Introduction. Heart failure (HF) is characterized by frequent episodes of decompensation, leading to a high hospitalization burden. More than 50% of index hospitalizations for HF patients return within 6 months of discharge. Once the patient is readmitted, the risk of further disease progression and the mortality rate are increased. A lot of patients are readmitted due to factors such as poor medication adherence, infections, or worsening comorbidities. The aim of our study was to identify the inpatient burden of HF readmission and to identify the factors associated with early readmission. Methods. A hospital-based cross-sectional analytical study was conducted from November 2018 to April 2019 within the medical wards at Kilimanjaro Christian Medical Centre (KCMC), which is a teaching and referral hospital in north-eastern Tanzania. The study population included all patients with HF admitted within the medical ward. Data were collected using questionnaires and blood and radiological investigations, and analysis was done using Statistical Package for Social Science (SPSS) version 25. Chi-square test was used to compare proportions of categorical variables. Logistic regression was used to determine the likelihood for readmission, and p-value of <0.05 was considered to be statistically significant. Results. A total of 353 patients were identified with HF, of whom 136 (38.5%) had a previous admission. Of the 136 patients analysed, the mean age was 62.8 years (SD 17.1), and 86 (63.2%) were females. Within 30 days after discharge, 34 (25.0%) of the patients were readmissions. Factors for early readmission were unemployment (OR = 2.38, 95% CI = 1.02–5.54, p=0.043), poor medication adherence (OR = 3.87, 95% CI = 1.67–8.97, p=0.002), absence of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) (OR = 2.40, 95% CI = 1.09–5.31, p=0.030), and pleural effusion (OR 3.25, 95% CI = 1.44–7.32, p=0.004). Conclusion. Heart failure is a burden due to a large number of admissions and readmissions. Factors such as poor medication adherence and absence of adequate HF therapy, especially the absence of regimes containing ACEI or ARB, need to be targeted to reduce the number of readmissions. This will help reduce the risk of further decompensations, disease progression, and mortality rate.

Background and Aims: The burden of noncommunicable diseases is increasing in developing countries and in settings with an existing communicable burden. The study aim was to identify the disease pattern, length of stay, and clinical outcome of medical admissions.Methods: A retrospective observational study of patients admitted to medical wards between 1st July 2019 and 30th June 2020, excluding those admitted for chemotherapy. The outcome measures were the pattern of disease, length of stay, and clinical outcome.Results: A total of 3930 patients were analyzed. A total of 53.5% were males, and 42.9% were aged 51–75 years, with a median age of 57 years (IQR 41–71). A total of 41.3% had health insurance, 21.7% died, and the median length of stay was 6 days (IQR 4–9). Cardiovascular diseases were the most common diagnosis (26.8%) on admission and cause of death (27.9%). The common causes of death were stroke (15.1%), chronic kidney disease (11.1%), and heart failure (9.0%). Noninsured patients had a high mortality risk (odds ratios [OR] 1.67, 95% confidence interval [CI] 1.42–1.96), which was also seen among patients aged more than 75 years (OR 1.3, 95% CI 1.08–1.57), patients with communicable diseases (OR 1.44, 95% CI 1.23–1.68), and weekend admissions (OR 1.29, 95% CI 1.08–1.55). The 72‐h admission window is critical due to a very high mortality risk (OR 3.03, 95% CI 2.58–3.56).Conclusion: Cardiovascular diseases are the leading cause of hospital admissions and deaths in a tertiary hospital in Northern Tanzania. Lifestyle modification, health education, and community resources are needed to combat the growing burden of cardiovascular and renal disease.

Objective We aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs. Design Prospective cohort study Setting Emergency department (ED) of a tertiary-level hospital in Dar es Salaam, Tanzania. Participants Injured adult patients seen at the ED of Muhimbili National Hospital from August 2019 to March 2020. Methods During alternating 12-hour shifts, consecutive trauma patients were approached in the ED after stabilisation. A case report form was used to collect social-demographics and patient clinical profile. Total charges billed for ED and in-hospital care and OOP payments were obtained from the hospital billing system. Patients were interviewed by phone to determine the measures they took to pay their bills. Primary outcome measure The primary outcome was the proportion of patients with catastrophic health expenditure (CHE), using the WHO definition of OOP expenditures ≥40% of monthly income. Results We enrolled 355 trauma patients of whom 51 (14.4%) were insured. The median age was 32 years (IQR 25–40), 238 (83.2%) were male, 162 (56.6%) were married and 87.8% had ≥2 household dependents. The majority 224 (78.3%) had informal employment with a median monthly income of US$86. Overall, 286 (80.6%) had OOP expenses for their care. 95.1% of all patients had an Injury Severity Score <16 among whom OOP payments were US$176.98 (IQR 62.33–311.97). Chest injury and spinal injury incurred the highest OOP payments of US$282.63 (84.71–369.33) and 277.71 (191.02–874.47), respectively. Overall, 85.3% had a CHE. 203 patients (70.9%) were interviewed after discharge. In this group, 13.8% borrowed money from family, and 12.3% sold personal items of value to pay for their hospital bills. Conclusion OOP costs place a significant economic burden on individuals and families. Measures to reduce injury and financial risk are needed in Tanzania.

Introduction: Tracking of blood glucose levels by patients and care providers remains an integral component in the management of diabetes mellitus (DM). Evidence, primarily from high‐income countries, has illustrated the effectiveness of self‐monitoring of blood glucose (SMBG) in controlling DM. However, there is limited data on the feasibility and impact of SMBG among patients in the rural regions of sub‐Saharan Africa. This study is aimed at assessing SMBG, its adherence, and associated factors on the effect of glycaemic control among insulin‐treated patients with DM in northeastern Tanzania.Materials and Methods: This was a single‐blinded, randomised clinical trial conducted from December 2022 to May 2023. The study included patients with DM who had already been on insulin treatment for at least 3 months. A total of 85 participants were recruited into the study and categorised into the intervention and control groups by a simple randomization method using numbered envelopes. The intervention group received glucose metres, test strips, logbooks, and extensive SMBG training. The control group received the usual care at the outpatient clinic. Each participant was followed for a period of 12 weeks, with glycated haemoglobin (HbA_1c) and fasting blood glucose (FBG) being checked both at the beginning and at the end of the study follow‐up. The primary and secondary outcomes were adherence to the SMBG schedule, barriers associated with the use of SMBG, and the ability to self‐manage DM, logbook data recording, and change in HbA_1c. The analysis included descriptive statistics, paired t‐tests, and logistic regression.Results: Eighty participants were analysed: 39 in the intervention group and 41 in the control group. In the intervention group, 24 (61.5%) of patients displayed favourable adherence to SMBG, as evidenced by tests documented in the logbooks and glucometer readings. Education on SMBG was significantly associated with adherence. Structured SMBG improved glycaemic control with a HbA_1c reduction of −1.01 (95% confidence interval (CI) −1.39, −0.63) in the intervention group within 3 months from baseline compared to controls of 0.18 (95% CI −0.07, 0.44) (p < 0.001).Conclusion: Structured SMBG positively impacted glycaemic control among insulin‐treated patients with DM in the outpatient clinic. The results suggest that implementing a structured testing programme can lead to significant reductions in HbA_1c and FBG levels.Trial Registration: Pan African Clinical Trials Registry identifier: PACTR202402642155729.

Background: The availability of medical intensive care unit (MICU) services is limited, which is the main obstacle to providing optimal care to critically ill patients. Describing disease patterns and clinical outcomes will help make better use of the limited resources. This retrospective study was conducted to determine the pattern and outcome of MICU admissions to aid continuous quality improvement in obstetric care. Materials and methods: This was a retrospective study conducted in a tertiary hospital in northeastern Tanzania. Data on participant characteristics were collected from patient records for all MICU admissions to identify the pattern of disease, length of stay, and clinical outcome from 1st January 2018 to 31st December 2020. Descriptive statistics were presented as frequencies, proportions, and tables. The odds ratio was generated for the relationship between MICU admission outcome and participant characteristics. A p-value <0.05 was considered statistically significant. Results: Of the 1425 patients analyzed, 780 (54.7%) were males. Most patients (61.5%) were admitted to the MICU from the emergency department. The overall mortality rate was 37.6%. Mortality was associated with being over 75 years old (OR 1.66, 95% CI 1.20–2.30, P 0.002), being transferred from the medical ward (OR 1.46, 95% CI 1.16–1.82, P 0.001), having a communicable disease (OR 2.63, 95% CI 1.98–3.50, P <0.001), and having cardiovascular disease (OR 1.46, 95% CI 1.14–1.86, P 0.002). Conclusion: The overall mortality rate in the MICU was high. Elderly patients, transfers from the medical ward, and short ICU stays were significantly associated with the poor outcome of MICU patients. Further studies are needed to better appreciate the causes underlying MICU admission outcomes.

Background: There has been increasing evidence of the association between hyperuricemia and diabetes mellitus (DM). In the general population, hyperuricemia has been associated with pre-diabetes. In DM patients, hyperuricemia has been associated with poor outcomes. Objectives: The objective was to determine the proportion of hyperuricemia and associated factors among patients with type 2 DM in Mwanza, Tanzania. Design: This was a cross-sectional study. Methods: This study was conducted from January to March 2023 among patients with type 2 DM attending clinic at Bugando Medical Centre, Mwanza. Data was obtained from a structured questionnaire. Serum uric acid, HbA1c, lipid profile, and renal functions were analyzed. Analysis was done via STATA version 17. The primary outcome was the proportion of hyperuricemia among patients with type 2 DM, and logistic regression models were used to analyze associated factors. Results: Out of 360 patients, 59.7% were female. The median age was 61 years [IQR 57-68], and the median duration of DM was 5 years [IQR 3-9]. The mean HbA1c was 8.2 ± 2.5%, with 60% of patients having poor control. Most patients had hypertension (78.9%) and were overweight or obese (81.9%). The proportion of patients with DM and hyperuricemia was 44.4%, with mean serum uric acid levels among males and females of 410 ± 137 and 385 ± 119 µmol/L, respectively. We found that being female (P = .001), overweight (P = .021), or obese (P = .007), and having chronic kidney disease (P < .001) was associated with hyperuricemia among patients with type 2 DM. Conclusion: The burden of hyperuricemia among type 2 DM patients is quite high, and it is associated with female gender, high body mass index, lipids, and chronic kidney disease. This calls for regular screening of hyperuricemia in the population, and more studies are needed to establish the outcomes associated with hyperuricemia and create a treatment guideline.