The effectiveness of ultrasound in the diagnosis of bladder tumours at the Muhimbili National Hospital, Dar es Salaam, Tanzania

The importance of an ultrasound in diagnosis of bladder tumours has been investigated by different authors. Some have questioned its effectiveness while others have considered the technique to be an important tool in the initial evaluation of bladder tumours. This study was carried out to establish the effectiveness of the ultrasound in diagnosis of bladder tumours at the Muhimbili National Hospital in Dar es Salaam, Tanzania. Clinical indications and ultrasound findings were recorded. Cystoscopy was done and findings recorded on a preformed questionnaire. The ultrasound findings were compared to cystoscopy findings and the sensitivity, negativity, positive predictive value and negative predictive value determined. A total of 110 patients were recruited in this study and the male to female ratio was 2:1. The commonest (37%) age group was 41-60 years. The most common clinical indication overall was haematuria in 37% of all cases. In males, bladder outlet obstruction due to stricture was the commonest indication (31%). Out of 110 patients scheduled for cystoscopy, 71 had ultrasound done preoperatively. In these patients 70% had some form of abnormal ultrasound findings. The sensitivity, specificity, positive predictive value, and the negative predictive value (NPV) of ultrasound in detection of bladder tumour were 83%, 93%, 89% and 89%, respectively. In conclusion, ultrasound is an effective method for evaluating patients presenting with haematuria or suspected to have bladder tumours. It is cheap, available, affordable and non-invasive; has a high sensitivity, and therefore it can also be useful in the follow-up of patient with bladder cancer

Post-operative pain prevalence, predictors, management practices and satisfaction among operated cases at a Regional Referral Hospital in Dar es Salaam, Tanzania

Background: Post-operative pain is an essential component of good surgical patient care plan. In developing countries however, the prevalence of post-operative pain is relatively very high and pain control strategies are not very promising. The objective of this study was to assess post-operative pain prevalence, predictors, management practices and satisfaction among operated cases at a regional referral hospital in Dar es Salaam, Tanzania.Methods: Prospective hospital based descriptive observational study of operated cases at a Temeke Regional Referral Hospital in Dar es Salaam, Tanzania. Data was collected using a pre-constructed questionnaire and a visual pain intensity scale.Results: A total of 136 patients were recruited with mean age of 37.1±15 years (range= 14–80 years). The prevalence of pain was 100%, 83.9%, and 36% at 12, 24 and 48 hours, respectively. At 12 hours moderate to worst pain was reported in 95.6% of cases. The main prediction factor for severe to worst pain at 12 hours was orthopaedic procedures (p=0.05, AOR=3.456), while widow/divorced marital status and female sex were negatively correlated to severity of pain (p=0.005, AOR=0.0230 and p=0.000, AOR=0.034, respectively). The commonest drugs prescribed post-operatively were injection pethidine (50.5%) and tramadol (48.9%) and oral tramadol (47.6%). Pain management satisfaction rate was paradoxically high (74.3%), with male sex being the main predictor.Conclusion: The prevalence of early post-operative pain is very high. Male sex and orthopaedic procedures are associated with severe pain. Surgeons therefore need to prioritize analgesic prescription at early hours following operation to minimize pain and suffering to patients focusing on orthopaedic procedures

Characteristics and Outcomes of Patients with Eclampsia and Severe Pre-eclampsia in a Rural Hospital in Western Tanzania: A Retrospective Medical Record Study.

Eclampsia and pre-eclampsia are well-recognized causes of maternal and neonatal mortality in low income countries, but are never studied in a district hospital. In order to get reliable data to facilitate the hospital's obstetric audit a retrospective medical record study was performed in Ndala Hospital, Tanzania. All patients diagnosed with severe pre-eclampsia or eclampsia between July 2011 and December 2012 were included. Medical records were searched immediately following discharge or death. General patient characteristics, medical history, obstetrical history, possible risk factors, information about the current pregnancy, antenatal clinic attendance and prescribed therapy before admission were recorded. Symptoms and complications were noted. Statistical analysis was done with Epi Info®. Of the 3398 women who gave birth in the hospital 26 cases of severe pre-eclampsia and 55 cases of eclampsia were diagnosed (0.8 and 1.6%). Six women with eclampsia died (case fatality rate 11%). Convulsions in patients with eclampsia were classified as antepartum (44%), intrapartum (42%) and postpartum (15%). Magnesium was given in 100% of patients with eclampsia and was effective in controlling convulsions. Intravenous antihypertensive treatment was only started in 5% of patients. Induction of labour was done in 29 patients (78% of women who were not yet in labour). Delivery was spontaneous in 67%, assisted vaginal (ventouse) in 14% and by Caesarean section in 19% of women. Perinatal deaths occurred in 30% of women with eclampsia and 27% of women with severe pre-eclampsia and were associated with low birth weight and prolonged time between admission and birth. 2.4% of women were diagnosed with severe pre-eclampsia or eclampsia. The case fatality rate and overall perinatal mortality were comparable to other reports. Better outcomes could be achieved by better treatment of hypertension and starting induction of labour as soon as possible

Prevalence and predictors of anaemia among patients presenting with kidney diseases at the University of Dodoma Hospital in central Tanzania

Background: Anaemia is a common complication that contributes to the burden of kidney diseases. Anaemia confers significant risk of cardiovascular disease and contributes to decreased quality of life. While the primary cause of anaemia is the inadequate production of erythropoietin by the kidneys to support erythropoiesis, other factors may contribute to anaemia. The aim of this study was to determine the prevalence and predictors of anaemia among patients presenting with kidney diseases at the haemodialysis unit of the University of Dodoma (UDOM) hospital in central Tanzania.Methodology: In this retrospective study we reviewed data of patients who presented at UDOM haemodialysis unit in Tanzania with kidney diseases as from January 2013 to June 2015. Data were descriptively and inferentially analysed using Stata version 11 software.Results: A total of 1,395 patients were involved in this study. Of these, 792 (56.8%) presented with kidney diseases, 249 (31.4%) were found to have anaemia.  The leading cause of anaemia was chronic kidney disease (CKD) 136 (54.6%), blood loss 74(29.7), haemolysis 15 (6.0%), Nutrition 13(5.2%) and others 11 (4.4%). Glomerular filtration rate of < 60 mL/min/1.73 m2 accounted for 59.1% of CKD. Median [IQR] serum creatinine level: 246 [177 – 317] μmol/L, Urea level 16[8 -24] mmol/L and haemoglobin of 9.8 [6.2 - 13.4] g/dL. Prevalence of anaemia was strongly associated with declining glomerular filtration rate (P= 0.01).Conclusion: Anaemia is very common among patients presenting with kidney diseases. These patients require a thorough evaluation to identify and correct causes of anaemia other than erythropoietin deficiency

The effectiveness of ultrasound in the diagnosis of bladder tumours at the Muhimbili National Hospital, Dar es Salaam, Tanzania

The importance of an ultrasound in diagnosis of bladder tumours has been investigated by different authors. Some have questioned its effectiveness while others have considered the technique to be an important tool in the initial evaluation of bladder tumours. This study was carried out to establish the effectiveness of the ultrasound in diagnosis of bladder tumours at the Muhimbili National Hospital in Dar es Salaam, Tanzania. Clinical indications and ultrasound findings were recorded. Cystoscopy was done and findings recorded on a preformed questionnaire. The ultrasound findings were compared to cystoscopy findings and the sensitivity, negativity, positive predictive value and negative predictive value determined. A total of 110 patients were recruited in this study and the male to female ratio was 2:1. The commonest (37%) age group was 41-60 years. The most common clinical indication overall was haematuria in 37% of all cases. In males, bladder outlet obstruction due to stricture was the commonest indication (31%). Out of 110 patients scheduled for cystoscopy, 71 had ultrasound done preoperatively. In these patients 70% had some form of abnormal ultrasound findings. The sensitivity, specificity, positive predictive value, and the negative predictive value (NPV) of ultrasound in detection of bladder tumour were 83%, 93%, 89% and 89%, respectively. In conclusion, ultrasound is an effective method for evaluating patients presenting with haematuria or suspected to have bladder tumours. It is cheap, available, affordable and non-invasive; has a high sensitivity, and therefore it can also be useful in the follow-up of patient with bladder cancer

Morpho-physiological features associated with menopause: recent knowledge and areas for future work

Menopause is the permanent cessation of menstruation resulting from loss of ovarian follicular activity which happens as a result of depletion of primary follicles which is basically an aging effect. Depletion of ovarian follicles is reflected as declined production of oestradiol which is currently known to be central to the morphologic and physiological changes that happen during the climacteric, menopause and post menopause periods. The cessation of oestradiol production is much more pronounced in tissues with oestrogen receptors such as bones, brain, blood vessels, central nervous system and the skin. But generally little is known on the subject and in particular the bioactive substances involved in the process such that there are some symptoms that menopause women experience which not only defy clinicians but also challenge the management of the condition. This article is presented to shade light to what is currently known, what is not known and stimulate future research which may reveal more understanding and advance our knowledge on management of women throughout the climacteric and menopausal periods

The male circumcision: the oldest ancient procedure, its past, present and future roles

Circumcision, a surgical removal of male prepuce has existed throughout human history, and it appears it shall exist until humanity ends. During its entire existence, there have been changing reasons or indications from cultural, traditional, religious and currently medical, and it has vehemently been criticized by some individuals for different reasons and in different countries. Emergency of new diseases particularly Human Immunodeficient virus (HIV) has brought the ancient procedure back on spot light, this has come as a result of recent studies which have demonstrated that it does not only reduces significantly the rate of HIV infection, as well as penile cancer and cervical cancer. This has lead to massive male circumcision campaigns in areas with low prevalence of circumcision. On the other hand the socio-cultural and sexual aspects of male circumcision have been studied but often ignored. This article will therefore increase awareness of male circumcision and the increasing roles with time, recommend up scaling of medical male circumcision and possible safe circumcision training to tradition circumcisers

Retrospective review of clinical and pathological pattern of prostatic diseases: a reminder to clinicians on an increased clinical vigilance, an experience from central, Tanzania

Introduction: Prostatic diseases are a very common in men over 40 years of age and pose a significant risk in terms of morbidity and mortality. Globally, benign prostatic hyperplasia (BPH), prostatic cancer and prostatitis are the most common conditions mainly presenting with lower urinary symptoms or symptoms related to complications of urinary bladder obstruction. Despite the relatively high prevalence of prostatic diseases, there is paucity of literature on in most developing countries, East Africa inclusive. The aim of this study was therefore to conduct a retrospective review of all prostatic biopsies submitted to private histopathology laboratory in Central, Tanzania in order to understand the clinical and histological pattern of the diseases.Methodology: This was a retrospective laboratory-based descriptive study. The study involved review of the available prostatic biopsy database for a period of one year, from February 2014 to February 2015.Results: Benign prostatic hyperplasia (61.6%) and prostate cancer (28.3%) are the most prevalent clinical diagnoses. They often presented with lower urinary tract symptoms (45.5%) and urinary retention (41.5%), although a significant proportion of cases were missing clinical information (10.1%). Histologically, BPH was the most common prostatic disease (60%), followed by prostate cancer (24.1%) and prostatitis (15.9%). The likelihood of making correct clinical diagnosis of BPH and cancer of prostate was consistently low (66.3% and 51.9% respectively). Despite clinical suspicion of prostatic cancer, there was high preponderance by clinicians to perform prostatectomy (80%), contrary to standard recommendation. Most histologically confirmed prostatic cancer had unfavorable scores in terms of histological extent of tumor (63.6%) and Gleason’s sum (92.9%).Conclusion: This study has demonstrated that clinical and histological patterns of prostatic diseases are similar to other studies, most of which are presenting with lower urinary tract symptoms and urinary retention. The accuracy of clinical diagnosis is low and a significant number of clinically suspected cases of prostate cancer underwent surgical operation, many of whom had unfavorable prognostic scores.Recommendations: It is recommended that clinicians should: scale up clinical vigilance and index of suspicion in dealing with cases of prostatic diseases, provide necessary information to histopathologists, and adhere to guidelines in managing prostatic cancer. Furthermore, resources for management of prostatic diseases should be increased and more studies should be conducted.Keywords: Prostatic diseases, presenting symptoms, histology, prostatectomy, tumor extent and Gleason’s su

Challenges and outcomes of haemodialysis among patients presenting with kidney diseases in Dodoma, Tanzania

Abstract Background Kidney Diseases contribute a significant proportion to the global burden of non-communicable diseases. Haemodialysis services as the main modality of renal replacement therapy in most resource limited countries is only available in few cities and at higher costs. The aim of this study was to determine the challenges and outcomes of patients who were on haemodialysis at the University of Dodoma (UDOM) haemodialysis unit in Tanzania. Methods In this retrospective study; we reviewed haemodialysis registers and charts of 116 patients dialyzed from January 2013 to June 2015 at The UDOM haemodialysis unit. Data were descriptively and inferentially analysed using Stata version 11 software. Results Of the 116 patients, 52 (44.9%) were male, and 38(32.8%) were married. Their median age was 45 years. Thirty-two (27.6%) had acute kidney injury, of them 26 (81.3%) patients had recovery of renal function after haemodialysis. Indications for hemodialysis were anuria (18), intoxications (14), electrolyte imbalance (9), uraemia (7) infections (6) and fluid overload (4). Eighty-four (72.4%) patients had End Stage Renal Diseases (ESRD), of which 37 (44.1%) absconded/lost to follow up, 15 (17.9%) died, 22 (26.2%) were referred to Muhimbili National Hospital (MNH), 12 for possible kidney transplant abroad after haemodialysis, and 10 (11.9%) were still attending our unit for haemodialysis. Residing outside Dodoma was predictive for poor outcomes while on haemodialysis (OR 5.2, 95% CI 3.2–8.6, p < 0.001). In addition the odds ratio for poor outcomes was 7.3 times for a patient ESRD (OR7.34, 95% CI 3.26–18.17, p < 0.001). Patients who had no National Health Insurance Fund (NHIF) coverage (OR 6.6, 95% CI 5.4–12.7, p < 0.001) also had higher odds of poor outcomes after starting haemodialysis. Conclusion Unavailability and high costs related to utilization of haemodialysis services among patients needing dialysis are the challenges for better outcomes. Therefore, haemodialysis and renal transplants services should be made easily available in regional referral hospitals at reasonable costs. In addition, members of the public should be educated on joining health insurance schemes and on making healthy life style choices for preventing chronic kidney disease and its progression

Prevalence and Risk Factors Associated With Chronic Kidney Disease Among Patients Presenting at a Haemodialysis Unit in Dodoma, Tanzania

Background: Chronic kidney disease (CKD) is a major public health problem worldwide, due to its epidemic proportions and the associated cardiovascular morbidity and mortality. However, data on the burden of CKD among patients attending hospitals in Tanzania are still limited. The aim of this study was to determine the prevalence and risk factors associated with CKD among patients presenting at the University of Dodoma (UDOM) haemodialysis unit in Tanzania. &nbsp; Methods: In this retrospective study, we reviewed data of 1,395 patients who presented at the UDOM haemodialysis unit from January 2013 to June 2015. Data were descriptively and inferentially analysed using Stata version 11.0. &nbsp; Results: From January 2013 to June 2015, a total of 1,395 patients presented at the UDOM haemodialysis unit with history of kidney disease. Of these patients, 1244 (89.2%) enrolled into this study, 651 (52.3%) of them were female. Almost two-thirds (n=792, 63.7%) of the patients were found to have CKD, 59.1% with an estimated glomerular filtration rate of &lt;60 mL/min/1.73 m2. Among those who had CKD, 347 (43.8%) had hypertension, 241 (30.4%) had diabetic mellitus, 79 (10.0%) had chronic glomerulonephritis, 70 (8.8%) had hypertension and diabetes mellitus, 38 (4.8%) had HIV/AIDS, and 17 (2.1%) had hepatitis B. The median serum creatinine level was 222 μmol/L (interquartile range [IQR] 126 to 317), urea level was 14.5 mmol/L (IQR 5 to 24), hemoglobin was 11.0 g/dL (IQR 6.2 to 15.7), and body mass index was 27.1 kg/m2&nbsp;(IQR 17.3 to 36.8). Obesity, diabetes mellitus, and systolic hypertension were associated with developing CKD (P&lt;.001). A total of 116 patients received haemodialysis during the study period. &nbsp; Conclusion: CKD was common among patients presenting in our hospital and is associated with high cardiovascular risk. To that end, patients should be thoroughly evaluated to identify and correct causes of their kidney disease, and efforts should be put in place for early detection and screening as well as advocacy on risk factors for CKD development in Tanzania