31 research outputs found
Burns in Tanzania: Morbidity and Mortality, Causes and Risk Factors: A Review.
No full textBurn injuries in low and middle income countries still remain a significant health problem, even though numbers of burn injuries in high income countries have decreased showing that such events are not "accidents" but are usually preventable. WHO states that the vast majority (over 95%) of fire-related burns occur in low and middle income countries. Burn injuries are a major cause of prolonged hospital stays, disfigurement, disability, and death in Africa Region. Evidence shows that prevention strategies can work. However prevention strategies need to be tailored to the specific environment taking into account local risk factors and available resources. An examination of the patterns and causes of burns should allow site specific recommendations for interventions. This literature review, specific to the United Republic of Tanzania, was conducted by researching PubMed, SafetyLit, and African Journals on Line data bases for primary sources using key words <Tanzania> plus <burns, suicide, homicide, injury mortality, injury morbidity>. Two sets of student data collected as part of Bachelor's degree final dissertations at Muhimbili University of Health and Allied Sciences were used. In all, twenty two primary sources were found. Risk factors for burn morbidity in Tanzania are: 1/ a young age, especially years 1-3, 2/ home environment, especially around cooking fires, 3/ epilepsy, during seizures, and 4/ perceived inevitability of the incident. It was expected that ground level cooking fires would be found to be a risk factor, but several studies have shown non-significant results about raised cooking fires, types of fuel used, and cooking appliances. Risk factors for burn mortality are: being male, between 20-30 years of age, and being punished for alleged thieving by community mobs. An important factor in reducing burn morbidity, especially in children, is to educate people that burns are preventable in most cases and that most burns occur in the home around cooking fires. Children need to be kept away from fires. Epileptics should be monitored for medication and kept away from cooking fires as well. Community members need to be encouraged to bring wrong doers to the police
Erratum to: Prevalence of methicillin-resistant Staphylococcus aureus carriage on admission among patients attending regional hospitals in Dar es Salaam, Tanzania
No full textFollowing publication of the original article [1], author Elia Mmbaga pointed out that her name had been misspelt as Elia Mbaga
The Pattern of Prognostic and Risk Indicators among Women with Breast Cancer Undergoing Modified Radical Mastectomy in Dar es Salaam, Tanzania.
No full textBreast cancer is the commonest female malignancy globally and the second (after uterine cervix) in sub-Saharan Africa including Tanzania. Prognostic indicators reportedly influence post-mastectomy adjuvant therapy by predicting risks on survival and recurrence although in Tanzania this data is lacking. Here, we evaluate the pattern of prognostic and risk indicators among women with breast cancer undergoing modified-radical-mastectomy (MRM) at Muhimbili National Hospital (MNH) and Tumaini Hospital (TH), Dar es Salaam, Tanzania. This hospital-based prospective cross-sectional study included female patients undergoing MRM from April 2011 to January 2012. Clinical stage I-III patients were enrolled after being scheduled for mastectomy. Patients with evidence of distant metastasis (stage IV) were excluded. Mastectomy and axillary lymph nodes biopsies were submitted to the Histopathology laboratory for grade, type, nodal and margins status. Data was collected using a structured questionnaire and analyzed using SPSS. A total of 348 patients were admitted with breast cancer including 86 patients (with 16 from TH having similar demography and presentation) meeting inclusion criteria. Age-range at diagnosis was 28-79 years, mean 52.1 years. Most (89 %) attained menarche after 11 years. About 56 % were postmenopausal. The majority (78 %) were multiparous with positive family history in 14.1 and 37.6 % used hormonal contraceptives. About 27.1 % were social alcohol drinkers. The majority (61 %) had T4b disease, 75.6 % had positive axillary nodes including 42.7 % with 4-9 involved nodes (N2). The commonest (91.9 %) histological type was invasive ductal carcinoma. Lobular, medullary and mucinous carcinomas were rare. Most (83.7 %) of our patients presented with stage III and the rest stage II. Intermediate- and high-grade tumors accounted for 73.5 %. Following MRM, 25 % of our patients had positive surgical margins and similarly for the base. Most of our breast cancer patients present with frequent risks including younger age, multiparity, hormonal contraceptives use, alcohol use and family history. Unfavourable prognostic indicators including late stages, large primary tumor size, skin infiltration, positive surgical margins, positive axillary lymph nodes and a high histological grade were associated. A sustainable screening program by self-examination to allow early diagnosis is needed to reduce morbidity and mortality from this cancer
Review Article Burns in Tanzania: morbidity and mortality, causes and risk factors: a review
No full textAbstract: Burn injuries in low and middle income countries still remain a significant health problem, even though numbers of burn injuries in high income countries have decreased showing that such events are not "accidents" but are usually preventable. WHO states that the vast majority (over 95%) of fire-related burns occur in low and middle income countries. Burn injuries are a major cause of prolonged hospital stays, disfigurement, disability, and death in Africa Region. Evidence shows that prevention strategies can work. However prevention strategies need to be tailored to the specific environment taking into account local risk factors and available resources. An examination of the patterns and causes of burns should allow site specific recommendations for interventions. This literature review, specific to the United Republic of Tanzania, was conducted by researching PubMed, SafetyLit, and African Journals on Line data bases for primary sources using key words <Tanzania> plus <burns, suicide, homicide, injury mortality, injury morbidity>. Two sets of student data collected as part of Bachelor's degree final dissertations at Muhimbili University of Health and Allied Sciences were used. In all, twenty two primary sources were found. Risk factors for burn morbidity in Tanzania are: 1/ a young age, especially years 1-3, 2/ home environment, especially around cooking fires, 3/ epilepsy, during seizures, and 4/ perceived inevitability of the incident. It was expected that ground level cooking fires would be found to be a risk factor, but several studies have shown non-significant results about raised cooking fires, types of fuel used, and cooking appliances. Risk factors for burn mortality are: being male, between 20-30 years of age, and being punished for alleged thieving by community mobs. An important factor in reducing burn morbidity, especially in children, is to educate people that burns are preventable in most cases and that most burns occur in the home around cooking fires. Children need to be kept away from fires. Epileptics should be monitored for medication and kept away from cooking fires as well. Community members need to be encouraged to bring wrong doers to the police
Performance Indicators for Quality in Surgical and Laboratory Services at Muhimbili National Hospital (MNH) In Tanzania
No full textObjectives: Muhimbili National Hospital (MNH), a teaching and national
referral hospital, is undergoing major reforms to improve the quality
of health care. We performed a retrospective descriptive study using a
set of performance indicators for the surgical and laboratory services
of MNH in years 2001 and 2002, to help monitor and evaluate the impact
of reforms on the quality of health care during and after the reform
process. Methodology: Hospital records were reviewed and information
recorded for planned and postponed operations, laboratory equipment,
reagents, laboratory tests and quality assurance programmes. Results:
In the year 2001 a total of 4332 non-emergency operations were planned,
3313 operations were performed and 1019 (23.5%) operations were
postponed. In the year 2002, 4301 non-emergency operations were
planned, 3046 were performed and 1255 (29%) were postponed. The most
common reasons for operation postponement were
“time-barred”, interference by emergency operations, no
show of patients and inoperable anaesthetic machines. Equipment
problems and supply and staff shortages together accounted for one
quarter of postponements. In the laboratory, a lack of equipment
prevented some tests, but quality assurance was performed for most
tests. Conclusion: Current surgical services at MNH are inadequate;
operating theatres require modern, functioning equipment and adequate
supplies of consumables to provide satisfactory car
Addressing gaps in surgical skills training by means of low-cost simulation at Muhimbili University in Tanzania
No full textAbstract Background Providing basic surgical and emergency care in rural settings is essential, particularly in Tanzania, where the mortality burden addressable by emergency and surgical interventions has been estimated at 40%. However, the shortages of teaching faculty and insufficient learning resources have hampered the traditionally intensive surgical training apprenticeships. The Muhimbili University of Health and Allied Sciences consequently has experienced suboptimal preparation for graduates practising surgery in the field and a drop in medical graduates willing to become surgeons. To address the decline in circumstances, the first step was to enhance technical skills in general surgery and emergency procedures for senior medical students by designing and implementing a surgical skills practicum using locally developed simulation models. Methods A two-day training course in nine different emergency procedures and surgical skills based on the Canadian Network for International Surgery curriculum was developed. Simulation models for the surgical skills were created with locally available materials. The curriculum was pilot-tested with a cohort of 60 senior medical students who had completed their surgery rotation at Muhimbili University. Two measures were used to evaluate surgical skill performance: Objective Structured Clinical Examinations and surveys of self-perceived performance administered pre- and post-training. Results Thirty-six students participated in the study. Prior to the training, no student was able to correctly perform a surgical hand tie, only one student was able to correctly perform adult intubation and three students were able to correctly scrub, gown and glove. Performance improved after training, demonstrated by Objective Structured Clinical Examination scores that rose from 6/30 to 15/30. Students perceived great benefit from practical skills training. The cost of the training using low-tech simulation was four United States dollars per student. Conclusion Simulation is valued to gain experience in practising surgical skills prior to working with patients. In the context of resource-limited settings, an additional benefit is that of learning skills not otherwise obtainable. Further testing of this approach will determine its applicability to other resource-limited settings seeking to develop skill-based surgical and emergency procedure apprenticeships. Additionally, skill sustainability and readiness for actual surgical and emergency experiences need to be assessed.</p
Antibiotic Use in Urological Surgeries: A Six Years Review at Muhimbili National Hospital, Dar es salaam-Tanzania.
No full textAntimicrobial prophylaxis for urologic procedures is a major issue, as potential advantages of antibiotic administration should be carefully weighed against potential side effects, microbial resistance, and health care costs. This study aimed to review a six years trend of antibiotic use in urological surgeries at Muhimbili National Hospital (MNH) being an experience in a typical third world environment. This was a six years hospital based descriptive, retrospective study conducted of which all case notes of urological patients operated on in between January 2007 to December, 2012 were reviewed by using a structured data collecting tool. The data were analyzed using SPSS software. Male patients were the majority at 62% (450). The age range was 0 - 90 years, with a mean of 30 ± 22.09. Among the urological surgeries done at MNH 86.5% (628) received prophylactic antibiotics regardless of the type surgery done. Majority 63.7% (463) received antibiotics during induction. Ceftriaxone was the commonly given antibiotic regardless of the type of urological surgery done. Most of patients (86.4%) were given antibiotics for five days regardless whether it was for prophylactic or treatment intention. Antibiotic use is still a challenge at our hospital with over use of prophylactic antibiotics without obvious indications. Prolonged use of prophylactic antibiotics beyond five days was the main finding. Ceftriaxone was the most given antibiotic regardless of the urological surgery done and its level of contamination. Antibiotic stewardship needs to be addressed urgently to avoid serious drug resistances leaving alone the cost implication
Motivation of Health Care Workers in Tanzania: A Case Study of Muhimbili National Hospital
No full textObjective: The Tanzanian health system is currently undergoing major
reforms. As part of this, a study was commissioned into the delivery of
services and care at the Muhimbili National Hospital.. One of the main
components of this comprehensive study was to measure the extent to
which workers in the hospital were satisfied with the tasks they
performed and to identify factors associated with low motivation in the
workplace. Methods: This was a cross sectional study involving a
sample of 448 hospital workers. Stratified sampling was used to
randomly pick 20% of: doctors, nursing staff, auxiliary clinical
workers and other administrative and supporting staff. About 44% of the
workers were female. Results: Almost half of both doctors and nurses
were not satisfied with their jobs, as was the case for 67% of
auxiliary clinical staff and 39% of supporting staff. This
dissatisfaction was multi-factorial in origin. Amongst the contributing
factors reported were low salary levels, the frequent unavailability of
necessary equipment and consumables to ensure proper patient care,
inadequate performance evaluation and feedback, poor communication
channels in different organizational units and between workers and
management, lack of participation in decision-making processes, and a
general lack of concern for workers welfare by the hospital management.
Conclusions: Many workers at all levels in the hospital were not
satisfied with the tasks they performed due to a variety of factors.
Based on the study findings, several recommendations were made
including setting defined job criteria and description of tasks for all
staff, improving availability and quality of working gear for the
hospital, the introduction of a reward system commensurate with
performance, improved communication at all levels, and introduction of
measures to demonstrate concern for the workers’ welfare
Referral Pattern of Patients Received at the National Referral Hospital: Challenges in Low Income Countries
No full textObjective: To examine the medical referral pattern of patients received
at the Muhimbili National Hospital (MNH) in order to inform the process
of strengthening the referral system. Methods: The study design was a
prospective study conducted at MNH during a 10-week study period from
January to March 2004. The study sample consisted of patients referred
to MNH Results: Of the 11,412 patients seen, 72.5% were
self-referrals. More than 70% of the patients seen required admission,
though not necessarily at tertiary level. Only 0.8% came from outside
the Dar es Salaam region. More than 70% of the patients seen required
admission. Surgical services were required by 66.8% of patients, with
obstetric conditions being most prominent (24.6% of all patients). For
those who were formally referred from other health services, lack of
expertise and equipment were the most common reasons given for referral
(96.3%). Conclusion: Efforts to improve referral systems in
low-income countries require that the primary and secondary level
hospitals services be strengthened and increased so as to limit
inappropriate use of national referral hospitals
Referral Pattern of Patients Received at the National Referral Hospital: Challenges in Low Income Countries
No full textObjective: To examine the medical referral pattern of patients received
at the Muhimbili National Hospital (MNH) in order to inform the process
of strengthening the referral system. Methods: The study design was a
prospective study conducted at MNH during a 10-week study period from
January to March 2004. The study sample consisted of patients referred
to MNH Results: Of the 11,412 patients seen, 72.5% were
self-referrals. More than 70% of the patients seen required admission,
though not necessarily at tertiary level. Only 0.8% came from outside
the Dar es Salaam region. More than 70% of the patients seen required
admission. Surgical services were required by 66.8% of patients, with
obstetric conditions being most prominent (24.6% of all patients). For
those who were formally referred from other health services, lack of
expertise and equipment were the most common reasons given for referral
(96.3%). Conclusion: Efforts to improve referral systems in
low-income countries require that the primary and secondary level
hospitals services be strengthened and increased so as to limit
inappropriate use of national referral hospitals
