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

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

Application of semi-automated settlement detection for an integrated topographic map information system update in South Africa

Complete, accurate and up-to-date topographic data is of vast importance as it is widely required by different government agencies, non-governmental organisations, the private sector as well as the general public for urban mapping, rural development and environmental management, to mention but a few applications. Efficient semi-automatic methods for detecting settlements as change area indicators are required in order to achieve a sustainable up-to-date topographic database. This study reviewed the capability of geographic object based image analysis (GEOBIA) as a semi-automated method for settlement detection using 2012 SPOT 5imagery in the KwaZulu-Natal Province, South Africa.The application of GEOBIA provide the ability to segment imagery into areas resembling features of interest. For this study GEOBIA settlement detection provided 70.7% overall accuracy while the existing semi-automated South African global human settlement layer (SA_GHSL) had 60% overall accuracy. These results presents an opportunity to apply GEOBIA semi-automated method to target areas of new settlement development more efficiently and with consistent repeatable manner. Thus assisting topographic update analyst to be drawn to more areas of new settlement development at an enhanced efficient rate. However the spectral variability of roof tops which are prominent identifiable feature by remote sensing for settlement areas prove to be the most challenging obstacle towards semi-automated settlement detection

Knowledge, Attitudes and Practices on Urinary Schistosomiasis-Related Morbidity among Communities in Itilima District, Tanzania

Long-term infections by urinary schistosomiasis can result in urinary tract morbidities and increase the threats to public health. Information on the community’s knowledge, attitudes, and practices (KAP) on various aspects of urinary schistosomiasis, caused by Schistosoma haematobium has been lacking in Itilima District, which is likely to perpetuate the transmission of the disease and its negative health consequences. This study assessed knowledge, attitudes and practices on schistosomiasis-related morbidities in Itilima District from February to June 2021. A cross-sectional survey using a structured questionnaire was used, and a total of 657 participants were involved in the study. A total of 575 participants (87.5%) had awareness on schistosomiasis compared to 82 (12.5%) who were not aware of the disease, and this variation was statistically significant (x² = 369.938, DF = 1, p < 0.001). The relationship between urinary schistosomiasis and its related morbidities was known by 111 (16.9%) respondents, while 546 (83.1%) knew nothing about it, and this variation was also statistically significant (c2 = 388.166, DF = 1, p < 0.001). It can be concluded that knowledge of urinary schistosomiasis and its related morbidities among the communities was limited. This is possibly because knowledge of infection stages of S. haematobium that causes the morbidity requires an understanding of disease etiology. Therefore, this study recommends that interventions to impart knowledge on schistosomiasis and the associated morbidities should be implemented in Itilima District. Keywords:     Schistosomiasis, Urinary tract morbidity, Knowledge, Attitudes and Practices, Itilima Distric

Early Marjolin’s ulcer developing in a penile human bite scar of an adult patient presenting at Bugando Medical Centre, Tanzania: A Case Report

Marjolin’s ulcer is a rare but well documented cutaneous malignancy that arises in a scar or chronic ulcer, and is characterized by an aggressive course. The latent period from the injury to the appearance of cancer has been reported to be 25-40 years. Early occurring Marjolin’s ulcer has rarely been described in the literature and its development in a penile human bite scar is still rare. We report a rare case of a 33 year-old patient who presented with an early appearance of Marjolin’s ulcer developing in a penile human bite scar. On histological examination it was found to be poorly differentiated squamous cell carcinoma. He was managed by total penile amputation. Five months after surgery, the patient presented to our surgical outpatient clinic with inguinal lymph node metastases and distant metastases to the lung, liver and bones. However, the patient died shortly after admission. This report highlights the possibility of early appearance of Marjolin’s ulcer arising from a chronic ulcer or healed scar in an unusual sites such as the penis. It is therefore recommended that all chronic ulcers should be thoroughly investigated at presentation, to avoid labelling malignancies ‘chronic ulcers’, leading to delay in appropriate treatment. Early recognition and aggressive treatment of Marjolin's ulcers and close follow-up are urgently needed to improve outcomes in our environment

Prevalence of clindamycin inducible resistance among methicillin-resistant Staphylococcus aureus at Bugando Medical Centre, Mwanza, Tanzania

Abstract: Methicillin-resistant Staphylococcus aureus (MRSA) has been recognized world wide as an important causative agent of nosocomial and community acquired infections. Clindamycin has been considered as analternative drug for the treatment of such strains. However, the possibility of clindamycin inducible resistance complicates the choice of treatment. The aim of this study was to determine the prevalence of clindamycininducible resistance of MRSA at Bugando Medical Centre (BMC) in Mwanza Tanzania. A total of 600 clinical specimens of pus, wound swabs and aspirates from patients admitted at BMC surgical wards were processedover a period of 4 months. Of these, 160 of S. aureus clinical isolates were analysed. MRSA was identified using cefoxitin disc, oxacillin disc and oxacillin agar. Inducible clindamycin resistance was detected usingerythromycin (15μg) and clindamycin (2μg) discs placed 15mm apart on Muller Hinton agar. Of the 160 isolates, 26 (16.3%) were found to be MRSA. Overall prevalence of inducible clindamycin resistance (iMLSB)was 28.8% (46/160), with 22% (30/134) of methicillin-susceptible S. aureus (MSSA) and 61% (16/26) of MRSA exhibiting inducible clindamycin resistance (P=0.0001). Constitutive resistance (cMLSB) was found in 1 (3.7%) of the MRSA isolates and was not detected among MSSA. MSB phenotype was detected in 1 (3.8%) of MRSA isolates and 2 (1.5%) of MSSA. Eight (29.6%) of the MRSA isolates were sensitive to both clindamycin and erythromycin. In conclusion, a high prevalence of inducible clindamycin resistance was observed among S. aureus with significant association between MRSA and inducible clindamycin resistance. It is important that susceptibility test of staphylococci is routinely done to facilitate early detection of clindamycin inducible resistance in the country

Patterns and outcome of surgical management of goitres at Bugando Medical Centre in northwestern Tanzania

Despite the well established endemicity of goitres little work has been done on the management of goiters in Tanzania. A cross-sectional study was conducted at Bugando Medical Centre (BMC) in Mwanza, Tanzania to determine the pattern and outcome of surgical management of goitres. Data was collected using a pre-tested, coded questionnaire. A total of 152 patients were studied of which 140 (92.1%) were females and males were 12 (7.9%) (F: M = 11.7: 1). Their ages ranged from 18 to 72 years (mean =38.4± 12.5 years). The mean duration of illness was 9.2 years. The thyroid gland size at admission was grade III in 63.8% of patients. Multinodular goitres were reported in 51.3% of patients. The majority of patients (92.1%) presented with euthyroid goitres and the remaining (7.9%) patients had toxic goitres. Pressure symptoms and cosmetic disfigurement were the common indications for thyroidectomy in 47.4% and 23.7%, respectively. Near total thyroidectomy and total thyroidectomy were the surgical procedures performed for benign and malignant goitres in 47.3% and 8.1% of patients, respectively. Simple multinodular goitres were the most common histopathological pattern accounting for 67.2% of cases. Twelve (7.9%) patients had a histologically proven thyroid malignancy, of which follicular and papillary carcinoma were reported in 41.7% and 33.3% of cases, respectively. Post-operative complications rate was 7.9%. The mean length of hospital stay was 14.4 days (range 3 to 34 days). Five patients died giving a mortality rate of 3.4%. In conclusion, this study has shown that the pattern of surgical goitres seen at Bugando Medical Centre is similar to what is reported from other parts of the world. However, the majority of patients present for surgery very late with huge goitres predisposing them to increased risk of post-operative complications, prolonged length of hospital stay and cost of medical care. It is therefore recommended that health education should be given to the community about the cause, prevention and treatment options so that patients could seek early medical attention

The burden and management of self-inflicted injuries at a tertiary care hospital in Mwanza, Tanzania

Background: Self-inflicted injuries are a serious but neglected public health problem in developing countries and contribute significantly to the global injury burden. There is a paucity of published data regarding self-inflicted injuries in Tanzania.  This study describes the aetiology, patterns and treatment outcome of these injuries in Mwanza, Tanzania.Methods: This was a combined retrospective and prospective study of self-inflicted injury patients who were managed at Bugando Medical Centre in Mwanza between February 2007 and April 2014. Data were collected using a pretested and coded questionnaire and analysed using SPSS computer software version 17.0Results: A total of 136 patients (M: F = 3.3: 1) were enrolled into the study. The median age was 30 years. Psychiatric illness (30.9%) was the most common risk factor for self-inflicted injuries. Self-poisoning (35.3%) was the most frequent mechanism of self-inflicted injuries. This was followed by cutting/stabbing and jumping from heights in 23.5% and 20.6% of patients, respectively. The trunk was the most frequent (31.9%) body region affected. Open wounds were the most (4.2%) common type of injuries sustained. The majority (72.1%) of patients were treated surgically. The complication rate was 50.7% and it was significantly associated with delayed presentation (p= 0.012). The median hospital stay was 12 days. Patients with long bone fractures and those who had surgical site infection stayed longer in the hospital (p < 0.001). The mortality rate was 22.8%. Late presentation (>24 hour), severe injuries (KTS II ≤ 6) and presence of surgical site infections were the main predictors of mortality (p<0.001).Conclusion: Self-inflicted injuries are an emerging but neglected public health problem in Mwanza, Tanzania and contribute to unacceptably high morbidity and mortality. Addressing the root causes of self-inflicted injuries may reduce the incidence of these injuries in our environment

Variability of High risk HPV Genotypes among HIV Infected Women in Mwanza, Tanzania- The Need for Evaluation of Current Vaccine Effectiveness in Developing Countries.

High risk (HR) human papilloma Virus (HPV) genotypes have been associated with cervical cancer. In Tanzania there is a limited data on the epidemiology of HPV and genotypes distribution among HIV infected women. Here we document varieties of HPV genotypes associated with cervical squamous intraepithelial lesions (SIL) among HIV- infected women at Bugando Medical Centre, Mwanza-Tanzania. A cross sectional hospital based study involving HIV infected women was conducted between August and October, 2014. Exfoliated cells from ectocervix and endocervix were collected using cytobrush. HPV genotypes were detected using polymerase chain reaction (PCR) followed by sequencing using specific primers targeting broad range of HPV types. Cytology was done to establish squamous intraepithelial lesions. Log binomial regression analysis was done to establish risk ratios (RR) associated with HPV infection using STATA version 11. A total of 255 HIV infected women with mean age 39.2 ± 9.1 years were enrolled in the study. HPV DNA was detected in 138/255 (54.1 %, 95 % CI: 47-60) of HIV infected women. Twenty six genotypes were detected in various combinations; of these 17(65.3 %) were of HR genotypes. HR genotypes were detected in 124(48.6 %) of HIV infected women. Common HR genotypes detected were HPV-52(26), HPV-58(21), HPV-35(20) and HPV-16(14). The risk of being HPV positive was significantly higher among women with CD4 counts <100 (RR: 1.20, 95 % CI: 1.05-1.35, P = 0.006) and women with SIL (RR: 1.37, 95 % CI: 1.11-1.68, P = 0.005). Significant proportion of HIV infected women with low CD4 counts have various grades of cervical SIL associated with varieties of uncommon HR genotypes. There is a need to evaluate the effectiveness of the current vaccine in preventing cervical cancer in developing countries where HIV is endemic