Prevalence and factors associated with Trichomonas vaginalis infection among pregnant women attending public antenatal clinics in Mwanza city, North-western Tanzania

Background: Trichomonas vaginalis is a sexually transmitted parasitic infection known to cause vaginitis especially in women of child bearing age. The objective of this study was to determine the prevalence and factors associated with T. vaginalis among pregnant women attending public health facilities in Mwanza City, Tanzania.Methods: This cross sectional study was conducted among pregnant women aged 17-46 years attending three public antenatal clinics in Mwanza City, north-western Tanzania. Wet preparation and Giemsa stained thick smears techniques were used to diagnose T. vaginalis infection. Socio-demographic characteristics and other risk related behaviours were collected.Results: A total of 365 pregnant women participated in this study, 38 (10.41%) and 84 (23.01%) of them had trichomoniasis based on wet preparation and Giemsa stained thick smears respectively. On multivariable analysis, being HIV seropositive (AOR=11.65, 95%CI; 1.15-117.49, P<0.03) and having other sexual transmitted disease such as syphilis (AOR=4.40, 95%CI: 1.32-14.7, P<0.01) were significantly associated with T. vaginalis.Conclusion: The prevalence of T. vaginalis in pregnant women in Mwanza city is high and the infection is associated with sexually transmitted diseases such as syphilis and HIV. Routine screening of T. vaginalis during ante-natal care clinics is highly recommended to reduce pregnancy complications related to T. vaginalis infection

Iatrogenic ureteric injuries following abdomino-pelvic operations: a 10-year tertiary care hospital experience in Tanzania

Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity and even mortality. There is paucity of data regarding iatrogenic ureteric injuries in Tanzania and Bugando Medical Centre in particular. This study describes our experience in the management and outcome of ureteric injuries following abdomino-pelvic operations outlining the causes, clinical presentation and outcome of management of this condition in our local setting. This was a retrospective descriptive study of patients with iatrogenic ureteric injuries following abdomino-pelvic operations that were managed in Bugando Medical Centre between July 2004 and June 2014. A total of 164 patients (M: F = 1: 1.6) were studied. Of these, 154 (93.9%) were referred to Bugando Medical Centre having had their initial surgeries performed at other hospitals, whereas 10 (6.1%) patients sustained ureteric injuries during abdomino-pelvic surgery at Bugando Medical Centre. The median age at presentation was 36 years. The most common cause of iatrogenic ureteric injuries was total abdominal hysterectomy occurring in 69.2% of cases. The distal ureter was more frequently injured in 75.6% of cases. Suture ligation was the commonest type of injury accounting for 36.6% of patients. One hundred and sixteen (70.7%) patients had delayed diagnosis but underwent immediate repair. Ureteroneocystostomy was the most frequent reconstructive surgery performed in 58.0% of cases. Of the 164 patients, 152 (92.7%) were treated successfully. Twelve (7.3%) patients died in hospital. The main predictors of deaths were delayed presentation, deranged renal function tests on admission, missed ureteric injuries and surgical site infections (P < 0.001). The overall median length of hospital stay was 12 days. Follow up of patients was generally poor as more than half of patients were lost to follow up. Total abdominal hysterectomy still accounts for most cases of iatrogenic ureteric injuries in our environment. Meticulous surgical technique as well as identification of the course of the ureter and associated anatomic locations where injury is most likely to occur is important to decrease the risk of ureteric injury. Timely recognition of ureteric injury and its management is associated with good outcome

Factors Associated with Women with Multiple Caesarean Deliveries Presenting in Labour and their Fetomaternal Outcomes in Mwanza Region, Tanzania.

Background: Emergency caesarean section(C-section) for women with two or more uterine scars is documented to be associated with poor fetomaternal outcomes. The World Health Organization recommends elective C-section for women with two or more previous scars. However, in Tanzania there is a paucity of data for women with two or more prior C-sections and how it contributes to increased maternal and perinatal morbidity and mortality when they come in active labour without a planned delivery. The purpose of the study was to determine factors associated with pregnant women with multiple C-section deliveries presenting in labour and their fetomaternal outcomes. Methods: This was a cross-sectional, hospital-based study, involving 275 pregnant women who underwent C-section due to multiple uterine scars in the Mwanza region. Socio-demographic and clinical characteristics were collected serially until the sample size was reached using a structured questionnaire and patients’ files. Data were analyzed using STATA version 13.0 software. Results: All pregnant women with two or more previous uterine scars attended antenatal care (ANC) and the majority, 62.2%, had four or more visits. However, 61.9% were not told of the need for elective C-section. In addition, 26% were not counselled about the obstetric danger signs. Among the study participants, 66.6% presented with labour pain requiring emergency C-section, 13.1% had postpartum hemorrhage and 3.3% had ruptured uterus. There were 3.3% peri-natal deaths and 10.9% required newborn resuscitation. The associated factors for women with two or more C-section scars presenting in active labour were: having the last ANC visit at primary healthcare (PHC) facility (p=0.046), unemployment (p&lt;0.001), visiting ANC &lt;4 visits (p=0.002) or being attended by a non-physician health provider in her last ANC visit(p&lt;0.001). Conclusion: Parturient women with uterine scars, when attending primary health care facilities for their ANC visits, ought to be counselled and referred to high facilities with clinicians who can plan an elective c-section delivery

Bowel Perforation Secondary to Illegally Induced Abortion: a Tertiary Hospital Experience in Tanzania.

Bowel perforation though rarely reported is a serious complication of induced abortion, which is often performed illegally by persons without any medical training in developing countries. A sudden increase in the number of patients in our centre in recent years prompted the authors to analyze this problem. The study was conducted to describe our own experiences in the surgical management of these patients. This was a retrospective study involving patients who were jointly managed by the surgical and gynecological teams at Bugando Medical Centre (BMC) for bowel perforation secondary to illegally induced abortion from January 2002 to December 2011. The statistical analysis was performed using SPSS version 17.0. A total of 68 patients (representing 4.2% of cases) were enrolled in the study. Their ages ranged from 14 to 45 years with a median age of 21 years. Majority of patients were, secondary school students/leavers (70.6%), unmarried (88.2%), nulliparous (80.9%), unemployed (82.4%) and most of them were dependent member of the family. Previous history of contraceptive use was reported in only 14.7% of cases. The majority of patients (79.4%) had procured the abortion in the 2nd trimester. Dilatation and curettage (82.4%) was the most common reported method used in procuring abortion. The interval from termination of pregnancy to presentation in hospital ranged from 1 to 14 days (median 6 days ). The ileum (51.5%) and sigmoid colon (22.1%) was the most common portions of the bowel affected. Resection and anastomosis with uterine repair was the most common (86.8%) surgical procedure performed. Complication and mortality rates were 47.1% and 10.3% respectively. According to multivariate logistic regression analysis, gestational age at termination of pregnancy, delayed presentation, delayed surgical treatment and presence of complications were significantly associated with mortality (P<0.001). The overall median length of hospital stay (LOS) was 18 days (1day to 128 days ). Patients who developed complications stayed longer in the hospital, and this was statistically significant (P=0.012). Bowel perforation following illegally induced abortion is still rampant in our environment and constitutes significantly to high maternal morbidity and mortality. Early recognition of the diagnosis, aggressive resuscitation and early institution of surgical management is of paramount importance if morbidity and mortality associated with bowel perforation are to be avoided

Maternal vaginorectal colonization by Group B Streptococcus and Listeria monocytogenes and its risk factors among pregnant women attending tertiary hospital in Mwanza, Tanzania

Background: Group B streptococcus (GBS) and Listeria monocytogenes are members of the normal microbes of the female genital tract. During labour GBS and Listeria monocytogenes may infect the new-borns, leading to neonatal sepsis and meningitis. So far, there is no report on prevalence of GBS and Listeria monocytogenes among pregnant women in Mwanza. The objective of the study was to determine the magnitude of Group B Streptococcus and Listeria monocytogenes and its associated factors at Bugando Medical Centre, Mwanza, Tanzania.Methods: The study was a cross section conducted from 1st November 2011 to 31st May 2012 at Bugando Medical Centre in Mwanza, Tanzania.  Vaginal and rectal swabs were obtained and cultured on 5% sheep blood agar and susceptibility testing done using disk diffusion technique.Results: A total of 295 pregnant women participated in the study. GBS strains were isolated from 28 (9.49%) and only two (0.68%) had isolates of Listeria spp. All GBS and Listeria spp. isolates were sensitive to penicillin and ampicillin. Eight GBS isolates were resistant to erythromycin (28.6%), seven GBS isolates were resistant to clindamycin (25%) and 15 of GBS isolates were resistant to tetracycline (53.6%). One Listeria spp isolate was resistant to cotrimoxazole. Pregnant women with no formal education and those dwelling in rural areas were more frequently colonized by GBS.Conclusion: There is a significant prevalence rate of GBS culture positive at Bugando Medical Centre with demonstrable resistant to some common antibiotics (tetracycline, erythromycin and Clindamycin). Screening for GBS should be instituted in Tanzania between 35 and 37 weeks of gestation coupled with regular check up for antimicrobial susceptibility pattern due to emerging resistance toward existing antibiotics

Prevalence of Bacterial Vaginosis and Associated Factors among Pregnant Women Attending at Bugando Medical Centre, Mwanza, Tanzania

Bacterial vaginosis (BV) is an extremely common reproductive tract condition worldwide with reported high prevalence among African population. Factors associated with this condition include preterm labour, premature rupture of membranes, preterm delivery and possibly spontaneous abortion. Nevertheless, antenatal screening and treatment is not routinely available in most poor-resource countries including Tanzania. A cross-sectional descriptive study was conducted among delivering women at Bugando Medical Centre (BMC), Mwanza, Tanzania to determine the magnitude of the BV using the Nugent’s criteria and to document factors associated with the condition. A total of 284 women who presented for delivery at BMC labour ward from February to March 2011 were recruited into the study. For each consented women, a vaginal swab was taken, samples collected tested and a Nugent’s score of at least seven indicated bacterial vaginosis. Overall, bacterial vaginosis was diagnosed in 28.5% (n=81) of all participants. Gardnerella was the commonest morphotypes found in approximately 66.2% (n=188) of all participants while 11.6% (33 participants) had Mobilincus. There were no evidence for the association between bacterial vaginosis having formal education, (OR, 1.42[95%CI, 0.29-6.97; p=0.667]). Urban residence (OR, 1.29 [95% CI, 0.76-2.19; p=0.352]), ever delivered before (OR 0.66[95%CI, 0.39-1.12; p=0.126]), vaginal practice to enhance dry sex (OR, 1.16[95%CI, 0.43-3.17; p=0.768]) or wet sex (OR 1.31[95%CI, 0.46-3.7; p=0.613]), gestation age less than 37 weeks (OR 0.82[95%CI, 0.45-1.51; p=0.534]) and HIV infection (OR 0.90[95%CI, 0.28-2.92; p=0.863]) were not associated with bacterial vaginosis. Bacterial vaginosis is common among women delivering at Bugando Medical Centre and more studies to include antenatal clinic attendees initiating care are required to reliably document the magnitude the condition

Maternal and Perinatal Outcomes among Eclamptic Patients Admitted to Bugando Medical Centre, Mwanza, Tanzania

Eclampsia continues to be a major problem, particularly in developing countries such as Tanzania, contributing significantly to high maternal and perinatal morbidity and mortality. We conducted a study to establish the incidence of eclampsia and the associated maternal and perinatal outcomes among eclamptic patients admitted to our center. A descriptive cross-sectional study of all women presenting with eclampsia was performed from June 2009 to February 2010. Seventy-six patients presented with eclampsia out of a total 5562 deliveries during the study period (incidence of 1.37%). Antenatal attendance was 96% among patients with eclampsia; however, only 45.21% and 24.66% were screened for blood pressure and proteinuria respectively. Maternal and perinatal case fatality rates were 7.89% and 20.73% respectively. The main factors contributing to maternal deaths were acute renal failure (10.5%), pulmonary oedema (10.5%), maternal stroke (8.8%), HELLP syndrome (50.9%), and Disseminated Intravascular Coagulopathy (3.5%). Perinatal deaths were caused by prematurity (42.9%) and birth asphyxia (57.1%). Forty-eight babies had low-birth weight (58.54%). The high incidence of eclampsia and its complications during this study period may indicate the need for earlier and more meticulous intervention at both the clinic and hospital levels Keywords: Eclampsia, maternal, perinatal, morbidity, mortality, TanzaniaAfr J Reprod Health 2012; 16[1]:35-4

Maternal Death Reviews at Bugando Hospital North-western Tanzania: A 2008-2012 Retrospective Analysis.

Unacceptably high levels of maternal deaths still occur in many sub-Saharan countries and the health systems may not favour effective use of lessons from maternal death reviews to improve maternal survival. We report results from the analysis of data from maternal death reviews at Bugando Medical Centre north-western Tanzania in the period 2008-2012 and highlight the process, challenges and how the analysis provided a better understanding of maternal deaths. Retrospective analysis using maternal death review data and extraction of missing information from patients' files. Analysis was done in STATA statistical package into frequencies and means ± SD and median with 95 % CI for categorical and numerical data respectively. There were 80 deaths; mean age of the deceased 27.1 ± 6.2 years and a median hospital stay of 11.0 days [95 % CI 11.0-15.3]. Most deaths were from direct obstetric causes (90); 60 % from eclampsia, severe pre-eclampsia, sepsis, abortion and anaesthetic complications. Information on ANC attendance was recorded in 36.2 % of the forms and gestation age of the pregnancy resulting into the death in 23.8 %. Sixty one deaths (76.3 %) occurred after delivery. The mode of delivery, place of delivery and delivery assistant were recorded in 44 (72.1), 38 (62.3) and 23 (37.7 %) respectively. Routine maternal death reviews in this setting do not involve comprehensive documentation of all relevant information, including actions taken to address some identified systemic weaknesses. Periodic analysis of available data may allow better understanding of vital information to improve the quality of maternity care

Blood transfusion practice in surgery at Bugando Medical Centre in northwestern Tanzania

 Background: Preoperative over-ordering of blood for surgical intervention, in excess of the actual and anticipated needs is a common practice in many developing countries. This can be decreased by simple means of changing the blood cross matching and ordering schedule depending upon the type of surgery performed. The aim of this study was to assess the blood transfusion practice in surgery at Bugando Medical Centre in northwestern Tanzania.Methods and Patients: This was a prospective cross sectional study among patients undergoing major operations at Bugando Medical Centre. We evaluated blood ordering and transfusion practices in emergency and elective surgical procedures at our centre and calculated different indices such as cross-match to transfusion ratio (C/T ratio), transfusion probability (% T) and transfusion index (TI). Next Maximal Surgical Blood Ordering System (MSBOS) was estimated for each procedure.Results: The overall blood utilization was only 28.2% at our centre, consisting of 17.1% in the elective operations and 26.9% in the emergency operations. Significant blood utilization was nil in most of the routine elective cases suggesting cross-matching of blood to be a culture than necessity. Generally, the overall blood transfusion of the requested blood as indicated by indices of C/T ratio, %T, TI and MSBOS were 3.5, 28.7%, 0.33 and 0.45, respectively. The overall CT ratio, %T, Ti and MSBOS in the elective operations were 5.8, 15.9%, 0.2 and 0.3, respectively. In the emergency operations, the overall CT ratio, %T, Ti and MSBOS were 3.7, 22%, 0.32 and 0.48, respectively.Conclusion: This study demonstrated that over-ordering of blood in excess of the actual needs is a common practice in our setting.  Blood ordering pattern needs to be revised and over-ordering of blood should be minimized. This can be possible by the estimation of MSBOS for each procedure and requisition as calculated