Raphael Zozimus Sangeda is an associate Professor at the Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences (MUHAS), in Tanzania. His main roles are teaching, research and consultancy. Areas of interest include bioinformatics, data management and big data analytics, antimicrobial resistance, antimicrobial stewardship and infectious disease epidemiology especially HIV drug resistance.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
The World Health Organization (WHO) ranks healthcare-associated infection (HCAI) as one of the to... more The World Health Organization (WHO) ranks healthcare-associated infection (HCAI) as one of the top ten causes of hospital death worldwide. Hand hygiene is arguably the simplest and most effective way to prevent the transmission of HCAI between one patient to another or from patients to healthcare workers. The practical implementation of hand hygiene depends on the attitude and knowledge of health practitioners regarding hand hygiene practices. The authors, therefore, investigated the knowledge attitude and hand washing practices of healthcare workers in Tanzania. The study was an institutional-based descriptive cross-sectional study conducted at Muhimbili National Hospital between 23rd July and 21st August 2020. Ethical clearance for conducting research was issued by the Institutional Review Board of the Muhimbili University of Health and Allied Sciences, Tanzania. A total of 148 healthcare workers participated in the study. The mean age of the participants was 31.06 ± 8.160 years (range: 21-57). Females comprises of 50.7% of the participants. Unmarried participants constituted 61.5%. Regarding educational qualifications, 63.5% had a medical degree, while 31.8% were the nursing staff. It was found that the healthcare cadre correlated with the attitude toward hand hygiene. Of all the respondents, 62.2% had moderate knowledge about hand hygiene, while 35.10% had good knowledge. Regarding attitudes to hand hygiene practices, 62.8% had a good attitude. Concerning practices, 57.4% had good practices toward hand hygiene. More than half (64.9%) of the study participants received training in hand hygiene. Continued education and training programs should be implemented at healthcare facilities to increase hand washing compliance and knowledge among workers.
Background Adherence to antiretroviral therapy (ART) among key populations like human immunodefic... more Background Adherence to antiretroviral therapy (ART) among key populations like human immunodeficiency virus (HIV)-positive People Who Inject Drugs (PWID) could be challenging, especially in low and middle-income countries (LMICs). Therefore we conducted this study to assess the adherence to ART among HIV-positive PWID attending three methadone clinics in Dar es Salaam, Tanzania. Methods A cross-sectional study was conducted at three methadone clinics in Dar es Salaam, Tanzania. Adherence to ART was measured by using pharmacy refill and patient self-report methods. Bivariate and multivariable logistic regression was performed to determine the association between dependent and independent variables. A p-value of less than 0.05 was considered to be statistically significant. Results Of the 180 participants, 97.2% recorded good adherence to ART as per the pharmacy refill method. However, only 66.1% of the PWID were found to adhere to ART based on the patient self-report method. Upon associating the self-report method with a viral load of >1000 copies/mL, participants were 3.37 times more likely to have missed their ART dose at least once in the last three days before their refill visit compared to those with a viral load of <1000 copies/mL [Adjusted Odds ratio; 3.37, 95% Confidence Interval (95% CI); 1.35-8.45, p = 0.009]. Conclusion The adherence to ART among HIV-infected PWID attending methadone clinics was high based on the pharmacy refill method but relatively much lower based on the patient self-report method. There was a strong correlation between viral load and the level of adherence measured by the patient self-report method.
Background: Cockroaches are common pests in homes and hospitals. They cause allergic reactions in... more Background: Cockroaches are common pests in homes and hospitals. They cause allergic reactions in some individuals and are potential vectors for various infectious pathogens. The study investigated the extent to which hospital cockroaches act as vectors and reservoirs of medically important fungal pathogens on their external surfaces. Methods: Cockroaches were captured from the selected hospital locations including the burn unit, adult surgical wards, pediatric oncology wards, intern hostel kitchen, and the central kitchen of a national referral teaching hospital in Tanzania. Normal saline washings from the external surface of cockroaches were cultured on standard mycological media to facilitate isolation and identification of medically important molds and yeasts. The susceptibility of Candida species isolates to fluconazole was tested using the Clinical and Laboratory Standards Institute (CLSI) M27-A3 microdilution method. Results: A total of 69 cockroaches were captured from various hospital sites between February and April 2017. All cockroaches captured were shown to carry medically important fungi. A total of 956 medically important fungi were isolated; 554 (57.9%) were of Candida species, 222 (23.2%) were of Aspergillus species, 30 (3.1%) were of Cladosporium species, 17 (1.8%) were of Rhizopus species, 11 (1.2%) were of Geotrichum species, nine (0.9%) were of Penicillium species, seven (0.7%) were of Alternaria species, six (0.6%) were of Fusarium species, three (0.3%) were of Mucor species, and 97 (10.1%) were of other species. Of the Aspergillus species, Aspergillus fumigatus (111, 50.0%) was the most commonly isolated, followed by Aspergillus niger (35, 15.8%) among the Aspergillus isolates. Out of the 103 selected isolates, 18 (17.5%) of the Candida isolates normally not intrinsically resistant to fluconazole demonstrated resistance to this drug. Resistance was most frequently found in Candida parapsilosis (3, 30%), Candida pseudotropicalis (10, 23.8%), and Candida glabrata (2, 18.2%). The isolates with the least proportion of resistance to fluconazole were Candida albicans (2, 6.3%). Conclusion: Cockroaches from this hospital may act as reservoirs of medically important opportunistic fungi exhibiting resistance to fluconazole.
Background The worldwide emergence of antibiotic-resistant bacteria threatens to overshadow the d... more Background The worldwide emergence of antibiotic-resistant bacteria threatens to overshadow the dramatic advances in medical sciences since the discovery of antibiotics. Antibiotic resistance has rendered some antibiotics obsolete, creating a reliance on synthetic drugs. In some instances, bacteria can be resistant to all antibiotics. The problem of antibiotic resistance is eminent in resource-limited countries like Tanzania, where systematic surveillance and routine susceptibility tests are rarely conducted. Therefore, this study aimed to investigate the magnitude of beta-lactamase-producing Gram-positive pathogens and Enterobacteriaceae with extended-spectrum beta-lactamase (ESBL) in Dar es Salaam, Tanzania. Methodology This multi-site cross-sectional study involved three private hospitals in Dar es Salaam, Tanzania. The study was conducted between July and September 2008. Bacterial isolates were collected, identified, and subjected to antibiotic-sensitivity testing against cephalosporins, including ceftriaxone, cefuroxime and cefotaxime, and clavulanic acid, which are antibiotics readily available on the Tanzanian market at the time of the study. The microdilution method was employed to determine beta-lactamase and ESBL production per the Clinical Laboratory and Standards Institute (CLSI) protocol. Cephalosporins, including ceftriaxone, cefuroxime and cefotaxime, the beta-lactamase inhibitor, and clavulanic acid, were serially diluted with concentrations ranging from 0.011 mg/ml to 200 mg/ml. Each of these antibiotics was subjected to sensitivity tests by determining the minimum inhibitory concentrations (MIC) of the clinical isolates of bacteria using a 96-well microdilution plate. Five microliters of bacterial suspension were inoculated into each well-containing 120µl of sterile Mueller-Hinton broth before incubation overnight.
Background: Pathogenic and non-pathogenic microbial contaminants can cause physical-chemical alte... more Background: Pathogenic and non-pathogenic microbial contaminants can cause physical-chemical alterations of pharmaceuticals and medicine-related infections. This study aimed to examine the microbiological quality of selected local and imported non-sterile pharmaceutical products in the Dar es Salaam market and the antibiogram of the isolated microorganisms. Methods: Samples were collected between April and June 2021 and analysed for microbial content as per the harmonised methods of the European Pharmacopoeia (EP). Antibiotic susceptibility of the microbial isolates was studied using Kirby-Bauer disc diffusion method. Results: Fifty percent (50%) of the samples failed both bacterial and fungal enumeration tests. In this study, local products recorded lower microbial counts than imported products. Major bacterial contaminants isolated were P. aeruginosa (45.5%), S. epidermidis, (45.5%) and K. pneumoniae, while major fungal contaminants were A. flavus (58.3%), followed by A. fumigatus (25%) and Penicillium spp (16.7%). The isolated bacterial contaminants recorded high resistance levels to commonly used antibiotics. Conclusion: The tested products were contaminated with microorganisms at different levels, most of them exceeding the maximum acceptable colony counts. Syrups or suspensions were more contaminated than tablets and capsules. The isolated bacterial contaminants were highly resistant to commonly used antibiotics. Recommendations: We recommend that pharmaceutical manufacturers abide by good manufacturing, distribution and storage practices to limit contamination and cross-contamination of products. Responsible drug regulatory authorities should heighten the frequency of inspection of manufacturing facilities and regularly conduct post-marketing surveillance (PMS) of registered products to assess continued conformity to GMP guidelines. Future studies should involve samples collected directly from manufacturing sites.
Background: HIV drug resistance (HIVDR) continues to threaten the effectiveness of worldwide anti... more Background: HIV drug resistance (HIVDR) continues to threaten the effectiveness of worldwide antiretroviral therapy (ART). Emergence and transmission of HIVDR are driven by several interconnected factors. Though much has been done to uncover factors influencing HIVDR, overall interconnectedness between these factors remains unclear and African policy makers encounter difficulties setting priorities combating HIVDR. By viewing HIVDR as a complex adaptive system, through the eyes of multidisciplinary HIVDR experts, we aimed to make a first attempt to linking different influencing factors and gaining a deeper understanding of the complexity of the system. Methods: We designed a detailed systems map of factors influencing HIVDR based on semi-structured interviews with 15 international HIVDR experts from or with experience in sub-Saharan Africa, from different disciplinary backgrounds and affiliated with different types of institutions. The resulting detailed system map was conceptualized into three main HIVDR feedback loops and further strengthened with literature evidence. Results: Factors influencing HIVDR in sub-Saharan Africa and their interactions were sorted in five categories: biology, individual, social context, healthcare system and 'overarching'. We identified three causal loops cross-cutting these layers, which relate to three interconnected subsystems of mechanisms influencing HIVDR. The 'adherence motivation' subsystem concerns the interplay of factors influencing people living with HIV to alternate between adherence and non-adherence. The 'healthcare burden' subsystem is a reinforcing loop leading to an increase in HIVDR at local population level. The 'ART overreliance' subsystem is a balancing feedback loop leading to complacency among program managers when there is overreliance on ART with a perceived low risk to drug resistance. The three subsystems are interconnected at different levels. Conclusions: Interconnectedness of the three subsystems underlines the need to act on the entire system of factors surrounding HIVDR in sub-Saharan Africa in order to target interventions and to prevent unwanted effects on other
Journal of the International Association of Providers of AIDS Care, 2022
Background: Adherence to antiretroviral therapy (ART) is the key determinant of virological suppr... more Background: Adherence to antiretroviral therapy (ART) is the key determinant of virological suppression in people living with HIV (PLHIV). This study reports factors associated with non-adherence among PLHIV one year after introducing dolutegravir (DTG) based regimens in Tanzania. Methods: A hospital-based cross-sectional study was conducted in two health facilities in Dar es Salaam, Tanzania, in 2020. Results: A total of 406 PLHIV were recruited, where the majority (73.4%) were females, with 94.6% of patients being on DTG based regimens. Factors such as refill interval and sharing of antiretrovirals had significant effects on adherence. Multivariate analysis found that patients attending care and treatment center (CTC) at Temeke Regional Referral Hospital (RRH) were 4.3 times more likely to have non-adherence compared to those attending Amana RRH (aOR [adjusted odds ratio] 4.3, 95% CI [confidence interval]: 2.38-7.91, p-value < 0.0001). Conclusions: Sustainable adherence counseling is warranted to overcome non-adherence to ART.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Conclusions: Utilization trends indicated a significant monthly increase in 2015 at MNH wards in ... more Conclusions: Utilization trends indicated a significant monthly increase in 2015 at MNH wards in Tanzania. The use of wide-spectrum antibacterials was widespread. This calls for continued antibacterial utilization surveillance and implementation of hospital-based ASP to mitigate the rapidly rising global threat of AMR.
Introduction: Immune reconstitution inflammatory syndrome (IRIS) is referred to as the flare up o... more Introduction: Immune reconstitution inflammatory syndrome (IRIS) is referred to as the flare up of an underlying, previously undiagnosed infection or the worsening of a previously treated infection soon after antiretroviral therapy (ART) is started. Information about the prevalence and associated risk factors for IRIS in resource-constrained countries like Tanzania where access to ART is increasing is scarce. Therefore, this study was conducted to determine the prevalence and risk factors associated with IRIS among patients attending care and treatment clinic at Muhimbili National Hospital (CTC-MNH). Methods: A retrospective cohort study was conducted in patients receiving highly active antiretroviral therapy (HAART) who attended CTCMNH between July 2016 and June 2018. Mann Whitney test was used to compare median CD4+ cells count and viral load at baseline and after 6 months of treatment. Associated factors were analysed using multi-logistic regression. Statistics were done using Gr...
Purpose: A scientometric analysis was conducted to map the research performance and citation impa... more Purpose: A scientometric analysis was conducted to map the research performance and citation impact of Tanzania scholars from 1991 to 2015. The study analyzed the growth of the Tanzanians’ scholarly literature; ascertained the year-wise distribution of publications, subjectwise distribution of publications; determined the authorship pattern and degree of collaboration; and analyzed the citation impact. Scientometric analysis is a type of quantitative methods used in evaluating research productivity of individual scientists. Data for research productivity of all Tanzania scholars were obtained using the SCOPUS database. For the Tanzanians’ scholars, a total of 12,379 articles were published from 34 academic and research institutions from 1991 to 2015. Most Tanzanians scholars had published journal articles (n= 10392, 83.9%), which was followed by review articles and conference papers. The top three universities with high cumulative number of publications were Muhimbili University of ...
An anonymised dataset of 199 pediatric patients aged 3-18 years of age, enrolled in the prospecti... more An anonymised dataset of 199 pediatric patients aged 3-18 years of age, enrolled in the prospective Muhimbili Sickle Cohort (MSC), (Makani et al. PloS ONE 2011), whose parent or guardian consented to participate, which included having blood and DNA samples archived for studies relating to understanding the pathophysiology of sickle cell disease in Tanzanian patients. The dataset contains variables on age, sex, sickle phenotype (derived from electrophoresis and high performance liquid chromatography), history of previous blood transfusion and averaged steady state hemoglobin concentrations over the previous year prior to the samples included in this analysis. Samples included in this analysis were collected at scheduled routine clinic visits at which children were assessed by the attending physician as “clinically well” with no current pain, no fever and were malaria test (smear and or rapid test) negative, and had no reported or recorded hospitalization in the previous month. Labora...
Background Proper usage of biomedical data can be useful in designing future research strategies ... more Background Proper usage of biomedical data can be useful in designing future research strategies and in patient management and care. Exploring the clinical data with text mining allow the prediction of healthcare costs, disease diagnosis and prognosis, and the discovery related healthcare pat terns from other databases establishing, relationships among diseases, and relationships among drugs. Moreover; clinical research on the data can allow discovering disease intervention strategies. However, exploration of clinical data can be hindered if the database is not properly designed, unnormalized or contain redundant data. We hereby describe the automated migration of a clinical database containing cohort data of Sickle cell disease (SCD) patients attending clinic at Muhimbili National Hospital, in Dar es Salaam, Tanzania. The main objective was to migrate in the old SCD database into a new consistent database. Methodology The new database was modeled using MySQL-Workbench by consulting...
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
The World Health Organization (WHO) ranks healthcare-associated infection (HCAI) as one of the to... more The World Health Organization (WHO) ranks healthcare-associated infection (HCAI) as one of the top ten causes of hospital death worldwide. Hand hygiene is arguably the simplest and most effective way to prevent the transmission of HCAI between one patient to another or from patients to healthcare workers. The practical implementation of hand hygiene depends on the attitude and knowledge of health practitioners regarding hand hygiene practices. The authors, therefore, investigated the knowledge attitude and hand washing practices of healthcare workers in Tanzania. The study was an institutional-based descriptive cross-sectional study conducted at Muhimbili National Hospital between 23rd July and 21st August 2020. Ethical clearance for conducting research was issued by the Institutional Review Board of the Muhimbili University of Health and Allied Sciences, Tanzania. A total of 148 healthcare workers participated in the study. The mean age of the participants was 31.06 ± 8.160 years (range: 21-57). Females comprises of 50.7% of the participants. Unmarried participants constituted 61.5%. Regarding educational qualifications, 63.5% had a medical degree, while 31.8% were the nursing staff. It was found that the healthcare cadre correlated with the attitude toward hand hygiene. Of all the respondents, 62.2% had moderate knowledge about hand hygiene, while 35.10% had good knowledge. Regarding attitudes to hand hygiene practices, 62.8% had a good attitude. Concerning practices, 57.4% had good practices toward hand hygiene. More than half (64.9%) of the study participants received training in hand hygiene. Continued education and training programs should be implemented at healthcare facilities to increase hand washing compliance and knowledge among workers.
Background Adherence to antiretroviral therapy (ART) among key populations like human immunodefic... more Background Adherence to antiretroviral therapy (ART) among key populations like human immunodeficiency virus (HIV)-positive People Who Inject Drugs (PWID) could be challenging, especially in low and middle-income countries (LMICs). Therefore we conducted this study to assess the adherence to ART among HIV-positive PWID attending three methadone clinics in Dar es Salaam, Tanzania. Methods A cross-sectional study was conducted at three methadone clinics in Dar es Salaam, Tanzania. Adherence to ART was measured by using pharmacy refill and patient self-report methods. Bivariate and multivariable logistic regression was performed to determine the association between dependent and independent variables. A p-value of less than 0.05 was considered to be statistically significant. Results Of the 180 participants, 97.2% recorded good adherence to ART as per the pharmacy refill method. However, only 66.1% of the PWID were found to adhere to ART based on the patient self-report method. Upon associating the self-report method with a viral load of >1000 copies/mL, participants were 3.37 times more likely to have missed their ART dose at least once in the last three days before their refill visit compared to those with a viral load of <1000 copies/mL [Adjusted Odds ratio; 3.37, 95% Confidence Interval (95% CI); 1.35-8.45, p = 0.009]. Conclusion The adherence to ART among HIV-infected PWID attending methadone clinics was high based on the pharmacy refill method but relatively much lower based on the patient self-report method. There was a strong correlation between viral load and the level of adherence measured by the patient self-report method.
Background: Cockroaches are common pests in homes and hospitals. They cause allergic reactions in... more Background: Cockroaches are common pests in homes and hospitals. They cause allergic reactions in some individuals and are potential vectors for various infectious pathogens. The study investigated the extent to which hospital cockroaches act as vectors and reservoirs of medically important fungal pathogens on their external surfaces. Methods: Cockroaches were captured from the selected hospital locations including the burn unit, adult surgical wards, pediatric oncology wards, intern hostel kitchen, and the central kitchen of a national referral teaching hospital in Tanzania. Normal saline washings from the external surface of cockroaches were cultured on standard mycological media to facilitate isolation and identification of medically important molds and yeasts. The susceptibility of Candida species isolates to fluconazole was tested using the Clinical and Laboratory Standards Institute (CLSI) M27-A3 microdilution method. Results: A total of 69 cockroaches were captured from various hospital sites between February and April 2017. All cockroaches captured were shown to carry medically important fungi. A total of 956 medically important fungi were isolated; 554 (57.9%) were of Candida species, 222 (23.2%) were of Aspergillus species, 30 (3.1%) were of Cladosporium species, 17 (1.8%) were of Rhizopus species, 11 (1.2%) were of Geotrichum species, nine (0.9%) were of Penicillium species, seven (0.7%) were of Alternaria species, six (0.6%) were of Fusarium species, three (0.3%) were of Mucor species, and 97 (10.1%) were of other species. Of the Aspergillus species, Aspergillus fumigatus (111, 50.0%) was the most commonly isolated, followed by Aspergillus niger (35, 15.8%) among the Aspergillus isolates. Out of the 103 selected isolates, 18 (17.5%) of the Candida isolates normally not intrinsically resistant to fluconazole demonstrated resistance to this drug. Resistance was most frequently found in Candida parapsilosis (3, 30%), Candida pseudotropicalis (10, 23.8%), and Candida glabrata (2, 18.2%). The isolates with the least proportion of resistance to fluconazole were Candida albicans (2, 6.3%). Conclusion: Cockroaches from this hospital may act as reservoirs of medically important opportunistic fungi exhibiting resistance to fluconazole.
Background The worldwide emergence of antibiotic-resistant bacteria threatens to overshadow the d... more Background The worldwide emergence of antibiotic-resistant bacteria threatens to overshadow the dramatic advances in medical sciences since the discovery of antibiotics. Antibiotic resistance has rendered some antibiotics obsolete, creating a reliance on synthetic drugs. In some instances, bacteria can be resistant to all antibiotics. The problem of antibiotic resistance is eminent in resource-limited countries like Tanzania, where systematic surveillance and routine susceptibility tests are rarely conducted. Therefore, this study aimed to investigate the magnitude of beta-lactamase-producing Gram-positive pathogens and Enterobacteriaceae with extended-spectrum beta-lactamase (ESBL) in Dar es Salaam, Tanzania. Methodology This multi-site cross-sectional study involved three private hospitals in Dar es Salaam, Tanzania. The study was conducted between July and September 2008. Bacterial isolates were collected, identified, and subjected to antibiotic-sensitivity testing against cephalosporins, including ceftriaxone, cefuroxime and cefotaxime, and clavulanic acid, which are antibiotics readily available on the Tanzanian market at the time of the study. The microdilution method was employed to determine beta-lactamase and ESBL production per the Clinical Laboratory and Standards Institute (CLSI) protocol. Cephalosporins, including ceftriaxone, cefuroxime and cefotaxime, the beta-lactamase inhibitor, and clavulanic acid, were serially diluted with concentrations ranging from 0.011 mg/ml to 200 mg/ml. Each of these antibiotics was subjected to sensitivity tests by determining the minimum inhibitory concentrations (MIC) of the clinical isolates of bacteria using a 96-well microdilution plate. Five microliters of bacterial suspension were inoculated into each well-containing 120µl of sterile Mueller-Hinton broth before incubation overnight.
Background: Pathogenic and non-pathogenic microbial contaminants can cause physical-chemical alte... more Background: Pathogenic and non-pathogenic microbial contaminants can cause physical-chemical alterations of pharmaceuticals and medicine-related infections. This study aimed to examine the microbiological quality of selected local and imported non-sterile pharmaceutical products in the Dar es Salaam market and the antibiogram of the isolated microorganisms. Methods: Samples were collected between April and June 2021 and analysed for microbial content as per the harmonised methods of the European Pharmacopoeia (EP). Antibiotic susceptibility of the microbial isolates was studied using Kirby-Bauer disc diffusion method. Results: Fifty percent (50%) of the samples failed both bacterial and fungal enumeration tests. In this study, local products recorded lower microbial counts than imported products. Major bacterial contaminants isolated were P. aeruginosa (45.5%), S. epidermidis, (45.5%) and K. pneumoniae, while major fungal contaminants were A. flavus (58.3%), followed by A. fumigatus (25%) and Penicillium spp (16.7%). The isolated bacterial contaminants recorded high resistance levels to commonly used antibiotics. Conclusion: The tested products were contaminated with microorganisms at different levels, most of them exceeding the maximum acceptable colony counts. Syrups or suspensions were more contaminated than tablets and capsules. The isolated bacterial contaminants were highly resistant to commonly used antibiotics. Recommendations: We recommend that pharmaceutical manufacturers abide by good manufacturing, distribution and storage practices to limit contamination and cross-contamination of products. Responsible drug regulatory authorities should heighten the frequency of inspection of manufacturing facilities and regularly conduct post-marketing surveillance (PMS) of registered products to assess continued conformity to GMP guidelines. Future studies should involve samples collected directly from manufacturing sites.
Background: HIV drug resistance (HIVDR) continues to threaten the effectiveness of worldwide anti... more Background: HIV drug resistance (HIVDR) continues to threaten the effectiveness of worldwide antiretroviral therapy (ART). Emergence and transmission of HIVDR are driven by several interconnected factors. Though much has been done to uncover factors influencing HIVDR, overall interconnectedness between these factors remains unclear and African policy makers encounter difficulties setting priorities combating HIVDR. By viewing HIVDR as a complex adaptive system, through the eyes of multidisciplinary HIVDR experts, we aimed to make a first attempt to linking different influencing factors and gaining a deeper understanding of the complexity of the system. Methods: We designed a detailed systems map of factors influencing HIVDR based on semi-structured interviews with 15 international HIVDR experts from or with experience in sub-Saharan Africa, from different disciplinary backgrounds and affiliated with different types of institutions. The resulting detailed system map was conceptualized into three main HIVDR feedback loops and further strengthened with literature evidence. Results: Factors influencing HIVDR in sub-Saharan Africa and their interactions were sorted in five categories: biology, individual, social context, healthcare system and 'overarching'. We identified three causal loops cross-cutting these layers, which relate to three interconnected subsystems of mechanisms influencing HIVDR. The 'adherence motivation' subsystem concerns the interplay of factors influencing people living with HIV to alternate between adherence and non-adherence. The 'healthcare burden' subsystem is a reinforcing loop leading to an increase in HIVDR at local population level. The 'ART overreliance' subsystem is a balancing feedback loop leading to complacency among program managers when there is overreliance on ART with a perceived low risk to drug resistance. The three subsystems are interconnected at different levels. Conclusions: Interconnectedness of the three subsystems underlines the need to act on the entire system of factors surrounding HIVDR in sub-Saharan Africa in order to target interventions and to prevent unwanted effects on other
Journal of the International Association of Providers of AIDS Care, 2022
Background: Adherence to antiretroviral therapy (ART) is the key determinant of virological suppr... more Background: Adherence to antiretroviral therapy (ART) is the key determinant of virological suppression in people living with HIV (PLHIV). This study reports factors associated with non-adherence among PLHIV one year after introducing dolutegravir (DTG) based regimens in Tanzania. Methods: A hospital-based cross-sectional study was conducted in two health facilities in Dar es Salaam, Tanzania, in 2020. Results: A total of 406 PLHIV were recruited, where the majority (73.4%) were females, with 94.6% of patients being on DTG based regimens. Factors such as refill interval and sharing of antiretrovirals had significant effects on adherence. Multivariate analysis found that patients attending care and treatment center (CTC) at Temeke Regional Referral Hospital (RRH) were 4.3 times more likely to have non-adherence compared to those attending Amana RRH (aOR [adjusted odds ratio] 4.3, 95% CI [confidence interval]: 2.38-7.91, p-value < 0.0001). Conclusions: Sustainable adherence counseling is warranted to overcome non-adherence to ART.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Conclusions: Utilization trends indicated a significant monthly increase in 2015 at MNH wards in ... more Conclusions: Utilization trends indicated a significant monthly increase in 2015 at MNH wards in Tanzania. The use of wide-spectrum antibacterials was widespread. This calls for continued antibacterial utilization surveillance and implementation of hospital-based ASP to mitigate the rapidly rising global threat of AMR.
Introduction: Immune reconstitution inflammatory syndrome (IRIS) is referred to as the flare up o... more Introduction: Immune reconstitution inflammatory syndrome (IRIS) is referred to as the flare up of an underlying, previously undiagnosed infection or the worsening of a previously treated infection soon after antiretroviral therapy (ART) is started. Information about the prevalence and associated risk factors for IRIS in resource-constrained countries like Tanzania where access to ART is increasing is scarce. Therefore, this study was conducted to determine the prevalence and risk factors associated with IRIS among patients attending care and treatment clinic at Muhimbili National Hospital (CTC-MNH). Methods: A retrospective cohort study was conducted in patients receiving highly active antiretroviral therapy (HAART) who attended CTCMNH between July 2016 and June 2018. Mann Whitney test was used to compare median CD4+ cells count and viral load at baseline and after 6 months of treatment. Associated factors were analysed using multi-logistic regression. Statistics were done using Gr...
Purpose: A scientometric analysis was conducted to map the research performance and citation impa... more Purpose: A scientometric analysis was conducted to map the research performance and citation impact of Tanzania scholars from 1991 to 2015. The study analyzed the growth of the Tanzanians’ scholarly literature; ascertained the year-wise distribution of publications, subjectwise distribution of publications; determined the authorship pattern and degree of collaboration; and analyzed the citation impact. Scientometric analysis is a type of quantitative methods used in evaluating research productivity of individual scientists. Data for research productivity of all Tanzania scholars were obtained using the SCOPUS database. For the Tanzanians’ scholars, a total of 12,379 articles were published from 34 academic and research institutions from 1991 to 2015. Most Tanzanians scholars had published journal articles (n= 10392, 83.9%), which was followed by review articles and conference papers. The top three universities with high cumulative number of publications were Muhimbili University of ...
An anonymised dataset of 199 pediatric patients aged 3-18 years of age, enrolled in the prospecti... more An anonymised dataset of 199 pediatric patients aged 3-18 years of age, enrolled in the prospective Muhimbili Sickle Cohort (MSC), (Makani et al. PloS ONE 2011), whose parent or guardian consented to participate, which included having blood and DNA samples archived for studies relating to understanding the pathophysiology of sickle cell disease in Tanzanian patients. The dataset contains variables on age, sex, sickle phenotype (derived from electrophoresis and high performance liquid chromatography), history of previous blood transfusion and averaged steady state hemoglobin concentrations over the previous year prior to the samples included in this analysis. Samples included in this analysis were collected at scheduled routine clinic visits at which children were assessed by the attending physician as “clinically well” with no current pain, no fever and were malaria test (smear and or rapid test) negative, and had no reported or recorded hospitalization in the previous month. Labora...
Background Proper usage of biomedical data can be useful in designing future research strategies ... more Background Proper usage of biomedical data can be useful in designing future research strategies and in patient management and care. Exploring the clinical data with text mining allow the prediction of healthcare costs, disease diagnosis and prognosis, and the discovery related healthcare pat terns from other databases establishing, relationships among diseases, and relationships among drugs. Moreover; clinical research on the data can allow discovering disease intervention strategies. However, exploration of clinical data can be hindered if the database is not properly designed, unnormalized or contain redundant data. We hereby describe the automated migration of a clinical database containing cohort data of Sickle cell disease (SCD) patients attending clinic at Muhimbili National Hospital, in Dar es Salaam, Tanzania. The main objective was to migrate in the old SCD database into a new consistent database. Methodology The new database was modeled using MySQL-Workbench by consulting...
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