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1. Hydroxyurea mobile directly observed therapy versus standard monitoring in patients with sickle cell anemia: a phase 2 randomized trial

Author

Philip Sasi, Abel Makubi, Raphael Z. Sangeda, Mariam Y. Ngaeje, Bruno P. Mmbando, Joseph Soka, Caterina Rosano, Alex S. Magesa, Sharon E. Cox, Julie Makani, and Enrico M. Novelli

Subjects
Medicine
Abstract

Abstract Background Sickle cell anemia (SCA) prevalence remains high in sub-Saharan Africa. Long-term treatment with hydroxyurea (HU) increases survival, however, poor adherence to treatment could limit effectiveness. Whilst HU treatment adherence is currently high, this might decrease over time. Methods We conducted a single-center, randomized, open-label, parallel group phase 2 controlled clinical trial to determine whether mobile Directly Observed Therapy (m-DOT) increases HU treatment adherence (NCT02844673). Eligible participants were adults with homozygous SCA. People on a chronic blood transfusion program, with hemoglobin (Hb) A levels greater than 20% of the total Hb, total Hb less than 4 g/dL, pregnant or HIV positive were excluded. After a 3-month pre-treatment period participants were randomized to either m-DOT or standard monitoring arm. All participants received smart mobile phones and were treated with HU (15 mg/kg) daily for three months. In the m-DOT arm, drug intake was video recorded on cell phone by the participant and the video sent to the study team. The primary objective was to evaluate the effect of m-DOT on adherence to HU treatment by medication possession ratio (MPR). Results Of the 86 participants randomized, 76 completed the trial (26.13 ± 6.97 years, 63.5 % female). Adherence was high (MPR > 95 %) in both groups, 29 (80.6 %) in m-DOT versus 37 (94.9 %) in the standard monitoring arm (P = 0.079). No HU treatment was withheld from participants due to safety concerns. Conclusions m-DOT did not increase adherence to HU treatment. We recommend that further testing in larger trials with a longer follow up period be undertaken.

Published
2024
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2. The epidemiology of very severe anaemia in sickle cell disease in Tanzania: a prospective cohort studyResearch in context

Author

Julie Makani, Upendo Masamu, Furahini Tluway, Raphael Z. Sangeda, Deogratius Soka, Elisha Osati, Christine Kindole, Sharon E. Cox, Josephine Mgaya, Sigfrid C. Shayo, Abel Makubi, Emmanuel Balandya, and Bruno P. Mmbando

Subjects
Sickle cell anaemia, Morbidity, Mortality Tanzania, Medicine (General), R5-920
Abstract

Summary: Background: Anaemia in sickle cell disease (SCD) is a significant cause of morbidity and mortality, but few studies have reported on the burden and outcome of very severe anaemia. This study described the epidemiology of very severe anaemia by determining the prevalence and incidence, investigating associated clinical and laboratory factors, and assessing outcomes in SCD. Methods: A 10-year prospective cohort study involving SCD patients of all ages was conducted at Muhimbili National Hospital in Tanzania between 2004 and 2013. SCD included Homozygous SS-Sickle cell anaemia and Sβ0 thalassemia at clinics and during hospitalization visits. Very severe anaemia was defined as Haemoglobin

Published
2024
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3. Clinical manifestations and treatment outcomes among hospitalised COVID-19 patients in tertiary hospitals in Tanzania, 2021–2022: a retrospective cohort study

Author

Abel Makubi, Candida Moshiro, Elisha Fred Otieno Osati, Grace Ambrose Shayo, Raphael Z Sangeda, Tumaini Joseph Nagu, Naveeda Adams, Athumani Ramadhani, Bahati Wajanga, Albert Muniko, Jeremiah Seni, Mary A Nicholaus, Gervas Nyaisonga, Christian Mbije, John Robson Meda, Denis Rainer, Martha Elisande Nkya, Paulo Mhame, Lucy Samwel, Liggyle Vumilia, Seif Shekalaghe, and Kajiru G Kilonzo

Subjects
Public aspects of medicine, RA1-1270
Abstract

Background There have been differential mortality rates from COVID-19 in different parts of the world. It is not clear whether the clinical presentation does also differ, thus the need for this study in a sub-Saharan African setting. The aim of this study was to describe the clinical manifestations and outcomes of patients diagnosed with COVID-19 in selected tertiary hospitals in Tanzania.Methods This was a retrospective analysis of hospitalised adults confirmed SAR-COV-2 infection in five tertiary-level hospitals in Tanzania. Data collected and analysed included sociodemographic, radiological and clinical characteristics of the patients as well as the outcome of the admission (discharge vs death).Results Out of 1387 COVID-19 patients, 52% were males. The median age was 60 years ((IQR)=(19–102)). The most common symptoms were dyspnoea (943,68%), cough (889, 64%), fever (597,43%) and fatigue (570, 41%). In-hospital mortality was (476, 34%). Mortality significantly increased with increasing age, being the most in age >90 years (aHR (95% CI)=4.4 (2.52 to 28.82), p=0.02). Other predictors of mortality were not possessing a health insurance, (aHR (95% CI)=3.7 (1.09 to 14.25), p=0.04); chest pain, (aHR (95% CI)=2.27 (1.36 to 4.13), p=0.03); HIV positivity, (aHR (95% CI)=3.9 (1.46 to 8.15), p=0.03); neutrophilia, (aHR (95% CI)=1.12 (1.01 to 2.65), p=0.03); no use of ivermectin, (aHR (95% CI)=1.21 (1.04 to 1.57), p=0.04) and non-use of steroids, (aHR (95% CI)=1.36 (1.18 to 2.78), p=0.04). The retrospective nature of this study which based on documented patients’ records, with a large number of patients left out of the analysis due to missed data, this might in a way affect the results of the present study.Conclusion In-hospital mortality was 34%. The independent predictors of mortality were advanced age, HIV infection, no possession of a health insurance, chest pain, neutrophilia and no use of steroids or ivermectin.

Published
2024
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4. Humoral Immune Responses following COVID-19 Vaccinations among Adults in Tanzania

Author

Muhammad Bakari, Said Aboud, Mabula Kasubi, Bruno P. Mmbando, Nyanda Elias Ntinginya, Aifello Sichalwe, Omary S. Ubuguyu, Alex Magesa, Nancy Ladislaus Rutananukwa, Helmut Nyawale, Abisai Kisinda, Medard Beyanga, Pius G. Horumpende, Paulo S. Mhame, Liggle M. Vumilia, Lucy S. Mziray, Reuben Mkala, Elichilia Shao, Abel Makubi, Stephen E. Mshana, and Rogath Kishimba

Subjects
COVID-19 vaccines, humoral immune response, adults, Tanzania, Medicine
Abstract

COVID-19 vaccination remains to be the most important intervention in the fight against the pandemic. The immunity among the vaccinated population and its durability can significantly vary due to various factors. This study investigated the humoral immune responses among individuals who received any of the COVID-19 vaccines approved for use in Tanzania. A total of 1048 randomly selected adults who received COVID-19 vaccines at different time points were enrolled and humoral immune responses (IR) were tested at baseline and three months later (960, 91.6%). The level of SARS-CoV-2 anti-spike/receptor binding domain (RBD) IgG, anti-nucleocapsid IgG, and IgM antibodies were determined using a commercially available chemiluminescent microparticle immunoassay. Descriptive data analysis was performed using STATA version 18 and R. At baseline, serum IgG against anti-spike/RBD was detected in 1010/1048 (96.4%) participants (95%CI: 94.9–97.5) and 98.3% (95%CI: 97.3–99) three months later. The IgG against the SARS-CoV-2 nucleocapsid proteins were detected in 40.8% and 45.3% of participants at baseline and follow-up, respectively. The proportion of seroconverters following vaccination and mean titers of anti-spike/RBD antibodies were significantly more among those who had past SARS-CoV-2 infection than in those with no evidence of past infection, (p < 0.001). Only 0.5% of those who had detectable anti-spike/RBD antibodies at baseline were negative after three months of follow-up and 1.5% had breakthrough infections. The majority of participants (99.5%) had detectable anti-spike/RBD antibodies beyond 6 months post-vaccination. The proportion of Tanzanians who mounted humoral IR following COVID-19 vaccination was very high. Seroconversions, as well as the mean titers and durability of humoral IR, were significantly enhanced by exposure to natural SARS-CoV-2 infection. In view of the limited availability of COVID-19 vaccines as well as challenges to completing subsequent doses, booster doses could only be suggested to high-risk groups.

Published
2023
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5. Development of multi-level standards of care recommendations for sickle cell disease: Experience from SickleInAfrica

Author

Vivian Paintsil, Mwashungi Ally, Hezekiah Isa, Kofi A. Anie, Josephine Mgaya, Malula Nkanyemka, Victoria Nembaware, Yaa Gyamfua Oppong-Mensah, Flora Ndobho, Lulu Chirande, Abel Makubi, Obiageli Nnodu, Ambroise Wonkam, Julie Makani, and Kwaku Ohene-Frempong

Subjects
standards of care, Sickle Cell Disease, SickleInAfrica, Sickle Pan African Research Consortium (SPARCO), Sub-Saharan Africa, Genetics, QH426-470
Abstract

Introduction: Sickle Cell Disease (SCD) causes significant morbidity and mortality particularly in sub-Saharan Africa (SSA) where it contributes to early childhood deaths. There is need to standardize treatment guidelines to help improve overall SCD patient health outcomes. We set out to review existing guidelines on SCD and to set minimum standards for management of SCD for the different referral levels of healthcare.Methods: A standards of care working group (SoC-WG) was established to develop the SoC recommendations. About 15 available SCD management guidelines and protocols were reviewed and themes extracted from them. The first draft was on chosen themes with 64 major headings and subtopics. Using a summarised WHO levels of referral document, we were able to get six different referral levels of healthcare. The highest referral level was the tertiary facilities whilst the lowest level was the home setting. Recommendations for SCD management for the regional, district, sub-districts, health posts and CHPs compounds were also drafted.Results: The results from this review yielded a guidelines document which had recommendations for management of SCD on 64 topics and subtopic for all the six (6) different referral levels.Discussions: Every child with SCD need to receive comprehensive care that is coordinated at each level. This recommendation is unique in terms of the availability of recommendations for different levels of care as compared to the traditional guidelines which is more focused at the tertiary levels. Patients can access care at any of the other lower referral hospitals and be managed with recommendations that are in keeping with institutional resources at that level. When such patients need care that requires expertise that is not available at that level, the recommendations will be to refer to the appropriate referral level where those expertise are available. This encourages patients to have good clinical care nearer their homes but also having access to specialist screening modalities and expertise at the tertiary hospitals if need be. With this, patient are not limited to a specific referral level when interventions cannot be instituted for them.Conclusion: This SoC recommendations document is a useful material that can be used for consistent standards of treatment in SSA.

Published
2023
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7. Rationale, design and protocol of a cross-sectional study on pregnancy-related cardiovascular diseases in Tanzania (PRECARDT): burden, characterisation and prognostic significance at delivery

Author

Karen Sliwa, Juliet Addo, Lindsay Kendall, Albert Kihunrwa, Bruno Mmbando, Abel Makubi, Peter Kisenge, Julie Makani, Josephine Mgaya, Belinda Balandya, Pilly Chillo, Reuben Mutagaywa, Vincent Tarimo, Eva Mujuni, Evarist B Msaki, Mohamed Janabi, and Gideon Kwesigabo

Subjects
Medicine
Abstract

Introduction The paucity of data describing cardiovascular disease (CVD) in pregnancy in many parts of Africa including Tanzania has given rise to challenges in proper management by the healthcare providers. This study is set out to (1) determine the prevalence of a range of CVDs during pregnancy in women attending antenatal clinics in Tanzania and (2) determine the impact of these CVDs on maternal and fetal outcomes at delivery.Methods and analysis This is a cross-sectional study with a prospective component to be conducted in two referral hospitals in Tanzania. Pregnant women aged ≥18 years diagnosed with a CVD during the antenatal period are being identified and extensively characterised by performing clinical assessment, modified WHO staging, electrocardiography, echocardiography and laboratory tests. Patients identified with CVDs (exposed) and a subset without (unexposed) will be followed up to determine maternal and fetal outcomes at delivery. A minimum sample of 1560 will be sufficient to estimate the prevalence of CVDs with a 95% CI of 2.75% to 5.25%.Ethics and dissemination The study is being conducted in accordance with the Helsinki declaration on studies involving human subjects. Ethical approvals have been obtained from Muhimbili University (reference number DA.282/298/01.C/) and Bugando Medical Centre (reference number CREC/330/2019) Ethics Committees. Informed consent is sought from all potential participants before any interview or investigations are performed. Study findings will be disseminated to the scientific community through different methods. Results will also be communicated to policymakers and to the public, as appropriate.

Published
2021
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8. Decreased Hepcidin Levels Are Associated with Low Steady-state Hemoglobin in Children With Sickle Cell Disease in TanzaniaResearch in Context

Author

Nathaniel Lee, Julie Makani, Furahini Tluway, Abel Makubi, Andrew E. Armitage, Sant-Rayn Pasricha, Hal Drakesmith, Andrew M. Prentice, and Sharon E. Cox

Subjects
Medicine, Medicine (General), R5-920
Abstract

Background: The contribution of hepcidin as a regulator of iron metabolism & erythropoiesis on the severity of anemia in sickle cell disease (SCD) remains poorly characterized, especially in Sub-Saharan African populations. The aims of the study were to determine if hepcidin is associated with severity of steady-state anemia in SCD and to investigate factors associated with hepcidin and anemia in SCD. Methods: Archived samples from 199 Tanzanian children, 56% boys aged 3–18 with laboratory-confirmed SCD were analysed based on recorded averaged steady-state hemoglobin (ASSH) quartiles (lowest vs. highest). Univariable and multivariable logistic regression was used to assess associations with ASSH quartiles. Findings: In univariable analysis, hepcidin

Published
2018
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9. Fetal Hemoglobin is Associated with Peripheral Oxygen Saturation in Sickle Cell Disease in Tanzania

Author

Siana Nkya, Josephine Mgaya, Florence Urio, Abel Makubi, Swee Lay Thein, Stephan Menzel, Sharon E. Cox, Charles R. Newton, Fenella J. Kirkham, Bruno P. Mmbando, and Julie Makani

Subjects
Fetal hemoglobin (HbF), Sickle cell disease, Hypoxia, Oxygen saturation, Reticulocytes, Medicine, Medicine (General), R5-920
Abstract

Fetal hemoglobin (HbF) and peripheral hemoglobin oxygen saturation (SpO2) both predict clinical severity in sickle cell disease (SCD), while reticulocytosis is associated with vasculopathy, but there are few data on mechanisms. HbF, SpO2 and routine clinical and laboratory measures were available in a Tanzanian cohort of 1175 SCD individuals aged ≥ 5 years and the association with SpO2 (as response variable transformed to a Poisson distribution) was assessed by negative binomial model with age and sex as covariates. Increase in HbF was associated with increased SpO2 (rate ratio, RR = 1.19; 95% confidence intervals [CI] 1.04, 1.37 per natural log unit of HbF; p = 0.0004). In univariable analysis, SpO2 was inversely associated with age, reticulocyte count, and log (total bilirubin) and directly with pulse, SBP, hemoglobin, and log(HbF). In multivariable regression log(HbF) (RR 1.191; 95%CI 1.04, 1.37; p = 0.013), pulse (RR 1.01; 95%CI 1.00, 1.01; p = 0.026), SBP (RR 1.008; 95%CI 1.00, 1.02; p = 0.014), and hemoglobin (1.120; 95%CI 1.05, 1.19; p = 0.001) were positively and independently associated with SpO2 while reticulocyte count (RR 0.985; 95%CI 0.97, 0.99; p = 0.019) was independently inversely associated with SpO2. In SCD, improving SpO2, in part through cardiovascular compensation and associated with reduced reticulocytosis, may be a mechanism by which HbF reduces disease severity.

Published
2017
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10. Rationale and design of mDOT-HuA study: a randomized trial to assess the effect of mobile-directly observed therapy on adherence to hydroxyurea in adults with sickle cell anemia in Tanzania

Author

Abel Makubi, Philip Sasi, Mariam Ngaeje, Enrico M. Novelli, Bruno P. Mmbando, Mark T. Gladwin, and Julie Makani

Subjects
Sickle cell disease, Hydroxyurea, Adherence, Medication possession ratio, Randomized trial, Medicine (General), R5-920
Abstract

Abstract Background Hydroxyurea (HU) has been demonstrated to be efficacious in reducing complications in individuals with sickle cell anemia (SCA) but poor adherence is a barrier. Directly Observed Therapy (DOT) has been shown to improve adherence in various chronic diseases but there is limited data in adults with SCA. Methods and design To examine the effect of mobile-directly observed therapy (mDOT) on adherence to HU (mDOT-HuA) in adults with SCA at Muhimbili National Hospital in Tanzania. The mDOT-HuA study is a single centre, prospective, randomized, open label clinical trial. One-hundred individuals with SCA with haemoglobin SS genotype, aged ≥18 years, living in Dar es Salaam, able and willing to record and submit videos electronically will be included. Participants will be divided into two treatment arms; 50 in the standard monitoring (SM) arm will receive mobile phones and fixed dose HU therapy with standard monitoring; 50 in the mDOT arm will receive mobile phones, fixed dose HU therapy with standard monitoring and a mobile directly observed web based medication adherence monitoring system. The primary outcome is the proportion of participants achieving ≥80 % HU adherence compared between the two arms as assessed through medication possession ratio at the end of 3 months of treatment. REDCap, an open source software application will be used to collect data using clinical research forms. The proportions of adherence in the two arms will be compared by Fisher’s exact test. Analysis of outcomes will have performed by both the intention-to treat and per-protocol methods. Discussion Should this study become sucessful, it will have the potential for the development of novel strategies for improving HU adherence in SCA. Trial registration ClinicalTrials.gov Identifier: NCT02844673 , registered on 25tht July 2016 (retrospectively registered).

Published
2016
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11. Understanding the performance of a pan-African intervention to reduce postoperative mortality: a mixed-methods process evaluation of the ASOS-2 trial

Author

Nicola Vickery, Timothy Stephens, Leon du Toit, Dawid van Straaten, Rupert Pearse, Alexandra Torborg, Lucy Rolt, Mariechen Puchert, Graham Martin, Bruce Biccard, Bruce M. Biccard, Maia Lesosky, Tim Stephens, Landon Myer, Agya BA. Prempeh, Hyla-Louise Kluyts, Akinyinka Omigbodun, Adesoji Ademuyiwa, Muhammed Elhadi, Mohamed Elfagieh, Bernard Mbwele, Mpoki Ulisubisya, Lazaro Mboma, Daniel Z. Ashebir, Mahlet Tesfaye Bahta, Mohammed Hassen, Mikiyas Teferi, Yakob Seman, Eugene Zoumenou, Adam Hewitt-Smith, Janat Tumukunde, Dolly Munlemvo, Atilio Morais, Apollo Basenero, Pisirai Ndarukwa, Nazinigouba Ouerdraogo, Maman Sani Chaibou, Mohyeddine Zarouf, Ahmed Rhassane El Adib, Veekash Gobin, Zimogo Sanogo, Youssouf Coulibaly, Zipporah Ngumi, Tarig Fadalla, Cynthia Iradukunda, Vénérand Barendegere, Isaac O. Smalle, Mustapha Bittaye, Ahmadou Lamin Samateh, Mahmoud Elfiky, Maher Fawzy, Wakisa Mulwafu, Vanessa Msosa, Lygia Lopes, Akwasi Antwi-Kusi, Hamza D. Sama, Patrice Forget, Rupert M. Pearse, Marichen Puchert, Kris Schwebler, Freddy Kabambi, Tebogo Mabotja, Leandys Cobas, Albino Freitas, Maria Antunes, Bartolomeu Cabo, Domingos Paulo, Carlos Camongua, Yvette Avognon, Osseni Marcos, Raymond Kintomonho, Onesime Demahou, Gisèle Hounsa, Hugues Chobli, Elie Fassinou, Aurore Zoglobossou, Blaise Tchaou, Charles Tchegnonsi, Fifame Amadji, Francine Bossa, Ernest Ahounou, Djima Alao, Roushdane Odérémi, Afissatou Montairou, Oswald Gbehade, Romaric Tobome, Adam Boukari, Patrick Bakantieba, Arouna Sambo, Fanou Lionelle, Nounagnon Gilbert, Julien Attinon, Roger Klikpezo, Aumar Dadjo, Dénis Fanou, Gilberte Hounkpe, Bachabi Fafana, Néné Nguilu, Bodourin Dossou-Yovo, Chantal Segla, Mohamed Toko, Evelyne Gnele-Dedewanou, Michel Noukounwoui, Ethienne Yado, Timothé Gouroubéra, Valéry Adjignon, Serge Mewanou, Aïcha Tchomgang, Urielle Agossou, Fernand Soton, Charbel Azanlin, Lidwine Zomahoun, Rawéléguinbasba Armel Flavien Kabore, Salam Savadogo, Fatou Fleur Rosine Sanou, Farid Belém, Victoria Hien, Cheik Tidiane Hafid W. Bougouma, Sie Ahmed Ouattara, Mariam Bambara Kabore, Ouedraogo Nazinigouba, Papougnezambo Bonkoungou, Martin Lankoandé, Mireille Traoré, Patrick Sawadogo, Inès Wenmenga, Boureima Kinda, André Simporé, Christian Sapo, Salah Idriss Traore, Haoua Dipama, Lydie WR. Kaboré, Salifou Napon, Télesphore G. Kaboré, Arouna Louré, Pélagie PP. Tondé, Christian Zoundi, Martin Lankoande, Harouna Sanou, Remy Ndikumana, Carlos Nsengiyumva, Gregory Sund, Alliance Niyukuri, Axel Kwizera, Jean-Claude Niyondiko, Adolphe Manzanza Kilembe, Jean Pierre Mwema Ilunga, Nehema Hailemariam Sarah, Gabriel Mubobo Makeya, Idesbald Mwebe Mwepu, Ted Botawaosenge Likongo, Richard Kapela Mvwala, Raphael Nzau Kapend Mubunda, Noellie Kanka Mukuna, Julie Djondo Pembe, Nicolas Lumuanga Ndaye, Eric Bibonge Amisi, Mike Ilunga Madika, Joe Kembo Lungela, Didier Ndonda Mayemba, Philomene Mamba Diyoyo, Alex Mbo Ngalala, Martin Mamba Mukenga, Patricia Tito Kabuni, Dany Bolimo Mpoto, Herve Inesnku Mole, Louise Keby, Oria Andavo Buti, Anselme Phaka, Belinda Mayenge, Jean Jeacques Kabuley Kalongo, Timothe Kemfuni Mawisa, Rodrigue Tondo Ngwizani, Kuyala Leya, Dieudonne Kisile Sanduku, Timothe Nkemfuni Mawisa, Coco Nseke Mfumu, Mbuta Bolenge, Desire Kinzenzengu Kabuce, Patrick Kintieti, Amelia Mbuluku, Vicky Mahuwa, Tharcice Khonde Mabiala, Guilain Ngoy, Patrick Boloko, Nono Mazangama Mvwama, Jose Kengbanda, Pitchou Mushimbonga, Blaise Kuhapala, Nzosani Marcel, Kienze Guylain, Gerard Mboma, Sandra Zalambo Sagboze, Michel Muteya Manika, Jean Pierre Mumbere Kigayi, Roger Mukanire Cishugi, Placide Buhendwa Mugisho, Roger Baguma, Moïse Kongolo, Michel Mandungu Mbayabu, Crispin Mukendi Muamba, Edmond Banema Kapinga, Vasco Ngolela Kapinga, Guylain Tshimanga Nsumpi, Patrick Kanda Odia, Salomon Bingidimi, Gilbert Kpengbemale, Desire Hubert Bofunga Bosonga Imposo, Patricia Matondo, Servet Lelo, Jeremie Kalambayi, Mohamed Abdel-Ghaffar, Abdelrahman Soliman, Mostafa Abdelrahman, Sameh Shehata, Alia Rabee, Mohamed Abou Heba, Mohamed Rabei Abdelfattah, Tamer Ahmed Maher Ghoniem, Sherif M.K. Shehata, Mohamed Lotfy, Ahmed ElHaddad, Bereket Gebremeskel, Girmay Fisseha, Mebrahtu Abay, Degena Bahrey, Assefa Hika, Abdurezak Ali, Kindie Moges, Jemal Ahmed, Desalegn Abdisa, Abebe Megersa, Wendwosen Abayne, Haftom Berhane, Reiye Esayas, Fitsum Kifle, Kokeb Desita, Abebe Addise, Dagim Shimelash, Shitalem Tadesse, Bezaye Zemedkun, Peniel Kenna, Ayenew Yirdie, Abinet Sisay, Tebikew Gashu, Fassil Mihretu, Yesuf Ahmed, Bekele Debebe, Abdureuf Misgea, Amare Agmas, Rahel Assefa, Abdurahman Gelmo, Seifu Alemu, Brook Damtachew, Merid Mersha, Yaekob Chemere, Samuel Fekadu, Sintayehu Regasa, Bonsa Sileshi, Desalegn Wosen, Rebira Adamu, Gersam Mulugeta, Teshome Bacha, Zewude Gudisa, Kebebe Bekele, Alelign Tasew, Habtamu Gezahegn, Daniel Atlaw, Damtew Solomon, Habtemariam Gebresillasie, Girmaye Tesfaye, Negussie Sarbecha, Biniyam Sahiledengle, Kenbon Seyoum, Gemechu Ganfure, Yohannes Tekalegn, Gosa Tesfaye, Temesgen Ayichew, Shibiru Sendaba, Musefa Redwan, Eyasu Muse, Girma Nina, Bizuneh Sime, Addisalem Tadege, Anbesse Jima, Nugusu Ayalew, Dagmawi Workneh, Daniel Teferi, Momodou T. Nyassi, Landing N. Sanyang, Omar Jallow, Abdoulie Keita, Kitabu Jammeh, Charles Roberts, Patrick Idoko, Kebba Marenah, Masirending Njie, Musa Marena, Karamba Suwareh, Simon Boissey, Fatoumatta Jarjusey, Awa Jah, Awa Sanyang, Dado Jabbi, Kajali Camara, Armando Correa, John Jabang, Lamin Jaiteh, Lamin Dampha, Aminata Manneh, Baboucarr Sowe, Abdoulie Bah, Edrisa Jawo, Victoria Okoje, Momodou Baro, Yaya Bah, Mustapha Njie, Sainabou Mbowe, Ebrima Kanteh, Sarjo Ceesay, Alagie Manneh, Evans Atito-Narh, Adwoa Wilson, Romeo Hussey, Emmanuel Okine, Jemima Kwarteng, Ridge Ntiamoah, Samuel Dadzie, Mark Aseti, Naa Sowah, Akosua Appiah, Charles Bankah, Patrick Mburugu, Thomas Chokwe, Patrick Olang, Vernon Gacii, Susane Nabulindo, Antony Gatheru, Timothy Mwiti, Caroline Mwangi, Julius Muriithi, Daniel Ojuka, Omondi Ogutu, Evans Masitara, Mohamed Chaudhry, Reuben Kamundi, Annmarie Kangangi, Thomas Massaquoi, Stephen Takow, Felister Moraa, Aziz Munubi, Moses Kimani, Adili Wobenjo, Linda Nguu, Vincent Omeddo, Rose Malaba, Ambrose Nabwana, Anita Mwancha, Alexandria Mugaa, John Wamwaki, Joyce Chege, Seymour Sinari, Andrew Ndonga, Rose Shitsinzi, Walter Akello, Winfred Kimani, Elisha Kirwa, Seno Saruni, Andrew Wainaina, Ernest Nshom, Aidah Kenseko, Kizito Shisanya, Purity Wanjiru, Julliah Cherotich, Judy Kimutai, Benson Wahome, Grace Wangui, Dennis Wamalwa, Stephen Mwangi, John Chege, Tabitha Wanjiku, Carolyne Njoki, Wachira Waititu, Conrad Ambani, Samuel Murimi, Sharon Waithira, Nilson Mouti, Collins Kibet, John Kibet, Virginia Sokobe, Beatrice Jeymah, Antony Kamadi, Faith Gichuri, Steve Moses, David Wasike, Favours Adeya, Caesar Bitta, Stephen Ogendo, Killian Kariuki, Hdaya BenAbdalla, Taha Suliaman, Fatima Ali Abokhzam, Mohaned Isa, Mohammed Huwaysh, Asma Bourawi, Kais Alzubaidy, Mohammed Albaraesi, Sumayyah Bahroun, Abdulmueti Alhadi, Ahmed Msherghi, Amira Mohamed, Ala Khaled, Nouran Aljadi, Elham Bareig, Khaled Elgazwi, Adel Elgazwi, Ibrahim El-busife, Safa Owhida, Almahdi Eltwati, Samah Elakeili, Taha Abubaker, Fatima Elkhfeefi, Soha Younis Hasan, Amal Alttaira, Imbarkah Elmraied, Rim Wishah, Omar Abugassa, Hazem Ahmed, Amera Ellafi, Shoukrie Shoukrie, Nawal Aldokali, Aws ElGammudi, Akram Alkaseek, Hoda Elhaddad, Ayyah Alqaarh, Ahlam Brish, Malek Abudsnnuga, Salsabil Albuaishi, Mohammed Albashri, Marwa Morgom, Mohammed Alawami, Eman Shawesh, Abdullah Almabrouk, Moaz Alwarfalli, Nagia Abeid, Anis Buzreg, Ans Malek, Ameerah Abayu, Butaina Abdulhafith, Wedad Abouruwes, Marim Albakuri, Sabria Almuammari, Esam Alsaghair, Fatheia Alreshi, Hassan Badi, Rabiee Alfetoey, Naji Zubia, Bushray Almiqlash, Abdulsalam Alshuhoumi, Rayet Al-islam Ben Jouira, Amaal Dier, Essra Gebril, Mohammed Abdelkabir, Sana Moussa, Marwa Alfitori, Mabroukah Azbeda, Hajar Alamin, Ejmeya Barka, Omlsaad Mosbah, Rema Abdasalam, Miftah Hiyoum, Maryam Abd allateef, Ibrahim Altomi, Mahdi Alsakloul, Ekhlas Karami, Munyah Alriqeeq, Mabruka Omar, Ashraf Samer, Aml Aemeesh, Ahmad Bouhuwaish, Ahmed Elusta, Sultan Ahmeed, Wesal AlFighi Hassan, Mouadah Ali Altayr, Mohamed Addalla, Abrar Geddeda, Kheria Khoja, Doaa Alhaj, Muaad Etturki, Ahmed Elhadi, Ibrahim Ellojli, Anshirah Shuwayyah, Ahmed Elfaghih, Malak Alduwayb, Mohamed Aleiyan, Wedad Aboubreeq, Soliman Alkassem, Sami Ashour, Hayat Ben Hasan, Najat Ben Hasan, Ali Yahya, Palesa Chisala, Edward Kommwa, Lusayo Simwinga, Agness Chalira, Precious Kachitsa, Onias Mtalimanja, Drissa Traoré, Moussa Sissoko, Moussa Camara, Adama Koita, Sekou Koumaré, Omar Sacko, Mahamadou Coulibaly, Lamine Soumaré, Soumaïla Keita, Sidiki Keita, Hamadoun Dicko, Boubacar Diallo, Boureima Bengaly, Mohamed Keita, Siaka Diallo, Drissa Ouattara, Nouhoun Ongoiba, Seydina Beye, Honoré Berthe, Mamadou Diakite, Mamadou Sima, Adégné Togo, Bakary Dembele, Djibo Diango, Moussa Samake, Youssouf Traoré, Louis Traoré, Ongoïba Oumar, Sogoba Gaoussou, Issaga Traoré, Sidy Sangaré, Doua Kanté, Lassana Cissé, Thiam Souleymane, Keita Koniba, Sundaresan Maiyalagan, Julien Chong, Adil Mohit, Khushyant Mungar, Shankaran Vinayagam, Kevin Ramlochun, Jamie Sim, Desai Sneha, Vishaal Kissoon, Yan Tseung, Mohamed Aboobakar, Nitish Fokeerah, Ravi Ramsewak, Jayprakash Gopall, Meetheelesh Abeeluck, Varun Seewoo, Divyanand Jankee, Ashveen Puryag, Senthil Beemadoo, Yashraj Deenoo, Abhisek Goureah, Munawwara Makoon, Hemanshu Rambojan, Beeharry Shanjugsingh, Kevin Viraswami, Shehzaad Joomye, Ashwant Bhugwandass, Bibi Deelawar, Vakil Leelodharry, Luckshmanraj Mungur, Sajid Aungraheeta, Sirsingh Bhajoo, Manpreet Rajcoomar, Rishi Seetaram, Subha Gaya, Gini Batra, Yoshvin Sunnassee, Shailendra Petkar, Sbai Hicham, Labib Smail, Ait Laalim Said, Motaai Youssef, Mouhssine Doumiri, Mustapha Alilou, Nora Farnaoui, Mustapha Bensghir, Abdelghafour Elkoundi, Abdelhamid Jaafari, Abderhmann Elwali, Mohammed Meziane, Walid Atmani, Houssam Rebahi, Hajar Chichou, Safae Zarouf, Abderraouf Soummani, Abou Elhassan Taoufik, Meryem Essafti, Aminata Oumou Traoré, Hamzaoui Hamza, Adnane Berdai, El allani Linda, Salhi Oussama, Nelson Mucopo, Machado Banze, Mouzinho Saide, Tomas Sitoi, Artur Machava, Antonio Carlos, Amilton Guidione, Antonio Saide de Carvalho, Natacha Gemo, Samiro Sema Camal, Arsénio Cuna, Ornelos Madeira, Ladino Assuade, Dercio Amde Fernandes, Dulce Alexandre Machavae Fernandes, Mandua Sebastião, Bernard Sikombe, Matti Kandjimi, Ayoub Shekimweri, Diana Shilomboleni, Mbaundju Kandjii, Leonard Kabongo, Cholastic Hangero, Ike Ndjoze, Ruben Nailonga, Immanuel Uukonga, Uutoni Nakanyala, Lavinia Johannes, Adrian Haruzuvi, Chris Terblanche, Natangwe Shimenda, Delwina Katjipu, Hilma Shalimba, Juliah Kaweendwa, Ali Mbuyi, John Oyedele, Mapumba Mulolo, Peter Njuki, Mutombo Ndaie, Akutu Munyika, Hilma Katangolo, David Tjiyokola, Tawanda Mhene, Archbald Masiambiri, Paidamoyo Mandudzo, Sandra Kapepiso, Haziel Mavesere, Cedia Tjihoto, Daylight Manyere, Charlotte Kauraisa, Learnmore Garanowako, Michael Tune, William DeKlerk, Benvenue Ndolo, Maria Angula, Ndapewoshali Hishekwa, Elizabeth Nandjendja, Elsabe Tsauses, Eunice Mouton, Kudzai Katandawa, Sophia Bruwer, Jaydee Van Staden, Beata Siteketa, Beata Kaholongo, Martha Ntinda, Pueya Nashidengo, Johanna Kandjumbwa, Lahia Lipumbu, Moussa Sirfi, Fouma Djibo, Moutari Mahaman, Abdoulaye Mahaman Bachir, Maikassoua Mamane, Adakal Ousseini, Maman Noury Hamissou Souley, Rabo Oumarou, Rekia Idrissa, Moussa Ichaou, Amina Saley, Abdoulay Seyni, Sahabi Amadou, Mahamane Sani Mahamane Laminou, Issoufou Moustapha Camara, Moussa Gagara, Hadjara Rabiou Daddy, Harissou Adamou, Ibrahim Amadou Magagi, Oumarou Habou, Sabo Ramatou, Saidu Kadas, Rabiu Mohammed, Abubakar Ballah, Tella Olalekan, Kefas Bwala, Mohammed Adamu, Adamu Isa, Ademola Adeyeye, Samuel Fayose, Akinola Akinmade, Taiwo Ajayi, Elizabeth Nwasor, Saidu Yakubu, Euphemia Ugwu, George Mukoro, Muhammed Ahmed, Gideon Akafa, Ahmad Lawal, Daniel Nwoye, Michael Odigbo, Zulaihatu Sarkin-Pawa, Tunde Sholadoye, Benjamin Fomete, Hamisu Yakubu, Abdulkadir Kabiru, Samaila Timothy, Ali Yusuf, Tasiu Saadu, Babangida Mohammed, Abdulghaffar Yunus, Ganiyat Olagunju, Muhammad Aminu, Mohammad Idris, Musliu Tolani, Nasiru Dalhat, Samuel Gana, Talent Adike, Lofty-John Anyanwu, Abdurrahman Sheshe, Sani Aji, Mamuda Atiku, Raphael Attah, Abubakar Muhammed, Rasaki Oseni, Halima Salisu-Kabara, Benjamin Nkemjika, Omotayo Salami, Adekunle Akadri, Bukola Olayinka, Clement Onuoha, Umar Usman Jamaare, Auwalu Saminu Jibrin, Sani Giade Abdullahi, Ibrahim Ishaku, Adenike Odewabi, John Bamigboye, Oladapo Kuforiji, Chidiebere Ogo, Stella Ogunmuyiwa, Abdussemee Abdurrazzaaq, Adebayo Tanimola, Michael Adeyanju, Oluwatimilehin Andero, Temitope Ojo, Olusi Adedotun, Gbadamosi Kehinde, Jimoh Buraimoh, Kabiru Muhammad, Sophia Baidoo, Patrick Okoli, Azeez Adigun, Ekene Ezeonye, Kabir Isa, Yetunde Aremu-Kasumu, Kamil Shoretire, Peter Enesi, Amechi Ezike, Olatunde Olawoye, Emmanuel Ugwu, Christopher Ukah, Abolade Olugbenga, Nwachukwu Chidiebere, Nasiru Abdulraman, Adebiyi Olusegun, Alisa Halisa, Semiat Yusuf, Jamila Salisu, Chidiebube Okoro, Abdul Suleiman, Fabian Onowighose, Aliyu Farinyaro, Suleiman Baba, Umar Abdulmajid, Aisha Abdurrahman, Ogochukwu Obi, Olatunde Alabi, William Adeyemi, Jelili Salau, Jones Taiwo, Nnaemeka Nwafulume, Taiye Ibiyeye, Edith Agu, Ayodeji Danboy, James Abdulazeez, Christopher Ekwunife, Chimaobi Nnaji, Chigozirim Onyekpere, Amara Arunsi, Jude Egwim, Obianuju Nwana, Nnabuike Ojiegbe, Charles Mbamba, Paul Ngwu, Frank Imahigbe, Emmanuel Okoroji, Iloh Ikenna, Abdulrahman Mohammed, Adebayo Adeniyi, Toluwalope Ariyo, Olajide Gabriel, Tesleem Orewole, Salawu Idris, Idowu Adebara, Abiodun Okunlola, Akinwale Akinbade, Oluwasesan Afolabi, Adewumi Bakare, Olabisi Adeyemo, Benjamin Ugwu, Samuel Nuhu, Henry Embu, Erdoo Isamade, Chinedu Obikili, Amaka Ocheke, Solomon Peter, Donald Orshio, Peter Onuminya, Jack Okopi, Olufemi Bankole, Bosede Afolabi, Dapo Osinowo, Ayodeji Oluwole, Muyiwa Rotimi, Ibironke Desalu, Rufus Ojewola, Bolaji Mofikoya, Kola Owonikoko, Adeolu Adeoye, Temidayo Bobo, Taiwo Akinloye, David Ama, Ebere Okoronkwo, Muhammad Mahmud, Jamiu Adebiyi, Temitope Babalola, Mansur Muhammad, Afeez Aruna, Maryrose Osazuwa, Ayodeji Yusuf, Isiaka Lawal, Bitrus Fidelis, Rephath Pius, Cyril Jomosu, Adebayo Adedayo, Abubakar Aliyu, Adaora Agholor, Abdullateef Abdulazeez, Chabiya Bala, Eziamaka Eze, Elizabeth Ani, Uchenna Okeke, Dominica Adebayo, Okechukwu Ekwunife, Victor Modekwe, Chuka Ugwunne, Chukwuemeka Okoro, Chisom Uche, Simeon Olateju, Fred Ige-Orhionkpaibima, Adedapo Adetoye, Olurotimi Aaron, Jeremiah Abimbola, Folayemi Faponle, Olumuyiwa Ajayeoba, Olusoji Jagun, Oluwabunmi Fatungase, Adeniyi Akiseku, Chigbundu Nwokoro, Ramotalai Shoyemi, Ibukunolu Ogundele, Nankat Joseph, Salihu Bura, Chukwuka Nwezoku, Manu Bwala, Meshach Philips, Abubakar Usman, Emmanuel Filibus, Zara Umate, Nwabuoke Chukwuka, Ahmed Nuhu, Watakiri Ibrahim, James Nggada, Ali Izge, Musa Ismail, Olayinka Eyelade, Tinuola Adigun, Babatunde Osinaike, Olayinka Ogunbode, Olusola Idowu, Taiwo Lawal, Temidayo Ogundiran, Olayiwola Shittu, Omobolaji Ayandipo, Stephen Edino, Zumnan Songden, Olumide Akitoye, Bissallah Ekele, Godwin Akaba, Terkaa Atim, Akitoye Adeleke, Owoicho Okochi, Sunday Akeju, Ernest Ukpoju, Osayomwanbo Osaheni, Ifunanya Obaseki, Lateef Kehinde, Osawemwenze Monday, Stanley Nte, Adesuwa Agboifo, Omajuwa Dawodu, Precious Orhiere, David Atiti, Queeneth Kalu, Felix Effiom, Israel Kolawole, Olawale Ojo, Afusat Olabinjo, Olufemi Ige, Beatrice Ogunyemi, Olusola Oladosu, Kikelomo Adesina, Sulaiman Agodirin, Asimiyu Shittu, Audu Idrisa, Sadiq Adamu, Nuhu Ali, Olayinka Adewunmi, Stephen Nwankwor, Akinwumi Olakanmi, Oluseye Ajayi, Ayotolu Ajayi, Victor Ogunmola, Oluwafunke Olakanmi, Adam Kuranga, Enoch Uche, Chukwuemeka Osuagwu, Chukwudi Ilo, Mesi Matthew, Uko Uko, Ngozi Mba, Olubusola Alagbe-Briggs, Amabra Dodiyi-Manuel, Bisola Onajin-Obembe, Bright Obasuyi, Richard Echem, Ihuoma Mike-Elechi, Job Otokwala, Mark Edubio, Catherine Eyo, Isaac Udo, Aliyu Abdulrahman, A.A. Abdullahi, Ibrahim Galadima Bello, Usman Adinoyin Mohammed, Abidemi Oyaromade, Mohammed Bello, Usman Muhammad, Emeri Mbah, Hyacinth Okereke, Almustapha Aminu, Anthony Ahmadu, Abu Rogers, Peter Samai, Sao Amara, Margaret Yankuba, Mary Josayah, Jayah Swarray Jnr, Alusine Dawo, Peter George, Mustapha Kabba, Mohamed Bah, Charles Mondeh, Ibrahim Kapuwa, Mohamed Sheku, Philip Mattia, Brima Sesay, Jones O.A. Omoshoro-Jones, Motselisi Mbeki, Estie Cloete, Philip Anderson, Busi Mrara, Annemarie Steyn, Tsakani Mhlari, Nic Proctor, Caroline Robertson, Gillian Lamacroft, Usha Singh, Sebenzile Sikhakhane, Kelly Gate, Shepherd Nzenza, John Tshimbalanga Kasonga, Sibongile Ndebele, Patrick Lufuta Kande, Jody Davids, Tino-vito Orlandi, Marischka de Jong, Hugo Stark, Francois Roodt, Jonathan Hall, Ian Nortje, Akanimo Akpakan, Vishendran Govindasamy, Ronisha Sathiram, Mohammad Kathrada, Zane Farina, Lucio Frittella, Charles Kohler, Sibuyiselwe Lubelwana, Sarwat Ikram-Hameed, Adriaan Smit, Muneerah Cassiem, Yvonne Freeman, Saaliha Goga, Larissa Cronje, Constantin Buzdugan, Subash Chirkut, Priyadeshni Singh, Sandhya Jithoo, Vivesh Rughubar, John Arnold, Rishan Bipath, Suman Mewa Kinoo, Ncumisa Khanyisa Msolo, Fleur Ackermans-Deijnen, Tshegofatso Mmasello Emma Boka, Martyn Biccard Greenwood, Shakthi Anand Jayrajh, Devarani Naidoo, Syndrini Reddy, Devandiran Harriraman Rungan, Kylene Subrayen, John Roos, Nina Tredoux, Pascal Plumacher, Anthony Reed, Harald Steinhaus, Mariesa Nock, Paul Ryan Herselman, Gareth Davies, Talitha Harvey, Franklin Muller, Willem Naude, Tania Pretorius, Johan Jochemus Swart, Merryn Walls, Prashant Gokal, Nicolette Rorke, Farzaana Dhoodhat, Precious Dzanibe, Mohammed Yusuf Hussain, Ashmita Junpath, Ameela Maharaj, Hylda Makanisi, Khalid Moosa, Ting Ting Wong, Sean Mould, Trisha Ramsamy, Roel Matos-Puig, Hayley Morgan, Nadeem Nabeebuccas, Ria Devi Naidoo, Viantha Pather, Vasheel Vasheel Bahadur, Renilda Pillay, Zahnne Fullerton, Nicole Bell, Bongisa Grey, Vincent Lorenzo Visentin, Hendrik Adriaan Van Zyl, Terri Anne Killingbeck, Emile Maneveldt, Gerhard Thiart, Magdelena May Venter, Oostewalt Swart, Mariette Grobelaar, Carel Cairns, David Bishop, Christien Steenkamp, Thandekile Khumalo, Noel Naidoo, Ross Murray, Martin Kopieniak, Melusi Sishange, Mxolisi Brian Ndimande, Megan Jaworska, Sarwat Ikram, Bence Rainier, Renier J. Liebenberg, Helena D. Zwiegers, Philip M. Nortje, Kamal Bhagwan, Margot Flint, Robert Dyer, Simone Adams, Yoshua Bwambale, Danny Ngomo, Patrice Kanku, Nivashen Pillay, Alexa de Castro, Atisha Maharaj, Janine Carim, Jenna Leigh Taylor, Karl M. Köhne, Leanne W. Drummond, Leanne Temlett, Lieze Geldenhuys, Yvonne Seilbea, Kathryn Naidoo, Nicola A. Kalafatis, Stefné Verwey, Thulile Biyase, Theroshnie Kisten, Belinda S. Kusel, Timothy Craig Hardcastle, Richard Magagula, Christian Kampik, Kuzolunga Xulu, Sivuyisiwe Solala, Mia Sayed, Basil Enicker, Anil Madaree, Innocent Mukama, Gladmore Madombwe, Nonhlanhla Zulu, Nompumelelo Gasa, Nokuzula Kanjana, Sebenzile Buthelezi, Thembelihle Buthelezi, Andries Brink, Francois Potgieter, Busisiwe Mrara, Zaynab Alexander, Charles Choto, Paula Ima, Zintle Gxagxisa, Baphethuxolo Ningiza, Gillian Lamacraft, Jerome Mogorosi, Nadia du Plessis, Leonie de Man, Suné Thompson, Gerrit van Heerden, Edwin W. Turton, Pieter M. van der Linde, Josephine K. Teme-Pitse, Reitumetse Tladi, Gillian D. Saffy, Ene-Mari Roscher, Kristel Fortune, George Barnard, Tiisetso Makhasane, Evan Bowen, Akangcha Pal, Rachel Moore, Maria Fourtounas, Mary Augusta Adam, Renessa Arumugan, Gabriella Hyman, Jaclyn Jonosky, Maninginingi Makondo, Heveshan Moodley, Phillip Munda, Mzwandile Nyalungu, Victor Olusola, Sohan Zane Pinto, Tristan Pillay, Lucinda Singh, Paul Mwindekuma Wondoh, John Devar, Boitumelo Baloyi-Mnisi, Zach Koto, Matlou Ernest Mabitsela, Sibongile Ruth Ndlovu, Branny Mthelebofu, Colin Beck, Matthew Dold, Alice Fan, Shannon MacQueen, Thembani Matabata, Catherine Mpehle, Charné Kulenkampf, Tsakani McCreath Mhlari, Simangele Cecilia Nyoka-Mokgalong, Felix Thumba Masinge, Randhir Ramnath Gunpath, Maropeng Petrus Pat Mothwa, Jo-Anne Asenath Mothwa, Danai Mhlanga, Jamie-Lyn Colly, Aunel Mallier Peter, Khalid Ben Hameda, Pulane Mokae, Stella Josephine Moumakoe, Kelechi Ekeh, Nezingu Lengo, Marnus Booyens, Inge Louise Seale, Pieter Daniel Theron, Nicolaas Abraham Schuman, Amber Carlyn Sonn, Jacobus Lukas Stander, Nadia Cloete, Marius Cloete, Catherine Ann Makepeace, Ronel van der Westhuizen, Leanne Robyn Messiahs, Amy Ruth Visagie, Fatima Vawda, Frans Christiaan Voster, Deepika Dhilraj, Oliver Smith, Stefan Bolon, Daniel Montwedi, Motsilisi Mbeki, Jayde Wyngaard, Mthunzi Ngcelwane, Thomas Kleyenstuber, Phyllis Phukubye, Liesel Schärf, Grace Laker, Elizabeth Semenya, Reinhard Dembskey, Thomas Tarlton, Tapiwa Jiri, Ngoie Hubert Mushid, Nhlanhla Samuel Ngwenya, Hazel Morongoa Mogodi, Carmen Sinevici, Anthony Osarogie Usenbo, Naledi Fodo, Anesu Chimini, Ntetelelo Sikobi, Sinovuyo Nokwange, Mluleki Noqhamza, Qumba Thembisa, Kajake Anantha Padmanabha Bhat, Rabin Mathew, Katrin Middleton, Abdus-sami Adewunmi, Craig Dickson, Humairah Bulbulia, Bianka Bester, Michelle de Klerk, Christia Benade, Francois Viljoen, Monique Fischer, Khalid Alfaki, Abdalmalik Awad, Abdelsalam Algray, Mohammed Elsiddig, Suha Mohamed, Salih Mahmoud, Muhammed Osman, Asia Elgailany, Mazin Suliman, Hanaa Mohammed, Lina Aljeally, Mohammed Dirar, Mohammed Osman, Mazin Mohamed, Mohamed Elhasan, Abrar Widatalla, Abubakr Abubakr, Eman Mohamed, Alshareef Nour, Ntonto Doris Gama, Dolorosa Khetsiwe Shabangu, Cynthia Iradikunda, Samuel Mkoko, Paul Kisanga, Emmanuel Lema, Benson Lyimo, Mohamed Binde, Alphonce Chandika, Salim Salim, Sylvia Jumbe, Abel Makubi, Vihar Kotecha, Felician Kachinde, Museleta Nyakiroto, Emmanuel Jitambi, Venant Geofrey, Johaphes Josiah, Phinius Makubi, Frank Manumbu, Suzan Mlingwa, Ernest Ibenzi, Peter Mbelle, Kato Peleus, Enid Chiwanga, Nillah Richard, Shoo Leonard, Paulo Sanka, Subira Mushi, Bashir Nyangasa, Mohamed Janabi, Naizihijwa Majani, Pedro Palangyo, Evarist Nyawawa, William Ramadhan, Faraj Lydenge, Gileard Gabriel Masenga, Sakina Rashid, Mubashir Jusabani, Ansbert Ndebea, Jenitha Cheru, Margaret Henjewele, Greyson Kilimanjaro, Sarah Sikimata, Deocles Donatus, Hazina Maduhu, Tumaini Mariro, Given Massasi, Moshi Moshi Shabani, Braison Cholela, Marco Mgeleka, Yohatinus Mbilinyi, Faraja Chiwanga, Bilton Exavery, Caspar Haule, Samson Ndile, Sirili Harya, Julieth Magandi, Deogratius Manyama, Redempta Matindi, Adam Moshi, Daudi Kitwana, Merida Makia, Philip Muhochi, Miriam Herman, Clauda Miombo, Furaha Kahindo, Langtone Kishebuka, Elijah Ussiri, Gloria Kinasa, Patrick Adel, Eric Malaba, Vensesla Sakwari, Sadot Lugereka, Mohamed Mungia, George Mocha, Herman Wella, Cecilia Protas, Patrick Karua, Ahmada Kashagama, Faraja Mwasambugu, Suzana Kajeri, Jacquiline Mchilla, Elibariki Lucumay, Robert Maise, Amon Marti, Beatrice Mahundi, Frederika Jager, Charles Majani, Ludovick Rukeha, Tareeq Mohamed, Nabila Fuad, Winifrida Halinga, Elias Chrisant, Gilbert Msoma, Titus Kihwili, Gadiel Temu, Naima Yusuf, Rashid Saleh, Rashid Inoja, Eva Shang'a, Stella Ibrahim, Hussein Msuma, Edwin Edward, Paul Kilamile, Stephen Mwakyolile, Talkana Adja, Edem Gueouguede, Hafoudhoi Oussene Seddoh, Saliou Adam, Pilakimwe Egbohou, Mawunyo Ahomagnon, Olivier Kadjossou, Abdul-Bassiti Boukari, Mary T. Nabukenya, Ruth Muhindo, Peter Waswa, Peter Kaahwa Agaba, Daphne Kabatoro, Joseph Kayongo, Margaret Naggujja, Nabasiige Rehema, Phiona Nansubuga, Daniel Kavuma, Aggrey Lubikire, Hope Bisilikirwa, Godfrey Ssebaggala, Emmanuel Muwema, Humble Joan Agaba, John Kiconco, Nicholas Wataaka, Bonet Chan, Mary Juliet Nampawu, Fred Bulamba, Emmanuel Bua, Christine Mugala, Caroline Nyakato, John Paul Ochieng, Linda Kyomuhendo Jovia, George Kateregga, Rachel Alum, Lazia Najjuma, Gorret Nampiina, Andrew Kintu, Joshua Sempiira, Luzige Simon, Peter Kayima, Jacob Eyul, Erick Odwar, Rita Nkwine, Christine Namata, Elizabeth Nabakka, Denis Kakaire, Velda Mushangwe-Mtisi, Erisha Munhamo, Celestino Dhege, Juliet Hungwa, Hemish Jasi, Crispin Ntoto, Derek Matsika, Brightson Mutseyekwa, Joseph Zimbovoora, Beaulah Gudyanga, Dennis Mazingi, Chenesa Mbanje, Busisiwe Mlambo, Michael Chiwanga, Harunavamwe N. Chifamba, Sarudzai Zhou, Esta Hove, Shamiso Dende, Beauty Manjengwa, Penias Kapisa, null Mashava, Caritas Chiura, Locadia Katsukunya, Godfrey Muguti, Doreen Mashava, Elton Ndhlovu, Zanele Mangwangwa, and Nombulelo Dube

Subjects
medicine.medical_specialty, Interprofessional Relations, media_common.quotation_subject, Psychological intervention, Fidelity, Postoperative Complications, Surveys and Questionnaires, Intervention (counseling), Humans, Medicine, Postoperative Period, Cooperative Behavior, Nursing management, media_common, Response rate (survey), business.industry, Standard of Care, Odds ratio, Hospitals, Confidence interval, Clinical trial, Anesthesiology and Pain Medicine, Population Surveillance, Africa, Physical therapy, business
Abstract

Background The African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. Methods Mixed-methods process evaluation, including field notes, interviews, and post-trial questionnaire responses. Qualitative analysis used the framework method with subsequent creation of comparative case studies, grouping hospitals by intervention fidelity. A post-trial questionnaire was developed using initial qualitative analyses. Categorical variables were summarised as count (%) and continuous variables as median (inter-quartile range [IQR]). Odds ratios (OR) were used to rank influences by impact on fidelity. Results The dataset included eight in-depth case studies, and 96 questionnaire responses (response rate 67%) plus intervention fidelity data for each trial site. Overall, 57% (n=55/96) of hospitals achieved intervention delivery using an inclusive definition of fidelity. Delivery of the ASOS-2 interventions and data collection presented a significant burden to the investigators, outstripping limited resources. The influences most associated with fidelity were: surgical staff enthusiasm for the trial (OR=3.0; 95% confidence interval [CI], 1.3–7.0); nursing management support of the trial (OR=2.6; 95% CI, 1.1–6.5); performance of a dummy run (OR=2.6; 95% CI, 1.1–6.1); nursing colleagues seeing the value of the intervention(s) (OR=2.1; 95% CI, 0.9–5.7); and site investigators' belief in the effectiveness of the intervention (OR=3.2; 95% CI, 1.2–9.4). Conclusions ASOS-2 has proved that coordinated interventional research across Africa is possible, but delivering the ASOS-2 interventions was a major challenge for many investigators. Future improvement science efforts must include better planning for intervention delivery, additional support to investigators, and promotion of strong inter-professional teamwork. Clinical trial registration ClinicalTrials gov NCT03853824.

Published
2021
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12. Enhanced postoperative surveillance versus standard of care to reduce mortality among adult surgical patients in Africa (ASOS-2): a cluster-randomised controlled trial

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Bruce M Biccard, Leon du Toit, Maia Lesosky, Tim Stephens, Landon Myer, Agya BA Prempeh, Nicola Vickery, Hyla-Louise Kluyts, Alexandra Torborg, Akinyinka Omigbodun, Adesoji Ademuyiwa, Muhammed Elhadi, Mohamed Elfagieh, Bernard Mbwele, Mpoki Ulisubisya, Lazaro Mboma, Daniel Z Ashebir, Mahlet Tesfaye Bahta, Mohammed Hassen, Mikiyas Teferi, Yakob Seman, Eugene Zoumenou, Adam Hewitt-Smith, Janat Tumukunde, Dolly Munlemvo, Atilio Morais, Apollo Basenero, Pisirai Ndarukwa, Nazinigouba Ouerdraogo, Maman Sani Chaibou, Mohyeddine Zarouf, Ahmed Rhassane El Adib, Veekash Gobin, Zimogo Sanogo, Youssouf Coulibaly, Zipporah Ngumi, Tarig Fadalla, Cynthia Iradukunda, Vénérand Barendegere, Isaac O Smalle, Mustapha Bittaye, Ahmadou Lamin Samateh, Mahmoud Elfiky, Maher Fawzy, Wakisa Mulwafu, Vanessa Msosa, Lygia Lopes, Akwasi Antwi-Kusi, Hamza D Sama, Patrice Forget, Dawid van Straaten, Rupert M Pearse, Marichen Puchert, Lucy Rolt, Kris Schwebler, Freddy Kabambi, Tebogo Mabotja, Leandys Cobas, Albino Freitas, Maria Antunes, Bartolomeu Cabo, Domingos Paulo, Carlos Camongua, Yvette Avognon, Osseni Marcos, Raymond Kintomonho, Onesime Demahou, Gisèle Hounsa, Hugues Chobli, Elie Fassinou, Aurore Zoglobossou, Blaise Tchaou, Charles Tchegnonsi, Fifame Amadji, Francine Bossa, Ernest Ahounou, Djima Alao, Roushdane Odérémi, Afissatou Montairou, Oswald Gbehade, Romaric Tobome, Adam Boukari, Patrick Bakantieba, Arouna Sambo, Fanou Lionelle, Nounagnon Gilbert, Julien Attinon, Roger Klikpezo, Aumar Dadjo, Dénis Fanou, Gilberte Hounkpe, Bachabi Fafana, Néné Nguilu, Bodourin Dossou-Yovo, Chantal Segla, Mohamed Toko, Evelyne Gnele-Dedewanou, Michel Noukounwoui, Ethienne Yado, Timothé Gouroubéra, Valéry Adjignon, Serge Mewanou, Aïcha Tchomgang, Urielle Agossou, Fernand Soton, Charbel Azanlin, Lidwine Zomahoun, Rawéléguinbasba Armel Flavien Kabore, Salam Savadogo, Fatou Fleur Rosine Sanou, Farid Belém, Victoria Hien, Cheik Tidiane Hafid W Bougouma, Sie Ahmed Ouattara, Mariam Bambara Kabore, Ouedraogo Nazinigouba, Papougnezambo Bonkoungou, Martin Lankoandé, Mireille Traoré, Patrick Sawadogo, Inès Wenmenga, Boureima Kinda, André Simporé, Christian Sapo, Salah Idriss Traore, Haoua Dipama, Lydie WR Kaboré, Salifou Napon, Télesphore G Kaboré, Arouna Louré, Pélagie PP Tondé, Christian Zoundi, Harouna Sanou, Remy Ndikumana, Carlos Nsengiyumva, Gregory Sund, Alliance Niyukuri, Axel Kwizera, Jean-Claude Niyondiko, Adolphe Manzanza Kilembe, Jean Pierre Mwema Ilunga, Nehema Hailemariam Sarah, Gabriel Mubobo Makeya, Idesbald Mwebe Mwepu, Ted Botawaosenge Likongo, Richard Kapela Mvwala, Raphael Nzau Kapend Mubunda, Noellie Kanka Mukuna, Julie Djondo Pembe, Nicolas Lumuanga Ndaye, Eric Bibonge Amisi, Mike Ilunga Madika, Joe Kembo Lungela, Didier Ndonda Mayemba, Philomene Mamba Diyoyo, Alex Mbo Ngalala, Martin Mamba Mukenga, Patricia Tito Kabuni, Dany Bolimo Mpoto, Herve Inesnku Mole, Louise Keby, Oria Andavo Buti, Anselme Phaka, Belinda Mayenge, Jean Jeacques Kabuley Kalongo, Timothe Kemfuni Mawisa, Rodrigue Tondo Ngwizani, Kuyala Leya, Dieudonne Kisile Sanduku, Timothe Nkemfuni Mawisa, Coco Nseke Mfumu, Mbuta Bolenge, Desire Kinzenzengu Kabuce, Patrick Kintieti, Amelia Mbuluku, Vicky Mahuwa, Tharcice Khonde Mabiala, Guilain Ngoy, Patrick Boloko, Nono Mazangama Mvwama, Jose Kengbanda, Pitchou Mushimbonga, Blaise Kuhapala, Nzosani Marcel, Kienze Guylain, Gerard Mboma, Sandra Zalambo Sagboze, Michel Muteya Manika, Jean Pierre Mumbere Kigayi, Roger Mukanire Cishugi, Placide Buhendwa Mugisho, Roger Baguma, Moïse Kongolo, Michel Mandungu Mbayabu, Crispin Mukendi Muamba, Edmond Banema Kapinga, Vasco Ngolela Kapinga, Guylain Tshimanga Nsumpi, Patrick Kanda Odia, Salomon Bingidimi, Gilbert Kpengbemale, Desire Hubert Bofunga Bosonga Imposo, Patricia Matondo, Servet Lelo, Jeremie Kalambayi, Mohamed Abdel-Ghaffar, Abdelrahman Soliman, Mostafa Abdelrahman, Sameh Shehata, Alia Rabee, Mohamed Abou Heba, Mohamed Rabei Abdelfattah, Tamer Ahmed Maher Ghoniem, Sherif M.K. Shehata, Mohamed Lotfy, Ahmed ElHaddad, Bereket Gebremeskel, Girmay Fisseha, Mebrahtu Abay, Degena Bahrey, Assefa Hika, Abdurezak Ali, Kindie Moges, Jemal Ahmed, Desalegn Abdisa, Abebe Megersa, Wendwosen Abayne, Haftom Berhane, Reiye Esayas, Fitsum Kifle, Kokeb Desita, Abebe Addise, Dagim Shimelash, Shitalem Tadesse, Bezaye Zemedkun, Peniel Kenna, Ayenew Yirdie, Abinet Sisay, Tebikew Gashu, Fassil Mihretu, Yesuf Ahmed, Bekele Debebe, Abdureuf Misgea, Amare Agmas, Rahel Assefa, Abdurahman Gelmo, Seifu Alemu, Brook Damtachew, Merid Mersha, Yaekob Chemere, Samuel Fekadu, Sintayehu Regasa, Bonsa Sileshi, Desalegn Wosen, Rebira Adamu, Gersam Mulugeta, Teshome Bacha, Zewude Gudisa, Kebebe Bekele, Alelign Tasew, Habtamu Gezahegn, Daniel Atlaw, Damtew Solomon, Habtemariam Gebresillasie, Girmaye Tesfaye, Negussie Sarbecha, Biniyam Sahiledengle, Kenbon Seyoum, Gemechu Ganfure, Yohannes Tekalegn, Gosa Tesfaye, Temesgen Ayichew, Shibiru Sendaba, Musefa Redwan, Eyasu Muse, Girma Nina, Bizuneh Sime, Addisalem Tadege, Anbesse Jima, Nugusu Ayalew, Dagmawi Workneh, Daniel Teferi, Momodou T Nyassi, Landing N Sanyang, Omar Jallow, Abdoulie Keita, Kitabu Jammeh, Charles Roberts, Patrick Idoko, Kebba Marenah, Masirending Njie, Musa Marena, Karamba Suwareh, Simon Boissey, Fatoumatta Jarjusey, Awa Jah, Awa Sanyang, Dado Jabbi, Kajali Camara, Armando Correa, John Jabang, Lamin Jaiteh, Lamin Dampha, Aminata Manneh, Baboucarr Sowe, Abdoulie Bah, Edrisa Jawo, Victoria Okoje, Momodou Baro, Yaya Bah, Mustapha Njie, Sainabou Mbowe, Ebrima Kanteh, Sarjo Ceesay, Alagie Manneh, Evans Atito-Narh, Adwoa Wilson, Romeo Hussey, Emmanuel Okine, Jemima Kwarteng, Ridge Ntiamoah, Samuel Dadzie, Mark Aseti, Naa Sowah, Akosua Appiah, Charles Bankah, Patrick Mburugu, Thomas Chokwe, Patrick Olang, Vernon Gacii, Susane Nabulindo, Antony Gatheru, Timothy Mwiti, Caroline Mwangi, Julius Muriithi, Daniel Ojuka, Omondi Ogutu, Evans Masitara, Mohamed Chaudhry, Reuben Kamundi, Annmarie Kangangi, Thomas Massaquoi, Stephen Takow, Felister Moraa, Aziz Munubi, Moses Kimani, Adili Wobenjo, Linda Nguu, Vincent Omeddo, Rose Malaba, Ambrose Nabwana, Anita Mwancha, Alexandria Mugaa, John Wamwaki, Joyce Chege, Seymour Sinari, Andrew Ndonga, Rose Shitsinzi, Walter Akello, Winfred Kimani, Elisha Kirwa, Seno Saruni, Andrew Wainaina, Ernest Nshom, Aidah Kenseko, Kizito Shisanya, Purity Wanjiru, Julliah Cherotich, Judy Kimutai, Benson Wahome, Grace Wangui, Dennis Wamalwa, Stephen Mwangi, John Chege, Tabitha Wanjiku, Carolyne Njoki, Wachira Waititu, Conrad Ambani, Samuel Murimi, Sharon Waithira, Nilson Mouti, Collins Kibet, John Kibet, Virginia Sokobe, Beatrice Jeymah, Antony Kamadi, Faith Gichuri, Steve Moses, David Wasike, Favours Adeya, Caesar Bitta, Stephen Ogendo, Killian Kariuki, Hdaya BenAbdalla, Taha Suliaman, Fatima Ali Abokhzam, Mohaned Isa, Mohammed Huwaysh, Asma Bourawi, Kais Alzubaidy, Mohammed Albaraesi, Sumayyah Bahroun, Abdulmueti Alhadi, Ahmed Msherghi, Amira Mohamed, Ala Khaled, Nouran Aljadi, Elham Bareig, Khaled Elgazwi, Adel Elgazwi, Ibrahim El-busife, Safa Owhida, Almahdi Eltwati, Samah Elakeili, Taha Abubaker, Fatima Elkhfeefi, Soha Younis Hasan, Amal Alttaira, Imbarkah Elmraied, Rim Wishah, Omar Abugassa, Hazem Ahmed, Amera Ellafi, Shoukrie Shoukrie, Nawal Aldokali, Aws ElGammudi, Akram Alkaseek, Hoda Elhaddad, Ayyah Alqaarh, Ahlam Brish, Malek Abudsnnuga, Salsabil Albuaishi, Mohammed Albashri, Marwa Morgom, Mohammed Alawami, Eman Shawesh, Abdullah Almabrouk, Moaz Alwarfalli, Nagia Abeid, Anis Buzreg, Ans Malek, Ameerah Abayu, Butaina Abdulhafith, Wedad Abouruwes, Marim Albakuri, Sabria Almuammari, Esam Alsaghair, Fatheia Alreshi, Hassan Badi, Rabiee Alfetoey, Naji Zubia, Bushray Almiqlash, Abdulsalam Alshuhoumi, Rayet Al-islam Ben Jouira, Amaal Dier, Essra Gebril, Mohammed Abdelkabir, Sana Moussa, Marwa Alfitori, Mabroukah Azbeda, Hajar Alamin, Ejmeya Barka, Omlsaad Mosbah, Rema Abdasalam, Miftah Hiyoum, Maryam Abd allateef, Ibrahim Altomi, Mahdi Alsakloul, Ekhlas Karami, Munyah Alriqeeq, Mabruka Omar, Ashraf Samer, Aml Aemeesh, Ahmad Bouhuwaish, Ahmed Elusta, Sultan Ahmeed, Wesal AlFighi Hassan, Mouadah Ali Altayr, Mohamed Addalla, Abrar Geddeda, Kheria Khoja, Doaa Alhaj, Muaad Etturki, Ahmed Elhadi, Ibrahim Ellojli, Anshirah Shuwayyah, Ahmed Elfaghih, Malak Alduwayb, Mohamed Aleiyan, Wedad Aboubreeq, Soliman Alkassem, Sami Ashour, Hayat Ben Hasan, Najat Ben Hasan, Ali Yahya, Palesa Chisala, Edward Kommwa, Lusayo Simwinga, Agness Chalira, Precious Kachitsa, Onias Mtalimanja, Drissa Traoré, Moussa Sissoko, Moussa Camara, Adama Koita, Sekou Koumaré, Omar Sacko, Mahamadou Coulibaly, Lamine Soumaré, Soumaïla Keita, Sidiki Keita, Hamadoun Dicko, Boubacar Diallo, Boureima Bengaly, Mohamed Keita, Siaka Diallo, Drissa Ouattara, Nouhoun Ongoiba, Seydina Beye, Honoré Berthe, Mamadou Diakite, Mamadou Sima, Adégné Togo, Bakary Dembele, Djibo Diango, Moussa Samake, Youssouf Traoré, Louis Traoré, Ongoïba Oumar, Sogoba Gaoussou, Issaga Traoré, Sidy Sangaré, Doua Kanté, Lassana Cissé, Thiam Souleymane, Keita Koniba, Sundaresan Maiyalagan, Julien Chong, Adil Mohit, Khushyant Mungar, Shankaran Vinayagam, Kevin Ramlochun, Jamie Sim, Desai Sneha, Vishaal Kissoon, Yan Tseung, Mohamed Aboobakar, Nitish Fokeerah, Ravi Ramsewak, Jayprakash Gopall, Meetheelesh Abeeluck, Varun Seewoo, Divyanand Jankee, Ashveen Puryag, Senthil Beemadoo, Yashraj Deenoo, Abhisek Goureah, Munawwara Makoon, Hemanshu Rambojan, Beeharry Shanjugsingh, Kevin Viraswami, Shehzaad Joomye, Ashwant Bhugwandass, Bibi Deelawar, Vakil Leelodharry, Luckshmanraj Mungur, Sajid Aungraheeta, Sirsingh Bhajoo, Manpreet Rajcoomar, Rishi Seetaram, Subha Gaya, Gini Batra, Yoshvin Sunnassee, Shailendra Petkar, Sbai Hicham, Labib Smail, Ait Laalim Said, Motaai Youssef, Mouhssine Doumiri, Mustapha Alilou, Nora Farnaoui, Mustapha Bensghir, Abdelghafour Elkoundi, Abdelhamid Jaafari, Abderhmann Elwali, Mohammed Meziane, Walid Atmani, Houssam Rebahi, Hajar Chichou, Safae Zarouf, Abderraouf 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James Nggada, Ali Izge, Musa Ismail, Olayinka Eyelade, Tinuola Adigun, Babatunde Osinaike, Olayinka Ogunbode, Olusola Idowu, Taiwo Lawal, Temidayo Ogundiran, Olayiwola Shittu, Omobolaji Ayandipo, Stephen Edino, Zumnan Songden, Olumide Akitoye, Bissallah Ekele, Godwin Akaba, Terkaa Atim, Akitoye Adeleke, Owoicho Okochi, Sunday Akeju, Ernest Ukpoju, Osayomwanbo Osaheni, Ifunanya Obaseki, Lateef Kehinde, Osawemwenze Monday, Stanley Nte, Adesuwa Agboifo, Omajuwa Dawodu, Precious Orhiere, David Atiti, Queeneth Kalu, Felix Effiom, Israel Kolawole, Olawale Ojo, Afusat Olabinjo, Olufemi Ige, Beatrice Ogunyemi, Olusola Oladosu, Kikelomo Adesina, Sulaiman Agodirin, Asimiyu Shittu, Audu Idrisa, Sadiq Adamu, Nuhu Ali, Olayinka Adewunmi, Stephen Nwankwor, Akinwumi Olakanmi, Oluseye Ajayi, Ayotolu Ajayi, Victor Ogunmola, Oluwafunke Olakanmi, Adam Kuranga, Enoch Uche, Chukwuemeka Osuagwu, Chukwudi Ilo, Mesi Matthew, Uko Uko, Ngozi Mba, Olubusola Alagbe-Briggs, Amabra Dodiyi-Manuel, Bisola Onajin-Obembe, Bright Obasuyi, Richard Echem, Ihuoma Mike-Elechi, Job Otokwala, Mark Edubio, Catherine Eyo, Isaac Udo, Aliyu Abdulrahman, A.A. 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Omoshoro-Jones, Motselisi Mbeki, Estie Cloete, Philip Anderson, Busi Mrara, Annemarie Steyn, Tsakani Mhlari, Nic Proctor, Caroline Robertson, Gillian Lamacroft, Usha Singh, Sebenzile Sikhakhane, Kelly Gate, Shepherd Nzenza, John Tshimbalanga Kasonga, Sibongile Ndebele, Patrick Lufuta Kande, Jody Davids, Tino-vito Orlandi, Marischka de Jong, Hugo Stark, Francois Roodt, Jonathan Hall, Ian Nortje, Akanimo Akpakan, Vishendran Govindasamy, Ronisha Sathiram, Mohammad Kathrada, Zane Farina, Lucio Frittella, Charles Kohler, Sibuyiselwe Lubelwana, Sarwat Ikram-Hameed, Adriaan Smit, Muneerah Cassiem, Yvonne Freeman, Saaliha Goga, Larissa Cronje, Constantin Buzdugan, Subash Chirkut, Priyadeshni Singh, Sandhya Jithoo, Vivesh Rughubar, John Arnold, Rishan Bipath, Suman Mewa Kinoo, Ncumisa Khanyisa Msolo, Fleur Ackermans-Deijnen, Tshegofatso Mmasello Emma Boka, Martyn Biccard Greenwood, Shakthi Anand Jayrajh, Devarani Naidoo, Syndrini Reddy, Devandiran Harriraman Rungan, Kylene Subrayen, John Roos, Nina Tredoux, Pascal Plumacher, Anthony Reed, Harald Steinhaus, Mariesa Nock, Paul Ryan Herselman, Gareth Davies, Talitha Harvey, Franklin Muller, Willem Naude, Tania Pretorius, Johan Jochemus Swart, Merryn Walls, Prashant Gokal, Nicolette Rorke, Farzaana Dhoodhat, Precious Dzanibe, Mohammed Yusuf Hussain, Ashmita Junpath, Ameela Maharaj, Hylda Makanisi, Khalid Moosa, Ting Ting Wong, Sean Mould, Trisha Ramsamy, Roel Matos-Puig, Hayley Morgan, Nadeem Nabeebuccas, Ria Devi Naidoo, Viantha Pather, Vasheel Vasheel Bahadur, Renilda Pillay, Zahnne Fullerton, Nicole Bell, Bongisa Grey, Vincent Lorenzo Visentin, Hendrik Adriaan Van Zyl, Terri Anne Killingbeck, Emile Maneveldt, Gerhard Thiart, Magdelena May Venter, Oostewalt Swart, Mariette Grobelaar, Carel Cairns, David Bishop, Christien Steenkamp, Thandekile Khumalo, Noel Naidoo, Ross Murray, Martin Kopieniak, Melusi Sishange, Mxolisi Brian Ndimande, Megan Jaworska, Sarwat Ikram, Bence Rainier, Renier J Liebenberg, Helena D Zwiegers, Philip M Nortje, Kamal Bhagwan, Margot Flint, Robert Dyer, Simone Adams, Yoshua Bwambale, Danny Ngomo, Patrice Kanku, Nivashen Pillay, Alexa de Castro, Atisha Maharaj, Janine Carim, Jenna Leigh Taylor, Karl M Köhne, Leanne W Drummond, Leanne Temlett, Lieze Geldenhuys, Yvonne Seilbea, Kathryn Naidoo, Nicola A Kalafatis, Stefné Verwey, Thulile Biyase, Theroshnie Kisten, Belinda S Kusel, Timothy Craig Hardcastle, Richard Magagula, Christian Kampik, Kuzolunga Xulu, Sivuyisiwe Solala, Mia Sayed, Basil Enicker, Anil Madaree, Innocent Mukama, Gladmore Madombwe, Nonhlanhla Zulu, Nompumelelo Gasa, Nokuzula Kanjana, Sebenzile Buthelezi, Thembelihle Buthelezi, Andries Brink, Francois Potgieter, Busisiwe Mrara, Zaynab Alexander, Charles Choto, Paula Ima, Zintle Gxagxisa, Baphethuxolo Ningiza, Gillian Lamacraft, Jerome Mogorosi, Nadia du Plessis, Leonie de Man, Suné Thompson, Gerrit van Heerden, Edwin W Turton, Pieter M van der Linde, Josephine K Teme-Pitse, Reitumetse Tladi, Gillian D Saffy, Ene-Mari Roscher, Kristel Fortune, George Barnard, Tiisetso Makhasane, Evan Bowen, Akangcha Pal, Rachel Moore, Maria Fourtounas, Mary Augusta Adam, Renessa Arumugan, Gabriella Hyman, Jaclyn Jonosky, Maninginingi Makondo, Heveshan Moodley, Phillip Munda, Mzwandile Nyalungu, Victor Olusola, Sohan Zane Pinto, Tristan Pillay, Lucinda Singh, Paul Mwindekuma Wondoh, John Devar, Boitumelo Baloyi-Mnisi, Zach Koto, Matlou Ernest Mabitsela, Sibongile Ruth Ndlovu, Branny Mthelebofu, Colin Beck, Matthew Dold, Alice Fan, Shannon MacQueen, Thembani Matabata, Catherine Mpehle, Charné Kulenkampf, Tsakani McCreath Mhlari, Simangele Cecilia Nyoka-Mokgalong, Felix Thumba Masinge, Randhir Ramnath Gunpath, Maropeng Petrus Pat Mothwa, Jo-Anne Asenath Mothwa, Danai Mhlanga, Jamie-Lyn Colly, Aunel Mallier Peter, Khalid Ben Hameda, Pulane Mokae, Stella Josephine Moumakoe, Kelechi Ekeh, Nezingu Lengo, Marnus Booyens, Inge Louise Seale, Pieter Daniel Theron, Nicolaas Abraham Schuman, Amber Carlyn Sonn, Jacobus Lukas Stander, Nadia Cloete, Marius Cloete, Catherine Ann Makepeace, Ronel van der Westhuizen, Leanne Robyn Messiahs, Amy Ruth Visagie, Fatima Vawda, Frans Christiaan Voster, Deepika Dhilraj, Oliver Smith, Stefan Bolon, Daniel Montwedi, Motsilisi Mbeki, Jayde Wyngaard, Mthunzi Ngcelwane, Thomas Kleyenstuber, Phyllis Phukubye, Liesel Schärf, Grace Laker, Elizabeth Semenya, Reinhard Dembskey, Thomas Tarlton, Tapiwa Jiri, Ngoie Hubert Mushid, Nhlanhla Samuel Ngwenya, Hazel Morongoa Mogodi, Carmen Sinevici, Anthony Osarogie Usenbo, Naledi Fodo, Anesu Chimini, Ntetelelo Sikobi, Sinovuyo Nokwange, Mluleki Noqhamza, Qumba Thembisa, Kajake Anantha Padmanabha Bhat, Rabin Mathew, Katrin Middleton, Abdus-sami Adewunmi, Craig Dickson, Humairah Bulbulia, Bianka Bester, Michelle de Klerk, Christia Benade, Francois Viljoen, Monique Fischer, Khalid Alfaki, Abdalmalik Awad, Abdelsalam Algray, Mohammed Elsiddig, Suha Mohamed, Salih Mahmoud, Muhammed Osman, Asia Elgailany, Mazin Suliman, Hanaa Mohammed, Lina Aljeally, Mohammed Dirar, Mohammed Osman, Mazin Mohamed, Mohamed Elhasan, Abrar Widatalla, Abubakr Abubakr, Eman Mohamed, Alshareef Nour, Ntonto Doris Gama, Dolorosa Khetsiwe Shabangu, Cynthia Iradikunda, Samuel Mkoko, Paul Kisanga, Emmanuel Lema, Benson Lyimo, Mohamed Binde, Alphonce Chandika, Salim Salim, Sylvia Jumbe, Abel Makubi, Vihar Kotecha, Felician Kachinde, Museleta Nyakiroto, Emmanuel Jitambi, Venant Geofrey, Johaphes Josiah, Phinius Makubi, Frank Manumbu, Suzan Mlingwa, Ernest Ibenzi, Peter Mbelle, Kato Peleus, Enid Chiwanga, Nillah Richard, Shoo Leonard, Paulo Sanka, Subira Mushi, Bashir Nyangasa, Mohamed Janabi, Naizihijwa Majani, Pedro Palangyo, Evarist Nyawawa, William Ramadhan, Faraj Lydenge, Gileard Gabriel Masenga, Sakina Rashid, Mubashir Jusabani, Ansbert Ndebea, Jenitha Cheru, Margaret Henjewele, Greyson Kilimanjaro, Sarah Sikimata, Deocles Donatus, Hazina Maduhu, Tumaini Mariro, Given Massasi, Moshi Moshi Shabani, Braison Cholela, Marco Mgeleka, Yohatinus Mbilinyi, Faraja Chiwanga, Bilton Exavery, Caspar Haule, Samson Ndile, Sirili Harya, Julieth Magandi, Deogratius Manyama, Redempta Matindi, Adam Moshi, Daudi Kitwana, Merida Makia, Philip Muhochi, Miriam Herman, Clauda Miombo, Furaha Kahindo, Langtone Kishebuka, Elijah Ussiri, Gloria Kinasa, Patrick Adel, Eric Malaba, Vensesla Sakwari, Sadot Lugereka, Mohamed Mungia, George Mocha, Herman Wella, Cecilia Protas, Patrick Karua, Ahmada Kashagama, Faraja Mwasambugu, Suzana Kajeri, Jacquiline Mchilla, Elibariki Lucumay, Robert Maise, Amon Marti, Beatrice Mahundi, Frederika Jager, Charles Majani, Ludovick Rukeha, Tareeq Mohamed, Nabila Fuad, Winifrida Halinga, Elias Chrisant, Gilbert Msoma, Titus Kihwili, Gadiel Temu, Naima Yusuf, Rashid Saleh, Rashid Inoja, Eva Shang'a, Stella Ibrahim, Hussein Msuma, Edwin Edward, Paul Kilamile, Stephen Mwakyolile, Talkana Adja, Edem Gueouguede, Hafoudhoi Oussene Seddoh, Saliou Adam, Pilakimwe Egbohou, Mawunyo Ahomagnon, Olivier Kadjossou, Abdul-Bassiti Boukari, Mary T Nabukenya, Ruth Muhindo, Peter Waswa, Peter Kaahwa Agaba, Daphne Kabatoro, Joseph Kayong, Margaret Naggujja, Nabasiige Rehema, Phiona Nansubuga, Daniel Kavuma, Aggrey Lubikire, Hope Bisilikirwa, Godfrey Ssebaggala, Emmanuel Muwema, Humble Joan Agaba, John Kiconco, Nicholas Wataaka, Bonet Chan, Mary Juliet Nampawu, Fred Bulamba, Emmanuel Bua, Christine Mugala, Caroline Nyakato, John Paul Ochieng, Linda Kyomuhendo Jovia, George Kateregga, Rachel Alum, Lazia Najjuma, Gorret Nampiina, Andrew Kintu, Joshua Sempiira, Luzige Simon, Peter Kayima, Jacob Eyul, Erick Odwar, Rita Nkwine, Christine Namata, Elizabeth Nabakka, Denis Kakaire, Velda Mushangwe-Mtisi, Erisha Munhamo, Celestino Dhege, Juliet Hungwa, Hemish Jasi, Crispin Ntoto, Derek Matsika, Brightson Mutseyekwa, Joseph Zimbovoora, Beaulah Gudyanga, Dennis Mazingi, Chenesa Mbanje, Busisiwe Mlambo, Michael Chiwanga, Harunavamwe N Chifamba, Sarudzai Zhou, Esta Hove, Shamiso Dende, Beauty Manjengwa, Penias Kapisa, null Mashava, Caritas Chiura, Locadia Katsukunya, Godfrey Muguti, Doreen Mashava, Elton Ndhlovu, Zanele Mangwangwa, and Nombulelo Dube

Subjects
Adult, medicine.medical_specialty, Standard of care, business.industry, Psychological intervention, MEDLINE, Standard of Care, General Medicine, Articles, Hospitals, Hospitalization, Intervention (counseling), Relative risk, Emergency medicine, Africa, medicine, Humans, In patient, Female, Cluster randomised controlled trial, Postoperative Period, business, Surgical patients
Abstract

Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists. Translations For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.

Published
2021

14. Blood pressure, T cells, and mortality in people with HIV in Tanzania during the first 2 years of antiretroviral therapy

Author

Robert N. Peck, Christina Myalla, Annet Kirabo, Justin R Kingery, Bernard Desderius, Saidi Kapiga, Myung Hee Lee, Karl Reis, and Abel Makubi

Subjects
Adult, Male, medicine.medical_specialty, Tuberculosis, T-Lymphocytes, Endocrinology, Diabetes and Metabolism, Human immunodeficiency virus (HIV), Blood Pressure, HIV Infections, Disease, 030204 cardiovascular system & hematology, medicine.disease_cause, Tanzania, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Internal Medicine, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, biology, business.industry, HIV, medicine.disease, biology.organism_classification, Antiretroviral therapy, Occult, CD4 Lymphocyte Count, Blood pressure, Hypertension, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Cardiovascular disease is now a leading cause of mortality in people with HIV (PWH). High blood pressure is the major driver of cardiovascular disease. Despite this, little is known about blood pressure in PWH during the early years of antiretroviral therapy (ART). In this prospective cohort study in Tanzania, the authors conducted unobserved blood pressure measurements at enrollment, 3, 6, 12, 18, and 24 months in 500 PWH initiating ART and 504 HIV-uninfected adults. The authors excluded measurements taken on antihypertensive medications. Although PWH had a significantly lower blood pressure before ART initiation, they had a significantly greater increase in blood pressure during the first 2 years of ART compared to HIV-uninfected controls. Blood pressure correlates in PWH differed from HIV-uninfected controls. In PWH, lower baseline CD4+ T-cell counts were associated with lower blood pressure, and greater increases in CD4+ T-cell counts on ART were associated with greater increases in blood pressure, both on average and within individuals. In addition, PWH with a systolic blood pressure (SBP)

Published
2020
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15. Clinical epidemiology of individuals with Sickle cell anemia using Hydroxyurea at Muhimbili National Hospital, Dar Es Salaam, Tanzania

Author

Raphael Z. Sangeda, Bruno Mmbando, Edward Kija, Furahini Tluway, Elisha Osati, Abel Makubi, Evarist Msaki, Julie Makani, Siana Nkya, Harvest Mariki, Florence Urio, Musa Makongoro, Deogratias Soka, Magdalena Lyimo, Christina Kindole, Josephine Mgaya, and Stella Rwezaura

Subjects
medicine.medical_specialty, Anemia, business.industry, Disease, medicine.disease, Sickle cell anemia, Pathophysiology, Acute chest syndrome, Clinical trial, hemic and lymphatic diseases, Internal medicine, Fetal hemoglobin, medicine, business, Stroke
Abstract

Background: The pathophysiology of sickle cell disease (SCD) is complex and involves nitric oxide depletion, increased inflammation/adhesion molecules and vaso-occlusion in addition to the chronic hemolytic anemia. This pathophysiology results in systemic clinical complications including recurrent episodes of severe pain, stroke, acute chest syndrome (ACS) and an increased susceptibility to infection. SCD severity varies among individuals and fetal hemoglobin (HbF) is known as a major modulator of the disease. To date, hydroxyurea (HU) is a known intervention that acts by increasing HbF in individuals with SCD. The increase in HbF reduces the risk of ‘sickling’ events and improves clinical outcomes. This is the first study on the use of HU in individuals with SCA in Tanzania.Methods: A case-control study to determine the proportion, indications, clinical and laboratory outcomes of SCD patients with HU use was conducted at Muhimbili National Hospital in Dar Es Salaam, Tanzania.Results: Forty-two patients with Sickle cell anemia (SCA) on HU treatment and 32 patients with SCA not on HU treatment were enrolled. The proportion of HU use by individuals with SCA at Muhimbili National Hospital was 10 per 1000. The mean HbF % was 9.8 ± 2.4 vs 6.2 ±1.4 for controls (P

Published
2020
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16. Human Immunodeficiency Virus–Associated Myocardial Diastolic Dysfunction and Soluble ST2 Concentration in Tanzanian Adults: A Cross-Sectional Study

Author

Robert N. Peck, Daniel Kaminstein, Abel Makubi, Fredrick Kalokola, Salama Fadhil, Bernard Desderius, Rahul Hosalli, Saidi Kapiga, Justin R Kingery, Richard B. Devereux, Daniel W. Fitzgerald, Dipan Karmali, Myung Hee Lee, Warren E. Johnson, Parag Goyal, and Margaret L. McNairy

Subjects
Adult, Male, medicine.medical_specialty, Cross-sectional study, Human immunodeficiency virus (HIV), Diastole, HIV Infections, 030204 cardiovascular system & hematology, medicine.disease_cause, Tanzania, Major Articles and Brief Reports, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, Immunology and Allergy, 030212 general & internal medicine, Young adult, biology, business.industry, Case-control study, Odds ratio, Middle Aged, biology.organism_classification, Interleukin-1 Receptor-Like 1 Protein, Confidence interval, Cross-Sectional Studies, Infectious Diseases, Echocardiography, Case-Control Studies, Female, Cardiomyopathies, business
Abstract

Background The aims of this study were (1) to compare the prevalence of myocardial diastolic dysfunction (DD) in antiretroviral therapy (ART)–naive people living with human immunodeficiency virus (PLWH) to human immunodeficiency virus (HIV)–uninfected adults in East Africa and (2) to determine the association between serum concentration of the cardiac biomarkers ST2 and DD. Methods In this cross-sectional study, we enrolled PLWH and uninfected adults at a referral HIV clinic in Mwanza, Tanzania. Standardized history, echocardiography, and serum were obtained. Regression models were used to quantify associations. Results We enrolled 388 ART-naive PLWH and 461 HIV-uninfected adults with an average age of 36.0 ± 10.2 years. Of PLWH in the third, fourth, and fifth decades of life, 5.0%, 12.5%, and 32.7%, respectively, had DD. PLWH had a higher prevalence of DD (adjusted odds ratio, 2.71 [95% confidence interval, 1.62–4.55]; P Conclusions In a large population of young adults in sub-Saharan Africa, DD prevalence increased starting in the third decade of life. HIV was independently associated with dysfunction. Serum ST2 concentration was associated with DD in PLWH but not HIV-uninfected participants. This pathway may provide insight into the mechanisms of HIV-associated dysfunction.

Published
2020
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17. Atrial fibrillation and mortality in outpatients with heart failure in Tanzania: a prospective cohort study

Author

Yunchan Chen, Emmanuel Alphonce, Eva Mujuni, Godfrey A Kisigo, Justin R Kingery, Abel Makubi, RN Peck, and Fredrick Kalokola

Subjects
Adult, Heart Failure, Adolescent, public health, audit, General Medicine, Middle Aged, Cardiovascular Medicine, Prognosis, preventive medicine, Tanzania, Risk Factors, cardiology, Atrial Fibrillation, Outpatients, Medicine, Humans, Female, Prospective Studies, Aged
Abstract

ObjectiveIn recent years, the prevalence and mortality of heart failure (HF) and other associated cardiovascular diseases have doubled in sub-Saharan Africa (SSA). Studies in high-income countries indicate that HF with concurrent atrial fibrillation (AF) is linked to increased mortality. Our objective was to determine the incidence and clinical outcomes of AF among patients with HF in SSA.DesignA prospective cohort study using data collected between October 2018 and May 2020.SettingOutpatient clinic at a tertiary hospital in Mwanza, Tanzania.Participants303 adult participants (aged ≥18 years) with HF as defined by the European Society of Cardiology guidelines (2016) and 100 adults with HF as defined by clinical criteria alone were enrolled into the study. Patients with comorbid medical condition that had prognosis of MethodsParticipants were screened for AF, and their medical history, physical examinations and sociodemographic information were obtained. Multivariable logistic regression models were used to examine factors associated with AF incidence. Cox regression models were used to analyse 3-month mortality and its associated risk factors.ResultsWe enrolled 403 participants with HF (mean age 60±19 years, 234 (58%) female). The AF prevalence was 17%. In multivariable models, factors associated with AF were low income, alcohol consumption and longer duration of HF. At the end of the 3-month follow-up, 120 out of 403 (30%) participants died, including 44% (31/70) of those with AF. Higher heart rate on ECG, more severe New York Heart Association HF class, rural residence and anaemia were significantly correlated with mortality.ConclusionAF is common, underdiagnosed and is associated with significant mortality among outpatients with HF in Tanzania (HR 1.749, 95% CI 1.162 to 2.633, p=0.007). Our findings additionally identify tachycardia (>110 bpm, HR 1.879, 95% CI 1.508 to 2.340, p

Published
2022

18. Compliance to infection prevention and control interventions for slowing down COVID-19 in early phase of disease transmission in Dar es Salaam, Tanzania

Author

Janneth Maridadi Mghamba, Ndekya Maria Oriyo, Andre Arsene Fouda Bita, Elizabeth Shayo, Gibson Kagaruki, Reggis Katsande, Ally Hussein, Rogath Saika Kishimba, Loveness John Urio, Nsiande Lema, Neema Camara, Vida Makundi, Tigest Ketsela Mengestu, Grace Elizabeth Saguti, Michael Mesfin Habtu, Elias Kwesi, Muhammad Bakari, Rashid Mfaume, Abel Makubi, and Leonard Subi

Subjects
Adult, Cross-Sectional Studies, COVID-19, Dar es Salaam, Tanzania, mask, physical distancing, handwashing, compliance, Masks, Humans, General Medicine, Pandemics
Abstract

Introduction:on 16thMarch 2020, Tanzania announced its first COVID-19 case. The country had already developed a 72-hour response plan and had enacted three compulsory infection prevention and control interventions. Here, we describe public compliance to Infection Prevention and Control (IPC) public health measures in Dar es Salaam during the early COVID-19 response and testing of the feasibility of an observational method. Methods:a cross sectional study was conducted between April and May 2020 in Dar es Salaam City. At that time, Dar es Salaam was the epi centre of the epidemic. Respondents were randomly selected from defined population strata (high, medium and low). Data were collected using a structured questionnaire and through observations. Results:a total of 390 subjects were interviewed, response rate was 388 (99.5%). Mean age of the respondents was 34.8 years and 168 (43.1%) had primary level education. Out of the 388 respondents, 384 (98.9%) reported to have heard about COVID-19 public health and social measures, 90.0% had heard from the television and 84.6% from the radio. Covering coughs and sneezes using a handkerchief was the most common behaviour observed among 320 (82.5%) respondents; followed by hand washing hygiene practice, 312 (80.4%) and wearing face masks, 240 (61.9%). Approximately 215 (55.4%) adhered to physical distancing guidance. Age and gender were associated with compliance to IPC measures (both, p

Published
2022
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19. Rationale, design and protocol of a cross-sectional study on pregnancy-related cardiovascular diseases in Tanzania (PRECARDT): burden, characterisation and prognostic significance at delivery

Author

Abel Makubi, Pilly Chillo, Reuben Mutagaywa, Belinda Balandya, Peter Kisenge, Vincent Tarimo, Eva Mujuni, Evarist B Msaki, Josephine Mgaya, Albert Kihunrwa, Mohamed Janabi, Gideon Kwesigabo, Julie Makani, Lindsay Kendall, Juliet Addo, Bruno Mmbando, and Karen Sliwa

Subjects
Adult, maternal medicine, Adolescent, Prenatal Care, General Medicine, Cardiovascular Medicine, Prognosis, Tanzania, Cross-Sectional Studies, Cardiovascular Diseases, Pregnancy, valvular heart disease, cardiology, adult cardiology, Humans, echocardiography, Female, Prospective Studies
Abstract

IntroductionThe paucity of data describing cardiovascular disease (CVD) in pregnancy in many parts of Africa including Tanzania has given rise to challenges in proper management by the healthcare providers. This study is set out to (1) determine the prevalence of a range of CVDs during pregnancy in women attending antenatal clinics in Tanzania and (2) determine the impact of these CVDs on maternal and fetal outcomes at delivery.Methods and analysisThis is a cross-sectional study with a prospective component to be conducted in two referral hospitals in Tanzania. Pregnant women aged ≥18 years diagnosed with a CVD during the antenatal period are being identified and extensively characterised by performing clinical assessment, modified WHO staging, electrocardiography, echocardiography and laboratory tests. Patients identified with CVDs (exposed) and a subset without (unexposed) will be followed up to determine maternal and fetal outcomes at delivery. A minimum sample of 1560 will be sufficient to estimate the prevalence of CVDs with a 95% CI of 2.75% to 5.25%.Ethics and disseminationThe study is being conducted in accordance with the Helsinki declaration on studies involving human subjects. Ethical approvals have been obtained from Muhimbili University (reference number DA.282/298/01.C/) and Bugando Medical Centre (reference number CREC/330/2019) Ethics Committees. Informed consent is sought from all potential participants before any interview or investigations are performed. Study findings will be disseminated to the scientific community through different methods. Results will also be communicated to policymakers and to the public, as appropriate.

Published
2022

20. Anemia, Iron Deficiency, and Iron Supplementation in Relation to Mortality among HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy in Tanzania

Author

Christopher Duggan, Guerino Chalamilla, Ellen Hertzmark, Abel Makubi, Christopher R. Sudfeld, Eric Aris, Batool A. Haider, Wafaie W. Fawzi, Donna Spiegelman, and David Sando

Subjects
Adult, Male, medicine.medical_specialty, Anti-HIV Agents, Anemia, Iron, medicine.medical_treatment, 030231 tropical medicine, HIV Infections, Iron supplement, Tanzania, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Antiretroviral Therapy, Highly Active, hemic and lymphatic diseases, Virology, Internal medicine, Humans, Medicine, Anemia, Iron-Deficiency, business.industry, Proportional hazards model, Iron Deficiencies, Articles, Iron deficiency, medicine.disease, Infectious Diseases, Iron-deficiency anemia, Female, Parasitology, Underweight, medicine.symptom, business, Body mass index, Cohort study
Abstract

Anemia in HIV-infected patients improves with highly active antiretroviral therapy (HAART); however, it may still be associated with mortality among patients receiving treatment. We examined the associations of anemia severity and iron deficiency anemia (IDA) at HAART initiation and during monthly prospective follow-up with mortality among 40,657 adult HIV-infected patients receiving HAART in Dar es Salaam, Tanzania. Proportional hazards models were used to examine the associations of anemia severity and IDA at HAART initiation and during follow-up with mortality. A total of 6,261 deaths were reported. Anemia severity at HAART initiation and during follow-up was associated with an increasing risk of mortality (trend tests P < 0.001). There was significantly higher mortality risk associated with IDA at HAART initiation and during follow-up versus no anemia or iron deficiency (both P < 0.001). These associations differed significantly by gender, body mass index, and iron supplement use (all interaction test P < 0.001). The magnitude of association was stronger among men. Mortality risk with severe anemia was 13 times greater versus no anemia among obese patients, whereas it was only two times greater among underweight patients. Higher mortality risk was observed among iron supplement users, irrespective of anemia severity. Anemia and IDA were significantly associated with a higher mortality risk in patients receiving HAART. Iron supplementation indicated an increased mortality risk, and its role in HIV infections should be examined in future studies. Given the low cost of assessing anemia, it can be used frequently to identify high-risk patients in resource-limited settings.

Published
2019
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21. Health-related quality of life and mortality in heart failure. The global congestive heart failure study of 23000 patients from 40 countries

Author

Andrzej Budaj, Abel Makubi, Philip Joseph, T. Wittlinger, Anastase Dzudie, Khalid F. AlHabib, Jefferey L. Probstfield, Patricio Lopez-Jaramillo, A. Temizhan, Isabelle Johansson, Aldo P. Maggioni, Koon K. Teo, Bianca Fukakusa, Tara McCready, Keith A.A. Fox, Alex Grinvalds, Kumar Balasubramanian, Antonio L. Dans, Salim Yusuf, John J.V. McMurray, Deepak Y. Kamath, Justin A. Ezekowitz, Antoni Bayes-Genis, Lars H. Lund, José Silva-Cardoso, Fernando Lanas, Karen Sliwa, Kamilu M. Karaye, Hisham Dokainish, and Masira

Subjects
Heart Failure, Male, Health related quality of life, medicine.medical_specialty, business.industry, heart failure, health status, medicine.disease, Survival Analysis, Quality of life (healthcare), quality of life, Physiology (medical), Heart failure, Quality of Life, medicine, Geographic regions, Humans, ventricular function, left, Female, prognosis, Cardiology and Cardiovascular Medicine, Intensive care medicine, business, Aged
Abstract

Digital, Background: Poor health-related quality of life (HRQL) is common in heart failure (HF), but there are few data on HRQL in HF and the association between HRQL and mortality outside Western countries. Methods: We used the Kansas City Cardiomyopathy Questionnaire–12 (KCCQ-12) to record HRQL in 23 291 patients with HF from 40 countries in 8 different world regions in the G-CHF study (Global Congestive Heart Failure). We compared standardized KCCQ-12 summary scores (adjusted for age, sex, and markers of HF severity) among regions (scores range from 0 to 100, with higher score indicating better HRQL). We used multivariable Cox regression with adjustment for 15 variables to assess the association between KCCQ-12 summary scores and the composite of all-cause death, HF hospitalization, and each component over a median follow-up of 1.6 years. Results: The mean age of participants was 65 years; 61% were men; 40% had New York Heart Association class III or IV symptoms; and 46% had left ventricular ejection fraction ≥40%. Average HRQL differed between regions (lowest in Africa [mean± SE, 39.5±0.3], highest in Western Europe [62.5±0.4]). There were 4460 (19%) deaths, 3885 (17%) HF hospitalizations, and 6949 (30%) instances of either event. Lower KCCQ-12 summary score was associated with higher risk of all outcomes; the adjusted hazard ratio (HR) for each 10-unit KCCQ-12 summary score decrement was 1.18 (95% CI, 1.17–1.20) for death. Although this association was observed in all regions, it was less marked in South Asia, South America, and Africa (weakest association in South Asia: HR, 1.08 [95% CI, 1.03–1.14]; strongest association in Eastern Europe: HR, 1.31 [95% CI, 1.21–1.42]; interaction P, Ciencias Medicas y de la Salud

Published
2021
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22. Anaemia and iron deficiency in heart failure: epidemiological gaps, diagnostic challenges and therapeutic barriers in sub-Saharan Africa

Author

Lars Lund, Abel Makubi, Okechukwu S Ogah, Julie Makani, Lars Rydén, and Johnson Lwakatare

Subjects
sub-Saharan Africa, medicine.medical_specialty, Sub saharan, review, Psychological intervention, MEDLINE, 030204 cardiovascular system & hematology, 03 medical and health sciences, iron deficiency, 0302 clinical medicine, Epidemiology, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, Africa South of the Sahara, Heart Failure, anaemia, therapy, business.industry, Cardiovascular Topics, Anemia, Iron Deficiencies, General Medicine, Iron deficiency, Prognosis, medicine.disease, Clinical trial, stomatognathic diseases, Malnutrition, Heart failure, Chronic Disease, Immunology, epidemiology, Cardiology and Cardiovascular Medicine, business
Abstract

Summary Anaemia and iron deficiency (ID) are common and of prognostic importance in heart failure (HF). In both conditions the epidemiology, diagnosis and therapies have been extensively studied in high-income countries but are still largely unexplored in sub-Saharan Africa (SSA). The lack of adequate and robust epidemiological data in SSA makes it difficult to recognise the significance of anaemia and ID in HF. From a clinical perspective, less attention is paid by clinicians to screening for anaemia in HF, and as far as interventions are concerned, there are no clinical trials in SSA that provide guidance on the appropriate interventional approach. Therefore studies are needed to provide more insight into the burden and peculiarities of and intervention for anaemia and ID in HF in SSA, where the pathophysiology might be different from that in high-income countries. There is increasing appreciation that targeting ID may serve as a useful additional treatment strategy for patients with chronic HF in high-income countries. However, there is limited information on the diagnosis of and therapy for ID in HF in SSA, where infections and malnutrition are more likely to influence the situation. This article reviews the present epidemiological gap in knowledge about anaemia and ID in HF, as well as the diagnostic and therapeutic challenges in SSA.

Published
2017
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23. Fetal Hemoglobin is Associated with Peripheral Oxygen Saturation in Sickle Cell Disease in Tanzania

Author

Florence Urio, Sharon E. Cox, Charles R. Newton, Fenella J. Kirkham, Bruno Mmbando, Josephine Mgaya, Stephan Menzel, Siana Nkya, Swee Lay Thein, Julie Makani, and Abel Makubi

Subjects
Male, Reticulocytes, Reticulocytosis, lcsh:Medicine, Rate ratio, Tanzania, Gastroenterology, chemistry.chemical_compound, 0302 clinical medicine, hemic and lymphatic diseases, Odds Ratio, Child, Hypoxia, Fetal Hemoglobin, lcsh:R5-920, General Medicine, 3. Good health, Peripheral, 030220 oncology & carcinogenesis, Cohort, Female, medicine.symptom, lcsh:Medicine (General), Research Paper, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Adolescent, Bilirubin, Oxygen saturation, Anemia, Sickle Cell, Biology, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Internal medicine, Fetal hemoglobin, medicine, Humans, Sickle cell disease, lcsh:R, fungi, Confidence interval, Oxygen, chemistry, Immunology, Hemoglobin, Blood Gas Analysis, Fetal hemoglobin (HbF), Biomarkers, 030215 immunology
Abstract

Fetal hemoglobin (HbF) and peripheral hemoglobin oxygen saturation (SpO2) both predict clinical severity in sickle cell disease (SCD), while reticulocytosis is associated with vasculopathy, but there are few data on mechanisms. HbF, SpO2 and routine clinical and laboratory measures were available in a Tanzanian cohort of 1175 SCD individuals aged ≥ 5 years and the association with SpO2 (as response variable transformed to a Poisson distribution) was assessed by negative binomial model with age and sex as covariates. Increase in HbF was associated with increased SpO2 (rate ratio, RR = 1.19; 95% confidence intervals [CI] 1.04, 1.37 per natural log unit of HbF; p = 0.0004). In univariable analysis, SpO2 was inversely associated with age, reticulocyte count, and log (total bilirubin) and directly with pulse, SBP, hemoglobin, and log(HbF). In multivariable regression log(HbF) (RR 1.191; 95%CI 1.04, 1.37; p = 0.013), pulse (RR 1.01; 95%CI 1.00, 1.01; p = 0.026), SBP (RR 1.008; 95%CI 1.00, 1.02; p = 0.014), and hemoglobin (1.120; 95%CI 1.05, 1.19; p = 0.001) were positively and independently associated with SpO2 while reticulocyte count (RR 0.985; 95%CI 0.97, 0.99; p = 0.019) was independently inversely associated with SpO2. In SCD, improving SpO2, in part through cardiovascular compensation and associated with reduced reticulocytosis, may be a mechanism by which HbF reduces disease severity., Highlights • Fetal hemoglobin may moderate sickle cell disease through increased oxygen saturation. • Low oxygen saturation is associated with reticulocytosis which might moderate cerebral vasculopathy and stroke risk. • Higher pulse rate and systolic blood pressure in those with higher SpO2 suggests cardiovascular compensation for low SpO2. Fetal hemoglobin (HbF) is normally synthesized during intrauterine life and it starts to decline before birth being replaced by adult hemoglobin (HbA). However some individuals continue to synthesize HbF to adulthood and are relatively protected from severe sickle cell disease. The mechanism of HbF protection in SCD has not been entirely established. This study reports a positive association between HbF and oxygen saturation (SpO2). Higher SpO2 is associated with decreased reticulocytes but increased pulse rate and systolic blood pressure, suggesting SpO2 is maintained in part through cardiovascular compensation. Increasing HbF may reduce disease severity partly through increasing SpO2.

Published
2017
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24. Investigation and treatment for iron deficiency in heart failure: the unmet need in Lower and Middle Income Countries

Author

Abel Makubi and David J. Roberts

Subjects
medicine.medical_specialty, Pediatrics, Iron, Population, Cardiomyopathy, Comorbidity, 030204 cardiovascular system & hematology, Unmet needs, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, education, Developing Countries, Heart Failure, education.field_of_study, Anemia, Iron-Deficiency, Transferrin saturation, business.industry, Middle income countries, Iron Deficiencies, Hematology, Iron deficiency, Prognosis, medicine.disease, Surgery, Heart failure, Africa, business
Abstract

Frank iron deficiency has been associated with a wide range of cardiac and pulmonary abnormalities including non-ischaemic cardiomyopathy. Iron deficiency anaemia and isolated iron deficiency are well-defined adverse prognostic factors in non-ischaemic cardiac failure. Furthermore, iron-deficient patients in chronic heart failure with a serum ferritin of

Published
2017
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25. Heart failure in Tanzania and Sweden: Comparative characterization and prognosis in the Tanzania Heart Failure (TaHeF) study and the Swedish Heart Failure Registry (SwedeHF)

Author

Abel Makubi, Ulrik Sartipy, Camilla Hage, Julie Makani, Johnson Lwakatare, Peter Kisenge, Lars H. Lund, Ulf Dahlström, M. Janabi, and Lars Rydén

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Anemia, 030204 cardiovascular system & hematology, Tanzania, Article, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, medicine, Humans, Prospective Studies, Registries, 030212 general & internal medicine, Prospective cohort study, Aged, Aged, 80 and over, Heart Failure, Sweden, biology, Proportional hazards model, business.industry, Middle Aged, Prognosis, biology.organism_classification, medicine.disease, Heart failure, Cohort, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, Cohort study
Abstract

Heart failure (HF) in developing countries is poorly described. We compare characteristics and prognosis of HF in Tanzania vs. Sweden.A prospective cohort study was conducted from the Tanzania HF study (TaHeF) and the Swedish HF Registry (SwedeHF). Patients were compared overall (n 427 vs. 51,060) and after matching 1:3 by gender and age±5years (n 411 vs. 1232). The association between cohort and all-cause mortality was assessed with multivariable Cox regression.In the unmatched cohorts, TaHeF (as compared to SwedeHF) patients were younger (median age [interquartile range] 55 [40-68] vs. 77 [64-84] years, p0.001) and more commonly women (51% vs. 40%, p0.001). The three-year survival was 61% in both cohorts. In the matched cohorts, TaHeF patients had more hypertension (47% vs. 37%, p0.001), more anemia (57% vs. 9%), more preserved EF, more advanced HF, longer duration of HF, and less use of beta-blockers. Crude mortality was worse in TaHeF (HR 2.25 [95% CI 1.78-2.85], p0.001), with three-year survival 61% vs. 83%. However, covariate-adjusted risk was similar (HR 1.07, 95% CI 0.69-1.66; p=0.760). In both cohorts, preserved EF was associated with higher mortality in crude but not adjusted analysis.Compared to in Sweden, HF patients in Tanzania were younger and more commonly female, and after age and gender matching, had more frequent hypertension and anemia, more severe HF despite higher EF, and worse crude but similar adjusted prognosis.

Published
2016
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26. Tuberculosis incidence rate and risk factors among HIV-infected adults with access to antiretroviral therapy

Author

Nan Li, Abel Makubi, Guerino Chalamilla, Ellen Hertzmark, Christopher R. Sudfeld, David Sando, Paul K. Drain, Wafaie W. Fawzi, Donna Spiegelman, and Enju Liu

Subjects
Adult, Male, medicine.medical_specialty, Multivariate analysis, Tuberculosis, Anti-HIV Agents, Immunology, HIV Infections, Tanzania, Article, Sex Factors, Acquired immunodeficiency syndrome (AIDS), Risk Factors, Interquartile range, Antiretroviral Therapy, Highly Active, Internal medicine, Humans, Immunology and Allergy, Medicine, Prospective Studies, Prospective cohort study, Proportional Hazards Models, business.industry, Proportional hazards model, Hazard ratio, Middle Aged, medicine.disease, Confidence interval, CD4 Lymphocyte Count, Infectious Diseases, Multivariate Analysis, Physical therapy, Female, business
Abstract

Objective The objective of this study is to determine the incidence rate and risk factors of tuberculosis (TB) among HIV-infected adults accessing antiretroviral therapy (ART) in Tanzania. Design A prospective observational study among HIV-infected adults attending HIV clinics in Dar es Salaam. Methods We estimated TB incidence rates among HIV-infected patients prior to and after ART initiation. We used Cox proportional hazard regressions to determine the predictors of incident TB among HIV-infected adults enrolled in the HIV care and treatment programme. Results We assessed 67 686 patients for a median follow-up period of 24 (interquartile range: 8-49) months; 7602 patients were diagnosed with active TB. The TB incidence rate was 7.9 [95% confidence interval (95% CI), 7.6-8.2] per 100 person-years prior to ART initiation, and 4.4 (95% CI, 4.2-4.4) per 100 person-years for patients receiving ART. In multivariate analyses, patients on ART in the first 3 months had a 57% higher risk of TB (hazard ratio: 1.57, 95% CI, 1.47-1.68) than those not on ART, but the risk significantly decreased with increasing duration of ART. Risk factors for incident TB included being male, having low BMI or middle upper arm circumference, lower CD4 cell count and advanced WHO disease stage. There was seasonal variation for incident TB, with higher risk observed following the rainy seasons (May, June and November). Conclusion In TB endemic regions, HIV-infected patients initiating ART, particularly men and those with poor nutritional status, should be closely monitored for active TB at ART initiation. In addition to increasing the access to ART, interventions should be considered to improve nutritional status among HIV-infected patients.

Published
2015
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27. Possible Risk Factors for Severe Anemia in Hospitalized Sickle Cell Patients at Muhimbili National Hospital, Tanzania: Protocol for a Cross-Sectional Study (Preprint)

Author

Furahini Tluway, Florence Urio, Bruno Mmbando, Raphael Zozimus Sangeda, Abel Makubi, and Julie Makani

Abstract

BACKGROUND Sickle cell disease (SCD) is the most common inherited disorder worldwide, with the highest burden in sub-Saharan Africa. The natural history of SCD is characterized by periods of steady state interspersed by acute episodes. The acute anemic crises may be transient and are precipitated by treatable factors like infections, nutritional deficiencies, and sequestration. Anemia is almost always present, although it occurs at different levels of severity. OBJECTIVE This paper describes the protocol of a cross-sectional study to determine the prevalence of severe anemia and associated factors among sickle cell patients hospitalized at the Muhimbili National Hospital. METHODS This is an ongoing, descriptive, cross-sectional, hospital-based study among individuals with SCD, admitted to the Muhimbili National Hospital in Dares Salaam, Tanzania. A minimum sample size of 369 was calculated based on the previous prevalence of hospitalizations due to severe anemia (20%) in the same cohort. We are using a piloted standardized case report form to document clinical and laboratory parameters following informed consent. Data analysis will be performed using Stata software. Severe anemia is defined as Hb RESULTS Enrolment commenced in January 2015 and concluded in September 2016. Complete data analysis will begin in February 2018. The study results are expected to be published in May 2018. CONCLUSIONS This protocol paper will provide a useful and practical model for conducting cross-sectional studies in hospitalized patients that cover a wide ranging of clinical and laboratory variables.

Published
2017
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28. Prevalence and prognostic implications of anaemia and iron deficiency in Tanzanian patients with heart failure

Author

Camilla Hage, Lars Lund, Abel Makubi, Julie Makani, Peter Kisenge, Johnson Lwakatare, Lars Rydén, and Bruno P. Mmbando

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Cross-sectional study, Anemia, Iron, Renal function, Risk Assessment, Tanzania, Article, Risk Factors, Epidemiology, Prevalence, medicine, Humans, Prospective Studies, Prospective cohort study, Aged, Heart Failure, Framingham Risk Score, Anemia, Iron-Deficiency, business.industry, Iron deficiency, Middle Aged, Prognosis, medicine.disease, Hospitalization, Survival Rate, Cross-Sectional Studies, Heart failure, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Objective To determine the prevalence, correlates and prognostic implications of anaemia and iron deficiency (ID) in patients with heart failure (HF) in Tanzania. Method This was a cross-sectional and prospective observational study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. Patients were ≥18 years of age, with HF defined according to the Framingham criteria. The primary outcome was anaemia and the secondary outcome was a composite of hospitalisation for HF or all-cause mortality. Results A total of 401 HF patients (median age 56 years, IQR 41–67 years; women 51%) were included. The prevalence of anaemia was 57%. The overall prevalence of ID was 49% distributed as 69% versus 21% in subjects with and without anaemia (p

Published
2014
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29. Determinants of anemia in postpartum HIV-negative women in Dar es Salaam, Tanzania

Author

Willy Urassa, Wafaie W. Fawzi, Abel Makubi, Christopher Duggan, Paul Petraro, Gernard I. Msamanga, and Donna Spiegelman

Subjects
Erythrocyte Indices, medicine.medical_specialty, Anemia, Medicine (miscellaneous), HIV Infections, Antenatal care, Tanzania, Article, Hemoglobins, Folic Acid, Pregnancy, Risk Factors, hemic and lymphatic diseases, medicine, Humans, Prospective Studies, Postpartum Recovery, Mean corpuscular volume, Proportional Hazards Models, Surveillance, Nutrition and Dietetics, Anemia, Iron-Deficiency, medicine.diagnostic_test, Obstetrics, business.industry, Postpartum Period, Maternal Nutritional Physiological Phenomena, Iron deficiency, medicine.disease, CD4 Lymphocyte Count, Diet, Socioeconomic Factors, Iron-deficiency anemia, Dietary Supplements, Multivariate Analysis, Immunology, Female, Hemoglobin, business, Iron, Dietary, Postpartum period
Abstract

The determinants of anemia during both pregnancy and postpartum recovery remain incompletely understood in sub-Saharan African women. In a prospective cohort study among pregnant women, we assessed dietary, biochemical, anthropometric, infectious and sociodemographic factors at baseline. In multivariate Cox proportional hazards models, we examined predictors of incident anemia (hemoglobin

Published
2013
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30. Complete haematological response to Imatinib in chronic myeloid leukaemia patients attending the Ocean Road Cancer Institute in Tanzania

Author

Abel Makubi, Khamza Maunda, and Erius Tebuka

Subjects
medicine.medical_specialty, Hematology, Clinical, laboratory, characteristics, time to diagnosis, chronic leukaemia, Tanzania, Referral, business.industry, Medical record, Cancer, Imatinib, General Medicine, Disease, medicine.disease, Pallor, Surgery, 03 medical and health sciences, 0302 clinical medicine, hemic and lymphatic diseases, 030220 oncology & carcinogenesis, Internal medicine, Medicine, Outpatient clinic, medicine.symptom, business, 030215 immunology, medicine.drug
Abstract

Background: There is limited information on clinical characteristics, diagnosis and response to therapy of patients with chronic myeloid leukaemia (CML) in Tanzania. This hospital-based retrospective and cross-sectional study was conducted to describe the clinical and laboratory characteristics, time to diagnosis and response to first line therapy with imatinib in Philadelphia chromosome positive CML.Methods: The study was conducted at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Participants were sequentially recruited from the outpatient clinic where a structured questionnaire was employed seeking details socio-clinical features of the disease. Haematology indices at baseline and at three months of treatment was obtained from patient’s medical records. Haematological response was determined at three months of imatinib use using leukaemia net definition.Results: Of 127 study participants, 63% were males. The mean (±standard deviation) age at diagnosis was 40 (±16) years, majority being in the third decade of life. Abdominal distention (88%) and symptoms of anaemia (84%) were the most frequent complaints. Splenomegaly (92%) and pallor (82.7%) were the common physical findings. The mean duration from consultation to diagnosis was 3(±0) weeks and mean duration from diagnosis to imatinib therapy initiation was 3 (±0.9) weeks. A total of 116 (91.3%) of patients had complete haematological response to imatinib therapy three months after therapy. There was significant decline in total white blood cell counts, basophils count, platelets and increase in haemoglobin at three months after imatinib therapy initiation.Conclusion: Majority of patients were young with clinical and laboratory findings of severe disease. Patients presented late to hospital and there was a considerable long time to reach a final diagnosis and yet haematological response was still achieved in majority of these patients with imatinib therapy. The elucidated clinical and laboratory findings should advocate early CML diagnosis and immediate referral to a tertiary hospital.

Published
2016

31. Rationale and design of mDOT-HuA study: a randomized trial to assess the effect of mobile-directly observed therapy on adherence to hydroxyurea in adults with sickle cell anemia in Tanzania

Author

Enrico M. Novelli, Bruno P. Mmbando, Mark T. Gladwin, Philip Sasi, Julie Makani, Mariam Ngaeje, and Abel Makubi

Subjects
medicine.medical_specialty, Epidemiology, Health Informatics, Anemia, Sickle Cell, Tanzania, Medication Adherence, law.invention, Study Protocol, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Antisickling Agents, law, Internal medicine, Humans, Hydroxyurea, Medicine, 030212 general & internal medicine, Directly Observed Therapy, Randomized Controlled Trials as Topic, Medication possession ratio, lcsh:R5-920, biology, business.industry, Sickle cell disease, medicine.disease, biology.organism_classification, Sickle cell anemia, Clinical trial, Exact test, Treatment Outcome, Clinical research, Adherence, 030220 oncology & carcinogenesis, Physical therapy, Randomized trial, lcsh:Medicine (General), business, Cell Phone
Abstract

Background Hydroxyurea (HU) has been demonstrated to be efficacious in reducing complications in individuals with sickle cell anemia (SCA) but poor adherence is a barrier. Directly Observed Therapy (DOT) has been shown to improve adherence in various chronic diseases but there is limited data in adults with SCA. Methods and design To examine the effect of mobile-directly observed therapy (mDOT) on adherence to HU (mDOT-HuA) in adults with SCA at Muhimbili National Hospital in Tanzania. The mDOT-HuA study is a single centre, prospective, randomized, open label clinical trial. One-hundred individuals with SCA with haemoglobin SS genotype, aged ≥18 years, living in Dar es Salaam, able and willing to record and submit videos electronically will be included. Participants will be divided into two treatment arms; 50 in the standard monitoring (SM) arm will receive mobile phones and fixed dose HU therapy with standard monitoring; 50 in the mDOT arm will receive mobile phones, fixed dose HU therapy with standard monitoring and a mobile directly observed web based medication adherence monitoring system. The primary outcome is the proportion of participants achieving ≥80 % HU adherence compared between the two arms as assessed through medication possession ratio at the end of 3 months of treatment. REDCap, an open source software application will be used to collect data using clinical research forms. The proportions of adherence in the two arms will be compared by Fisher’s exact test. Analysis of outcomes will have performed by both the intention-to treat and per-protocol methods. Discussion Should this study become sucessful, it will have the potential for the development of novel strategies for improving HU adherence in SCA. Trial registration ClinicalTrials.gov Identifier: NCT02844673 , registered on 25tht July 2016 (retrospectively registered).

Published
2016
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32. Contemporary aetiology, clinical characteristics and prognosis of adults with heart failure observed in a tertiary hospital in Tanzania: the prospective Tanzania Heart Failure (TaHeF) study

Author

Camilla Hage, Lars Rydén, Abel Makubi, Johnson Lwakatare, Julie Makani, Lars H. Lund, and Peter Kisenge

Subjects
Male, Pediatrics, medicine.medical_specialty, Heart disease, Cardiomyopathy, HIV Infections, Comorbidity, Kidney Function Tests, Tanzania, Tertiary Care Centers, Atrial Fibrillation, Epidemiology, Diabetes Mellitus, medicine, Humans, Tuberculosis, Prospective Studies, Mortality, Prospective cohort study, Heart Failure, Framingham Risk Score, business.industry, Mortality rate, Anemia, Atrial fibrillation, Middle Aged, Prognosis, medicine.disease, Heart failure, Educational Status, Female, Warfarin, Cardiology and Cardiovascular Medicine, business
Abstract

Objective This study aimed to describe the contemporary aetiology, clinical characteristics and mortality and its predictors in heart failure (HF) in Tanzania. Methods Design ; Prospective observational study. Setting ; Cardiovascular Center of the Muhimbili National Hospital in Dar es Salaam, Tanzania. Patients ≥18 years of age with HF defined by the Framingham criteria. Main outcome measure All-cause mortality. Results Among 427 included patients, 217 (51%) were females and the mean (SD) age was 55 (17) years. HF aetiologies included hypertension (45%), cardiomyopathy (28%), rheumatic heart disease (RHD) (12%) and ischaemic heart disease (9%). Concurrent atrial fibrillation (AF), clinically significant anaemia, diabetes, tuberculosis and HIV were found in 16%, 12%, 12%, 3% and 2%, respectively, while warfarin was used in 3% of the patients. The mortality rate, 22.4 per 100 person-years over a median follow-up of 7 months, was independently associated with AF, HR 3.4 (95% CI 1.6 to 7.0); in-patient 3.2 (1.5 to 6.8); anaemia 2.3 (1.2 to 4.5); pulmonary hypertension 2.1 (1.1 to 4.2) creatinine clearance 0.98 (0.97 to 1.00) and lack of education 2.3 (1.3 to 4.2). Conclusions In HF in Tanzania, patients are younger than in the developed world, but aetiologies are becoming more similar, with hypertension becoming more and RHD less important. Predictors of mortality possible to intervene against are anaemia, AF and lack of education.

Published
2016

33. Audit of clinical-laboratory practices in haematology and blood transfusion at Muhimbili national hospital in Tanzania

Author

James Rwehabura, Zubeda Salum, Ephata E Kaaya, Abel Makubi, David Robert, Alex Sifaeli Magesa, Amrana Quaresh, Rumisha E. Kweka, Pius Magesa, Juliana Mlalasi, Julie Makani, Collins Meda, Peter Minja, and DelPhe, Muhimbilil University of Health and Allied Sciences

Subjects
medicine.medical_specialty, Blood transfusion, medicine.medical_treatment, Medical laboratory, Audit, Tanzania, Article, Internal medicine, External quality assessment, Health care, medicine, Humans, Blood Transfusion, Intensive care medicine, Medical Audit, Hematology, business.industry, Donor selection, General Medicine, Clinical Laboratory Services, medicine.disease, Checklist, Hospitals, Cross-Sectional Studies, Medical emergency, business, audit, laboratory, haematology, practices, hospital, Tanzania
Abstract

In Tanzania, there is paucity of data for monitoring laboratory medicine including haematology. This therefore calls for audits of practices in haematology and blood transfusion in order to provide appraise practice and devise strategies that would result in improved quality of health care services. This descriptive cross-sectional study which audited laboratory practice in haematology and blood transfusion at Muhimbili National Hospital (MNH) aimed at assessing the pre-analytical stage of laboratory investigations including laboratory request forms and handling specimen processing in the haematology laboratory and assessing the chain from donor selection, blood component processing to administration of blood during transfusion. A national standard checklist was used to audit the laboratory request forms (LRF), phlebotomists’ practices on handling and assessing the from donor selection to administration of blood during transfusion. Both interview and observations were used. A total of 195 LRF were audited and 100% of had incomplete information such as patients’ identification numbers, time sample ordered, reason for request, summary of clinical assessment and differential diagnoses. The labelling of specimens was poorly done by phlebotomists/clinicians in 82% of the specimens. Also 65% (132/202) of the blood samples delivered in the haematology laboratory did not contain the recommended volume of blood. There was no laboratory request form specific for ordering blood and there were no guidelines for indication of blood transfusion in the wards/clinics. The blood transfusion laboratory section was not participating in external quality assessment and the hospital transfusion committee was not in operation. It is recommended that a referral hospital like MNH should have a transfusion committee to provide an active forum to facilitate communication between those involved with transfusion, monitor, coordinate and audit blood transfusion practices as per national guidelines.

Published
2016

34. Anaemia prevalence and factors associated with haemoglobin change following radiotherapy in individuals with cancers at the Ocean Road Cancer Institute in Tanzania

Author

Andrew Shiyo, Abel Makubi, and Crispin Kahesa

Subjects
medicine.medical_specialty, Pediatrics, biology, business.industry, Cross-sectional study, Public health, education, Prevalence, Developing country, General Medicine, 030501 epidemiology, biology.organism_classification, Occupational safety and health, 03 medical and health sciences, 0302 clinical medicine, Tanzania, cancer, anaemia, haemoglobin, radiotherapy, Tanzania, Universal precautions, 030220 oncology & carcinogenesis, Family medicine, Health care, medicine, 0305 other medical science, business
Abstract

Background: Healthcare workers (HCWs) are exposed to blood-borne infections by pathogens, such as HIV, and Hepatitis B and C viruses, as they perform their clinical activities in hospitals. Compliance with universal precautions has been shown to reduce the risk of exposure to these pathogens. This aimed at assessing the knowledge, practices and factors associated with poor compliance to universal precautions among HCWs at Bugando Medical Centre in Mwanza, Tanzania. Methods: This was a cross sectional study carried out from December 2014 to February 2015. Results : There were 200 participants including 62 (31.0%) doctors, 74 (37.0%) nurses, laboratory personnel 34 (17.0%) and 29 (14.5%) auxiliary HCWs. More than three quarters (82%) of participants had adequate knowledge of uni­versal precautions. There was statistically significant difference between knowledge of universal precautions and sex, job category, working experience (≥ 5 years) and previous training on universal precautions. Out of 200 HCWs, 154 (77.0%) practiced universal precautions. Working experience (≥ 5 years) and previous training on universal precautions were significantly associated with good practice of universal precautions (P < 0.001). There was a strong correlation between knowledge and compliance (practice) with universal precautions (r=0.76, p

Published
2016

35. Determinants of Anemia Among Human Immunodeficiency Virus-Positive Adults at Care and Treatment Clinics in Dar es Salaam, Tanzania

Author

Donna Spiegelman, Guerino Chalamilla, Wafaie W. Fawzi, Helen Siril, Said Aboud, Christopher Duggan, David Sando, Abel Makubi, Ellen Hertzmark, and Paul Petraro

Subjects
Adult, Male, medicine.medical_specialty, Tuberculosis, Anemia, Anti-HIV Agents, Context (language use), HIV Infections, 030204 cardiovascular system & hematology, Tanzania, Body Mass Index, 03 medical and health sciences, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Risk Factors, Virology, Internal medicine, hemic and lymphatic diseases, medicine, Humans, 030212 general & internal medicine, business.industry, Incidence (epidemiology), Body Weight, Articles, Middle Aged, medicine.disease, Comorbidity, CD4 Lymphocyte Count, Infectious Diseases, Iron-deficiency anemia, Immunology, Parasitology, Female, business, Body mass index
Abstract

Anemia is often a comorbidity of human immunodeficiency virus (HIV) infection. Many cross-sectional studies have been conducted on anemia and HIV, but few, if any, have addressed incidence of anemia prospectively. A longitudinal analysis was conducted in 48,068 nonpregnant HIV-infected adults in Dar es Salaam, Tanzania, seen at Management and Development for Health-U.S. President's Emergency Plan for AIDS Relief HIV care and treatment programs between 2004 and 2011. Almost 56% (N = 27,184) of study participants had anemia (hemoglobin < 11 g/dL) at the time of enrollment at the clinic. Female gender, low body mass index (BMI), low CD4 T-cell count, high levels of liver enzyme alanine aminotransferase, antiretroviral treatment (ART) regimens, and concurrent tuberculosis treatment were all independently significantly associated with an increased risk of anemia. Low BMI and low CD4 T-cell count were independently significantly associated with an increased risk for iron deficiency anemia (IDA). Higher BMI status and ART use were associated with recovery from anemia. Anemia, including IDA, is a comorbidity that is associated with other adverse consequences (e.g., low BMI and CD4 T-cell count) among individuals with HIV infection, including those on ART. Interventions to prevent anemia and its complications need to be examined in the context of future studies.

Published
2015

36. Burden and Determinants of Severe Anemia among HIV-Infected Adults: Results from a Large Urban HIV Program in Tanzania, East Africa

Author

James Okuma, Abel Makubi, Elizabeth Jackson, Donna Spiegelman, Claudia Hawkins, Anne Marie Darling, Guerino Chalamilla, Wafaie W. Fawzi, and Ferdinand Mugusi

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Multivariate analysis, Adolescent, Anemia, Microcytic anemia, Immunology, Population, HIV Infections, Dermatology, Tanzania, Article, Young Adult, hemic and lymphatic diseases, medicine, Prevalence, Humans, education, Child, Aged, Aged, 80 and over, education.field_of_study, biology, business.industry, Urban Health, Normocytic anemia, Middle Aged, medicine.disease, biology.organism_classification, Infectious Diseases, Cross-Sectional Studies, Female, Hemoglobin, business, Body mass index
Abstract

Background and Methods: This cross-sectional study aimed at determining the prevalence and risk factors for severe anemia, severe microcytic anemia, and severe normocytic anemia among HIV-infected individuals aged >15 years. Univariate and multivariate analyses were performed to identify the risk factors for anemia. Results: Data from 40 408 patients were analyzed, showing an overall prevalence of 22% for severe anemia. The risk of developing severe anemia increased by 49% among patients with a body mass index of 2, by approximately 2-fold among patients with the World Health Organization (WHO) stage III, and by 3-fold among patients with WHO stage IV illness. Severe normocytic anemia was uniquely increased among patients aged ≥50 years, among those with chronic diarrhea and Kaposi's sarcoma, and those taking cotrimoxazole. Conclusion: There was a high prevalence of severe anemia among adults infected with HIV. Focused identification of anemia should be based on the hemoglobin and mean corpuscular volume measurements.

Published
2013

37. Teaching and educational scholarship in Tanzania: faculty initiative to improve performance of health professions' students

Author

Abel Makubi, Doreen Mloka, Charles A. Mkony, Germana H Leyna, Sarah B. Macfarlane, Molly Fyfe, Edith A. M. Tarimo, Ephata E Kaaya, Selma Omer, Phyllis Freeman, Sirra S Owibingire, Patricia S. O'Sullivan, and Carmen J. Portillo

Subjects
medicine.medical_specialty, Faculty, Medical, Public health law, education, Tanzania, Environmental health, ComputingMilieux_COMPUTERSANDEDUCATION, medicine, Humans, Curriculum, Health policy, Medical sociology, Academic Medical Centers, Health Services Needs and Demand, Education, Medical, business.industry, Health Policy, Public health, Teaching, Public Health, Environmental and Occupational Health, International health, Competency-Based Education, Health Occupations, Health care reform, Faculty development, business, Psychology
Abstract

Well-educated and competent health professionals influence the health system in which they work to improve health outcomes, through clinical care and community interventions, and by raising standards of practice and supervision. To prepare these individuals, training institutions must ensure that their faculty members, who design and deliver education, are effective teachers. We describe the experience of the Muhimbili University of Health and Allied Sciences (MUHAS) in encouraging improvements in the teaching capacity of its faculty and postgraduate students triggered by a major institutional transition to competency-based education. We employed a multi-stage process that started by identifying the teaching and learning needs and challenges of MUHAS students and faculty. Collaborating with the University of California San Francisco (UCSF), MUHAS responded to these needs by introducing faculty to competency-based curricula and later to strategies for long term continuing improvement. We demonstrate that teaching faculty members are keen for local institutional support to enable them to enhance their skills as educators, and that they have been able to sustain a program of faculty development for their peers.

Published
2012

38. Moyamoya Disease, a Rare Cause of Recurrent Strokes in an African Sickle Cell Child: Does hydroxyurea have a Role in this Context?

Author

Abel Makubi, Julie Makani, and Deogratius Soka

Subjects
Pediatrics, medicine.medical_specialty, business.industry, Incidence (epidemiology), Context (language use), Disease, Case presentation, medicine.disease, Moyamoya sickle cell, stroke, Sickle cell anemia, hydroxyurea, Recurrent stroke, medicine, Moyamoya disease, business, Stroke
Abstract

Background: Neurological complications are a significant cause of morbidity and mortality in sickle cell patients with reported incidence of stroke in Africa as high as 1􀀁3/100 patient per year [1,2]. There is an association between sickle cell disease (as well as other hemoglobinopathies) and Moyamoya disease [3]. Data on the occurrence of this condition in African sickle patient are scare. Likewise the role of hydroxyurea among patients with both sickle cell anemia and Moyamoya disease in preventing stroke has not yet been studied in Africa. Case presentation: In the present report, we describe an African child who had a recurrent stroke. She was later diagnosed as having Moyamoya disease while already receiving hydroxyurea. Conclusion: Moyamoya disease is a rare condition associated with recurrent stroke in African sickle children. The role of hydroxyurea in this context is still unclear.

Published
2012

39. The burden and morhological types of anaemia among HIV infected children in Dar es salaam,Tanzania

Author

Pius Magesa, A Quaresh, Ferdinand Mugusi, Abel Makubi, and D Roberts

Subjects
Pediatrics, medicine.medical_specialty, biology, Cross-sectional study, business.industry, Microcytosis, Iron deficiency, medicine.disease, biology.organism_classification, Exact test, Tanzania, Dar es salaam, hemic and lymphatic diseases, Hypochromia, Etiology, Medicine, business
Abstract

Background: There is paucity of data describing magnitude of anaemia among HIV infected children in Tanzania. Most of the studies among anaemic Tanzanian children were conducted before the era of HIV and HAART.Materials and Methods: This was a cross sectional study aimed at determining the prevalence and morphological types of anaemia among HIV-infected children attending public hospitals in Dar es Salaam. The prevalence of anaemia was determined as a percentage among all children infected with HIV. To describe the spectrum of red blood cell (RBC) morphology on blood films a pairwise comparison was conducted using Chi squire test or Fisher’s exact test.Findings: In this study the overall prevalence of anaemia (Hb

Published
2011

40. Anticoagulant Control Results among Patients with Mechanical Heart Valves at Muhimbili National hospital, Tanzania

Author

J.E. Nordrehaug, Abel Makubi, P Magesa, and J Lwakatare

Subjects
Prothrombin time, medicine.medical_specialty, Percentile, biology, medicine.diagnostic_test, business.industry, medicine.drug_class, Medical record, Anticoagulant, Warfarin, Retrospective cohort study, biology.organism_classification, Logistic regression, Tanzania, Emergency medicine, Medicine, business, Intensive care medicine, medicine.drug
Abstract

Background: Patients with mechanical heart valves receive life long, oral anticoagulant therapy to prevent thromboembolic complications, but this treatment is associated with an increased risk of bleeding (1). However no study in Tanzania has been done to review the adequacy of anticoagulation monitoring and risk factors involved in the operated patients receiving warfarin. Broad objective: The study aimed at reviewing the adequacy of anticoagulant control results among patients with mechanical heart valves attending the anticoagulation clinic at Muhimbili National Hospital (MNH). Study design: This was a retrospective cohort study. Study settings. The study was conducted in Dar es Salaam at the anticoagulation clinic, MNH. Measure of outcome: Review of adequacy of anticoagulation control results was analyzed as percentages of all prothrombin ratio tests done during the whole period of follow up to determine the proportion of tests which were within the therapeutic level, below or above it. Basing on defined percentile levels, the number of patients who were adequately controlled was calculated. Univariate and Multivariate logistic regression was also done to assess factors such as warfarin dose, source, food habits and drugs that could be associated with the high level of anticoagulation Subjects: The study involved all patients-receiving- warfarin with mechanical heart valves operated from 1990 to 2003 attending the anticoagulation clinic at MNH. Methods: Assessment of anticoagulation adequacy was based on the prothrombin ratio measurements that were recorded in the anticoagulation booklets. Each prothrombin ratio measurement was assessed if it was within the therapeutic level, above or below it. Information on risk factors influencing the anticoagulation monitoring was obtained from medical records and interviews. Findings: During study follow-up, a total of 10583 prothrombin ratio measurements were done among all 189 patients who were available for interview. Only 35.5% of the measurements were within the recommended therapeutic (normal) range, 33.4% above therapeutic and 31.1% below it. Thus, in only 35.5% of the follow-up prothrombin ratios, was adequate anticoagulation maintained. The study also only 23.8% (45/189 patients) of the patients were able to maintain adequate anticoagulation for more than 56.5% (more than 80 percentile) of their Prothrombin ratio measurements done during follow up. The occurrence of both thromboembolic and bleeding complications was only significantly reduced when the level of anticoagulation adequacy was above 80 percentile. Conclusions and recommendations: Most of the Prothrombin Time results were out of therapeutic ranges reflecting high anticoagulation inadequacy. It was recommended to improve the anticoagulant adequacy among study patients. Tanzania Medical Journal Vol. 23 (1) 2008: pp. 12-15

Published
2008
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41. Thromboembolic and Bleeding Complications among Patients with Mechanical Heart Valves Attending the MuhimbilI National Hospital, Tanzania

Author

P Magesa, Abel Makubi, J Lwakatare, and J Killewo

Subjects
medicine.medical_specialty, Pediatrics, biology, business.industry, medicine.drug_class, Medical record, Incidence (epidemiology), medicine.medical_treatment, Anticoagulant, Retrospective cohort study, biology.organism_classification, Tanzania, Valve replacement, Emergency medicine, medicine, Complication, business, Survival analysis
Abstract

Background: Thromboembolic and anticoagulant related bleeding complications are the main causes of morbidity and mortality in patients with mechanical heart valves. A review of articles published since 1979 indicates that thromboembolic and bleeding complications account for about 75% of valve-related complications in patients with mechanical heart valves (2). However, the magnitude of these complications in Tanzania has not been established. Objective: This study was conducted to determine the incidence of thromboembolic and bleeding complications among patients with mechanical heart valves operated from 1990 to 2003 attending the Muhimbili National Hospital. Study design: This was a retrospective cohort study conducted at the cardiac, anticoagulation clinics and medical records section. Study settings: The study was conducted in Dar es Salaam at Muhimbili National Hospital in either the cardiac or anticoagulant clinics. Measure of outcome: The incidence rate of complications was reported as the number of complications per patient year of observation. Survival curves were obtained using the method of Kaplan and Meier to determine the freedom (survival) rate from either thromboembolic or bleeding complications. The time taken to develop a first complication since valve replacement was used for analysis. Subjects: All patients with mechanical heart valves who were operated from 1990 to 2003 attending the Muhimbili National Hospital Methodology: Determination of complications involved tracing complications recorded in the file for all patients. This also included tracing their operational (surgical) notes to obtain their baseline demographical and surgical information .Additional collaborative information, by interview, was added for patients who were still attending the clinics Results: Among the 232 study patients, 59 (25.4%) suffered a total of 83 thromboembolic episodes. The linearized incidence of minor (grade I and II) episodes was 5.5% person-years and 3.5 % person-years for major (grade III) episodes. The study also indicated that 87 (37.5%) patients suffered a total of 132 bleeding events. The linearized incidence rate of minor bleedings was 11.4% person-years while that of major bleeding was 2.9 % person-years. Conclusion and recommendation: It was concluded that the incidence of both thromboembolic and bleeding complications was high among study patients. It was recommended to conduct further studies that will focus on the factors contributing to this high incidence Tanzania Medical Journal Vol. 22 (1) 2007: pp. 12-16

Published
2007
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