Bugando Medical Centre (BMC) is a tertiary care medical facility owned by the Episcopal Conference of the Catholic Bishops of Tanzania. The hospital is operated in collaboration with the Tanzania Ministry of Health and Social Welfare.
Background Stroke is a leading cause of death and disability globally, with sub-Saharan Africa, bearing the greatest burden. Tanzania has only one active stroke registry, limiting evidence-based care and policy development. We aimed to expand the registry into a multi-centre study across eight major tertiary hospitals to generate baseline data for a national stroke registry. Methods From January to August 2024, we analysed de-identified data from adults (≥18 years) admitted with a World Health Organisation defined stroke. Data collected included demographics, risk factors, imaging, and in-hospital mortality. Logistic regression identified predictors of mortality. Results A total of 1000 patients were registered with a mean age 60.2±15 years and 56.2% (562/1000) were females. Most strokes occurred in those aged 50-69 years 46.3% (463/1000). Hypertension was the most common risk factor 90.1% (901/1000), followed by diabetes 13.1% (131/1000), prior stroke 10.6% (106/1000) and HIV infection 3.5% (35/1000). Haemorrhagic and ischaemic strokes accounted for 57.9% (579/1000) and 38.3% (383/1000) of cases, respectively; and 5% (19/383) of ischaemic strokes presented within 4.5 h from symptom onset. In-hospital mortality was 31.5% (315/1000), highest among patients aged 50–59 years (23.2%). Independent predictors of mortality included previous cardiac disease (aOR 2.15; 95% CI: 1.18–3.94) and haemorrhagic stroke (aOR 1.38; 95% CI: 1.12–2.02). Conclusions Stroke imposes a high burden in Tanzania, with substantial mortality and delayed presentation. Strengthening hypertension control, early stroke recognition, and organized stroke unit care are critical priorities. These findings provide foundational data for the national stroke surveillance initiative and support evidence-based planning for stroke prevention, acute care, and system readiness across Tanzania.
Background Accurate grossing and histopathological reporting of colorectal cancer (CRC) resection specimens are critical for staging, prognostication and treatment planning. International guidelines such as those developed by the International Collaboration on Cancer Reporting (ICCR) provide standardized datasets to improve reporting quality. However, implementation of these standards remains inconsistent in many low- and middle-income countries (LMICs). Methods We conducted a retrospective cross-sectional audit of colorectal cancer resection specimens reported at the Central Pathology Laboratory of Muhimbili National Hospital, Tanzania, between January 2019 and December 2021. Histopathology reports, archived slides and clinical request forms were reviewed. Data were extracted using the ICCR colorectal cancer reporting checklist to assess adequacy of pre-analytical clinical information, grossing practices and histopathological reporting. Results A total of 183 colorectal cancer resections were included. The mean age of patients was 52.7 (± 14.9)years and 59% were male. Clinical information accompanying specimens was generally adequate with clinical impression provided in 83.6% of cases and type of colectomy documented in 91.3%. However, neoadjuvant therapy history (57.4%) and intraoperative tumor extent (50.8%) were frequently missing. Grossing documentation was satisfactory for tumor location (90.7%) and margin sampling of proximal (95.1%) and distal margins (99.5%). Major deficiencies were observed in lymph node harvesting (44.8%) and radial margin sampling (45.9%). Histopathology reports consistently included histologic subtype and tumor extension (92.3%), but lymph node status (67.2%), pathological staging (71%) and radial margin status (45.9%) were incompletely reported. Provision of detailed intraoperative findings was significantly associated with improved grossing and reporting quality. Conclusion Significant gaps exist in the pathology handling and reporting of colorectal cancer resections at a national referral hospital in Tanzania. Deficiencies in lymph node assessment, circumferential margin evaluation and standardized staging may compromise prognostic assessment and treatment planning. Adoption of ICCR synoptic reporting and strengthened multidisciplinary communication are urgently needed to improve pathology quality standards in resource-limited settings.
This project aimed to reintroduce and evaluate a pediatric ketamine sedation protocol at a Zonal Referral Center in Mwanza, Tanzania, where nonanesthesia clinicians provide sedation when trained anesthesia personnel are unavailable. The objectives were to assess knowledge retention, confidence, and protocol compliance. The study design used a pre- and postintervention design. Nonanesthesia clinicians at a > 1,000-bed hospital were surveyed to assess their knowledge and confidence about ketamine sedation. Over 10 days, 50 clinicians received training that included lectures and cognitive aid resources in English and Swahili (the local language). Knowledge and confidence were measured using paired surveys. Clinicians were observed for compliance, skill demonstration, and feedback during postimplementation sedation encounters. Results showed significant improvements in knowledge (M = 6.93-8.77; P = .001) and confidence (M = 5.94-8.98; P = .001). Seven sedation encounters were observed over a 7-day period, and compliance with the presedation assessment was 100% for last food or drink intake, allergy history, and medication history. Reintroducing this protocol in a low-resource setting led to improvements in knowledge, confidence, and skills among nonanesthesia clinicians.
Background: Antiretroviral therapy improves outcomes for people living with HIV (PLHIV) and prevents transmission through viral load suppression (VLS). To evaluate progress toward HIV epidemic control, VLS prevalences and correlates among PLHIV were analyzed from Tanzania HIV Impact Assessment Surveys (THIS), independent, cross-sectional using stratified-cluster design, conducted in 2016-2017 (S1) and 2022-2023 (S2). Methods: Participants 15 years and older provided consent, completed an interviewer-administered questionnaire, and tested for HIV using the national rapid testing algorithm. HIV-positive specimens were tested for viral load. Prevalence of population VLS (<1000 copies/mL) was determined irrespective of HIV-knowledge or antiretroviral therapy status. Modified Poisson Regression Model was used. We reported percentages (%) and adjusted prevalence ratios with 95% confidence intervals (CIs) accounting for complex survey design. Results: We analyzed data from 1830 PLHIV in S1 and 1849 in S2. Population VLS prevalence increased by 26.1% (95% CI: 22.1 to 30.2, P < 0.0001) between surveys. In both surveys, women were more likely to experience VLS [S1: 1.43 (95% CI: 1.25 to 1.63), S2: 1.15 (95% CI: 1.06 to 1.24)] than men. In both surveys, PLHIV 35 years and older were more likely to experience VLS than those 15-24 years, [S1 35-49 years: 1.46 (95% CI: 1.13 to 1.90), 50 years and older: 1.69 (95% CI: 1.28 to 2.23), and S2 35-49 years: 1.31 (95% CI: 1.06 to 1.62), 50 years and older: 1.42 (95% CI: 1.15 to 1.76)]. Conclusion: Tanzania has made progress toward HIV epidemic control, as evidenced by the significant increase in VLS prevalence in 6 years. Targeted sex-age strategies are essential for HIV epidemic control.
Background: Vitamin D deficiency (VDD) is a global public health problem which affects all age groups and it is prevalent even in countries with adequate sunlight due to inadequate sunlight exposure and consumption of diet poor in vitamin D. The effects of VDD peak between 3 to 18 months due to increased requirement of vitamin D. This study was done in order to determine the prevalence and predictors of VDD among children attending Makongoro reproductive and child health (RCH) in Mwanza, Tanzania Methods: This was a cross sectional study involving children aged 1 month and 2 weeks to 24 months attending Makongoro RCH clinic in Mwanza Tanzania. The sample size for prevalence was estimated using Kish Leslie formula while double proportion formula was used for calculations of predictors of low serum vitamin D levels. Convenient sampling was therefore used to recruit 305 children who met the inclusion criteria. Social demographic and clinical data were obtained using data collection tool. Rapid vitamin D (25-hydroxy-vitamin-D [25(OH)D]) test was done followed by serum 25(OH)D and calcium levels in all children with positive rapid 25(OH)D test results. Vitamin D deficiency was defined as serum levels <20ng/ml and Vitamin D insufficiency (VDI) when levels were between 20 and 30ng/ml. Hypocalcaemia was defined as serum ionized calcium <1.17mmol/l. Data was analyzed using STATA version 13. Results: A total of 305 children were enrolled in this study. While normal serum vitamin D levels were observed in 80% of the studied children, 9% had VDI and 11% had VDD. Low serum vitamin D levels were independently associated with prematurity (OR 6.9, 95% CI; 2.28-20.69,P=.001), delayed milestones (OR 3.3, 95% CI; 1.38-28.57, P =.03), inadequate sun exposure (OR 12, 95% CI; 4.14-35.49, P<.001) and malnutrition (OR= 7.9, 95% CI; 1.91-32.96, P=.004). Hypocalcaemia was observed in 24% of children with low serum vitamin D levels. Conclusion: Substantial proportion of children attending Makongoro RCH clinic have VDD. Prematurity, inadequate sun exposure, malnutrition and delayed milestones significantly predicted low serum vitamin D levels hence screening should be prioritized in children with these conditions.
