Regional Hospitals In Tanzania Research Articles

The burden and management strategies of hypertensive crisis in adult patients presenting to emergency departments of district and regional hospitals in Sub-Saharan Africa

BackgroundHypertensive crisis is among the causes of morbidity and mortality in adult patients with hypertension in Sub-Saharan Africa. We aimed to determine the burden, risk factors and describe the management strategies of hypertensive crisis among adult patients seen at emergency departments of district and regional hospitals in Tanzania.MethodsThis was a prospective multicenter longitudinal study which included all 162 district and regional hospitals in Tanzania. It was part of the Tanzania Emergency Care Capacity Survey (TECCS), a large assessment of burden of acute illness and emergency care capacity in Tanzania. Adult patients who presented to emergency departments with blood pressure ≥ 180/110mmHg were enrolled. Demographics, clinical presentation, management, and 24-hours outcomes were recorded using a structured case report form. Descriptive statistics were summarized in frequency and median, while logistic regression was used to evaluate the association between risk factors and presence of hypertensive crisis.ResultsWe screened 2700 patients and enrolled 169 adults, henceforth proportion of adult patients with hypertensive crisis was 63 per 1000. Median age was 62 years (IQR 50–70 years) and predominantly females, 112 (66.3%). Majority 151(89.3%) were self-referred with two-wheel motorcycle being the commonest 46 (27.2%) mode of arrival to the hospital. Hypertensive emergency was found in over half 96 (56.8%) of the patients with hypertensive crisis, with oral medications administered in more than half of them, 71 (74%) as means to control the high blood pressure, and one-third 33 (34.4%) were discharged home. On multivariate analysis increasing age (AOR 4.53, p < 0.001), use of illicit drug (AOR 4.14, p-0.04) and pre-existing hypertension (AOR 8.1, p < 0.001) were independent risk factors for hypertensive crisis occurrence.ConclusionHypertensive crisis among adult patients attending district and regional hospitals is common (63 patients per every 1000 patients). Increasing age, use of illicit drug and pre-existing hypertension are independent associated factors for developing hypertensive crisis.

Estimation of Persistent Organic Pollutants releases and emission levels from Healthcare Waste in Mwananyamala and Temeke Regional Hospitals in Tanzania

This study estimated the amount of polychlorinated dibenzodioxin (PCDDs) and polychlorinated dibenzofurans (PCDFs) from healthcare wastes generated in Mwananyamala and Temeke regional hospitals located in Dar es Salaam using Standardized Toolkit for sources of persistent organic pollutant (POPs) developed by UNEP. Healthcare wastes were collected in different categories and measured for fourteen (14) consecutive days. By using a weighing scale machine, the assessment of the healthcare waste generation rate in each hospital was measured. The average amount of healthcare waste were 67.12 Tons/year and 105.34 Tons/year at Mwananyamala and Temeke hospitals respectively. The recommended tolerable daily intake (TDI) of dioxin/furans for an adult is 1.75 x 10-10 g I-TEQ/day. The value obtained in this study (2.38 x 10-4 g 1-TEQ/day) at Mwananyamala hospital and 3.62 x 10-4 g 1- TEQ/day at Temeke is about 1.36 x 106 and 2.07 x 106 times higher than the recommended value for adults respectively. It is hereby recommended the emission of dioxin/furan from hospitals must be controlled and if possible, reduced to below the recommended limit. More detailed studies and the permanent monitoring of air quality around different healthcare facilities would be appropriate.

The Linguistic Landscape of Regional Hospitals in Tanzania: Language Choice on Signage

The study aimed at identifying the language choice on the signage and assessing the outpatients and their aides’ views on the language choice on the signage in regional hospitals, namely Bukoba and Sekou Toure. The study was guided by language choice theory on the signage where qualitative approach was employed. Data were gathered through observation and interview methods. Thirty-six respondents who were hospital management teams, medical care providers, patients and their aides were involved. The study findings reveal that there were two languages on the signage including Kiswahili and English where Kiswahili was predominant. This indicates the linguistic landscape of the selected hospitals suits the targeted people though it excludes some clients who cannot understand Kiswahili. The study recommends that there is a great need of using two languages on the signage and establishing a clear national policy on language choice on the signage. This will help to direct, inform, educate, warn and instruct the clients around the hospital surroundings.

ABC-VEN Analysis of Medicine Expenditure at Mwananyamala Regional Hospital in Tanzania

Policymakers in developing countries are looking for effective and efficient ways to control hiking expenditure on medicines. This article shows the effectiveness of the ABC-VEN method to improve efficiency in resource use with data from Mwananyamala hospital in Tanzania. We used expenditure data for 233 medicines worth 909.9 million Tsh (392,386.4 USD) bought in the year 2018/2019. Data were extracted from the electronic system, receipts, and other relevant documents. Medicines were categorized according to their contribution to the total medicine expenditure (ABC) and their importance to the functioning of the hospital (VEN). 39 (17%) medicines belong to group A and 134 (57%) to C, which accounted for 70% and 10% of the total medicine expenditure, respectively. 15%, 78%, and 7% of the medicines belong to the Vital, Essential, and Non-essential groups, respectively. 65 medicines (28%) that accounted for 73% of the total medicine expenditure were in group I that requires stringent control. 4 high-cost non-essential medicines and 20 low-cost vital medicines accounted for 7% and 1% of the total medicine expenditure, respectively. Efficiency can be improved through rational prescribing and substituting high-cost non-essential with low-cost vital medicines.

In-Hospital Postoperative Mortality Rates for Selected Procedures in Tanzania\u2019s Lake Zone

BackgroundPostoperative mortality rate is one of six surgical indicators identified by the Lancet Commission on Global Surgery for monitoring access to high-quality surgical care. The primary aim of this study was to measure the postoperative mortality rate in Tanzania’s Lake Zone to provide a baseline for surgical strengthening efforts. The secondary aim was to measure the effect of Safe Surgery 2020, a multi-component intervention to improve surgical quality, on postoperative mortality after 10 months.MethodsWe prospectively collected data on postoperative mortality from 20 health centers, district hospitals, and regional hospitals in Tanzania’s Lake Zone over two time periods: pre-intervention (February to April 2018) and post-intervention (March to May 2019). We analyzed postoperative mortality rates by procedure type. We used logistic regression to determine the impact of Safe Surgery 2020 on postoperative mortality.ResultsThe overall average in-hospital non-obstetric postoperative mortality rate for all surgery procedures was 2.62%. The postoperative mortality rates for laparotomy were 3.92% and for cesarean delivery was 0.24%. Logistic regression demonstrated no difference in the postoperative mortality rate after the Safe Surgery 2020 intervention.ConclusionsOur results inform national surgical planning in Tanzania by providing a sub-national baseline estimate of postoperative mortality rates for multiple surgical procedures and serve as a basis from which to measure the impact of future surgical quality interventions. Our study showed no improvement in postoperative mortality after implementation of Safe Surgery 2020, possibly due to low power to detect change.

The burden of trauma in Tanzania: Analysis of prospective trauma registry data at regional hospitals in Tanzania

BackgroundTrauma contributes significantly to the burden of disease and mortality in sub-Saharan Africa (SSA). Like most of SSA, Tanzania lacks prospective trauma registries (TRs), resulting in poor and inconsistent availability of injury data. A model TR was implemented at five representative regional hospitals in Tanzania; the TR incorporates the variables recommended by the World Health Organisation (WHO) Data Set for Injury. This study characterises the burden of trauma seen at five regional hospital Emergency Units (EUs) in Tanzania using data from this new TR. MethodsThis prospective descriptive study used TR data from EUs of five regional Hospitals in Tanzania between February 2019 to September 2019. Descriptive statistics were calculated for mechanism of injury, injury severity, disposition and mortality. Injury severity scores were calculated. We determined relative risk for mortality by injury type. ResultsOver a seven-month period, 6,302 (9.6%) patients presented to these EUs with trauma-related complaints. They had a median age of 27 (IQR: 19–37) years and 71.3% were male. Most patients (76.6%) were self-referred and presented to EU on motorized (two or three-wheeler) vehicle (55.9%). Road traffic accidents (RTAs) 3786 (60.3%) were the most common mechanism of injury. Most patients (63.3%) presented with injuries to the upper and lower extremities, while few (2.0%) had injuries to the chest. The overall mean Injury Severity Score (ISS) was 9 (Interquartile Range (IQR): 4–13], and varied by hospital. Total 24-hour mortality was 3.3% and 126 (2.1%) patients died while receiving care at the EU. Among those who died, 156 (81.7%) had an intracranial injury; relative risk of death was [13.3 (CI95%: 9.3 -19.1), p<0.0001] for intracranial injuries compared to other injury patterns. ConclusionsTR from these five Tanzanian regional hospitals has provided an opportunity to more accurately describe the country's burden of injury. Having sufficient data for ISS and other key trauma variables allows us to compare the burden and outcomes of trauma in Tanzania with other countries, which will help to quantify an accurate burden of injury, inform quality improvement initiatives, and suggest where to focus preventative measures.

Perceptions of health providers towards the use of standardised trauma form in managing trauma patients: a qualitative study from Tanzania

BackgroundTrauma registries (TRs) are essential to informing the quality of trauma care within health systems. Lack of standardised trauma documentation is a major cause of inconsistent and poor availability of trauma data in most low- and middle-income countries (LMICs), hindering the development of TRs in these regions. We explored health providers’ perceptions on the use of a standardised trauma form to record trauma patient information in Tanzania.MethodsAn exploratory qualitative research using a semi-structured interview guide was carried out to purposefully selected key informants comprising of healthcare providers working in Emergency Units and surgical disciplines in five regional hospitals in Tanzania. Data were analysed using a thematic analysis approach to identify key themes surrounding potential implementation of the standardised trauma form.ResultsThirty-three healthcare providers participated, the majority of whom had no experience in the use of standardised charting. Only five respondents had prior experience with trauma forms. Responses fell into three themes: perspectives on the concept of a standardised trauma form, potential benefits of a trauma form, and concerns regarding successful and sustainable implementation.ConclusionFindings of this study revealed wide healthcare provider acceptance of moving towards standardised clinical documentation for trauma patients. Successful implementation likely depends on the perceived benefits of using a trauma form as a tool to guide clinical management, standardise care and standardise data reporting; however, it will be important moving forward to factor concerns brought up in this study. Potential barriers to successful and sustainable implementation of the form, including the need for training and tailoring of form to match existing resources and knowledge of providers, must be considered.

Trauma care and capture rate of variables of World Health Organisation data set for injury at regional hospitals in Tanzania: first steps to a national trauma registry

BackgroundIn Tanzania, there is no national trauma registry. The World Health Organization (WHO) has developed a data set for injury that specifies the variables necessary for documenting the burden of injury and patient-related clinical processes. As a first step in developing and implementing a national Trauma Registry, we determined how well hospitals currently capture the variables that are specified in the WHO injury set.MethodsThis was a prospective, observational cross-sectional study of all trauma patients conducted in the Emergency Units of five regional referral hospitals in Tanzania from February 2018 to July 2018. Research assistants observed the provision of clinical care in the EU for all patients, and documented performed assessment, clinical interventions and final disposition. Research assistants used a purposefully designed case report form to audit the injury variable capture rate, and to review Ministry of Health (MoH) issued facility Register book recording the documentation of variables. We present descriptive statistics for hospital characteristics, patient volume, facility infrastructure, and capture rate of trauma variables.ResultsDuring the study period, 2891 (9.3%) patients presented with trauma-related complaints, 70.7% were male. Overall, the capture rate of all variables was 33.6%. Documentation was most complete for demographics 71.6%, while initial clinical condition, and details of injury were documented in 20.5 and 20.8% respectively. There was no documentation for the care prior to Emergency Unit arrival in all hospitals. 1430 (49.5%) of all trauma-related visits seen were documented in the facility Health Management Information System register submitted to the MoH. Among the cases reported in the register book, the date of EU care was correctly documented in 77% cases, age 43.6%, diagnosis 66.7%, and outcome in 38.9% cases. Among the observed procedures, initial clinical condition (28.7%), interventions at Emergency Unit (52.1%), investigations (49.0%), and disposition (62.9%) were documented in the clinical charts.ConclusionsIn the regional hospitals of Tanzania, there is inadequate documentation of the minimum trauma variables specified in the WHO injury data set. Reasons for this are unclear, but will need to be addressed in order to improve documentation to inform a national injury registry.

Influence of Work Schedulling On Performance of Nurses In Regional Hospitals In Tanzania

Influence of Work Schedulling On Performance of Nurses In Regional Hospitals In Tanzania

Disaster preparedness and response capacity of regional hospitals in Tanzania: a descriptive cross-sectional study

BackgroundTanzania has witnessed several disasters in the past decade, which resulted in substantial mortality, long-term morbidity, and significant socio-economic losses. Health care facilities and personnel are critical to disaster response. We assessed the current state of disaster preparedness and response capacity among Tanzanian regional hospitals.MethodsThis descriptive cross-sectional survey was conducted in all Tanzanian regional hospitals between May 2012 and December 2012. Data were prospectively collected using a structured questionnaire based on the World Health Organization National Health Sector Emergency Preparedness and Response Tool. Trained medical doctors conducted structured interviews and direct observations in each hospital.ResultsWe surveyed 25 regional hospitals (100% capture) in mainland Tanzania, in which interviews were conducted with 13-hospital doctors incharge, 9 matrons and 4 heads of casualty. All the hospitals were found to have inadequate numbers of all cadres of health care providers to support effective disaster response. 92% of hospitals reported experiencing a disaster in the past 5 years; with the top three being large motor vehicle accidents 22 (87%), floods 7 (26%) and infectious disease outbreaks 6 (22%). Fifteen hospitals (60%) had a disaster committee, but only five (20%) had a disaster plan. No hospital had all components of surge capacity. Although all had electricity and back-up generators, only 3 (12%) had a back-up communication system.ConclusionThis nationwide survey found that hospital disaster preparedness is at an early stage of development in Tanzania, and important opportunities exist to better prepare regional hospitals to respond to disasters.

Patients' willingness to pay for dental services in a population with limited restorative services.

To determine and compare patients' willingness-to-pay (WTP) for tooth extraction and filling services in Tanzania and to assess the socio-demographic factors that are associated with such valuations. Contingent valuation survey utilizing an open-ended willingness-to-pay format was administered among 1522 outpatients in four regional hospitals in Tanzania. WTP for extraction and tooth filling services for various tooth categories were determined and compared using Mann-Whitney and Kruskal-Wallis tests. The association of WTP values with socio-demographic background factors was assessed using multiple regression analysis. The mean WTP amounts for tooth filling were Tanzania shillings (Tshs) 7,398 (3.4 US$) and Tshs 7,726 (3.5 US$) for anterior and posterior teeth respectively. The mean WTP for tooth filling services was lower than the average charged fees in dental facilities. The mean WTP amounts for tooth extraction were Tshs 5,448 (2.5 US$) and Tshs 6,188 (2.8 US$) for anterior and posterior teeth respectively. WTP amounts were shown to vary by age, income, outpatient status and previous experience with the dental services. Belonging in youngest age group (18-24 years) and having a high-income level was associated with increased odds for high WTP valuations irrespective of tooth and treatment types. WTP reveals a preference for tooth filling rather than extraction services in this population. More studies are needed to address the discrepancy between the stated preferences and utilization patterns for dental services.

Attitudes towards tooth fillings in Tanzanian adults and its association with previous filling experience

BackgroundTooth filling treatment is utilized at low levels in many low and middle-income countries (LMICs), further, little is known about the prevailing attitudes towards such treatment. This study aimed to assess attitudes towards tooth filling among Tanzanian adults and how previous tooth filling experience is associated with these attitudes.MethodsA pretested structured questionnaire was distributed among 1522 out-patients in four regional hospitals in Tanzania in 2015–16. The questionnaire had eight statements on a 6-point Likert scale measuring attitudes towards tooth filling. Responses were analyzed independently and through a constructed attitude sum score. Linear regression analysis was used to assess the association of previous tooth fillings on attitudes towards tooth filling treatment.ResultsThe respondents were mostly female (57.3%), with a mean age of 33.1 years (SD 11.3). About one third of the respondents (36.4%) had primary level of education. Attitudes towards tooth filling treatment were generally negative. Low levels of education and income were associated with more negative attitudes. A small proportion (11.5%) had a previous tooth filling. Having a previous tooth filling was associated with a more positive attitude towards tooth fillings regardless of socioeconomic status.ConclusionsThis study shows that even in areas with limited resources and availability of services, previous experience of tooth fillings is related to more positive attitudes towards restorative treatment, which should be taken into account when planning oral health care programs.

Trauma burden in Tanzania: a one-day survey of all district and regional public hospitals

BackgroundTrauma contributes significantly to the burden of disease and mortality throughout the world, but particularly in developing countries. In Tanzania, there is an enormous research gap on trauma; the limited data available reflects realities in cities and areas with moderately- to highly-resourced treatment centers. Our aim was to provide a description of the injury epidemiology across all of Tanzania. Our data will serve as a basis for future larger studies.MethodsThis is a subgroup analysis of a cross-sectional, prospective study of the clinical epidemiology of patients presenting at all public district and regional hospitals in Tanzania. The study was conducted between May 2012 and December 2012. A team of emergency doctors used a purpose-designed data collection sheet to gather the demographic and clinical information of all patients presenting during the day-site visit to each hospital. Descriptive statistics, including means, standard deviations, medians, and ranges are reported.ResultsA total of 5227 patients were seen in 24-h period in 105 (100% response rate) district (or designated district) and regional hospitals in mainland Tanzania. Of these patients, 508 (9.7%) presented with trauma-related complaints. Among patients with trauma-related complaints, 286 (56.3%) were male, and the overall median age of 30 (interquartile range of 22–35) years. Road traffic crash was the most common mechanism of injury, accounting for 227 (44.7%) complaints. Open wounds and bone fractures were the two most frequent diagnoses, with a combined 300 (59%) cases. Most of the patients - 325 (64%) - were discharged, 11 (2.2%) went to operating theatres and 4 (0.8%) of patients died while receiving care at the acute intake areas.ConclusionsTrauma-related complaints constitute a substantial burden among patients seeking care in acute intake areas of hospitals across Tanzania. There is a need to develop, implement and study systems that can support the improvement of trauma care and optimize outcomes of trauma patients.

Introducing eHealth strategies to enhance maternal and perinatal health care in rural Tanzania

BackgroundGlobally, eHealth has attracted considerable attention as a means of supporting maternal and perinatal health care. This article describes best practices, gains and challenges of implementing eHealth for maternal and perinatal health care in extremely remote and rural Tanzania.MethodsTeleconsultation for obstetric emergency care, audio teleconferences and online eLearning systems were installed in ten upgraded rural health centres, four rural district hospitals and one regional hospital in Tanzania. Uptake of teleconsultation and teleconference platforms were evaluated retrospectively. A cross sectional descriptive study design was applied to assess performance and adoption of eLearning.ResultsIn 2015 a total of 38 teleconsultations were attended by consultant obstetricians and 33 teleconferences were conducted and attended by 40 health care providers from 14 facilities. A total of 240 clinical cases mainly caesarean sections (CS), maternal and perinatal morbidities and mortalities were discussed and recommendations for improvement were provided. Four modules were hosted and 43 care providers were registered on the eLearning system. For a period of 18–21 months total views on the site, weekly conference forum, chatroom and learning resources ranged between 106 and 1,438. Completion of learning modules, acknowledgment of having acquired and utilized new knowledge and skills in clinical practice were reported in 43–89% of 20 interviewed health care providers. Competencies in using the eLearning system were demonstrated in 62% of the targeted users.ConclusionsE-Health presents an opportunity for improving maternal health care in underserved remote areas in low-resource settings by broadening knowledge and skills, and by connecting frontline care providers with consultants for emergency teleconsultations.

Assessment of Maternal Mortality and its Associated Causes at Shinyanga Regional Hospital in Tanzania

Background: Maternal mortality remains a public health concern in low income countries particularly in sub-Saharan Africa where majority (62%) of maternal deaths occurs. In Tanzania maternal mortality ratio is as high as 432 deaths per 100,000 live births. Objectives: This study aimed to describe pattern of maternal mortality ratio and its associated causes at Shinyanga regional referral hospital. We also assessed the availability of the comprehensive emergency obstetric care services in the study setting. Methods: This was retrospective cross-sectional study which was conducted from April to May 2015 at Shinyanga Regional Referral Hospital. Information on demographic data, obstetric factors associated with maternal death and their causes as well as their management were extracted from the patient’s record file between 2010 and 2014 by using data extraction sheet. Data analysis was performed using SPSS version 18.0 for Windows (SPSS Inc, Chicago, IL, USA). Descriptive statistical analysis were summarized. Results: Overall maternal mortality ratio declined from 635/100,000 live births in 2010 to 449/100,000 live births in 2014. The main causes of maternal death were postpartum haemorrhage (50%) and pre-eclampsia/eclampsia (20%). Majority (77%) of the delays were encountered at hospital and at home (56%). Numerous forms of management were provided to women who experienced maternal death including C-section (35.5%) for antepartum haemorrhage and hysterectomy (17%) for postpartum haemorrhage. For pre-eclampsia/eclampsia, only 12.5% had C-section. Of all of the maternal deaths, only 2.5% had assisted vaginal delivery and 14% had puerperal sepsis. Conclusions: The observed maternal mortality ratio in this population is higher compared to the national average. Postpartum haemorrhage and preeclampsia/eclampsia remains to be the main direct causes of maternal deaths. Delay in decision making in seeking fortreatment and provision of treatment contributed to high maternal mortality observed in this study. This requires more effort to address the direct and indirect causes of maternal death.

The underreported challenge of disabling psychogenic neurological disorders in Sub-Saharan Africa: a case series of patients presenting to a regional hospital in Tanzania (P1.271)

The underreported challenge of disabling psychogenic neurological disorders in Sub-Saharan Africa: a case series of patients presenting to a regional hospital in Tanzania (P1.271)

Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania.

BackgroundThe maternal near-miss (MNM) concept has been developed to assess life-threatening conditions during pregnancy, childhood, and puerperium. In recent years, caesarean section (CS) rates have increased rapidly in many low- and middle-income countries, a trend which might have serious effects on maternal health. Our aim was to describe the occurrence and panorama of maternal near-miss and death in two low-resource settings, and explore their association with CS complications.MethodsWe performed a cross-sectional study, including all women who fulfilled the WHO criteria for MNM or death between February and June 2012 at a university hospital and a regional hospital in Dar es Salaam, Tanzania. Cases were assessed individually to determine their association with CS. Main outcome measures included MNM ratio; maternal mortality ratio; proportion of MNM and death associated with CS complications; and the risk for such outcomes per 1,000 operations. The risk ratio of life-threatening CS complications at the university hospital compared to the regional hospital was calculated.ResultsWe identified 467 MNM events and 77 maternal deaths. The MNM ratio was 36 per 1,000 live births (95% CI 33–39) and the maternal mortality ratio was 587 per 100,000 live births (95% CI 460–730). Major causes were eclampsia and postpartum haemorrhage, but we also detected nine MNM events and five deaths from iatrogenic complications. CS complications accounted for 7.9% (95% CI 5.6–11) of the MNM events and 13% (95% CI 6.4–23) of the maternal deaths. The risk of experiencing a life-threatening CS complication was three times higher at the regional hospital (22/1,000 operations, 95% CI 12–37) compared to the university hospital (7.0/1,000 operations, 95% CI 3.8–12) (risk ratio 3.2, 95% CI 1.5–6.6).ConclusionsThe occurrence of MNM and death at the two hospitals was high, and many cases were associated with CS complications. The maternal risks of CS in low-resource settings must not be overlooked, and measures should be taken to avoid unnecessary CSs. More comprehensive training of staff, improved postoperative surveillance, and a more even distribution of resources within the health care system might reduce the risks of CS.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-244) contains supplementary material, which is available to authorized users.

Geriatric injuries among patients attending a regional hospital in Shinyanga Tanzania.

Geriatric injuries pose a major challenge to surgeons and general practitioners in developing countries. The objective of this study was to determine the prevalence, injury characteristics and outcomes of geriatric injury among patients at Shinyanga Regional Hospital in Tanzania. Data was collected using a pre-tested, coded questionnaire and analyzed using SPSS computer system. A total of 94 geriatric trauma patients constituting 22.7% of all trauma admissions were studied. The male to female ratio was 1.4:1. Their mean age was 68.5 years (ranged 60-98 years). Premorbid illness was reported in 38.3% of patients. Most injuries were intentional in fifty-three (56.4%) patients. Assaults, falls and road traffic crashes were the mechanism of injuries in 52.1%, 19.1% and 11.7% of cases, respectively. The majority of cases of assault were females accounting for 64.6%. The majority of injuries (81.9%) occurred at home. Pre-hospital care was recorded in 5.3% of cases. The musculoskeletal (72.3%) and head (66.0%) regions were commonly affected. Soft tissue injuries (wounds) (89.4%) and fractures (52.2%) were the most common type of injuries. The majority of patients (90.4%) underwent surgical treatment of which wound debridement was the most common procedure performed in 91.8% of cases. Complication rate was 39.4%. The mean length of hospital stay was 28.6 days (ranged 1-124 days). The length of hospital stay was significantly longer in patients with co-morbidities, long bone fractures and those with complications (P<0.05). Mortality rate was 14.9% and it was significantly related to advanced age, presence of pre-morbid illness, high injury severity score, severe head injuries and the need for ventilatory support (P<0.05). In conclusion, traumatic injuries in elderly constitute a major but preventable public health problem in Shinyanga region and contribute significantly to high morbidity and mortality. Urgent preventive measures focusing at the root causes of the injuries and early appropriate treatment is highly needed to reduce the occurrence, morbidity and mortality associated with these injuries.

Knowledge of cervical cancer and screening practices of nurses at a regional hospital in Tanzania.

Cervical cancer, the most common cancer among women in Tanzania is strongly linked to Human Papilloma Virus. Precancerous lesions can be detected by Papanicolau smear screening. Nurses, being the largest group of health workers, have an important role in promotion of cervical cancer screening. To determine nurses' awareness of cervical cancer and their own screening practices at a hospital in Tanzania. A descriptive cross sectional study using questionnaires on 137 nurses. Data analysis was made by descriptive statistics and chi square tests. Less than half of the nurses had adequate knowledge regarding cervical cancer. There was a significant association between knowledge levels of causes of cervical cancer and transmission of HPV and age. Knowledge was more adequate among the young nurses (p = 0.027) and knowledge differed significantly between cadres. Registered nurses had more adequate knowledge than enrolled nurses (p = 0.006). The majority did not know screening intervals and a few were aware of HPV vaccine. Most nurses (84.6%) had never had a Pap smear examination. These results reflect a need for continuing medical education, creation of cervical cancer prevention policies and strategies at all levels of the health sector.

Substandard emergency obstetric care - a confidential enquiry into maternal deaths at a regional hospital in Tanzania

(i) To identify clinical causes of maternal deaths at a regional hospital in Tanzania and through confidential enquiry (CE) assess major substandard care and make a comparison to the findings of the internal maternal deaths audits (MDAs); (ii) to describe hospital staff reflections on causes of substandard care. A CE into maternal deaths was conducted based on information available from written sources supplemented with participatory observations and interviews with staff. The compiled information was summarized and presented anonymously for external expert review to assess for major substandard care. Hospital based maternal deaths between 2006 and 2008 (35 months) were included. Of 68 registered maternal deaths sufficient information for reviewing was retrieved for 62 cases (91%). As a supplement, in-depth interviews with staff about the underlying causes of substandard care were performed. The causes of death were infection (40%), abortion (25%), eclampsia (13%), post-partum haemorrhage (12%), obstructed labour (6%) and others (4%). The median time available for hospital staff to manage the fatal complication was 47 h. The CE identified major substandard care in 46 (74%) of the 62 cases reviewed. During the same time period MDA identified substandard care in 18 cases. Staff perceived poor organization of work and lack of training as important causes for substandard care. Local MDA was considered useful although time-consuming and sometimes threatening, and staff dedication to the process was questioned. Quality assurance of emergency obstetric care might be strengthened by supplementing internal MDA with external CE.