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Asymptomatic hypoglycemia among pretermnewborns: A cross-sectional analysis
(Plos One, 2024-04-30) Kalabamu, Florence S.; Fataki, Maulidi R.
Background: Hypoglycemia is the commonest metabolic abnormality encountered in newborns. Besides, there is a growing body of evidence that links the causes of early neonatal mortality to neonatal hypoglycemia in Tanzania. However exact factors associated with asymptomatic hypoglycemia in preterm newborns are not known. Objective: Toassess factors associated with asymptomatic hypoglycemia among preterm newborns. Materials and methods Across sectional, analytical hospital- based study was carried out at Dar es salaam public regional referral hospitals. Preterm newborns with asymptomatic hypoglycemia were the target population. Data on demographic and clinical characteristics of preterm newborns andtheir mothers were collected and analyzed using Epi-Info™ software version 7.4. Main data analysis was done by applying a multivariable binary logistic regression model with neonatal random glycaemia coded in a binary fashion at a cut-off point of 2.6 mmol/L. An α level of 5% was used as a limit of type I error. Results: Werecruited and analysed 217 preterm newborns within 6–24 hours post-delivery. Male: Female =1.1:1 (females n = 105, 48.4%). Median glycemic level was 2.6 (IQR; 2.1–3.9) mmol/L. Median gestational age at delivery was 33 (IQR: 30–35) weeks. Breastfeeding within 1st hour post-delivery was a statistically significant factor against glycemic level associated with hypoglycemia (OR; 0.123, 95%-CI; 0.052–0.287) in a fitted multivariable logistic regression model. Conclusion: About half of all preterm newborns studied had glycemic values in a statistical range associated with hypoglycemia. Exclusive breast feeding within 1st hour post-delivery was associated with glycemic levels protective from risk of asymptomatic neonatal hypoglycemia. Recommendations: Exclusive breastfeeding practices within 1st hour post-delivery may need to be emphasized to all expectant mothers in order to avoid potential risk of asymptomatic hypoglycemia in preterm newborns.
Prevalence and factors associated with hypothermia among neonates in regional referral hospitals in Dar es Salaam, Tanzania
(Global Journal of Health Science, 2022-10-31) Malasa, Leonard J.; Kalabamu, Florence S.; Rutachunzibwa, Felician; Fataki, Maulidi R.; Mashalla, Yohana J.
Background: Neonatal hypothermia is a major cause of mortality. This study determined the prevalence and factors associated with neonatal hypothermia in two regional referral hospitals in Dar es Salaam, Tanzania. Methods: Cross-sectional study was carried out between March and May 2021 at the Mwananyamala and Temeke Regional Referral Hospitals. Simple random and stratified sampling procedures were used to select study sites and proportionate population samples from each hospital respectively. Body temperature was measured within 90 minutes post birth; knowledge of the WHO guidelines on thermal protection of new-borns was collected from the mothers and health care providers using questionnaires. Logistic regression was used to assess associations between variables. SPSS version 25 was used to analyse the data and p < 0.05 was considered significant. Results: Total of 296 mother-new-born pairs and 41 health care providers were enrolled in the study. 26 mothers did not consent for the study. 25.6% of the 270 studied neonates were hypothermic. Lack of skin-to-skin contact with the mother; early neonatal weighing and bathing increased likelihood of neonatal hypothermia. Knowledge of neonatal thermal protection among mothers and care-providers was inadequate. Conclusions: The prevalence of neonatal hypothermia among neonates in the referral hospitals is high. The findings suggest knowledge gaps of the WHO recommended guidelines on neonatal hypothermia are associated with neonatal hypothermia. Efforts to increase awareness of the WHO recommended thermal protection guidelines are needed.
Iron deficiency and iron deficiency anemia among children 3 to 59 months of age in Kinondoni municipal, Dar es Salaam: a facility-based cross-sectional study
(East Africa Science, 2023-05-23) Malasa, Leonard J.; Rutachunzibwa, Felician; Fataki, Maulidi R.; Kalabamu, Florence S.
Background: Iron deficiency with subsequent iron deficiency anemia is the most common micronutrient disorder in children below 5 years of age worldwide. The developing countries bear more weight on the problem as the result of multifactorial factors including but not limited to recurrent infections such as malaria, helminths infestation, and inadequate food security. However, its magnitude in children living in Kinondoni Municipal in Dar es salaam is not well understood. Therefore, the aim of this study was to determine the prevalence of anemia and how it is contributed by the presence of iron deficiency among children between 3-59months of age in the above-mentioned setting. Methods: A facility-based cross-section study was conducted among children 3-59months attending Reproductive and Child Health Services at Kairuki, Sinza Hospital, and Kambangwa dispensary. Children who met the criteria, their basic social demographic information, complete blood count and differentials as well as blood ferritin levels were collected to assess the level of anemia, erythrocytic indices, and iron deficiency. Data were analyzed using the Statistical Package of Social Sciences (SPSS version 22). The magnitude of anemia and iron deficiencies were presented in percentages, and the relationship between hemoglobin and blood ferritin was assessed using Spearman’s correlation test for two continuous variables. The p-value of less or equal to 0.05 was considered statistically significant. Results: A total of 350 children were recruited for the study, 255 Children (72.9%) were anemic. Children below 24 months of age were more anemic compared to the older age group (X2 = 50, p <0.001). Furthermore, anemia was significantly associated with low ferritin levels (X2 = 65, p <0.001). Iron deficiency was found in 156 (44.6%) participants while iron deficiency anemia (low MCV, low ferritin, and low hemoglobin) was found in 138 (39.4%) participants. However, among 255 participants with anemia, 147(65.3%) had iron deficiency. There was a significant positive correlation between hemoglobin and blood ferritin levels (Spearman’s correlation coefficient = 0.6; p<0.01. Conclusion: Prevalence of anemia was high among children and was highly associated with younger age and iron deficiency. To overcome this problem, appropriate interventions such as massive promotion of breastfeeding, appropriate complementary feeding, and ensuring food security are warranted.
Implementing adaptive e- learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains
(BMJ open, 2024-01-14) Kalabamu, Florence S.
Introduction:To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e- learning environment. The objectives of this study were to (1) assess implementation success with use of in- person support and nudging strategy and (2) describe baseline provider knowledge and metacognition. Methods 6- month observational study at one zonal hospital and three health centres in Mwanza, Tanzania. To assess implementation success, we used the Reach, Efficacy, Adoption, Implementation and Maintenance framework and to describe baseline provider knowledge and metacognition we used Howell’s conscious- competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity. Results: aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centres. Median clinical experience was 4 years (IQR 1–9) and 45 (23%) had previous in- service training for both newborn essential and sick newborn care. Efficacy was 42% (SD ±17%). Providers averaged 78% (SD ±31%) completion of initial learning and 7% (SD ±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious- competence was 53% (IQR: 38%–63%), unconscious- incompetence 32% (IQR: 23%–42%), conscious- incompetence 7% (IQR: 2%–15%), and unconscious- competence 2% (IQR: 0%–3%). Higher baseline conscious- competence (OR 31.6 (95% CI 5.8 to 183.5)) and being a nursing officer (aOR: 5.6 (95% CI 1.8 to 18.1)), compared with medical officer, were associated with initial learning completion or persistent activity. Conclusion: aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in- person support and nudging increased reach, initial learning and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e- learning normalisation is needed.
Improvements in obstetric and newborn health information documentation following the implementation of the safer births bundle of care at 30 facilities in Tanzania
(Healthcare, 2024-01-26) Kalabamu, Florence S.
Abstract: This paper examines changes in the completeness of documentation in clinical practice before and during the implementation of the Safer Births Bundle of Care (SBBC) project. This observational study enrolled parturient women with a gestation age of at least 28 weeks at the onset of labour. Data collectors extracted information from facility registers and then a central data manager summarised and reported weekly statistics. Variables of clinical significance for CQI were selected, and the proportion of non-documentation was analysed over time. A Pearson chi-square test was used to test for significant differences in non-documentation between the periods. Between 1 March 2021 and 31 July 2022, a total of 138,442 deliveries were recorded. Overall, 75% of all patient cases had at least one missing variable among the selected variables across both periods. A lack of variable documentation occurred more frequently at the district hospital level (81% of patient cases) and health centres (74%) than at regional referral hospitals (56%) (p < 0.001). Non-documentation decreased significantly from 79% to 70% after the introduction of the SBBC (p < 0.001). A tendency towards negative correlations was noted for most variables. We noted an increased attention to data quality and use which may have a positive impact on the completeness of documentation. However, halfway through the project’s implementation, the completeness of documentation was still low. Our Findings support the recommendation to establish short-spaced feedback loops of locally collected data using one data platform. Keywords: documentation; data missingness; data quality; Safer Births Bundle of Care; quality of care; mentorship; supervision
Acceptance of COVID-19 vaccination in children among adults attending selected health facilities in Kinondoni municipality; Dar es salaam, Tanzania: a cross sectional study
(Canadian Center of Science and Education, 2024-03-13) Malasa, Leonard J.; Fataki, Maulid R.; Rutachunzibwa, Felician; Kalabamu, Florence S.
Background: Safe and effective vaccines are crucial for controlling and containing COVID-19 pandemic. However, poor acceptance and hesitance to vaccinate limit effective utilization. In Tanzania, COVID-19 vaccines have been in use with adequate coverage in adults from 18-years old, however, the acceptability of their use in children is not well understood. This study was aimed at determining the acceptability of COVID-19 vaccination in children among adults in Dar es salaam, Tanzania. Methods: A cross section study was conducted among adults attending outpatient clinic in Dar es salaam and were having children below 18-years at home. A self-administered questionnaire was used to collect their demographic information and their opinions regarding COVID-19 vaccine use in their children. Data was analyzed using Statistical Package for Social Sciences (SPSS version 23). Level of acceptance and other categorical variables were calculated in frequency and percentages while factors associated with COVID-19 vaccination in children were determined using binary logistic regression analysis. A type II error of less or equal to 0.05 was considered statistically significant. Results: A total of 320 participants were recruited in the study. Among these, 289 (90.3%) were females. Out of all participants, 124 (38.57%) were willing for their children to receive COVID-19 vaccines upon availability and recommendation by respective authorities. Confidence in the safety of COVID-19 vaccines (Adjusted Odd Ratio= 0.03; 95% CI: 0.01-0.13; p=0.02, and perceived importance of COVID-19 vaccine use in children (AOR=0.29; 95% CI: 0.1-0.84; p=0.02) were independent factors associated with acceptance of COVID-19 vaccination in children. Conclusion: The level of acceptance of COVID-19 vaccination for children in this study was low (38.57%), with uncertainty around vaccine safety being the major concern. Therefore, to increase COVID-19 vaccines acceptance and uptake in children, effective public communication supported by data on safety and effectiveness of COVID19 vaccines should be emphasized. Keywords: Acceptance, COVID-19, children, Dar es Salaam, vaccines
Use of Haematological Changes as a Predictor of Dengue Infection among Suspected Cases at Kairuki Hospital in Dar Es Salaam, Tanzania: A Retrospective Cross Sectional Study
(East African Health Research Journal, 2021) Kalabamu, Florence S.
Background: Dengue is a viral disease transmitted by female Aedes mosquitoes which are commonly found in tropical and subtropical areas. There is a dramatic increase in annual incidence rate of dengue attributed to urbanisation, poor environmental management as well as increased people mobility. Outbreak of dengue have been reported in Tanzania in recent years with Dar es salaam being the most affected region. Dengue is associated with haematological derange- ments and itindicates the severity of the disease. These changes have not been well elucidated in Tanzanian patients. The aim of this study was to determine these derangements among dengue patients admitted at Kairuki hospital in Dar es salaam, and compare these changes with non- dengue febrile patients. Methods: A retrospective cross sectional study was conducted among patients who were suspected to have dengue; tested for dengue IgM and their Complete Blood Count were tested during the index illness. This information was ob- tained from Kairuki hospital laboratory database. Haematological parameters were compared between dengue and non-dengue patients using SPSS Version 20.0. Binary logistic regression analysis was used to determine haematological predictors of dengue positive results. Results: A total of 255 patients were enrolled, whereby 188(73.7%) were dengue positive and 67 (26.3%) were neg- ative. Dengue patients had relatively low mean total white blood cell counts compared to non-dengue patients (Student’s test= -2.7; p value=.007). Furthermore, Mean lymphocyte count was significantly low in dengue patients compared to non-dengue patients (Student’s (t) test=-5.1; p<.001). Other haematological parameters were not significantly different. Lymphopenia was a significant predictor for dengue positive results (Adjusted Odd Ration =5.26 (95% CI=2.28-12.2; P value <.001). Conclusion: Patients with dengue had significantly low total white blood cell and lymphocyte count compared to non-dengue febrile patients. Lymphopenia is a significant haematological predictor for dengue positive results. Case defining signs and symptoms combined with these haematological changes may be used by clinicians as a guide to order confirmatory test for suspected dengue cases.
Missed Opportunity for Vaccination among Children Under-five years of age: A Cross- Sectional Study at Mwananyamala Regional Hospital, Dar es Salaam, Tanzania
(TMJ Original research, 2021) Kalabamu, Florence S.
Background Immunization is among the most important public health interventions against common childhood diseases. However, a missed opportunity for vaccination (MOV), may hamper the progress made in reducing childhood illness through vaccination. Knowing the magnitude and contributing factors for MOV, is essential for planning and executing preventive measures; however, these factors are not well elucidated in the Tanzania context. Broad Objective To determine the magnitude and factors for MOV among children under five-years old admitted at Mwananyamala hospital. Methodology We conducted a hospital-based, cross-sectional descriptive study among children under-five year old who were admitted at Mwananyamala hospital and their respective care givers from October to November 2018. An interview-guided questionnaire was used to collect data from the caregivers. The childhood immunization history was obtained from the immunization cards. Data were analyzed using Statistical Package for Social Sciences (SPSS version 20). Results A total of 209 caretakers and their respective children were enrolled in the study. Thirty-eight (18.2%) had MOV, and among the missed vaccines, the second dose of measles and rubella was the most missed vaccine (45.5%). Identified factors for MOV were unavailability of the vaccine on the day of vaccination 12 (31.3%), the child being sick on the day of vaccination 10(26.3%), due date forgotten 8 (20.8%), not informed on when to return for vaccination 7(18.1%), and no money for transport to vaccination center 1 (2.7%). Conclusion and recommendation The magnitude of missed opportunity for vaccination is still high among hospital admitted children. Vaccine procurement and distribution as well as improved communication among caretakers and health personnel should be more strengthened to reduce the number of children who are missing vaccines.
Designing and Implementing Health System Strengthening Intervention Using Performance Score Card; the Effect on Health Service Delivery in Tanzania, a Study Protocol
(Science journal of public health, 2023-06-29) Kalabamu, Florence S.
Introduction: Sustainable development goals (SDGs) need to be achieved by Low and Middle Income countries in order to achieve the Universal Health Care (UHC). The strategies and interventions to achieve UHC need to be robust and effective for health system to work optimally. Simiyu Region (Health department) designed a health system strengthening (HSS) intervention which uses a continuous quality improvement (CQI) approach to address health system challenges. The designed HSS intervention had a major focus on improving health system performance using governance and leadership health system pillar as a lever. Methods: This is a prospective observational study implemented along with national essential health intervention packages. The governance priority areas included formulation of performance measurement/score card tool with 34 indicators and 87 operational standards comprised of structural, processes and outcome indicators. Governance domains are; supportive supervision, data quality assessment, monthly and quarterly data review meetings, star rating assessment, health facility governance committee meetings, medicine and drug audit and so forth. Performance measurement was done in all six councils quarterly to ensure intervention institutionalization and improved indicators performance. Data collection: Quantitative data; Data collection tools for the intervention will be developed according to the objectives, research questions and outcomes and outputs from this intervention. Routine data collection tools of Ministry of Health will be used to collect data outcome data of service delivery. Observational data of governance performance are collected using the generated performance measurement tool. Qualitative data. Will be collected using in-depth interviews and focus group discussions with regional and council management teams, health care staff, HMTs and council leaders. The interview will explore program acceptability, drivers and barriers towards its implementation of this intervention. Data analysis: Quantitative data will be analyzed using appropriate statistical software and data are presented in tables, charts and frequencies. Statistical significance test for association of independent and dependent variables will be performed accordingly. Qualitative data will be analysed by using Ground theory where the contents analysis will be performed after the data being transcribed verbatim. Discussion: Leadership and governance is critical cross-cutting pillar for HSS. Routine performance measurement using validated tool is important to monitor the strengths and weaknesses of governance structures and health system performance with end results of health system responsiveness and resilient. Conclusion: HSS interventions with CQI involving leadership and governance are indispensable in restricted resource countries for achieving large ends with restricted resources.
Feasibility of an adaptive e-learning environment to improve provider proficiency in essential and sick newborn care in Mwanza, Tanzania
(MedRxiv, 2023-07-13) Kalabamu, Florence S.
Introduction. To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment (AEE). The objectives of this study were to 1) assess implementation success with use of in-person support and nudging strategy and 2) describe baseline provider knowledge and metacognition. Methods. 6-month observational study at 1 zonal hospital and 3 health centers in Mwanza, Tanzania. To assess implementation success, we used the RE-AIM framework and to describe baseline provider knowledge and metacognition we used Howell’s conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity. Results. aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing, and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centers. Median clinical experience was 4 years [IQR 1,9] and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD±17%). Providers averaged 78% (SD±31%) completion of initial learning and 7%(SD±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% [IQR:38-63%], unconscious-incompetence 32% [IQR:23-42%], conscious-incompetence 7% [IQR:2- 15%], and unconscious-competence 2% [IQR:0-3%]. Higher baseline conscious-competence (OR 31.6 [95%CI:5.8, 183.5) and being a nursing officer (aOR: 5.6 [95%CI:1.8, 18.1]), compared to medical officer) were associated with initial learning completion or persistent activity. Conclusion. aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning, and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalization is needed.
Dimethylarginines: endogenous inhibitors of nitric oxide synthesis in children with falciparum malaria
(The Journal of infectious diseases, 2014) Kalabamu, Florence S.
Background. Nitric oxide (NO) bioavailability is impaired in children and adults with severe falciparum malaria (SM). Asymmetric-dimethylarginine (ADMA) limits NO production by inhibiting NO synthase and is increased in adult SM. The role of ADMA in the pathogenesis of childhood SM is unknown. Methods. We studied Tanzanian children ages 4–8 years with malaria. Plasma levels of arginine, arginase, cell-free hemoglobin, ADMA, symmetric-dimethylarginine (SDMA), histidine-rich protein-2, and angiopoietin-2 were measured. Results. ADMA was low in children with SM relative to controls. Nevertheless, arginine and arginine:ADMA ratios were very low in SM. SDMA was high in children with SM. With treatment, arginine and the arginine:ADMA ratio normalized, but SDMA did not. Arginine:ADMA ratios, but not arginine, were significantly and independently inversely associated with lactate and angiopoietin-2. Plasma arginase was not elevated in those with malaria, and plasma free hemoglobin was elevated only in patients with cerebral malaria. Conclusions. In contrast to adults, plasma ADMA is reduced in SM in children, but hypoargininemia is more severe. Arginine bioavailability (reflected by low arginine:ADMA ratios) is therefore comparably low in SM in children as in adults. Therapies to increase NO bioavailability in malaria may be useful as adjunctive treatment of severe malaria in children.
Severity and morphological classification of anaemia among children aged 2- 59 months in dar es salaam, tanzania: a cross sectional study protocol
(MedRxiv, 2022-11-11) Kalabamu, Florence S.; Fataki, Maulidi R.
Background: Anaemia is a clinically significant secondary diagnosis in children under the age of five in most parts of developing world, including Tanzania. Studies that assess clinical conditions associated with prenatal and postnatal era are highly relevant to global health as they tend to reflect patterns of significant health challenges across the entire human lifespan. Objective: To assess for morphological characteristics and severity of anaemia among under-five population seen at Dar es Salaam regional referral facilities in Tanzania. Design & Methods: A cross-sectional hospital based study will be conducted at Temeke Regional Referral and Mbagala Rangi Tatu district hospitals in Dar es Salaam, Tanzania. All children aged 2-59 months will be eligible to participate in the study. All children aged 2 – 59 months with anaemia will be the target population. The study main tool will be a self-administered questionnaire with five distinct parts. Data analysis will commence with summarisation. Specifically, continuous data will be summarised using median (with inter-quartile range) and categorical data will be summarised using frequency (and proportion by %) Graphical tools will also be employed where by important correlations as well as +/- outliers will be assessed. Besides, univariate and bivariate statistics will be computed for all clinically relevant data. Main outcome measure will be severity and morphological classification of anaemia. Unless otherwise stated, an alpha-level of 5% will be used as a limit of type 1 error in findings. Written informed consent will be sought from the parent/guardian of each participant child prior to inclusion into the study. Keywords: Anaemia, children, Temeke, Dar es Salaam
Prevalence and factors associated with asymptomatic hypoglycemia among preterm newborns in dar es salaam regional referral hospitals, tanzania: a cross sectional analytical study protocol
(MedRxiv, 2022-10-30) Kalabamu, Florence S.; Fataki, Maulidi R.
Background: Hypoglycemia is the most common metabolic abnormality in newborns. It is still unclear whether the condition is truly pathological, especially if it occurs transiently during the 1st 24 hours of birth in an asymptomatic phase. Besides, there is hardly any data on the burden of asymptomatic neonatal hypoglycemia and its associated factors among preterm newborns in Africa. Aim: To assess the prevalence and associated factors of asymptomatic neonatal hypoglycemia among preterm newborns in a typical African settings. Design and Methods: We plan to conduct a quick, cross-sectional analytical hospital-based survey at all public regional referral hospitals in Dar es Salaam, Tanzania. We will consider all preterm newborns delivered in the specified settings between June 2022 and December 2022. Our study population will be all preterm newborns delivered at Dar es Salaam public regional referral hospitals. Our target population will be all preterm newborns with asymptomatic hypoglycemia. All newborns with clinically detected congenital anomalies and those who will be delivered at home but brought to the facilities for care will thus be excluded from the study. Our primary outcome measure will be neonatal RBG < 2.6 mmol/L without any symptoms associated with hypoglycemia. Maternal, fetal and early neonatal (> 6 hours but within 24 hours post-delivery) factors will be logistically regressed against the outcome variable after appropriate model validation. Unless otherwise stated, an α-level of 5% will be used as a limit of type I error in findings. Written informed consent will be obtained from mothers of each newborn prior to inclusion into the study. Main Outcome measure: Prevalence of asymptomatic hypoglycemia among preterm newborns in Dar es Salaam hospitals. Relevance of the findings to science, policy & practice: Current clinical practice does not provide evidence for routine glycaemic screening among preterm newborns asymptomatic for hypoglycemia. The study will have a potential to assess stata of preterm newborn with asymptomatic hypoglycemia
Detection of four mutations in six unrelated South African patients with acute intermittent porphyria
(Molecular and cellular probes, 1996) Mgone, Charles S.
We have screened the hydroxymethylbilane synthase cDNA from six South African patients with acute intermittent porphyria, using a combination of chemical cleavage mismatch analysis and direct sequencing of asymmetrically amplified PCR products. Four mutations were detected, a novel T insertion (771insT) and three missense mutations (R26H, R116W and R173Q). The 771insT mutation produces a stop codon, thirty-three codons downstream and a loss of approximately 20% of the protein is predicted. The R116W mutation, which was found to have a high prevalence in the Dutch population, was detected in three unrelated South African patients.
Strengthening research partnerships for better health and sustainable development
(Tropical Medicine & International Health, 2012) Mgone, Charles S.
Strengthening the Effectiveness of National Capacity Effortsplatform (ESSENCE) and the ‘Switching the Poles’ ClinicalResearch Network which are closely linked to EDCTP, were alsopresented.
Research priorities in maternal and neonatal health in Africa: results using the child health and nutrition research Initiative method involving over 900 experts across the continen
(AAS open research, 2021) Mgone, Charles S.
Background: Africa will miss the maternal and neonatal health (MNH) Sustainable Development Goals (SDGs) targets if the current trajectory is followed. The African Academy of Sciences has formed an expert maternal and newborn health group to discuss actions to improve MNH SDG targets. The team, among other recommendations, chose to implement an MNH research prioritization exercise for Africa covering four grand challenge areas. Methods: The team used the Child Health and Nutrition Research Initiative (CHNRI) research prioritization method to identify research priorities in maternal and newborn health in Africa. From 609 research options, a ranking of the top 46 research questions was achieved. Research priority scores and agreement statistics were calculated, with sub-analysis possible for the regions of East Africa, West Africa and those living out of the continent. Results: The top research priorities generally fell into (i) improving identification of high-risk mothers and newborns, or diagnosis of high-risk conditions in mothers and newborns to improve health outcomes; (ii) improving access to treatment through improving incentives to attract and retain skilled health workers in remote, rural areas, improving emergency transport, and assessing health systems' readiness; and (iii) improving uptake of proven existing interventions such as Kangaroo Mother Care. Conclusions: The research priorities emphasized building interventions that improved access to quality healthcare in the lowest possible units of the provision of MNH interventions. The lists prioritized participation of communities in delivering MNH interventions. The current burden of disease from MNCH in Africa aligns well with the list of priorities listed from this exercise but provides extra insights into current needs by African practitioners. The MNCH Africa expert group believes that the recommendations from this work should be implemented by multisectoral teams as soon as possible to provide adequate lead time for results of the succeeding programmes to be seen before 2030.
The emerging shape of a global HIV research agenda: how partnerships between Northern and Southern researchers are addressing questions relevant to both
(Current Opinion in HIV and AIDS, 2008) Mgone, Charles S.
Purpose of review In this review I will narrate and discuss recent North–South health research partnerships and how such partnerships are of mutual benefit to both. Recent developments Globalization has shrunk the world into a virtual single community in which actions of individuals may have global repercussion. The ever-improving accessibility to fast communications through both transportation and knowledge and information exchange is making this virtual community even smaller. The current large global burden of diseases of poverty, made worse by the HIV/AIDS pandemic is a major concern for all. Although the South bears the brunt of this burden and is disproportionately adversely affected, the ill effects are global. Among these effects, include global poverty, development constraints and insecurity. It is no wonder that scientists from both north and south are working together to mitigate the effects of this scourge for the mutual benefit of all. Summary Despite a period of 25 years since the onset of the HIV/AIDS pandemic many challenges still abound. A preventive vaccine is still illusive and care and prevention programmes not universal. To mitigate this several global initiatives and North–South partnerships are working together for the common good. Such collaborations seen in academic settings, research institutions, networks of excellence and the private sector engage in research, training and service provision. This cooperation includes discovery and evaluations of HIV vaccine candidates as well as treatment and prevention methods.
Child mortality in relation to HIV infection, nutritional status, and socio-economic background
(International journal of epidemiology, 2005) Fataki, Maulidi R.
Abstract Background The aims of this study were to examine the impact of child HIV infection on mortality and to identify nutritional and sociodemographic factors that increase the risk of child mortality independent of human immunodeficiency virus (HIV) infection. Methods We conducted a prospective study in Dar es Salaam, Tanzania, among 687 children 6–60 months of age who were admitted to hospital with pneumonia. After discharge, children were followed up every 2 weeks during the first year and every 4 months thereafter. Sociodemographic characteristics were determined at baseline, and HIV status, haemoglobin, and malaria infection were assessed from a blood sample. During the first year of follow-up, we measured height, weight, and mid-upper arm circumference (MUAC) monthly. We estimated the risk of mortality according to HIV status and socio-economic characteristics using Cox proportional hazards models. Nutritional status variables (wasting and stunting) were examined as time-varying risk factors. Results Mean age at enrolment was 18 months. A total of 90 children died during an average 24.7 months of follow-up. HIV infection was associated with an adjusted 4-fold higher risk of mortality [relative risk (RR) = 3.92, 95% confidence interval (CI) 2.34–6.55, P < 0.0001]. Other risk factors included child's age <24 months, stunting, low MUAC, anaemia, and lack of water supply in the household. In models with time-varying covariates, stunting and wasting during the previous month were both significant and independently related to increased risk of death. HIV infection appeared to be a stronger predictor of mortality among children who were wasted than among those who were not (P for interaction = 0.05). Conclusions HIV infection is a strong predictor of death among children who have been hospitalized with pneumonia. Preventable conditions including inadequate water supply, child undernutrition, and anaemia contribute significantly to infant and child mortality independent of HIV infection. Keyword:Child mortality, infant mortality, HIV, stunting, wasting, anaemia,
Development of pediatric acute care education (PACE): An adaptive electronic learning (e-learning) environment for healthcare providers in Tanzania
(Digital Health, 2023-07-24) Kalabamu, Florence S.
Globally, inadequate healthcare provider (HCP) proficiency with evidence-based guidelines contributes to millions of newborn, infant, and child deaths each year. HCP guideline proficiency would improve patient outcomes. Conventional (in person) HCP in- service education is limited in 4 ways: reach, scalability, adaptability, and the ability to contextualize. Adaptive e-learning envir- onments (AEE), a subdomain of e-learning, incorporate artificial intelligence technology to create a unique cognitive model of each HCP to improve education effectiveness. AEEs that use existing internet access and personal mobile devices may overcome limits of conventional education. This paper provides an overview of the development of our AEE HCP in-service education, Pediatric Acute Care Education (PACE). PACE uses an innovative approach to address HCPs’ proficiency in evidence-based guidelines for care of newborns, infants, and children. PACE is novel in 2 ways: 1) its patient-centric approach using clinical audit data or frontline provider input to determine content and 2) its ability to incorporate refresher learning over time to solid- ify knowledge gains. We describe PACE’s integration into the Pediatric Association of Tanzania’s (PAT) Clinical Learning Network (CLN), a multifaceted intervention to improve facility-based care along a single referral chain. Using principles of co-design, stakeholder meetings modified PACE’s characteristics and optimized integration with CLN. We plan to use three-phase, mixed-methods, implementation process. Phase I will examine the feasibility of PACE and refine its components and protocol. Lessons gained from this initial phase will guide the design of Phase II proof of concept studies which will generate insights into the appropriate empirical framework for (Phase III) implementation at scale to examine effectiveness.
A randomized trial of vitamin A supplements in relation to mortality among human immunodeficiency virus-infected and uninfected children in Tanzania
(The Pediatric infectious disease journal, 1999) Fataki, Maulidi R.; Ndossi, Godwin D.
Objectives. To determine whether vitamin A supplements result in reduced mortality among HIV-infected and uninfected children. Design. Randomized, double blind, placebo-controlled trial. Methods. Starting in April, 1993, we randomized 687 children age 6 months to 5 years who were admitted to the hospital with pneumonia. Children who were severely malnourished or had clinical signs of vitamin A deficiency were excluded. At baseline children received placebo or 400 000 IU (or half that for infants) of vitamin A, in addition to standard treatment for pneumonia. They received further doses of the same regimen 4 and 8 months after hospital discharge. Sera from children were tested for HIV antibodies by enzyme-linked immunosorbent assay and Western blot tests. For positive children <15 months of age, HIV infection was confirmed by amplified heat-denatured HIV-p24 antigen assays with confirmatory neutralization assays. HIV status was ascertained for 648 of 687 enrolled children. The mean duration of follow-up was 24.4 months (SD = 12.1). Results. Of 648 children 58 (9%) were HIV-infected. Compared with uninfected children, all-cause mortality was higher among HIV-infected children, as was mortality caused by pneumonia or diarrhea (P < 0.001 for each). Overall vitamin A supplements resulted in a 49% reduction in mortality [relative risk (RR), 0.51; 95% confidence interval (CI), 0.29 to 0.90, P = 0.02]. Vitamin A supplements reduced all-cause mortality by 63% among HIV-infected children (RR 0.37; CI 0.14 to 0.95, P = 0.04) and by 42% among uninfected children (RR 0.58, CI 0.28 to 1.19, P = 0.14). Vitamin A supplements were also associated with a 68% reduction in AIDS-related deaths (P = 0.05) and a 92% reduction in diarrhea-related deaths (P = 0.01). Conclusion. Vitamin A deficiency, which is common among children in many developing countries, is particularly severe among HIV-infected children. Our findings indicate that vitamin A supplements, a low cost intervention, reduce mortality of HIV-infected children.

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