Catholic University of Health and Allied Sciences

www.bugando.ac.tz
Mwanza, Tanzania

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Nyanza E.C.,Catholic University of Health and Allied Sciences | Joseph M.,University of Dar es Salaam | Premji S.S.,University of Calgary | Thomas D.S.K.,University of Colorado at Denver | Mannion C.,University of Calgary
BMC Pregnancy and Childbirth | Year: 2014

Background: Geophagy, a form of pica, is the deliberate consumption of soil and is relatively common across Sub-Saharan Africa. In Tanzania, pregnant women commonly eat soil sticks sold in the market (pemba), soil from walls of houses, termite mounds, and ground soil (kichuguu). The present study examined geophagy practices of pregnant women in a gold mining area of Geita District in northwestern Tanzania, and also examined the potential for exposure to chemical elements by testing soil samples. Method: We conducted a cross sectional study using a convenience sample of 340 pregnant women, ranging in age from 15-49 years, who attended six government antenatal clinics in the Geita District, Tanzania. Structured interviews were conducted in June-August, 2012, to understand geophagy practices. In addition, soil samples taken from sources identified by pregnant women practicing geophagy were analysed for mineral element content. Results: Geophagy was reported by 155 (45.6%) pregnant women with 85 (54.8%) initiating the practice in the first trimester. A total of 101 (65%) pregnant women reported eating soil 2 to 3 times per day while 20 (13%) ate soil more than 3 times per day. Of 155 pregnant women 107 (69%) bought pemba from local shops, while 48 (31%) consumed ground soil kichuguu. The estimated mean quantity of soil consumed from pemba was 62.5 grams/day. Arsenic, chromium, copper, iron, manganese, nickel and zinc levels were found in both pemba and kichuguu samples. Cadmium and mercury were found only in the kichuguu samples. Based on daily intake estimates, arsenic, copper and manganese for kichuguu and copper and manganese for pemba samples exceed the oral Minimum Risk Levels designated by the U.S. Agency for Toxic Substance and Disease Registry. Conclusion: Almost 50% of participants practiced geophagy in Geita District consistent with other reports from Africa. Both pemba and kichuguu contained chemical elements at varying concentration, mostly above MRLs. As such, pregnant women who eat soil in Geita District are exposed to potentially high levels of chemical elements, depending upon frequency of consumption, daily amount consumed and the source location of soil eaten. © 2014 Nyanza et al.; licensee BioMed Central Ltd.


Kiplagat A.,Zonal Health Resource Center Lake Zone | Musto R.,University of Calgary | Mwizamholya D.,Catholic University of Health and Allied Sciences | Morona D.,Catholic University of Health and Allied Sciences
BMC Public Health | Year: 2014

Background: Integrated Management of Childhood Illness (IMCI) was developed by the World Health Organization (WHO) and the United Nations International Children's Fund (UNICEF) and aims at reducing childhood morbidity and mortality in resource-limited settings including Tanzania. It was introduced in 1996 and has been scaled up in all districts in the country. The purpose of this study was to identify factors influencing the implementation of IMCI in the health facilities in Mwanza, Tanzania since reports indicates that the guidelines are not full adhered to by the healthcare workers. Methods. A cross-sectional study design was used and a sample size of 95 healthcare workers drawn from health centers and dispensaries within Mwanza city were interviewed using self-administered questionnaires. Structured interview was also used to get views from the city IMCI focal person and the 2 facilitators. Data were analyzed using SPSS and presented using figures and tables. Results: Only 51% of healthcare workers interviewed had been trained. 69% of trained Healthcare workers expressed understanding of the IMCI approach. Most of the respondents (77%) had a positive attitude that IMCI approach was a better approach in managing common childhood illnesses especially with the reality of resource constraint in the health facilities. The main challenges identified in the implementation of IMCI are low initial training coverage among health care workers, lack of essential drugs and supplies, lack of onsite mentoring and lack of refresher courses and regular supportive supervision. Supporting the healthcare workers through training, onsite mentoring, supportive supervision and strengthening the healthcare system through increasing access to essential medicines, vaccines, strengthening supply chain management, increasing healthcare financing, improving leadership & management were the major interventions that could assist in IMCI implementation. Conclusions: The healthcare workers can implement better IMCI through the collaboration of supervisors, IMCI focal person, Council Health Management Teams (CHMT) and other stakeholders interested in child health. However, significant barriers impede a sustainable IMCI implementation. Recommendations have been made related to supportive supervision and HealthCare system strengthening among others. © 2014 Kiplagat et al.; licensee BioMed Central Ltd.


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.


Gilyoma J.M.,Catholic University of Health and Allied Sciences | Mabula J.B.,Catholic University of Health and Allied Sciences | Chalya P.L.,Catholic University of Health and Allied Sciences
World Journal of Emergency Surgery | Year: 2013

Background: Animal related injuries are a major but neglected emerging public health problem and contribute significantly to high morbidity and mortality worldwide. No prospective studies have been done on animal related injuries in our setting. This study was conducted to determine the management patterns and outcome of animal related injuries and their social impact on public health policy in the region.Methods: This was a descriptive prospective study of animal related injury patients that presented to Bugando Medical Centre between September 2007 and August 2011. Statistical data analysis was done using SPSS computer software version 17.0.Results: A total of 452 (8.3%) animal-related injury patients were studied. The modal age group was 21-30 years. The male to female ratio was 2.1:1. Dog-bites (61.1%) were the most common injuries. Musculoskeletal (71.7%) region was the most frequent body region injured. Soft tissue injuries (92.5%) and fractures (49.1%) were the most common type of injuries sustained. Only 140 (31.0%) patients were hospitalized and most of them (97.1%) were treated surgically. Wound debridement was the most common procedure performed in 91.2% of patients. Postoperative complication rate was 15.9%, the commonest being surgical site infections (SSI) in 55.1% of patients. SSI was significantly associated with late presentation and open fractures (P < 0.001). The overall median duration of hospitalization was 16 days. Patients who had severe injuries, long bone fractures and those with hemiplegia stayed longer in the hospital (P < 0.001). Mortality rate was 10.2% and was significantly high in patients with severe injuries, severe head injury, tetanus and admission SBP < 90 mmHg (P < 0.001). The follow up of patients was poor.Conclusion: Animal related injuries constitute a major public health problem in our setting and commonly affect the young adult male in their economically productive age-group. Measures towards prevention and proper treatment and follow up are important in order to reduce morbidity and mortality resulting from this form of trauma. © 2013 Gilyoma et al.; licensee BioMed Central Ltd.


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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