Haydom Lutheran Hospital

Poor linear growth over time can lead to stunting, a significant public health problem in low-resource settings. Catch-up growth, the process of accelerated growth following growth faltering, is important for mitigating the long-term impacts of early stunting. This study aimed to identify key predictors of growth over time, stunting and catch-up growth among children in rural Tanzania. We evaluated 182 children from the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development cohort, whose anthropometric measurements were collected at six points from birth to 11.5 years. We assessed outcomes of height-for-age z-score (HAZ), stunting and catch-up growth using mixed-model linear and logistic regression to assess associations of maternal education, household income, socioeconomic status, insulin-like growth factor 1 (IGF-1) and thyroid function tests. We defined stunting as HAZ ≤-2 and catch-up growth both as stunting resolved from age 2 years to 11.5 years and a HAZ increase of >0.5 from 2 years to 11.5 years. Cohort participants exhibited a moderate amount of catch-up growth, with per cent stunting decreasing from 72.6% at 2 years to 39.0% at 11.5 years. Maternal education, household income, socioeconomic status and IGF-1 were positively associated with HAZ (eg, IGF-1 point estimate 0.141±0.067, p=0.036) and negatively associated with odds of stunting across time points, while thyroid-stimulating hormone was negatively associated with HAZ and positively associated with odds of stunting (all p<0.05). For the definitions of catch-up growth, only IGF-1 was associated with odds of catch-up growth by both definitions (both p<0.01). Because of the potential for IGF-1 to be associated with maturation (and potential early growth cessation), we also assessed regression models that included IGF-1, luteinizing hormone and follicle-stimulating hormone, revealing that IGF-1 remained associated with catch-up growth (p<0.05). These findings highlight the need for comprehensive interventions that address socioeconomic, hormonal and biological factors to promote catch-up growth and reduce stunting in resource-limited settings. The results offer valuable insights towards improving child health outcomes in similar contexts. NCT02441426 (post-results) and NCT05121935.

Shigellosis is a leading cause of diarrhoea in children globally. We aimed to assess the burden of specific Shigella species and Shigella flexneri serotypes, characterise their clinical syndromes and natural immunity, and evaluate their relevance as causes of diarrhoea and linear growth faltering. In the MAL-ED birth cohort study, children younger than 17 days were enrolled from Nov 3, 2009, to Feb 29, 2012, in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, Tanzania, and South Africa and were followed up for 2 years. In this retrospective substudy, we retested Shigella quantitative PCR-positive diarrhoeal and non-diarrhoeal stool samples with molecular subtyping assays. We estimated the prevalence of specific Shigella species and serotypes, estimated their associations with diarrhoea and clinical characteristics using generalised linear mixed models, estimated their associations with linear growth using linear regression, and used longitudinal infection data to estimate protection due to previous infection using the Andersen and Gill extension of the Cox model. 1715 children (874 [51·0%] male and 841 [49·0%] female) with complete follow-up to 2 years provided 45 835 stool samples collected between age 0 and 2 years. 1294 (75·5%) children had at least one Shigella detection in a non-diarrhoeal or asymptomatic stool and 507 (29·6%) had at least one Shigella-attributed diarrhoea episode. In this substudy, we were able to type 1202 samples. The most common species and serotypes were Shigella sonnei (366 [30·4%] of 1202), S flexneri 2a (250 [20·8%]), and S flexneri 6 (296 [24·6%]). The associations of S flexneri and S sonnei detection with diarrhoea versus asymptomatic control stools were similar. Compared with diarrhoea episodes attributable to S flexneri, those attributable to S sonnei were less likely to be bloody (prevalence ratio 0·36 [95% CI 0·23 to 0·56]) or severe (prevalence ratio 0·58 [0·35 to 0·96]). The associations between asymptomatic Shigella infections and impaired linear growth at age 2 years were stronger for S flexneri than S sonnei (S flexneri length-for-age Z score difference -0·18 [95% CI -0·29 to -0·07] and S sonnei length-for-age Z score difference -0·07 [-0·21 to 0·07]). Examination of longitudinal infections showed that previous S sonnei infection was associated with a lower hazard of subsequent S sonnei diarrhoea (calibrated hazard ratio 0·41 [95% CI 0·19 to 0·90]). Otherwise, evidence for homotypic or heterotypic natural immunity was not apparent. This study provides data on prevailing Shigella species and serotypes in settings with a high burden of disease, underscoring the importance of asymptomatic S flexneri infection on growth impairment and the severity of S flexneri diarrhoea. Upcoming Shigella vaccines might need to induce immune responses that improve upon those produced by natural infection. Bill & Melinda Gates Foundation.

BackgroundThe neonatal mortality rate in Tanzania has remained persistently high, at 24 deaths per 1000 live births. To halve the current death rate by 2030, the WHO recommends that by 2025, at least 80% of districts should have a neonatal care unit (NCU) and use a continuous positive airway pressure (CPAP) device for respiratory support, among small and sick newborns. This study describes the availability and functioning of NCUs and facility-based neonatal mortality in Tanzania.MethodsFrom December 2020 to March 2021, a cross-sectional study was conducted in 127 health facilities in five regions. Data were collected using structured checklists. The presence of a neonatal intensive care unit or a high dependency unit, a kangaroo mother care ward and a general neonatal ward defined a minimum national NCU recommendation. The presence of one or more admission beds and a neonatal CPAP in the established NCU described the functioning.ResultsOf all health facilities providing comprehensive emergency obstetric and newborn care services, 48% (61/127) had established an NCU. Only 3% (4/127) met the minimum national NCU recommendation. NCUs were significantly less available in health centres and district hospitals than in regional referral hospitals (p<0.001), and less in public and private facilities than in faith-based organisations (p = 0.001). Moreover, only 31% (40/127) of facilities had at least one neonatal admission bed, and 3% (4/127) had a neonatal CPAP in the NCU. Besides, 75% (30/40) of the functioning NCUs, had one to four beds only. Only 17% (22/127) of facilities had a neonatal admission register. Neonatal admissions and deaths were significantly lower in facilities without functioning NCUs and admission registers (p<0.008, 0.001, respectively). The early (0–7 days) neonatal mortality accounted for 96% (529/550) of registered neonatal deaths.ConclusionsHealth facilities with functioning NCUs are scarce, with few admission beds and CPAP devices. The lack of admission registers implies a significant under-reporting. Tanzania needs to improve the availability of functioning NCUs, with adequate admission beds and equipment to end preventable neonatal deaths, as per global targets, by 2030

Deprivation of oxygen in an infant during and after birth leads to birth asphyxia, which is considered one of the leading causes of death in the neonatal period. Adequate resuscitation activities are performed immediately after birth to save the majority of newborns. The primary resuscitation activities include ventilation, stimulation, drying, suction, and chest compression. While resuscitation guidelines exist, little research has been conducted on measured resuscitation episodes. Objective data collected for measuring and registration of the executed resuscitation activities can be used to generate temporal timelines. This paper is primarily aimed to introduce methods for analyzing newborn resuscitation activity timelines, through visualization, aggregation, redundancy and dimensionality reduction. We are using two datasets: 1) from Stavanger University Hospital with 108 resuscitation episodes, and 2) from Haydom Lutheran Hospital with 76 episodes. The resuscitation activity timelines were manually annotated, but in future work we will use the proposed method on automatically generated timelines from video and sensor data. We propose an encoding generator with unique codes for combination of activities. A visualization of aggregated episodes is proposed using sparse nearest neighbor graph, shown to be useful to compare datasets and give insights. Finally, we propose a method consisting of an autoencoder trained for reducing redundancy in encoded resuscitation timeline descriptions, followed by a neighborhood component analysis for dimensionality reduction. Visualization of the resulting features shows very good class separability and potential for clustering the resuscitation files according to the outcome of the newborns as dead, admitted to NICU or normal. This shows great potential for extracting important resuscitation patterns when tested on larger datasets.

<sec id="st1"><title>BACKGROUND</title>Tanzanian TB guidelines recommend facility-based TB screening for symptomatic household contacts (HHCs) or those aged <5 years, but cost remains a major barrier. In this study, we evaluate the use of unconditional cash transfers (UCTs) to facilitate completion of HHC TB screening.</sec><sec id="st2"><title>METHODS</title>In this prospective interventional study, we enrolled index people diagnosed with TB (PWTB) within 8 weeks of TB treatment initiation from the TB clinic at Haydom Lutheran Hospital, Haydom, Tanzania, and surrounding TB dispensaries in rural Tanzania. The study provided at the time of enrollment an UCT up to 40,000 Tanzanian shillings (USD16.91) directly to heads of households with PWTB, covered medical costs from screening activities and provided three bi-weekly phone reminders to facilitate HHC TB screening. The primary outcome was TB screening completion for all HHCs compared to the same period of the preceding year.</sec><sec id="st3"><title>RESULTS</title>We enrolled 120 index PWTB, including 398 HHCs between July and December 2022. The median age for index PWTB was 35 years; 38% were females. Sixty-five (54%) households completed screening for all HHCs, compared to 7% during the same period of the preceding year.</sec><sec id="st4"><title>CONCLUSION</title>These interventions may considerably improve completion of HHC TB screening in rural Tanzania.</sec>.

Newborn mortality is a global challenge with around 2.4 million neonatal deaths in 2019. One third of these occur within the first-and-only day of life with labour complications and birth asphyxia being the primary causes. Existing guidelines for newborn resuscitation are based on limited scientific evidence, and evidens based research is sought for. To increase our knowledge on resuscitation of newborns, it is crucial to first quantify what is currently being done in terms of therapeutic activities, such as ventilation and stimulation, and how they affect resuscitation outcomes. In the current study, the therapeutic activities during newborn resuscitation are quantified by estimating a timeline describing the start and stop of activities. The proposed approach is combining methods using both video and time series data recorded during resuscitation, where the predictions are based on the available sources. From video the activity recognition is done by a 3D CNN method. For the signal data feature extraction is performed on ECG and accelerometer signals and thereafter machine learning is done to perform stimulation detection. We show that best results are achieved with all signals and video available, for the activity “stimulation” we get an AUC of 0.86, sensitivity of 82.32%, specificity of 82.23%, and precision of 57.59%. If only signals or video is available we still get good results with AUC at 0.80, and 0.84 respectively.

BackgroundThe quality of nursing education depends largely on the experience student receive in the clinical environment. The learning environment is complex with factors that may positively or negatively influence students learning. The current study aimed to explore the experiences and perceptions of diploma nursing students toward their clinical learning in Dodoma-Tanzania.MethodsA qualitative descriptive study design was employed. The study was conducted in four nursing schools involving 32 nursing students who were purposively selected. Data was collected using focus-group discussions and analyzed using thematic analysis.ResultsThree main themes emerged during the discussions: experience on personal and technical support for clinical learning, the importance of the clinical environment in clinical learning, and insufficient clinical educational planning. The majority of students had negative experiences including poor clinical supervision, lack of equipment, congestion of students, and inability to meet clinical objectives. Few students had positive experiences related to exposure to a real clinical environment and great support from staff nurses.ConclusionStudents had mixed experiences, both positive and negative on their clinical learning. The majority of students had negative experiences. This may have a serious impact on the student completing their education, the services they will offer to patients when employed, and nursing professional development.