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Background Stroke is a leading cause of death and disability globally, with sub-Saharan Africa, bearing the greatest burden. Tanzania has only one active stroke registry, limiting evidence-based care and policy development. We aimed to expand the registry into a multi-centre study across eight major tertiary hospitals to generate baseline data for a national stroke registry. Methods From January to August 2024, we analysed de-identified data from adults (≥18 years) admitted with a World Health Organisation defined stroke. Data collected included demographics, risk factors, imaging, and in-hospital mortality. Logistic regression identified predictors of mortality. Results A total of 1000 patients were registered with a mean age 60.2±15 years and 56.2% (562/1000) were females. Most strokes occurred in those aged 50-69 years 46.3% (463/1000). Hypertension was the most common risk factor 90.1% (901/1000), followed by diabetes 13.1% (131/1000), prior stroke 10.6% (106/1000) and HIV infection 3.5% (35/1000). Haemorrhagic and ischaemic strokes accounted for 57.9% (579/1000) and 38.3% (383/1000) of cases, respectively; and 5% (19/383) of ischaemic strokes presented within 4.5 h from symptom onset. In-hospital mortality was 31.5% (315/1000), highest among patients aged 50–59 years (23.2%). Independent predictors of mortality included previous cardiac disease (aOR 2.15; 95% CI: 1.18–3.94) and haemorrhagic stroke (aOR 1.38; 95% CI: 1.12–2.02). Conclusions Stroke imposes a high burden in Tanzania, with substantial mortality and delayed presentation. Strengthening hypertension control, early stroke recognition, and organized stroke unit care are critical priorities. These findings provide foundational data for the national stroke surveillance initiative and support evidence-based planning for stroke prevention, acute care, and system readiness across Tanzania.
Despite the life-saving potential of mental health interventions, their scalability and integration within healthcare systems present significant challenges, particularly in low-resource global settings. This study investigated scaling IDEAS for Hope, a telehealth counseling intervention designed to reduce suicide risk and improve HIV care engagement among people living with HIV in Kilimanjaro, Tanzania, and identified actionable implementation strategies for successful scale-up. We conducted 20 semi-structured interviews, between May and July of 2024, with purposively sampled stakeholders from the Ministry of Health, healthcare administrations, telecommunications, insurance providers, and community organizations. We analyzed the data thematically in NVivo 14 and used CFIR-ERIC mapping to align identified barriers and participant-recommended strategies with evidence-based implementation strategies. Findings showed institutional support and emerging policy directives promoting mental health integration within HIV care, but also persistent barriers, including shortages of trained mental health professionals, inadequate rural digital infrastructure, criminalization of suicide and stigma. Stakeholders recommended policy reform, workforce capacity strengthening, digital infrastructure expansion, integration of telehealth into insurance schemes, and task-shifting strategies. Implementation of IDEAS for Hope appears feasible but requires addressing systemic, legal, and infrastructural barriers. These findings inform future scale-up and provide a framework for integrating telehealth mental health services within national healthcare systems.
BACKGROUND:Extraintestinal pathogenic Escherichia coli (ExPEC) are a leading cause of human bloodstream infections (BSIs) in sub-Saharan Africa, yet few studies have characterized African strains implicated in BSI or explored their potential reservoirs. METHODS:We enrolled febrile patients at 2 hospitals in Moshi, Tanzania, 2007-2019, and performed blood cultures. Whole-genome sequencing was conducted on E. coli originating from the bloodstream to characterize sequence types (STs), serotypes, and theoretical coverage of a 9-valent ExPEC polysaccharide conjugate vaccine (ExPEC9V). Separately, we evaluated 601 E. coli whole-genome sequences from humans, animals, and environmental sources in nearby communities. We assessed genetic relatedness between bloodstream and community isolates based on single-nucleotide polymorphisms and allele differences. FINDINGS:Of 3046 participants receiving blood culture, 48 (0.2%) had BSI yielding 48 E. coli isolates. The median (range) age of participants with E. coli BSI was 40.7 (0.3-89.0) years, and 32 (68.1%) were female. We identified 16 STs including ST131 (n = 16, 33.3%), ST73 (n = 10, 20.8%), and ST69 (n = 6, 12.5%) and 19 O groups including O25 (n = 13, 27.1%), O6 (n = 10, 20.3%), O17 (n = 4, 8.3%), and O18 (n = 4, 8.3%). Theoretical coverage for an ExPEC9V was 72.9%. None of the bloodstream and community E. coli pairs were closely related. CONCLUSIONS:We found a high diversity of STs among E. coli human bloodstream isolates in Tanzania. Despite this diversity, we observed that an EXPEC9V in development would provide good coverage. Reservoir-attribution studies at finer spatial and temporal scales may better identify transmission networks and reservoirs of ExPECs.
Emphysematous pyelonephritis is a rare, life-threatening infection of the kidney characterized by necrosis and gas formation within the renal parenchyma, collecting system, and perinephric tissue. It commonly occurs in patients with poorly controlled type 2 diabetes mellitus (T2DM) and in those with obstructive nephropathy. The most frequent causative pathogen is Escherichia coli, while Candida albicans is rarely implicated. This condition carries a high fatality rate, and early, aggressive medical interventions are recommended. We report a 66-year-old female with uncontrolled T2DM who presented with constitutional symptoms and abdominal pain, clinically suggestive of diabetic ketoacidosis with urinary tract infection (UTI). Urine culture revealed Candida albicans, and abdominal computed tomography (CT) revealed gas within the renal parenchyma, confirming the diagnosis of EPN. The patient initially responded well to medical therapy; however, she subsequently developed complications a few days after discharge, ultimately leading to her demise. Emphysematous pyelonephritis is a life-threatening condition, and sequential microbial (fungal-bacterial) infection underscores its unpredictable clinical course, even after initial improvement. The challenges are further magnified in settings with limited access to advanced diagnostic and interventional resources. Sustained vigilance, along with timely and aggressive multidisciplinary management during the post-acute phase, remains essential to prevent catastrophic outcomes.
Abstract Background Kaposi sarcoma is a malignant vascular neoplasm caused by human herpesvirus-8. It is mostly seen in immunocompromised individuals, particularly those with human immunodeficiency virus/acquired immunodeficiency syndrome or organ transplants. Cutaneous and mucosal Kaposi sarcoma manifestation is common; however, Kaposi sarcoma may involve the visceral organs. Iatrogenic or drug-induced Kaposi sarcoma may develop in immunocompromised patients undergoing immunosuppressive medication. It is quite uncommon for patients with inflammatory bowel diseases on immunosuppressive medication to develop intestinal Kaposi sarcoma. This case report describes the clinical presentation of steroid-induced disseminated upper gastrointestinal Kaposi sarcoma in a patient with underlying Crohn’s disease and examines the management approach, associated challenges, and clinical outcome. Case presentation We report a rare case of iatrogenic Kaposi sarcoma in a 39-year-old African male patient with Crohn’s disease undergoing long-term corticosteroid treatment. Patient history, clinical examination, and investigations revealed mucosal Kaposi sarcoma with human herpes virus-8 positivity. This prompted discontinuation of corticosteroids with subsequent transition to infliximab a biologic agent. During the course of treatment with infliximab, the patient presented with extensive Kaposi sarcoma and was started on systemic chemotherapy with improvement. Conclusion This case underscores the importance of maintaining a high index of suspicion for Kaposi sarcoma in patients on chronic immunosuppressive therapy who present with unusual skin or mucosal lesions.
