Reducing Road Traffic Accidents and Mortalities in Mwanza, Tanzania: Proposal

We will implement a multi-disciplinary approach to help resolve the high instances of motor vehicle accidents and mortalities in Mwanza, Tanzania. We intend to reduce RTAs, injuries, morbidities, and mortalities, and increase road safety awareness through: Education services through various advertising strategies; Training services to medical personnel, healthcare professionals, and local citizens; and GPS intervention to implement smart phones with GPS to dala dalas and taxi drivers

Common Preventable Health and Social Problems Encountered by Elderly in Shinyanga Region in the Northern Part of Tanzania

In Tanzania elders are respected as repositories of inherited wisdom, experienced and principal decision makers in the community. However, evidence shows that such repositories are no longer considered important in most societies. As a result elders are neglected with some mistreatment in terms of provision of health and social services for instance; at times they get denied and ignored of their obvious rights, ignoring their retirement benefits and the rights onto free social services as per the Tanzania National Ageing Policy of 2003. Elders are therefore faced with physical, psychological and geriatric social suffering. It is on this basis that this study tries to explore the common preventable health and social problems encountered by elderly in Shinyanga Region in northern part of Tanzania. Across sectional community based study of 465 subjects randomly selected was done in three wards of Kahama District. The district was selected randomly out of 8 districts of Shinyanga Region, structured questionnaires with both closed and opened endower used; the information was collected from house to house and other information collected from health facilities within the wards as every ward had one public health facility; subjects (respondents) were obtained using purposive sampling technique aiming at elderly with 60 years of age and above. Kahama district has a population of approximately 36,014 of which 1500 (4%) are in the elderly age group of 60 years and above. The study population was 465 which is 30% (465/1500) of the geriatric population of Kahama. Among this group 5% were female while 41% were male and 53% (248/465) were married. 64% (297/465) were taking care of themselves, 32% (150/465) cared by relatives and 4% (18/465) cared by the community. Among the respondents, 40% (185/465) were affected by HIV/AIDs in one way or another either living with orphans whose parents died of HIV/AIDS or asking care of the infected patients within the family. It was also found that 73% of the geriatrics were not exempted from medical treatment fees so they had to pay for their medical care. However, only 32% were aware of getting free treatment and 61% of the study populations were not satisfied with the medical care provided at the public health facilities. The common diseases affecting this age group are: Eye problem 59% (273/465); Arthritis 52% (241/465); Dental problems 27% (124/465); Hypertension 23% (107/465); Backache 22% (105/465); Malaria 28% (132/465); Hearing problems 26% (121/645); Urinary tract Infection 35% (165/465); Depression 8% (36/465). Dementia was also a problem though we had no tools to confirm the diagnosis; some of the geriatrics had more than two diseases. The majority of the elderly age group in Kahama District are not aware of their rights that they deserve free treatment according to Tanzania policy, furthermore for assessment and screening of health problems. A majority of the elderly die prematurely due to preventable diseases and more than half of the diseases affecting geriatrics are preventable

Clinicopathological pattern of benign breast diseases among female patients at a tertiary health institution in Tanzania

Background: Benign breast diseases are a neglected entity in developing countries despite the fact that they constitute the majority of breast complaints. There is a paucity of published information regarding benign breast diseases in Tanzania. This study describes our experience in the management of benign breast diseases outlining the clinicopathological pattern and treatment modalities of these diseases in our local setting.Methods: This prospective descriptive study was conducted between November 2009 and March 2013 at Bugando Medical Centre in Tanzania on female patients aged 10 years and above presenting with benign breast diseases.Results: A total of 346 female patients with benign breast diseases were studied. The majority of patients, 255 (73.7%) were younger than 30 years. Breast lump was the most frequent presentation in 67.6% of patients. Fibroadenoma 95 (60.0%) was the most frequently diagnosed benign breast disease followed by fibrocystic changes (19.0%). Out of 295 patients who had histopathological examination, 64 (21.7%) had proliferative lesions. Of these, 18 (28.1%) had proliferative lesions with atypia while 46(71.9%) had proliferative lesions without atypia. Eight (2.6%) patients were HIV positive with the median CD 4+ count of 258 cells/μl. The majority of patients, 295(85.2%) underwent surgical treatment of which lumpectomy was the most common procedure performed. Conclusion: Benign breast diseases are more common than malignancies in our environment and occur mainly in young women less than 30 years of age and were mostly fibroadenoma and fibrocystic change. Though premalignant lesions of proliferative lesions with atypia were less common in this study, it is advisable that all cases of breast lesions should be carefully evaluated to exclude possibility of breast cancer

Trauma admissions among street children at a tertiary care hospital in north-western Tanzania: a neglected public health problem

Background: Trauma among street children is an emerging but neglected public health problem in most low and middle income countries. This study was conducted to determine the incidence, etiological spectrum, injury characteristics and treatment outcome among street children and to identify the predictors of the outcome of these patients at Bugando Medical Centre in Mwanza, Tanzania.Methods: The study included street children aged <18 years. Routine investigations including haematological, biochemical and imaging were performed on admission. The severity of injury was determined using the Kampala Trauma Score II. Data on patient’s characteristics, circumstances of injury, injury characteristics, treatment offered, outcome variables, length of hospital stay and mortality were collected using a questionnaire.Results: A total of 342 street children (M: F = 6.8: 1) representing 11.5% of all paediatric injury patients were studied. The modal age group was 11-15 years (median = 12 years) accounting for 53.2% (n=182) of the patients. Assault was the most frequent (73.7%) cause of injury. More than three quarter of injuries occurred along the street. Most of patients (59.1%) presented late (>24 hours) after injury. Blunt injuries were the most common (76.0%) mechanism of injuries. Musculoskeletal (30.8%) and head (25.3%) were the most frequent body regions affected. Soft tissue injuries were the most common type of injuries affecting 322 (94.2%) cases. Majority of patients (96.5%) underwent surgical treatment of which wound debridement (97.6%) was the most common surgical procedure performed.  Complication rate was 39.5%. The median hospital stay was 6 days.  Mortality rate was 13.5% and it was significantly associated with injury-arrival time (OR =2.4, 95%CI (1.3-5.6), p = 0.002), severe injury (Kampala Trauma Score <6) (OR = 3.6, 95%CI (2.5-7.9), p = 0.001), severe head injuries (OR= 5.1, 95%CI (4.6 – 8.2), p =0.012) and surgical site infection.Conclusion: Trauma among street children is an emerging but neglected epidemic in Tanzania and contributes significantly to high morbidity and mortality. Assault was the most frequent cause of injury.  Urgent preventive measures targeting at reducing the occurrence of assault is necessary to reduce the incidence of trauma among street children in this region

Geriatric Injuries among Patients Attending a Regional Hospital in Shinyanga Tanzania

Geriatric injuries pose a major challenge to surgeons and general practitioners in developing countries. The objective of this study was to determine the prevalence, injury characteristics and outcomes of geriatric injury among patients at Shinyanga Regional Hospital in Tanzania. Data was collected using a pre-tested, coded questionnaire and analyzed using SPSS computer system. A total of 94 geriatric trauma patients constituting 22.7% of all trauma admissions were studied. The male to female ratio was 1.4:1. Their mean age was 68.5 years (ranged 60-98 years). Premorbid illness was reported in 38.3% of patients. Most injuries were intentional in fifty-three (56.4%) patients. Assaults, falls and road traffic crashes were the mechanism of injuries in 52.1%, 19.1% and 11.7% of cases, respectively. The majority of cases of assault were females accounting for 64.6%. The majority of injuries (81.9%) occurred at home. Pre-hospital care was recorded in 5.3% of cases. The musculoskeletal (72.3%) and head (66.0%) regions were commonly affected. Soft tissue injuries (wounds) (89.4%) and fractures (52.2%) were the most common type of injuries. The majority of patients (90.4%) underwent surgical treatment of which wound debridement was the most common procedure performed in 91.8% of cases. Complication rate was 39.4%. The mean length of hospital stay was 28.6 days (ranged 1 – 124 days). The length of hospital stay was significantly longer in patients with co-morbidities, long bone fractures and those with complications (P<0.05). Mortality rate was 14.9% and it was significantly related to advanced age, presence of pre-morbid illness, high injury severity score, severe head injuries and the need for ventilatory support (P< 0.05). In conclusion, traumatic injuries in elderly constitute a major but preventable public health problem in Shinyanga region and contribute significantly to high morbidity and mortality. Urgent preventive measures focusing at the root causes of the injuries and early appropriate treatment is highly needed to reduce the occurrence, morbidity and mortality associated with these injurie

Assessment of quality of operable breast cancer care in a tertiary care hospital in northwestern Tanzania: a single institution experience

Breast cancer and its treatment constitute a great challenge in resource limited countries as found in Africa. A retrospective analysis of all breast cancer patients seen in our institution was conducted to assess the quality of operable breast cancer care in our setting and compare with the international standards. Data collected were compared with the internationally accepted quality care indictors throughout the continuum of care. A total of 374 patients were studied. The median age at diagnosis was 48 years (range 18- 84 years). Pre-operative bilateral mammography was performed in 56 (14.9%) and fine needle aspiration cytology in 221 (59.0%) patients. Triple assessment before definitive surgery was performed in only 42 (11.2%) patients. Excisional biopsy was performed in 214 (57.2%) patients. Complete pre-operative staging according to AJCC was performed in 289 (77.3%) patients. Definitive surgical procedure was performed in 372 (99.5%) patients, of which 366 (98.4%) patients had mastectomy. Axillary dissection was performed in 224 (65.5%) patients. None of our patients had sentinel node biopsy performed. The tumor size, histopathological grade, margins of excision, and the total number of nodes removed were recorded in 158 (42.5%), 308 (82.4%), 69(18.5%) and 198 (53.2%) patients respectively. Histopathological type was reported in all patients (100%). Estrogen receptor and progesterone receptor status was not reported in all patients. Adjuvant chemotherapy and hormonal therapy were given in 59 (42.8%) patients and 208 (55.6%) patients respectively. Our study demonstrated that the quality of breast cancer care in this institution was below the accepted international standards. This study may be used to make interventions for improvement of quality of breast cancer care in our setting and in similar institutions in resource limited countries

Mob justice as an emerging medico-legal, social and public health problem in north-western Tanzania: a need for immediate attention

Background: Mob-justice poses a medico-legal, social and public health problem in most developing countries including Tanzania and has shown to have negative effects on social and health of the country, communities, and families. This study was conducted to analyze the mob-justice situation in north-western Tanzania to determine the causes and injury characteristics of mob-justice cases and the outcome of treatment among survivors.Methods: This prospective study involved non-consecutive cases of mob-justice that were reported at Bugando Medical Centre in northwestern Tanzania from August 2006 to June 2014. Bugando Medical Centre in Mwanza, north-western Tanzania. Recruitment of cases to participate in the study was done in the pathology and surgery departments. All mob justice cases that were brought in dead (deceased) underwent autopsy examination in the pathology department and those who were severely injured (alive) were managed in the surgical wards by the admitting surgical team. Information on the cases was obtained from police, the relatives, friends and other witnesses if available. Variables studied included socio-demographic data of victims (age, sex, occupation and education), causes of mob-justice, weapons and methods used in executing mob-justice, body region affected and the type of injury.Results: A total of 234 cases (i.e. 170(72.6%) deaths and 64 (27.4%) seriously injured patients) of mob-justice were studied. The median age of victims was 28 years. Males outnumbered females by a ratio of 6.1: 1. The most common reason for a mob-justice was theft/robbery in 63.2% of cases.  Stoning (50.4%) and burning (43.6%) were the most frequent methods used in executing mob-justice. The head (95.7%) and the musculoskeletal (63.2%) were the most common body region injured. Open wounds (97.4%) and fractures (47.9%) were the most common type of injuries sustained. More than 70% of the victims who were brought in alive (64 cases) were treated surgically, of which wound debridement (75.6%) was the most common procedure performed. Complication and mortality rates were 51.6% and 51.1% respectively. The age &gt; 60 years, late presentation &gt; 48 hours, severe head injury (GCS 3-8) and admission systolic blood pressure &lt; 90 mmHg significantly influenced mortality (p &lt; 0.001). The overall median length of hospital stay was 28 days. Patients who had long bone fractures stayed longer in the hospital and this was statistically significant (p &lt; 0.001).Conclusion: Mob-justice constitutes a medico-legal, social and public health problem in Tanzania that needs immediate attention. Addressing the root causes of mob-justice such as poverty, lack of education, unemployment, and substance abuse will reduce the incidence of mob-justice in our environment, hence saving life

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.

Injury outcome among helmeted and non-helmeted motorcycle riders and passengers at a tertiary care hospital in north-western Tanzania

Motorcycle helmets have been reported to reduce the risk of death and head injuries following motorcycle accidents. The aim of this descriptive prospective study was to determine the injury outcome among helmeted and non-helmeted motorcyclists and passengers at a tertiary hospital in north-western Tanzania. A total of 654 patients involved in the motorcycle accident were studied. Of these, 468 (71.6%) were motorcyclists (riders) and the remaining 186 (28.4%) were passengers. The median age of patients at presentation was 26 years.  Male outnumbered females by a ratio of 4.5: 1. Helmet use was reported in 312 (47.7%) patients. Non-helmeted patients were young compared with helmeted patients and this was statistically significant (p=0.021). The rate of helmet use was significantly higher among motorcyclists than among passengers (p=0.004).  History of alcohol consumption prior to the accident was reported in 212 (32.4%) patients. The rate of helmet use was significantly low among alcohol consumers compared with non-alcohol consumers (p=0.011). Lack of helmet use was significantly associated with abnormal head Computed Tomography scans, admission to the Intensive care unit, severe trauma, and worse traumatic brain injury severity (p&lt;0.001). Helmet use was significantly associated with shorter period of hospitalization and reduced mortality rate (p&lt;0.001). Motorcycle helmet use is still low in this part of Tanzania and this poses a great impact on injury outcome among motorcycle injury patients. This observation calls for action to implement more widespread injury prevention and helmet safety education and advocacy