Browsing by Author "Kinyenje, Erick"

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    PublicationOpen Access
    Aflatoxicosis outbreak and its associated factors in Kiteto, Chemba and Kondoa Districts, Tanzania
    (Plos Global Public Health, 2023-08-08) Kinyenje, Erick; Kishimba, Rogath; Mohamed, Mohamed; Mwafulango, Ambele; Eliakimu, Eliudi; Kwesigabo, Gideon
    Abstract Tanzania had experienced hundreds of cases of aflatoxicosis in the districts of Kiteto, Chemba, and Kondoa for the three consecutive years since 2016. Cases may end up with liver cancer. Aflatoxin-induced liver cancer had resulted in the demise of roughly three persons per 100,000 in the country during the same year, 2016. We investigated to characterize the latest outbreak of 2019 and identify its risk factors. This case-control study enrolled all patients presented with acute jaundice of unknown origin and laboratory test results confirmed an acute liver injury with or without abdominal pain, distension, vomiting, or fever during the period of June to November 2019 and had epidemiological link with cases confirmed with Aflatoxin-B1-Lysine. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to identify independent factors associated with aflatoxicosis. We analyzed 62 cases with median age of 7 years (0.58–50 years) and 186 controls with median age of 24 years (range 0.42–55) with onset of symptoms ranging from 1st June 2019 to 16th July 2019. Case-parents had higher serum aflatoxin-B1–lysine adduct concentrations than did controls; 208.80 ng/mg (n = 45) vs. 32.2 ng/mg (n = 26); p<0.01. Storing foods at poor conditions (AOR 5.49; 95% CI 2.30–13.1), age <15 years (AOR 4.48; 95% CI 1.63–12.3), chronic illness (AOR 3.05; 95% CI 1.19–7.83) and being male (AOR 2.31; 95% CI 1.01–5.30) were significantly associated with the disease, whereas cleaning foods before milling decreased the risk of getting the disease by 88% (AOR 0.12; 95% CI 0.05–0.29). According to the results, the outbreak resulted from a globally highest-ever recorded aflatoxin-B1-lysine that originated from a common source. To prevent future outbreaks, it is crucial to store and clean food crops safely before milling. We recommend strict regulations and enforcement around aflatoxin levels in food products
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    PublicationOpen Access
    Infection prevention and control of highly infectious pathogens in resource-limited countries: an experience from Marburg viral disease outbreak in Kagera Region - Tanzania
    (BMC Infectious Diseases, 2024-06-24) Kinyenje, Erick; Hokororo, Joseph; Ngowi, Ruth; Kiremeji, Michael; Mnunga, Elice; Samwel, Angela; Mnken, Emmanuel; Yango, Missana; Mtalika, Mikidadi; Mmbaga, Vida
    Marburg viral disease (MVD) is a highly infectious disease with a case fatality rate of up to 90%, particularly impacting resource-limited countries where implementing Infection Prevention and Control (IPC) measures is challenging. This paper shares the experience of how Tanzania has improved its capacity to prevent and control highly infectious diseases, and how this capacity was utilized during the outbreak of the MVD disease that occurred for the first time in the country in 2023. In 2016 and the subsequent years, Tanzania conducted self and external assessments that revealed limited IPC capacity in responding to highly infectious diseases. To address these gaps, initiatives were undertaken, including the enhancement of IPC readiness through the development and dissemination of guidelines, assessments of healthcare facilities, supportive supervision and mentorship, procurement of supplies, and the renovation or construction of environments to bolster IPC implementation. The official confirmation and declaration of MVD on March 21, 2023, came after five patients had already died of the disease. MVD primarily spreads through contact and presents with severe symptoms, which make patient care and prevention challenging, especially in resource-limited settings. However, with the use of a trained workforce; IPC rapid needs assessment was conducted, identifying specific gaps. Based on the results; mentorship programs were carried out, specific policies and guidelines were developed, security measures were enhanced, all burial activities in the area were supervised, and both patients and staff were monitored across all facilities. By the end of the outbreak response on June 1, 2023, a total of 212 contacts had been identified, with the addition of only three deaths. Invasive procedures like dialysis and Manual Vacuum Aspiration prevented some deaths in infected patients, procedures previously discouraged. In summary, this experience underscores the critical importance of strict adherence to IPC practices in controlling highly infectious diseases. Recommendations for low-income countries include motivating healthcare providers and improving working conditions to enhance commitment in challenging environments. This report offers valuable insights and practical interventions for preparing for and addressing highly infectious disease outbreaks through implementation of IPC measures.
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    PublicationOpen Access
    Status of countrywide laboratory services quality and capacity in primary healthcare facilities in Tanzania: Findings from Star Rating Assessment
    (Plos Global Public Health, 2023-10-18) Kinyenje, Erick; Ngowi, Ruth R.; Msigwa, Yohanes S.; Hokororo, Joseph C.; Yahya, Talhiya A.; German, Chrisogone J.; Mawazo, Akili; Mohamed, Mohamed A.; Nassoro, Omary A.; Degeh, Mbwana M.
    Accurate disease diagnosis relies on a well-organized and reliable laboratory system. This study assesses the quality of laboratory services in Tanzania based on the nationwide Star Rating Assessment (SRA) of Primary Healthcare (PHC) facilities conducted in 2017/18. This cross-sectional study utilized secondary data from all the country’s PHC facilities stored in the SRA database. Laboratory service quality was assessed by aggregating scores as percentages of the maximum achievable score across various indicators: dedicated laboratory department/room, adequate equipment, staffing levels, adherence to testing protocols, establishment of turnaround times, internal and external quality controls, and safety and supplies management. Scores equal to or exceeding 80% were deemed compliant. Multiple linear regression was used to determine the influence of facility characteristics (level, ownership, location, staffing) on quality scores, with statistical significance set at p < 0.05. The study included 6,663 PHC facilities (85.9% dispensaries, 11% health centers, 3.2% hospital-level-1), with the majority being public (82.3% vs. 17.7%) and located in rural areas (77.1% vs. 22.9%). On average, facilities scored 30.8% (SD = 35.7), and only 26.6% met staffing requirements. Compliance with quality standards was higher in private (63% vs. 19%, p<0.001) and urban facilities (62% vs. 16%, p<0.001). More than half of the facilities did not meet either of the eight quality indicators. Quality was positively linked to staffing compliance (Beta = 5.770) but negatively impacted by dispensaries (Beta = -6.342), rural locations (Beta = -0.945), and public ownership (Beta = -1.459). A score of 30% falls significantly short of the national target of 80%. Improving laboratory staffing levels at PHC facilities could improve the quality of laboratory services, especially in public facilities that are based in rural areas. There is a need to further strengthen laboratory services in PHC facilities to ensure the quality of laboratory services and clients’ satisfaction.