Objective To determine the factors associated with poor glycemic control in children (1‐10 years), adolescents (11‐18 years) and young adults (19‐40 years) with Type 1 Diabetes Mellitus (T1DM) in Kilimanjaro Christian Medical Center (KCMC) in Moshi, Mount Meru Regional Referral Hospital (MMRRH) and Meru District Hospital (MDH) in Arusha, Tanzania. Methods Cross sectional study of 150 participants conducted from January to June 2019, data was collected by structured questionnaire and analyzed using SPSS version 23. Results The mean HbA1c was 12.3 ± 2.2%, 146 had poor glycemic control (HbA1c > 7.5%). BMI, insulin regime and caretaker education were associated with poor glycemic control. There were 16 participants diagnosed in DKA and the most frequently reported complications in the prior 3 months were hyperglycemia (n = 25), DKA (n = 18) and hypoglycemia (n = 4). Conclusions Glycemic control is still very poor particularly in adolescents. Significant associations with glycemic control were higher BMI, insulin regime and guardian education. The study revealed lower prevalence of DKA at diagnosis compared to previous studies.

Objective To determine the placental pathologies and maternal factors associated with stillbirth at Kilimanjaro Christian Medical Centre, a tertiary referral hospital in Northern Tanzania. Methods A 1:2 unmatched case-control study was carried out among deliveries over an 8-month period. Stillbirths were a case group and live births were the control group. Respective placentas of the newborns from both groups were histopathologically analyzed. Maternal information was collected via chart review. Mean and standard deviation were used to summarize the numerical variables while frequency and percentage were used to summarize categorical variables. Crude and adjusted logistic regressions were done to test the association between each variable and the risk of stillbirth. Results A total of 2305 women delivered during the study period. Their mean age was 30 ± 5.9 years. Of all deliveries, 2207 (95.8%) were live births while 98 (4.2%) were stillbirths. Of these, 96 stillbirths (cases) and 192 live births (controls) were enrolled. The average gestational age for the enrolled cases was 33.8 ±3.2 weeks while that of the controls was 36.3±3.6 weeks, (p-value 0.244). Of all stillbirths, nearly two thirds 61(63.5%) were males while the females were 35(36.5%). Of the stillbirth, 41were fresh stillbirths while 55 were macerated. The risk of stillbirth was significantly associated with lower maternal education [aOR (95% CI): 5.22(2.01–13.58)], history of stillbirth [aOR (95%CI): 3.17(1.20–8.36)], lower number of antenatal visits [aOR (95%CI): 6.68(2.71–16.48), pre/eclampsia [aOR (95%CI): 4.06(2.03–8.13)], and ante partum haemorrhage [OR (95%CI): 2.39(1.04–5.53)]. Placental pathology associated with stillbirth included utero-placental vascular pathology and acute chorioamnionitis. Conclusions Educating the mothers on the importance of regular antenatal clinic attendance, monitoring and managing maternal conditions during antenatal periods should be emphasized. Placentas from stillbirths should be histo-pathologically evaluated to better understand the possible aetiology of stillbirths.

Background Approximately 200 million women and girls were reported to have undergone female genital mutilation worldwide in 2015.UNICEF’s data based on household survey estimates 15% of women from 15–49 years have undergone FGM from year 2004–2015. Despite this, reliable data on trend of prevalence of female genital mutilation and its associated birth outcomes have not been documented in Tanzania. This study aimed at determining the trends of female genital mutilation and associated maternal and neonatal adverse outcomes in northern Tanzania. Methods A cross-sectional study was conducted using maternally-linked data from Kilimanjaro Christian Medical birth registry involving 30,286 women who gave birth to singletons from 2004–2014. The prevalence of female genital mutilation was computed as proportion of women with female genital mutilation yearly over 10 years. Odds ratios with 95% confidence intervals for adverse birth outcomes associated with female genital mutilation were estimated using multivariable logistic regression model. Results Over the 10-year period, the prevalence of female genital mutilation averaged 15.4%. Female genital mutilation decreased from 23.6% in 2005 to 10.6% in 2014. Female genital mutilation was associated with increased odds for caesarean section (aOR1.26; 95% CI: 1.18–1.34), post-partum haemorrhage (aOR 1.31; 95% CI: 1.10–1.57) and long hospital stay (aOR 1.21; 95% CI: 1.14–1.29). Female genital mutilation also increased women’s likelihood of delivering an infant with low Apgar score at 5th minute (aOR 1.60; 95% CI: 1.37–1.89).FGM type III and IV had increased odds of caesarean section, episiotomy and prolonged duration of hospital stay as compared to FGM type I and II, although the association was statistically insignificant. Conclusion Female genital mutilation prevalence has declined over the study period. Our study has demonstrated that postpartum haemorrhage, delivery by caesarean section, long maternal hospital stays and low APGAR score are associated with FGM. Initiatives to mitigate FGM practice should be strengthened further to reduce/eliminate this practice. Moreover, surgical interventions to improve severe form FGM are welcomed to improve the aforementioned aspects of obstetric outcome in this locality.

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Purpose: In sub-Saharan Africa, cancer treatment facilities are often scarce and centered in urban areas, which means many patients must travel long distances to reach cancer care. Still, little is known about how this distribution of cancer centers impacts patients' ability to access care. Methods: Records of all pediatric patients (<18yo) treated for cancer in Tanzania in 2019 through the Tanzanian Pediatric Cancer Network were reviewed. This network represents all 9 hospitals currently treating children with cancer in Tanzania. Demographic and diagnostic information was recorded. ArcGIS was used to estimate patients' travel times from home addresses to cancer care. AccessMod was used to calculate 4-hour access for the population. Results: In 2019, a total of 821 pediatric patients were diagnosed with cancer with an incidence of 1.42/100,000 population. The most common diagnoses were Wilms tumor (17.2%, n=134), retinoblastoma (16.8%, n=131), and acute lymphoblastic leukemia (15.9%, n=124). There was regional variation by diagnosis, with the Lake Zone having the highest incidence of Burkitt lymphoma (0.29; average 0.15) and retinoblastoma (0.5; average 0.33). Reported regional incidence inversely correlated to distance to cancer treatment facility. Median travel time to cancer care for patients was 4.55 hours. Currently 74.5% of the population lives within 4 hours of existing cancer care facilities, and it would require adding cancer care capacity to 8 additional facilities to reach 95% coverage. Conclusions: This is the first comprehensive evaluation of the incidence of presenting pediatric cancer patients in Tanzania. Only 18.8% of the estimated pediatric patients with cancer in Tanzania were treated in 2019. The reported incidence was lower in areas further away from treatment centers, suggesting the importance of increased access to cancer care facilities as part of a future national scale-up strategy. Citation Format: Luke Maillie, Alice Mutagonda, Lulu Chirande, Laiti Rehema, Shakilu Jumanne, Elton Meleki, Furaha Serventi, Julius Alloyce, Franco Afyusisye, Sebastian Sanchez, Matthew Sisk, Marie Jose Voeten, Ester Kawira, Heronima Joas, Trish Scanlan, Kristin Schroeder. The Tanzanian Pediatric Cancer Network: A Comprehensive Evaluation of the Incidence of Presenting Patients and Access to Pediatric Cancer Care in Tanzania [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 101.