Dynamics of nasopharyngeal bacterial colonisation in HIV-exposed young infants in Tanzania.

OBJECTIVES: To estimate the prevalence of nasopharyngeal bacterial colonisation (NPBC) patterns in young Tanzanian HIV-exposed infants and to analyse the influence of maternal NPBC and of the infant's HIV status on the NPBC pattern. METHODS: Longitudinal cohort study of neonates born to HIV-infected mothers visiting Kilimanjaro Christian Medical Centre, Tanzania, between 2005 and 2009. Demographic and clinical data and nasopharyngeal bacterial cultures were obtained at the age of 6 weeks, 3 and 6 months, and at one time point, a paired mother-infant nasopharyngeal swab was taken. RESULTS: Four hundred and twenty-two swabs were taken from 338 eligible infants. At 6 weeks of age, colonisation rates were 66% for Staphylococcus aureus, 56% for Streptococcus pneumoniae, 50% for Moraxella catarrhalis and 14% for Haemophilus influenzae. Colonisation with S. aureus diminished over time and was more common in HIV-infected infants. S. pneumoniae and H. influenzae colonisation rose over time and was more prevalent in HIV-uninfected children. Co-colonisation of S. pneumoniae with H. influenzae or M. catarrhalis was mostly noticed in HIV-infected infants. S. pneumoniae and M.catarrhalis colonisation of the mother was a risk factor for colonisation in HIV-uninfected infants, while maternal S. aureus colonisation was a risk factor for colonisation in HIV-infected infants. Among the 104 S. pneumoniae isolates, 19F was most prevalent, and 57 (55%) displayed capsular serotypes represented in the 13-valent pneumococcal conjugate vaccine. CONCLUSIONS: NPBC was common in Tanzanian HIV-exposed infants. The significant prevalence of pneumococcal vaccine serotypes colonising this paediatric population justifies the use of the 13-valent pneumococcal vaccine to reduce the burden of pneumococcal invasive disease.

Diabetes care in Kilimanjaro region: clinical presentation and problems of patients of the diabetes clinic at the regional referral hospital-an inventory before structured intervention.

BACKGROUND: In order to improve care for diabetic patients in a developing country at the regional referral hospital for the Northern zone of Tanzania, a specialized clinic was established in November 1996. AIM: The aim of this study was to provide a situational analysis about the problems of the diabetic patient population treated at the hospital. For all patients who registered at the clinic a questionnaire was completed about personal data, diabetes history, symptoms, treatment, eating habits and psycho-social aspects of the disease. Results from patients who registered between November 1996 and December 1998 were analysed. RESULTS: Data from 474 diabetic patients (46% female) were obtained. Mean age was 53.75 (+/- 16; range 4-88 years), 15% were classified Type 1, 75% Type 2 and 10% remained unclassified. A body mass index of < 25 was recorded in > 80% of the Type 1 and approx. 50% of the Type 2 patients. Among complications, numbness of the legs was mentioned by 44%, hypertension was diagnosed in about 25%, retinopathy in 14%, foot ulcers in 10% and nephropathy in 7.5% of the patients. About 50% of the patients saw their disease as a big physical and psychological problem. Monthly cost for an average insulin-treated patient equalled around 25% of the minimal wage. CONCLUSION: Diabetes care in a developing country needs to address the specific background of the patient population, their needs, the medical problems and the social constraints. Active participation of the patients can help to overcome some of the difficulties.