Background:The emergence of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. There has been paucity of data for hospitalized African patients suffering from COVID-19. This study aimed to identify factors associated with in-hospital mortality in patients suffering from COVID-19 in Tanzania. Methods: This was a single center, retrospective, observational cohort study in adult patients hospitalized with confirmed COVID-19 infection. Demographics, clinical pattern, laboratory and radiological investigations associated with increased odds of mortality were analyzed. Results: Of the 157 patients, 107 (68.1%) patients survived and 50 (31.8%) died. Mortality was highest in patients suffering with severe (26%) and critical (68%) forms of the disease. The median age of the cohort was 52 years (IQR 42-61), majority of patients were male (86%) and of African origin (46%), who presented with fever (69%), cough (62%) and difficulty in breathing (43%). Factors that were associated with mortality among our cohort were advanced age (OR 1.07, 95% CI 1.03-1.11), being overweight and obese (OR 9.44, 95% CI 2.71-41.0), suffering with severe form of the disease (OR 4.77, 95% CI 1.18-25.0) and being admitted to the HDU and ICU (OR 6.68, 95% CI 2.06-24.6). Conclusion:The overall in-hospital mortality was 31.8%. Older age, obesity, the severe form of the disease and admission to the ICU and HDU were major risk factors associated with in-hospital mortality.

BackgroundBreastfeeding is a key intervention to improve global targets on nutrition, health and survival. The World Health Organization (WHO) recommends early initiation of breastfeeding to prevent infections in the newborn and achieve targets of exclusive breastfeeding for the first six months of life. Early initiation of breastfeeding improves neonatal-maternal bonding, reduces jaundice and prevents gastrointestinal and respiratory tract infections. Global prevalence of early initiation of breastfeeding is 45% and 51% for Tanzania. The recommended prevalence is at least 80% by WHO guidelines.ObjectiveTo explore barriers to early initiation of breastfeeding in a hospital setting.MethodsA descriptive exploratory qualitative study with semi-structured individual interviews was employed to explore the barriers to early initiation of breastfeeding in a hospital setting. Three midwives and six mothers were interviewed. The interview topic guide covered experiences and challenges of early initiation of breastfeeding. Data was analyzed using Systematic Text Condensation as described by Malterud.ResultsParticipants perceived that inadequate breastfeeding information especially on ideal time to start breastfeeding contributed to delayed initiation. The practices and environment post-delivery such as perineal tear repair and dirty labor room prevented women from initiating breastfeeding immediately.ConclusionsThe barriers identified were related to gaps in knowledge, immediate postpartum practices and individual perceptions of a non-conducive environment.

Background Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the Intensive Care Unit (ICU). They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management of patients while optimizing the use of hospital resources. We evaluated mortality predictive performance of Simplified Acute Physiology Score (SAPS 3) and Mortality Probability Models (MPM0-III) and compared their performance in predicting outcome as well as identifying disease pattern and factors associated with increased mortality. Methods This was a retrospective cohort study of adult patients admitted to the ICU of the Aga Khan Hospital, Dar- es- Salaam, Tanzania between August 2018 and April 2020. Demographics, clinical characteristics, outcomes, source of admission, primary admission category, length of stay and the support provided with the worst physiological data within the first hour of ICU admission were extracted. SAPS 3 and MPM0-III scores were calculated using an online web-based calculator. The performance of each model was assessed by discrimination and calibration. Discrimination between survivors and non–survivors was assessed by the area under the receiver operator characteristic curve (ROC) and calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. Results A total of 331 patients were enrolled in the study with a median age of 58 years (IQR 43-71), most of whom were male (n = 208, 62.8%), of African origin (n = 178, 53.8%) and admitted from the emergency department (n = 306, 92.4%). In- hospital mortality of critically ill patients was 16.1%. Discrimination was very good for all models, the area under the receiver-operating characteristic (ROC) curve for SAPS 3 and MPM0-III was 0.89 (95% CI [0.844–0.935]) and 0.90 (95% CI [0.864–0.944]) respectively. Calibration as calculated by Hosmer-Lemeshow goodness-of-fit test showed good calibration for SAPS 3 and MPM0-III with Chi- square values of 4.61 and 5.08 respectively and P–Value > 0.05. Conclusion Both SAPS 3 and MPM0-III performed well in predicting mortality and outcome in our cohort of patients admitted to the intensive care unit of a private tertiary hospital. The in-hospital mortality of critically ill patients was lower compared to studies done in other intensive care units in tertiary referral hospitals within Tanzania.

Introduction World Health Organization (WHO) has developed HIV specific quality of life tool called World Health Organization Quality of Life brief questionnaire in HIV population (WHOQOL-HIV BREF) for assessing the quality of life of people living with HIV/AIDS (PLWHA). Despite its sound validity and reliability from several studies, the developers recommend it to be validated in different cultures to assess its psychometric properties before its adoption. The study aimed at evaluating the validity and reliability of the Kiswahili version of the WHOQOL-HIV BREF questionnaire in Tanzania among people living with HIV/AIDS. Methods a cross-sectional study with 103 participants recruited via systematic random sampling. The internal consistency of the questionnaire was assessed by the Cronbach alpha coefficient. Validity of the WHOQOL-HIV BREF was assessed through analysis of construct, concurrent, convergent and discriminant validity. The model performance was assessed by exploratory and confirmatory factor analysis. Results the mean age of the participants was 40.5 ± 9.702 years. The internal consistency of the items of the Kiswahili version of WHOQOL-HIV BREF shows Cronbach's alpha values of 0.89-0.90 (p < 0.001). Analysis of test-retest reliability showed a statistically significant Intra-class correlation (ICC) of 0.91 - 0.92 (p < 0.001). The spiritual and physical domains were highly discriminated from the rest of the domains (Psychological, Environmental, Social and Independent domain). Conclusion Kiswahili WHOQOL-HIV BREF tool was found to have good validity and reliability among Tanzanian people living with HIV/AIDS. These findings provide support for the use of this tool in assessing the quality of life in Tanzania.

Smartwatches like the Apple Watch have been on the rise worldwide and their use is gaining popularity in developing countries. Their ability to detect dysrhythmias is well documented. Present practice discourages the use of these devices as a diagnostic tool. Nevertheless, atypical findings from these devices should be clinically investigated. This case demonstrates an eventual diagnosis of supraventricular tachycardia (SVT) based on an Apple watch alert which was subsequently confirmed by electrophysiological evaluation.