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Antimicrobial peptides (AMPs) are crucial components of the innate immune system in various organisms, including humans. Beyond their direct antimicrobial effects, AMPs play essential roles in various physiological processes. They induce angiogenesis, promote wound healing, modulate immune responses, and serve as chemoattractants for immune cells. AMPs regulate the microbiome and combat microbial infections on the skin, lungs, and gastrointestinal tract. Produced in response to microbial signals, AMPs help maintain a balanced microbial community and provide a first line of defense against infection. In preterm infants, alterations in microbiome composition have been linked to various health outcomes, including sepsis, necrotizing enterocolitis, atopic dermatitis, and respiratory infections. Dysbiosis, or an imbalance in the microbiome, can alter AMP profiles and potentially lead to inflammation-mediated diseases such as chronic lung disease and obesity. In the following review, we summarize what is known about the vital role of AMPs as multifunctional peptides in protecting newborn infants against infections and modulating the microbiome and immune response. Understanding their roles in preterm infants and high-risk populations offers the potential for innovative approaches to disease prevention and treatment. [ABSTRACT FROM AUTHOR]

Mumps is an acute contagious viral disease caused by paramyxovirus characterized by complications that include orchitis, oophoritis, aseptic meningitis, and spontaneous abortion among many others. This study reports high mumps IgG seropositivity among school-aged children in rural areas of the Mbeya region, information that might be useful in understanding the epidemiology of mumps and instituting appropriate control measures including vaccination. Between May and July 2023, a cross-sectional study involving 196 enrolled children aged 5–13 years was conducted. Sociodemographic information and other relevant information were collected using a structured data collection tool. Blood samples were collected and used to detect mumps immunoglobulin G antibodies using indirect enzyme-linked immunosorbent assay (ELISA). A descriptive analysis was performed using STATA version 15. The median age of the enrolled children was 13 (interquartile range (IQR): 8–13) years. The seropositivity of mumps IgG antibodies was 88.8% (174/196, 95% CI: 83.5–92.5). By multivariable logistic regression analysis, history of fever (OR: 5.36, 95% CI: 1.02–28.22, p = 0.047) and sharing utensils (OR: 8.05, 95% CI: 1.99–32.65, p = 0.003) independently predicted mumps IgG seropositivity. More than three-quarters of school-aged children in rural areas of the Mbeya region are mumps IgG-seropositive, which is significantly associated with the sharing of utensils and history of fever. This suggests that the virus is endemic in this region, which calls for further studies across the country so as to institute evidence-based, appropriate control measures including a vaccination program. [ABSTRACT FROM AUTHOR]

Background Uncertainty exists regarding the ideal interval between the administration of antenatal corticosteroids (ACS) and delivery. The study's objective was to assess the risks of perinatal mortality and respiratory distress syndrome (RDS) among preterm neonates whose mothers gave birth within 48 h of the administration of ACS and those whose mothers gave birth between 48 h and 7 days. Methods The study design was a secondary analysis of data from an observational prospective chart review study that was carried out in Tanzania in 2020. Preterm infants born to mothers who got at least one dose of ACS between 28 and 34 weeks of pregnancy were included. Results A total of 346 preterm neonates (294 singletons and 52 twins) were exposed to ACS. Compared to infants born 48 h following the first dose of ACS, those exposed to the drug between 48 h and 7 days had significantly decreased rates of perinatal mortality and RDS. Multivariable analysis revealed that infants exposed ACS between 48 h and 7 days prior to delivery had lower risk of perinatal mortality (aRR 0.30, 95% CI 0.14–0.66) and RDS (aRR 0.27, 95% CI 0.14–0.52). Conclusion The first dose of ACS given between 48 h and 7 days before delivery was associated with a lower risk of perinatal mortality and RDS than when the first dose was given <48 h before delivery. To improve neonatal outcomes, healthcare providers should consider administering ACS to mothers at the appropriate time. [ABSTRACT FROM AUTHOR]

Rubella virus (RV) infection in susceptible women during the first trimester of pregnancy is associated with congenital Rubella syndrome (CRS). In countries where a vaccination program is implemented, active case surveillance is emphasized. This report documents the magnitude of active cases before and after vaccine implementation in Tanzania. A total of 8750 children and adolescents with signs and symptoms of RV infection were tested for Rubella IgM antibodies between 2013 and 2019 using enzyme immunoassay followed by descriptive analysis. The median age of participants was 3.8 (IQR: 2–6.4) years. About half (4867; 55.6%) of the participants were aged 1–5 years. The prevalence of RV active cases was 534 (32.6%, 95% CI: 30.2–34.9) and 219 (3.2%, 95% CI: 2.7–3.6) before and after vaccine implementation, respectively. Before vaccination, the highest prevalence was recorded in Pemba (78.6%) and the lowest was reported in Geita (15.6%), whereas, after vaccination, the prevalence ranged between 0.5% in Iringa and 6.5% in Pemba. Overall, >50% of the regions had a >90% reduction in active cases. The significant reduction in active cases after vaccine implementation in Tanzania underscores the need to sustain high vaccination coverage to prevent active infections and eventually eliminate CRS, which is the main goal of Rubella vaccine implementation. [ABSTRACT FROM AUTHOR]

Colonization of multidrug resistant (MDR) bacteria is associated with subsequent invasive infections in children with comorbidities. This study aimed to determine the resistance profile and factors associated with MDR pathogen colonization among HIV−and HIV+ children below five years of age in Mwanza, Tanzania. A total of 399 (HIV− 255 and HIV+ 144) children were enrolled and investigated for the presence of MDR bacteria. The median [IQR] age of children was 19 (10–36) months. Out of 27 Staphylococcus aureus colonizing the nasal cavity, 16 (59.5%) were methicillin resistant while 132/278 (47.2%) of Enterobacteriaceae from rectal swabs were resistant to third generation cephalosporins, with 69.7% (92/132) exhibiting extended spectrum beta lactamase (ESBL) phenotypes. The proportion of resistance to gentamicin, amoxicillin/clavulanic acid and meropenem were significantly higher among HIV+ than HIV− children. A history of antibiotic use in the last month OR 2.62 [1.1, 6.9] (p = 0.04) and history of a relative admitted from the same household in the past three months OR 3.73 [1.1, 13.2] (p = 0.03) independently predicted ESBL rectal colonization. HIV+ children had significantly more fecal carriage of isolates resistant to uncommonly used antibiotics. There is a need to strengthen antimicrobial stewardship and Infection Prevention and Control (IPC) programs to prevent the emergence and spread of MDR pathogens in children. [ABSTRACT FROM AUTHOR]

Diarrhea is the commonest cause of morbidity and mortality in many resource-limited countries including Tanzania among children below five years of age. A significant number of diarrhea cases associated with severe dehydration are still being reported among children despite five years of rotavirus vaccine implementation in Tanzania necessitating the need to investigate other causes of diarrhea in this population. This study is aimed at determining the prevalence of human adenovirus infection and associated factors among rotavirus-vaccinated children with acute diarrhea in Mwanza, Tanzania. A cross-sectional study was conducted from June to August 2017 involving 137 children less than two years of age admitted with acute diarrhea in the health facilities located in Mwanza, Tanzania. Sociodemographic and other relevant information were collected using standardized rotavirus surveillance tool adopted from WHO. Stool specimens were collected and tested for human adenovirus antigen using immunochromatographic tests. Data were analyzed by using STATA version 13. The median age of enrolled children was 12 (IQR 8-17) months. The prevalence of human adenovirus was found to be 46 (33.6%, 95% CI: 25-41). By multivariable logistic regression analysis, only prolonged duration of diarrhea (OR: 1.619, 95% CI: 1.142-2.295, p = 0.007) was found to predict human adenovirus infection among rotavirus-vaccinated children with acute diarrhea. A significant proportion of rotavirus-vaccinated children with prolonged acute diarrhea have adenovirus infection. There is a need to consider other viral pathogens as potential cause of diarrhea especially in this postrotavirus vaccination period. [ABSTRACT FROM AUTHOR]

Background. Toxoplasma gondii infection during pregnancy is associated with serious neonatal complications, including hydrocephalus. In many high-income countries, T. gondii screening and treatment during the antenatal period are routinely carried out to prevent associated complications, whereas in most low-income countries, there is no routine screening of T. gondii during pregnancy. Despite the parasite being common in Tanzania, there is a paucity of information on the prevalence of T. gondii and cranial ultrasound patterns among children with hydrocephalus. Methods. An analytical cross-sectional hospital-based study involving 125 infants with hydrocephalus attending the Bugando Medical Centre (BMC) was conducted between May 2017 and February 2018. Sociodemographic and other relevant information was collected using a pretested data collection tool. Venous blood samples were collected, and sera were used for the detection of specific T. gondii antibodies by indirect enzyme-linked immunosorbent assay (ELISA) as per manufacturer's instructions. Data were analysed using STATA version 13 software. Results. The mean age of enrolled children was 4.8 ± 3.5 months. Out of 125 infants with hydrocephalus, 29 (23.2%, 95% CI: 21-36) were seropositive for T. gondii-specific IgG antibodies. By multiple generalized linear model analysis, being male (aRR = 1.1 , 95% CI: 0.9–1.5, p = 0.049), higher birth order (aRR = 1.2 , 95% CI: 1.0–1.5, p = 0.023), consumption of fish meat (aRR = 1.6 , 95% CI: 1.2–2.3, p = 0.003), and using other methods of cooking meat than boiling (aRR = 1.7 , 95% CI: 1.1–2.5, p = 0.015) were independent risk factors for T. gondii IgG seropositivity. Obstructive hydrocephalus was significantly more common among T. gondii-seronegative infants compared to IgG-seropositive infants (31.3% [30/96] vs. 13.8% [4/29]; p = 0.049). Conclusions. A significant proportion of infants with nonobstructive hydrocephalus are T. gondii IgG seropositive, and this is predicted by male gender, increase of birth order, consuming fish, and using other methods of cooking meat than boiling. These facts highlight the importance of continuing health education for pregnant women regarding T. gondii transmission and the need to follow-up their infants so that appropriate counselling and management can be provided. [ABSTRACT FROM AUTHOR]

Clostridium difficile causes a million of illnesses each year worldwide and can affect people of all ages. Limited data exist on the prevalence of C. difficile infections (CDI) among children below five years of age in developing countries. This study is aimed at determining the prevalence, associated factors, and outcome of the Clostridium difficile infection among children with diarrhea attending a tertiary hospital in Mwanza, Tanzania. Stool samples were collected and cultured anaerobically to isolate Clostridium difficile, followed by C. difficile toxin A and B assay and ribotyping. A total of 301 children with diarrhea were enrolled. A total of 22 (7.31%, 95% CI: 0.89-0.95) nonrepetitive stool samples were positive for Clostridium difficile. Eighteen (81%) of C. difficile isolates were toxigenic, and 16 (72.7%) had unknown ribotypes. Independent predictors of positive C. difficile were as follows: positive HIV status, hospital stay of more than four days, high stool leukocyte count, and watery stool. Clostridium difficile-positive children had significantly higher median duration of the diarrhea than those without C. difficile. Clinicians should consider C. difficile as a possible cause of diarrhea in children living in developing countries and institute appropriate management to prevent associated morbidities and mortalities. Furthermore, there is a need of joint effort to improve C. difficile diagnosis and surveillance in developing countries to establish the unknown epidemiology of CDI in these countries. [ABSTRACT FROM AUTHOR]

Background: Unsuppressed viral load which is strong indicator of treatment failure can lead to HIV related morbidity and mortality. Children below five years of age have increased risk of unsuppressed viral load due to various clinical and socio-demographic factors. The aim of the study was to determine the prevalence and factors associated with unsuppressed viral load among children below five years of age living with HIV in Mwanza, Northwest, Tanzania. Methods: A cross sectional study involving children below five years of age who were on antiretroviral therapy (ART) for at least six months was conducted in four major care and treatment clinics (CTC) in Mwanza region from December 2020 to April 2021. Children were categorized as having unsuppressed HIV viral load if viral load count was more than 1000 ribonucleic acid (RNA) copies/mL. Data were collected using structured pretested data collection tool. Multivariate logistic regression analysis was done to identify factors associated with unsuppressed HIV viral load among children below five years of age. Results: The mean age of 279 children below five years of age was 41.3 ± 12.7 months, and more than half 144 (52%) were female. More than two thirds 194 (69.5%) were biological mothers and mean age were 37.1 ± 12.4 years. 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: 50 1.2-12.0, P=0.026). [ABSTRACT FROM AUTHOR]

Well-documented vital signs are key in the prediction of sepsis in low- and middle-income countries. We determined prevalence, associated factors, and outcomes of positive blood culture sepsis in premature neonates at Bugando Medical Centre Mwanza, Tanzania. Temperature, oxygen saturation, heart rate, respiratory rate, and random blood glucose were repeatedly recorded at admission, 8 h, and 24 h in all 250 neonates enrolled. Clinical and microbiological data were collected from patient records followed by descriptive data analysis. The mean age of the neonates was 3 ± 5.2 days, with the majority (90%) aged <10 days. The prevalence of positive blood culture sepsis was 21.2% (95% CI: 16.1-26.2). The fluctuation of the random blood glucose (RBG) (aOR = 1.34, 95% CI: (1.07-1.67), p = 0.010), low oxygen saturation (aOR = 0.94, 95% CI: (0.88-0.99), p = 0.031), premature rupture of membrane aOR = 4.28, 95% CI: (1.71-10.71), p = 0.002), gestational age < 34 weeks (aOR = 2.73, 95% CI: (1.20-6.24), p = 0.017), and home delivery (aOR = 3.90, 95% CI: (1.07-14.19), p = 0.039) independently predicted positive blood culture. Significantly more deaths were recorded in neonates with a positive blood culture than those with a negative blood culture (32.1% vs. 5.1%, p < 0.001). In limited-resource settings, clinicians should use the vital signs and clinical information to initiate timely sepsis treatment among preterm neonates to prevent deaths and other morbidities.

Background: Africa is experiencing a rapid increase in morbidity and mortality related to diabetes mellitus (DM). Contemporary data are needed to guide efforts to improve prevention and treatment for microvascular complications in children and adolescents in Africa. This study was conducted to assess prevalence of diabetic microvascular complications in northwestern Tanzania, including nephropathy, retinopathy, and neuropathy, as well as associated risk factors., Objectives: 1) To determine the prevalence of microvascular complications and the overlap of nephropathy, retinopathy and neuropathy and 2) to determine factors associated with the development of microvascular complications., Methods: This cross-sectional study included 155 children and adolescents with DM consecutively attending all three health centers providing diabetes care for children in the Mwanza region of Tanzania. Participants were examined for microvascular complications and possible risk factors., Results: Fifty-one of 155 participants (age: 5-19 years) had diabetic nephropathy (32.9%), 16 had diabetic retinopathy (10.3%), and 21 had diabetic neuropathy (13.6%). Risk factors for development of a microvascular complication included age, duration of DM, and poor glycemic control. Of the participants, 107 had poor levels of glycemic control (69%) with HbA1C levels >10%., Conclusion: The prevalence of microvascular complications, especially that of nephropathy, was disturbingly high. Risk factors for microvascular complications were similar to other studies from Africa and included poor glycemic control, older age, and longer duration of DM. Innovative, locally appropriate systems for optimizing glycemic control are urgently needed., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2020 The Author(s).)