KAIRUKI UNIVERSITY REPOSITORY
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Adverse pregnancy outcomes among HIV-positive women on art before and during pregnancy delivered At Mwananyamala and Amana Hospitals, From December 2018 To July 2019
(Hubert Kairuki Memorial University, 2019) Mzige,Hamza M.
Background: Adverse pregnancy outcome among HIV positive women who delivery are those observation in the studies which have shown that HIV infection with associated with varying with rates of stillbirth, perinatal and infants mortality, intra-uterine fetal growth restriction and low birth weight and chorioamnionitis.
HIV in pregnancy is a problem that needs special consideration as far as fetal and maternal wellbeing was concerned. Is a major medical problem encountered especially in developing countries including Tanzania and is associated with high morbidities and mortality. It is associated with detrimental fetal outcome especially when the patient has advanced stage of the diseases. (19, 20).
Objective: To determine adverse pregnancy outcomes among HIV-positive women delivered at Mwananyamala and Amana Hospitals in Dar es Salaam.
Study Design: A Descriptive cross sectional study was used.
Study Area: Mwananyamala and Amana Regional Referral Hospitals in Dar es Salaam.
Study Population: All HIV positive pregnant women on ART before and during pregnancy, delivery at Mwananyamala and Amana Regional Referral Hospitals in Dar es Salaam.
Data Collection and Analysis: The collected data were checked for quality, Coding was done before entering the data into the computer statistical program. Analysis was done. Structured questionnaire was filled.
Results: In this study prevalence of adverse pregnancy outcome among HIV pregnancy women on ART was found to be 19.5%; delivery by caesarian section, and 1.24%; by assisted delivery, while 27.02%; had preterm delivery which is higher compared to the study conducted in Tanzania Urban and Rural in 2014 where by the prevalence was 11%. This result was also contrary to the study conducted in Zanzibar prevalence was found to be lower by 3%.
Conclusion: This study has found that postnatal women who were started ART during pregnancy were at higher risk of getting newborn with adverse outcome compared to those who started ART before pregnancy.
Acceptability Among Healthcare Providers of In Situ, Low-Dose, High-Frequency Neonatal Resuscitation Simulation Training Using Innovative Tools: Evidence from the Safer Births Bundle of Care
(Children, 2025-07-02) Kalabamu Florence S.
Introduction: Newborn mortality is unacceptably high, especially in low- and middle-income countries. The Safer Births Bundle of Care (SBBC) was implemented in Tanzania, including training of healthcare workers on neonatal resuscitation by means of frequent in situ simulation training using improved training tools. We aimed to assess the acceptability of this training model among healthcare providers in selected health facilities under SBBC intervention. Methods: A cross-sectional study was conducted among healthcare workers in labor wards and obstetric theaters in selected facilities one year after the introduction of the SBBC model. The theoretical framework for assessment of the acceptability of healthcare interventions was used to assess the acceptability of the training model and accompanying tools. The chi-square test was used to assess the association between acceptability in specific constructs and average individual practice per month, while a modified Poisson regression analysis was used to assess factors associated with acceptability in specific framework constructs. Results: A total of 227 healthcare workers were enrolled in the study. Overall, 223 (98.2%) accepted the intervention. However, 207 (91.2%) reported that the intervention increased their work burden, while 39 (17.2%) reported that it interfered with other equally important activities. The level of health facility was independently associated with the reporting that engaging in simulation practice interfered with other equally important activities. Conclusions: In situ, low-dose, high-frequency facility-based simulation training for neonatal resuscitation was highly acceptable among healthcare providers. However, the perceived increased work burden of this intervention and interference with other equally important activities were identified as potential threats to successful implementation.
Keywords: acceptability; simulation; resuscitation; Neonatalie Live; NeoBeat
Potential activities to improve primary care prescribing of antibiotics across Africa
(Frontiers in Tropical Diseases, 2025-08-25) Massele,Amos
There are considerable concerns with antimicrobial resistance (AMR) across Africa, enhanced by the inappropriate prescribing of antibiotics in ambulatory care. This includes prescribing for self-limiting conditions and Watch antibiotics. Inappropriate prescribing is enhanced by concerns with ambulatory care prescribers’ knowledge of antibiotics, including their perceived effectiveness for self-limiting conditions, AMR, and antimicrobial stewardship programs (ASPs). Appropriate education of prescribers, including surrounding the AWaRe (Access, Watch, and Reserve) system and guidance, which recommends the prescribing of antibiotics with less resistance potential, alongside introducing ASPs in ambulatory care, can help address these concerns. This will increasingly include instigating agreed quality indicators, and their monitoring, surrounding the AWaRe system and guidance. Improved surveillance of local resistance patterns can help with appropriately updating antibiotic prescribing guidance, including revising the AWaRe guidance based on local resistance patterns. Additional financing is also needed to help attain national goals.
Evaluating infection prevention and control programs in Zambian hospitals using the WHO infection prevention and control assessment framework (IPCAF) tool.
(Frontiers in Public Health, 2025-08-26) Massele,Amos Y
Background: Infection Prevention and Control (IPC) is key to preventing healthcare-associated infections (HAIs) and the spread of antimicrobial resistance (AMR). This study evaluated the implementation of IPC in Zambian hospitals.Materials and methods: We conducted a multicentric cross-sectional study in nine hospitals across Zambia using the WHO IPCAF tool. Data were collected from September 1 to 30, 2024 and analyzed using the self-scoring Excel and IBM SPSS version 25.0.Results: Out of the nine hospitals assessed, four were tertiary-level hospitals while the rest were secondary-level hospitals. Overall, the implementation of IPC core components was intermediate (IPCAF Score of 594 out of 800). Four hospitals had IPCAF scores between 401 and 600, indicating an intermediate level of IPC implementation. Five hospitals scored between 601 and 800, indicating an advanced implementation of IPC in these hospitals. Three tertiary hospitals scored between 601 and 800, demonstrating their advanced implementation of IPC core components.Conclusion: This study found that the overall implementation of IPC in the surveyed hospitals was intermediate, indicating that further improvements were needed. There is a need to provide peer-learning support and strengthen IPC implementation to respond to new or re-emerging infections and AMR in the country and beyond.
Mutation Rates and Fitness Genes in Staphylococcus aureus Treated with the Medicinal Plant Synadenium glaucescens
(Applied Sciences, 2025-08-07) Mafuru,Magesa
Extracts, fractions and the pure compound epifriedelanol of the medicinal plant Synadenium glaucescens have antibacterial properties. Herbal products are generally considered less prone to resistance development than conventional antimicrobials, as they contain multiple compounds, which makes bacteria less likely to develop resistance. However, data supporting this notion are lacking. This study evaluated the development of resistance in Staphylococcus aureus subjected to extract, fractions and epifriedelanol of S. glaucescens. It also identified S. aureus fitness genes contributing to intrinsic resistance to extract of S. glaucescens. Fluctuation and gradient concentration assays were used to determine mutation rates and growth adaptation, respectively, which were lower following exposure to growth in crude extract than the pure compound epifriedelanol. By subjecting 1920 single gene mutants from the Nebraska Transposon Mutant Library to growth in the presence of extract of S. glaucescens, 12 genes were identified as important for natural resistance in S. aureus JE2; however, only mutation in the hemB gene decreased the minimum inhibitory concentration by greater than 4-fold (64-fold). In conclusion, purifying active antimicrobial compounds from S. glaucescens and using them as antibacterial substances as an alternative to crude extract increased the risk of resistance development. Further, the gene hemB appears to have a significant role in the natural resistance to the extracts obtained from S. glaucescens in this study.
Keywords: intrinsic resistance; mutation rate; fluctuation assay; gradient concentration; Staphylococcus aureus; Synadenium glaucescens; antimicrobials; antimicrobial resistance