Ku Repository :: Browsing by Author "Kalabamu, Florence S."

Browsing by Author "Kalabamu, Florence S."

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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
Acute diarrhea in children less than five years of age: epidemiology of bacterial pathogens
(Journal of Microbiology and Infectious Diseases, 2020-12-15) Kalabamu, Florence S.; Mwaikambo, Esther D.
Objectives: Acute diarrhea is among the leading causes of mortality and morbidity worldwide. Bacteria tend to cause more fatal illnesses and complications such as septicemia and persistent diarrhea. This study aimed to determine the causes of acute diarrhea, laboratory and clinical predictors of bacterial causes, and antimicrobial resistance pattern among the isolates among children in Dar es salaam, Tanzania. Methods: A cross-sectional hospital-based study was conducted in Dar es salaam Hospitals from April 2015 to March 2016 among children below five years of age who presented with acute diarrhea. Demographic characteristics and results from stool specimen analysis, complete blood count,C-reactive protein and antimicrobial resistance results were recorded using a pre-structured clinical research form. Results: Among 200 children enrolled, viruses were identified in 149 (74.5%) of the cases. Bacterial pathogens were found in 15 (7.5%) cases only. Elevated stool red blood cell count, stool white blood cell count, and fever were highly associated with enteric bacterial pathogens (p<0.001, p=0.002 and p=0.04 respectively). Most of the bacterial isolates were resistant to Cotrimoxazole and erythromycin but highly sensitive to ciprofloxacin and Ceftriaxone. Conclusion: Fever, elevated stool leukocyte and elevated stool red blood cells are significant predictors of bacterial enteric pathogens in children with acute diarrhea. These parameters may guide clinicians in resource-limited settings in the diagnosis and management of acute diarrhea. Further studies should be conducted to determine local antimicrobial resistance patterns. J Microbiol Infect Dis 2020; 10(3):208-214. Keywords:Acute diarrhea, causes, predictors, antimicrobial resistance, children
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.
Cerebrospinal fluid pterins, pterin-dependent neurotransmitters, and mortality in pediatric cerebral malaria
(The Journal of Infectious Diseases, 2021-02-22) Kalabamu, Florence S.; Mwaikambo, Esther D.
Background Cerebral malaria (CM) pathogenesis remains incompletely understood. Having shownlow systemic levels of tetrahydrobiopterin (BH4), an enzymatic cofactor forneurotransmitter synthesis, we hypothesized that BH4and BH4-dependentneurotransmitters would likewise be low in cerebrospinal fluid (CSF) in CM. Methods We prospectively enrolled Tanzanian children with CM and children with nonmalariacentral nervous system conditions (NMCs). We measured CSF levels of BH4, neopterin,and BH4-dependent neurotransmittermetabolites, 3-O-methyldopa, homovanillic acid,and 5-hydroxyindoleacetate, and we derived age-adjusted z-scores using publishedreference ranges. Results Cerebrospinal fluid BH4was elevated in CM (n=49) compared with NMC (n=51) (z-score 0.75 vs−0.08;P<.001). Neopterin was increased in CM (z-score 4.05 vs 0.09;P<.001), and a cutoff at the upper limit of normal (60 nmol/L) was 100% sensitive forCM. Neurotransmitter metabolite levels were overall preserved. A higher CSFBH4/BH2ratio was associated with increased odds of survival (odds ratio, 2.94; 95%confidence interval, 1.03–8.33;P=.043). Conclusion Despite low systemic BH4, CSF BH4was elevated and associated with increased odds ofsurvival in CM. Coma in malaria is not explained by deficiency of BH4-dependentneurotransmitters. Elevated CSF neopterin was 100% sensitive for CM diagnosis andwarrants further assessment of its clinical utility for ruling out CM in malaria-endemicareas. Keywords: cerebralmalaria, neopterin, neurotransmitter, Palciparum, tetrahydrobiopterin
Decreased Microvascular Function in Tanzanian Children With Severe and Uncomplicated Falciparum Malaria
(Open Forum Infectious Diseases, 2017) Kalabamu, Florence S.; Kalingonji, Ayam R.; Mwaikambo, Esther D.
Microvascular function and oxygen consumption affect oxygen homeostasis but have not been assessed in African children with malaria. Microvascular function in Tanzanian children with severe malaria (SM) or uncomplicated malaria were 39% and 72%, respectively, of controls (P < .001). Uncomplicated malaria (P = .04), not SM (P = .06), children had increased oxygen consumption compared with controls. A major pathogenic mechanism in severe falciparum malaria is microcirculatory obstruction due to parasite sequestration [1]. However, several studies suggest that sequestration alone may not impair microcirculatory flow in malaria [1–3]. The normal microvasculature matches oxygen delivery and demand, with a major mediator being nitric oxide (NO) [2, 4]. In malaria, NO pathway dysregulation impairs host NO production and bioavailability [5–8]. In Indonesian children, vascular NO and microvascular function was decreased in severe and uncomplicated falciparum malaria [3]. Oxygen demand may exacerbate tissue hypoxia and was increased in Indonesian adults and children with malaria [2, 3]. However, microvascular function and oxygen demand have not been assessed in African children, the group with the highest burden of malaria. We assessed skeletal muscle microvascular function and oxygen consumption in Tanzanian children with severe malaria (SM) or uncomplicated malaria (UM) and compared these to controls.
Decreased systemic tetrahydrobiopterin bioavailability and increased oxidized biopterins in children with cerebral malaria
(Nitric Oxide-Biology and Chemistry, 2014) Kalabamu, Florence S.; Mwaikambo, Esther D.
Background: Falciparum malaria causes over 600,000 deaths worldwide each year. Despite advances in anti-parasitic drug therapies, 10–20% of children treated for severe malaria die. We have previously documented that NO protects against development of severe malaria, and that NO levels are low in malaria patients. Tetrahydrobiopterin (BH4) is an enzyme cofactor required for NO synthase that converts L-arginine to NO. Low or absent BH4 results in superoxide (instead of NO) production by NOS, with a consequent increase in “oxidative stress.” Hypothesis: Systemic levels of BH4 are decreased in children with cerebral malaria, contributing to low NO bioavailability and increased severity of malaria. Objective: Determine systemic levels of BH4 in children with malaria. Methods: In an observational study in Tanzania, we measured urine levels of biopterin in its various redox states [fully reduced biopterin (BH4), and the oxidized metabolites dihydrobiopterin (BH2) and biopterin (B0)] in children with uncomplicated malaria (UM, n = 55), cerebral malaria (CM, n = 46), as well as control children with non-malaria central nervous system conditions (NMC, n = 48) and healthy control children (HC, n = 111). Urine was collected into dithioerythritol and diethylene triamine penta-acetic acid (DETAPAC). Pterins were measured by high-performance liquid chromatography using sequential electrochemical and fluorescence detection. Results: Urine BH4 concentrations [µmol/mmol creatinine; median (IQR)] in CM were significantly lower compared to those in children in each of the other three groups. Oxidized biopterins were increased, and the BH4:BH2 ratio was markedly reduced in CM. Blood mononuclear cell guanosine triphosphate cyclohydrolase I mRNA was not low in any of the groups compared to the HC children. In a multivariate logistic regression model, each unit decrease in urine BH4 was independently associated with a 3.85 (95% CI: 1.89–7.69) fold increase in odds of CM (p < 0.001). Conclusions: Low systemic BH4 levels and increased oxidized biopterins likely contribute to the low NO bioavailability observed in cerebral malaria. Adjunctive interventions to increase BH4 may reduce occurrence of severe falciparum malaria in children.
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.
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.
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.
Effects of induced arginase enzyme on arginine availability for nitric oxide production in children with severe malaria
(Hubert Kairuki Memorial University, 2013) Kalabamu, Florence S.
INTRODUCTION: Malaria is still one of the major leading causesof morbidity and mortality in developing countries regardlessof the use of effective antimalarial drugs. Immunological response as a result of malaria acquisition contributes much to pathogenesis of malaria. Recent studies have indicated that malaria infection is associated with low plasma arginine levels with subsequent low NO productionand endothelial dysfunction. NO is important for normal endothelial function which is impaired during malaria infection. The causes ofhypoargininemiawith low NO production in malariaarenot well understood. Arginase,anenzyme responsiblefor metabolism of arginine to ornithine,competes with NOS for its substratearginine. Ornithine is a precursor for polyamine biosynthesis and other anabolicpathways. The contributionofarginase tothedevelopment of low plasma arginine levelshasnot been studied in children. OBJECTIVES: The aim of this study was to assess the role of plasmaArginasein the observedhypoargininemiain children with malaria. METHODS: Across-sectionprospective,observationalstudy was done in Dar es Salaam, Tanzania. Children aged 6 months to 9 years were recruited from Mwananyamala, Amana,and Mikocheni hospitals afterobtaining informedconsent. Participants were grouped into severe malaria(SM), uncomplicated malaria (UM),and healthy controls (HC) using WHO criteria. Blood samples were taken from participants and analyzed for plasmaarginine,plasmaarginaseactivity,andcell-freehemoglobin. PBMCswereseparated from anticoagulated bloodfor determination of mRNA for arginase1,arginase2,and NOS2. RESULTS: Eighty (80) SM, 80UM,and48HCwere recruited. Plasma arginine levels were significantly lower in malaria groups compared to healthy controls (p<0.0001).The mean values were 58.8±3.9µmol/L in SM, 54.8±3.3µmol/L in UM,and94.58±4.2 µmol/L inHC.Plasma arginase activity was higher in children with malaria, but it was not statistically significantly higher (p=0.75).Themean values were 0.273±0.034µmol/ml/hour inSM, 0.252±0.030µmol/ml/hour in UM,and 0.200±0.0566µmol/ml/hour in HC.There was no correlation between plasma arginase activity and plasma arginine levels in SM group (Pearson r=-0.001).Cell free Hb levels werehigher in the SM and UM groups (p=0.02), but it did not correlate with plasma arginase activity(r=-0.09). Therewas amarked increaseinarginase 1mRNAin PBMCs7 fromSM and UM compared to HC group. The median values were9.31and4.51fold increaseinSMandUMgroups,respectively (p=0.008 and 0.02,respectively).mRNA valuesfor arginase2 wereslightly higher in the HCgroup, but this was notsignificantly higherthan that of the other groups(p=0.89).NOS2 mRNA was lower in PBMC of malaria patients(SMand UM)compared toHC(p=0.0001foreachcomparison). DISCUSSION, CONCLUSION,AND RECOMMENDATIONS: Plasma arginine levels were lowin children with malariacomparedtopreviouslyreportedfindings. Hypoargininemiaand plasma arginase activity do notsignificantlycorrelate with one another. ElevatedarginaseImRNA levelsin PBMCpatients withmalaria,suggests that arginase 1 could alsobe induced in othermononuclear phagocytes, including fixed macrophages. These arginase1-bearing cells may in part beresponsible for hypoargininemia. Induction of mononuclear phagocyte arginase1anddiminished NOS2mRNA and NO production bymononuclear phagocytes conforms to the phenotype of “alternative macrophage activation.” Hypoargininemia and alternative macrophage activation correlate with clinical malaria and may be markers ofmalaria diseaseseverity.Assessment of arginase activity inPBMCs (andpurifiedmononuclear phagocytes)during malaria infection is warranted to fully establishtheroleof alternativelyactived monocytes-macrophagesinthehypoarginaemia observed during themalaria infection.
Evidence of Degradation of Endothelial Glycocalyx in African Children with Falciparum Malaria
(The FASEB Journal, 2020-04-19) Mwaikambo, Esther D.; Kalingonji, Ayam R.; Kalabamu, Florence S.
Abstract The microvasculature and endothelium play a pivotal role in pathophysiology of malaria. The endothelial glycocalyx (eGC) is a layer on the luminal side of vascular endothelial cells with involvement in homeostatic functions including regulation of vascular permeability, cellular adhesion and blood flow‐mediated nitric oxide formation. Breakdown products of eGC degradation include glycosaminoglycans (GAG) and syndecan‐1, a core protein. The objective of this study was to evaluate a possible role of eGC breakdown in the pathogenesis of malaria. We prospectively evaluated measures of endothelial glycocalyx integrity in children with severe and moderately severe malaria and healthy controls, and determined the relationship between glycocalyx integrity and markers of malaria severity, microvascular reactivity, and endothelial activation. At the Hubert Kairuki Medical Center in Dar es Salaam, Tanzania we studied 146 subjects, aged 2–11 years, including 60 healthy controls (HC), 49 patients with moderately severe malaria (MSM) and 37 patients meeting WHO criteria for severe malaria (SM). Ethics committee approvals were obtained prior to study initiation. We assessed eGC integrity biochemically by measuring plasma syndecan‐1 (ELISA) and total urinary glycosaminoglycan (GAG) breakdown products (dimethylmethylene blue assay). Angiopoietin‐2 has been reported to cause breakdown of eGC and was measured by ELISA. Quantitative measures of eGC were assessed using non‐invasive, side‐stream dark field (SDF) microscopy of the pinna and axilla. Levels of urinary GAG were increased in malaria patients compared with HC (mean±SEM 4.3±0.4 g/mol creatinine); MSM (12.4±1.0); SM (13.4±1.0); p<0.0001. Plasma levels of angiopoietin‐2 and syndecan‐1 were also elevated in MSM and SM compared with HC (p<0.0001), and significantly correlated with each other. For HC compared with MSM, imaging results showed eGC degradation [an increase in the perfused boundary region (mean±SEM 1.55±0.04 microns vs.1.68±0.05; p<0.05)], increased microvascular density (549± 34 μm/mm2 vs. 649 ±38; p<0.05)], and a decrease in the extent of RBC filling (79.1± 0.98% vs. 74.9±1.02%; p<0.01). In conclusion, these results provide evidence for degradation of the eGC that could contribute to pathogenesis of vascular dysfunction in malaria. Decreased nitric oxide formation, endothelial activation and increased adhesion of infected RBC are potential consequences of the eGC degradation and vascular dysfunction. Administration of an agent that prevents or repairs eGC degradation may be helpful as adjunctive therapy for malaria. Support or Funding Information National Institutes of Health (R01 HL130783)
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.
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
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.
Kinetic and Cross-Sectional Studies on the Genesis of Hypoargininemia in Severe Pediatric Plasmodium falciparum Malaria
(Infection and immunity, 2019) Kalabamu, Florence S.; Kalingonji, Ayam R.; Mwaikambo, Esther D.
The low bioavailability of nitric oxide (NO) and its precursor, arginine, contributes to the microvascular pathophysiology of severe falciparum malaria. To better characterize the mechanisms underlying hypoargininemia in severe malaria, we measured the plasma concentrations of amino acids involved in de novo arginine synthesis in children with uncomplicated falciparum malaria (UM; n = 61), children with cerebral falciparum malaria (CM; n = 45), and healthy children (HC; n = 109). We also administered primed infusions of l-arginine uniformly labeled with 13C6 and 15N4 to 8 children with severe falciparum malaria (SM; age range, 4 to 9 years) and 7 healthy children (HC; age range, 4 to 8 years) to measure the metabolic flux of arginine, hypothesizing that arginine flux is increased in SM. Using two different tandem mass spectrometric methods, we measured the isotopic enrichment of arginine in plasma obtained at 0, 60, 90, 120, 150, and 180 min during the infusion. The plasma concentrations of glutamine, glutamate, proline, ornithine, citrulline, and arginine were significantly lower in UM and CM than in HC (P ≤ 0.04 for all pairwise comparisons). Of these, glutamine concentrations were the most markedly decreased: median, 457 μM (interquartile range [IQR], 400 to 508 μM) in HC, 300 μM (IQR, 256 to 365 μM) in UM, and 257 μM (IQR, 195 to 320 μM) in CM. Arginine flux during steady state was not significantly different in SM than in HC by the respective mass spectrometric methods: 93.2 μmol/h/kg of body weight (IQR, 84.4 to 129.3 μmol/h/kg) versus 88.0 μmol/h/kg (IQR, 73.0 to 102.2 μmol/h/kg) (P = 0.247) by the two mass spectrometric methods in SM and 93.7 μmol/h/kg (IQR, 79.1 to 117.8 μmol/h/kg) versus 81.0 μmol/h/kg (IQR, 75.9 to 88.6 μmol/h/kg) (P = 0.165) by the two mass spectrometric methods in HC. A limited supply of amino acid precursors for arginine synthesis likely contributes to the hypoargininemia and NO insufficiency in falciparum malaria in children.
Magnitude of overweight, obesity and insufficient physical sports activities among secondary school students in Kinondoni Municipal, Dar es Salaam.
(The East African Health Research Journal, 2020-11-26) Kalabamu, Florence S.
Introduction: There is an overwhelming increase of Non-Communicable Disease worldwide such as diabetes and cardiovascular diseases. Overweight and obesity are highly associated with development of these diseases. Unhealthy lifestyle such as excessive sugar, alcohol intake and lack of adequate physical activities has been associated with development of obesity. However, these risk factors are not well elucidated among adolescents in Tanzania. We conducted this survey to determine obesity, overweight, self-reported physical activities, and preferred foods among secondary school students in Kinondoni Municipal in Dar es salaam, Tanzania. Methods: A cross sectional descriptive survey was conducted among secondary school students at Kambangwa and Makumbusho secondary schools in Kinondoni municipal in Dar es Salaam city. A simple random sampling technique was used to select participating schools with systemic random selection procedure was used to select participants. A pre structured, self-administered questionnaire was used to collect demographic information from the participants. Anthropometric measurement for Body Mass Index (BMI) was done using standard tools. Interpretation of the findings was done using World Health Organization (WHO) standard charts for age and sex. Data were analysed using Statistical Package for Social Sciences (SPSS version 20; SPSS Inc., Chicago, US). Results: A total of 234 participants were enrolled in the study. A total of 204 (87.2%) of study participants reported to regularly participate in physical sports activities. Furthermore, Males reported to participate more in physical sports activities compared to females ( X2 (1) =8.13., p = 0.004). During sex-wise comparison, 30 (46.2%) of males reported to participate in sports once per week compared to 71 (51.5%) of females. Reported frequency was influenced by participants’ sex ( X2 (3) =16.4., p= 0.001). A total of 28 (12%) participants reported fruits as their favourite food. Food preference was influenced by the participants’ sex (X 2 (5) =13.1., p < 0.02). 32(47.7%) of males reported fresh fruits juice as their favourite drink compared to 106(63.5%) of females) while 6(9%) of males reported to prefer commercial industrial juice compared to 4 (2.4%) of females Conclusion: Obesity and overweight are prevalent among secondary school adolescents in Kinondoni Municipal, Dar es salaam. In addition, the magnitude of physical activities was below the recommended amount. Therefore, awareness campaigns and advocacy programs aiming at preventive measures against NCDs such as healthy eating behaviour and promotion of physical activities among adolescents should be given high priority.
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.
Monocyte polarization in children with falciparum malaria: relationship to nitric oxide insufficiency and disease severity
(Scientific reports, 2016) Kalabamu, Florence S.; Kalingonji, Ayam R.; Mwaikambo, Esther D.
Abstract We earlier established that nitric oxide (NO) is protective against severe malaria and that arginine and NO levels are reduced in malaria patients. We now show that an M2-like blood monocyte phenotype is significantly associated with hypoargininemia, NO insufficiency, and disease severity in Tanzanian children with falciparum malaria. Compared to control children (n = 106), children with moderately severe (n = 77) and severe falciparum malaria (n = 129) had significantly higher mononuclear cell arginase 1 mRNA, protein, and enzyme activity; lower NOS2 mRNA; lower plasma arginine; and higher plasma IL-10, IL-13, and IL-4. In addition, monocyte CD206 and CD163 and plasma soluble CD163 were elevated. Multivariate logistic regression analysis revealed a significant correlation of risk of severe malaria with both plasma IL-10 and soluble CD163 levels. Monocyte M2 skewing likely contributes to NO bio insufficiency in falciparum malaria in children. Treatments that reverse the M2 polarization may have potential as adjunctive treatment for malaria.
Oral 1731-1 - The role of alternatively activated (M2) monocytes in limiting NO bioavailability in falciparum malaria
(Weinberg, J.B., Volkheimer, A.D., Chen, Y., Rubach, M.P., Mwaikambo, E.D., Mukemba, J., Florence, S., Yeo, T.W., Granger, D.L. and Anstey, N.M., 2014. The role of alternatively activated (M2) monocytes in limiting NO bioavailability in falciparum malaria. Nitric Oxide, (42), p.101., 2014) Mwaikambo, Esther D.; Kalabamu, Florence S.
Background: We established earlier that NO has potent anti-malaria disease activity in humans. We have discovered a variety of mechanisms by which host NO bioavailability is decreased in children and adults with falciparum malaria (Weinberg et al., Curr. Opin. Infect. Dis. 21 (2008) 468–475, for review). The underlying process(es) causing changes in these factors with resultant low NO in malaria is not known. Monocytes-macrophages can be activated through the classical pathway (“M1”) with cytokines such as IFN-g and TNF, or through the alternative pathway (“M2”) with cytokines such asIL-4, IL-10, and IL-13. M1 cells are characterized by increased NOS2, NO, and superoxide production, while M2 cells have de-creased NOS2 and NO production, increased arginase 1expression, and increased expression of the scavenger receptor CD163 and the mannose receptor CD206 by monocytes. Hypothesis: Monocytes in falciparum malaria patients are alternatively activated, and this activation contributes to the low NO bioavailability in malaria. Objective: Determine the status of monocyte activation in Tanzanian children with falciparum malaria. Methods: We studied the categories healthy control (HC, n=62), moderately severe malaria (MSM, n=54), and severe malaria (SM, n=50) (total n=166). We used real-time RT-PCR to measure PBMC mRNA for arginase1& 2, NOS2, and GTP cyclohydrolase 1; flow cytometry for monocyte surface CD163& CD206; ELISA for plasma soluble CD163; and ELISA for plasmacytokine levels. Results: Compared to HC subjects, patients with malaria had significantly higher PBMC arginase 1 mRNA, lower NOS2 mRNA, slightly higher GTPCH-1 mRNA, and unchanged arginase 2mRNA; higher PBMC arginase 1 protein by immunoblot; higher plasma arginase enzyme activity and soluble CD163; higher monocyte surface CD206 and CD163; and higher plasma IL-10, IL-4, and IL-13. Overall, this pattern of changes we see in malaria patients is characteristic of alternatively activated (M2) monocytes. Conclusions: Our results indicate presence of alternatively activated (M2) monocytes in children with falciparum malaria. We speculate that the M2 status of mononuclear phagocytes is a major factor underlying certain causes of low NO bioavailability in malaria. Preventing M2 development or reversing M2 status to either no activation or M1 activation status will likely be useful in preventing and treating malaria.

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