Sickle cell disease (SCD), a genetic hemoglobin disorder, is a major public health challenge in sub-Saharan Africa, particularly in Tanzania, due to its association with high morbidity and mortality from infections. The disease is the leading cause of complications, emphasizing the urgent need for effective preventive strategies and diagnostic protocols. We evaluated the implementation and effectiveness of infection prevention measures and laboratory diagnostic compliance at Nyamagana District Hospital, emphasizing their effects on patient outcomes and survival rates. This retrospective observational study analyzed the medical records of 157 patients with SCD admitted to Nyamagana District Hospital for infection treatment between January 2022 and 2024. The infection profiles, utilization of preventive interventions (recommended drugs, vaccinations, and chemoprophylaxis), and diagnostic laboratory compliance were assessed. Of the 157 participants, 90.4% had at least one infection during their hospital stay, suggesting the vulnerability of this population to infections. Furthermore, malaria emerged as the most prevalent type of infection (40.1%), which is consistent with its endemic status in Tanzania. Other significant infections included unspecified diarrhea (12.5%) and upper respiratory tract infections (10.8%). Despite the high coverage rates of penicillin V prophylaxis (72%) and pneumococcal vaccination (100%), the utilization of malaria chemoprophylaxis and hydroxyurea was low (only 10.8% and 16.6%, respectively). The diagnostic laboratory test compliance, essential for accurate infection management, was moderate at 63.1%, with significant deficiencies in the blood, urine, and stool cultures and antibiotic susceptibility testing. The administration of hydroxyurea significantly reduced malaria prevalence (P=0.005), fewer vaso-occlusive crises (P<0.001), and severe anemia incidence (P=0.034). Thus, enhancing access to preventive measures and improving diagnostic laboratory compliance are crucial steps for reducing infection-related complications among patients with SCD in Nyamagana.
Detailed description of malaria in low transmission areas is crucial for elimination. The current study aimed to provide a comprehensive description for malaria transmission in Jazan, a low transmission district, southwestern Saudi Arabia. Patients at a tertiary care hospital were recruited in our study between August 2016 and September 2018. Malaria diagnosis was performed through a species-specific nested polymerase chain reaction (nested PCR), microscopy and Paramax-3TM rapid detection test (RDT). Malaria was detected in 30 patients by the PCR, with point prevalence of 10.9%. Of these malaria infections, 80% was imported, 26.6% was asymptomatic and 23.3% was sub-microscopic. Malaria was reported throughout the year, with February/March and September/October peaks. Infection was significantly more in males than in females (P=0.01). Likewise, infections were detected more in febrile than in non-febrile patients (P=0.01). Adult aged 15-24 years, fever and travel were identified as high-risk factors. Malaria was primarily attributed to Plasmodium falciparum mono-infections, followed by P. vivax mono-infections and lastly to falciparum/vivax mixed infections accounting 76.6%, 16.6%, and 6.6% of PCR-confirmed malaria cases, respectively. The nested PCR was superior to the smear microscopy (sensitivity 76.6%; specificity 100%) and the RDT (sensitivity 83.3%, specificity 94.2%). The overall percent agreement between microscopy and the RDT was 92.7% (kappa=0.63). High proportion of imported malaria including sub-microscopic and sub-patent cases were described. We suggest that incorporation of molecular tool into the conventional malaria diagnosis is beneficial in Jazan district.
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