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Nathanael Sirili,1 Doreen Mloka,2 Lilian Mselle,3 Rodrick Kisenge,4 Erasto Mbugi,5 Dennis Russa,6 Obadia Nyongole,7 Stephen E Mshana,8 Rose Laisser,9 Kien Mteta,10 Levina Msuya,11 Eligius Lyamuya,12 Judith Martin-Holland,13 Gideon Kwesigabo,14 Ephata Kaaya15 1Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 3Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 4Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 5Department of Biochemistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 6Department of Anatomy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 7Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 8Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 9Archbishop Anthony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 10Department of Surgery, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 11Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 12Department of Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 13Department of Physiological Nursing, University of San Francisco California, San Francisco, CA, USA; 14Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; 15Department of Pathology, Kilimanjaro Christian Medical University College, Moshi, TanzaniaCorrespondence: Nathanael Sirili, Email drnsirili@gmail.comBackground: In 2012, the Muhimbili University of Health and Allied Sciences (MUHAS) embarked on structured competency-based curricula (CBC) for its programmes. Other health profession training institutions continued with their traditional way of teaching and thus causing variability in the competencies of the graduates. We aimed to analyze the experiences of different stakeholders on the implementation of CBC specifically on biomedical sciences by MUHAS to inform the development of harmonized competency-based curricula in three health professional training institutions in Tanzania.Methods: We adopted an exploratory case study to analyse the implementation of CBC in programmes of Medicine and Nursing involving MUHAS graduates, immediate supervisors at the employment sites, faculty, and continuing students at MUHAS. Kiswahili guides were used to conduct the in-depth interviews (IDIs) and focus group discussions (FGDs). Qualitative content analysis was adopted for analysis.Results: From the 38 IDIs and 15 FGDs, four categories of human resources teaching and learning environment; curriculum content; and support systems emerged. Human resources were attributed to the shortage of an adequate number of faculty and teaching skills variation. The curriculum content category was linked to the redundancy of courses or topics, poor sequencing of some topics or courses, and limited time for teaching some essential courses or topics. Training and practice area mismatch, accommodation to students, teaching space, and library were the sub-categories linked to teaching and learning environment. Lastly, support systems related to teaching methods and opportunities for improving teaching and learning were revealed.Conclusion: The findings of this study highlight the challenges and opportunities for the implementation of CBC. The solutions to the revealed challenges are beyond the training institutions’ capacity. The latter call for multi-stakeholder engagement including those from the public and private sectors in health, higher education and finance for common and sustainable solutions.Keywords: competency-based curricula, biomedical sciences, teaching pedagogy, health training institutions, harmonized training, Tanzania

James Samwel Mundamshimu,1 Kija Malale,1 Benson R Kidenya,1 Daniel W Gunda,1 Logious Bwemelo,1,* Mwakile Mwashiuya,1,* Salhida Shamnte Omar,1,* Neema Mlowe,1,* Magwa Kiyumbi,1 James S Ngocho,2,3 Emmanuel Balandya,4 Bruno Sunguya,4 Stephen E Mshana,1 Kien Mteta,2 John Bartlett,5,6 Eligius Lyamuya,4 Blandina Theophil Mmbaga,2,3 Samuel Kalluvya1 1Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 2Kilimanjaro Christian Medical University College, Moshi, Tanzania; 3Kilimanjaro Clinical Research Institute, Moshi, Tanzania; 4Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 5Kilimanjaro Christian Medical University College, Mosh, Tanzania; 6Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA*These authors contributed equally to this workCorrespondence: James Samwel Mundamshimu, Tel +255746999249, Email jamessamwel913@yahoo.comBackground: Introduction and expansion of antiretroviral therapy (ART) have turned the tide of HIV pandemic, thus helping people living with HIV (PLHIV) achieve viral suppression. This success may need to be complemented by intensified adherence counseling (IAC) to improve adherence to treatment. However, some PLHIV still face higher than acceptable viral loads despite being on treatment.Purpose: We investigated the factors associated with the failure to suppress HIV viral load after three months of IAC sessions.Patients and Methods: This cross-sectional study analyzed secondary data from PLHIV-attended care and treatment clinics in Mwanza between January 2018 and December 2019 who had unsuppressed VL after being on ART for at least six months. We identified PLHIV in first-line ART with viral load evaluation before receiving IAC and had viral load results done at 90 days after IAC. We conducted descriptive statistics to examine the magnitude of viral suppression. Wilcoxon signed-rank test used to compare the median viral load before and after IAC sessions, and logistic regressions predicted the factors associated with failure.Results: This study included 212 subjects. After intervention, most participants 85.9% (182) had significantly improved adherence compared to baseline. More than half 75.5% (160) of the participants had viral suppression after the intervention. Participants aged 18– 25 years (AOR = 5.6, 95% CI, 1.1– 29.6), unstable client during ART initiation (AOR = 0.3, 95% CI, 0.13– 0.62), and poor adherence to ART (AOR = 4, 95% CI, 1.3– 12.3) remained the main predictors of virological failure after IAC intervention.Conclusion: Even though virological suppression is influenced by ART adherence, the findings in this study have shown co-existence of other factors to be addressed. Unstable during ART initiation is a new factor identified in this study.Keywords: people living with HIV, virological failure, intensified adherence counseling, factors, Tanzania

Emmanuel Balandya,1 Bruno Sunguya,2 Benson Kidenya,3 Tumaini Nyamhanga,4 Irene K Minja,5 Michael Mahande,6 Blandina T Mmbaga,7 Stephen E Mshana,8 Kien Mteta,9 John Bartlett,10 Eligius Lyamuya11 1Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania; 2Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania; 3Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 4Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania; 5Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania; 6Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 7Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 8Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 9Department of Urology, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 10Duke Global Health Institute, Duke University, Durham, NC, USA; 11Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, TanzaniaCorrespondence: Emmanuel Balandya, Department of Physiology, Muhimbili University of Health and Allied Sciences, P.O. Box. 65001, Dar-es-salaam, Tanzania, Tel +255-768-431600, Fax +255-22-2150465, Email ebalandya@muhas.ac.tzBackground: Mentorship is pivotal for sustainability of a successful research culture at higher learning institutions. Various models have been proposed for provision of research mentorship in health sciences but are challenged by utilizing predominantly hierarchical mentoring, as well as being centred on one discipline or one institution. This paper describes the approach and successes of an inclusive mentorship model employed in a resource-limited setting in sub-Saharan Africa.Methods: Through the NIH-funded Transforming Health Professions Education in Tanzania (THET) project, a consortium of three prominent health sciences higher learning institutions in Tanzania (MUHAS, CUHAS and KCMUCo) and two collaborating US institutions (UCSF and Duke University) was formed. Within THET, the Community of Young Research Peers (CYRP) was constituted, comprised two cohorts of undergraduate students and young faculty (fellows), and senior scientists. Besides mentorship and research training, fellows received funded research awards and in turn mentored undergraduate students.Results: By the first quarter of project year four, the number of fellows and mentored undergraduate students had increased from 12 to 24 and from 41 to 67, respectively. Fellows in the second cohort (junior fellows) included medical doctors, nurses, dentist, biomedical scientist, sociologist and education psychologist. In fostering peer-to-peer mentoring, the cross-institutional pairs of fellows from the first cohort (senior fellows) were assigned to reciprocal pairs of junior fellow mentees and took a leading role in research training. Furthermore, the senior fellows had made significant strides, including eight enrolled in PhD programmes, eight publications from mentored research projects, and six small to medium-size research grants won.Conclusion: The unifying model of research mentorship employed by the CYRP has been demonstrated as an effective model for joint research mentorship of the diverse group of young investigators from collaborating higher learning institutions in Tanzania. This model is recommended for scale-up, particularly in sub-Saharan Africa.Keywords: health research, cross-institutional, inter-disciplinary, young faculty, mentorship, undergraduate

Background: PrEPVacc is a phase IIb multicenter HIV vaccine trial planned to be conducted at five sites in four sub-Saharan African countries that aims to evaluate safety and efficacy of two combinations of HIV vaccine regimens; HIV DNA + gp120/alum and HIV DNA, MVA + gp140/MPLA. A PrEPVacc HIV-negative registration cohort study was established to determine HIV prevalence and incidence among female sex workers (FSW) in Dar es Salaam, Tanzania. Methods: Between October and December 2018, a total of 773 FSW aged 18-45 years were screened for eligibility and 700 were enrolled. At screening and at 3-monthly follow-up visits, demographics and risky behavioural assessment and collection of blood samples were done. HIV testing was performed using two sequential rapid diagnostic tests; SD Bioline HIV1/2 and Uni-Gold HIV-1/2. HIV reactive samples were confirmed using Siemens Enzygnost HIV Integral 4 ELISA. Logistic regression was used to estimate odds Ratios for factors associated with HIV prevalence. Time-to-event analysis was performed using Poisson regression to estimate HIV incidence. Women were censored at 12 months of follow-up or earliest date of HIV seroconversion. Date of seroconversion was assumed to be midway between last negative and first positive HIV test results. Results: HIV prevalence at screening was 8% (59/773), associated with older age (p < 0.001), lower education levels (p < 0.001) and being single (either never married or separated/divorced/widowed) (p < 0.001). FSWs who reported being raped or having used drugs, were more likely be HIV-infected than their counterparts (p = 0.01 and p = 0.002, respectively). Attendance at 12 months was 80% (560/700) with women in the cohort contributing a total of 609 person-years-at risk (PYR). Twenty-one FSWs seroconverted with the HIV incidence rate in the cohort of 3.45 per 100 PYRS (95% CI; 2.25 to 5.28/100 PYRS). Conclusions: HIV prevalence and incidence were high among FSW in Dar es Salaam. These findings demonstrate feasibility of recruiting FSW for HIV vaccine prevention trials., OA02.04 D. Faini (1); F. Msafiri (2); P. Munseri (3); M. Bakari (4); A. Joachim (2); T. Nagu (3); E. Tarimo (5); E. Lyamuya (2); E. Sandstrom (6); G. Biberfeld [...]

As international collaborative health research activities increase, building research ethics committees (REC) infrastructure and capacity in low- and middle-income countries for efficient and thorough review of research protocols becomes more critical, especially in sub-Saharan Africa. International investigators may face multiple challenges when conducting research in these settings, an important one being the length of time involved in securing REC review and approval. We discuss an approach to the problem that involved organisation of 'rapid review' REC sub-committees who met via video-conference for collaborative review of research protocols. [ABSTRACT FROM AUTHOR]

Raphael Z Sangeda,1,2 Fausta Mosha,3 Said Aboud,4 Appolinary Kamuhabwa,5 Guerino Chalamilla,6,† Jurgen Vercauteren,2 Eric Van Wijngaerden,7 Eligius F Lyamuya,4 Anne-Mieke Vandamme2,8 1Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, KU Leuven – University of Leuven, Leuven, Belgium; 3Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania; 4Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 5Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 6Management and Development for Health (MDH), Dar es Salaam, Tanzania; 7Department of General Internal Medicine, University Hospitals, KU Leuven – University of Leuven, Belgium; 8Center for Global Health and Tropical Medicine, Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal †Dr Guerino Chalamilla passed away in November 2015 Background: Measurement of adherence to antiretroviral therapy (ART) can serve as a proxy for virologic failure in resource-limited settings. The aim of this study was to determine the factors underlying nonadherence measured by three methods. Patients and methods: This is a prospective longitudinal cohort of 220 patients on ART at Amana Hospital in Dar es Salaam, Tanzania. We measured adherence using a structured questionnaire combining a visual analog scale (VAS) and Swiss HIV Cohort Study Adherence Questionnaire (SHCS-AQ), pharmacy refill, and appointment keeping during four periods over 1 year. Overall adherence was calculated as the mean adherence for all time points over the 1 year of follow-up. At each time point, adherence was defined as achieving a validated cutoff for adherence previously defined for each method. Results: The proportion of overall adherence was 86.4% by VAS, 69% by SHCS-AQ, 79.8% by appointment keeping, and 51.8% by pharmacy refill. Forgetfulness was the major reported reason for patients to skip their medications. In multivariate analysis, significant predictors to good adherence were older age, less alcohol consumption, more advanced World Health Organization clinical staging, and having a lower body mass index with odds ratio (CI): 3.11 (1.55–6.93), 0.24 (0.09–0.62), 1.78 (1.14–2.84), and 0.93 (0.88–0.98), respectively. Conclusion: We found relatively good adherence to ART in this setting. Barriers to adherence include young age and perception of well-being. Keywords: self-report, appointment keeping, pharmacy refill, adherence barriers, resource-limited settings, AIDS

AbstractAs human immunodeficiency virus (HIV) diversity may have an impact on both vaccine efficacy and drug resistance, it is important to have knowledge of circulating genetic variants. With widespread use of antiretroviral (ARV) drugs in Africa, one of the major potential challenges is the risk of emergence of ARV drug-resistant HIV strains. This study aimed to determine the circulating HIV subtypes and recombinant forms, as well as the prevalence of ARV drug resistance mutations, among 75 treatment-naive HIV-infected youths in Dar es Salaam, Tanzania. Gag(n = 48), partial pol(n = 44), and partial env(n = 35) sequencing was performed; all three regions were sequenced in 26 samples. Evidence of infection with recombinant viruses was found in 12 (46%) participants; AC recombinants were the most commonly detected and they were identified in six (23%) participants. Of individuals infected with nonrecombinant strains, subtype A was most commonly detected in seven (27%) participants, followed by subtype C detected in six (23%) participants and subtype D detected in one (4%) participant. Among the polsequences from 44 individuals, three (7%) had resistance to nucleoside reverse transcriptase (RT) inhibitors and four (9%) had nonnucleoside RT inhibitor resistance mutations. Of these, three (7%) individuals were infected with viruses with cross-resistance mutations to both classes of RT inhibitors. These resistant mutations were all associated with drugs currently used in first-line therapy and in the prevention of vertical transmission. This high prevalence of resistance mutations is of considerable concern in apparently drug-naive populations as it may result in treatment failure and the spread of ARV-resistant strains. [ABSTRACT FROM AUTHOR]

Methicillin-resistant Staphylococcus aureus (MRSA) has been recognized world wide as an important causative agent of nosocomial and community acquired infections. Clindamycin has been considered as an alternative drug for the treatment of such strains. However, the possibility of clindamycin inducible resistance complicates the choice of treatment. The aim of this study was to determine the prevalence of clindamycin inducible resistance of MRSA at Bugando Medical Centre (BMC) in Mwanza Tanzania. A total of 600 clinical specimens of pus, wound swabs and aspirates from patients admitted at BMC surgical wards were processed over a period of 4 months. Of these, 160 of S. aureus clinical isolates were analysed. MRSA was identified using cefoxitin disc, oxacillin disc and oxacillin agar. Inducible clindamycin resistance was detected using erythromycin (15µg) and clindamycin (2µg) discs placed 15mm apart on Muller Hinton agar. Of the 160 isolates, 26 (16.3%) were found to be MRSA. Overall prevalence of inducible clindamycin resistance (iMLSB) was 28.8% (46/160), with 22% (30/134) of methicillin-susceptible S. aureus (MSSA) and 61% (16/26) of MRSA exhibiting inducible clindamycin resistance (P=0.0001). Constitutive resistance (cMLSB) was found in 1 (3.7%) of the MRSA isolates and was not detected among MSSA. MSB phenotype was detected in 1 (3.8%) of MRSA isolates and 2 (1.5%) of MSSA. Eight (29.6%) of the MRSA isolates were sensitive to both clindamycin and erythromycin. In conclusion, a high prevalence of inducible clindamycin resistance was observed among S. aureus with significant association between MRSA and inducible clindamycin resistance. It is important that susceptibility test of staphylococci is routinely done to facilitate early detection of clindamycin inducible resistance in the country. [ABSTRACT FROM AUTHOR]

The shortage of qualified health professionals is a major obstacle to achieving better health outcomes in many parts of the world, particularly in Africa. The role of health science universities in addressing this shortage is to provide quality education and continuing professional development opportunities for the healthcare workforce. Academic institutions in Africa, however, are also short of faculty and especially under-resourced. We describe the initial phase of an institutional partnership between the Muhimbili University of Health and Allied Sciences (MUHAS) and the University of California San Francisco (UCSF) centred on promoting medical education at MUHAS. The challenges facing the development of the partnership include the need: (1) for new funding mechanisms to provide long-term support for institutional partnerships, and (2) for institutional change at UCSF and MUHAS to recognize and support faculty activities that are important to the partnership. The growing interest in global health worldwide offers opportunities to explore new academic partnerships. It is important that their development and implementation be documented and evaluated as well as for lessons to be shared. [ABSTRACT FROM AUTHOR]

A study was undertaken to determine the serological response in children (aged 1-15 years) immunized with diphtheria-pertussis-tetanus vaccine (DPT) alone or with a tetanus toxoid (TT) booster dose under the Expanded Programme on Immunization in Dar es Salaam and Bagamoyo, Tanzania. Using an ELISA technique, serum levels of anti-TT antibody, antibody avidity and anti-TT IgG subclasses were determined in 138 apparently healthy children. Our findings revealed that 94.7% and 98% of children aged 1-5 years in Dar es Salaam and Bagamoyo, respectively, had anti-TT antibody levels above that considered protective (≥ 0.1 IU/ml). Among 6-15-year-old children, 53.3% in Dar es Salaam and 55% in Bagamoyo had anti-TT antibody levels ≥ 0.1 IU/ml. The avidity index of anti-TT antibodies was high in most of the younger children, 84.2% in Dar es Salaam and 92% in Bagamoyo. Significantly fewer older children in Dar es Salaam and Bagamoyo (53.3% and 50%, respectively) had high avidity index antibodies. The predominant anti-TT IgG subclasses were IgG[sub 1] and IgG[sub 3]. It is concluded that the current DPT immunization schedule provides adequate tetanus immunity for children under 5. However, about half of the older children had no protection against tetanus. [ABSTRACT FROM AUTHOR]

Measles IgG antibody levels were estimated in sera from 685 Tanzanian children, 374 (54.6%) boys and 311 (45.4%) girls aged 18 months to 5 years, using an enzyme-linked immunosorbent assay (ELISA). The children were screened for HIV-1 and 2 antibodies using ELISA, and reactive sera were confirmed by Western blot. Nutritional status was assessed by anthropometry. Overall measles vaccination coverage was 98.8%. Measles antibody activity was not detected in 41 (6.0%) children, and ten (1.5%) had antibody levels below 200 mIU/ml, the cut-off level considered to be protective. The non-reactive samples were from one unvaccinated child, one child with unknown vaccination status and 39 vaccinated children. Measles IgG antibody levels were higher in girls (3452.1 mIU/ml) than in boys (2928.2 mIU/ml) (p=0.02). Higher mean levels were found in children with a history of low birthweight (2.5 kg) (p=0.03). There were no significant differences in measles antibody levels with regard to variations in nutritional status. No correlation (r2=0.002) was found between antibody levels and time elapsed since vaccination. In a multivariable logistic regression analysis, children who were HIVseropositive (n=9) were more likely to have non-protective antibody levels 200 mIU/ml (OR =5.85; 95% CI: 1.37-24.93). [ABSTRACT FROM AUTHOR]

Evaluates the performance of a p24 antigen (ag) assay on preheated plasma and serum samples of HIV-infected Tanzanian mothers and infants. Improvement in the sensitivity of the p24 ag assay by the dissociation of immune complexes through acid treatment of the test sample before assay; Reduction in the cost for detection of HIV infection in children.

An outbreak of meningitis with 85 secondary cases and an unusually high attack rate of 16% occurred in a rural village in southern Tanzania. We investigated risk factors for clinical illness in a community-based case–control study. Attending a commercial mobile video show carried an age- and sex-adjusted odds ratio of 8.0 (95% confidence interval: 3.8–16.8). The videos had been shown in a windowless and overcrowded storeroom and had been attended by the primary case, a visitor from neighbouring Mozambique who died from meningitis on the following day. We conclude that mobile video shows, which have become popular in many developing countries, constitute a potential health hazard in areas prone to meningitis epidemics. [ABSTRACT FROM AUTHOR]

Abstract Background Published data on the existence and magnitude of extended spectrum beta-lactamase (ESBL) production in urinary pathogens in local setting is limited. The aim of the present study was to determine the prevalence of antimicrobial resistance and ESBL production among Escherichia coli and Klebsiella spp from urine samples in a tertiary hospital. This was a cross sectional study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. Findings A total of 270 E.coli and Klebsiella spp urinary pathogens from children and adults isolated from January to March 2010 were included in the study. E. coli and Klebsiella spp isolates were tested for antimicrobial susceptibility by the Clinical and Laboratory Standard Institute's disc diffusion method. These isolates were further screened for ESBL phenotype using cefotaxime and ceftazidime discs. Isolates with reduced sensitivity were confirmed using ESBL E-test strips. Of 270 isolates, 138 (51.1%) were E. coli and 132 (48.9%) were Klebsiella spp. ESBL was detected in 122 (45.2%) of all the isolates. ESBL- producing E. coli strains were significantly more resistance to cotrimoxazole (90.7%), ciprofloxacin (46.3%) and nalidixic acid (61.6%) than strains that did not produce ESBL (p < 0.05). Similarly, ESBL- producing Klebsiella spp strains were significantly more resistance to cotrimoxazole (92.6%), ciprofloxacin (25.0%), nalidixic acid (66.2%), and gentamicin (38.2%) than strains that did not produce ESBL (P < 0.05). Multi-drug resistance was found to be significantly (P < 0.05) more in ESBL producing isolates (90.5%) than non ESBL producers (68.9%). The occurrence of ESBL was significantly higher among isolates from inpatients than outpatients [95 (50.5%) vs. 27(32.9%)] (p = 0.008). The occurrence of ESBL was significantly higher among isolates from children than in adults [84 (54.9%) vs. 38(32.5%)] (p < 0.001). Conclusions High prevalence of ESBL-producing E. coli and Klebsiella spp strains was found among inpatients and children. Most of the ESBL- producing isolates were multi-drug resistant making available therapeutic choices limited. We recommend continued antibiotic surveillance as well comprehensive multi-center studies to address the emerging problem of ESBL-associated infections in order to preserve the continued usefulness of most antimicrobial drugs. Further more conducting molecular studies will help to evaluate the various ESBL types.

Abstract Background Group B streptococcus (GBS), which asymptomatically colonises the vaginal and rectal areas of women, is the leading cause of septicemia, meningitis and pneumonia in neonates. In Tanzania no studies have been done on GBS colonisation of pregnant women and neonates. This study was conducted in Dar es Salaam, Tanzania to determine the prevalence of GBS colonisation among pregnant women, the neonatal colonisation rate and the antimicrobial susceptibility, thus providing essential information to formulate a policy for treatment and prevention regarding perinatal GBS diseases. Methods This cross sectional study involved 300 pregnant women attending antenatal clinic and their newborns delivered at Muhimbili National Hospital (MNH) between October 2008 and March 2009. High vaginal, rectal, nasal, ear and umbilical swabs were cultured on Todd Hewitt Broth and in 5% sheep blood agar followed by identification of isolates using conventional methods and testing for their susceptibility to antimicrobial agents using the Kirby-Bauer method. Results GBS colonisation was confirmed in 23% of pregnant women and 8.9% of neonates. A higher proportion of GBS were isolated from the vagina (12.3%) as compared to the rectum (5%). Prolonged duration of labour (>12 hrs) was significantly shown to influence GBS colonisation in neonates P < 0.05. Other risk factors such as prolonged rupture of membrane, intrapartum fever, low birth weight and HIV infection did not correlate with GBS colonisation. All isolates were sensitive to vancomycin and ampicillin. Resistance to clindamycin, erythromycin and penicillin G was found to 17.6%, 13% and 9.4%, respectively. Conclusion Our findings seem to suggest that a quarter of pregnant women attending ANC clinic at MNH and approximately 10% of their newborns are colonised with GBS. All isolates were found to be sensitive to vancomycin and ampicillin which seem to be the most effective antibiotics for the time being. However there is a need for continuous antibiotics surveillance of GBS to monitor trend of resistance. The high isolation frequency of GBS among pregnant women suggests routine antenatal screening at 35 to 37 weeks of gestation in order to provide antibiotic prophylaxis to GBS carrier.

Abstract Background Antimicrobial resistance is fast becoming a global concern with rapid increases in multidrug-resistant Gram negative organisms. The prevalence of extended spectrum beta-lactamase (ESBL)-producing clinical isolates increases the burden on implementing infectious disease management in low socio-economic regions. As incidence can vary widely between regions, this study was done to determine resistance patterns of Gram-negative organisms at Bugando Medical Center, a tertiary hospital in Mwanza, Tanzania. Methods A total of 800 clinical samples (urine, wound swab, pus, blood, aspirate, sputum etc) were processed over a period of 6 months. Gram-negative bacteria were identified using conventional in-house biochemical tests and susceptibility to common antibiotics done using disc diffusion methods. The disc approximation method was used to identify ESBL producers. Results A total of 377 Gram-negative bacteria (GNB) recovered from 377 clinical specimens were analyzed of which 76.9% were Enterobacteriaceae. Among all GNB, 110/377 (29.2%) were found to be ESBL producers. Species specific ESBLs rate among Klebsiella pneumoniae, Escherichia coli, Acinetobacter spp, Proteus spp and other enterobacteria were 63.7%, 24.4%, 17.7%, 6.4% and 27.9% respectively. A statistically significant higher number of inpatients 100/283 (35.3%) compared to 10/94 (10.6%) of outpatients had ESBL-producing organisms (p = 0.000023). Rates of resistances to gentamicin, tetracycline, sulphamethaxazole/trimethoprim and ciprofloxacin were significantly higher among ESBLs isolates than non-ESBL isolates (p = 0.000001). Conclusion ESBL producing organisms are common at BMC (Bugando Medical Center) and pose a challenge to antibiotic therapy. Successful implementation of a routine detection of ESBL production is essential in designing appropriate antibiotic prescribing policies and infection control intervention programmes.

Abstract Background Suitable algorithms based on a combination of two or more simple rapid HIV assays have been shown to have a diagnostic accuracy comparable to double enzyme-linked immunosorbent assay (ELISA) or double ELISA with Western Blot strategies. The aims of this study were to evaluate the performance of five simple rapid HIV assays using whole blood samples from HIV-infected patients, pregnant women, voluntary counseling and testing attendees and blood donors, and to formulate an alternative confirmatory strategy based on rapid HIV testing algorithms suitable for use in Tanzania. Methods Five rapid HIV assays: Determine™ HIV-1/2 (Inverness Medical), SD Bioline HIV 1/2 3.0 (Standard Diagnostics Inc.), First Response HIV Card 1–2.0 (PMC Medical India Pvt Ltd), HIV1/2 Stat-Pak Dipstick (Chembio Diagnostic System, Inc) and Uni-Gold™ HIV-1/2 (Trinity Biotech) were evaluated between June and September 2006 using 1433 whole blood samples from hospital patients, pregnant women, voluntary counseling and testing attendees and blood donors. All samples that were reactive on all or any of the five rapid assays and 10% of non-reactive samples were tested on a confirmatory Inno-Lia HIV I/II immunoblot assay (Immunogenetics). Results Three hundred and ninety samples were confirmed HIV-1 antibody positive, while 1043 were HIV negative. The sensitivity at initial testing of Determine, SD Bioline and Uni-Gold™ was 100% (95% CI; 99.1–100) while First Response and Stat-Pak had sensitivity of 99.5% (95% CI; 98.2–99.9) and 97.7% (95% CI; 95.7–98.9), respectively, which increased to 100% (95% CI; 99.1–100) on repeat testing. The initial specificity of the Uni-Gold™ assay was 100% (95% CI; 99.6–100) while specificities were 99.6% (95% CI; 99–99.9), 99.4% (95% CI; 98.8–99.7), 99.6% (95% CI; 99–99.9) and 99.8% (95% CI; 99.3–99.9) for Determine, SD Bioline, First Response and Stat-Pak assays, respectively. There was no any sample which was concordantly false positive in Uni-Gold™, Determine and SD Bioline assays. Conclusion An alternative confirmatory HIV testing strategy based on initial testing on either SD Bioline or Determine assays followed by testing of reactive samples on the Determine or SD Bioline gave 100% sensitivity (95% CI; 99.1–100) and 100% specificity (95% CI; 96–99.1) with Uni-Gold™ as tiebreaker for discordant results.

Abstract Background The Estimations and Projections Package (EPP 2005) for HIV/AIDS estimates and projects HIV prevalence, number of people living with HIV and new HIV infections and AIDS cases using antenatal clinic (ANC) surveillance data. The prevalence projection produced by EPP can be transferred to SPECTRUM, a demographic projectionmodel, to calculate the number of AIDS deaths. This paper presents estimates and projections of HIV prevalence, new cases of HIV infections and AIDS deaths in Tanzania between 2001 and 2010 using the EPP 2005 and SPECTRUM soft-wares on ANC data. Methods For this study we used; the 1985 – 2004 ANC data set, the 2005 UN population estimates for urban and rural adults, which is based on the 2002 population census, and results of the 2003 Tanzania HIV Indicator Survey. The ANC surveillance sites were categorized into urban and rural areas on the basis of the standard national definitions of urban and rural areas, which led to 40 urban and 35 rural clinic sites. The rural and urban epidemics were run independently by fitting the model to all data and on level fits. Results The national HIV prevalence increased from 0% in 1981 to a peak of 8.1% in 1995, and gradually decreased to 6.5% in 2004 which stabilized until 2010. The urban HIV epidemic increased from 0% in 1981 peaking at 12.6% in 1992 and leveled to between 10.9% and 11.8% from 2003 to 2010. The rural epidemic peaked in 1995 at 7.0% and gradually declined to 5.2% in 2004, and then stabilized at between 5.1% and 5.3% from 2005 to 2010. New infections are projected to rise steadily, resulting in 250,000 new cases in 2010. Deaths due to AIDS started in 1985 and rose steadily to reach 120,000 deaths in 2010, with more females dying than men. Conclusion The fact that the number of new infections is projected to increase steadily to reach 250,000 per year in 2010 calls for more concerted efforts to combat the spread of HIV infection particularly in the rural areas where the infrastructure needed for prevention programmes such as counseling and testing, condom accessibility and AIDS information is less developed.

Abstract Background This paper presents the prevalence of human immunodeficiency virus (HIV) and syphilis infections among women attending antenatal clinics (ANC) in Tanzania obtained during the 2003/2004 ANC surveillance. Methods Ten geographical regions; six of them were involved in a previous survey, while the remaining four were freshly selected on the basis of having the largest population among the remaining 20 regions. For each region, six ANC were selected, two from each of three strata (urban, peri-urban and rural). Three of the sites did not participate, resulting into 57 surveyed clinics. 17,813 women who were attending the chosen clinics for the first time for any pregnancy between October 2003 and January 2004. Patient particulars were obtained by interview and blood specimens were drawn for HIV and syphilis testing. HIV testing was done anonymously and the results were unlinked. Results Of the 17,813 women screened for HIV, 1,545 (8.7% (95% CI = 8.3–9.1)) tested positive with the highest prevalence in women aged 25–34 years (11%), being higher among single women (9.7%) than married women (8.6%) (p < 0.07), and increased with level of education from 5.2% among women with no education to 9.3% among those at least primary education (p < 0.001). Prevalence ranged from 4.8% (95% CI = 3.8% – 9.8%) in Kagera to 15.3% (95% CI = 13.9% – 16.8%) in Mbeya and was; 3.7%, 4.7%, 9.1%, 11.2% and 15.3% for rural, semi-urban, road side, urban and 15.3% border clinics, respectively (p < 0.001). Of the 17,323 women screened for syphilis, 1265 (7.3% (95%CI = 6.9–7.7)) were positive, with highest prevalence in the age group 35–49 yrs (10.4%) (p < 0.001), and being higher among women with no education than those with some education (9.8% versus 6.8%) (p < 0.0001), but marital status had no influence. Prevalence ranged from 2.1% (95% CI = 1.4% – 3.0%) in Kigoma to 14.9% (95% CI = 13.3%-16.6%) in Kagera and was 16.0% (95% CI = 13.3–18.9), 10.5% (95% CI = 9.5–11.5) and 5.8% (95% CI = 5.4–6.3) for roadside, rural and urban clinics, respectively. Syphilis and HIV co-infection was seen in 130/17813 (0.7%). Conclusion The high HIV prevalence observed among the ANC clinic attendees in Tanzania call for expansion of current voluntary counselling and testing (VCT) services and access to antiretroviral drugs (ARV) in the clinics. There is also a need for modification of obstetric practices and infant feeding options in HIV infection in order to prevent mother to child transmission of HIV. To increase uptake to HIV testing the opt-out strategy in which all clients are offered HIV testing is recommended in order to meet the needs of as many pregnant women as possible.

Abstract Background According to the latest Tanzanian National AIDS Control Programme (NACP) report a total of 147,271 individuals donated blood during the year 2002. However, blood safety remains an issue of major concern in transfusion medicine in Tanzania where national blood transfusion services and policies, appropriate infrastructure, trained personnel and financial resources are inadequate. Most of the donated blood is screened for HIV alone. Methods We determined among blood donors at Muhimbili National Hospital (MNH), the seroprevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B surface antigen (HBsAg) and syphilis by donor type, sex and age and to determine association, if any, in the occurrence of the pathogens. The sample included 1599 consecutive donors, 1424(89.1%) males and 175 (10.9%) females, who donated blood between April 2004 and May, 2005. Most of them 1125 (70.4%) were replacement donors and a few 474 (29.6%) voluntary donors. Their age (in years) ranged from 16 to 69, and most (72.2%) were between 20–39 years. Results Two hundred and fifty four (15.9%) of the donated blood had serological evidence of infection with at least one pathogen and 28 (1.8%) had multiple infections. The current seroprevalence of HIV, HBsAg, HCV and syphilis among blood donors at MNH in Dar es Salaam was found to be 3.8%, 8.8%, 1.5% and 4.7%, respectively. Respective seroprevalences among HIV seronegative blood donors were 8.7% for HBV, 1.6% for HCV and 4.6% for syphilis. The differences in the prevalence of HIV and syphilis infections between replacement and voluntary donors were statistically significant (P < 0.05). Syphilis was the only infection that occurred more frequently among HIV infected (12.1%) than non-infected (4.6%) blood donors (P < 0.05), and whose prevalence increased with age (X2 = 58.5 df = 5, P < 0.001). There were no significant sex differences in the occurrence of pathogens. Finally, there were significant associations in the occurrence of HBsAg and syphilis (OR = 2.2, 95% CI 1.1.-4.2) and HIV and syphilis (OR = 2.2, 95% CI 1.0–5.3). Conclusion The high (15.9%) seroprevalence of blood-borne infections in blood donated at MNH calls for routine screening of blood donors for HBV, HCV, HIV and syphilis and for strict selection criteria of donors, with emphasis on getting young voluntary donors and for establishment of strict guidelines for blood transfusions.

The article offers information related to the surveillance and diagnosis of plague and anthrax in Tanzania and Zambia with the help of polymerase chain reaction (PCR) and through use of rodent and human samples to detect the presence of yersinia pestis DNA.

Clin Microbiol Infect 2011; 17: 1279-1282 Abstract The molecular epidemiology of 32 non-duplicate, CTX-M-15 extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli strains, isolated from clinical samples, was investigated. Multilocus sequence typing revealed multiple sequence type clonal complexes: ST131 (12), ST405 (4), ST638 (3), ST38 (2), ST827 (2), ST224 (1), ST648 (1), ST46 (1) and two new sequence type clonal complexes (1845 and 1848) in 22 pulsed field gel electrophoresis clusters. The blaCTX-M-15 gene was located on conjugative IncF plasmids. This is the first report of the worldwide emerging clonal complex ST131 linked to blaCTX-M-15 in Tanzania and demonstrates the need for constant surveillance in developing countries to prevent the spread of these multiresistant isolates. [ABSTRACT FROM AUTHOR]

Objectives: The objectives are to determine the prevalence of urinary tract infection (UTI) and associated factors among patients diagnosed with benign prostatic hyperplasia and prostate cancer., Design: Hospital-based cross-sectional study., Settings: Urology clinic and urology ward at Muhimbili National Hospital, which is the main tertiary hospital in Tanzania's largest city., Participants: Patients with benign prostate hyperplasia and prostate cancer presenting with genitourinary symptoms., Main Outcome Measure: The primary outcome was the occurrence of UTI and factors associated with UTI in patients with benign prostatic hyperplasia and prostate cancer., Results: 402 participants were enrolled, with a median age of 68 years and IQR of 61-75 years. The proportion of UTI was 46.5% (95% CI 41.56% to 51.53%). UTI was more prevalent among inpatients, patients with indwelling urinary catheters, patients with prostate size>80 cm 3 and those with residual urine volume of >100 mL. In multivariate analysis, age>60 years (adjusted OR (aOR)=2.0, 95% CI 1.13 to 3.55, p=0.018), post-void residual urine volume>100 mL (aOR 1.32, 95% CI 0.67 to 2.59 p=0.001), patient with incomplete bladder emptying (aOR=2.57, 95% CI 1.44 to 4.59, p=0.001) and prolonged catheter duration (aOR=1.24, 95% CI 1.11 to 1.38, p=0.005) were significantly associated with UTI., Conclusion: Almost half of the patients with an enlarged prostate and genitourinary symptoms had a laboratory-confirmed UTI. The risk of UTI increases with age, incomplete bladder emptying and increased duration of catheterisation. A 1-day increase in the duration of catheterisation increased the risk of UTI by 24%., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)