Histopathological patterns and topographical distribution of Kaposi Sarcoma at Muhimbili National Hospital, Tanzania

Background: Kaposi sarcoma (KS) is derived from endothelial cell lineage; it is caused by Human Herpes Virus-8 (HHV-8) facilitated by immune suppression. KS remains one of the commonest sarcoma seen in Tanzania. The paucity of recent data makes monitoring the disease a challenge. This study describes the Histopathological Patterns and Topographical distribution of Kaposi Sarcoma at Muhimbili National Hospital, a tertiary care hospital in Tanzania. Methods: A hospital-based retrospective cross-sectional study was done to review biopsies sent to the Central Pathology Laboratory (CPL), Muhimbili National Hospital from 2010 to 2014. Results: A total of 818 cases representing 1.8 % of all malignancies during the study period were enrolled in the study. The age of patients at diagnosis ranged from 6 months to 94 years old, with the median age being 37 years. Male to female ratiowas 1.4:1.0. Females were younger than males (p < 0.001). The majority of the lesions were in the lower limbs, 352 (64.1%). Nodular KS accounted for 74.5% of all cases. Conclusion: Kaposi’s sarcoma remains a common malignancy. The patients present late at diagnosis. Early diagnosis and improved treatment protocols remain to be key steps towards reducing the burden of KS. Keywords: Kaposi's Sarcoma; Histopathological Patterns; Topographical distribution.

Patterns, Predictors and Outcome of Time to Presentation Among Critically ill Paediatric Patients at Emergency Department of Muhimbili National Hospital, Dar es Salaam, Tanzania

Background: Mortality among under-five children in Tanzania remains high. While early presentation for treatment increases likelihood of survival, delays to care are common and factors causing delay to presentation among critically ill children are unknown. Methodology: This was a prospective cohort study of critically ill children aged 28days to 14 years attending emergency department (ED) at Muhimbili National Hospital in Tanzania from September 2019 to January 2020. We documented demographics, time to ED presentation, ED interventions and 30-day outcome. The primary outcome was delay (>48 hours) from the onset of illness to ED presentation. Logistic regression and relative risk were calculated to measure the strength of the predictor and relationship between delay and mortality respectively. Results: We enrolled 440 (59.1%) critically ill children, their median age was 12 [IQR =9-60] months and 63.9% were males. The median time to ED arrival was 3 days [IQR=1-5] and more than half (56.6%) of critically ill children presented to ED in > 48 hours where by being an infant, self-referral and belonging to poor family were independent predictors of delay. Infants and those referred from other facilities had 2.2 (95% CI 1.3-3.8) and 1.7 (95% CI 1.1-2.7) times increased odds of presenting late to the ED respectively. The overall 30-day in-hospital mortality was 26.5% in which those who presented late were 1.3 more likely to die than those who presented early (RR=1.3, CI: 0.9-1.9). Majority died >24 hours of ED arrival (P-value=0.021).Conclusion: Delayed ED presentation of more than 48 hours from onset of illness was associated with in-hospital mortality. A larger study is needed to evaluate the care pathway of critically ill paediatric patients to identify preventable course of delay to tertiary care facility.

Poor weight gain and its predictors among preterm neonates admitted at Muhimbili National Hospital in Dar-es-salaam, Tanzania: a prospective cohort study

Background Preterm delivery is among the major public health problems worldwide and the leading cause of morbidity and mortality among neonates. Postnatal poor weight gain, which can contribute to mortality, can be influenced by feeding practices, medical complications and quality of care that is provided to these high-risk neonates. This study aimed to investigate the proportion and predictors of poor weight gain among preterm neonates at Muhimbili National Hospital (MNH), from September 2018 to February 2019. Methods A hospital-based prospective cohort study involving preterm neonates with Gestation age (GA) < 37 weeks receiving care at MNH. Eligible preterm, were consecutively recruited at admission and followed up until discharge, death or end of neonatal period. Poor weight gain was defined as weight gain less than 15 g per kg per day. The risk factors associated with poor weight gain were evaluated. Predictors of poor weight gain were evaluated using a multivariate analysis. Results were considered statistically significant if P -value was < 0.05 and 95% confidence interval (CI) did not include 1. Results A total of 227 preterm neonates < 37 weeks GA, with male to female ratio of 1:1.2 were enrolled in the study. The overall proportion of preterm with poor weight gain was 197/227 (86.8%). Proportion of poor weight gain among the early and late preterm babies, were 100/113 (88.5%) and 97/114 (85.1%) respectively. Predictors of poor weight gain were low level of maternal education (AOR = 2.58; 95%Cl: 1.02–6.53), cup feeding as the initial method of feeding (AOR = 8.65; 95%Cl: 1.59–16.24) and delayed initiation of the first feed more than 48 h (AOR = 10.06; 95%Cl: 4.14–24.43). A previous history of preterm delivery was protective against poor weight gain (AOR = 0.33; 95% Cl: 0.11–0.79). Conclusion and recommendation Poor weight gain was a significant problem among preterm neonates receiving care at MNH. This can be addressed by emphasizing on early initiation of feed and tube feeding for neonates who are not able to breastfeed. Health education and counselling to mothers focusing on feeding practices as well as close supervision of feeding especially for mothers experiencing difficulties in feeding their preterm will potentially minimize risk of growth failure.

Prevalence and predictors of heart failure among patients on maintenance hemodialysis therapy at Muhimbili National Hospital in Tanzania: a cross-sectional study

Background Heart failure among patients on hemodialysis therapy portends poor outcomes. Traditional risk factors like aging, hypertension and diabetes mellitus are relatively common in these patients and may not accurately predict the occurrence of heart failure. Such patients may have other factors that contribute to heart failure. This study aimed to investigate the prevalence and predictors of heart failure among patients on maintenance hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania. Results Among 160 patients on maintenance hemodialysis, 49 (30.6%) were female. The mean age of patients was 52.2 ± 13.3 years. Almost all patients had hypertension and 69 (43.1%) had diabetes mellitus. Heart failure was prevalent in 17 (10.6%) patients. On multivariate analysis, presence of angina, intradialytic hypertension, and anemia were independent predictors of heart failure. Patients with heart failure had significantly higher malnutrition inflammation scores and erythropoietin resistance indexes. Conclusions Heart failure among hemodialysis patients correlates with the presence of angina, intradialytic hypertension, and anemia. Patients with heart failure had a greater degree of malnutrition–inflammation complex, and erythropoietin resistance. Patients with these conditions require a thorough cardiac evaluation and appropriate treatment.

Glycosylated Hemoglobin Levels Among Non-Diabetic Children With Sickle Cell Anemia At Muhimbili National Hospital. A Case For Establishing Normal Values

BackgroundImprovement in the management of children with SCA, has led to increase in their lifespan. However, the increased lifespan, has been accompanied with emergence of various endocrinopathies such as Diabetes mellitus (DM).Glycosylated Hemoglobin (HbA1c) levels have been found to be lower in children with SCA compared to children without SCA in various studies. This can lead to missed children with DM hence delaying their treatment. There is a need to establish normal ranges of HbA1c levels corresponding to children with SCA.ObjectiveTo determine normal range of HbA1c levels among non-diabetic children with SCA attending clinics at Muhimbili National Hospital in Dar-es-salaamMethodologyThis was a hospital-based cross sectional study conducted at Paediatric clinics in Muhimbili National Hospital involving children from 9 months to 14 years. The study was approved by Institutional review Board of MUHAS. A written informed consent was obtained.120 children with SCA and 40 children without SCA were recruited. Data was reported as median and IQR or as mean ± standard deviation. Chi-square was used for categorical data while independent t-test and Mann Whitney test were used for continuous data. ResultsThe reference range of HbA1c levels in children with SCA was from 3.4% to 5.2%. Median HbA1c level in children with SCA was 4.2% with IQR of (4.1% - 4.6%) while for children without SCA median HbA1c levels was 5.3% with IQR of (4.9% - 5.5%). The median HbA1c level was significantly lower in children with SCA than children without SCA.Conclusion and RecommendationThe reference range of HbA1c levels in children with SCA was from 3.4% to 5.2%. Children with SCA had lower levels of HbA1c compared to children without SCA. Health personnel are advised to use HbA1c reference ranges obtained from this study when screening for Diabetes mellitus in children with SCA.

Individual capacities influencing uses of routine health data for decision making among health workersat Muhimbili National Hospital; Dar es Salaam – Tanzania: a quantitative study

Background: The availability of health workers with the capacity to read and understand statistical data and then use them for work-related decision-making, therefore, supporting their institutions or the existing health system at large in developing countries is important. However, in some countries, Tanzania inclusive, this has remained critical. This requires the capacity-building of potential users. The study aimed to assess individual capacities influencing use of routine health data for decision-making among Emergency Medicine health workers at Muhimbili National Hospital (MNH). Methods: The study design used was a descriptive cross-sectional using a quantitative approach. Stratified random sampling was used to sample Nurses, Medical officers, Residents, and Emergency medicine specialists. A semi-structured questionnaire was used to collect data. The study involved 76 health workers working in the Emergency Medicine Department (EMD) at MNH. Results: Results showed 61.6% use of routine health data for decision making. Working experience, job title, and education level had a statistically significant association with information used for decision-making. There was a statistically significant difference in routine data use between those who had poor and good knowledge to collect, analyze, interpret, and use data. Also, results showed that there was a statistically significant difference in routine data use between those who had poor and good skills to collect, analyze, interpret, and use data. Specialists had a good level of knowledge and skills on data use compared to other health workers. Conclusion: The study demonstrates partial use of routine health data for decision-making with an interplay of individual capacities. A framework for statistical capacity building in Tanzania needs to be built, by training a cadre of health workers with core competencies and skills in measuring progress in the health system that could generate sustainable demand for data use within the health systems of the country.

Clinical picture and grouping of retinoblastoma at first presentation to a tertiary Hospital in Dar es Salaam: Implications for treatment outcomes

Objectives: To assess the clinical picture and grouping of retinoblastoma at first presentation to the oncology ward at Muhimbili National Hospital. Methods: A cross sectional descriptive hospital based study was conducted from April to December 2018. Seventy two patients who presented for the first time to Muhimbili National Hospital (MNH) with a diagnosis of retinoblastoma were consecutively sampled and recruited in the study. Visual acuity, horizontal corneal diameter, intraocular pressure, anterior and posterior segments of the eye were assessed and each eye was classified according to the International Classification of Retinoblastoma (ICRB) group. Ultrasonography, neuroimaging and histology were performed. Results: A total of 72 patients comprising of 90 affected eyes were recruited and analyzed: 39(54.2%) males and 33(45.8%) females. Majority of patients were residents of the Coastal and Lake Zones. Family history of Retinoblastoma was positive in only one patient. Fifty four (75.0%) patients had unilateral disease. Leukocoria (77.8%) and proptosis (41.7%) were the commonest first clinical signs noted by the family and health workers at MNH respectively. At MNH, both bilateral and unilateral cases presented with advanced disease of group E and extra ocular extension where 84(93.3%) eyes were indicated for enucleation. The median lag time from disease onset to presentation at MNH was 4 months. Conclusion: Leukocoria was the commonest first sign of retinoblastoma presentation at home. However, despite early presentation to primary health facilities, most patients presented to the tertiary centre of MNH late with advanced disease. Efforts to raise awareness on retinoblastoma to both health workers and the community are important for early case detection, referral, diagnosis and treatment in order to improve visual outcomes and survival rates of retinoblastoma patients.

Effects of Hydroxyurea Treatment on Haemolysis in Patients with Sickle Cell Disease at Muhimbili National Hospital, Tanzania

Tanzania is one of the countries with a high burden of sickle cell disease (SCD). Haemolytic anaemia is a clinical feature of SCD, and has been linked to major complications leading to morbidity and mortality. Treatment with hydroxyurea (HU) has shown to induce foetal haemoglobin (HbF) which in turn decreases haemolysis in patients. This study aimed to investigate the effects of HU on haemolysis in SCD patients attending Muhimbili National Hospital, Tanzania by comparing their haemolytic parameters before and after therapy. Patients meeting the criteria were initiated on HU therapy for 3 months. Two haemolytic biomarkers: unconjugated plasma bilirubin levels and absolute reticulocyte counts were measured from patients’ blood samples at baseline and after 3 months of HU therapy and compared. Both absolute reticulocyte counts and indirect plasma bilirubin levels significantly declined after HU therapy. Median (IQR) plasma unconjugated bilirubin levels dropped significantly from 20.3 (12.7–34.4) μmol/L to 14.5 (9.6–24.1) μmol/L (p < 0.001) and mean (SD) absolute reticulocyte counts dropped significantly from 0.29 (0.1) x 109/L to 0.17 (0.1) x 109/L (p < 0.001) after therapy, thus, a decline in both haemolytic biomarkers after treatment was observed. This study found a potential for use of HU therapy in managing SCD patients in our settings evidenced by improvements in their haemolytic parameters. Clinical trials with a lager sample size conducted for a longer time period would be beneficial in guiding towards the inclusion of HU in treatment protocols for the Tanzanian population. Keywords: Sickle cell disease; hydroxyurea; haemolysis; foetal haemoglobin

Peripheral neuropathy in HIV-infected children attending care and treatment clinic, at Muhimbili National Hospital, Dar es Salaam: a cross sectional study

Background Peripheral neuropathy (PN) is a neurological complication of untreated Human Immunodeficiency Virus (HIV) infection or exposure to certain antiretroviral drugs. In Tanzania where HIV is a major public health problem, the burden of HIV associated peripheral neuropathy has not yet been well defined in children.Thisstudy investigated the prevalence and associated factors for peripheral neuropathy among children living with HIV, attending Care and Treatment Clinic (CTC) at Muhimbili National Hospital (MNH). Materials and methods A cross-sectional study was conducted among 383 HIV positive children aged 5 to 18 years at MNH, CTC in Dar es Salaam between October to December 2019. All participants provided written assent/consent. Structured questionnaires designed for this study was used to collect data and screening for peripheral neuropathy was done on each participant using the Pediatric modified Total Neuropathy Score (Ped m TNS) that includes subjective and objective assessment. A score of 5 or greater on the Ped m TNS was used to define peripheral neuropathy. Data analysis was done using SPSS Version 23. Results The prevalence of peripheral neuropathy among HIV infected children was 14.1 % (95 % CI (10.8 − 18 %). Common neuropathic symptoms were numbness, tingling sensation, reduced ankle reflexes and reduced sensation to light touch and pain that was limited to the toes. Low CD4 cell count (OR = 12.21; 95 % CI3.75–39.66; p = 0.0001), high viral load (OR = 10.54; 95 % CI 3.19–34.77; p = 0.0001), ART regime containing NRTI plus PI (OR = 3.93; 95 % CI 1.43– 10.74; p = 0.01) and the last exposure to isoniazid more than 6 months ago (OR = 3.71; 95 % CI 1.57–8.77; p = 0.003) were independent predictors for peripheral neuropathy. Conclusion Peripheral neuropathy is common among HIV infected children attending CTC at MNH and its frequency increases with advanced disease. The choice of ART regimen and other drugs for treating comorbid conditions should carefully be evaluated.