Knowledge and utilization of prevention of mother-to-child transmission of HIV services among pregnant women in Tanzania

Background: Human Immunodeficiency Virus (HIV) infection among children is mainly vectored through mother-to-child transmission. Prevention of mother-to-child-transmission strategy is highly effective; however, its accessibility and utilization is affected by the lack of knowledge among other factors. Methods: A cross-sectional study was conducted among antenatal care attendees in two districts in Tanzania to determine their knowledge and utilization of the prevention of MTCT services. Results: We interviewed 160 antenatal care attendees aged 18-45 years with a mean (SD) age of 30.4 (6.3) years; 74 (46.2 %) were HIV-infected. HIV-infected women demonstrated significantly correct knowledge of HIV (p=0.001) and AIDS (p=0.014) than uninfected individuals. HIV-infected women also significantly demonstrated correct knowledge of mother-to-child transmission during pregnancy than HIV-uninfected women (p=0.016) and during delivery (p=0.005). A significant proportion of HIV-positive women compared to HIV-negative women were aware that correct use of antiretroviral during pregnancy can reduce the risk of mother-to-child-transmission of HIV (p<0.039), but only 6 (3.75%) of all women were aware that correct use of antiretroviral during delivery can significantly reduce the risk of mother-to-child-transmission. HIV-infected women had significant comprehensive knowledge of HIV/AIDS (p=0.001) and prevention of mother-to-child transmission of HIV (p=0.006) than HIV-negative women. Comprehensive knowledge prevention of mother-to-child transmission of HIV was low among the study participants. Male partners’ involvement in maternal antenatal care was significantly higher among HIV-infected women than males from the HIV-infected women group (p<0.006). Conclusion: The study demonstrated inadequate knowledge of PMTCT among women who made ANC visits. HIV uninfected women had poorer knowledge compared to the HIV-infected ones. Routine HIV counseling and testing services were highly accepted among these women.

Dyke-Davidoff-Masson Syndrome as a rare congenital hemiatrophy: a case report

Introduction: Dyke-Davidoff-Masson syndrome (DDMS) is a rare condition in childhood with very few cases reported in sub-Saharan Africa. Typically, the patient presents with facial asymmetry, seizures, and hemiparesis. Radiological findings include cerebral hemiatrophy, ipsilateral lateral ventricular dilatation, and hypertrophy of the calvarium and sinuses. Case presentation: We present the report of a 3-year-old male with weakness of right upper and lower limbs, facial asymmetry, and seizures. Physical examination showed a well-nourished child with a squint of the right eye. There were brisk tendon reflexes with right-sided hemiplegia which is spastic with left limb preference. Computer tomography of the brain showed atrophy of the left cerebral hemisphere, ipsilateral lateral ventricular dilatation, and thickening of the ipsilateral cranium. The diagnosis of Dyke-Davidoff-Masson syndrome was made. He was treated with sodium valproate and lamotrigine and presently physiotherapy and he had remained seizure-free. Conclusion: Dyke-Davidoff-Masson syndrome still affects children despite being a rare condition. There is a need for appropriate clinical and radiological assessment for the diagnosis of DDMS. Early identification and appropriate treatment will improve the general outcome of children with DDMS.

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.

A cross-sectional study on mother’s knowledge, feeding practices, childcare and malnutrition in Sumbawanga, Tanzania

Background: Malnutrition is the major cause linked to many diseases and is a burden recognized in many developing countries including Tanzania. A child’s intake can have a significant impact on health, growth, and development. Understanding mothers’ knowledge of children’s intake can play a vital role in improving their nutritional status. This study aimed at exploring mothers’ knowledge, feeding practices, childcare, and malnutrition among children aged between six months and five years. Methods: A hospital-based cross-sectional study was undertaken in Sumbawanga municipal, from September to December 2020. Data was collected from interviews filled in structured questionnaires among mothers of children aged six months to less than five years. Data were analyzed using SPSS version 20 based on a total of 190 study participants. Descriptive statistics and c2 tests were used to assess the significance levels of associated variables. Results: The total sample of children included in the study was 190, therefore 190 mothers. Out of the 190 mothers, 65 (34.21%) had not attended formal education, 53 (27.89%) had a primary education level, 42 (22.11%) had a secondary education level and 30 (15.79%) has a college or university education level. The majority of mothers, 145 (51.58%) were single, divorced or widowed whereas the majority of mothers, 51.58% (98) were not employed. Marital status and education level had an impact on child’s care and malnutrition reported cases (c2 = 15.06, p < 0.0001). Food availability in families of many children with more individuals living together showed to be significantly associated with incidences related to malnutrition (χ2 = 25.76, p < 0.001). Mother’s feeding practices of less than two times a day showed to be significantly associated with and incidences related to malnutrition (χ2 = 23.54, p < 0.0001). Mother’s good maternal care showed to be significantly associated with attendance to ANC services and husband/ partner's financial support (χ2 = 43.22, p < 0.001). Conclusion: Current mothers’ knowledge and practices about malnutrition and incidences of nutritional related-illness in children in Sumbawanga municipal calls for urgent health education to improve children’s health status.

Early clinical markers of metabolic syndrome among secondary school adolescents in Dar es Salaam, Tanzania

Background: Metabolic syndrome is defined by the presence of three of four disorders; hypertension, obesity, dyslipidemia, and diabetes mellitus type 2. The presence of anyone or two of these constitutes early markers of the syndrome. It occurs in children and adolescents but its magnitude has not been determined consistently in many countries including Tanzania. Detection of early clinical markers is an effective preventive strategy. The aim of this study was to determine the prevalence of early clinical markers of metabolic syndrome among secondary school adolescents in Dar es Salaam. Methods: A descriptive cross-sectional study was conducted among secondary schools in Dar es Salaam. Structured questionnaires were used to record demographic data. Blood pressure and anthropometric measurements were taken using standard methods. Fasting blood samples were collected for blood glucose, total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride. The International Diabetes Federation (IDF) criteria were utilized. Results: A total of 217 adolescents were enrolled; of these males and females were 32% (69) and 68% (148) respectively. Of these; 75% (162) were young adolescents (14-17years). Participants from public and private schools were 48% (104) and 52% (113) respectively. Early clinical markers of metabolic syndrome were detected in 43% (94) with at least one clinical marker and 9% (19) with two markers. The prevalence of full-blown metabolic syndrome was 1.4% (3). Overall, the clinical markers included; dyslipidemia 30% (64), central obesity 22% (48), hyperglycemia 13% (29) and hypertension 2% (4). The prevalence of central obesity was 26% (42) among young adolescents and 11% (6) among elderly adolescents and the difference was significant (p value= 0.02). Conclusion: Early clinical markers of metabolic syndrome exist among Dar es Salaam secondary school adolescents with dyslipidemia being the commonest marker while central obesity was much common among young adolescents. School programs for screening students for detection of early markers of metabolic syndrome are needed.

Antimicrobial activities and phytochemical analysis of extracts from Ormocarpum trichocarpum (Taub.) and Euclea divinorum (Hiern) used as traditional medicine in Tanzania

Background: Medicinal plants have been of great value to human healthcare in most parts of the world for thousands of years. In Tanzania, over 12,000 species of higher plants have been reported, and about 10% are estimated to be used as medicines to treat different human health conditions. The present study aimed to determine in vitro antimicrobial activities and phytochemical analysis of Ormocarpum trichocarpum and Euclea divinorum which are commonly used as a traditional medicine in Tanzania. Methods: Minimum Inhibitory Concentration (MIC) of plants extracts against tested bacterial and fungal species were determined using 96 wells microdilution method. In this method, 50 μL of nutrient and saboraud’s dextrose broth for bacteria and fungus respectively were loaded in each well followed by 50 μL of extract to make final volume of 100 μL. Subsequently 50 μL were transferred from first rows of each well to the second rows and the process was repeated down the columns to the last wells from which 50 μL were discarded. Thereafter, 50 μL of the selected bacterial and fungal suspension was added to each well thus making final volume of 100μL. The lowest concentration which showed no microbe growth was considered as MIC. The study also evaluated phytochemical compounds present in the ethyl acetate extracts from O. trichocarpum stem bark and E. divinorum root bark extract using Gas Chromatography-Mass Spectrometry (GC-MS) technique. Results: It was revealed that 66% of the tested microbes were susceptible to plant extracts at MIC value of 0.39 mg/mL whereas 83% being susceptible to extracts at MIC value of 0.781 mg/mL. Interestingly, four out of 18 tested plant extracts exhibited high antifungal activity below that of the standard antifungal drug, fluconazole. The GC-MS analysis revealed the presence of various low molecular weight phytochemicals which belongs to six groups of secondary metabolites namely dieterpenes, alphatic hydrocarbons, tetraterpenes, sesquiterpenes, steroid and triterpenes. Conclusion: It was concluded that the presence of various phytochemicals in the tested plant extracts may be associated with pharmacological properties of O. trichocarpum and E. divinorum and therefore justifying ethnomedical usage of such plants. Keywords: Antibacterial, antifungal, Ormocarpum trichocarpum, Euclea divinorum

Giant vulva fibroma presenting as a genital mass: a case report

Introduction: Even though vulva fibroma is rare, it is among the solid tumors of the vulva. Its cause is unknown although it has been associated with physiological hormonal changes. We report a patient with a unique vulva fibroma which has grown to the extent of interfering with her gait and urination. Case presentation: A 22-year-old woman presented with a genital mass which had been present for the duration of 2 years and felt embarrassed to report to the hospital early as the growth was in the genital area, with the perception of it being a sexually related illness, despite having not yet started engaging in sexual activity. On physical examination, a palpable pendulous mass of about [30 x 22] cm was seen originating from the right labia and extending to the right perineum. The mass was firm, nodulated, non-tender and had limited mobility. Surgical excision was performed under spinal anesthesia. Histologically, features suggestive of mixoid fibroma were reached after the mass was excised. No recurrence has been observed. Conclusion: Clinicians should be aware of this rare disease which can be associated with recurrence if there is incomplete excision. Again, the unusual finding of the genital mass can be very embarrassing to the patient affecting her psychosocial well-being. It needs to be treated immediately upon diagnosis.

Some Traits on the Outcome of the Treatment of Cervical Cancer in Tanzania: A Case Study of Ocean Road Cancer Institute (ORCI)

Background: In Tanzania, like in many other poor African countries, cervical cancer is a major problem facing women especially for those aged 30 years and above. This study aimed at constructing a statistical model to enable the prediction of the outcome of treatment for cervical cancer patients in Tanzania. Methods: Data were collected retrospectively from patient’s files with histological proven cervical cancer who were treated at Ocean Road Cancer Institute (ORCI) from year 2009 and followed up to year 2011. The factors considered are screening status, HIV status, disease stage, age, treatment type and the intent of the treatment. The study employed the Chi-square (χ2) test and the logistic regression model for its analysis. Results: The Chi-square (χ2) test result showed that there was a significant relationship between outcome of treatment and the patient screening status, HIV status, disease stage and intent of treatment at 5% level of significance. On the other hand, the logistic regression results found patient disease stage and intent of the treatment to be statistically significant at 95 percent. Logistic regression results also showed that patients who attended ORCI when their disease at a late stage had an odds ratio of 0.128 less likely to have favorable outcomes compared to those patients who attended ORCI when their disease stage was at early stages. The odds ratio for cervical cancer patients who received both treatment, radiotherapy, and chemotherapy was 2.643 more likely to have favorable outcomes Conclusion: More emphasis and campaigns should be made in order to encourage women all over the country to attend cancer centers for screening and treatment at early stages or even before any symptoms for cervical cancer and other types of cancers.

Stem Cells: Prospects and Potential Applications in Tanzania: A review

Stem cell technology and its application in regenerative medicine is the future gateway for the treatment of most non-communicable diseases (NCDs). As the burden of NCDs continues to rises globally, regenerating the cells, tissues and organs will be the mainstream treatment option. The world is prepared for this intriguing but promising avenue of biomedical technology and medicine but Africa is grossly lagging far behind. African governments, universities, research and health institutions need to take a leading role in empowering and mainstreaming stem cell research. Moreover, for Africa, there is a huge potential for translating stem cell technology into clinical treatments due to the fact that there are limited treatment options for life-threatening forms of NCDs. Some African countries have well-developed stem cell facilities and large-scale stem cell therapy centers. The use of adult stem cells in liver failure, diabetes and cardiac infarcts has shown success in some African countries. The present work reviews the status, potential and future prospects of stem cell technology and regenerative medicine in Tanzania with particular emphasis on the adult stem cells applicability into the immediate use inpatient care. The paper also reviews the available cell identification systems and markers and moral and ethical aspects of stem cell science necessary in the translational treatment regimens.