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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 trend
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.
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.
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.
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.
Risk Factors of Surgical Site Infection at Muhimbili National Hospital, Dar es Salaam, Tanzania.
(East and Central African Journal of Surgery, 2012) Mbembati, Naboth A.
Background: Surgical site infection (SSI) is a common source of morbidity among operated patients. At Muhimbili National Hospital (MNH), studies indicate that the rate of SSI has been increasing over the past thirty years. The aim of this study was to determine the prevalence and factors associated with SSI among patients undergoing surgery at MNH. Methods: This was a hospital-based cross-sectional study. One hundred and eighteen patients who underwent surgical procedures in the surgical wards were recruited. Demographic information was obtained using standardised questionnaire, surgical sites were examined to determine infections, and case notes were reviewed for clinical information including surgical notes. Blood sample was collected for HIV serology. Results: SSI occurred in 42 patients (35.6%). Wound class, abdominal surgeries, emergency procedures and HIV infection increased the risk of SSI. Superficial SSI was the most commonly observed type, 54.8%. Overall HIV prevalence in this study was 16.9% with a 5 times risk of developing SSI. Conclusions: Surgical site infection has remained a major Nosocomial infection in developing countries. Factors shown to be associated with increased risk are wound class, site and nature of surgery, and HIV infection. This study found higher prevalence of HIV infection among surgical patients.
The Pattern and Surgical Management of Diabetic Foot at Muhimbili National Hospital, Dar-es-salaam, Tanzania
(East and Central African Journal of Surgery, 2011) Mbembati, Naboth A.
Background: Diabetic foot is one of the chronic consequences of diabetes mellitus and is responsible for about 50% of non-traumatic lower limb amputations. It is thus associated with social devastation to the patients and their families, both emotionally and economically. This study aimed at determining the pattern and the surgical management of patients with Diabetic Foot at Muhimbili National Hospital, from March to December 2008. Methods: All in-patients with diabetic foot who were admitted in the hospital during the study period were included into the study. Results: A total of 67 patients presented with diabetic foot during the study period of 10 months. 4.5% had Type 1 Diabetes Mellitus and 95.5% had Type 2. The mean age of the patients was 52.4 years with a range of 21-75 years. The mean hospital stay was 35.5 days. Most patients had a positive family history of Diabetes Mellitus (59.7%). Majority of them lacked the known risk factors for foot ulceration such as hypertension, elevated cholesterol levels, trauma and duration of Diabetes Mellitus for longer than 10 years. Wagner Grade 4 and 5 were the most common ulcers encountered and major amputation was done in 44.8% of the patients. The mortality rate was relatively high (25.4%). Mortality was significantly higher in those with Wagner’s Grade ulcers ≥ 3 (p-value = 0.0322). Conclusion: Diabetic foot ulceration was found to be a significant cause of morbidity and mortality in our setting. These patients stay in the surgical ward for a prolonged period of time. This causes a significant strain to the provision health services in the hospital. Designing a diabetic foot management protocol and initiating a diabetic foot unit for admission of these patients could reduce the associated morbidity and mortality and improve outcome.
Patients Satsifaction at theMuhimbili National Hospital in Dar es Salaam, Tanzania
(East Afr J Public Health, 2008) Mbembati, Naboth A.
Objectives: Patients are the primary beneficiaries of the services and care that hospitals provide. The Patient Satisfaction study examined the extent to which patients at the Muhimbili National Hospital (MNH) were satisfied with the services and care they received at MNH. This was part of a baseline study that sought to determine the level of performance of the hospital before massive restructuring, reform, and renovations were undertaken. Methodology: Exit interviews were the main research method used to determine patient satisfaction. Patients were interviewed as they were leaving the OPD clinics, laboratory, X-ray, pharmacy and inpatient wards. Results: The study found that most patients were satisfied with the services and care they received. This high level of satisfaction must be viewed within the context of a hierarchical public health care delivery system, with MNH at the apex. The services and care MNH provides can only be excellent compared to that provided by lower level health facilities. Indeed, patients covered by this study perceived the services provided by MNH as superior, and this was reflected in the high level of satisfaction they reported. Some patients expressed dissatisfaction with specific aspects of the services that they received. They were particularly dissatisfied with long waiting times before receiving services, the high costs of treatment and investigations charged at MNH, poor levels of hygiene in the wards, and negative attitudes of staff towards patients. Conclusion: Although only a small proportion of patients expressed dissatisfaction with these aspects of the services provided, they are significant in that they constitute a call for action by the MNH management to encourage the health personnel to embrace a new staff-patient relationship ethos, in which the patient is a viewed as a customer. Conflict of interest: the authors declare no conflict of interest regarding this study.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.

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