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Makani J, Mgaya J, Balandya E, Msami K, Soka D, Cox SE, Komba AN, Rwezaula S, Meda E, Muturi D, Kitundu J, Fegan G, Kirkham FJ, Newton CR, Snow RW, Lowe B. Bacteraemia in sickle cell anaemia is associated with low haemoglobin: a report of 890 admissions to a tertiary hospital in Tanzania. Br J Haematol 2015; 171:273-276. [PMID: 26084722 PMCID: PMC4744759 DOI: 10.1111/bjh.13553] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/17/2015] [Indexed: 11/30/2022]
Abstract
Bacteraemia is a leading cause of morbidity in sickle cell anaemia (SCA), but information from studies in Africa is limited. We evaluated 890 admissions from 648 SCA patients at a tertiary hospital in Tanzania. Bacteraemia was present in 43 admissions (4·8%); isolates included Staphylococcus aureus (12/43; 28%), non‐Typhi Salmonella (9/43; 21%), Streptococcus pneumoniae (3/43; 7%) and Salmonella Typhi (2/43; 5%). Compared to SCA patients without bacteraemia, SCA patients with bacteraemia had significantly lower haemoglobin [71 g/l vs. 62 g/l, odds ratio 0·72 (95% confidence interval 0·56–0·91), P < 0·01]. Further exploration is needed of the relationship between anaemia and bacterial infections in SCA in Africa.
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Affiliation(s)
- Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,University of Oxford, Oxford, UK
| | - Josephine Mgaya
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Khadija Msami
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Deogratias Soka
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Sharon E Cox
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,London School of Hygiene & Tropical Medicine, London, UK
| | - Albert N Komba
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Stella Rwezaula
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Elineema Meda
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - David Muturi
- Kenya Medical Research Institute (KEMRI)-Wellcome Collaborative Programme, Kilifi, Kenya
| | - Jesse Kitundu
- Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Gregory Fegan
- University of Oxford, Oxford, UK.,Kenya Medical Research Institute (KEMRI)-Wellcome Collaborative Programme, Kilifi, Kenya
| | | | - Charles R Newton
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,University of Oxford, Oxford, UK.,Kenya Medical Research Institute (KEMRI)-Wellcome Collaborative Programme, Kilifi, Kenya
| | - Robert W Snow
- University of Oxford, Oxford, UK.,Kenya Medical Research Institute (KEMRI)-Wellcome Collaborative Programme, Kilifi, Kenya
| | - Brett Lowe
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,University of Oxford, Oxford, UK.,Kenya Medical Research Institute (KEMRI)-Wellcome Collaborative Programme, Kilifi, Kenya
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Moyo SJ, Gro N, Matee MI, Kitundu J, Myrmel H, Mylvaganam H, Maselle SY, Langeland N. Age specific aetiological agents of diarrhoea in hospitalized children aged less than five years in Dar es Salaam, Tanzania. BMC Pediatr 2011; 11:19. [PMID: 21345186 PMCID: PMC3050719 DOI: 10.1186/1471-2431-11-19] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 02/23/2011] [Indexed: 01/24/2023] Open
Abstract
Background This study aimed to determine the age-specific aetiologic agents of diarrhoea in children aged less than five years. The study also assessed the efficacy of the empiric treatment of childhood diarrhoea using Integrated Management of Childhood Illness (IMCI) guidelines. Methods This study included 280 children aged less than 5 years, admitted with diarrhoea to any of the four major hospitals in Dar es Salaam. Bacterial pathogens were identified using conventional methods. Enzyme Linked Immunosorbent Assay (ELISA) and agglutination assay were used to detect viruses and intestinal protozoa, respectively. Antimicrobial susceptibility was determined using Kirby-Bauer disk diffusion method. Results At least one of the searched pathogens was detected in 67.1% of the cases, and mixed infections were detected in 20.7% of cases. Overall, bacteria and viruses contributed equally accounting for 33.2% and 32.2% of all the cases, respectively, while parasites were detected in 19.2% patients. Diarrhoeagenic Escherichia coli (DEC) was the most common enteric pathogen, isolated in 22.9% of patients, followed by Cryptosporidium parvum (18.9%), rotavirus (18.1%) and norovirus (13.7%). The main cause of diarrhoea in children aged 0 to 6 months were bacteria, predominantly DEC, while viruses predominated in the 7-12 months age group. Vibrio cholerae was isolated mostly in children above two years. Shigella spp, V. cholerae and DEC showed moderate to high rates of resistance to erythromycin, ampicillin, chloramphenicol and tetracycline (56.2-100%). V. cholerae showed full susceptibility to co-trimoxazole (100%), while DEC and Shigella showed high rate of resistance to co-trimoxazole; 90.6% and 93.3% respectively. None of the bacterial pathogens isolated showed resistance to ciprofloxacin which is not recommended for use in children. Cefotaxime resistance was found only in 4.7% of the DEC. Conclusion During the dry season, acute watery diarrhoea is the most common type of diarrhoea in children under five years in Dar es Salaam and is predominantly due to DEC, C. parvum, rotaviruses and noroviruses. Constant antibiotic surveillance is warranted as bacteria were highly resistant to various antimicrobial agents including co-trimoxazole and erythromycin which are currently recommended for empiric treatment of diarrhoea.
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Affiliation(s)
- Sabrina J Moyo
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS) Dar es Salaam, Tanzania.
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Moyo SJ, Gro N, Kirsti V, Matee MI, Kitundu J, Maselle SY, Langeland N, Myrmel H. Prevalence of enteropathogenic viruses and molecular characterization of group A rotavirus among children with diarrhea in Dar es Salaam Tanzania. BMC Public Health 2007; 7:359. [PMID: 18162127 PMCID: PMC2235852 DOI: 10.1186/1471-2458-7-359] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2007] [Accepted: 12/27/2007] [Indexed: 12/13/2022] Open
Abstract
Background Different groups of viruses have been shown to be responsible for acute diarrhea among children during their first few years of life. Epidemiological knowledge of viral agents is critical for the development of effective preventive measures, including vaccines. Methods In this study we determined the prevalence of the four major enteropathogenic viruses – rotavirus, norovirus, adenovirus and astrovirus – was determined in 270 stool samples collected from children aged 0 – 60 months who were admitted with diarrhea in four hospitals in Dar es Salaam, Tanzania, using commercially available ELISA kits. In addition, the molecular epidemiology of group A rotavirus was investigated using reverse transcriptase multiplex polymerase chain reaction (RT-PCR). Results At least one viral agent was detected in 87/270 (32.2%) of the children. The prevalence of rotavirus, norovirus, adenovirus and astrovirus was 18.1%, 13.7%, 2.6% and 0.4%, respectively. In most cases (62.1%) of viruses were detected in children aged 7–12 months. The G and P types (VP7 and VP4 genotypes respectively) were further investigated in 49 rotavirus ELISA positive samples. G9 was the predominant G type (81.6%), followed by G1 (10.2%) and G3 (0.2%). P[8] was the predominant P type (83.7%), followed by P[6] (0.4%) and P[4] (0.2%). The following G and P types were not detected in this study population; G2, G4, G8 G10, P[9], P[10] and P[11]. The dominating G/P combination was G9P[8], accounting for 39 (90.7%) of the 43 fully characterized strains. Three (6.1%) of the 49 rotavirus strains could not be typed. Conclusion Nearly one third of children with diarrhea admitted to hospitals in Dar es Salaam had one of the four viral agents. The predominance of rotavirus serotype G9 may have implication for rotavirus vaccination in Tanzania.
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Affiliation(s)
- Sabrina J Moyo
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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Herbert G, Ndiritu M, Idro R, Makani JB, Kitundu J. Analysis of the indications for routine lumbar puncture and results of cerebrospinal fluid examination in children admitted to the paediatric wards of two hospitals in East Africa. ACTA ACUST UNITED AC 2006; 8:7-10. [PMID: 17058793 DOI: 10.4314/thrb.v8i1.14263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lumbar puncture (LP) is an important diagnostic tool for investigating neurological conditions/diseases. This study was carried out to compare the indications for lumbar puncture and findings of cerebrospinal fluid examination in children admitted to Muhimbili National Hospital (MNH) in Dar-es-salaam, Tanzania and Kilifi District Hospital (KDH) in Kenya. Records of all children admitted to the paediatric wards of the two hospitals from 1st November 2004 to 30th April 2005 with suspected central nervous system infections and had LPs performed were analysed. Overall, 8,741 paediatric admissions were recorded in the two hospitals (Muhimbili = 6,228; Kilifi = 2,513). Of these, 607 (6.9%) had a LP performed; 154 out 6,228 (2.5%) in MNH and 453 out of 2,513 (18.0%) in KDH. LPs were performed less frequently in Muhimbili than in Kilifi Hospital. The most common indications for LP at MNH were convulsions (62.5%), neck stiffness (14.3%) and prostration (17%), whereas at KDH were convulsions (56.3%), neck stiffness (7.3%) and prostration (22.1%). The bacterial isolates were rarely (23%) obtained on culture at both hospitals. Streptococcus pneumonaie and Salmonella species were the commonest causes of pyogenic meningitis. In conclusion, the rate of LP performance in the two hospitals is low. There is need therefore to improve the rates of LP and the isolation of bacterial pathogens from cerebrospinal fluid cultures. Other possible causes for meningitis such as viruses need to be investigated.
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Affiliation(s)
- G Herbert
- Muhimbili University College of Health Sciences, P.O. Box 65000, Dar es Salaam, Tanzania.
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Kitundu J, Msengi A, Matee M, Fataki M, Kazimoto T, Mpembeni R, Mnubhi E, Kalokola F. Post-transfusion hepatitis C seroprevalence in Tanzanian children. Ann Trop Paediatr 2001; 21:343-8. [PMID: 11732153 DOI: 10.1080/07430170120093535] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In Tanzania, children with malaria-associated anaemia are frequently given blood transfusions, and donor blood is not screened for hepatitis C virus (HCV) infection. To determine the seroprevalence of HCV infection in Tanzanian children previously transfused with blood, 184 children (92 transfused, 92 not transfused) aged between 15 and 59 months matched for age and sex were screened for HCV antibodies by the particle agglutination test using Serodia anti-HCV (Fujirebio Inc., Japan). The overall prevalence of HCV infection was 7.1% (13/184). HCV seropositivity was 5.4% (5/92) among children with a history of blood transfusion and 8.6% (8/92) among the non-transfused. There was no significant difference in the prevalence of HCV infection between transfused and non-transfused children. None of the factors investigated, such as gender, the nutrition and HIV serostatus of the children and the marital and education status of their mothers, was associated with HCV seropositivity. Further studies are recommended to identify the factors associated with HCV infection in Tanzanian children.
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Affiliation(s)
- J Kitundu
- Departments of Paediatrics and Child Health, Muhimbili University College of Health Sciences, PO Box 65001, Dar es Salaam, Tanzania.
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Kawo G, Karlsson K, Lyamuya E, Kalokola F, Fataki M, Kazimoto T, Kitundu J, Msaky H, Munubhi E, Ostborn A, Bredberg-Rådén U, Swai A, Mbise R, Msengi A, Mhalu F, Biberfeld G. Prevalence of HIV type 1 infection, associated clinical features and mortality among hospitalized children in Dar es Salaam, Tanzania. Scand J Infect Dis 2001; 32:357-63. [PMID: 10959642 DOI: 10.1080/003655400750044917] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The aim of this study was to determine the prevalence of HIV-1 infection, the clinical spectrum of HIV-1-associated conditions and HIV-1-associated mortality among children hospitalized in the medical paediatric wards at Muhimbili Medical Centre (MMC), Dar es Salaam, Tanzania. All children admitted to the medical paediatric wards of MMC between August 1995 and January 1996 were eligible for the study. Testing for HIV antibodies was done using 2 consecutive enzyme linked immunosorbent assays (ELISAs). ELISA-reactive samples from children aged 18 months and below were further tested by a recently developed heat-denatured p24 antigen assay. The prevalence of HIV-1 infection among the 2015 children studied was 19.2%. When present for 14 days or more, fever, cough, diarrhoea, ear discharge, oral ulcers and skin rash were all significantly more common in HIV-1-infected than in HIV-uninfected children (p < 0.001). In the multivariate analysis cough, ear discharge, oropharyngeal ulcers and skin rash were found to be the most important symptoms. Clinical signs found to be significantly associated with HIV-1 infection in the univariate analysis were wasting, stunting, hair changes, oral thrush, oropharyngeal ulcers, lymphadenopathy, lung consolidation and lung crepitations (p < 0.001). In the multivariate analysis, oral thrush, lung crepitations, cervical lymphadenopathy, wasting and inguinal lymphadenopathy were found to be the most important signs. The 3 most common diagnoses in HIV-1-infected children were acute respiratory infection (ARI) (39.4%), malnutrition (38.1%) and tuberculosis (19.3%), while in HIV-uninfected children they were malaria (47.0%), ARI (25.0%) and malnutrition (16.1%). The mortality rate was 21.4% in HIV-1-infected children and 8.4% in HIV-uninfected children (p < 0.001). In conclusion, the prevalence of HIV-1 infection among hospitalized children at the main hospital in Dar es Salaam was high and associated with high mortality. Many symptoms and signs are indicative of HIV-1 infection, but appropriate laboratory testing is required for diagnosis.
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Affiliation(s)
- G Kawo
- Department of Paediatrics, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
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