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Emmanuela E Ambrose,1 Benson R Kidenya,2 Mwesige Charles,3 Joyce Ndunguru,4 Agnes Jonathan,4 Julie Makani,4 Irene K Minja,4,5 Paschal Ruggajo,4,6 Emmanuel Balandya4,7 1Department of Paediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 2Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 3Department of Laboratory Services, Bugando Medical Centre, Mwanza, Tanzania; 4Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 5Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 6Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 7Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaCorrespondence: Emmanuela E Ambrose, Department of Paediatrics and Child Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania, Tel +255789733833, Fax +255282500799, Email emmanuelaambrose@gmail.comPurpose: To assess clinical and haematological outcomes of Hydroxyurea accessed via various access means and uncover the barriers to its utilization in children with Sickle cell anaemia (SCA), North-western Tanzania.Patients and Methods: A retrospective study was conducted between October 2020 and April 2021 at Bugando Medical Centre (BMC) through review of medical files to compare the clinical and haematological outcomes among children with SCA at baseline and followed up retrospectively for at least one year of hydroxyurea utilization, accessed via cash, insurance and projects. Subsequently, a cross-sectional survey was conducted among parents and caregivers to ascertain the barriers to access of hydroxyurea via the various means. The p-values < 0.05 were considered statistically significant.Results: We identified 87 children with SCA who were on hydroxyurea for at least one year. The median age at baseline (before hydroxyurea) was 99 [78– 151] months, and 52/87 (59.8%) were male. Compared to baseline, there was a significant reduction in proportion of patients reporting vaso-occlusive crisis, admissions and blood transfusions, a significant increase in Haemoglobin and mean corpuscular volume, conversely a significant reduction in absolute neutrophil and reticulocytes to both insurance and project participants. There was no significant change in most of these parameters among patients who accessed hydroxyurea via cash. Further, a total of 24/87 (27.6%) participants reported different barriers to access of hydroxyurea, where 10/24 (41.7%) reported hydroxyurea to be very expensive, 10/24 (41.7%) reported insurance challenges, and 4/21 (16.6%) reported unavailability of the drug.Conclusion: The paediatric patients utilizing hydroxyurea accessed via insurance and projects, but not cash, experienced significant improvement in the clinical and haematological outcomes. Several barriers for access to hydroxyurea were observed which appeared to impact these outcomes. These findings call for concerted efforts to improve the sustainable access to hydroxyurea among all patients with SCA.Keywords: sickle cell anaemia, hydroxyurea, access, outcomes, North-western Tanzania

Ritah F Mutagonda,1,2 George Bwire,3 Raphael Zozimus Sangeda,2,3 Manase Kilonzi,1 Hamu Mlyuka,1 Joyce Ndunguru,2,4 Agnes Jonathan,2,4 Julie Makani,2,4 Irene Kida Minja,2,5 Paschal Ruggajo,2,6 Emmanuel Balandya,2,7 Appolinary AR Kamuhabwa1 1Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania; 2Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania; 3Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania; 4Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania; 5Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania; 6Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania; 7Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es salaam, TanzaniaCorrespondence: Ritah F Mutagonda, Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, P.O BOX 65013, Dar es salaam, Tanzania, Tel +255 713 816481, Email mutagonda@muhas.ac.tz; rittdavisrida@yahoo.comBackground: Bacterial infections contribute significantly to morbidity and mortality in sickle cell disease (SCD) patients, particularly children under five years of age. In Tanzania, prophylaxis against pneumococcal infection among children with SCD advocates the use of both oral penicillin V (PV) and pneumococcal vaccines (PNV). Therefore, this study aimed to investigate nasopharyngeal carriage and antibiogram of Streptococcal pneumoniae (S. pneumoniae) and Staphylococcus aureus (S. aureus) in children with SCD in Tanzania.Methods: This cross-sectional study was undertaken at the two Sickle Pan-African Research Consortium (SPARCO) study sites in Dar es salaam, Tanzania. The study was conducted for six months and enrolled children with SCD between the ages of 6 to 59-months. A semi-structured questionnaire was used to collect patient data. Nasopharyngeal swabs were collected from all participants and cultured for Streptococcal pneumoniae and other bacterial isolates. Antimicrobial susceptibility tests of the isolates were done using the disc diffusion method.Results: Out of 204 participants, the overall prevalence of bacterial carriage was 53.4%, with S. aureus (23.5%), coagulase-negative Staphylococci (CoNS) (23%) and S. pneumoniae (7.8%) being commonly isolated. In antibiotic susceptibility testing, S. aureus isolates were most resistant to penicillin (81.8%), whereas 81.3% of S. pneumoniae isolates were resistant to co-trimoxazole. The least antimicrobial resistance was observed for chloramphenicol for both S. aureus and S. pneumoniae isolates (6.3% versus 0%). The proportion of multi-drug resistance (MDR) was 66.7% for S. aureus isolates and 25% for S. pneumoniae isolates.Conclusion: There are substantially high nasopharyngeal carriage pathogenic bacteria in children with SCD in Dar es Salaam, Tanzania. The presence of MDR strains to the commonly used antibiotics suggests the need to reconsider optimizing antimicrobial prophylaxis in children with SCD and advocacy on pneumococcal vaccines.Keywords: pneumococcal carriage, bacterial pathogens, pneumococcal prophylaxis, antimicrobial resistance

Background Heart failure among patients on hemodialysis therapy portends poor outcomes. Traditional risk factors like aging, hypertension and diabetes mellitus are relatively common in these patients and may not accurately predict the occurrence of heart failure. Such patients may have other factors that contribute to heart failure. This study aimed to investigate the prevalence and predictors of heart failure among patients on maintenance hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania. Results Among 160 patients on maintenance hemodialysis, 49 (30.6%) were female. The mean age of patients was 52.2 ± 13.3 years. Almost all patients had hypertension and 69 (43.1%) had diabetes mellitus. Heart failure was prevalent in 17 (10.6%) patients. On multivariate analysis, presence of angina, intradialytic hypertension, and anemia were independent predictors of heart failure. Patients with heart failure had significantly higher malnutrition inflammation scores and erythropoietin resistance indexes. Conclusions Heart failure among hemodialysis patients correlates with the presence of angina, intradialytic hypertension, and anemia. Patients with heart failure had a greater degree of malnutrition–inflammation complex, and erythropoietin resistance. Patients with these conditions require a thorough cardiac evaluation and appropriate treatment.

Despite three decades of proven safety and effectiveness of hydroxyurea in modifying sickle cell disease (SCD), its accessibility is limited in Sub-Saharan Africa, which shares 75% of the world's SCD burden. Therefore, it is time to explore the barriers and facilitators for manufacturing and importation of hydroxyurea for SCD in Tanzania. This was qualitative research that employed a case study approach. Purposive sampling followed by an in-depth interview (IDI) using a semi-structured questionnaire aspired by data saturation enabled us to gather data from 10 participants. The study participants were people with more than three years of experience in pharmaceuticals importation, manufacturing, and regulation. The audio-recorded data were verbatim transcribed and analyzed using thematic analysis. Two themes were generated. The first comprised barriers for importation and manufacturing of hydroxyurea with sub-themes such as inadequate awareness of SCD and hydroxyurea, limited market, and investment viability. The second comprised opportunities for importation and manufacturing of hydroxyurea with sub-themes such as awareness of activities performed by medicines regulatory authority and basic knowledge on SCD and hydroxyurea. Inadequate understanding of SCD, hydroxyurea, and orphan drug regulation are major issues that aggravate the concern for limited market and investment viability. Existing opportunities are a starting point towards increasing the availability of hydroxyurea. ispartof: HEALTHCARE vol:10 issue:11 ispartof: location:Switzerland status: published

Tanzania is one of the countries with a high burden of sickle cell disease (SCD). Haemolytic anaemia is a clinical feature of SCD, and has been linked to major complications leading to morbidity and mortality. Treatment with hydroxyurea (HU) has shown to induce foetal haemoglobin (HbF) which in turn decreases haemolysis in patients. This study aimed to investigate the effects of HU on haemolysis in SCD patients attending Muhimbili National Hospital, Tanzania by comparing their haemolytic parameters before and after therapy. Patients meeting the criteria were initiated on HU therapy for 3 months. Two haemolytic biomarkers: unconjugated plasma bilirubin levels and absolute reticulocyte counts were measured from patients’ blood samples at baseline and after 3 months of HU therapy and compared. Both absolute reticulocyte counts and indirect plasma bilirubin levels significantly declined after HU therapy. Median (IQR) plasma unconjugated bilirubin levels dropped significantly from 20.3 (12.7–34.4) μmol/L to 14.5 (9.6–24.1) μmol/L (p < 0.001) and mean (SD) absolute reticulocyte counts dropped significantly from 0.29 (0.1) x 109/L to 0.17 (0.1) x 109/L (p < 0.001) after therapy, thus, a decline in both haemolytic biomarkers after treatment was observed. This study found a potential for use of HU therapy in managing SCD patients in our settings evidenced by improvements in their haemolytic parameters. Clinical trials with a lager sample size conducted for a longer time period would be beneficial in guiding towards the inclusion of HU in treatment protocols for the Tanzanian population. Keywords: Sickle cell disease; hydroxyurea; haemolysis; foetal haemoglobin

Background: Globally, Sickle cell disease (SCD) is one of the most common genetic disease with high childhood mortality. Early identification of babies with SCD through newborn screening (NBS) and linking them to care are among the recommended interventions. The purpose of this study was to assess the predictors of the effectiveness of health education intervention and the uptake of infant diagnosis for sickle cell disease among pregnant women attending antenatal clinics in Dar-Es-Salaam, Tanzania.Methods: This was a quasi-experimental study which involved pregnant women attending antenatal clinics at Buguruni health center, Mbagala hospital and Sinza hospital in Dar Es Salaam. A structured questionnaire was used in data collection. Knowledge on SCD (poor if score effectiveness” of health education intervention as the post-intervention minus baseline knowledge score. We used two-sample test of proportions, univariate and multivariate logistic regression to analyze the effectiveness of health education intervention and also predictors of infant diagnosis. Results: Total of 467 pregnant women completed two sessions of health education intervention and 218 were screened for SCD during antenatal visits. The proportion of participants with good knowledge on SCD had significantly increased from 12.4% at baseline to 85.9% following the education intervention. During multivariate analysis, sharing the received education on SCD was an independent predictor of the effectiveness of health education intervention. Likewise, independent predictors of the uptake of infant diagnosis for SCD included maternal occupation, maternal SCD status as well as sharing the received education on SCD.Conclusion: This study has demonstrated that maternal health education and maternal screening for SCD are feasible and effective interventions in raising awareness and improving the uptake of infant diagnosis for SCD. These interventions are strongly recommended to be included in the comprehensive care package for pregnant women attending antenatal clinics, particularly in areas with a high burden of SCD.

Evarist Mulyahela Wilson,1 Irene Kida Minja,1,2 Ferdinand Mabula Machibya,3 Agnes Jonathan,4 Julie Makani,2,4 Paschal Ruggajo,5 Emmanuel Balandya2,6 1Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Sickle Pan-African Research Consortium (SPARCO), Dar es Salaam, Tanzania; 3Department of Orthodontics, Pedodontics and Community Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 4Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 5Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 6Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaCorrespondence: Evarist Mulyahela Wilson, Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, P. O. Box 65014, Dar es Salaam, Tanzania, Tel +255757352296, Email evarist1818@gmail.comPurpose: To determine oxygen saturation in the pulp of primary teeth in children with sickle cell disease (SCD) and sickle cell trait (SCT) for establishing the usefulness of pulse oximetry in screening and monitoring of SCD or therapy.Materials and Methods: A cross-sectional study among 30– 60 months children with sickle cell disease (SCD) and sickle cell trait (SCT) compared with healthy children (HbAA). A pulse oximeter (BCI 3301) recorded oxygen saturation on six anterior primary maxillary teeth and on index fingers. Data were analyzed using SPSS version 20.0. Mean oxygen saturation for teeth and fingers was calculated. Comparison of Mean across groups was done using post hoc analysis in one-way ANOVA (Bonferroni test). Pearson correlation coefficient was calculated for mean oxygen saturation on fingers and teeth. Level of significance was set at 0.05.Results: Altogether 360, 102, and 96 teeth were examined from children with SCD, SCT, and HbAA respectively. 53% of participants were girls. The mean age of participants was 46.3 months ± 9.4 SD. Low mean oxygen saturation (77.5%) was recorded from teeth of children with SCD relative to those with SCT and HbAA (> 86%; P = 0.00). There was no statistically significant difference in oxygen saturation on teeth between children with SCT and HbAA. The mean oxygen saturation on fingers was found to be above 97.2% regardless of sickle cell status. There was no correlation between oxygen saturation on teeth and fingers.Conclusion: Pulse oximeter detected a lower oxygen saturation in dental pulp of primary teeth of participants with SCD (HbSS) relative to those with SCT (HbAS) and HbAA. Oxygen saturation on fingers remained unaffected regardless of sickle cell disease status. Although more studies are needed, our study shows that when other conditions affecting peripheral tissue oxygen delivery are ruled out, the low pulse oximetry in primary teeth may be indicative of SCD. The oximeter may also be useful in monitoring response to SCD therapy targeted at improving oxygen carrying capacity and delivery.Keywords: pulse oximeter, dental pulp, microcirculation, oximetry

Background: Bleeding at fistula sites in patients with end stage renal disease (ESRD) is a common and potentially serious complication that contributes to blood loss (anemia). This study aimed to determine the factors that influence prolonged bleeding at fistula puncture sites following removal of fistula needles.Methods: This was a descriptive cross-sectional study. We consecutively enrolled patients who underwent maintenance hemodialysis between May and October 2017 at Muhimbili National Hospital and Access Dialysis Centre in Dar es Salaam, Tanzania. A case report form (CRF) was used for data collection.Prolonged bleeding was assessed by measuring activated partial thromboplastin time (aPTT) and compression time (CT). Descriptive statistics and regression analysis were used to assess the association between factors and tease out the independent factors associated with prolonged bleeding at fistula puncture site. A two-tailed p-value 31 seconds) and 4 (3.5%) had prolonged compression time (> 15 minutes). The mean aPTT and compression time of the participants were 42 ± 17.6 seconds and 5 ± 2.9 minutes respectively. Over half of participants 67(58.2%) had normal compression time (≤ 15 minutes). Elevated serum urea levels (> 7.4mmol/L) was the only factor significantly associated with elevated aPTT (OR=4.143 95% C.I (1.021-16.810), p=0.047).Conclusion: The findings have demonstrated that elevated serum urea levels are significantly associated with prolonged bleeding time following removal of Arterio-Venous fistula needles after completion of a hemodialysis therapy session. This study suggests that, in hemodialysis procedure where a fixed dose of heparin is generalized to all patients there is a chance of exceeding the individual’s requirements.Recommendations: Serum urea levels should be factored in when gauging the individual risk of arterio-venous fistula site bleeding for patients using heparin for anticoagulation during hemodialysis. Further studies with large sample sizes are recommended to elucidate how other predisposing factors may affect A-V fistula bleeding. Keywords: Hemodialysis, heparin, prolonged bleeding, urea reduction ratio, A-V Fistula, aPTT, Compression time, blood urea.

Background: Renal replacement therapy (RRT), which includes dialysis and kidney transplantation, is the treatment of choice for patients with end stage renal failure (ESRF). Most sub-Saharan African countries have not developed renal transplantation services and are relying on referring patients to overseas countries. This study was carried out to describe renal transplantation experience in Tanzania.Methods: Forty-four renal transplant recipients were recruited in this study. Standardized questionnaire and Swahili version of standard form – 36 (SF-36) were used to collect socio-demographic information, clinical data, laboratory test results and health related quality of life information.Results: Ages of transplant recipient ranged from 21 to 66 years with mean age of 45.9 ± 10.5 years. The leading causes of end stage renal failure among participants was hypertension 58.8% (25/44) followed by glomerulonephritis 15.9% (7/44). Twentyeight (63.6%) of transplantations were paid by the government. Most of the donors (97.7%) were living out of which 26 (59.1%) were siblings and 11 (25%) were second-degree relatives (cousins and nephews). Most common complication noted following transplantation was diabetes mellitus 9 (20.5%) and 3 (6.8%) had chronic rejection. Mental health was the domain with highest mean score (75.6 ± 14.3) and role physical had the least mean score (44 ± 45.6).Conclusions: Hypertension was the leading cause of ESRF in this study. Most of the donors were siblings and the costs of transplantation were largely covered by the government. There is a need for concerted effort to establish local kidney transplantation services in Tanzania. Keywords: Renal transplantation, quality of life in transplantation, Tanzania.

Tanzania is among the top five countries with a high burden of sickle cell disease (SCD) in the world. Even though the effects of SCD on quality of life have been documented in other countries including Nigeria and the United States of America, few are known from Tanzania. Therefore, this study focused on evaluating the effects of SCD on the quality of life among children living with SCD and their parents. The study employed a qualitative approach to interview purposively selected parents of children who have lived with SCD and have used hydroxyurea (HU) for more than 3 years. The in-depth interviews were conducted with 11 parents of children with SCD at the Muhimbili University of Health and Allied Sciences (MUHAS) in Dar-es-salaam, Tanzania. A semi-structured interview guide was used. Interviews were audio-recorded, transcribed, and thematically analyzed. Three themes were generated including psycho-social effects: family conflicts and divorce, limited access to education, stress and fear; financial effects: Employment limitation, reduced efficiency and productivity, loss of job and lack of self-keeping expenses; and physical effects: physical disability and dependence, and burden of the frequent crisis. Children living with SCD and their parents suffer psycho-social, financial, and physical impacts of the disease. Appropriate interventions should be introduced to minimize the observed effects as ways of improving the quality of life of the individuals living with SCD and their caregivers. ispartof: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH vol:19 issue:11 ispartof: location:Switzerland status: published

Background: Sickle cell disease (SCD) is the single most important genetic cause of childhood mortality globally. Newborn screening (NBS) is the recommended intervention aimed at early identification of babies with SCD and their linkage to care. To ensure success of NBS, pregnant women need to have the required knowledge on SCD and therefore motivation to screen their babies.Objective: The aim of this study was to determine the prevalence of hemoglobin-S and assess the baseline level of knowledge on SCD among pregnant women attending antenatal clinics in urban settings in Dar-es-Salaam, Tanzania.Methods: This cross-sectional study was conducted between August 2020 and February 2021, involving 600 pregnant women at 20–28 weeks of gestation attending antenatal clinics at Buguruni Health Center, Mbagala Hospital, and Sinza Hospital in Dar-es-Salaam, Tanzania. We administered a structured questionnaire to all participants to assess socio-demographic characteristics and baseline level of knowledge on SCD, where those scoring 7 or higher out of 10 questions were considered to have good knowledge. We screened for SCD a total of 300 participants from two centers (Buguruni Health Center and Mbagala Hospital) by using Sickle SCAN point-of-care test (BioMedomics Inc., United States). We used SPSS version 23 to analyze the data. On determining the association between level of knowledge and socio-demographic factors, we used Pearson’s Chi-square and multivariate logistic regression in ascertaining the strength of associations.Results: Of the 600 participants, the majority were of the age between 26 and 35 years (51%), with the parity of 1-3 children (55.8%) and secondary level of education (43%), while 56% were self-employed. Only 14.7% had good knowledge on SCD. The majority of the participants had ever heard of SCD (81.3%), most of them heard from the streets (42.4%), and only 2.4% heard from hospitals. Of all 600 study participants, only 2 (0.3%) knew their SCD status while 7.7% declared having a family history of SCD. A proficient level of knowledge on SCD is associated with a high level of education, occupation, and knowing personal status of SCD. Among 300 participants who were screened for SCD, 252 were Hb-AA (84%), 47 were Hb-AS (15.7%), and 1 (0.3%) was Hb-SS.Conclusion: Despite the high prevalence of hemoglobin-S among pregnant women attending antenatal clinics in urban settings in Tanzania, there is a poor level of knowledge on SCD and personal knowledge of SCD status. Maternal screening and health education on SCD should be included as part of the comprehensive package for health promotion at antenatal clinics.

Background. Patients on hemodialysis therapy are at high risk of malnutrition which is attributed to multiple factors. Protein-energy malnutrition in these patients confers poor clinical outcomes. This study investigated the nutritional status of patients on maintenance hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods. A cross-sectional descriptive study was done among 160 adult patients on maintenance hemodialysis therapy. Data concerning patients’ personal, medical, dietary, and hemodialysis-related information were collected. Patients’ anthropometric and laboratory tests (complete blood count, albumin, total cholesterol, creatinine, and urea) were measured. The quantitative Subjective Global Assessment (SGA) dialysis malnutrition score (DMS) was used to assess their nutritional status. Data analysis was done using the SPSS software version 20. Results. Among the 160 hemodialysis patients, 49 (30.6%) were female. Patients’ mean age was 52.2 ± 13.3 years. The median duration on hemodialysis was 18 (8.25–29.75) months. Malnutrition was present in 98 (61.2%) of the patients. Severe malnutrition was found in only 3 (1.9%) patients and 16.9% were underweight. The longer duration on hemodialysis, having diabetes mellitus, and being single were associated with increased risk for malnutrition in multivariate logistic regression. Malnourished patients had significantly lower dry weight, body mass index, mid-upper arm circumference, waist circumference, albumin, total cholesterol, and creatinine levels. Conclusion. Malnutrition is very common among hemodialysis patients at Muhimbili National Hospital, especially those on longer duration of hemodialysis, and diabetic patients. We recommend that hemodialysis patients should be regularly assessed for malnutrition and appropriately treated which if left unattended heralds worse outcomes.

Background: Metabolic bone disease in chronic kidney disease patients is associated with high morbidity and mortality, and it has been reported to start early in the course of the disease and worsen as the kidney damage progresses. However, the prevalence and factors associated with metabolic bone disease in chronic kidney disease patients in our setting has not been established, so we aimed to determine the prevalence and factors associated with metabolic bone disease among patients with chronic kidney disease at a tertiary Muhimbili National Hospital in Dar es salaam, Tanzania so as to help physicians recognize the patients at risk, diagnose the problem and prevent complications sooner. Methods: This was a hospital based cross-sectional study involving adult patients with chronic kidney disease attending renal unit Muhimbili National Hospital, a tertiary referral center in Dar es Salaam, Tanzania. Systematic sampling technique was employed to get study participants after being given informed consent. In this study, CKD-MBD was defined basing on the abnormality of serum calcium, phosphate or parathyroid hormone level. Data analysis was done using the SPSS version 23.0 software. Results: A total of 300 participants with chronic kidney disease stage 3 and above were included in this study. Majority were male, 198 (66.0%), with a mean age of 53 years. The prevalence of metabolic bone disease was found to be 75.0%. The most common form of metabolic bone disease was hyperparathyroidism 196 (87.1%), followed by hypocalcemia 174 (77.3%) and hyperphosphatemia 82 (36.4%), which was the least common. Factors which were found to be significantly associated with CKD-MBD were the use of calcium supplements, use of phosphate binders, being on dialysis, a calcium rich diet and a low phosphate diet. Conclusion: Metabolic bone diseases are common in patients with CKD at Muhimbili National Hospital. Patients with CKD should undergo serial assessment of phosphate, calcium and parathyroid hormone level, considered together, so as to diagnose metabolic bone disease early and treat those patients who will be found to have persistently or prolonged abnormalities in these bone mineral biomarkers.

Background. HIV-associated renal dysfunction is common among infected patients; the growing burden of this condition may be partly accounted for by improved survival attributed to sustained viral suppression with antiretroviral therapies (ART). Some ART regimens are nephrotoxic and may potentially contribute to renal dysfunction observed in these patients. This study aimed at investigating the prevalence of renal dysfunction among people living with HIV (PLHIV) on ART attending the care and treatment clinic (CTC). Methods. A cross-sectional study was conducted between June and October 2019 among adults living with HIV on ART for 6 months or more attending CTC at Muhimbili National Hospital in Dar es Salaam, Tanzania. A total of 287 participants were screened for proteinuria and microalbuminuria using the Cybow 300 urine analyzer. Serum creatinine was tested for all participants, and it was used to estimate glomerular filtration rate (eGFR) using the CKD-EPI formula. Results. Out of 287 participants (72.1% female, mean age ± SD: 46.7 ± 10.6 years), about one-third (32.8%) had eGFR less than 90 ml/min, whereas 7% had eGFR less than 60 ml/min. Microalbuminuria and proteinuria were detected in 38.6% and 25.1% of participants, respectively. In the multivariate analysis, predictive determinants for renal dysfunction were higher viral loads (OR 2.5 (1.1–5.8), p=0.031), diabetes mellitus (OR 5.5 (1.6–18.6), p=0.006), and age above 60 years (OR 2.8 (1.0–7.3), p=0.041); however, this was not the case for serum CD4 counts (OR 1.25 (0.7–2.3), p=0.46). Conclusion. High prevalence of renal dysfunction among PLHIV on ART was noted in this study. Viral loads above 1000 cp/ml and diabetes mellitus were noted to be associated with increased risk for renal dysfunction.

Background: Malnutrition, inflammation and combination thereof are predictors of poor outcomes in haemodialysis patients. Malnutrition Inflammation Complex Syndrome (MICS) is an accelerator of atherosclerosis and portends high mortality. Early recognition and treatment of MICS may help to improve the clinical outlook of such patients. This study investigated on the prevalence of MICS and its associated factors among patients on maintenance haemodialysis at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. Methods: This was a cross-sectional descriptive study done among 160 adult patients on maintenance haemodialysis at MNH in 2019. All participants provided written informed consent. Questionnaires were used to collect data and some laboratory investigations were done. The Malnutrition Inflammation Score was used to access MICS and its severity. Data analysis was done using the SPSS 20 software.Results: Of the 160 patients included in the study, 111 (69.4%) were male. The mean age (±SD) of patients and mean duration (±SD) on haemodialysis were 52.2(13.3) years and 22(18) months respectively. MICS was prevalent in 46.3% (mild in 24.4% and moderate to severe in 21.9%). Long-term haemodialysis (>4years) was an independent predictor of MICS [Adjusted Odds Ratio, AOR 5.04 (95% CI: 1.33–19.2), pConclusion: Malnutrition Inflammation Complex Syndrome is relatively common among patients on haemodialysis in Dar es Salaam, Tanzania. Our study has shown longer duration on haemodialysis to be associated with the occurrence of MICS; to the contrary, having hypercholesterolaemia seems to be protective against MICS rhyming well with the concept of reverse epidemiology. Patients on haemodialysis should to be regularly assessed and accordingly treated for malnutrition and inflammation which if left unattended, compounds morbidity and mortality among these patients.

Background: Making ethical decisions in Withholding and withdrawing life support measures from terminally ill patients are challenges in clinical practice. Still there is no consensus around the world. In Tanzania, there is neither guideline nor legal frameworks governing the practice.Methods: Aim: The aim of the study was to explore the perceptions and ethical challenges of healthcare workers in making ethical decisions of withholding and withdrawing life supportive measures from terminally ill patients.Results: A healthcare workers perceptions varies in decisions of withholding and withdrawing life supportive measures from terminally ill patients.Conclusions: Decisions of withholding and withdrawing life support measures from terminally ill patients face many challenges. Lack of legal and ethical framework to guide the practices inhibits the ethical decisions of physicians and nurses.

Additional file 1: Supplementary S1. Questionnaire on MICS.

Background: Childhood nephrotic syndrome, if left untreated, leads to progressive kidney disease or death. We quantified the prevalence of steroid-sensitive nephrotic syndrome, steroid-resistant nephrotic syndrome and histological types as the epidemiology of nephrotic syndrome in Africa remains unknown, yet impacts outcomes. Methods: We searched MEDLINE, Embase, African Journals Online and WHO Global Health Library for articles in English or French reporting on childhood nephrotic syndrome in Africa from January 1, 1946 to July 1, 2020. Primary outcomes included steroid response, biopsy defined minimal change disease, and focal segmental glomerulosclerosis (FSGS) by both pooled and individual proportions across regions and overall. Findings: There were 81 papers from 17 countries included. Majority of 8,131 children were steroid-sensitive (64% [95% CI: 63-66%]) and the remaining were steroid-resistant (34% [95% CI: 33-35%]). Of children biopsied, pathological findings were 38% [95% CI: 36-40%] minimal change, 24% [95% CI: 22-25%] FSGS, and 38% [95% CI: 36-40%] secondary causes of nephrotic syndrome. Interpretation: Few African countries reported on the prevalence of childhood nephrotic syndrome. Steroid-sensitive disease is more common than steroid-resistant disease although prevalence of steroid-resistant nephrotic syndrome is higher than reported in European populations. Pathology findings suggest minimal change and secondary causes are common. Scarcity of data in Africa prevents appropriate healthcare resource allocation to diagnose and treat this treatable childhood kidney disease to prevent poor health outcomes. Funding Statement: Funding was provided by the Canadian Institute for Health Research (CIHR) and the National Institute of Health (NIH) for the H3 Africa Kidney Disease Research Network. This research was undertaken, in part, from the Canada Research Chairs program. Declaration of Interests: The authors have no competing interests or conflicts to declare.

Background The burden of kidney diseases is reported to be higher in lower- and middle-income countries as compared to developed countries, and countries in sub-Saharan Africa are reported to be most affected. Health systems in most sub-Sahara African countries have limited capacity in the form of trained and skilled health care providers, diagnostic support, equipment and policies to provide nephrology services. Several initiatives have been implemented to support establishment of these services. Methods This is a situation analysis to examine the nephrology services in Tanzania. It was conducted by interviewing key personnel in institutions providing nephrology services aiming at describing available services and international collaborators supporting nephrology services. Results Tanzania is a low-income country in Sub-Saharan Africa with a population of more than 55 million that has seen remarkable improvement in the provision of nephrology services and these include increase in the number of nephrologists to 14 in 2018 from one in 2006, increase in number of dialysis units from one unit (0.03 unit per million) before 2007 to 28 units (0.5 units per million) in 2018 and improved diagnostic services with introduction of nephropathology services. Government of Tanzania has been providing kidney transplantation services by funding referral of donor and recipients abroad and has now introduced local transplantation services in two hospitals. There have been strong international collaborators who have supported nephrology services and establishment of nephrology training in Tanzania. Conclusion Tanzania has seen remarkable achievement in provision of nephrology services and provides an interesting model to be used in supporting nephrology services in low income countries.

Background Previous studies have demonstrated that low birth weight (LBW) is associated with higher risk for end-stage renal disease (ESRD). However, both LBW and ESRD cluster in families. The present study investigates whether familial factors explain the association between LBW and ESRD. Study Design Retrospective registry-based cohort study. Setting & Participants Since 1967, the Medical Birth Registry of Norway has recorded medical data for all births in the country. Sibling data are available through the Norwegian Population Registry. Since 1980, all patients with ESRD in Norway have been registered in the Norwegian Renal Registry. Individuals registered in the Medical Birth Registry with at least 1 registered sibling were included. Predictor LBW in the participant and/or LBW in at least 1 sibling. Outcome ESRD. Results Of 1,852,080 included individuals, 527 developed ESRD. Compared with individuals without LBW and with no siblings with LBW, individuals without LBW but with a sibling with LBW had an HR for ESRD of 1.20 (95% CI, 0.91-1.59), individuals with LBW but no siblings with LBW had an HR of 1.59 (95% CI, 1.18-2.14), and individuals with LBW and a sibling with LBW had an HR of 1.78 (95% CI, 1.26-2.53). Similar results were observed for individuals who were small for gestational age (SGA). Separate analyses for the association of age 18 to 42 years and noncongenital ESRD showed stronger associations for SGA than for LBW, and the associations were not statistically significant for age 18 to 42 years for LBW. Limitations Follow-up only until 42 years of age. Conclusions LBW and SGA are associated with higher risk for ESRD during the first 40 years of life, and the associations were not explained by familial factors. Our results support the hypothesis that impaired intrauterine nephron development may be a causal risk factor for progressive kidney disease.

Pilly Chillo,1 Ame Ismail,1 Anna Sanyiwa,2 Paschal Ruggajo,1 Appolinary Kamuhabwa31Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Department of Ophthalmology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 3Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaBackground: Hypertensive retinopathy is a known marker of cardiovascular disease, and among unselected patients with chronic kidney disease (CKD) more severe retinopathy has been associated with lower estimated glomerular filtration rate (eGFR). This association has, however, not been widely studied among nondiabetic hypertensive patients with CKD, especially in sub-Saharan Africa. We aimed to determine the prevalence and severity of hypertensive retinopathy and its relationship with eGFR among nondiabetic CKD patients seen at Muhimbili National Hospital in Dar es Salaam, Tanzania.Methods: A hospital-based cross-sectional study was conducted among nondiabetic CKD adult (≥18 years) patients with hypertension. A structured questionnaire was used to record patients’ demographic characteristics and their cardiovascular risk profile. eGFR was calculated using the Modification of Diet in the Renal Disease (MDRD) equation and only patients with CKD stage 3 or more were enrolled in the study. Grading of retinopathy was done using the Keith–Wagener classification.Results: In total, 224 patients fulfilled the inclusion criteria and were enrolled. Their mean age was 45.8±14.1 years, and 59.4% were men. The proportions of patients with stage 3, 4, and 5 CKD were 21.4%, 19.6%, and 58.9%, respectively. Hypertensive retinopathy was present in 157 (70.1%) patients and the proportions with grade I, grade II, grade III, and grade IV retinopathy were 17.9%, 18.8%, 19.6%, and 13.8%, respectively. The severity of retinopathy increased with decreasing levels of eGFR, and in multivariate logistic regression analysis, factors found to be independently associated with ≥grade II hypertensive retinopathy were more severe CKD, higher hypertension grades, and alcohol use, all p

Figure S1. Flowchart for Selection of Cases and Controls. (DOCX 39 kb)

Background Human Immunodeficiency Virus infection is a multisystem disease that contributes to significant morbidity. Renal involvement is reported to be common among patients with HIV. This study was carried out to determine renal involvement using simple bedside tests combined with ultrasonography examination. Methods We recruited 240 children from the HIV clinic at Muhimbili National Hospital. Data were collected using structured questionnaires and included demographic, clinical information, radiological tests; renal ultrasound and laboratory tests; serum creatinine, white blood cells, CD4+ counts and percent, urine for microalbuminuria and proteinuria. Results Microalbuminuria and proteinuria were present in 20.4 % and 7.1 % respectively. Significantly higher prevalence of microalbuminuria (p

We describe a case of a 30 years old female patient who presented with nephrotic syndrome and impaired renal function which was diagnosed to have systemic lupus erythematosus (SLE) with lupus nephritis. This is the first biopsy proven lupus nephritis in Tanzania. SLE is common among females and is reported be more common among Africans as compared to other races. This patient presented with nephrotic syndrome, pleural effusion and pericardial effusion which depicts the multisystem effects of SLE. This patient was treated with cyclophosphamide in combination with steroid as induction therapy and attained remission after one month of treatment. Systemic lupus erythematosus should be considered in patients with nephrotic syndrome and these patients should have renal biopsy to determine renal involvement.

Human Immunodeficiency Virus infection is a global challenge and sub-Saharan African countries contribute significantly to this pandemic. Children are vulnerable and acquire the infection mostly from their mothers. Highly Active Anti-retroviral Therapy have led to dramatic changes in the incidence of opportunistic infections with reduction in morbidity and mortality, which has paved way for manifestation of non-infectious complications including renal complications. The aim of this study was to determine prevalence of microalbuminuria, proteinuria and associated factors among Tanzanian children We recruited 240 HIV infected children attending care and treatment clinic. Microalbuminuria and proteinuria were determined by using dipstick and Microalbumin 2-1 combo test strips on spot urine respectively. Serum Creatinine, white blood cell and CD4 counts were determined. Renal ultrasound examinations were also performed. Forty nine children (20.4%) had microalbuminuria and 17 (7.1%) had proteinuria. Prevalence of proteinuria was significantly higher among children aged 120 months and above (p-value