Post-Circumcision Urethro-Cutaneous Fistula: The Key to Successful Reconstruction.

Background: Routine circumcision of boys is a common practice in Tanzania. Because sometimes it is performed by persons with no surgical training, complications, including urethro-cutaneous fistula (UCF), are not uncommon.Methods: Five boys whose ages ranged between 4 and 12 years with UCF were seen at four Dar es Salaam hospitals between 2002 and 2005. Personal particulars, the personnel doing the circumcision, description of the repair and follow up were recorded on a data sheet. Intravenous Augmentin was given at induction of anaesthesia for the fistula repair. A urethral catheter was inserted, and then a tourniquet was applied at the base of the penis. After incision and development of skin flaps the urethra was closed, a layer of dartos fascia interposed, followed by closure of the skin, all with 6/0 Vicryl. A compression dressing was applied, and the catheter was left in for 5-7 days.Results: The boys ranged in age between 5 and 12 years, and had undergone circumcision at age 2 to 12 years. All patients were circumcised by paramedical personnel or a traditional practitioner. Urine leakage commenced 2 days to 2 weeks after circumcision. Four boys had coronal while one had a glandular UCF. No post repair complication was reported after follow up of 3 to 20 weeks.Conclusion: Use of fine synthetic absorbable sutures and careful closure of the fistula with interposition of a pedicles dartos graft, are the main prerequisites for success. Attention to details of surgical technique can produce consistently good results in repair of UCF

Where teachers are few: documenting available faculty in five Tanzanian medical schools.

BACKGROUND:Faced with one of the lowest physician-to-population ratios in the world, the Government of Tanzania is urging its medical schools to train more physicians. The annual number of medical students admitted across the country rose from 55 in the 1990s to 1,680 approved places for the 2015/16 academic year. These escalating numbers strain existing faculty. OBJECTIVE:To describe the availability of faculty in medical schools in Tanzania. DESIGN:We identified faculty lists published on the Internet by five Tanzanian medical schools for the 2011/12 academic year and analyzed the appointment status, rank, discipline, and qualifications of faculty members. RESULTS:The five schools reported 366 appointed faculty members (excluding visiting, part-time, or honorary appointments) for an estimated total enrolled student capacity of 3,275. Thirty-eight percent of these faculty were senior lecturers or higher. Twenty-seven percent of the appointments were in basic science, 51% in clinical science, and 21% in public health departments. The most populated disciplines (more than 20 faculty members across the five institutions) were biochemistry and molecular biology, medicine, obstetrics and gynecology, pediatrics, and surgery; the least populated disciplines (less than 10 faculty members) were anesthesiology, behavioral sciences, dermatology, dental surgery, emergency medicine, hematology, ophthalmology, orthopedics, otorhinolaryngology, oncology and radiology, psychiatry. These figures are only indicative of faculty numbers because of differences in the way the schools published their faculty lists. CONCLUSIONS:Universities are not recruiting faculty at the same rate that they are admitting students, and there is an imbalance in the distribution of faculty across disciplines. Although there are differences among the universities, all are struggling to recruit and retain staff. If Tanzanian universities, the government, donors, and international partners commit resources to develop, recruit, and retain new faculty, Tanzania could build faculty numbers to permit a quality educational experience for its doctors of tomorrow

Sutured and open clean-contaminated and contaminated laparotomy wounds at Muhimbili National Hospital: A comparison of complications

Background: Whether to close or leave open an abdominal incision wound depends on the degree of wound contamination at the end of operation. The aim of this study was to compare the complication rates between delayed primary closure and primarily closed laparotomy wounds for clean-contaminated and contaminated abdominal operations.Methods: Eighty-six patients undergoing laparotomy were included in a randomized clinical trial. Patients were randomized to have their wounds left open or closed primarily. In this study, all patients received Ceftriaxone Sodium (Powercef ®) as a prophylactic antibiotic at the time of induction of anaesthesia.Results: There was a statistically significant difference (p=0.002) in wound infection rate between those wounds left open (30.2%) and those closed primarily (2.1%). It required a longer duration of time for dressing those wounds left open compared to those closed primarily, The average duration for wound dressing was 16 days for open wounds compared to 11 days for primarily closed ones (p=0.0002). There was no significant difference in the development of wound dehiscence between the two groups (p>0.05). No death was related to wound complication.Conclusion: Clean-contaminated and contaminated laparotomy wounds should be closed primarily if no gross spillage of visceral contents occurs during operation and a patient receives prophylactic antibiotics

A comparison of topical Phenytoin with Silverex in the treatment of superficial dermal burn wounds

Burn injuries constitute a major health problem causing considerable morbidity and mortality in Tanzania and around the world. It is a common surgical problem and leading cause of death (20% mortality) in our paediatric surgical ward (Morbidity/Mortality report 2000 — Muhimbili National Hospital). Mzezewa et al. reported an overall mortality of 22% in a three year study at the Harare Burn Units. Inappropriate treatment facilities lead to severe complications like wound infections and septicaemia, anaemia and contracture deformities resulting in prolonged hospitalization with enormous economic impact in medical cost and loss of time from school and work. Socio-economic factors contributing to increased incidence of burns especially in children include domestic accidents resulting from explosion of cheap kerosene stoves, poor architectural design of the kitchen in low-income families and cooking on open fires at floor level often in the open where children are playing

Surgical wound infection in clean-contaminated and contaminated laparotomy wounds at Muhimbili National Hospital

Background: Surgical wound (site) infection is the commonest complication following laparotomy for clean-contaminated and contaminated abdominal operations. Good surgical technique and perioperative prophylactic antibiotics in clean-contaminated and contaminated abdominal operations contribute to the low rate of surgical wound infection and its complications. The objectives of this study were to determine the prevalence and complications of surgical wound infection following laparotomy for clean-contaminated and contaminated abdominal operations at Muhimbili National Hospital.Methods: This was a prospective descriptive study done over a period of nine months from January 2001. The study population included patients assessed to have clean-contaminated and contaminated laparotomy woundsResults: The study revealed that surgical wound infection was the commonest complication accounting for 15.6%. Other complications include mortality rate of 8.9% and wound dehiscence (1.1%).Conclusion: It was concluded that another study is required in order to determine the cost of surgical wound infection in this hospital that is in transition towards cost-sharing and health management reform. Also, a long follow up study is required to determine the prevalence of incisional hernia in these wounds

Prevalence and clinical presentation of HIV infection among newly hospitalised surgical patients at Muhimbili National Hospital, Dar Es Salaam, Tanzania

Background: In Tanzania information is lacking on the prevalence of HIV infection in surgical patients in tertiary care facilities, in whom there are many points of special interest. Objective: To determine the prevalence of HIV infection and associated clinical and demographic features among hospitalised surgical patients at Muhimbili National Hospital (MNH). Setting: Muhimbili National Hospital. Materials and Methods: Consecutive newly admitted patients were tested for HIV antibodies after pre-test counselling. Sera were tested using a dual ELISA algorithm. The data were analysed to determine the prevalence of HIV infection and relationships of serostatus with clinical and socio-demographic characteristics. Results: Of 1,534 patients admitted during the study, 1,031(67.2%) consented to HIV testing following pre-test counselling. The prevalence of AlDS-related clinical features in patients who declined to be HIV tested was similar to that of seronegative patients, but significantly lower than that of seropositive patients. The overall age-adjusted HIV prevalence was 10.5% (95% Cl=9.9-14.0). The highest age-specific HIV prevalence was in the age group 35-44 years at 27.9%. No one was infected in the age group 0-4 years (n=111). Differences in prevalence between age groups were statistically significant (

The role of inter-institutional cooperation in surgical training and practice: A German-Tanzanian model

Objective: To highlight the feasibility and importance of inter-institutional cooperation, particularly between countries of the north and south, in improving and maintaining standards in medical training and practice.Setting and sources: A four-year academic exchange program was set up between the departments of Surgery at Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania, and the Mannheim Faculty of Medicine of Heidelberg University, Germany.Methods: Contact was first initiated between the heads of department at the two institutions and communications was almost entirely through e-mail. A Memorandum of Understanding between the two institutions was prepared and signed. The program was sponsored by the German Academic Exchange Service (DAAD), and involved exchange of teaching material, diagnostic equipment and 30 students, residents and surgical teachers between the two institutions over the 4 year period. A number of research projects were also initiated between the two departments.Conclusion: Academic Exchange programs between institutions in developed and developing countries can provide badly needed technical cooperation and valuable experiences for students and staff from both sides of North-South divide in addition to forging lasting professional and personal relationships between those taking part in the exchange programs.Keywords: Surgical training, North-South divide, academic exchange programs, Tanzania, German

Treatment Options and Outcomes of Urethral Stricture in Dar Es Salaam,Tanzania. Have we utilized all the Options?

Background: The historical management of urethral strictures constituted regular dilations of the scar tissue but this inevitably failed for long strictures or subjected to secondary trauma, ischemia, scarring and further reduction of luminal caliber. A urethral stricture would best be managed bytaking into account its etiology, site, length and caliber as well as applying the right procedure. Length, patient’s age and co morbid factors play significant roles in the choice of treatment. Therefore this study was set to document treatment options and early treatment outcomes of urethralstricture among patients seeking urological services in Dar es Salaam.Methodology: This was a hospital based descriptive, prospective study which involved all patients presenting to urology clinics confirmed to have urethral strictures during the period of study from March 2011 to December2011.Results: A total of 111 patients with urethral strictures were recruited into the study, all were male with age range of 10 – 97 years with a mean of 52.7. DVU was the most performed procedure accounting for 73 (65.8%) of all patients followed by primary urethroplasty at 31 (27.9%) and multistage urethroplasty at 7 (6.3%). DVU was the commonest procedure in all age groups.Conclusions: Three treatment options of urethral stricture DVIU, primary urethroplasty, multistage urethroplasty including clean intermittent catheterization (cic) were adopted as modes of treatment of patients with urethral stricture seeking urological services at Muhimbili National hospital and Tumaini hospital in Dar es Salaam, DVIU being the commonest mode treatment. Primary urethroplasty and DVIU had better treatment outcome during the follow up of 3months.Key words: Treatment options, urethral stricture, outcome

Elective Abdominal Ultrasonography by Surgeons at MNH, Dar-Es-Salaam, Tanzania.

Background: Ultrasound scanning (USS) is an important diagnostic tool in most specialties of surgery. The abdomen is the most commonly scanned region and learning and practicing abdominal USS is the most rewarding. This study was aimed at sharing our experience of elective abdominal ultrasound scanning (USS) done by surgeons at the Department of Surgery, Muhimbili National Hospital (MNH).Methods: This is a retrospective audit of indications and sonographic findings in 1782 elective scannings done over a 42-month period. All scanning was done by surgeons using Aloka SSD 500scanner with a 3.5 MHz probe. Average patient scanning time was 5-10 minutes.Results: The most frequent indications for abdominal ultrasound scanning were abdominal pain (27%), urinary tract symptoms (25%) and abdominal swelling / mass (13%). Overall 47 % of all scanned patients and 58% of those with abdominal pain had normal findings. Of all the patients with abnormal USS findings 42% had abdominal mass. Stone disease was infrequent, seen in 49 (2.7% of all scanned) patients.Conclusion: Pain is the most frequent reason for requesting abdominal ultrasound scanning but it has a low yield of sonographic findings. Scanning for abdominal swelling/mass gave the highest proportion of abnormal findings. USS of a surgical patient done by surgeons expedites diagnostic workup, shortens hospitalization, facilitates biopsy and may help to avoid diagnostic laparotomy

Educating Enough Competent Health Professionals: Advancing Educational Innovation at Muhimbili University of Health and Allied Sciences, Tanzania.

Sarah MacFarlane and colleagues share their lessons engaging in educational reform and faculty development with the Muhimbili University of Health and Allied Sciences in Tanzania and the University of California San Francisco