Naizihijwa Majani

Background: The World health organization (WHO) identifies Down syndrome (DS) as one among common congenital disorders, along with congenital heart defects. Approximately fifty percent of children diagnosed with DS are affected by congenital heart defects which significantly impact their survival. Nevertheless, in low and middle income countries, there is limited published data on congenital heart defects in children with DS and their treatment outcomes. Therefore, this study aimed to document the clinical characteristics and hospital outcomes of children with DS who were diagnosed with heart defects. The goal is to assist healthcare providers and policymakers in improving care for these children. Methods: This was a retrospective descriptive study of children with DS diagnosed with heart disease admitted at the Jakaya Kikwete Cardiac Institute (JKCI) from December 2022 through December 2024. Socio-demographics, clinical characteristics, and survival data were extracted from medical records. Frequencies and proportions were calculated for categorical variables. The description of mean with standard deviation (SD) and median with and interquartile range (IQR) were calculated for continuous data. For the missing data, the case deletion approach was used. Results: In two years, out of 1,356 admitted children, data from 104 children with Down syndrome were analysed. Most of them, 93.2%, were aged below 5 years, with a slight predominance of male children, of almost 58%. Fifty percent (58/104) of study participants resided in the coastal region of Tanzania, followed by the northern zone (19.2%, 20/104). The most frequent cardiac diagnoses were AVSD, 46.2% and VSD, 14.4% with a median age at diagnosis of 5 months (IQR, 3.3–10). The median age of the mothers was 38 years (IQR, 38–42) while the mean age of the fathers was 36.9 years (SD, ± 7.1). At discharge, nearly a quarter, 19.2% of children had prolonged hospital stays of more than 2 weeks, and 7.7% (8/104) of enrolled children died. Nevertheless, 4.8% of children with Down syndrome underwent open cardiac surgery during the study period. Conclusion: Advanced maternal age, paternal age and AVSD were frequently observed in this study, nevertheless; a significant number of the enrolled children were first diagnosed beyond 5 months of age. Hence, the study recommends early screening echocardiography among children with Down syndrome and more studies with a large sample size to evaluate long-term outcomes in this population.

Introduction: Cardiovascular diseases remain a major cause of morbidity and mortality in sub-Saharan Africa; however, little is known about inpatient cardiovascular medicine utilisation in Tanzania. This study quantified cardiovascular medicine utilisation patterns at a national cardiac referral centre using the standardised WHO ATC/DDD methodology. Methods: A retrospective longitudinal pharmacoepidemiological study was conducted using inpatient prescription data from the Jakaya Kikwete Cardiac Institute (JKCI) for the fiscal years 2016/2017 to 2021/2022. Non-medicinal items and topical formulations were excluded from the analyses. Utilisation was expressed as Defined Daily Doses (DDD) per 100 bed-days using the WHO ATC/DDD methodology. Descriptive statistics and non-parametric tests were performed using SPSS version 26. Results: Of the 290,591 prescription records screened, 224,290 were eligible following the exclusion of 64,781 non-medicinal items and 1,520 topical agents. Cardiovascular medicines (ATC class C) accounted for 99,634 (44.4%) of all prescriptions, followed by alimentary tract and metabolism agents (18.1%). The prescribing volumes increased annually and peaked in 2021/2022. Furosemide (C03CA01), spironolactone (C03DA01) and paracetamol (N02BE01) were the three most frequently prescribed medicines. The 12 most commonly used medicines represented approximately half of all the prescriptions. Conclusion: Cardiovascular medicines accounted for nearly half of all inpatient prescriptions, reflecting the substantial clinical demand and disease burden associated with cardiovascular conditions. Utilisation was dominated by loop and potassium-sparing diuretics, highlighting their central role in inpatient cardiac care. Routine surveillance using ATC/DDD metrics should be institutionalised to guide procurement, prescribing audits, and patient safety monitoring. Trial registration number Not applicable. What is already known on this topic: The incidence of cardiovascular diseases is increasing globally, with increasing medicine use in both high-and low-income settings. Evidence of inpatient cardiovascular medicine consumption in sub-Saharan Africa is limited to a few studies. Previous pharmacoepidemiological studies from SSA have mainly focused on antibiotics rather than medicines for chronic noncommunicable diseases. What this study adds”: This is the first longitudinal analysis of inpatient cardiovascular medicine use in Tanzania based on ATC/DDD. Nearly half of all inpatient prescriptions at the national cardiac referral centre were cardiovascular agents, predominantly diuretics. These findings establish a baseline for stewardship, informed procurement decisions, and future national monitoring efforts.

Background: Cardiovascular diseases are among the leading causes of morbidity and mortality worldwide. Routine quantification of cardiovascular medicine utilisation is essential for stewardship, formulary decision-making and procurement planning. Objective: To describe outpatient utilisation of cardiovascular medicines at the Jakaya Kikwete Cardiac Institute (JKCI) using ATC/DDD methodology. Methods: This was a retrospective longitudinal analysis of outpatient prescriptions (2017/2018-2021/2022). Medicines were classified according to the ATC system and quantified as Defined Daily Doses (DDD) per 100 outpatient days. The analyses progressed hierarchically from ATC levels 1 to 5. DU metrics (DU50/DU90) were used to assess the concentration. Monthly utilisation was examined using Seasonal Trend decomposition using Loess (STL). Statistical analyses were performed using SPSS (version 26). Results: Across the study period, the cumulative utilisation of cardiovascular medicines totalled 360.55 DDD per 100 outpatient days. Annual intensity peaked in 2018/2019 (82.92 DDD per 100 outpatient-days), was the second-highest in 2020/2021 (82.39), and was lowest in 2017/2018 (55.68). At ATC level 5, amlodipine (C08CA01), candesartan (C09CA06) and clonidine (C02AC01) were the principal contributors. The DU50 segment comprised five molecules (amlodipine, candesartan, clonidine, furosemide, and atorvastatin), whereas DU90 ranked 18th, indicating concentrated utilisation within a small number of agents. The STL showed a gradual secular rise with no statistically significant month-specific seasonality. Conclusion: Outpatient cardiovascular medicine utilisation at JKCI was concentrated within a narrow set of anti-hypertensive agents, with a cumulative burden of 360.55 DDD per 100 outpatient-days and a fiscal-year peak in 2018/2019. Institutionalising routine outpatient DDD surveillance may support stewardship, rational prescribing, and more equitable access to high-impact cardiovascular medicines in Tanzania.

We assessed inpatient antibiotic use over six fiscal years at Tanzania’s national cardiac referral hospital. Overall use was 29.9 defined daily doses per 100 bed-days. Carbapenems were dominant. Reserve agents comprised 47.0%, and watch agents comprised 31.7%. Patterns indicate missed access targets and a need to strengthen stewardship in cardiac care.

Background: Outpatient encounters are significant contributors to avoidable antibiotic exposure. However, the dispensing-based outpatient consumption data for Tanzania are limited. Most national estimates rely on import or sales data that do not reflect patient-level use. Cardiovascular clinics are particularly relevant because cardiopulmonary symptom overlap can lead to precautionary prescribing. Methods: We conducted a retrospective dispensing-based utilization analysis of cardiovascular outpatients at the Jakaya Kikwete Cardiac Institute (JKCI) in Dar es Salaam, Tanzania, from July 2017 to June 2022. Systemic antibacterial agents were mapped to the World Health Organization anatomical therapeutic chemical/defined daily dose (WHO ATC/DDD) and expressed as defined daily doses per 100 outpatients per day. Consumption patterns were summarized by fiscal year, molecule, ATC level 3, and WHO Access/Watch/Reserve (AWaRe) category. Monthly consumption was decomposed to evaluate trends and seasonality. Results: A total of 11,586 outpatients received at least one systemic antibiotic during the study period. Annual outpatient antibiotic utilization remained low and stable, ranging from approximately 0.27 to 0.38 DDD per 100 outpatients per day across fiscal years, with a cumulative total of 1.68 DDD per 100 outpatients per day across the five years. Consumption was dominated by beta-lactam/penicillin antibiotics, with Access antibiotics accounting for 48.5% of cumulative exposure, followed by Watch antibiotics (45.5%) and minimal Reserve use (5.9%). However, the Access proportion was below the WHO Access-60 benchmark for optimal outpatient use. Time-series decomposition revealed a modest upward trend, peaking in early 2021, accompanied by a recurring seasonal pattern of monthly use. Conclusion: Outpatient antibiotic utilization at JKCI was quantitatively low, yet showed persistent exposure dominated by Access antibiotics. Dispensing-based outpatient surveillance is feasible and should be integrated into routine stewardship dashboards to target avoidable outpatient antibiotic use.

Objective: To analyse trends in antibiotic use among cardiovascular inpatients at the Jakaya Kikwete Cardiac Institute (JKCI), Tanzania, from 2016 to 2022, using the World Health Organisation (WHO) Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. Design: Retrospective longitudinal study. Setting: Jakaya Kikwete Cardiac Institute, a 150-bed national referral and teaching hospital in Dar es Salaam, Tanzania. Patients: 11,656 cardiovascular inpatients; 6,612 (56.7%) received at least one systemic antibiotic. Methods: Prescription data (250,591 total; 30,885 antibiotic-related) were extracted from the JKCI MedPro dispensing system. Antibiotic use was expressed in Defined Daily Doses per 100 bed-days (DDD/100). Analyses were conducted using Microsoft Excel, SPSS version 26, and time-series forecasting with AutoRegressive Integrated Moving Average (ARIMA) modelling in R. Results: Overall, antibiotic use was 29.88 DDD/100 bed-days. Injections accounted for more than 55% of use. At the ATC Class 4 level, carbapenems (J01DH) dominated (45.6%), followed by third-generation cephalosporins (17.0%) and extended-spectrum penicillins (14.6%). At the molecular level, meropenem contributed 45.6%, with amoxicillin and ceftriaxone also being prominent; the top 11 antibiotics comprised more than 90% of total use (Drug Utilisation 90% [DU90%]). By WHO Access, Watch, Reserve (AWaRe) classification, Reserve agents contributed 46.4% of use, followed by Watch (31.3%) and Access (21.1%). ARIMA (1,1,0) modelling forecasts a continued upward trend through 2026. Conclusions: Antibiotic use among cardiovascular inpatients at JKCI is high, with heavy reliance on broad-spectrum and Reserve agents. Strengthened antimicrobial stewardship measures, such as intravenous-to-oral switch protocols, DU90 audits, and stricter control of Reserve antibiotic prescribing, are urgently needed to mitigate antimicrobial resistance risks.

Early detection of Critical Congenital Heart Disease (CCHD) is crucial for reducing infant mortality. Pulse oximetry (POX) is widely utilised for screening CCHD in high-resource settings; however, its diagnostic accuracy in low-resource environments, such as sub-Saharan Africa, remains under-researched. This study aimed to assess the diagnostic accuracy of POX in screening Tanzanian newborns for CCHD. This prospective cohort study was conducted in two hospitals in Dar es Salaam, Tanzania. We used pre- and post-ductal saturation (SpO2) readings prior to discharge. A positive screen was defined as SpO2 < 90%; two pre- and post-ductal SpO2 readings <95%; and/or a pre- or post-ductal difference that exceeded 3%. All newborns with positive screening tests underwent echocardiography, while those with negative tests were followed for six months. The primary outcome was POX diagnostic accuracy. The study adhered to STARD guidelines for reporting diagnostic accuracy studies. Between October 2020 and June 2023, 10,630 newborns were screened. The majority (5,721; 54.0%) were male, resulting in a male-to-female ratio of 1.2. The median birth weight was 3.0 (IQR: 2.6–4.4) kg. A total of 51 (0.5%) newborns tested positive on POX, of which 18 (35.3%) had congenital heart disease (CHD), and 15 (83.3%) were classified as critical, leading to a CCHD prevalence of 1.41 per 1,000 live births (95% CI: 0.70–2.13), which increased to a cumulative prevalence of 3.27 per 1,000 live births (95% CI: 2.29–4.67) at six months. With a follow-up rate of 86.7% (9,170/10,574), POX demonstrated a sensitivity of 50.0% (95% CI: 32.1–67.9), a specificity of 99.5% (95% CI: 99.4–99.7), a false-positive rate of 0.4%, and an overall accuracy of 99.5% (95% CI: 99.2–99.5). Screenings conducted between 48 and 72 hours exhibited the highest diagnostic performance, AUC 0.79 (95% CI: 0.64–0.93), with a significant odds ratio (OR) of 5.31 (95% CI: 2.45–11.49, p = 0.00001). Newborns with a birth weight <2.5 kg were less likely to have CCHD detected by POX, OR 0.403 (95% CI: 0.19–0.87, p = 0.021). POX demonstrated lower sensitivity but higher specificity and diagnostic accuracy after 48 hours. The timing of screening and birth weight affected its accuracy, indicating a need for protocol adjustment.

The Pediatric Quality of Life Inventory™ (PedsQL™) family impact module is a widely used tool for assessing the health-related quality of life (HRQoL) of caregivers of children with chronic illnesses; however, it has not been available in Swahili. This study aimed to translate, culturally adapt, and validate the Swahili version of the PedsQL family impact module (FIM) among caregivers of children with heart disease in Tanzania. As a secondary aim, the study explored differences in caregiver HRQoL between those whose children had undergone surgery and those who had not, using the newly translated tool. A cross-sectional survey was conducted among 204 primary caregivers at a national cardiac referral centre. Standardised translation and adaptation procedures were followed. Psychometric evaluation included internal consistency reliability, construct validity through known-groups comparisons, and effect size estimation. The Swahili version demonstrated excellent internal consistency (Cronbach’s α = 0.99) and good construct validity. Socioeconomic status was the only consistent predictor of HRQoL in multivariable models. Caregivers in the operated group consistently reported higher HRQoL scores, highlighting the potential benefit of surgical intervention on family well-being. These findings strongly support the Swahili PedsQL FIM as a culturally appropriate and psychometrically sound tool. It offers promise for clinical care and future outcome evaluations in similar settings.

Tetralogy of Fallot (TOF) is typically treated in infancy but often done late in many resource-limited countries, jeopardizing surgical outcomes. This study examined the early results of children undergoing primary complete TOF repair at the Jakaya Kikwete Cardiac Institute (JKCI) in Tanzania, an emerging cardiac center in Eastern Africa. A retrospective cohort study of children ≤ 18 years undergoing primary TOF complete repair between 2019 and 2021 was conducted. Patients with complex TOF and those with obvious genetic syndrome were excluded. Data on socio-demography, pre-and postoperative cardiac complications, Intensive Care Unit (ICU) and hospital stay, and in-hospital and 30-day mortality were analyzed. Logistic regressions were employed to find the factors for mortality, ICU, and hospital stays. The I02 children underwent primary TOF complete repair were majority male (65.7%; n = 67), with a median age of 3.0 years (IQR: 2–6), ranging from 3 months to 17 years.Only 20 patients (19.6%) were below one year of age. Almost all (90%; n = 92) were underweight, with a mean BMI of 14.6 + 3.1 kg/m2 Haematocrits were high, with a median of 48.7 (IQR: 37.4–59.0). The median oxygen saturation was 81% (IQR:72–93). Over a third of patients (38.2%; n = 39) needed Trans annular patch (TAP) during surgery. The median ICU stay was 72 h (IQR:48–120), with ICU duration exceeding three days for most patients. The median hospital stay was 8.5 days (IQR:7–11), with 70 patients (68.2%)experiencing an extended hospital stay of > 7 days. Bacterial sepsis was more common than surgical site infection (5.6%; n = 6 vs. 0.9%;n = 1). No patient needed re-operation for the period of follow up. The in-hospital mortality rate was 5.9%, with no deaths occurring in children less than one year of age nor after discharge during the 30-day follow-up period. No statistically significant differences were observed in outcomes in relation to age, sex, levels of hematocrit and saturations, presence of medical illnesses, and placement of TAP. TOF repairs in this African setting at a national cardiac referral hospital face challenges associated with patients’ older age and compromised nutritional status during the surgery. Perioperative mortality rates and morbidity for patients operated at an older age remain elevated. It’s important to address these issues to improve outcomes in these settings. This study examined the clinical characteristics and 30-day surgical outcomes of patients with Tetralogy of Fallot who were treated in a low-middle-income setting.

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