Kilimanjaro Christian Medical University College

A health system is a network of institutions, people, organizations, as well as resources aimed at delivering health care. We conducted an extensive review of the literature using Google Scholar and PubMed to identify relevant peer-reviewed articles, reports, and policy documents published from 2000 to date. Keywords such as “health systems,” “Tanzania,” “Nigeria,” “World Health Organization (WHO) building blocks,” “health service delivery,” “health financing,” and “access to essential medicines” were used. Inclusion criteria were defined to ensure the selection of articles that provided insights into the six WHO building blocks: Health service delivery, leadership/governance, access to essential medicines, health information systems, health financing, and health workforce. Appraising and analyzing the current state of their health systems, we found several similarities and some peculiarities contributing to the success and poor delivery of health. The probable causes of the inefficiencies were analyzed, and recommendations and strategies targeted at improving the current state of the health systems of Tanzania and Nigeria were suggested. Comparing the health systems of the two countries has highlighted some strengths that each nation can adopt to improve healthcare delivery, as well as identified multiple weaknesses that require attention to ensure the provision of high-quality care across both systems.

Objective. Population growth and ageing are placing increasing pressure on eye care services. We present a model estimating comprehensive eye care needs using data across six countries. Methods and analysis. We used cross-sectional data from community screening programmes (n = 2,338,193; all ages) conducted in 2022 - 2023 in India, Pakistan and Nepal (South Asia) and Kenya, Tanzania and Uganda (sub-Saharan Africa). Total eye care need was defined as the presence of distance visual impairment (VI), near VI, or any other eye condition requiring care in at least one eye, reported with 95% confidence intervals (CI). Distance and near VI were assessed on presenting visual acuity, measured with existing correction where available; estimates therefore reflect unmet need rather than total impairment. Logistic regression identified factors associated with increased need, reported as adjusted odds ratios (AORs). Results. Among those aged ≥ 50 years, the prevalence of distance VI was 36.3% (95% CI: 36.1 - 36.5), and 74.8% (95% CI: 74.6 - 74.9) had at least one eye care need. In those aged < 50 years, the prevalence of distance VI was 6.3% (95% CI: 6.2 - 6.3), and 19.9% (95% CI: 19.8 -19.9) had at least one eye care need. Higher need was observed among older individuals (AOR: 1.06 per year), females (AOR: 1.13), and in programmes conducted in sub-Saharan Africa compared to South Asia (AOR: 2.75); all p-values < 0.001. Conclusion. This study expands knowledge by including all age groups, all types of eye care needs, and each affected eye, not only bilateral problems, offering a more complete picture of eye care needs in mass screening programmes. ### Competing Interest Statement The authors have declared no competing interest. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The screening programmes were delivered as part of routine eye care service delivery, with the involvement of local health authorities, and participation was voluntary. Review by a research ethics committee was not required, as the data used in this study were routine programme data collected as part of service delivery, and the analysis was conducted on anonymised data. Data storage, transmission and retrieval were governed by Data Protection Agreements with local stakeholders in each country and complied with the European Union General Data Protection Regulation (GDPR). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

The burden of Acute Myocardial Infarction (AMI) is growing in sub-Saharan Africa. In Tanzania, uptake of diagnostic testing and evidence-based therapy for AMI is suboptimal. We aimed to describe current gaps in evidence-based AMI care in a Tanzanian emergency department (ED) and estimate the potential benefit of closing key performance gaps. Adults presenting with chest pain or dyspnea to the Kilimanjaro Christian Medical Centre (KCMC) ED were prospectively enrolled from February to September 2023 and their diagnostic tests and treatments were recorded. Thirty days following enrollment, a follow-up telephone survey was administered to assess mortality and medication use. Key performance metrics included the proportion of participants receiving both electrocardiography (ECG) and cardiac biomarker testing, as well as the proportion of participants with AMI receiving evidence-based therapies. To estimate the benefits of closing performance gaps, the annualized number of participants not receiving each evidence-based therapy was divided by published numbers needed to treat (NNTs) for each intervention. An exploratory analysis was conducted using performance metrics at KCMC and published national incidence data to estimate the potential benefits of closing performance gaps in AMI care at scale across Tanzania. Of 275 enrolled participants, 41 (14.9

Background: Chronic pain is complicated by comorbid substance misuse. This multifaceted problem increases the risks of polypharmacy, overdose, impaired driving, and avoidable emergency care. Methods: This is an observational study of a convenience sample of twenty adult chronic pain patients who underwent regular monthly intramuscular ketamine for multimodal pain therapy. Ketamine was administered at 0.25 mg/kg per treatment session. Each treatment also involved lidocaine plus magnesium nerve blocks. The cohort was profiled by gender and substance misuse category (benzodiazepine, cocaine, kratom, opioid). Numeric pain score, Severity of Dependence Scale (SDS), and PHQ-9 scores were analyzed. Results: Females comprised 55% (11/20) and males 45% (9/20). Opioids were the most frequent misuse category (45%; 9/20), followed by benzodiazepines (25%; 5/20), cocaine (20%; 4/20), and kratom (10%; 2/20). After repeated treatments, substance misuse improved in all patients, with concordant improvements in mood, pain, and dependence severity. PHQ-9 improved from moderately severe to mild mood disorder, pain improved from severe to moderate, and SDS improved to satisfactory levels. Conclusion: These outcomes indicate that ketamine-based chronic pain therapy is a potential system for integrated substance-misuse therapy within value-based healthcare, highlighting measurable outcomes, risk mitigation, and public safety. Future studies should include larger prospective studies and collaboration with clinical pharmacists and public safety professionals.

Purpose: Patient satisfaction after urethroplasty is underexplored, as traditional outcome assessments rely on objective measures, like imaging and invasive tests, overlooking patients’ perspectives and the associated factors that influence their overall experience. Materials and methods: A prospective cohort study was conducted between August 2024 and July 2025 at Kilimanjaro Christian Medical Centre (KCMC), a tertiary referral hospital in northern Tanzania. Male patients undergoing urethroplasty for urethral stricture disease were consecutively enrolled using convenience sampling. Preoperative and three-month postoperative assessments were done using the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) tool. Data on demographics, clinical characteristics, symptoms, postoperative treatment satisfaction at three months, and quality of life (QoL) were collected using a Swahili-translated questionnaire. Data were analysed using IBM SPSS version 25, with paired t-tests and relative risk used to assess changes and associations. Results: A total of 32 male patients (mean age 54 ± 19 years) underwent urethroplasty. Trauma was the most common cause (75%), and the bulbar urethra was the most affected site (78%). At the three-month follow-up, 81.3% of patients reported being very satisfied with their surgical outcomes, while 18.7% were dissatisfied. Among satisfied patients, significant improvements were observed in lower urinary tract symptom (LUTS) severity, QoL, and urine stream (p < 0.001). Dissatisfaction was associated with age ≥ 45 years, immediate postoperative complications, stricture recurrence, and lower USS-PROM score reductions in LUTS and QoL domains (p < 0.05). Conclusion: Most patients reported high satisfaction with urethroplasty outcomes. However, dissatisfaction was linked to older age, complications, and poor symptom improvement. Our findings underscore the value of incorporating patient-reported outcome measures (PROM) in routine postoperative follow-up.