Ultrasonographic findings in patients with abdominal symptoms or trauma presenting to an emergency room in rural Tanzania

BACKGROUND: Frequencies of ultrasonographic findings and diagnoses in emergency departments in sub-Saharan Africa are unknown. This study aimed to describe the frequencies of different sonographic findings and diagnoses found in patients with abdominal symptoms or trauma presenting to a rural referral hospital in Tanzania. METHODS: In this prospective observational study, we consecutively enrolled patients with abdominal symptoms or trauma triaged to the emergency room of the Saint Francis Referral Hospital, Ifakara. Patients with abdominal symptoms received an abdominal ultrasound. Patients with an abdominal or thoracic trauma received an Extended Focused Assessment with Ultrasound in Trauma (eFAST). RESULTS: From July 1st 2020 to June 30th 2021, a total of 88838 patients attended the emergency department, of which 7590 patients were triaged as 'very urgent' and were seen at the emergency room. A total of 1130 patients with abdominal symptoms received an ultrasound. The most frequent findings were abnormalities of the uterus or adnexa in 409/754 females (54.2%) and abdominal free fluid in 368 (32.6%) patients; no abnormality was found in 150 (13.5%) patients. A tumour in the abdomen or pelvis was found in 183 (16.2%) patients, an intrauterine pregnancy in 129/754 (17.1%) females, complete or incomplete abortion in 96 (12.7%), and a ruptured ectopic pregnancy in 32 (4.2%) females. In males, most common diagnosis was intestinal obstruction in 54/376 (14.4%), and splenomegaly in 42 (11.2%). Of 1556 trauma patients, 283 (18.1%) received an eFAST, and 53 (18.7%) had positive findings. A total of 27 (9.4%) trauma patients and 51 (4.5%) non-trauma patients were sent directly to the operating theatre. CONCLUSION: In this study, ultrasound examination revealed abnormal findings for the majority of patients with non-traumatic abdominal symptoms. Building up capacity to provide diagnostic ultrasound is a promising strategy to improve emergency services, especially in a setting where diagnostic modalities are limited

The Chronic Diseases Clinic of Ifakara (CDCI)- establishing a model clinic for chronic care delivery in rural sub-Saharan Africa

The rollout of antiretroviral drugs in sub-Saharan Africa to address the huge health impact of the HIV pandemic has been one of the largest projects undertaken in medical history and is an unprecedented medical success story. However, the path has been and still is characterized by many far reaching implementational challenges. Here, we report on the building and maintaining of a role model clinic in Ifakara, rural Southwestern Tanzania, within a collaborative project to support HIV services within the national program, training for staff and integrated research to better understand local needs and improve patients' outcomes

Projekt Notfallstation im St. Francis Referral Hospital, Ifakara, Tansania

Zusammenfassung. Vor dem Start unseres Projekts gab es im St. Francis Referral Hospital, Ifakara, Tansania, wie auch in den meisten Spitälern im südlichen Afrika keine Notfallstation. Durch eine Ausbildung in Notfallmedizin und Ultraschall, die Organisation eines Dreischichtbetriebes und einer Triage war die neu geschaffene Notfallstation weniger als sechs Monate nach Beginn des Projekts voll funktionstüchtig. Einige wenige Geräte (zwei Überwachungsmonitore, EKG-Gerät, Thoraxdrainagesystem, Vernebler, Defibrillator, Ultraschallgeräte) mussten angeschafft werden oder wurden gespendet. Derzeit werden täglich 80–100 Patienten betreut, etwa 20 % der Patienten sind schwer krank. Neben Anamnese und klinischer Untersuchung ist der Ultraschall das wichtigste diagnostische Instrument. Die klinische Arbeit steht im Mittelpunkt. In einer Studie werden mittels «Focused Assessment with Sonography for HIV-Associated Tuberculosis (FASH)» Patienten mit Verdacht auf Tuberkulose untersucht, mit Echokardiografie ermitteln wir die Häufigkeit von Herzkrankheiten. </jats:p

Heart diseases and echocardiography in rural Tanzania: Occurrence, characteristics, and etiologies of underappreciated cardiac pathologies.

BackgroundLittle is known about heart diseases and their treatment in rural sub-Saharan Africa. This study aimed to describe the occurrence, characteristics, and etiologies of heart diseases, and the medication taken before and prescribed after echocardiography in a rural referral Hospital in Tanzania.MethodsThis prospective descriptive cohort study included all adults and children referred for echocardiography. Clinical and echocardiographic data were collated for analysis.ResultsFrom December 2015 to October 2017, a total of 1'243 echocardiograms were performed. A total of 815 adults and 59 children ≤15 years had abnormal echocardiographic findings; in adults 537/815 (66%) had hypertension, with 230/537(43%) on antihypertensive drugs, and 506/815 (62%) were not on regular cardiac medication; 346/815 (42%) had severe eccentric or concentric left ventricular hypertrophy, and 182/815 (22%) had severe systolic heart failure. Only 44% demonstrated normal left ventricular systolic function. The most frequent heart diseases were hypertensive heart disease (41%), valvular heart disease (18%), coronary heart disease (18%), peripartum cardiomyopathy (7%), and other non-hypertensive dilated cardiomyopathies (6%) in adults, and congenital heart disease (34%) in children. Following echocardiography, 802/815 (98%) adults and 40/59 (68%) children had an indication for cardiac medication, 70/815 (9%) and 2/59 (3%) for oral anticoagulation, and 35/815 (4%) and 23/59 (39%) for cardiac surgery, respectively.ConclusionHypertension is the leading etiology of heart diseases in rural Tanzania. Most patients present with advanced stages of heart disease, and the majority are not treated before echocardiography. There is an urgent need for increased awareness, expertise and infrastructure to detect and treat hypertension and heart failure in rural Africa

Ultrasound in managing extrapulmonary tuberculosis: a randomised, controlled, parallel, superiority, open-label trial

BACKGROUND: Patients with suspected extrapulmonary tuberculosis are often treated empirically. We hypothesized that extended Focused Assessment of Sonography for HIV and Tuberculosis (eFASH), in combination with other tests, would increase the proportion of correctly managed patients with suspected extrapulmonary tuberculosis. METHODS: This trial in adults with suspected extrapulmonary tuberculosis was performed in a rural and an urban hospital in Tanzania. Participants were randomised 1:1 to intervention or routine care, stratified by site and HIV status. All participants received a clinical evaluation, chest X-ray, sputum Xpert MTB/RIF, and urine Xpert MTB/RIF Ultra. The intervention was a management algorithm based on eFASH plus microbiology, adenosine deaminase (ADA) and chest X-ray. The primary outcome was the proportion of correctly managed patients. Presence of positive microbiology or ADA defined definite tuberculosis. An independent endpoint review committee determined diagnoses of probable or no tuberculosis. We evaluated outcomes using logistic regression models, adjusted for randomisation stratification factors. RESULTS: From 09/2018 to 10/2020, 1,036 patients were screened and 701 randomised (350 intervention, 351 control). 251 (72%) intervention participants had a positive eFASH. 258 (74%) intervention and 227 (65%) control participants were initiated anti-tuberculosis treatment at baseline. More intervention participants had definite tuberculosis (n = 124, 35%) compared to controls (n = 85, 24%). There was no difference between groups for the primary outcome (intervention 266/286 (93%); control: 245/266 (92%); odds ratio 1.14 (95% confidence interval 0.60-2.16, p = 0.68)). There were no procedure-associated adverse events. CONCLUSION: eFASH did not change the proportion of correctly managed patients, but increased the proportion of definite tuberculosis