Peter Kisenge

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.

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.

Objective To determine the prevalence, correlates and prognostic implications of anaemia and iron deficiency (ID) in patients with heart failure (HF) in Tanzania. Method This was a cross-sectional and prospective observational study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. Patients were ≥18 years of age, with HF defined according to the Framingham criteria. The primary outcome was anaemia and the secondary outcome was a composite of hospitalisation for HF or all-cause mortality. Results A total of 401 HF patients (median age 56 years, IQR 41–67 years; women 51%) were included. The prevalence of anaemia was 57%. The overall prevalence of ID was 49% distributed as 69% versus 21% in subjects with and without anaemia (p<0.001). Normocytic anaemia was seen in 18% of the patients while none had macrocytic anaemia. The risk of having anaemia was positively associated with residency outside Dar es Salaam (OR 1.72 (95% CI 1.02 to 2.89); p=0.038), atrial fibrillation (4.12 (1.60 to 10.61); p=0.003), LVEF <45% (2.70 (1.57 to 4.67); p<0.001) and negatively (ORs per unit decrease) with creatinine clearance (0.98 (0.97 to 0.99); p=0.012) and total cholesterol (0.78 (0.63 to 0.98); p=0.029). One-year survival free from a composite endpoint was 70%. The presence of ID anaemia increased the likelihood for an event (HR 2.67; 95% CI 1.39 to 5.07; p=0.003), while anaemia without ID did not influence the risk. Conclusions ID anaemia was common in Tanzanian patients with HF and was independently associated with the risk for hospitalisation or death.