The quality of operation notes after trans-urethral resection of the prostate at Kilimanjaro Christian Medical University College Hospital Tanzania

Background: Operation notes are very vital in the practice of surgery. They are the only comprehensive account of what took place in theatre. Accurate and detailed documentation of surgical notes after Transurethral Resection of the Prostate (TURP) is vital. Yet it is usually forgotten in medical teaching. The Royal College of Surgeons of England (RCSE) safety standards are usually used as the benchmark for the assessment of operation notes.Patients and Methods: The study was descriptive retrospective conducted at Kilimanjaro Christian Medical Centre (KCMC). All patients who underwent TURP between January and December 2017 were enrolled. The Urology theatre register was used to trace patient identities. The Files were then extracted from the registry. Operation note sheets were analysed by the research team using a structured data collection tool. Two Independent assessors(residents) were used to assess legibility. If both agreed that the notes were decipherable, then they were deemed legible. The content of the notes was assessed for Presence or absence of recorded variables. Utmost confidentiality was kept about the surgeon and the patient.Results: A total of 251 files were assessed. Recording of date, Inpatient number, Post-Operative instructions and whether there were any intraoperative complications was at 100%. However, the time of surgery, Resection technique and Method of introduction of the resectoscope were not recorded at all. Other variables recorded were: Signature of surgeon -99.6%, Patient name-99.6%, Details of prostate chips-89%, Sheath used-81%, Circulating nurse-68%, Working element used-35%, Telescope used-12%, Type of diarthermy-7%, Loop Specifications-0.8% and type of Irrigant at 0.8%. Ninety-eight percent of the  operation notes were legible. Overall 56.6% of the operation notes had recorded variables after TURP.Conclusion: Some variables (Inpatient number, Date of operation, intraoperative complications and Postoperative instructions) were recorded at 100%. Others (Time of operation, Resection technique and method of introduction of resectoscope) were not recorded at all. Overall 56.6% of the variables were recorded and 98% of the notes were legible

Socio-economic and partner relationship factors associated with antenatal depressive morbidity among pregnant women in

Depression during pregnancy may negatively influence social functioning, birth outcomes and postnatal mental health. A cross-sectional analysis of the baseline survey of a prospective study was undertaken with an objective of determining the prevalence and socio-demographic factors associated with depressive morbidity during pregnancy in a Tanzanian peri-urban setting. Seven hundred and eighty seven second to third trimester pregnant women were recruited at booking for antenatal care at two primary health care clinics. Prenatal structured interviews assessed socio-economic, quality of partner relationships and selected physical health measures. Depressive symptoms were measured at recruitment and three and eight months postpartum using the Kiswahili version of the Hopkins Symptom Checklist. Completed antenatal measures available for 76.2% participants, showed a 39.5% prevalence of depression. Having a previous depressive episode (OR 4.35,

Social venues that protect against and promote HIV risk for young men in Dar es Salaam, Tanzania

Developing effective place-based health interventions requires understanding of the dynamic between place and health. The therapeutic landscape framework explains how place-based social processes and physical geography interact and influence health behavior. This study applied this framework to examine how venues, or social gathering places, influenced HIV risk behavior among young, urban men in Tanzania. Eighty-three public venues where men ages 15–19 met new sexual partners were identified by community informants in one city ward. The majority (86%) of the venues were called ‘camps’, social gathering places that had formal leaders and members. Observations were conducted at 23 camps and in-depth interviews were conducted with 36 camp members and 10 camp leaders in 15 purposively selected camps. Geographic and social features of camps were examined to understand their contributions to men’s behaviors. Camps were characterized by a geographic space claimed by members, a unique name and a democratic system of leadership and governance. Members were mostly men and socialized daily at their camp. They reported strong social bonds and engaging in health-promoting activities such as playing sports and generating income. Members also engaged in HIV risk behaviors, such as meeting new sexual partners and having sex in or around the camp at night. Some members promoted concurrent sexual partnerships with their friends and resisted camp leaders’ efforts to change their sexual risk behavior

High burden of tuberculosis infection and disease among people receiving medication-assisted treatment for substance use disorder in Tanzania

OBJECTIVE: To determine the prevalence of tuberculosis (TB) disease and infection as well as incident TB disease among people who use drugs (PWUD) attending Medication Assisted Treatment (MAT) clinics in Dar-es-Salaam, Tanzania. METHODS: In this prospective cohort study, a total of 901 consenting participants were enrolled from November 2016 to February 2017 and a structured questionnaire administered to them through the open data kit application on android tablets. Twenty-two months later, we revisited the MAT clinics and reviewed 823 of the 901 enrolled participant's medical records in search for documentation on TB disease diagnosis and treatment. Medical records reviewed included those of participants whom at enrolment were asymptomatic, not on TB disease treatment, not on TB preventive therapy and those who had a documented tuberculin skin test (TST) result. RESULTS: Of the 823 medical records reviewed 22 months after enrolment, 42 had documentation of being diagnosed with TB disease and initiated on TB treatment. This is equivalent to a TB disease incidence rate of 2,925.2 patients per 100,000 person years with a total follow up time of 1,440 person-years. At enrolment the prevalence of TB disease and TB infection was 2.6% and 54% respectively and the HIV prevalence was 44% and 16% among females and males respectively. CONCLUSION: PWUD attending MAT clinics bear an extremely high burden of TB and HIV and are known to have driven TB epidemics in a number of countries. Our reported TB disease incidence is 12 times that of the general Tanzanian incidence of 237 per 100,000 further emphasizing that this group should be prioritized for TB screening, testing and treatment. Gender specific approaches should also be developed as female PWUDs are markedly more affected with HIV and TB disease than male PWUDs

Rain-Fed Farming System at a Crossroads in Semi-Arid Areas of Tanzania: What Roles do Climate Variability and Change Play?

Positive changes, like adopting drought resistant crop varieties, in the rain-fed farming system (RFFS) in response to climate variability and change enhance system’s ability to support people’s living as opposed to negative changes, like lack of pastures, which put the system at risk of failure in supporting the living. Using participatory rural appraisal (PRA) and household survey, this paper examined the roles of climate variability and change in triggering changes in RFFS. Specifically, the paper: (i) assessed dominant crop and livestock farming system; (ii) assessed the change element of crop and livestock production systems; and (iii) examined factors for the changes in RFFS. A random sample of 388 households was used. Qualitative data analysis was done through content analysis. Binary logistic regression was used to assess factors that explain changes on RFFS. The results showed that dominant crops were different in each village. Secondly, some changes in crop varieties and in livestock grazing arrangements were noted in response to climate variability and change. Unlike the hypothesis (P>0.05), the results demonstrated that warming (ß = -10.61, Wald = 36.26, P ? 0.001) showed highest significant impact on likelihood of adopting new crop varieties relative to other factors. Similarly, drought (ß = 2.16, Wald = 6.82, P ? 0.009) showed highest impact on the likelihood of changing a grazing place. Yet, the changes were constrained by factors like natural resources protective policies, failure of crop varieties to withstand warming and drought, and poor land use management. Therefore, the RFFS was at a crossroads with implications on system sustainability and livelihoods. The government and private interventions should support farmers and agro-pastoralists to manage risks related to the changes in RFFS in response to climate variability and change. Keywords: Climate change, agro-pastoralism, livelihoods, semi-arid, Tanzani

Age-related differences in socio-demographic and behavioral determinants of HIV testing and counseling in HPTN 043/NIMH Project Accept

Youth represent a large proportion of new HIV infections worldwide, yet their utilization of HIV testing and counseling (HTC) remains low. Using the post-intervention, cross-sectional, population-based household survey done in 2011 as part of HPTN 043/NIMH Project Accept, a cluster-randomized trial of community mobilization and mobile HTC in South Africa (Soweto and KwaZulu Natal), Zimbabwe, Tanzania and Thailand, we evaluated age-related differences among socio-demographic and behavioral determinants of HTC in study participants by study arm, site, and gender. A multivariate logistic regression model was developed using complete individual data from 13,755 participants with recent HIV testing (prior 12 months) as the outcome. Youth (18–24 years) was not predictive of recent HTC, except for high-risk youth with multiple concurrent partners, who were less likely (aOR 0.75; 95% CI 0.61–0.92) to have recently been tested than youth reporting a single partner. Importantly, the intervention was successful in reaching men with site specific success ranging from aOR 1.27 (95% CI 1.05–1.53) in South Africa to aOR 2.30 in Thailand (95% CI 1.85–2.84). Finally, across a diverse range of settings, higher education (aOR 1.67; 95% CI 1.42, 1.96), higher socio-economic status (aOR 1.21; 95% CI 1.08–1.36), and marriage (aOR 1.55; 95% CI 1.37–1.75) were all predictive of recent HTC, which did not significantly vary across study arm, site, gender or age category (18–24 vs. 25–32 years)

Antibacterial, Anti-HIV-1 Protease and Cytotoxic Activities of Aqueous Ethanolic Extracts from Combretum Adenogonium Steud. Ex A. Rich (Combretaceae).

\ud \ud Records have shown that Combretum adenogonium Steud. Ex A. Rich (Combretaceae) is used in traditional medicine systems of several tribes in Tanzania. This study focused on the investigation of antibacterial activity, anti-HIV-1 protease activity, toxicity properties and classes of phytochemicals in extracts from C. adenogonium Steud. Ex A. Rich (Combretaceae) to evaluate potential of these extracts for development as herbal remedies. Dried plant material were ground to fine powder and extracted using 80% aqueous ethanol to afford root, leaf and stem bark extracts. The extracts were assayed for anti-HIV-1 protease activities, antibacterial activities using microdilution methods and cytotoxicity using brine shrimps lethality assay. Screening for major phytochemical classes was carried out using standard chemical tests. All extracts exhibited antibacterial activity to at least one of the test bacteria with MIC-values ranging from 0.31-5.0 mg/ml. Two extracts, namely, root and stem bark exhibited anti-HIV-1 PR activity with IC50 values of 24.7 and 26.5 μg/ml, respectively. Stem bark and leaf extracts showed mild toxicity with LC50 values of 65.768 μg/ml and 76.965 μg/ml, respectively, whereas roots were relatively non-toxic (LC50 = 110.042 μg/ml). Phytochemical screening of the extracts indicated presence of flavonoids, terpenoids, alkaloids, tannins, glycosides and saponins. These results provide promising baseline information for the potential development of C. adenogonium extracts in treatment of bacterial and HIV/AIDS-related opportunistic infections

From Coitus to Concurrency: Sexual Partnership Characteristics and Risk Behaviors of 15–19 Year Old Men Recruited from Urban Venues in Tanzania

Understanding the uptake and patterns of sexual partnerships of adolescent males reveals their risky behaviors that could persist into adulthood. Using venue-based sampling, we surveyed 671 male youth ages 15–19 from an urban Tanzanian neighborhood about their sexual partnerships during the past six months. The proportion of males who had ever had sex increased with age (21% at age 15; 70% at age 17; 94% at age 19), as did the proportion who engaged in concurrency (5% at age 15; 28% at age 17; 44% at age 19). Attendance at ≥2 social venues per day and meeting a sexual partner at a venue was associated with concurrency. Concurrency was associated with alcohol consumption before sex among 18–19 year olds and with not being in school among 15–17 year olds. We find that concurrency becomes normative over male adolescence. Venue-based sampling may reach youth vulnerable to developing risky sexual partnership patterns

Age-Related Differences in Socio-demographic and Behavioral Determinants of HIV Testing and Counseling in HPTN 043/NIMH Project Accept

Youth represent a large proportion of new HIV infections worldwide, yet their utilization of HIV testing and counseling (HTC) remains low. Using the post-intervention, cross-sectional, population-based household survey done in 2011 as part of HPTN 043/NIMH Project Accept, a cluster-randomized trial of community mobilization and mobile HTC in South Africa (Soweto and KwaZulu Natal), Zimbabwe, Tanzania and Thailand, we evaluated age-related differences among socio-demographic and behavioral determinants of HTC in study participants by study arm, site, and gender. A multivariate logistic regression model was developed using complete individual data from 13,755 participants with recent HIV testing (prior 12 months) as the outcome. Youth (18–24 years) was not predictive of recent HTC, except for high-risk youth with multiple concurrent partners, who were less likely (aOR 0.75; 95% CI 0.61–0.92) to have recently been tested than youth reporting a single partner. Importantly, the intervention was successful in reaching men with site specific success ranging from aOR 1.27 (95% CI 1.05–1.53) in South Africa to aOR 2.30 in Thailand (95% CI 1.85–2.84). Finally, across a diverse range of settings, higher education (aOR 1.67; 95% CI 1.42, 1.96), higher socio-economic status (aOR 1.21; 95% CI 1.08–1.36), and marriage (aOR 1.55; 95% CI 1.37–1.75) were all predictive of recent HTC, which did not significantly vary across study arm, site, gender or age category (18–24 vs. 25–32 years)