Browsing by Author "Mbembati, Naboth A."
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Item Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap(Health policy and planning, 2012) Mbembati, Naboth A.Background The effort to increase access to emergency and surgical care in low-income countries has received global attention. While most of the literature on this issue focuses on workforce challenges, it is critical to recognize infrastructure gaps that hinder the ability of health systems to make emergency and surgical care a reality. Methods This study reviews key barriers to the provision of emergency and surgical care in sub-Saharan Africa using aggregate data from the Service Provision Assessments and Demographic and Health Surveys of five countries: Ghana, Kenya, Rwanda, Tanzania and Uganda. For hospitals and health centres, competency was assessed in six areas: basic infrastructure, equipment, medicine storage, infection control, education and quality control. Percentage of compliant facilities in each country was calculated for each of the six areas to facilitate comparison of hospitals and health centres across the five countries. Results The percentage of hospitals with dependable running water and electricity ranged from 22% to 46%. In countries analysed, only 19–50% of hospitals had the ability to provide 24-hour emergency care. For storage of medication, only 18% to 41% of facilities had unexpired drugs and current inventories. Availability of supplies to control infection and safely dispose of hazardous waste was generally poor (less than 50%) across all facilities. As few as 14% of hospitals (and as high as 76%) among those surveyed had training and supervision in place. Conclusions No surveyed hospital had enough infrastructure to follow minimum standards and practices that the World Health Organization has deemed essential for the provision of emergency and surgical care. The countries where these hospitals are located may be representative of other low-income countries in sub-Saharan Africa. Thus, the results suggest that increased attention to building up the infrastructure within struggling health systems is necessary for improvements in global access to medical care.Item Addressing gaps in surgical skills training by means of low-cost simulation at Muhimbili University in Tanzania(Human Resources for Health, 2009) Mbembati, Naboth A.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.Item African Safety Promotion - Childhood burn injuries in children in Dar es Salaam: patterns and perceptions of prevention: short research article(African Safety Promotion, 2002) Mbembati, Naboth A.A study was conducted in the three city hospitals of Dar es Salaam and two national referral hospitals to describe the pattern of burn injuries and to determine victims' and guardians' perceptions of the causes and prevention of burns. The study included all injured children younger than 18 years attending Mwananyamala, Ilala and Temeke city hospitals, Muhimbili National Hospital and Muhimbili Orthopaedic Institute between May and November 1999. Data were obtained by filling in a prepared questionnaire. A total of 253 children attended the hospitals with burn injuries during the period of study. Children younger than five years of age constituted 63.6% of the group. Scalding from hot liquids accounted for 75.8% of the burns, followed by open flame burns (16.2%). Most burns (82.9%) occurred in low socio-economic groups, and 94.4% occurred at home. Over half of the parents (51.5%) thought that burns could not be prevented since 'accidents' are unpreventable and it is difficult to control children; 48.5% of the parents thought that burns could be prevented. There is a need to change parental and guardians' attitudes and beliefs that burns are unpreventable, if burn prevention interventions are to be effective.Item African Safety Promotion - Patterns of road traffic injuries and associated factors among school-aged children in Dar es Salaam, Tanzania: short research article Author L.(African safety promotion, 2002) Mbembati, Naboth A.A study was conducted to describe the pattern of road traffic injuries and associated factors among school-aged children attending public hospitals in Dar es Salaam, Tanzania, between May and October 1999. The study included all children younger than 18 years, and data were collected using a structured interview guide. This article is based on an analysis of 286 children who sustained road traffic injuries out of a total of 1886 children presenting with various injuries during the study period. Almost 52% of these children were in primary school, with the most common age group between 5 and 9 years. A large majority of the children came from the poorer socio-economic residential areas of the city. Almost one-third of the victims and 36% of guardians were unaware of safer ways of walking on the road. Parents or guardians perceived the risk of road traffic injuries as low, with one-third thinking that they were not a major problem in their community. Similarly, two-thirds of guardians thought that collisions to children could not be prevented. This study demonstrates that road traffic injuries are a major problem among school-aged children in Dar es Salaam. Furthermore, the study reveals that there is significant ignorance about safe road usage among the parents or guardians of injured children, and that the majority of them think that collisions are not preventable.Item Antibiotic use in urological surgeries: a six years review at Muhimbili National Hospital, Dar es salaam-Tanzania(Pan African Medical Journal, 2015) Mbembati, Naboth A.Abstract Introduction: Antimicrobial 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. Methods: 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. Results: 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. Conclusion: 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.Item Antibiotic use in urological surgeries: a six years review at Muhimbili National Hospital, Dar es salaam-Tanzania(Pan African Medical Journal, 2015) Mbembati, Naboth A.Introduction: Antimicrobial 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. Methods: 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. Results: 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. Conclusion: 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.Item Appendicitis in Dar es Salaam, histological pattern.(The Central African journal of medicine, 1996) Mbembati, Naboth A.Histology of 378 appendicectomy specimens submitted to the Histopathology Department of Muhimbili Medical Centre from its surgical wards over a 10 year period (1985 to 1994) were reviewed. There were 185 cases (48.9 pc) of acute appendicitis, 101 cases (26.7 pc) of chronic appendicitis, 74 (19.6 pc) normal appendices and 13 cases (3.5 pc) schistosomal appendicitis. There were two cases of tuberculous appendicitis and two cases of mucocele of the appendix. Apart from the high frequency of chronic appendicitis the histological findings in this study compare well with findings reported from other studies.Item Assessing the Impact of the Trauma Team Training Program in Tanzania(Journal of Trauma and Acute Care Surgery, 2008) Mbembati, Naboth A.Background: In sub-Saharan Africa, injury is responsible for more deaths and disability adjusted life years than AIDS and malaria combined. The trauma team training (TTT) program is a low-cost course designed to teach a multidisciplinary team approach to trauma evaluation and resuscitation. The purpose of this study was to assess the impact of TTT on trauma knowledge and performance of Tanzanian physicians and nurses; and to demonstrate the validity of a questionnaire assessing trauma knowledge. Methods: This is a prospective study of physicians and nurses from Dar es Salaam undergoing TTT (n = 20). Subjects received a pre course test and, after the course, an alternate post course test. The equivalence and construct validity of these 15-item multiple-choice questionnaires was previously demonstrated. After the course, subjects were divided into four teams and underwent a multiple injuries simulation, which was scored with a trauma resuscitation simulation assessment checklist. A satisfaction questionnaire was then administered. Test data are expressed as median score (inter quartile ratio) and were analyzed with the Wilcoxon's signed rank test. Results: After the TTT course, subjects improved their scores from 9 (5-12) to 13 (9-13), p = 0.0004. Team performance scores for the simulation were all >80%. Seventy-five percent of subjects were very satisfied with TTT and 90% would strongly recommend it to others and would agree to teach future courses. Conclusions: After completion of TTT, there was a significant improvement in trauma resuscitation knowledge, based on results from a validated questionnaire. Trauma team performance was excellent when assessed with a novel trauma simulation assessment tool. Participants were very supportive of the course.Item Awareness of colorectal cancer screening and its associated risk factors among adults attending outpatient clinics in regional referral hospitals in Dar es Salaam.(ISAR Journal of Medical and Pharmaceutical Sciences, 2024-11-28) Mziray, Amir N.; Mbembati, Naboth A.; Swai, Samuel P.; Wandwi, Wambura B.; Mkiramweni, Jerome P.; Kategile, Albert M.; Muganyizi, Daniel J.; Gangji, Raidah R.Background: Colorectal cancer screening aims to detect early signs of colorectal cancer before symptoms develop, increasing the chances of successful treatment and survival. Screening methods include colonoscopy, and stool-based tests like fecal occult blood tests (FOBT) or fecal immunochemical tests (FIT), which detect blood in the stool. Screening guidelines vary by country, but it is generally recommended to start regular screenings around age 40 for the average-risk individuals. Objective: To assess colorectal cancer (CRC) awareness, risk factors and screening utilizing FOBT and colonoscopy among participants in regional referral hospitals in Dar es Salaam. Methodology: A total of 150 participants were recruited for the study. FOBT was done to all participants, with positive cases undergoing further diagnostic interventions, including stool analysis, H. pylori antigen testing, and endoscopic interventions. Results: Of the 150 participants, 73.3% tested negative and 26.67% tested positive for FOBT. Further investigations revealed hookworm ova 12.5% (n=5/40) and H. pylori infection 22.5% (n=9/40) among FOBT positive cases. Conclusion: CRC screening using FOBT demonstrated significant number of positive cases, highlighting the need for improved awareness and education about CRC and its risk factorsItem Burns in Tanzania: morbidity and mortality, causes and risk factors: a review(Outwater, A.H., Ismail, H., Mgalilwa, L., Temu, M.J. and Mbembati, N.A., 2013. Burns in Tanzania: morbidity and mortality, causes and risk factors: a review. International journal of burns and trauma, 3(1), p.18, 2013) Mbembati, Naboth A.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 plus . 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.Item Characterization of Benign Lesions and Carcinomas of the Female Breast in a Sub- Saharan African Population(Pathology-Research and Practice, 1998) Mbembati, Naboth A.Carcinoma of the breast is the second most frequent tumour in African females. Breast carcinomas in African females appear about a decade earlier and follow a more aggressive clinical course than those in developed countries. To elucidate this difference we investigated 63 biopsied benign lesions of the female breast for their potential to malignant progression. We also performed histologic typing and grading of 184 female breast carcinomas received at the Muhimbili University Hospital in Dar es Salaam, Tanzania. Fibrocystic disease and fibroadenomas were the most frequent lesions. The majority of patients with fibrocystic disease had no proliferative lesion and thus were not at a significantly increased risk of developing breast carcinomas. For fibroadenomas, no indication for precancerous lesions was found. The vast majority of breast carcinomas investigated were invasive. As a striking feature, the majority of those studied (66%) were of the non-special type (NST), displaying a more aggressive behaviour than the remaining tumours of the special type (ST). In the group of ST tumours, cribriform types constituted 41 % of the cases which may be a special feature of the carcinomas in African females. Among the NST, the tumours were either of grade II or grade III, whereas in ST, 25% of the cases were of grade I. Since histology observed in this study is comparable to that seen in patients from the Western society, late hospital presentation with advanced tumour stages may be a major reason for differences in clinical behaviour between African and Western females. A genetic factor, however, may be an important contributing factor.Item Clinical assessment and examinations of colorectal cancer in outpatient clinics: a synopsis from a study conducted in regional referral hospitals in Dar es Salaam – Tanzania(ISAR Journal of Medical and Pharmaceutical Sciences, 2024-11-28) Mziray, Amir N.; Mbembati, Naboth A.; Swai, Samuel P.; Wandwi, Wambura B.; Mkiramweni, Jerome P.; Kategile, Albert M.; Muganyizi, Daniel J.; Gangji, Raidah R.Background: Colorectal cancer (CRC) is one of the most preventable cancers, with early detection significantly improving treatment outcomes. Screening methods such as FOBT and colonoscopy are crucial but underutilized, especially in resource-limited settings. Objective: To assess awareness of colorectal cancer screening and risk factors among adults attending outpatient clinics in regional referral hospitals in Dar es Salaam. Methodology: This cross-sectional study involved 150 participants, and screening was done through FOBT, followed by further diagnostic tests for those with positive results. Results: Of the participants, 26.67% tested positive for FOBT, and 5 of them were diagnosed with colorectal cancer. There was a significant gap in knowledge and awareness regarding colorectal cancer screening. Conclusion: There is a need for enhanced public health efforts to raise awareness about colorectal cancer and its risk factors in Tanzania.Item Complete rectal prolapse in adults: a Tanzanian experience(Central African Journal of Medicine, 1994) Mbembati, Naboth A.This is a retrospective report of nine patients with complete rectal prolapse managed by the authors at the Muhimbili Medical Centre, Dar es Salaam between 1990 and 1993. The average age of patients was 36 years and eight of the patients were males. Six of the patients presented as emergency admissions of whom three had irreducibility and required perineal proctosigmoidectomy. This was the procedure of choice for irreducible complete rectal prolapse.Item Distal oesophageal cancer and its histological pattern: a five years retrospective review at Muhimbili National Hospital, Dar es Salaam(Ethiopian Medical Journal, 2022-03-29) Mbembati, Naboth A.Background: Esophageal carcinoma is a significant cause of morbidity and mortality among cancer patients in Tanzania. Squamous cell carcinoma is the most predominant subtype encountered. But the adenocarcinoma might also occur, especially in the distal third of the esophagus. Risk factors and treatment of these two histological sub- types vary significantly. Hence it is important to understand the true prevalence of Distal oesophageal cancer and that of adenocarcinoma. This study aimed to understand the prevalence of Distal oesophageal cancer and that of adenocarcinoma. Methods: This was a retrospective chart review for patients treated with oesophageal cancer from April 2013 to April 2017 at Muhimbili National hospital. Patients with Distal oesophageal cancer were identified and their socio -demography, Takita’s dysphagia grade, tumor length from the upper incisor teeth, endoscopic tumor morphology, histology and stage of the disease was abstracted. Data was analyzed using SPSS where descriptive statistics were computed. Associations were determined using chi-square test with significance set at <5%. Ethical approval was obtained from Muhimbili University Institutional Review Board. Results: Distal oesophageal cancer made 34.1% of all esophageal cancers, with no variations over the five-year review. The mean age of patients with Distal oesophageal cancer was 59.7 years with female predominance at 2:1 for men. Adenocarcinoma was the most predominant histological subtype at 3:1 for squamous cell carcinoma. Low socio-economic status, alcohol drinking, smoking cigarettes and positive history suggestive of Gastro Oesophageal Reflux Disease were common among these patients. Most of the tumors are fungating with late presentation judged clinically with dysphagia as the most common presentation. Conclusion: Clinicians and researchers should be aware of the higher incidence of Distal oesophageal cancer presenting with adenocarcinoma. Failure to recognize this unique entity in a region where squamous cell carcino- ma is the most predominant type might result in misinterpretation of data and misallocation during treatment and prognostication. Keywords: Distal oesophageal cancer; Distal esophageal cancer; esophageal adenocarcinoma; gastro esophage- al cancer; esophageal cancer trendItem Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries(PLoS Med, 2010) Mbembati, Naboth A.Background Surgical conditions contribute significantly to the disease burden in sub-Saharan Africa. Yet there is an apparent neglect of surgical care as a public health intervention to counter this burden. There is increasing enthusiasm to reverse this trend, by promoting essential surgical services at the district hospital, the first point of contact for critical conditions for rural populations. This study investigated the scope of surgery conducted at district hospitals in three sub-Saharan African countries. Methods and Findings In a retrospective descriptive study, field data were collected from eight district hospitals in Uganda, Tanzania, and Mozambique using a standardized form and interviews with key informants. Overall, the scope of surgical procedures performed was narrow and included mainly essential and life-saving emergency procedures. Surgical output varied across hospitals from five to 45 major procedures/10,000 people. Obstetric operations were most common and included cesarean sections and uterine evacuations. Hernia repair and wound care accounted for 65% of general surgical procedures. The number of beds in the studied hospitals ranged from 0.2 to 1.0 per 1,000 population. Conclusion The findings of this study clearly indicate low levels of surgical care provision at the district level for the hospitals studied. The extent to which this translates into unmet need remains unknown although the very low proportions of live births in the catchment areas of these eight hospitals that are born by cesarean section suggest that there is a substantial unmet need for surgical services. The district hospital in the current health system in sub-Saharan Africa lends itself to feasible integration of essential surgery into the spectrum of comprehensive primary care services. It is therefore critical that the surgical capacity of the district hospital is significantly expanded; this will result in sustainable preventable morbidity and mortality.Item The frequency of carcinoma in solitary thyroid nodules and in multinodular goitres(East and Central African journal of surgery, 1996) Mbembati, Naboth A.A retrospective study of all patients with goitre seen from 1988 to 1992 inclusive at the Muhimbili Medical Centre, Dar es Salaam was made to determine the frequency of malignancy in patients with solitary non-toxic thyroid nodule (STN) and in those with multinodular goitre (MNG). There were 60 cases of STN and 178 with MNG. Nodular goitre was found to be predominantly a disease of females with sex ratios of M:F;1:7 for the STN group and of M:F;1:13 in the MNG group. The final diagnosis in all cases was made by histology which found malignancy in 10% of STN and in 5% of MNG patients, a difference which was not statistically significant. Patients in the 20-29 years age group with STN appeared to have an increased risk of malignancy when compared with the MNG group. No cause for this was discovered. The predominant malignancy in the STN group of patients was papillary carcinoma, while that in the MNG group was follicular carcinoItem Human Resource and Funding Constraints for Essential Surgery in District Hospitals in Africa: A Retrospective Cross-Sectional Survey(PLoS medicine, 2010) Mbembati, Naboth A.Background:There is a growing recognition that the provision of surgical services in low-income countries is inadequate tothe need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery,there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study describedthe range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitalsin three African countries. Methods and Findings:We conducted a retrospective cross-sectional survey of data from eight district hospitals inMozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of thehealth workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), andMLPs trained to perform surgical procedures (3.8%). There were one to six medical doctors per hospital (4.2% of clinicalstaff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done byMLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. Of thetotal operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery. Thesecosts represent a per capita expenditure on surgery ranging from US$0.05 to US$0.14 between the eight hospitals. Conclusion:African countries have adopted different policies to ensure the provision of surgical care in their respectivedistrict hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expendituresfor surgery. We found that most surgical and anesthesia services in the three countries in the study were provided bygeneralist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasingthe funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPsappears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas.Item Increasing Access to Surgical Services in Sub-Saharan Africa: Priorities for National and International Agencies Recommended by the Bellagio Essential Surgery Group(PLoS medicine, 2009) Mbembati, Naboth A.Item Introduction of Regular Formative Assessment to Enhance Learnning for Clinical Students at Muhimbili University College, Tanzania(Education for Health, 2007) Mbembati, Naboth A.Objective: To determine if undertaking regular Formative Assessment (FA) in the setting of our medical school enhanced the students' learning experience. Methods: An FA intervention was designed and implemented with clinical students during their clerkship in the academic year 2003/04. FA was administered as structured verbal comments on daily clinical case presentations. Evaluation of the intervention included pre- and post-surveys exploring the perceptions of students and teachers on the quality of the learning experience. Focus group discussions with students and with teachers were held at the start and conclusion of the intervention to identify strengths and weaknesses of FA. Findings: All participating teachers perceived that students were interested in learning before the intervention. Teachers who perceived that students achieved the set learning objectives increased from 0% before to 28% after the intervention. Most teachers (71%) and students (86%) perceived FA to enrich students' learning experience. Students appreciated the positive change in teachers' attitudes during the FA intervention. Both students and teachers recommended that FA become a regular and routine activity. Conclusions: Students and teachers viewed FA as a positive, feasible intervention. They thought it enriched the learning process and recommended it be a routine learning activity.Item Isolation of Mycobacterium bovis from human cases of cervical adenitis in Tanzania: a cause for concern?(The International Journal of Tuberculosis and Lung Disease, 2001) Mbembati, Naboth A.SETTING: Pastoralist communities in the Northern and Southern zones of Tanzania. DESIGN: Observational study. OBJECTIVES: To determine the involvement of Mycobacterium bovis in tuberculosis cases presenting at tuberculosis (TB) clinics in rural areas in these zones. METHODS: A total of 149 tuberculosis cases identified on the bases of clinical manifestation were sampled. Appropriate specimens were cultured on two Löweinstein Jensen slants with respectively glycerol and pyruvate added. Forty-one isolates were cultured and subjected to biochemical typing. RESULTS: Overall, 31 (70.5%) of the mycobacterial isolates recovered from all forms of tuberculosis were identified as M. tuberculosis, seven (16.0%) were identified as M. bovis, and six (13.6%) were other mycobacterial species. There was a significantly higher isolation rate (P < 0.05) of M. bovis among strains recovered from extra-pulmonary (26.8%) than pulmonary tuberculosis samples (4.3%). CONCLUSION: Based on these findings, it is imperative that M. bovis be considered as a pathogen of concern to people living in rural areas of Tanzania. Further work is required to establish a zoonotic link between cattle and the people in these communities who rear them.