Knee fusion using sign nail, an addition to the armamentarium: Technique and outcome

Background: Knee arthrodesis still has indications in this modern era of arthroplasty and ranges from failed total knee arthroplasty, advanced tuberculous infection to severe contractures. Of the implants that can be used for knee fusion, intramedullary devices have the lowest rates of major complications, shortest time to fusion and the highest fusion rates.Objective: To describe the results and technique of a case series of knee fusions performed using SIGN nails at AIC Kijabe Hospital, Kenya.Design: A retrospective case series.Methods: This case series describes a novel implant choice for knee fusion in eight patients. Of the eight patients, six were male and two were female. The average age was 40 years. They were followed up for an average of 13 months. All the surgeries were performed by a single surgeon and utilised the same technique. Outcome was based on assessment for clinical and radiologic union.Results: Four (50%) of the arthrodeses were secondary to advanced tuberculous infection, one was due to chronic knee dislocation and three were due to failed total knee replacement. Seven (87.5%) went on to primary union. One (12.5%) patient needed bone grafting and dynamization and 2(25%) sustained a peri-prosthetic fracture. All patients are ambulant with no weight-bearing restrictions.Conclusion: The SIGN intramedullary nail system allows an easy and reproducible knee fusion technique in resource and equipment limited settings. Our case series demonstrated that the knee fusion with the SIGN nail lead to successful union in majority of our patients. In addition, 25% of our patients developed a periprosthetic fracture at the nail insertion site which has not been reported in other similar studies. Key words: Knee, Arthrodesis, Fusion, SIGN nail, Infectio

Intermittent preventive treatment of malaria during pregnancy: a qualitative study of knowledge, attitudes and practices of district health managers, antenatal care staff and pregnant women in Korogwe District, North-Eastern Tanzania

BACKGROUND: Intermittent preventive treatment of malaria during pregnancy (IPTp) is a key intervention in the national strategy for malaria control in Tanzania. SP, the current drug of choice, is recommended to be administered in the second and third trimesters of pregnancy during antenatal care (ANC) visits. To allow for a proper design of planned scaling up of IPT services in Tanzania it is useful to understand the IPTp strategy's acceptability to health managers, ANC service providers and pregnant women. This study assesses the knowledge, attitudes and practices of these groups in relation to malaria control with emphasis on IPTp services. METHODS: The study was conducted in February 2004, in Korogwe District, Tanzania. It involved in-depth interviews with the district medical officer (DMO), district hospital medical officer in charge and relevant health service staff at two peripheral dispensaries, and separate focus group discussions (FGDs) with district Council Health Management Team members at district level and pregnant women at dispensary and community levels. RESULTS: Knowledge of malaria risks during pregnancy was high among pregnant women although some women did not associate coma and convulsions with malaria. Contacting traditional healers and self-medication with local herbs for malaria management was reported to be common. Pregnant women and ANC staff were generally aware of SP as the drug recommended for IPTp, albeit some nurses and the majority of pregnant women expressed concern about the use of SP during pregnancy. Some pregnant women testified that sometimes ANC staff allow the women to swallow SP tablets at home which gives a room for some women to throw away SP tablets after leaving the clinic. The DMO was sceptical about health workers' compliance with the direct observed therapy in administering SP for IPTp due to a shortage of clean water and cups at ANC clinics. Intensified sensitization of pregnant women about the benefits of IPTp was suggested by the study participants as an important approach for improving IPTp compliance. CONCLUSION: The successful implementation of the IPTp strategy in Tanzania depends on the proper planning of, and support to, the training of health staff and sustained sensitization of pregnant women at health facility and community levels about the benefits of IPTp for the women and their unborn babies

Malaria, burden, HIV, Poor countries, Research Infrastructure, Tazania

Developing countries carry 90% of the global burden\ud of disease. Infections such as malaria and HIV are\ud debilitating their economies by killing the young and\ud economically productive workforce. Research is essen­\ud tial for health development, yet less than 10% of the\ud annual global expenditure on health research is\ud allocated to addressing developing countries' prob­\ud lems.1 Poor countries must face this challenge seriously.\ud It is essential that they create strong national research\ud infrastructures so that they can define priorities for\ud health research priorities; influence national, regional,\ud and global health agendas; and lobby for a more equi­\ud table allocation of resources. This paper discusses\ud some of the barriers to establishing coordinated health\ud research programmes in developing countries and\ud describes how Tanzania has developed a new research\ud model to try and overcome these

Prevalence and Factors Associated With Hazardous Alcohol Consumption Among Motorcycle Taxi Riders in Kinondoni District, Dar-Es-Salaam, Tanzania: A Cross-Sectional Study

Background: Hazardous alcohol consumption is a significant public health problem contributing to road traffic accidents in nearly all countries. Despite the fact that motorcycles are involved in more than half of all road traffic accidents in Tanzania, little has been reported about hazardous alcohol consumption among motorcyclists. This study investigated the prevalence and factors associated with hazardous alcohol consumption among motorcycle taxi riders in Kinondoni District, Dar es Salaam.   Methods: A cross-sectional survey was conducted in Kinondoni District in August 2018 among motorcycle taxi riders. Multistage sampling was applied to select the study participants. Data were collected using structured self-administered questionnaires incorporating the Alcohol Use Disorders Identification Test. Analysis was done using IBM SPSS version 20.   Results: A total of 210 individuals participated in the study. Within the study sample, the prevalence of hazardous alcohol consumption was 61.5% (n=128). Hazardous alcohol consumption was positively associated with a positive family history of alcohol consumption (odds ratio [OR] 11.74; 95% confidence interval [CI], 5.14 to 26.79; P<.001). Protective factors were younger age (OR  0.09; 95% CI, 0.02 to 0.40; P<.001), having a secondary level of education (OR 0.21; 95% CI, 0.04 to 0.99; P=.034), having a primary level of education (OR 0.06; 95% CI, 0.01 to 0.26; P<.001), and being employed (OR 11.74; 95% CI, 5.14 to 26.79; P<.001).   Conclusion: A high prevalence of hazardous alcohol consumption among motorcycle taxi riders was reported along with several associated factors. Interventions to mitigate hazardous alcohol consumption among commercial motor vehicle drivers must be developed and implemented

Hospital-based safety and telerability study to assesss efficacy of oral doxycycline in the treatment of Wuchereria bancrofti infection in north-eastern Tanzania

No Abstract

7. Dynamics of multiple Plasmodium falciparum infections in infants in a highly endemic area of Tanzania

The force of infection and recovery rate for malaria in infants in a highly endemic area of Tanzania were analysed using polymerase chain reaction-restriction fragment length polymorphism genotyping of the Plasmodium falciparum msp2 locus in 99 paired blood samples. Overall, new genotypes were acquired at a rate of 0·064 per day, and the average duration of infections was estimated to be 23 d. The highest recovery rates were in children under 4 months of age. The higher susceptibility of infants to clinical malaria in comparison with older children, in areas of very high transmission, may be largely a consequence of the short duration of infections which precludes the establishment of concomitant immunity. The high turnover of infections also implies that infection prevalence and multiplicity approach an equilibrium even in very young children, and calls into question the use of infant conversion rates as a measure of transmission intensit

Implication of diethylcarbamazine induced morbidity and the role of cellular responses associated with bancroftian filariasis pathologies

Pre and post-diethylcarbamazine treatment clinical expression, microfilaraemia prevalence and cellular responses were investigated in individuals in Tanga, Tanzania. Fifty-seven male individuals (aged =15 years old) were identified for further studies on IL-4, IL-6, IL-8, IFN-γ, IL-β, TNF-α and nitric oxide in plasma and hydrocoele fluid. Microfilarial prevalence in the examined individuals was 12% with a geometric mean intensity (GMI) of 838 mff/ml in a community with a population of 1018 individuals. Microfilaraemic hydrocoele stage II and III were the most frequent pathologies observed with prevalence of 17.5% and 42.1%, respectively. All study individuals treated with diethylcarbamazine (DEC) standard dose of 6mg/kg experienced post-treatment adverse events. There was no direct relationship between elevated IL- 6 and the occurrence and severity of clinical adverse effects post-treatment. The findings from this study suggests that, blood elevated cytokine profile is not the main etiological factor in the inflammatory responses developing after treatment of bancroftian filariasis infections and pathology with DEC. Plasma levels of cellular (cytokines) responses during treatment revealed a proportion of symptomatic patients. Prior to treatment, patients with hydroecoele had high levels of IL-6 than those without the pathology. In conclusion these findings do not support the hypothesis that pro-inflammatory cytokines are directly responsible for adverse events to DEC chemotherapy in bancroftian filariasis infections and pathologies such as hydrocoele, lymphoedema and elephantiasis. Tanzania Health Research Bulletin Vol. 8(1) 2006: 11-1

A Comprehensive Overview of In-patients Treated for Hepatocellular Carcinoma at a Tertiary Care Facility in Tanzania

Hepatocellular carcinoma (HCC) is one of the commonest causes of cancer-related morbidity and mortality worldwide. However, only a limited number of studies on HCC have been conducted in Tanzania. We therefore conducted a cross-sectional study among in-patients treated for HCC in a tertiary referral hospital located in Dar es Salaam, Tanzania, in order to provide a concise description of the clinical characteristics and treatment options offered in the study setting. We identified 36 in-patients treated for HCC over a 6-month data collection period. Seventy-seven percent (n = 28) of the participants were males and about two-thirds (61.2%) were aged between 40 and 60 years. Majority (44.4% [n = 16]) of the patients had Child-Pugh class B and an Eastern Cooperative Oncology Group (ECOG) performance status of 2 (33.3% [n = 12]). Patients with tumors >6.5 cm and multinodular tumors (>3 nodules) accounted for 69.4% (n = 25) and 55.6% (n = 20), respectively. Portal vascular invasion and extrahepatic metastasis were respectively present in 27.8% (n = 10) and 25% (n = 9) of the patients. Of the study participants, only two had early-stage disease as per the Barcelona Clinic Liver Cancer (BCLC) staging system, corresponding to the observed tumor resection rate of 5.6%. The most frequently reported inoperable factor among the study participants was an ECOG performance status > 0 (n = 30 [83.3%]). Findings thus reveal a high proportion of late-stage diseases among participants that could have resulted in the observed low tumor resection rate. Initiatives to facilitate identification of the disease at an early stage are therefore paramount in optimizing care

Incidental actinomycosis in a 44-year-old female during total abdominal hysterectomy for abnormal uterine bleeding: A case report

Actinomycosis, a rare chronic bacterial infection caused by Actinomyces species, presents diagnostic challenges due to diverse clinical presentations. This report presents a case of peritoneal actinomycosis incidentally discovered during a total abdominal hysterectomy in a 44-year-old female with refractory abnormal uterine bleeding and a history of long-term intrauterine contraceptive device use. The patient presented with persistent abnormal uterine bleeding despite conservative management. Intraoperative findings during total abdominal hysterectomy revealed peritoneal involvement, prompting histopathological evaluation confirming actinomycosis. This case highlights diagnostic complexities associated with actinomycosis, emphasizing the significance of histopathological confirmation. Postoperative management with antibiotics demonstrated favorable outcomes, supporting their efficacy in treating actinomycosis. The case underscores the importance of considering uncommon infections in pelvic pathology, particularly in patients with prolonged intrauterine contraceptive device usage. It prompts further exploration of actinomycosis in relation to intrauterine contraceptive device use and highlights the need for timely intervention and histopathological confirmation for optimal patient care

Community knowledge, perceptions and practices on malaria in Mpwapwa District, central Tanzania

A study on community knowledge, attitudes and perception on malaria and its management was conducted in Mpwapwa district of central Tanzania in January-February 2001. Six villages, three with health facilities (Kibakwe, Makose and Mwanawota) and three without health facilities (Chogola, Kidenge and Wangi) lying between 975 and 1859 m above sea level were selected for the study. According to most respondents, the general health problems for adults in the district included malaria, diarrhoea, typhoid fever and pneumonia. Malaria, pneumonia and diarrhoea were the major health problems among children. Among pregnant women, malaria, abortions and diarrhoea were identified as the major public health problems in the district. In the view of most of villagers, malaria was the cause of most fevers and convulsions at low and intermediate altitudes. Cold weather was considered as the main predisposing factor to most of the fevers experienced in the highland villages. The common antimalarial drugs used in Mpwapwa district were chloroquine and quinine. The cost of antimalarial drugs ranged between TShs. 10/- and 20/- for one tablet of chloroquine, 600/- for chloroquine syrup, and 320/- for a single dose of chloroquine injection. However, shortage of drugs was frequently encountered in most of the health facilities. Traditional medicine practitioners were most frequently consulted for cases of convulsions in the district. Our findings showed that only 2.1% of the children in the district were sleeping under mosquito nets. The use of mosquito net was common among individuals living in the villages with health facilities than in those without health facilities. Generally, most respondents considered long distances to health facilities and inability to pay for health services as the main constraints in obtaining proper health care. Tanzania Health Research Bulletin Vol.6(2) 2004: 37-4