Catholic University of Health and Allied Sciences
Mwanza, Tanzania
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Seni J.,Catholic University of Health and Allied Sciences
Ethiopian Medical Journal | Year: 2017

Introduction: Obstetric fistula is the most distressing condition in developing countries due to morbidity and loss of quality of life attributable to it. This study was conducted to determine short term complications and factors associated with these complications after repair the fistula. Methods: This was descriptive follow up study conducted at Bugando Medical Centre from September 2014 to April 2015 involving 132 women with obstetric fistula and operated at the Centre. Social, demographic and clinical information were collected using questionnaires. Urine samples for culture and sensitivity were collected intra-operatively and data was analyzed using STATA version 11 software. Results: The median (interquartile range) age of the participants was 23 (20-32) years. The proportion of women who developed short term complications was 42 (31.8%); with predominant complications being failed repair 18 (42.9%) and stress incontinence 10 (23.8%). Asymptomatic bacteriuria was found in 50.8% (33/65) of patients with preponderance of Gram negative bacteria. HIV seropositivity was documented in 4.1% of 123 tested patients and it was significantly associated with short term complications (p=0.002). Moreover, residing in rural areas (p=0.042); median duration of labor for more than 24 hours (p=0.002) with OR (95%CI) 4.38 (1.59-13.89), fistula type (p =0.005) and size (p =0.006), reduced bladder capacity (p <0.001) and urethral length (p =0.001) as well as presence of fibrosis (p =0.004) were significantly associated with short term complications among women repaired for obstetric fistulas. Conclusion: The proportion of women developing short term complications at Bugando Medical Centre is high; with the common complications being failed repair and stress incontinence. The complications were associated with residing in rural areas, HIV seropositivity and fistula characteristics.

Rambau P.F.,Catholic University of Health and Allied Sciences
American Journal of Surgical Pathology | Year: 2017

The 2014 World Health Organization Classification of Tumors of Female Reproductive Organs endorsed the new category of seromucinous carcinoma, a neoplasm that exhibits morphologic and immunophenotypic overlap with other histotypes of ovarian carcinoma. The goal of this study was to determine whether seromucinous carcinoma was a distinct histotype by assessing its diagnostic reproducibility and comparing its molecular composition to the 5 major histotypes of ovarian carcinoma. Thirty-two tumors diagnosed as seromucinous carcinomas from 2 centers were studied. Eighteen cases were randomly selected for a review set comprising a total of 50 ovarian carcinomas of various histotypes. Morphologic histotype was independently assessed by 4 pathologists. For the 32 seromucinous carcinomas, a histotype-specific immunophenotype was assigned using a diagnostic immunohistochemical panel. Histotype-specific genotype was assigned using a combination of immunohistochemistry and targeted next-generation sequencing for somatic mutations, including genes recurrently mutated in ovarian carcinomas. There was low to modest agreement between pathologists with the reference diagnosis of seromucinous carcinoma, ranging from 39% to 56% for the 4 observers. The immunophenotype was not unique but overlapped predominantly with endometrioid and to a lesser extent with mucinous and low-grade serous carcinoma. Genomic and immunohistochemical alterations were detected in a number of target genes, including KRAS (70%), PIK3CA (37%), PTEN (19%), and ARID1A (16%); no CTNNB1 mutations were identified. Nine cases (30%) harbored concurrent KRAS/PIK3CA mutations. An endometrioid genotype was assigned to 19 cases, a low-grade serous genotype to 9, and a mucinous genotype to 1 and 3 cases were uninformative. Integrating morphology, immunophenotype, and genotyping resulted in reclassifying the seromucinous carcinomas to endometrioid 23/32 (72%), low-grade serous 8/32 (25%), and mucinous 1/32 (3%). The morphologic diagnosis of seromucinous carcinomas is not very reliable and it does not exhibit a distinct immunophenotype or genotype. The molecular features overlap mostly with endometrioid and low-grade serous carcinomas. Our data suggest the category of seromucinous carcinoma be discontinued as ancillary molecular tests can assign cases to one of the major histotypes. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Laisser R.M.,Catholic University of Health and Allied Sciences | Ng'Home J.F.,Kahama District Hospital
Tanzania Journal of Health Research | Year: 2017

Background: Percutaneous injuries and mucocutaneous blood and other body fluids exposure are among the common hospital hazards affecting health care workers (HCWs) worldwide. These exposures pose risks of contracting infections such as Hepatitis B and C and Human Immunodeficiency viruses. This study aimed to determine the incidence and human factors associated with percutaneous injuries and splash exposures among healthcare workers in Kahama District, Tanzania. Methods: This descriptive cross sectional study was conducted in Kahama District of north-western Tanzania and involved randomly selected healthcare workers. Structured self-administered questionnaire was used to collect data between July and October 2015. Results: A total of 277 HCWs participated in the study. Among them 146 (53%) were nurses, 138 (14%) auxiliary staff 36 (13%), 32 (12%) laboratory personnel and 25 (9%) were doctors. The mean age was 37.4 years. Seventy-one percent of the participants had more than 10 years’ of working experience. About 59% of participants reported incidences of percutaneous injuries and mucocutaneous blood and other fluids exposures. About 90% of participants agreed to experience the incidences several times. While 60% disagreed with availability of personal protective gears, non-reporting of the cases was noted by 26% of participants. Majority (81%) disagreed with existence of infection prevention and control (IPC) guidelines and protocols. The main human factors associated with the percutaneous injuries and splash exposures included HCWs experience at work (71%), long working hours (29%), type of workplace (48%) and inadequate use of IPC guidelines and protocols (48%). Conclusion: More than half of participants reported incidents of percutaneous injuries and mucocutaneous blood and other body fluids in Kahama District of Tanzania. Adherence to universal precautions, training and reduction of long working hours are necessary in order to reduce infections from percutaneous injuries and exposures. © 2017, National Institute for Medical Research. All rights reserved.

Heukelbach J.,Federal University of Ceará | Heukelbach J.,James Cook University | Mazigo H.D.,Catholic University of Health and Allied Sciences | Ugbomoiko U.S.,University Of Ilorin
Current Opinion in Infectious Diseases | Year: 2013

PURPOSE OF REVIEW: Features of endemic scabies are specific in resource-poor and underprivileged communities, with implications for control measures on the community level. In this review, these special aspects are addressed. RECENT FINDINGS: Scabies is endemic in many resource-poor communities, with a prevalence of 20% and higher. Transmission is influenced by social attitudes, migration, access to healthcare services, housing conditions, hygiene conditions, and crowding. Endemic scabies occurs with severe infestations, complications, and sequels, mainly in children. Sleep loss as a result of scabies-related itching is common. Complications include secondary infections by group A streptococci and acute poststreptococcal glomerulonephritis. Shame, restriction of leisure activities, and stigmatization are common. Treatment of scabies includes a variety of topical compounds, but control on the community level is not an easy task. As ivermectin kills a variety of other parasites, this oral drug is increasingly used for mass treatment. Intervention should address socioemotional aspects using an integrated approach with professionals from different areas, and the community. SUMMARY: Scabies is a neglected disease and needs to be perceived as an important public health problem causing morbidity in many resource-poor communities. Future work on epidemiology, clinical aspects, transmission dynamics, socioeconomic aspects, and sustainable control in resource-poor communities is needed. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Rambau P.F.,Catholic University of Health and Allied Sciences | Chalya P.L.,Bugando Medical Center | Jackson K.,Catholic University of Health and Allied Sciences
Infectious Agents and Cancer | Year: 2013

Introduction. Worldwide, cancers of the urinary bladder are well known to be associated with environmental chemical carcinogens such as smoking and occupational exposure to polycyclic aromatic hydrocarbons. These cancers are typically transitional cell carcinoma (urothelial carcinoma). In areas where schistosomiasis is endemic there is a high incidence of squamous cell carcinoma of the urinary bladder. Schistosomiasis causes chronic granulomatous cystitis leading to squamous metaplasia of transitional epithelium, and subsequently development of squamous cell carcinoma. The western part of Tanzania on the shores of Lake Victoria is such an endemic area. This study was done to document the burden of urinary bladder cancer associated with schistosomiasis in this region. Methods. This was a descriptive retrospective study of histologically confirmed cases of urinary bladder cancer seen at the Department of Pathology Bugando Medical Centre (BMC) over a period of 10 years. Data were retrieved from the records of the Departments of Pathology, Medical Records and Surgery. Data were analyzed by the use of contingency tables. Results: A total of 185 patients were diagnosed with cancer of the urinary bladder during the study period, where as 90 (48.6%) were males and 95 (51.4) were females. The mean age at diagnosis was 54.3 years. Squamous cell carcinoma was the most frequent histological type (55.1%), followed by conventional transitional cell carcinoma (40.5%). Eighty three of all cancer cases (44.9%) were found to have schistosomal eggs. Schistosomiasis was commonly associated with squamous cancers compared to non squamous cancers. Most of the cancers associated with schistosomiasis had invaded the muscularis propria of the urinary bladder at the time of diagnosis (p<0.001) and such cancers were frequent below 50 years of age with a significant statistical difference (p<0.001). Poorly differentiated tumors were more frequent in females than males with a significant statistical difference (p=0.006). Conclusion: The majority of urinary bladder cancers seen in the Lake Region were squamous cell carcinoma associated with schistosomiasis. These cancers showed an aggressive behavior and were commonly seen in the younger age groups. Effective control of schistosomiasis in this region should significantly reduce the burden of urinary bladder cancer. © 2013 Rambau et al.; licensee BioMed Central Ltd.

Matovelo D.,Catholic University of Health and Allied Sciences | Ng'Walida N.,Bugando Medical Center
BMC Research Notes | Year: 2014

Background: Abdominal pregnancy is a rare condition which is usually missed during prenatal assessment particularly in settings lacking routine ultrasound surveillance. We report a case of abdominal pregnancy at 32 weeks, which is most likely to have been a tubal abortion with secondary implantation, leading to delivery of a healthy baby girl weighing 1.7 kg. Case presentation. A 22-year-old woman, gravid 3 para 2 was referred to our centre from a district hospital with complaint of generalized abdominal pain and reduced fetal movements. Although the initial abdomino-pelvic ultrasound done at our centre was read as normal, there was subsequently a strong clinical suspicion of abdominal pregnancy, which was confirmed by a second ultrasound. The patient underwent laparotomy and was found to have an intact uterus with a viable fetus floating in the abdominal cavity without its amniotic sac and with hemoperitoneum of 1litre. The baby was extracted successfully; the placenta was found to be deeply implanted on the right cornual side extending to the fundus superiorly. Wedge resection of the cornual area and fundus was performed to remove the placenta. Intraoperatively, one unit of blood was transfused due to severe anemia prior to surgery. Both the mother and the baby were discharged home in good condition. Conclusion: Abdominal pregnancy can be missed prenatally even when an imaging (ultrasound) facility is available. Emphasis should be placed on clinical assessment and thorough evaluation of patients. © 2014 Matovelo and Ng'walida; licensee BioMed Central Ltd.

Chalya P.L.,Bugando Medical Center | Rambau P.F.,Catholic University of Health and Allied Sciences | Masalu N.,Bugando Medical Center | Simbila S.,Bugando Medical Center
World Journal of Surgical Oncology | Year: 2015

Background: Penile cancer is an uncommon malignancy in developed countries, but the incidence is as high as 10% to 20% of all male cancers in some developing countries. There is a paucity of published data on this subject in our setting. This study describes the clinicopathological presentation and treatment outcome of this condition in our environment, and highlights challenges associated with the care of these patients and proffers solutions for improved outcome. Methods: This was a retrospective study of histologically confirmed cases of penile cancer seen at Bugando Medical Centre between January 2004 and December 2013. Results: There were 236 penile cancer patients representing 2.2% of all male malignancies during the study period. The median age was 47 years with a modal age group of 41 to 50 years. Of the 236 patients, 147 (62.3%) had severe phimosis. The majority of patients (89.8%) were uncircumcised. A history of human papilloma virus (HPV) was reported in 12 (5.1%) cases. One hundred eighty-two (77.1%) patients reported history of cigarette smoking. Seven (6.7%) patients were human immunodeficiency virus (HIV) positive. The majority of the patients (68.6%) presented with Jackson's stages III and IV. Squamous cell carcinoma was the most common histopathological type (99.2%). Lymph node metastasis was recorded in 65.3% of cases, and it was significantly associated with the tumor size, histopathological subtype, histopathological grade, lympho-vascular invasion, positive resection margins, and urethral involvement (P < 0.001). Distant metastasis accounted for 4.2% of cases. The majority of patients (63.1%) underwent partial penectomy. Chemotherapy and radiotherapy were given in 14 (5.9%) and 12 (5.1%) patients, respectively. Complication and mortality rates were 22.0% and 4.2%, respectively. HIV positivity, histopathological stage and grade of the tumor, and presence of metastases at the time of diagnosis were the main predictors of death (P < 0.001). The median length of hospitalization was 14 days. Local recurrence was reported in 12 (5.3%) patients. Data on long-term survivals were not available as the majority of patients were lost to follow-up. Conclusions: Penile cancer is not rare in our environment. The majority of patients present late with advanced stage of the disease. Early detection of primary cancer at an early stage may improve the prognosis. © Chalya et al.

Chalya P.L.,Catholic University of Health and Allied Sciences | Kayange N.M.,Catholic University of Health and Allied Sciences | Chandika A.B.,Catholic University of Health and Allied Sciences
Italian Journal of Pediatrics | Year: 2014

Background: Intussusception remains a common cause of bowel obstruction in children and results in significant morbidity and mortality if not promptly treated. There is a paucity of prospective studies regarding childhood intussusception in Tanzania and particularly the study area. This study describes the pattern, clinical presentations and management outcomes of childhood intussusception in our setting and highlights the challenging problems in the management of this disease. Methods. This was a prospective descriptive study of patients aged < 10 years operated for intussusception at Bugando Medical Centre. Ethical approval to conduct the study was obtained from relevant authorities. Data was analyzed using SPSS version 17.0. Results: A total of 56 patients were studied. The male to female ratio was 3.3: 1. The median age was 6 months. Three-quarter of patients were < 1 year. Etiology was mainly idiopathic in 91.1% of cases. The classic triad of bloody stool, vomiting and abdominal distention/abdominal pain was found in 24 (42.5%) patients. The diagnosis of intussusception was mainly clinically in 71.4% of cases. All patients were treated surgically. Ileo-colic was the most frequent type of intussusception (67.9%). Twenty-six (46.4%) patients required bowel resection. The rate of bowel resection was significantly associated with late presentation > 24 hour (p = 0.001). Complication rate was 32.1% and surgical site infection (37.5%) was the most frequent complication. The median length of hospital stay was 7 days. Patients who had bowel resection and those who developed complications stayed longer in the hospital and this was statistically significant (p < 0.001). Mortality rate was 14.3%. Age < 1 year, delayed presentation, associated peritonitis, bowel resection and surgical site infection were the main predictors of mortality (p < 0.001). The follow up of patients was generally poor. Conclusion: Intussusception in our setting is characterized by late presentation, lack of specialized facilities and trained personnel for nonsurgical reduction. Therefore, surgery remains the main stay of treatment in our centre. A high index of suspicion and proper evaluation of patients is essential for an early diagnosis and timely definitive treatment, in order to decrease the morbidity and mortality associated with this disease. © 2014 Chalya et al.; licensee BioMed Central Ltd.

Bosse Jonsson J.,University of Glasgow | Charles E.,Catholic University of Health and Allied Sciences | Kalvig P.,Geological Survey of Denmark
Resources Policy | Year: 2013

Mercury-usage in artisanal and small-scale gold mining (ASGM) has accelerated in developing countries during the last thirty years resulting in negative environmental and health impacts. As awareness of mercury contamination from ASGM has grown, a number of strategic initiatives have been introduced to reduce the impact of the toxic substance. The adoption of the retort, a device capable of recycling up to 95 per cent of mercury in gold extraction, constitutes a broadly recognized approach. Based on case-study research in Tanzania, this paper examines an ASGM area, which has been targeted by several mercury-reducing efforts. Based on survey data, key informants interviews, and visitor observations, the paper examines the impact of these efforts on mining techniques and residents' attitudes towards the use of mercury. Despite the seemingly obvious advantages from adopting retorts or other mercury-reducing techniques - economic, environmental, and health-wise - miners continue to use mercury haphazardly, while demonstrating an only limited awareness of the toxicity of the substance. The paper discusses the possible explanations behind this as well as possible ways forward in facilitating the reduction of mercury in ASGM operations. © 2012 Elsevier Ltd.

Mabula J.B.,Catholic University of Health and Allied Sciences | Chalya P.L.,Catholic University of Health and Allied Sciences
BMC Research Notes | Year: 2012

Background: Inguinal hernia repair remains the commonest operation performed by general surgeons all over the world. There is paucity of published data on surgical management of inguinal hernias in our environment. This study is intended to describe our own experiences in the surgical management of inguinal hernias and compare our results with that reported in literature. Methods. A descriptive prospective study was conducted at Bugando Medical Centre in northwestern Tanzania. Ethical approval to conduct the study was obtained from relevant authorities before the commencement of the study. Statistical data analysis was done using SPSS software version 17.0. Results: A total of 452 patients with inguinal hernias were enrolled in the study. The median age of patients was 36 years (range 3 months to 78 years). Males outnumbered females by a ratio of 36.7:1. This gender deference was statistically significant (P = 0.003). Most patients (44.7%) presented late (more than five years of onset of hernia). Inguinoscrotal hernia (66.8%) was the commonest presentation. At presentation, 208 (46.0%) patients had reducible hernia, 110 (24.3%) had irreducible hernia, 84 (18.6%) and 50(11.1%) patients had obstructed and strangulated hernias respectively. The majority of patients (53.1%) had right sided inguinal hernia with a right-to-left ratio of 2.1: 1. Ninety-two (20.4%) patients had bilateral inguinal hernias. 296 (65.5%) patients had indirect hernia, 102 (22.6%) had direct hernia and 54 (11.9%) had both indirect and direct types (pantaloon hernia). All patients in this study underwent open herniorrhaphy. The majority of patients (61.5%) underwent elective herniorrhaphy under spinal anaesthesia (69.2%). Local anaesthesia was used in only 1.1% of cases. Bowel resection was required in 15.9% of patients. Modified Bassini's repair (79.9%) was the most common technique of posterior wall repair of the inguinal canal. Lichtenstein mesh repair was used in only one (0.2%) patient. Complication rate was 12.4% and it was significantly higher in emergency herniorrhaphy than in elective herniorrhaphy (P = 0.002). The median length of hospital stay was 8 days and it was significantly longer in patients with advanced age, delayed admission, concomitant medical illness, high ASA class, the need for bowel resection and in those with surgical repair performed under general anesthesia (P < 0.001). Mortality rate was 9.7%. Longer duration of symptoms, late hospitalization, coexisting disease, high ASA class, delayed operation, the need for bowel resection and presence of complications were found to be predictors of mortality (P < 0.001). Conclusion: Inguinal hernias continue to be a source of morbidity and mortality in our centre. Early presentation and elective repair of inguinal hernias is pivotal in order to eliminate the morbidity and mortality associated with this very common problem. © 2012 Mabula and Chalya; licensee BioMed Central Ltd.

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