Post-Circumcision Urethro-Cutaneous Fistula: The Key to Successful Reconstruction.

Background: Routine circumcision of boys is a common practice in Tanzania. Because sometimes it is performed by persons with no surgical training, complications, including urethro-cutaneous fistula (UCF), are not uncommon.Methods: Five boys whose ages ranged between 4 and 12 years with UCF were seen at four Dar es Salaam hospitals between 2002 and 2005. Personal particulars, the personnel doing the circumcision, description of the repair and follow up were recorded on a data sheet. Intravenous Augmentin was given at induction of anaesthesia for the fistula repair. A urethral catheter was inserted, and then a tourniquet was applied at the base of the penis. After incision and development of skin flaps the urethra was closed, a layer of dartos fascia interposed, followed by closure of the skin, all with 6/0 Vicryl. A compression dressing was applied, and the catheter was left in for 5-7 days.Results: The boys ranged in age between 5 and 12 years, and had undergone circumcision at age 2 to 12 years. All patients were circumcised by paramedical personnel or a traditional practitioner. Urine leakage commenced 2 days to 2 weeks after circumcision. Four boys had coronal while one had a glandular UCF. No post repair complication was reported after follow up of 3 to 20 weeks.Conclusion: Use of fine synthetic absorbable sutures and careful closure of the fistula with interposition of a pedicles dartos graft, are the main prerequisites for success. Attention to details of surgical technique can produce consistently good results in repair of UCF

Experiences of obesity among Saudi Arabian women contemplating bariatric surgery: An interpretative phenomenological analysis

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2013 The Authors.This study explored experiences of obesity, its perceived causes and motives for surgery, as described by seven Saudi women contemplating bariatric surgery. The women experienced cultural restrictions on their physical and social activities. Obesity embodied these restrictions, attracting stigma and moral failure. Traditional clothing, foods, hospitality norms and limited outdoor female activities were regarded as barriers to weight loss. Bariatric surgery was chosen to protect health and to access normative female roles. Some were encouraged by relatives who had undergone surgery. Opting for surgery reflected both participants’ sense of powerlessness to self-manage weight and the social acceptability, within their family context, of this biomedical approach

Integrity of Indigenous Knowledge Systems in Natural Resource Management: The Case of the Arid and Semi-Arid Baringo Herders of Kenya

Ineffective management of natural resources in arid and semi-arid lands (ASALs), resulting in resource depletion, rapid loss of biodiversity and environmental degradation, is of great concern globally. The Baringo herders in the ASALs of Kenya have been branded as perpetrators of this vice, with the blame placed particularly on their traditional livestock management, utilising indigenous knowledge systems (IKS). These IKS involve livestock mobility and maximisation, and have been regarded as being outdated and inefficient in meeting the challenges and demands for environmental conservation and sustainable management of the natural resources. A common reaction of the government has been to advocate modern interventions that are based on exogenous knowledge systems (EKS), involving sedentary livestock raising and destocking. These EKS are, however, not performing as well as expected, since they are not adapted to the ASALs ecological conditions and the herders\u27 socio-economic and cultural situations (Aboud et al 1997; Makenzi, 2003). This study empirically explored the above propositions, in order to test the integrity of the IKS, in relation to EKS and the herders\u27 levels of education

Elective Abdominal Ultrasonography by Surgeons at MNH, Dar-Es-Salaam, Tanzania.

Background: Ultrasound scanning (USS) is an important diagnostic tool in most specialties of surgery. The abdomen is the most commonly scanned region and learning and practicing abdominal USS is the most rewarding. This study was aimed at sharing our experience of elective abdominal ultrasound scanning (USS) done by surgeons at the Department of Surgery, Muhimbili National Hospital (MNH).Methods: This is a retrospective audit of indications and sonographic findings in 1782 elective scannings done over a 42-month period. All scanning was done by surgeons using Aloka SSD 500scanner with a 3.5 MHz probe. Average patient scanning time was 5-10 minutes.Results: The most frequent indications for abdominal ultrasound scanning were abdominal pain (27%), urinary tract symptoms (25%) and abdominal swelling / mass (13%). Overall 47 % of all scanned patients and 58% of those with abdominal pain had normal findings. Of all the patients with abnormal USS findings 42% had abdominal mass. Stone disease was infrequent, seen in 49 (2.7% of all scanned) patients.Conclusion: Pain is the most frequent reason for requesting abdominal ultrasound scanning but it has a low yield of sonographic findings. Scanning for abdominal swelling/mass gave the highest proportion of abnormal findings. USS of a surgical patient done by surgeons expedites diagnostic workup, shortens hospitalization, facilitates biopsy and may help to avoid diagnostic laparotomy

Bacteria isolated from bloodstream infections at a tertiary hospital in Dar es Salaam, Tanzania – antimicrobial resistance of isolates

Objective. A bloodstream infection (BSI) is a life-threatening condition. We studied the causative agents of BSIs and antimicrobial susceptibility patterns of bacterial isolates at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods. A retrospective analysis of blood culture results obtained at MNH from January 2005 to December 2009 was done. Blood culture isolates judged to be clinically significant and antimicrobial susceptibility results of the bacteria were included. The frequencies and proportions of bacteria isolated and antimicrobial susceptibility results were analysed and compared using Pearson’s chi-square test and Fisher’s exact test where applicable, or the Mann-Whitney U-test. Results. A total of 13 833 blood cultures were performed. Bacterial pathogens were detected in 1 855 (13.4%), Gram-positive bacteria (1 523; 82.1%) being significantly more prevalent than Gramnegative bacteria (332; 17.9%) (p=0.008). The most common bacterial pathogens isolated were coagulase-negative staphylococci (CoNS) (1 250; 67.4%), S. aureus (245; 13.2%), Escherichia coli (131; 7%) and Klebsiella spp. (130; 7.0%). All bacteria isolated showed high resistance to penicillin G (70.6%), tetracycline (63.8%), cefotaxime (62.5%) and ampicillin (62.3%). Moderate to high resistance was seen against chloramphenicol (45.2%), erythromycin (35.0%), ciprofloxacin (29.3%), co-trimoxazole (25.0%) and gentamicin (23.5%). Of S. aureus isolates, 23.3% were resistant to methicillin. Conclusions. CoNS accounted for two-thirds of the bacterial pathogens isolated. High-level resistance was seen to first-line and inexpensive antimicrobial agents. Routine screening for extendedspectrum beta-lactamase production and methicillin resistance among Gram-negative rods and S. aureus from blood cultures should be instituted to monitor spread of multidrug-resistant isolates

Vitamin D Status and TB Treatment Outcomes in Adult Patients in Tanzania: A Cohort Study.

Vitamin D is an immunomodulator and can alter response to tuberculosis (TB) treatment, though randomised trials have been inconclusive to date. We present one of the first comprehensive analysis of the associations between vitamin D status and TB treatment, T-cell counts and nutritional outcomes by HIV status. Cohort study. Outpatient clinics in Tanzania. 25-hydroxyvitamin D levels were assessed in a cohort of 677 patients with TB (344 HIV infected) initiating anti-TB treatment at enrolment in a multivitamin supplementation (excluding vitamin D) trial (Clinicaltrials.gov identifier: NCT00197704). Information on treatment outcomes such as failure and relapse, HIV disease progression, T-cell counts and anthropometry was collected routinely, with a median follow-up of 52 and 30 months for HIV-uninfected and HIV-infected patients, respectively. Cox and binomial regression, and generalised estimating equations were used to assess the association of vitamin D status with these outcomes. Mean 25-hydroxyvitamin D concentrations at enrolment were 69.8 (±21.5) nmol/L (27.9 (±8.6) ng/mL). Vitamin D insufficiency (<75 nmol/L) was associated with a 66% higher risk of relapse (95% CI 4% to 164%; 133% higher risk in HIV-uninfected patients). Each unit higher 25-hydroxyvitamin D levels at baseline were associated with a decrease of 3 (p=0.004) CD8 and 3 (p=0.01) CD3 T-cells/µL during follow-up in patients with HIV infection. Vitamin D insufficiency was also associated with a greater decrease of body mass index (BMI; -0.21 kg/m(2); 95% CI -0.39 to -0.02), during the first 8 months of follow-up. No association was observed for vitamin D status with mortality or HIV disease progression. Adequate vitamin D status is associated with a lower risk of relapse and with improved nutritional indicators such as BMI in patients with TB, with or without HIV infection. Further research is needed to determine the optimal dose of vitamin D and effectiveness of daily vitamin D supplementation among patients with TB

Adherence to Hippocratic Oath in the Treatment of Urinary Tract Stones by Minimally Invasive Surgery; A five Years Experience in Dar es Salaam, Tanzania

Background: Minimally invasive treatment – (referring to endoscopic,  laparoscopic and shockwave procedures) have made open surgery for stones nearly obsolete hence adhering to the father’s of medicine that not to provide treatments which are pointless or harmful. The development of shock wave lithotripsy, percutaneous nephrolithotomy techniques and intracorporeal lithotripsy devices has conferred unprecedented  management tools for upper tract stones. With experience, successful stone retrieval has occurred in upwards of 90% of cases, again with  minimal complications. Moreover, transfusion rates, hospital costs, and convalescence periods have been markedly reduced when compared to open surgery.Objective: This study aimed to document the profile and outcome of patients treated for urinary tract stones by minimally invasive approach at Apollo Medical Centre – Dar-es-salaam, for five years being an experience in a typical third world environment.Methods: This was a five years hospital based descriptive, combined retrospective and prospective study conducted by using a structured data collecting tool. The data were analyzed using SPSS software.Results: A total of 281patients treated for urinary tract stones by minimally invasive approach in a period of five years were enrolled, of which 204 were retrospective, and 77 patients were prospective. Males were the majority at 66.9% (188) giving M:F ratio of 2:1. Majority of the patients, 274 (80%) were over 30 years of age. Renal stones were the commonest at 45.5% with ESWL being the most popular procedure performed in 47.7% of all patients. ESWL had a success rate of 70.7%, lower than contact lithotripsy and forceps picking. Only 4.6% complication rate was reported, both being minor.Conclusions: the prevalence of urinary tract stones is increasing among female. Our patients deserve the benefits of minimally invasive techniques in the management of urolithiasis as they have been demonstrated to be feasible, safe and ESWL non-technically demanding.Key words; Minimal invasive treatment, Urinary stones, Complications, Succes

Iringa Regional and District Projections.

This report presents population projections for the period 2003 to 2025 for Iringa Region and its districts. The projections were made using a Cohort Component Method (Spectrum System), whereby three components responsible for population change, namely: mortality, fertility and migration were projected separately as well as HIV/AIDS prevalence. The projected components were then applied to 2002 midyear base population in order to come up with the desired projections from 2003 to 2025. The report gives mortality, fertility, migration and HIV/AIDS assumptions, and shows Iringa’s demographic and socio-economic future trends. The results include estimated population by sex in single years and five-year age groups as well as some demographic indicators. Population growth for the period 2003 to 2025 shows a decrease in growth rates. The projections show that population growth rate will decrease from 1.6 percent in 2003 (with a population of 1,520,891) to 0.4 percent in 2025 (with a population of 2,019,217). Sex Ratio at birth is projected to increase from 90 male births per 100 females in 2003 to 99 male births per 100 females in 2025. Mortality estimates show that Infant Mortality Rate (IMR) is expected to decline for both sexes from 127 deaths per 1,000 live births in 2003 to 78 deaths per 1,000 live births in 2025. Under Five Mortality Rate (U5MR) for both sexes will also decline from 207 deaths per 1,000 live births in 2003 to 122 deaths per 1,000 live births in the year 2025. The mortality projected estimates further show that the life expectancy at birth for both males and females stands at 45 years in 2003. Life expectancy at birth for Iringa will decline from 45 years in 2003 to 44 years in 2025 for both sexes. For male population, life expectancy at birth will remain at the same level of 45 years in year 2003 and year 2025, while for female population the life expectancy at birth will decline from 45 years in 2003 to 43 years in 2025. On fertility, TFR will decline from 4.9 children per woman in 2003 to 2.6 children per woman in 2025.\u