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Uptake of family planning among postpartum women at Mwananyamala regional referral hospital in Dar es Salaam, Tanzania
(Kairuki University, 2024) Kessy, Ancil X.
Background: Effective family planning is crucial for improving maternal and child health outcomes, especially in regions experiencing rapid population growth like Tanzania. Despite global efforts, immediate postpartum modern family planning uptake remains a challenge in resource-constrained countries like Tanzania. Identifying local barriers and determinants is essential for developing targeted interventions to enhance family planning utilization among postpartum women. Objective: The broad objective of the study was to determine uptake and the factors influencing modern family planning utilization among postpartum women at Mwananyamala Regional Referral Hospital in Dar es Salaam, Tanzania. Methodology: The study included postpartum women at postnatal care unit in Mwananyamala Regional Referral Hospital. A sample size of 363 participants was obtained using simple random sampling. Data was collected through structured questionnaires and medical record reviews. Data analysis was conducted using Stata 18. Statistical analyses included descriptive statistics to summarize data, chi-square tests, bivariate, and multivariate logistic regression to determine independent factors associated with PPFP uptake, with significance set at p < 0.05 and 95% confidence intervals. Findings were presented using tables and figures. Results: The study included 363 participants in the final data analysis. The mean age of participants was 30 years (SD=7) and the uptake of immediate family planning was found to be 26%. The significant variables associated with positive influence on uptake of family planning included previous use of family planning (AOR: 32.67, 95% CI: 2.25474.63, p-value =0.011) and prior discussion on family planning with partners (AOR: 26.19, 95% CI: 1.30-527.29, p-value =0.033). Concerns about side-effects had a significant negative influence adjusted OR of 40.67 (95% CI: 7.03-235.12, p-value <0.001), indicating that if these concerns were appropriately addressed the uptake of family might have been boosted. Conclusions: The study highlights that a significant proportion of postpartum women in the study site are not utilizing family planning PPFP services immediately after childbirth. Key factors having positive influence on uptake includes prior use of family planning and having had prior discussions with partner regarding family planning services; while concerns about side-effects of modern family planning methods had a negative influence on uptake of family planning. Recommendations: To enhance uptake of family planning among postpartum women targeted educational interventions should focus on promoting male partner involvement in all matters pertaining to Reproductive and Maternal Health including uptake of family planning to facilitate informed decision making regarding utilization of services. Furthermore addressing concerns about side-effects of modern family planning methods potentially might boost uptake of family planning.
Urinary Tract Infection among patients with Human Immunodeficiency Virus infection attending selected care and treatment clinics in Dar es Salaam.
(Kairuki University, 2024) Chacha, Catherine
Introduction: Urinary tract infections are common worldwide and represent a major concern in developing countries among immunocompromised populations. This study aimed to determine the prevalence of UTI by age, gender, marital status and the distribution of the CD4+ lymphocyte count, and viral load among people living with HIV. In addition, the study aimed to determine the common bacterial etiologies of UTI and their susceptibility patterns among people living with HIV attending Care and Treatment Clinics at Dar-es-salaam. Methods: A cross-sectional design was employed, involving interviews, medical record reviews, and laboratory analyses. Descriptive statistics, chi-square analysis, and logistic regression were used for data analysis. Results: The study found that urinary tract infection had a prevalence of 30.6%, was common in participants above 35 years and most specifically in those aged between 35- and 44 years, accounting for 37% of cases. The female gender and married participants were the most affected, with respective rates of 69.9 % and 78.5%. Participants with undetectable viral loads had a low chance of developing UTI (OR=0.1; 95% Cl=0.05-0.2). Conversely, participants with a CD4+ lymphocyte count >500 (OR=0.2, 95% Cl=0.11-0.3) had a decreased risk of presenting with UTI compared to those with a CD4+ lymphocyte count <500 (OR=3.4; 95% Cl=2.0-5.7). In addition, participants who take alcohol had significant (p=0.012) high risk (AOR=2; 95% Cl=1.1-3.5) to present with Urinary tract infection. E.coli, followed by Klebsiella pneumonia, was the most isolated, with respective rates of 51.6% and 29.2%. Ciprofloxacin and Nitrofurantoin were the most active drugs, with 63% and 53%, respectively, against isolated bacteria, both gram-positive and negative. The least effective antibiotic agent was ampicillin, which showed high resistance at 66.3% and sensitivity at 5.6% in all isolated bacteria. Conclusion: The prevalence of UTI by age and gender among People Living with HIV attending Care and Treatment Clinics in Dar-es-salaam was relatively average compared to that reported in the literature. Participants with low CD4+ lymphocyte count <500 and those with unsuppressed viral load had a high risk of presenting UTI. On the other hand, gramnegative bacteria (E.coli and Klebsiella pneumonia) were prevalent bacteria isolated. Nitrofurantoin, ciprofloxacin, and ceftriaxone were the most sensitive antibiotic agents, with ampicillin being the least sensitive to all isolated bacteria. Recommendations: Use nitrofurantoin, ciprofloxacin, and ceftriaxone as the empirical antibiotic agents in People Living with HIV with undetectable viral load. In addition, patients should be selected by culture and sensitivity before prescribing ampicillin and cotrimoxazole in managing UTIs.
Accuracy of obstetric ultrasound versus Johnson and Dare’s clinical methods to estimate fetal weight in fullterm pregnancy in regional referral hospitals, Dar es Salaam, from march to May 2024
(Kairuki University, 2024) Kumbakumba, Fadhil S.
Introduction: Fetal weight is among the determinants of birth outcomes for both the mother and the neonate. Various techniques have been used to estimate births with inconclusive results. This study has been done to compare the accuracy in estimating birth weight using the clinical methods and ultrasonography. Methods: This was a cross sectional, study that consisted of using interviews, consultation of medical record and assessment of 100 pregnant mother and neonatal in antenatal and postpartum period. Descriptive statistics, t paired sample test, were used for data analysis. Results: ultrasonography was the best technic observed to estimate birth weight with no significant difference (t=1.4, p value >0.05) with actual birth weight. The study found a low accuracy in estimating birth weight when using the Dares formula which have shown significant difference with actual birth weight (t=12.7, p value <0.05). However, there was no significant difference (t=2.1,p value >0.05) between estimating birth weight using the Johnson formula and actual birth weight with high accuracy. On the other side, there was a significant difference (t=12.5, p value < 0.05) in birth weight when estimating birth weight using ultrasonography and the clinical technique based on Dares formula. In contrast, there was no discernible difference (t=2.2;p value > 0.05) when the Johnson formula and ultrasound estimation were used. Conclusion: Ultrasonography and Johnson formula provided the best estimates of the birth weight before delivery compared to the Dares formula. Therefore, in absence of ultrasonography services, the use of the Johnson's clinical methods for estimating the birth weight should be encouraged.
Parental self-medication practice and associated factors of under-five children in Zanzibar
(Kairuki Univesity, 2024) Habib, Saida M.
Background: Self-medication, defined as the use of medications without a healthcare professional's supervision, is a widespread public health problem across both developed and developing countries. Objective: The broad objective of the study was to determine the magnitude, type and source of parental self-medication as well as the factors associated with parental selfmedication practice of under-five children in Zanzibar. Methods: This study was a descriptive cross-sectional study conducted among guardians of under-five year children attending at Reproductive and Child Health clinics in four public health centers in Magharibi B Zanzibar. Socio-demographic characteristics and information related to parental self-medication practice of children were collected using a structured questionnaire. Descriptive statistics were used to summarize the data and to determine the magnitude of parental self-medication practice. Results: A total of 427 participants were enrolled in the study. The magnitude of parental self-medication was at 92.3 % (394). Paracetamol and cough syrup were the most common medicines in 38.3% (151) and paracetamol 37.8 % (149) of the study participants. Pharmacy, left over medicine, heath centers and relatives were the common sources of parental self-medication practice of under-five children in 212 (49.6%). Conclusions: The magnitude of parental self-medication of under-five children was relatively high compared to the average of other studies done in Tanzania. Paracetamol and cough syrup were the common medications administered by guardians. The common sources of parental self-medication for under-fives medications were community pharmacies, health centers and relatives.
Violence against children and self-esteem among secondary school adolescents in Zanzibar
(Kairuki University, 2024) Said, Fatma I.
Background: Violence against children comprise all forms of violence against people under 18 years old, whether perpetrated by parents or other caregivers, peers, romantic partners, or strangers. It’s a global concern and approximately one in two children aged 2 to 17 years across the world, experience violence each year which has life lifelong impact on the health and wellbeing of children according to WHO. Objectives: The broad objective was to determine the magnitude and specific types of violence against the children as well as to assess the level of self-esteem and the association with violence against the children among secondary school adolescents in Maghrib-B district in Zanzibar. Methods: This was a cross-sectional study conducted among secondary school adolescents. Socio-demographic characteristics were collected using a structured questionnaire. Assessment of different forms of violence such as physical, emotional, negligent and sexual abuse was conducted using a self-administered questionnaire. The level of self-esteem was assessed using Rosenberg scale. Data was analysed using Statistical Package for Social Sciences version 25. Descriptive statistics were used to summarize the data, while Chi-square test was used to determine the association between the level of self-esteem and violence against the children. A p-value of less or equal to 0.05 was considered statistically significant. Then Paired sample T test was used to compare means of level of self-esteem between student in public and private secondary schools. Results: A total of 352 participants were enrolled in the study. The magnitude of violence against children was noted among 252 (71.6%), regarding the type of violence against children emotional abuse was the prevalent in 225 963.9 %); followed by physical abuse in 184 (47.7 %), neglect abuse in 96 (27.3 %) and sexual abuse in 67 (19%). On the other hand the majority of participants had medium level of self esteem in 256 (72.75 %) of participants. Low self-esteem was observed in 80 (22.7 %) of participants. In addition, there was significant (p-value <0.05) association between emotional (χ2 = 15.5, p-value =0.01), physical (χ2=8.9, p-value = 0.04), sexual (χ2= 9.2, p-value =0.01), negligent (χ2 =15.1, p-value = 0.001) and low self-esteem. Participants from public schools had elevated mean self-esteem score (20.9 ± 4) compared to those from private schools (17.03 ± 3.6). Moreover, there was a trend towards low self-esteem of participants from private schools compared to those from public schools and the difference was statistically significant (p-value=0.001, T=3.8). Conclusions: The study found that secondary school adolescents in Maghrib-B district in Zanzibar experience average levels of violence against children, with emotional and physical abuse being the most common. Low self-esteem was significantly associated with VAC. Also, the result show participants from private schools have low self-esteem compared to those from the public schools.
Hyperuricemia among hypertensive patients attending cardiac clinics in Dar es Salaam
(Kairuki University, 2024) Kaupunda, Cellina J.
Background: Hypertension, characterized by systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, is a significant global health concern. In sub-Saharan Africa, it poses a growing public health challenge. Elevated uric acid levels have been associated with an increased risk of hypertension. Hyperuricemia, defined as abnormally high serum uric acid (UA) levels, predominantly exists as urate ions. The thresholds for hyperuricemia are >360 μmol/L for females, >420 μmol/L for males, and 5.5 mg/dL for youth (<18 years old). However, in Tanzania, specifically in Dar es Salaam, the prevalence and impact of hyperuricemia among p hypertensive patients remain unreported. Early detection and appropriate intervention could serve as effective preventive measures against hyperuricemia. Objective: This study aims to assess the distribution of hyperuricemia among hypertensive patients attending cardiac clinics in Dar es Salaam. Methodology: A descriptive cross-sectional study was conducted among hypertensive patients attending cardiac clinics in Dar es Salaam. Structured questionnaires were used to record demographic data. Blood pressure and anthropometric measurements were taken using standard methods. Blood samples were collected for serum uric acid test. Results: In this study of 381 hypertensive patients from three regional referral hospitals, the majority were female (68.0%), married or cohabiting (60.4%), with no formal or primary education (70.9%), and from a lower income bracket (56.7%). The median age was 63 years, with a range of 28 to 88 years. The median duration since hypertension diagnosis was 3 years, with a BMI median of 26.1. Notably, 40.4% were overweight, and 29.7% were obese. Hyperuricemia was found in 42.5% of participants, with a median value of 335.4. A higher occurrence of elevated uric acid levels was observed in individuals over 45 years of age, nearly doubling from 30% to 49.7% in those aged 65 and above. Males exhibited a higher proportion of normal uric acid levels (68.9%) compared to females (52.1%). Additionally, a slight increase in normal uric acid levels was noted among the middle-income group versus the low-income group, and a significant association was found between alcohol consumption and higher uric acid levels. Individuals with Grade 1 hypertension had a higher incidence of elevated uric acid status compared to those with normal or high-normal blood pressure. The multivariable logistic regression has shown that being 65 or older, female, and consuming alcohol are all significant predictors of the hyperuricemia, with each group showing a higher adjusted odd ratio (AOR). Conclusion: The study highlights a significant correlation between hyperuricemia and factors such as age, gender, and alcohol consumption, family history of hypertension among hypertensive patients. Females, older individuals, and those who consume alcohol are particularly at risk for higher uric acid levels,which could have implications for managing hypertension. Recommendations: These findings suggest the need for targeted interventions and lifestyle modifications to address the risks associated with elevated uric acid levels in hypertensive populations.
Awareness of colorectal cancer screening and its associated risk factors among adults attending outpatient clinics in regional referral hospitals in Dar es Salaam.
(Kairuki University, 2024) Mziray, Amir N.
Background: Colorectal cancer screening aims to detect early signs of colorectal cancer before symptoms develop, increasing the chances of successful treatment and survival. Screening methods include colonoscopy, and stool-based tests like fecal occult blood tests (FOBT) or fecal immunochemical tests (FIT), which detect blood in the stool. Screening guidelines vary by country, but it is generally recommended to start regular screenings around age 40 for the average-risk individuals. However, those with a family history of colorectal cancer or other risk factors may need earlier or more frequent screening. Regular and early screening can significantly reduce colorectal cancer incidence and mortality by detecting and removing precancerous polyps or detecting cancer at an early, more treatable stage. Objective: To assess colorectal cancer (CRC) awareness, risk factors and screening utilizing FOBT and colonoscopy among participants in regional referral hospitals in Dar es Salaam. Methodology: A total of 150 participants were recruited for the study. FOBT was done to all participants, with positive cases undergoing further diagnostic interventions, including stool analysis, H. pylori antigen testing, and endoscopic interventions. Socio-demographic characteristics, knowledge, and awareness about CRC were assessed through questionnaires. Risk assessment for CRC was conducted based on dietary habits and medical history. Results: Of the 150 participants, 73.3% tested negative and 26.67% tested positive for FOBT. Further investigations revealed hookworm ova 12.5% (n=5/40) and H. pylori infection 22.5% (n=9/40) among FOBT positive cases. Colonoscopy identified normal results in 42.86% (n=15/35) and different pathologies in 57.14% (n=20/35), including 25.0% (n=5/20) diagnosed with CRC, overall prevalence of CRC among patients attending surgical outpatient clinics in regional referral hospitals was found to be 3.45. Socio-demographic analysis revealed limited awareness and knowledge about CRC, with notable disparities between positive and negative CRC cases. Conclusion: CRC screening using FOBT demonstrated significant number of positive cases, highlighting the need for improved awareness and education about CRC and its risk factors. Comprehensive screening programs, coupled with increased knowledge dissemination, are crucial for early detection and prevention of CRC in Tanzania. Recommendation: In developing countries where resources may be limited, a simple recommendation for colorectal cancer prevention and early detection would be to prioritize public health education campaigns that raise awareness about the importance of healthy lifestyle choices and regular screening. Encouraging individuals to maintain a balanced diet rich in fruits, vegetables, and whole grains while reducing consumption of processed foods and red meats, promoting physical activity and discouraging tobacco use in order to reduce risk of CRC. Emphasizing the significance of early detection through low-cost screening methods such as FOBT, and ensuring access to these tests through community health centers or outreach programs, can make a significant impact on reducing the burden of colorectal cancer in resource-limited settings.
Cardiac changes among pregnant women with pre-eclampsia and associated fetal – maternal outcomes at Mnazi mmoja tertiary hospital – Zanzibar
(Kairuki University, 2024) Omar, Aysha M.
Background: Pre-eclampsia, a pregnancy complication marked by high blood pressure and protein in urine, can lead to heart problems in mothers. This study investigated the link between echocardiographic abnormalities (identified through echocardiography) and maternal and fetal outcomes in Pre-eclamptic patients in Zanzibar. Methods: A prospective cohort study enrolled 151 pregnant women with pre-eclampsia. Social-demographic characteristics of study participants were collected using a pre-designed questionnaire. Echocardiographic (ECHO) studies were performed among participants to determine cardiac changes due to preeclampsia. Participants were monitored up to delivery to determine the immediate maternal and fetal outcome. Data was analyzed using Statistical Package for Social Sciences (SPSS). Categorical variables were presented in frequency and respective percentages. Association between ECHO changes and severity of Pre-eclampsia, maternal and fetal outcome were assessed using Chi-square test. A p-value of less or equal to 0.05 was regarded as statistically significant. Results: A total of 151 participants were enrolled in the study. Among participants, 101(67.5%) had severe form of Pre-eclampsia. Additionally, 80 (53%) of study participants had abnormal ECHO findings with left ventricular hypertrophy the most frequent finding (22%). There were a significant association between abnormal ECHO findings and severity of Preeclampsia (p<0.001). Furthermore abnormal ECHO findings was associated with adverse maternal and fetal/ neonatal outcome; (p<0.001), and (p=0.05) respectively. Conclusion: In this study, the majority of patients with Pre-eclampsia had abnormal ECHO findings, which was associated with severity of the disease, maternal and fetal/neonatal outcomes. To improve maternal and neonatal survival, routine cardiac screening using echocardiogram among pregnant mothers at risk for early appropriate treatment should be considered. In this study, the majority of patients with Pre-eclampsia had abnormal ECHO findings, which was associated with severity of the disease, maternal and fetal/neonatal outcomes.
Determining cutaneous markers of dyslipidemia among hiv seropositive patients on antiretroviral therapy attending care and treatment clinics in Dar es Salaam
(Kairuki University, 2024) Mlangwa, Mhina E.
Background: The prevalence of ischaemic heart disease (IHD) in Sub-Saharan Africa has been on the rise among people living with HIV. HIV infection and antiretroviral drugs (ARTs) are both associated with dyslipidemia. Objective: This study aimed to determine the prevalence of cutaneous markers of dyslipidemia and associated factors among HIV seropositive on ARTs attending CTCs in Dares Salaam. Method: A descriptive cross-sectional study among HIV seropositive individuals aged 18 years and above were enrolled at Kairuki Hospital and Mwananyamala Regional Referral Hospital, from February to July 2024, and a 100% response rate was obtained. The diagnosis of cutaneous markers of dyslipidemia was based on physical examination (Visual inspection by naked eye keenly looking for cutaneous markers). A fasting blood sample was obtained for serum markers of dyslipidemia Results: The study recruited 305 people, 21 persons were excluded due to missing data, and a total of 284 were analysed with a response rate of 100%. The mean age of participants was 46.7±10.9, and 182(64.1%). The mean BMI was 26.2±5.5, with 80(28.2%) were overweight. Fifty per cent of participants were on ART for 10 years or more. A total of 17(5.9%) participants were found to have cutaneous markers of dyslipidemia. No association was found between alcohol consumption, cigarette smoking, and other predictors of dyslipidemia. Conclusion: This study found the prevalence of cutaneous markers of dyslipidemia; henceforth heralding the need of incorporating lipid screening as a component of care among HIV seropositive individuals on ARTs, for reducing mortality and morbidity.
Utilization of postnatal services and associated factors among women attending postnatal clinic in Kinondoni Dar es Salaam: a cross-sectional study
(Kairuki University, 2024) Mboga, Edith M.
Background: Postnatal care (PNC) is a critical period for ensuring the health and well-being of both mothers and their newborns. In Africa, many women and newborns do not seek healthcare services after childbirth, despite the fact that most maternal and neonatal deaths occur during this time. Aim: The aim of the study was to investigate the utilization of postnatal services and associated factors among women attending postnatal clinic in Kinondoni Dar es salaam. Methodology: A cross-sectional study was conducted among 384 postpartum women in the late phase of the postnatal period (6 weeks to 6 months). The study aimed to determine the prevalence of PNC service utilization and identify barriers and facilitators influencing its use. A multi-stage systematic sampling technique was employed to select participants, and data were collected using a structured questionnaire digitalized through the Kobo Toolbox. Bivariate logistic regression was used to analyze associations between categorical variables, and multivariate binary logistic regression was applied to identify predictors. Results and Conclusion: Despite 95.1% of women delivering their most recent child at a health facility, only 40.5% attended at least one postnatal care visit within two days after birth, thus indicating suboptimal postnatal care service utilization. The most common reasons for attending PNC visits included vaccinations, breastfeeding support, and family planning advice. Factors influencing PNC service utilization included sociodemographic, obstetric characteristics, and service access. Strategies to enhance PNC utilization should focus on raising awareness, improving access, enhancing care quality, and strengthening counseling and education during antenatal care visits. Key words: antenatal care, postpartum period, postnatal care services, mother-baby dyad.
Obesity and associated comorbidities among adults in Dar es Salaam; a community based study
(Kairuki University, 2024) Ally, Fatma K.
Background Obesity is defined by a Body Mass Index (BMI) of 30kg/m2 or higher. It is an epidemic that threatens to overwhelm health care resources by increasing the incidences of chronic health conditions. For instance, 70% of hypertension, 44% of diabetes, 14% of heart failure, 23% of ischemic heart disease, and up to 41% of cancer burden is attributed to obesity. This is associated with increased morbidity and mortality. Risk factors of obesity include unhealthy eating habits, physical inactivity, genetics as well as some health conditions and medications. It is preventable by lifestyle modifications to reduce weight by reducing calory intake and incorporating physical activity. Broad objective To determine the prevalence of obesity and associated comorbidities; hypertension and diabetes mellitus, among adults in Dar es Salaam community. Methodology This was a descriptive, cross-sectional, community-based study among residents in the five districts of Dar es Salaam. Sociodemographic data were collected by a structured questionnaire. Height, weight, waist circumference, blood pressure and random blood glucose were measured using standard equipment and procedure. Results A total of 260 participants were recruited in the study. Out of 260 participants 83 (31.9%) were obese, and 83 (31.9%) were overweight. Of the obese individuals 42.2% had elevated blood pressure above 140mmHg systolic and/or above 90mmHg diastolic, 36.1% had a blood pressure in the pre hypertension range (130-139 systolic and/or 85-89 diastolic). Only 21.7% had normal blood pressure readings. Prevalence of obesity was highest in the middle age group (43.3%). It was more prevalent among females (47%), compared to males (16.4%). There were no statistically significant differences in prevalence of obesity by classes of socioeconomic status. Conclusion One third of the participants in this study were obese and more than half of them were either overweight or obese. The prevalence of obesity was higher in women compared to men, and was highest in the middle age group. It was not affected by socioeconomic status. Most of the obese individuals had a deranged blood pressure however there was no significant differences in the RBG (random blood glucose) levels compared to the non-obese individuals. Recommendations Checking of body mass index and/or waist circumference as part of the vitals should be upheld where practiced and should be introduced where it’s not practiced. Those identified to be obese should be counselled and educated on the grave consequences of obesity on health and be prescribed measures to manage their weight. Moreover, emphasis on women in the community projects aimed at combating obesity such as health education on proper diet and physical activity should be upheld and introduced where it’s not being practiced. Further research on other comorbidities of obesity should be done to shed more light on the negative health effects of obesity
Helicobacter pylori infection and anaemia among pregnant women attending antenatal care at Mwananyamala regional referral hospital Dar es Salaam, Tanzania
(Kairuki University, 2024) Fedy Israel
Background: Helicobacter pylori (H. pylori) is a gram-negative bacterium commonly associated with gastrointestinal disorders. Its impact on anemia, particularly in pregnant women, is an area of growing interest, as pregnancy introduces additional nutritional and physiological stresses that can exacerbate anemia. Objective: To investigate the effects of H. pylori infection on anemia in pregnant women attending antenatal care at Mwananyamala Regional Referral Hospital between May and June 2024. Methods: This study involved a cross-sectional hospital-based analysis of 300 pregnant women attending antenatal clinics. Participants were screened for H. pylori infection using stool antigen tests. FBP was measured to hemoglobin level, and additional tests were a blood sample for malaria parasites and a stool sample for HP infection and intestinal worms. Also, MUAC was done to assess the malnutrition status of the participants. Clinical data, including demographic and obstetric history, were also collected. SPSS version 20 was used for data analysis; bivariate multivariable logistic regression used for confound factors analysis and Chi square were used for exploration of the association of HP infection on anemia in pregnant women. Results: There were effects of H. pylori infection on increased prevalence of anemia among pregnant women who had H. pylori infection, H.P Infection were 2.4 times (AOR = 2.40, 95% CI = 1.354-3.674) more likely to be anemic than the H. pylori-negative ones. Independent of confounding factors associated with increased anemia were education levels (AOR = 3.24, 95% CI = 1.58-6.63), occupation (AOR = 1.90, 95% CI = 0.99-3.72), third-trimester pregnancy (AOR = 1.97, 95% CI = 1.01-2.2), and history of hyperemesis gravidurum (AOR = 6.42, 95% CI = 2.97-13.91). Conclusion: H. pylori infection has effects on anemia in pregnant women. The infection appears to exacerbate the risk of anemia, likely through mechanisms related to impaired iron absorption and increased gastrointestinal inflammation. These findings highlight the importance of screening and managing H. pylori infection as part of prenatal care to improve maternal and fetal health outcomes.
Bacterial profile of amniotic fluid infection among women with premature rupture of membranes at Amana regional referral hospital: magnitude, aetiology and antimicrobial susceptibility in Tanzania
(Kairuki University, 2024) Daud, Naima A.
Introduction : Premature rupture of the membrane is a frequent finding in maternity wards and constitutes a major concern for fetal maternal well-being. This study determined the magnitude of amniotic fluid infection, the common bacteria isolated, and their susceptibility to the common antibiotic used among pregnant mothers with premature rupture of membranes attending Amana regional referral hospital. Methods : This study utilized a cross-sectional design involving pregnant women with premature rupture of membranes. Amniotic fluid from study participants was collected using standard methods ; amniotic fluid culture was done using Gram staining technique and sensitivity of isolated pathogens was tested using Kirby-Bauer disc diffusion method. The method for analyzing the data used was descriptive statistics. Results : This study found a magnitude of infected amniotic fluid infection among pregnant mother with premature rupture of membrane at (19.1%) corresponding to 21 out of 110 participants. E. coli followed by klebsiella were the prevalent microbial isolated with respectively rate of (42.8 %) n=9 and (33.3 %) n=7. Ciprofloxacin followed by gentamicin were the most active antibiotic in all isolated bacteria. The least active agents were ampicillin and ceftazidime. Conclusions: The magnitude of amniotic fluid infection among pregnant mothers attending Amana Referral Hospital was high among study participants. The most common isolated bacteria were E.coli and Klebsiella pneumonia. Despite the fact that Ampicillin is the first line recommended treatment or prophylaxis when amniotic fluid infection is suspected, it was the least sensitive among the isolates whereas ciprofloxacin and gentamicin were the most sensitive antibiotics among the isolates. Whenever amnionitis is suspected, amniotic fluid culture and sensitivity should be considered for rational use of appropriate antibiotics. Additionally, further studies involving larger sample size and larger geographical distribution and routine surveillance are needed to have more insight on this problem.
Clinic biochemical indicators of kidney disease among newly diagnosed diabetes mellitus type 2 adults attending diabetic clinics in Dar es Salaam
(Kairuki University, 2024) Kakoko, Consolata D.
Background: Kidney disease affects the functionality and structure of the kidney or both. It is the highest cause of mortality among diabetic mellitus patients. Diabetes mellitus type 2, has a long asymptomatic period of hyperglycemia, whereby longstanding hyperglycemia leads to activation and changes of metabolic pathways, which causes dysfunction of renal and vascular cells. Kidney disease is present in about half of patients with DM type 2. Despite diabetes mellitus being discussed as the leading cause of kidney disease, there has been a paucity of information in Dar es Salaam on clinico-biochemical indicators of kidney disease among newly diagnosed DM 2 adults. These indicators include urine protein(albuminuria) as well as serum creatinine which is used in the estimation of glomerular filtration rate. The study findings are expected to show the burden of kidney disease among newly diagnosed DM 2 adult patients in Dar es Salaam, hence emphasizing early detection of kidney disease during diagnosis of DM 2 adults, to avoid poor renal outcomes at a later stage. Objective: To determine the pattern of clinical biochemical indicators of kidney disease among newly diagnosed diabetes mellitus type 2 adults in Dar es Salaam. Methodology: This cross-sectional design study was conducted among newly diagnosed type 2 patients in the public regional referral hospitals in Dar es Salaam city. Random sampling was used to select 380 newly diagnosed type 2 diabetic patients. The study's dependent variable was kidney disease, the composite variable of eGFR and UACR. Independent variables were social demographics such as age, gender, education level, and occupation. Also, risk factors such as history of smoking and drinking alcohol, family history of diabetes, and kidney disease. Data analysis was done using SPSS version 28. Continuous variables were summarized using mean and standard deviations, while categorical variables were summarized using absolute count and percentage. The categorical comparisons of predictors variables of kidney disease (eGFR and UACR) were made using the chi-square test of independence. The variables that achieved a statistical significance of 0.2 were collectively analyzed in a multivariable logistic regression. A significance level of 0.05 at 95% CI was considered statistically significantly associated with kidney disease (eGFR and UACR). Results: Of the 380 participants recruited, 203(53.4%) were females 177(46.6%) were males and the mean age was 57.2 ± 13.0 standard deviation years. The average serum creatinine level was 90.6 ± 35.5 standard deviation, with an eGFR of 71.6 ± 23.4 standard deviation. The median UACR was 14.0. Among the study participants, 110(28.9%), had an eGFR of less than 60. About 85 participants (22.4%) had a UACR of greater than 30. About 83 participants (21.8%), had both UACR of greater than 30 and eGFR of less than 60. Kidney disease increased with age, mostly observed among participants older than 60. The proportion of KD was most common among divorced and widowed marital groups. The occurrence of KD increased with BMI, with the majority being 25-29.9 and 30+, with relatively equal proportions. The distribution of KD diagnosis was similar between hyperglycemic and non-hyperglycemic patients and was typical among those with a history of alcohol and smoking. Females had a higher proportion of kidney disease compared to males, however, multivariable regression has shown that being female was associated with a lower risk of kidney disease (p<0.05). Conclusion: Clinico-biochemical indicators of kidney disease among newly diagnosed DM 2 adult patients included reduced estimated glomerular filtration rate to <60mL/min/1.73m2 and increased UACR> 30mg/g. In this study, there were more study participants with reduced estimated glomerular filtration rate to <60mL/min/1.73m2 than those with increased UACR> 30mg/g. Moreover, the study findings show that, despite females having a higher proportion of clinico-biochemical indicators of kidney disease than males, they have a lower risk of developing kidney disease. Recommendation: Healthcare providers are emphasized on early screening of clinico-biochemical indicators of kidney disease during the diagnosis of diabetes mellitus type 2 in adult patients. This includes screening both serum creatinine to obtain an estimated glomerular filtration rate and for albuminuria, since DM type 2 asymptomatic patients may develop both or one among the 2 clinico-biochemical indicators. Also regular monitoring of these clinico-biochemical indicators of kidney disease in short intervals during follow-up of the DM 2 patients attending diabetic clinics.
Early childhood development scores among 24-59 months children attending RCH clinics in Temeke municipal Dar es Salaam, Tanzania
(Kairuki University, 2024) Mshimba, Mufida A.
Background: Early childhood development is an important public health problem in Child Health in low- and middle-income countries with approximately 43% of children living in these countries at risk of developmental delay. In Tanzania, at the district level, early childhood development status in children between 24 -59 months is unknown. Objective: The broad objective of this study was to determine the early childhood development scores among children aged 24-59 months attending Reproductive and Child Health clinics in Temeke Municipal, Dar-es-Salaam Region Tanzania. Methodology: For three months, from November 2023 to January 2024, children aged 24 to 59 months who attended Reproductive and Child Health clinics in Temeke Municipal, Dar es Salaam Region, participated in the study using a facility based analytical cross-sectional study design. Four hundred and twenty-two children from four health facilities were enrolled. ECD scores among participants were determined using the UNICEF tool (ECDI2030). Data were analyzed using IBM Corp.'s SPSS version 20.0, New York, USA. Frequency and percentages were used to express the magnitude of children on track for early childhood development. Binary logistic regression was employed to evaluate the factors linked with poor Early Childhood Development (ECD). A p-value of 0.05 or less was considered to be statistically significant. Results: A total of 422 children enrolled into the study were in the final data analysis. Among these only 144 (34.1%) were on track based on their early development scores. The child's early age (AOR 0.149 (0.63-0.354 and p-value = 0.001), malnutrition (AOR 7.729 (2.234-26.735 and p-value = 0.010), and the parents' occupation (AOR 3.730 (1.937-7.184 and p-value = 0.001) were factors linked to sub-optimal performance of ECD using ECDI2030. Conclusions: Most of the study participants were off-track in their ECD scores, which potentially might be a barrier to their full development. Young age, malnutrition, and unemployment among parents were significant factors associated with ECD delays. Recommendations: 1. Parents should ensure a responsive relationship with their young children by spending time with them, engaging in face-to-face interactions, and having positive physical contact which helps in bonding and attachment. Provide access to simple toys, and household items that encourage exploration and learning. Promote regular talking, reading, and singing to infants and toddlers. It helps to build vocabulary and communication skills. 2. Appropriate feeding of every child including promotion of breastfeeding exclusively during the first 6 months of life should be emphasized as breastmilk provides nutrients needed to strengthen immunity. Supplementation of micronutrients and macronutrients during complementary feeding and fortified food provides essential nutrients. These interventions may improve the nutrition status of young children with subsequent improvement in ECD. 3. Unemployed parents should engage in support groups or community programs that provide support and resources. Parents who receive vocational training gain skills that improve the family's financial status.
Early mortality and associated factors among preterm neonates admitted at public regional referral hospitals in Dar es Salaam, Tanzania.
(Kairuki University, 2024) Malenda, Rukia M.
Background: Approximately 22% of neonates in Tanzania are born prematurely which increases the possibility of early death. However, the early mortality of preterm birth and associated factors are not well understood. This study was conducted to determine the early clinical outcome and associated factors among preterm neonates born in Regional Referral Hospitals in Dar es Salaam, Tanzania. Understanding the magnitude and the associated factors can lead to improvement in quality of care with subsequent reduction of mortality among preterm neonates. Objectives: The broad objective of the study was to determine the early mortality and associated factors among preterm neonates born in Regional Referral Hospitals in Dar es Salaam, Tanzania Methodology: This was a descriptive longitudinal study conducted in Dar es Salaam Regional Referral Hospitals. Participants were enrolled consecutively after meeting the eligibility criteria and were followed-up for seven days post-delivery to determine early neonatal outcome. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 28.0 (IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp). Chi-square test or Fisher's exact test were used to compare categorical variables while binary logistic regression was used to identify factors associated with early mortality among the preterm neonates. Results: A total of 216 preterm neonates who were enrolled in the study were involved in final data analysis. Among these, 35 (16.2%) neonates died within the first seven days of life. The most common causes of deaths were respiratory distress syndrome in 21 (61.8%) neonates and sepsis in 8 (23%) neonates. Seventy-two (33.3%) neonates were admitted due to respiratory distress syndrome and anaemia. The presence of hypoglycaemia (AOR=3.4 (1.08–10.94 and p-value =0.04); extreme and very low birth weight (AOR=5.56 (1.36–22.67 and p value=0.02) and need for resuscitation at birth (AOR=7.4 (1.2-44.5 and p-value =0.03) were factors associated with early neonatal mortality. Conclusions: The magnitude of early neonatal mortality among preterm neonates was relatively high with respiratory distress syndrome and sepsis being the leading causes of mortality. Additionally, extreme and very low birth weight; hypoglycaemia and need for resuscitation at birth were the factors associated with early neonatal mortality. Recommendations: To reduce early neonatal deaths, it is important to quickly identify and treat respiratory distress syndrome and sepsis in preterm babies. Additionally, focusing on babies with extreme- and very low birth weight, low blood sugar, and those needing help to initiate spontaneous breathing at birth can improve the chances of survival.
Outcome of untreated depression among people living with HIV attending clinic at Mwananyamala regional referral hospital, Dar es salaam Tanzania.
(Kairuki University, 2023) Mulokozi, Judith J.
Background: Depression is prevalent among individuals living with HIV/AIDS and can have detrimental effects on treatment adherence, patient stability and overall well being. However, at Mwananyamala Regional Referral Hospital, routine diagnosis and care for depression among this population are lacking. Objective: The study sought to determine the association of untreated depression on treatment outcome, patient stability, and engagement in risky behaviors among individuals living with HIV/AIDS attending CTC at Mwananyamala Hospital from July to August 2023. Materials and methods: An analytical cross-sectional study design was employed. The study population consisted of people living with HIV/AIDS who attended the CTC at Mwananyamala Hospital. A structured questionnaire was used to collect data on socio-demographic characteristics, depression status, HIV treatment history, clinical presentation variables, and other relevant factors. Patient Health Questionnaire (PHQ-9) Quick Depression Assessment which has been developed by Pfizer Inc. was administered by the Principal Investigator to all participants to determine presence of depression and the severity. During data analysis Descriptive statistics was used to summarize socio-demographic characteristics and clinical parameters; while Chi-squared test was used to assess the association between untreated depression and treatment outcomes, patient stability, and engagement in risky behaviors. Logistic regression analysis was conducted to identify factors associated with untreated depression among people living with HIV/AIDS. The significance level was set at p-value < 0.05. Results: During the study period a total of 596 eligible study participants above 18 years of age attending HIV Care and Treatment Clinic at Mwananyamala Regional Referral Hospital were screened for eligibility criteria to participate in the study and were enrolled into the study. Out of this number a total of 149 were determined to have depression based on PHQ 9 score results and were in the final data analysis. The prevalence of depression among the study participants was 25% (149/596 participants). Study participants with depression who received treatment for depression were 25%; while the rest did not receive treatment for depression. Not getting treatment for depression had adverse outcome for comprehensive care and treatment for HIV. Among the 149 study participants with depression virological non-response was quite high with more than 50 copies in 118 participants (79.19%). Conclusions: The study offers a comprehensive analysis of the socio-demographic and clinical parameters of HIV patients, focusing on the critical influence of depression on patient stability. The socio-demographic data underscores the need for tailored interventions, especially for younger individuals, women, and those with low level of education and marital instability, as these factors interact adversely with HIV outcome. The clinical parameters show the pressing need for early diagnosis, timely HIV management, and mental health support to improve the overall well being of individuals living with HIV. Recommendations: There are four recommendations which are shown below: 1. Integrated Mental Health Services: Health care facilities should integrate mental health services into routine HIV care. Screening for depression and providing timely treatment is crucial for improving patient stability and overall well-being. Multidisciplinary teams that include mental health professionals can ensure a holistic approach to patient care. 2. Early diagnosis and interventions: Given the high prevalence of severe depression and its impact on HIV patients, health care providers should prioritize early diagnosis of depression, particularly among newly diagnosed individuals. Offering psychological support and counseling immediately after an HIV diagnosis can help mitigate distress and improve mental health outcome. 3. Special attention - Focus on vulnerable sub-groups: Tailored interventions should be developed to address the unique needs of vulnerable subgroups, including younger individuals, women, and those with lower education levels. These subgroups may face specific challenges in managing their HIV diagnosis, and targeted support programs can help mitigate these challenges. 4. Comprehensive education and support: Health care facilities should provide comprehensive education and support to patients regarding HIV management and the importance of treatment adherence. Patients with higher education levels tend to have better access to information and healthcare resources, but efforts should be made to bridge educational disparities to ensure all patients have equal access to essential information and support.
Determinants of perception and willingness to uptake premarital screening test for sickle cell disease among health sciences undergraduate students in Dar es Salaam, Tanzania
(Kairuki University, 2024-11-19) Ndaigeze, Indo
Background: Sickle cell disease is a serious genetic disorder with a significant global burden. The significant burden of SCD in Tanzania and the substantial economic, psychological and social costs, highlights the significance of premarital genetic screening for sickle cell disease (SCD) for timely diagnosis as well as for identifying carriers of SCT. Objectives: The objective of the was study to assess the determinants of perception and willingness to uptake premarital screening test for sickle cell disease among health sciences undergraduate students in Kairuki University, Dar es Salaam Tanzania. Methodology: An analytical cross-sectional design was used among 448 undergraduate students (aged 18-35 years) who were selected using stratified random sampling technique. A structured questionnaire was used to collect data via Google forms. Data was analysed by using SPSS version 25 and presented as Tables and Charts. Bivariate logistic regression was employed to examine the relationship between multiple independent variables and dependent variable (perception). Results: The study found out that more than half of the students (57.3%) had good perception regarding premarital screening and the majority agreed to uptake premarital genetic screening for Sickle Cell Disease. Respondents who received information from healthcare professionals had significant association with good perception. Conclusions: In summary, over half of the respondents (57.24%) had a good perception of premarital screening for sickle cell disease. Most respondents had good perception on premarital screening and the influencing factor that has been vii found appropriate information from healthcare providers. Moreover, a substantial percentage of respondents (92.2%) expressed their intention to undergo premarital genetic screening for sickle cell disease. This indicates a high level of awareness and a willingness to take proactive health measures prior to marriage, demonstrating a favourable attitude toward genetic screening. Recommendations: The Ministry of Health, Community Development, Gender, Elderly and Children in collaboration with the Ministry of Education should develop a curriculum focused on educating the public about premarital genotype screening for sickle cell disease. This education should be delivered through various media channels, schools, health facilities, and public meetings to ensure that everyone in the community can participate in addressing and preventing sickle cell disease and is empowered to make informed choices in relation to genetic screening for Sickle Cell Disease before marriage.
Magnitude of adverse maternal and newborn outcomes among women with pregnancy induced pre-hypertension at three regional referral hospitals, Dar es Salaam from January to April 2024
(Kairuki Univerity, 2024) Abeid, Mwalim. A.
Introduction : Prehypertension is a prevalent condition in maternity wards worldwide. The debate is still ongoing on the contribution of prehypertension to the occurrence of adverse birth outcomes in both mothers and neonates, specifically in low-income countries where scarce studies have been conducted in this field. This study aimed to determine the early neonatal outcome, mother outcome, and their respective factors associated with women with and without prehypertension attending antenatal clinics at the Amana, Temeke, and Mwananyamala Regional Referral Hospitals. Adverse birth outcomes and their associated factors were examined. Methods : This study was a case control study conducted among pregnant mothers with and without late prehypertension as well as their newborns from the antenatal period to one week postpartum periods. Social demographic and clinical data were collected using a pre-designed questionnaire. Data was analyzed using Statistical Package for Social Sciences. Descriptive statistics were used to summarize the data, while Chi square test was used to assess maternal and neonatal outcome among the study groups. Binary logistic regression analysis was used to assess factors associated with adverse maternal and neonatal outcome among prehypertensive pregnant women. A p value of less or equal to 0.05 was considered statistically significant. Results : A total of 330 participants were enrolled in the study. The magnitude of neonatal birth outcome and maternal outcome in pregnant mothers with late pregnancy prehypertension were of 120 (65%) and 76 (96.2%) respectively. Low Apgar score, low birth weight, still birth, and fresh still death were the most frequent adverse neonatal birth outcomes observed, with a respective rate of 44 (13%), 41 (12.4%), 30 (9%), and 4(1.2%). On the other hand, gestational hypertension followed by preeclampsia were the most common adverse maternal outcome observed in 54 (71%) and 22 (28.1%) of study participants respectively. Neonates from mothers with an age range of 20 to 24 years( OR=5.7;95%CI=2.4-6.7;P=0.04),prolonged labor(AOR=1.6;95%CI=1.4-6.2;P=0.001) and Caesarian sections(AOR=1.3; 95%CI=1.14-1.6,p=0.04) were the most affected. On the other hand, mothers with business activities (AOR=1.2; 95%CI=1.1-1.9) those with 12 children(AOR=1.4;95%CI=1.15;1.7),and those who had malpresentation (AOR=1.4;95% CI=1.15-1.5) in labor were the most affected. Conclusion: The magnitude of adverse neonatal and maternal outcomes in pregnant mothers was more frequent in participants with late pregnancy hypertension than in those with normal blood pressure. The most affected newborns were those born from caesarian sections and those whose mothers had prolonged labor.
Predictors of lower limb amputation in diabetic foot ulcer among adults in Dar-es-salaam regional referral hospitals, Tanzania
(Hubert Kairuki Memorial University, 2023-11) Salim, Khamis R.
Background: Risk factors for Lower Extremity Amputation (LEA) in Diabetic Foot Ulcer (DFU) patients are peripheral arterial disease, peripheral neuropathy, uncontrolled blood glucose level, and a history of diabetic foot ulcers or amputations. However, DFU is the main cause of prolonged hospital stays because of late presentation, but the prognosis of the patients will be good if the problem is identified early and optimal treatment is initiated. Objectives: To determine the predictors of LEA in DFU among adults in Dar-es-Salaam RRH, Tanzania. Methods: An observational prospective hospital-based study was conducted in Amana, Mwananyamala, and Temeke in Dar-es-Salaam (RRH), Tanzania. Between February 2023 and July 2023, patients' details and data were collected using a questionnaire form from each participant who was admitted with a diagnosis of DFU. Written informed consent was sought from all patients who were eligible for the study before including them in the study. A total of 195 adult patients with DFUs were included in this study. Logistic regression was used to evaluate the associations between risk factors and amputation. Results: The study recruited and followed up on 195 adult diabetics. The median age was 53 (IQR: 47–57) years, with female preponderance (54.9%). The median random blood glucose level (mmol/L) of participants was 15 (IQR: 12–18) mmol/L, with a median duration since diabetes mellitus diagnosis of 7 (IQR: 3–10) years. About three-fifths (59.5%) of study participants ended up with LEA. Post-tibial artery pulse (A.O.R.: 0.01, 95% C.I.: 0.00–0.021), dorsalis pedis artery pulse (A.O.R.: 0.005, 95% C.I.: 0.001 0.045), as well as the Ipswich test (A.O.R.: 0.001, 95% C.I.: 0.000–0.342) were significant factors associated with lower extremity amputation. More than half (55.9%) of study participants had Wagner-grade 4- or 5-foot ulcers. Dorsalis pedis artery pulse had an almost perfect negative correlation with LEA (r =-0.928, p = 0.000). Conclusion: Amputation rates were high in this study population. On average, most study participants were in the 4th grade Wagner classification. Undetectable of Ipswich tests, absence of posterior tibia artery pulse and absence dorsalis pedis artery pulse were significant risk factors associated with amputation in this study population. Recommendations: Glycaemic control strategies need to be emphasized in order to achieve wound healing and reduce the amputation rate among adult diabetic foot ulcers in Dar-es-Salaam.

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