Aga Khan Hospital Dar es Salaam

BACKGROUNDPosterior hypopharyngeal perforation is a rare yet serious complication of anterior cervical discectomy and fusion (ACDF), especially at upper cervical levels where anatomical relationships are critical. Prompt recognition and tailored management are key to minimizing morbidity and achieving favorable outcomes.OBSERVATIONSThe authors report the case of a 54-year-old man who underwent ACDF at C3–5 for cervical disc prolapse. Within hours postoperatively, he developed a sore throat, hypersalivation, subcutaneous emphysema, and anterior neck swelling. Initial imaging showed emphysema without contrast leakage, prompting empiric conservative management with nothing by mouth, intravenous antibiotics, steroids, and proton pump inhibitor. A contrast-enhanced CT study on day 7 revealed a 5.3 × 4.7–mm (length × thickness) posterior hypopharyngeal fistulous tract with contrast leakage but no collection. The patient improved with nonoperative management and close outpatient follow-up, gaining 2 kg over 4 weeks. Follow-up imaging at week 4 confirmed tract resolution, and oral feeding was reintroduced with progressive dietary advancement.LESSONSEarly hypopharyngeal perforation following ACDF may present subtly. High clinical suspicion, even in the absence of early imaging findings, is essential. Contained injuries without systemic deterioration may be successfully treated with conservative therapy, including nutritional support and imaging-guided follow-up. This case underscores the importance of vigilance and individualized management.https://thejns.org/doi/10.3171/CASE25513

Background Diabetes is a common comorbidity among people living with HIV. As the prevalence of diabetes rises across sub-Saharan Africa (SSA), there is an urgent need for effective interventions to address diabetes and pre-diabetic conditions in HIV patients. The META (Metformin Treatment in Africa) trial aims to assess the effectiveness of metformin in preventing diabetes among people living with HIV (PLHIV) on antiretroviral therapy (ART) who have pre-diabetes. This paper presents the process evaluation, which explores the feasibility, acceptability, and perceived effectiveness of the META trial and its intervention in real-world clinical settings in Dar es Salaam, Tanzania. Methods A mixed methods approach will be employed using a pragmatic realist theoretical framework. Qualitative data will be gathered through in-depth semi-structured interviews using stratified purposive sampling of trial participants (n=20), policymakers (n=10) and focus group discussions with associated health care providers and clinicians working in HIV and non-communicable disease care (n=20). Short cross-sectional surveys will be administered prior to interviews. Data collection will take place across five health facilities in Dar es Salaam, Tanzania. Qualitative data analysis will be complemented by Braun and Clarke’s ‘Reflexive Thematic Analysis’ technique, and survey data will be analysed using SPSS. Discussion The study’s pragmatic realist framework is expected to produce findings with greater depth, scope, and practical relevance. The study findings will contribute to existing knowledge regarding the experiential components of trials involving persons on ART and/or with pre-diabetes, as well as metformin-based interventions. Findings will support interpretation of trial outcomes, highlight facilitators and barriers to implementation, and provide evidence to guide future policy, scale-up, and integration of diabetes prevention strategies into HIV care in SSA. Process evaluation registration: Clinicaltrials.gov, NCT06743698 Trial registration: ISRCTN77382043

Animal rabies remains underreported in low-income countries, hindering effective control. This scoping review aimed to map reported animal rabies cases, identify key reservoir species, and assess gaps in surveillance coverage in mainland Tanzania from 1993 to 2023. Specifically, it addressed the distribution of cases, species involved, and the extent of surveillance coverage during this period. Literature searches in PubMed, Google Scholar, and Science Direct were screened using Rayyan. Twenty articles published between 1993 and 2023 reported 7319 animal rabies cases across the Northern Zone (NZ), Southeastern Zone (SEZ), and Coastal Zone (CZ). In the NZ, domestic dogs accounted for most cases (5387), followed by jackals (225), cats (77), livestock (311), and various wildlife species including African wild dogs, bat-eared foxes, lions, cheetahs, and striped hyenas. Additionally, 102 cases involved unidentified animals. In SEZ, domestic dogs (588) were the primary source, followed by jackals (262), hyenas (8), cats (10), honey badgers (5), and leopards (2). In CZ, domestic dogs accounted for 94 cases. The findings confirm domestic dogs as the main rabies reservoir, highlighting the need for strengthened surveillance and control. The role of wildlife in rabies maintenance and spillover remains poorly understood and warrants further investigation, especially in enzootic hotspots.

Caregivers face numerous physical and emotional challenges when providing care to people suffering from life-threatening illnesses such as cancer. The study aimed to explore caregivers' experiencesin providing care for terminally ill cancer patients in Dar es Salaam, Tanzania. A phenomenological study design was conducted among caregivers of terminally ill cancer patients at Ocean Road Cancer Institute (ORCI). A purposive sampling technique was used to select a sample size of 10 participants. An in-depth interview method was used to collect the data. A semi-structured interview guide with an audio recorder was used to collect the information from the participants. Data were transcribed verbatim and analysed using a thematic analysis approach. The three themes were challenges in caring for patients, availability of social support, and coping strategies. Physical exhaustion and burnout, emotional distress and reduced social interaction were the challenges in caring for patients described by participants during the caring process. Family member support, community support and religious support were the available support systems that facilitated caregivers to care for the patients. However, adopting self-distraction towards patient behaviour, acquiring and using practical skills and following professional guidance were the individual coping strategies used by participants in caring for terminally ill cancer patients. Study findings highlight the fundamental role of caregivers in the care, and illuminate the neglected physical, psychological and social challenges they face amidst health system tensions and conflicting roles. The needs of caregivers should be embedded within cancer care, prevention and control programs, particularly in low-resource settings.

Background Dengue fever significantly burdens healthcare systems, particularly in resource-limited settings such as Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan. Mufti Mehmood Memorial Teaching Hospital, the designated Dengue Isolation Unit in the region, continues toreceive a steady influx of patients. This study analyzed the epidemiological profile of dengue cases admitted to the hospital to support public health planning and guide resource allocation. Methods This retrospective study was conducted at Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, from October to December 2024, following ethical approval from the Institutional Review Board. A total of 168 patients with confirmed dengue fever (based on positive non-structural protein 1 (NS1) antigen or immunoglobulin M (IgM)/immunoglobulin G (IgG) antibody tests) were included. The hospital also serves neighboring districts, covering a combined population of over 4.2 million. Patients with co-infections (e.g., malaria, typhoid, or leptospirosis) or without consent were excluded. Data were collected using a structured abstraction form and included demographic variables (age, gender, district of residence), clinical features (fever, body aches, hemorrhagic signs, skin rash), epidemiological information (recent travel history and destination), and laboratory findings (NS1 antigen or IgM/IgG results). Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2018; IBM Corp., Armonk, NY, US). Associations between categorical variables were tested using the chi-square test, with p-values less than0.05 considered statistically significant. Grammar was checked using Grammarly software (Grammarly, Inc., San Francisco, CA). Results Among the 168 patients diagnosed with dengue virus infection, 137 (81.5%) were male and 31 (18.5%) were female. The mean age was higher among females (34.5 ± 13.5 years) than males (28.0 ± 10.6 years), indicating more age variability in female patients. The most affected age group was 16-30 years (n = 101, 60.1%), followed by 31-45 (n = 44, 26.2%). Cases rose progressively from October (n = 37, 22%) to a peak in November (n = 108, 64.3%), before declining in December (n = 23, 13.7%). Serological testing showed fullpositivity for NS1, IgM, or IgG in all female patients. In contrast, a few male patients were negative for at least one marker(NS1, 4/137; IgM, 13/137; IgG, 9/137), though these differences were not statistically significant. Similarly, no significant gender-based differences were observed in clinical features such as fever, body aches, bleeding, or rashes.Most patients (n = 114, 67.9%) reportedno recent travel history, while 54 (32.1%) had travelled to Karachi, Islamabad, or Rawalpindi. The highest number of cases originated from District Tank(n = 63, 37.5%), followed by Lakki Marwat (n = 46, 27.4%) and Dera Ismail Khan (n = 44, 26.2%). Conclusion Dengue fever peaks during the post-monsoon season and disproportionately affects males and young adults. DistrictTank and Lakki Marwat reported the highest burden of disease. Poor sanitation and limited mosquito control appear to drive transmission. These findingsunderscore the need for targeted vector control measures, public health awareness campaigns, andstrengthened healthcare infrastructure to manage future outbreaks more effectively.

BACKGROUNDTo prevent mother to child transmission (MTCT) of human immunodeficiency virus (HIV), sustained maternal viral load suppression (VLS) and early HIV testing among HIV exposed infants (HEI) is critical.AIMTo investigate maternal viral load results and infant HIV testing uptake at 6–weeks, and 9–months and 18–months in Rwanda.METHODSBetween 2015 and 2022, VLS (< 200 copies/mL) was measured among pregnant women living with HIV (WLHIV) from 38–healthcare facilities. Viral loads (VL) were measured at 6–months, 12–months and 24–months, respectively. For maternal VL, the unit of analysis was visit–pair, and the pairs were created to define those with VL < 200 copies/mL at two consecutive visits as having sustained VLS, persistent viremia (VL ≥ 200 copies/mL at two consecutive visits), viral rebound (VL < 200 copies/mL at prior visit only) and newly suppressed (VL < 200 copies/mL at subsequent visit only). HEI were considered to have persistent HIV testing if they had all three HIV tests. Poisson regression models with generalized estimating equations were used to estimate the adjusted incidence rate ratio (aIRR) and 95%CI for factors associated with sustained VLS and persistent HIV testing.RESULTSA total of 1145 mother-infant pairs were analyzed. Infant HIV testing uptake at 6– weeks, 9–months and 18–months was 1145 (100.0%), 1089 (95.1%), 1006 (87.9%) respectively. Nine hundred ninety–nine HEI (87.3%) tested for HIV persistently. At 18–months, the incidence of HIV among HEI was 8 (0.7%). Of 1145 mothers, 1076 (94.0%) had ≥ 2 VL results making a total of 2010 visit–pairs (142–single; 934–double visit–pairs). The incidence rate of sustained VLS, persistent viremia, viral rebound and new suppression were 91.0%, 1.3%, 3.6% and 4.0% respectively. Maternal disclosure of HIV status (aIRR = 1.08, 95%CI: 1.02–1.14) was associated with increased likelihood of sustained VLS. Having peer support (aIRR = 1.05 95%CI: 1.01–1.10) was associated with persistent HIV testing among HEI.CONCLUSIONSustained VLS is high among pregnant WLHIV in Rwanda. The low incidence of HIV among HEI may be attributed to high VLS levels. Targeted interventions, including enhanced HIV disclosure and peer support, are crucial for improving sustained VLS and increasing infant HIV testing uptake to reduce MTCT.

BackgroundEnsuring the widespread availability and accessibility of anticancer medications is crucial. This aligns with the World Health Organization's recommendation to achieve a coverage of over 80%.ObjectiveThis study aimed to analyse anticancer procurement data to identify utilisation patterns and expenditures, aiding future planning and investment in oncology pharmacy services. The findings can enhance resource allocation, ensuring better availability and accessibility for patient care.MethodologyThe retrospective cross-sectional descriptive study meticulously examined procurement, prescribing, and dispensing records at Benjamin Mkapa Hospital (BMH).ResultsThe expenses linked to anticancer medications have markedly escalated, experiencing successive increases of 5.74%, 16.12%, 24.10%, and 17.73% in 2020, 2021, 2022, and 2023, respectively. Notably, Bevacizumab, Rituximab, Trastuzumab, Docetaxel, Paclitaxel and Goserelin (3.6 mcg) were the most frequently utilised anticancer medications, accounting for over 64% of total drug dispensation from 2020 to 2023. Concurrently, the availability of essential anticancer treatments significantly improved, rising from 54% in 2020 to 84% in 2022 and 2023. Over the four-year period (2020-2023), anticancer drugs comprised a mere 2.8% (580 out of 20,542) of all prescriptions, predominantly for patients aged 46 and above, with 85% covered by health insurance. Breast, prostate, and stomach cancers stood out as the most prevalent, representing over 40%, 30%, and 5% of all reported cases, respectively.ConclusionThe oncology pharmacy department at BMH improved anticancer drug availability from 54% to 84% over four years, primarily treating breast, prostate, and stomach cancers with Taxane and ACT regimens.

Background:The World Health Organization (WHO) defined low-level viremia (LLV) as a viral load (VL) of 51–999 copies/mL, and LLV has been associated with an increased risk of virological failure and drug resistance. Limited information is available from low- and mid-income countries (LMICs), which predominantly use WHO guidelines in HIV program monitoring. We estimated pooled prevalence of LLV, non-viral load suppression (VLS), and association between LLV and non-VLS among people living with HIV in LMICs.Materials and methods:In this systematic review and meta-analysis, databases were searched for articles reporting the association between LLV and non-VLS in LMICs between January 2015 and December 2023. Participants with VL ≤50 copies/mL were considered fully suppressed and those with VL ≥1000 copies/mL were non-suppressed. Using random effects models, we computed the pooled prevalence of LLV, non-VLS, and their corresponding 95% confidence intervals (CIs). We compared pooled prevalence of LLV and non-VLS between children vs adults and between studies done in Africa vs Asia.Results:Sixteen studies with 1 159 317 people living with HIV were analyzed. Overall, pooled prevalence of LLV was 19.7% (95% CI: 15.8–23.6) and that of non-VLS was 8.6% (95% CI: 6.5–10.7). Prevalence of LLV was significantly higher among children compared to adults (25.8% vs 17.2%; P < 0.001) and higher among studies done in Africa compared to those in Asia (22.3% vs 15.6%; P < 0.001). Prevalence of non-VLS was higher among studies involving children compared to adults (17.7% vs 5.6%; P < 0.001), but lower among studies done in Africa compared to Asia 8.3% vs 9.0%; P < 0.001). Overall, LLV increased the risk of non-VLS on a subsequent VL test compared to fully suppressed (RR = 2.6; 95% CI: 2.2–3.1).Conclusions:LLV was associated with an increased risk of non-VLS. Stakeholders should consider reviewing guidelines for the threshold of VLS given that LLV was consistently associated with increased risk of non-VLS across all groups.