The quality of operation notes after trans-urethral resection of the prostate at Kilimanjaro Christian Medical University College Hospital Tanzania

Background: Operation notes are very vital in the practice of surgery. They are the only comprehensive account of what took place in theatre. Accurate and detailed documentation of surgical notes after Transurethral Resection of the Prostate (TURP) is vital. Yet it is usually forgotten in medical teaching. The Royal College of Surgeons of England (RCSE) safety standards are usually used as the benchmark for the assessment of operation notes.Patients and Methods: The study was descriptive retrospective conducted at Kilimanjaro Christian Medical Centre (KCMC). All patients who underwent TURP between January and December 2017 were enrolled. The Urology theatre register was used to trace patient identities. The Files were then extracted from the registry. Operation note sheets were analysed by the research team using a structured data collection tool. Two Independent assessors(residents) were used to assess legibility. If both agreed that the notes were decipherable, then they were deemed legible. The content of the notes was assessed for Presence or absence of recorded variables. Utmost confidentiality was kept about the surgeon and the patient.Results: A total of 251 files were assessed. Recording of date, Inpatient number, Post-Operative instructions and whether there were any intraoperative complications was at 100%. However, the time of surgery, Resection technique and Method of introduction of the resectoscope were not recorded at all. Other variables recorded were: Signature of surgeon -99.6%, Patient name-99.6%, Details of prostate chips-89%, Sheath used-81%, Circulating nurse-68%, Working element used-35%, Telescope used-12%, Type of diarthermy-7%, Loop Specifications-0.8% and type of Irrigant at 0.8%. Ninety-eight percent of the  operation notes were legible. Overall 56.6% of the operation notes had recorded variables after TURP.Conclusion: Some variables (Inpatient number, Date of operation, intraoperative complications and Postoperative instructions) were recorded at 100%. Others (Time of operation, Resection technique and method of introduction of resectoscope) were not recorded at all. Overall 56.6% of the variables were recorded and 98% of the notes were legible

Introduction of a learning management system at the Kilimanjaro Christian Medical University College

Background. Medical schools in Africa face daunting challenges including faculty shortages, growing class sizes, and inadequate resources. Learningmanagement systems (LMS) may be powerful tools for organising and presenting curricular learning materials, with the potential for monitoring and evaluation functions.Objective. To introduce a LMS for the first-year medical student curriculum at the Kilimanjaro Christian Medical University College (KCMU Co), inMoshi, Tanzania, in partnership with the Duke University School of Medicine (Durham, North Carolina, USA).Methods. Observations were made on the requisite information technology (IT) infrastructure and human resource needs, and participation in trainingexercises. LMS utilisation was recorded, and two (student and faculty) surveys were done.Results. The KCMU Co IT infrastructure was upgraded, and an expert team trained for LMS implementation. An introductory LMS workshop forfaculty had 7 out of 25 invitees, but attendance improved to more than 50% in subsequent workshops. Student attendance at workshops was mandatory. Use of the LMS by students rapidly expanded, and growing faculty utilisation followed later. By the end of the second semester, online examinations were offered, resulting in greater student and faculty  satisfaction owing to rapid availability of results. A year after LMS   introduction, 90% of students were accessing the LMS at least 4 days/week. A student survey identified high levels of satisfaction with the LMS software, quality of content, and learning enhancement.Conclusion. LMS can be a useful and efficient tool for curriculum  organisation, administration of online examinations, and continuous monitoring. The lessons learned from KCMU Co may be useful for similar academic settings

The surgical pathology laboratory in Mwanza, Tanzania: A survey on the reproducibility of diagnoses after the first years of autonomous activity

Background: In 2000, an Italian non-governmental organisation (NGO) began a 9-year project to establish a surgical pathology laboratory at the Bugando Medical Centre (BMC) in Mwanza, Tanzania, a country with a low Human Development Index (HDI), and as of 2009, the laboratory was operating autonomously. The present survey aims to evaluate the reproducibility of histological and cytological diagnoses assigned in the laboratory's early years of autonomous activity. We selected a random sample of 196 histological and cytological diagnoses issued in 2010-2011 at the BMC surgical pathology laboratory. The corresponding samples were sent to Italy for review by Italian senior pathologists, who were blinded to the local results. Samples were classified into four diagnostic categories: malignant, benign, inflammatory, and suspicious. The two-observer kappa-statistic for categorised (qualitative) data was then calculated to measure diagnostic concordance between the local Tanzanian pathologists and Italian senior pathologists. The k-Cohen was calculated for concordance in the overall study sample. Concordance and discordance rates were also stratified by subset: general adult, paediatric/adolescent, and lymphoproliferative histopathological diagnoses; fluid and fine needle aspiration (FNA) cytological diagnoses; and PAP tests. Discordance was also categorised by the corresponding hypothetical clinical implications: high, intermediate, and not significant. Results: Overall concordance was 85.2% (167 of 196 diagnoses), with a k-Cohen of 0.7691 (P = 0.0000). Very high concordance was observed in the subsets of adult general pathological diagnoses (90%) and paediatric/adolescent pathological diagnoses (91.18%). Concordance in the subset of PAP tests was 75%, and for fluid/FNA cytological diagnoses it was 56.52%. Concordance among 12 histological subtypes of lymphoma was 75.86%, with substantial discordance observed in the diagnosis of Burkitt lymphoma (five cases diagnosed by Italian pathologists versus 2 by local pathologists). The overall proportion of discordance with high hypothetical clinical implications was 6.1% (12 diagnoses). Conclusion: This blind review of diagnoses assigned in Tanzania, a country with low HDI, and in Italy, a country with a very high HDI, seemed to be a sensitive and effective method to identify areas of potential error and may represent a reference point for future, more detailed quality control processes or audits of surgical pathology services located in limited-resource regions

From easing lockdowns to scaling up community-based coronavirus disease 2019 screening, testing, and contact tracing in Africa-shared approaches, innovations, and challenges to minimize morbidity and mortality

CITATION: Nachega, J. B. et al. 2021. From easing lockdowns to scaling up community-based coronavirus disease 2019 screening, testing, and contact tracing in Africa-shared approaches, innovations, and challenges to minimize morbidity and mortality. Clinical infectious diseases, 72(2):327–331. doi:10.1093/cid/ciaa695The original publication is available at https://academic.oup.com/cid/The arrival of coronavirus disease 2019 (COVID-19) on the African continent resulted in a range of lockdown measures that curtailed the spread of the infection but caused economic hardship. African countries now face difficult choices regarding easing of lockdowns and sustaining effective public health control measures and surveillance. Pandemic control will require efficient community screening, testing, and contact tracing; behavioral change interventions; adequate resources; and well-supported, community-based teams of trained, protected personnel. We discuss COVID-19 control approaches in selected African countries and the need for shared, affordable, innovative methods to overcome challenges and minimize mortality. This crisis presents a unique opportunity to align COVID-19 services with those already in place for human immunodeficiency virus, tuberculosis, malaria, and non communicable diseases through mobilization of Africa's interprofessional healthcare workforce. By addressing the challenges, the detrimental effect of the COVID-19 pandemic on African citizens can be minimized.https://academic.oup.com/cid/article/72/2/327/5849218?login=truePublishers versio

The Medical Education Partnership Initiative (MEPI): Innovations and Lessons for Health Professions Training and Research in Africa

MEPI was a $130 million competitively awarded grant by President's Emergency Plan for AIDS Relief (PEPFAR) and National Institutes of Health (NIH) to 13 Medical Schools in 12 Sub-Saharan African countries and a Coordinating Centre (CC). Implementation was led by Principal investigators (PIs) from the grantee institutions supported by Health Resources and Services Administration (HRSA), NIH and the CC from September, 2010 to August, 2015. The goals were to increase the capacity of the awardees to produce more and better doctors, strengthen locally relevant research, promote retention of the graduates within their countries and ensure sustainability. MEPI ignited excitement and stimulated a broad range of improvements in the grantee schools and countries. Through in-country consortium arrangements African PIs expanded the programme from the 13 grantees to over 60 medical schools in Africa, creating vibrant South–South and South–North partnerships in medical education, and research. Grantees revised curricular to competency based models, created medical education units to upgrade the quality of education and established research support centres to promote institutional and collaborative research. MEPI stimulated the establishment of ten new schools, doubling of the students’ intake, in some schools, a three-fold increase in post graduate student numbers, and faculty expansion and retention. Sustainability of the MEPI innovations was assured by enlisting the support of universities and ministries of education and health in the countries thus enabling integration of the new programs into the regular national budgets. The vibrant MEPI annual symposia are now the largest medical education events in Africa attracting global participation. These symposia and innovations will be carried forward by the successor of MEPI, the African Forum for Research and Education in Health (AFREhealth). AFREhealth promises to be more inclusive and transformative bringing together other health professionals including nurses, pharmacists, and dentists.<p

The critical need for pooled data on coronavirus disease 2019 in African children : an AFREhealth call for action through multicountry research collaboration

Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children and adolescents; and these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of coronavirus disease 2019 (COVID-19) among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and coinfections such as human immunodeficiency virus (HIV), tuberculosis, malaria, sickle cell disease, and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consortium is expected to generate key evidence to inform clinical practice and public health policy-making for COVID-19 while concurrently addressing other major diseases affecting children in African countries.The US National Institutes of Health (NIH)/ Fogarty International Centre (FIC) to the African Forum for Research and Education in Health (AFREhealth).https://academic.oup.com/cidam2022Paediatrics and Child Healt

Complex therapy for hepatic trauma

Background: Hepatic trauma is a major cause of death in abdominal injury patients. This study was aimed at investigating the outcome of management of 197 patients presenting with hepatic injuries. Methods: This was a retrospective study of all patients treated for hepatic injuries at Oilu Hospital from January 1980 to January 1999 and at Dodoma Regional Hospital from January 1990 to January 2001.Seven patients were treated non-surgically while 188 had surgery. Conservative treatment included absolute bed rest, replacement and stabilization of the blood capacity, anti-inflammation drugs and styptic. Surgical procedures for patients with grade III and IV hepatic trauma included packing with omentum and repair of liver lacerations, debridment or irregular hepatectomy under Pringle&apos;s maneuver, perihepatic tamponade with or without selective ligation of hepatic artery and post hepatic vein repair together with T-tube and perihepatic drainage. Results: There were 30 deaths (15.3% mortality rate). All the seven patients treated conservatively survived. The main cause of death was exsanguination with or without coagulopathy, multiple organ failure (MOSF) and associated injuries. Conc1usion:The basic operative principles for liver injuries are thorough debridment and haemostasis, elimination of bile leakage and unobstructed drainage

The urinary diversion in children with bladder exstrophy and epispadias: alternative to primary bladder closure.

The main objective of this study was to evaluate the outcome of management of bladder exstrophy and epispadias with continent urinary diversion. A total of 15 children, 10 females and 5 males underwent continent urinary diversion at Kilimanjaro Christian Medical Centre (KCMC) between 1985 and 1997. Their ages ranged between one month and 13 years with an average of 5.4 years. Eight (53%) of them had exstrophy epispadias complex, 4 (27%) had incontinent epispadias, 2 (13%) presented with neurological conditions and 1 (7%) had traumatic destruction of the bladder neck and urethra. Seven (47%) had Mainz pouch II procedure, 6 (40%) underwent the classical ureterosigmoidostomy while 2 (13%) had appendicovesicostomy. The mean duration of follow up was 3.2 years. Three patients developed mild non-progressive hydronephrosis, which required no surgical intervention. One patient with a solitary kidney developed ureteral stenosis at the implantation site that was undiverted. Metabolic acidosis was well compensated with none of the patients requiring sodium bicarbonate supplements. Only one patient had night soiling that required wearing of diapers. Our experience with continent urinary diversion in children with other benign bladder conditions has been favourable and in our view, it offers a viable treatment method in children with exstrophy epispadia complex