Dodoma Regional Research Articles

Rate of cervical dilatation and duration of active phase of labor among low-risk pregnant women delivering at Dodoma regional referral hospital

Background: Cervical dilation at the onset of the active phase of labor determines the rate of cervical dilatation and the duration of the active phase of labor. Identifying the abnormality toward the natural progress of the active phase of labor is important because timely intervention has been observed to be controversial among developing countries during the current practice among health care providers due to different opinion on the onset of the active phase. Thus, indication like poor progress of labor has been poorly explained in which it has become a common indication for a steady increased rate of primary cesarean section and increased new born morbidity due to birth asphyxia. Objective: This study aimed at determining the rate of cervical dilatation and duration of active phase of labor among low-risk pregnant women delivered at Dodoma Regional Referral Hospital. Methods: This is a hospital-based prospective cross-sectional study where systematic sampling method was employed in obtaining sample of 300 pregnant women. Local partograph and a semi structured questionnaire were used to record the information and findings. Data were analyzed using SPSS version 25. One sample t-test was used to determine and compare the rate and duration of active labor with the WHO standard rate. P value < 0.05 was considered statistically significant. Results: The mean rate of cervical dilatation during active phase for nulliparous was 0.81cm/hour and multiparous was 0.89cm/hour respectively, which is observed to be slower than standard WHO rates. The duration of the active phase of labor was 7.6 hours for nulliparous and 6.8 hours for multiparous. Conclusion: The rate of cervical dilatation was much slower hence the longer duration of active phase in both groups than the WHO standards.

Patterns of head and neck lesions among HIV/AIDS patients on highly active antiretroviral therapy at Dodoma Regional Referral Hospital in Tanzania

Introduction: Head and neck lesions associated with Human Immunodeficiency Virus are considered to occur in over 50% of HIV- positive patients and occur in nearly 80% of all patients with acquired immunodeficiency syndrome. The introduction of highly active antiretroviral therapy has led to a remarkable reduction in the global burden of such lesions. Suppose such lesions are undiagnosed or untreated on a prompt basis. In that case, they may cause morbidity and mortality since some lesions, for example, head and neck cancers may interfere with vital functions of life such as respiration, deglutition, and speech. This study determined head and neck lesions among HIV/AIDS patients in Tanzania. Methods: This was a hospital-based descriptive cross-sectional study that recruited 222 HIV/AIDS patients at a care and treatment clinic at Dodoma Regional Referral Hospital. Physical examination and laboratory investigations (histopathology, viral load and CD4 counts) were collected and data was analyzed using Statistical Package for Social Sciences (SPSS) version 23. P-value<0.05 was statistically significant. Results: Of all the 222 patients recruited in this study, 26 (11.7%) had head and neck lesions. Most patients with head and neck lesions were females (57.6%). Half of the patients (50.0%) were between 40 and 59 years old. About 21 (80.8%) patients were diagnosed with HIV/AIDS within two years, and 22 (84.6%) were initially diagnosed with CD4 counts less than 200 cells/μL. The most common head and neck lesion was oral candidiasis (46.2%) and others were cervicofacial lymphadenitis (15.4%), head and neck squamous cell carcinoma (laryngeal and hypopharyngeal) (11.5%), sinonasal Kaposi’s sarcoma (7.7%), odontogenic abscess (7.7%) and aphthous ulcers (7.7%) and the least encountered head and neck lesion was a ranula in 3.8% of patients. Similarly, a significant association was found between the occurrence of head and neck lesions with viral load, CD4 counts, duration since a patient was diagnosed with HIV/AIDS, presence of comorbid illness, alcohol consumption and cigarette smoking. Conclusions: The prevalence of head and neck lesions among HIV/AIDS patients on HAART was low. Females outnumbered males in terms of being affected by head and neck lesions. Oral candidiasis was the most common head and neck lesion. Head and neck (laryngeal and hypopharyngeal) squamous cell carcinoma was the predominant subtype of malignant lesions in HIV/AIDS patients on HAART.

Surgical Antibiotic Prophylaxis Practices and Occurrence of Surgical Site Infections Among Operated Patients at Dodoma Regional Referral Hospital, Tanzania

This study was conducted to determine association between perioperative antibiotic prophylaxis practices and occurrence of surgical site infections at Dodoma Regional Referral Hospital in Tanzania. Surgical site infections (SSIs) are preventable complications following surgery, but still cause significant burden in terms of patient morbidity, mortality and increased cost of treatment. A prospective cohort study was conducted among 162 operated patients. Patients with different trends of antibiotic prophylaxis were followed up for occurrence SSIs. Analysis of data was done by SPSS version 20 program using frequency tables, chi square test, Kaplan-meier and Cox regression methods. Significance level of < 0.05 was taken to establish associations between variables. It was found that, 60.5% of patients received preoperative antibiotic prophylaxis, the overall surgical site infections rate was 14.8%. There was no significant difference in occurrence of surgical site infections between patients who received and those who did not receive preoperative antibiotic prophylaxis (p=0.88). The study concluded that SSIs are significant complications. Perioperative antibiotic prophylaxis is commonly practiced. Establishment of local protocol on antibiotic prophylaxis and adherence to infection prevention can improve the prevailing situation.

Correlates of the HIV-associated neurocognitive disorders among adults living with HIV in Dodoma region, central Tanzania: A cross-sectional study.

HIV-associated neurocognitive disorders (HAND) continue to manifest despite advancements and improved antiretroviral therapy coverage. Neurocognitive impairment is a significant predictor of poor prognosis related to poor antiretroviral therapy adherence and retention in HIV care. This cross-sectional study examined 397 participants attending cared for and treatment at Dodoma Regional Referral Hospital (DRRH) and selected by systematic sampling. The combination of Montreal Cognitive Assessment (MoCA), International HIV Dementia Scale (IHDS), and The Lawton Instrumental Activity of Daily Living (IADL) were used to assess HIV-associated neurocognitive disorders. Factors associated with HAND were determined using univariate and multivariable logistic regression. Of 397 participants, 234(59.1%) met the criteria for HAND with 231(58.2%) comprising asymptomatic neurocognitive disorder (ANI) or mild neurocognitive disorders (MND), and 3 (0.76%) HIV- associated dementia (HAD). Participants with HAND had significantly poorer performance in each cognitive domain on both MoCA and IHDS. Under multivariable regression, age of 55 years or above with Adjusted Odds Ratio (AOR): 3.5 (95%CI: 1.1, 11.6), p = 0.041 and female gender (AOR): 2.7 (95%CI: 1, 6, 4.5), p<0.001 were significantly associated with HAND. Adherence to antiretroviral therapy AOR: 0.4(95%CI: 0.2, 1.0), p = 0.044, and attaining primary education AOR: 0.3(95%CI: 0.1, 0.8), p = 0.01 or secondary education AOR: 0.1(95%CI: 0.03, 0.2), p<0.001 compared to having no formal education showed good cognitive performance. HIV-associated neurocognitive disorders are common in HIV, especially ANI and MND, are common in HIV infected Tanzanians. Both socio-demographic and clinical variables influence neurocognitive functioning in this population. Screening for mild neurocognitive disorders may be indicated if effective treatment becomes available.

Neurocognitive decline as a major predictor of nonadherence to antiretroviral therapy among adults living with HIV in Dodoma region, central Tanzania.

BackgroundThe survival of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome largely depends on good adherence to antiretroviral medications. Neuropsychiatric conditions such as major depressive disorders (MDDs) and neurocognitive disorders, in particular, are common in the HIV population and attributed to suboptimal adherence to antiretroviral treatment and overall poor clinical outcomes. This study aimed to determine the association between neurocognitive disorders and nonadherence to antiretroviral therapy (ART) in the Dodoma region's adult population living with HIV.MethodsThe study was conducted in Dodoma Regional Referral Hospital using a cross‐sectional design to assess 397 participants through a systematic sampling approach. Montreal Cognitive Assessment was used to determine neurocognitive function, while the Simplified Medical Adherence Questionnaire was used to assess nonadherence to ART. Logistic regression analysis was computed to determine the association between cognitive decline and nonadherence to ART while controlling for sociodemographic and clinical confounders.ResultsOut of the 397 recruited participants, 266 (67.00%) and 41 (10.33%) met the criteria for neurocognitive decline and nonadherence to ART. Participants with cognitive impairment had a significantly poorer adherence rate than those without, even after controlling for confounders adjusted odds ratio (aOR): 2.183 (95% confidence interval [CI]: 1.031, 4.630, p = 0.0413). MDD was the only additional factor that remained significantly associated with ART nonadherence (aOR: 4.332, 95% CI: 1.634, 11.485, p = 0.0032).ConclusionNeurocognitive disorders are strong predictor of suboptimal adherence to ART; a comorbid neuropsychiatric condition such as MDD may further compromise the ART adherence rate leading to poor HIV care and poor clinical outcome. Further research with systematic and more robust studies in the field will provide a baseline to design and integrate appropriate care models to maximize ART adherence in HIV care. Integration of psychiatric services in HIV care can benefit the overall patient outcome.

P21 An assessment of knowledge and hand hygiene practices among healthcare workers at Dodoma Regional Referral hospital

IntroductionThe WHO-promoted ‘My 5 moments for hand hygiene’ is designed to prevent the spread of infectious organisms in healthcare settings which occurs mostly via contaminated hands of healthcare workers (HCWs), items/equipment and the environment. Information on its implementation in Tanzania is needed.Table 1.Practice of WHO five moments of hand hygiene as observed in two wards (gynaecology & obstetrics and male orthopaedic ward)Total no. of opportunitiesHH action before touching the patientHH action after touching the surroundings exemplified by mobile phonesHH action before aseptic procedure269Yes6Yes0Yes1No157No41No641634165The overall hand hygiene compliance was 2.6%Figure 1.The results above show the highest contamination in the most sensitive wards like theatre and male surgical wards.Figure 2.Percentage resistance of three tested samples from different three hospital units. From the results above the isolated bacteria obtained from the healthcare workers cell phones are showing resistant to commonly used antibiotics.ObjectivesThe main objective of the study was to assess knowledge, availability, and access to facilities for hand hygiene and the adherence to the WHO's five moments of hand hygiene by healthcare workers at Dodoma Regional Referral Hospital. The bacterial content of cell phones of HCWs was assessed as a source of microbial contamination.MethodsThis was a descriptive cross-sectional study. Three sets of data were collected through (i) questionnaires to assess knowledge, attitudes, and barriers to effective hand hygiene; (ii) observation to assess the adherence of five moments of hand hygiene; and (iii) laboratory examination of cell phones for bacterial contamination. Analysis used Statistical Package for Social Science (SPSS).ResultsOver 75% of HCWs had formal training on hand hygiene and had access to handwashing facilities, but only 63% were aware of the WHO five moments. Of 270 doctors, nurses, and healthcare students only 7 (2.6%) complied with expected action with no difference between groups. No hand hygiene was observed after touching cell phones. Thirty-four percent of sampled cell phones were contaminated with staphylococci species, which were resistant to penicillin and had varying resistance to erythromycin, clindamycin and gentamicin.ConclusionsHand hygiene is the most effective way to reduce the risk of healthcare-associated infections. However, many healthcare workers do not adhere to recommended hand hygiene despite training and the availability of handwashing facilities. The low practice of hand hygiene means that cell phones of healthcare workers can easily act as a reservoir of transmissible organisms. The use of cell phones as a source of contamination must be included in the interventional training of HCW.

Prevalence and Factors Associated with Renal Dysfunction Among hiv Infected Children Attending hiv clinic at Dodoma Referal Regional Hospital and Makole health Centre.

Background: Human Immunodeficiency Virus infection (HIV) is a multisystem disease that contributes to significant morbidity. Renal involvement is reported to be common among patients with HIV. This study was carried out to determine renal involvement using simple bedside tests combined with ultrasonography examination. Methodology: A crossectional Study design was carried out and included, The Total number of 236 Children’s Infected with HIV were Recruited at Dodoma Regional Referral Hospital and Makole Urban Health Centre. During the study Population included HIV/AIDS Positive Children male and Female were aged less than 15 years whether on or not on HAART regimen. The study duration was carried out for the period of six months (6 months). Results: The prevalence and factors associated with Renal dysfunction in HIV infected Children were among boys and girls Recruited infected children’s were 52.5% and 47.5% Respectively and were by those accounting below 5 years were 39.8% and among above of Five years of the age recruited were 60.2% .The association of the number of the infected children with renal dysfunction prevalence was 56% and The association between HIV with the renal dysfunction with the estimated eGlomerular Filtration (eGFR) of below &lt;60ml/min of the patient recruited below five years were 7.6% and above 5&lt; Years of Age recruited were 80.8% with significantly P Value &lt;0.001.Enrolled Children with Proteinuria Investigated accounted for the 20.5 % .With this similar study that was conducted at MNH Fredrick et al which correlated with our study and findings. Proportional of the children with anemia account for Renal Dysfunction was 91.7% with significance P Value &lt; 0.019. Conclusion: The prevalence of renal dysfunction among recruited patients were 56% and this finding are higher compared to previously research study. The association of Renal Dysfunction that were included in the study showed proportional with the association of High viral load, low CD4 count, Drug adherence, Malnutrition, Comorbidities anemia and over all HIV Human Immuno deficiency Staging.

Maternal Deaths due to Obstetric Haemorrhage in Dodoma Regional Referral Hospital, Tanzania

Background Despite the availability of comprehensive emergency obstetric care at Dodoma Regional Referral Hospital, deaths due to obstetric haemorrhage are still high. This study was carried out to analyse the circumstances that had caused these deaths. Methods A retrospective review of all files of women who had died of obstetric haemorrhage from January 2018 to December 2019 was made. Results A total of 18,296 women gave birth at DRRH; out of these, 61 died of pregnancy-related complications of the deceased while 23 (38%) died of haemorrhage, with many of them 10 (44%) between the age of 30 and 34. Many were grand multiparous women 8 (35%) and almost half of them (11 (48%)) had stayed at DRRH for less than 24 hours. More than half (12 (52%)) had delivered by caesarean section followed by laparotomy due to ruptured uterus (8 (35%)). The leading contributing factors to the deaths of these women were late referral (6 (26%)), delays in managing postpartum haemorrhage due to uterine atony (4 (17%)), inadequate preparations in patients with the possibility of developing PPH (4 (17%)), and delay in performing caesarean section (3 (13%)). Conclusion Maternal mortality due to obstetric haemorrhage is high at Dodoma Regional Referral Hospital where more than one-third of women died between 2018 and 2019. Almost all of these deaths were avoidable. The leading contributing factors were late referral from other health facilities, inadequate skills in managing PPH due to uterine atony, delays in performing caesarean section at DRRH, and inadequate preparation for managing PPH in patients with abruptio placentae and IUFD which are risk factors for the condition. There is a need of conducting supportive supervision, mentorship, and other modes of teaching programmes on the management of obstetric haemorrhage to health care workers of referring facilities as well as those at DRRH. Monitoring of labour by using partograph and identifying pregnant women at risk should also be emphasized in order to avoid uterine rupture.

Cervical Cancer Screening among Women Receiving Antiretroviral Therapy in a Resource-Limited Environment.

Background:Cervical cancer is among the most prevalent cancer among women worldwide and women living with HIV are at increased risk, especially in a resource-limited environment. Objective:This study aimed to determine levels of awareness, knowledge, uptake, and willingness to screen for cervical cancer among women receiving care in an HIV clinic at Dodoma Regional Referral Hospital (DRRH), Tanzania. Methods:Data were collected for a period of three weeks from July 21 to August 11, 2017 using a mobile phone data collection App. A total of 421 Women aged 18-50 years old were included in the study. Results: Majority of the women interviewed (n=306, 73%) were aware of cervical cancer. Among those who were aware, 84% (n=257) did not recall ever being screened for cervical cancer, and majority had a poor knowledge of cervical cancer. Educational level completed (p=0.01), income per month (p=0.02), age group (p<0.0001), and area of residence (p<0.0001) were all significantly associated to awareness of cervical cancer. Most of the women who have never screened (n=231, 91%) expressed willingness to be screened. Prior uptake of cervical cancer screening was associated with number of live births (p=0.001) and area of residence (p=0.04). And Willingness to screen was significantly associated with age groups (p=0.03) and the number of live births (p=0.03). Moreover, we found that younger age and urban residence was positively associated with awareness and uptake of cervical cancer screening. Willingness was found to decrease as age increased. Conclusion:The study found that despite older women’s higher risk of cervical cancer, those who indicated willingness to screen were younger. Additional education, health promotion, and integration of cervical cancer screening services is needed to improve cervical cancer awareness and screening uptake at the HIV clinic.

Maternal Mortality in Dodoma Regional Referral Hospital, Tanzania.

Background Maternal mortality has remained a challenge in Tanzania. The Tanzania Demographic and Health Survey 2015-16 has shown that the problem has been increasing despite various strategies instituted to curb it. It has been shown that most of the maternal deaths occurring in health facilities, whether direct or indirect, have other contributing factors. The objective of this study was to analyse causes and associated factors for maternal deaths in Dodoma Regional Referral Hospital (DRRH). Methods A retrospective review of all files of the women who died in 2018 and were classified as maternal deaths. Results A total of 8722 women gave birth in DRRH, out of which 35 died and were confirmed as maternal deaths. The number of live births was 8404 making the maternal mortality ratio of 417 per 100,000 live births. The leading causes of maternal death were eclampsia (9), sepsis (6), ruptured uterus (5), and haemorrhage (5). The third-phase delay was the leading contributing factor to 19 maternal deaths. This includes delays in referral from another facility as well as delays in getting treatment at DRRH and inadequate skills of providers at both the referring facilities and DRRH. The first-phase and second-phase delays contributed to 7 and 6 deaths, respectively. Furthermore, poor antenatal care contributed to 2 deaths. Conclusion Maternal mortality is still high in Dodoma Regional Referral Hospital. Eclampsia was the leading cause of maternal deaths in 2018 followed by sepsis and obstetric haemorrhage. Delays associated with health system factors (third-phase delay) contributed much more to maternal mortality than the first-phase delay. Mentorship programmes on management of obstetric complications need to be instituted in order to reduce maternal deaths in Dodoma Regional Referral Hospital.

Incidence and Predictors of Maternal and Perinatal Mortality among Women with Severe Maternal Outcomes: A Tanzanian Facility-Based Survey for Improving Maternal and Newborn Care.

Introduction Maternal and perinatal mortality is still a major public health challenge in Tanzania, despite the ongoing government efforts to improve maternal and newborn care. Among the contributors to these problems is the high magnitude of severe maternal outcomes (maternal near-miss). The current study, therefore, aimed to identify the magnitude and predictors of maternal and perinatal mortality among women with severe maternal outcomes admitted to Dodoma Regional Referral Hospital. Methods A retrospective cross-sectional study was conducted from October 2015 to January 2016 at Dodoma Regional Referral Hospital in Dodoma City. All maternal deaths and maternal near-misses based on WHO criteria were included in this study. Three outcome variables have been identified: maternal mortality, perinatal mortality, and neonatal complications. To examine the predictors for the three predetermined outcome variables, the three logit models each containing unadjusted and adjusted findings were fitted. A P-value less than 0.05 was considered indicative of statistically significant. Results A total of 3600 pregnant women were admitted for obstetric reasons during the mentioned period. 140 of them were diagnosed with severe maternal outcomes; hence, they were included in this study. The severe maternal outcome incidence ratio was 40.23 per 1000 live births, the institutional maternal mortality ratio was 459.77 per 100000 live births, and the perinatal mortality rate was 10.83 per 1000 total births. Most of the maternal morbidity and mortality were due to direct causes in which postpartum hemorrhage and hypertensive disorders were the leading causes. In adjusted analysis, per-protocol management, maternal age, and mode of birth were predictors of maternal mortality, perinatal mortality, and neonatal complications, respectively. Conclusion Establishing and strengthening obstetric ICUs will help reduce maternal mortality as the response time from the onset of obstetric complications, while the provision of high-quality care will be substantially reduced. Furthermore, the study recommends regular provision of in-service refresher training to emphasize the practice and compliance of per-protocol case management through a team approach in order to reduce the burden of maternal and perinatal mortality in Tanzania.

Anemia and Associated Risk Factors among People Living with Hiv in Dodoma Region, Central Tanzania

Background: Anemia is the most frequent hematologic abnormality of HIV disease and one of the most common manifestations of nutritional deficiency disorders in the world. In sub-Saharan Africa, about 70% of the world’s people living with HIV/AIDS, where the prevalence of anemia is higher than in developed countries. The aim of this study was to determine the prevalence and factors associated with anemia among people living with HIV at Dodoma regional hospital during 2013-2014. Methodology: A retrospective cross-section study conducted among PLWHIV at Dodoma Regional Hospital between 2015 and 2016. A total of 869 PLWHIV were enrolled. Data extraction sheet were used to collect Socio- demographics, immune-hematological data and ARV status from existing patient’s files (CTC 2 card). Double entry of data in Microsoft excel were done and transferred for analyzing using SPSS v.16. Results: Majority of them were females 648(74.6%)and 508(58.2%) were between 19-45years with mean age of 38.84(±14.09). 824(94. 8%) were on ARV; where 640(73.6%) are from urban. The overall prevalence of anaemia among PLHIV was 59.5% of which 56.6% of these were on ARV, and 2.9% were not on ARV. Age, sex and CD4+ counts Conclusion: Moderate anaemia was common in the study population. Screening and management of anemia along with the proper use Anti-retroviral therapy may decrease risk of anemia and the effect ARV on red blood cells. Haemoglobin measurements should be taken before initiation of ARV and routinely followed among ARV users.

A retrospective evaluation of bites at risk of rabies transmission across 7 years: The need to improve surveillance and reporting systems for rabies elimination

The vast majority of rabies deaths occur in developing countries and rural areas. Due to the absence of surveillance and the lack of reliable information, many endemic countries are not able to assess their rabies burden and implement appropriate solutions. This study reports the incidence of animal bites considered at risk of rabies transmission, along with rates and determinants of the adherence to post-exposure prophylaxis (PEP) between 2008 and 2014 in Dodoma Region, Tanzania. A retrospective analysis of rabid animal bites considered at risk of rabies transmission at Dodoma Regional Referral Hospital (DRRH) during 2008–2014 was conducted. Data were collected from the registers of patients presenting to the hospital because of a potential rabies exposure. The patients were assessed by a trained health worker and each bite was considered as “at risk of rabies” based on the victim’s description of the event. Overall, 10,771 patients coming from Dodoma Region attended DRRH because of a bite from a suspected rabid animal, giving a mean incidence of 74 bites at risk of rabies transmission per 100,000 persons per year. Overall, only 46.0% of people exposed received a complete course of PEP and 61.6% attended the clinic within 48 hours after the bite. Multivariate analysis shows that people age >15 years, residence in rural areas and occurrence during the rainy season were independently associated to delayed access to care. Male gender, age below 15 years. and bites occurring during the dry season were associated with completion of PEP. In this area with a high rate of at-risk bites, several factors—mainly related to health care access and to the affordability and delivery of rabies vaccines—still need to be addressed in order to reduce gender and social inequalities in rabies prevention and control. Further efforts are required to establish an efficient rabies surveillance system in Dodoma Region.

Trends in diarrhea hospitalizations among infants at three hospitals in Tanzania before and after rotavirus vaccine introduction

BackgroundThe Tanzania Ministry of Health introduced monovalent human rotavirus vaccine in January 2013, to be administered at ages 6 and 10 weeks. Data suggest there was high vaccine uptake. We used hospital ward registers from 3 hospitals to examine trends in diarrhea hospitalizations among infants before and after vaccine introduction. MethodsWard registers from Dodoma Regional Referral Hospital (Central Tanzania), and two hospitals in Mbeya (Southwest area), Mbeya Zonal Referral Hospital and Mbalizi Hospital, were used to tally admissions for diarrhea among children by age group, month and year. Rotavirus surveillance had started at these hospitals in early 2013; the proportion of infants enrolled and rotavirus-EIA positive were examined by month to determine peak periods of rotavirus disease post-vaccine introduction. ResultsRegisters were available for 2–4 prevaccine years and 2–3 post introduction years. At Dodoma Regional Referral Hospital, compared with the mean of 2011 and 2012, diarrhea hospitalizations among infants were 26% lower in 2015 and 58% lower in 2016. The diarrhea peak shifted later in the year first by 1 and then by 2–3 months from prevaccine. At the Mbeya hospitals, the number of diarrhea admissions in prevaccine period varied substantially by year. At Mbeya Referral Hospital, diarrhea hospitalizations among infants were lower by 25–37% in 2014 and 11–26% in 2015, while at Mbalizi Hospital, these hospitalizations were 4% lower in 2014 and 14% higher in 2015. Rotavirus testing data demonstrated a lowering of the prevaccine peak, a shift in timing of the peak months and indicated that other diarrheal peaks in post-introduction years were not due to rotavirus. ConclusionsIn this ecological evaluation, total diarrhea hospitalizations among infants were lower (≥25% lower in ≥1 year) following introduction in 2 of 3 hospitals. There are challenges in using ward registers to ascertain possible impact of rotavirus vaccine introduction on trends in hospitalizations for treatment of all diarrheal illness.

Patterns and Early Treatment Outcomes of Peritonitis among Patients Admitted at Dodoma Regional Referral Hospital, Dodoma Region, Tanzania

Patterns and Early Treatment Outcomes of Peritonitis among Patients Admitted at Dodoma Regional Referral Hospital, Dodoma Region, Tanzania

Post-caesarean section surgical site infections at a Tanzanian tertiary hospital: a prospective observational study

Few data are available on the determinants and characteristics of post-caesarean section (CS) surgical site infections (SSIs) in resource-limited settings. We conducted a prospective observational cohort study to evaluate the rates, determinants, and microbiological characteristics of post-CS SSI at the Dodoma Regional Referral Hospital (DRRH) Gynaecology and Obstetrics Department in Tanzania. Spanning a three-month period, all pregnant women who underwent CS were enrolled and followed up for 30 days. SSI following CS occurred in 224 (48%) women. Only 10 (2.1%) women received pre-incision antibiotic prophylaxis. Urgent intervention is needed to prevent and control infections and contain the rising rate of post-CS SSI at the DRRH.

Распространенность возбудителей гнойных хирургических инфекций в региональной клинической больнице города Додомы Объединенной Республики Танзании и их чувствительность к антибактериальной терапии

The study investigates epidemiology of microorganisms, responsible for the development of septic surgical infections in sick persons who underwent inpatient treatment in a large referral state hospital - Dodoma Regional Hospital, Tanzania in November 2014 - March 2015 as well as nurses’ carriage of opportunistic pathogens. The assessment of isolated microorganisms’ sensitivity to common antibacterial agents was conducted. The study included analysis of the consistency of drugs initially administered for the patients’ treatment (therapia ex juvantibus) to the results of microbiological sensitivity tests. The study attempted to select candidates for the role of nosocomial infections in the hospital. The list of practical recommendations was developed for the prevention of the circulation of such infectious agents among patients and medical staff.

Intentional Injuries: The experiance from Dodoma Regional Hospital, Central Tanzania

Background: Worldwide intentional injuries cause about 9 deaths for every 100,000 persons; in Africa the contribution is estimated to be twice as much (25 out of 100000 persons).The true incidence of intentional injuries in Tanzania is unknown. There are very few hospital based studies which have characterized patients with intentional injuries. This study shares the experience obtained in management of patients with intentional injuries at Dodoma Regional Hospital for a period of about 9 months. Methods: A hospital based prospective descriptive study was carried out, in which all patients admitted with history of intentional injury were conveniently recruited into the study. Demographic data, injury causes and pattern were recorded; treatment was given according to hospital standard protocol. Consent was obtained from all patients. Results: Two hundred and fifty two patients were studied, the age ranged from 10 to 60 years with a mean age of 30.54 (standard deviation = 9.6). Males outnumbered females by1.6. The commonest assailants were persons not related to victims (80%). The majority of injuries occurred outside home environment (70%), with marital status having a significant contribution. Most injuries took place at night. Sexual violence was a leading overall cause (27%), in men robbery or theft was the commonest cause (82%). Knives/machetes in 42% were among the commonest weapons used, followed by wooden sticks 26%. Head and neck were the most common body parts injured (79%), followed by chest and abdomen (19%), with significant difference between men and women (p value = 0.0001). Non-penetrating stabs or cuts wounds were the commonest injuries (70%), followed by penetrating chest and abdominal injuries (12%). Surgical debridement and primary suture was performed in 77% of cases, followed by thoracotomy and or laporatomy. Men needed more radical forms of surgical intervention than women (p value< 0.0001). The wound complication rate was 37%. The mean hospital stay was 4.7 days, with standard deviation of 7.7 and a range of 1 to 64 days. Conclusion: Intentional injuries in Dodoma are probably very high, and there is possibility that domestic violence may be higher in this area, if findings from this study are to be extrapolated into the community. There is no doubt that this may significantly contribute to family poverty through morbidity, hospital expenses and lost hours of productivity. Further community based studies and community advocacy through health education are recommended. This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source (including a link to the formal publication), provide a link to the Creative Commons license, and indicate if changes were made.

Strengthening tuberculosis diagnosis in a low-resource setting: experience learned in Dodoma, Tanzania

Diagnosing tuberculosis in low-resource settings mostly relies on sputum smear microscopy. Improvement through capacity building is a priority. This project aimed to strengthen tuberculosis diagnosis at an intermediate level laboratory. The Italian National Institute for Infectious Diseases and the Italian Development Cooperation closely collaborated with regional and national institutions and reference laboratories to provide laboratory setup, equipment and reagents, personnel training, and the implementation of culture and quality assessment programs at Dodoma Regional Hospital, Dodoma, Tanzania. Microscopy sensitivity was increased, personnel were trained, and culture techniques and quality assessment programs were introduced. Implementing tuberculosis diagnosis in resource-constrained settings is feasible and represents a basis for further strengthening.

Full-term abdominal pregnancy with delivery of a normal living child: Diagnostic and management challenges in resource-limited settings

Abdominal pregnancy is a rare type of ectopic pregnancy where the fetus is implanted within the peritoneal cavity. The condition is extremely rare accounting for about 1% of all ectopic pregnancies. It presents a great threat to the life of the mother and, in most cases, the fetus does not survive. Full-term abdominal pregnancies are even rarer, particularly when a live baby is delivered. It Is this rarity that justifies it being of medical curiosity. This article presents the case of a 30-year-old woman who was referred to Dodoma Regional and Teaching Hospital with a history of ‘labour-like abdominal pains’ for 3 days associated with vaginal spotting. After examination, the tentative diagnosis of early abruption placenta with a live fetus was reached and a decision to deliver by caesarean section was made. After opening the abdomen the amniotic sac was identified within the peritoneal cavity and it was ruptured to deliver a live 2.650 kilogram female baby with an Apgar score of 7–10 at 1 and 5 minutes respectively. The mother recovered uneventfully and was discharged home with her healthy baby 1 week later.