Delfina R. Msanga

Hepatobiliary complications are common in children with sickle cell anemia (SCA) due to chronic hemolysis and vaso-occlusion, but are often underdiagnosed in low-resource settings where imaging is limited. This hospital-based cross-sectional study, conducted from March to May 2023, assessed the prevalence and characteristics of hepatobiliary abnormalities using ultrasound among children younger than 18 years with SCA at a tertiary hospital in Tanzania. Demographic and clinical characteristics, laboratory findings, and abdominal ultrasonography were obtained. Logistic regression was used to identify factors associated with hepatobiliary abnormalities. A total of 194 children aged 2 to 16 years were enrolled, of whom 52% were male and 47.9% were receiving hydroxyurea. The overall prevalence of hepatobiliary abnormalities was 57.2%. The most common findings were hepatomegaly (41%), low portal vein peak systolic velocity (14%), and biliary calculi or sludge (9%). Children aged 6 to 10 years (aOR=0.1, 95% CI: 0.05-0.3; P P P =0.005). Hepatobiliary abnormalities are highly prevalent and often asymptomatic, highlighting the importance of early screening and routine monitoring.

Neonatal sepsis is the significant cause of morbidity and mortality in low- and middle-income countries (LMICs) such as Tanzania, where 99% of global neonatal deaths occur. Epidemiological data regarding the causative agents and their resistance profiles can guide clinical practice and prevention strategies. A systematic review and meta-analysis was conducted to determine the prevalence, pathogens and the outcome of neonatal sepsis in Tanzania. We conducted a systematic literature search using online databases such as PubMed/ Medline, Embase, Cochrane, Google Scholar, and Web of Science to identify peer-reviewed publications from January 2010 until May 2023. The data were analysed to determine the effect size using risk ratios (RR) and their 95% confidence interval (CI). We included twelve hospital-based studies from 559 records, of which nine were prospective in design. The overall prevalence of microbiological confirmed neonatal sepsis in Tanzania was 33% (95% CI 22–44, p < 0.001). The most prevalent pathogen was Staphylococcus haemolyticus 23.7% (95% CI 20.57–27.02%) followed by Klebsiella spp. 19.3% (95% CI 9.2% to 32%, I² 98%). The resistance of pathogens to first-line (ampicillin plus gentamicin) and second-line (ceftriaxone) treatments were almost similar (RR:1.12 (95% CI: 1.09–1.16; I² = 79.5%, p < 0.001). The pathogens were more resistant to third-generation cephalosporins compared to meropenem with the overall pooled relative risk (RR) of 1.84 (95% CI: 1.77–1.91). Death occurred in 15.1% (95% CI 5.39–28.44) of the affected neonates. There was considerable heterogeneity among all analyses which may result from the different facilities where the studies were sampled. Furthermore, a sampling bias with the majority of studies being from tertiary hospital settings, may result in overestimating the burden of antimicrobial resistance (AMR). AMR and neonatal sepsis mortality remain a significant challenge. It is crucial to consider the early and optimal points for interventions to manage neonatal sepsis’s prevalence and outcomes. Revised recommendations for effective first-line antibiotics in the management of neonatal and infant sepsis in Tanzania are urgently needed. Further research is needed to come up with rapid and robust diagnostics to guide treatment and reduce unnecessary antibiotic use.

Background: Timely diagnosis and effective management are critical for improving outcomes in neonatal bloodstream infections (BSIs), particularly in resource-limited settings. This study aimed to determine clinical signs and laboratory markers associated with BSIs among neonates at Tertiary hospital in Mwanza, Tanzania. Methods: A hospital-based cross-sectional study was conducted, among neonates treated for suspected BSI from January 2023 to June 2024. Clinical signs of sepsis were systematically documented. Blood samples were collected for culture, serial C-reactive protein (CRP), and complete blood count at admission, 24 h, and 72 h. Data were analyzed using R software version 4.4. Results: A total of 327 neonates with suspected BSI were enrolled, with a median age of 1 day [interquartile range (IQR): 1–5 days]. The case-fatality rate was 9.2% (30/327). BSIs were confirmed in 53/327 (16.2%) neonates. Among confirmed cases, 39/53 (73.5%) were caused by Gram-negative bacteria, predominantly Klebsiella pneumoniae and Acinetobacter spp. Neonates with confirmed BSI had a significantly longer mean hospital stay than those with culture-negative sepsis (10.1 ± 8.0 days vs. 6.6 ± 6.6 days; p < 0.001). Elevated CRP was an independent predictor of BSI ( p < 0.001). Conclusion: BSIs remain a significant cause of neonatal morbidity and mortality in this setting. Gram-negative organisms predominated and were associated with worse outcomes. A combination of clinical features, early warning signs, and CRP may aid in the early identification of neonates at high risk of BSIs and support timely initiation of appropriate management in resource limited settings.

Background: Toxoplasmosis infection affects at least 30% of the human population globally. Transmission primarily occurs through the ingestion of Toxoplasma gondii oocysts. Various studies have documented the seroprevalence of T. gondii among children with neurological manifestations such as autism, epilepsy, and hydrocephalus; however, data on asymptomatic infants remain limited. Therefore, this study is aimed at determining the seroprevalence of T. gondii infection and identify associated risk factors among children in Mwanza, Tanzania. Methods: This was a hospital‐based cross‐sectional study conducted between September 2017 and April 2018 in Mwanza, Tanzania. A structured and pretested questionnaire was used to capture sociodemographic, clinical data, and environmental exposure factors for T. gondii infection for the enrolled infants and the mother or caregivers. Clinical data were retrieved from the electronic hospital information management system. T. gondii specific IgG and IgM antibodies were detected by indirect enzyme‐linked immunosorbent assay (ELISA). Logistic regression analyses were used to test for associations. Results: A total of 223 infants were enrolled, with a median age (IQR) of 3 (1–7) months; 55.6% were male. Mothers or caretakers had a median age (IQR) of 27 (22–32) years. The majority were aged < 35 years, resided in urban areas, and were married. Most infants were exclusively breastfed. Good hygiene practices, including handwashing and appropriate latrine waste disposal, were commonly reported among mothers or caretakers. None of the infants tested positive for T. gondii –specific IgM antibodies, whereas 83 (37.2%; 95% CI: 30.0%–43.0%) were seropositive for IgG antibodies. On multivariate logistic regression analyses, having a peasant mother or caretaker (OR = 0.3, 95% CI: 0.1–0.8, p = 0.02) decreases the odds of being T. gondii IgG seropositive. Conclusion: More than one‐third of asymptomatic infants in Mwanza were seropositive for T. gondii IgG antibodies. The odds of T. gondii IgG seropositivity were significantly lower among infants whose mothers or caretakers were peasants.

Antimicrobial peptides (AMPs) are crucial components of the innate immune system in various organisms, including humans. Beyond their direct antimicrobial effects, AMPs play essential roles in various physiological processes. They induce angiogenesis, promote wound healing, modulate immune responses, and serve as chemoattractants for immune cells. AMPs regulate the microbiome and combat microbial infections on the skin, lungs, and gastrointestinal tract. Produced in response to microbial signals, AMPs help maintain a balanced microbial community and provide a first line of defense against infection. In preterm infants, alterations in microbiome composition have been linked to various health outcomes, including sepsis, necrotizing enterocolitis, atopic dermatitis, and respiratory infections. Dysbiosis, or an imbalance in the microbiome, can alter AMP profiles and potentially lead to inflammation-mediated diseases such as chronic lung disease and obesity. In the following review, we summarize what is known about the vital role of AMPs as multifunctional peptides in protecting newborn infants against infections and modulating the microbiome and immune response. Understanding their roles in preterm infants and high-risk populations offers the potential for innovative approaches to disease prevention and treatment.

Background: Children below five years of age have increased risk of unsuppressed viral load due to various socio-demographic and clinical factors. This study investigated the prevalence and predictors of unsuppressed viral load among HIV infected children below five years of age in Mwanza, Tanzania.Methods: A cross sectional study involving 279 children below five years of age who were on antiretroviral therapy (ART) for at least six months was conducted in the care and treatment clinics (CTC), from December 2020 to April 2021.Results: A total, 20 (7.2%, 95% CI; 4.2-10.2) had unsuppressed HIV viral load. The duration on ARVs less than 24 months (AOR 3.8, 95% CI: 1.2-12.0; P=.026), poor ARVs adherence in the past six months (AOR 5.7; 95% CI: 1.6-18.6; P=.004), severe or moderate malnutrition (AOR 3.3, 95% CI: 1.2-8.9; P=.020) and caregivers with no home supporters (AOR 4.4, 95% CI: 1.5-13.3; P=.008) independently predicted unsuppressed HIV viral load among children below five years of age.Conclusions: More than 90% of children below the age of five years on ART had suppressed viral load. Short time on ARVs, moderate and severe malnutrition, poor ARV adherence and economic constrain among caregivers were found to predict unsuppressed viral load. These factors should be used to identify children at risk of unsuppressed viral load and provide tailored support.

Rubella virus (RV) infection in susceptible women during the first trimester of pregnancy is associated with congenital Rubella syndrome (CRS). In countries where a vaccination program is implemented, active case surveillance is emphasized. This report documents the magnitude of active cases before and after vaccine implementation in Tanzania. A total of 8750 children and adolescents with signs and symptoms of RV infection were tested for Rubella IgM antibodies between 2013 and 2019 using enzyme immunoassay followed by descriptive analysis. The median age of participants was 3.8 (IQR: 2–6.4) years. About half (4867; 55.6%) of the participants were aged 1–5 years. The prevalence of RV active cases was 534 (32.6%, 95% CI: 30.2–34.9) and 219 (3.2%, 95% CI: 2.7–3.6) before and after vaccine implementation, respectively. Before vaccination, the highest prevalence was recorded in Pemba (78.6%) and the lowest was reported in Geita (15.6%), whereas, after vaccination, the prevalence ranged between 0.5% in Iringa and 6.5% in Pemba. Overall, >50% of the regions had a >90% reduction in active cases. The significant reduction in active cases after vaccine implementation in Tanzania underscores the need to sustain high vaccination coverage to prevent active infections and eventually eliminate CRS, which is the main goal of Rubella vaccine implementation.

Rectal carriage of extended spectrum β-lactamase-lactose fermenters (ESBL-LF) is the major risk factor for the development of subsequent endogenous infections. This study determined the patterns and factors associated with the rectal carriage of ESBL-LF among children with Human Immunodeficiency Virus (HIV), Diabetes Mellitus (DM), and Sickle Cell Disease (SCD) attending clinics at different health care facilities in the city of Mwanza, Tanzania. A cross-sectional study was conducted among children living with HIV (n = 236), DM (n = 42) and SCD (n = 126) between July and September 2021. Socio-demographic and clinical data were collected using a structured questionnaire. Rectal swabs/stool samples were collected and processed to detect the rectal carriage of ESBL-LF following laboratory standard operating procedures (SOPs). Descriptive statistical analysis was conducted using STATA 13.0. The overall prevalence of ESBL-LF carriage was 94/404 (23.3%). Significantly higher resistance was observed to ampicillin, trimethoprim-sulfamethoxazole, and tetracycline among Enterobacteriaceae isolated from HIV infected children than in non-HIV infected children (p < 0.05). The commonest ESBL allele 45/62 (72.6%) detected was bla_CTX-M. Generally, a parent’s low education level was found to be associated with ESBL-LF colonization among children living with HIV; (OR 4.60 [95%CI] [1.04–20], p = 0.044). A higher proportion of ESBL-LF from DM 10/10 (100%) carried ESBL genes than ESBL-LF from HIV 37/56 (66.1%) and SCD 15/28 (53.6%), p = 0.02. There is a need to collect more data regarding trimethoprim-sulfamethoxazole (SXT) prophylaxis and antibiotic resistance to guide the decision of providing SXT prophylaxis in HIV-infected children especially at this time, when testing and treatment is carried out.

Neonatal bloodstream infections (BSI) can lead to sepsis, with high morbidity and mortality, particularly in low-income settings. The high prevalence of third-generation cephalosporin-resistant organisms (3GC-RO) complicates the management of BSI. Whether BSI is linked to carriage of 3GC-RO, or to acquisition from the hospital environment is important for infection prevention and control, but the relationship remains unclear, especially in low-income settings. At a tertiary hospital in Mwanza, Tanzania, we screened neonatal blood and rectal samples from 200 neonates, and 400 (hospital) environmental samples. We used logistic regression to identify risk factors, and Kolmogorov–Smirnov tests and randomisation analyses to compare distributions of species and resistance patterns to assess potential routes of transmission. We found that BSIs caused by 3GC-RO were frequent (of 59 cases of BSI, 55 were caused by 3GC-RO), as was carriage of 3GC-RO, particularly Escherichia coli, Klebsiella pneumoniae, and Acinetobacter species. In the 28 infants with both a carriage and blood isolate, there were more (4 of 28) isolate pairs of the same species and susceptibility profile than expected by chance (p < 0.05), but most pairs were discordant (24 of 28). Logistic regression models found no association between BSI and carriage with either 3GC-RO or only 3GC-R K. pneumoniae. These analyses suggest that carriage of 3GC-RO is not a major driver of BSI caused by 3GC-RO in this setting. Comparison with environmental isolates showed very similar distributions of species and resistance patterns in the carriage, BSI, and the environment. These similar distributions, a high frequency of Acinetobacter spp. isolations, the lack of strong association between carriage and BSI, together with the high proportion of 3GC-RO in BSI all suggest that these neonates acquire multidrug-resistant carriage and blood isolates directly from the hospital environment.

Colonization of multidrug resistant (MDR) bacteria is associated with subsequent invasive infections in children with comorbidities. This study aimed to determine the resistance profile and factors associated with MDR pathogen colonization among HIV−and HIV+ children below five years of age in Mwanza, Tanzania. A total of 399 (HIV− 255 and HIV+ 144) children were enrolled and investigated for the presence of MDR bacteria. The median [IQR] age of children was 19 (10–36) months. Out of 27 Staphylococcus aureus colonizing the nasal cavity, 16 (59.5%) were methicillin resistant while 132/278 (47.2%) of Enterobacteriaceae from rectal swabs were resistant to third generation cephalosporins, with 69.7% (92/132) exhibiting extended spectrum beta lactamase (ESBL) phenotypes. The proportion of resistance to gentamicin, amoxicillin/clavulanic acid and meropenem were significantly higher among HIV+ than HIV− children. A history of antibiotic use in the last month OR 2.62 [1.1, 6.9] (p = 0.04) and history of a relative admitted from the same household in the past three months OR 3.73 [1.1, 13.2] (p = 0.03) independently predicted ESBL rectal colonization. HIV+ children had significantly more fecal carriage of isolates resistant to uncommonly used antibiotics. There is a need to strengthen antimicrobial stewardship and Infection Prevention and Control (IPC) programs to prevent the emergence and spread of MDR pathogens in children.