Community violence in Dar es Salaam, Tanzania: A mixed methods study

Most homicide deaths in Dar es Salaam, Tanzania (DSM) are a result of violence arising from within the community. This type of violence is commonly called, by perpetrators and victims, “mob justice”. Unilateral non-state collective violence can take four forms: lynching, vigilantism, rioting, and terrorism. The purpose of this paper is to report what leads to death by such violence in DSM. A cross-sectional mixed methods study design was used. Surveillance data were collected on all 206 victims of “mob justice” in DSM for the year 2005. Fifteen in-depth interviews were conducted with the relatives of deceased victims, a policeman, a journalist, community members, and youths who survived these types of community violence. A focus group discussion was conducted with eight youths at risk of such violence. The deceased were young adult males and differed significantly from assault victims as to age, occupation, weapon causing death, and injury site. Ninety percent were identified as: unemployed, thieves, unknowns, or street vendors. The immediate history of the deceased usually involved theft. The stated desire of community members was to live in peace; they acknowledged that murder is unlawful. Often the victims had been warned; if transgressions continued, male community members punished the individual, which led to death. Family reactions varied from relief, to confusion, and loss. Community level violence in DSM is defensive; the goal is to protect the community. It is focused on individuals, not groups; incidents can be classified along the continuum of lynching and vigilantism in which lynching is a spontaneous reaction to deviance and vigilantism is an organised activity. Decreasing the number of deviant social acts should theoretically decrease cases of lynching and vigilantism. The most humane way to decrease petty theft is through appropriate employment.Keywords: homicide; Africa; Tanzania; vigilantism; lynching; community; mo

Challenges of caring for children with mental disorders: Experiences and views of caregivers attending the outpatient clinic at Muhimbili National Hospital, Dar es Salaam - Tanzania

It is estimated that world-wide up to 20 % of children suffer from debilitating mental illness. Mental disorders that pose a significant concern include learning disorders, hyperkinetic disorders (ADHD), depression, psychosis, pervasive development disorders, attachment disorders, anxiety disorders, conduct disorder, substance abuse and eating disorders. Living with such children can be very stressful for caregivers in the family. Therefore, determination of challenges of living with these children is important in the process of finding ways to help or support caregivers to provide proper care for their children. The purpose of this study was to explore the psychological and emotional, social, and economic challenges that parents or guardians experience when caring for mentally ill children and what they do to address or deal with them. A qualitative study design using in-depth interviews and focus group discussions was applied. The study was conducted at the psychiatric unit of Muhimbili National Hospital in Tanzania. Two focus groups discussions (FGDs) and 8 in-depth interviews were conducted with caregivers who attended the psychiatric clinic with their children. Data analysis was done using content analysis. The study revealed psychological and emotional, social, and economic challenges caregivers endure while living with mentally ill children. Psychological and emotional challenges included being stressed by caring tasks and having worries about the present and future life of their children. They had feelings of sadness, and inner pain or bitterness due to the disturbing behaviour of the children. They also experienced some communication problems with their children due to their inability to talk. Social challenges were inadequate social services for their children, stigma, burden of caring task, lack of public awareness of mental illness, lack of social support, and problems with social life. The economic challenges were poverty, child care interfering with various income generating activities in the family, and extra expenses associated with the child's illness. Caregivers of mentally ill children experience various psychological and emotional, social, and economic challenges. Professional assistance, public awareness of mental illnesses in children, social support by the government, private sector, and non-governmental organizations (NGOs) are important in addressing these challenges

Lobar and segmental liver atrophy associated with hilar cholangiocarcinoma and the impact of hilar biliary anatomical variants: a pictorial essay

The radiological features of lobar and segmental liver atrophy and compensatory hypertrophy associated with biliary obstruction are important to recognise for diagnostic and therapeutic reasons. Atrophied lobes/segments reduce in volume and usually contain crowded dilated bile ducts extending close to the liver surface. There is often a “step” in the liver contour between the atrophied and non-atrophied parts. Hypertrophied right lobe or segments enlarge and show a prominently convex or “bulbous” visceral surface. The atrophied liver parenchyma may show lower attenuation on pre-contrast computed tomography (CT) and CT intravenous cholangiography (CT-IVC) and lower signal intensity on T1-weighted magnetic resonance imaging (MRI). Hilar biliary anatomical variants can have an impact on the patterns of lobar/segmental atrophy, as the cause of obstruction (e.g. cholangiocarcinoma) often commences in one branch, leading to atrophy in that drainage region before progressing to complete biliary obstruction and jaundice. Such variants are common and can result in unusual but explainable patterns of atrophy and hypertrophy. Examples of changes seen with and without hilar variants are presented that illustrate the radiological features of atrophy/hypertrophy

Primary fallopian tube carcinoma: review of MR imaging findings

Objectives To review the epidemiological and clinical features of primary fallopian tube carcinoma (PFTC), and to illustrate the spectrum of MRI findings, with pathological confirmation. Methods This article reviews the relevant literature on the epidemiological, clinical, and imaging features of primary fallopian tube carcinoma, with pathological confirmation, using illustrations from the authors' teaching files. Results Primary fallopian tube carcinoma came under focus over the last few years due to its possible role on the pathogenesis of high-grade serous epithelial ovarian and peritoneal cancers. Typical symptoms, together with the presence of some of the most characteristic MRI signs, such as a "sausage-shaped" pelvic mass, hydrosalpinx, and hydrometra, may signal the presence of primary fallopian cancer, and allow the radiologist to report it as a differential diagnosis. Conclusions Primary fallopian tube carcinoma has a constellation of clinical symptoms and magnetic resonance imaging features, which may be diagnostic. Although these findings are not present together in the majority of cases, radiologists who are aware of them may include the diagnosis of primary fallopian tube cancer in their report more frequently and with more confidence. Teaching Points PFTC may be more frequent than previously thought PFTC has specific clinical and MRI characteristics Knowledge of typical PFTC signs enables its inclusion in the differential diagnosis PFTC is currently staged under the 2013 FIGO system PFTC is staged collectively with ovarian and peritoneal neoplasmsinfo:eu-repo/remantics/publishedVersio

Adnexal masses: benign ovarian lesions and characterization - benign ovarian masses

Incidental adnexal masses are commonly identified in radiologists’ daily practice. Most of them are benign ovarian lesions of no concern. However, sometimes defining the origin of a pelvic mass may be challenging, especially on ultrasound alone. Moreover, ultrasound not always allows the distinction between a benign and a malignant adnexal tumor. Most of sonographically indeterminate adnexal masses turn out to be common benign entities that can be readily diagnosed by magnetic resonance imaging. The clinical impact of predicting the likelihood of malignancy is crucial for proper patient management. The first part of this chapter will cover the technical magnetic resonance imaging aspects of ovarian lesions characterization as well as the imaging features that allow the radiologist to correctly define the anatomic origin of a pelvic mass. Next, the authors will go through different benign ovarian entities and through the different histologic types of benign ovarian tumors. Finally the functional ovarian tumors and the ovarian tumors in children, adolescents, young females, and pregnant women will be covered.info:eu-repo/semantics/publishedVersio

Disease Prevention: An Overview

Disease prevention can be defined as measures that seek to avert the occurrence of disease (including injury), arrest its progress, and reduce its consequences once it is established. Disease prevention can be classified into levels: primordial, primary, secondary, and tertiary prevention. Preventive interventions aim at interrupting the web of causality leading to one or more aspects of ill-health. They are directed at different phases in the development of disease, aiming at eradicating, eliminating, or minimizing its impact, or if none of this is feasible, retarding the progress of disease and disability. Building on the model of disease causation this article illustrates the different levels of disease prevention and describes core strategies toward prevention, juxtaposing the high-risk strategy and the population strategy of prevention as first outlined by Geoffrey Rose. It illustrates the challenges related to disease prevention using examples of noncommunicable diseases and injuries, drawing on both successes and failures of different preventive approaches. It then discusses some fundamental aspects of prevention as they relate to ethical considerations and the evidence base of preventive intervention. The article closes with a brief reminder that decisions made outside the health-care sector can have major consequences for population health and discusses its implications for disease prevention

Homicide deaths in sub-Saharan Africa: a review 1970-2004

No Abstract.African Safety Promotion Vol. 5(1) 2007: pp. 31-4