Post-Circumcision Urethro-Cutaneous Fistula: The Key to Successful Reconstruction.

Background: Routine circumcision of boys is a common practice in Tanzania. Because sometimes it is performed by persons with no surgical training, complications, including urethro-cutaneous fistula (UCF), are not uncommon.Methods: Five boys whose ages ranged between 4 and 12 years with UCF were seen at four Dar es Salaam hospitals between 2002 and 2005. Personal particulars, the personnel doing the circumcision, description of the repair and follow up were recorded on a data sheet. Intravenous Augmentin was given at induction of anaesthesia for the fistula repair. A urethral catheter was inserted, and then a tourniquet was applied at the base of the penis. After incision and development of skin flaps the urethra was closed, a layer of dartos fascia interposed, followed by closure of the skin, all with 6/0 Vicryl. A compression dressing was applied, and the catheter was left in for 5-7 days.Results: The boys ranged in age between 5 and 12 years, and had undergone circumcision at age 2 to 12 years. All patients were circumcised by paramedical personnel or a traditional practitioner. Urine leakage commenced 2 days to 2 weeks after circumcision. Four boys had coronal while one had a glandular UCF. No post repair complication was reported after follow up of 3 to 20 weeks.Conclusion: Use of fine synthetic absorbable sutures and careful closure of the fistula with interposition of a pedicles dartos graft, are the main prerequisites for success. Attention to details of surgical technique can produce consistently good results in repair of UCF

Integrity of Indigenous Knowledge Systems in Natural Resource Management: The Case of the Arid and Semi-Arid Baringo Herders of Kenya

Ineffective management of natural resources in arid and semi-arid lands (ASALs), resulting in resource depletion, rapid loss of biodiversity and environmental degradation, is of great concern globally. The Baringo herders in the ASALs of Kenya have been branded as perpetrators of this vice, with the blame placed particularly on their traditional livestock management, utilising indigenous knowledge systems (IKS). These IKS involve livestock mobility and maximisation, and have been regarded as being outdated and inefficient in meeting the challenges and demands for environmental conservation and sustainable management of the natural resources. A common reaction of the government has been to advocate modern interventions that are based on exogenous knowledge systems (EKS), involving sedentary livestock raising and destocking. These EKS are, however, not performing as well as expected, since they are not adapted to the ASALs ecological conditions and the herders\u27 socio-economic and cultural situations (Aboud et al 1997; Makenzi, 2003). This study empirically explored the above propositions, in order to test the integrity of the IKS, in relation to EKS and the herders\u27 levels of education

Of Grasslands and Guns: Natural-Resource Based Conflict Among the Waso Borana Pastoralists of Northern Kenya

The once productive, arid rangelands of northern Kenya, traditionally dominated by a mix of woody species (Acacia, Commiphora, Cordia spp.) and graminoids (Tetrapogon, Aristida, Chrysopogon and Sporobolus spp.) have gradually deteriorated in ecological condition over recent decades (Herlocker, 1999). A major factor considered to be responsible for this trend is the disintegration of traditional systems of land stewardship. Traditional authority has waned in northern Kenya and has often been replaced by open-access tenure, overseen by ineffectual government administrators. Couple this with frequent droughts that typify this zone, as well as expanding populations of people and livestock, and the net result is increased competition for diminishing quantity and quality of grazing and water resources. Local people throughout northern Kenya have reportedly entered a survival mode of existence where the incidence of armed conflict has increased because resource-based disputes have intensified (Smith et al., 2000). The objective of this research was to investigate and quantify the views of the Waso Boran people, one of many ethnic groups in the northern Kenyan rangelands, concerning the causes, and possible solutions, for their conflicts that revolve around natural resources

Experiences of obesity among Saudi Arabian women contemplating bariatric surgery: An interpretative phenomenological analysis

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2013 The Authors.This study explored experiences of obesity, its perceived causes and motives for surgery, as described by seven Saudi women contemplating bariatric surgery. The women experienced cultural restrictions on their physical and social activities. Obesity embodied these restrictions, attracting stigma and moral failure. Traditional clothing, foods, hospitality norms and limited outdoor female activities were regarded as barriers to weight loss. Bariatric surgery was chosen to protect health and to access normative female roles. Some were encouraged by relatives who had undergone surgery. Opting for surgery reflected both participants’ sense of powerlessness to self-manage weight and the social acceptability, within their family context, of this biomedical approach

Kagera Regional and District Projections

This report presents population projections for the period 2003 to 2025 for the Kagera Region and its districts. The projections were made using a Cohort Component Method (Spectrum System), whereby three components responsible for population change, namely: mortality, fertility and migration were projected separately as well as HIV/AIDS prevalence. The projected components were then applied to 2002 midyear base population in order to come up with the desired projections from 2003 to 2025. The report gives mortality, fertility, migration and HIV/AIDS assumptions, which depicts Kagera’s demographic and socio-economic future trends. The results include estimated population by sex in single years and five-year age groups as well as some demographic indicators. Population growth for the period 2003 to 2025 shows an increase in growth rates. The projections show that population growth rate will increase from 3.1 percent in 2003 (with a population of 1,982,612) to 3.7 percent in 2025 (with a population of 4,511,927). Sex Ratio at birth is projected to increase from 96 male births per 100 females in 2003 to 99 male births per 100 females in 2025. Mortality estimates show that Infant Mortality Rate (IMR) is expected to decline for both sexes from 117 deaths per 1,000 live births in 2003 to 72 deaths per 1,000 live births in 2025. Under Five Mortality Rate (U5MR) for both sexes will also decline from 195 deaths per 1,000 live births in 2003 to 113 deaths per 1,000 live births in the year 2025. The mortality projected estimates further show that the life expectancy at birth for females is higher compared to that of males, which is expected. Life expectancy at birth for Kagera will increase from 48 years in 2003 to 55 years in 2025 for both sexes. For male population, life expectancy at birth will increase from 46 years in year 2003 to 54 years in 2025, while for female population the life expectancy at birth will increase from 49 years in 2003 to 56 years in 2025

Lindi Regional and District Projections

\ud This report presents population projections for the period 2003 to 2025 for Lindi Region and its districts. The projections were made using a Cohort Component Method (Spectrum System), whereby three components responsible for population change, namely: mortality, fertility and migration were projected separately as well as HIV/AIDS prevalence. The projected components were then applied to 2002 midyear base population in order to come up with the desired projections from 2003 to 2025. The report gives mortality, fertility, migration and HIV/AIDS assumptions, and shows Lindi’s demographic and socio-economic future trends. The results include estimated population by sex in single years and five-year age groups as well as some demographic indicators. Population growth for the period 2003 to 2025 shows fluctuations. The projections show that\ud population growth rate will increase from 1.4 percent in 2003 (with a population of 801,189) to 1.6 percent in 2025 (with a population of 1,209,623). Sex Ratio at birth is projected to increase from 93 males births per 100 females in 2003 to 97 males births per 100 females in 2025. Mortality estimates show that Infant Mortality Rate (IMR) is expected to decline for both sexes from 116 deaths per 1,000 live births in 2003 to 53 deaths per 1,000 live births in 2025. Under Five Mortality Rate (U5MR) for both sexes will also decline from 194 deaths per 1,000 live births in 2003 to 80 deaths per 1,000 live births in the year 2025. The mortality projected estimates further show that the life expectancy at birth for females is higher compared to that of males. Life expectancy at birth for Lindi will increase from 48 years in 2003 to 60 years in 2025 for both sexes. For male population, life expectancy at birth will increase from 47 years in year 2003 to 59 years in 2025, while for female population the life expectancy at birth will increase from 49 years in 2003 to 61 years in 2025. On fertility, TFR will decline from 4.4 children per woman in 2003 to 3.4 children per woman in 2025.\u

Iringa Regional and District Projections.

This report presents population projections for the period 2003 to 2025 for Iringa Region and its districts. The projections were made using a Cohort Component Method (Spectrum System), whereby three components responsible for population change, namely: mortality, fertility and migration were projected separately as well as HIV/AIDS prevalence. The projected components were then applied to 2002 midyear base population in order to come up with the desired projections from 2003 to 2025. The report gives mortality, fertility, migration and HIV/AIDS assumptions, and shows Iringa’s demographic and socio-economic future trends. The results include estimated population by sex in single years and five-year age groups as well as some demographic indicators. Population growth for the period 2003 to 2025 shows a decrease in growth rates. The projections show that population growth rate will decrease from 1.6 percent in 2003 (with a population of 1,520,891) to 0.4 percent in 2025 (with a population of 2,019,217). Sex Ratio at birth is projected to increase from 90 male births per 100 females in 2003 to 99 male births per 100 females in 2025. Mortality estimates show that Infant Mortality Rate (IMR) is expected to decline for both sexes from 127 deaths per 1,000 live births in 2003 to 78 deaths per 1,000 live births in 2025. Under Five Mortality Rate (U5MR) for both sexes will also decline from 207 deaths per 1,000 live births in 2003 to 122 deaths per 1,000 live births in the year 2025. The mortality projected estimates further show that the life expectancy at birth for both males and females stands at 45 years in 2003. Life expectancy at birth for Iringa will decline from 45 years in 2003 to 44 years in 2025 for both sexes. For male population, life expectancy at birth will remain at the same level of 45 years in year 2003 and year 2025, while for female population the life expectancy at birth will decline from 45 years in 2003 to 43 years in 2025. On fertility, TFR will decline from 4.9 children per woman in 2003 to 2.6 children per woman in 2025.\u

An exploration of the lived experience of leaving Jehovah's Witnesses

The act of disaffiliating from one’s religion has become more common in recent years, although few studies have investigated the phenomenon in an experiential way. For those who are socialised into a high-demand religion, disaffiliation may involve excommunication, where individuals are cut off from their closest family and friends. This study investigates one such religion, Jehovah’s Witnesses, by asking how former Jehovah’s Witnesses experience leaving the religion. Interpretive Phenomenological Analysis was used to analyse interview data collected from eight former Jehovah’s Witnesses. Findings suggested that leaving the movement is characterised by emotional trauma and existential insecurity. With this, three master themes emerged: Chancing one’s own truth encapsulated a desire to rebel from the religion which deprived them of experiences which were wanted. An outcast in a foreign world evidenced the alienation and emotional trauma participants experienced in relation to their closest relatives. Held captive to death sentence reflected a deep insecurity which former members held about being deserving of death at the hands of their once loving God, Jehovah. The findings relate to studies involving the intersection of religion, disaffiliation and mental health. Implications for counsellors and psychologists working with former members of high-demand religions are discussed

Dar es Salaam Regional and District Projections.

This report presents population projections for the period 2003 to 2025 for Dar es Salaam Region. The projections were made using a Cohort Component Method (Spectrum System), whereby three components responsible for population change, namely: mortality, fertility and migration were projected separately as well as HIV/AIDS prevalence. The projected components were then applied to 2002 midyear base population in order to come up with the desired projections from 2003 to 2025. The report gives mortality, fertility, migration and HIV/AIDS assumptions, and shows Dar es Salaam’s demographic and socio-economic future trends. The results include estimated population by sex in single years and five-year age groups as well as some demographic indicators. Population growth for the period 2003 to 2025 shows a decrease in growth rates. The projections show that population growth rate will decrease from 1.99 percent in 2003 (with a population of 2,535,594) to 0.27 percent in 2025 (with a population of 3,055,456). Sex Ratio at birth is projected to increase slightly from 102 male per 100 females in 2003 to 103 male per 100 females in 2025. Mortality estimates show that Infant Mortality Rate (IMR) is expected to decline for both sexes from 80 deaths per 1,000 live births in 2003 to 49 deaths per 1,000 live births in 2025. Under Five Mortality Rate (U5MR) for both sexes will also decline from 122 deaths per 1,000 live births in 2003 to 71 deaths per 1,000 live births in the year 2025. As expected, the mortality projected estimates further show that the life expectancy at birth for females is higher compared to that of males. Life expectancy at birth for Dar es Salaam will decline from 55 years in 2003 to 52 years in 2025 for both sexes. For male population, life expectancy at birth will almost remain at 53 years for the whole period. For female population, the life expectancy at birth will decline from 57 years in 2003 to 52 years in 2025. On fertility, TFR will decline from 2.7 children per woman in 2003 to about 2 children per woman in 2025.\u