Digital Commons Network^™

Vitamin D Status And Risk Of Incident Tuberculosis Disease: A Nested Case-Control Study, Systematic Review, And Individual-Participant Data Meta-Analysis, Omowunmi Aibana, Chuan-Chin Huang, Said Aboud, Alberto Arnedo-Pena, Mercedes C Becerra, Juan Bautista Bellido-Blasco, Ramesh Bhosale, Roger Calderon, Silvia Chiang, Carmen Contreras, Ganmaa Davaasambuu, Wafaie W Fawzi, Molly F Franke, Jerome T Galea, Daniel Garcia-Ferrer, Maria Gil-Fortuño, Barbará Gomila-Sard, Amita Gupta, Nikhil Gupte, Rabia Hussain, Jesus Iborra-Millet, Najeeha T Iqbal, Jose Vicente Juan-Cerdán, Aarti Kinikar, Leonid Lecca, Vidya Mave, Noemi Meseguer-Ferrer, Grace Montepiedra, Ferdinand M Mugusi, Olumuyiwa A Owolabi, Julie Parsonnet, Freddy Roach-Poblete, Maria Angeles Romeu-García, Stephen A Spector, Christopher R Sudfeld, Mark W Tenforde, Toyin O Togun, Rosa Yataco, Zibiao Zhang, Megan B Murray

Faculty, Staff and Student Publications

BACKGROUND: Few studies have evaluated the association between preexisting vitamin D deficiency and incident tuberculosis (TB). We assessed the impact of baseline vitamins D levels on TB disease risk.

METHODS AND FINDINGS: We assessed the association between baseline vitamin D and incident TB in a prospective cohort of 6,751 HIV-negative household contacts of TB patients enrolled between September 1, 2009, and August 29, 2012, in Lima, Peru. We screened for TB disease at 2, 6, and 12 months after enrollment. We defined cases as household contacts who developed TB disease at least 15 days after enrollment of the index patient. …

Evaluation Of The Influence Of Additional Beam Filtration On Image Quality And Patient Dose In X-Ray Fluoroscopy Procedures, Justin Ngaile, Peter Msaki, Ramadhani Kazema, Jerome Mwimanzi, Mechris Mango

Tanzania Journal of Science

The aim of the study was to evaluate the influence of additional filtration on radiation dose and image quality for patients during hysterosalpingography (HSG) and retrograde urethrography (RUG) procedures. The influence of filtering on image quality for each phantom thickness was made using a combination of different filter thicknesses. Entrance surface air kerma (ESAK) rates to Perspex phantom were measured using a solid state detector for various added combination of filter materials. Fluoroscopic image contrast was assessed using a Leeds TOR-18FG test object with a range of filter materials and phantom thicknesses. Phantom studies demonstrated that the use of additional …

Explore Barriers Associated With Not Testing For Hiv Among Men Who Have Sex With Men In Dodoma, City, Tanzania, Maria M. Mushi

Capstone Experience: Master of Public Health

Goal

The goal of the project is to explore barriers associated with not testing for HIV among men who have sex with men (MSM) in Dodoma City, Tanzania.

Objectives

In order to achieve the goal of exploring barriers associated with not testing for HIV among MSM, I will plan and conduct the study, analyze the data, and prepare the final research report.

Methods

A qualitative descriptive study will be conducted in Dodoma City, Tanzania. A total of 10 MSM 19 years of age and above will be purposefully selected by 3 peer educators to be part of the study. I …

Cervical Cancer In Tanzania: A Systematic Review Of Current Challenges In Six Domains., Ava S Runge, Megan E Bernstein, Alexa N Lucas, Krishnansu S Tewari

Articles, Abstracts, and Reports

Cervical cancer is the most common cancer in Tanzania. After excluding human immunodeficiency virus, lower respiratory infections, malaria, diarrheal diseases, and tuberculosis, cervical cancer kills more women than any other form of illness in the country. Unfortunately, Tanzania has a low doctor-to-patient ratio (1:50,000) and nearly 7000 women die each year from this disease. The clinical problem is further magnified by the country's lack of resources and prevailing poverty, sporadic cervical cancer screening, prevalence of high-risk oncogenic human papillomavirus subtypes, and relatively high rates of human immunodeficiency virus co-infection. In recent years, addressing the cervical cancer problem has become a …

"Courage 2 Test": An Evaluation Of A Social Media Marketing Campaign To Increase Hiv Testing Among Young Black Men, Jamal T. Jones, Laura F. Salazar, Richard A. Crosby

Journal of Health Disparities Research and Practice

The purpose of this study was to evaluate a social media marketing (SMM) campaign designed to increase HIV testing among young Black men attending a public university in Atlanta, GA. “Courage 2 Test” was a three-month SMM campaign (launched from February 2017 to April 2017) that included targeted Facebook and Instagram advertisements to encourage HIV testing. Students completed an online survey via two cross-sectional samples (n=106 at baseline and n=98 post campaign). Campaign evaluation involved assessing the effects of campaign exposure and the pre/post-grouping variable on ever testing for HIV and testing for HIV in the previous six months via …

Reasons For Delay In Seeking Treatment Among Women With Obstetric Fistula In Tanzania: A Qualitative Study, Mary Lyimo, Idda H. Mosha

School of Nursing & Midwifery, East Africa

Background: Obstetric fistula is among the serious and distressing maternal morbidities in Tanzania. Obstetric fistula is a childbirth-related injury caused by prolonged and obstructed labor which has a devastating impact on affected women and their families. The aim of this study was to explore reasons why women with obstetric fistula admitted to the Comprehensive Community- Based Rehabilitation in Tanzania (CCBRT) hospital delayed seeking fistula treatment.

Methods: This exploratory study incorporated qualitative approach. In-depth interviews were used to collect data from 18 women with obstetric fistula admitted to CCBRT hospital. The interviews were conducted in Kiswahili and lasted for 40–45 min. …

Clinical Emergency Care Research In Low-Income And Middle-Income Countries: Opportunities And Challenges, Adam R. Aluisio, Shahan Waheed, Peter Cameron, Jermey Hess, Shevin Jacob, Niranjan Kissoon, Adam C. Levine, Asad Mian, Shammi Ramlakhan, Hendry R. Sawe, Junaid Razzak

Department of Emergency Medicine

Disease processes that frequently require emergency care constitute approximately 50% of the total disease burden in low-income and middle-income countries (LMICs). Many LMICs continue to deal with emergencies caused by communicable disease states such as pneumonia, diarrhoea, malaria and meningitis, while also experiencing a marked increase in non-communicable diseases, such as cardiovascular diseases, diabetes mellitus and trauma. For many of these states, emergency care interventions have been developed through research in high-income countries (HICs) and advances in care have been achieved. However, in LMICs, clinical research, especially interventional trials, in emergency care are rare. Furthermore, there exists minimal research on …

Position Statement:Emerging Genetic Therapies For Rare Disorders, Pauline Samia, Adam Kirton, Russell Dale, Silvia Tenembaum, Chahnez Charfi Triki, Anaita Hegde, Richard Idro, Jo M. Wilmshurst, Ingrid Tein, Haluk Topaloğlu

Paediatrics and Child Health, East Africa

Emerging genetic therapies for rare disorders at high cost, cannot realistically address the global burden of disease. Stakeholders must develop new pathways to ensure safe, fair and sustainable provision of such therapies.

The Validation Of Swahili Version Of The International Prostate Symptom Score Questionnaire, Miten Ramesh Patel

Master of Surgery

Background: Benign prostatic hyperplasia is a common condition encountered in men who are 50 years and above, presenting in hospitals for evaluation of lower urinary tract symptoms. The International Prostate Symptom Score is one of the questionnaires used to assess these symptoms. However, this questionnaire has not yet been validated among patients with Benign Prostate Hypertrophy in the Tanzanian setting. Objectives: The primary objective of this study was to assess the validity of the Swahili version of the IPSS questionnaire among patients with benign prostatic hyperplasia. Methods: We employed a cross-sectional study design in patients that presented at the Aga …

Pick’S Disease And Subdural Haematoma: A Diagnostic Red Herring, Philip Adebayo, Funmilola Taiwo, Fatma Bakshi, Sunham Nur

Internal Medicine, East Africa

Frontotemporal dementia (FTD), otherwise known as Pick’s disease, is a clinically heterogeneous group of sporadic and familial neurodegenerative diseases. These conditions are characterized by dementia, behavioural and language dysfunction and loss of executive skills resulting from the degeneration of the frontal and temporal lobes. Although reversible causes of dementia are always sought during the evaluation of patients with progressive cognitive decline, the occurrence of a reversible aetiology may distract from evaluating for neurodegenerative causes of dementia. This report is about a 66-year old man with features of FTD and superimposed chronic subdural haematoma.

Negative Appendectomy Rate And Associated Factors In Urban Referral Hospitals In Tanzania, Masawa Klint Nyamuryekung’E

Master of Medicine in General Surgery

Background: Acute appendicitis is a common surgical emergency. In atypical presentation, making a clinical diagnosis is difficult leading to delays with high perforation rate or misdiagnoses and high negative appendectomy rates. In the urban referral hospitals in Tanzania the baseline perforation rate, negative appendectomy rate, and factors that drive it are unknown. These could serve as measures of performance, and as evaluation parameters of future interventions aimed at improving acute appendicitis case management in Tanzania. Objectives: The aim of this study was to establish the negative appendectomy rate and associated factors among patients undergoing emergency appendectomy for suspected acute appendicitis …

Prevalence And Outcome Of Asymptomatic Cryptococcal Antigenemia In Art Naive And Art Experienced Hiv Patients In Dar Es Salaam, Tanzania, Charles Mandela Makakala

Master of Medicine in Internal Medicine

Introduction: Cryptococcal meningitis (CM) is a highly fatal disease and contributes to about 20% of all-cause mortality in HIV/AIDS. Sub-Saharan Africa is facing substantial challenges in the treatment of the disease; the focus has been shifted towards prevention of the condition in ART-naive patients with CD4 counts of less than 100 cells/μL. Most studies and interventions have been conducted on ART-naive HIV patients despite there being cases and deaths due to cryptococcal meningitis among ART-experienced patients. Recent studies have shown that although there is an increase in ART coverage among HIV patients, this has not affected the incidence of cryptococcal …

Perceptions And Experiences Of Skilled Birth Attendants On Using A Newly Developed Strap-On Electronic Fetal Heart Rate Monitor In Tanzania, Sara Rivenes Lafontan, Hussein Kidanto, Hege L. Ersdal, Columba Mbekenga, Johanne Sundby

School of Nursing & Midwifery, East Africa

Background: Regular fetal heart rate monitoring during labor can drastically reduce fresh stillbirths and neonatal mortality through early detection and management of fetal distress. Fetal monitoring in low-resource settings is often inadequate. An electronic strap-on fetal heart rate monitor called Moyo was introduced in Tanzania to improve intrapartum fetal heart rate monitoring. There is limited knowledge about how skilled birth attendants in low-resource settings perceive using new technology in routine labor care. This study aimed to explore the attitude and perceptions of skilled birth attendants using Moyo in Dar es Salaam, Tanzania.

Methods: A qualitative design was used to collect …

Magnitude Of Screening For Gestational Diabetes Mellitus In An Urban Setting In Tanzania, Akampa Mukuve

Master of Medicine in Family Medicine

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 pregnancy it is important to detect conditions which may harm the mother and fetus during antenatal care (ANC). Gestational diabetes mellitus (GDM) is one such condition which causes adverse effects during pregnancy, acutely and in the long term. There is lack of consensus on uniform screening and diagnostic guidelines for GDM both internationally and locally. Furthermore, there is evidence that recommendations in antenatal care guidelines are not routinely performed by health care providers …

Complementary Feeding Practices And Their Determinants In Infants And Young Children On Follow Up At A Private Tertiary Hospital In Nairobi, Catherine Muthoni

Master of Medicine in Paediatrics and Child Health

Background: More than a third of all deaths in children under five years of age worldwide, are linked to maternal and child under-nutrition. Appropriate complementary feeding is one of the interventions with the greatest potential for reduction of nutrition-related diseases and mortalities, yet uptake of the recommended World Health Organisation (WHO) infant and young child feeding practices in Kenya remains low. Despite provision of nutrition education at Aga Khan University Hospital- Nairobi (AKUH-N), both growth faltering and over-weight trends have been observed, pointing to both under- and over-nutrition. Objectives: This study investigated caregivers' knowledge , attitude and practice (KAP) of …

Data Visualization Of Treatment Outcomes For Tuberculosis Patients, Joy Jenkins

Industrial Engineering Undergraduate Honors Theses

Tuberculosis is an infectious disease, and different treatments have been discovered over the years. However, patients may develop various drug resistance levels that affect the likelihood of becoming cured or dying. In this study, we sought to employ data visualization to explore the relationship between treatment trajectory, as indicated by smear and culture results in the follow-up tests and patient outcomes. A large sample of patients have been broken down by demographics including age, gender, and drug resistance status. Sankey diagrams were used to visualize the pathway progression of the patients over time split between two time periods- months 0-6 …

My Husband Will Love Me More If I Give Birth To More Children: Rural Women’S Perceptions And Beliefs On Family Planning Services Utilization In A Low Resource Setting, Agnes Msoka, Eunice Pallangyo, Sharon Brownie, Eleanor Holroyd

School of Nursing & Midwifery, East Africa

Introduction: Responsibility for family planning in low resource settings is almost solely delegated to women, with very low male involvement. This study investigated rural Tanzanian women’s perceptions and cultural beliefs of the barriers to family planning services utilization.

Methods: This study used a qualitative descriptive approach drawing on four group discussions with 20 purposively selected married women with two or more children. The study followed COREQ guidelines for reporting qualitative studies. Data were collected from participants at four health facilities in Bagamoyo and Kisarawe districts in Pwani, Tanzania.

Results: Participants’ occupations included housewives, small-scale farmers, and entrepreneurs. Most women were …

Maternal Health In Eastern Tanzania: Antenatal, Delivery And Postnatal Care, Christina Sego

Mahurin Honors College Capstone Experience/Thesis Projects

The purpose of this study is to evaluate maternal health conditions in eastern Tanzania and identify areas and conditions for improvement of healthcare. Tanzania is ranked 27th highest country in maternal mortality in the world (The World Factbook: Tanzania, 2018). Maternal health is an ongoing challenge Tanzania is facing as a country. This experiment was designed to identity areas of service in the district hospital setting that could advance quality of care. This study was conducted in Sinza Palestina Hospital, a district hospital on the outskirts of Dar es Salaam, Tanzania. Data was collected in the form of observation, interviews …

Contextual Design Choices And Partnerships For Scaling Early Child Development Programmes, Kate M. Milner, Raquel Bernal Salazar, Sunil Bhopal, Alexandra Brentani, Pia Rebello Britto, Tarun Dua, Melissa Gladstone, Esther Goh, Jena Hamadani, Muneera Rasheed

Department of Paediatrics and Child Health

Translating the Nurturing Care Framework and unprecedented global policy support for early child development (ECD) into action requires evidence-informed guidance about how to implement ECD programmes at national and regional scale. We completed a literature review and participatory mixed-method evaluation of projects in Saving Brains®, Grand Challenges Canada® funded ECD portfolio across 23 low- and middle-income countries (LMIC). Using an adapted programme cycle, findings from evaluation related to partnerships and leadership, situational analyses, and design for scaling ECD were considered. 39 projects (5 'Transition to Scale' and 34 'Seed') were evaluated. 63% were delivered through health and 84% focused on …

Determination Of Radiation Doses To Patients Undergoing Fluoroscopically Guided Orthopaedic Procedures At Muhimbili Orthopaedic Institute In Tanzania, Jacob Busumabu, Ismael N. Makundi, Justin E. Ngaile

Tanzania Journal of Science

The aim of the present study was to determine the magnitude of radiation doses delivered to patients undergoing Fluoroscopically Guided Orthopaedic Procedures (FGOP’s) in Tanzania. The air Kerma Area Product (KAP), fluoroscopy time, organ dose and effective dose to patients undergoing FGOP’s were obtained from Muhimbili Orthopaedic Institute. A total of 72 adult patients from selected three FGOPs namely Lumbar Spine (LS), Dynamic Hip Screw (DHS) and Thoracic Spine (TS) procedures were investigated using C-arm fluoroscopy machine. The knowledge of patient demographic data, radiographic data, KAP and Monte Carlo-based PCXMC software were used to obtain the magnitude of organ doses …

Prevalence Of Zoonotic Parasites In Stray Dogs In Rural Communities, Tanzania, Winifrida Kidima

Tanzania Journal of Science

The aim of this study was to identify and establish the baseline information on the prevalence of zoonotic parasites in stray dogs in Tanzania. A cross sectional study was conducted in Katavi, Arusha and Rukwa Regions in Tanzania. Intestinal parasites were analyzed from faecal samples collected from 364 dogs using modified sedimentation technique. Sixty-sixpercentage (66%) of the faecal samples were positive for gastrointestinal parasites while 7% had mixed infections, 27% were negative for the parasites. Higher proportions of the faecal samples were positive for gastrointestinal parasites in Arusha and Rukwa compared to Katavi (p< 0.0001). The prevalence of Ancylostomacaninum(49%) was higher compared to that of other parasites (p <0.0001). Prevalence of A. lumbricoideswas significantly higher compared to that of E. granulosusand S. stercoralis(p = 0.0046). There was a positive association between parasite positivity rates and collecting dog’s faecal samples near domestic animals (p < 0.00001). Parasite diversity was higher in stray dogs from Katavi and Arusha (p > 0.05). There was no association between …

Ada News - 03/18/2019, American Dental Association, Publishing Division

ADA News

Established in 1970 as the official newspaper of the American Dental Association, the ADA News serves practicing dentists and others allied to the dental profession in the U.S. and internationally. It is the No. 1 source of news and information about the many benefits and services the ADA delivers to members daily as well as timely information on scientific, social, political and economic developments affecting dentistry and health care.

Early Neonatal Vitamin A Supplementation And Infant Mortality: An Individual Participant Data Meta-Analysis Of Randomised Controlled Trials, Rajiv Bahl, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Biannual vitamin A supplementation is a well-established survival tool for preschool children 6 months and older in vitamin A deficient populations but this schedule misses the opportunity to intervene on most young infant deaths. Randomised trials of neonatal vitamin A supplementation (NVAS) in the first few days of life to assess its impact on under 6-month mortality in low/middle-income countries have had varying results.
Methods: Investigators of 11 published randomised placebo-controlled NVAS trials (n=163 567 children) reanalysed their data according to an agreed plan and pooled the primary outcomes of mortality from supplementation through 6 and 12 months of …

National Policies And Care Provision In Pregnancy And Childbirth For Twins In Eastern And Southern Africa: A Mixed-Methods Multi-Country Study, Claudia Hanson, Stephen Munjanja, Agnes Binagwaho, Bellington Vwalika, Andrea B. Pembe, Elsa Jacinto, George K. Chilinda, Kateri B. Donahoe, Sikolia Wanyonyi, Peter Waiswa, Muchabayiwa F. Gidiri, Lenka Benova

Obstetrics and Gynaecology, East Africa

Background: High-risk pregnancies, such as twin pregnancies, deserve particular attention as mortality is very high in this group. With a view to inform policy and national guidelines development for the Sustainable Development Goals, we reviewed national training materials, guidelines, and policies underpinning the provision of care in relation to twin pregnancies and assessed care provided to twins in 8 Eastern and Southern African countries: Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe.

Methods and findings: We located policies and guidelines by reviewing national repositories and by contacting experts to systematically map country-level maternal and newborn training materials, guidelines, and …

Structured On-The-Job Training To Improve Retention Of Newborn Resuscitation Skills: A National Cohort Helping Babies Breathe Study In Tanzania, Mary Drake, Dunstan R. Bishanga, Akwila Temu, Mustafa Njozi, Erica Thomas, Victor Mponzi, Lauren Arlington, Georgina Msemo, Mary Azayo, Allan Kairuki, Amunga R. Meda, Kahabi Isangula, Brett D. Nelson

School of Nursing & Midwifery, East Africa

Background: Newborn resuscitation is a life-saving intervention for birth asphyxia, a leading cause of neonatal mortality. Improving provider newborn resuscitation skills is critical for delivering quality care, but the retention of these skills has been a challenge. Tanzania implemented a national newborn resuscitation using the Helping Babies Breathe (HBB) training program to help address this problem. Our objective was to evaluate the effectiveness of two training approaches to newborn resuscitation skills retention implemented across 16 regions of Tanzania.

Methods: An initial training approach implemented included verbal instructions for participating providers to replicate the training back at their service delivery site …

Ada News - 02/04/2019, American Dental Association, Publishing Division

ADA News

Established in 1970 as the official newspaper of the American Dental Association, the ADA News serves practicing dentists and others allied to the dental profession in the U.S. and internationally. It is the No. 1 source of news and information about the many benefits and services the ADA delivers to members daily as well as timely information on scientific, social, political and economic developments affecting dentistry and health care.

Ecological Niche Modeling As A Tool For Prediction Of The Potential Geographic Distribution Of Bacillus Anthracis Spores In Tanzania, Elibariki R. Mwakapeje, Sood A. Ndimuligo, Gladys Mosomtai, Samuel Ayebare, Luke Nyakarahuka, Hezron E. Nonga, Robinson H. Mdegela, Eystein Skjerve

All Peer-Reviewed Publications

Introduction: Anthrax is caused by the spore-forming, Gram-positive bacterium Bacillus anthracis. The aim of this study was to predict the potential distribution of B. anthracis in Tanzania and produce epidemiological evidence for the management of anthrax outbreaks in the country. Methods: The Maxent algorithm was used to predict areas at risk of anthrax outbreaks based on the occurrence and environmental data in Arusha and Kilimanjaro regions; the model was later transferred to predict the entire country. Seventy percent of the occurrence data were used to train the model, while 30% were used for model evaluation. Results: Four regions of northern …

Regional Prevalence Of Health Worker Absenteeism In Tanzania, Tomoki Fujii

Research Collection School Of Economics

Absenteeism of health workers in developing countries is common and can severely undermine the reliability of the health system. Therefore, it is important to understand where the prevalence of absenteeism is high. We develop a simple imputation method that combines a Service Delivery Indicators survey and a Service Provision Assessment survey to estimate the prevalence of absenteeism of health workers at the level of regions in Tanzania. The resulting estimates allow one to identify the regions in which the prevalence of absenteeism is significantly higher or lower than the national average and help policymakers determine priority areas for intervention.

Tanzanian Mothers’ Cultural Beliefs And Misinformation Regarding The Reasons For Their Cesarean Sections, Victor Mathias, Eleanor Holroyd, Grace Edwards

School of Nursing & Midwifery, East Africa

Background: In Tanzania, cesarean section (CS) rates have been steadily increasing, yet little is known about mothers’ understanding of the medical rationale for their CSs.

Aim: To identify mothers’ cultural understandings of the rationale for their CSs.

Methods: Design: A qualitative descriptive design was employed.

Setting: A government hospital in the western region in Tanzania.

Participants: A total of 117 mothers were interviewed using convenience sampling post CS.

Findings: Forty percent of the mothers were younger than 18 years, with more than 50% having had five or more live babies. Among multigravida women, 40.2% had had one or more previous …

Knowledge, Attitudes, Practices And Barriers In Use Of Evidence-Based Medicine Among Resident Physicians In Aga Khan University Hospital, Nairobi., Megha Unadkat

Master of Medicine in Paediatrics and Child Health

Background: Evidence based medicine (EBM) helps clinicians to integrate latest research evidence into their daily clinical practice. There is a need for all healthcare professions to adopt it in order to provide scientific, safe, efficient and most cost-effective care. Postgraduate residents are at the frontline of healthcare delivery and all medical institutions should strive to produce practitioners of EBM. Studies have shown that physicians are still struggling to adapt to this paradigm shift in the practice of medicine, especially in Sub Saharan Africa (SSA). However, very few studies have been done in SSA and none in East Africa to explore …