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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
Adhesion of Plasmodium falciparum-infected red blood cells to CD36 under flow is enhanced by the cerebral malaria-protective trait South–East Asian ovalocytosis
(Molecular and biochemical parasitology, 2005) Mgone, Charles S.
Aetiology, antimicrobial susceptibility and predictors of urinary tract infection among febrile under-fives at Muhimbili National Hospital, Dar es Salaam-Tanzania
(African Journal of Microbiology Research, 2013) Fataki, Maulidi R.
Urinary tract infection (UTI) is a common cause of fever in children and contributes to morbidity and mortality. This study aimed at determining prevalence, aetiology and antimicrobial susceptibility pattern of the isolates at Muhimbili National Hospital (MNH), Dar es Salaam- Tanzania. Demographic data were collected using a pretested questionnaire. 382 febrile children below five years admitted in the general paediatric wards were recruited. Urine specimens were obtained for urinalysis, culture and antimicrobial sensitivity testing. UTI was detected in 16.8% (64/382). Children who presented prolonged duration of fever (7 days or longer) were more likely to have UTI (p< 0.01). Duration of fever, positive leukocyte and nitrite tests were independent predictors of UTI. Isolated bacteria included Escherichia coli (39.1%), Klebsiella spp (31.2%), Staphylococcus epidermidis (6.2%), Staphylococcus aureus (4.7%) and Pseudomonas aeruginosa (4.7%). We observed high resistance of the isolated uropathogens to ampicillin (79.9%), co-trimoxazole (89%) and clavulanate-amoxillin (70.3%). Amikacin had the least resistance (12.5%) from the isolated pathogens.
Age-related susceptibility to severe malaria associated with galectin-2 in highland Papuans
(The Journal of infectious diseases, 2010) Mwaikambo, Esther D.
Background. Age and host genetics are important determinants of malaria severity. Lymphotoxin-α (LTα) has been associated with the development of cerebral malaria (CM) and other severe malaria (SM) syndromes. Mutations in genes regulating LTα production contribute to other acute vascular diseases and may contribute to malaria pathogenesis. Methods. We tested the association between rs7291467, a single-nucleotide polymorphism (SNP) in the LTαrelated gene encoding galectin-2 (LGALS2), disease severity, and function in a case-control study of ethnic Highland Papuan adults and children with SM (n=380) and asymptomatic malaria-exposed controls (n=356) originating from a non-malaria-endemic region but residing in a lowland malaria-endemic area of Papua, Indonesia. Results. The LGALS2 SNP showed a significant association with susceptibility to SM (including CM), in children (odds ratio, 2.02 [95% confidence interval, 1.14–3.57]) but not in adults. In SM, the C allele at rs7291467 was associated with enhanced galectin-2 transcript levels. In a separate group of Tanzanian children originating from a malaria-endemic region, we found preservation of the major ancestral LGALS2 allele and no association with susceptibility to CM. Conclusions. Results suggest differences in the inflammatory contribution to the development of SM between children and adults in the same population and potential differences between individuals originating from malariaendemic and non-malaria-endemic areas.
Allelic frequencies of p53 codon 72 polymorphism and human papillomavirusmediated cervical cancer In Papua New Guinean women
(Pacific Journal of Medical Sciences, 2015) Mgone, Charles S.
Cervical cancer is regarded as a sexually transmitted disease caused by the human papilloma virus (HPV) detected in up to 80 per cent of the cancer biopsies. Genetic susceptibility of a p53 allelic variant has been postulated to play a vital role in carcinogenesis. This study was aimed at determining the allelic frequencies of p53 codon 72 polymorphism in Papua New Guinean women and also assessing the presence of HPV in cervical cancer biopsies. Peripheral blood (3-5 mL) was collected from 53 healthy females of reproductive age (19-37 years) with no known past and current history of HPV infections. Sixty-two cervical biopsies along with cervical swaps were obtained from patients (19-54 years) with clinical symptoms and histopathological confirmation of cervical cancer. DNA was extracted from the peripheral blood samples and cervical samples. Exon 4 was amplified with PCR and further genotypic analyses performed by Restriction fragment length polymorphism (RFLP) and single-stranded conformational polymorphism (SSCP). Of the 53 normal samples analyzed, 3.8 % (2/53) were Arginine homozygous, 58.5 % were Proline homozygous and 37.7 % were heterozygous. For the cancer samples, 14.5 % (9/62) were Arginine homozygous, 54.8 % were Proline homozygous and 30.7% were heterozygous. HPV genome was detected in 83.9 % (52/62) of the cervical cancer samples. The genotypic trend and allelic frequencies were consistent with literature.
Amoebic Liver Abscess in Infancy A Case Report
(University of Zimbabwe, 1983) Mgone, Charles S.
A case report on infantile amoebic abscess is presented. Pitfalls in the proper diagnosis are mentioned. These include the general belief that the condition is rare and the difficulties encountered in recovery of the offending organisms both in stools and from the liver abscess. The pus itself may also not be characteristic. The need for early diagnosis is emphasized and we recommend draining the abscess and instituting metronidazole.
Analysis of pan-African Centres of excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent
(BMC international health and human rights, 2012) Mgone, Charles S.
A pool of 38 pan-African Centres of Excellence (CoEs) in health innovation has been selected and recognized by the African Network for Drugs and Diagnostics Innovation (ANDI), through a competitive criteria based process. The process identified a number of opportunities and challenges for health R&D and innovation in the continent: i) it provides a direct evidence for the existence of innovation capability that can be leveraged to fill specific gaps in the continent; ii) it revealed a research and financing pattern that is largely fragmented and uncoordinated, and iii) it highlights the most frequent funders of health research in the continent. The CoEs are envisioned as an innovative network of public and private institutions with a critical mass of expertise and resources to support projects and a variety of activities for capacity building and scientific exchange, including hosting fellows, trainees, scientists on sabbaticals and exchange with other African and non-African institutions.
Antibodies to Plasmodium falciparum Glycosylphosphatidylinositols: Inverse Association with Tolerance of Parasitemia in Papua New Guinean Children and Adults
(Infection and immunity, 2002) Mgone, Charles S.
Individuals living in regions of intense malaria transmission exhibit natural immunity that facilitates persistence of parasitemia at controlled densities for much of the time without symptoms. This aspect of immunity has been referred to as malarial “tolerance” and is thought to partly involve inhibition of the chain of events initiated by a parasite toxin(s) that may otherwise result in cytokine release and symptoms such as fever. Antibodies to the candidate Plasmodium falciparum glycosylphosphatidylinositol (GPI) toxin have been viewed as likely mediators of such tolerance. In this study, the relationship between antibodies to P. falciparum GPIs, age, and parasitemia was determined in asymptomatic children and adults living in Madang, Papua New Guinea. The prevalence and intensity of antibody responses increased with age and were lowest in children 1 to 4 years old with the highest-density parasitemias. In children of this age group who were tolerant of parasitemia during the study, only 8.3% had detectable immunoglobulin G (IgG) and none had IgM antibodies to GPI. This suggests that anti-GPI antibodies are unlikely to be the sole mediator of malarial tolerance, especially in children younger than 5 years. Following antimalarial treatment, clearance of parasitemia led to a fall in anti-GPI IgG response in children and adolescents within 6 weeks. As anti-GPI antibodies potentially play a role in protecting against disease progression, our results caution against the treatment of asymptomatic parasitemia and suggest that generation of a sustained antibody response in children poses a challenge to novel antitoxic vaccination strategies.
Application of Direct cDNA Sequencing for the Characterisation of Molecular Pathology in Acute Intermittent Porphyria
(University of Glasgow, 1991) Mgone, Charles S.
Acute intermittent porphyria (AIP) is an autosomal dominant disorder caused by partial deficiency of the enzyme porphobilinogen deaminase (PBG-D). It is heterogeneous and commonly gene carriers of the disorder remain asymptomatic and may not always be diagnosed by conventional biochemical methods. Since detection of gene carriers is of central importance to the management of this condition, an alternative method of diagnosis is essential. Mutations causing acute intermittent porphyria have not however, been fully characterised. In the current study, direct cDNA sequencing of polymerase chain reaction (PCR) amplified templates has been developed and applied for the characterisation of mutations associated with this disorder. The procedure was developed by amplifying RNA from various sources including human placenta, chorion, lymphocytes and lymphoblastoid cells. The amplification was performed by a technique referred to as reverse-transcriptase polymerase chain reaction (R-T PCR) in which both the first strand cDNA synthesis and the subsequent amplification are performed in the same reaction mixture. Two approaches to the R-T PCR amplification were employed and compared. In the first approach, the first strand cDNA synthesis was carried out with one of the primers complementary to the non-erythroid PBG-D mRNA and in the second, by using oligo(dT)12-18. Both methods were successful and comparable, but the later was preferred because it could be modified in asymmetric PCR to directly produce either the sense or the anti-sense strand. The PBG-D cDNA synthesised and amplified by the R-T PCR was either directly sequenced as double-stranded (ds) templates or eluted and reamplified by asymmetric PCR to produce singlestranded templates. Alternatively, single-stranded templates were produced directly by 'asymmetric' R-T PCR. Prior to sequencing, the PCR amplified templates were concentrated, desalted and purified to remove excess deoxyribonucleoside triphosphates (dNTPs) and amplification primers. Several purification methods were employed and their efficacy compared. These included, spun-column chromatography, nucleic acid chromatography system (NACS) purification, centrifuge-driven dialysis, geneclean TM purification, gel fractionation and selective precipitation in ammonium acetate and propan-2-ol. Selective precipitation with ammonium acetate and propan-2-ol was found to be the simplest and most effective method of template purification. In addition it was also inexpensive, reliable and convenient. Dideoxy sequencing of both double-stranded and single-stranded (ss) templates was performed with either Sequenase T7 DNA polymerase or Taq DNA polymerase. Sequencing of the singlestranded templates, especially when produced by asymmetric reamplification of cDNA gave the most consistent and reliable results. For routine sequencing, there was no difference in the performance of the two sequencing enzymes used, although Taq DNA polymerase was better than Sequenase T7 DNA polymerase in handling templates with complex secondary structures. The procedure of direct sequencing was applied on asymetrically amplified templates of thirty patients with acute intermittent porphyria (AIP) and ten normal controls. The diagnosis of acute intermittent porphyria was based on increased excretion of aminolevulinic acid (ALA) and porphobilinogen (PBG) in urine and decreased activity of erythrocyte porphobilinogen deaminase (PBG-D) coupled with a clinical history of one or more acute attacks. The mean erythrocyte porphobilinogen activity in the acute intermittent porphyria patients was 22. 3 nmol/h/ml erythrocytes. The normal adult activity range for the enzyme is 25-42 nmol/h/ml erythrocytes in the females and 30-48 in males. After optimisation of the R-T PCR, correct sized products were obtained from the amplification of all samples, indicating absence of any major deletions, Sequencing of these products revealed seven point mutations in twelve patients with acute intermittent porphyria and none in the control subjects. All mutations were due to single base substitutions, four of which were associated with amino acid substitutions and are likely to be the cause of AIP in these individuals. The remaining three were silent mutations without change of amino acid and are therefore regarded as neutral polymorphisms. The detected mutations were Q34K (C100→A) seen in two related individuals, L177R (T530→G) also observed in two unrelated individuals, R167Q (G500→A) and H256N (C766→A) each seen separately in single subjects. The silent mutation L42L (G117→A) was seen in one individual whereas S45S (G135→A) and V202V (G606→T) were seen in two and four individuals respectively. With the exception of the mutation R167Q which has been previously reported in four other individuals, the rest of the mutations were novel, emphasising the heterogeneity of this condition. (Abstract shortened by ProQuest.).
Arginine, nitric oxide, carbon monoxide, and endothelial function in severe malaria
(Current opinion in infectious diseases, 2008) Mwaikambo, Esther D.
Purpose of review Parasiticidal therapy of severe falciparum malaria improves outcome, but up to 30% of these patients die despite best therapy. Nitric oxide is protective against severe disease, and both nitric oxide and arginine (the substrate for nitric oxide synthase) are low in clinical malaria. Parasitized red blood cell interactions with endothelium are important in the pathophysiology of malaria. This review describes new information regarding nitric oxide, arginine, carbon monoxide, and endothelial function in malaria. Recent findings Low arginine, low nitric oxide production, and endothelial dysfunction are common in severe malaria. The degree of hypoargininemia and endothelial dysfunction (measured by reactive hyperemia peripheral artery tonometry) is proportional to parasite burden and severity of illness. Plasma arginase (an enzyme that catabolizes arginine) is elevated in severe malaria. Administering arginine intravenously reverses hypoargininemia and endothelial dysfunction. The cause(s) of hypoargininemia in malaria is unknown. Carbon monoxide (which shares certain functional properties with nitric oxide) protects against cerebral malaria in mice. Summary Replenishment of arginine and restoration of nitric oxide production in clinical malaria should diminish parasitized red blood cells adherence to endothelium and reduce the sequelae of these interactions (e.g., cerebral malaria). Arginine therapy given in addition to conventional antimalaria treatment may prove to be beneficial in severe malaria.
The association of the glycophorin C exon 3 deletion with ovalocytosis and malaria susceptibility in the Wosera, Papua New Guinea
(The Journal of the American Society of Hematology, 2001) Mgone, Charles S.
Erythrocyte polymorphisms, including ovalocytosis, have been associated with protection against malaria. This study in the Wosera, a malaria holoendemic region of Papua New Guinea, examined the genetic basis of ovalocytosis and its influence on susceptibility to malaria infection. Whereas previous studies showed significant associations between Southeast Asian ovalocytosis (caused by a 27– base pair deletion in the anion exchanger 1 protein gene) and protection from cerebral malaria, this mutation was observed in only 1 of 1019 individuals in the Wosera. Polymerase chain reaction strategies were developed to genotype individuals for the glycophorin C exon 3 deletion associated with Melanesian Gerbich negativity (GPCΔex3). This polymorphism was commonly observed in the study population (GPCΔex3 frequency = 0.465, n = 742). Although GPCΔex3 was significantly associated with increased ovalocytosis, it was not associated with differences in either Plasmodium falciparumor P vivax infection measured over the 7-month study period. Future case-control studies will determine if GPCΔex3 reduces susceptibility to malaria morbidity.
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.
Bibliometric Assessment of European and Sub-Saharan African Research Output on Poverty-Related and Neglected Infectious Diseases from 2003 to 2011
(PLoS neglected tropical diseases, 2015) Mgone, Charles S.
Background The European & Developing Countries Clinical Trials Partnership (EDCTP) is a partnership of European and sub-Saharan African countries that aims to accelerate the development of medical interventions against poverty-related diseases (PRDs). A bibliometric analysis was conducted to 1) measure research output from European and African researchers on PRDs, 2) describe collaboration patterns, and 3) assess the citation impact of clinical research funded by EDCTP. Methodology/ Principal Findings Disease-specific research publications were identified in Thomson Reuters Web of Science using search terms in titles, abstracts and keywords. Publication data, including citation counts, were extracted for 2003–2011. Analyses including output, share of global papers, normalised citation impact (NCI), and geographical distribution are presented. Data are presented as five-year moving averages. European EDCTP member countries accounted for ~33% of global research output in PRDs and sub-Saharan African countries for ~10% (2007–2011). Both regions contributed more to the global research output in malaria (43.4% and 22.2%, respectively). The overall number of PRD papers from sub-Saharan Africa increased markedly (>47%) since 2003, particularly for HIV/AIDS (102%) and tuberculosis (TB) (81%), and principally involving Southern and East Africa. For 2007–2011, European and sub-Saharan African research collaboration on PRDs was highly cited compared with the world average (NCI in brackets): HIV/AIDS 1.62 (NCI: 1.16), TB 2.11 (NCI: 1.06), malaria 1.81 (NCI: 1.22), and neglected infectious diseases 1.34 (NCI: 0.97). The NCI of EDCTP-funded papers for 2003–2011 was exceptionally high for HIV/AIDS (3.24), TB (4.08) and HIV/TB co-infection (5.10) compared with global research benchmarks (1.14, 1.05 and 1.35, respectively). Conclusions The volume and citation impact of papers from sub-Saharan Africa has increased since 2003, as has collaborative research between Europe and sub-Saharan Africa. >90% of publications from EDCTP-funded research were published in high-impact journals and are highly cited. These findings corroborate the benefit of collaborative research on PRDs. Author Summary The European & Developing Countries Clinical Trials Partnership (EDCTP) was created in 2003 as a European response to the global health crisis caused by the three main poverty-related diseases (PRDs) of HIV/AIDS, tuberculosis and malaria. EDCTP funds research focusing on clinical trials for diagnosing, preventing and treating these diseases. We conducted a bibliometric analysis to 1) measure research output and citation impact from European and African researchers working on PRDs, 2) describe collaboration patterns, and 3) assess the citation impact of research funded by EDCTP. Citation analysis is a commonly used bibliometric tool to analyse scientific literature. Overall, the volume and citation impact of papers from sub-Saharan Africa has increased since 2003, as has collaborative research between Europe and sub-Saharan Africa. Papers arising from collaborative research had a higher citation impact than non-collaborative research and >90% of publications from EDCTP-funded research projects were published in high-impact journals. These results suggest that research on PRDs in sub-Saharan Africa is growing and that the EDCTP partnership contributes to high-impact, collaborative research published in high-impact journals. By providing research funds and supporting activities to strengthen the research environment, the partnership contributes to sub-Saharan African researchers taking the lead in PRD research.
Birthweight and neonatal outcome at the Muhimbili Medical Centre, Dar Es Salaam, Tanzania
(East African Medical Journal, 1998) Mgone, Charles S.
A prospective study of neonatal morbidity and mortality was made over four months in 1990 at the neonatal unit in Muhimbili Medical Centre. The incidence of low birthweight (LBW) was 16%. Seven hundred and eighty four LBW infants and 612 heavier infants admitted for care in the unit were followed up for six weeks. The mean birth weight was 2854 grams. LBW carried a seven-fold increased risk of mortality (291/784;37%); this was 64% (291/341) of the total. The risk of morbidity in LBW infants was increased three-fold (436/784;56%) being 73% (436/598) of the total. Factors significantly associated with increased morbidity and mortality were prematurity, birth asphyxia, sepsis, respiratory distress syndrome, hypothermia and hypoglycaemia. The majority of the deaths (83%) occurred within the first week of life.
Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam, Tanzania.
(The Pediatric infectious disease journal, 2010) Fataki, Maulidi R.
To understand patient and clinician attitudes toward Streptococ- cus pharyngitis and rheumatic heart disease prevention in Tanzania, data from 3 sources were obtained: a survey of 119 clinicians, outpatient rapid test screening, and interviews with 17 rheumatic heart disease patients. Patients do not seek care for sore throat. Clinicians stated that identifying and treating Streptococcus pharyngitis is not prioritized
Cerebral palsy in Dar es Salaam
(Central African Journal of Medicine, 1990) Mgone, Charles S.
Between December 1985 and July 1986 a study on cerebral palsy was undertaken among the inpatients and outpatients of the department of Paediatrics and Child Health, Muhimbili Medical Centre Centre, Dar Es Salaam. The objective of the study was to determine the clinical pattern of cerebral palsy and its associated handicaps. During this period, 100 children with cerebral palsy, 56 boys and 44 girls ranging in age between four months and 10 years, were seen. The commonest type of cerebral palsy seen was spastic tetraplegia which occurred in 36 percent of the cases followed by spastic diplegia and hemiplegia seen in 20 and 15 percent of the cases respectively. In 70 children the cerebral palsy was associated with other severe handicaps, the commonest being epilepsy which occurred in 35 percent of the children followed by deafness, speech disorders and blindness. Birth asphyxia, convulsions of undetermined causes, low birth weight, meningitis and cerebral birth trauma were found to be the leading causes of cerebral palsy. As these conditions are largely preventable or amenable to treatment, it is suggested that improvement of antenatal and perinatal care is important in the reduction of the incidence of cerebral palsy.
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
Challenges in diagnosing paediatric malaria in Dar es Salaam, Tanzania
(Malaria journal, 2013) Fataki, Maulidi R.
Background Malaria is a major cause of paediatric morbidity and mortality. As no clinical features clearly differentiate malaria from other febrile illnesses, and malaria diagnosis is challenged by often lacking laboratory equipment and expertise, overdiagnosis and overtreatment is common. Methods Children admitted with fever at the general paediatric wards at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania from January to June 2009 were recruited consecutively and prospectively. Demographic and clinical features were registered. Routine thick blood smear microscopy at MNH was compared to results of subsequent thin blood smear microscopy, and rapid diagnostics tests (RDTs). Genus-specific PCR of Plasmodium mitochondrial DNA was performed on DNA extracted from whole blood and species-specific PCR was done on positive samples. Results Among 304 included children, 62.6% had received anti-malarials during the last four weeks prior to admission and 65.1% during the hospital stay. Routine thick blood smears, research blood smears, PCR and RDT detected malaria in 13.2%, 6.6%, 25.0% and 13.5%, respectively. Positive routine microscopy was confirmed in only 43% (17/40), 45% (18/40) and 53% (21/40), by research microscopy, RDTs and PCR, respectively. Eighteen percent (56/304) had positive PCR but negative research microscopy. Reported low parasitaemia on routine microscopy was associated with negative research blood slide and PCR. RDT-positive cases were associated with signs of severe malaria. Palmar pallor, low haemoglobin and low platelet count were significantly associated with positive PCR, research microscopy and RDT. Conclusions The true morbidity attributable to malaria in the study population remains uncertain due to the discrepancies in results among the diagnostic methods. The current routine microscopy appears to result in overdiagnosis of malaria and, consequently, overuse of anti-malarials. Conversely, children with a false positive malaria diagnosis may die because they do not receive treatment for the true cause of their illness. RDTs appear to have the potential to improve routine diagnostics, but the clinical implication of the many RDT-negative, PCR-positive samples needs to be elucidated.
Child mortality in relation to HIV infection, nutritional status, and socio-economic background
(International journal of epidemiology, 2005) Fataki, Maulidi R.
Abstract Background The aims of this study were to examine the impact of child HIV infection on mortality and to identify nutritional and sociodemographic factors that increase the risk of child mortality independent of human immunodeficiency virus (HIV) infection. Methods We conducted a prospective study in Dar es Salaam, Tanzania, among 687 children 6–60 months of age who were admitted to hospital with pneumonia. After discharge, children were followed up every 2 weeks during the first year and every 4 months thereafter. Sociodemographic characteristics were determined at baseline, and HIV status, haemoglobin, and malaria infection were assessed from a blood sample. During the first year of follow-up, we measured height, weight, and mid-upper arm circumference (MUAC) monthly. We estimated the risk of mortality according to HIV status and socio-economic characteristics using Cox proportional hazards models. Nutritional status variables (wasting and stunting) were examined as time-varying risk factors. Results Mean age at enrolment was 18 months. A total of 90 children died during an average 24.7 months of follow-up. HIV infection was associated with an adjusted 4-fold higher risk of mortality [relative risk (RR) = 3.92, 95% confidence interval (CI) 2.34–6.55, P < 0.0001]. Other risk factors included child's age <24 months, stunting, low MUAC, anaemia, and lack of water supply in the household. In models with time-varying covariates, stunting and wasting during the previous month were both significant and independently related to increased risk of death. HIV infection appeared to be a stronger predictor of mortality among children who were wasted than among those who were not (P for interaction = 0.05). Conclusions HIV infection is a strong predictor of death among children who have been hospitalized with pneumonia. Preventable conditions including inadequate water supply, child undernutrition, and anaemia contribute significantly to infant and child mortality independent of HIV infection. Keyword:Child mortality, infant mortality, HIV, stunting, wasting, anaemia,

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