Master Dissertations

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Browsing Master Dissertations by Subject "Acquired Immunodeficiency Syndrome"

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    Clinical presentations, common microbial isolates and antibiotic susceptibility in women with abnormal vaginal discharge attending gynaecological clinic at Iringa regional referral hospital
    (The University of Dodoma, 2022) Kushoka, Patrick J.
    Abnormal vaginal discharge in women of reproductive age is common with regards of increase in quantity, change in consistency, odour and colour brought about by sexually and non-sexually transmitted infections. This study determined clinical presentation, microbial isolates and their antibiotic susceptibility in women presenting with abnormal vaginal discharge attending gynaecological clinic at Iringa regional referral hospital, Tanzania. Hospital cross-sectional prospective study was carried on women of reproductive age presenting with abnormal vaginal discharge. Convenient-purposive sampling technique was used to sample 346 individuals attending gynaecological clinic during the period of study. Data were analysed using SPSS version 25. Out of 346 women, 292 (84.4%) had infectious pathogen with mean age of 33.5 +/-8.4 years, 173 (50.0%) had educational level below secondary school, 246 (71.1%) were married and 176 (50.9% were grand multiparous. Among women of abnormal vaginal discharge, 176 (50.9%) had creamy whitish vaginal discharge, 265 (76.6%) had no foul-odour. Microbial isolates, G. vaginalis was common by 110 (31.8%), 81 (23.4%) were C. albicans, 47 (13.6%) were N. gonorrhoea, 28 (8.1%) were T. vaginalis and 26 (7.5%) were C. trachomatis. Predictor of antibiotic susceptibility were marital status, education, comorbid conditions and contraceptive use. Completely resistance to penicillin group was observed in all bacterial isolates, 11/47 (61.1%) resistant to cephalosporin and resistance to ciprofloxacin was 3/4 (75%) against N. gonorrhoea. The proportion of women with AVD related to infectious pathogens is raising with drug resistance among recommended antibiotics in syndromic approach becoming significant. Therefore, point-of-care approach is needed to compliment the management regime. Amikacin and Azithromycin can be considered as excellent first-line regime as increasing resistance rate of ciprofloxacin and cephalosporin challenges the use of these antibiotics in the syndromic algorithm for vaginal discharge syndrome.
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    Performance of tuberculosis scoring chart in diagnosis of tuberculosis in children living with HIV in Dodoma municipal.
    (The University of Dodoma, 2019) Mutabazi, Sauda Abbas
    Background: Tuberculosis is the most common opportunistic infection and the major cause of deaths among HIV and AIDS patients. Data reports highest prevalence of TB and HIV infection in sub Saharan Africa. Mycobacterium culture is the gold standard test for diagnosis of tuberculosis though not widely available, takes longer to get results and cannot help in management of patients hence clinical or scoring system is widely used to aid in diagnosis and management of TB in children and in areas where laboratory confirmation is not feasible. The study aims to determine performance of TB scoring chart in diagnosis of TB in children aged 1 to 15 years living with HIV in Dodoma Municipal. Methods: Cross sectional study, 252 children aged 1 to 15 years living with HIV were enrolled from November 2018 to March 2019. Participants were assessed by using Modified Keith Edward TB score chart, either of the following samples gastric aspirates, lymphnode aspirates or sputum were collected for gene expert and culture. Results: Out of 252 HIV positive children investigated for TB, probable TB were 34(13.5%) and 10 (29.4%) were bacteriological confirmed TB. Sensitivity of TB score was76.9% and specificity of 90%. Clinical features associated with culture positive TB were lymphadenopathy (AOR 13.74 (3.86 – 48.86) p value< 0.001), weight loss (AOR 3.19 (1.38 – 7.36) p value 0.007) and difficulty in breathing (AOR 7.25 (1.54 – 34.16) p value 0.012). Conclusion: Tuberculosis in children and adolescent living with HIV is still common. Difficulty in breathing, lymphadenopathy and weight loss were independently associated with culture positive TB.TB score chart in its present form should be used cautiously as a diagnostic tool in children with HIV and malnutrition as it has low positive predictive value can lead to over diagnosis (high false positive rates) of TB and unnecessary use of anti TB drugs.
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    Response of intravenous fluconazole monotherapy during the induction phase in the treatment of cryptococcal meningitis in HIV/AIDS adult patients in Dodoma, Tanzania
    (The University of Dodoma, 2019) Missanga, Marco Thomas
    Background: Cryptococcal Meningitis (CM) is the most common central nervous system (CNS) manifestation encountered in advanced HIV/AIDS patients. In low resource settings, it has high documented mortality rate at 2 and 10 weeks because of poor management of intracranial pressure (ICP), untimely ART initiation, and inappropriate antifungal regimen used during the induction phase. Objective: To evaluate the response of intravenous fluconazole monotherapy during the induction phase in the treatment of CM in HIV/AIDS adult patients in Dodoma. Methods: A prospective longitudinal study was conducted in DRRH in Dodoma City from November 2018 through May 2019. The confirmed HIV/AIDS adult patients with CM were enrolled into the study. Patient demographic and clinical data were collected using structured questionnaire. Blood and CSF samples were analysed at the time of enrolment and during the course of admission. At the end of the induction phase, clinical progress was evaluated along with repeat CSF analysis. Collected data were subsequently entered and analysed by SPSS version 23. Results: A total of 38 patients were enrolled into the study. Of these 24 (63.2%) were female and majority were ≥40 years old. Some clinical improvement was observed in 68.4% of the patients, 2 (5.6%) patients died, and 2 (5.6%) patients lost to follow up. Two thirds of the patients 22 (66.7%) were unable to sterilise the CSF at the end of the induction phase. Conclusion: Clinical improvement was observed in the majority of the patients, however there was poor response of intravenous fluconazole monotherapy during the induction phase in the treatment of CM in advanced HIV/AIDS patients.