Massive vulval oedema in multiple pregnancies at Bugando Medical Centre: Case reports

Massive vulval oedema is not common during pregnancy, but when it develops, it often is associated with patient discomfort and management challenges. Two pregnant women presented to Bugando Medical Centre in Mwanza, Tanzania, with massive swelling of the vulva at 39 weeks and 32 weeks of gestation. Both women were found to have multiple gestations.  Despite medical management, there was no resolution of the oedema.  In both cases, vulval oedema subsided after being delivered by caesarean section. Major vulval oedema during pregnancy is a serious issue.  If not treated appropriately, it can lead to major complications of increased blood loss and poor wound healing. Abdominally delivery is the preferred mode of delivery at our institution for massive vulval oedema

Iatrogenic ureteric injuries following abdomino-pelvic operations: a 10-year tertiary care hospital experience in Tanzania

Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity and even mortality. There is paucity of data regarding iatrogenic ureteric injuries in Tanzania and Bugando Medical Centre in particular. This study describes our experience in the management and outcome of ureteric injuries following abdomino-pelvic operations outlining the causes, clinical presentation and outcome of management of this condition in our local setting. This was a retrospective descriptive study of patients with iatrogenic ureteric injuries following abdomino-pelvic operations that were managed in Bugando Medical Centre between July 2004 and June 2014. A total of 164 patients (M: F = 1: 1.6) were studied. Of these, 154 (93.9%) were referred to Bugando Medical Centre having had their initial surgeries performed at other hospitals, whereas 10 (6.1%) patients sustained ureteric injuries during abdomino-pelvic surgery at Bugando Medical Centre. The median age at presentation was 36 years. The most common cause of iatrogenic ureteric injuries was total abdominal hysterectomy occurring in 69.2% of cases. The distal ureter was more frequently injured in 75.6% of cases. Suture ligation was the commonest type of injury accounting for 36.6% of patients. One hundred and sixteen (70.7%) patients had delayed diagnosis but underwent immediate repair. Ureteroneocystostomy was the most frequent reconstructive surgery performed in 58.0% of cases. Of the 164 patients, 152 (92.7%) were treated successfully. Twelve (7.3%) patients died in hospital. The main predictors of deaths were delayed presentation, deranged renal function tests on admission, missed ureteric injuries and surgical site infections (P < 0.001). The overall median length of hospital stay was 12 days. Follow up of patients was generally poor as more than half of patients were lost to follow up. Total abdominal hysterectomy still accounts for most cases of iatrogenic ureteric injuries in our environment. Meticulous surgical technique as well as identification of the course of the ureter and associated anatomic locations where injury is most likely to occur is important to decrease the risk of ureteric injury. Timely recognition of ureteric injury and its management is associated with good outcome

Maternal and Perinatal Outcomes among Eclamptic Patients Admitted to Bugando Medical Centre, Mwanza, Tanzania

Eclampsia continues to be a major problem, particularly in developing countries such as Tanzania, contributing significantly to high maternal and perinatal morbidity and mortality. We conducted a study to establish the incidence of eclampsia and the associated maternal and perinatal outcomes among eclamptic patients admitted to our center. A descriptive cross-sectional study of all women presenting with eclampsia was performed from June 2009 to February 2010. Seventy-six patients presented with eclampsia out of a total 5562 deliveries during the study period (incidence of 1.37%). Antenatal attendance was 96% among patients with eclampsia; however, only 45.21% and 24.66% were screened for blood pressure and proteinuria respectively. Maternal and perinatal case fatality rates were 7.89% and 20.73% respectively. The main factors contributing to maternal deaths were acute renal failure (10.5%), pulmonary oedema (10.5%), maternal stroke (8.8%), HELLP syndrome (50.9%), and Disseminated Intravascular Coagulopathy (3.5%). Perinatal deaths were caused by prematurity (42.9%) and birth asphyxia (57.1%). Forty-eight babies had low-birth weight (58.54%). The high incidence of eclampsia and its complications during this study period may indicate the need for earlier and more meticulous intervention at both the clinic and hospital levels Keywords: Eclampsia, maternal, perinatal, morbidity, mortality, TanzaniaAfr J Reprod Health 2012; 16[1]:35-4

Prevalence of Bacterial Vaginosis and Associated Factors among Pregnant Women Attending at Bugando Medical Centre, Mwanza, Tanzania

Bacterial vaginosis (BV) is an extremely common reproductive tract condition worldwide with reported high prevalence among African population. Factors associated with this condition include preterm labour, premature rupture of membranes, preterm delivery and possibly spontaneous abortion. Nevertheless, antenatal screening and treatment is not routinely available in most poor-resource countries including Tanzania. A cross-sectional descriptive study was conducted among delivering women at Bugando Medical Centre (BMC), Mwanza, Tanzania to determine the magnitude of the BV using the Nugent’s criteria and to document factors associated with the condition. A total of 284 women who presented for delivery at BMC labour ward from February to March 2011 were recruited into the study. For each consented women, a vaginal swab was taken, samples collected tested and a Nugent’s score of at least seven indicated bacterial vaginosis. Overall, bacterial vaginosis was diagnosed in 28.5% (n=81) of all participants. Gardnerella was the commonest morphotypes found in approximately 66.2% (n=188) of all participants while 11.6% (33 participants) had Mobilincus. There were no evidence for the association between bacterial vaginosis having formal education, (OR, 1.42[95%CI, 0.29-6.97; p=0.667]). Urban residence (OR, 1.29 [95% CI, 0.76-2.19; p=0.352]), ever delivered before (OR 0.66[95%CI, 0.39-1.12; p=0.126]), vaginal practice to enhance dry sex (OR, 1.16[95%CI, 0.43-3.17; p=0.768]) or wet sex (OR 1.31[95%CI, 0.46-3.7; p=0.613]), gestation age less than 37 weeks (OR 0.82[95%CI, 0.45-1.51; p=0.534]) and HIV infection (OR 0.90[95%CI, 0.28-2.92; p=0.863]) were not associated with bacterial vaginosis. Bacterial vaginosis is common among women delivering at Bugando Medical Centre and more studies to include antenatal clinic attendees initiating care are required to reliably document the magnitude the condition

Sero-Prevalence and Factors Associated with Toxoplasma gondii Infection among Pregnant Women Attending Antenatal Care in Mwanza, Tanzania.

Serological screening of pregnant women for Toxoplasma gondii-specific antibodies is not practiced as an antenatal care in Tanzania; and there is a limited data about sero-prevalence of T. gondii infection in developing countries. We therefore conducted this study to determine the sero-prevalence and factors associated with T. gondii infection among pregnant women attending antenatal care clinics in Mwanza, Tanzania. Between 1st November 2012 and 31st May 2013 a total of 350 pregnant women attending antenatal care clinics in Mwanza were enrolled and screened for IgG and IgM antibodies against T. gondii using the ELISA technique. Of 350 pregnant women, 108 (30.9%) were sero-positive for T. gondii-specific antibodies. The risk of contracting T. gondii infection increases by 7% with each yearly increase in a woman's age (OR=1.07, 95% CI: 1.02 - 1.11, p=0.002). The sero-positivity rate of T. gondii-specific antibodies was higher among pregnant women from the urban than those from rural communities (41.5% versus 22.0%); [OR=2.2, 95% CI; 1.4 - 3.7, p=0.001]. Likewise employed/business women were more likely to get T. gondii infection than peasants (40.0% versus 25.9%) [OR=1.9, 95% CI: 1.2 - 3.0, p=0.006]. Sero-prevalence of T. gondii-specific antibodies is high among pregnant women in Mwanza with a significant proportion of women at risk of contracting primary T. gondii infections. Screening of T. gondii infections during antenatal care should be considered in Tanzania as the main strategy to minimize congenital toxoplasmosis

Blood transfusion practice in surgery at Bugando Medical Centre in northwestern Tanzania

 Background: Preoperative over-ordering of blood for surgical intervention, in excess of the actual and anticipated needs is a common practice in many developing countries. This can be decreased by simple means of changing the blood cross matching and ordering schedule depending upon the type of surgery performed. The aim of this study was to assess the blood transfusion practice in surgery at Bugando Medical Centre in northwestern Tanzania.Methods and Patients: This was a prospective cross sectional study among patients undergoing major operations at Bugando Medical Centre. We evaluated blood ordering and transfusion practices in emergency and elective surgical procedures at our centre and calculated different indices such as cross-match to transfusion ratio (C/T ratio), transfusion probability (% T) and transfusion index (TI). Next Maximal Surgical Blood Ordering System (MSBOS) was estimated for each procedure.Results: The overall blood utilization was only 28.2% at our centre, consisting of 17.1% in the elective operations and 26.9% in the emergency operations. Significant blood utilization was nil in most of the routine elective cases suggesting cross-matching of blood to be a culture than necessity. Generally, the overall blood transfusion of the requested blood as indicated by indices of C/T ratio, %T, TI and MSBOS were 3.5, 28.7%, 0.33 and 0.45, respectively. The overall CT ratio, %T, Ti and MSBOS in the elective operations were 5.8, 15.9%, 0.2 and 0.3, respectively. In the emergency operations, the overall CT ratio, %T, Ti and MSBOS were 3.7, 22%, 0.32 and 0.48, respectively.Conclusion: This study demonstrated that over-ordering of blood in excess of the actual needs is a common practice in our setting.  Blood ordering pattern needs to be revised and over-ordering of blood should be minimized. This can be possible by the estimation of MSBOS for each procedure and requisition as calculated

Trauma admissions among victims of domestic violence at a tertiary care hospital in north-western Tanzania: an urgent call to action

Background: Despite the growing recognition of domestic violence as a public health and human rights concern, it remains rampant in developing countries and has a negative impact on the victim’s health. This study describes the injury characteristics and treatment outcome of trauma associated with domestic violence in north-western Tanzania.Methods: This was a descriptive prospective study of patients who were managed for domestic violence related trauma at Bugando Medical Centre in Mwanza, Tanzania from April 2009 to March 2014.Results: A total of 324 patients (M: F = 1: 10.6) were studied. Majority of the patients were in the second and third decades of life. The perpetrators were mainly husbands and ex-partners (55.5%). Suspecting sexual partner being unfaithful was the most common reason given by victims for domestic violence in 63.4% of cases. Blunt and sharp objects (56.8%) were the most common weapons used. Gunshot injuries were recorded in 0.6% of cases. The head/neck was commonly affected in 68.5%. Soft tissue injuries (77.8%) were the most frequent type of injuries. The majority of patients (65.4%) sustained mild injuries. Twenty-three (7.1%) patients were HIV positive. Surgical treatment was performed in only 34.6% of cases.  Complication rate was 26.8%. The median hospital stay was 12 days. Mortality rate was 6.5%. The main predictors of mortality were advanced age (&gt; 60 years),  late presentation,  severity of injury, severe head injury, HIV seropositivity, low CD 4 count (&lt;200 cells), surgical site infection (p&lt;0.001). More than two-thirds of patients were lost to follow up.Conclusion: Domestic violence related trauma remains rampant in northwestern Tanzania and contributes significantly to high morbidity and mortality. Urgent preventive measures targeting at reducing the occurrence of domestic physical violence is necessary to reduce the morbidity and mortality resulting from these injuries.

Needle-stick injuries and splash exposures among health-care workers at a tertiary care hospital in north-western Tanzania

Background: Needle-stick injuries (NSIs) and splash exposures carry a risk of occupational acquisition of HIV and other blood borne pathogens to healthcare workers (HCWs) involved in clinical care. This study was carried out to determine the frequency and factors contributing to NSIs and splash exposures as well as post-exposure practices among HCWs in our centre. Methods: This was a cross-sectional study among healthcare workers which was conducted at Bugando Medical Centre (BMC) over a one-year period between April 2013 and March 2014. Results:  Out of 436 HCWs who participated in this study, 212 (48.6%) reported incidents of NSIs and splash exposures within the previous 12 months. NSIs were reported by 65.1% (n= 138) and splash exposures by 27.4% (n = 58). Sixteen (7.5%) respondents had both NSIs and splash exposures. High rates of NSIs were observed among nurses (71.0%), during procedures (53.6%) and occurred commonly in the Accident and Emergency department (33.3%). Hollow bore needles were responsible for 63.8% of NSIs.  Splash exposures occurred more commonly in operating theatre (41.4%). At the time of the exposure, 116 (54.7%) HCWs wore protective equipment. The most common action following exposure was washing the site with soap and water (55.6%). Only 68 (32.1%) reported the incident of exposure to the relevant authority.  Healthcare workers aged ≤ 40 years; those with work experience of ≤ 5 years and those not trained on issues related to infection prevention and occupational risk reduction were more likely to be exposed to any type of occupational injuries studied. While male healthcare workers were less likely to be exposed to NSIs, female were more likely to encounter both NSIs and mucocutaneous splashes (p &lt; 0.001). The majority of HCWs, 185 (87.3%) were not adequately immunized for hepatitis B virus and only 17 (8.0%) were fully vaccinated, having received three doses of the vaccine. Only 16.7% of exposed HCWs received post-exposure prophylaxis for HIV. Subsequent six-month follow-up for HIV showed zero seroconversion. Conclusion: NSIs and splash exposures are common among HCWs at our centre and are under-reported. Post-exposure management is generally poor. All HCWs should be trained on issues related to infection prevention and occupational risk reduction. The hospital should establish surveillance system for registering, reporting and management of occupational injuries and exposures.

Massive vulval oedema in multiple pregnancies at Bugando Medical Centre: Case reports

Massive vulval oedema is not common during pregnancy, but when it develops, it often is associated with patient discomfort and management challenges. Two pregnant women presented to Bugando Medical Centre in Mwanza, Tanzania, with massive swelling of the vulva at 39 weeks and 32 weeks of gestation. Both women were found to have multiple gestations. Despite medical management, there was no resolution of the oedema. In both cases, vulval oedema subsided after being delivered by caesarean section. Major vulval oedema during pregnancy is a serious issue. If not treated appropriately, it can lead to major complications of increased blood loss and poor wound healing. Abdominally delivery is the preferred mode of delivery at our institution for massive vulval oedema