of protection conferred by vaccination and natural exposure.

Evaluation of Performance Characteristics of the StandardTM Q IgM/IgG and the Wantai SARS-CoV-2 Ab Rapid Tests in Tanzania

Lwitiho Sudi — 2024-03-29

Background: Rapid diagnostic tests (RDTs) have played a critical role in the detection and monitoring of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections globally. A number of RDTs are currently available, and their accuracy is dependent on several factors that include disease stage, circulating virus variants at the particular time, and the population being tested. This study aimed to evaluate the performance characteristics of two RDTs, the StandardTM Q IgM/IgG and the Wantai SARS-CoV-2 Ab Rapid Test, for the detection of SARS-CoV-2 antibodies in a Tanzanian population.
Methods: Plasma samples from a total of 80 individuals stored at the National Institute for Medical Research-Mbeya Medical Research Centre (NIMR-MMRC) biobank were tested. Of these, 37 (46.3%) were confirmed to have been exposed to the SARS-CoV-2 virus through either RT-PCR or Ag rapid tests from ongoing COVID-19 studies. The remaining 43 (53.6%) serving as negative controls, were stored samples from SARS-CoV-2 unexposed individuals obtained from an HIV cohort enrolled between 2014 and 2017. All the samples were tested using both the StandardTM Q IgM/IgG and the Wantai SARS-CoV-2 Ab Rapid Test. The sensitivity, specificity, and other performance characteristics of each test were determined.
Results: The StandardTM Q IgM/IgG test demonstrated a higher sensitivity of 100% (95% CI: 74–100%) for patients with acute COVID-19 (less than ten days since onset of symptoms). The Wantai SARS-CoV-2 Ab rapid test had a sensitivity of 75% (95% CI: 43–95%). Both tests revealed a specificity of 100% (95% CI: 74–100%). For patients with more than 30 days since the onset of symptoms, the StandardTM Q IgM/IgG test showed a sensitivity of 96% (95% CI: 80-100%), while the Wantai total Ab assay had a sensitivity of 92% (95% CI: 74-99%), and again both test kits revealed a specificity of 100% (95% CI: 74-100%).
Conclusion: The StandardTM Q IgM/IgG Rapid Diagnostic Test is recommended to be used as the primary test for COVID-19 survey screening purposes due to its higher sensitivity, while the Wantai total Ab RDT is recommended to be regarded as the second option.

Prevalence of Sexually Transmitted Infections and Associated Factors Among Young Adult Female Students at Higher Learning Institutions in Mbeya, Tanzania: A Cross-Sectional Study

Anifrid Mahenge — 2024-05-11

Background: Sexually Transmitted Infections (STIs) are prevalent among young people and bring about adverse reproductive, pregnancy and neonatal outcomes, as well as increasing the risk of acquiring HIV infection. STIs are often asymptomatic; however, in many low- and middle-income countries like Tanzania, they are routinely managed syndromically. There is uncertainty in the number of studies done among female students in higher learning institutions (HLIs) in Sub-Saharan Africa, and the majority of these assessed STIs based on the presence of symptoms. Due to the asymptomatic nature of STIs, syndromic management may underrate their magnitude. We report STI prevalence and associated factors among female students aged 18-24 from HLIs in Mbeya, Tanzania.
Methods: A cross-sectional study was conducted from February 2020 to June 2021. We tested self-collected cytobrush from female students aged 18-24 years. Deoxyribonucleic acid (DNA) extraction and molecular detection were done using 7-essential STIs Seegene assay with a real-time Polymerase Chain Reaction (RT-PCR) to test for Mycoplasma genitalium (MG), Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG), Trichomonas vaginalis (TV), Ureaplasma parvum (UP), Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU). Information on STI symptoms, sexual activity, and risk factors for STIs was collected using a self-administered questionnaire.
Results: We enrolled 150 participants from 5 HLIs. Accounting for (19.33%, 29/150) of the tested STIs were MG, CT, NG and TV, others were UP (56%), and a combination of MH and UU (38%). More than half (59.01%, 72/122) of positive cases had multiple infections. The majority of participants had poor levels of STI knowledge. Being a young female student (< 20 years) and having a history of practising oral sex were significantly associated with an increased likelihood of having an STI.
Conclusion: STI diagnosis using molecular assays is beneficial in detecting pathogens not routinely tested in health facilities; and for identifying asymptomatic infected individuals. There is a paramount necessity for health promotion, to scale up STI education and prevention intervention strategies among female students in HLIs.

Association of Sickle Cell Disease, Malaria and HIV in Multi Drug Resistant Invasive Non-typhoidal Salmonella Isolated from Outpatient and Hospitalised Children Below 16 Years in Informal Settlements in Nairobi County, Kenya

Susan Mutile Kavai — 2024-03-29

Background: Invasive non-typhoidal Salmonella (iNTS) disease continues to be a major public health problem, especially in sub-Saharan Africa (SSA), where incidence rates are 227 cases [range 152–341] per 100,000 populations. Populations at risk of iNTS include adults with human immunodeficiency virus (HIV) infection, malnourished children, and those with recent malaria or sickle-cell anaemia (SCA). In Kenya, iNTS disease is particularly a major challenge in poor informal settlements, with infants and young children less than 5 years of age being the most affected. Our study aimed to investigate the association between sickle cell disease, malaria, and HIV in multi-drug-resistant invasive non-typhoidal Salmonella from outpatient and hospitalised children ≤16 years in informal settlements in Nairobi County, Kenya.
Methods: This study recruited 16,679 children aged ≤16 years who presented with salmonellosis symptoms for a period of 6 years (2013–2018). The patients were age-matched with controls (asymptomatic individuals). The study was conducted at 3 outpatient sites and 1 inpatient site; the outpatient sites were all located within the Mukuru informal settlement. The inpatient site was Mbagathi district hospital, which serves patients residing in Kibera informal settlement. Blood and stool samples from children with fever ≥380C and/or diarrhea and stool samples alone from controls were collected for processing for the presence of iNTS using basic microbiology procedures including culture, serology, and Kirby Bauer disc diffusion for sensitivity testing. Dry blood spots were also taken and processed for sickle cell protein markers using high-performance liquid chromatography (HPLC). HIV and malaria tests were also conducted using rapid tests, respectively.
Results: From the total of 22,246 blood and stool samples tested, 741 (3.3%) tested positive for Salmonella species. A total of 338 (45.6%) iNTS were isolated across all 4 sites; these consisted of 158 (21.3%) Salmonella Enteritidis and 180 (24.3%) Salmonella Typhimurium. The most common resistance phenotype was against ampicillin, chloramphenicol, and sulfamethoxazole trimethoprim. A total of 118 (34.9%) isolates were multidrug-resistant (MDR). Out of 2,684 dry blood samples subjected to HPLC for investigation of sickle cell disease traits, 1820 (67.8%) had normal haemoglobin (Hb AA/Hb AF); 162/2684 (6%) tested positive for sickle cell traits (Hb AS/Hb AFS). Some patients positive for iNTS were also found to have other co-morbidities; 4 (0.1%) tested positive for sickle cell disease (Hb FS), malaria, and HIV 8 (2.4%) and 5 (1.5%), respectively.
Conclusion: The high prevalence of MDR iNTS isolates and emerging resistance to third-generation cephalosporins is of great concern, as they are the recommended drugs for the management of iNTS in our settings. Sickle cell disease, malaria, and HIV were all not major factors associated with iNTS disease among children in Mukuru and Kibera informal settlements.

Frequency, Types and Antimicrobial Susceptibility Pattern of Bacteria in Culture Positive Ear Swabs of Patients Attending Referral Hospital in Southern Zone of Tanzania

Sia Temu — 2024-03-29

Background: Ear infections affect adults and children, and when left untreated, they may cause hearing loss and life-threatening complications. In our setting, ear infections are a common health problem. However, there is paucity of information on the etiology and antimicrobial susceptibility pattern.
Objective: This study aimed to determine the spectrum of bacteria causing ear infection and their antimicrobial susceptibility patterns at Secondary-level health facilities.
Methods: This cross sectional retrospective hospital-based study reviewed 288 data of patients diagnosed with ear infections from January 2021 to March 2023. Demographic, isolates and antimicrobial susceptibility information’s were abstracted. Multidrug resistance (MDR) was regarded as resistance to at least one antibiotic in three or more categories/groups of antibiotics. Analysis was done using STATA software version 15. Descriptive analysis was summarized as frequency and proportion for categorical variables, and results presented using tables.
Results: We included 288 (50.4%) positive bacteria culture out of ear swab samples collected for culture in the analysis. Of the total bacterial isolates, majority were gram-negative, 178 (58.2%). The predominant isolate was Staphylococcus aureus 124 (40.5%), followed by Pseudomonas aeruginosa 80 (26.1%). Mixed bacterial infection was observed in 18 (6.2%) patients. Most enterobacterales were resistant to ampicillin, amoxicillin/clavulanic acid, tetracycline and trimethoprim-sulfamethoxazole. Pseudomonas aeruginosa was highly resistant to piperacillin. Multidrug resistance (MDR) was observed in 245 (80%) of the isolates. Gram positive isolates showed high resistance to erythromycin. Methicillin-resistant Staphylococcus aureus (MRSA) was observed in 67(59.3%) isolated Staphylococcus aureus.
Conclusion: Staphylococcus aureus and Pseudomonas aeruginosa were the predominant isolates in ear infections. Most of the bacteria were resistant to commonly used antibiotics. Multidrug resistance and MRSA were highly observed. Therefore, an antibiotic susceptibility test is important to guide antibiotic prescription practice.

Association of Blood Glucose and Lipid Profile Concentrations in Diabetic Patients Attending Gisenyi District Hospital in Rwanda: A Cross-Sectional Study

Emmanuel Ndagijimana — 2024-03-29

Background: Poor glycemic monitoring of type 2 diabetes mellitus has been linked with dyslipidemia and this led to an augmentation of mortality in diabetic patients. This study assessed the association of blood glucose and serum lipid concentrations in type 2 diabetic patients at Gisenyi District Hospital in Rwanda.
Methods: This investigation was cross-sectional and used the Cochran formula (n = Z2PQ/d2) to estimate the number of participants. Predisposing aspects of dyslipidemia such as age, gender, blood pressure, and BMI were obtained from the participants. Blood glucose was tested in capillary blood samples using Accu-Check Aviva and lipid profiles were checked in blood serum drawn from each participant, using Cobas C311. Ranges for dyslipidemia considered were: TC < 200 mg/dl, TG < 150 mg/dl, LDL-C < 100 mg/dl, 51-60 mg/dl for females, and HDL-C 41- 60 mg/dl for males. A transformed Friedewald formula was utilized to quantify LDL-C. The chi-square test (X2) was considered to investigate the association between categorical variables, whereas Pearson’s coefficient was utilized to find out the correlation between continuous variables.
Results: A significant association was noted between the BMI and hyper TC (X2 = 9.936; p =.001), hyper TG (X2 = 10.761; p = .001), and hyper LDL-C (X2 = 10.410; p = .001), whereas the association was not significant with low HDL-C (X2 = 2.416; p = .137). A positive significant correlation was noticed between blood glucose and TC (r = 0.678, p = 0.000) and between blood glucose and LDL-C (r = 0.293, p = .039). A positive no-significant association was noted between blood glucose and TG (r = 0.163, p = .259), whereas a negative no-significant link was between blood glucose and decreased HDL-C (r = -0.126 p = .381).
Conclusion: A significant association was noted between the BMI and TG, TC, and LDL-C, but the link with HDL-C was not significant as it was for age, gender, and blood pressure with serum lipids. Blood glucose levels were positively linked with TG, TC, and LDL-C levels, but negatively linked with HDL-C. Thus, poor control of type 2 diabetes results in increased serum concentrations of harmful lipids.

Amputation Risk Factors Among Patients With Diabetic Foot Attending A Tertiary Hospital, Dar Es Salaam, Tanzania

Anna L. Jazza — 2024-03-29

Background: About 79% of the 463 million people who have diabetes globally live in low- and middle-income countries. Along with the unprecedented growing burden of diabetes, the related complications such as diabetic foot affect up to 60 million adults. Diabetic foot complications are known to be the leading cause of non-traumatic amputation. This study aimed to determine the risk factors of amputation among patients with diabetic foot admitted at a tertiary care hospital.
Methods: This hospital based retrospective study was conducted among patients with diabetic foot and required admission between Jan 2017 to Dec 2020. The selection was based on availability within the specified period. Data were retrospectively extracted from patient files and the hospital electronic database. The effect of risk factors was analyzed using multiple linear logistic regression models. Variables included age, sex, type and duration of diabetes, co-morbidities, pharmacological therapy, and diabetic complications. A P value <.05 was considered statistically significant.
Results: A total of 56 adult patients with diabetic foot were seen at Shree Hindu Mandal Hospital between January 2017 and December 2020. Of them, 44 (78.6%) were male. The mean age was 60.6 (SD ±11.7) years, and the mean duration of diabetes was 10.7 years. More than half 33 (58.9%) had their lower limb amputated and 66.7% of the total amputated, were between 50-69 years old. Fifty-four patients (96.4%) had foot ulcers and about one third 10 (30.3%) had a previous history of amputation. Over two thirds of all patients 49 (87.5%) had poor glycemic control with HbA1C above 6.5% and 31 (94%) of those who had amputation had their lower limb amputated. Patients with gangrene were more likely to have amputation than those without gangrene (aRR 4.03, 95% CI 1.31, 12.43; P=.015).
Conclusion: Poor glycemic control and gangrene are important risk factors for amputation among patients with diabetic foot. The study highlights the necessity for enhanced patient education on comprehensive foot care to prevent amputations and improve patient outcomes. Targeted interventions focusing on glycemic control and early detection of foot complications, especially in the elderly population, are urgently needed.

Indications and Outcome of Flexible Bronchoscopy at Muhimbili National Hospital in Dar es Salaam, Tanzania

Tito Lyimo — 2024-03-29

Background: A flexible bronchoscopy is an essential tool that is globally used for the diagnosis and treatment of Broncho-pulmonary diseases. However the indication and outcome of flexible bronchoscopy has not been widely documented in majority of low resource settings.
Objective: To determine the indications and outcome of flexible bronchoscopy (FB) at Muhimbili National Hospital (MNH).
Methodology: A cross sectional analytical study was conducted for a period of 12months. Details involving indications and outcome of flexible bronchoscopy includes; bronchoscopy findings, therapeutic value, diagnostic yield, and early procedural related complications together with their demographic data were documented after each procedure followed by analysis using SPSS version 25.
Results: Among 151 patients underwent flexible bronchoscopy 76(50.30%) were male and 75(49.70%) were female. The median age of 58 years with IQR (43, 65). Among the indications of flexible bronchoscopy, Cough and hemoptysis were the leading by 124(82.10%) and 38(25.20%) respectively. On the other hand hyperemic mucosa 47(31.10%) and endobronchial mass 32(21.20%) constituted the majority of the bronchoscopy findings. The overall diagnostic yield was 34.3% and procedural related complications was 18.54%. Among the indications for flexible bronchoscopy, the hemoptysis was associated with procedure related complications by 48(31.6%) OR (95%CI),2.779 (2.339-3.219) p<.020. Among sampling technique of flexible bronchoscopy, the endobronchial biopsy and bronchi alveolar lavage (BAL) sampling technique were associated with procedure related complications by 60(39.5%), OR (95%CI), 4.393 (3.957-4.829) p <.001 and 22(14.70%),OR (95%CI) 1.870 (1.656-2.084) p<.005 respectively .
Conclusion: We have demonstrated that flexible bronchoscopy is a safe and reliable procedure in diagnosis of respiratory maladies including Mycobacterium tuberculosis (MTB) at Muhimbili National Hospital.

Imprint Cytology of Gastrointestinal Endoscopic Tissue Biopsies at Kenyatta National Hospital, East Africa, Kenya

Nadia Kalinganire — 2024-03-29

Background: Endoscopic biopsy is the gold standard for the diagnosis of gastrointestinal pathology. However, imprint cytology of endoscopic biopsies which is a rapid and inexpensive method has gained less attention. This study intended to examine the performance of imprint cytology of endoscopic biopsies for rapid diagnosis of malignant gastrointestinal lesions at Kenyatta National Hospital, Kenya.
Methodology: A cross-sectional descriptive study was carried out on 124 consecutive patients in Endoscopy Unit at Kenyatta National Hospital, within a period of 3 months. Endoscopic biopsies were gently rolled on two microscopic slides to make imprint smears prior to formalin fixation. Both slides were air-dried and subsequently stained with Papanicolaou and Giemsa stains. Cytological findings were compared with those of histology to determine the diagnostic performance of imprint cytology in endoscopic specimens. Representative photomicrographs were used to describe and display morphological features.
Results: Imprint cytology revealed that 37 (29.83%) were positive for malignancy. For cases where both histology and imprint cytology were used as diagnostic methods for malignancy detection, the percentage of agreement between the two methods was 94.3% (Kappa =0.857, P<.001)
Conclusion: The performance of imprint cytology in this study, underscores the need to embrace the technique in our health care settings as it can provide results in a short period of time for proper patients’ management.

Community Directed Ivermectin Treatment Coverage in Burundi: A Spatio-Temporal Analysis for 2030 World Health Organization Road Map

Arnaud Iradukunda — 2024-03-29

Background: Integrated national programme for the control of neglected tropical diseases and blindness aims to achieve a paradigm shift from control of morbidity to interruption of transmission and ultimately elimination.
Objective: The aim of this study was to understand onchocerciasis epidemiology and control strategies in the context of Burundi. Specifically, the study sought to understand the coverage of Ivermectin treatment in onchocerciasis endemic zones, to assess the impact of African Programme for Onchocerciasis Control (APOC) approach on treatment coverage and forecast the therapeutic coverage to 2030 horizon in Burundi.
Methods: We used retrospective data collected from 2005 to 2019 in four onchocerciasis endemic provinces in Burundi. For mapping and ivermectin coverage rates comparison, we respectively used a spatial analysis and welch testing methods. After, we forecasted the therapeutic coverage using the Autoregressive Integrated Moving Average (ARIMA) model, a statistical analysis model which uses time series data to predict future trends. All analysis were done using Quantum Geographic Information System (QGIS) and the R 3.5.3 software.
Results: During study period, a mean population of 1,536, 392 (95% CI: 1,114 ,870 -1,932 ,403) has been targeted by ivermectin treatment in all the four provinces. The ivermectin coverage rate was 77.8% (95% CI: 67.8% to 81.6%). Specifically, ivermectin coverage rates were 76.4%, 76.6% and 78.7% in Rutana, Bururi and Cibitoke - Bubanza respectively. After six years of massive drug administration under World Health Organization community guidelines launched in 2011, the coverage rates were, except the 2016 year, above 80%. Forecasts for 2030 showed that the coverage rate for treatment could increase.
Conclusion: This study showed that the ivermectin coverage rate significantly increased during the community-directed treatment approach period. The coverage rate should remain over 80% until 2030 in endemic regions, a strategy which should contribute to decrease the onchocerciasis prevalence and lead to onchocerciasis elimination.

Male Infertility: A Retrospective Review of Laboratory Charts at a Tertiary Teaching Hospital in Nairobi City County

Festus Mulakoli — 2024-03-29

Background: Globally, approximately 50 million couples experience one form of infertility, and 10 million cases of subfertility have been reported in sub-Saharan Africa. Infertility is characterized by a lack of clinical conception among couples who live together for more than one year with regular coitus, without the use of contraception. Factors related to fertility vary by sex and geographical region. These factors include age, lifestyle, infectious diseases, and genetic disorders. In African culture, children are considered a simple inheritance and a measure of masculinity, so efforts are needed to address the growing problem of male infertility in this context.
Objective: To determine the prevalence of male infertility among adult men seeking semen analysis services in a tertiary teaching hospital in Nairobi, Kenya.
Methods: This was a cross-sectional study that involved a retrospective review of archived electronic data in the hospital information system. These data were from male patients who visited the laboratory with a request for semen analysis between January 2016 and December 2020. A checklist was used to extract data related to sociodemographic factors and laboratory results (age, seminal volume, and diagnosis).
Results: The average age of the male clients seen during the review period was 36±8 years, with the majority aged 31–40 years n= 996 (46.7%). The youngest was 21 years old, and the oldest was 70 years old. The total prevalence of seminal abnormalities was 1628 (77%) of the 2131 electronic data that was reviewed. Only 502 (23%) of the patients had a normal seminal diagnosis. Most clients exhibited at least one form of seminal abnormalities, such as asthenospermia 913 (43%), oligospermia 441 (21%), and azoospermia 272 (13%). There was a statistically significant association between age and seminal abnormality (X 2 = 31.393, P=.013). A significant association was also found between seminal volume and abnormalities (X 2 = 94.538, P=.000).
Conclusion: Our findings showed that there were some seminal abnormalities among Kenyan men in Nairobi County. More effort is required to identify the cause of this increase in seminal abnormalities. Initiation of health interventions to reduce this burden of infertility may be necessary.

Detection of Biofilm Formation and Antibiotic Susceptibility in Escherichia coli Isolated from the Urine of Pregnant Women at Mnazi Mmoja Hospital, Zanzibar, Tanzania

Ali M. Mahmoud — 2024-03-29

Background: Escherichia coli is one of the species mostly involved in biofilm formation, being the most important cause of relapse or chronic urinary tract infections. To develop alternative biofilm-fighting treatments, it is important to understand which types of E. coli form biofilms.
Study objectives: To detect biofilm formation and antibiotic susceptibility among E. coli isolated from the urine of pregnant women at Mnazi Mmoja Hospital, Zanzibar, Tanzania.
Methodology: Hospital-based cross-sectional study was conducted at Mnazi Mmoja Hospital in Zanzibar. A questionnaire was used to collect all the information regarding demographic characteristics. Midstream urine samples were collected and sent to the laboratory for culture, sensitivity, and biofilm tests. Positive growth culture was subjected to differential identification tests such as Motility Indole Ornithine, Urea, and citrate. The antimicrobial susceptibility test was conducted on all E. coli species. Biofilm production was detected using a microtitre plate assay. IBM SPSS Statistics for Windows version 20.0 (IBM Corp, Armonk, NY, USA) was used in the analysis of data.
Result: Out of 400 participants, significant growth of E. coli was detected in 22 (5.5%), of which 6 (27.3%) were symptomatic and 16 (72.7%) were asymptomatic. Of all E. coli isolates, 22 (100%) were biofilm formers, 15 (68.2%) were resistant to Amoxicillin & clavulanic acid, and 16 (72.7%) were resistant to Ampicillin. However, all isolates were sensitive to Gentamycin, Ceftriaxone, Nitrofurantoin, Norfloxacin, and Meropenem, while 21 (95.4%) were sensitive to Ciprofloxacin and Nalidixic acid.
Conclusion: We revealed that E. coli that formed biofilms showed significant levels of antibiotic resistance to commonly used drugs.

Toothpastes Inhibitory Effects on Microorganisms Isolated from Dental Decay of Patients Attending Ruhengeri Referral Hospital, Musanze, Rwanda

Mucumbitsi Joseph — 2024-03-29

Background: Oral disease affects about 3.5 billion people worldwide annually, with 3 out 4 people affected are from middle income countries. Toothpastes have been used to improve and maintain oral health. This study was carried out to determine the inhibitory effects of selected toothpastes in Rwanda’s market.
Materials and Methods: This was a cross sectional study carried out from September 2021 to January 2022. A total of 30 dental surface swab samples were collected from dental decay patients and cultured at INES-RUHENGERI clinical microbiology laboratory for microbial isolation and identification. The three types of toothpastes (white dent, ABC dent, Colgate) plus one mouthwash (sonatec) were selected as antimicrobials. Statistical analysis was done using SPSS version 24.0 (IBM Corporation, Armonk, NY, USA). ANOVA was used to test for mean difference of toothpastes inhibitory effects on isolated microorganisms.
Results: Streptococcus mutans 15 (29.4%) was the most isolated microorganism among dental decay patients. Colgate and ABC dent were the least effective while white dent and sonatec were the most effective, they showed inhibitory effects to all isolated microorganisms. Pseudomonas aeruginosa, Streptococcus pyogenes, and Candida albicans exhibited resistance to both Colgate and ABC dent toothpastes. Staphylococcus aureus and Lactobacillus spp were resistant to Colgate, while only Streptococcus mutans demonstrated sensitivity to all types of toothpastes). The mean difference of inhibitory effect of toothpastes (p= .0004,) was statistically significant. The average mean values of toothpaste inhibitory effects (mm) were 15.166 for SONATEC, 5.666 for ABC dent, 24 for White dent, and 3.333 for Colgate.
Conclusion: Streptococcus mutans and Lactobacillus spp were the main colonizer of oral cavity in dental decay patients. white dent and sonatec were the most inhibitors of bacterial growth, dental decay patients should use the effective toothpaste such as SONATEC.