Nyasatu G. Chamba

Background: Diabetic peripheral neuropathy (DPN) is a common and disabling complication of Type 2 diabetes mellitus (T2DM). Emerging evidence suggests that elevated serum uric acid (SUA) may associate with microvascular complications; however, data from sub‐Saharan Africa remain limited. We examined the association between hyperuricemia and DPN among adults with T2DM in northern Tanzania. Methods: We conducted a hospital‐based cross‐sectional analytical study at a tertiary diabetes clinic from November 2024 to April 2025. Adults aged ≥ 18 years with established T2DM were consecutively recruited. DPN was assessed using the Toronto Clinical Scoring System (TCSS), with DPN defined as TCSS ≥ 6. Fasting SUA was classified as elevated at ≥ 340 μ mol/L in women and ≥ 420 μ mol/L in men. Multivariable logistic regression estimated adjusted odds ratios (aORs). Receiver operating characteristic (ROC) analysis assessed discriminatory performance. Results: Of 321 clinic attendees, 220 participants met eligibility criteria and were analyzed (mean age < 65 years: 69.1%; male: 53.2%). DPN prevalence was 51.8% (114/220). Elevated SUA was present in 52.7% and was strongly associated with DPN (aOR 5.89, 95% CI 3.01–11.51, p < 0.001). Diabetes duration ≥ 5 years (aOR 3.81, p = 0.016), overweight status (aOR 2.18, p = 0.034), elevated fasting glucose (aOR 2.20, p = 0.022), and low HDL (aOR 2.10, p = 0.040) were independently associated with DPN. Elevated total cholesterol was inversely associated (aOR 0.36, p = 0.003). SUA demonstrated moderate discrimination for DPN (AUC 0.773). Conclusions: Hyperuricemia was independently associated with prevalent DPN in this Tanzanian study. SUA may represent a clinically accessible marker for neuropathy risk stratification in resource‐limited settings.

People living with HIV/AIDS (PLWHA) are more likely to experience significant generalized anxiety symptoms compared to the general population, which require both pharmacological and psychological treatment. There is limited evidence on the specific facilitators and barriers to treatment-seeking behaviours for significant generalized anxiety symptoms among PLWHA in Kilimanjaro region. This study aims to determine facilitators and barriers to treatment-seeking behaviours for significant generalized anxiety symptoms among PLWHA in Kilimanjaro region. This exploratory pilot study employed a qualitative design to assess facilitators and barriers to treatment-seeking for generalized anxiety symptoms among PLWHA in Kilimanjaro region and used the Generalized Anxiety Disorder-7 (GAD-7) screener to identify significant generalized anxiety symptoms in adult PLWHA who were followed up for three months. Thematic framework analysis was employed to identify and interpret patterns in treatment-seeking behaviors. Among 348 PLWHA, only 8.6% (30 PLWHA) had screened positive for significant generalized anxiety symptoms. Among 30 with significant anxiety symptoms, 6 (20%) PLWHA attended mental health services, 15 (50%) PLWHA did not attend, and 9 (30%) PLWHA were lost to follow-up. Facilitators identified were having mental health awareness, support from family and friends, and having good customer service in mental health clinics. Economic burdens, few mental health services, and stigma were potential barriers to treatment seeking for significant generalized anxiety symptoms. Addressing both facilitators and barriers to treatment-seeking for significant generalized anxiety symptoms among PLWHA, including increasing awareness, reducing stigma, improving access to services, and providing strong social support, is essential for enhancing mental health care.

Background: Among acute stroke patients (ASPs), diabetes mellitus (DM) is associated with a higher risk of death, functional dependency, and recurrence. This study aimed to determine the impact of DM on the 30-day mortality among admitted ASPs in northern Tanzania. Materials and methods: This was a hospital-based prospective cohort study performed among ASPs with and without DM who were admitted to Kilimanjaro Christian Medical Centre from November 2022 to May2023. ASPs were followed for 30 days after the onset of an acute stroke to identify the primary outcome, which was all-cause mortality. Descriptive statistics, logistic regression, and survival analysis were conducted, Results: Out of 213 ASP, 82 (38.5%) had DM. The overall crude mortality rate was 46.9%. ASPs with DM had a higher mortality rate of 53.7% compared with those without DM (42.7%). A higher proportion of acute stroke patients with DM (84.1%) had a poor outcome (mRS 3-6) (p = 0.038). DM was statistically non-significant for 30-day mortality (aHR 1.56; 95% CI: 0.73–3.32; p = 0.252). However, fever (p = 0.005), severe admission Glasgow coma scale (p = 0.005), severe stroke (p = 0.008), elevated serum creatinine (p = 0.008), and an abnormal respiratory pattern (p = 0.042), were predictors of 30-day mortality, Conclusion: This study demonstrated a high mortality in ASPs. Although DM did not have a significant impact on 30-day mortality, other factors, such as altered mental state, stroke severity, fever, elevated creatinine, and abnormal respiration, need to be accounted for that may have a significant impact on the mortality in ASPs. These findings highlight the significant burden of DM in stroke patients and underscore the importance of early diagnosis and treatment of ASPs, in the hopes of improving clinical practice and guidelines and reducing morbidity and mortality in Tanzania.

Introduction: Statins have been implicated in poor glycemic control among patients with diabetes mellitus (DM), prompting the US Food and Drug Administration (FDA) to update warning labels on all statins to reflect the risk of increased blood glucose levels. However, few studies from sub‐Saharan Africa have assessed this concern. This study investigated the effects of statins on glycemic control among patients with Type 2 diabetes mellitus (T2DM) in Kilimanjaro, northeastern Tanzania. Materials and Methods: This was a hospital‐based retrospective cohort study evaluating changes in glycated hemoglobin (HbA _1c ) at 1–3, 7–12, and 19–24 months, as the primary outcome, comparing statin users and nonusers among T2DM patients attending DM clinic at Kilimanjaro Christian Medical Centre in Tanzania. Binomial regression models were fitted to calculate adjusted risk ratios for independent predictors of a ≥ 0.2% rise in HbA _1c , with statistical significance set at p < 0.05. Results: Out of 122 patients, 51 (41.8%) were on statin therapy. Among these, 46 (90.2%) were prescribed atorvastatin. Statin users had an increase of mean HbA _1c from 10.6 % ± 2.7 % at baseline compared to 11.6 % ± 2.8 % at 1–3 months ( p = 0.114), followed by a decrease to 10.1 % ± 2.2 % at 7–12 months ( p = 1.0), and 10.0 % ± 2.5 % at 19–24 months ( p = 1.0). However, atorvastatin users ( n = 46) had a significant increase of mean HbA _1c from 10.7 % ± 2.8 % at baseline compared to 11.9 % ± 2.7 % at 1–3 months ( p = 0.04). In contrast, nonstatin users had a consistent and significant decrease in HbA _1c from 11.3 % ± 2.8 % at baseline compared to 9.7 % ± 2.2 % at 1–3 months ( p = 0.001), to 9.7 % ± 2.6 % at 7–12 months ( p = 0.011), and to 9.3 % ± 2.2 % at 19–24 months ( p = 0.001). Conclusion: Statin therapy among patients with T2DM was associated with short‐lived worsening of glycemic control at 1–3 months posttherapy.

Diabetes is known to be a risk factor for active pulmonary tuberculosis (TB) and the reactivation of latent or previous TB. It is also associated with poor TB treatment outcomes. Conversely, TB infection in itself can worsen glycaemic control temporarily and possibly lead to diabetes, among other non-communicable comorbidities. Post-TB lung disease decreases life expectancy and increases the risk of recurrent TB infection. There are efforts in low- and middle-income countries to integrate TB and diabetes healthcare services, as encouraged by the WHO and other international health organisations. However, integration measures, including bidirectional screening and coordinated care for both diseases in low- and middle-income countries, are scarce. This may lead to a lack of control over either condition. The authors present the journey of a 48-year-old man with Type 2 diabetes and previous pulmonary TB. He presented with a 2-week history of productive coughing and massive haemoptysis amounting to 500 mL in total. Recurrent pulmonary TB was confirmed by Gene Xpert, a chest X-ray, and CT of the chest. Glycaemic control improved while on TB treatment after counselling on adherence. The difficulties and dilemmas in managing and following up on a communicable and non-communicable disease traditionally cared for can be improved upon with the integration of TB/diabetes healthcare services.

Diabetes is known to be a risk factor for active pulmonary tuberculosis (TB) and the reactivation of latent or previous TB. It is also associated with poor TB treatment outcomes. Conversely, TB infection in itself can worsen glycaemic control temporarily and possibly lead to diabetes, among other non-communicable comorbidities. Post-TB lung disease decreases life expectancy and increases the risk of recurrent TB infection. There are efforts in low- and middle-income countries to integrate TB and diabetes healthcare services, as encouraged by the WHO and other international health organisations. However, integration measures, including bidirectional screening and coordinated care for both diseases in low- and middle-income countries, are scarce. This may lead to a lack of control over either condition. The authors present the journey of a 48-year-old man with Type 2 diabetes and previous pulmonary TB. He presented with a 2-week history of productive coughing and massive haemoptysis amounting to 500 mL in total. Recurrent pulmonary TB was confirmed by Gene Xpert, a chest X-ray, and CT of the chest. Glycaemic control improved while on TB treatment after counselling on adherence. The difficulties and dilemmas in managing and following up on a communicable and non-communicable disease traditionally cared for can be improved upon with the integration of TB/diabetes healthcare services.

PURPOSE: This study sought to delineate the clinical, laboratory, and imaging characteristics during multiple myeloma (MM) diagnosis, outline the treatment modalities administered, and ascertain the survival rates among patients with MM over a comprehensive 5-year span in Tanzania. METHODS: This retrospective cohort study investigated patients diagnosed with MM at the Cancer Care Clinic, Kilimanjaro Christian Medical Centre, between January 2017 and June 2022. Demographic data, clinical profiles, and survival outcomes were collected. The study employed the Kaplan-Meier method to determine overall survival (OS) and survival rates, supported by univariate analysis and a multivariate Cox regression model with significance of P < .05. RESULTS: In this study of 76 patients with MM, bone pain was the most common complaint (76.3%), and patients were age typically older than 50 years (82.5%). Laboratory tests showed frequent abnormalities, such as anemia (51.3%) and hypercalcemia (23.9%). Most patients were at stage III according to Durie Salmon Staging (82.7%), with imaging revealing various bone abnormalities. The median OS was 18.0 months, with 46.1% of patients passing away during the study period. Factors linked to shorter survival included anemia, renal failure, and bone involvement. Infection was the primary cause of death among these patients. The presenting complaint of bone pain significantly affected survival outcomes. CONCLUSION: This study provides a comprehensive understanding of MM within the Sub-Saharan African context, highlighting age-related disparities in diagnosis, predominant presenting symptoms like bone pain, factors contributing to delayed diagnoses, and the impact on survival rates. The findings underscore the critical need for early recognition, improved diagnostics, and tailored interventions to enhance outcomes for patients with MM in this region.

Background: Africa has consistently had the highest prevalence (70.1%) of H. pylori, and this has led to significant cases of dyspepsia, gastric cancers, and upper gastrointestinal bleeding. However, most studies have used sero-prevalence, which might not give the current state of the infection. Among the tests, the stool antigen test is simple, quick, and effective. The study aimed to determine the feco-prevalence, endoscopic pattern, and associated factors of H. pylori infection among symptomatic adult patients in Northern Tanzania. Materials and methods: A hospital-based, cross-sectional study was conducted from October 2022 to April 2023 among adults attending the gastroenterology clinic at Kilimanjaro Chistian Medical Centre. A systematic random sampling was used to select the participants with indications of undergoing esophagogastroduodenoscopy. Questionnaires, stool and blood samples, and endoscopy were used to collect variable data. Numerical and categorical variables were summarized into narrations and tables. Logistic regression was used to assess the factors associated with H. pylori. Results: The feco-prevalence of H. pylori was 43.4%. Chronic gastritis (51.1%) was the most common endoscopic pattern, whereas duodenal ulcers and gastric ulcers were significantly associated with H. pylori infection. Increasing in age (p H. pylori infection in the adjusted analysis. Conclusion: The feco-prevalence of H. pylori is high in this setting. H. pylori stool antigen can be used as the initial workup for symptomatic patients before the initiation of proton pump inhibitors. Additionally, due to other causes of dyspepsia, it is advised that H. pylori stool antigen testing be part of the initial evaluation and esophagogastroduodenoscopy be considered in the absence of other alarm symptoms if symptoms persist despite an appropriate trial of medical therapy.

Introduction: Tracking of blood glucose levels by patients and care providers remains an integral component in the management of diabetes mellitus (DM). Evidence, primarily from high‐income countries, has illustrated the effectiveness of self‐monitoring of blood glucose (SMBG) in controlling DM. However, there is limited data on the feasibility and impact of SMBG among patients in the rural regions of sub‐Saharan Africa. This study is aimed at assessing SMBG, its adherence, and associated factors on the effect of glycaemic control among insulin‐treated patients with DM in northeastern Tanzania.Materials and Methods: This was a single‐blinded, randomised clinical trial conducted from December 2022 to May 2023. The study included patients with DM who had already been on insulin treatment for at least 3 months. A total of 85 participants were recruited into the study and categorised into the intervention and control groups by a simple randomization method using numbered envelopes. The intervention group received glucose metres, test strips, logbooks, and extensive SMBG training. The control group received the usual care at the outpatient clinic. Each participant was followed for a period of 12 weeks, with glycated haemoglobin (HbA_1c) and fasting blood glucose (FBG) being checked both at the beginning and at the end of the study follow‐up. The primary and secondary outcomes were adherence to the SMBG schedule, barriers associated with the use of SMBG, and the ability to self‐manage DM, logbook data recording, and change in HbA_1c. The analysis included descriptive statistics, paired t‐tests, and logistic regression.Results: Eighty participants were analysed: 39 in the intervention group and 41 in the control group. In the intervention group, 24 (61.5%) of patients displayed favourable adherence to SMBG, as evidenced by tests documented in the logbooks and glucometer readings. Education on SMBG was significantly associated with adherence. Structured SMBG improved glycaemic control with a HbA_1c reduction of −1.01 (95% confidence interval (CI) −1.39, −0.63) in the intervention group within 3 months from baseline compared to controls of 0.18 (95% CI −0.07, 0.44) (p < 0.001).Conclusion: Structured SMBG positively impacted glycaemic control among insulin‐treated patients with DM in the outpatient clinic. The results suggest that implementing a structured testing programme can lead to significant reductions in HbA_1c and FBG levels.Trial Registration: Pan African Clinical Trials Registry identifier: PACTR202402642155729.

Background: Many evidence-based health interventions, particularly in low-income settings, have failed to deliver the expected impact. We designed an Adaptive Diseases Control Expert Programme in Tanzania (ADEPT) to address systemic challenges in health care delivery and examined the feasibility, acceptability and effectiveness of the model using tuberculosis (TB) and diabetes mellitus (DM) as a prototype. Methods: This was an effectiveness-implementation hybrid type-3 design that was implemented in Dar es Salaam, Iringa and Kilimanjaro regions. The strategy included a stepwise training approach with web-based platforms adapting the Gibbs’ reflective cycle. Health facilities with TB services were supplemented with DM diagnostics, including glycated haemoglobin A1c (HbA1c). The clinical audit was deployed as a measure of fidelity. Retrospective and cross-sectional designs were used to assess the fidelity, acceptability and feasibility of the model. Results: From 2019–2021, the clinical audit showed that ADEPT intervention health facilities more often identified median 8 (IQR 6–19) individuals with dual TB and DM, compared with control health facilities, median of 1 (IQR 0–3) (p = 0.02). Likewise, the clinical utility of HbA1c on intervention sites was 63% (IQR:35–75%) in TB/DM individuals compared to none in the control sites at all levels, whereas other components of the standard of clinical management of patients with dual TB and DM did not significantly differ. The health facilities showed no difference in screening for additional comorbidities such as hypertension and malnutrition. The stepwise training enrolled a total of 46 nurse officers and medical doctors/specialists for web-based training and 40 (87%) attended the workshop. Thirty-one (67%), 18 nurse officers and 13 medical doctors/specialists, implemented the second step of training others and yielded a total of 519 additional front-line health care workers trained: 371 nurses and 148 clinicians. Overall, the ADEPT model was scored as feasible by metrics applied to both front-line health care providers and health facilities. Conclusions: It was feasible to use a stepwise training and clinical audit to support the integration of TB and DM management and it was largely acceptable and effective in differing regions within Tanzania. When adapted in the Tanzania health system context, the model will likely improve quality of services.