HIV seroprevalence and factors affecting clinical outcomes among patients with surgical acute abdomen in selected hospitals in Mwanza, north-western in Tanzania

Background:  HIV infection has been reported to be prevalent in patients with surgical acute abdomen. This study aimed to establish HIV seroprevalence among patients with surgical acute abdomen and to identify factors affecting clinical outcomes among these patients at a tertiary care hospital in Tanzania Methods: This was a prospective cross-sectional study of patients with surgical acute abdomen admitted to three selected hospitals in Mwanza between February 2016 and July 2016.Results: Out of the 106 patients (M: F = 1.5:1) included in the study, 15 (14.2%) were HIV positive. Of these, nine were males and 6 were females. Surgical site infection was the most common postoperative compilation and was found to be significantly higher in HIV positive patients with CD 4+ count below 200 cells/μl (p<0.001). The median length of hospital stay (LOS) was 16 days. There was no significant difference in LOS between HIV positive and negative patients (p=0.791). Mortality rate was 13.2% and it was significantly higher in patients with advanced age (> 65 years), pre-existing medical illness, delayed presentation (>48 hours), HIV positivity, high American Society of Anesthetists class, surgical site infections (p< 0.001).Conclusion: This study has shown that HIV infection is prevalent among patients with surgical acute abdomen in our setting. Factors influencing the clinical outcome of these patients need to be addressed, in order to deliver optimal patient care and improve their treatment outcome

Patterns and outcome of surgical management of anorectal malformations at a tertiary care hospital in resource limited setting: a Tanzanian experience

 Background: Anorectal malformations (ARM) are common congenital abnormalities in most parts of the world and its management remains a challenge to surgeons practicing in resource-limited setting such as Tanzania. This study aimed to determine the patterns and outcome of surgical management of ARM at a Tanzanian tertiary care hospital. Methods and Patients: This was a cross sectional study (with a follow up component) of patients with ARMs admitted to Bugando Medical Centre between May 2014 and April 2017.Results: A total of 109 patients (M: F ratio= 1:1.4) were studied. The median age at diagnosis was 50 days. The majority of patients, 78(71.6%) were less than a year old. Most of patients, 91(83.5%) had major clinical type of ARMs. Associated congenital anomalies were recorded in 18 (16.5%) patients. The majority of patients, 64(58.7%) reported to hospital late in acute intestinal obstruction. Most of patients in this study, 107(98.2%) were initially managed by a preliminary colostomy before definitive treatment. Out of 109 patients with ARMs, only 39 (33.0%) underwent definitive operations. Of the 107 patients who had preliminary colostomy, only 28(26.2%) had their colostomies closed at the end of study period. The overall complication and mortality rates were 47.7% and 16.0% respectively. Delayed presentation (> 48 hours), associated congenital anomalies, prolonged duration of operation (> 3 hours) and surgical site infections were the main predictors of mortality (p < 0.001). The follow up of patients in this study was generally good as only 3(8.3%) patients were lost to follow up. Good results using Kelly’s scoring system were obtained in 83.3% of surviving patients.Conclusion: Anorectal malformations are common in our setting. The major type of ARMs is commoner than the minor type. The outcome of surgery is good when the patients present early at birth. Therefore there is need for increasing community awareness and among all healthcare workers who handle neonates to effect early presentation and therefore prompt management