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Evidence- based obstetrics services at Amana maternity and labour ward in Dar-es-salaam, Tanzania. an observational study to explore clinical practice, women's preferences and the health service providers' views.
(Hubert Kairuki Memorial University, 2006) Kairuki, Clementina A.
Background: In most of the Sub-Saharan countries, many health workers do not have easy access to the most recent and reliable information on effective reproductive health care, despite evidence-based obstetric care being widely promoted in developing countries. In Tanzania, efforts have been done to introduce evidence based reproductive health care. However, the success of its implementation is not known. Objectives: In this study I documented current obstetric practices rates, against evidence based information, and explored the barriers and opportunities to implementing these procedures from the provider's perspectives. Women's preferences and their satisfaction with care they received were also documented. Methods: The Cochrane Library was used to identify few common and relevant childbirth practices. These were grouped as lives saving, quality childbirth and avoid as routine practices. Using the above selected childbirth practices, an observational study was done using quantitative and qualitative methods. Practice rates were determined by exit interviews with a consecutive sample of postnatal women. Health providers (midwives' and doctors') views were explored using in-depth semi-structured interviews. Women's opinions and preferences were also documented using in depth semi-structured interviews. The study site was at Amana Hospital in Dar es Salaam, Tanzania.
Prevalence of adverse pregnancy outcome and associated risk factors among HIV infected women delivered at Mwananyamala hospital from May to October 2008
(Hubert Kairuki Memorial University, 2008) Sangawe, Grace D.
Background: HIV infection among pregnant women has been associated with various perinatal and maternal complications. Studies conducted in the developing world have associated HIV infection with this poor outcome such as prematurity, low birth weight, and stillbirths. Others are premature rupture of membranes, postpartum haemorrhage and puerperia infections and delayed wound healing. However, some social demographic factors have been found to be predictors of this poor perinatal and maternal outcome among HIV infected women. Objectives: The main objective of this study was to determine the prevalence of pregnancy complications and the associated social demographic factors among HIV infected women delivered at Mwananyamala hospital in Dar es Salaam, Tanzania. Material and methods: Patients who were admitted in the labor ward due to labor pains or premature rupture of membranes were randomly recruited. Questionnaires were filled, antenatal cards were assessed, and, in some blood, samples were collected for VDRL Hb level and HIV status. These participants were then followed up on the seventh day postpartum and were assessed for presence of fever, abnormal lochia, episiotomy site and post C/ section wound were examined. Results: A total of 280 pregnant women were included in the study. Among them 9.3% presented with PROM. These pregnant women with PROM were found to have a poor weight gain OR 8.89 (95% CI 8.08 - 9.68). PPH was more observed following C/ section than normal delivery 11% and 0.4% respectively. Age between 30-39 yrs was found to be associated with this outcome OR 3.35 (6.63 - 17.02). Among the study population 2.9% developed wound sepsis following C/ section, primigravidae were at higher risk of this complication OR 1.41 (95% CI 0.73 - 2.73). primigravidae were also found to have higher risk of developing postpartum fever OR 2.32 (95% CI 6.05 - 8.87), but this was not statistically significant. Women who reported back with infected lochia were 5.4% of the study population. Infants born prematurely were more observed among women aged between 20 and 29 yrs. Prevalence of preterm delivery was 9.6%. In univariate logistic analysis low parity was found to be associated with this poor outcome, OR 6.09 (95% CI 0.23 - 16.16). Anaemia was also found to be associated with prematurity (<0.0001). Prevalence of still births in this study was 6%, Among them 2.5% were MSB and 3.6% were FSB. Reactive VDRL results and poor maternal weight gain during pregnancy were associated with MSB, OR 2.82 (95% CI 0.53-15.0) and OR 5.39 (95% CI 1.14 -25. 38) respectively. The prevalence of LB W babies was 11.8%. Among them 6% were due to prematurity while 15.4% were bom at term. Poor maternal weight gain was found to be the predictor of this poor neonatal outcome, OR 5.60 (95% CI 2.01-16.0). CONCLUSION High prevalence of HIV infection was observed among young, married women with low parity and literate. Most of them were housewives. Anemia and poor weight gain during pregnant was very high, and this was found to be associated with prematurity and LBW. Maternal HIV and syphilis co-infection was found to increase the risk of MSB. Operative delivery was associated with postpartum morbidity. Also, PPH was observed following C/section as compared to normal deliveries. It was observed that social demographic factors influence the poor pregnant outcome among HIV infected women.
Possible mechanism for hyperphenylalaninemia in children with falciparum malaria in Dar es Salaam
(Hubert Kairuki Memorial University, 2009) Mukemba, Jackson P.
Introduction: Patients with falciparum malaria develop reversible hyperphenylalaninemia (HPA) (Lopansri, et al. Infect Immun 74:3355, 2006). HPA is relevant to cerebral malaria since brain aromatic amino acid metabolism is critical for synthesis of biogenic amine neurotransmitters. Phe levels are controlled by substrate-level regulation of Phe hydroxylase (PAH), an enzyme activated by elevated plasma Phe and inhibited by elevated intracellular tetrahydrobiopterin (BH4; PAH's obligatory cofactor). This substrate regulation of PAH tightly controls plasma Phe levels. HPA could result from BH4 deficiency or increased pterin synthesis with elevated intracellular BH4 and inhibition of PAH. Methods: I prospectively measured urine pterin metabolites and plasma Phe in 62 healthy controls (HC) and 47 with uncomplicated malaria (UM) (6 months to 6 years old) from outpatient clinics at Amana and Mwananyamala district hospitals in Dar es Salaam, Tanzania. Blood samples were immediately processed, and plasma was frozen for measurements of amino acids by ion exchange chromatography. Urine was collected directly into pterin stabilizers, frozen, and later analyzed for biopterin and neopterin metabolites by HPLC using both fluorescence and electrochemical detection. Urine pterin levels were normalized to urine creatinine concentration. Results: Children with UM had significant HPA (plasma Phe > 80 uM, p<0.0001). The Phe:tyrosine ratio (a sensitive measure of Phe regulation; normal ~1.0;) was elevated (^1.3) more often in UM (43 of 47) (p<0.0001; ; UM vs. HC). Likewise, urine BH4 was significantly higher in UM (p = 0.017; UM v^. HC). Other urine pterin metabolites (dihydrobiopterin, biopterin, and neopterin), and total biopterins were also significantly higher in UM vj'. HC participants. Discussion/conclusions: Thus, UM is associated with elevated pterin synthesis. This is likely due to inflammatory cytokine-stimulated increases in expression of GTP cyclohydrolase, the rate-limiting enzyme for BH4 de novo synthesis, with consequent production of neopterins and biopterins (including BH4). Allosteric inhibition of hepatocyte PAH by rising BH4 concentration follows, leading to disrupted Phe homeostasis. Plasma Phe levels rise as the liver is unable to catabolize the increased Phe flux from accelerated protein turnover in malaria infection. Hence, increased intracellular BH4 likely contributes to HPA observed in UM.
Duration of symptoms and clinical outcomes post treatment among patients with aids-related Kaposi’s Sarcoma seen at ocean road cancer institute
(Hubert Kairuki Memorial University, 2009) Mohammed, Shaaban I.
The number of patients with Epidemic Kaposi's Sarcoma (EKS) is increasing, bringing suffering to the patients and affecting the manpower of our society. While prevalence in developed countries is going down due to wide use of HAART, the case is different in our set up, where the modality of treatment differs from the west. Data to substantiate the study were gathered from the Medical Registry Office at ORCI using ail available medical documents (files, etc). The findings which were obtained revealed that most affected personnel reach ORCI late. The median duration of onset was twelve months. Only 61.5% of patients were on ARV for different periods of time before attending ORCI. Chemotherapy was not always sustainable. The number of patients, whose fate was not stated, was not negligible. For the period of time of the data collected, it can be concluded that despite being on ARV the outcomes are not convincing, probably there are other contributing factors for the prognosis among patients with AIDS-KS. Duration or rather onset of symptoms does not play a major role in the expected clinical outcome. Women had worse results than men despite the former reported early to the centre. Compared to other modalities of treatment available at the centre external radiotherapy has shown relatively good results. Therefore, it is recommended that external radiotherapy is a fairly better treatment modality in our set up than other regimens, which so far do not meet basic requirements such as compliance and affordability.
Elevated phenylalanine and urine pterin levels in Tanzanian children with falciparum malaria
(Hubert Kairuki Memorial University, 2009) Mukemba, Jackson P.
Introduction: Patients with falciparum malaria develop reversible hyperphenylalaninemia (HPA) (Lopansri, et al. Infect Immun 74:3355, 2006). HPA is relevant to malaria since brain aromatic amino acid metabolism is critical for synthesis of biogenic amme neurotransmitters. Phenylalanine levels are controlled by substrate-level regulation of Phe hydroxylase (PAH), an enzyme activated by elevated plasma Phe and inhibited by elevated intracellular tetrahydrobiopterin (BH4; PAH's obligatory cofactor). This substrate regulation of PAH tightly controls plasma Phe levels. HPA could result from BH4 deficiency or increased pterin synthesis with elevated intracellular BH4 and inhibition of PAH. Methods: This was a prospective cohort study in which urine pterin metabolites and plasma Phe were measured in 62 healthy controls (HC) and 47 with uncomplicated malaria (UM) (6 months to 6 years old) from outpatient clinics at Amana and Mwananyamala district hospitals in Dar es Salaam, Tanzania. Blood samples were immediately processed, and plasma was frozen for measurements of amino acids by ion exchange chromatography. Urine was collected directly into pterin stabilizers, frozen, and later analyzed for biopterin and neopterin metabolites by HPLC using both fluorescence and electrochemical detection. Urine pterin levels were normalized to urine creatinine concentration. Results: Children with UM had significant HPA (plasma Phe > 80 uM, /71.3) more often in UM (43 of 47) (p<0.0001). The Phertyrosine ratio (a sensitive measure of Phe regulation; normal ~I.O;) was elevated (>1.3) more often in UM (43 of 47) (P<0.0001UM vs. HC). Likewise, urine BH4 was significantly higher in UM (p = 0.017; UM vs. HC). Other urine pterin metabolites (dihydrobiopterin, biopterin, and neopterin), and total biopterins were also significantly higher in UM vs. HC participants. Discussion/conclusions: Thus, UM is associated with elevated pterin synthesis. This is likely due to inflammatory cytokine-stimulated increases in expression of GTP cyclohydrolase, the rate-limiting enzyme for BH4 de novo synthesis, with consequent production of neopterins and biopterins (including BH4). Allosteric inhibition of hepatocyte PAH by rising BH4 concentration follows, leading to disrupted Phe homeostasis. Plasma Phe levels rise as the liver is unable to catabolize the increased Phe flux from accelerated protein tumover in malaria infection. Hence, increased intracellular BH4 likely contributes to HPA observed in UM.
Magnitude and outcomes of advanced stage breast cancer as compared to early stage disease among women in Dar es Salaam.
(Hubert Kairuki Memorial University, 2010-05) Ayuk, Nelson
Advanced Breast Cancer is associated with a very poor prognosis and high mortality among women. Despite substantial improvements in its prevention, diagnosis and treatment, advanced breast cancer remains a significant clinical problem. Advanced stage breast cancer is rarely seen in the Western countries but is common in African countries. In Tanzania, many women turn up at hospitals with cancer at a very advanced stage, often only palliative care can be offered. The objective of this study was to determine the prevalence of advanced breast cancer and outcomes as compared to early stage disease among women at Ocean Road Cancer Institute (ORCI), Dar es Salaam. The study was a retrospective descriptive hospital based study in which data were gathered from the Medical Registry Office at ORCI using all available medical documents (files, records, etc), worked on and evaluated accordingly. Of the 171 patients with breast cancer recorded in this study, majority were in the age group 46-60 years (n=69; 40.4%). There was no patient below the age of 30 years. The mean age was 50.9 years. A great number of patients came from Dar es Salaam (n=67; 39.2%), and the least number of patients came from Mara and Songea with 0.6% (n=l) each. Most of the patients were peasants (n=49; 28.7%). A great majority of patients presented with advanced disease, the prevalence being 84.8%, with 53.2% in stage III and 31.6% in stage IV. Only 1.2% of patients had stage I disease at presentation. Meanwhile, 8.3% of patients with late stage presentation had progression of disease at 3 months after treatment, as compared to 3.8% of patients with early stage disease. Metastatic disease was present in 15.2% of late stage patients at 3 months as compared to 3.8% of those with early stage presentation. Mortality rate was 7.6% for those with advanced disease at presentation and 3.8% for patients with early stage disease at presentation. At 6 months of follow-up after treatment; 13.8% of late presentation patients had disease progression while none of the patients with early stage had progression of the disease. Furthermore, 13.1% of late stage patients had metastases at 6 months compared to none with early stage presentation. Ductal carcinoma was the most common type among women having breast cancer, with a proportion of 65.5%. Stage at presentation was significantly associated with age and occupation: A higher risk of having advanced breast cancer at presentation was found for women of over 46 years age as compared to women with age between 30-45 years (OR = 1.17, P < 0.05). Also, a higher risk was found in unemployed patients compared to patients who had been employed (OR = 1.68, P < 0.05). The study has conclusively shown that there is a high prevalence of advanced breast cancer at presentation at ORCI. It was also observed that outcomes after treatment were poor for patients with advanced disease particularly at 6 months follow-up. Therefore, it is recommended that more public health efforts be made focusing on screening, public awareness and treatment centers towards improving on early detection of breast cancer.
Mode of prostatectomy in relation to its late complications at Muhimbili national hospital
(Hubert Kairuki Memorial University, 2010-09) Binzoo, Ameir A.
Benign prostatic hyperplasia (BPH) becomes increasingly common as men age. BPH can lead to urinary symptoms that may benefit from medical or surgical treatment. Despite the availability of modem techniques, and a wide range of modes of prostatectomy, Post-prostatectomy late complications still are burden to many surgeons after performing the procedure. Our main objective is to determine the association between late post-prostatectomy complications and the different modes of prostatectomy done at MNH. This study is a retrospective descriptive hospital based study, which included all patients who had prostatectomy, between the years 2005 to 2008. The study involved all patients who undergone prostatectomy at MNH. The data regarding the patient records and progress were collected from the patients file. We were interested to look for the mode of prostatectomy done to these patients, and the complaints of the late post-prostatectomy complications, if any, and finally to relate these infomiation's. In our study we had a total of 169 patients, who had prostatectomies. We found that the majority of our surgeons used the Transvesical mode of open prostatectomy [78.9%], while the Retropubic prostectomy was very minimal [1.8%]. For the closed method, we found that 33 [19.5%] patients out of 169, had TURP. In this study, we found that, the most common late complication post prostatectomy was the Retrograde ejaculation 7.7%, followed by Urethral stricture 4.1%. Urinary incontinence and bladder neck stenosis also seen in 3.6% and 3% of the patients respectively. The least complication in this study is the erectile dysfunction 1.8% It shows that the Retrograde ejaculation was found more in the TVP mode of prostatectomy [12 patients], only one patient in TURP mode, and no patients in the RPP mode. Bladder neck stenosis, urinary incontinence, and urethral stricture were only found in the TVP mode. Erectile dysfunction was only found in TURP mode.
Magnitude and factors contributing to occurrence of upper gastrointestinal bleeding at Amana hospital, Dar es Salaam from March 2010 to June 2011.
(Hubert Kairuki Memorial University, 2012) Muhumba, Erick K.
OBJECTVE: Very few epidemiological upper gastrointestinal bleeding (UGIB) surveys have been done. However, information about the current epidemiology of UGIB in Tanzania is not known. The aim of this study was to determine the magnitude and factors contributing to occurrence of upper gastrointestinal bleeding. METHODS: From March 2010 to June 2011, 394 participants consecutively attended at endoscopic unit at Amana regional referral hospital were prospectively included. Data were collected prospectively with a standard questionnaire and included demographic as well as specific data relating to UGIB. RESULTS: Among all participants 21.6% presented with UGIB, male patients were most affected by 59.1%. Varices were the commonest cause of UGIB accounting for 36.5% of all causes followed by erosive mucosal disease (esophagitis, gastritis and duodenitis) for 30%. In 10% of patients with UGIB no diagnosis could be made at the endoscopy. CONCLUSIONS: The magnitude and proportional of the causes of UGIB is similar to other African and Indian studies, but different from those for the Europe and United States. Bleeding could have been prevented if people at risk and symptoms do endoscopy early.
Assessment of partogram filling practices and its associated effect on labour outcome to low-risk pregnant women delivering at Amana hospital, ilala Municipality, Dar es salaam, Tanzania. from 1st April 2012 – 31st December 2012.
(Hubert Kairuki Memerial University, 2012) Bakengesa, Victor K.
Background: The World Health Organization has been advocating the use of Partograph as a necessary tool in the management of labour and recommends its universal use during labour. However, some health-care practitioners, especially in high-income countries, have questioned its effectiveness. Objective: The aim of this study was to assess Partogram filling practices and its associated effect on labor Outcomes to Low risk Pregnant women. Materials and Methods: This Cross sectional comparative study with a prospective follow up of Labor and Delivery till twenty four hours post delivery was conducted from April to December 2012 to women who delivered at Amana Municipal Hospital, Ilala district, Dar-es-salaam. The Partographs from attached Case Notes and Antenatal Cards were retrieved and reviewed for the necessary information including partogram filling components and the labor outcomes (Maternal and Fetal outcomes). A total of 1249 Patients were recruited in the study and only 702 Patients/Partographs were available for analysis. The rest were lost to follow up, some left before twenty four hours and others had misplaced Partographs. Results: A total of 661 (94.2%) Partographs were incompletely filled. In this study it was revealed that all participants with Bad Maternal Outcomes had incomplete Partograph and result was significant at (p<0.05). This was not true for fetal outcomes which showed no statistical significance. Assessment of Contractions once every four hours intervals 423(60.3%) and taking blood pressure at least once every hour 658(93.7%) were the most Partograph components which were not done. Ninety four percent (94%) with Perineal tears and eighty nine (89%) with Postpartum hemorrhage; the contractions component was not assessed as needed for at least once in 4 hours intervals (p<0.0001). The results also showed that out of 702 Participants, 89(12.7%) crossed the Action Line before delivery. The main clinical decision made after crossing the Action Line was Augmentation 60 (64%) and Caesarean Section 21 (23.6/o). Conclusions and Recommendations: The study revealed that Partograph tool was not properly filled and therefore the outcome of that Malpractice was associated with Bad maternal outcomes though didn't show significant association with fetal outcomes in Low risk Pregnant Women. Despite the above findings the health-care practitioners should not be discouraged from the utilization of the Partograph to reduce poor Maternal outcome and Fetal Outcome as well.
Factors contributing to the maternal mortality in Dar es salaam municipal hospitals, Tanzania, from August 2011 to April 2012.
(Hubert Kairuki Memorial University, 2012) Kiani, Joseph S.
Complications of pregnancy and childbirth are the leading causes of maternal mortality among women of reproductive age in the developing countries where about 99% of all maternal death in the World occurs. The objective of this study was to determine the causes and factors contributing to maternal mortality in Dar es Salaam municipal hospitals from August 2011 to April 2012. This was a prospective cross sectional hospital-based study where the sample size was all maternal deaths which occurred, and the study population was all deliveries which took place in these hospitals during the period of study. The source of data was hospital records and interviews to the deceased close relatives which were then entered in the structured questionnaire and analyzed using a computer SPSS Program Version 17. Level of significance used was 95% (p95%) in order to confirm the actual cause of death. Inadequate skills of the attending health personnel was found to be the leading contributing factor to death followed by delay in getting appropriate treatment in the hospital due to multiple factors such as lack of blood in the hospital blood bank; inadequate staff; absence of theatre services in some of the health centers; late referrals; delay in decision making at the family level and delay in seeking treatment for HIV/AIDS. According to the researchers assessment majority (57) of the audit report forms (68.7%) were found to have relevant causes of death and 26 of the forms (31.3%) the causes of death written were not relevant, for example 'high spinal anesthesia, amniotic fluid embolism, local herb intoxication, eclampsia, infection, prolonged obstructed labour etc need to be clarified more as being the real causes of death because they sound more as the diagnoses rather than the real causes of death. It is recommended that; more efforts are still needed to reduce maternal deaths in our country in order to reach the MDG 5 target for the remaining three years; municipal hospitals must, at all times, have enough blood which can be used during emergencies; auditing meetings should be done shortly (preferably within a week) after death so that important information regarding death is not forgotten; postmortem should be done routinely to all deaths in order to get the actual cause of deaths and on-job training to the health workers and motivation should be increased in order to improve the service in our hospitals. The real causes of death should be emphasized rather than the diagnoses as being the causes of death which are somehow confusing because they do not reflect the actual causes of death.
Use of partogram and its effect on labour outcomes amongst women delivering at Amana hospital, ilala municipality, Dar es salaam, Tanzania. From 1st April 2012-31st December 2012.
(Hubert Kairuki Memorial University, 2012) Bakengesa, Victor K.
Background: The World Health Organization has been advocating the use of Partograph as a necessary tool in the management of labour and recommends its universal use during labour. However, some health-care practitioners, especially in high-income countries, have questioned its effectiveness. Objective: The aim of this study was to assess practices in the use of Partogram and its effect on labor outcome amongst women. Materials and Methods: This Cross sectional comparative study with a prospective follow up of Labor and Delivery till twenty four hours post delivery was conducted from April to December 2012 t6 women who delivered at Amana Municipal Hospital, Ilala district, Dar-es-salaam. The • Partographs from attached Case Notes and Antenatal Cards were retrieved and reviewed for the necessary information including partogram filling components and the labor (Maternal and Fetal outcomes). A total of 1249 patients were recruited in the study and only 702 Patients/Partographs were available for analysis. The rest were either in the lost to follow up, some left before twenty four hours and others misplaced partographs and etc. Results: A total of 661 (942%) Partographs were incompletely filled. In this study it was revealed that all participants with bad maternal outcomes had incomplete Partograph and result was significant at (p<0.05). This was not true for fetal outcomes which showed no statistical significance. On the other side, among all participants whose Partographs were completely, filled there was one who had bad Maternal outcome. Assessment of Contractions once every hour in four hours intervals 423(60.3%) and taking blood pressure at least once every hour 658(93.7%) were the most Partograph components which were not done. Ninety four percent (94%) with perineal tears and eighty nine (89%) with Postpartum hemorrhage; the contractions component was not assessed as needed for at least once in 4 hours intervals (p<0.0001). The results also showed that out of 702 Participants, 89(12.7%) crossed the Action Line before delivery. The main clinical decision made after crossing the Action Line was Augmentation 60 (64%) and Caesarean Section was which was done in 21 (23.6%). Conclusions and Recommendations: This study revealed that The Partograph tool was not properly used and therefore the outcome of that malpractice was associated with bad maternal outcomes though didn't show significant association with fetal outcomes. Despite the above findings the health-care practitioners should not be discouraged from the utilization of the Partograph to reduce poor maternal outcome and fetal outcome as well. This study will encourage further research to come up with more evidence based results on the effectiveness of the Partograph in prevention of both poor maternal and fetal outcome.
Epidemiology of road traffic injuries among patients presenting to Tumbi district designated hospital, Kibaha district, Pwani region – 2011
(Hubert Kairuki Memorial University, 2012) Hamad, Makame O.
Introduction: Road traffic injuries (RTI) are a worldwide disaster. The World Health Organization (WHO) reported that an estimated 1.2 million die and 50 million are injured yearly as a result of road traffic injuries around the world and projects that road traffic injuries will become the third leading contributor to the global burden of disease and injury by 2020 (Peden M, Scurfield R, Sleet D, et a,: WHO, 2004). Road traffic injuries disproportionately affect developing countries, where the burden of road traffic injuries is escalating in low and mid income countries. Tanzania has not been left behind with regard to this disaster, and fractures are of most morbidity and so a cause of ill health and death in our health facilities. The choice of interventions to be implemented depends on the main types of road traffic injuries in the population, together with their expected cost and impact. Broad Objective of this study was: to explore the magnitude and patterns of road traffic injuries (RTIs) among victims and drivers presenting to Tumbi DDH in Kibaha, Pwani region from May to December 2011. Specific Objectives are: to determine the prevalence of RTI; to determine the pattern of injuries of RTI; to determine the demographic and other risk factors causing RTI; to establish the association between RTI and identified risk factors; and to assess type and outcome of injuries on all admitted patients Methodology: This was a prospective cross-sectional analytical institutional-based study. Findings from this study focused on public health implication of exposures so as to help to complement and strengthen existing control measures on RTIs Results: The study included 126 participants who were involved in a RTA and met criteria; about 83.3% of the participants were men who outnumbered female participants by 5-times. The mean age was 33.3years wwith SD of 12.23, and the majority of the participants were age group 15-34 years. Common RTl reported was bruises and soft tissue injuries for about 61% followed by fracture and head injuries which were 27% and 12% respectively, where men were the most victims. Them main reason claimed by the respondent for RTA was high speed, however, the inappropriate use of preventive measures like Use of seat belt was significantly associated with injuries p=0.002 as mostly cited by respondents Conclusion: RTA is a hidden epidemic that needs to be addressed. Inappropriate use of seatbelt appears to be the main risk factors for injuries. More studies as well as preventive measures in the work places are urgently needed to address this health problem.
Prevalence of metabolic syndrome and its risk factors in people living with aids using highly active antiretroviral therapy at care and treatment centres in ilala municipality 2009-2010
(Hubert Kairuki Memorial University, 2012) Riwa, Digna N.
INTODUCTION: Metabolic syndrome refers to a clustering of cardiovascular risk factors that include diabetes, obesity, aging, physical inactivity, dyslipidaemia, hypertension and lipodystrophy. Lipodystrophy is more common in People Living with AIDS using HAART, and there is little data on metabolic syndrome in people living with AIDS using HAART in our environment. OBJECTIVE: This study was carried out to determine the prevalence of metabolic syndrome in PLWA using HAART in Ilala municipality between 2009/2010 METHODOLOGY: A total of 652 people aged above 18 years living with HIV/AIDS, being tested for lipids profile and using HAART for not less than nine months were recruited from five care and treatment centers out of 13 centers in Ilala district in Dar Es Salaam. This study was done for one year from January, 2011 to December 2011. RESULTS: Out of 652 people living with HIV/AIDS 332(50.9%) were females. About 60% of the participants were obese and about three quarters of obese participants were aged 35-54 years, p= O.OOOl.Among 156 participants who had elevated BP only 37(23.7%) were using anti- hypertensive drugs, and two third of participants with elevated BP, elevated serum Triglycerides, were aged 35-54 years., p = 0.0001.The magnitude of metabolic syndrome in the PI based regimen was sigmficantly higher than in NNRTIs based regimens, in those participants who had been using HAART for more than 18 months withp value 0.0001. CONCLUSION: My study observed that there was high prevalence of metabolic syndrome in PLWA using HAART. with strong association of person age group, dyslipidaemia, and duration in both NNRTIs and Pis based regimens.
Lipodystrophy in HIV - infected patients attending HIV clinic at Muhimbili national hospital
(Hubert Kairuki Memorial University, 2013) KHAN, G. M. H.
Background: The use of highly active antiretroviral therapy (HAART) has decreased morbidity and mortality rate associated with HIV infection. HAART is associated with increased incidence of morphological and metabolic changes, including hyperlipidaemia and hyperglycaemia, insulin resistance. These metabolic changes may increase the risk for cardiovascular disease and the morphological changes have significant psychological impact. The prevalence of HIV lipodystrophy is not well established so far, and no data has been reported in Tanzania, therefore, there is a need to conduct a comprehensive study to determine the prevalence of lipodystrophy and serum biochemical changes in HIV infected patients who are on HAART at Muhimbili National Hospital, Dar es salaam, Tanzania. Study objective: To determine the prevalence of lipodystrophy and metabolic changes in HIV infected patients on HAART for at least one year at the HIV clinic in MNH. Methodology: This was a descriptive cross sectional study at the HIV clinic at MNH, during November 2010 to December 2010. Study population included HIV infected patients attending HIV/AIDS clinic at MNH, who were on HAART for more than I year. The subjects were obtained by systematic random sampling technique. Data collection included interview using standardized structured questionnaire, lipodystrophy was defined as self- reporting and clinical examination, explanatory variables investigated included age, sex, duration of HIV disease, duration of HAART used, BMI, Waist-to Hip ratio, serum total cholesterol, serum triglycerides, fasting blood glucose Data analysis was done by statistical package for social science (SPSS) version 13. The associations of different variables and presence of lipodystrophy was compared using the Student's t-test for continuous variables and the Pearson's jl test or Fisher's Exact test for categorical data was analyzed. A multivariate analysis was performed by multiple logistic regression analysis to determine the independent predictors of lipodystrophy. A two-sided P value < 0.05 was considered statistically significant. Results: A total of 239 HIV- infected patients participated in the study with 68.7% female and the participants mean age was 45.4 (range from 20 - 67 years). Forty four percent were diagnosed to have HIV for more than 5 years and 78.2% were on ARV's for more than 3 years. Lipodystrophy was observed in 27.6% (n=66). Among study participants with lipodystrophy 20 (8.4%) had lipoatrophy, 15 (6.3%) had lipohypertrophy and 31 (13.0%) participants had mixed type. By univariate analysis the prevalence of lipodystrophy was significantly associated with increased duration of HIV disease (P=0.007), increased duration of HAART use (P=0.009), systolic blood pressure (P=0.017), body mass index (P=0.011), high female waist- to- hip ratio (P= 0.001), fasting blood glucose (0.038), serum triglyceride (0.016). When a multivariate logistic regression analysis was performed, duration of HIV disease (p= 047), and female waist to hip ratio (p= 0.041) were independently associated with Lipodystrophy in HIV infected patients. Conclusion The prevalence of lipodystrophy is high (27.6%) among HIV infected patients. Lipodystrophy was significantly associated with increased duration of HIV disease, increased duration of HAART use, body mass index, female waist-to-hip ratio, high serum triglyceride and fasting blood glucose. This highly prevalence of lipodystrophy does not only contribute to an accelerated risk of premature atherosclerosis and cardiovascular events among HIV Infected patients; but also its morphological changes to individuals may lead to psychosocial stigmatization, reduced self esteem and poor adherence to HAART. Recommendation Routine assessment of HIV lipodystrophy and its risk factors among HIV infected patients should be essential part of HIV/AIDS Treatment and Care. This will facilitate early vigilant diagnosis and timely intervention of lipodystrophy and metabolic alterations, including cardiovascular risk factors.
Assessment of quality of focused antenatal care and its effectiveness among women attending selected clinics in ilala district in Dar-es-salaam Tanzania from March 2012 March 2013
(Hubert Kairuki Memorial University, 2013) Shinyala, A.
Background: The present study was conducted to investigate on the overall quality of provision of antenatal care services and its effect on the reduction of Maternal and Fetal Mortality and Morbidity among women attending selected health facilities at ilala municipality in Dare s salaam. Methods: A cross sectional comparative study was performed in ten months and follow up in the Antentenal Clinics from March 2012 to December 2012. Target population was all women attending antenatal clinics and government health workers providing services to those women. A sample size of 350 women has been attained in this study. Tools used were checklists and questionnaires and data analysis was performed through SPSS version 11.0. Frequencies and percentages were used to describe variables Univariate and multivariate logistics, regression analysis were used determine the odd ratio. T test and chi square tests were used to assess the statistical significance at a confidence level of 95%, where p values less than 0.005 indicated a statistical significance. RESULTS: The study has revealed that only 38% of the recruited mothers attending antenatal clinics had adequate awareness on pregnancy danger signs. A higher level of education was the most predictive factor for increased awareness of danger signs. Other factors associated with awareness include skilled health care providers, employment, attendance to health facilities and counseling of women during antenatal care services. In this study the number of children (parity) significantly associates with the use of ITN (P<0.05. more for those who had one parity. DISCUSSION: Educated women had higher awareness on danger signs than women with no formal education. Better education is associated with enlightenment and awareness of different health conditions although exposure to information is crucial. A study done by Okour in Jordan revealed that education level of study participants and receiving information about danger signs and symptoms were all associated with awareness (P=0.02 for all associations). Studies in Tanzania and elsewhere indicate that a higher level of education is associated with awareness on danger signs whereas other studies have shown no association. CONCLUSION AND RECOMMENDATION: The study concludes that there is still a need to improve quality of Antenatal Care Services in developing countries and that pregnant women are not aware of the pregnancy danger signs. There is suboptimal quality of counseling during antenatal care visits on pregnancy danger signs.
Determinants of referral among patients transferred for emergency surgical operation from secondary level hospitals to tertiary level hospitals in Dar es salaam region, June - October 2013
(Hubert Kairuki Memorial University, 2013) Mwamkoa, Leonard L.
OBJECTIVE: To assess the determinants of referred patients for emergency surgicai operation from second level hospitals to tertiary level hospitals in Dar es Salaam region. Little information is documented for the determinants of referral of general surgery patients for emergency operations. METHODOLOGY: The cross-sectional descriptive hospital based study, conducted at emergency department of MNH in a period of five months in 2013. A total of 363 patients were referred from second level hospitals to tertiary level hospital in Dar es Salaam region during the study period. RESULTS: The determinants grouped into four main groups and several small sub groups in each main group. The 62.5% of referred patients required urgent attention and the remaining 37.5% were cold cases. The type of disease/diagnosis was first main group; the leading referral disease about half of all referrals due to diseases were musculoskeletal conditions 50.7%, followed by gastrointestinal diseases 26.7%. Lack or shortage of the health personnel was second main group; The leading shortage of personnel was about 36.6% referrals was due to the shortage of General Surgeons, 29.8% due to shortage of Orthopedic Surgeons and 15.15% referrals due to shortage ofNeurosurgeons. The lack of equipment was third main group; leading factor was lack of investigation services about 33.3% referrals, lack of sterile gauze at the theaters was about 24.8% and lack of sterile trays for surgeries was about 18.5%. The insufficient infrastructure was fourth main group; leading factor were due to overcrowding of patients in the surgical wards about 68.9% referred patients due to few beds in the surgical wards, followed by lack of ICU facility about 16.0% of referred patients and overcrowding of patients waiting theatre service 15.2%. Only 25.3% of all referred patients were due to patient's request (or self referral) and Mwananyamala hospital was the leading hospital for referring many patients, for about 53.4% of referred patients. CONCLUSIONS: The determinants of the referred surgical patients showed some similarities and difference in some aspects, to other studies done in Tanzania and in Africa. High rate of referral of general surgical patients for emergency treatments to tertiary level hospital could be minimized if; theatre, surgical clinics standards and management are followed at the second level facilities.
Urinary tract infection: prevalence pathogens and antimicrobial susceptibility pattern among febrile children at Mwananyamala Hospital Tanzania
(Hubert Kairuki Memorial University, 2013) Barongo, Aileen K.
Background: Urinary tract infection (UTI) is a common and important cause of morbidity in the pediatric population in developing countries. Prevalence rates of urinary tract infection in children range from 3.3% in the United States to 39.7% in Northwestern Tanzania. Diagnosis of Urinary Tractjnfection in children is difficult to establish in our setup, therefore in resource-limited settings most children with Urinary Tract Infection are either misdiagnosed or given empiric treatment without laboratory confirmation of the infection. Moreover, many uropathogens are developing resistance to antibiotics recommended by World health Organization (WHO) to treat urinary tract infection. The magnitude, etiology and antimicrobial susceptibility of Urinary Tract Infection in Tanzanian febrile children are not well defined. All published studies to date on the prevalence and etiology of UTI in febrile children have not included a control group which is necessary to investigate false positives due to poor collection procedures or a latent period before the sample is inoculated to the agar growth media. The urine collected for urinalysis or microscopic needs to be tested as soon as possible so as to prevent multiplications of organisms. If the urine has to be cultured, it should be refrigerated during transit and held refrigerated until cultured. Objective: The objectives of this study was to determine the prevalence of Urinary Tract Infection, aetiologic pathogens and antimicrobial susceptibility of these pathogens in febrile children aged two to five (2-5) years in Mwananyamala District Hospital. Methodology: This was a Cross-sectional descriptive hospital-based study which was conducted among febrile children aged two to five years. Febrile and afebrile children were consecutively recruited from the paediatric and the Reproductive and vii Child health (RCH) clinics at Mwananyamala District Hospital. The study was carried out for six months, i.e. from July to December 2012. Urine was collected by use of clean catch method into a sterile container. The diagnosis of Urinary Tract Infection was confumed by bacteriological culture of urine specimen. If bacterial uropathogens was isolated from the urine specimen, antimicrobial susceptibility testing was performed using discs for the following antimicrobials: Cotrimoxazole, Amoxicillin, Erythromycin, Gentamycin, Ceftriaxone, Ciprofloxacin and Amikacin Results: A total of 556 children fulfilled the eligibility criteria and were enrolled into the study. Of these 370 (66.5%) were febrile and 186 (33.5%) were afebrile. Among the 370 febrile children 29 children were confirmed to have urinary tract infection by urine culture, giving an overall prevalence rate of 7.8%. Females were noted to have higher prevalence of UTI than males, however, the difference was not statistically significant (P^ 0.418). Of the 186 afebrile children 11 were confirmed by urine culture to have urinary tract infection giving an overall prevalence rate of 5.9%. Febrile children were noted to have higher prevalence of urinary tract infection than afebrile children, however the difference was not statistically significant (P= 0.729). Escherichia coli was the most commonly isolated organism accounting for 38%, followed by Klebsiella species which accounted for 21%. Other organisms isolated included Proteus species, Pseudomonas species and Staphylococcus aureus. Resistance rates of the isolated uropathogens to, Co-trimoxazole, Erythromycin and Amoxillin were 100%, 89.7% and 86.2%, respectively. Gentamycin and Ceftriaxone had slightly lower resistance rates of 48% and 57% respectively while Amikacin and Ciprofloxacin had least resistance rates of 0% and 6.9%respectively. Conclusion: Prevalence of Urinary Tract Infection among febrile children aged two to five (2-5) years attending the Paediatric and the Reproductive and Child Health Clinics in Mwananyamala District Hospital, Dar es Salaam is 7.8%. The commonest bacterial Uropathogens isolated fi^om the urine of these children were Exoli and Klebsiella Species. The isolated bacterial uropathogens showed a relatively high resistance to Amoxillin, Co-trimoxazole and Erythromycin. Recommendations: One study conducted at Mwananyamala District Hospital in children aged 2 to 5 years is not enough to make a recommendation on the prevalence and pattern of organisms causing Urinary Tract Infection in children between two and five years in Dar es Salaam. It is proposed that further long term studies be conducted in order to produce results to advice government to change the current standard of antibiotic treatment for urinary tract infection.
Effects of induced arginase enzyme on arginine availability for nitric oxide production in children with severe malaria
(Hubert Kairuki Memorial University, 2013) Kalabamu, Florence S.
INTRODUCTION: Malaria is still one of the major leading causesof morbidity and mortality in developing countries regardlessof the use of effective antimalarial drugs. Immunological response as a result of malaria acquisition contributes much to pathogenesis of malaria. Recent studies have indicated that malaria infection is associated with low plasma arginine levels with subsequent low NO productionand endothelial dysfunction. NO is important for normal endothelial function which is impaired during malaria infection. The causes ofhypoargininemiawith low NO production in malariaarenot well understood. Arginase,anenzyme responsiblefor metabolism of arginine to ornithine,competes with NOS for its substratearginine. Ornithine is a precursor for polyamine biosynthesis and other anabolicpathways. The contributionofarginase tothedevelopment of low plasma arginine levelshasnot been studied in children. OBJECTIVES: The aim of this study was to assess the role of plasmaArginasein the observedhypoargininemiain children with malaria. METHODS: Across-sectionprospective,observationalstudy was done in Dar es Salaam, Tanzania. Children aged 6 months to 9 years were recruited from Mwananyamala, Amana,and Mikocheni hospitals afterobtaining informedconsent. Participants were grouped into severe malaria(SM), uncomplicated malaria (UM),and healthy controls (HC) using WHO criteria. Blood samples were taken from participants and analyzed for plasmaarginine,plasmaarginaseactivity,andcell-freehemoglobin. PBMCswereseparated from anticoagulated bloodfor determination of mRNA for arginase1,arginase2,and NOS2. RESULTS: Eighty (80) SM, 80UM,and48HCwere recruited. Plasma arginine levels were significantly lower in malaria groups compared to healthy controls (p<0.0001).The mean values were 58.8±3.9µmol/L in SM, 54.8±3.3µmol/L in UM,and94.58±4.2 µmol/L inHC.Plasma arginase activity was higher in children with malaria, but it was not statistically significantly higher (p=0.75).Themean values were 0.273±0.034µmol/ml/hour inSM, 0.252±0.030µmol/ml/hour in UM,and 0.200±0.0566µmol/ml/hour in HC.There was no correlation between plasma arginase activity and plasma arginine levels in SM group (Pearson r=-0.001).Cell free Hb levels werehigher in the SM and UM groups (p=0.02), but it did not correlate with plasma arginase activity(r=-0.09). Therewas amarked increaseinarginase 1mRNAin PBMCs7 fromSM and UM compared to HC group. The median values were9.31and4.51fold increaseinSMandUMgroups,respectively (p=0.008 and 0.02,respectively).mRNA valuesfor arginase2 wereslightly higher in the HCgroup, but this was notsignificantly higherthan that of the other groups(p=0.89).NOS2 mRNA was lower in PBMC of malaria patients(SMand UM)compared toHC(p=0.0001foreachcomparison). DISCUSSION, CONCLUSION,AND RECOMMENDATIONS: Plasma arginine levels were lowin children with malariacomparedtopreviouslyreportedfindings. Hypoargininemiaand plasma arginase activity do notsignificantlycorrelate with one another. ElevatedarginaseImRNA levelsin PBMCpatients withmalaria,suggests that arginase 1 could alsobe induced in othermononuclear phagocytes, including fixed macrophages. These arginase1-bearing cells may in part beresponsible for hypoargininemia. Induction of mononuclear phagocyte arginase1anddiminished NOS2mRNA and NO production bymononuclear phagocytes conforms to the phenotype of “alternative macrophage activation.” Hypoargininemia and alternative macrophage activation correlate with clinical malaria and may be markers ofmalaria diseaseseverity.Assessment of arginase activity inPBMCs (andpurifiedmononuclear phagocytes)during malaria infection is warranted to fully establishtheroleof alternativelyactived monocytes-macrophagesinthehypoarginaemia observed during themalaria infection.
Prevalence and determinants of pre-term deliveries among pregnant mothers at Amana, Temeke and Mwananyamala municipal hospitals, Dar es salaam, Tanzania from January 2013-september 2013.
(Hubert Kairuki Memorial University, 2013-09) Mahapula, Fanaka A.
BACKGROUND: Preterm birth is one of the most significant problems in perinatology. Prematurity is a leading cause of Neonatal Mortality. The morbidity associated with Preterm Birth often extends to later life, resulting in enormous physical, psychological problems and economic costs. Sixty percent of preterm births in the world do occur in Sub-Saharan Africa and South Asia every year, among of them 12% born too small compared with 9%in the industrialized countries. Different risk factors play a role in the high rates of preterm births in different regions in the world. Several studies have been done to assess the determinants of preterm births in developed and developing countries. The the majority of preterm births are idiopathic. OBJECTIVES: The main objective was to establish the prevalence of preterm deliveries among pregnant mothers at Amana, Mwananyamala and Temeke Municipal Hospitals in Dar-es-salaam, Tanzania and determining associated factors in 2013. STUDY DESIGN: Cross-sectional analytical study. MATERIAL AND METHODS: All pregnant women who delivered premature babies and met inclusion criteria were recruited in the study and those who delivered term babies were randomly recruited in the study. Structured questionnaires were used to fill data on maternal profile. Last menstrual period and Finn storm score were used to estimate the gestational age. RESULTS: During the study period of nine months a total of 40,896 women delivered at Amana, Mwananyamala and Temeke Municipal hospitals. Among them 39,866 delivered term babies, 198 post term babies and 832 preterm babies. The prevalence of preterm delivery was 20 per VI 1,000 deliveries. A total of 828 subjects who met inclusion criteria were recruited into the study. Four hundred and nine (409) of them were pre-term deliveries and 419 were term deliveries. Significant determinants of preterm delivery identified were marital status (P=0.001; OR=0.4; 95%CI=0.3-0.7), occupation (p=0.028; oi: =1.9;95%CI=l.1-3.5), previous preterm delivery (P=0.016; OR=2.1; 95%CI=1.1-4.0), mode of delivery (P=0.001; OR=32.5;95%CI=4 259), multiple gestation (P=<0.001; OR=10.9;95%C1=5.7-21.1), prenatal care (P=0.001; OR=0.1;95%CI=0.1-0.3), maternal urinary tract infection (P=0.003, OR=2.195%CI=l.1-3.9), genital tract infection (P=0.012; OR=6.8; 95%CI=1.5-30.5) and maternal medical chronic disease(P=0.001;OR=3.5;95%CI=l.6-7.5). CONCLUSIONS: Factors significantly associated with preterm delivery were Marital status. Occupation, Previous preterm delivery. Multiple gestations. Prenatal care, Maternal urinary tract infection, Genital tract infection and Chronic disease.
Assessment of quality of abortion and post abortal care services among women admitted in gynecological wards at Amana and Mwananyamala municipal hospital, Dar es salaam, Tanzania; from January 2013 - September 2013.
(Hubert Kairuki Memorial University, 2013-09) Kashagama, Ahmada M.
Background: The International Conference for Population Development [ICPD] in 1994 stated post abortion care being the element of safe motherhood initiative to reduce maternal morbidity and mortality. It is of great importance where access to safe abortion is restricted by law and services are inaccessible. Objective The objective of the study was to assess quality of post abortal care and prevalence of abortion among women admitted in gynecological wards at Mwananyamala and Amana municipal hospitals. Methodology The study was hospital based cross sectional study which was conducted within nine months from January 2013 to September 2013. Patient interview, health care provider interview and direct service delivery observation, data from register books were used to compute different aspects of care. Two government health facilities were involved in the study, where 350 post abortion patients were interviewed 21 health care providers were observed and 21 direct health care providers were interviewed. Results A total of 3283 patients were admitted, 1438 of them were abortion cases and only 350 post abortion patients met criteria and were interviewed. Twenty one health care providers were interviewed and were observed while providing services. From this study the prevalence of abortion found to be 43.8%. There was a delay to some patients before getting services because about 67.4% of the patients reported that they had to pay before the procedure. Moreover, drugs and other supplies were to be collected from other sources out of the facilities. Majority of the patients felt that there was no privacy during evacuation procedure, people could get in and out from procedure room, this was stated by 74.3% of respondents. About 65.7% of respondent left the facilities with no family planning information. Among interviewed post abortion women 72.3% were multigravida indicating that there is a need for family planning in order to prevent unplanned pregnancies. Most of the attended post abortion patients left without checking their BP and Hemoglobin level but majority reported to have been given analgesics and few of them were given antibiotics

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