Blood utilization in elective surgery in a tertiary hospital in Dar es Salaam, Tanzania

Background: There has been an observation of blood being unnecessarily requested even for surgeries that will not require transfusion. Furthermore, some patients have been denied surgery due to lack of blood causing surgical list disruptions and inconveniency to patients and their families. This study was carried out to determine the status of blood utilization practices at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania.Methods: A descriptive cross-sectional study was carried out for a period of eight months. Data on blood requisition and usage was collected on a structured questionnaire, and analyzed for Cross-match to Transfusion (C/T) ratio, Transfusion probability (%T), and Transfusion Index (TI). For those procedures that showed more than two indices to be significant, a Maximum Surgical Blood ordering Schedule MSBOS was proposed.Results: Blood was over ordered for 76% of the patients while over eight percent of the patients had haemoglobin levels over 10g/dl. Only amputation, laparotomy for malignancies, pneumonenctomy, and bowel resection for malignancy had at least two of the transfusion indices showing significant blood utilization for general surgery cases.  For urological cases, only Cystectomy for bladder cancer and nephrectomy had at least two of the indices showing significant blood utilization. In the remaining cases, blood utilization was inefficient suggesting cross-matching of blood was unnecessary, which resulted in loss of nearly 73% of technician’s working hours and USD 425 for the study period.Conclusion: There is existence of over ordering of blood in this hospital. Blood ordering practices needs to be reviewed to minimize over ordering of blood. All the three indices showed inefficient use of blood in most of the operations. But even so, utilization can still be improved in some of the operations which showed significant utilization

Antibiotic use in urological surgeries: a six years review at Muhimbili National Hospital, Dar es salaam-Tanzania

Introduction: Antimicrobial prophylaxis for urologic procedures is a major issue, as potential   advantages of antibiotic administration should be carefully weighed against potential side effects,   microbial resistance, and health care costs. This study aimed to review a six years trend of antibiotic  use  in urological surgeries at Muhimbili National Hospital (MNH) being an experience in a typical third  world environment.Methods: This was a six years hospital based descriptive, retrospective study conducted of which all case notes of urological patients operated on in between January 2007 to December, 2012 were reviewed by using a structured data collecting tool. The data were analyzed using SPSS software.Results: Male patients were the majority at 62% (450). The age range was 0 - 90 years, with a mean of 30 ± 22.09. Among the urological surgeries done at MNH 86.5% (628) received prophylactic antibiotics  regardless of the type surgery done. Majority 63.7% (463) received antibiotics during induction.  Ceftriaxone was the commonly given antibiotic regardless of the type of urological surgery done. Most of patients (86.4%) were given antibiotics for five days regardless whether it was for prophylactic or  treatment intention.Conclusion: Antibiotic use is still a challenge at our hospital with over use of prophylactic antibiotics  without obvious indications. Prolonged use of prophylactic antibiotics beyond five days was the main finding. Ceftriaxone was the most given antibiotic regardless of the urological surgery done and its level of contamination. Antibiotic stewardship needs to be addressed urgently to avoid serious drug resistances leaving alone the cost implication.Key words: Antibiotics, urological surgeries, Tanzania

Antibiotic use in urological surgeries: a six years review at Muhimbili National Hospital, Dar es salaam-Tanzania

Introduction: Antimicrobial prophylaxis for urologic procedures is a major issue, as potential   advantages of antibiotic administration should be carefully weighed against potential side effects,   microbial resistance, and health care costs. This study aimed to review a six years trend of antibiotic  use  in urological surgeries at Muhimbili National Hospital (MNH) being an experience in a typical third  world environment.Methods: This was a six years hospital based descriptive, retrospective study conducted of which all case notes of urological patients operated on in between January 2007 to December, 2012 were reviewed by using a structured data collecting tool. The data were analyzed using SPSS software.Results: Male patients were the majority at 62% (450). The age range was 0 - 90 years, with a mean of 30 ± 22.09. Among the urological surgeries done at MNH 86.5% (628) received prophylactic antibiotics  regardless of the type surgery done. Majority 63.7% (463) received antibiotics during induction.  Ceftriaxone was the commonly given antibiotic regardless of the type of urological surgery done. Most of patients (86.4%) were given antibiotics for five days regardless whether it was for prophylactic or  treatment intention.Conclusion: Antibiotic use is still a challenge at our hospital with over use of prophylactic antibiotics  without obvious indications. Prolonged use of prophylactic antibiotics beyond five days was the main finding. Ceftriaxone was the most given antibiotic regardless of the urological surgery done and its level of contamination. Antibiotic stewardship needs to be addressed urgently to avoid serious drug resistances leaving alone the cost implication.Key words: Antibiotics, urological surgeries, Tanzania

Surgical Apgar Score can accurately predict the severity of post-operative complications following emergency laparotomy

Abstract Background The Surgical Apgar Score (SAS) describes a feasible and objective tool for predicting surgical outcomes. However, the accuracy of the score and its correlation with the complication severity has not been well established in many grounds of low resource settings. Objective To determine the accuracy of Surgical Apgar Score in predicting the severity of post-operative complications among patients undergoing emergency laparotomy at Muhimbili National Hospital. Methods A prospective cohort study was conducted for a period of 12 months; patients were followed for 30 days, the risk of complication was classified using the Surgical Apgar Score (SAS), severity of complication was estimated using the Clavien Dindo Classification (CDC) grading scheme and Comprehensive Complication Index (CCI). Spearman correlation and simple linear regression statistic models were applied to establish the relationship between Surgical Apgar Score (SAS) and Comprehensive Complication Index (CCI). The Accuracy of SAS was evaluated by determining its discriminatory capacity on Receiver Operating Characteristics (ROC) curve, data normality was tested by Shapiro–Wilk statistic 0.929 (p < 0.001).Analysis was done using International Business Machine Statistical Product and Service Solution (IBM SPSS) version 27. Results Out of the 111 patients who underwent emergency laparotomy, 71 (64%) were Male and the median age (IQR) was 49 (36, 59).The mean SAS was 4.86 (± 1.29) and the median CCI (IQR) was 36.20 (26.2, 42.40). Patients in the high-risk SAS group (0–4) were more likely to experience severe and life-threatening complications, with a mean CCI of 53.3 (95% CI: 47.2–63.4), compared to the low-risk SAS group (7–10) with a mean CCI of 21.0 (95% CI: 5.3–36.2). A negative correlation was observed between SAS and CCI, with a Spearman r of -0.575 (p < 0.001) and a regression coefficient b of -11.5 (p < 0.001). The SAS demonstrated good accuracy in predicting post-operative complications, with an area under the curve of 0.712 (95% CI: 0.523–0.902, p < 0.001) on the ROC. Conclusion This study has demonstrated that SAS can accurately predict the occurrence of complications following emergency laparotomy at Muhimbili National Hospital

Estimating cost of prostate cancer management: an experience from Tanzania

Abstract Background Prostate cancer (PC) is a significant public health problem affecting men worldwide and ranks third in incidence and mortality in East Africa. Cost of prostate cancer management is high in low-income countries because majority of patients presents with advanced (metastatic) PC. The cost related to management of PC including castrate resistant cancer in Tanzania has remained unknown; hence, policy makers do not have enough information for planning and resource allocation. This study therefore aimed to document costs related to the management of patients with prostate cancer including castrate resistant prostate cancer (CRPC) at Muhimbili National Hospital in Tanzania. Methods This was a retrospective descriptive hospital-based study which was conducted at Muhimbili National Hospital (MNH). Case notes of patients who were treated for prostate cancer were retrieved from medical records for review. A structured checklist was used to extract information regarding age, clinical presentation, investigations, stage of disease, type of treatment, payment modality and reimbursement. We considered data on the direct costs of prostate cancer management (diagnosis, treatment and follow-up) based on hospital price list of different categories. Costs reported were based on payment category in total and unit cost but also source of funding. Descriptive statistics were prepared and summarized as tables and figures. Results A total of 292 case notes of patients with prostate cancer were reviewed of which 189 patients received androgen deprivation therapy. Ninety-six (50.8%) met the criteria for the diagnoses of CRPC, and their mean age was 71.23 ± 4.2. Most of the patients had a poorly differentiated histology with prostate-specific antigen (PSA) over 100 ng/l. Bilateral orchiectomy was the most common treatment modality offered for advanced prostate cancer. Total cost for all PC patients was $148,136.4, equivalent to a unit cost per patient of$507.3. However, patients were in different categories of payment, 53% were public patients with an average cost of $471.3 per patient; 36.6$441.8 per patient; 8.2% were National Health Insurance (NHIF) patients with an average cost of $893.8 per patient; and only 2.2$1060.9 per patient. Conclusion Costs related to prostate cancer management need harmonization to accommodate different categories of patients in need

Colorectal cancer in Tanzania: the current status and future directions.

IntroductionGlobally, colorectal cancer (CRC) is the third most common malignancy and the second most common cause of cancer death. By 2030, the incidence is expected to increase to reach 2.2 million cases and 1.1 million deaths. In Sub-Saharan Africa, accurate cancer incidence data is limited, but anecdotally, clinicians note a significant rise in the incidence of CRC in the past decade. To educate clinicians on the growing burden of CRC, the Tanzanian Surgical Association hosted a 4-day CRC symposium from 3rd to 6th October 2022. Following the meeting, a group of multidisciplinary stakeholders created a working group whose first task was to assess the epidemiology, presentation and available resources for CRC care in Tanzania. The findings of that assessment are described in this article.FindingsThe true incidence of CRC in Tanzania is currently unknown. However, individual high-volume centres have noted a dramatic rise in cases of colon and rectal cancer on their wards. A review of the published data on CRC in Tanzania showed that most patients present with CRC late and the limited availability of endoscopic and diagnostic services poses a challenge for accurately staging these patients prior to treatment. Multidisciplinary care, including surgery, chemotherapy and radiation, is available for the treatment of CRC in Tanzania, although the capacity and quality of these services vary throughout the country.ConclusionThere is a substantial burden of CRC in Tanzania that appears to be increasing. While there is capacity in the country to provide all aspects of multidisciplinary care, late presentation, limited access to diagnostic and treatment services and poor coordination continue to be significant barriers to providing optimal treatment to these patients

A Retrospective Study of Patients with Castrate Resistant Prostate Cancer at Muhimbili National Hospital, Tanzania

Background: Prostate cancer (PC) is a common health problem among men globally with high incidence and mortality. The mortality following PC is associated with advanced disease progressing to castrate resistance following androgen ablation therapies. While advances to addresscastrate resistant prostatic cancer (CRPC) have shown good results, the burden of castrate resistant cancer in Tanzania has remained unknown hence our patients cannot benefit from such advances. This study therefore aimed to determine the magnitude and clinical presentation among patients with a diagnosis of castrate resistant cancer at Muhimbili National Hospital in 2018-2019. Methods: This was a retrospective descriptive hospital based study carried out at Muhimbili National Hospital. Patients who were treated with androgen blockade, had evidence of attainment of castrate levels of testosterone with a diagnosis of castrate resistant prostate cancer were identified. Information regarding primary prostatic cancer treatment, clinical disease progression symptoms, and age of the patients were collected. Descriptive statistics were prepared and summarized as tables and figures. Results: We recruited 293 patients with prostate cancer treated by androgen deprivation therapy. Bilateral orchiectomy was the most common treatment modality offered for advanced PC. Castrate levels of testosterone were achieved in 189 (95.5%) of the patients who had testosterone levels checked. Ninety-Six (50.8%) had met the criteria for diagnosis of castrate resistant prostate cancer with mean age of 71.23±4.2 years. Patients presented with lower urinary tract symptoms and metastatic features. Most of the patients had a poorly differentiated histology with prostate specific antigen (PSA) over 100ng/l. Only 13.5% of the patients had spine magnetic resonance imaging (MRI) for their work up. Conclusion and recommendation: Half of patients treated for advanced PC at MNH will progress to castrate resistance following androgen deprivation therapy. More studies are needed to understand the predictors of CRPC and related treatment strategies. Key words: Castrate Resistant Prostate cancer, androgen deprivation therapy, advanced prostate cance

Risk Factors Associated With Early-Onset Esophageal Cancer in Tanzania

Eastern Africa is one of several regions affected by high incidence rates of esophageal squamous cell carcinoma (ESCC). A unique epidemiologic feature of ESCC in Eastern Africa is the high incidence in young people, with one-third of cases diagnosed at age < 45 years. This study aimed to investigate risk factors for early-onset ESCC in Tanzania through a secondary analysis of a matched case-control study. MATERIALS AND METHODS: From 2013 to 2015, ESCC cases were recruited at Muhimbili National Hospital and Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Hospital controls were identified from patients with nonmalignant conditions and matched 1:1 for sex and age (± 10 years). Questionnaires were used to assess sociodemographic characteristics and environmental, dietary, and lifestyle risk exposures. Multivariate logistic regression models were used to estimate age-specific odds ratios of ESCC for exposures among participants age 30-44 and ≥ 45 years. RESULTS: A total of 471 cases and 471 controls were enrolled. Among cases, 100 (21%) were < 45 years. Multiple exposures were identified as risk factors for early-onset ESCC, several of which were unique to this age group, including infrequent teeth cleaning, secondhand tobacco smoke exposure, and pest infestation of grain and/or nuts. Lower socioeconomic status, family history of ESCC, tobacco smoking, home-brewed alcohol consumption, home storage of grain and/or nuts, and use of firewood for cooking were associated in the older but not the younger age group. Hot beverage intake was associated with increased ESCC risk in both age groups. CONCLUSION: Our results suggest that ESCC risk factors in Tanzania vary between age groups. With the data currently available, environmental and behavioral risk factors appear to play an important role in the high incidence of ESCC among young people

Highlights from the Second Choosing Wisely Africa conference: a roadmap to value-based cancer care in East Africa (9–10 February 2023, Dar es Salaam, Tanzania)

The ecancer Choosing Wisely conference was held for the second time in Africa in Dar es Salaam, Tanzania, from the 9th to 10th of February 2023. ecancer in collaboration with the Tanzania Oncology Society organised this conference which was attended by more than 150 local and international delegates. During the 2 days of the conference, more than ten speakers from different specialties in the field of oncology gave insights into Choosing Wisely in oncology. Topics from all fields linked to cancer care such as radiation oncology, medical oncology, prevention, oncological surgery, palliative care, patient advocacy, pathology, radiology, clinical trials, research and training were presented to share and bring awareness to professionals in oncology, on how to choose wisely in their approach to their daily practice, based on the available resources, while trying to offer the maximum benefit to the patient. This report, therefore, shares the highlights of this conference