Basis for Treatment of Tuberculosis among HIV-Infected Patients in Tanzania: The Role of Chest X-Ray and Sputum Culture

Active tuberculosis (TB) is common among HIV-infected persons living in tuberculosis endemic countries, and screening for tuberculosis (TB) is recommended routinely. We sought to determine the role of chest x-ray and sputum culture in the decision to treat for presumptive TB using active case finding in a large cohort of HIV-infected patients. Ambulatory HIV-positive subjects with CD4 counts ≥ 200/mm3 entering a Phase III TB vaccine study in Tanzania were screened for TB with a physical examination, standard interview, CD4 count, chest x-ray (CXR), blood culture for TB, and three sputum samples for acid fast bacillus (AFB) smear and culture

Sputum Microscopy for the Diagnosis of HIV-Associated Pulmonary Tuberculosis in Tanzania

Background: In many resource poor settings only sputum microscopy is employed for the diagnosis of HIV-associated pulmonary tuberculosis; sputum culture may not be available. Methods: We determined the diagnostic accuracy of sputum microscopy for active case finding of HIV-associated pulmonary tuberculosis using TB culture as the reference standard. Results: 2216 potential subjects screened for a TB vaccine trial submitted 9454 expectorated sputum specimens: 212 (2.2%) were sputum culture positive for Mycobacterium tuberculosis (MTB), 31 (0.3%) for non-tuberculous mycobacteria, and 79 (0.8%) were contaminated. The overall sensitivity of sputum microscopy was 61.8% (131/212) and specificity 99.7% (9108/9132). Sputum microscopy sensitivity varied from 22.6% in specimens with \u3c 20 colony forming units (CFU)/specimen to 94.2% in patients with \u3e 100 CFU/specimen plus confluent growth. The incremental diagnostic value for sputum microscopy was 92.1%, 1.8% and 7.1% for the first, second and third specimens, respectively. The positive predictive value and negative predictive values for sputum microscopy were 84.5% and 99.1%, respectively. The likelihood ratio (LR) of a positive sputum microscopy was 235.1 (95% CI 155.8 – 354.8), while the LR of a negative test was 0.38 (95CI 0.32 – 0.45). The 212 positive sputum cultures for MTB represented 103 patients; sputum microscopy was positive for 57 (55.3%) of 103 patients. Conclusion: Sputum microscopy on 3 expectorated sputum specimens will only detect 55% of culture positive HIV-infected patients in active screening for pulmonary tuberculosis. Sensitivity is higher in patients with greater numbers of CFUs in the sputum. Culture is required for active case finding of HIV- associated pulmonary tuberculosis

Low survival in younger adults with Acute Myeloid Leukemia (AML) in Tanzania linked to high disease burden and socioeconomic factors

BACKGROUND: Acute Myeloid Leukemia (AML) accounts for 20-25% of all leukemia diagnosed worldwide. According to Globoccan 2020, leukemia ranked the 15th most prevalent cancer with an estimated 474,519 new cases and 311,594 deaths annually. However, due to scarcity of well documented cancer registries, epidemiological and survival data of patients with AML is lacking in many African countries, including Tanzania. Therefore, the primary objective of this study was to determine the clinical features, laboratory characteristics and survival outcomes of AML patients treated with different regimens in Tanzania. METHODS: Data from all adult patients diagnosed with AML at Muhimbili National Hospital (MNH) between January 2018 and December 2023 were analyzed in this retrospective study. STATA version 16 was used for data analysis. The survival outcome was calculated using the Kaplan-Meier method. To evaluate the statistical significance of the results, a p-value cut-off of 0.05 was used. The Cox proportional hazards model was used to identify predictors of survival and to estimate the effect of covariates on the hazard of death. Kruskal Wallis was used to compare the median values for laboratory results and pairwise comparison of median laboratory values was done using the Dunn Test. RESULTS: A total of 245 patients were diagnosed with acute leukemia during the five-year period (2018-2023), of which 169 (68%) had AML. The mean age at diagnosis was 47.2 (SD ± 18.5) years. Majority of the patients were females (60.7%), and had de novo AML. Most of the patients presented with symptoms of anemia (98.2%) and fever (79.5%). The median survival time was 81 days with a one-year overall survival probability of 15.2%. Patients that resided outside of the Dar es Salaam region had a 74% increase hazard of mortality compared to those living within the Dar es Salaam region (aHR: 1.74, 95% CI: 1.15-2.64, p = 0.008). Patients receiving any form of chemotherapy had a 39% lower hazard of mortality compared to those who were on supportive treatment alone (aHR: 0.61, 95% CI: 0.40-0.93, p = 0.022). CONCLUSION: AML is the most common acute leukemia among adults in Tanzania, primarily affecting young females under 50 years. Resource constraints and limited treatment options result in poor outcomes, with a median survival of 81 days and one-year overall survival of 15.2%

Occurrence of the leucine-to-phenylalanine knockdown resistance (kdr) mutation in Anopheles arabiensis populations in Tanzania, detected by a simplified high-throughput SSOP-ELISA method

BACKGROUND: Molecular markers of insecticide resistance can provide sensitive indicators of resistance development in malaria vector populations. Monitoring of insecticide resistance in vector populations is an important component of current malaria control programmes. Knockdown resistance (kdr) confers resistance to the pyrethroid class of insecticides with cross-resistance to DDT through single nucleotide polymorphisms (SNPs) in the voltage-gated sodium channel gene. METHODS: To enable detection of kdr mutations at low frequency a method was developed that uses polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA)-based technology, allowing rapid, reliable and cost-effective testing of large numbers of individual mosquitoes. This was used to assay mosquitoes from sites in lower Moshi, Tanzania. RESULTS: Sequence-specific oligonucleotide probes (SSOP) were used for simultaneous detection of both East and West African kdr mutations with high specificity and sensitivity. Application of the SSOP-ELISA method to 1,620 field-collected Anopheles arabiensis from Tanzania identified the West African leucine-phenylalanine kdr mutation in two heterozygous individuals, indicating the potential for resistance development that requires close monitoring. CONCLUSION: The presence of the West African kdr mutation at low frequency in this East African population of An. arabiensis has implications for the spread of the kdr gene across the African continent

Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district of Tanzania: Three public policy implications

Cervical cancer is an important public health problem worldwide, which comprises approximately 12% of all cancers in women. In Tanzania, the estimated incidence rate is 30 to 40 per 100,000 women, indicating a high disease burden. Cervical cancer screening is acknowledged as currently the most effective approach for cervical cancer control, and it is associated with reduced incidence and mortality from the disease. The aim of the study was to identify the most important factors related to the uptake of cervical cancer screening among women in a rural district of Tanzania. A cross sectional study was conducted with a sample of 354 women aged 18 to 69 years residing in Moshi Rural District. A multistage sampling technique was used to randomly select eligible women. A one-hour interview was conducted with each woman in her home. The 17 questions were modified from similar questions used in previous research. Less than one quarter (22.6%) of the participants had obtained cervical cancer screening. The following characteristics, when examined separately in relation to the uptake of cervical cancer screening service, were significant: husband approval of cervical cancer screening, women's level of education, women's knowledge of cervical cancer and its prevention, women's concerns about embarrassment and pain of screening, women's preference for the sex of health provider, and women's awareness of and distance to cervical cancer screening services. When examined simultaneously in a logistic regression, we found that only knowledge of cervical cancer and its prevention (OR = 8.90, 95%CI = 2.14-16.03) and distance to the facility which provides cervical cancer screening (OR = 3.98, 95%CI = 0.18-5.10) were significantly associated with screening uptake. Based on the study findings, three recommendations are made. First, information about cervical cancer must be presented to women. Second, public education of the disease must include specific information on how to prevent it as well as screening services available. Third, it is important to provide cervical cancer screening services within 5 km of where women reside

Basis for treatment of tuberculosis among HIV-infected patients in Tanzania: the role of chest x-ray and sputum culture

BACKGROUND: Active tuberculosis (TB) is common among HIV-infected persons living in tuberculosis endemic countries, and screening for tuberculosis (TB) is recommended routinely. We sought to determine the role of chest x-ray and sputum culture in the decision to treat for presumptive TB using active case finding in a large cohort of HIV-infected patients. METHODS: Ambulatory HIV-positive subjects with CD4 counts ≥ 200/mm3 entering a Phase III TB vaccine study in Tanzania were screened for TB with a physical examination, standard interview, CD4 count, chest x-ray (CXR), blood culture for TB, and three sputum samples for acid fast bacillus (AFB) smear and culture. RESULTS: Among 1176 subjects 136 (12%) were treated for presumptive TB. These patients were more frequently male than those without treatment (34% vs. 25%, respectively; p = 0.049) and had lower median CD4 counts (319/μL vs. 425/μL, respectively; p < .0001). Among the 136 patients treated for TB, 38 (28%) had microbiologic confirmation, including 13 (10%) who had a normal CXR and no symptoms. There were 58 (43%) treated patients in whom the only positive finding was an abnormal CXR. Blood cultures were negative in all patients. CONCLUSION: Many ambulatory HIV-infected patients with CD4 counts ≥ 200/mm3 are treated for presumptive TB. Our data suggest that optimal detection requires comprehensive evaluation, including CXR and sputum culture on both symptomatic and asymptomatic subjects.National Institutes of Health (A1 45407); Fogarty International Center (D43-TW006807

Comprehensive transcriptome of the maize stalk borer, Busseola fusca, from multiple tissue types, developmental stages, and parasitoid wasp exposures

International audienc

Implication Analysis of Pre and Post-Harvest Losses of Maize to Household Food Security in Kongwa and Kondoa Districts-Tanzania

The contribution of food losses occurring in the food system to reduced household food security is undoubted. This study therefore investigated the status of the pre- and post-harvest losses in maize and their implication on household food availability, utilization and access in Kongwa and Kondoa districts. The study sites were selected because of their potential in maize production and losses.&nbsp; A mixed method approach was used to collect data for the study including secondary and primary data.&nbsp; Secondary data collection was achieved through literature review of published papers, reports, proceeding, policy documents and strategies relevant to agriculture. Primary data collection was achieved through discussion with key informants (14 people), focus group discussion (6 groups from each village comprising of 4 males and 4 females). A total of 376 (5.9%) households were surveyed and Transect Walk was also done to verify information obtained. Qualitative data was analyzed thematically using NVIVO software whereas quantitative data was descriptively analyzed using Statistical Package for Social Sciences (SPSS) software. The cumulative pre and post-harvest losses estimates were compared against provided pre and post-harvest losses threshold values. The comparison between pre and post-harvest losses was confirmed by two ways ANOVA analysis using Levene test. Findings showed that status of maize pre and post-harvest losses are below the thresholds of 31.2% and 40% whereby maize post-harvest losses are significantly (p = 0.015) higher than pre harvest losses. Pre harvest losses in maize were also significantly (p &lt; 0.011) associated with reduced food availability while post-harvest losses are significantly (p &lt; 0.000) associated with reduced food utilization. The study recommends increased awareness among farmers on the implication of food losses to household food security through trainings and seminars from agriculture extension officers

A systematic review of endpoint definitions in late phase tuberculosis therapeutic trials

Abstract Background. Safe, more efficacious treatments are needed to address the considerable morbidity and mortality associated with tuberculosis (TB). However, the current practice in TB therapeutics trials is to use composite binary outcomes, which in the absence of standardization may inflate false positive and negative errors in evaluating regimens. The lack of standardization of outcomes is a barrier to the identification of highly efficacious regimens and the introduction of innovative methodologiesMethods. We conducted a systematic review of trials designed to advance new TB drugs or regimens for regulatory approval and inform practice guidelines. Trials were primarily identified from the WHO International Clinical Trial Registry Platform (ICTRP). Only trials that collected post-treatment follow-up data and enrolled at least 100 patients were included. Protocols and Statistical Analysis Plans (SAP) for eligible trials from 1995 to the present were obtained from trial investigators. Details of outcome data, both explicit and implied, were abstracted and organized into three broad categories: Favorable, Unfavorable, and Not Assessable. Within these categories, individual trial definitions were recorded and collated, and areas of broad consensus and disagreement were identified and described. Results. From 2205 TB-related trials, 51 were selected for protocol and SAP review, from which 31 were both eligible and had accessible documentation. Within the three designated categories, we found broad consensus in the definitions of Favorable and Unfavorable outcomes, although specific details were not always provided, and when explicitly addressed, were heterogeneous. Favorable outcomes were handled the most consistently but were widely variable with respect to specification. In some cases, the same events were defined differently by different protocols, particularly in distinguishing Unfavorable from Not Assessable events. Death was often interpreted conditional on cause. Patients who did not complete the study because of withdrawal or loss to follow-up presented a particular challenge to consistent interpretation and analytic treatment of outcomes.Conclusions. In a review of 31 clinical trials, we found that outcome definitions were heterogeneous, highlighting the need to establish clearer specification and a move towards universal standardization of outcomes across TB trials. The ICH E9 (R1) addendum provides guidelines for undertaking and achieving this goal.Registration PROSPERO 2020 CRD42020197993</jats:p