Bugando Medical Centre Research Articles

Epidemiological pattern and clinical indications for tracheostomy at Bugando Medical Centre Mwanza Tanzania

Background: Tracheostomy is among the first surgical procedures done by man and is performed from generation to generation with the major reason of saving lives. In Tanzania this procedure is commonly done and in the medical universities is taught as one of the procedures that all doctors should know. Tracheostomy is a common emergency lifesaving procedure performed between 21 to 25 patients per year among all patients receiving ENT services (13, 14). Though there is a scarcity in recent data and literature on the magnitude of tracheostomies performed in the lake zone. The most common indication for tracheostomy varies in studies from upper airway obstruction due to trauma, neoplasm, or prolonged intubation (13, 14). The pattern of tracheostomy indications may have changed with time due to advancement in medical practice. However, we lack current data in our setting highlighting indications for tracheostomies performed Methodology: This study aims at finding the epidemiological pattern and clinical indications for tracheostomy patients attending at Bugando medical centre. The engagement was done in a zonal referral hospital serving 6 regions of the country. This is a descriptive cross-sectional study which spanned from September 2023 to May 2024. Results: The total number of patients was 35 whereby males were 51.4%(18) and females 48.6% (17).Number of males was slightly higher compared to females by 1.1%.The median age for the patient was 23 years, with the mean age of 20 years. The leading age group with the largest number of patients was 50 to 59 years. Most patients came from rural areas 74 %(26). Among clinical indications for tracheostomy the leading was upper airway obstruction by 65.7%, within which malignancy predominated other conditions by 65.2%, followed by trauma 26.1%, then prolonged intubation. Females showed a significant predominant distribution of malignancies of head and Neck by 60% which were evenly distributed in varying head and neck sites with p value of 0.039 which is statistical significant; with exception of laryngeal malignancies which were observed in males alone accounting for 26.7% in the whole study period. In conclusion this study shows the prevalence of tracheostomy in our environment, which is 1.8% and the clinical indication pattern has changed from trauma in previous studies to upper airway obstruction secondary to neoplastic conditions. It also shows the significance of site of malignancy to its relation to gender and this findings are not found in other studies. Recommendation: Molecular studies are needed to analyze further the differences in subsite in terms of gender.

Modern Family Planning Utilization and Associated Factors among Hiv Women of Reproductive Age Attending at Care and Treatment Clinics (CTC) in Mwanza City,tanzania

Background: In Sub-Saharan Africa HIV/AIDS prevalence remains high and makes it the world’s most severely affected region. The use of family planning helps to prevent unplanned pregnancies among HIV positive women of reproductive age. There is a dearth of evidence on the preferred methods, reasons for use and non-use and discontinuation of the use of family planning among HIV positive women of reproductive age appearing at HIV Care and Treatment Clinics (CTCs) in Mwanza City. Therefore this study was conducted to determine family planning uptake, methods preferred and the reasons for discontinuation of the use of family planning among HIV positive women of reproductive age appearing at HIV Care and Treatment Clinics (CTCs) in Mwanza City. Objective: To determine family planning uptake, methods preferred and reasons for discontinuation among HIV positive women of reproductive age appearing at HIV Care and Treatment Clinics (CTCs) in Mwanza City. Methodology: This is a hospital based cross-sectional study involving 440 HIV positive reproductive age women (18 – 49 years) who were attending Bugando Medical Centre, Sekou Toure Regional Referral Hospital and Buzuruga Health Centre HIV Care and Treatment Clinics was carried out. A structured pre tested questionnaire was used to collect data on socio-demographic characteristics, information on current family planning use, health service related factors, family factors, disclosure and ART status, and factors associated with modern family planning use. Data analysis was done using STATA version 13 according to objectives. Results: A total of 440 participants were enrolled in the study and their median age was 36 [IQR 30 – 42] years. Majority, 246(56.2%) of the participants were aged 35 to 49 years. Majority 279 (63.4%) of women attained primary education. Factor associated with family planning discontinuation were not been counseled on FP(AOR 5.5; 95% CI 2.0 – 15.1; p-value 0.001), Partner has desire of children AOR 0.3; 95% CI 0.1 – 0.8;p-value=0.029), Advanced stage of HIV(AOR13.4; 95% CI 5.1 – 35.0; p-value<0.001 ), Divorced women(AOR 3.2; 95% CI 1.1 – 9.7; p-value=0.038) and women’s age ≥35 years(AOR 6.8; 95% CI 2.2-20.9 p-value=0.001). Conclusion: The overall uptake of modern family planning methods was low. Integration of modern family planning services within the CTCs was low too in all the facilities. Furthermore, the proportions of HIV positive women using dual family planning methods were very low. Factor associated with family planning discontinuation were not been counseled on FP, Partner has desire of children, Advanced stage of HIV, Divorced women and women’s age ≥35 years.

Seroprevalence of human papilloma virus 6, 11, 16 and 18 among pregnant women in Mwanza-Tanzania

IntroductionHigh-risk human-papilloma viruses 16 and 18 (HR-HPV 16 and HR-HPV-18) are well known to be associated with carcinoma of the cervix, head and neck, penis, and anus. Low-risk human papillomaviruses 6 and 11 (LR-HPV 6 and LR 11) infection has been associated with anogenital warts, oral papilloma, and laryngeal papillomatosis in children. HPV infection during pregnancy (HR-HPV and LR-HPV) increases the risk of vertical transmission from infected pregnant women to unborn children. The burden of HR-HPV type 16 and 18 and LR-HPV 6 and 11 is not well documented among pregnant women attending antenatal clinics (ANC). This study determined the seroprevalence and distributions of HR-HPV 16, 18, and LR –HPV 6, 11 antibodies among pregnant women attending ANC at Bugando Medical Centre (BMC) in Mwanza, Tanzania.MethodologyA cross-sectional study involving 255 pregnant women enrolled in obstetrics and gynecology outpatient clinics was conducted between November 2020 and March 2021 at Bugando Medical Centre (BMC) in Mwanza. A structured pre-tested questionnaire was used to obtain patients’ information. Sandwich Enzyme-Linked Immunosorbent Assay (ELISA) was used to detect HPV 6, 11, 16 and 18 specific immunoglobulin G (IgG) from sera. Stata version 15v1 was used for the descriptive data analysis.ResultsThe median age was 27(IQR: 22–31) years. The overall HPV seropositivity for any of the four serotypes was 63.9% (165/255), 95% CI: 58.0-69.7, whereby 37.6%(97/255), 32.2%( 83/255), 15.5% (40/255) and 27.1% (70) were positive for HPV 6, 11, 16 and 18 respectively. Eight participants (3.1%) were positive for all 4 genotypes.ConclusionAbout two-thirds of pregnant women had antibodies against HPV 6, 11 16, and 18 indicating previous HPV exposure. Vaccination programs should be emphasized to reduce the HPV-related manifestations in this population.

Hepatitis B infection: Evaluation of demographics and treatment of chronic hepatitis B infection in Northern-western Tanzania.

Chronic hepatitis B virus (HBV) infection is still a major public health problem. In response to the World Health Organization (WHO), Tanzania implemented immunization and treatment to achieve the eradication of HBV infection by 2030. To achieve this goal, frequent updates of demographic data, antiviral therapy eligibility, and uptake are essential. We therefore evaluated demographic data, antiviral therapy eligibility, and uptake among chronically HBV-infected patients attending at Bugando Medical Centre (BMC), Tanzania. A cross-sectional study enrolled 196 chronic HBV patients from April 23, 2023, to October 10, 2023, at BMC, where 100 and 96 patients were retrospectively and prospectively enrolled, respectively. Study's ethical clearance and permission were observed by the Catholic University of Health and Allied Sciences/Bugando Medical Centre research ethics and review committee and the Bugando Medical Centre management respectively. For all patients, socio-demographic data and whole blood samples were obtained. Full blood picture, alanine and aspartate amino transferases, and HBV viral load parameters were determined. Aspartate-Platelet Ratio Index (APRI) and Fibrosis Four (FIB-4) scores were calculated according to their respective formulas. Therapy eligibility and uptake were evaluated according to the 2015 WHO HBV prevention, treatment, and care guidelines. The data were summarized and analysed using STATA version 15. The median age for all patients was 39 [IQR: 32-47.5] years. Nearly all study patients, 99% (194/196), were older than 20 years old, with significant male dominance (73.5% [144/196] versus 26.5% [52/196]; p<0.0001). Anti-HBV antiviral therapy eligibility was 22.4%, while uptake was 6.8% (3/4), which was significantly lower than the WHO expectation of 80% (p <0.0001). Almost all chronically HBV-infected patients attending at BMC were older than 20 years old and were significantly dominated by males. Antiviral therapy uptake was remarkably lower than expected by the WHO towards combating HBV infection by 2030.

164 - Geographical distribution, histological types and clinical presentation of pediatric malignancies at Bugando Medical Center Mwanza, Tanzania

164 - Geographical distribution, histological types and clinical presentation of pediatric malignancies at Bugando Medical Center Mwanza, Tanzania

Patterns of Microbial Infections in Post-Infective Hydrocephalus and Treatment Methods at Bugando Medical Center

Background: Post Infective Hydrocephalus is among the complicated types of hydrocephalus and poses a challenge in management of these patients, globally. Antibiotics susceptibility patterns of common bacteria implicating in pyogenic ventriculitis complicated with hydrocephalus were not clearly known at our setting. Therefore, we determined antibiotics susceptibility patterns of common bacteria implicating in pyogenic ventriculitis complicated with hydrocephalus to recommend empirical therapy while waiting for culture and sensitivity results at Bugando Medical Centre (BMC) in Mwanza, Tanzania. Methods: Thirty-five patients with hydrocephalus who had undergone cerebrospinal fluid (CSF) tapping and analysis were selected randomly retrospectively and their bacteriological culture and sensitivity results were analyzed to determine the common microbial patterns. Patients were rationally prescribed antibiotics depending on laboratory results for 7 days and were later done control CSF cultures until negative cultures were achieved. Results: A total of 35 patients with median (interquartile range [IQR]) age was 5.5 [2-8] months were reviewed. The majority of participants were males, 62.9% (22/35). 20% (7/35) and 37.1% (13/35) had turbid CSF-shunt sample and first culture positive results, respectively, whereas one patient had culture positive with two pathogens resulting to 14 isolates. Gram positive bacteria were predominantly isolated (66.7%, 8/14), whereby S. aureus was frequently encountered (35.7%, 5/14). Overall, gram positive and negative bacteria exhibited least resistance against tetracycline (16.7% and 25%) and ciprofloxacin (16.7% and 25%) respectively. Three (8.6%) patients died from respiratory complications. Conclusion: Post infective hydrocephalus is a clinically challenging but treatable form of hydrocephalus and Staphylococcus aurous is the most common cause. This study found that the use of a seven-day regimen as cost effective and associated with a shorter hospital stay with the focus on CSF analysis with subsequent microbial targeted antibiotic therapy to achieve sterile CSF culture. Treatment strategy should be multidisciplinary approach with collaboration from microbiologists, radiologists, pediatricians and neurosurgeons.

Comparison of Copper (II) Sulphate to Hemocue Analyser in the Estimation of Haemoglobin among Voluntary and Replacement Blood Donors at Bugando Medical Centre

Background Pre-donation haemoglobin (Hb) screening is among the foremost test done on blood donors to determine whether an individual is fit to donate with the intention of preventing inadvertent donation from an anaemic donor. The National Blood Transfusion Service (NBTS) in Tanzania uses the Copper II Sulphate (CuSO4) gravimetric method to estimate haemoglobin (Hb) in blood donors. The accuracy of the copper II sulphate method for the rapid screening of prospective blood donors has been questioned because this rapid screening method may lead to false deferral of truly eligible prospective blood donors. However, this and other point-of-care method may provide false results. Methods This was a cross-sectional study conducted among 236 eligible blood donors attending BMC transfusion centre at Mwanza, Tanzania. The blood donors were asked for their consent to participate in this study from 1st May to 1st August 2024. Capillary blood samples were obtained for Hb estimation by CuSO4 and HemoCue methods, and 3mls of venous blood were also collected for Hb quantification by AHA (gold standard). Descriptive statistics were used to analyse the demographic details of the donor. Kappa statistics were used to determine the level of agreement between the two methods of Hb estimation. Results The median age of the study participants was 30 years (IQR: 25-36). The proportion of false eligible donors was 5.5%, and false deferral donors were 2.3% using the CuSO4 gravimetric method. The specificity, sensitivity, positive and negative predictive values, and Kappa agreement for CuSO4 were 53.8%, 94.7%, 93.8%, 58.3%, and 0.51, respectively. In contrast, the specificity, sensitivity, positive and negative predictive values, and Kappa agreement for HemoCue were 63.6%, 97.9%, 96%, 77.7%, and 0.67, respectively. Conclusion. The current study revealed that, the performance of the CuSO4 gravimetric method is relatively poor, with a high proportion of false eligible donors than the HemoCue method. These findings warrant further studies to evaluate the quality control measures for CuSO4 gravimetric method and explore alternative point-of-care methods for Hb estimation among blood donors in similar resource limited-settings.

Prevalence of Meconium Stained Amniotic Fluid and Predictors for Poor Fetal Outcomes Among Women Delivering at Bugando Medical Centre Mwanza Tanzania

&amp;lt;i&amp;gt;Background:&amp;lt;/i&amp;gt; Meconium stained amniotic fluid occurs in up to 20% of all deliveries and is reported to vary in different settings across the world. Babies delivered by these women are at high risk of low score and meconium aspiration syndrome. Limited studies have reported on the predictors for poor fetal outcomes in women presenting with meconium stained amniotic fluid. &amp;lt;i&amp;gt;Methods:&amp;lt;/i&amp;gt; This was a cross sectional study involving 209 pregnant women with meconium stained amniotic fluid. Semi structured questionnaire was used for data collection. Data were analyzed using STATA version 12. &amp;lt;i&amp;gt;Results: &amp;lt;/i&amp;gt;A total of 1202 women delivered during the study period from December 2017 to February 2018. Amongst, 209 (17.4%) women had meconium stained amniotic fluid. Of the 209 babies, 35 (16.7%) had low score, 41 (19.6%) were admitted due to meconium aspiration syndrome and 3 (1.4%) died due to meconium aspiration syndrome related complications. Predictors for poor fetal outcomes were found to be Thick meconium (Grade III), Meconium as a new event during labor monitoring and null parity. &amp;lt;i&amp;gt;Conclusion:&amp;lt;/i&amp;gt; The prevalence of meconium stained amniotic fluid at Bugando Medical Centre was found to be 17.4%. Thick meconium, development of meconium as a new event and nullparous were found to predict for poor fetal outcomes. Immediate interventions are recommended for those with the identified predictors for poor fetal outcome.

Indications and Early Outcomes of WALANT among Patients Undergoing Surgical Procedures at a Tertiary Care Hospital, Mwanza, Tanzania

Introduction: The concept of "Wide Awake Local Anesthesia No Tourniquet" (WALANT) technique is gaining popularity in the field of plastic, orthopedic and general surgery owing to its benefits of reduced cost, improved safety, improved patient satisfaction, avoiding costly preoperative tests, decreased operative time, reduced utilization of hospital resources and length of hospital stay. Objective: To determine indications for surgery and early outcomes of "Wide Awake Local Anesthesia No Tourniquet" among patients undergoing surgical procedures at Bugando Medical Centre (BMC). Method: This was a 4 months’ prospective longitudinal study conducted from April to July 2023 involving 91 patients aged 12 years and above who underwent surgical procedures from plastic, orthopaedics and general surgery departments at Bugando Medical Centre. Structured questionnaire was used to obtain operative information and the Visual Analogue Scale (VAS) was used to obtain intra operative pain score. Results: The most common indication for using WALANT was surgeon's preference (65/91,70%). The most common procedure done was sloughectomy (16/91,17.6%) the least being colostomy placement (1/91, 1.1%). Intraoperative VAS score range from 0 to 4 with a mean of 1.1 (±0.39). (88/91, 97%) of the participants had no any complication post-operatively and the majority of the remaining few presented with tachycardia (2/91, 2.2%). The level of satisfaction was significant associated with the length of hospital stay having the p-value of 0.00. Conclusions: The WALANT technique can be performed as the best alternative type of anesthesia for both minor and selected major surgeries with minimal pain score, high patient’s satisfaction rate, minimum risk of infection and significant reduced length of hospital stay.

Epidemiological distribution of high-risk human papillomavirus genotypes and associated factors among patients with esophageal carcinoma at Bugando medical center in Mwanza, Tanzania

BackgroundEsophageal carcinoma is a growing concern in regions that have a high incidence of human papillomavirus (HPV) infection such as East Africa. HPV, particularly the high-risk genotypes, is increasingly recognized as a risk factor for esophageal carcinoma. We set out to investigate the prevalence and associated factors of high-risk HPV in formalin-fixed paraffin-embedded (FFPE) tissue blocks with esophageal carcinoma at Bugando Medical Center, a tertiary referral hospital in Mwanza, Tanzania, East Africa.MethodsA total of 118 esophageal carcinoma FFPE tissue blocks, collected from January 2021 to December 2022, were analyzed. Genomic DNA was extracted from these tissues, and multiplex polymerase chain reaction (PCR) was performed to detect HPV using degenerate primers for the L1 region and type-specific primers for detecting HPV16, HPV18, and other high-risk HPV genotypes. Data were collected using questionnaires and factors associated with high-risk HPV genotypes were analyzed using STATA version 15 software.ResultsOf the 118 patients’ samples investigated, the mean age was 58.3 ± 13.4 years with a range of 29–88 years. The majority of the tissue blocks were from male patients 81/118 (68.7%), and most of them were from patients residing in Mwanza region 44/118 (37.3%). Esophageal Squamous Cell Carcinoma (ESCC) was the predominant histological type 107/118 (91.0%). Almost half of the tissue blocks 63/118 (53.3%) tested positive for high-risk HPV. Among these, HPV genotype 16 (HPV16) was the most common 41/63 (65.1%), followed by HPV genotype 18 (HPV18) 15/63 (23.8%), and the rest were other high-risk HPV genotypes detected by the degenerate primers 7/63 (11.1%). The factors associated with high-risk HPV genotypes were cigarette smoking (p-value < 0.001) and alcohol consumption (p-value < 0.001).ConclusionA substantial number of esophageal carcinomas from Bugando Medical Center in Tanzania tested positive for HPV, with HPV genotype 16 being the most prevalent. This study also revealed a significant association between HPV status and cigarette smoking and alcohol consumption. These findings provide important insights into the role of high-risk HPV in esophageal carcinoma in this region.

Laboratory confirmed Puerperal Sepsis and Associated Factors Among Post Delivery Women Admitted at Bugando Medical Centre,Sekou Toure and Sengerema Hospitals in Mwanza ,Tanzania.

ABSTRACT Background: Puerperal sepsis is one of the leading causes of preventable maternal morbidity and mortality. It accounts for about 11 % of maternal death worldwide, with highest prevalence being reported from low-income countries. However, in Mwanza data on the proportion of post-delivery women with laboratory confirmed puerperal sepsis, bacterial patterns and associated factors were still limited. This is turn limits institution of specific antimicrobial therapies for this population. Objective: To determine the proportion of laboratory confirmed puerperal sepsis, associated factors and bacterial patterns among post-delivery women with clinical features of puerperal sepsis admitted at BMC, SRRH and SDDH in Mwanza, Tanzania. Methodology: A cross-sectional analytical hospital based study involving 340 post-delivery women admitted at BMC (152), SRRH(108) and SDDH (80) was conducted between October 2017 to April 2018.A structured pre-tested questionnaire was used to obtain socio- demographic, clinical and obstetric information from the participants. The endocervical swab and venous blood were aseptically taken for culture and antimicrobial susceptibility testing as per standard operating procedures. Data were analysed using STATA version 13 according to objectives of the study. RESULTS; The mean age of the study participant was 26.2 ± 6.5 years. The proportion of laboratory confirmed puerperal sepsis was 58.8% (200/340). Of these, 164 (82%) had positive culture for endocervical swabs, 17 (8.5%) were blood culture positive and 19 (9.5%) had positive culture results from both blood and endocervical swabs. Staphylococcus aureus were the most predominant bacteria isolate from blood culture 13 (36.1%), while the Escherichia coli 52 (26.0%) were the most predominant bacteria isolated from the endocervical swabs. All Staphylococcus aureus (except one strain) were sensitive to gentamicin and vancomycin. Over three quarter of E.coli was resistance to ampicilin, trimethoprim-sulfamethoxazole, amoxicillin-clavulanate and ceftriaxone; and none of these were resistant to meropenem. Acinetobacter spp. were mostly multidrug resistance, with variable resistance to meropenem (0% to 20%). On multivariable logistic regression analysis, primipara (OR: 10.14, 95%CI: 4.20-24.46, P&lt;0.001), grand multipara OR: 3.85, 95%CI: 1.52-9.74, P=0.004, premature rupture of membrane with OR: 4.31, 95%CI: 1.61-11.47, P=0.003 , pre/eclampsia OR: 3.66, 95%CI: 1.7-11.40, P=0.025, anemia OR: 2.56, 95%CI: 1.20-5.79, P=0.018 and prolonged labor duration OR: 12.69, 95%CI: 5.7-28.0, P=&lt;0.001 were found to be independent predictors of laboratory confirmed puerperal sepsis CONCLUSION: Approximately 60% of women with clinical features of puerperal sepsis had laboratory confirmed puerperal sepsis, with Staphylcococcus aureus and E. coli being predominant bacteria species. High resistance to various agents among bacteria recovered calls for laboratory guided specific antimicrobial therapies to ensure favourable patients outcomes. Patients with premature rupture of membranes, prolonged duration of labours and co-morbid conditions such as anaemia and pre/eclamsia should be targets for preventive measures against puerperal sepsis.

Association between fetal hemoglobin, lactate dehydrogenase, and disease severity in patients with sickle cell disease at Bugando Medical Centre, Mwanza, Tanzania.

There is a wide range of clinical manifestations in sickle cell disease (SCD). Despite having the same condition, each person's response to disease complications differs greatly. Individuals can be categorized according to the severity of their diseases to determine which group they fall into and receive the appropriate care based on their needs. The relationship between fetal hemoglobin (HbF), lactate dehydrogenase (LDH), and disease severity in Tanzania is little understood. This investigation sought to ascertain the relationship between HbF, LDH, and disease severity in SCD patients at the Bugando Medical Center. This cross-sectional study was carried out on SCD patients aged 6 months and older at the Bugando Medical Center in Mwanza, Tanzania. A total of 130 SCD patients were enrolled. The clinical history and laboratory test results for SCD patients were recorded on a specially constructed patient report form. The majority of participants (56.9%) were men. For the population under study, more than half (60.8%) of participants had a moderate clinical phenotype (MCP), followed by 31.5% of asymptomatic participants and 7.7% of people with severe clinical phenotypes (SCP). Participants with SCP had substantially higher levels of LDH, with a mean level of 810.97IU/L (95% CI: 559.31-1062.64) and a p-value of 0.005. The severe clinical phenotype exhibited a significantly higher mean HbF score value of 10.09% (95% CI: 7.44-13.74%) with a p-value of 0.024 when compared to the asymptomatic and moderate clinical phenotypes. In SCD patients with SCP compared to ACP and MCP, the HbF levels were higher, but did not show a protective effects, and LDH can be used to predict the severity of SCD.

Prevalence of Malnutrition and its Association with Early Outcomes among Adult Patients Undergoing Abdominal Surgery Admitted at Bugando Medical Centre, Mwanza, Tanzania

Introduction: Malnutrition is an emerging but neglected problem in hospitalized surgical patients which contributes significantly to the adverse postoperative outcomes. However, in most of our settings; patients scheduled for abdominal surgeries are not routinely assessed for nutritional status rendering difficultness in mitigating the avoidable predicaments. Objective: To determine the prevalence of malnutrition and its association with the early outcomes among patients undergoing abdominal surgery at Bugando Medical Centre (BMC), Mwanza, Tanzania. Methods: This was a prospective longitudinal study involving adult patients who underwent abdominal surgeries at BMC from January 2023 to June 2023. Nutritional status assessment was done according to the Nutrition Risk Screening tool (NRS-2002). Results: The overall prevalence of malnutrition was found to be 51.8%. Complication and mortality rates were 25.4% and 8.3% respectively. The overall length of hospital stay ranged from 5 days to 14 days (median of 9 days). Preoperative malnutrition was found to be statistically significant associated with early postoperative complications (OR=4.1, 95% [2.0-8.2], p-value&lt; 0.001), prolonged Length of hospital stay (LOS) (OR=2.5, 95% [1.4-5.8], p-value = 0.003) and mortality (OR=4.6, 95% [2.5-11.2], p-value &lt; 0.001). Furthermore, preoperative malnutrition significantly predicted surgical site infections (OR=2.2, 95% [1.0-4.8], p-value =0.047) and anastomotic leakage (OR=3.1, 95% [1.1-8.9], p-value =0.035). Conclusion: Preoperative malnutrition is a significant and independent risk factor for postoperative complications, prolonged hospital stay and mortality following abdominal surgery. This study emphasizes the need for routine assessment of nutritional status using a validated tool preoperatively so as to draft a nutrition care strategy to prevent postoperative malnutrition-related adverse outcomes.

Prevalence and antimicrobial susceptibility patterns of bacteria colonizing the external ocular surfaces of patients undergoing ocular surgeries at Bugando Medical Center in Mwanza, Tanzania

ObjectiveUnderstanding microbiota colonizing ocular surfaces is key to expedite antibiotic prophylactic options for ocular surgeries, and therefore, prevent subsequent surgical site infections (SSIs). To fill this critical gap, we aimed at determining the prevalence and antibiotic susceptibility patterns of bacteria colonizing the external ocular surfaces of 224 patients undergoing ocular surgeries at Bugando Medical Centre (BMC) in Mwanza, Tanzania between May and August 2023.ResultsThe study participants had a median age of 62.5 (interquartile range: 39.5–75.0) years. A total of 78.1% (175/224) ocular swabs were culture positive yielding 196 bacterial isolates. Staphylococcus epidermidis [43.4% (n = 85)], Staphylococcus aureus [21.9% (n = 43)] and Pseudomonas aeruginosa [14.3% (n = 28)] were the most common bacteria. There were low proportions of resistance among predominant Gram-positive and Gram-negative bacteria to gentamicin (≤ 25.0%), and similarly, low resistance among Gram negative bacteria was observed against 3rd generation cephalosporins (≤ 25.0%) and piperacillin-tazobactam (0.0%). Variable resistance profiles were notable to the most commonly used antibiotics (ciprofloxacin and tetracycline: 0.0–66.7%). Our findings underscore an urgent need to revisit antibiotic prophylactic guidelines for ocular surgeries in this tertiary hospital, and calls for prospective evaluation of incident SSIs post-ocular surgeries to guide specific management.

Retrospective analysis of pediatric patients with Burkitt lymphoma treated in Tanzania following the implementation of the 2016 National Treatment Guidelines: Poor outcomes to current standard-of-care therapy.

Despite the excellent outcomes achieved in the treatment of pediatric Burkitt lymphoma (BL) in high-income countries (HICs), outcomes remain poor in low- and middle-income countries (LMICs). Efforts to improve BL outcomes in Tanzania included the creation of National Treatment Guidelines in 2016. However, disease outcomes in Tanzania following the creation of these guidelines have not been reported to date. Historical records from 2016 to 2021 for patients 0-18years of age with a diagnosis of BL and seen at Bugando Medical Centre (BMC), in Mwanza, Tanzania, were curated into an electronic database and analyzed descriptively. Patients in this cohort were treated per the Tanzanian National Treatment Guidelines, which include six cycles of cyclophosphamide, vincristine, and methotrexate (COM) chemotherapy with intrathecal methotrexate and cytarabine. In total, 92 BL patients' records were eligible for analysis. Patients in this cohort were most commonly Murphy stage II (28%) or stage III (34%). Nearly all, 91%, met International Network for Cancer Treatment and Research (INCTR) high-risk criteria at presentation. Forty-two percent of patients did not receive a biopsy and were treated with a presumed diagnosis of BL alone. A 1-year event-free survival of 29.6% (95% confidence interval [CI]: 20.3%-39.5%) and a 1-year overall survival of 38.5% (95% CI: 28%-48.9%) were observed. A high rate of treatment abandonment (34%) was also observed. In a historical cohort of pediatric patients with BL treated per the 2016 Tanzanian National Treatment Guidelines, we observed poor outcomes and a high rate of abandonment. These outcomes appear inferior to those achieved in the INCTR clinical trial that informed the guidelines' creation, and highlights the importance of "real-world" outcomes data in LMICs. These data reinforce the idea that continued clinical research and capacity building efforts are necessary to improve BL outcomes in LMICs.

Indications for Tube Thoracostomies and Factors Associated with Complications among Patients Admitted to Bugando Medical Centre, Mwanza, Tanzania

Introduction: Tube thoracostomy is the procedure used in management of traumatic and atraumatic chest conditions. Despite its relative safety, it can still lead to potentially severe complications during or post its insertion.  Objective: To determine the common indications and complications for tube thoracostomies with their associated factors.  Patients and methods: This was a prospective longitudinal study for a total duration of 6 months involving patients who underwent tube thoracostomy during the study period. Recruitment of the patients was done under Convenience sampling technique from all hospital wards and units. A standardized structured questionnaire with TT Complication Reporting Tool incorporated into it was used and all data were entered into an Excel sheet then transferred to STATA version 15.0 software for analysis.  Results: Tuberculous and malignant effusion were the commonest indication by 36.9% followed by thoracic empyema (10.81%) in atraumatic category. In trauma; 16.22% had hemo-pneumothorax followed by pneumothorax (13.5%). 15.3% underwent tube thoracostomy as a post thoracotomy requirement. The observed 33.3% complications rate was significantly associated with age and tube duration where by tube size and urgency showed significant association with the depicted individual complications.  Conclusions: The usefulness of tube thoracostomy cuts across both atraumatic and traumatic indications. Despite its usefulness, it is not without complications as factors like age and tube duration are highly associated with its occurrence. We therefore emphasize on the utilization of proper measures towards complication rates reduction whilst accommodating its desired management outcome.

A retrospective study of congenital anomalies and associated risk factors among children admitted at a tertiary hospital in northwestern Tanzania.

Congenital anomalies in Sub-Sahara Africa (SSA) are understudied despite the significant pediatric health burden. This retrospective longitudinal hospital-based study evaluated the records of 326 inpatient children under the age of two years with congenital anomalies at Bugando Medical Centre, a tertiary referral hospital in northwestern Tanzania. Classical logistic regression was used in the analysis of congenital malformation of muscles, gastrointestinal malformation, oral facial clefts, neural tube defects, and skeletal malformations. A modified poisson regression was used to model risk factors for Central Nervous System (CNS) hydrocephalus and congenital heart disease (CHD). A majority (78.8%) of children included in the study were less than six months of age. Nearly half (48.8%) were diagnosed with CHD followed by CNS hydrocephalus (10.4%) and congenital malformation of muscles (8.9%). Babies whose mothers missed periconceptual folic acid supplementation had 83% higher risk of hydrocephalus (aPR = 1.83, 95% CI = 1.11-1.96) and 78% higher for CHD (aPR = 1.78, 95% CI = 1.31-1.94). Male children had 1.67 higher odds of muscular congenital malformations (aOR = 1.67, 95% CI = 1.23-1.89). Less than 37 gestational age had a 1.86 higher odds of muscular congenital malformations (aOR = 1.86, 95% CI = 1.53-3.66). Our study highlights the critical need for folic acid supplementation and establishes a need for a registry and the potential for mapping.

Exploring Symphysio-Fundal Height and Abdominal Girth in Predicting Fetal Weight: Lessons from Bugando Medical Centre, Mwanza, Tanzania

Background: Estimating fetal weight plays a crucial role in decision-making, particularly in high-risk pregnancies when determining the timing and method of delivery. In resource-limited settings where ultrasound availability is limited, Symphysio-Fundal Height and Abdominal Girth (clinical method) have been utilized as a substitute for predicting fetal weight. However, the accuracy of this clinical method has not been assessed locally. This study seeks to evaluate the precision of clinical method in estimating fetal weight and its correlation with the actual birth weight at Bugando Medical Centre. Methods: A hospital-based cross-sectional study was conducted in the Lake Zone area of Tanzania at Bugando Medical Centre. The study conveniently enrolled 400 mothers with singleton pregnancies who were admitted for normal vaginal delivery, elective cesarean section, or induction of labor. Fetal weight was estimated using clinical methods and compared with the birth weight at delivery. Statistical analysis was performed using SPSS version 20, employing descriptive statistics such as frequency, mean, and standard deviation. The relationship between estimated fetal weight, and birth weight were examined using the Chi-square and Pearson's correlation coefficient. A P-value of 0.05 was considered statistically significant. Results: The study participants had an average age of 29.13 years (± 5.346). Our analysis revealed that the mean estimated fetal weight slightly exceeded the actual birth weight, with values of 3495 grams and 3250 grams, respectively. Notably, this difference was statistically significant with a P-value &lt; 0.001, indicating the clinical method's tendency to overestimate fetal weight. Furthermore, the clinical method showed a strong positive correlation with actual birth weight (correlation coefficient = 0.7309, p-value &lt; 0.001), demonstrating its reliability in fetal weight estimation. The positive linear correlation between clinical fetal weight ...........

Clinical profile, treatment modalities and outcomes among patients with upper aero-digestive tract emergencies at Bugando Medical Centre, Mwanza, Tanzania

Background: Upper aero-digestive tract emergencies (UADTEs) are common in our setting and can be life-threatening and challenging to otolaryngologists. However, 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. Results: Of 487 ENT emergencies seen during the study period, 128 (26.3%) patients had UADTEs. Males 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 and neck tumours, 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). Age ≤ 40 years (p=0.02), prolonged duration to treatment (p=0.04) and low blood oxygen saturation (SPO2) (p=0.04) were significantly associated with poor outcomes following esophagoscopy. In addition, delayed duration to treatment (p=0.01) and foreign body ingestion (p=0.001) were significantly associated with prolonged hospital stay. Conclusion: UADTEs are common at BMC and constitute a significant cause of otorhinolaryngological admission with foreign bodies in the aerodigestive tract as the most typical cause of these emergencies. Most of these injuries can be prevented through public enlightenment campaigns. Early detection and management of UADTEs is essential to reduce morbidity and mortality associated with these emergencies.

Prevalence and Risk Factors of Hearing Loss at Bugando Medical Centre Mwanza Tanzania

Hearing enable us to communicate and interact all over the world. When hearing is reduced or not there at all then is a major problem. In Africa more so in the Sub Sahara, this problem is on the rise due to the activities that are been carried out. There is no clinical data that is available from our national and zonal referral hospital, this study is a stepping stone for more studies. The outcome will show the burden of the people with reduced or has no ability to hear, distribution of hearing loss and the contributing factors. The engagement was conducted in a tertiary hospital serving more than five regions of the country. It`s a descriptive cross-sectional study. The study spanned from July 2020 to December 2020 with the total number of patients visited the otorhinolaryngology and audiology clinic being 6,234 the ones hearing loss 526. The study found prevalence of 8.4% for reduce/inability to hear. Females found to be more by 1.3%. Sensorineural hearing was the leading (51%), followed by conductive hearing (41%). The group most affected by sensorineural hearing were 40-59 (53.7%). On conductive hearing, the leading group being affected were 3-39 years (46.6%). In the distribution of sensorineural hearing the leading one was mild hearing in the age group of 3-39 (63%), followed by moderate hearing at 25.5%. The contributory factors were inflammation, such as allergic rhinitis (38%), otitis (34%), and wax (9.5). These factors contributed to about 60% of hearing loss. A group of young adults have been found to have mild hearing (63%); this shows that in a few years, the majority of the young group will have severe hearing problems, hence decreasing the manpower of our economy. Public knowledge about ear care should be offered to people, and this should be done by the media and the health sector as a whole