Bugando Medical Centre Research Articles

The effect of early versus delayed surgical debridement on the outcome of open long bone fractures at Bugando Medical Centre, Mwanza, Tanzania.

BackgroundUrgent surgical debridement of open long bone fractures is of paramount importance for prevention of subsequent infection. Due to limited information on the timing of this surgical procedure in Mwanza, Tanzania; the present study was conducted to evaluate the effect of early versus delayed surgical debridement on the outcome of open long bone fractures.MethodsA prospective cohort study involving 143 patients with open long bone fractures admitted at Bugando Medical Centre (BMC) between December 2014 and April 2015 was conducted. Patients were stratified into two main groups basing on whether they presented at BMC and operated early (within 6 h) or late (more than 6 h). Socio-demographic and clinical information were collected using structured questionnaire. Analysis was done using STATA software version 11.ResultsThe male to female ratio was 1.6: 1, with most of the patients being in their third decade of life (30.8 %). Road traffic accident (RTA) was the most common cause of fractures (67.8 %). Majority of patients, 91 (63.6 %) had Gustillo-Anderson grade II and the timing of debridement was significantly associated with this grading (p-value = 0.05). Nine (6.3 %) patients developed surgical site infection (SSI) and the median length of hospital stay (LOS) (interquartile range) was 7 (5–10) days, ranging from 3 to 35 days. SSI was found more in the late group compared to the early group [7.5 % (6/80) versus 4.8 % (3/63) respectively, p-value = 0.503)] and LOS was also longer in the late group compared to the early group [7 (6–11.5) days and 6 (5–10) days respectively, p-value = 0.06]. Pseudomonas aeruginosa was the predominant bacteria causing SSI.ConclusionsOpen long bone fracture injuries due to RTA are common at BMC. The risk of developing SSI in this setting is low and comparable to many other countries. Despite the fact that there was no statistical significant difference between early versus delayed debrided groups on SSI and LOS stays; the need for prompt surgical intervention in both groups should be an enduring focus to maintain these favorable outcomes.

Radiation Needs In Pediatric Oncology in the Lake Region Of Tanzania

Abstract 32 Background: The majority of new pediatric cancer diagnoses are made in resource-poor countries where survival rates range from 5-25%, compared with 80% in high-resource countries. A key component of treatment includes radiation therapy, but access is extremely limited in East Africa. This study estimates the potential clinical benefit of radiation therapy for pediatric oncology patients at Bugando Medical Centre (BMC), a tertiary referral center in the lake zone of Tanzania, one of two cancer treatment centers in Tanzania. Methods: Study design is a retrospective review of recorded hospital admissions and clinic visits to the oncology department at BMC from January 2010-December 2014. The indication for radiation therapy was extrapolated from contemporary SIOP and COG protocols. The benefits of radiotherapy, both for curative and palliative intent, were estimated based on age, diagnosis and stage at presentation by two radiation oncologists. Results: A total of 221 pediatric patients were identified. The most common recorded diagnoses were Burkitt lymphoma (n=36), other non-Hodgkin lymphoma (n=33), Wilms tumor (n=32), acute leukemia (n=28) and retinoblastoma (n=23). Treatment received included chemotherapy only for 163 patients (74%), surgery only for 5 patients (2%), and a combination of chemotherapy and surgery for 30 patients (14%). No patients received radiation therapy due to lack of availability at our center. For 77 patients (35%), staging information was insufficient and the potential benefit of radiation therapy could not be determined. Of the remaining 144 cases, radiation could have been included in the treatment plan for 49 patients (34%, 95% CI 26-42%). Of these, 41 patients (84%, 95% CI 74-94%) could have been treated with curative intent and 8 patients (16%, 95% CI 6-26%) could have benefitted from palliative radiation therapy. Conclusion: Radiation therapy is an essential treatment modality for pediatric cancer but has limited availability in East Africa. In our population, roughly one third of presenting patients would have benefitted from radiation as part of their treatment. Most patients who would benefit from radiation therapy would be treated with curative intent. Introducing radiation has the potential to significantly improve pediatric cancer outcomes in the lake zone of Tanzania. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

Complications of sickle cell anaemia in children in Northwestern Tanzania

Objectives: Tanzania has the third highest birth rate of sickle cell anaemia (SCA) in Africa, but few studies describe severity of complications or available treatments, especially in Northwest Tanzania around Lake Victoria where the sickle gene is most prevalent. This is a report of the spectrum of clinical disease and range of interventions available at Bugando Medical Centre (Bugando) in Northwest Tanzania in Africa.Methods: A cross-sectional study was carried out in Bugando between 1 August 2012 and 30 September 2012. Children (<15 years old) with SCA attending Bugando were sequentially enrolled. A trained research assistant completed a Swahili questionnaire with the parent or guardian of each participant concerning demographic information, clinical features of disease, and treatments received.Results: Among the 124 participants enrolled, the median age was 6 years (interquartile range [IQR] 4–8.5), and only 13 (10.5%) were < 3 years old. Almost all participants (97.6%) had a prior history of a vaso-occlusive episode, 83 (66.9%) had prior acute chest syndrome, and 21 (16.9%) had prior stroke. In the preceding 12 months, 120 (96.8%) had been hospitalized, and a vaso-occlusive episode was the most common reason for hospitalization (35.5%). Prescriptions for folic acid (92.7%) and malaria prophylaxis (84.7%) were common, but only one had received a pneumococcal vaccine, and none had received hydroxyurea or prophylactic penicillin.Conclusion: Children with SCA receiving care in Tanzania are diagnosed late, hospitalized frequently, and have severe complications. Opportunities exist to improve care through wider access to screening and diagnosis as well as better coordination of comprehensive care.

Patient and disease characteristics associated with late tumour stage at presentation of cervical cancer in northwestern Tanzania.

BackgroundAbout two thirds of patients with cervical cancer in Tanzania present with advanced tumor stage, leading to significant morbidity and mortality. We designed a study to determine the factors associated with the late tumour stage at presentation among patients with cervical cancer in Mwanza.MethodsThis cross-sectional study recruited women at Bugando Medical Centre (BMC) with histologically confirmed cervical cancer from November 2013 to April 2014. Patients were recruited serially until the sample size was reached.ResultsA total of 202 women with histologically confirmed cervical cancer were recruited. The mean age of the patients was 50.5 ± 13.3 years. The majority of patients (n = 129, 63.9 %) were diagnosed with late stage disease (IIB-IVB). Patients also presented with severe anemia (n = 78, 38.6 %), urinary tract infections (n = 74, 36.6 %), hydronephrosis (n = 43, 21.2 %), elevated serum creatinine levels (n = 33, 16.3 %), vesicovaginal fistula (VVF), (n = 13, 6.4 %), lung metastasis (n = 5, 2.4 %), metastasis to the urinary bladder (n = 4, 1.9 %), rectovaginal fistula (RVF) (n = 3, 1.4 %), liver metastasis (n = 2, 0.9 %) and hydroureter (n = 2, 0.9 %). In multivariate logistic regression, factors associated with late stage at presentation were attending to alternative health practitioners and lack of personal initiative to seek care to formal health facilities (OR 2.3; 95 % CI 1.2–4.2, p = 0.011 and OR 2.0; 95 % CI 1.0–3.8, p = 0.028) respectively.ConclusionCommunities should be sensitized to women’s empowerment, provide community education on early symptoms of cervical cancer, and the importance of early hospital attendance.

Hydatidiform moles among patients with incomplete abortion in Mwanza City, North western Tanzania.

Prevalence of hydatidiform mole is not clearly defined, partly because most studies have reported different prevalence rates from different regions. However, there is no previous study that has determined the prevalence and associated risk factors of HM among patients with incomplete abortion evacuated at Bugando Medical Centre (BMC) and Sekou Toure Regional Hospital (STRH). A total of 180 patients with incomplete abortion were enrolled between February 2013 and April 2013. The products of conception were collected and analyzed using Haemotoxylin and Eosin staining technique for hydatidiform moles. One hundred and eighty patients with incomplete abortion scheduled for uterine evacuation agreed to participate in this study. The overall prevalence of HM was 12.8%. Majority of patients (27.5%) with HM were those aged below 20 years. No significant association was observed with risk factors such as parity, contraceptive use, previous abortion and blood group. The prevalence of HM (12.8%) was high and age between 15-20 years was the only significant associated risk factor with the presence of HM among patients with incomplete abortion. Therefore, we recommend submission of evacuated products of conception for histopathological analysis to minimize missed opportunity.

Clinicopathological pattern of benign breast diseases among female patients at a tertiary health institution in Tanzania

Background: Benign breast diseases are a neglected entity in developing countries despite the fact that they constitute the majority of breast complaints. There is a paucity of published information regarding benign breast diseases in Tanzania. This study describes our experience in the management of benign breast diseases outlining the clinicopathological pattern and treatment modalities of these diseases in our local setting.Methods: This prospective descriptive study was conducted between November 2009 and March 2013 at Bugando Medical Centre in Tanzania on female patients aged 10 years and above presenting with benign breast diseases.Results: A total of 346 female patients with benign breast diseases were studied. The majority of patients, 255 (73.7%) were younger than 30 years. Breast lump was the most frequent presentation in 67.6% of patients. Fibroadenoma 95 (60.0%) was the most frequently diagnosed benign breast disease followed by fibrocystic changes (19.0%). Out of 295 patients who had histopathological examination, 64 (21.7%) had proliferative lesions. Of these, 18 (28.1%) had proliferative lesions with atypia while 46(71.9%) had proliferative lesions without atypia. Eight (2.6%) patients were HIV positive with the median CD 4+ count of 258 cells/μl. The majority of patients, 295(85.2%) underwent surgical treatment of which lumpectomy was the most common procedure performed. Conclusion: Benign breast diseases are more common than malignancies in our environment and occur mainly in young women less than 30 years of age and were mostly fibroadenoma and fibrocystic change. Though premalignant lesions of proliferative lesions with atypia were less common in this study, it is advisable that all cases of breast lesions should be carefully evaluated to exclude possibility of breast cancer.

An Innovative Telepathology Solution For Developing Countries

Introduction/ Background The increasing incidence of pathologies like tumors and infections is a significant public health burden in developing countries. The ability to provide early diagnosis, treatments, follow-up care has a strong impact on the survival. Telemedicine is of great utility in countries lacking appropriate healthcare facilities by allowing for the performance of good level healthcare practices. Sub-Saharan African Countries suffer a dramatic shortage of medical pathologists (in the range of 1 to 10 pathologists per 10 million people) and are also victims of digital divide. Vittorio Tison Association (Tison), IRST research cancer hospital and Patologi Oltre Frontiera NGO (APOF) cooperate in the sanitary mission founded in 1999 in Bugando Medical Centre (BMC), a hospital located in Mwanza, Tanzania. In that mission, during 2011 we started the development of our telemedicine project. The project utilizes a novel telematic platform oriented to several sanitary branches with a special focus in pathology and oncology. Aims The main project goals are: to provide ICT and TLC services between healthcare facilities in developed and developing countries; to allow for simultaneous telepathology counselling sharing microscopy and radiology images, conference calling, remote diagnosis, double-blind evaluation, second opinion and the remote control of medical instrumentation; to perform e-learning and remote quality control; to carry out GCP clinical trials through data collection, monitoring and evaluation; to encourage and support scientific research; to reduce the knowledge gaps inherent to the digital divide. Methods APOF has been developing the BMC pathology lab from 2000 to 2008. In the meantime Tison took care of training in Oncology of local medical doctors, opened the BMC Oncology Department in 2010 and patronized the building of a new clinic dedicated to the Oncologic Institute. We started the development of the project in 2011 with a general assessment of the needs and lacks in local working procedures, related to the possible improvements in ICT. Our first step involved the Internet connections activation and the implementation of the project informatic core in the IT room of the BMC Oncologic Institute. The telematic link between IRST’s Italian site and BMC has been realized during the early pilot phase. We carried out several experimental sessions to investigate the compatibility of the main third-parts digital pathology products with our platform, choosing digital microscope Menarini D-SIGHT in association with D-SIGHT+ telepathology web-based application. Finally, on June 2015 we launched the BMC Telepathology Facility performing a complete demo of the system during the AORTIC East African Regional Meeting. Results We validated the system in a wide range of conditions. Experimental data indicate an improvement of a factor up to 100 in the overall images transmission rate in comparison to the previous models. The pathology images remotely viewed are fully compliant with the diagnostic requirements in terms of definition and magnification. The platform is easy-to-use, all sanitary operators involved in the testing found it friendly and effective. The images browsing on the screen is very fast and precise, professional operators evaluated this solution equivalent to the use of the microscope. Our project is characterized by a high level of innovation which increases efficiency and efficacy of health practices and can boost the use of telepathology in developing countries.

Reversible Severe Pulmonary Hypertension after Adenotonsillectomy: A Case Report of a Child Treated at Bugando Medical Centre, Northwestern Tanzania.

Upper airway obstruction (UAO) due to adenotonsillar hypertrophy represents one of the rare causes of pulmonary hypertension in children. We report a case of adenotonsillar hypertrophy, managed at pediatric and otorhinolaryngology departments in Bugando Medical Centre (BMC), northwestern Tanzania, with complete remission of symptoms of pulmonary hypertension following adenotonsillectomy. A 17-month-old boy presented with difficulty breathing, dry cough, and noisy breathing since 1 year. He had facial and lower limb oedema with a pan systolic murmur at the tricuspid area, fine crepitations, and tender hepatomegaly. A grade II tonsillar hypertrophy and hypertrophied adenoids were seen on nasal and throat evaluation. A 2D-echocardiography showed grossly distended right atrium and ventricle, dilated pulmonary artery, and grade III tricuspid regurgitation. His final diagnosis was severe pulmonary hypertension with right-sided heart failure due to adenotonsillar hypertrophy. He had complete remission of cardiopulmonary symptoms after adenotonsillectomy and had normal control echocardiography six and twelve months after surgery. Children with symptoms of upper airway obstruction and cardiopulmonary involvement could benefit from routine screening for pulmonary hypertension. Adenotonsillectomy should be considered for possible complete remission of both UAO and cardiopulmonary symptoms.

Predictors of disease complications and treatment outcome among patients with chronic suppurative otitis media attending a tertiary hospital, Mwanza Tanzania.

BackgroundChronic suppurative otitis media (CSOM) is a major health problem in developing countries causing hearing loss and life threatening complications. Early and effective treatment based on the knowledge of causative micro-organisms and predictors of outcome are crucial in preventing these associated complications. This study was conducted to determine the predictors of CSOM complications, treatment outcome and antimicrobial susceptibility of pathogens, thus providing essential evidence to formulate a policy for management of CSOM.MethodsThis was a prospective hospital based cross sectional study involving 301 patients attending Ear Nose and Throat (ENT) clinics at Bugando Medical Centre (BMC) between October 2013 and March 2014. A standardized data collection tool was used to collect demographics and clinical characteristics of patients with CSOM. Ear swabs were collected using sterile cotton swabs and transported to the laboratory for culture and antibiotic susceptibility testing.ResultsOut of 301 patients with CSOM; 187 (62.1 %) had positive aerobic culture within 48 h of incubation. Disease complications and poor treatment outcome were observed in 114 (37.8 %, 95 % CI; 32.2–43.3) and 46 (15.3 %, 95 % CI; 11.2–19.3) respectively. On multivariate logistic regression analysis factors found independently to predict both disease complications and poor treatment outcome were otalgia, being infected by multi drug resistant bacteria and being HIV positive. Prolonged illness duration before seeking medical attention was also found to be associated with disease complications (OR 1.029, 95 % CI 1.007–1.05, p = 0.01). A total of 116 (61 %) of gram negative bacteria were isolated. Of 34 Staphylococcus aureus, 14 (41 %) were found to be methicillin resistant Staphylococcus aureus (MRSA) while of 116 g negative enteric bacteria, 49 (42 %) were extended spectrum beta lactamases producers (ESBL).ConclusionsFindings of this study suggest that positive HIV status, infection due to multidrug resistant pathogens and otalgia are significantly associated with disease complications and poor treatment outcome. Of great importance this study confirms that prolonged illness duration without seeking medical attention significantly predicts disease complications. Urgent preventive measures and laboratory guided early treatment are necessary to reduce complications associated with CSOM.

Magnitude and correlates of moderate to severe anemia among adult HIV patients receiving first line HAART in Northwestern Tanzania: a cross sectional clinic based study.

IntroductionModerate to severe anemia is an important clinical problem in HIV patients on Highly Active Antiretroviral Therapy. The rate of progression and mortality in this sub group of patients is high compared to non anemic patients. In sub Saharan Africa with scale up of Anti retroviral therapy, the magnitude of this problem is not known especially in Tanzania. This study aimed at determining the magnitude and correlates of moderate to severe anemia in HIV patients receiving first line ART in northwestern Tanzania.MethodsThis was a cross sectional clinic based study, involving adult HIV patients on first line Highly Active Antiretroviral Therapy at Bugando Medical Centre Care and Treatment Center. The patients’ data were analyzed using STATA version 11 to determine the prevalence of moderate to severe anemia and risk factors that could predict occurrence of anemia.ResultsIn this study 346 patients on Highly Active Anti-Retroviral Therapy were enrolled, of whom 100(40.46%) had moderate to severe anemia. The odds of being anemic were strongly predicted by Zidovudine based regime, low baseline CD4 count (< 200 cells/μl) and HIV stage 3&4 at enrollment. Most of the anemic patients had mean corpuscular volume of >100fl.ConclusionThe prevalence of moderate to severe anemia is significantly high in this cohort of HIV-infected patients on first line Anti Retroviral Therapy and it is strongly predicted by Zidovudine based regime, low baseline CD4 and HIV stage 3 and 4. On clinical grounds this suggests that patients who are initiated on Zidovudine based regimen and those in advanced HIV at enrollment should have regular haemoglobin follow up to identify anemia at its earliest stage to improve the clinical outcome of these patients.

Hepatic Encephalopathy; Prevalence, Precipitating Factors and Challenges of Management in a Resource-Limited Setting

Background and Aims: Hepatic encephalopathy, a neuropsychiatric syndrome caused by portosystemic venous shunting, clinical presentation ranges from minimal to overt H.E. It is a common complication of advanced liver disease with significant morbidity and mortality The aim of this study was to assess the prevalence, common precipitating factors, and outcomes of hepatic encephalopathy in patients with preexisting liver disease. Methods: A hospital based, retrospective chart review study was conducted at Bugando Medical Centre a tertiary hospital in Mwanza region. The target population included all patients aged > 18 years admitted with Hepatic encephalopathy from January 2009 to June 2015. Patients were enrolled using a detailed checklist, personal identifications were removed and analysis was done using the SPSS version 17.0. Results: A population of 88 patients with Hepatic encephalopathy were enrolled with a mean of 47 years (SD +/-17 years). Among patients admitted to the medical ward, the prevalence was 0.4% (88/23942). Most common liver disease and complications including alcoholic cirrhosis, hepatitis B infection, and hepatocellular carcinoma were present in 47.7% of (42/88), 22.7% (20/88), and 23.9% (21/88) patients, respectively. Majority had West Haven grade 3, 36.4% (32/88), and grade 4, 18.2% (16/88). Precipitating factors included diuretic therapy on patients with ascites 27.2% (44/162), infections 21.6% (35/162), blood transfusions, 16.7% (27/162), and upper gastrointestinal bleeding 17.3% (28/162). Most died during their hospitalization, 75% (66/88). The remaining 25% (22/88) were discharged. Majority of the cohort, 72.7% (64/88), had less than 3 months survival after diagnosis, while 27.3% (24/88) survived more than 1 year. Conclusions: We found severe Hepatic encephalopathy presenting in patients with preexisting liver disease associated with poor outcomes, posing challenges in management and survival. The use of newer and superior agents like polyethylene glycol, identification of subclinical Hepatic encephalopathy and targeting early removal of precipitating factors is imperative. Screening those at risk of developing Hepatic encephalopathy would likely improve outcomes.

Predictors of foeto-maternal outcome of patients with abruptio placenta at Bugando Medical Centre, Tanzania

Background: Abruptio placenta (AP) is one of the life-threatening obstetric complications for both the foetus and mother. We conducted this study to determine the incidence and predictors of adverse outcomes of abruptio placenta at Bugando Medical Centre (BMC) in northwest Tanzania.Methods: This descriptive cross-sectional study was conducted from October 2012 to April 2013. Women with clinical features of abruptio placenta attending BMC were recruited. Data were collected using a structured checklist and analysed with STATA 11.Results: A total of 3,800 deliveries occurred during study period. The incidence of AP was 2.5% (95/3800). Among patients with AP, 49 (51.6%) delivered by Caesarean section. Three (3.2%) maternal deaths occurred. These deaths were strongly associated with the presence of maternal anaemia (p&lt;0.05), and postpartum haemorrhage (p&lt;0.05). The foetal adverse outcomes were prematurity 78 (82.1%), foetal distress 65 (68.4%), low birth weight 46 (48.4%) and intrauterine foetal deaths 30 (31.6%). Perinatal deaths occurred in 52 (54.7 %) of the cases, and were predicted by low birth weight (p&lt;0.001), vaginal delivery (p=0.001), birth asphyxia (p&lt;0.001), and retroplacental clot (&gt;700ml) (p&lt;0.001).Conclusion: The incidence of AP at BMC is high and characterised by poor maternal and foetal outcomes. Patients with AP should be delivered promptly to improve their survival.

High seroprevalence of specific Toxoplasma gondii IgG antibodies among HIV/AIDS patients with immunological failure attending a tertiary hospital in northwestern Tanzania

Toxoplasmosis is a major cause of morbidity and mortality among patients with advanced HIV disease. However, there is limited data on the magnitude of toxoplasmosis among HIV patients with immunological treatment failure. Therefore, this study was designed to determine the seroprevalence of specific Toxoplasma gondii IgG antibodies among HIV/AIDS patients attending Bugando Medical Centre in Mwanza, Tanzania. Immunological treatment failure was defined using the World Health Organization (WHO) criteria and specific T.gondii IgG antibodies were determined using indirect enzyme linked immunosorbent (ELISA). A total of 178 non-repetitive sera from HIV/AIDS patients were analyzed. The mean age of study participants was 38.5±11.3 years. Majority of study participants were males 120 (67.42%). Out of 178 patients, 38 (21.34%) were diagnosed to have immunological failure. T.gondii specific IgG antibodies were found in 26 (68.4%) of the patients with immunological failure compared to 46 (32.86%) of those without immunological failure (OR: 4.42, CI: 2.05-9.55; p&lt;0.001). The seroprevalence of T.gondii infection is high among patients with immunological treatment failure and place them at a high risk of T. gondii encephalitis necessitating sustained trimethoprim-sulfamethaxazole prophylaxis to prevent reactivation.

Blood transfusion practice in surgery at Bugando Medical Centre in northwestern Tanzania

Background: Preoperative over-ordering of blood for surgical intervention, in excess of the actual and anticipated needs is a common practice in many developing countries. This can be decreased by simple means of changing the blood cross matching and ordering schedule depending upon the type of surgery performed. The aim of this study was to assess the blood transfusion practice in surgery at Bugando Medical Centre in northwestern Tanzania.Methods and Patients: This was a prospective cross sectional study among patients undergoing major operations at Bugando Medical Centre. We evaluated blood ordering and transfusion practices in emergency and elective surgical procedures at our centre and calculated different indices such as cross-match to transfusion ratio (C/T ratio), transfusion probability (% T) and transfusion index (TI). Next Maximal Surgical Blood Ordering System (MSBOS) was estimated for each procedure.Results: The overall blood utilization was only 28.2% at our centre, consisting of 17.1% in the elective operations and 26.9% in the emergency operations. Significant blood utilization was nil in most of the routine elective cases suggesting cross-matching of blood to be a culture than necessity. Generally, the overall blood transfusion of the requested blood as indicated by indices of C/T ratio, %T, TI and MSBOS were 3.5, 28.7%, 0.33 and 0.45, respectively. The overall CT ratio, %T, Ti and MSBOS in the elective operations were 5.8, 15.9%, 0.2 and 0.3, respectively. In the emergency operations, the overall CT ratio, %T, Ti and MSBOS were 3.7, 22%, 0.32 and 0.48, respectively.Conclusion: This study demonstrated that over-ordering of blood in excess of the actual needs is a common practice in our setting. Blood ordering pattern needs to be revised and over-ordering of blood should be minimized. This can be possible by the estimation of MSBOS for each procedure and requisition as calculated.

Head and neck cancers: a clinico-pathological profile and management challenges in a resource-limited setting.

BackgroundHead and neck cancer (HNC) is one of the most common cancers worldwide and its incidence is reported to be increasing in resource-limited countries. There is a paucity of published data regarding head and neck cancers in Tanzania, and Bugando Medical Centre in particular. This study describes the clinicopathological profile of HNC in our local setting and highlights the challenges in the management of this disease.MethodsThis was a retrospective study of histopathologically confirmed cases of head and neck cancers treated at Bugando Medical Center between January 2009 and December 2013.ResultsA total of 346 patients (M:F = 2.1:1) were studied representing 9.5 % of all malignancies. The median age of patients was 42 years. Cigarette smoking (76.6 %) and heavy alcohol consumption (69.9 %) were the most frequently identified risk factors for head and neck cancer. The majority of patients (95.9 %) presented late with advanced stages. Twenty-five (7.2 %) patients were HIV positive with a median CD4+ count of 244 cells/μl. The oral cavity (37.3 %) was the most frequent anatomical site affected. The most common histopathological type was carcinomas (59.6 %) of which 75.7 % were squamous cell carcinoma. A total of 196 (56.6 %) patients underwent surgical procedures for HNC. Radiotherapy and chemotherapy was reported in 9.5 and 16.8 % of patients, respectively. Only 2 (0.6 %) patients received chemo-radiation therapy. The mortality rate was 24.4 %. The overall 5-year survival rate (5-YSR) was 20.6 %. The predictors of overall 5-YSR were age of patient at diagnosis, stage of disease, extent of lymph node involvement, HIV seropositivity and CD4+ count <200 cells/μl (P < 0.001). Local recurrence was reported in 22 (23.4 %) patients and this was significantly associated with positive resection margins, stage of the tumor and presence of metastasis at diagnosis and non-adherence to adjuvant therapy (P < 0.001).ConclusionHead and neck cancers are not uncommon at Bugando Medical Centre and show a trend towards a relative young age at diagnosis and the majority of patients present late with advanced stage cancer. Therefore, public enlightenment, early diagnosis, and effective cost-effective treatment and follow-up are urgently needed to improve outcomes of these patients in our environment.

Maternal death reviews at Bugando hospital north-western Tanzania: a 2008-2012 retrospective analysis.

BackgroundUnacceptably high levels of maternal deaths still occur in many sub-Saharan countries and the health systems may not favour effective use of lessons from maternal death reviews to improve maternal survival. We report results from the analysis of data from maternal death reviews at Bugando Medical Centre north-western Tanzania in the period 2008–2012 and highlight the process, challenges and how the analysis provided a better understanding of maternal deaths.MethodologyRetrospective analysis using maternal death review data and extraction of missing information from patients’ files. Analysis was done in STATA statistical package into frequencies and means ± SD and median with 95 % CI for categorical and numerical data respectively.ResultsThere were 80 deaths; mean age of the deceased 27.1 ± 6.2 years and a median hospital stay of 11.0 days [95 % CI 11.0–15.3]. Most deaths were from direct obstetric causes (90); 60 % from eclampsia, severe pre-eclampsia, sepsis, abortion and anaesthetic complications. Information on ANC attendance was recorded in 36.2 % of the forms and gestation age of the pregnancy resulting into the death in 23.8 %. Sixty one deaths (76.3 %) occurred after delivery. The mode of delivery, place of delivery and delivery assistant were recorded in 44 (72.1), 38 (62.3) and 23 (37.7 %) respectively.ConclusionRoutine maternal death reviews in this setting do not involve comprehensive documentation of all relevant information, including actions taken to address some identified systemic weaknesses. Periodic analysis of available data may allow better understanding of vital information to improve the quality of maternity care.

Surgical management of vascular anomalies in children at a tertiary care hospital in a resource-limited setting: a Tanzanian experience with 134 patients.

BackgroundVascular anomalies pose major diagnostic and therapeutic challenges among pediatricians and pediatric surgeons practicing in resource limited countries. There is paucity of published data regarding this subject in Tanzania and Bugando Medical Centre in particular. This study describes our experiences on the challenges and outcome of surgical management of childhood vascular anomalies in our environment.MethodsBetween January 2009 and December 2013, a prospective study on the surgical management of vascular anomalies was undertaken at Bugando Medical Centre.ResultsA total of 134 patients (M; F = 1:2.5) were studied. The median age at presentation was 6 years. Of the 134 patients, 101 (75.4 %) were diagnosed as having vascular tumors and 33 (24.6 %) had vascular malformations. The head and the neck were the most frequent anatomical site recorded as having a tumor (56.7 % of patients). Out of 134 patients, 129 (96.3 %) underwent surgical treatment. Failure to respond to non-operative treatment (86.8 %), huge disfiguring/obstructing mass (4.7 %), infection (3.1 %), ulceration (3.1 %) and hemorrhage (2.3 %) were indications for surgical intervention. Tumor excision and primary wound closure was the most common type of surgical procedure performed in 80.6 % of patients. Surgical site infection was the most frequent complications accounting for 33.8 % of cases. Mortality rate was 1.5 %. Tumor excision and primary wound closure gave better outcome compared with other surgical options (p < 0.001). Outcome of injection sclerotherapy in 3 (3.7 %) children, serial ligation of feeder vessels employed in 2 (1.6 %), and conservative treatment in 5 (3.7 %), were poor and required conversion to surgical excision. Despite low mortality rate recorded in this study, but ugly scar, 14 (20.6 %) and limb deformity, 6 (8.8 %) were problems. The overall result of surgical treatment at the end of follow up period was excellent in 108 (87.1 %) patients.ConclusionSurgical excision and primary wound closure gave good outcome which could be employed in complicated and vascular anomalies which failed to respond to other treatment in regions with limited resources.

Infantile hypertrophic pyloric stenosis at a tertiary care hospital in Tanzania: a surgical experience with 102 patients over a 5-year period.

BackgroundInfantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants. There is paucity of published data regarding this condition in our setting. This study describes the clinical presentation, mode of treatment and outcome of treatment of this disease and identifies factors responsible for poor outcome of these patients.MethodsThis was a descriptive retrospective study of infants with HPS admitted to Bugando Medical Centre and subsequently underwent surgery between February 2009 and January 2014.ResultsA total of 102 patients (M:F = 4.7:1) were studied. The median age at presentation was 5 weeks. The median duration of illness was 4 weeks. Fifty-four (52.9 %) patients occur in first-born children. Associated anomalies were reported in 7 (6.9 %) patients. Non-bilious vomiting was the most frequent symptom and it was described in all (100 %) patients. A palpable mass was found in 23.5 % of infants. The diagnosis of IHPS was made clinically in 86 (84.3 %) and by ultrasound in 16 (15.7 %) patients. The treatment was Ramstedt’s pyloromyotomy in all cases. There were 6 (5.9 %) intra-operative mucosal perforations which were repaired successively. Postoperative complication was 11.8 %. The median length of hospital stay was 12 days and it was significantly associated with prolonged pre-operative hospitalization (p = 0.001). The mortality rate was 4.9 %. Age below 2 weeks, late presentation (≥14 days), severe dehydration on admission, hypokalaemia on admission and surgical site infection were the main predictors of mortality (p < 0.001).ConclusionThis study has shown that IHPS is a common condition in our setting. Age <2 weeks, delayed presentation, prolonged preoperative hospital stay, surgical site infection and high proportion of dehydration and electrolyte disturbance were the main predictors of poor outcome. A high index of suspicion is needed in infants with non-bilious vomiting to avoid delay in diagnosis.

Experiences with surgical management of undescended testis at a tertiary care hospital in north-western Tanzania

Background: Undescended testes (UDT) are prone to a lot of complications but early detection and correction give good results. There is paucity of published data on UDT in our setting. This study describes the clinical presentation, management and outcome of this condition at Bugando Medical Centre (BMC) in northwestern TanzaniaMethods: This was a retrospective study of patients who were admitted and operated for undescended testis at BMC between July 2006 and June 2014. Results: A total of 84 patients with 102 UDT were studied. Forty-six (54.9%) patients were aged above 5 years. Majority (72.5%) UDT were non-palpable. The right side was involved in 54.8%; left side in 23.8% while 21.4% were bilateral. Associated inguinal hernia was reported in 48 (77.4%) patients. Ultrasonography was performed in 34 (45.9%) patients with non-palpable testes and was used to locate 12(35.3%) testes. Laparoscopy was not used in any patient. At surgery, 54 (52.9%) testes were found in the inguinal canal, 28 (27.5%) in the superficial inguinal pouch, 10 (9.8%) in the abdomen and 10 (9.8%) testes were not found. Out of the 92 (90.2%) visible testes, 69 (75.0%) underwent orchidopexy (single stage in 54 (78.3%) testes and multistage in 15 (21.7%) testes) and 23 (25.0%) orchidectomy. Single stage procedures were more likely in patients less than 5 years, with palpable testes and those with testes located at the superficial inguinal pouch (p &lt; 0.001). Postoperative complications were recorded in 8(9.5%) patients. The overall success rate of treatment was 95.7%. In this study, only 12 (14.3%) patients were available for follow up at 12 months after discharge.Conclusion: Patients with UDT presented late in our hospital because diagnosis by birth attendants was rarely made even though the anomaly was obvious at birth. The parents, patients themselves and development of complications drew attention to undescended testis. Health awareness campaign, thorough genital examination after birth and regular screening of toddlers for UDT may result in early presentation

Trauma admissions among victims of domestic violence at a tertiary care hospital in north-western Tanzania: an urgent call to action

Background: Despite the growing recognition of domestic violence as a public health and human rights concern, it remains rampant in developing countries and has a negative impact on the victim’s health. This study describes the injury characteristics and treatment outcome of trauma associated with domestic violence in north-western Tanzania.Methods: This was a descriptive prospective study of patients who were managed for domestic violence related trauma at Bugando Medical Centre in Mwanza, Tanzania from April 2009 to March 2014.Results: A total of 324 patients (M: F = 1: 10.6) were studied. Majority of the patients were in the second and third decades of life. The perpetrators were mainly husbands and ex-partners (55.5%). Suspecting sexual partner being unfaithful was the most common reason given by victims for domestic violence in 63.4% of cases. Blunt and sharp objects (56.8%) were the most common weapons used. Gunshot injuries were recorded in 0.6% of cases. The head/neck was commonly affected in 68.5%. Soft tissue injuries (77.8%) were the most frequent type of injuries. The majority of patients (65.4%) sustained mild injuries. Twenty-three (7.1%) patients were HIV positive. Surgical treatment was performed in only 34.6% of cases. Complication rate was 26.8%. The median hospital stay was 12 days. Mortality rate was 6.5%. The main predictors of mortality were advanced age (&gt; 60 years), late presentation, severity of injury, severe head injury, HIV seropositivity, low CD 4 count (&lt;200 cells), surgical site infection (p&lt;0.001). More than two-thirds of patients were lost to follow up.Conclusion: Domestic violence related trauma remains rampant in northwestern Tanzania and contributes significantly to high morbidity and mortality. Urgent preventive measures targeting at reducing the occurrence of domestic physical violence is necessary to reduce the morbidity and mortality resulting from these injuries.