Prevalence and antimicrobial susceptibility patterns of bacteria colonizing the external ocular surfaces of patients undergoing ocular surgeries at Bugando Medical Center in Mwanza, Tanzania.

OBJECTIVE: Understanding microbiota colonizing ocular surfaces is key to expedite antibiotic prophylactic options for ocular surgeries, and therefore, prevent subsequent surgical site infections (SSIs). To fill this critical gap, we aimed at determining the prevalence and antibiotic susceptibility patterns of bacteria colonizing the external ocular surfaces of 224 patients undergoing ocular surgeries at Bugando Medical Centre (BMC) in Mwanza, Tanzania between May and August 2023. RESULTS: The study participants had a median age of 62.5 (interquartile range: 39.5-75.0) years. A total of 78.1% (175/224) ocular swabs were culture positive yielding 196 bacterial isolates. Staphylococcus epidermidis [43.4% (n = 85)], Staphylococcus aureus [21.9% (n = 43)] and Pseudomonas aeruginosa [14.3% (n = 28)] were the most common bacteria. There were low proportions of resistance among predominant Gram-positive and Gram-negative bacteria to gentamicin (≤ 25.0%), and similarly, low resistance among Gram negative bacteria was observed against 3rd generation cephalosporins (≤ 25.0%) and piperacillin-tazobactam (0.0%). Variable resistance profiles were notable to the most commonly used antibiotics (ciprofloxacin and tetracycline: 0.0-66.7%). Our findings underscore an urgent need to revisit antibiotic prophylactic guidelines for ocular surgeries in this tertiary hospital, and calls for prospective evaluation of incident SSIs post-ocular surgeries to guide specific management.

Prevalence of Retinal Diseases and Associated Risk Factors in an African Population From Mwanza, Tanzania.

BACKGROUND AND OBJECTIVE: To determine the prevalence of retinal disease among a population in Mwanza, Tanzania, and to identify relevant risk factors for retinal disorders in this cohort. PATIENTS AND METHODS: A cross-sectional population-based study was conducted in Mwanza, Tanzania, among patients older than 18 years. Participants completed a demographics survey and underwent an ophthalmic examination that included fundus photography. RESULTS: Complete data were available for 1,007 (93.8%) of the 1,073 persons examined. The prevalence of vitreoretinal disorders was 22.8% (230/1,007). The leading retinal diseases were age-related macular degeneration (7.0%), hypertensive retinopathy (4.5%), and macular scars (2.7%). CONCLUSION: This study is the first population-based study of retinal disease in Mwanza. The findings reveal a considerable burden of retinal disease in this region, suggesting a need for trained local ophthalmic personnel and resources. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:S17-S25.].

Diabetic Microvascular Complications Among Children and Adolescents in Northwestern Tanzania: A Cross-Sectional Study.

Background: Africa is experiencing a rapid increase in morbidity and mortality related to diabetes mellitus (DM). Contemporary data are needed to guide efforts to improve prevention and treatment for microvascular complications in children and adolescents in Africa. This study was conducted to assess prevalence of diabetic microvascular complications in northwestern Tanzania, including nephropathy, retinopathy, and neuropathy, as well as associated risk factors. Objectives: 1) To determine the prevalence of microvascular complications and the overlap of nephropathy, retinopathy and neuropathy and 2) to determine factors associated with the development of microvascular complications. Methods: This cross-sectional study included 155 children and adolescents with DM consecutively attending all three health centers providing diabetes care for children in the Mwanza region of Tanzania. Participants were examined for microvascular complications and possible risk factors. Results: Fifty-one of 155 participants (age: 5-19 years) had diabetic nephropathy (32.9%), 16 had diabetic retinopathy (10.3%), and 21 had diabetic neuropathy (13.6%). Risk factors for development of a microvascular complication included age, duration of DM, and poor glycemic control. Of the participants, 107 had poor levels of glycemic control (69%) with HbA1C levels >10%. Conclusion: The prevalence of microvascular complications, especially that of nephropathy, was disturbingly high. Risk factors for microvascular complications were similar to other studies from Africa and included poor glycemic control, older age, and longer duration of DM. Innovative, locally appropriate systems for optimizing glycemic control are urgently needed.

Retinopathy in adults with hypertension and diabetes mellitus in Western Tanzania: a cross-sectional study.

OBJECTIVE: Little is known about the retinal manifestations of arterial hypertension (HTN) and diabetes mellitus (DM) in Western Tanzania and how to maximise the utilisation of scarce eye health resources. To address this, we determined the prevalence of hypertensive and diabetic retinopathy (DR), associated risk factors and relevant patient knowledge. METHODS: Adults with HTN or DM attending outpatient clinics at Bugando Medical Center (BMC) from June to August 2017 were enrolled. Fundus photographs were obtained, and data were collected on blood pressure (BP), body mass index (BMI), blood sugar, visual acuity (VA) and responses to questions about the effects of HTN and DM on the eye. RESULTS: A total of 180 persons were screened. When only individuals with DR were considered, bivariate regression found systolic BP was significantly associated with severity of DR (P = 0.034). Receiver operating characteristic (ROC) curve analysis using the maximum Youden index revealed the optimum cut-off using duration of DM to predict any DR was 8 years (AUC = 0.75, 95% CI 0.65-0.85). Fewer persons with HTN were aware of the effect of high BP on the eye (61.6%) than persons with DM who were aware of the effect of high blood sugar on the eye (74.4%) (P = 0.048). CONCLUSION: Efforts should be made to vigorously treat HTN among adults with DM and refer adults with duration of DM of 8 years or more for a dilated retinal examination. Additional efforts should be made to promote awareness of the sight threatening potential of HTN in resource-limited settings.

OBJECTIF: On en sait peu sur les manifestations rétiniennes de l'hypertension artérielle (HTA) et du diabète sucré (DS) dans l'ouest de la Tanzanie et sur la manière de maximiser l'utilisation des rares ressources de la santé oculaire. Pour répondre à ceci, nous avons déterminé la prévalence de la rétinopathie hypertensive et diabétique (RD), les facteurs de risque associés et la connaissance du patient concerné. MÉTHODES: Les adultes atteints d'HTA ou de DS fréquentant les cliniques ambulatoires au Bugando Medical Center (BMC) de juin à août 2017 ont été inscrits. Des photos du fond de l'œil ont été obtenues et des données ont été recueillies sur la pression artérielle (TA), l'indice de masse corporelle (IMC), la glycémie, l'acuité visuelle (AV) et les réponses aux questions sur les effets de l'HTA et du DS sur l'œil. RÉSULTATS: Au total, 180 personnes ont été dépistées. Lorsque seules les personnes atteintes de RD étaient considérées, la régression bivariée a révélé que la TA systolique était significativement associée à la sévérité de la RD (P = 0,034). L'analyse de la courbe des caractéristiques de fonctionnement du récepteur (ROC) à l'aide de l'indice de Youden maximal a révélé que le seuil optimal utilisant la durée du DS pour prédire toute RD était de 8 ans (ASC = 0,75 ; IC95%: 0,65 à 0,85). Moins de personnes atteintes de HTA étaient conscientes de l'effet d'une TA élevée sur l'œil (61,6%) que les personnes atteintes de DS qui étaient conscientes de l'effet de l'hyperglycémie sur l'œil (74,4%) (P = 0,048). CONCLUSION: Des efforts doivent être faits pour traiter effectivement l'HTA chez les adultes atteints de DS et référer les adultes avec une durée de DS de 8 ans ou plus pour un examen de la rétine dilatée. Des efforts supplémentaires devraient être faits pour promouvoir la prise de conscience du potentiel de menace pour la vue de l'HTA dans les zones à ressources limitées.