Sutured and open clean-contaminated and contaminated laparotomy wounds at Muhimbili National Hospital: A comparison of complications

Background: Whether to close or leave open an abdominal incision wound depends on the degree of wound contamination at the end of operation. The aim of this study was to compare the complication rates between delayed primary closure and primarily closed laparotomy wounds for clean-contaminated and contaminated abdominal operations.Methods: Eighty-six patients undergoing laparotomy were included in a randomized clinical trial. Patients were randomized to have their wounds left open or closed primarily. In this study, all patients received Ceftriaxone Sodium (Powercef ®) as a prophylactic antibiotic at the time of induction of anaesthesia.Results: There was a statistically significant difference (p=0.002) in wound infection rate between those wounds left open (30.2%) and those closed primarily (2.1%). It required a longer duration of time for dressing those wounds left open compared to those closed primarily, The average duration for wound dressing was 16 days for open wounds compared to 11 days for primarily closed ones (p=0.0002). There was no significant difference in the development of wound dehiscence between the two groups (p>0.05). No death was related to wound complication.Conclusion: Clean-contaminated and contaminated laparotomy wounds should be closed primarily if no gross spillage of visceral contents occurs during operation and a patient receives prophylactic antibiotics

Educating Enough Competent Health Professionals: Advancing Educational Innovation at Muhimbili University of Health and Allied Sciences, Tanzania.

Sarah MacFarlane and colleagues share their lessons engaging in educational reform and faculty development with the Muhimbili University of Health and Allied Sciences in Tanzania and the University of California San Francisco

Hydraulic urethral dilatation after optical internal urethrotomy: preliminary report

Objectives: To determine the rate of early recurrence of urethral stricture in the first six months in patients who perform hydraulic urethral dilatation(HUD) after optical internal urethrotomy (OIU) and compare the early recurrence Fate in patients who perform HUD after OIU with the recurrence rates in patients reported in the literature whoundergo OIU without performing HUD.Design: Prospective descriptive rase series.Settings: Urology clinic, Muhimbili Medical Centre, Dar es Salaam, Tanzania.Subjects: Patients with symptoms of urethral structure subsequently radiologically demonstrated to have urethral structure that was deemed treatable by OIU.Interventions: Evaluation included urethrography, renal biochemical profile and urethroscopy at the time of OIU. Patients with structures no longer than 50mm, no complete block or marked tortuousness, and no paraurethral sepsis were selected for OIU. urethral catheter for seven days followed by HUD) for one month.Results: During a follow up period of five to seventeen months (mean 10.1 months), only two out of twenty three patients (8.7%) showed clinical evidence of stricture recurrence. The remaining patients reported normal voiding.Conclusion: This report suggests that HUD, a cost-free technique, is an effective method  or preventing stricture recurrence after 01U. As follow up of these and subsequent patients continue. it is hoped that this not-so-well- known technique will undergo evaluation at other centres in our region

Survey of surgical training and experience of associate clinicians compared with medical officers to understand task-shifting in a low-income country.

BackgroundA workforce crisis exists in global surgery. One solution is task-shifting, the delegation of surgical tasks to non-physician clinicians or associate clinicians (ACs). Although several studies have shown that ACs have similar postoperative outcomes compared with physicians, little is known about their surgical training. This study aimed to characterize the surgical training and experience of ACs compared with medical officers (MOs) in Tanzania.MethodsAll surgical care providers in Pwani Region, Tanzania, were surveyed. Participants reported demographic data, years of training, and procedures assisted and performed during training. They answered open-ended questions about training and post-training surgical experience. The median number of training cases for commonly performed procedures was compared by cadre using Wilcoxon rank sum and Student's t tests. The researchers performed modified content analysis of participants' answers to open-ended questions on training needs and experiences.ResultsA total of 21 ACs and 12 MOs participated. ACs reported higher exposure than MOs to similar procedures before their first independent operation (median 40 versus 17 cases respectively; P = 0·031). There was no difference between ACs and MOs in total training surgical volume across common procedures (median 150 versus 171 cases; P = 0·995). Both groups reflected similarly upon their training. Each cadre relied on the other for support and teaching, but noted insufficient specialist supervision during training and independent practice.ConclusionsACs report similar training and operative experience compared with their physician colleagues in Tanzania