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Background As coronavirus disease 2019 (COVID-19) spreads, weak health systems must not become a vehicle for transmission through poor infection prevention and control practices. We assessed the compliance of health workers with infection prevention and control practices relevant to COVID-19 in outpatient settings in Tanzania, before the pandemic.Methods This study was based on a secondary analysis of cross-sectional data collected as part of a randomised controlled trial in private for-profit dispensaries and health centres and in faith-based dispensaries, health centres, and hospitals, in 18 regions. We observed provider-patient interactions in outpatient consultation rooms, laboratories, and dressing rooms, and categorised infection prevention and control practices into four domains: hand hygiene, glove use, disinfection of reusable equipment, and waste management. We calculated compliance as the proportion of indications (infection risks) in which a health worker performed a correct action, and examined associations between compliance and health worker and facility characteristics using multilevel mixed-effects logistic regression models. FindingsBetween Feb 7 and April 5, 2018, we visited 228 health facilities, and observed at least one infection prevention and control indication in 220 facilities (118 [54%] dispensaries, 66 [30%] health centres, and 36 [16%] hospitals). 18 710 indications were observed across 734 health workers (49 [7%] medical doctors, 214 [29%] assistant medical officers or clinical officers, 106 [14%] nurses or midwives, 126 [17%] clinical assistants, and 238 [32%] laboratory technicians or assistants). Compliance was 6•9% for hand hygiene (n=8655 indications), 74•8% for glove use (n=4915), 4•8% for disinfection of reusable equipment (n=841), and 43•3% for waste management (n=4299). Facility location was not associated with compliance in any of the infection prevention and control domains. Facility level and ownership were also not significantly associated with compliance, except for waste management. For hand hygiene, nurses and midwives (odds ratio 5•80 [95% CI 3•91-8•61]) and nursing and medical assistants (2•65 [1•67-4•20]) significantly outperformed the reference category of assistant medical officers or clinical officers. For glove use, nurses and midwives (10•06 [6•68-15•13]) and nursing and medical assistants (5•93 [4•05-8•71]) also significantly outperformed the reference category. Laboratory technicians performed significantly better in glove use (11•95 [8•98-15•89]), but significantly worse in hand hygiene (0•27 [0•17-0•43]) and waste management (0•25 [0•14-0•44] than the reference category. Health worker age was negatively associated with correct glove use and female health workers were more likely to comply with hand hygiene.Interpretation Health worker infection prevention and control compliance, particularly for hand hygiene and disinfection, was inadequate in these outpatient settings. Improvements in provision of supplies and health worker behaviours are urgently needed ...

Background: Lactational mastitis is a maternal morbidity that affects the wellbeing of women and their babies, including through breastfeeding discontinuation. Research Aim: To systematically review the available global literature on the frequency of lactational mastitis, and to summarize the evidence on risk factors for lactational mastitis. We also describe gaps in the evidence and identify priority areas for future research. Methods: We systematically searched and screened 6 databases and included 26 articles, conducted meta-analysis of disease frequency, and narratively synthesized evidence on risk factors. Results: In 11 (42%) articles researchers reported a measure of disease frequency; 5 (19%) reported risk factors, and 10 (39%) included both. Overall, the quality of studies was low, related to suboptimal measurement of disease frequency, high risk of bias, reverse causality, and incomplete adjustment for confounding. Meta-analysis was based on 3 studies (pooled incidence between birth and Week 25 postpartum: 11.1 episodes per 1,000 breastfeeding weeks; 95% CI [10.2–12.0]); with high heterogeneity across contexts and highest incidence in the first four weeks postpartum. Researchers assessed 42 potential risk factors; nipple damage was the most frequently studied and strongly associated with mastitis. There was a scarcity of studies from low-resource settings. Conclusions: Lactational mastitis is a common condition, but the wide variability in incidence across contexts suggested that a substantial portion of this burden might be preventable. Provision of care to breastfeeding women at risk for or affected by mastitis is currently constrained due to a critical lack of high quality epidemiological evidence about its incidence and risk factors.

BackgroundMalnourished HIV-infected African adults are at high risk of early mortality after starting antiretroviral therapy (ART). We hypothesized that short-course, high-dose vitamin and mineral supplementation in lipid nutritional supplements would decrease mortality.MethodsThe study was an individually-randomised phase III trial conducted in ART clinics in Mwanza, Tanzania, and Lusaka, Zambia. Participants were 1,815 ART-naïve non-pregnant adults with body mass index (BMI) <18.5 kg/m2 who were referred for ART based on CD4 count <350 cells/μL or WHO stage 3 or 4 disease. The intervention was a lipid-based nutritional supplement either without (LNS) or with additional vitamins and minerals (LNS-VM), beginning prior to ART initiation; supplement amounts were 30 g/day (150 kcal) from recruitment until 2 weeks after starting ART and 250 g/day (1,400 kcal) from weeks 2 to 6 after starting ART. The primary outcome was mortality between recruitment and 12 weeks of ART. Secondary outcomes were serious adverse events (SAEs) and abnormal electrolytes throughout, and BMI and CD4 count at 12 weeks ART.ResultsFollow-up for the primary outcome was 91%. Median adherence was 66%. There were 181 deaths in the LNS group (83.7/100 person-years) and 184 (82.6/100 person-years) in the LNS-VM group (rate ratio (RR), 0.99; 95% CI, 0.80–1.21; P = 0.89). The intervention did not affect SAEs or BMI, but decreased the incidence of low serum phosphate (RR, 0.73; 95% CI, 0.55–0.97; P = 0.03) and increased the incidence of high serum potassium (RR, 1.60; 95% CI, 1.19–2.15; P = 0.002) and phosphate (RR, 1.23; 95% CI, 1.10–1.37; P <0.001). Mean CD4 count at 12 weeks post-ART was 25 cells/μL (95% CI, 4–46) higher in the LNS-VM compared to the LNS arm (P = 0.02).ConclusionsHigh-dose vitamin and mineral supplementation in LNS, compared to LNS alone, did not decrease mortality or clinical SAEs in malnourished African adults initiating ART, but improved CD4 count. The higher frequency of elevated serum potassium and phosphate levels suggests high-level electrolyte supplementation for all patients is inadvisable but the addition of micronutrient supplements to ART may provide clinical benefits in these patients.Trial registrationPACTR201106000300631, registered on 1st June 2011.