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Mwakikunga A.,University of Witwatersrand | Mwakikunga A.,University of Malawi | Katundu K.,University of Malawi | Msamati B.,The Hubert Kairuki Memorial University | And 2 more authors.
African Health Sciences | Year: 2016

Background: Femoral sulcus angle is particularly important in clinical evaluation of patellofemoral joint. Individuals show considerable differences in asymmetrical dimensions of the femur. Objectives: To determine the size of femoral sulcus angles in adult black Malawians using the skeletal collection in the department of Anatomy, College of Medicine and assess their gender differences; to compare femoral sulcus angles of Malawians with other ethnic groups. Methods: A cross sectional study was done in which femoral sulcus angles of dry bones were measured using a goniometer. Results: There is no significant difference in the mean sulcus angles between right and left femora in males (p=0.8100) and females (p=0.0742); between all males combined and females combined (p=0.8845). There is a significant difference in the mean between all left femora combined and all right femora combined (p=0.0260). Conclusion: This study has provided the mean size of the femoral sulcus angle of adult Malawians. These findings suggest that the size of the sulcus angle cannot determine gender among adult black Malawians suggesting the interpretation that femora asymmetric dimensions are population specific, which should be considered in the patellofemoral joint evaluation. © 2016, Makerere University, Medical School. All rights reserved.


Lufukuja G.J.,The Hubert Kairuki Memorial University
Italian Journal of Anatomy and Embryology | Year: 2016

The arterial supply of the heart is provided by the left and right coronary arteries, which arise from the ascending aorta immediately above the aortic valve. An anomalous origin of the left coronary artery from the right aortic sinus and vice versa is reported to be between 0.6% - 5.6% and is a clinical relevant congenital coronary malformation as it can lead to sudden death. Coronary anomalies are a poorly understood topic in modern cardiology especially in developing countries like Tanzania. Anomalous origins of coronary arteries may cause potentially dangerous symptoms and even sudden death during strenuous activity. A cadaveric study in an unsuspected population provides a basis for understanding the normal variants, which may facilitate determination of the prevalence of anomalies and evaluation of the value of screening for such anomalies. The present study describes the normal and variant anatomy of coronary arteries in a Tanzanian population. A total of 75 hearts were studied, where 77.3% of them were obtained from male cadaverous specimens. Results revealed that in 2.7% of the hearts the left and right coronary artery had originated from a common ostium in the left aortic sinus. These variations have been reported in several case reports and studies. However, there are no such extensive studies being conducted among Tanzanians. The present study was undertaken to shed more light on this topic and it provides a basis for understanding the normal variants, for determining the incidence of anomalies, and for evaluating the value of screening for such anomalies. © 2016 Firenze University Press.


Mutabingwa T.K.,The Hubert Kairuki Memorial University | Adam I.,University of Khartoum
Expert Review of Anti-Infective Therapy | Year: 2013

Artemether-lumefantrine is a fixed-dose combination containing 20 mg artemether/120 mg lumefantrine per tablet, used for treating uncomplicated malaria in patients weighing ≥5 kg. It is the first artemisinin-based combination registered in some European countries and in the USA. It is marketed in Europe as Riamet® (Novartis, Basel, Switzerland) and in malaria-endemic countries as Coartem® (Novartis). Safety concerns prevent early pregnancy usage, while limited postmarketing surveillance has delayed safety assessment and policy development. Large clinical studies, postmarketing surveillance and pharmacovigillance ongoing in some countries may soon bridge safety issues. Fatty diet requirements for optimal absorption, pregnancy-induced changes in pharmacokinetics, pregnancy-related anorexia and food taboos, and emerging reduced parasite sensitivity to artemisinin, challenges optimal artemether-lumefantrine dosing and efficacy during pregnancy. This evaluation addresses drug usage, safety concerns following early exposure, implications for changed pharmacokinetics and reduced parasite susceptibility. Clinical-use updates and strategies to address some knowledge gaps including key operational research are discussed. © 2013 Expert Reviews Ltd.


Mukherjee N.,Yale University | Kidd K.K.,Yale University | Pakstis A.J.,Yale University | Speed W.C.,Yale University | And 5 more authors.
Molecular Psychiatry | Year: 2010

Genetic variation at the catechol-O-methyltransferase (COMT) gene has been significantly associated with risk for various neuropsychiatric conditions such as schizophrenia, panic disorder, bipolar disorders, anorexia nervosa and others. It has also been associated with nicotine dependence, sensitivity to pain and cognitive dysfunctions especially in schizophrenia. The non-synonymous single nucleotide polymorphism (SNP) in exon 4Val108/158Metis the most studied SNP at COMT and is the basis for most associations. It is not, however, the only variation in the gene; several haplotypes exist across the gene. Some studies indicate that the haplotypic combinations of alleles at the Val108/158Met SNP with those in the promoter region and in the 3′-untranslated region are responsible for the associations with disorders and not the non-synonymous SNP by itself. We have now studied DNA samples from 45 populations for 63 SNPs in a region of 172 kb across the region of 22q11.2 encompassing the COMT gene. We focused on 28 SNPs spanning the COMT-coding region and immediately flanking DNA, and found that the haplotypes are from diverse evolutionary lineages that could harbor as yet undetected variants with functional consequences. Future association studies should be based on SNPs that define the common haplotypes in the population(s) being studied. © 2010 Nature Publishing Group All rights reserved.


Gutman J.,Malaria Branch | Kachur S.,Malaria Branch | Slutsker L.,Centers for Disease Control and Prevention | Nzila A.,King Fahd University of Petroleum and Minerals | Mutabingwa T.,The Hubert Kairuki Memorial University
Malaria Journal | Year: 2012

The antifolate sulphadoxine-pyrimethamine (SP) has been used in the intermittent prevention of malaria in pregnancy (IPTp). SP is an ideal choice for IPTp, however, as resistance of Plasmodium falciparum to SP increases, data are accumulating that SP may no longer provide benefit in areas of high-level resistance. Probenecid was initially used as an adjunctive therapy to increase the blood concentration of penicillin; it has since been used to augment concentrations of other drugs, including antifolates. The addition of probenecid has been shown to increase the treatment efficacy of SP against malaria, suggesting that the combination of probenecid plus SP may prolong the useful lifespan of SP as an effective agent for IPTp. Here, the literature on the pharmacokinetics, adverse reactions, interactions and available data on the use of these drugs in pregnancy is reviewed, and the possible utility of an SP-probenecid combination is discussed. This article concludes by calling for further research into this potentially useful combination. © 2012 Gutman et al; BioMed Central Ltd.


Sariah A.E.,The Hubert Kairuki Memorial University | Outwater A.H.,Muhimbili University of Health and Allied Sciences | Malima K.I.Y.,Tanzania Commission for Science and Technology COSTECH
BMC Psychiatry | Year: 2014

Background: Relapse in people with schizophrenia is a major challenge for mental health service providers in Tanzania and other countries. Approximately 10% of people with schizophrenia are re-admitted due to relapse at Muhimbili National Hospital (MNH) Psychiatric Unit each month. Relapse brings about negative effects and it results in a huge burden to patients, their families, the mental health sector and the country's economy. So far no study has been done to address relapse in Tanzania. The purpose of the study was to explore perspectives on risk and protective factors influencing relapse of people with schizophrenia and their caregivers attending Muhimbili National Hospital Psychiatric Out-patient Department, Dar es Salaam, Tanzania.Methods: A qualitative study was conducted, involving in-depth interviews of seven people with schizophrenia who are out-patients and their seven family caregivers at MNH. Purposive sampling procedure was used to select participants for the study. Audio recorded in-depth interviews in Swahili language were conducted with all study participants. The recorded information was transcribed and analyzed using NVivo 9 computer assisted qualitative data analysis software.Results: Personal risk and protective factors for relapse, environmental risk and protective factors for relapse and suggestions to reduce relapse were the main themes that emerged from this study. People with schizophrenia and their caregivers (all of whom were relatives) perceived non adherence to antipsychotic medication as a leading risk factor of relapse; other risks included poor family support, stressful life events and substance use. Family support, adherence to antipsychotic medication, employment and religion were viewed as protective factors. Participants suggested strengthening mental health psycho-education sessions and community home visits conducted by mental health nurses to help reduce relapse. Other suggestions included strengthening the nurse-patient therapeutic relationship in provision of mental health care.Conclusions: This study calls for improvement in mental health care service delivery to individuals with schizophrenia. Establishing a curricular in mental health nursing that aims to produce competent mental health nurse force would improve nursing practice in mental health care service delivery. © 2014 Sariah et al.; licensee BioMed Central Ltd.


PubMed | National Institute for Medical Research, Johns Hopkins University, University of California at San Francisco and The Hubert Kairuki Memorial University
Type: Journal Article | Journal: Qualitative health research | Year: 2016

The Fataki campaign aired in Tanzania via radio from 2008 to 2011 to address cross-generational sex, a major driver of HIV in the region. The campaign sought to incite social disapproval of men who engage in such relationships, generate dialogue around the issue, and encourage community interventions in these relationships through social learning. Using qualitative methods, we explored campaign reactions, use of the term Fataki to describe men in relationships with much younger women, and the nature of discussions spurred by the campaign. We conducted focus group discussions and individual interviews in Iringa and Pwani regions with young women, older men, and community leaders. Results showed that the Fataki term was widely used and had negative connotations reflecting social disapproval of men who participate in such relationships. Dialogue spurred by the campaign, primarily directed toward young women, focused on reasons for avoiding these relationships. We conclude with suggestions for relevant future interventions.


PubMed | Muhimbili University of Health and Allied Sciences and The Hubert Kairuki Memorial University
Type: | Journal: The Pan African medical journal | Year: 2016

Antimicrobial prophylaxis for urologic procedures is a major issue, as potential advantages of antibiotic administration should be carefully weighed against potential side effects, microbial resistance, and health care costs. This study aimed to review a six years trend of antibiotic use in urological surgeries at Muhimbili National Hospital (MNH) being an experience in a typical third world environment.This was a six years hospital based descriptive, retrospective study conducted of which all case notes of urological patients operated on in between January 2007 to December, 2012 were reviewed by using a structured data collecting tool. The data were analyzed using SPSS software.Male patients were the majority at 62% (450). The age range was 0 - 90 years, with a mean of 30 22.09. Among the urological surgeries done at MNH 86.5% (628) received prophylactic antibiotics regardless of the type surgery done. Majority 63.7% (463) received antibiotics during induction. Ceftriaxone was the commonly given antibiotic regardless of the type of urological surgery done. Most of patients (86.4%) were given antibiotics for five days regardless whether it was for prophylactic or treatment intention.Antibiotic use is still a challenge at our hospital with over use of prophylactic antibiotics without obvious indications. Prolonged use of prophylactic antibiotics beyond five days was the main finding. Ceftriaxone was the most given antibiotic regardless of the urological surgery done and its level of contamination. Antibiotic stewardship needs to be addressed urgently to avoid serious drug resistances leaving alone the cost implication.


PubMed | African Academy for Public Health AAPH, Muhimbili National Hospital, Muhimbili University of Health and Allied Sciences, The Hubert Kairuki Memorial University and Mbagala Rangi Tatu Hospital
Type: Journal Article | Journal: BMC public health | Year: 2016

The specific age to which an HIV infected child can be disclosed to is stipulated to begin between ages 4 and 6 years. It has also been documented that before disclosure of HIV positive status to the infected child. Health care providers should consider childrens cognitive-developmental ability. However, observation and situation analysis show that, health care providers still feel uncomfortable disclosing the HIV positive status to the infected child. The aim of the study was to explore healthcare providers experiences in disclosure of HIV-positive status to the infected child.A qualitative study involving 20 health care providers who attend HIV-positive children was conducted in September, 2014 in Dar es Salaam, Tanzania. Participants were selected from ten HIV care and treatment clinics (CTC) by purposive sampling. An interview guide, translated into participants national language (Kiswahili) was used during in-depth interviews. Sampling followed the principle of data saturation. The interviews focused on perspectives of health-care providers regarding their experience with paediatric HIV disclosure. Data from in-depth interviews were transcribed into text; data analysis followed qualitative content analysis.The results show how complex the process of disclosure to children living with HIV can be to healthcare providers. Confusion was noted among healthcare providers about their role and responsibility in the process of disclosing to the HIV infected child. This was reported to be largely due to unclear guidelines and lack of standardized training in paediatric HIV disclosure. Furthermore, healthcare providers were concerned about parental hesitancy to disclose early to the child due to lack of disclosure skills and fear of stigma. In order to improve the disclosure process in HIV infected children, healthcare providers recommended further standardized training on paediatric HIV disclosure with more emphasis on practical skills and inclusion of disclosure content that is age appropriate for children with HIV.The disclosure process was found to be a complex process. Perspectives regarding disclosure in children infected with HIV varied among healthcare providers in terms of their role in the process, clear national guidelines and appropriate standardized training for paediatric disclosure. Consistent with other studies, healthcare providers reported difficulties during disclosure because parents /guardians largely fear blame, social stigma, childs negative emotional reaction when disclosed to and have concerns about the child being too young and immature to understand the HIV condition.In order to prevent inconsistencies during the disclosure process, it is important to have in place clear guidelines and standardized paediatric HIV disclosure training for healthcare providers. This would help improve their skills in paediatric disclosure, leading to positive health outcomes for childreninfected with HIV.


PubMed | Juaben Government Hospital, Tropical Diseases Research Center, Kwame Nkrumah University Of Science And Technology, University of Antwerp and 7 more.
Type: Journal Article | Journal: Malawi medical journal : the journal of Medical Association of Malawi | Year: 2016

Information regarding the safety and efficacy of artemisinin combination treatments for malaria in pregnant women is limited, particularly among women who live in sub-Saharan Africa.We conducted a multicenter, randomized, open-label trial of treatments for malaria in pregnant women in four African countries. A total of 3428 pregnant women in the second or third trimester who had falciparum malaria (at any parasite density and regardless of symptoms) were treated with artemether-lumefantrine, amodiaquine-artesunate, mefloquine-artesunate, or dihydroartemisinin-piperaquine. The primary end points were the polymerase-chain-reaction (PCR)-adjusted cure rates (i.e., cure of the original infection; new infections during follow-up were not considered to be treatment failures) at day 63 and safety outcomes.The PCR-adjusted cure rates in the per-protocol analysis were 94.8% in the artemether-lumefantrine group, 98.5% in the amodiaquine-artesunate group, 99.2% in the dihydroartemisinin-piperaquine group, and 96.8% in the mefloquine-artesunate group; the PCR-adjusted cure rates in the intention-to-treat analysis were 94.2%, 96.9%, 98.0%, and 95.5%, respectively. There was no significant difference among the amodiaquine-artesunate group, dihydroartemisinin-piperaquine group, and the mefloquine-artesunate group. The cure rate in the artemether-lumefantrine group was significantly lower than that in the other three groups, although the absolute difference was within the 5-percentage-point margin for equivalence. The unadjusted cure rates, used as a measure of the post-treatment prophylactic effect, were significantly lower in the artemether-lumefantrine group (52.5%) than in groups that received amodiaquine-artesunate (82.3%), dihydroartemisinin-piperaquine (86.9%), or mefloquine-artesunate (73.8%). No significant difference in the rate of serious adverse events and in birth outcomes was found among the treatment groups. Drug-related adverse events such as asthenia, poor appetite, dizziness, nausea, and vomiting occurred significantly more frequently in the mefloquine-artesunate group (50.6%) and the amodiaquine-artesunate group (48.5%) than in the dihydroartemisinin-piperaquine group (20.6%) and the artemether-lumefantrine group (11.5%) (P<0.001 for comparison among the four groups).Artemether-lumefantrine was associated with the fewest adverse effects and with acceptable cure rates but provided the shortest posttreatment prophylaxis, whereas dihydroartemisinin-piperaquine had the best efficacy and an acceptable safety profile. (Funded by the European and Developing Countries Clinical Trials Partnership and others; ClinicalTrials.gov number, NCT00852423.).

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