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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., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2020 Delfina R. Msanga et al.)

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., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2020 Sofia Ottaru et al.)

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., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2020 Mwanaisha Seugendo et al.)