Gastric Cancer at a University Teaching Hospital in Northwestern Tanzania: A Retrospective Review of 232 Cases.

Despite marked decreases in its incidence, particularly in developed countries, gastric cancer is still the second most common tumor worldwide. There is a paucity of information regarding gastric cancer in northwestern Tanzania. This study was undertaken to describe our experience, in our local setting, on the management of gastric cancer, outlining the clinicopathological and treatment outcome of these patients and suggesting ways to improve the treatment outcome. This was a retrospective study of histologically confirmed cases of gastric cancer seen at Bugando Medical Centre between January 2007 and December 2011. Data were retrieved from patients' files and analyzed using SPSS computer software version 17.0. A total of 232 gastric cancer patients were enrolled in the study, representing 4.5% of all malignancies. The male to female ratio was 2.9:1. The median age of patients was 52 years. The majority of the patients (92.1%) presented late with advanced gastric cancer (Stages III and IV). Lymph node and distant metastasis at the time of diagnosis was recorded in 31.9% and 29.3% of cases, respectively. The antrum was the most frequent anatomical site (56.5%) involved and gastric adenocarcinoma (95.1%) was the most common histopathological type. Out of 232 patients, 223 (96.1%) patients underwent surgical procedures for gastric cancer of which gastro-jejunostomy was the most frequent performed surgical procedure, accounting for 53.8% of cases. The use of chemotherapy and radiotherapy was documented in 56 (24.1%) and 12 (5.1%) patients, respectively. Postoperative complication and mortality rates were 37.1% and 18.1%, respectively. According to multivariate logistic regression analysis, preoperative co-morbidity, histological grade and stage of the tumor, presence of metastases at the time of diagnosis was the main predictors of death (P <0.001). At the end of five years, only 76 (32.8%) patients were available for follow-up and the overall five-year survival rate was 6.9%. Evidence of cancer recurrence was reported in 45 (19.4%) patients. Positive resection margins, stage of the tumor and presence of metastasis at the time of diagnosis were the main predictors of local recurrence (P <0.001). Gastric cancer in this region shows a trend towards relative young age at diagnosis and the majority of patients present late with an advanced stage. Lack of awareness of the disease, poor accessibility to health care facilities and lack of screening programs in this region may contribute to advanced disease at the time of diagnosis. There is a need for early detection, adequate treatment and proper follow-up to improve treatment outcome

Bowel Perforation Secondary to Illegally Induced Abortion: a Tertiary Hospital Experience in Tanzania.

Bowel perforation though rarely reported is a serious complication of induced abortion, which is often performed illegally by persons without any medical training in developing countries. A sudden increase in the number of patients in our centre in recent years prompted the authors to analyze this problem. The study was conducted to describe our own experiences in the surgical management of these patients. This was a retrospective study involving patients who were jointly managed by the surgical and gynecological teams at Bugando Medical Centre (BMC) for bowel perforation secondary to illegally induced abortion from January 2002 to December 2011. The statistical analysis was performed using SPSS version 17.0. A total of 68 patients (representing 4.2% of cases) were enrolled in the study. Their ages ranged from 14 to 45 years with a median age of 21 years. Majority of patients were, secondary school students/leavers (70.6%), unmarried (88.2%), nulliparous (80.9%), unemployed (82.4%) and most of them were dependent member of the family. Previous history of contraceptive use was reported in only 14.7% of cases. The majority of patients (79.4%) had procured the abortion in the 2nd trimester. Dilatation and curettage (82.4%) was the most common reported method used in procuring abortion. The interval from termination of pregnancy to presentation in hospital ranged from 1 to 14 days (median 6 days ). The ileum (51.5%) and sigmoid colon (22.1%) was the most common portions of the bowel affected. Resection and anastomosis with uterine repair was the most common (86.8%) surgical procedure performed. Complication and mortality rates were 47.1% and 10.3% respectively. According to multivariate logistic regression analysis, gestational age at termination of pregnancy, delayed presentation, delayed surgical treatment and presence of complications were significantly associated with mortality (P<0.001). The overall median length of hospital stay (LOS) was 18 days (1day to 128 days ). Patients who developed complications stayed longer in the hospital, and this was statistically significant (P=0.012). Bowel perforation following illegally induced abortion is still rampant in our environment and constitutes significantly to high maternal morbidity and mortality. Early recognition of the diagnosis, aggressive resuscitation and early institution of surgical management is of paramount importance if morbidity and mortality associated with bowel perforation are to be avoided

Modeling Student Performance in Mathematics Using Binary Logistic Regression at Selected Secondary Schools A Case Study of Mtwara Municipality and Ilemela District

This study investigated the performance of secondary school students in Mathematics at the Selected Secondary Schools in Mtwara Municipality and Ilemela District by Absenteeism, Conduct, Type of School and Gender as explanatory Factors. The data used in the study was collected from documented records of 250 form three students with 1:1 gender ratio – 50 students from each of the five selected secondary schools in the academic year 2011/2012. The sample was considered appropriate as they had covered more than half of the Mathematics syllabus in Ordinary Secondary Schools. Binary logistic regression was used to model a binary variable ‘performance’ (fail, pass) against a systematic component of linear combination predictors (absenteeism, conduct, type of school and gender). The model fitted for the log-odds in favour of poor performance is . The essence of this study is to provide student performance analysis method (Binary Logistic Regression) not commonly used in Tanzania. Findings show that two out of four explanatory factors used in the study (absenteeism and misconduct) significantly predict student performance in Mathematics based on binary logistic regression fitted. Absenteeism and misconduct predict the log-odds of poor performance by multiplicative effect of 1.414 and 3.137 respectively. Future work is recommended to focus on analysis using other Generalized Linear Models (GLM) as well considering other locations with more/other variables affecting performance of students in mathematics. Keywords: Binary Logistic Modeling, Misconduct, Performance

Animal-Related Injuries in a Resource-Limited Setting: Experiences from a Tertiary Health Institution in Northwestern Tanzania.

Animal related injuries are a major but neglected emerging public health problem and contribute significantly to high morbidity and mortality worldwide. No prospective studies have been done on animal related injuries in our setting. This study was conducted to determine the management patterns and outcome of animal related injuries and their social impact on public health policy in the region. This was a descriptive prospective study of animal related injury patients that presented to Bugando Medical Centre between September 2007 and August 2011. Statistical data analysis was done using SPSS computer software version 17.0. A total of 452 (8.3%) animal-related injury patients were studied. The modal age group was 21-30 years. The male to female ratio was 2.1:1. Dog-bites (61.1%) were the most common injuries. Musculoskeletal (71.7%) region was the most frequent body region injured. Soft tissue injuries (92.5%) and fractures (49.1%) were the most common type of injuries sustained. Only 140 (31.0%) patients were hospitalized and most of them (97.1%) were treated surgically. Wound debridement was the most common procedure performed in 91.2% of patients. Postoperative complication rate was 15.9%, the commonest being surgical site infections (SSI) in 55.1% of patients. SSI was significantly associated with late presentation and open fractures (P < 0.001). The overall median duration of hospitalization was 16 days. Patients who had severe injuries, long bone fractures and those with hemiplegia stayed longer in the hospital (P < 0.001). Mortality rate was 10.2% and was significantly high in patients with severe injuries, severe head injury, tetanus and admission SBP < 90 mmHg (P < 0.001). The follow up of patients was poor. Animal related injuries constitute a major public health problem in our setting and commonly affect the young adult male in their economically productive age-group. Measures towards prevention and proper treatment and follow up are important in order to reduce morbidity and mortality resulting from this form of trauma

Geriatric Injuries among Patients Attending a Regional Hospital in Shinyanga Tanzania

Geriatric injuries pose a major challenge to surgeons and general practitioners in developing countries. The objective of this study was to determine the prevalence, injury characteristics and outcomes of geriatric injury among patients at Shinyanga Regional Hospital in Tanzania. Data was collected using a pre-tested, coded questionnaire and analyzed using SPSS computer system. A total of 94 geriatric trauma patients constituting 22.7% of all trauma admissions were studied. The male to female ratio was 1.4:1. Their mean age was 68.5 years (ranged 60-98 years). Premorbid illness was reported in 38.3% of patients. Most injuries were intentional in fifty-three (56.4%) patients. Assaults, falls and road traffic crashes were the mechanism of injuries in 52.1%, 19.1% and 11.7% of cases, respectively. The majority of cases of assault were females accounting for 64.6%. The majority of injuries (81.9%) occurred at home. Pre-hospital care was recorded in 5.3% of cases. The musculoskeletal (72.3%) and head (66.0%) regions were commonly affected. Soft tissue injuries (wounds) (89.4%) and fractures (52.2%) were the most common type of injuries. The majority of patients (90.4%) underwent surgical treatment of which wound debridement was the most common procedure performed in 91.8% of cases. Complication rate was 39.4%. The mean length of hospital stay was 28.6 days (ranged 1 – 124 days). The length of hospital stay was significantly longer in patients with co-morbidities, long bone fractures and those with complications (P<0.05). Mortality rate was 14.9% and it was significantly related to advanced age, presence of pre-morbid illness, high injury severity score, severe head injuries and the need for ventilatory support (P< 0.05). In conclusion, traumatic injuries in elderly constitute a major but preventable public health problem in Shinyanga region and contribute significantly to high morbidity and mortality. Urgent preventive measures focusing at the root causes of the injuries and early appropriate treatment is highly needed to reduce the occurrence, morbidity and mortality associated with these injurie

Compactness in asymmetrically normed lattices.

Includes abstract.Includes bibliographical references.The aim of the thesis is to investigate aspects of the theory of such spaces, concentrating mainly, but not exclusively, on nite dimensional spaces. One of the main aims of this thesis is to investigate compactness in the setting of asymmetrically normed lattices. In order to do this, it was necessary to study convergence of sequences and left-K-sequential completeness and precompactness of subsets of such spaces

The Impact of Fiscal Decentralization on Provision of Quality Education and Education Spending in Tanzania

This article uses panel data from 94 LGAs in Tanzania mainland over the period 2005/06 to 2009/10, to examine the impact of Fiscal Decentralization on education spending and provision of quality education. Using local share of total fiscal expenditure as a proxy for fiscal decentralization, this article concludes that Fiscal Decentralization exerts significant impact on education spending and quality of education in Tanzania.Keywords: Fiscal decentralization, education, government spending, Tanzani

Teaching Sexuality Education in Primary Schools in Tanzania: Challenges and Implications

The purpose of this paper is to investigate the effectiveness of school based sexuality education in promoting knowledge and skills relating to the prevention of pregnancy and HIV and AIDS. The rationale was that understanding how teachers and pupils experience sexuality education in schools could perhaps contribute to better ways of mitigating HIV/AIDS and pregnancies. In this regard, the study  focused on exploring the way in which sexuality education is provided in primary schools, explore teachers’ training on sexuality education provision, pupils’ source of sexuality education knowledge and challenges that affect the provision of  sexuality education. The study used mixed method design, where by both quantitative and qualitative approaches were utilized. The study population was drawn from a total of 120 teachers and 204 pupils. Data collection methods included, questionnaires and interviews. The research findings shows although sexuality education seem to be intergrated in subjects, pupils’ source of sexuality knowledge seem to be not from schools teaching and learning rather other sources out of schools. On the other hand there was evidence of inadequate training for teachers on how to teach and handle sexuality classes in primary schools. Furthermore pupils faces difficulties in learning sexualit topics due to different factors such as cultural barrier, religious beliefs and personal background, teachers with relevant teaching skills and learning facilities. The study recommend several approaches to improve sexuality education in schools which include training for teachers to improve the content and methodology for teaching sexuality education, providing teaching and learning facilities relevant for improving sexuality education teaching. It is concluded that an open discussions on sexuality education among parents, pupils, religious leaders and policy makers should be carried out so as to develop a guideline on what should be included in the syllabus for sexuality education topics and how the contents should be taught. The study therefore calls for other researchers to investigate the application of sexuality knowledge and skills to pupils in protecting them from sexual risks