Center In Tanzania Research Articles

Follicular thyroid carcinoma with an iliac wing metastasis – Rare case report at Bugando Medical Centre in Tanzania

Thyroid carcinoma is uncommon in our geographical setting. When it occurs the leading histological type is papillary thyroid carcinoma followed by follicular thyroid carcinoma which are differentiated thyroid carcinomas. Differentiated thyroid carcinomas usually have a good prognosis as compared to undifferentiated thyroid carcinomas. Follicular Thyroid Carcinoma usually presents with a solitary thyroid nodule with or without cervical lymphadenopathy. We present a 57 year old female with history of anterior neck swelling for 5 years and inability to walk using the left lower limb for 2 years. Total thyroidectomy and modified neck dissection was done. Histopathology results revealed follicular thyroid carcinoma. Patient was received radiochemotherapy treatment post-surgery. Follicular thyroid carcinoma may present with a symptomatic distant metastatic bony lesion as presented. It is important for clinicians to be aware this and carry out confirmatory relative investigations.

Rate and reasons for discarding blood and blood product units at the Northern Zone Blood Transfusion Centre in Tanzania

Blood transfusion is an essential component in modern healthcare. Blood being an irreplaceable resource needs to be appropriately utilized with preferably minimal or zero percent wastage. Only one third of required blood units are collected in a Northern Tanzania Hospital, demanding the need for zero rate of discard of blood and blood products. This study aimed to determine the rate and reasons for discarding blood and blood products at Northern Zone Blood Transfusion Centre in Tanzania. From the current study the discard rate of blood and blood component units was 2.48% and the main reason for discarding blood and blood components was Transfusion Transmitted infections, followed by plasma prepared after 24 hours of collection of blood. . Furthermore, the common discarded blood product was packed red blood cells in Northern Tanzania.

Rate and reasons for discarding blood and blood product units at the Northern Zone Blood Transfusion Centre in Tanzania

Rate and reasons for discarding blood and blood product units at the Northern Zone Blood Transfusion Centre in Tanzania

Teamwork Makes the Dream Work: Revolution of Therapeutic Care at The Plaster House Through Collaboration With St. Catherine University

<h3>Research Objectives</h3> After participating in this interactive presentation, participants will: Verbalize an understanding of the program evaluation process utilized by the teams Explore ways to use similar strategies to evaluate rehabilitation services in a variety of settings Brainstorm the use of program evaluation to ensure processes and procedures are working toward the mission and vision of a program. <h3>Design</h3> Introduction / Rationale: The Plaster House provides holistic high love, low-cost care to almost 700 children with surgically treatable disabilities every year. By creating this temporary home away from home, The Plaster House is helping children realize their full potential. With a goal of a world where children do not have to live with treatable disabilities, The Plaster House saw the need to evaluate their programming and care pathways. To ensure The Plaster House is meeting the needs of Tanzanian children in a sustainable, purposeful way, a collaboration was forged with St. Catherine University (St. Paul, MN). Through virtual meetings, small group work, email, and site visits, The Plaster House team and the St. Catherine University team developed an interdisciplinary team to facilitate a program evaluation. <h3>Setting</h3> Pediatric rehabilitation center in Tanzania. <h3>Participants</h3> Children with surgically treatable disabilities in Tanzania. <h3>Interventions</h3> Program evaluation. <h3>Main Outcome Measures</h3> Program evaluation. <h3>Results</h3> Program evaluation. <h3>Conclusions</h3> Method / Approach: This presentation will explore the collaboration between a rehabilitation center in Tanzania and a University in the United States. Participants will engage in dialogue about the program evaluation process, obstacles that may appear in the process, and how to organize and facilitate effective collaboration between teams in a virtual environment. Through group discussions, and interactive brainstorming, participants will leave this presentation with an understanding of a collaborative program evaluation process facilitated by teams an ocean apart. <h3>Author(s) Disclosures</h3> Nothing to disclose at this time.

An International Virtual Classroom: The Emergency Department Experience at Weill Cornell Medicine and Weill Bugando Medical Center in Tanzania.

Emergency medicine (EM) is rapidly being recognized as a specialty around the globe. This has particular promise for low- and middle-income countries (LMICs) that experience the largest burden of disease for emergency conditions. Specialty education and training in EM remain essentially an apprenticeship model. Finding the required expertise to educate graduate learners can be challenging in regions where there are low densities of specialty providers.We describe an initiative to implement a sustainable, bidirectional partnership between the Emergency Medicine Departments of Weill Cornell Medicine (WCM) in New York, NY, USA, and Bugando Medical Center (BMC) in Mwanza, Tanzania. We used synchronous and asynchronous telecommunication technology to enhance an ongoing emergency medicine education collaboration.The Internet infrastructure for this collaboration was created by bolstering 4G services available in Mwanza, Tanzania. By maximizing the 4G signal, sufficient bandwidth could be created to allow for live 2-way audio/video communication. Using synchronous and asynchronous applications such as Zoom and WhatsApp, providers at WCM and BMC can attend real-time didactic lectures, participate in discussion forums on clinical topics, and collaborate on the development of clinical protocols. Proof of concept exercises demonstrated that this system can be used for real-time mentoring in EKG interpretation and ultrasound technique, for example. This system was also used to share information and develop operations flows during the COVID-19 pandemic. The use of telecommunication technology and e-learning in a format that promotes long-term, sustainable interaction is practical and innovative, provides benefit to all partners, and should be considered as a mechanism by which global partnerships can assist with training in emergency medicine in LMICs.

Head and Neck Lymphatic Malformation Management Algorithm: An Experience from a Tertiary Centre in Tanzania

Head and Neck Lymphatic Malformation Management Algorithm: An Experience from a Tertiary Centre in Tanzania

Head and Neck Lymphatic Malformation Management Algorithm: An Experience from a Tertiary Centre in Tanzania

Background: Lymphatic malformations are localized areas of malformed lymphatic system that can either be congenital or acquired which commonly occur in the head and neck region. Several treatment options for lymphatic malformations have been proposed, despite this, there is no consensus as to optimal management.&#x0D; Objective: To determine the pattern and management of head and neck lymphatic malformations in a tertiary health facility in Tanzania.&#x0D; Material and Methods: This was a one-year crosssectional study that involved patients with head and neck lymphatic malformations treated in Muhimbili National Hospital. A structured questionnaire was used to collect information including age and sex ofthe patient, chief complaint and, duration, size and site of the lesion. The treatment modalities were surgery and/or intralesional bleomycin injection (IL-Bleo) using a locally developed algorithm. A standard dose of bleomycin was 0.3 to 0.6 mg/kg per injection not exceeding 15 units per cycle with a maximum of 6 cycles.&#x0D; Results: a total of 33 patients were included in the study. Males were 21 (63.6%) and the male to female ratio was 1.8:1. The age of patients ranged from 5 months to 28 years with a median age of 6 years. In 29 (87.9%) patients, the lesions were evident during birth. The median area covered by the lesion in 2 patients was 12.00 cm . Nine (27.3%) patients were managed by surgery alone, while majority (24, 72.7%) were given intralesional bleomycin (ILBleo), of whom majority (20, 83.3%) required surgical intervention subsequently. The overall outcome of management of patients was considered successful in 87% of patients.&#x0D; Conclusion: Head and neck lymphatic malformations are more common in males. Most of the lymphangiomas are of congenital type. Combining IL-Bleo and surgery an effective way of managing head and neck lymphatic malformations.

Management of chronic lung diseases in Sudan and Tanzania: how ready are the country health systems?

BackgroundChronic lung diseases (CLDs), responsible for 4 million deaths globally every year, are increasingly important in low- and middle-income countries where most of the global mortality due to CLDs currently occurs. As existing health systems in resource-poor contexts, especially sub-Saharan Africa (SSA), are not generally oriented to provide quality care for chronic diseases, a first step in re-imagining them is to critically consider readiness for service delivery across all aspects of the existing system.MethodsWe conducted a mixed-methods assessment of CLD service readiness in 18 purposively selected health facilities in two differing SSA health system contexts, Tanzania and Sudan. We used the World Health Organization’s (WHO) Service Availability and Readiness Assessment checklist, qualitative interviews of key health system stakeholders, health facility registers review and assessed clinicians’ capacity to manage CLD using patient vignettes. CLD service readiness was scored as a composite of availability of service-specific tracer items from the WHO service availability checklist in three domains: staff training and guidelines, diagnostics and equipment, and basic medicines. Qualitative data were analysed using the same domains.ResultsOne health facility in Tanzania and five in Sudan, attained a CLD readiness score of ≥ 50 % for CLD care. Scores ranged from 14.9 % in a dispensary to 53.3 % in a health center in Tanzania, and from 36.4 to 86.4 % in Sudan. The least available tracer items across both countries were trained human resources and guidelines, and peak flow meters. Only two facilities had COPD guidelines. Patient vignette analysis revealed significant gaps in clinicians’ capacity to manage CLD. Key informants identified low prioritization as key barrier to CLD care.ConclusionsGaps in service availability and readiness for CLD care in Tanzania and Sudan threaten attainment of universal health coverage in these settings. Detailed assessments by health systems researchers in discussion with stakeholders at all levels of the health system can identify critical blockages to reimagining CLD service provision with people-centered, integrated approaches at its heart.

Feasibility of point-of-care cardiac ultrasound performed by clinicians at health centers in Tanzania

BackgroundPoint-of-care cardiac ultrasound (cardiac POCUS) has potential to become a useful tool for improving cardiovascular care in Tanzania. We conducted a pilot program to train clinicians at peripheral health centers to obtain and interpret focused cardiac POCUS examinations using a hand-held portable device.MethodsOver a 5-day period, didactic and experiential methods were used to train clinicians to conduct a pre-specified scanning protocol and recognize key pathologies. Pre- and post-training knowledge and post-training image acquisition competency were assessed. In their usual clinical practices, trainees then scanned patients with cardiovascular signs/symptoms, recorded a pre-specified set of images for each scan, and documented their interpretation as to presence or absence of key pathologies on a case report form. A cardiologist subsequently reviewed all images, graded them for image quality, and then documented their interpretation of key pathologies in a blinded fashion; the cardiologist interpretation was considered the gold standard.Results8 trainees (6 Clinical Officers, 1 Assistant Medical Officer, and 1 Medical Doctor) initiated and completed the training. Trainees subsequently performed a total of 429 cardiac POCUS examinations in their clinical practices over a 9 week period. Stratified by trainee, the median percent of images that were of sufficient quality to be interpretable was 76.7% (range 18.0–94.2%). For five of eight trainees, 75% or more of images were interpretable. For detection of pre-specified key pathologies, kappa statistics for agreement between trainee and cardiologist ranged from − 0.03 (no agreement) for detection of pericardial effusion to 0.42 (moderate agreement) for detection of tricuspid valve regurgitation. Mean kappa values across the key pathologies varied by trainee from 0 (no agreement) to 0.32 (fair agreement).ConclusionsThe 5-day training program was sufficient to train most clinicians to obtain basic cardiac images but not to accurately interpret them. Proficiency in image interpretation may require a more intensive training program.

Scalp Swelling and Headache in a 12-year-old Boy

1. Kathryn Westphal, MD* 2. Respicius Bakalemwa, MD† 3. Elizabeth Groothuis, MD, MPH* 1. *Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 2. †Department of Pediatrics, Bugando Medical Centre, Mwanza, Tanzania A 12-year-old boy with sickle cell disease (SCD) is admitted to a hospital in Mwanza, Tanzania, with acute onset of periorbital and scalp swelling. Associated symptoms include fever, headache, difficulty breathing, and back pain. Because resources in sub-Saharan Africa are limited, access to comprehensive care for patients with SCD is variable. The general principles of management focus on early diagnosis, parental education, prevention of infection with vaccinations and prophylactic medications, prompt treatment of infection and pain, the use of hydroxyurea for stroke prevention, and blood transfusions for life-threatening anemia. This patient has a known diagnosis of SCD but has infrequent pain episodes and no previous transfusions. He is not receiving hydroxyurea or prophylaxis against bacterial infections or malaria. He has no history of stroke and no known head trauma. On presentation he is afebrile and his heart rate is 120 beats/min, respiratory rate is 40 breaths/min, and blood pressure is 105/75 mm Hg. His oxygen saturation is 92% in room air. Physical examination is significant for pallor, periorbital edema, scalp edema, dyspnea without adventitious lung sounds, and splenomegaly with diffuse abdominal tenderness. His scalp edema is fluctuant and extends posteriorly from the periorbital region, encompassing the entire scalp. Swelling is most prominent in the frontal and parietal areas. The overlying skin is nonerythematous and nontender but is warm to the touch. His neurologic examination has no focal findings, although generally he appears tired. Initial laboratory results demonstrate a white blood cell count of 84,000/μL (84×109/L) with a lymphocytic predominance (57%), a hemoglobin level of …

Transfusion-Transmitted Infections and associated risk factors at the Northern Zone Blood Transfusion Center in Tanzania: A study of blood donors between 2017 and 2019.

BackgroundBlood transfusion saves many people every year that would otherwise have died. The present study aimed to provide an update and insightful information regarding prevalence of the common Transfusion-Transmitted Infections (TTIs) and associated factors among blood donors in Tanzania.MethodsThis was a cross-sectional study involving retrospectively collected data of blood donors from the Tanzania Northern Zone Blood Transfusion Center between 2017 and 2019. Descriptive statistics were performed to describe characteristics of the blood donors. Univariable and multivariable logistic regression analyses were performed to determine association between prevalence of TTIs and socio-demographic factors. P-value <0.05 was considered statistically significant.ResultsA total of 101, 616 blood donors were included in the present study of which 85,053(83.7%) were males while 16,563 (16.3%) were females. Of all participants, the majority 45,400 (44.7%) were aged between 18 and 25 years; 79,582 (78.3%) were voluntary non-remunerated donors while 22,034 (21.7%) were replacement donors. The vast majority of them 99,626 (98%) were first time blood donors while 1990 (2%) were multiple donors. The overall prevalence of TTIs was 10.1% (10,226 out of 101,616) of which the leading was HBV accounting for 5.1% (5,264 out of 101,616). Being a replacement donor was associated with all the four types of TTIs: HIV (AOR = 1.22, 95% CI = 1.10–1.35), HBV (AOR = 1.35, 95% CI = 1.27–1.44), HCV (AOR = 1.28, 95% CI = 1.12–1.46), and syphilis (AOR = 1.33, 95% CI = 1.20–1.48).ConclusionsOur study has demonstrated that Tanzania has relatively high prevalence of TTIs compared to some countries in Sub-Saharan Africa. HBV infection seems to be the most common infection among blood donors and replacement blood donors are at a higher risk of harboring the commonest TTIs among blood donors.

Agreement between careHPV and hybrid capture 2 in detecting high-risk HPV in women in Tanzania.

Visual inspection of the cervix with acetic acid is used to control the burden of cervical cancer in low- and middle-income countries. This method has some limitations and HPV DNA testing may be an alternative, but it is expensive and requires a laboratory setup. Cheaper and faster HPV tests have been developed. This study describe the agreement between a fast HPV test (careHPV) and hybrid capture 2 (HC2) in detection of high-risk HPV among Tanzanian women. The study involved women attending routine cervical cancer screening at the Ocean Road Cancer Institute and Kilimanjaro Christian Medical Centre in Tanzania. The women were offered HIV testing. Two cervical samples were subsequently obtained; the first sample was processed at the clinics using careHPV and the second sample was transported to Denmark and Germany for cytology and HC2 analysis. Kappa statistic was calculated to assess the agreement between careHPV and HC2. The sensitivity, specificity and predictive values of careHPV were calculated using HC2 as reference. The analyses were done for the overall study population and stratified by testing site and HIV status. A total of 4080 women were enrolled, with 437 being excluded due to invalid information, lack of careHPV or HC2 results. Overall agreement between the tests was substantial with a kappa value of 0.69 (95% confidence interval [CI] 0.66-0.72). The sensitivity and specificity of careHPV was 90.7% (95% CI 89.6-91.8) and 84.2% (95% CI 81.2-86.8), respectively. The agreement was similar in the stratified analyses where the kappa values were 0.75 (95% CI 0.70-0.79) in women aged 25-34, 0.66 (95% CI 0.62-0.70) in women aged 35-60, 0.73 (95% CI 0.70-0.77) at the Ocean Road Cancer Institute, 0.64 (95% CI 0.60-0.69) at the Kilimanjaro Christian Medical Center, 0.73 (95% CI 0.68-0.79) in HIV-positive and 0.66 (95% CI 0.63-0.70) in HIV-negative women. The kappa value of 0.64 (95% CI 0.39-0.88) for cervical high-grade lesions indicates a substantial agreement between careHPV and HC2 in detecting HPV among women with cervical high-grade lesions. A substantial agreement was found between careHPV and HC2 in detecting HPV overall as well as detecting HPV among women with cervical high-grade lesions. However, given the limited resources available in low and middle-income countries, the HPV testing assay should be weighed against the cost-effectiveness of the test.

Downstaging of cervical cancer in Tanzania over a 16-year period.

Globally, the highest cervical cancer mortality rates are found in East Africa. Visual inspection with acetic acid (VIA)-based screening in resource-poor settings has been shown to decrease the proportion of women presenting with late-stage cervical cancer, a process known as clinical downstaging. The only cancer treatment center in Tanzania, Ocean Road Cancer Institute (ORCI) in Dar es Salaam, opened a VIA-based cervical cancer screening program in 2002. We reviewed 6,676 medical records of cervical cancer patients at the ORCI from 2002-2011 to 2014-2018 for stage at diagnosis and screening status, among other variables. We investigated whether clinical downstaging occurred in this period among women screened at the ORCI, when compared to unscreened women. Our results indicated that the proportion of women presenting with late-stage cervical cancer among women screened at the ORCI decreased by 27.7% over the 16-year period (χ2 = 16.99; p = 0.0002). Among unscreened women, a non-significant 13.2% decrease in late-stage disease was observed (χ2 = 1.74; p = 0.4179). Our results suggest clinical downstaging occurred among women screened at the ORCI over the 16-year period, and this difference may be attributed to the screening program as the same decrease in stage was not observed among unscreened women during the same time period. At present, less than one percent of Tanzanian women receive yearly cervical cancer screenings. Access to screening through expansion of the ORCI screening clinic and the creation of more clinics should be prioritized.

Is a Training Program Sufficient to Improve the Smallholder Farmers’ Productivity in Africa? Empirical Evidence from a Chinese Agricultural Technology Demonstration Center in Tanzania

The article aims to analyze the effect of training programs on the yield of smallholder farmers. The empirical analysis employed a sample of data collected from a rice farming household in the Mvomero district of Tanzania. The results indicate that the yield outcome among trained and non-trained farmers with water access for irrigation was significantly more than double; however, the yield difference between trained and non-trained farmers was insignificant in non-irrigated plots. Our findings have policy implications for agricultural development in developing countries where training programs alone may not be a panacea for smallholder farmers’ productivity improvement. Therefore, respective governments, policymakers, and other agricultural stakeholders, should consider both farm and non-farm factors altogether, which may increase agricultural training effectiveness to address the challenges of low yields.

Severe traumatic brain injury management in Tanzania: analysis of a prospective cohort.

Given the high burden of neurotrauma in low- and middle-income countries (LMICs), in this observational study, the authors evaluated the treatment and outcomes of patients with severe traumatic brain injury (TBI) accessing care at the national neurosurgical institute in Tanzania. A neurotrauma registry was established at Muhimbili Orthopaedic Institute, Dar-es-Salaam, and patients with severe TBI admitted within 24 hours of injury were included. Detailed emergency department and subsequent medical and surgical management of patients was recorded. Two-week mortality was measured and compared with estimates of predicted mortality computed with admission clinical variables using the Corticoid Randomisation After Significant Head Injury (CRASH) core model. In total, 462 patients (mean age 33.9 years) with severe TBI were enrolled over 4.5 years; 89% of patients were male. The mean time to arrival to the hospital after injury was 8 hours; 48.7% of patients had advanced airway management in the emergency department, 55% underwent cranial CT scanning, and 19.9% underwent surgical intervention. Tiered medical therapies for intracranial hypertension were used in less than 50% of patients. The observed 2-week mortality was 67%, which was 24% higher than expected based on the CRASH core model. The 2-week mortality from severe TBI at a tertiary referral center in Tanzania was 67%, which was significantly higher than the predicted estimates. The higher mortality was related to gaps in the continuum of care of patients with severe TBI, including cardiorespiratory monitoring, resuscitation, neuroimaging, and surgical rates, along with lower rates of utilization of available medical therapies. In ongoing work, the authors are attempting to identify reasons associated with the gaps in care to implement programmatic improvements. Capacity building by twinning provides an avenue for acquiring data to accurately estimate local needs and direct programmatic education and interventions to reduce excess in-hospital mortality from TBI.

Mycetoma in Moshi, Tanzania.

The geographic spread of the neglected tropical disease mycetoma is still poorly understood, largely because there is no mechanism for official reporting and the general lack of identification facilities in many regions. Nonetheless many countries in the tropics have such cases. This brief report is submitted to provide an example of recent experience of mycetoma in six patients presenting to a single centre in Tanzania.

Factors Associated with HIV Viral Load suppression AmongAdults at HIV Care and Treatment Centers in Dodoma, Mtwaraand Lindi Region, July 2018-June 2019

Despite the increase number of people living with HIV still there are limited information about the factors associated with viral load suppression among HIV+ individual enrolled into HIV care and treatment centers in Tanzania. Data reports that 87% of those who are living with HIV have attained viral suppression. However this is still low compare to the UNAIDS global targets that by 2020 of 90% on treatment must achieve viral suppression. Viral load remains a gold standard for assessing treatment outcome for those who are on treatment. In 2014 UNAIDS introduced 90- 90-90 goal so as to combat HIV epidemic by 2020. First 90% know there status, second 90 accessing treatment and Third 90% viral suppression. The aim of this study was therefore to identify factors affecting viral load suppression among HIV+ adults attending care and treatment services in the regions. Crossectional analytical study conducted at Dodoma, Mtwara and Lindi regions in randomly selected health facilities. 459 participants who are on ART for atleast 12 months and 18+ years were recruited for the study. Structured questionnaire was used. Data was entered, cleaned and analyzed using EPI info 7.2.2.16. Odds ratio was used to establish association, 95% CI, and P value of 0.05 were used for statistically significance. A total of 459 study participants were enrolled. The prevalence of viral load suppression was 79%. Viral load suppression was found to be association with Satisfaction to care OR, 11.6 (95% CI: 1.2, 113.6) and Stigma level OR, 2.5 (95% CI: 1.03, 6.1) and found to be statistically significant. Majority of participants were female 165 (68.6%), married 185 (40.3%), with primary education 309 (67.3%) and 280 (61%) had small business or self-employed. Those younger than 35 years had a 70% reduced chance of having viral load suppression OR 0.7 (95% CI: 0.41 OR 1.18), gender OR 0.85 (95% CI: 0.5,1.35), marital status OR, 0.93 ( 95% CI: 0.59, 1.47), those with primary education level OR, 0.47, (95% CI: 0.22 OR 0.99), duration on ART OR, 0.46 (95%:0.15,1.42) disclosure status OR, 0.39 (95% CI: 0.15, 1.01)there were found to be associated with viral suppression but not statistically significant. Satisfaction with care and low level of stigma were associated with viral load suppression.

The Students ways of Financing the Higher Learning Education at The Open University of Tanzania

This paper assesses the ways the students from the Open University of Tanzania finance their education by using descriptive analysis. The study involved 182 students from Manyara regional centre in Tanzania who were selected by using the systematic random sampling technique. The study reveals that only 45% of the students finance higher education by using a loan from commercial banks. The study further found that students financed their higher education by using money from SACCOS, NGO MFIs and VICOBA. This paper recommends that commercial banks and other MFIs devise ways to finance higher education in Tanzania.

English

Trauma to the perineum following vaginal delivery is common and can lead to anal incontinence and pain but can be prevented by perineal support. However, the incidence and how to prevent perineal injury in sub Saharan Africa has not previously been described. The objective of the study was to assess the incidence of perineal trauma at vaginal delivery and to assess a training intervention in perineal support using a criterion-based audit (CBA) design. A CBA was conducted at Kilimanjaro Christian Medical Centre in Tanzania.&nbsp; In total, 552 women who delivered vaginally were included, of whom 80% completed a follow-up interview after three months. Perineal support as trained for this study was not performed before the intervention but was performed in 78.6% of deliveries after the intervention (p&lt;0.000). The number of women with second degree lacerations decreased after the intervention (RR 0.74, CI: 0.61-0.90), and more had an intact perineum (RR 2.85, CI: 1.74-4.69). Anal sphincter lacerations were not significantly changed by the intervention (6.6 to 3.4%, RR 0.52, CI: 0.24-1.14). The frequency of anal incontinence changed insignificantly from 6.1 to 4.9% (RR 0.81, CI: 0.37-1.77) after intervention. Perineal pain three months after delivery was reduced by 72% (RR 0.28, CI: 0.15-0.52). The study demonstrates that CBA may be useful in introducing a simple intervention such as perineal support thereby decreasing the number of women having perineal trauma following vaginal delivery. However, the impact of our intervention on the sustainability of our observations is uncertain and must await long-term studies.&nbsp; Key words: Clinical audit, developing countries, perineum, trauma, obstetric labor, complications. &nbsp

Knowledge of cardiovascular risk factors among caretakers of outpatients attending a tertiary cardiovascular center in Tanzania: a cross-sectional survey

BackgroundHealth literacy on cardiovascular diseases (CVDs) plays an effective role in preventing or delaying the disease onset as well as in impacting the efficacy of their management. In view of the projected low health literacy in Tanzania, we conducted this cross-sectional survey to assess for CVD risk knowledge and its associated factors among patient escorts.MethodsA total of 1063 caretakers were consecutively enrolled in this cross-sectional study. An adopted questionnaire consisting of 22 statements assessing various CVD risk behaviors was utilized for assessment of knowledge. Logistic regression analyses were performed to assess for factors associated with poor knowledge of CVD risks.ResultsThe mean age was 40.5 years and women predominated (55.7%). Over two-thirds had a body mass index (BMI) ≥25 kg/m2, 18.5% were alcohol drinkers, 3.2% were current smokers, and 47% were physically inactive. The mean score was 78.2 and 80.0% had good knowledge of CVD risks. About 16.3% believed CVDs are diseases of affluence, 17.4% thought CVDs are not preventable, and 56.7% had a perception that CVDs are curable. Low education (OR 2.6, 95%CI 1.9–3.7, p < 0.001), lack of health insurance (OR 1.5, 95%CI 1.1–2.3, p = 0.03), and negative family history of CVD death (OR 2.2, 95%CI 1.4–3.5, p < 0.001), were independently associated with poor CVD knowledge.ConclusionsIn conclusion, despite of a good level of CVD knowledge established in this study, a disparity between individual’s knowledge and self-care practices is apparent.