Testing a consensus conference method by discussing the management of traumatic dental injuries in Tanzania

Objectives: To test the recommended consensus conference methods in Tanzania by discussing the management of traumatic dental injuries, and to reach consensus on the feasibility of the treatment modalities of traumatic dental injuries recommended in western countries in theTanzanian situation.Study participants: Fifteen dentists as representatives of the profession and two lay people as representative of potential consumers.Interventions: Presentation of treatment modalities for traumatic dental injuries recommended in western countries.Main outcome measure: Consensus on the feasibility of the recommended treatment modalities of traumatic dental injuries in the Tanzanian situation.Results: For most types of injuries, consensus on the feasibility of the recommended treatment methods for Tanzania was reached immediately. More time was spent to discuss management of some injuries where the members felt that the recommended managementregimes for these injuries are not feasible in the current Tanzanian situation. Panel members made three recommendations. First, parents and teachers should be provided with guidelines or instructions about self-care following trauma. Second, teaching on the management oftraumatic dental injuries at training institutions should be emphasised and third, dental practitioners at dental clinics in the country should get continuing education about the management of traumatic dental injuries.Conclusion: The methods for achieving consensus were useful in the Tanzanian dental situation, therefore it is recommended that the methods be adopted to reach consensus on other oral health issues

Introduction of a learning management system at the Kilimanjaro Christian Medical University College

Background. Medical schools in Africa face daunting challenges including faculty shortages, growing class sizes, and inadequate resources. Learningmanagement systems (LMS) may be powerful tools for organising and presenting curricular learning materials, with the potential for monitoring and evaluation functions.Objective. To introduce a LMS for the first-year medical student curriculum at the Kilimanjaro Christian Medical University College (KCMU Co), inMoshi, Tanzania, in partnership with the Duke University School of Medicine (Durham, North Carolina, USA).Methods. Observations were made on the requisite information technology (IT) infrastructure and human resource needs, and participation in trainingexercises. LMS utilisation was recorded, and two (student and faculty) surveys were done.Results. The KCMU Co IT infrastructure was upgraded, and an expert team trained for LMS implementation. An introductory LMS workshop forfaculty had 7 out of 25 invitees, but attendance improved to more than 50% in subsequent workshops. Student attendance at workshops was mandatory. Use of the LMS by students rapidly expanded, and growing faculty utilisation followed later. By the end of the second semester, online examinations were offered, resulting in greater student and faculty  satisfaction owing to rapid availability of results. A year after LMS   introduction, 90% of students were accessing the LMS at least 4 days/week. A student survey identified high levels of satisfaction with the LMS software, quality of content, and learning enhancement.Conclusion. LMS can be a useful and efficient tool for curriculum  organisation, administration of online examinations, and continuous monitoring. The lessons learned from KCMU Co may be useful for similar academic settings

Emergency pulpotomy in relieving acute dental pain among Tanzanian patients

BACKGROUND: In Tanzania, oral health services are mostly in the form of dental extractions aimed at alleviating acute dental pain. Conservative methods of alleviating acute dental pain are virtually non-existent. Therefore, it was the aim of this study to determine treatment success of emergency pulpotomy in relieving acute dental pain. METHODS: Setting: School of Dentistry, Muhimbili National Hospital, Dar es Salaam, Tanzania. Study design: Longitudinal study. Participants: 180 patients who presented with dental pain due to acute irreversible pulpitis during the study period between July and August 2001. Treatment and evaluation: Patients were treated by emergency pulpotomy on permanent posterior teeth and were evaluated for pain after one, three and six week's post-treatment. Pain, if present, was categorised as either mild or acute. RESULTS: Of the patients with treated premolars, 25 (13.9%) patients did not experience pain at all while 19 (10.6%) experienced mild pain. None of the patients with treated premolars experienced acute pain. Among 136 patients with treated molars 56 (31%) did not experience any pain, 76 (42.2%) experienced mild pain and the other 4 (2.2%) suffered acute pain. CONCLUSION: The short term treatment success of emergency pulpotomy was high being 100% for premolars and 97.1% for molars, suggesting that it can be recommended as a measure to alleviate acute dental pain while other conservative treatment options are being considered

Perceived dental treatment need among older Tanzanian adults – a cross-sectional study

Need perceptions for dental care play a key role as to whether people in general will seek dental care. The aim was to assess the prevalence of perceived need of problem based dental care, dental check-ups and any type of dental care. Guided by the conceptual model of Wilson and Cleary, the relationship of perceived need for dental care with socio-demographic characteristics, clinically defined dental problems and self-reported oral health outcomes was investigated. Partial prosthetic treatment need was estimated using a socio-dental approach. A cross-sectional survey was conducted in Pwani region and in Dar es Salaam in 2004/2005. Information from interviews and clinical examination became available for 511 urban and 520 rural adults (mean age 62.9 yr). 51.7% (95% CI 46.2, 57.0) urban and 62.5 % (95% CI 53.1, 70.9) rural inhabitants confirmed need for dental check-up, 42.9% (95% CI 36.9, 48.9) urban and 52.7% (95% CI 44.5, 60.6) rural subjects confirmed need for problem oriented care and 38.4% (95% CI 32.4, 44.6) urban versus 49.6% (95% CI 41.8, 57.4) rural residents reported need for any type of dental care. Binary and ordinal multiple logistic regression analyses revealed that adults who reported bad oral health and broken teeth were more likely to perceive need for dental care across the three outcome measures than their counterparts. Socio-demographic factors and clinically defined problems had less impact. Based on a normative and an integrated socio-dental approach respectively 39.5% and 4.7% were in need for partial dentures. About half of the participants confirmed need for problem oriented care, dental check-ups and any type of dental care. Need perceptions were influenced by perceived oral health, clinically assessed oral problems and socio-demographic characteristics. Need estimates for partial denture was higher when based on clinical examination alone compared to an integrative socio-dental approach

Epidemiology of traumatic brain injury patients at Kilimanjaro Christian medical centre, Moshi, Tanzania

Traumatic brain injury (TBI) affects 10 million people annually. Clinical epidemiology can inform prevention initiatives to curb this burden. Kilimanjaro Christian Medical Centre (KCMC) is a referral hospital for 11 million people with neurosurgical capacity located in Moshi, Tanzania. Methods: Secondary analysis of a prospective observational TBI Acute Care Registry at the KCMC Casualty Department (CD) included all patients presenting between May 5 and July 27th, 2013. Means with standard deviations (SD), Fisher’s exact or Chi-squared with a binomial logistic regression reporting Odds Ratios (OR) with 95% confidence intervals (CI) was calculated using Stata IC (College Station, TX). Results: 171 total patients were enrolled in the TBI Registry. The mean age was 32.1 years (range 1–99, SD 16.6), with 71% between 15 and 45 years of age. 82% were male and 28% cases involved alcohol. Causes of TBI were road traffic injuries (RTI) (74%), assaults (13%) or falls (8%). 52% of RTI’s involved motorcycle users. The mean Glasgow Coma Score (GCS) was 12.6 (range 3-15, SD 4.04) with 19% of patients having severe TBI (GCS of <9). The overall mortality rate was 13% for all CD patients, 14% for admitted patients and 80% for patients admitted to the ICU. Death was associated with hypoxia (OR 16.0 (95% CI 5.4, 47.5), hypotension (OR 7.3 (95% CI 1.4, 38.4) and low GCS (GCS <9, OR 29.7 (95% CI 9.6, 92.0). Severe TBI had a 53% mortality rate, while moderate and mild TBI 12% and 3% fatality rates respectively. Of severe TBI patients, 63.6% suffered disability from their injury compared to 27% of moderate and 3% of mild TBI. Conclusion: Most TBI patients were young males involved in road traffic collisions, predominantly involving motorcycles. Over a quarter of them involve alcohol. Our data support that TBI causes significant death and disability