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Overview Of Antiretropulsion Devices For Prevention Of Inadvertent Stone Migration During Pneumatic Lithotripsy For Ureteric Stone, Ali Akbar Zehri, Miten Patel, Philip Adebayo, Authar Ali

Faculty of Health Sciences, East Africa

The purpose of the present chapter is to provide an update about the use of preventive devices used to stop retrograde stone migration during pneumatic lithotripsy for ureteric stone management. The aim to reduce the cost, ancillary procedure, reduce the operative time and improve the stone free rate. The hunt for ideal cadget to stop retrograde stone migration is still continue in 21 century.

Effect Of Meteorological Elements On The Dynamics Of Bacillary And Amoebic Dysentery Disease: A Mathematical Approach, Furaha M. Chuma, Rigobert C. Ngeleja, Triphonia Ngailo

Journal of Humanities and Social Sciences

Bacillary dysentery, commonly known as shigellosis, is a potentially perilous and extremely contagious bacterial infection of the colon caused by—but not limited to—bacteria shigella, bacillus, E. coli, Yersinia, and the parasite amoeba. This paper formulates and analyses a mathematical model for the transmission dynamics of dysentery epidemic that incorporate the effects of weather variations. It examines the stability of equilibria and compute the basic reproduction number that is coupled with the time-periodic model, and establishes results on the threshold dynamics. In the non-autonomous case, it investigates the disease extinction and uniform persistence. Results suggest that the dynamics of bacillary dysentery …

Ethoxylation And Polymerization Of Cardanol Derived Bifunctional Monomers, James Mgaya

Journal of Humanities and Social Sciences

Cardanol and its derivative; 3-(non-8-enyl)phenol (obtained by ethenolysis reaction of cardanol) were ethoxylated via one-pot reaction with urea and ethylene glycol using Na2CO3/ZnO as co-catalysts. The ethoxylates were later methoxycarbonylated using a 1,2-bis(ditertbutylphosphinomethyl)benzene (DTBPMB) modified palladium catalyst to produce ethoxylated bifunctional monomers. Polymerization of these monomers by heating in the presence of a standard polymerization catalyst, Ti(OBu)4, formed oligomers that were plastic-like. Analysis of these oligomers by MALDI-TOF MS indicated the condensation of up to nine monomer units.

The Rural-Urban Divide In Tanzania: Residential Context And Socioeconomic Inequalities In Maternal Health Care Utilization, Neema Langa, Tirth Bhatta

Sociology Faculty Research

Background Existing studies in Tanzania, based mostly on rural samples, have primarily focused on individual behaviors responsible for the lower utilization of maternal health care. Relatively less attention had been paid to inequalities in structural circumstances that contribute to reduced utilization of maternal health care. More importantly, scholarship concerning the impact of the rural-urban divide on socioeconomic disparities in the utilization of maternal health care is virtually nonexistent in Tanzania. Methods Drawing from the Demographic Health Survey (2015-2016) conducted in Tanzania, our study includes a total of 3,595 women aged between 15-49 years old, who had given birth in five …

Genetics And Geography Of Leukocyte Telomere Length In Sub-Saharan Africans, Steven C Hunt, Michael A Province, Et Al.

2020-Current year OA Pubs

Leukocyte telomere length (LTL) might be causal in cardiovascular disease and major cancers. To elucidate the roles of genetics and geography in LTL variability across humans, we compared LTL measured in 1295 sub-Saharan Africans (SSAs) with 559 African-Americans (AAms) and 2464 European-Americans (EAms). LTL differed significantly across SSAs (P = 0.003), with the San from Botswana (with the oldest genomic ancestry) having the longest LTL and populations from Ethiopia having the shortest LTL. SSAs had significantly longer LTL than AAms [P = 6.5(e-16)] whose LTL was significantly longer than EAms [P = 2.5(e-7)]. Genetic variation in SSAs explained 52% of …

Validation Of Kiswahili Version Of Hoqolhivbref Questionnaire Among People Living With Hiv/Aids In Tanzania: A Cross-Sectional Study, Nuru Kondo, Tumbwene Mwansisya, Eric Aghan, Riaz Ratansi

Faculty of Health Sciences, East Africa

Background: Quality of life is an important element of surveillance in people living with HIV/AIDS. WHO has developed an HIV specific quality of life tool (WHOQOLHIV-Bref) for assessing Quality of life of HIV individuals. This tool takes into account the different cultural variations that exist worldwide and hence enable assessment of the quality of life across different cultures. Despite its preliminary sound validity and reliability from several studies, the developers recommend it to be validated in different cultures to fully assess its psychometric properties before its adaptation.

Objectives: To evaluate the validity and reliability of WHOQOLHIV-Bref questionnaire in …

State Transition Modeling Of Complex Monitored Health Data, Jörn Schulz, Jan Terje Kvaløy, Kjersti Engan, Trygve Eftestol, Samwel Jatosh, Hussein Kidanto, Hege Ersdal

Faculty of Health Sciences, East Africa

This article considers the analysis of complex monitored health data, where often one or several signals are reflecting the current health status that can be represented by a finite number of states, in addition to a set of covariates. In particular, we consider a novel application of a non-parametric state intensity regression method in order to study time-dependent effects of covariates on the state transition intensities. The method can handle baseline, time varying as well as dynamic covariates. Because of the non-parametric nature, the method can handle different data types and challenges under minimal assumptions. If the signal that is …

Overview Of Antiretropulsion Devices For Prevention Of Inadvertent Stone Migration During Pneumatic Lithotripsy For Ureteric Stone, Ali Akbar Zehri, Miten Patel, Philip Adebayo, Authar Ali

General Surgery, East Africa

The purpose of the present chapter is to provide an update about the use of preventive devices used to stop retrograde stone migration during pneumatic lithotripsy for ureteric stone management. The aim to reduce the cost, ancillary procedure, reduce the operative time and improve the stone free rate. The hunt for ideal cadget to stop retrograde stone migration is still continue in 21 century.

Socio-Demographic Evaluation Of Ownership Levels And Utilization Rates Of Llins Against Malaria Vectors Within Urban Settlements Of Osogbo District, Osun State, Nigeria, Kamilu A. Fasasi, Akinlabi M. Rufai, Damilola H. Familoni, Monsuru A. Adeleke

Tanzania Journal of Science

Globally, malaria is one of the major endemic diseases of public health importance caused by Plasmodium spp. and transmitted by Anopheles mosquitoes. Efforts to eradicate malaria disease are on the decline despite appreciable progress recorded in the past. This warranted holistic review of malaria interventions which include among others, the assessment of Long Lasting Insecticidal Treated Nets (LLINs). Adopted questionnaires from Roll Back Malaria (RBM), World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) were administered to evaluate ownership levels and utilization rates of LLINs against malaria vectors in urban settlements of Osogbo district, Osun state, Nigeria. Out of …

Annual Committed Effective Doses Of Primordial Radionuclides And Excess Lifetime Cancer Risk To The Consumers Of Some Foodstuffs In Lagos, Southwest Of Nigeria, Olusegun Sowole, Sadudeen Kayode Aliyu

Tanzania Journal of Science

Food plays vital role in the survival of man as it provides necessary nutrients to the body in order to carry out the daily activities and also to be in good health. Activity concentrations of 40K, 238Uand 232Th in some foodstuffs from three highly rated markets   in Lagos, Southwest of Nigeria have been determined by gamma spectrometry method using NaI (TI) detector coupled with a pre-amplifier base to a multiple channel analyzer (MCA). Fifteen (15) samples of maize flour, yam flour, beans, cassava flour and rice were randomly purchased from the markets: Ketu, Oyingbo and Ikeja. The highest activity concentrations …

Radiation Dose To The Contralateral Breast And Effectiveness Of Superflab In Dose Reduction During Treatment Of Breast Cancer By Cobalt-60 External Beam, Julius S. Chiuyo, Peter K. Msaki, Ismail N. Makundi

Tanzania Journal of Science

Radiation therapy for breast cancer inevitably results in scattered dose to contralateral breast. Breast tissues being highly sensitive to ionizing radiations, the chance of the contralateral breast developing second cancer after radiation therapy is high. This study investigated dose to contralateral breast and its reduction by superflab during the course of breast cancer radiation therapy. A thorax breast phantom constructed from tissue-equivalent materials and diodes (type IVD2 1137) were used to measure surface doses to the contralateral breast. The mean doses received by the contralateral breast were 2.2% and 7.1% of the prescribed dose of 200 cGy for 5 × …

Parental Concerns And Uptake Of Childhood Vaccines In Rural Tanzania – A Mixed Methods Study, Lavanya Vasudevan, Joy Noel Baumgartner, Sara Moses, Esther Ngadaya, Sayoki Godfrey Mfinanga, Jan Ostermann

Faculty Publications

Background

Vaccine hesitancy has been recognized as an important barrier to timely vaccinations around the world, including in sub-Saharan Africa. In Tanzania, 1 in 4 children is not fully vaccinated. The objective of this mixed methods study was to describe and contextualize parental concerns towards vaccines in Tanzania.

Methods

Between 2016 and 2017, we conducted a cross-sectional survey (n = 134) and four focus group discussions (FGDs, n = 38) with mothers of children under 2 years of age residing in Mtwara region in Southern Tanzania. The survey and FGDs assessed vaccination knowledge and concerns and barriers to timely vaccinations. …

Low Use Of Vacuum Extraction: Health Care Professionals’ Perspective In A University Hospital, Dar Es Salaam, Henrik Makokha-Sandell, Andrew Mgaya, Johanna Belachew, Helena Litorp, Hussein Kidanto, Birgitta Essén

Faculty of Health Sciences, East Africa

Background Use of vacuum extraction (VE) has been declining in low and middle income countries. At the highest referral hospital Tanzania, 54% of deliveries are performed by caesarean section (CS) and only 0.8% by VE. Use of VE has the potential to reduce CS rates and improve maternal and neonatal outcomes but causes for its low use is not fully explored.

Method During November and December of 2017 participatory observations, semi-structured in-depth interviews (n = 29) and focus group discussions (n = 2) were held with midwives, residents and specialists working at the highest referral hospital in Tanzania. Thematic analysis …

Birth Preparedness And Complication Readiness Among Women Of Reproductive Age In Kenya And Tanzania: A Community-Based Cross-Sectional Survey, James Orwa, Samwel Gatimu, Michaela Mantel, Stanley Luchters, Micheal Mugerwa, Sharon Brownie, Leonard Subi, Secilia Mrema, Lucy Nyaga, Grace Edwards, Loveluck Mwasha, Kahabi Isangula, Edna Selestine, Sofia Jadavji, Rachel Pell, Columba Mbekenga, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Delayed health-seeking continues to contribute to preventable maternal and neonatal deaths in low resource countries. Some of the strategies to avoid the delay include early preparation for the birth and detection of danger signs. We aimed to assess the level of practice and factors associated with birth preparedness and complication readiness (BPCR) in Kenya and Tanzania.

Methods: We conducted community-based multi-stage cross-sectional surveys in Kilifi and Kisii counties in Kenya and Mwanza region in Tanzania and included women who delivered two years preceding the survey (2016–2017). A woman who mentioned at least three out of five BPCR components was …

Improving Data For Decision-Making: A Toolkit For Cervical Cancer Prevention And Control Programmes, Elkanah Omenge, Edwin Were, Oliver Rode, Kapten Muthoka, Michael Byczkowski, Heike Sartor, Davy Vanden Broeck, Dietmar Schmidt, Miriam Reuschenbach, Magnus Von Knebel Doeberitz

Obstetrics and Gynaecology, East Africa

Background: Screening of unvaccinated women remains essential to mitigate the high morbidity/mortality of cervical cancer. Here, we compared visual inspection with acetic acid (VIA), recommended by WHO as the most cost-effective screening approach in LMICs, with HPV-based screening, and usage of p16INK4a/Ki-67 dual stain cytology.

Methods: We prospectively enrolled women participating in a VIA-based cervical cancer screening program in two peri-urban health centers of Kenya. Consenting women had a VIA examination preceded by collection of a liquid-based cytology sample from the cervix stored in PreservCyt medium (Hologic®). Analysis of all samples included a hrHPV DNA test and evaluation of a …

Inadvertent Stone Migration During Pneumatic Lithotripsy: Still A Conundrum In The 21st Century, Ali Akbar Zehri, Miten Patel, Philip Adebayo, Authar Ali

General Surgery, East Africa

Currently, an ideal gadget to stop retrograde stone migration remains a holy grail, and the hunt for such a device is still ongoing in the 21st century. The quest for an ideal instrument is driven by the need to reduce cost, minimize ancillary procedure rates, reduce the device's operative time, and improve the stone-free rate. The purpose of the present review is to provide an update on the use of preventive measures that are used to stop retrograde stone migration during pneumatic lithotripsy for ureteric stone management.

Inadvertent Stone Migration During Pneumatic Lithotripsy: Still A Conundrum In The 21st Century, Ali Akbar Zehri, Miten Patel, Philip Adebayo, Authar Ali

General Surgery, East Africa

Currently, an ideal gadget to stop retrograde stone migration remains a holy grail, and the hunt for such a device is still ongoing in the 21st century. The quest for an ideal instrument is driven by the need to reduce cost, minimize ancillary procedure rates, reduce the device's operative time, and improve the stone-free rate. The purpose of the present review is to provide an update on the use of preventive measures that are used to stop retrograde stone migration during pneumatic lithotripsy for ureteric stone management.

Currently, an ideal gadget to stop retrograde stone migration remains a holy grail, …

High Burden Of Self-Reported Sexually Transmitted Infections Among Key Populations In Mozambique: The Urgent Need For An Integrated Surveillance System, Makini A. S. Boothe, Charlotte Comé, Cynthia Semá Baltazar, Noela Chicuecue, Jessica Seleme, Denise Chitsondzo Langa, Isabel Sathane, Henry F. Raymond, Erika Fazito, Marleen Temmerman, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Background: Key populations - men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID) - are at high risk for sexually transmitted infections (STI) given their sexual risk behaviours along with social, legal and structural barriers to prevention, care and treatment services. The purpose of this secondary analysis is to assess the prevalence of self-reported STIs and to describe associated risk factors among participations of the first Biological Behavioural Surveillance (BBS) in Mozambique.

Methods: Responses from the first BBS surveys conducted in 2011-2014 were aggregated across survey-cities to produce pooled estimates …

Adherence To Hiv Antiretroviral Therapy Among Pregnant And Postpartum Women During The Option B+ Era: 12-Month Cohort Study In Urban South Africa And Rural Uganda, Lynn T. Matthews, Catherine Orrell, Mwebesa B. Bwana, Alexander C. Tsai, Christina A. Psaros, Stephen Asiimwe, Gideon Amanyire, Nicholas Musinguzi, Kathleen Bell, David Bangsberg, Jessica E. Haberer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: We conducted a cohort study to understand patterns of anti-retroviral therapy (ART) adherence during pregnancy, postpartum and non-pregnancy follow-up among women initiating ART in public clinics offering Option B+ in rural Uganda and urban South Africa. Methods: We collected survey data, continuously monitored ART adherence (Wisepill), HIV-RNA and pregnancy tests at zero, six and twelve months from women initiating ART in Uganda and South Africa, 2015 to 2017. The primary predictor of interest was follow-up time categorized as pregnant (pregnancy diagnosis to pregnancy end), postpartum (pregnancy end to study exit) or non-pregnancy-related (neither pregnant nor postpartum). Fractional regression …

What Factors Shape Doctors’ Trustworthiness? Patients’ Perspectives In The Context Of Hypertension Care In Rural Tanzania, Kahabi Isangula, Holly Seale, Rohan Jayasuriya, Tumaini M. Nyamhanga, Niamh Stephenson

School of Nursing & Midwifery, East Africa

Introduction: There is increasing evidence that improving patient trust in doctors can improve patients’ use of healthcare services, compliance and continuing engagement with care –particularly for chronic diseases. Consequently, much of the current literature on trust in therapeutic relationships focuses on factors shaping doctors’ trustworthiness. However, few studies on this issue have been conducted among rural populations in low-income Africa, where health service delivery, cultural norms and patient expectations differ from those in high-income countries. This study examined patients’ perspectives of factors that shape doctors’ trustworthiness in rural Tanzania in the context of hypertension care.

Methods: A qualitative inquiry using …

Out-Patient Neurological Disorders In Tanzania: Experience From A Private Institution In Dar Es Salaam, Philip Adebayo, Omar Aziz, Rose E. Mwakabatika, Mandela Makakala, Mugisha Clement, Shabbir Adamjee, Noureen Mushi, Ahmed Jusabani, Eric Aris

Internal Medicine, East Africa

Background and introduction: Low and middle-income countries (LMIC) have a considerable burden of neurological disorders. Available profile of neurological disorders in our environment is biased towards neurological admissions. There is a paucity of data on out-patient neurological conditions in sub-Saharan Africa.

Objective: To determine the frequency and demographic data of neurological illnesses being managed at the adult out-patient neurology clinic of the Aga Khan Hospital, Dar es Salaam (AKHD).

Materials and methods: The electronic medical records of all cases with neurological diseases who presented to the adult neurology clinic of the AKHD between January 2018, and December 2019 were retrospectively …

Trajectories Of Initiation For The Heroin-Based Drug Whoonga – Qualitative Evidence From South Africa, Griffin A. Tyree, Nzwakie Mosery, Elizabeth F. Closson, Zonke Mabude, Carol Du Toit, David Bangsberg, Steven A. Safren, Kenneth H. Mayer, Jennifer A. Smit, Matthew J. Mimiaga, David J. Grelotti

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Whoonga is a smoked heroin-based street drug that first emerged in South Africa a decade ago. While previous scientific reports suggest that use is growing and youth are particularly vulnerable, trajectories of initiation are not well characterized. Methods: In 2015, 30 men undergoing residential addiction treatment for this smoked heroin drug in KwaZulu-Natal, South Africa participated in semi-structured interviews about their experiences using the drug. Interview data were coded using qualitative content analysis. Results: Participant trajectories to initiating smoked heroin were “vertical” in the context of marijuana use or “horizontal” in the context of other hard drug use. Participants …

Qualitative Approach To Understanding Barriers To Delivering Difficult News In Sub Saharan Africa, Karishma Sharma, Jasmit Shah, Sayed Karar

Internal Medicine, East Africa

Communication, especially delivery of difficult news (DDN), remains a key part of clinical practice. Despite its importance, many medical providers lack the skill and ability to effectively DDN to their patients. Due to lack of data specific to sub-Saharan Africa and to help us develop an appropriate training tool for this geographical area, we sought to explore what challenges and barriers residents at our institution faced when they deliver difficult news to their patients.

Magnitude Of Screening For Gestational Diabetes Mellitus In An Urban Setting In Tanzania; A Cross-Sectional Analytic Study, Akampa Mukuve, Mariam Noorani, Ibrahim Sendagire, Miriam Mgonja

Family Medicine, East Africa

Background: Medical screening detects risk factors for disease or presence of disease in otherwise well persons in order to intervene early and reduce morbidity and mortality. During antenatal care (ANC) it is important to detect conditions that complicate pregnancy, like gestational diabetes mellitus (GDM). Despite international and local guidelines recommending screening for GDM during ANC, there is evidence to suggest that the practice was not being carried out adequately. A major challenge may be lack of consensus on uniform GDM screening and diagnostic guidelines internationally and locally.

The primary objective was to determine the magnitude of screening for GDM among …

Introduction Of An Advanced Practice Nurse Program In Kenya: A New Era In Nursing Education, Sheila Shaibu, Eunice Ndirangu, Eunice Pallangyo, Gladys Mbuthia, Rachel Kimani, Isabel Kambo

School of Nursing & Midwifery, East Africa

Purpose: The purpose of this presentation is to share the intra and interprofessional collaborative process of developing an Advanced Practice Nursing (APN) program to be offered in 2020 in Kenya, a low middle-income country.

Methods: Engagement with stakeholders (students, clinicians, regulators and educators) affirmed the need for an APN program. Faculty from Schools of Nursing and Midwifery in three East African countries developed an APN curriculum with input from local and international agencies such as the Nursing Council of Kenya with linkages to the ICN, the Nursing Now Team and partner universities in the UK and USA. The …

Negative Appendectomy Rate In Urban Referral Hospitals In Tanzania: A Cross-Sectional Analysis Of Associated Factors, Nyamuryekung’E Klint Masawa, Authar Ali, Miten Ramesh Patel, Aidan Njau, Omar Sherman, Ahmed Jusabani, Ali Akbar Zehri

Faculty of Health Sciences, East Africa

Background:

Acute appendicitis (AA) has a lifetime risk of 8.3% with a consequent 23% lifetime risk of emergency appendectomy. In atypical presentation, making a clinical diagnosis is difficult, leading to a high perforation rate (PR) or misdiagnoses and high negative appendectomy rates (NAR). This study aimed to establish NAR and explore the associated factors and possible attainable solutions to reduce it in urban referral hospitals in Tanzania.

Methods:

This was a crosssectional study with 91 consecutive patients, aged 10 years and older undergoing appendectomy for suspected AA with histological evaluation of specimens. The study was powered to detect the NAR …

Negative Appendectomy Rate In Urban Referral Hospitals In Tanzania: A Cross-Sectional Analysis Of Associated Factors, Masawa Klint Nyamuryekung’E, Ali Syed Muhammad Akhtar, Miten Ramesh Patel, Aidan Njau, Omar Sherman, Ahmed Jusabani, Ali Akbar Zehri

General Surgery, East Africa

Background: Acute appendicitis (AA) has a lifetime risk of 8.3% with a consequent 23% lifetime risk of emergency appendectomy. In atypical presentation, making a clinical diagnosis is difficult, leading to a high perforation rate (PR) or misdiagnoses and high negative appendectomy rates (NAR). This study aimed to establish NAR and explore the associated factors and possible attainable solutions to reduce it in urban referral hospitals in Tanzania.

Methods: This was a crosssectional study with 91 consecutive patients, aged 10 years and older undergoing appendectomy for suspected AA with histological evaluation of specimens. The study was powered to detect the NAR …

Negative Appendectomy Rate In Urban Referral Hospitals In Tanzania: A Cross-Sectional Analysis Of Associated Factors, Nyamuryekung'e Klint Masawa, Authar Ali, Miten Ramesh Pate, Aidan Njau, Omar Sherman, Ahmed Jusabani, Ali Akbar Zehri

General Surgery, East Africa

Background: Acute appendicitis (AA) has a lifetime risk of 8.3% with a consequent 23% lifetime risk of emergency appendectomy. In atypical presentation, making a clinical diagnosis is difficult, leading to a high perforation rate (PR) or misdiagnoses and high negative appendectomy rates (NAR). This study aimed to establish NAR and explore the associated factors and possible attainable solutions to reduce it in urban referral hospitals in Tanzania.

Methods: This was a crosssectional study with 91 consecutive patients, aged 10 years and older undergoing appendectomy for suspected AA with histological evaluation of specimens. The study was powered to detect the NAR …

Determination Of Reference Intervals For Common Chemistry And Immunoassay Tests For Kenyan Adults Based On An Internationally Harmonized Protocol And Up-To-Date Statistical Methods, Geoffrey Omuse, Kiyoshi Ichihara, Daniel Maina, Mariza Hoffman, Elizabeth Kagotho, Alice Kanyua, Jane Mwangi, Caroline Wambua, Angela Amayo, Peter Ojwang, Zul Premji, Rajiv Erasmus

Pathology, East Africa

Background: Due to a lack of reliable reference intervals (RIs) for Kenya, we set out to determine RIs for 40 common chemistry and immunoassay tests as part of the IFCC global RI project.

Methods: Apparently healthy adults aged 18–65 years were recruited according to a harmonized protocol and samples analyzed using Beckman-Coulter analyzers. Value assigned serum panels were measured to standardize chemistry results. The need for partitioning reference values by sex and age was based on between-subgroup differences expressed as standard deviation ratio (SDR) or bias in lower or upper limits (LLs and ULs) of the RI. RIs …

Covid-19 And Stroke In Sub-Saharan Africa: Case Series From Dar Es Salaam, Philip Adebayo, Nadeem Kassam, Omar Aziz, Ahmed Jusabani, Samina Somji, Mugisha Clement

Internal Medicine, East Africa

Low and middle-income countries including those in sub-Saharan (SSA) Africa are experiencing a steady increase in the number of COVID-19 cases. To the best of our knowledge, reports of COVID-19 related strokes are scarce in SSA. The peculiar situation of stroke care in SSA makes COVID-19 associated stroke a bothersome entity as it adds other dynamics that tilt the prognostic balance. We present a case series of COVID -19 related stroke in 3 patients from Tanzania. We emphasized protected code stroke protocol.