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Urinary stone disease in Dar es Salaam
(East African medical journal, 1991) Mbembati, Naboth A.
Forty four adult patients, 34 males and 10 females, with urinary stones were seen over a six-month-period at Muhimbili Medical Centre, Dar es Salaam. Most patients were peasants and semiskilled workers. 8 of the patients were Arabs, which suggests a high predisposition for this race. 12 of the patients had a history of having suffered from bilharzia. There was a high proportion of bladder (and urethral) stones (30%) but upper urinary tract stones were still predominant (70%). Of 20 patients whose stones were available for analysis, 8 were composed of calcium oxalate, 7 of calcium phosphate and 5 of mixed composition. The ratio of stone patients to all hospital admissions of 243 per 100,000 suggests the prevalence of urinary stone disease is comparable to that found in Western countries.
Operative management of achalasia of the esophagus.
(East African medical journal, 1994) Mbembati, Naboth A.
Twenty patients with achalasia of the oesophagus were managed in one thoracic surgical unit over a period of seven years. Eighteen of these were aged 16 to 40 years. There was a female:male ratio of 2:1. Dysphagia to both solids and liquids with diffuse bilateral parotid gland enlargement were the most common clinical features. All the patients had an oesophagomyotomy without an additional anti-reflux procedure. There was no mortality. The trans-thoracic approach for oesophagomyotomy was associated with better results without complications of gastro-oesophageal reflux. This approach is recommended and an additional routine anti-reflux procedure at the same sitting may be unnecessary.
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.
Pneumatosis cystoides intestinalis--in Tanzania.
(The Central African journal of medicine, 1995) Wandwi, Wambura B.
Pneumatosis cystoides intestinalis (PCI) is a rare benign condition affecting portions of the intestinal tract, characterised by: multiple subserosa and submucosal gas cysts, unknown aetiology, and non specific clinical presentation. Its diagnosis is often coincidental. Management of PCI entails that of the associated condition.
Coronary artery fistula to bronchial artery on contralateral side of coronary atherosclerosis and myocardial insufficiency. A case report.
(Angiology, 1996) Wandwi, Wambura B.
Among coronary vessels anomalies is the rare coronary artery fistula. Myocardial insufficiency resulting from fistula steal phenomenon can not be clinically distinguished from that of coronary atherosclerosis, if these conditions coexists in the same patient. The authors present a case of extracardiac left coronary artery fistula connecting the circumflex branch and left bronchial artery, with inferior wall myocardial insufficiency attributable to the right coronary artery atherosclerosis.
Cholelithiasis in Dar es Salaam, Tanzania.
(The Central African Journal of Medicine, 1996) Wandwi, Wambura B.
In a five year review, there were 30 cases of cholelithiasis treated at the Muhimbili Medical Centre, Dar es Salaam, Tanzania. The male to female ratio was 1:3, and the peak age for cholelithiasis was in the 30 to 49 years age group. Right upper quadrant abdominal pain was the commonest presenting symptom (100 pc), and cholecystectomy was performed in all patients. Local complications of gall stones were recorded in seven patients (23.3 pc) and these included; gall bladder empyema, pericholecysteal abscess, CBD stone, gall bladder adenoma, gall bladder mucocele, and two patients had acute cholecystis. Stones were multiple in 90 pc of patients, and on macroscopic classification the ratio of cholesterol to pigment stones was 2:1. There was no death in this series of 30 patients.
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 carcino
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.
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.
Pulmonary aspergilloma: A 15 years experience in Dar es Salaam, Tanzania.
(East and Central African Journal of Surgery, 2001) Mbembati, Naboth A.
There is a paucity of literature on the prevalence and surgical treatment of pulmonary aspergilloma in African countries. This was a retrospective review of cases managed at the Thoracic Surgical Unit of Muhimbili National Hospital, Dar es Salaam, Tanzania, over a 15-year period from June 1986 to May 2000. Ten patients were operated on for pulmonary aspergilloma out of 345 major thoracic surgical operations performed by the unit during the period of study. There were eight males and two females. The surgical treatment offered included left upper lobectomy in six patients, right upper lobectomy in two, right lower lobectomy in one and extra pleural pneumonectomy in one other patient. There were three deaths. It is recommended that pulmonary aspergilloma should be considered as one of the differential diagnosis in any patient who presents with recurrent episodes of haemoptysis.
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.
Management of opportunistic infections and other conditions in Infected patients
(East and Central African Journal of Surgery, 2001) Mbembati, Naboth A.
The emergence of HIV infection and AIDS has changed the pattern of many diseases in various fields of medicine including surgery. In surgical practice changes have been documented in the pattern of diseases such as pyomyositis, Kaposi's sarcoma, tuberculosis, empyema thoracis among others. The pattern of change is however different between the developed and the developing world. The management may also differ according to the disease presentation. The patient's response to surgical treatment has also changed. This paper reviews and discusses the pattern of disease presentation of HIV related surgical conditions and the management of such conditions in the developing world.
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.
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.
The use of 'BioGlue' for the repair of aortic Insufficiency in acute aortic dissection
(Journal of heart valve disease, 2004) Wandwi, Wambura B.
Background and aim of the study: Concern has been raised regarding the late effects of tissue glues. Herein is described the authors' experience with a new bioadhesive (BioGlue; Cryolife) for repair of the aortic root in acute dissection. Methods: BioGlue is composed of bovine serum albumin (BSA) and glutaraldehyde. Glutaraldehyde exposure causes the lysine molecules of BSA, extracellular proteins and cell surfaces to bind to each other, creating a strong scaffold. Between January 2001 and January 2003, BioGlue was used to repair the aortic root in 22 patients with acute aortic dissection. Moderate or severe insufficiency was present in 16 cases, and mild insufficiency in six. The mechanism of insufficiency was commissure detachment in 15 cases, penetration of the intimal flap into the valve in three, and dilatation of the sinotubular junction in four. The aortic valve was resuspended to the aortic wall using pledgeted sutures. BioGlue was used to glue the dissected layers of the aortic root and create stronger tissue for sewing. Two patients required complete resection of the sinuses and aortic root remodeling with a Dacron graft. Results: There were two operative deaths. Postoperative transesophageal echocardiography showed mild or no aortic insufficiency in 18 patients, and moderate insufficiency in two. During follow up (mean 16 months), none of the patients required reoperation for proximal redissection, delayed rupture, or aortic insufficiency. Conclusion: BioGlue is useful for aortic valve repair in aortic dissection. It is less toxic and has a stronger adhesive effect than the older surgical glues, and is expected to have better long-term results.
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.
Teachers\' and Students\' Perceptions of the Learning Environment in Clinical Departments at the School of Medicine, Muhimbili University College of Health Sciences
(Tanzania Medical Journal, 2007) Mbembati, Naboth A.
Background: The School of Medicine at Muhimbili is the main doctor-training institution in the country. It runs a five-year MD programme taking 200 students annually. As for many schools in low-income countries, the majority of teachers have no formal training in educational theory Objective: To describe the physical and psychosocial learning environment from teachers' and students' perspectives, describe the perceptions of teachers and students of each other, and propose ways of improving the learning environment. Methods: Fourth year students of the 2005 graduating) class and selected clinical teachers took part in a survey to document their perceptions of the school's learning environment, and the perceptions of teachers and students of each other. Structured questionnaires designed by the authors were used for recording the required information from teachers and from students for analysis. Findings: The availability of ward patients suitable for clinical training was considered adequate by 84% of the students. However, less than 50% of students thought the wards, clinics, library and operating rooms provided a conducive learning environment. Only a third of the students said they used the Internet to access learning material. Two thirds of students said it was difficult to access teachers for consultation outside of scheduled classes. While 63% of students said teachers regularly showed them how to elicit physical signs on patients, a modest 58% of students perceived their teachers as professional role models. Only 13% of students felt that teachers avoided intimidating them during clinical teaching. Seventy one per cent of teachers provided feedback to students after clinical assessment, but only 21% of the teachers believed feedback to students should be directed towards identifying students' strengths and reinforcing them rather than seeking their weaknesses for correction. Conclusion: The learning environment at the school has some strengths that should to be amplified, and numerous weaknesses that need to be corrected in order to make the environment more conducive to teaching and learning.
Primary Gastrointestinal Lymphoma In Immunocompromised Patient. Case Report And Literature Review
(East and Central African Journal of Surgery, 2007) Mbembati, Naboth A.
Primary gastrointestinal lymphoma is a rare disease with no specific clinical presentation. Early diagnosis is usually based on suspicious index, otherwise majority of patients present at late with very advanced disease with complications. The incidence of primary gastrointestinal lymphoma is increasing with HIV disease. There are several classification and staging systems with different treatment options varying from one center to another. Prognosis depends on the stage at presentation, degree of differentiation and age. It was concluded that early diagnosis depends on degree of suspicious index with good treatment response. Late presentation is accompanied by marked immunosuppresion. Future research needs to determine whether single or combined modalities of treatment have good treatment outcomes. A case of primary gastrointestinal lymphoma in immunocompromised patient is reported with literature review.
Management and organization reforms at The Muhimbili National Hospital: challenges and prospects.
(East African Public Health Association, 2008) Mbembati, Naboth A.
Objective: To establish the state of organization structures and management situation existing at the Muhimbili National Hospital (MNH) and Muhimbili University College of Health Sciences (MUCHS) prior to the start of the MNH reforms and physical infrastructure rehabilitations. Methods: A checklist of key information items was used to get facts and figures about the organization of the MNH and management situation. Interviews with MNH and MUCHS leaders, and documentation of existing hospital data were done to gather the necessary information. Results: The survey reveals that there are a number of organizational, managerial and human resource deficiencies that are impinging on the smooth running of the hospital as a national referral entity. The survey also revealed a complex relationship existing between the hospital and the college (MUCHS) that has a bearing on the functioning of both entities. Conclusion: In order for the hospital to function effectively as a referral hospital with a training component inbuilt, four basic things need to be put in place among others: a sound organization structure; adequate staffing levels especially of specialist cadre; a functional information system especially for inpatient services and a good working relationship with the college.
Motivation of health care workers in Tanzania: a case study of Muhimbili National Hospital
(East Afr J Public Health, 2008) Mbembati, Naboth A.
Objective: 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.

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