Bugando Medical Centre Research Articles

Insights into Placental Pathology: Analyzing Patterns and Fetal Outcomes in 205 Livebirths at Bugando Medical Centre, Mwanza, Tanzania

Background: The placenta facilitates vital nutrient exchange between fetus and mother, offering insights into fetal and maternal health. Despite its significance, research on placental histopathology in Tanzania is scarce. This study investigates placental features, maternal factors, and their impact on fetal outcomes at Bugando Medical Centre from January to May 2022. Methods: This 5-month cohort study included 205 mothers delivering at BMC. Fetal outcomes were evaluated at birth and after seven days, with maternal characteristics recorded at delivery. Participants were from the twenty-eighth week of gestation, excluding those with intrauterine fetal death or multiple pregnancies. Data on placental histology, maternal factors, and fetal outcomes were collected systematically, while statistical analysis employed STATA version 15, utilizing descriptive statistics. Results: In this study of 205 placentas, participants had a median age of 29 years and a mean gestational age of 38 weeks. Histopathological patterns were present in 61% of placentas, with acute inflammation (22%) and maternal vascular malperfusion (20.8%) being most common. Favorable outcomes were observed in 81% of newborns, while 19% experienced poor outcomes, including 1.9% early neonatal deaths. Most placental lesions were mild (53.6%), with severe pathology in 2.9% of cases. Acute inflammation correlated with various admission reasons, especially neonatal sepsis (60%). Maternal vascular lesions were associated with prematurity (63.6%) and birth asphyxia (40%). Chronic inflammation was more prevalent among low-birth-weight infants (18.8%), while very low birth weight was common in cases of maternal vascular lesions (68.8%). Conclusion: The majority of placentas showed normal or mild pathology, associated with positive fetal outcomes. Further research is needed to understand placental changes and their impact on maternal-fetal health.

Stage at Presentation and Associated Factors for Late Diagnosis of Head and Neck Malignancies at Bugando Medical Centre Tanzania

Head and neck cancer is among the most common cancers with an increase in number worldwide. It has a management challenge due to late-stage presentation. Its epidemiology and characteristics are changing from anatomical to biological due to its viral etiological. This study was done to determine the presentation and factors of head and neck malignancies at Bugando Medical Centre Tanzania. This was an analytical cross-section prospective study involving all patients confirmed to have head and neck malignancy at Bugando Medical Centre from February to June 2019. A total number of 60 patients (M: F=1.4:1) were studied. The median age was 56 years. The associated factors were the symptoms ranging from 1 to 104 weeks at the first consultation, Late-stage observed among patients coming from the rural areas by 58.3% and those using local medicine at 70%. Low level of education, which was primary education, was leading 51.7%. Those who attended the dispensary for their first consultation had an advanced stage of disease at presentation. It showed that the dispensary was the preferred centre for the first consultation of the majority at 41%. The major of patients presented at an advanced stage which was 73% and the contributory factor of delayed presentation of head and neck cancer at Bugando Medical Centre was attributed by patients themselves, whereas health care had a small contribution. The main reasons observed were rural settlement, local medication, and low level of education. Training must be conducted at health care providers in dispensaries and health centres on how to suspect patients with HNC at an early stage and refer them directly to tertiary hospitals without passing through a series of referrals

Unraveling cervical cancer screening dilemmas: histopathological insights from VIA and LEEP at bugando medical centre, Mwanza

BackgroundThe single-visit strategy, also known as the “screen-and-treat” approach, is widely used to screen for cervical cancer in low- and middle-income countries. The screen-and-treat approach leads to unnecessary or inadequate treatment. Thus, a study was conducted to determine the histopathological patterns of aceto-white lesions on visual inspection with acetic acid (VIA) in patients who underwent a Loop Electrosurgical Excision Procedure (LEEP) at Bugando Medical Centre between January 2016 and December 2020.MethodA 5-year retrospective cross-sectional case record review was conducted on 329 women who had LEEP at Bugando Medical Centre following a positive VIA cervical screening test. A standard data abstraction form was used to collect patient information. Missing client information records and LEEP without histopathological results were exclusion criteria. For statistical analysis, STATA version 15 was used; in descriptive statistics, frequency, mean, and standard deviation were used. The Chi2 and Fisher’s exact tests were used to investigate the relationship between patient characteristics and histopathological patterns, and a P-value of 0.05 was considered statistically significant in multinomial models.ResultsThis study looked at 329 patients who had LEEP following a VIA positive but were not eligible for cryotherapy. Our study participants had a mean age of 40 ± 8.2 SD. There were 203 (61.7%) patients with benign lesions, including 4 with schistosomiasis and 2 with cervical tuberculosis. The precancerous lesions were discovered in 100 cases (30.4%), and 26 (7.9%) already had invasive cervical cancer. Out of 100 patients with precancerous lesions, 58 (17.6%) and 42 (12.8%) have high- and low-grade squamous intraepithelial (HSIL and LSIL) lesions, respectively. The presence of a precancerous lesion was found to be associated with age 31–40 years (P-value 0.042) and HIV positivity (P-value 0.004).ConclusionMost patients in this study had benign cervical lesions, which do not require LEEP treatment. Nonetheless, a considerable percentage of invasive cervical malignancies and rare benign diseases such as schistosomiasis and cervical tuberculosis were identified. A screen-and-treat approach within well-equipped tertiary hospitals like Bugando Medical Centre should explore alternative options instead of relying solely on straight LEEP.

Dignity Preservation Among Hospitalized Patient: A Case Study of Bugando Medical Centre, North-western Tanzania

Dignity Preservation Among Hospitalized Patient: A Case Study of Bugando Medical Centre, North-western Tanzania

Prevalence and Factors Associated with Anastomotic Leakage Among Patients Undergoing Bowel Resection and Anastomosis.

Purpose: This study aimed at giving evidence on prevalence and factors associated with anastomotic leakage among patients undergoing bowel resection and anastomosis at Bugando Medical Centre (BMC) and Sekou Toure Regional Referral Hospital (SRRH).
 Methodology: A descriptive cross-sectional analytical study was used involving patients undergoing bowel resection and anastomosis at Bugando Medical Centre and Sekotoure regional referral hospital over a four-month period from March 2017 to June 2017 inclusive.
 Findings: Eight out of 144 patients (5.6%) developed anastomotic leakage. The common indication for surgery was sigmoid volvulus, the common performed anastomosis was ileo-ileo end to end, and double layer continuous anastomotic suture was the common method of anastomosis Anemia (0.012), presence of premorbid illnesses (p=0.003), American association for anesthesia (ASA) greater than II (p=0.001), intraoperative contamination/sepsis (p< 0.001), low ranked operator (p=0.046), prolonged duration of operation (p=0.001), and delayed passage of stool and flatus (p=0.001) were found to be variables associated with anastomotic leakage among study participants. Anastomotic leakage in our setting occurs in approximately 5.6% of patients operated. Several factors such as high American society for Anesthesiologist above III, premorbid condition such as uncontrolled Diabetes Mellitus, intraoperative contamination/sepsis, low ranked operator, prolonged duration of operation above 3 hours and prolonged ileus were among factors that the present study found to be associated with high risk of anastomotic leakage.

Asymptomatic bacteriuria and its associated fetomaternal outcomes among pregnant women delivering at Bugando Medical Centre in Mwanza, Tanzania.

Asymptomatic bacteriuria (ASB) affects 23.9% of pregnant women globally and, if left untreated, can lead to adverse fetomaternal outcomes. In Tanzania, ASB prevalence has ranged from 13% to 17% over the past decade. Yet, its impact on fetomaternal outcomes remains unexplored, hindering the development of screening strategies, antimicrobial therapies, and preventive measures for this vulnerable population. A cross-sectional analytical study was conducted on 1,093 pregnant women admitted for delivery at Bugando Medical Center (BMC) in Mwanza, Tanzania, from July to December 2022. Socio-demographic, obstetric, and clinical data were collected from the women, along with mid-stream urine samples for analysis. Fetomaternal outcomes were assessed within 72 hours after delivery. The median age of participants was 29 years (range: 15-45 years). ASB prevalence among pregnant women was 16.9% (185/1093), with a 95% CI of 14.6-19.3%. Risk factors for ASB included anemia (OR: 5.3; 95% CI = 3.7-8.2, p-value <0.001) and a history of antenatal care admission (OR 4.2; 95% CI = 2.9-6.1, p-value <0.001). Among all participants, 82 (7.5%), 65 (5.9%), 49 (4.5%), and 79 (7.2%) experienced pre-term labor (PTL), premature rupture of membrane (PROM), preeclampsia, and delivered newborns with low birthweight (LBW), respectively. Among the 185 patients with ASB, the respective proportions of PTL, PROM, preeclampsia, and LBW were 25.4%, 17.3%, 9.2%, and 12.4%. Multivariable logistic regression analysis revealed significant associations between ASB and PTL [OR (95% CI): 8.8 (5.5-14.5); p-value <0.001], PROM [OR (95% CI): 4.5 (2.5-8.0); p-value <0.001], and LBW [OR (95% CI): 2.0 (1.2-3.5); p-value = 0.011]. Escherichia coli (50.8%) and Klebsiella pneumoniae (14.05%) were the most common pathogens, with low resistance rates to nitrofurantoin, amoxicillin-clavulanate, and cephalosporins-antibiotics considered safe during pregnancy-ranging from 8.2% to 31.0%. The prevalence of ASB among pregnant women in Tanzania remains high and is associated with adverse fetomaternal outcomes. Integrating routine urine culture screening for all pregnant women, irrespective of symptoms, and providing specific antimicrobial therapies during antenatal care can help prevent adverse pregnancy outcomes.

Factors associated with glycaemic control and diabetes complications in patients at Bugando Medical Centre, Mwanza, Tanzania: A cross-sectional study design.

Glycaemic control is essential for improving the quality of life in patients with Diabetes Mellitus (DM). Untreated hyperglycaemia can result in numerous severe and life-threatening complications, such as damage to the eyes, kidneys, nerves, heart, and peripheral vascular system. Appropriate glycaemic control and management is fundamental to prevent and delay diabetes complications. Therefore, this study aims to assess the prevalence of poor glycaemic control, its associated factors, and the prevalence of diabetes-related complications among DM patients. A cross-sectional study was conducted among 340 DM patients treated at Bugando Medical Center from 4th - 30th April 2023 to determine the prevalence of poor glycaemic control and its predictors. Secondary data from 7952 DM patients treated between April 2022 and 30th May 2023 were used to determine DM-related complications. STATA 15 version …was used for analysis. Out of 340 patients, 66.4% had poor glycaemic control with HbA1c or Random Blood Glucose greater than 7% or 7mmol/L, respectively. Older age, duration of DM of more than 10 years, insulin therapy, and those unaware of glycaemic target goals were factors associated with poor glycaemic control. (AOR: 2.46, 95% CI: 1.28-6.01, P = 0.03), (AOR: 3.15, 95% CI: 2.22-6.55, P = 0.016), (AOR: 3.07, 95% CI: 2.10-6.12, P = 0.022) and (AOR: 3.42, 95% CI: 2.17-5.97, P = 0.001), respectively. Of the 7952 patient records reviewed indicated that 44.5% had complications, of which 25.8% had neurological complications and 55.3% had multiple complications. Two-third of DM patients failed to achieve good glycaemic control and about half of the patient's records reviewed indicated they developed diabetic complications. Thus appropriate interventions are necessary to improve glycaemic control and prevent or control complications among DM patients.

Prevalence of Hyperuricemia and Associated Factors Among Patients With Type 2 Diabetes Mellitus in Northwestern Tanzania: A Cross-Sectional Study.

There has been increasing evidence of the association between hyperuricemia and diabetes mellitus (DM). In the general population, hyperuricemia has been associated with pre-diabetes. In DM patients, hyperuricemia has been associated with poor outcomes. The objective was to determine the proportion of hyperuricemia and associated factors among patients with type 2 DM in Mwanza, Tanzania. This was a cross-sectional study. This study was conducted from January to March 2023 among patients with type 2 DM attending clinic at Bugando Medical Centre, Mwanza. Data was obtained from a structured questionnaire. Serum uric acid, HbA1c, lipid profile, and renal functions were analyzed. Analysis was done via STATA version 17. The primary outcome was the proportion of hyperuricemia among patients with type 2 DM, and logistic regression models were used to analyze associated factors. Out of 360 patients, 59.7% were female. The median age was 61 years [IQR 57-68], and the median duration of DM was 5 years [IQR 3-9]. The mean HbA1c was 8.2 ± 2.5%, with 60% of patients having poor control. Most patients had hypertension (78.9%) and were overweight or obese (81.9%). The proportion of patients with DM and hyperuricemia was 44.4%, with mean serum uric acid levels among males and females of 410 ± 137 and 385 ± 119 µmol/L, respectively. We found that being female (P = .001), overweight (P = .021), or obese (P = .007), and having chronic kidney disease (P < .001) was associated with hyperuricemia among patients with type 2 DM. The burden of hyperuricemia among type 2 DM patients is quite high, and it is associated with female gender, high body mass index, lipids, and chronic kidney disease. This calls for regular screening of hyperuricemia in the population, and more studies are needed to establish the outcomes associated with hyperuricemia and create a treatment guideline.

Factors Affecting Cotrimoxazole Prophylactic Therapy Compliance in HIV Patients Attending a Care and Treatment Clinic at Bugando Medical Centre in Mwanza, Tanzania

Factors Affecting Cotrimoxazole Prophylactic Therapy Compliance in HIV Patients Attending a Care and Treatment Clinic at Bugando Medical Centre in Mwanza, Tanzania

Histopathological Patterns and Early Postoperative Complications among Patients with Surgically Treated Thyroid Diseases at Bugando Medical Centre, Mwanza, Tanzania

Histopathological Patterns and Early Postoperative Complications among Patients with Surgically Treated Thyroid Diseases at Bugando Medical Centre, Mwanza, Tanzania

Stroke characteristics and outcomes in urban Tanzania: Data from the Prospective Lake Zone Stroke Registry.

Stroke is a second leading cause of death globally, with an estimated one in four adults suffering a stroke in their lifetime. We aimed to describe the clinical characteristics, quality of care, and outcomes in adults with stroke in urban Northwestern Tanzania. We analyzed de-identified data from a prospective stroke registry from Bugando Medical Centre in Mwanza, the second largest city in Tanzania, between March 2020 and October 2022. This registry included all adults ⩾18 years admitted to our hospital who met the World Health Organization clinical definition of stroke. Information collected included demographics, risk factors, stroke severity using the National Institutes of Health Stroke Scale, brain imaging, indicators for quality of care, discharge modified Rankin Scale, and in-hospital mortality. We examined independent factors associated with mortality using logistic regression. The cohort included 566 adults, of which 52% (294) were female with a mean age of 65 ± 15 years. The majority had a first-ever stroke 88% (498). Premorbid hypertension was present in 86% (488) but only 41% (200) were taking antihypertensive medications before hospital admission; 6% (32) had HIV infection. Ischemic strokes accounted for 66% (371) but only 6% (22) arriving within 4.5 h of symptom onset. In-hospital mortality was 29% (127). Independent factors associated with mortality were severe stroke (adjusted odds ratio (aOR) = 1.81, 95% confidence interval (CI) = 1.47-2.24, p < 0.001), moderate to severe stroke (aOR = 1.49, 95% CI = 1.22-1.84, p < 0.001), moderate stroke (aOR = 1.80, 95% CI = 1.52-2.14, p < 0.001), leukocytosis (aOR = 1.19, 95% CI = 1.03-1.38, p = 0.022), lack of health insurance coverage (aOR = 1.15, 95% CI = 1.02-1.29, p = 0.025), and not receiving any form of venous thromboembolism prophylaxis (aOR = 1.18, 95% CI = 1.02-1.37, p = 0.027). We report a stroke cohort with poor in-hospital outcomes in urban Northwestern Tanzania. Early diagnosis and treatment of hypertension could prevent stroke in this region. More work is needed to raise awareness about stroke symptoms and to ensure that people with stroke receive guidelines-directed therapy.

Patterns and outcomes of health-care associated infections in the medical wards at Bugando medical centre: a longitudinal cohort study

BackgroundThe burden of healthcare associated infections (HCAIs) in low- and middle-income countries (LMICs) remains underestimated due to diagnostic complexity and lack of quality surveillance systems. We designed this study to determine clinical diagnosis, laboratory-confirmed, associated factors and risks of HCAIs.MethodsThis hospital-based longitudinal cohort study was conducted between March and June 2022 among adults (≥ 18 years) admitted in medical wards at BMC in Mwanza, Tanzania. Patients who were negative for HCAIs by clinical evaluations and laboratory investigations during admission were enrolled and followed-up until discharge or death. Clinical samples were collected from patients with clinical diagnosis of HCAIs for conventional culture and antimicrobial sensitivity testing.ResultsA total of 350 adult patients with a median [IQR] age of 54 [38–68] years were enrolled in the study. Males accounted for 54.6% (n = 191). The prevalence of clinically diagnosed HCAIs was 8.6% (30/350) of which 26.7% (8/30) had laboratory-confirmed HCAIs by a positive culture. Central-line-associated bloodstream infection (43.3%; 13/30) and catheter-associated urinary tract infection (36.7%; 11/30) were the most common HCAIs. Older age was the only factor associated with development of HCAIs [mean (± SD); [95%CI]: 58.9(± 12.5); [54.2–63.5] vs. 51.5(± 19.1); [49.4–53.6] years; p = 0.0391) and HCAIs increased the length of hospital stay [mean (± SD); [95%CI]: 13.8 (± 3.4); [12.5–15.1] vs. 4.5 (± 1.7); [4.3–4.7] days; p < 0.0001].ConclusionWe observed a low prevalence of HCAIs among adult patients admitted to medical wards in our setting. Central-line-associated bloodstream infections and catheter-associated urinary tract infections are common HCAIs. Significantly, older patients are at higher risk of acquiring HCAIs as well as patients with HCAIs had long duration of hospital stays.

Five-year cross-sectional study to determine the burden of Candida spp. infections of the urinary tract system among patients attending tertiary hospital in Northwestern Tanzania

ObjectiveUrinary tract infections (UTIs) stand as a prominent global health concern. This study entails a 5-year retrospective analysis, using a cross-sectional study design to examine microbiology laboratory data of individuals...

Factors Associated with Short-Term Surgical Outcomes Among Women Presenting with Pelvic Peritonitis at Bugando Medical Centre Mwanza, Tanzania.

Pelvic peritonitis is a rarely reported pathological condition in literature and emergency laparotomies are a common surgical procedure performed for these conditions in developing countries. This study was designed to investigate factors that are associated with short-term surgical outcomes among women with pelvic peritonitis. The study included retrospective and prospective data obtained between November 2021 and May 2022 from Bugando Medical Centre (BMC). Standardized data collection tool was used to capture clinical, surgical and laboratory data. Descriptive data analysis was done using STATA version 13. A total of 101 participants were recruited; 22 prospectively and 79 retrospectively. The median age was 29[Interquartile range (IQR) 24 to 35] years. Majority (76.2%) of participants were referred patients. Obstetric related peritonitis 82.2% (83/101) was the most frequently detected with a necrotic and or dehiscent lower uterine segment (LUS) that necessitated a subtotal abdominal hysterectomy (STAH) being the commonest (40.8%) intraoperative finding. Postoperative complications were reported in 36.7% (36/98) and were significantly associated with pulse rates >100b/min (P=.041) and platelets <150 × 103 mm3 (P=.049). The median length of hospital stay was 19[IQR: 7 to 35] days and temperature >37.5°C (aOR=5.08, 95% CI 1.23-20.97, P=.025) independently predicted prolonged hospital stay. Death occurred in 9.2% of patients and having ASA score of 5 (P=.045) was associated with death. Multi-drug resistant (MDR) gram-negative bacteria (85.2%) were the predominant pathogens causing pelvic peritonitis. A significant proportion of patients with pelvic peritonitis and deranged sepsis markers develop short-term surgical complications with a significant number of those with fever stay more than 14 days. There is a need of timely complete sepsis work up of the patients with pelvic peritonitis to ensure appropriate management is instituted to prevent associated morbidity and mortality.

Clinical Profile, Treatment Modalities and Outcomes among Patients with Upper Aero-Digestive Tract Emergencies at Bugando Medical Centre, Mwanza, Tanzania

Background: Emergencies of the upper aero-digestive tract emergencies (UADTEs) are common in our setting, can be life threatening, challenging to the otolaryngologists and yet there is a paucity of clinical studies on these emergencies. This study aimed to determine the clinical profile, treatment modalities and outcomes of upper aero- digestive tract emergencies at Bugando Medical Centre (BMC), Mwanza, Tanzania. Methods: Between January and May 2019, a cross sectional study involving patients presenting with a clinical diagnosis of UADTEs was conducted at BMC. Data on socio-demography, clinical presentation, duration of symptoms, time interval between admission and intervention, type of intervention, postoperative complications and length of hospital stay were collected in questionnaire designed for the study. Ethical clearance was obtained from the Joint CUHAS/BMC Research, Ethics and Review Committee. Results: Of 487 ENT emergencies seen during study period, 128 (26.3%) patients had UADTEs. Male outnumbered females by a ratio of 1.5: 1. Their median age at presentation was 5 [range, 2-40] years. The major causes of UADTEs were foreign body ingestion, head &amp; neck tumors and foreign body aspiration and cut-throat injuries that were seen in 56(43.8%), 33(25.8%), 25(19.5%) and (3.9%) respectively. The most frequent presentations were dysphagia 81(63.3%), difficulty in breathing 61(47.7%) and odynophagia 56(43.8). Poor outcome following esophagoscopy was associated with younger age (0-17 years) (p=0.02), prolonged duration to treatment (p=0.04) and low blood oxygen saturation (SPO2) (p=0.04). In addition, delayed duration to treatment (p=0.01) and foreign body ingestion (p=0.001) were significantly associated with prolonged hospital stay. Conclusion: At Bugando Medical Centre, UADTE pose a serious burden and challenge. Peripheral hospitals should be equipped with trained health workers and basic equipment to resuscitate and manage these patients before they are ......

Analysis of Nutrition Status and Outcomes for Pediatric Patients with Burkitt Lymphoma Treated in Mwanza, Tanzania

Introduction: Despite decades of improvement in outcomes for pediatric cancers in High-Income Countries (HICs), outcomes remain incredibly disparate as compared to those achieved in Low- and Middle-Income Countries (LMICs). While the source of this disparity is multifactorial, it is known that medical comorbidities, such as malnutrition, are seen in higher frequency in LMICs, and almost certainly contribute to poor outcomes. However, akin to other resource limitations in LMICs, there is a relative paucity of available cancer registries in LMICs to more completely characterize outcomes and associated comorbidities. Subsequently, at our study site, Bugando Medical Centre (BMC) in Mwanza, Tanzania, we aimed to understand the rate of malnutrition at presentation for a subset of our patients, those with Burkitt lymphoma, and its association with their outcomes at our site. We theorize that a more robust understanding of malnutrition and outcomes at our site will inform future interventions to improve the care of these patients at our site and in LMICs as a whole. Methods: Historical patient data from were available from a recent IRB and local ethical board (NIMR) approved study. Records from pediatric patients with a diagnosis of Burkitt lymphoma treated at Bugando Medical Centre between 2016 and 2021 were analyzed. Anthropomorphic data including weight and height at time of diagnosis were available from these records. BMI Z scores were calculated use WHO criteria and these scores were used to assess for malnutrition using standard cutoffs. Results: 82 pediatric patients with a diagnosis of Burkitt lymphoma were analyzed. Patients on average were 7.6 years old. A majority of patients (65%) were male. 28 patients (34%) met WHO criteria for malnutrition with 12 (15%) meeting criteria for severe malnutrition (Z score ≤-3). Little association between nutrition status assigned from BMI at diagnosis and outcomes were observed. 5 of 12 (42%) of the severely malnourished children were known to have survived as compared to 14 of 37 (38%) of patients with a normal BMI. These trends were similar when analyzing the under 5 years cohort which was theorized to be at greater risk for complication. 1 of 4 (25%) patients under 5 with severe malnutrition were known to have survived compared to 5 of 17 (29%) of patients under 5 with normal BMI. Treatment abandonment was felt to be a potentially confounding factor in these data with 26 of these 82 patients (32%) having abandoned. Conclusions: Malnutrition was a common comorbidity at the time of diagnosis for our historic pediatric patients with Burkitt lymphoma treated at BMC in Mwanza, Tanzania. Outcomes as a whole, while poor, surprisingly did not show a clear association with nutrition status at diagnosis in this cohort. It is possible, however, that other factors, such as treatment abandonment, may have confounded these data. An additional limitation is that patients at diagnosis may have an effusion or edema which may influence the weight at diagnosis. Future investigations at our site will use Mid Upper Arm Circumference (MUAC), which is now collected as standard of care at our site. MUAC would likely be less influenced by the fluid status of these patients and subsequently improve the accuracy of the nutrition assessment. We posit that the continued investigation of malnutrition in these patients and their outcomes is needed in order to inform targeted interventions to address nutrition status and improve outcomes for these patients.

Stage at Presentation and Factors Associated with Late Diagnosis of Head and Neck Malignancies at Bugando Medical Center, Mwanza, Tanzania

Background: Head and neck malignancies are often diagnosed at a late stage in sub-Saharan Africa including Tanzania, thus resulting in a generally poor prognosis. The reason for this sad experience is not known. This study was undertaken in our local setting, to describe the stage at presentation and factors associated with late diagnosis of head and neck malignancies at Bugando Medical Centre, Mwanza, Tanzania. Methods: This was analytical cross sectional study involving all patients confirmed to have head and neck malignances at Bugando Medical Center from February to June 2019. Results: Out of 60 patients enrolled in the study, 35(58.3%) were males and 25(41.7%) were female making a male to female of 1.4:1. The mean age was 56 [range, 12-89] years. Majority of patients, 44(73.3%) presented with advanced (late) stage of the disease, with stage III been the most prevalent stage accounting for 49.3% of cases. Only one (1.7%) patient had stage I tumor involving the oral cavity. Distant metastasis was documented in only 16.7% of cases. The oropharynx was the most common anatomical site for head and neck malignancies (n=18, 30%). Patients with oropharyngeal malignancies were associated with late-stage presentation whereas those with laryngeal malignancies were associated with early-stage presentation. Patient-related factors such as rural residence (p-value = 0.048) and use of local herbs (p-value = 0.001) were significantly associated with advanced (late) tumor stage at presentation. The level of health care facility first visited (p-value = 0.876) and the number of referrals (p-value =0.579) were not significantly associated with late stage at presentation. Conclusion: This study demonstrated that the head and neck malignancies are not uncommon at Bugando Medical Center and the majority of patients present late with advanced stage cancer. Therefore, increasing awareness among rural residence regarding head and neck malignancies and their symptoms, and training ......

Surgical Management of Oro-Facial Clefts at a Tertiary Care Hospital in a Resource-Limited Setting: A Tanzanian Experience

Background: Orofacial clefts are the most common craniofacial anomalies in most parts of the world and its management remains a challenge to otorhinolaryngology, plastic/reconstructive, oral and maxillofacial surgeons practicing in resource limited countries. There is limited data on surgical management of these birth defects in Tanzania and Bugando Medical Centre (BMC) in particular. This study aimed to describe our own experience regarding the surgical management of orofacial clefts at BMC, a tertiary care hospital in Tanzania. Methods: This was a cross sectional study involving all children with orofacial clefts that were treated at BMC between February 2019 and June 2019. Results: A total of 98 patients with orofacial clefts were recruited. Males outnumbered males by a male to female ratio of 1.7:1. The majority of patients (64.3%) were within 12 months at presentation. The median ages at surgery in patients with cleft lip and those with cleft palate were 3 [IQR, 2 to 8] and 11(IQR, 7 to 18) months, respectively. Orofacial clefts in association with congenital anomalies were recorded in 5(5.1%) patients. More than half of patients (55.1%) had combined cleft lip and palate. Unilateral clefts, 77(78.5%) were more common and showed left side preponderance in 52(53.1%) patients. All patients underwent cleft surgery under general anesthesia. Millard rotation advancement flap repair and von-Langenbeck were the most common techniques of cleft lip and palate repair performed in 42(52.5%) and 30 (41.7%) patients, respectively. The overall complication rate was 14.3% and the most common postoperative complications were bleeding, palatal fistula, wound dehiscence and surgical site infections in 6(31.6%), 4(21.1%) and 3(15.8%) each respectively. No death was recorded in this study. Among the 98 patients operated, 79 were treated successfully giving an overall success rate of 80.6%. The success rate was significantly influenced by nutrition status (p= 0.010), co-existing con

Introduction of WHO BEC course for nurses at Bugando Medical Center in Mwanza, Tanzania

IntroductionThe Basic Emergency Care (BEC) course is an open-access training designed for frontline providers in low resource settings which focuses on recognizing and managing emergent conditions. This study describes the implementation of the BEC course for nurses at Bugando Medical Center (BMC) in Mwanza, Tanzania in March 2020 as part of an educational initiative to improve nurses’ knowledge and confidence in providing emergency care. MethodsThis is a 2-week educational intervention with pre-post measurements. 12 nurses (cohort 1) received BEC training from in-country facilitators over the course of 4 days. A training-of-trainers (ToT) course followed immediately and the 5 newly trained facilitators then taught the BEC course to 12 additional nurses (cohort 2). Pre- and post-BEC knowledge was assessed with a standardized 25-question multiple choice (MCQ) exam; confidence levels were evaluated using a 4-point Likert scale survey; and qualitative feedback obtained was examined by thematic analysis. Results24 participants completed the BEC course, 5 of which completed a ToT to become BEC facilitators. For the combined group, knowledge assessment scores improved significantly from 63.8% to 85.2% with a mean difference of 21.5% (t(24)= 9.3, p<0.0001). Similar improvements were seen when cohort 1 and cohort 2 were analyzed separately. Analysis comparing the results across different demographic groups demonstrated a significant improvement in post-course score for each group. Confidence levels increased significantly across all domains. Main qualitative feedback themes were: quality of teaching; method of teaching; applicability of training to daily nursing practice; more time allotment; and the need to expand the course to other healthcare providers and to rural sites. ConclusionImplementation of the BEC course at BMC led to an improvement in nursing emergency care knowledge and self-confidence. The course was well received and the ToT model was successful, giving the nurses the ability to train additional local nurses.

Patterns of Pathogens and Antimicrobial Susceptibility Profiles in Diabetic Foot Ulcers’ Infections among Patients at Bugando Medical Centre in Mwanza, Tanzania

Background: Diabetic foot ulcer (DFU) is an open sore or wound on the foot of a person with diabetes, and is most commonly located on the plantar surface, or bottom of the foot. The defect is relatively common in adult and elders with diabetes mellitus. Infected lower extremities wound with multi-drug resistant bacteria usually are associated with increased morbidity, mortality and long-term disabilities among diabetic patients. Although the burden of DFU is known in Tanzania (and Mwanza in particular), there is limited information on the patterns of pathogens associated with DFU in our setting, on bacterial and fungal pathogens which in turn limit specific management options to these patients. Methodology: Analytical cross section hospital-based study was conducted among patients with DFU admitted or attending outpatient clinics at BMC from May to July 2022. A structured questionnaire was used to collect socio-demographic, clinical and laboratory data from patients with DFU. Tissue culture was obtained from the base of the ulcer after cleaning with normal saline followed by removing of cellular debris and normal flora over the lesion. Finally, the obtained samples were subjected to culture methods to identify the presence of pathogens (bacteria and fungi) and antimicrobial susceptibility profiles of bacteria. Result: During the study period and based on inclusion criteria, a total of 71 patients, with a mean age of 59.2 ± 13.0 years were recruited. The majority of the participants were male 47 (66.2%). A total of 60 (84.5%) samples were culture positive, resulting into a total of 92 microorganisms isolated. More than half of cultures 34 (56.7%) revealed the presence of single microorganisms. Pathogens isolated were both bacterial 70 (76.1%) and fungi species 22 (23.9%), all bacterial isolates were aerobic. P. aeruginosa and E. coli were most frequent isolated gram-negative bacteria 12(23.5%) and 9(17.6%) respectively. On other hand common isolated gram-positive strains were S. aureus 13 (68.4%) out of all 19 gram-positive culture isolates. A total of 22 fungi spp were isolated, among them 7 (31.8%) were yeast C. albicans 3 (42.8%), A. fumigatus were frequent isolated 13 (86.7%). Polymicrobial growth was observed in 43.3% samples against 56.7% of monomicrobial growth. Most prevalent gram-negative bacteria Pseudomonas aeruginosa showed low resistance to ciprofloxacin, meropenem, gentamicin, piperacillin tazobactam (7.1%, 21.4%, 21.4% and 21.4 respectively) but more resistant to cephalosporins. Staphylococcus aureus showed low resistance to ciprofloxacin, gentamicin and clindamycin (30.8%, 15.4%, and 38.5% respectively), Total MDR bacteria isolates were 64.3%, where methicillin resistance staphylococcus aureus (MRSA) were 76.9%. More than 85.7% of the patient with higher grade ulcer, stage 3 and 4 according to Wagner’s classification were positive to diabetic foot infection and 14.3% of patients with Wagner’s stage 3 and 4 were not infected on their ulcers. Conclusion: Gram negative bacteria were most commonly isolated than gram positive bacteria in causing DFU infections. For gram negative spp the most effective antibiotic were ciprofloxacin, gentamicin, piperaccilin tazobactam and meropenem. Third generation cephalosporins, amoxicillin clavulanate showed poor effectiveness. All cases of DFU infection should therefore be subjected to culture and antimicrobial sensitivity testing for targeted infection management. More studies involving anaerobic pathogens and antifungal susceptibility patterns