Introduction: Highly skilled and competent human resources are needed for quality healthcare services. There is a growing concern about unemployment among health professionals in Sub-Saharan Africa. Employers in many developing countries reportedly complain that graduates lack in-demand employable skills. Objective: We aimed to examine the experiences of graduates and employers regarding the perceived required attributes for the employability of graduates from health-related programs in Tanzania. Methods: We used an exploratory qualitative approach though this specific report focuses on the qualitative findings from a secondary analysis which was conducted from December 2022 to February 2023. Data were collected across nine regions in Tanzania, including zonal and regional hospitals. Participants were purposefully selected MUHAS alumni who graduated in 2017 or later and their immediate supervisors at regional and zonal hospitals chosen due to their capacity employment of MUHAS graduates. Data collection involved semi-structured in-depth interviews, mostly conducted face-to-face in Kiswahili. Data analysis employed the framework method for content analysis, involving transcription, familiarization, thematic framework development, coding, and indexing. The analysis specifically focused on specialist medical doctors, specialist nurses, and specialist pharmacists. Results: A total of 282 in-depth interviews were conducted, comprising 238 alumni and 44 supervisors/employers. Five themes emerged from the qualitative interviews including employability and career trajectories, curriculum relevance to labour market needs, supervisory and learning experiences, workplace readiness and professional skills and working within the system and system and institutional factors affecting employability. Conclusion: The employability of graduates depends on the attributes they possess, which employers considered positively. Both employers and alumni hold high expectations for the attributes of MUHAS graduates. The study suggests that graduate tracking is important for quality improvement, along with regular evaluation of competencies demanded by the labor market. The findings support a multidimensional view of employability, including knowledge, skills, personal characteristics, and social experience. The perceived facilitators and barriers to employability should be considered positively during curriculum revision.
Background: Iodine deficiency is a major public health problem and a leading cause of preventable cognitive impairment globally. It accounts for approximately 90% of goiter cases and 5–15% of cretinism in severely endemic areas. To address iodine deficiency disorders (IDD), Tanzania implemented Universal Salt Iodization (USI) in 1994. However, previous assessments indicated that household coverage of adequately iodized salt was below the World Health Organization (WHO) recommended level of ≥90%. Regular monitoring is recommended every three years. This study assessed knowledge of iodine and availability of iodized salt among households and street vendors in Nyamagana District, Mwanza, Tanzania. Methods: A cross-sectional mixed-methods study was conducted. A total of 417 participants were included in the quantitative component and 30 in the qualitative component. Salt samples were tested for iodine content using MBI rapid test kits. Quantitative data were analyzed using descriptive statistics (means and percentages), while qualitative data were analyzed using thematic analysis. Results: Of the 417 salt samples tested, 399 (95.7%) contained iodine, with 355 (85.0%) having adequate iodine levels (>15 ppm). All packed salt samples (342, 100%) contained iodine, compared to 45 (97.8%) of unpacked salt and 16 (55.2%) of crude salt. In total, 18 (4.3%) samples contained no iodine, all of which were crude salt. Despite the high availability of iodized salt, knowledge levels were limited. Although 265 (63.5%) participants had heard of iodine, only 217 (51.1%) correctly identified at least one function, and less than one-third (32.6%) could identify any dietary source. Awareness of vulnerable groups requiring higher iodine intake was low (8.9%), and only 6 (1.4%) participants reported checking salt labels to confirm iodization. Additionally, improper storage practices were common, with 98 (23.5%) storing salt in open containers, which was associated with lower iodine levels. Qualitative findings revealed widespread misconceptions about iodized salt, including beliefs that it contains harmful chemicals and that crude salt is superior. Conclusion: High availability of iodized salt indicates substantial progress in USI implementation in Tanzania. However, gaps in public knowledge persist. Strengthening community education alongside continued monitoring and enforcement of iodization standards is essential to sustain achievement.
Introduction Peritonitis remains a significant cause of morbidity and mortality among surgical patients. Understanding its aetiology and antimicrobial susceptibility is essential for effective treatment. This study investigates the causative organisms, antimicrobial agents used, and sensitivity patterns among patients with peritonitis who underwent surgery at Kilimanjaro Christian Medical Centre in northern Tanzania. Methods A prospective hospital-based cross-sectional study was conducted at Kilimanjaro Christian Medical Centre (KCMC) from October 2015 to March 2016 on admitted patients. Peritoneal fluid (5-10) mls and aerobic culture using standard microbiological techniques was taken during the operation. Antibiotic sensitivity testing was conducted against locally available antibiotics using the disk diffusion method. Results A total of 60 patients with a median age of 22.5 and an interquartile range (IQR) of 12.0-44.5 were enrolled in this study, and the majority (65.0%) of them were males. Secondary peritonitis was the leading cause of peritonitis by 81.7%, mainly due to ruptured appendix (41.6%), gastric perforation (10.0%), jejunum perforation (10.0%), and ileal perforation (8.3%). Gram-negative bacteria were the most frequently isolated bacteria. Escherichia coli (38.2%) was the most frequently isolated bacterium, followed by coliform species (14.8%) and another Streptococcus pyogenes, Staphylococcus aureus, and Klebsiella pneumoniae, all of which were isolated by 11.8%. Most of the gram-negative bacteria were sensitive to Amikacin (100.0%), Gentamycin (72.7), and Ceftriaxone (54.5%). Gram-positive bacteria were sensitive of 100.0% of Vancomycin, clindamycin, and Ciprofloxacin. All bacteria isolated and tested for ampicillin were resistant. Conclusion The most common causes of secondary peritonitis at Kilimanjaro Christian Medical Centre (KCMC) are perforated appendix, gastroduodenal, and jejunal perforations. Gram-negative bacteria were isolated the most, and E. coli was the commonest. Effective antibiotics for gram-negative bacteria were Amikacin, Gentamycin, and Ceftriaxone, and for gram-positive bacteria were Vancomycin, Clindamycin, and Ciprofloxacin. All bacteria were resistant to Ampicillin.
Background: The term cranial-spinal tumours refer to a mixed group of neoplasms originating from anywhere along the cranium extending up to the sacral region of the spine, including superficial scalp neoplasms to the deep-seated lesions of variable histopathologic pattern, with various presentations, some presenting as primary benign or malignant, metastatic, unilateral or bilateral lesions. Objective: To understand the demographic characteristics and histopathologic patterns of cranial-spinal tumours (CSTs) at a tertiary hospital in Mwanza Methods: Patients who underwent surgery for CSTs at our institution between January 2014 and December 2022 and had histopathologic results were included in a retrospective database. Patients with clinical and radiological diagnosis of CSTs without histopathological results were excluded. Collected data included basic demographics, clinical presentation, and histopathologic findings. Results: A total of 151 cranial spinal tumours in 72 (47.7%) males and 79 (52.3%) female patients were recorded. Pediatric and adult patients were 27% and 73%, respectively. The predominant age group was 40 and 49 years (23.5%). The most common histopathological diagnosis was meningioma (31.3%), followed by gliomas (16.7%), metastatic tumors (10.7%), and lymphomas (7.3%). The meningothelial meningioma was the most common among meningiomas (48.5%). Glioblastoma Multiforme accounted for 36% of the gliomas. Medulloblastoma was the most common among the pediatric group. Conclusion: This retrospective study established a baseline profile of cranial-spinal tumors of 151 patients based on the histopathological experience at BMC. The peak age group was between 40 and 49 years. Meningioma was the most common neoplasm, whereas medulloblastoma was the most common among the pediatric population.
Background: Post-operative wound sepsis by hospital multidrug-resistant strains is a life-threatening phenomenon that poses significant management challenges to medical personnel and often results in increased morbidity and mortality. Case presentation: We report a case of a 38-year-old African woman, para 5 living 4, referred to our facility from a health centre after sustaining an iatrogenic bilateral ureteric injury while undergoing supracervical hysterectomy following a complicated cesarean delivery. Bilateral ureteric re-implantation was done, and 6 days post-operation, she developed wound dehiscence with foul-smelling pus discharge. Multidrug-resistant Acinetobacter spp. and Pseudomonas aeruginosa were isolated from pus and urine cultures, respectively. Conclusion: Healthcare-associated wound sepsis from multidrug-resistant (MDR) pathogens poses severe challenges. Adhering strictly to antibiotic stewardship and infection control measures is crucial, with culture and sensitivity testing essential for appropriate treatment.
Background: Phosphodiesterase-5 inhibitors (PDE5i) are approved for erectile dysfunction but increasingly misused by young men without medical indications. Such non-medical use raises concerns about adverse effects, drug interactions, and risky sexual behaviours. Objectives: To determine the prevalence and factors associated with recreational use of PDE5i among healthy male university students in Tanzania. Methods: This was a cross-sectional study conducted at the Catholic University of Health and Allied Sciences (CUHAS) between April and July 2020, involving male undergraduate students enrolled in medicine, pharmacy, nursing, laboratory sciences, and diploma programmes. A semi-structured online questionnaire was administered via a secure Google Forms platform, with an embedded electronic informed consent form completed before enrolment. Data collected included participant demographics, medical history, substance use, and PDE5i-related knowledge and practices. Logistic regression was used to determine independent factors of PDE5i use. Results: A total of 196 male undergraduate students were enrolled, with a mean age of 24±2.2 years, and 7.7% (15/196) reported PDE5i use. Most accessed drugs without prescription (60%), mainly sildenafil (73.3%). Common side effects included headache (53.3%) and dizziness (46.7%). Older age, cigarette smoking, alcohol consumption, and having a sexual partner were associated with use in crude analysis, but only older age (AOR 4.04, 95% CI 1.20–13.61) and cigarette smoking (AOR 6.8, 95% CI 1.17–39.4) remained independent predictors. Conclusions: Non-medical PDE5i use for sexual enhancement was present among university students, associated with older age and cigarette smoking. These findings highlight the need for awareness of the risks of misuse and stricter regulation of non-prescription access.
Background: Ear infection is a common public health problem in developing countries. There is limited data on the factors associated with ear infections, which have hastened their spread and the repercussions of ear infections, including hearing loss. The study aimed to determine the magnitude and factors associated with ear infection among patients attending the Otorhinolaryngology clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania. Methods: A hospital-based cross-sectional study was conducted from March to July 2021. Participants with signs and symptoms of ear infection who attended the otorhinolaryngology clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania, were recruited into this study. The clinical information from the participants was collected using a standardized data collection tool, and an ear swab was collected and taken to the lab for culture and identification. Data analysis was conducted using Statistical Package for the Social Sciences (SPSS v23), and proportions and percentages were used to indicate the magnitude. The Chi-square test was employed to assess associations between variables, with statistical significance determined at a p-value of 0.05. Logistic regression was used to measure the strength of the association between dependent and independent variables. Results: A total of 255 eligible participants were enrolled, with ages ranging from 1 to above 50 years (median 31 years; IQR: 15–49). The magnitude of ear infection was found to be 53.3% (136 out of 255). The majority (26.8%) of participants with ear infection were elderly above 50 years, followed by children under 10 years (17.9%). Additionally, we observed that the factors such as cotton buds use (AOR 2.78, 95%CI 1.08–7.15, p=0.035) and ear cleaning using objects other than cotton buds, including keys, pins, and pens (AOR 3.45, 95%CI 1.44–8.25, p=0.005), p=0.035), cerumen impaction (AOR 12.86, 95%CI 2.78-59.33, p <0.001), p=0.035), cerumen impaction (AOR 12.86, 95%CI 2.78-59.33, p <0.001), recurrent upper respiratory tract infection (URTI) (AOR 3.43, 95%CI 1.22-10.03, p=0.019), and nasal /congestion/discharge (AOR 3.55, 95% CI 1.36-9.27, p = 0.010) were independently associated with ear infection. Conclusions: The present study has revealed a 53.3% magnitude of ear infection, with elders above 50 years and children below 10 years accounting for most cases. Our study findings showed that nasal congestion, recurrent URTI, use of cotton buds, cerumen impaction and ear cleaning were potential risk factors for ear infection. Recommendations: Health education campaigns promoting safe ear hygiene, early treatment of URTI and nasal congestion, and discouragement of the use of cotton buds and sharp objects for ear cleaning are recommended to reduce the burden of ear infections in similar settings.
Background Oesophageal cancer is among the most common cancers in Tanzania. Patients usually, unfortunately, come to medical care with advanced disease and for this reason, despite advancement in treatment of cancer and multidisciplinary treatment approaches (surgery and chemoradiotherapy), Oesophageal cancer still has a 5-year survival rate of less than 20% and high rate of recurrence after initial treatments. Here in Dar es Salaam, we studied the outcomes of treatment in these cases to have an estimation of the general prognosis of patients and have a general picture of the treatment modalities and outcomes. Methods In this retrospective study we reviewed data of patients which included cancer stage at diagnosis, types of treatments and their treatment outcomes. This involved data from patients who were admitted from January 2015 to December 2017. The total period of survival recorded was taken up to 2yrs from the date of onset of treatment. This study was done in Muhimbili National hospital and Ocean Road Cancer Institute, both located in Dar es Salaam, Tanzania. Results The Study included 128 patients of which 77(60.2%) were males with a general median age of 55.9 years (range: 20 years to 91 years). Majority of the patients were diagnosed at an advanced stage of the disease. Stage III or IV was observed in 82.5% (106/128) of patients with Oesophageal cancer, rendering them to get only palliative therapy (79%). The overall 2-year survival rate was 8%, and the mean duration for local recurrence was 3.6 ± 1.2 months. Late diagnosis was the main factor for poor outcomes and hence low 2-year survival rate. Conclusion and recommendation Oesophageal cancer has higher mortality and shorter survival period because it is diagnosed very late. The treatment offered, therefore, at this stage is usually palliative which doesn’t alter the dismal course of the disease. More efforts are needed to sensitize the general population to seek consultation for early diagnosis and treatment.
Background : Currently, non-communicable diseases (NCDs) are among the global health problems accounting for more than 70% of deaths. Yet, healthcare, workers, university and college students who are key educators to the public are at high risk of NCDs. The objective of this study was to assess modifiable risk factors for NCDs among medical and non-medical university students in Dar es Salaam, Tanzania. Methods : A cross-sectional study included respondents from six universities; split equally between medical and non-medical programmes. From universities with medical programmes, we randomly selected students in clinical track. We administered a modified WHO STEP-1 questionnaire to collect data on modifiable risk factors of NCDs. Results : A total of 574 students participated in the study. Of these, 315 (54.9%) undergraduates were in medical programmes. Few, 7 (3.1%), of the non-medical undergraduates and 14 (4.7%) of the non-medical undergraduates had none of the NCDs risk factors. The proportion of harmful alcohol consumption among medical and non-medical university students was 15 (4.8%) and 6 (2.3%) respectively. Students reporting sedentary lifestyle was significantly (p < 0.01) higher among non-medical undergraduates, 97 (37.5%), as compared to 82 (31.2%) students in non-medical universities. Undergraduates in non-medical programmes have 10% significantly increased prevalence ratio of high modifiable risk as compared to medical university students, (aPR=1.1, 95%CI: 1.0–1.2) independent of age and sex. Conclusion : Tobacco and armful alcohol consumption among students in medical and non-medical universities is low. Reported physical inactivity and unhealthy diet are high. We suggest broader communication strategies targeting university students in medical and non-medical programmes on dangers of NCDs and awareness of their modifiable risk factors.
Introduction The integrase inhibitor dolutegravir (DTG) has recently replaced the non-nucleoside reverse transcriptase inhibitors (efavirenz and nevirapine) in several Sub-Saharan African countries, including Tanzania. Since this change, there is scarce data on the current treatment outcomes focusing on treatment-experienced HIV-infected patients switched to DTG based regimens in Tanzania. Objectives This study aimed to investigate immunological and virological outcomes among treatment-experienced HIV-infected patients who were switched to DTG based regimen in Tanzania. Results We enrolled 397 patients, majority (65%) were female patients with mean age of 42.7 (95% CI; 40.7 – 44.7) years. The mean baseline CD4+ cell count was 457.1 (95% CI; 426.6 – 489.8) cells/mm3 with 8.3% of patients with CD4+ cell count <200 cells/mm3. The mean baseline viral load (VL) was 169.8 (95% CI; 128.8 – 223.9) copies/ml, whereby 20.6% had VL ≥ 1000 copies/ml. After the use of a new fixed dose combination of Tenofovir (TDF) 300 mg + Lamivudine (3TC) 300 mg + DTG 50 mg (TLD) for at least 24 weeks, the overall rate of virological suppression (<50 copies/ml) was 89.9% (95%CI 86.7% - 92.7%). The significant predictors of virological failure were overall duration on ART use (p = 0.004), duration on TDF + 3TC, and Efavirenz (EFV) (TLE) (p = 0.007), and baseline VL (p < 0.001). Conclusion TLD regimen has provided favorable preliminary results among patients who previously used TLE in HIV/AIDS treatment by showing good virological and immunological outcomes. The long-term treatment outcomes require further investigation.
Background Knowledge on the assessment of patients' conscious level by using the Glasgow Coma Scale (GCS) among nurses working in the Intensive Care Unit (ICU) and Emergency Medicine Department (EMD) remains a major challenge. Lack of knowledge and expert skills on assessment of conscious level among nurses has been associated with outcomes such as mortality, prolonged hospitalization, and development of complications associated with the primary conditions and hospitalization. This study aimed at assessing the knowledge on GCS scoring among nurses working in EMD and ICU for possible interventions to improve the quality of nursing care to patients in need of close monitoring. Methods The study used a cross-sectional descriptive approach. Data were obtained from 76 nurses working in EMD and ICU recruited by simple random sampling technique. Data were collected by using a self-administered English structured questionnaire after obtaining informed consent from the study participants. Data were then cleaned for missing information analyzed using SPSS computer software version 21. Descriptive and inferential statistics were used to analyze the demographic and knowledge responses. Fisher's exact test was used to determine the association between socio-demographic characteristics and knowledge level; p<0.05 was considered statistically significant. Results This study included 76 nurses; the majority 42(55.3%) working at the ICU. In general, none of the nurses had attended any formal training on GCS Scoring. Majority of the nurses had moderate level of knowledge 51(67.1%) and none had poor knowledge. Although there was no statistically significant difference in knowledge level among the study nurses based on the socio-demographic characteristics, nurses with age 21-30years, working experience 1-3years, and working in ICU, had good knowledge compared to other subgroups. Conclusion and Recommendations The study found that the majority of the nurses had moderate level of knowledge. Since none of them had attended any formal training hence the level of knowledge demonstrated might be from experience sharing and bedside training. The findings suggest the need for post-basic education training for nurses on GCS scoring. In addition, continual profession training focusing at improving nurses’ skills on GCS scoring should be strengthened.
Background Incidental prostate cancer is detected by histological examination of resected biopsy tissue that has been previously diagnosed as benign. It has the potential for progressing to become a disease necessitating active treatment. There is paucity of data on detection of incidental prostate cancer in Tanzania. A study done in northern Tanzania among the urban public sector revealed an alarming detection rate of 21.71%. We aimed to establish the prevalence of incidental prostate cancer among men surgically treated for benign prostate enlargement with considered normal range of prostate specific antigen. Methods This was a retrospective hospital-based cross-sectional study conducted to establish the prevalence of incidental prostate cancer among men who underwent transurethral resection of prostate with considered normal range of prostate-specific antigen from 2010 to 2019 at Aga Khan Hospital Dar es salaam, Tanzania. To find the prevalence of incidental prostate cancer with 95% confidence level, 5% tolerable error, minimum of 195 participants’ data was reviewed, and factors associated with incidental prostate carcinoma were evaluated by binary regression analysis. Results Total of 195 men were included in the study. The prevalence of incidental prostate cancer among men with prostate-specific antigen levels of less than 5.5ng/mL was 7.2% (95% CI, 4.0 to 11.8%). More than half of the patients had high-grade cancer and three quarters had T1b histological subtype making up the clinically significant category. For every 1-year increase in age from age of 65 years, risk of incidental prostate cancer increased by 1.6 (95% CI, 1.054 to 23.38; P<0.05) and for every unit increase in prostate specific antigen, incidental prostate cancer increased by 2.2 (95% CI, 1.953 to 42.28; P<0.05). Conclusion The Incidental prostate cancer detection rate of 7.2% in our settings is within the range found internationally.
Background The management of adhesive small bowel obstruction has evolved significantly in high income countries with improvements in diagnosis and treatment, from conservative to minimally invasive approaches. In Tanzania, like in many low and middle income economies, these developments have not been herald. Addressing adhesive small bowel obstruction in this setting is therefore vital to improve outcomes. This study aimed to explore current treatment modalities and their outcome among patients with ‘adhesive small bowel obstruction’ at Muhimbili national hospital. Methodology A descriptive retrospective, cross-sectional study was conducted at Muhimbili National Hospital covering the period 2014 to 2016. Patients with a documented diagnosis of adhesive Small Bowel Obstruction were sought from medical records. Using a predefined data capture sheets, age, sex, type of management, complications, mortality and time to feeding (among patients who were managed conservatively) were captured. The study had 80% power to detect a mortality rate of 8.7% at 95% confidence interval. Descriptive statistics were populated and summarized as proportions while mortality between the operated versus the conservative group compared using chi square test with significant value set at p value of <5%. Results A total of 127 patients with diagnosis of adhesive small bowel obstruction were identified. The mean age was 40.5±17.6 and a slight male predominance at a ratio of 1.6:1. Operative approach was predominant over conservative at ratio of 1.7:1. One third of the surgical group had bowel resection and anastomosis performed. In 18.8% of the operated cases, a complication was reported with Enterocutaneous fistula and surgical site infection being the most common. Overall mortality was 8.7% being higher in the operated group at 10%. Conclusion Open surgical approach is the predominant management approach in patients with Adhesive Small Bowel Obstruction. One in three of surgically managed required bowel resection signifying late presentation. Managing adhesive small bowel obstruction carries high morbidity and mortality. There is no standardized protocol for the management of these patients at the tertiary level. Recommendation Locally adoptable protocol for diagnosis and treatment of adhesive small bowel obstruction is needed. This should maximize on resources that are available even at district level facilities with much consideration of the role of surgery.
Background Head and neck cancers are primarily treated by three main modalities; surgery, radiotherapy and chemotherapy administered alone or in combination. Radiotherapy and chemotherapy may cause complications to patients including hearing loss with various outcomes on types and severity. Broad objective To determine the prevalence and pattern of hearing loss among head and neck cancer patients receiving chemotherapy with or without radiation therapy at Ocean Road Cancer Institute, Tanzania. Methodology This was a hospital based descriptive cross sectional study which included 138 histopathological confirmed head and neck cancer patients from June to December 2017. Data collected using structured questionnaires included demographic characteristics, site of the tumor, treatment modality, type of chemotherapy groups used, dosage and duration. Pure tone audiometry at a frequency range of 250HZ to 8000HZ using Amplivox 270 audiometer was performed to all patients after otoscopy. Data was analyzed using Statistical Package for Social Science version 20 and a p value of <0.05 was considered to be statistically significant. Results Out of 138 patients who were involved in the study, 98(71%) had hearing loss. Among 98 patients who had hearing loss, 53(54.1%) received chemotherapy alone and all had sensorineural hearing loss, the remaining 45(45.9%) patients received concurrent chemoradiation and 40(88.9%) had sensorineural hearing loss. Conductive and mixed hearing loss were observed in 3 (6.7%) and 2 (4.4%) patients who received chemoradiation, respectively (p value = 0.045). The severity of sensorineural hearing loss was higher among patients who received chemoradiation than those who received chemotherapy alone (p value =0.682). Use of a single drug group or combined drug groups had no significant difference in terms of outcomes on severity of hearing loss (p value =0.603) but high cumulative doses of platinum and taxane compounds had significant increase in terms of outcomes on severity of hearing loss. (p value =0.003, 0.021 respectively). Conclusion and recommendation Hearing loss following chemotherapy alone or with concurrent chemoradiation therapy is quite prevalent in our settings thus hearing evaluation pre, during and post chemotherapy/radiotherapy is encouraged for earlier detection of hearing loss and establishing prompt intervention.
Background Chronic kidney disease has been on the rise worldwide as well as in sub- Saharan Africa. End-stage renal disease (ESRD) is a major public health problem worldwide and is associated with significant morbidity and mortality. There is a dearth of data on the epidemiology of ESRD patients on renal replacement therapy in sub-Saharan Africa including Botswana. Aim To describe the socio-demographic and clinical profiles of ESRD participants on haemodialysis by gender and HIV status in Botswana. Methods A cross sectional study involving participants undergoing maintenance haemodialysis in three centers was conducted between February and June 2019. Data was analysed using Stata 14 statistical software. Chi-square test, Fisher’s exact test and t-test were used to determine association between socio-demographic/clinical characteristics and gender/HIV status. Results Overall, 107 participants were enrolled and 65.4% were males. Their mean age± standard deviation at the time of initiation of haemodialysis was 47.5+13.0 years. The prevalence of HIV-infection, diabetes mellitus and hypertension were 24.3%, 26.2% and 90.7%, respectively. The regular use of traditional medicine was ascertained in 43.9% of participants. HIV-infection was significantly associated with hypertension (p=0.04) and low body mass index (p<0.01). Reported use of traditional herbal medicine was a significant associated factor among males (p= 0.01). Unemployment rate among participants was 41.1%, with 54.5% of these participants attributing their unemployment to ill health, with women significantly more affected than men (p=0.04). Conclusion Hypertension was the most common associated factor among our study participants. Participants on maintenance haemodialysis in our study were mostly males. Traditional herbal medicine use was significantly more common in men whereas female participants appeared to have higher prevalence of obesity compared to male counterparts. HIV-infected participants were significantly more likely to have low body mass index and be hypertensive. Women were significantly more likely to be unemployed due to ill health as compared to men. Prospective studies with large sample sizes are recommended to help understanding the role of individual associated factors in causing ESRD in Botswana and similar settings in sub-Saharan Africa.
Introduction Obstructive jaundice is defined as a condition occurring due to a block in the pathway between the site of conjugation of bile in liver cells and the entry of bile into the duodenum through the ampulla. The block may be intrahepatic or extrahepatic in the bile duct. Majority of the patients with portal biliopathy are asymptomatic and only about 20% presents with symptoms hence management is limited to this group and is dictated by the clinical manifestations and complications. Case presentation We are reporting a case of female patient aged 66 years who had features of obstructive jaundice. Abdominal CT-scan revealed obstructive biliopathy due to compression of the extrahepatic common bile duct by dilated periportal collaterals. She underwent bypass cholecystojejunostomy with Braun’s anastomosis surgery with no morbidities and her jaundice resolved clinically. Conclusion Jaundice due to extra-hepatic biliary obstruction may arise as a result of diverse clinical conditions ranging from those commonly encountered during routine clinical practice to the ones which are rarely seen.
Background Acute coronary syndrome refers to a group of clinical symptoms consistent with acute myocardial ischemia or infarction that are potentially life threating requiring immediate interventions. Certain proportion of patients can present with atypical symptoms leading to a missed diagnosis associated with devastating outcomes. Case presentation We present a 60 years’ female of African descent with a medical history of hypertension and type 2 Diabetes mellitus who presented with a 2 months’ history of right-sided anterior chest pain and was diagnosed with costochondritis. Further assessment revealed, normal cardiac markers and an electrocardiogram suggestive of anterior wall myocardial infarction. A coronary computed tomography and cardiac magnetic imaging scans revealed a total occlusion of the proximal left anterior descending artery and a viable myocardium respectively. She underwent successful percutaneous coronary interventions with stenting with complete alleviation of her chest pain. Conclusions This case report highlights the importance of having a high index of suspicion in high-risk groups such as older females with co-morbidities presenting with atypical symptoms suggestive of acute coronary syndrome to health care providers. This ensures early diagnosis and provision of appropriate treatment associated with good outcomes. Likewise, the case also advocates on the use of advanced cardiac imaging in patients with inconclusive electrocardiographic and biochemical tests.
Background There is limited research evidence on the pattern and factors influencing help-seeking among women experiencing intimate partner violence (IPV) in sub-Saharan Africa and in Tanzania in particular. This study sought to assess the pattern and predictors of help-seeking among women reporting ever experienced violence in Tanzania. Methods This was analysis of secondary data of the 2015-2016, Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS – MIS). Out of 13,266 eligible women, for 9,322 (70.3%) women were analyzed using STATA. The findings were summarized using descriptive statistics – frequencies and percentages. The association between the dependent variable (help-seeking behavior) and independent variables was established using Pearson’s Chi Square test and Chi square test for trend; and associations with p-value <0.05 were considered statistically significant. Additionally, the Poisson regression model was used to determine independent predictors associated with the dependent variable. Results Overall, 4060 (43.6%) women reported ever experienced physical, sexual, or emotional violence. Of these, 2196 (54.1%) [95% CI=52.5, 55.6] reported seeking help in response. The victims of violence mentioned preferred several sources where they sought help. These include consanguine relative, husband’s or partner’s relatives. Independent factors associated with help-seeking include advanced age and not being in marital union (p< 0.001). Conclusion Combating violence may require addressing factors that impair help-seeking by the victims. Young women and those in union (married or cohabiting) need be particularly supported to seek help in rponse to violence. Factors that contribute to the culture of silence in these groups such as lack of assertiveness and self-confidence among young women and socioeconomic dependence and cultural inhibitions among married or cohabiting women need to be recognized and addressed accordingly.
Background Health insurance is one of the health financing methods aiming at bringing equity in health care by providing access of quality and affordable health care services to all groups of the population. In Tanzania, children are mainly covered as dependents with no well- established insurance programmes that target children. The burden of out of pocket payments for health care and hence low health care utilization for the uninsured is significant. Study Objective To assess the role of health insurance on health service utilization among children in Misungwi District. Methods A multi-stage cluster sampling was used and interview administered questionnaire with both closed and open ended questions was used to gather primary data on insurance coverage patterns, health care utilization and facility pretences in Misungwi. The sample size used was 227. Analysis was done using statistic computer software SPSS version 20 and data was interpreted and presented based on objectives. Results Health Insurance coverage among children was found to be low with overall coverage being 16.7%. Health insurance status of the child was found to influence health care seeking behaviour of parents and hence health care utilization of the child. Out of pocket payments burden to parents of the uninsured children was evident with 13.6% reporting to borrow money from relatives. Conclusion In this study, it was found that health insurance coverage is low and the child’s health insurance coverage influence the health care seeking behaviour with high cost burden to uninsured children. The need for health insurance coverage is importance for improvement of health service utilization and thus worth further studies.
Backgorund Gallbladder diseases requiring surgery are a common condition among general surgical practice. Cholecystectomy is thus commonly practiced/practice with laparoscopic cholecystectomy (LC) as the gold standard. Seven years now, LC has slowly developed at Muhimbili National Hospital (MNH) but proportional numbers of patients still receive open cholecystectomy. This study was therefore undertaken to assess and compare the outcomes of the two methods of surgical treatment in a resource-limited setting in order to provide evidence based data for informed change in surgical care of patients with symptomatic gallbladder stone disease. Methods A retrospective chart review of patients who had cholecystectomy from February 2012 to February 2017 was carried out. Medical records in the operating room were searched and case notes retrieved. Information regarding demography, operative time, post-operative stay, complications, and mortality was extracted. Between groups comparison of variables was done using chi square test, where p value of greater than 0.05 indicated similarity between the two groups. An independent sample t test was used to compare the operative time, hospital stay and for post-operative complications. Results This retrospective study reviewed 182 cases for the period of 6years. The patients undergone laparoscopic cholecystectomy or or open cholecystectomy. The hospital stay was significantly shorter in the LC group compared to open cholecystectomy (OC) group with mean hospital stay of 2.15± 1.165 days and 3.82±2.25 days respectively (p< 0.001). The mean operative time for LC was longer 109.78±40.38 minutes compared with patients in the OC group 79.78±27.23 minutes (p < 0.001). No significant differences were observed in complications and mortality between the two groups. Conclusion LC and OC are comparable procedures for the treatment of gallstone disease in terms of morbidity and mortality although LC had significantly shorter hospitals stay. However, the operative time was longer in LC group. At MNH, LC should be a procedure of choice and further study on cost-effectiveness of LC should be conducted. Key words: Gall stones, Laparascopy Gallstones, Laparoscopy Cholecystectom.
