Knowledge, practice and factors associated with poor compliance with universal precautions among healthcare workers at Bugando Medical Centre, Mwanza, Tanzania

Background: Healthcare workers (HCWs) are exposed to blood-borne infections by pathogens, such as HIV, and Hepatitis B and C viruses, as they perform their clinical activities in hospitals. Compliance with universal precautions has been shown to reduce the risk of exposure to these pathogens. This aimed at assessing the knowledge, practices and factors associated with poor compliance to universal precautions among HCWs at Bugando Medical Centre in Mwanza, Tanzania.Methods: This was a cross sectional study carried out from December 2014 to February 2015.Results: There were 200 participants including 62 (31.0%) doctors, 74 (37.0%) nurses, laboratory personnel 34 (17.0%) and 29 (14.5%) auxiliary HCWs. More than three quarters (82%) of participants had adequate knowledge of uni­versal precautions. There was statistically significant difference between knowledge of universal precautions and sex, job category, working experience (≥ 5 years) and previous training on universal precautions. Out of 200 HCWs, 154 (77.0%) practiced universal precautions. Working experience (≥ 5 years) and previous training on universal precautions were significantly associated with good practice of universal precautions (P < 0.001). There was a strong correlation between knowledge and compliance (practice) with universal precautions (r=0.76, p<0.001). Factors associated with poor compliance with universal precautions included lack of personal protection equipment (69.5%), lack of knowledge (65.0%), emergency situations (63.0%), presumption that patient is not infected with HIV or HBV (59.0%), time constraints (53.0%), heavy workload (48.0%) and absence of penalties (34.0%).Conclusion: There was adequate knowledge and a fair level of compliance among HCWs towards universal precautions. These findings sug­gest that training of health care workers to increase their knowledge about blood-borne pathogens and universal precau­tions could improve their compliance and thus reduce health care workers’ risk of blood-borne patho­gen exposure

Animal-Related Injuries in a Resource-Limited Setting: Experiences from a Tertiary Health Institution in Northwestern Tanzania.

Animal related injuries are a major but neglected emerging public health problem and contribute significantly to high morbidity and mortality worldwide. No prospective studies have been done on animal related injuries in our setting. This study was conducted to determine the management patterns and outcome of animal related injuries and their social impact on public health policy in the region. This was a descriptive prospective study of animal related injury patients that presented to Bugando Medical Centre between September 2007 and August 2011. Statistical data analysis was done using SPSS computer software version 17.0. A total of 452 (8.3%) animal-related injury patients were studied. The modal age group was 21-30 years. The male to female ratio was 2.1:1. Dog-bites (61.1%) were the most common injuries. Musculoskeletal (71.7%) region was the most frequent body region injured. Soft tissue injuries (92.5%) and fractures (49.1%) were the most common type of injuries sustained. Only 140 (31.0%) patients were hospitalized and most of them (97.1%) were treated surgically. Wound debridement was the most common procedure performed in 91.2% of patients. Postoperative complication rate was 15.9%, the commonest being surgical site infections (SSI) in 55.1% of patients. SSI was significantly associated with late presentation and open fractures (P < 0.001). The overall median duration of hospitalization was 16 days. Patients who had severe injuries, long bone fractures and those with hemiplegia stayed longer in the hospital (P < 0.001). Mortality rate was 10.2% and was significantly high in patients with severe injuries, severe head injury, tetanus and admission SBP < 90 mmHg (P < 0.001). The follow up of patients was poor. Animal related injuries constitute a major public health problem in our setting and commonly affect the young adult male in their economically productive age-group. Measures towards prevention and proper treatment and follow up are important in order to reduce morbidity and mortality resulting from this form of trauma

Prevalence of HIV Infection among Trauma Patients Admitted to\ud Bugando Medical Centre, Mwanza, Tanzania and its\ud Influence on Outcome

HIV infection, a major health problem worldwide, has been reported to be prevalent in trauma patients, thus presents an occupational hazard to health care workers who care for these patients. The purpose of this study was to establish the prevalence of HIV among trauma patients in our setting and to compare the outcome of these patients who are HIV positive with those who are HIV negative. This was a descriptive cross sectional study involving trauma patients aged 11 years and above, admitted to the surgical wards of Bugando Medical Centre in Mwanza, Tanzania over a six-month period from October 2008 to March 2009. All eligible patients were consecutively enrolled in the study. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS computer software. A total of 250 trauma patients were recruited and studied. The mean age of the study population was 36.37±15.35. Males accounted for the majority (N=202; 80.8%) of the study population. The prevalence of HIV among trauma patients was 11.6%. Among the HIV positive patients, 26 (89.7%) were males and majority aged 31-40 years. Seventy two percent of HIV positive patients had CD4+ count of ≥ 200 cells/μl. Overall length of hospital stays (LOS) ranged from 1 - 90 days with mean of 19.11 ± 15.84 days. Using multivariate logistic regression, injury severity score (ISS) (P=0.0026), revised trauma scores (RTS) (P= 0.002,), HIV seropositivity (P= 0.0012) and CD4+ count (P= 0.001) were significantly found to be associated with increased LOS. Mortality rate was 10.8% and was significantly associated with; the body region injured (P < 0.05), ISS (P = 0.026), RTS (P = 0.001), PTS (P= 0.01), HIV positivity (P= 0.0001) and CD4+ count (P= 0.035). HIV is prevalent among trauma patients in our setting. A substantial risk of exposure to HIV exists in health workers who care for these patients. Thus, all trauma health care workers in this region need to practice universal barrier precautions in order to reduce the risk of exposure to HIV infection. HIV positive patients with CD4+ count ≥200cells/μl have similar prognosis as HIV negative patients and therefore should be treated the same way

Experiences With Surgical Treatment of Chronic Lower Limb Ulcers at a Tertiary Hospital in Northwestern Tanzania: A Prospective Review of 300 Cases.

Chronic lower limb ulcers constitute a major public health problem of great important all over the world and contribute significantly to high morbidity and long-term disabilities. There is paucity of information regarding chronic lower limb ulcers in our setting; therefore it was necessary to conduct this study to establish the patterns and outcome of chronic lower limb ulcers and to identify predictors of outcome in our local setting. This was a descriptive prospective study of patients with chronic lower limb ulcers conducted at Bugando Medical Centre between November 2010 and April 2012. Ethical approval to conduct the study was sought from relevant authorities. Statistical data analysis was done using SPSS version 17.0 and STATA version 11.0. A total of 300 patients were studied. Their ages ranged from 3 months to 85 years (median 32 years). The male to female ratio was 2:1. The median duration of illness was 44 days. Traumatic ulcer was the most frequent type of ulcer accounting for 60.3% of patients. The median duration of illness was 44 days. The leg was commonly affected in 33.7% of cases and the right side (48.7%) was frequently involved. Out of 300 patients, 212 (70.7%) had positive aerobic bacterial growth within 48 hours of incubation. Pseudomonas aeruginosa (25.5%) was the most frequent gram negative bacteria isolated, whereas gram positive bacteria commonly isolated was Staphylococcus aureus (13.7%). Twenty (6.7%) patients were HIV positive with a median CD4+ count of 350 cells/μl. Mycological investigation was not performed. Bony involvement was radiologically reported in 83.0% of cases. Histopathological examination performed in 56 patients revealed malignancy in 20 (35.7%) patients, of which malignant melanoma (45.0%) was the most common histopathological type. The vast majority of patients, 270 (90.0%) were treated surgically, and surgical debridement was the most common surgical procedure performed in 24.1% of cases. Limb amputation rate was 8.7%. Postoperative complication rate was 58.3% of which surgical site infection (77.5%) was the most common post-operative complications. The median length of hospital stay was 23 days. Mortality rate was 4.3%. Out of the two hundred and eighty-seven (95.7%) survivors, 253 (91.6%) were treated successfully and discharged well (healed). After discharge, only 35.5% of cases were available for follow up at the end of study period. Chronic lower limb ulcers remain a major public health problem in this part of Tanzania. The majority of patients in our environment present late when the disease is already in advanced stages. Early recognition and aggressive treatment of the acute phase of chronic lower limb ulcers at the peripheral hospitals and close follow-up are urgently needed to improve outcomes of these patients in our environment

Dermatological Malignancies at a University Teaching Hospital in north-western Tanzania: A Retrospective Review of 154 Cases

Dermatological malignancies are among the most common form of cancers and the global incidence has been increasing at an alarming rate. A retrospective study was conducted to determine the prevalence, histopathological pattern, anatomical distribution and treatment outcome of dermatological malignancies at Bugando Medical Centre in North-western Tanzania. Data were collected from patients’ files kept in the Medical record department; the surgical wards, operating theatre and histopathology laboratory and analyzed using Statistical package for social sciences system. A total of 154 patients with a histopathological diagnosis of dermatological malignancy were studied. Generally, males outnumbered females by a ratio of 1.4:1. The majority of patients were in the 5th and 6th decades of life. Malignant melanoma was the most common dermatological malignancy (67.5%) followed by Kaposi’s sarcoma (10.4%), Squamous cell carcinoma (8.4%) and Basal cell carcinoma(7.8%). The lower limbs were the most frequent site accounting for 55.8%. Wide local excision was the most common surgical procedure performed in 79.2% of cases. Post-operative wound infection was the most common complication in 58.3% of patients. Mortality rate was 3.8%. Dermatological malignancies are more prevalent in our setting. A high index of suspicion is needed to avoid labelling malignancies “chronic ulcers” and all suspected lesions should be biopse

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

Gastric Cancer at a University Teaching Hospital in Northwestern Tanzania: A Retrospective Review of 232 Cases.

Despite marked decreases in its incidence, particularly in developed countries, gastric cancer is still the second most common tumor worldwide. There is a paucity of information regarding gastric cancer in northwestern Tanzania. This study was undertaken to describe our experience, in our local setting, on the management of gastric cancer, outlining the clinicopathological and treatment outcome of these patients and suggesting ways to improve the treatment outcome. This was a retrospective study of histologically confirmed cases of gastric cancer seen at Bugando Medical Centre between January 2007 and December 2011. Data were retrieved from patients' files and analyzed using SPSS computer software version 17.0. A total of 232 gastric cancer patients were enrolled in the study, representing 4.5% of all malignancies. The male to female ratio was 2.9:1. The median age of patients was 52 years. The majority of the patients (92.1%) presented late with advanced gastric cancer (Stages III and IV). Lymph node and distant metastasis at the time of diagnosis was recorded in 31.9% and 29.3% of cases, respectively. The antrum was the most frequent anatomical site (56.5%) involved and gastric adenocarcinoma (95.1%) was the most common histopathological type. Out of 232 patients, 223 (96.1%) patients underwent surgical procedures for gastric cancer of which gastro-jejunostomy was the most frequent performed surgical procedure, accounting for 53.8% of cases. The use of chemotherapy and radiotherapy was documented in 56 (24.1%) and 12 (5.1%) patients, respectively. Postoperative complication and mortality rates were 37.1% and 18.1%, respectively. According to multivariate logistic regression analysis, preoperative co-morbidity, histological grade and stage of the tumor, presence of metastases at the time of diagnosis was the main predictors of death (P <0.001). At the end of five years, only 76 (32.8%) patients were available for follow-up and the overall five-year survival rate was 6.9%. Evidence of cancer recurrence was reported in 45 (19.4%) patients. Positive resection margins, stage of the tumor and presence of metastasis at the time of diagnosis were the main predictors of local recurrence (P <0.001). Gastric cancer in this region shows a trend towards relative young age at diagnosis and the majority of patients present late with an advanced stage. Lack of awareness of the disease, poor accessibility to health care facilities and lack of screening programs in this region may contribute to advanced disease at the time of diagnosis. There is a need for early detection, adequate treatment and proper follow-up to improve treatment outcome

Major Limb Amputations: A Tertiary Hospital Experience in Northwestern Tanzania.

Major limb amputation is reported to be a major but preventable public health problem that is associated with profound economic, social and psychological effects on the patient and family especially in developing countries where the prosthetic services are poor. The purpose of this study was to outline the patterns, indications and short term complications of major limb amputations and to compare our experience with that of other published data. This was a descriptive cross-sectional study that was conducted at Bugando Medical Centre between March 2008 and February 2010. All patients who underwent major limb amputation were, after informed consent for the study, enrolled into the study. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS version 11.5 computer software. A total of 162 patients were entered into the study. Their ages ranged between 2-78 years (mean 28.30 ± 13.72 days). Males outnumbered females by a ratio of 2:1. The majority of patients (76.5%) had primary or no formal education. One hundred and twelve (69.1%) patients were unemployed. The most common indication for major limb amputation was diabetic foot complications in 41.9%, followed by trauma in 38.4% and vascular disease in 8.6% respectively. Lower limbs were involved in 86.4% of cases and upper limbs in 13.6% of cases giving a lower limb to upper limb ratio of 6.4:1 Below knee amputation was the most common procedure performed in 46.3%. There was no bilateral limb amputation. The most common additional procedures performed were wound debridement, secondary suture and skin grafting in 42.3%, 34.5% and 23.2% respectively. Two-stage operation was required in 45.4% of patients. Revision amputation rate was 29.6%. Post-operative complication rate was 33.3% and surgical site infection was the most common complication accounting for 21.0%. The mean length of hospital stay was 22.4 days and mortality rate was 16.7%. Complications of diabetic foot ulcers and trauma resulting from road traffic crashes were the most common indications for major limb amputation in our environment. The majority of these amputations are preventable by provision of health education, early presentation and appropriate management of the common indications

Scrotal Swelling and Testicular Atrophy due to Schistosomiasis in a 9-Year-Old Boy: A Case Report

Schistosomiasis is a communicable disease which commonly involves urinary bladder causing hematuria, or large bowel causing bloody stool. The common species encountered in this lake region surrounding Lake Victoria in Tanzania are Schistosoma haematobium and Schistosoma mansoni. Complications can lead to portal hypertension due portal fibrosis in liver, and fibrosis in lung can lead to pulmonary hypertension; this commonly seen with S. mansoni. Major complications of S. maeametobium are chronic cystitis with squamous metaplasia with subsequent development of squamous cell carcinoma. Involvement of spinal cord causing paraplegia has been observed in S. haematobium. Other unusual pathology of schistosomiasis has been described, such as involvement of the appendix, ovary, prostate, and cervix. Here, we present a case of schistosomiasis in a 9-year-old boy who presented with left scrotal pain for one year which was accompanied by scrotal swelling; surgical exploration was done, and the finding was hydrocele and atrophic testes with nodules on the surface. Histological examination reveals atrophic testis and heavy active granulomatous inflammation with schistosoma eggs consistent with Schistosoma haematobium in the tunica vaginalis

Knowledge, attitudes and practices of parents on child sexual abuse and its prevention in Shinyanga district, Tanzania

Background: The role of parents in preventing child sexual abuse in the community in low-and-middle income countries has not been adequately emphasized. The objective of this study was to assess parents’ knowledge, attitudes and practices on child sexual abuse and its prevention in Shinyanga district, Tanzania in order to strengthen child protection.  Methods: This was a cross-sectional study conducted during July 2015. Multistage cluster sampling technique was employed to obtain study participants from a list of sampling frame. Parents with children below 18 years old were randomly selected to form a study population. A quantitative technique using structured questions was used to assess parents’ knowledge, attitude and practices about preventing child sexual abuse.Results: A total of 384 respondents were included in the study. The majority (95.6%) of respondents had high knowledge regarding prevention of child sexual abuse.  Majority (98.7%) of the respondents had positive attitudes on preventing child sexual abuse. However, only about a quarter (27.3%) of respondents had good practices on protection and prevention of child sexual abuse.Conclusion: Knowledge and attitudes of parents on child sexual abuse prevention was high in the study area.  However, the practices of parents on child sexual abuse prevention were poor. Therefore, a public education programme is needed for parents, with the ultimate aim of protecting children from the preventable harm and trauma of sexual abuse in rural communities of Tanzania