Knowledge, practice and factors associated with poor compliance with universal precautions among healthcare workers at Bugando Medical Centre, Mwanza, Tanzania

Background: Healthcare workers (HCWs) are exposed to blood-borne infections by pathogens, such as HIV, and Hepatitis B and C viruses, as they perform their clinical activities in hospitals. Compliance with universal precautions has been shown to reduce the risk of exposure to these pathogens. This aimed at assessing the knowledge, practices and factors associated with poor compliance to universal precautions among HCWs at Bugando Medical Centre in Mwanza, Tanzania.Methods: This was a cross sectional study carried out from December 2014 to February 2015.Results: There were 200 participants including 62 (31.0%) doctors, 74 (37.0%) nurses, laboratory personnel 34 (17.0%) and 29 (14.5%) auxiliary HCWs. More than three quarters (82%) of participants had adequate knowledge of uni­versal precautions. There was statistically significant difference between knowledge of universal precautions and sex, job category, working experience (≥ 5 years) and previous training on universal precautions. Out of 200 HCWs, 154 (77.0%) practiced universal precautions. Working experience (≥ 5 years) and previous training on universal precautions were significantly associated with good practice of universal precautions (P < 0.001). There was a strong correlation between knowledge and compliance (practice) with universal precautions (r=0.76, p<0.001). Factors associated with poor compliance with universal precautions included lack of personal protection equipment (69.5%), lack of knowledge (65.0%), emergency situations (63.0%), presumption that patient is not infected with HIV or HBV (59.0%), time constraints (53.0%), heavy workload (48.0%) and absence of penalties (34.0%).Conclusion: There was adequate knowledge and a fair level of compliance among HCWs towards universal precautions. These findings sug­gest that training of health care workers to increase their knowledge about blood-borne pathogens and universal precau­tions could improve their compliance and thus reduce health care workers’ risk of blood-borne patho­gen exposure

Animal-Related Injuries in a Resource-Limited Setting: Experiences from a Tertiary Health Institution in Northwestern Tanzania.

Animal related injuries are a major but neglected emerging public health problem and contribute significantly to high morbidity and mortality worldwide. No prospective studies have been done on animal related injuries in our setting. This study was conducted to determine the management patterns and outcome of animal related injuries and their social impact on public health policy in the region. This was a descriptive prospective study of animal related injury patients that presented to Bugando Medical Centre between September 2007 and August 2011. Statistical data analysis was done using SPSS computer software version 17.0. A total of 452 (8.3%) animal-related injury patients were studied. The modal age group was 21-30 years. The male to female ratio was 2.1:1. Dog-bites (61.1%) were the most common injuries. Musculoskeletal (71.7%) region was the most frequent body region injured. Soft tissue injuries (92.5%) and fractures (49.1%) were the most common type of injuries sustained. Only 140 (31.0%) patients were hospitalized and most of them (97.1%) were treated surgically. Wound debridement was the most common procedure performed in 91.2% of patients. Postoperative complication rate was 15.9%, the commonest being surgical site infections (SSI) in 55.1% of patients. SSI was significantly associated with late presentation and open fractures (P < 0.001). The overall median duration of hospitalization was 16 days. Patients who had severe injuries, long bone fractures and those with hemiplegia stayed longer in the hospital (P < 0.001). Mortality rate was 10.2% and was significantly high in patients with severe injuries, severe head injury, tetanus and admission SBP < 90 mmHg (P < 0.001). The follow up of patients was poor. Animal related injuries constitute a major public health problem in our setting and commonly affect the young adult male in their economically productive age-group. Measures towards prevention and proper treatment and follow up are important in order to reduce morbidity and mortality resulting from this form of trauma

Ten-year experiences with Tracheostomy at a University teaching hospital in Northwestern Tanzania: A retrospective review of 214 cases

Tracheostomy remains a very important life saving surgical procedure worldwide and particularly in our environment where patients present late in upper airway obstruction. Little work has been done on this subject in our environment and therefore it was necessary to conduct this study to describe our own experiences with tracheostomy, outlining the common indications and outcome of tracheostomized patients in our setting and compare our results with those from other centers in the world. This was a 10-year retrospective study which was conducted at Bugando Medical Centre from January 2001 to December 2010. Data were retrieved from patients' files kept in the Medical record department and analyzed using SPSS computer software version 15.0. Ethical approval to conduct the study was obtained from relevant authority before the commencement of the study. A total of 214 patients were studied. The male to female ratio was 3.1: 1. The majority of patients were in the 3rd decade of life. The most common indication for tracheostomy was upper airway obstruction secondary to traumatic causes in 55.1% of patients, followed by upper airway obstruction due to neoplastic causes in 39.3% of cases. The majority of tracheostomies (80.4%) were performed as an emergency. Transverse skin crease incision was employed in all the cases. Post-tracheostomy complication rate was 21.5%. Complication rate was significantly higher in emergency tracheostomy than in electives (P < 0.001). The duration of temporary tracheostomy ranged from 8 days to 46 months, with a median duration of 4 months. Tracheostomy decannulation was successively performed in 72.4% of patients who survived. Mortality rate was 13.6%. The mortality was due to their underlying illnesses, none had tracheostomy-related mortality. Upper airway obstruction secondary to trauma and laryngeal tumors still remains the most common indication for tracheostomy in our centre and tracheostomy is still a life saving procedure in the surgical management of airway despite complications which are seen more commonly in paediatric patients. Most of tracheostomy related complications can be avoided by meticulous attention to the details of the technique and postoperative tracheostomy care by skilled and trained staff

Knowledge, attitudes and practices of parents on child sexual abuse and its prevention in Shinyanga district, Tanzania

Background: The role of parents in preventing child sexual abuse in the community in low-and-middle income countries has not been adequately emphasized. The objective of this study was to assess parents’ knowledge, attitudes and practices on child sexual abuse and its prevention in Shinyanga district, Tanzania in order to strengthen child protection.  Methods: This was a cross-sectional study conducted during July 2015. Multistage cluster sampling technique was employed to obtain study participants from a list of sampling frame. Parents with children below 18 years old were randomly selected to form a study population. A quantitative technique using structured questions was used to assess parents’ knowledge, attitude and practices about preventing child sexual abuse.Results: A total of 384 respondents were included in the study. The majority (95.6%) of respondents had high knowledge regarding prevention of child sexual abuse.  Majority (98.7%) of the respondents had positive attitudes on preventing child sexual abuse. However, only about a quarter (27.3%) of respondents had good practices on protection and prevention of child sexual abuse.Conclusion: Knowledge and attitudes of parents on child sexual abuse prevention was high in the study area.  However, the practices of parents on child sexual abuse prevention were poor. Therefore, a public education programme is needed for parents, with the ultimate aim of protecting children from the preventable harm and trauma of sexual abuse in rural communities of Tanzania

Aetiological spectrum, injury characteristics and treatment outcome of multiple injuries at a tertiary care hospital in Tanzania

Background: Multiple injuries constitute a public health problem and contribute significantly to high morbidity, mortality and long-term disabilities worldwide. This study describes the etiological spectrum, injury characteristics and treatment outcome of multiple injuries at a tertiary care hospital in Tanzania.Methods: This was a descriptive prospective study involving multiple injury patients admitted to Bugando Medical Centre (BMC) from March 2013 to June 2013 inclusive.Results: Out of 712 trauma patients who were admitted to BMC during the study period, 150 (21.1%) had multiple injuries. Their male to female ratio was of 2.3:1. The majority of patients were in the second decade of life. Road traffic accidents (RTAs) were the most common (93.3%) cause of injury. The majority of patients, 142 (94.7%) sustained blunt injuries. Twelve (8.0%) patients had pre-hospital care. The limbs (89.2%) and the head (78.7%) were the most common body regions injured. The majority of patients (85.3%) sustained severe injuries (ISS ≥ 16). Out of 150 patients, 46 (30.7%) had 65 missed injuries. A total of 142 (94.7%) patients were treated surgically. Wound debridement (87.3%) was the most common surgical procedure performed. The complication and mortality rates were 54.7% and 38.7%, respectively. The overall median length of hospital stay (LOS) was 23 days. Co-morbid illness, HIV positivity, CD4 count (≤ 200 cells/μl), severe trauma (ISS ≥ 16), admission Systolic Blood Pressure &lt; 90 mmHg, missed injuries and surgical site infection significantly influenced mortality (P &lt; 0.001). Patients who developed complications and those who had long bone fractures stayed longer in the hospital (p &lt; 0.001).Conclusion: Road traffic accidents remain a major cause of multiple injuries at BMC and contribute significantly to unacceptably high morbidity and mortality. Urgent preventive measures targeting at reducing the occurrence of road traffic accidents is necessary to reduce the incidence of multiple injuries in our centre

Prevalence of HIV Infection among Trauma Patients Admitted to\ud Bugando Medical Centre, Mwanza, Tanzania and its\ud Influence on Outcome

HIV infection, a major health problem worldwide, has been reported to be prevalent in trauma patients, thus presents an occupational hazard to health care workers who care for these patients. The purpose of this study was to establish the prevalence of HIV among trauma patients in our setting and to compare the outcome of these patients who are HIV positive with those who are HIV negative. This was a descriptive cross sectional study involving trauma patients aged 11 years and above, admitted to the surgical wards of Bugando Medical Centre in Mwanza, Tanzania over a six-month period from October 2008 to March 2009. All eligible patients were consecutively enrolled in the study. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS computer software. A total of 250 trauma patients were recruited and studied. The mean age of the study population was 36.37±15.35. Males accounted for the majority (N=202; 80.8%) of the study population. The prevalence of HIV among trauma patients was 11.6%. Among the HIV positive patients, 26 (89.7%) were males and majority aged 31-40 years. Seventy two percent of HIV positive patients had CD4+ count of ≥ 200 cells/μl. Overall length of hospital stays (LOS) ranged from 1 - 90 days with mean of 19.11 ± 15.84 days. Using multivariate logistic regression, injury severity score (ISS) (P=0.0026), revised trauma scores (RTS) (P= 0.002,), HIV seropositivity (P= 0.0012) and CD4+ count (P= 0.001) were significantly found to be associated with increased LOS. Mortality rate was 10.8% and was significantly associated with; the body region injured (P < 0.05), ISS (P = 0.026), RTS (P = 0.001), PTS (P= 0.01), HIV positivity (P= 0.0001) and CD4+ count (P= 0.035). HIV is prevalent among trauma patients in our setting. A substantial risk of exposure to HIV exists in health workers who care for these patients. Thus, all trauma health care workers in this region need to practice universal barrier precautions in order to reduce the risk of exposure to HIV infection. HIV positive patients with CD4+ count ≥200cells/μl have similar prognosis as HIV negative patients and therefore should be treated the same way

Postoperative nausea and vomiting at a tertiary care hospital in north-western Tanzania

Background: Postoperative nausea and vomiting is one of the most distressing morbidities associated with surgery. This descriptive prospective study was conducted to determine the incidence, predictors and management of postoperative nausea and vomiting among patients attending a tertiary hospital in north-western Tanzania.Methods: The study was conducted in the surgical wards and intensive care unit of Bugando Medical Centre in Mwanza, Tanzania between January 2013 and December 2013. The study population included adult patients aged ≥18 years, classified as ASA I and who were scheduled for elective surgeries under general or region anaesthesia. Patients were assessed preoperatively, intraoperatively and postoperatively.  A questionnaire was administered to each patient in order to collect the information on demographic characteristics, estimated patient’s body mass index, smoking  status, prior history of motion sickness or post-operative nausea and vomiting (PONV), type and duration of surgery/anaesthesia, intraoperative pethidine use, postoperative pain and timing of oral intake.Results: A total of 348 patients (age=18-76 years) were included in the study. The male to female ratio was 1.4: 1. The incidence of postoperative nausea and vomiting was 41.4%. Age group 21-30, female gender, history of PONV, general anaesthesia and intraoperative pethidine were the main predictors of PONV (p &lt; 0.001). Only forty-five (31.3%) out of the 144 patients who reported their episodes of PONV received any medications.Conclusion: The incidence of PONV among surgical patients at Bugando Medical Centre is unacceptably high and the predictors of postoperative nausea and vomiting within 24 hours included being a young adult, female, having history of PONV, been under general anaesthesia and intraoperative pethidine. It is recommended that patients with increased likelihood of developing postoperative nausea and vomiting should be given anti-emetic prophylaxis and other preventive measures

Iatrogenic ureteric injuries following abdomino-pelvic operations: a 10-year tertiary care hospital experience in Tanzania

Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity and even mortality. There is paucity of data regarding iatrogenic ureteric injuries in Tanzania and Bugando Medical Centre in particular. This study describes our experience in the management and outcome of ureteric injuries following abdomino-pelvic operations outlining the causes, clinical presentation and outcome of management of this condition in our local setting. This was a retrospective descriptive study of patients with iatrogenic ureteric injuries following abdomino-pelvic operations that were managed in Bugando Medical Centre between July 2004 and June 2014. A total of 164 patients (M: F = 1: 1.6) were studied. Of these, 154 (93.9%) were referred to Bugando Medical Centre having had their initial surgeries performed at other hospitals, whereas 10 (6.1%) patients sustained ureteric injuries during abdomino-pelvic surgery at Bugando Medical Centre. The median age at presentation was 36 years. The most common cause of iatrogenic ureteric injuries was total abdominal hysterectomy occurring in 69.2% of cases. The distal ureter was more frequently injured in 75.6% of cases. Suture ligation was the commonest type of injury accounting for 36.6% of patients. One hundred and sixteen (70.7%) patients had delayed diagnosis but underwent immediate repair. Ureteroneocystostomy was the most frequent reconstructive surgery performed in 58.0% of cases. Of the 164 patients, 152 (92.7%) were treated successfully. Twelve (7.3%) patients died in hospital. The main predictors of deaths were delayed presentation, deranged renal function tests on admission, missed ureteric injuries and surgical site infections (P < 0.001). The overall median length of hospital stay was 12 days. Follow up of patients was generally poor as more than half of patients were lost to follow up. Total abdominal hysterectomy still accounts for most cases of iatrogenic ureteric injuries in our environment. Meticulous surgical technique as well as identification of the course of the ureter and associated anatomic locations where injury is most likely to occur is important to decrease the risk of ureteric injury. Timely recognition of ureteric injury and its management is associated with good outcome

Diagnostic utility of abdominal ultrasound in the evaluation of abdomino-pelvic lesions at Bugando Medical Centre in Mwanza, Tanzania

Background: Despite the fact that abdominal ultrasound has been widely used in many centres in Tanzania as a primary diagnostic imaging for patients with abdomino-pelvic lesions, its diagnostic utility has not yet been assessed in Tanzania, and therefore its use as an alternative diagnostic tool in patients with abdomino-pelvic lesions is not justified. This study aimed to determine the utility of abdominal ultrasound in the diagnosis of abdomino-pelvic lesions in our local setting.Methods: This was a cross sectional study to evaluate the diagnostic utility of abdominal ultrasound in patients presenting with abdomino-pelvic lesions at Bugando Medical Centre between January 2017 and July 2017. Abdominal ultrasonographic findings were cross-tabulated against operative findings (the gold standard). Then, the sensitivity, specificity, accuracy, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy were calculated to determine the diagnostic utility of abdominal ultrasound.Results: A total of 146 patients (M: F ratio = 1: 2.2) were studied. The mean age at diagnosis was 39.3 years. The diagnostic utility of abdominal ultrasound in terms of sensitivity, specificity, PPV, NPV and accuracy were 39.4-100%, 0-100%, 64.7-100%, 0-100% and 40.8-100% respectively.  The kappa statistic (қ) showed good to excellent agreement with the operative findings, the gold standard (қ = 0.75-1.00).Conclusion: The diagnostic utility of abdominal ultrasound in detecting abdomino-pelvic lesions is much lower than that seen in developed countries, hence, abdominal ultrasound is not a reliable tool in detecting abdomino-pelvic lesions at Bugando Medical Centre and therefore its use should be supplemented with abdominal CT scan in selected cases

Experiences with surgical management of undescended testis at a tertiary care hospital in north-western Tanzania

Background: Undescended testes (UDT) are prone to a lot of complications but early detection and correction give good results. There is paucity of published data on UDT in our setting. This study describes the clinical presentation, management and outcome of this condition at Bugando Medical Centre (BMC) in northwestern TanzaniaMethods: This was a retrospective study of patients who were admitted and operated for undescended testis at BMC between July 2006 and June 2014. Results: A total of 84 patients with 102 UDT were studied. Forty-six (54.9%) patients were aged above 5 years. Majority (72.5%) UDT were non-palpable. The right side was involved in 54.8%; left side in 23.8% while 21.4% were bilateral.  Associated inguinal hernia was reported in 48 (77.4%) patients. Ultrasonography was performed in 34 (45.9%) patients with non-palpable testes and was used to locate 12(35.3%) testes.  Laparoscopy was not used in any patient. At surgery, 54 (52.9%) testes were found in the inguinal canal, 28 (27.5%) in the superficial inguinal pouch, 10 (9.8%) in the abdomen and 10 (9.8%) testes were not found. Out of the 92 (90.2%) visible testes, 69 (75.0%) underwent orchidopexy (single stage in 54 (78.3%) testes and multistage in 15 (21.7%) testes) and 23 (25.0%) orchidectomy. Single stage procedures were more likely in patients less than 5 years, with palpable testes and those with testes located at the superficial inguinal pouch (p &lt; 0.001). Postoperative complications were recorded in 8(9.5%) patients. The overall success rate of treatment was 95.7%. In this study, only 12 (14.3%) patients were available for follow up at 12 months after discharge.Conclusion: Patients with UDT presented late in our hospital because diagnosis by birth attendants was rarely made even though the anomaly was obvious at birth. The parents, patients themselves and development of complications drew attention to undescended testis. Health awareness campaign, thorough genital examination after birth and regular screening of toddlers for UDT may result in early presentatio