1
|
Kilonzo SB, Kamala E, Jaka H, Ngoya P. Non-alcoholic fatty liver disease in Tanzania: prevalence, determinants, and diagnostic performance of triglycerides-glucose index and triglycerides-glucose index -body mass index compared to the hepatic ultrasound in overweight and obese individuals. BMC Gastroenterol 2024; 24:96. [PMID: 38438930 PMCID: PMC10910753 DOI: 10.1186/s12876-024-03164-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 02/08/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD), which is closely associated with metabolic syndrome (MetS), is rarely reported in Tanzania, where MetS is prevalent. The purpose of this study was to determine the prevalence and associated factors of this condition in overweight and obese individuals and to correlate standard ultrasound diagnosis with triglyceride-glucose index (TyG) and TyG-body mass index (TyG-BMI). METHODS A cross-sectional analysis was performed in 181 adult outpatients attending a general medical clinic. The presence of fatty liver was detected by ultrasound. Demographic, clinical, and laboratory data were collected and analyzed using STATA 15. To compare categorical variables, a chi-square test was employed, while a Student's t-test was used to compare continuous variables. Additionally, a multivariate regression analysis was conducted to identify the determinants of NAFLD. A significance level was set at p < 0.05. The discriminatory power of TyG and TyG-BMI for diagnosing NAFLD was evaluated using Receiver Operating Characteristic (ROC) Curve analysis and the Area Under the ROC Curve (AUC) was reported. RESULTS The overall prevalence of NAFLD was 30.4% (55/181). The prevalence's of NAFLD in patients with class III obesity, class II obesity, class I obesity and overweight were 50.0% (12/24),, 38% (19/50), 23.7% (18/76), and 19.5% (6/31),respectively. NAFLD was strongly predicted by hyperuricemia (≥ 360 μmol/L) (p = 0.04) and TyG ≥ 8.99 (p = 0.003). The best cut-off values of TyG and TyG-BMI to predict NAFLD were 8.99 [AUC 0.735; sensitivity 70.9%, specificity 79.3%] and 312 [AUC 0.711; sensitivity 60% and specificity 75.4%] respectively. CONCLUSIONS The prevalence of NAFLD is high among people with overweight and obesity in Tanzania. We did not find sufficient evidence to recommend the use of TyG and TyG-BMI as surrogates for hepatic ultrasound in detecting NAFLD, and further evaluation is recommended.
Collapse
Affiliation(s)
- Semvua B Kilonzo
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
- Department of Internal Medicine, Bugando Medical Centre, P.O. Box 1370, Mwanza, Tanzania.
| | - Eliud Kamala
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Hyasinta Jaka
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, P.O. Box 1370, Mwanza, Tanzania
| | - Patrick Ngoya
- Department of Radiology, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| |
Collapse
|
2
|
Mangowi I, Mirambo MM, Kilonzo SB, Mlewa M, Nyawale H, Majinge D, Hyera F, Jaka H, Mtemisika C, Michael F, Mshana SE. Hepatitis B virus infection, associated factors, knowledge and vaccination status among household contacts of hepatitis B index cases in Mwanza, Tanzania. IJID Reg 2024; 10:168-173. [PMID: 38317663 PMCID: PMC10840095 DOI: 10.1016/j.ijregi.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 02/07/2024]
Abstract
Objectives To determine the prevalence of hepatitis B virus (HBV) infection, knowledge regarding HBV, vaccination status, and associated factors among household contacts of HBV index cases in Mwanza, Tanzania. Methods Between July and August 2023, a cross-sectional study involving 97 index cases and 402 household contacts was conducted. Data were collected using pre-tested structured questionnaire and blood samples were collected from household contacts for HBV surface antigen (HBsAg) testing. Results The prevalence of HBV among household contacts was 5.4% (95% confidence interval, 2.9-9.0) with a significantly high proportion observed in > 45 years (16.6%) and in males (9.9%). A total of 40.0% of the household contacts had completed the full HBV vaccination series. On multivariate analysis, being male was significantly associated with HBsAg positivity (odds ratio: 7.16, 95% confidence interval: 1.81-28.2, P = 0.005). Conclusion About one-tenth of adults' male household contacts were HBsAg positive. In addition, the majority of household contacts had poor to fair knowledge regarding HBV infection with more than half being unvaccinated against HBV. There is a need to enhance awareness and education regarding HBV infection among household contacts in Tanzania and other low- and middle-income countries.
Collapse
Affiliation(s)
- Ivon Mangowi
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mariam M. Mirambo
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Semvua B. Kilonzo
- Department of Internal Medicine, Catholic University of Health and Allied Sciences- Bugando, Mwanza, Tanzania
| | - Mathias Mlewa
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Helmut Nyawale
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | | | - Hyasinta Jaka
- Department of Internal Medicine, Catholic University of Health and Allied Sciences- Bugando, Mwanza, Tanzania
| | | | - Fausta Michael
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma, Tanzania
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| |
Collapse
|
3
|
Kilonzo SB, Gunda DW, Majinge DC, Jaka H, Manyiri PM, Kalokola F, Mtui G, Shao ER, Bakshi FA, Stephano A. Seroprevalence of hepatitis B virus infection, anti-HCV antibodies and HIV and knowledge among people who use drugs attending methadone therapy clinic in Tanzania; a cross-sectional study. BMC Infect Dis 2021; 21:699. [PMID: 34289801 PMCID: PMC8296674 DOI: 10.1186/s12879-021-06393-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/07/2021] [Indexed: 12/24/2022] Open
Abstract
Background Methadone therapy clinics have been recently introduced in Tanzania, aiming at reducing risk behaviors and infection rates of viral hepatitis and HIV among people who use drugs. The objective of this study was to estimate the prevalence, associated factors and knowledge level of these conditions among people who use drugs attending a methadone clinic in Tanzania. Methods We enrolled 253 People who using drugs receiving Methadone therapy. Clinical data was retrospectively collected from the medical records and face-to face interviews were conducted to determine the behavioral risk factors and respondents’ knowledge on viral hepatitis and HIV. Results An overall seroprevalence of viral hepatitis (either hepatitis B surface antigen or anti-hepatitis C virus) was 6.3%, while that of hepatitis B virus mono infection was 3.5% and anti-hepatitis C antibodies was 3.5%. Seroprevalence of HIV was 12.6%. Viral hepatitis was strongly predicted by advanced age (> 35 years) (p = 0.02) and staying at Kirumba area (p = 0.004), and HIV infection was predicted by increased age (> 37 years) (p = 0.04) and female sex (p < 0.001). Regarding the knowledge of viral hepatitis, majority of the respondents were unaware of the transmission methods and availability of hepatitis B virus vaccines and only 17% were classified as well informed (provided ≥4 correct answers out of 7 questions). Good knowledge was highly predicted by higher education level of the individual (p = 0.001). Conclusions Despite the efforts to curb viral hepatitis and HIV infections through Methadone clinics, infection rates among people who use drugs are still high and the general knowledge on preventive measures is inadequate.
Collapse
Affiliation(s)
- Semvua B Kilonzo
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania. .,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania.
| | - Daniel W Gunda
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - David C Majinge
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - Hyasinta Jaka
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - Paulina M Manyiri
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - Grahame Mtui
- Department of Medicine, Sekou Toure Regional Referral Hospital, P.O Box 132, Mwanza, Tanzania
| | - Elichilia R Shao
- Department of Medicine Kilimanjaro Christian University College, P.O Box 2240, Moshi, Tanzania
| | - Fatma A Bakshi
- Department of Medicine, Aga Khan Hospital, P.O Box 2289, Dar es Salaam, Tanzania
| | - Alex Stephano
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania
| |
Collapse
|
4
|
Gunda DW, Mtui EF, Manyiri PM, Majinge DC, Kilonzo SB, Mazigo HD, Kidenya BR. Schistosoma mansoni-related periportal fibrosis; can we use APRI and PSDR levels in the real-time selection of patients for targeted endoscopy in a resource-limited setting? A case-control study. BMC Gastroenterol 2021; 21:219. [PMID: 33985430 PMCID: PMC8117578 DOI: 10.1186/s12876-021-01802-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/03/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Schistosoma mansoni related hepatic fibrosis is usually associated with hemodynamic alteration with increased mortality due to bleeding varices. The diagnosis of varices before bleeding imposes a big challenge in resource-limited countries using endoscopy. Published evidence on the utility of non-invasive clinical tools in predicting the presence of varices among patients with S. mansoni related periportal fibrosis is still inadequate including Aspartate to platelet ratio index (APRI) and Platelet to splenic diameter ratio (PSDR) levels. This study describes the determinants of portal varices and assesses the potential utility of the APRI and PSDR level in the discrimination of portal varices among patients with S. mansoni related periportal fibrosis (PPF). METHODS A case-control study using cross-sectional data was done among patients with Schistosoma mansoni related periportal fibrosis at Bugando Medical Centre, in Mwanza Tanzania. The derivation cohort included patients enrolled between 2015 and 2019 and the validation cohort included patients enrolled from 2019 till March 2021. Socio-demographic, laboratory, ultrasound, and upper digestive endoscopic information were analyzed using STATA 13. The prevalence and determinants of varices were determined by logistic regression. The sensitivity and specificity of independent factors were determined to assess their utility in discriminating the presence of portal varices in patients with PPF. RESULTS In total, 250 patients were included in the derivation cohort, 109 (43.6%; 95% CI 37.3-49.9) of them had varices. The odds of having varices were independently increased among patients with higher APRI levels than 1.51, (AOR: 5.8; 95% CI 3.1-11.1; p < 0.001) and PSDR levels that were lower than 5700 (AOR: 5.9; 95% CI 3.2-11.2; p < 0.001). Both APRI and PSDR levels had significantly high sensitivity and specificity in predicting the presence of esophageal varices. However, the combined values of APRI and PSDR had higher specificity than any of the two markers. Of the 200 patients in the validation cohort 94 (47.0%; 95% CI 40.0-54.2) had varices, the discriminative power of the final model and the predictive ability of both APRI, PSDR, and APRI-PSDR combined levels were highly maintained. CONCLUSIONS This study indicates that varices are a common encounter among patients with S. mansoni related periportal fibrosis and it is independently associated with higher APRI and lower PSDR levels suggesting that these tools are potential discriminators of varices in this subgroup of patients. The reproducibility of these results should further be assessed longitudinally as potential non-invasive tools in selecting patients at high risk of having esophageal varices who could benefit from the targeted endoscopic intervention in a resource-limited setting like ours.
Collapse
Affiliation(s)
- Daniel W. Gunda
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, 1370 Mwanza, Tanzania
| | - Elizabeth F. Mtui
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
| | - Paulina M. Manyiri
- Department of Internal Medicine, Bugando Medical Centre, 1370 Mwanza, Tanzania
| | - David C. Majinge
- Department of Internal Medicine, Bugando Medical Centre, 1370 Mwanza, Tanzania
| | - Semvua B. Kilonzo
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, 1370 Mwanza, Tanzania
| | - Humphrey D. Mazigo
- Department of Parasitology, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
| | - Benson R. Kidenya
- Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
| |
Collapse
|
5
|
Gunda DW, Kilonzo SB, Manyiri PM, Peck RN, Mazigo HD. Morbidity and Mortality Due to Schistosoma mansoni Related Periportal Fibrosis: Could Early Diagnosis of Varices Improve the Outcome Following Available Treatment Modalities in Sub Saharan Africa? A Scoping Review. Trop Med Infect Dis 2020; 5:tropicalmed5010020. [PMID: 32028581 PMCID: PMC7157192 DOI: 10.3390/tropicalmed5010020] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/19/2019] [Accepted: 01/09/2020] [Indexed: 12/11/2022] Open
Abstract
Schistosomiasis affects about 240 million people worldwide and Schistosoma mansoni alone affects over 54 million people leaving 400 million at-risk especially in Sub Saharan Africa (SSA). About 20 million people are currently suffering from complications of chronic S. mansoni infection and up to 42% of those infected have been found with periportal fibrosis (PPF). About 0.2 million deaths are attributed to chronic S. mansoni every year, which is mainly due to varices. Death occurs in up to 29% of those who present late with bleeding varices even with the best available in-hospital care. The diagnosis of varices before incident bleeding could potentially improve the outcome of this subgroup of patients is SSA. However, there is no prior review which has ever evaluated this issue detailing the magnitude and outcome of varices following available treatment modalities among patients with Schistosoma PPF in SSA. This review summarizes the available literature on this matter and exposes potential practical gaps that could be bridged to maximize the long-term outcome of patients with S. mansoni related PPF in SSA. A total of 22 studies were included in this review. The average prevalence of varices was 82.1% (SD: 29.6; range: 11.1%–100%) among patients with PPF. Late diagnosis of varices was frequent with average bleeding and mortality of 71.2% (SD: 36.5; range: 4.3%–100.0%) and 13.6% (SD: 9.9; range: 3.5%–29%), respectively. Predictors were reported in seven (31.8%) studies including platelet count to splenic diameter ratio (PSDR) for prediction large varices in one study. Active S. mansoni infection was very prevalent, (mean: 69.9%; SD: 24.4; range: 29.2–100.0%). Praziquantel could reverse PPF and use of non-selective B-blockers reduced both rebleeding and mortality. Use of sclerotherapy for secondary prevention of variceal bleeding was associated with high rebleeding and mortality rates. Conclusions: This review shows that varices due to schistosomal PPF are a big problem in SSA. However, patients are often diagnosed late with fatal bleeding varices. No study had reported a clinical tool that could be useful in early diagnosis of patients with varices and no study reported on primary and effective secondary prevention of bleeding and its outcome. Regular screening for S. mansoni and the provision of Praziquantel (PZQ) is suggested in this review. More studies are required to bridge these practical gaps in Sub Saharan Africa.
Collapse
Affiliation(s)
- Daniel W. Gunda
- Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza 1464, Tanzania
- Correspondence: (D.W.G.); (H.D.M.)
| | - Semvua B. Kilonzo
- Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza 1464, Tanzania
| | - Paulina M. Manyiri
- Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza 1464, Tanzania
| | - Robert N. Peck
- Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza 1464, Tanzania
| | - Humphrey D. Mazigo
- Department of Parasitology, Catholic University of Health and Allied Sciences, Mwanza 1464, Tanzania
- Correspondence: (D.W.G.); (H.D.M.)
| |
Collapse
|
6
|
Gunda DW, Kilonzo SB, Mamballah Z, Manyiri PM, Majinge DC, Jaka H, Kidenya BR, Mazigo HD. The magnitude and correlates of esophageal Varices among newly diagnosed cirrhotic patients undergoing screening fibre optic endoscope before incident bleeding in North-Western Tanzania; a cross-sectional study. BMC Gastroenterol 2019; 19:203. [PMID: 31783802 PMCID: PMC6884911 DOI: 10.1186/s12876-019-1123-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 11/19/2019] [Indexed: 01/09/2023] Open
Abstract
Background Bleeding esophageal varices is a deadly complication of liver cirrhosis. Guidelines recommend an early diagnosis of esophageal varices before incident bleeding by screening all patients diagnosed with liver cirrhosis. Though it has been reported elsewhere that the presence of esophageal varices varies widely among cirrhotic patients this has not been assessed in Tanzania since endoscopy is not readily available for routine use in our setting. This study was designed to determine the prevalence of esophageal varices and assess the utility of clinical parameters in predicting the presence of varices among cirrhotic patients in northwestern Tanzania. Methods A cross-sectional analysis of adult patients with liver cirrhosis was done at Bugando Medical Centre. Demographic, clinical, laboratory and endoscopic data were collected and analyzed using STATA 13. The presence of esophageal varices was detected using endoscopic examination and associated factors were assessed by logistic regression. The predictive value of clinical predictors was also assessed by calculating sensitivity and specificity. Results A total of 223 patients were enrolled, where 88 (39.5%; 95%CI: 33.0–45.9) had esophageal varices. The varices were independently associated with increased age (OR: 1.02; 95%CI: 1.0–1.04; p = 0.030); increased splenic diameter (OR:1.3; 95%CI:1.2–1.5; p < 0.001), increased portal vein diameter (OR:1.2; 95%CI: 1.07–1.4; p = 0.003), having ascites (OR: 3.0; 95%CI: 1.01–8.7; p = 0.046), and advanced liver disease (OR: 2.9; 95%CI: 1.3–6.7; p = 0.008). PSDR least performed in predicting varices, (AUC: 0.382; 95%CI: 0.304–0.459; cutoff: < 640; Sensitivity: 58.0%; 95%CI: 46.9–68.4; specificity: 57.0%; 95%CI: 48.2–65.5). SPD had better prediction; (AUC: 0.713; 95%CI: 0.646–0.781; cut off: > 15.2 cm; sensitivity: 65.9%; (95% CI: 55–75.7 and specificity:65.2%; 95%CI: 56.5–73.2), followed by PVD, (AUC: 0.6392; 95%CI: 0.566–0.712;cutoff: > 1.45 cm; sensitivity: 62.5%; 95CI: 51.5–72.6; specificity: 61.5%; 95%CI: 52.7–69.7). Conclusion Esophageal varices were prevalent among cirrhotic patients, most of which were at risk of bleeding. The non-invasive prediction of varices was not strong enough to replace endoscopic diagnosis. However, the predictors in this study can potentially assist in the selection of patients at high risk of having varices and prioritize them for endoscopic screening and appropriate management.
Collapse
Affiliation(s)
- Daniel W Gunda
- Department of medicine, Weill Bugando School of Medicine, P.O Box 1464, Mwanza, Tanzania. .,Department of medicine, Bugando medical center, 1370, Mwanza, Tanzania.
| | - Semvua B Kilonzo
- Department of medicine, Weill Bugando School of Medicine, P.O Box 1464, Mwanza, Tanzania.,Department of medicine, Bugando medical center, 1370, Mwanza, Tanzania
| | - Zakhia Mamballah
- Department of medicine, Weill Bugando School of Medicine, P.O Box 1464, Mwanza, Tanzania
| | - Paulina M Manyiri
- Department of medicine, Bugando medical center, 1370, Mwanza, Tanzania
| | - David C Majinge
- Department of medicine, Bugando medical center, 1370, Mwanza, Tanzania
| | - Hyasinta Jaka
- Department of medicine, Bugando medical center, 1370, Mwanza, Tanzania.,Lake Zone Health Training institute, 11351, Bugando Mwanza, Tanzania
| | - Benson R Kidenya
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Humphrey D Mazigo
- Department of Parasitology, Weill Bugando School of Medicine, 1464, Mwanza, Tanzania
| |
Collapse
|
7
|
Kilonzo SB, Gunda D, Ning Q, Han M. Where Hepatitis B and Hepatitis E Meet: Epidemiological and Clinical Aspects. Hepat Mon 2019; 19. [DOI: 10.5812/hepatmon.93840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/09/2019] [Indexed: 08/30/2023]
|
8
|
Gunda DW, Kilonzo SB, Mtaki T, Bernard DM, Kalluvya SE, Shao ER. Magnitude and correlates of virological failure among adult HIV patients receiving PI based second line ART regimens in north western Tanzania; a case control study. BMC Infect Dis 2019; 19:235. [PMID: 30845924 PMCID: PMC6407235 DOI: 10.1186/s12879-019-3852-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background With a growing access to free ART, switching of ART to second line regimen has also become common following failure of first line ART regimens. Patients failing on first line ART regimens have been shown to stand a high risk of failing on subsequent second line ART regimens. The magnitude of those who are failing virologicaly on second line ART is not documented in our setting. This study was designed to assess the magnitude and correlates of second line ART treatment failure. Methods A retrospective analysis of patients on second line ART for at least 1 year was done at Bugando care and treatment center. Information on demographic, clinical and laboratory data were collected and analyzed using STATA 11. The proportion of patients with Virological failure was calculated and potential correlates of virological failure were determined by logistic regression model. Results In total 197 patients on second line ART were included in this study and 24 (12.18%) of them met criteria for virological failure. The odds of having virological failure on second line ART were independently associated with age of less than 30 years (AOR = 12.5, p = 0.001), being on first line for less than 3 years (AOR = 6.1, p = 0.002) and CD4 at switch to second line ART of less than 200cells/μl (AOR = 16.3, p < 0.001). Conclusion Virological failure among patients on second line ART is common. Predictors of virological failure in this study could assist in planning for strategies to improve the outcome of this subgroup of patients including close clinical follow up of patients at risk, a continued adherence intensification and a targeted resistance testing before switching to second line ART.
Collapse
Affiliation(s)
- Daniel W Gunda
- Department of Medicine, Bugando Medical centre, 1370, Mwanza, Tanzania. .,Department of medicine, Weill Bugando School of Medicine, 1464, Mwanza, Tanzania.
| | - Semvua B Kilonzo
- Department of Medicine, Bugando Medical centre, 1370, Mwanza, Tanzania.,Department of medicine, Weill Bugando School of Medicine, 1464, Mwanza, Tanzania
| | - Tarcisius Mtaki
- Department of medicine, Weill Bugando School of Medicine, 1464, Mwanza, Tanzania
| | - Desderius M Bernard
- Department of medicine, Weill Bugando School of Medicine, 1464, Mwanza, Tanzania
| | - Samwel E Kalluvya
- Department of Medicine, Bugando Medical centre, 1370, Mwanza, Tanzania.,Department of medicine, Weill Bugando School of Medicine, 1464, Mwanza, Tanzania
| | - Elichilia R Shao
- Department of Medicine, Kilimanjaro Christian Medical University College, 2240, Moshi, Tanzania
| |
Collapse
|
9
|
Kilonzo SB, Gunda DW, Bakshi FA, Kalokola F, Mayala HA, Dadi H. Control of Hypertension among Diabetic Patients in a Referral Hospital in Tanzania: A Cross-Sectional Study. Ethiop J Health Sci 2018; 27:473-480. [PMID: 29217952 PMCID: PMC5615008 DOI: 10.4314/ejhs.v27i5.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Indexed: 01/24/2023] Open
Abstract
Background Hypertension is common among diabetic patients. The co-existence of two conditions carries an excessive risk of severe complications and mortalities. Limited information exists on the determinants of poor hypertension control among these patients. We aimed at determining the prevalence and factors associated with poor hypertension control in these patients. Methods Data of diabetic patients who were also hypertensive attending an outpatient clinic from 1 August 2015 to 31 December 2015 at Bugando Medical Centre were retrospectively analyzed. Uncontrolled hypertension was defined as a blood pressure of ≥130mmHg and/or ≥80mmHg systolic and diastolic respectively. A designed questionnaire was used to collect data of patients. Continuous variables were summarized by median and interquartile ranges (IQR) and categorical variables were summarized by frequency and percentage. Logistic regression was used to find the predictors of uncontrolled hypertension. Results The majority of our study population were females, 161/295 (54.6%), and the median age was 57 years (IQR 50–64). The prevalence of hypertension was 206/295 (69.8%). A total of 174/206 (84.5%) patients had uncontrolled hypertension. This poor control was significantly associated with poor adherence to anti-hypertensives (OR 1.73[1.26–2.38] p=0.002), presence of any long-term complication (OR 3.19 [1.65–6.18] p=0.03) and overweight (BMI>24.9 Vs <24.9) (OR 1.68 [0.98–2.88], p=0.04). Under-prescription and ambiguous drugs combination was also observed. Conclusion The prevalence of poor hypertension control among diabetic patients in Tanzania is alarming. Most of the factors associated with this situation can be modified. The clinicians should advocate individualized management, continuous health education and adherence to the available guidelines.
Collapse
Affiliation(s)
- Semvua B Kilonzo
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza-Tanzania.,Department of Internal Medicine, Bugando Medical Centre, Mwanza-Tanzania
| | - Daniel W Gunda
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza-Tanzania.,Department of Internal Medicine, Bugando Medical Centre, Mwanza-Tanzania
| | - Fatma A Bakshi
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza-Tanzania.,Department of Internal Medicine, Bugando Medical Centre, Mwanza-Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza-Tanzania.,Department of Internal Medicine, Bugando Medical Centre, Mwanza-Tanzania
| | - Henry A Mayala
- Cardiovascular department, Jakaya Kikwete Cardiac Institute, Dar es Salaam-Tanzania
| | - Hollo Dadi
- Faculty of Undergraduate Studies, Weill School of Medicine, Mwanza-Tanzania
| |
Collapse
|
10
|
Gunda DW, Maganga SC, Nkandala I, Kilonzo SB, Mpondo BC, Shao ER, Kalluvya SE. Prevalence and Risk Factors of Active TB among Adult HIV Patients Receiving ART in Northwestern Tanzania: A Retrospective Cohort Study. Can J Infect Dis Med Microbiol 2018; 2018:1346104. [PMID: 30073038 PMCID: PMC6057398 DOI: 10.1155/2018/1346104] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/19/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Although ART has improved the outcome of people living with HIV/AIDS, still some patients develop TB while receiving ART. The literature on the magnitude of this problem is still scarce in our setting especially northwestern Tanzania. This study was designed to determine the prevalence of active TB among HIV patients on ART and assess its potential risk factors. METHODS A retrospective cohort study was done among adult HIV-positive patients initiated on ART at Bugando Medical Centre. Patients who were TB positive before ART initiation were excluded. Data regarding demographic, clinical, and laboratory information, TB status on receipt of ART, and time on ART were collected and analyzed using STATA 11 to determine the prevalence of TB and its associated factors. RESULTS In total, 391 patients were enrolled in this study. The median age was 39 (32-46) years, and a total of 129 (32.99%) participants had CD4 counts <200 cells/µl and 179 (45.78%) had WHO stage 3 and 4 illnesses. A total of 43 (11.0%) participants developed TB while receiving ART which was independently associated with male gender (OR = 2.9; p=0.007), WHO clinical stage 3 and 4 (OR = 1.4; p=0.029), baseline CD4 count <200 cells/µl (OR = 9.1; p < 0.001), and having not used IPT (OR = 3.1; p=0.05). CONCLUSIONS Active TB is prevalent among HIV patients while receiving ART in northwestern Tanzania which is independently associated with male gender, advanced HIV disease, and nonuse of IPT. Universal HIV testing could reduce late HIV diagnosis and hence reduce the risk of developing TB while receiving ART in our setting. Also IPT should be widely used for those who are negative for TB on screening.
Collapse
Affiliation(s)
- Daniel W. Gunda
- Department of Medicine, Weill Bugando School of Medicine, 1464 Mwanza, Tanzania
| | - Simon C. Maganga
- Department of Medicine, Weill Bugando School of Medicine, 1464 Mwanza, Tanzania
| | - Igembe Nkandala
- Department of Medicine, Weill Bugando School of Medicine, 1464 Mwanza, Tanzania
| | - Semvua B. Kilonzo
- Department of Medicine, Weill Bugando School of Medicine, 1464 Mwanza, Tanzania
| | - Bonaventura C. Mpondo
- Department of Medicine, College of Health Sciences, University of Dodoma, 395 Dodoma, Tanzania
| | - Elichilia R. Shao
- Department of Infectious Disease, Kilimanjaro Christian Medical College, Moshi, Tanzania
| | | |
Collapse
|
11
|
Gunda DW, Godfrey KG, Kilonzo SB, Mpondo BC. Cytopenias among ART-naive patients with advanced HIV disease on enrolment to care and treatment services at a tertiary hospital in Tanzania: A cross-sectional study. Malawi Med J 2017; 29:43-52. [PMID: 28567196 DOI: 10.4314/mmj.v29i1.9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND HIV/AIDS causes high morbidity and mortality through both immunosuppression and complications not directly related to immunosuppression. Haematological abnormalities, including various cytopenias, occur commonly in HIV through immune and non-immune pathways. Though these complications could potentially cause serious clinical implications, published literature on the magnitude of this problem and its associated factors in Tanzania is scarce. This study aimed at determining the prevalence and risk factors of HIV-associated cytopenias among ART-naive patients enrolling for care and treatment services at Bugando Care and Treatment Centre (CTC) in Mwanza, Tanzania. METHODS This was a cross-sectional clinic-based study done between March 2015 and February 2016, involving all antiretroviral therapy (ART)-naive adult HIV-positive patients enrolling for care and treatment services at Bugando CTC. Patients younger than 18 years and those with missing data were excluded. Data were analysed using Stata version 11 to determine the prevalence and risk factors of cytopenias. RESULTS A total of 1205 ART-naive patients were included. Median age was 41 years (interquartile range [IQR] 32 to 48). Most participants were female (n = 789; 65.6%), with a female-to-male ratio of 2:1. The median baseline CD4 count was 200 cells/µL (IQR 113 to 439). About half (49%) of the study participants had baseline CD4 counts less than 200 cells/µL. Anaemia, leucopenia, and thrombocytopenia were found in 704 (58.4%), 285 (23.6%), and 174 (14.4%) participants, respectively, and these were strongly associated with advanced HIV infection. CONCLUSIONS The magnitude of cytopenias is high among ART-naive HIV-positive adults, and cytopenias are more marked with advanced HIV infection. Early diagnosis of HIV and timely initiation of ART could potentially reduce the number of people living with advanced HIV disease and its associated complications, including the cytopenias investigated in this study. Patients with cytopenias should undergo thorough screening for tuberculosis, which is an important and treatable correlate of cytopenia, in addition to close follow-up for any potential negative outcomes.
Collapse
Affiliation(s)
- Daniel W Gunda
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Kahamba G Godfrey
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Semvua B Kilonzo
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Bonaventura C Mpondo
- Department of Internal Medicine, School of Health Sciences, University of Dodoma, Dodoma, Tanzania
| |
Collapse
|
12
|
Gunda DW, Kilonzo SB, Kamugisha E, Rauya EZ, Mpondo BC. Prevalence and risk factors of poor immune recovery among adult HIV patients attending care and treatment centre in northwestern Tanzania following the use of highly active antiretroviral therapy: a retrospective study. BMC Res Notes 2017; 10:197. [PMID: 28595630 PMCID: PMC5465538 DOI: 10.1186/s13104-017-2521-0] [Citation(s) in RCA: 15] [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: 09/25/2015] [Accepted: 05/31/2017] [Indexed: 12/22/2022] Open
Abstract
Background Highly Active Antiretroviral therapy (HAART) reverses the effect of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) by durably suppressing viral replication. This allows CD4 gain to levels that are adequate enough to restore the body’s capability to fight against opportunistic infections (OIs). Patients with poor immune recovery have been shown to have higher risk of developing both AIDS and non AIDS related clinical events. This study aimed at assessing the proportions and risk factors of poor immune recovery in adult HIV-infected patients on 48 months of HAART attending care and treatment center (CTC) in northwestern Tanzania. Methods A retrospective analysis of adult HIV patients’ data attending CTC at Sekou Toure hospital and who initiated HAART between February 2004 and January 2008 was done. Poor immune recovery was defined as a CD4 count less than 350 cells/µl on follow up as used in other studies. Results A total of 734 patients were included in the study. In this study 50.25% of patients attending CTC at Sekou Toure hospital were found to have poor immune recovery. The risk of developing inadequate immune recovery was independently associated with male gender, age older than 50 years, low baseline CD4 counts, and advanced World Health Organization (WHO) clinical stage. Conclusions Poor immune recovery is prevalent among adult HIV patients attending CTC at Sekou Toure hospital in Northwestern part of Tanzania and opportunistic infections are common in this sub group of patients. Clinicians in resource limited countries need to identify these patients timely and plan them for targeted viral assessment and close clinical follow up to improve their long term clinical outcome.
Collapse
Affiliation(s)
- Daniel W Gunda
- Department of Medicine, Weill Bugando School of Medicine, 1464, Mwanza, Tanzania.
| | - Semvua B Kilonzo
- Department of Medicine, Weill Bugando School of Medicine, 1464, Mwanza, Tanzania
| | - Erasmus Kamugisha
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, 1464, Mwanza, Tanzania
| | - Engelbert Z Rauya
- Care and Treatment Center, Sekouture Regional Referral Hospital, 132, Mwanza, Tanzania
| | - Bonaventura C Mpondo
- Department of Medicine, University of Dodoma, School of Medicine, 395, Dodoma, Tanzania
| |
Collapse
|
13
|
Gunda DW, Kidenya BR, Mshana SE, Kilonzo SB, Mpondo BCT. Accuracy of WHO immunological criteria in identifying virological failure among HIV-infected adults on First line antiretroviral therapy in Mwanza, North-western Tanzania. BMC Res Notes 2017; 10:45. [PMID: 28095920 PMCID: PMC5240422 DOI: 10.1186/s13104-016-2334-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 05/15/2016] [Accepted: 12/10/2016] [Indexed: 11/10/2022] Open
Abstract
Background Optimal HIV treatment monitoring remains a big challenge in resource limited settings. Guidelines recommend the use of clinical and immunological criteria in resource limited settings due to unavailability of viral load monitoring; however their utility is questionable. This study aimed at assessing the accuracy of immunological criteria in detecting treatment failure among HIV infected Tanzanian adults receiving first line ART. Methods A clinic based cross sectional study was conducted between February and July 2011 at Bugando Medical centre (BMC) HIV care and treatment clinic (CTC) involving HIV infected patients aged 18 years and above, receiving first line ART; followed up for at least 1 year. Viral load was tested for every enrolled patient. Standard WHO criteria were used to define immunological failure. Virological failure was defined as one viral load measurement of >5000 copies/ml and was used as a gold standard. A 2 × 2 table was used to assess the accuracy of immunological criteria in detecting treatment failure. Results A total of 274 HIV-infected adults were enrolled into the study. Out of these, 65.7% were females, the median age was 39 years (IQR 33–45), the median BMI 21.9 kg/m2 (IQR 19.7–24.0). Out of the 274 study participants 156 (56.9%) had immunological failure. Only 60 of the study participants (21.9%) had viral load >5000. Only 42 patients (70%) were found to have both immunological failure and virological failure. The sensitivity of immunological criteria in detecting treatment failure was 70%, specificity 46.7%, positive predictive and negative predictive values of 26.9 and 84.7% respectively. Conclusion WHO immunological criteria have low sensitivity and positive predictive value for detecting treatment failure. Relying on CD4 counts for treatment monitoring would therefore lead to misclassifications of treatment failure that could result into unnecessary or delayed switch to second line ART. Access to viral load monitoring is important to avoid these misclassifications.
Collapse
Affiliation(s)
- Daniel W Gunda
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Benson R Kidenya
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Stephen E Mshana
- Department of Microbiology/Immunology, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Semvua B Kilonzo
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Bonaventura C T Mpondo
- Department of Medicine, College of Health Sciences, The University of Dodoma, P.O Box 395, Dodoma, Tanzania.
| |
Collapse
|
14
|
Gunda DW, Bakshi FA, Rambau P, Kilonzo SB. Pulmonary cryptococcosis presenting as acute severe respiratory distress in a newly diagnosed HIV patient in Tanzania: a case report. Clin Case Rep 2015; 3:749-52. [PMID: 26401280 PMCID: PMC4574791 DOI: 10.1002/ccr3.337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/25/2015] [Accepted: 07/02/2015] [Indexed: 11/11/2022] Open
Abstract
Pulmonary cryptococcosis is a common condition in HIV-infected patients which is frequently missed or misdiagnosed in resource-limited countries. We report a case of HIV/AIDS patient who was misdiagnosed with a fatal outcome. There is a need to implement screening tools to be used where the diagnosis may not be confirmed.
Collapse
Affiliation(s)
- Daniel W Gunda
- Department of Internal Medicine, Bugando Medical Centre, Catholic University of Health and Allied Science P. O BOX 1464, Mwanza, Tanzania
| | - Fatma A Bakshi
- Department of Internal Medicine, Bugando Medical Centre, Catholic University of Health and Allied Science P. O BOX 1464, Mwanza, Tanzania
| | - Peter Rambau
- Department of Pathology, Bugando Medical Centre, Catholic University of Health and Allied Sciences P. O BOX 1464, Mwanza, Tanzania
| | - Semvua B Kilonzo
- Department of Internal Medicine, Bugando Medical Centre, Catholic University of Health and Allied Science P. O BOX 1464, Mwanza, Tanzania
| |
Collapse
|
15
|
Meda JR, Seni J, Mpondo B, Peck RN, Jaka H, Kilonzo SB. Behcet's disease presenting with recurrent ocular, oral, and scrotal inflammatory lesions in a young Tanzanian man: a case report. Clin Case Rep 2014; 2:133-6. [PMID: 25356270 PMCID: PMC4184648 DOI: 10.1002/ccr3.79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 04/15/2014] [Indexed: 11/07/2022] Open
Abstract
KEY CLINICAL MESSAGE Behcet's disease (BD) is a rare condition which is diagnosed clinically. Only few cases have been reported in sub-Saharan Africa. We report a Tanzanian male who presented with typical features of BD and was successfully treated. There should be an increase in awareness on BD to improve the management.
Collapse
Affiliation(s)
- John R Meda
- Department of Internal Medicine, Catholic University of Health and Allied Sciences P.O. Box 1464, Mwanza, Tanzania ; Department of Internal medicine, Bugando Medical Centre P.O. Box 1370, Mwanza, Tanzania ; Department of Internal Medicine, University of Dodoma P.O. Box 395, Dodoma, Tanzania
| | - Jeremiah Seni
- Department of Microbiology/Immunology, Catholic University of Health and Allied Sciences P.O. Box 1464, Mwanza, Tanzania
| | - Bonaventura Mpondo
- Department of Internal Medicine, Catholic University of Health and Allied Sciences P.O. Box 1464, Mwanza, Tanzania ; Department of Internal medicine, Bugando Medical Centre P.O. Box 1370, Mwanza, Tanzania ; Department of Internal Medicine, University of Dodoma P.O. Box 395, Dodoma, Tanzania
| | - Robert N Peck
- Department of Internal Medicine, Catholic University of Health and Allied Sciences P.O. Box 1464, Mwanza, Tanzania ; Department of Internal medicine, Bugando Medical Centre P.O. Box 1370, Mwanza, Tanzania ; Department of Medicine, Weill Cornell Medical College 440 East 69th Street, New York, New York, 10065
| | - Hyasinta Jaka
- Department of Internal Medicine, Catholic University of Health and Allied Sciences P.O. Box 1464, Mwanza, Tanzania ; Department of Internal medicine, Bugando Medical Centre P.O. Box 1370, Mwanza, Tanzania
| | - Semvua B Kilonzo
- Department of Internal Medicine, Catholic University of Health and Allied Sciences P.O. Box 1464, Mwanza, Tanzania ; Department of Internal medicine, Bugando Medical Centre P.O. Box 1370, Mwanza, Tanzania
| |
Collapse
|
16
|
Meremo AJ, Kilonzo SB, Munisi D, Kapinga J, Juma M, Mwanakulya S, Mpondo B. Acute renal failure in a Caucasian traveler with severe malaria: a case report. Clin Case Rep 2014; 2:82-5. [PMID: 25356255 PMCID: PMC4184599 DOI: 10.1002/ccr3.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/01/2013] [Accepted: 12/22/2013] [Indexed: 11/09/2022] Open
Abstract
KEY CLINICAL MESSAGE Acute renal failure (ARF) secondary to severe malaria is uncommon. We report a case of a patient visiting Africa for the first time presenting with malaria and ARF. There was complete recovery after hemodialysis. Early initiation of hemodialysis proves to be useful in restoration of renal function.
Collapse
Affiliation(s)
- Alfred J Meremo
- Haemodialysis Unit, University of Dodoma Dodoma, Tanzania ; Department of Internal Medicine, College of Health sciences, University of Dodoma Dodoma, Tanzania
| | - Semvua B Kilonzo
- Department of Internal Medicine, Morogoro Regional Referral Hospital Dodoma, Tanzania
| | - David Munisi
- Department of Biomedical sciences, College of Health sciences, University of Dodoma Dodoma, Tanzania
| | - Janet Kapinga
- Haemodialysis Unit, University of Dodoma Dodoma, Tanzania
| | - Mwinyikondo Juma
- Haemodialysis Unit, University of Dodoma Dodoma, Tanzania ; Department of Internal Medicine, College of Health sciences, University of Dodoma Dodoma, Tanzania
| | - Simfukwe Mwanakulya
- Department of Internal Medicine, Morogoro Regional Referral Hospital Dodoma, Tanzania
| | - Bonaventura Mpondo
- Haemodialysis Unit, University of Dodoma Dodoma, Tanzania ; Department of Internal Medicine, College of Health sciences, University of Dodoma Dodoma, Tanzania
| |
Collapse
|
17
|
Kilonzo SB, Kamugisha E, Downs JA, Kataraihya J, Onesmo R, Mheta K, Jeong JM, Verweij JJ, Fitzgerald DW, Peck RN. Malaria among adult inpatients in two Tanzanian referral hospitals: a prospective study. Acta Trop 2014; 134:95-100. [PMID: 24657845 DOI: 10.1016/j.actatropica.2014.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/25/2014] [Accepted: 03/10/2014] [Indexed: 12/25/2022]
Abstract
Most malaria research in sub-Saharan Africa has focused on children and pregnant women, but malaria among hospitalized adults in this region is poorly characterized. In this prospective study, we assessed the prevalence and clinical characteristics of malaria among the inpatient adults in two hospitals in Tanzania. We enrolled adults admitted with suspected malaria and performed routine thick blood smear (BS) and malaria rapid diagnostic tests (RDT). We also assessed malaria parasite clearance rates. We considered malaria status 'confirmed' or 'excluded' only in patients with two concordant tests. Malaria polymerase chain reaction (PCR) was performed in a subset of patients with discordant BS and RDT. After BS and RDT were performed on 579 adults with suspected malaria, malaria was excluded in 458/579 (79.1%) and confirmed in 16/579 (2.8%). One hundred and five out of 579 (18.1%) had discordant results. The prevalences of positive BS and positive RDT were 102/579 (17.6%) and 35/579 (6.0%), respectively, with only fair agreement (Kappa=0.354, p<0.0001). PCR results agreed with RDT in 35/35 (100%) of patients with a negative RDT but positive BS. PCR results also agreed with RDT in 9/13 (69.2%) of cases with a positive RDT but negative BS. Clinical correlates of malaria by multivariable analysis included subjective fever (OR 3.6 [1.0-12.3], p=0.04), headache (OR 3.1 [1.2-8.0], p=0.02) and vomiting (OR 2.7 [1.2-6.4], p=0.02). Malaria parasite clearance was significantly delayed in the HIV-infected group. Our study demonstrated only fair agreement between RDT and BS malaria tests among Tanzanian adult inpatients with suspected malaria. PCR generally agreed with RDT results. HIV was associated with delayed parasite clearance in adults with malaria. We recommend the routine use of RDTs for malaria diagnosis among adults admitted to hospitals in sub-Saharan Africa.
Collapse
Affiliation(s)
- Semvua B Kilonzo
- Catholic University of Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania; Bugando Medical Centre, PO Box 1370, Mwanza, Tanzania.
| | - Erasmus Kamugisha
- Catholic University of Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania
| | - Jennifer A Downs
- Catholic University of Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania; Bugando Medical Centre, PO Box 1370, Mwanza, Tanzania; Weill Cornell Medical College, NY, USA
| | - Johannes Kataraihya
- Catholic University of Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania; Bugando Medical Centre, PO Box 1370, Mwanza, Tanzania
| | | | - Koy Mheta
- Catholic University of Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania; Bugando Medical Centre, PO Box 1370, Mwanza, Tanzania
| | | | - Jaco J Verweij
- Laboratory of Medical Microbiology and Immunology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | | | - Robert N Peck
- Catholic University of Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania; Bugando Medical Centre, PO Box 1370, Mwanza, Tanzania; Weill Cornell Medical College, NY, USA
| |
Collapse
|