Building Clinical Clerkships Capacity in a Resource-limited Setting: The Case of the Kilimanjaro Christian Medical University College in Tanzania

Background: The shortage of medical doctors in sub-Saharan Africa (SSA) has resulted in increased enrolment in medical schools, which has not been matched with increased faculty size or physical infrastructure. This process has led to overcrowding and possibly reduced quality of training. To reduce overcrowding at its teaching hospital, the Kilimanjaro Christian Medical University College introduced eight-week peripheral clerkship rotations in 2012. We explore students’ perceptions and attitudes towards peripheral hospital placements. Method: The clerkship rotations were conducted in eight hospitals operating in the northern Tanzania, after evaluating each hospitals’ capabilities and establishing the optimum number of students per hospital. Paper-based surveys were conducted after student rotations from 2014 to 2016. Results: Overall student satisfaction was moderate (strength of consensus measure (sCns), 77%). The three cohorts exhibited improving trends over three years with respect to satisfaction with clinical skills and attitude towards placements. student-preceptor interaction was rated highly (sCns 81–84%). The first cohort students expressed concerns about limited laboratory support, and poor access to Internet and learning resources. Specific interventions were undertaken to address these concerns. Conclusions: Student experiences in peripheral rotations were positive with adequate satisfaction levels. Opportunities exist for medical schools in SSA to enhance clinical training and relieve overcrowding through peripheral clerkship rotations.<p

The dominant Anopheles vectors of human malaria in Africa, Europe and the Middle East: occurrence data, distribution maps and bionomic précis

<p>Abstract</p> <p>Background</p> <p>This is the second in a series of three articles documenting the geographical distribution of 41 dominant vector species (DVS) of human malaria. The first paper addressed the DVS of the Americas and the third will consider those of the Asian Pacific Region. Here, the DVS of Africa, Europe and the Middle East are discussed. The continent of Africa experiences the bulk of the global malaria burden due in part to the presence of the <it>An. gambiae </it>complex. <it>Anopheles gambiae </it>is one of four DVS within the <it>An. gambiae </it>complex, the others being <it>An. arabiensis </it>and the coastal <it>An. merus </it>and <it>An. melas</it>. There are a further three, highly anthropophilic DVS in Africa, <it>An. funestus</it>, <it>An. moucheti </it>and <it>An. nili</it>. Conversely, across Europe and the Middle East, malaria transmission is low and frequently absent, despite the presence of six DVS. To help control malaria in Africa and the Middle East, or to identify the risk of its re-emergence in Europe, the contemporary distribution and bionomics of the relevant DVS are needed.</p> <p>Results</p> <p>A contemporary database of occurrence data, compiled from the formal literature and other relevant resources, resulted in the collation of information for seven DVS from 44 countries in Africa containing 4234 geo-referenced, independent sites. In Europe and the Middle East, six DVS were identified from 2784 geo-referenced sites across 49 countries. These occurrence data were combined with expert opinion ranges and a suite of environmental and climatic variables of relevance to anopheline ecology to produce predictive distribution maps using the Boosted Regression Tree (BRT) method.</p> <p>Conclusions</p> <p>The predicted geographic extent for the following DVS (or species/suspected species complex*) is provided for Africa: <it>Anopheles </it>(<it>Cellia</it>) <it>arabiensis</it>, <it>An. </it>(<it>Cel.</it>) <it>funestus*</it>, <it>An. </it>(<it>Cel.</it>) <it>gambiae</it>, <it>An. </it>(<it>Cel.</it>) <it>melas</it>, <it>An. </it>(<it>Cel.</it>) <it>merus</it>, <it>An. </it>(<it>Cel.</it>) <it>moucheti </it>and <it>An. </it>(<it>Cel.</it>) <it>nili*</it>, and in the European and Middle Eastern Region: <it>An. </it>(<it>Anopheles</it>) <it>atroparvus</it>, <it>An. </it>(<it>Ano.</it>) <it>labranchiae</it>, <it>An. </it>(<it>Ano.</it>) <it>messeae</it>, <it>An. </it>(<it>Ano.</it>) <it>sacharovi</it>, <it>An. </it>(<it>Cel.</it>) <it>sergentii </it>and <it>An. </it>(<it>Cel.</it>) <it>superpictus*</it>. These maps are presented alongside a bionomics summary for each species relevant to its control.</p

Clinicopathological guide to malignant bone tumours: A retrospective analysis of the cancer registry at Kilimanjaro Christian Medical Centre in northern Tanzania

Background: Primary neoplasms of the skeleton are rare. This study aimed at determining the spectrum of different malignant bone tumours at a tertiary hospital cancer registry in the Northern Zone of Tanzania, along with related symptoms, clinical presentations, and clinical diagnosis accuracy (using histology as the standard).Methods: This retrospective study reviewed bone specimen records in the cancer registry at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania, for the period from 1 January 1998-31 December 2012. Patient information for corresponding cancer registry records was traced from hospital files and x-ray reports. Data were analysed using a mixed quantitative and qualitative approach.Results: Two hundred twenty-five malignant bone tumours were recorded at KCMC Cancer Registry over a period of 14 years. Seventy-five with adequate records were analysed. Forty-seven patients (62.7%) were male. Mean age was 34.1 (standard deviation 20) years. The femur was affected in 26 cases (34.7%). Osteosarcoma (22 cases; 29.3%) was the most common malignant bone tumour. Clinicians correctly preliminarily diagnosed multiple myeloma, osteosarcoma, and ameloblastoma, but had inexperience with carcinomas and other types of sarcomas. Chronic osteomyelitis and metastatic lesions were mentioned frequently by radiologists as the diagnosis of some malignant bone tumours that turned out to be carcinomas or sarcomas on histology.Conclusions: Clinician and radiologist training of other types of malignant bone tumours other than multiple myeloma, osteosarcoma, and ameloblastoma is required. An Orthopaedic Biopsy Form (OBF) was developed to address high loss to follow-up (66.7%). Keywords: malignant bone tumours; cancer registry; KCM

Prevalence and Risk Factors for Acute Postoperative Pain After Elective Orthopedic and General Surgery at a Tertiary Referral Hospital in Tanzania

Background: In Africa, postoperative pain management is still a major problem with a prevalence of postoperative pain in up to 95.2% of the patients. There are little data on the prevalence and potential risk factors for postoperative pain in Tanzania. Therefore, we aimed to investigate these at Kilimanjaro Christian Medical Centre in Northern Tanzania. Our goal is to optimize pain management. Methods: A prospective cohort study was carried out from December 2016 to April 2017. Patients ≥18 years admitted for elective general or orthopedic surgery were included in the study. Demographic data were collected during a pre-operative visit, and pain was assessed with a numerical rating scale (NRS 0–10) at 4, 24, 36 and 48 hours postoperatively. A NRS >3 was considered as moderate to severe postoperative pain. Potential risk factors for postoperative pain were identified using univariate and multivariable binary logistic regression analyses. Results: A total of 281 patients were included in the study. The prevalence of postoperative pain was 61%, 73%, 67% and 58% at 4, 24, 36 and 48 hours after surgery, respectively. Pethidine was the most frequently prescribed analgesic for postoperative pain management (85.1%) in the first 24 hours postoperatively; only 1% received paracetamol or diclofenac, and 13% received tramadol. In the multivariable model, general anesthesia and intra-opera-tive analgesia (OR = 3.70, 95% CI 1.70–8.04) were significant risk factors for postoperative pain. Conclusion: Pain is still inadequately managed at Kilimanjaro Christian Medical Centre leading to a high prevalence (73% on the first day after surgery) of reported postoperative pain in this study. It reflects the need for adequate postoperative analgesia, especially in low-and middle-income countries. Further research identifying risk factors in larger cohorts can be performed if adequate analgesia is given