Kilimanjaro Christian Medical Center

Moshi, Tanzania

Kilimanjaro Christian Medical Center

Moshi, Tanzania
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Makupa I.I.,Kilimanjaro Christian Medical Center | Swai B.,Kilimanjaro Christian Medical Center | Makupa W.U.,Kilimanjaro Christian Medical Center | White V.A.,Vancouver General Hospital | Lewallen S.,The Good
British Journal of Ophthalmology | Year: 2012

Aims: To describe the clinical characteristics of ocular surface squamous neoplasia (OSSN) in a sub-Saharan referral hospital setting according to histopathological diagnosis and HIV status. Methods: All patients were enrolled who presented consecutively to the Kilimanjaro Christian Medical College eye department with lesions suspected to be OSSN from September 2005 to May 2007 and from February 2008 to September 2008. Clinical characteristics were documented on a standardised form, excision biopsies were performed and histopathological diagnosis was obtained on all cases. Data were analysed to look for associations among various factors. Results: 150 patients were enrolled. Histopathological study showed OSSN in 88% of cases. Of these, 128 (85.6%) were under the age of 50 years and 60% were HIV positive. The median CD4 cell count was 71 cells/μl among HIV-positive cases. Independent of size, the lesions of patients who were HIV positive were more likely to be higher grade malignancy than those who were HIV negative. Conclusion: In a sub-Saharan setting, OSSN occurs in persons who are younger than in industrialised countries and is often associated with HIV positivity. CD4 cell counts indicate that a majority of HIV-positive patients with OSSN are significantly immunosuppressed at presentation. Higher grade malignancy in this group could indicate a more aggressive course.

The International Nurses Association is pleased to welcome Mary Popp, RN, to their prestigious organization with her upcoming publication in the Worldwide Leaders In Healthcare. Mary Popp is a Registered Nurse working for MetroDerm, P.C. in Atlanta, Georgia. Having been in practice in Atlanta since 2000, Mary has an extensive expertise in all facets of nursing, especially plastic surgery nursing, Botox, and filler injectables. Mary received her Bachelor of Science degree in Nursing from the University of South Alabama in Mobile, in 1996. Since her graduation, Mary has completed a number of advanced courses, and holds certification in Basic Life Support and Advanced Cardiac Life Support. Additionally, she is a Registered Nurse First Assistant, and a Certified Nurse, Operating Room. Mary’s expertise lies in Botox and filler injectables, and she has written and published about injectables in the peer reviewed surgical textbook, Eyelid and Periorbital Surgery. With her well-known reputation, Mary has built an established and busy practice in injectables. Furthermore, she has provided training to residents at Emory University’s Plastic Surgery Residency program, and has been an injectable trainer for Allergan, makers of Botox, and Juvederm. In addition, Mary has extensive experience in plastic surgery itself, as she has been the primary surgical assistant for renowned plastic surgeons at Paces Plastic Surgery. Mary is now the surgical assistant to Dr. Farzad Nahai, a plastic surgeon for the Center for Plastic Surgery at MetroDerm, and helps aid in the management and care for their surgical patients. Mary’s other achievements include developing and organizing a medical mission to Kilimanjaro Christian Medical Center in Moshi, Tanzania, and plans to continue her endeavor with future medical missions. Mary attributes her success to her determination, and being excited by what she can achieve in her career. When she is not working, Mary enjoys traveling, playing golf, and spending time with her family. Learn more Mary Popp here and read her upcoming publication in Worldwide Leaders In Healthcare.

Walker R.W.,North Tyneside General Hospital | Walker R.W.,Northumbria University | Jusabani A.,Kilimanjaro Christian Medical Center | Aris E.,University of Dar es Salaam | And 5 more authors.
The Lancet Global Health | Year: 2013

Background The burden of stroke on health systems in low-income and middle-income countries is increasing. However, high-quality data for modifiable stroke risk factors in sub-Saharan Africa are scarce, with no communitybased, case-control studies previously published. We aimed to identify risk factors for stroke in an incident population from rural and urban Tanzania. Methods Stroke cases from urban Dar-es-Salaam and the rural Hai district were recruited in a wider study of stroke incidence between June 15, 2003, and June 15, 2006. We included cases with first-ever and recurrent stroke. Community-acquired controls recruited from the background census populations of the two study regions were matched with cases for age and sex and were interviewed and assessed. Data relating to medical and social history were recorded and blood samples taken. Findings We included 200 stroke cases (69 from Dar-es-Salaam and 131 from Hai) and 398 controls (138 from Dar-es- Salaam and 260 from Hai). Risk factors were similar at both sites, with previous cardiac event (odds ratio [OR] 7·39, 95% CI 2·42-22·53; p<0·0001), HIV infection (5·61, 2·41-13·09; p<0·0001), a high ratio of total cholesterol to HDL cholesterol (4·54, 2·49-8·28; p<0·0001), smoking (2·72, 1·49-4·96; p=0·001), and hypertension (2·14, 1·09-4·17; p=0·026) identified as significant independent risk factors for stroke. In Hai, additional risk factors of diabetes (4·04, 1·29-12·64) and low HDL cholesterol (9·84, 4·06-23·84) were also significant. Interpretation We have identified many of the risk factors for stroke already reported for other world regions. HIV status was an independent risk factor for stroke within an antiretroviral-naive population. Clinicians should be aware of the increased risk of stroke in people with HIV, even in the absence of antiretroviral treatment.

Khamis K.,Kilimanjaro Christian Medical University College | Njau B.,Kilimanjaro Christian Medical University College | Njau B.,Kilimanjaro Christian Medical Center
BMC Health Services Research | Year: 2014

Methods. A cross-sectional study design was conducted from April to May, 2012. A systematic sampling method was employed to select 422 study subjects. A pre-tested SERVQUAL questionnaire was used to collect data and one-sample t-test was employed to identify patients' level of satisfaction and principal component analysis to identify key items that measure quality of care.Results: Patients' level of satisfaction mean gap score was (-2.88 ± 3.1) indicating overall dissatisfaction with the quality of care. The level of dissatisfaction in the five service dimensions were as follows: assurance (-0.47), reliability (-0.49), tangible (-0.52), empathy (-0.55), and responsiveness (-0.72).Conclusion: Patients attending OPD at Mwananyamala hospital demonstrates an overall dissatisfaction on quality of care. Hospital management should focus on: improvement on communication skills among OPD staff in showing compassion, politeness and active listening, ensure availability of essential drugs, and improvement on clinicians' prescription skills.Background: Enhancing quality of health care delivered in public health facilities in developing countries is a key prerequisite to increase utilization and sustainability of health care services in the population. The aim of the study was to determine patients' level of satisfaction on the quality of health care delivered at the out-patient department (OPD) in Mwananyamala hospital in Dar es Salaam, Tanzania. © 2014 Khamis and Njau; licensee BioMed Central Ltd.

Lakhoo K.,Oxford Childrens Hospital | Msuya D.,Kilimanjaro Christian Medical Center
African Journal of Paediatric Surgery | Year: 2015

Background: To emphasise the value of on-going commitment in Global Health Partnerships. Materials and Methods: A hospital link, by invitation, was set up between United Kingdom and Tanzania since 2002. The project involved annual visits with activities ranging from exchange of skill to training health professionals. Furthermore, the programme attracted teaching and research activities. For continuity, there was electronic communication between visits. Results: Six paediatric surgeons are now fully trained with three further in training in Africa. Paediatric surgery services are now separate from adult services. Seven trainee exchanges have taken place with four awarded fellowships/scholarships. Twenty-three clinical projects have been presented internationally resulting in eight international publications. The programme has attracted other health professionals, especially nursing and engineering. The Tropical Health and Education Trust prize was recently achieved for nursing and radiography. National Health Service has benefited from volunteering staff bringing new cost-effective ideas. A fully funded medical student elective programme has been achieved since 2008. Conclusion: Global Health Partnerships are an excellent initiative in establishing specialist services in countries with limited resources. In the future, this will translate into improved patient care as long as it is sustained and valued by long term commitment.

Reddy E.A.,Duke University | Reddy E.A.,Kilimanjaro Christian Medical Center | Shaw A.V.,Duke University | Crump J.A.,Duke University | And 2 more authors.
The Lancet Infectious Diseases | Year: 2010

Data on the prevalence and causes of community-acquired bloodstream infections in Africa are scarce. We searched three databases for studies that prospectively studied patients admitted to hospital with at least a blood culture, and found 22 eligible studies describing 58 296 patients, of whom 2051 (13·5%) of 15 166 adults and 3527 (8·2%) of 43 130 children had bloodstream infections. 1643 (29·1%) non-malaria bloodstream infections were due to Salmonella enterica (58·4% of these non-typhoidal Salmonella), the most prevalent isolate overall and in adults, and 1031 (18·3% overall) were due to Streptococcus pneumoniae, the most common isolate in children. Other common isolates included Staphylococcus aureus (531 infections; 9·5%) and Escherichia coli (412; 7·3%). Mycobacterium tuberculosis complex accounted for 166 (30·7%) of 539 isolates in seven studies that used mycobacterial culture techniques. HIV infection was associated with any bloodstream infection, particularly with S enterica and M tuberculosis complex bacteraemia. Where recorded, patients with bloodstream infections had an in-hospital case fatality of 18·1%. Our results show that bloodstream infections are common and associated with high mortality. Improved clinical microbiology services and reassessment of empirical treatment guidelines that account for the epidemiology of bloodstream infections might contribute to better outcomes. © 2010 Elsevier Ltd. All rights reserved.

Hu V.H.,London School of Hygiene and Tropical Medicine | Hu V.H.,Kilimanjaro Christian Medical Center | Holland M.J.,London School of Hygiene and Tropical Medicine | Burton M.J.,London School of Hygiene and Tropical Medicine | Burton M.J.,Kilimanjaro Christian Medical Center
PLoS Neglected Tropical Diseases | Year: 2013

Trachoma, caused by Chlamydia trachomatis (Ct), is the leading infectious blinding disease worldwide. Chronic conjunctival inflammation develops in childhood and leads to eyelid scarring and blindness in adulthood. The immune response to Ct provides only partial protection against re-infection, which can be frequent. Moreover, the immune response is central to the development of scarring pathology, leading to loss of vision. Here we review the current literature on both protective and pathological immune responses in trachoma. The resolution of Ct infection in animal models is IFNγ-dependent, involving Th1 cells, but whether this is the case in human ocular infection still needs to be confirmed. An increasing number of studies indicate that innate immune responses arising from the epithelium and other innate immune cells, along with changes in matrix metalloproteinase activity, are important in the development of tissue damage and scarring. Current trachoma control measures, which are centred on repeated mass antibiotic treatment of populations, are logistically challenging and have the potential to drive antimicrobial resistance. A trachoma vaccine would offer significant advantages. However, limited understanding of the mechanisms of both protective immunity and immunopathology to Ct remain barriers to vaccine development. © 2013 Hu et al.

Dotchin C.,Northumbria University | Jusabani A.,Kilimanjaro Christian Medical Center | Walker R.,Foundation Medicine
Journal of Neurology | Year: 2011

It was previously thought that the prevalence of Parkinson's disease (PD) in developing countries, and in particular sub-Saharan Africa (SSA), was lower than the rest of the world. The Hai PD prevalence project [1] diagnosed 32 patients (the majority previously undiagnosed and untreated) with PD from a population of 161,000, giving age standardised prevalence rates of 64 (men) and 20 (women)/100,000, respectively. Subsequently, drug treatment has been commenced for all surviving patients with annual follow up. The aim of the study was to document response to treatment, development of side effects, progression of disease and feasibility and sustainability of supplying medication to patients in rural Tanzania. Eleven patients died before the start of medication, and a further four during follow up. One patient moved away from the study area. At the end of 3 years of treatment, 16 patients were surviving. Only one stopped medication due to side effects (dyskinesia). At 3 years, 9/16 experienced wearing off and a further three had dyskinesias. Non motor symptoms were a problem at initial assessment [2] and continued to be a problem for many of the patients. We have shown that it is possible to find, treat and follow up patients with PD in a rural sub-Saharan African setting. Availability of affordable medication locally is a major issue. Acknowledging that movement disorders and neurological diseases in general are an issue in this setting is important to drive education and training, and for allocation of funding from health care providers in SSA. © 2011 Springer-Verlag.

Jordan I.,Justus Liebig University | Hebestreit A.,Bremen Institute for Prevention Research and Social Medicine | Swai B.,Kilimanjaro Christian Medical Center | Krawinkel M.B.,Justus Liebig University
Breast Cancer Research and Treatment | Year: 2013

Breast cancer is the leading cause of death among women worldwide. Studies in industrialised countries identified age at menarche, age at first full-term pregnancy, and lactation as determining factors in the aetiology of breast cancer. 115 female breast cancer patients (cases) and 230 age- and district-matched women clinically free from breast cancer (controls) were interviewed about their reproductive history and socioeconomic condition. Semi-structured interviews including anthropometric measurements were conducted by trained enumerators. The median age was 50 years (min/max 26 to 85 years). Estimated median BMI at age 20 was 21 kg/m2 in both cases and controls. Median lifelong lactation of the mothers was 96 months (cases) and 108 months (controls). A high BMI at 20 years was associated with an increased breast cancer risk (OR 1.31 95% CI 1.11-1.55, P < 0.01). The odds ratio for lifelong lactation was slightly below one (OR 0.99 95% CI 0.98-1.00, P < 0.01). There was no significant association in risk for BMI at interview (median 25 kg/m2 of cases and 26 kg/m2 of controls), age at menarche (median 16 years), and age at first full-term pregnancy (median 20 years). The association of increased risk with higher BMI at age 20 years remained significant after stratification for menopause (premenopausal: OR 1.41 95% CI 1.10-1.81, P = 0.01; postmenopausal: OR 1.38 95% CI 1.06-1.80, P = 0.02). Late age at menarche and prolonged lifelong lactation were associated with a risk reduction among premenopausal women (ORmenarche 0.74 95% CI 0.56-1.00, P = 0.05; ORlactation 0.98 95% CI 0.97-0.99, P < 0.01). In conclusion, long-standing lactation and reproductive behaviour are associated with a lower breast cancer risk in the region. As current changes in lifestyle affect age at menarche, reproductive behaviour, and nutritional status, an increased incidence of breast cancer is to be expected. Preventive efforts should include advice on reproductive and breastfeeding behaviour. © 2010 Springer Science+Business Media, LLC.

Rubach M.P.,University of Utah | Maro V.P.,Kilimanjaro Christian Medical Center | Bartlett J.A.,Duke University | Crump J.A.,Duke University
American Journal of Tropical Medicine and Hygiene | Year: 2015

We describe the laboratory-confirmed etiologies of illness among participants in a hospital-based febrile illness cohort study in northern Tanzania who retrospectively met Integrated Management of Adolescent and Adult Illness District Clinician Manual (IMAI) criteria for septic shock, severe respiratory distress without shock, and severe pneumonia, and compare these etiologies against commonly used antimicrobials, including IMAI recommendations for emergency antibacterials (ceftriaxone or ampicillin plus gentamicin) and IMAI first-line recommendations for severe pneumonia (ceftriaxone and a macrolide).Among 423 participants hospitalized with febrile illness, there were 25 septic shock, 37 severe respiratory distress without shock, and 109 severe pneumonia cases. Ceftriaxone had the highest potential utility of all antimicrobials assessed, with responsive etiologies in 12 (48%) septic shock, 5 (14%) severe respiratory distress without shock, and 19 (17%) severe pneumonia illnesses. For each syndrome 17-27% of participants had etiologic diagnoses that would be non-responsive to ceftriaxone, but responsive to other Available antimicrobial regimens including amphotericin for cryptococcosis and histoplasmosis; anti-tuberculosis therapy for bacteremic disseminated tuberculosis; or tetracycline therapy for rickettsioses and Q fever.We conclude that although empiric ceftriaxone is appropriate in our setting, etiologies not explicitly addressed in IMAI guidance for these syndromes, such as cryptococcosis, histoplasmosis, and tetracyclineresponsive bacterial infections, were common. Copyright © 2015 by The American Society of Tropical Medicine and Hygiene.

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