Kilimanjaro Christian Medical Centre Research Articles

"When a man drinks alcohol it's cool but when a woman drinks she is a hoe": A qualitative exploration of alcohol, gender, stigma, and sexual assault in Moshi, Tanzania.

Alcohol's ever-increasing global use poses a distinct threat to human well-being, with intake and associated burdens rising especially quickly in low- and middle-income countries like Tanzania. Prior research has shown alcohol use and related consequences differ by gender in Moshi, Tanzania, with important implications for both clinical care and future alcohol-reduction interventions. This study builds upon this knowledge by providing a deeper understanding of how gender differences affect alcohol-related stigma and sexual assault among Emergency Department (ED) and Reproductive Health Center (RHC) patients at Kilimanjaro Christian Medical Center (KCMC) in Moshi. In-depth interviews were conducted among ED and RHC KCMC patients (n = 19) selected for participation via purposive sampling. A mix of inductive and deductive coding schemes was used to identify themes and subthemes. All data were analyzed through a grounded theory approach. Gender roles that linked men with financial responsibilities and women with child caretaking led to different expectations on alcohol intake, with alcohol use encouraged for men but vilified for women. Women who drank, for example, were deemed poor mothers and undesirable spouses. Patients likewise emphasized that both alcohol-related stigma and sexual violence disproportionately impacted women, the latter fueled through alcohol use, with serious and lasting acts of discrimination and isolation from community members seen among women alcohol users but not for men. Women alcohol users in Moshi are subject to severe social consequences, facing disproportionate stigma and sexual violence as compared to men. Alcohol-related treatment for women should be mindful of the disproportionate burdens present in this context while treatment for men should be cognizant of the social pressures to drink. Strategies to address and/or mitigate these factors should be incorporated in subsequent care and interventions.

Impact of advanced maternal age on perinatal outcomes in Tanzania: Insights from Kilimanjaro Christian Medical Center Birth Registry

The increasing prevalence of advanced maternal age (AMA) births necessitates the exploration of associated pregnancy outcomes within the healthcare-limited context of northern Tanzania to elucidate potential region-specific risks and implications. This study explored the influence of AMA on pregnancy outcomes in northern Tanzania, where healthcare resources and infrastructure are constrained in comparison to developed countries. This cross-sectional hospital-based study utilized maternally linked data from the Kilimanjaro Christian Medical Center (KCMC) Medical Registry and included 32,798 women who delivered single infants between 2004 and 2013. Multiple logistic regression models were used to determine adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) for AMA-associated adverse pregnancy outcomes. A total of 16 % of mothers belonged to AMA with increased odds of undergoing a cesarean section (aOR: 1.32; 95%CI [1.24–1.41]; P < 0.001), gestational diabetes (aOR: 13.16; 95%CI [3.28–52.86]; P < 0.001) or pregestational diabetes (aOR: 3.15; 95%CI [1.87–5.31]; P < 0.000), and developing pre-eclampsia (aOR: 1.63; 95%CI [1.41–1.89]; P < 0.000). More women with AMA reported alcohol use during pregnancy and had preexisting conditions before conception than did younger women. Maternal education level, employment status, urban residency, and Christianity were statistically significant. This study establishes a connection between AMA and higher odds of cesarean section, gestational diabetes, pregestational diabetes, and pre-eclampsia. Women with AMA were more inclined to consume alcohol during pregnancy and exhibited preexisting conditions before conception. Moreover, AMA was linked to increased odds of low birth weight, stillbirths, and NICU transfers.

Artificial intelligence-supported diabetic retinopathy screening in Tanzania: rationale and design of a randomised controlled trial

IntroductionGlobally, diabetic retinopathy (DR) is a major cause of blindness. Sub-Saharan Africa is projected to see the largest proportionate increase in the number of people living with diabetes over the...

Patient Satisfaction With, and Outcomes of, Ultrasound-Guided Regional Anesthesia at a Referral Hospital in Tanzania: A Cross-Sectional Study.

Regional anesthesia techniques are increasingly used in high-income countries (HICs) for both surgical anesthesia and postoperative analgesia. However, regional anesthesia has not been utilized to the same degree in low- to middle-income countries (LMICs) due to a lack of resources and trained personnel. This study evaluates patient satisfaction with, and outcomes of, ultrasound-guided regional anesthesia for extremity surgery at Kilimanjaro Christian Medical Center (KCMC) in the Northeastern zone of Tanzania. Study patients were ≥18 years of age; American Society of Anesthesiologists (ASA) physical status I, II, or III; and underwent extremity surgery under peripheral nerve block with ultrasound guidance at KCMC. After placement, blocks were assessed for effectiveness intraoperatively, as demonstrated by the need for supplemental analgesic or sedative medication or conversion to a general anesthetic. Postoperatively, patients were assessed for satisfaction with their nerve block and pain at 12 and 24 hours. Adverse events related to regional anesthesia were assessed immediately, 45 minutes after block placement, and at 12 and 24 hours postoperatively. The primary outcome was patient satisfaction at 12 hours. Secondary outcomes were block success rate and analgesia at 12 and 24 hours postoperatively. A convenience sample of 170 patients was included in the study, of whom 156 (95% confidence interval [CI], 87-95) were either satisfied or very satisfied with their block. Block placement was highly successful with only 8 of 170 participants (95% CI, 2.4-8.3), requiring conversion to a general anesthetic. Analgesia continued in the postoperative period, with 164 of 170 (95% CI, 93-98) patients and 145 of 170 (95% CI, 80-90) patients reporting acceptable analgesia at 12 and 24 hours, respectively. No major adverse events, such as local anesthetic toxicity, infection, bleeding, nerve injury, or pneumothorax, were observed. Our study found that ultrasound-guided regional anesthesia in a resource-constrained setting was effective for extremity surgery and resulted in high patient satisfaction. No complications occurred. The use of ultrasound-guided regional anesthesia shows promise for the safe and effective care of patients undergoing extremity surgery in LMICs.

Outcomes of traumatic brain injury patients with acute epidural and subdural hematoma who underwent burr hole surgery: A two-year study at Kilimanjaro Christian Medical Centre, Tanzania

BackgroundTraumatic brain injury is a leading cause of mortality and morbidity in Africa. Craniotomy is the surgical standard for acute extra-axial hematomas that is not realistic in LMIC due to deficient human and operative resources. Burr hole surgery may be an alternative in resource-limited settings. This study aimed at determining outcomes and factors associated with burr hole surgery as definitive management of traumatic extra-axial hematomas. MethodsHospital-based cross-sectional study of patients with acute traumatic extra-axial hematomas who underwent burr hole surgery. Data were extracted from the patient's medical records after confirmation of the surgery and CT scan findings. The data were entered to SPSS 25 for analysis where a bivariate analysis was done. Results156 participants were enrolled; 149 (95.5 %) were males. The mean age of the participants was 35.33 (SD 15.37) years. The mean arrival GCS was 11.76 ± 3.59. Most participants had mild, followed by severe then moderate (55.8 %, 24.4 %, and 19.9 % respectively) TBI. 118 (75.6 %) participants had good outcomes and the overall in-hospital mortality was 18.6 %. 109 (69.9 %) had epidural hematomas mostly (21 %) in the parietal lobe. 30 (19.2 %) had brain herniation syndromes. Poor outcomes were associated with age above 50 years, severe TBI, motor response <4, abnormal pupil size, other injuries, ICU admission, SDH, midline shift >10 mm, cerebral edema, and brain herniation syndromes. Surgical site infection and hemostasis by packing were associated with a long length of hospital stay. ConclusionBurr hole surgery is still a safe, effective, and simple life-saving procedure in patients with acute hematomas in resource-constrained areas.

A feasibility assessment of a traumatic brain injury predictive modelling tool at Kilimanjaro Christian Medical Center and Duke University Hospital.

Traumatic brain injury (TBI) is the most common cause of death and disability globally. TBI, which disproportionately affects low middle-income countries (LMIC), uses significant amounts of health system resources in costly care and management. Innovative solutions are required to address this high burden of TBI. One possible solution is prognostic models which enhance diagnostic ability of physicians, thereby helping to tailor treatments more effectively. This study aims to evaluate the feasibility of a TBI prognostic model developed in Tanzania for use by Kilimanjaro Christian Medical Center (KCMC) healthcare providers and Duke-affiliated healthcare providers using human centered design methodology. Duke participants were included to gain insight from a different context with more established practices to inform the TBI tool implementation strategy at KCMC. To evaluate the feasibility of integrating the TBI tool into potential workflows, co-design interviews were conducted with emergency physicians and nursing staff at KCMC and Duke. Qualitatively, the TBI tool was assessed using human centered design (HCD) techniques. Our research design methods were created using the Consolidated Framework for Implementation Research which considers overarching characteristics of successful implementation to contribute to theory development and verification of implementation strategies across multiple contexts. Our knowledge translation method was guided using the knowledge-to-action framework. Of the 21 participants interviewed, 12 were associated with Duke Hospital, and 9 from Kilimanjaro Christian Medical Centre. Emerging from the data were 6 themes that impacted the implementation of the TBI tool: access, barriers, facilitators, use of the TBI tool, outer setting, and inner setting. To our knowledge, this is the first study to investigate the pre-implementation of a sub-Saharan Africa (SSA) data- based TBI prediction tool using human centered design methodology. Findings of this study will aid in determining under what conditions a TBI prognostic model intervention will work at KCMC.

Healthcare provider perspective on barriers and facilitators in the care of pediatric injury patients at a tertiary hospital in Northern Tanzania: A qualitative study.

Pediatric injuries are a leading cause of morbidity and mortality in low- and middle-income countries (LMICs). The recovery of injured children in LMICs is often impeded by barriers in accessing and receiving timely and quality care at healthcare facilities. The purpose of this study was to identify the barriers and the facilitators in pediatric injury care at Kilimanjaro Christian Medical Center (KCMC), a tertiary zonal referral hospital in Northern Tanzania. In this study, focus group discussions (FGDs) were conducted by trained interviewers who were fluent in English and Swahili in order to examine the barriers and facilitators in pediatric injury care. Five FGDs were completed from February 2021 to July 2021. Participants (n = 30) were healthcare providers from the emergency department, burn ward, surgical ward, and pediatric ward. De-identified transcripts were analyzed with team-based, applied thematic analysis using qualitative memo writing and consensus discussions. Our study found barriers that impeded pediatric injury care were: lack of pediatric-specific injury training and care guidelines, lack of appropriate pediatric-specific equipment, staffing shortages, lack of specialist care, and complexity of cases due to pre-hospital delays in patients presenting for care due to cultural and financial barriers. Facilitators that improved pediatric injury care were: team cooperation and commitment, strong priority and triage processes, benefits of a tertiary care facility, and flexibility of healthcare providers to provide specialized care if needed. The data highlights barriers and facilitators that could inform interventions to improve the care of pediatric injury patients in Northern Tanzania such as: increasing specialized provider training in pediatric injury management, the development of pediatric injury care guidelines, and improving access to pediatric-specific technologies and equipment.

Alcohol use among emergency medicine department patients in Tanzania: A comparative analysis of injury versus non-injury patients.

Alcohol is a leading behavioral risk factor for death and disability worldwide. Tanzania has few trained personnel and resources for treating unhealthy alcohol use. In Emergency Medicine Departments (EMDs), alcohol is a well-known risk factor for injury patients. At Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania, 30% of EMD injury patients (IP) test positive for alcohol upon arrival to the ED. While the IP population is prime for EMD-based interventions, there is limited data on if non-injury patients (NIP) have similar alcohol use behavior and potentially benefit from screening and intervention as well. This was a secondary analysis of a systematic random sampling of adult (≥18 years old), KiSwahili speaking, KCMC EMD patients surveyed between October 2021 and May 2022. When medically stable and clinically sober, participants provided informed consent. Information on demographics (sex, age, years of education, type of employment, income, marital status, tribe, and religion), injury status, self-reported alcohol use, and Alcohol Use Disorder (AUD) Identification Test (AUDIT) scores were collected. Descriptive statistics were analyzed in RStudio using frequencies and proportions. Of the 376 patients enrolled, 59 (15.7%) presented with an injury. The IP and NIP groups did not differ in any demographics except sex, an expected difference as females were intentionally oversampled in the original study design. The mean [SD] AUDIT score (IP: 5.8 [6.6]; NIP: 3.9 [6.1]), drinks per week, and proportion of AUDIT ≥8 was higher for IP (IP:37%; NIP: 21%). However, alcohol preferences, drinking quantity, weekly expenditure on alcohol, perceptions of unhealthy alcohol use, attempts and reasons to quit, and treatment seeking were comparable between IPs and NIPs. Our data suggests 37% of injury and 20% of non-injury patients screen positive for harmful or hazardous drinking in our setting. An EMD-based alcohol treatment and referral process could be beneficial to reduce this growing behavioral risk factor in non-injury as well as injury populations.

A mixed-methods comparison of gender differences in alcohol consumption and drinking characteristics among patients in Moshi, Tanzania.

Excessive alcohol use stands as a serious threat to individual and community well-being, having been linked to a wide array of physical, social, mental, and economic harms. Alcohol consumption differs by gender, a trend seen both globally and in Moshi, Tanzania, a region with especially high rates of intake and few resources for alcohol-related care. To develop effective gender-appropriate treatment interventions, differences in drinking behaviors between men and women must be better understood. Our study aims to identify and explore gender-based discrepancies in alcohol consumption among Kilimanjaro Christian Medical Center (KCMC) patients. A systematic random sampling of adult patients presenting to KCMC's Emergency Department (ED) or Reproductive Health Center (RHC) was conducted from October 2021 until May 2022. Patients answered demographic and alcohol use-related questions and completed brief surveys, including the Alcohol Use Disorder Identification Test (AUDIT). Through purposeful sampling, 19 individuals also participated in in-depth interviews (IDIs) that focused on identifying gender differences in alcohol use. Quantitative data was analyzed in RStudio through descriptive frequencies, proportions, ANOVA, and Chi-squared tests, while IDIs were analyzed in Nvivo following a grounded theory approach. During the 8-month data collection timeline, 676 patients were enrolled. Men and women patients at KCMC's ED and RHC were found to have significant differences in their alcohol use behaviors. For our quantitative data, this included lower average AUDIT scores among women (average [SD] AUDIT scores were 6.76 [8.16] among ED men, 3.07 [4.76] among ED women, and 1.86 [3.46] among RHC women). A subsequent IDI analysis revealed greater social restrictions around women's drinking and more secretive alcohol use behaviors for where and when women would drink. For men, excess drinking was normalized within Moshi, tied to men's social interactions with other men, and generally motivated by stress, social pressure, and despair over lack of opportunity. Significant gender differences in drinking behaviors were found, primarily influenced by sociocultural norms. These dissimilarities in alcohol use suggest that future alcohol-related programs should incorporate gender in their conceptualization and implementation.

Machine learning models to predict traumatic brain injury outcomes in Tanzania: Using delays to emergency care as predictors.

Constraints to emergency department resources may prevent the timely provision of care following a patient's arrival to the hospital. In-hospital delays may adversely affect health outcomes, particularly among trauma patients who require prompt management. Prognostic models can help optimize resource allocation thereby reducing in-hospital delays and improving trauma outcomes. The objective of this study was to investigate the predictive value of delays to emergency care in machine learning based traumatic brain injury (TBI) prognostic models. Our data source was a TBI registry from Kilimanjaro Christian Medical Centre Emergency Department in Moshi, Tanzania. We created twelve unique variables representing delays to emergency care and included them in eight different machine learning based TBI prognostic models that predict in-hospital outcome. Model performance was compared using the area under the receiver operating characteristic curve (AUC). Inclusion of our twelve time to care variables improved predictability in each of our eight prognostic models. Our Bayesian generalized linear model produced the largest AUC, with a value of 89.5 (95% CI: 88.8, 90.3). Time to care variables were among the most important predictors of in-hospital outcome in our best three performing models. In low-resource settings where delays to care are highly prevalent and contribute to high mortality rates, incorporation of care delays into prediction models that support clinical decision making may benefit both emergency medicine physicians and trauma patients by improving prognostication performance.

Willingness of advanced cancer patients to receive palliative care and its determinants: A cross-sectional study in Northern Tanzania.

The purpose of this study was to assess willingness of advanced cancer patients to receive palliative care and its determinants at Cancer Care Centre in Kilimanjaro Christian Medical Centre Northern Tanzania. The purpose of this study was to assess willingness of advanced cancer patients to receive palliative care and its determinants at Cancer Care Centre in Kilimanjaro Christian Medical Centre Northern Tanzania. This was an institution-based cross-sectional study and the target population was all advanced cancer patients attending care at Cancer care Centre in Northern Tanzania. Data was collected using a structured questionnaire and analysed using Stata for windows 15. A descriptive analysis was conducted to summarize the data using mean standard deviation, while categorical data was summarized using frequency and percentages. Both bivariate and multivariate logistic regression analysis was used to determine the predictors associated with willingness to receive palliative care. The results showed that more than half of the respondents had willingness to accept palliative care. The degree of willingness PC among advanced cancer patients was high 60.6% (95%CI: 55.8-65.3). The predictors which remained significant associated with willingness to receive palliative care in multivariate analysis were the knowledgeable of palliative care [AOR: 2.86; 95%CI: 1.69-4.85] and high perceived benefits of palliative care [AOR: 3.58; 95%CI: 2.12-6.04]. Willingness to accept palliative care services was more than half of the patients just 60.6% among patients with advanced cancer from the study site. Advanced age of a patient, occupations, better knowledge, and perceived benefits for palliative care was the significant predictor for patients' willingness to accept palliative care.

Pattern, Management, and Outcomes of Chest Injury At Kilimanjaro Christian Medical Centre.

Chest trauma is a major cause of morbidity and mortality in the region. Lacking data in our environment has been a challenging part of knowing the burden of the problem. Long hospital stays and associated injuries are an essential measure of morbidity. The study results will provide a basis for planning prevention strategies and establishment of treatment protocols. To determine the prevalence, pattern, and management outcomes of chest injury patients at Kilimanjaro Christian Medical Center (KCMC), a Tertiary Hospital in Northern zone Tanzania from October 2021 to April 2022. A hospital-based cross-sectional study was conducted among patients with chest injuries who were admitted and managed at Tertiary Hospital Northern Zone (Kilimanjaro Christian Medical Center-KCMC) in the Emergency medicine and General Surgery departments. Using a designated data collection tool, details of the mechanism of injury, radiological and laboratory investigations, management, and outcomes were recorded. A total of 114 chest injury patients were studied. Males outnumbered females by a ratio of 7.14:1. Their ages ranged from 2 to 83 years (mean = 36.18 years). The Majority of patients (95.58%) sustained blunt injuries. Road traffic crush was the most common cause of injuries affecting 65.79% of patients. Lung contusion, hemothorax, and rib fractures were the most common type of injuries accounting for 54.4%, 27.2%, and 21.1%, respectively. Associated injuries were noted in 85.7% of patients, and head injury (60.5%) was found in most patients. The Majority of patients (60.5%) were treated successfully with a non-operative approach. Underwater seal drainage was performed at (38.9%). One Patient (0.9%) underwent a thoracotomy. 14% of patients had complications of surgical site infection, and 69% were found in the Majority of patients. The median length of hospital stay was 4.5 days. The mortality rate was 21. Motor traffic crash was the principal cause of chest trauma. Young male patients were most affected by chest trauma and the majority of patients were treated conservatively. Chest X-ray remains to be the main imaging modality for diagnosing thoracic trauma lesions. Associated injuries such as head injuries, were found to contribute to a high mortality rate.

Prevalence of Heavy Menstrual Bleeding and Its Associated Factors Among Women Attending Kilimanjaro Christian Medical Centre In Northern Eastern, Tanzania: A Cross-Sectional Study.

Women of reproductive age experience a lower quality of life and considerable morbidity as a result of heavy menstrual bleeding. This issue needs to be addressed to achieve gender equality and permit women and girls to engage in a range of economic activities. In this study, we aimed to determine the prevalence and the most common factors associated with heavy menstrual bleeding. Cross-sectional study was conducted at a zonal referral hospital in Northern Eastern, Tanzania. Data was extracted from women files who attended the hospital obstetrics and gynaecology clinic retrospectively. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Descriptive statistics were used to summarize the data. A univariate logistic regression model was fitted to assess the strength of the association between heavy menstrual bleeding and exposure variables. A total of 162 women aged 15-54 years were enrolled. The prevalence of heavy menstrual bleeding was found to be 24.1%. The following factors were found to be significantly associated with heavy menstrual bleeding; age range of 20-44 years (OR: 0.16;95% CI: 0.02-1.01), hormonal contraceptives (OR: 3.16; 95% CI: 1.15-8.69), having no clots on menstrual blood (OR: 0.19; 95% CI: 0.58-0.651), low haemoglobin level (OR: 5.61; 95% CI: 1.44-21.90), and uterine fibroid (OR: 0.35; 95% CI: 0.17-0.73). Despite the extreme measurements of Heavy Menstrual Bleeding (HMB) in this study, its prevalence remained high. To spread awareness of HMB and its consequences, we recommend screening the general public and offering health education initiatives.

Trends of frequency, mortality and risk factors among patients admitted with stroke from 2017 to 2019 to the medical ward at Kilimanjaro Christian Medical Centre hospital: a retrospective observational study

ObjectiveThe burden of stroke has increased in recent years worldwide, particularly in low-income and middle-income countries. In this study we aim to determine the number of stroke admissions, and associated...

A Role for Isoniazid Prophylaxis Against Mycobacterium Tuberculosis During Treatment for Acute Myeloid Leukaemia in Highly Endemic Areas?

Hematological malignancy is an increasing burden on the Tanzanian healthcare system accounting for around 10% of all cancer diagnosis [1]. Acute myeloid leukemia (AML) is particularly challenging in the context of limited diagnostic services, restricted blood product availability, high cost of chemotherapy drugs and the complete absence of bone marrow transplantation. Despite this Kilimanjaro Christian Medical Centre (KCMC) has attempted to overcome these barriers and has commenced induction therapy with daunorubicin and cytarabine in a number of suitable candidates in an attempt to treat their disease. However, to date treatment during nadir poses an unresolved threat despite the use of prophylactic antiviral, anti-fungal and antibiotic therapies and broad-spectrum antibiotics in the case of infection.

Childhood and Adolescent Cancer Care at a Tertiary Hospital in Northern Tanzania: A Retrospective Study.

Over 400,000 children are diagnosed with cancer around the world each year, with over 80% of these children residing in low- and middle-income countries. This study aims to summarize the epidemiology and care patterns of newly diagnosed childhood cancer patients in Northern Tanzania. Data from all children and adolescents (age 0-19 years) with newly diagnosed cancers were collected from the Kilimanjaro Cancer Registry located at the Kilimanjaro Christian Medical Centre. Descriptive and inferential analyses were used to compare the demographic and clinical characteristics of the participants over time, stage, and status at last contact. Statistical significance was set at P < .05. Secondary descriptive analysis was conducted on a subset sample with available staging data. A total of 417 patients were diagnosed with cancer between 2016 and 2021. There was an increase in the rate of patients with newly diagnosed pediatric cancer each year, particularly among children under age 5 years and 10 years. Leukemias and lymphomas were the leading diagnoses and accounted for 183 (43.8%) of all patients. Over 75% of patients were diagnosed at stage III or above. From a subset analysis of patients with available staging data (n = 101), chemotherapy was the most common treatment (87.1%), compared with radiotherapy and surgery. There is a significant burden of children with cancer in Tanzania. Our study fills crucial gaps in the literature related to the large burden of disease and survival for children with cancer in the Kilimanjaro region. Furthermore, our results can be used to understand the regional needs and guide research and strategic interventions to improve childhood cancer survival in Northern Tanzania.

Abstract 51: Impacts of the COVID-19 Pandemic on Pediatric and Adolescent Cancer Care in Northern Tanzania

Abstract Purpose: Low- and middle-income countries (LMICs) have an increasing burden of pediatric cancer cases over recent years. In 2020, the COVID-19 pandemic further strained healthcare systems, presenting unique challenges for children requiring cancer care. The aim of this study was to assess differences in diagnoses, treatments, and outcomes of pediatric cancer patients before and during the COVID pandemic in Northern Tanzania. Methods: In this cross-sectional study, we assessed the demographic and clinical characteristics of pediatric and adolescent cancer patients (ages 0-18 years old) between 2016 and 2021 using the population-based Kilimanjaro Cancer Registry (KMCR). We categorized data into pre-COVID (2016-2019) and COVID (2020-2021) eras to perform descriptive analysis of the diagnosis, treatment, and demographic information before and during the COVID pandemic. We conducted inferential statistical analyses to compare all demographic and clinical variables, and used chi-square statistics for categorical variables with significance set at p&amp;lt;0.05. A secondary analysis was conducted on a subset of 101 children for whom cancer stage at diagnosis was recorded. This study received approval by the Kilimanjaro Christian Medical Centre (KCMC) and Duke University Institutional Review Boards and the National Institute for Medical Research. Results: Among the 417 patients included in this study, a higher proportion of patients during the COVID pandemic were diagnosed with hematological malignancies (48.2%) compared to patients diagnosed during the pre-COVID era (42.9%). Rates of chemotherapy (71.7%) and radiotherapy (6.8%) were lower during the pandemic compared to pre-COVID cases (83.8% and 9.6%, respectively), while rates of surgical treatments increased from 14.6% to 19.6% after 2019. However, only rates of chemotherapy were significantly different between pre-COVID and COVID era cases. Conclusion: Pediatric cancer care has changed in Tanzania during the COVID pandemic, with higher rates of hematologic malignancies and surgical therapies, but lower rates of chemotherapy and radiation therapy. Understanding the impact of the COVID pandemic on pediatric cancer care can help us better adapt healthcare systems and interventions to the emerging needs of children experiencing the compounding effects of cancer treatment and the global COVID crisis. Citation Format: Hannah Rice, Esther Majaliwa, Cesia Cotache-Condor, Yotham Gwanika, Nelson Chao, Kristin Schroeder, Henry Rice, Catherine Staton, Blandina Mmbaga, Emily Smith. Impacts of the COVID-19 Pandemic on Pediatric and Adolescent Cancer Care in Northern Tanzania [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 51.

Editorial introductions.

Editorial introductions.

Recurrence of post-term pregnancy and associated factors among women who delivered at Kilimanjaro Christian Medical Centre in northern Tanzania: A retrospective cohort study.

Post-term pregnancy is a health problem of clinical importance and; tends to recur in subsequent pregnancies. Maternal age, height, and male fetal sex are risk factors associated with Post-term pregnancy. The study aimed to determine the recurrence risk of post-term pregnancy and associated factors among women delivered at KCMC referral hospital. This retrospective cohort study used KCMC zonal referral hospital medical birth registry cohort data for 43472 women delivered between 2000 and 2018. Data were analyzed using STATA version 15 software. Log-binomial regression with robust variance estimator determined the factors associated recurrence of post-term pregnancy adjusted for other factors. A total of 43472 women were analyzed. The proportion of post-term pregnancy was 11.4%, and the recurrence was 14.8%. The recurrence risk of post-term pregnancy was increased when a woman had a history of previous post-term pregnancy (aRR: 1.75; 95%CI: 1.44, 2.11). Advanced maternal age, i.e., ≥35years (aRR: 0.80; 95%CI: 0.65, 0.99), having secondary and higher education (aRR: 0.8; 95%CI: 0.66, 0.97), and being employed (aRR: 0.68; 95%CI: 0.55, 0.84) decreased the recurrence risk of post-term pregnancy. Women with recurrence of post-term pregnancy had a higher risk of delivering newborns weighed ≥4000gm (aRR: 5.05; 95% CI: 2.80, 9.09). Post-term pregnancy is associated with recurrence risk in subsequent pregnancies. A history of previous post-term pregnancy is associated risk factor and these women are at increased risk of delivering newborns weighed ≥4000gm. Clinical counselling of women at risk of post-term pregnancy and timely management is recommended to prevent adverse neonatal and maternal outcomes.

MP49-13 MANAGEMENT OF UROLOGIC CANCERS AT KCMC, TANZANIA: EXPERIENCE FROM A RESOURCE LIMITED SETTING

You have accessJournal of UrologyCME1 Apr 2023MP49-13 MANAGEMENT OF UROLOGIC CANCERS AT KCMC, TANZANIA: EXPERIENCE FROM A RESOURCE LIMITED SETTING Nicholaus Ngowi Bartholomeo, Harrison Gottlich, and Furaha Serventi Nicholaus Ngowi BartholomeoNicholaus Ngowi Bartholomeo More articles by this author , Harrison GottlichHarrison Gottlich More articles by this author , and Furaha ServentiFuraha Serventi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003297.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urologic cancers contribute to significant morbidity and mortality globally, despite being underestimated in most African countries. As the epidemiological transition continues, it will become even more important to properly screen, treat, and research them. Common urologic cancers (Table 1) treated at the Kilimanjaro Christian Medical Center (KCMC) center include prostate, bladder, renal, and Wilm’s tumor with management including surgical, endoscopic, and chemotherapy options. Radiation treatment is available by referral to Ocean Road Cancer institute and soon to be available at our center. KCMC continues to develop initiatives to improve patient outcomes for Urologic cancers in the Northern zone of Tanzania. METHODS: The center employed a community survey and screening using serum prostate specific antigen (PSA) among men aged 40 years and above to assess level of awareness and burden of prostate cancer (Pca) in northern Tanzania (catchment area of KCMC). Total serum PSA > 4 ng/mil was regarded as the critical value for tru cut biopsy of the prostate. Awareness was assessed using pretested questionnaire and categorized as poor (score < 50%) or good (score > 50%). In addition, after we obtained consent for all participants, more than 500 prostate tissue and about 6000 serum samples have been biobanked to investigate in genomic studies if there is a distinct mutation observed in these cancers contributing to late presentation. Lastly, the center recently broke ground on a radiation treatment building that will become another treatment option for our patients. RESULTS: The yet to be published cross-sectional study assessing burden and knowledge of Pca among at risk men in northern Tanzania showed a prevalence of Pca of 3% with most cases having intermediate risk disease based on Gleason score (Gleason score 7). Most respondents had poor knowledge and low perceived risk of Pca. CONCLUSIONS: Urological cancers are an important source of disease burden in developing countries like Tanzania, for which multi-modal approaches are needed to improve population health, including screening, community education, human and infrastructure investment, and basic science research. Source of Funding: PCF-Pfizer and CIRGO funded the assessment of prostate cancer awareness and burden in northern Tanzania © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e683 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholaus Ngowi Bartholomeo More articles by this author Harrison Gottlich More articles by this author Furaha Serventi More articles by this author Expand All Advertisement PDF downloadLoading ...