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99mTc sestamibi scintimammography in the diagnosis of palpable breast masses
(Nuclear medicine communications, 2003) Chande, Hassan M.
The aim of this prospective study was to evaluate the diagnostic performance of 99mTc sestamibi scintimammography in a region with a low incidence of breast cancer (East, central and West Africa) and to verify the clinical usefulness of this technique in identifying benign breast diseases. Thirty-eight women (age range 22-38 years) with palpable breast masses (n =38) and inconclusive mammograms were included. Prone scintimammography was performed 10 min and 60-90 min in all patients after injection using an isotime acquisition of 10 min. A positive scan for breast cancer was defined as tracer uptake on the 10 min image and retention of activity on the 60-90 min image. A negative scan was defined as uptake on the 10 min image and complete washout of activity on the 60-90 min image. All patients subsequently underwent excisional biopsy of the breast masses and histological confirmation of the pathology. The results of scintimammography and histopathology were in agreement in all patients, revealing 36 benign lesions and two malignant lesions. Histopathologically, the lesions were fibroadenomas (27), fibrocystic disease (five), abscesses (four) and invasive intraductal carcinoma (two). It is concluded that, in regions with high incidence of benign breast diseases in young women, 99mTc sestamibi scintimammography can be used to rapidly characterize benign and malignant breast masses and thereby give priority to the management of those with a serious condition.
99mTc sestamibi scintimammography in the diagnosis of palpable breast masses
(Clinical trial, 2003) Chande, Hassan M.
Summary The aim of this prospective study was to evaluate the diagnostic performance of 99m Tc sestamibi scintimammography in a region with a low incidence of breast cancer (East, central and West Africa) and to verify the clinical usefulness of this technique in identifying benign breast diseases. Thirty-eight women (age range 22±38 years) with palpable breast masses (n = 38) and inconclusive mammograms were included. Prone scintimammography was performed 10 min and 60±90 min in all patients after injection using an isotime acquisition of 10 min. A positive scan for breast cancer was defined as tracer uptake on the 10 min image and retention of activity on the 60±90 min image. A negative scan was defined as uptake on the 10 min image and complete washout of activity on the 60±90 min image. All patients subsequently underwent excisional biopsy of the breast masses and histological confirmation of the pathology. The results of scintimammography and histopathology were in agreement in all patients, revealing 36 benign lesions and two malignant lesions. Histopathologically, the lesions were fibroadenomas (27), fibrocystic disease (five), abscesses (four) and invasive intraductal carcinoma (two). It is concluded that, in regions with high incidence of benign breast diseases in young women, 99m Tc sestamibi scintimammography can be used to rapidly characterize benign and malignant breast masses and thereby give priority to the management of those with a serious condition. (# 2003 Lippincott Williams & Wilkins) Keywords: benign, breast disease, fibroadenomas, palpable, scintimammography
Anaemia, renal dysfunction and in-hospital outcomes in patients with heart failure in Botswana
(2018) Mashalla, Yohana J.
Background. Anaemia and renal dysfunction are associated with an increased morbidity and mortality in heart failure (HF) patients. Objective. To estimate the frequency and impact of anaemia and renal dysfunction on in-hospital outcomes in patients with HF. Methods. A total of 193 consecutive patients with HF admitted to Princess Marina Hospital, Gaborone, Botswana, from February 2014 to February 2015, were studied. Anaemia was defined as haemoglobin <13 g/dL for men and <12 g/dL for women. Renal dysfunction was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, calculated by the simplified Modification of Diet in Renal Disease formula. The in-hospital outcomes included length of hospital stay and mortality. Results. The mean (standard deviation (SD)) age was 54.2 (17.1) years and 53.9% of the patients were men. The overall median eGFR was 75.9 mL/min/1.73 m2 and renal dysfunction was detected in 60 (31.1%) patients. Renal dysfunction was associated with hypertension (p=0.01), diabetes mellitus (p=0.01) and a lower haemoglobin level (p=0.008). The mean (SD) haemoglobin was 12.0 (3.0) g/dL and 54.9% of the patients were anaemic. Microcytic, normocytic and macrocytic anaemia were found in 32.1%, 57.5% and 10.4% of patients, respectively. The mean (SD) haemoglobin level for males was significantly higher than for females (12.4 (3.3) g/dL v. 11.5 (2.5) g/dL; p=0.038). Anaemia was more common in patients with diabetes (p=0.028) and in those with increased left ventricular ejection fraction (p=0.005). Neither renal dysfunction nor anaemia was significantly associated with the length of hospital stay or in-hospital mortality. Conclusion. Anaemia and renal dysfunction are prevalent in HF patients, but neither was an independent predictor of length of stay or in-hospital mortality in this population. These findings indicate that HF data in developed countries may not apply to countries in sub- Saharan Africa, and call for more studies to be done in this region.
The anti inflamatory activity of rumex usambarensis
(The East and Central African Journal of Pharmaceutical Sciences, 2000) Chande, Hassan M.
The anti-inflammatory activity of the extract of Rumex usambarensis Dammer (Polygonaceae) was compared to that of diclofenac sodium. The results of this study have shown that the 0.4 ml and 0.8 ml of the extract had 40.6% and 69.3% of the anti-inflammatory activity of 10mg diclofenac sodium. Histological results were also consistent with the anti-inflammatory activity of Rumex usambarensis.
The Anti-Inflammatory Activity Of Rumex usambarensis
(The East and Central African Journal of Pharmaceutical Sciences, 2000) Chande, Hassan M.
The anti-inflammatory activity of the extract of Rumex usambarensis Dammer (Polygonaceae) was compared to that of diclofenac sodium. The results of this study have shown that the 0.4 ml and 0.8 ml of the extract had 40.6% and 69.3% of the anti-inflammatory activity of 10mg diclofenac sodium. Histological results were also consistent with the anti-inflammatory activity of Rumex usambarensis.
Assessment of prescribing practices at the primary healthcare facilities in Botswana with an emphasis on antibiotics: Findings and implications
(International journal of clinical practice, 2017) Mashalla, Yohana J.
Background and Aims: Inappropriate drug prescribing has increased especially in developing countries where systems for monitoring medicine use are not well developed. This increases the rate of antimicrobial resistance. The study aim was to assess the prescribing patterns among urban primary health facilities in Botswana to provide future guidance including developing future quality indicators. Methods: Retrospective data from patients’ records between January and December 2013 in 19 clinics were collected in a cross-sectional study. The WHO/International Network for Rational Use of Drugs indicators were used to assess prescribing patterns in the study clinics. Results: Average number of drugs per prescription was 2.8; 78.6% of the prescribed antibiotics were by International Non-proprietary Name and 96.1% complied with the Botswana Essential Drugs List. Overall rate of antibiotic prescribing was high (42.7%) with 14.7%, 5.9% and 1.3% of prescriptions having two, three and four antibiotics, respectively. Systemic antibiotics (JO1C) accounted for 45.4% of prescribed antibiotics of which amoxicillin accounted for 28.4% and metronidazole 14.4% of all antibiotic prescriptions. There was low use of co-amoxiclav (0.3% of all antibiotic prescriptions). Third generation cephalosporins and macrolides accounted for 9.8% and 6.2% of antibiotic prescriptions respectively, with no prescribing of fluoroquinolones. The majority of indications (87%) for antibiotic prescriptions were according to ICD classification. Conclusions: While most indications for antibiotic prescriptions were based on signs and symptoms according to ICD, antibiotic prescribing rates were high with some conditions not requiring antibiotics because they are viral infections. There is a need to further improve prescribing practices through induction and training of in-service prescribers. An effective management tool for monitoring antibiotic prescribing practices at Primary Health Care facilities should be designed and implemented, including developing robust quality indicators.
Assessment of women's knowledge and attitude towards carcinoma of the cervix in Ilala Municipality
(East African Journal of Public Health, 2010) Chande, Hassan M.
Main objective: To asses knowledge and attitudes of women towards carcinoma of the cervix in Ilala Municipality. Methodology: A community based cross-sectional study targeting all women in Ilala municipality. Therefore the sample size was 196 women but for the purpose of this study it was increased up to 201 women.A multistage random sampling procedure was used to select a representative sample. Permission was sought at all the appropriate levels in the form of oral as well as written consent.Only women who were willing to participate in the study were interviewed. A questionnaire was developed and data analysed using Epi info software was used to analyse data. Differences beween proportions found in different groups were tested for statistical significant using chi-squared test. Results: A total of 210 women were interviewed. A number of respondents were in the age groups 21-30 and 31-40 years and 76.1% of the respondents were aware of carcinoma of the cervix. The most common mentioned risk factors were early marriage (37.1%) and multiparity (36%). Irregular vaginal bleeding was the most common symptom metioned (51.7%). Irrespective of the level of education 98%-100% of all respondents knew the importance of screening for carcinoma of the cervix. Conclusion: It was therefore concluded that women were aware of carcinoma of the cervix but the knowledge on this disease is still very low.
Assessment of women's knowledge and attitude towards carcinoma of the cervix in Ilala municipality.
(East African Journal of Public Health, 2010) Chande, Hassan M.
Main objective: To asses knowledge and attitudes of women towards carcinoma of the cervix in Ilala Municipality. Methodology: A community based cross-sectional study targeting all women in Ilala municipality. Therefore the sample size was 196 women but for the purpose of this study it was increased up to 201 women.A multistage random sampling procedure was used to select a representative sample. Permission was sought at all the appropriate levels in the form of oral as well as written consent.Only women who were willing to participate in the study were interviewed. A questionnaire was developed and data analysed using Epi info software was used to analyse data. Differences beween proportions found in different groups were tested for statistical significant using chi-squared test. Results: A total of 210 women were interviewed. A number of respondents were in the age groups 21-30 and 31-40 years and 76.1% of the respondents were aware of carcinoma of the cervix. The most common mentioned risk factors were early marriage (37.1%) and multiparity (36%). Irregular vaginal bleeding was the most common symptom metioned (51.7%). Irrespective of the level of education 98%-100% of all respondents knew the importance of screening for carcinoma of the cervix. Conclusion: It was therefore concluded that women were aware of carcinoma of the cervix but the knowledge on this disease is still very low.
Choledochal cyst type I with dilated intrahepatic biliary radicles: a type IVA mimic
(Egyptian Liver Journal, 2022) Chande, Hassan M.
Background: A choledochal cyst is a relatively rare congenital anomaly of the biliary tree requiring surgery as the definitive treatment. Amongst the five Todani variants, type I poses a diagnostic and treatment challenge owing to its infrequent, yet clinically significant mimicry for type IVA cysts. Case presentation: We present a case of a 4-year-old female diagnosed to have a giant type IA choledochal cyst that mimicked a type IVA cyst on radiological imaging. The patient was treated by complete cyst excision, cholecys- tectomy, and restoration of the biliary-enteric communication by a Roux-en-Y hepaticojejunostomy. Regression of the dilated intrahepatic radicles that counterfeited a type IVA cyst was confirmed on follow-up imaging studies. Conclusion: Such an encounter, although rare, can significantly alter the course of management. We recommend extrahepatic cyst excision with biliary reconstruction as the standard treatment when preoperative and intraoperative imaging studies fall short in differentiating the aforementioned variants. Keywords: Choledochal cyst excision, Giant choledochal cyst, Roux-en-Y hepaticojejunostomy, Todani classification
Choledochal cyst type I with dilated intrahepatic biliary radicles: a type IVA mimic
(Egyptian Liver Journal, 2022) Chande, Hassan M.
Background: A choledochal cyst is a relatively rare congenital anomaly of the biliary tree requiring surgery as the definitive treatment. Amongst the five Todani variants, type I poses a diagnostic and treatment challenge owing to its infrequent, yet clinically significant mimicry for type IVA cysts. Case presentation: We present a case of a 4-year-old female diagnosed to have a giant type IA choledochal cyst that mimicked a type IVA cyst on radiological imaging. The patient was treated by complete cyst excision, cholecys- tectomy, and restoration of the biliary-enteric communication by a Roux-en-Y hepaticojejunostomy. Regression of the dilated intrahepatic radicles that counterfeited a type IVA cyst was confirmed on follow-up imaging studies. Conclusion: Such an encounter, although rare, can significantly alter the course of management. We recommend extrahepatic cyst excision with biliary reconstruction as the standard treatment when preoperative and intraoperative imaging studies fall short in differentiating the aforementioned variants. Keywords: Choledochal cyst excision, Giant choledochal cyst, Roux-en-Y hepaticojejunostomy, Todani classification
Discrepancy of clinical symptoms and prognosis of a patient — forensic significance of “talk and die” head injury
(Legal medicine, 2000) Ng'walali, Paul M.
Deaths of patients who had talked after sustaining a head injury and were then assumed clinically to be recovering from the head trauma raise medicolegal questions about the precise causes of deaths. A forensic autopsy on a 77-year-old man who had been talking after a road traffic accident and died on the sixth day showed slight subdural hematoma, bifrontal cerebral contusions and diffuse axonal injury. No natural diseases or delayed complications of injury were found. The cause of death was certified as head injury due to a traffic accident. This is a case of “talk and die” head injury. Forensic autopsy is important in patients with “talk and die” to clarify the causal relation to the head trauma in relation to any further forensic dispute.
[Ethanol concentrations in multi-site sampling blood in forensic autopsy cases--a retrospective analysis over a period of six years (1994-1999) in Kumamoto University].
(The Japanese Journal of Legal Medicine, 2002) Ng'walali, Paul M.
Ethanol and n-propanol concentrations in forensic autopsy cases determined in Department of Forensic Medicine, Kumamoto University School of Medicine were reviewed retrospectively. Out of 388 autopsies in 6 years (1994-1999), ethanol was positive in 88 (22.7%) cases. Higher positive rates were observed in bleeding and burning cases compared to other cases. Histograms of the blood ethanol concentrations in all ethanol positive cases had two peaks at 0.1 mg/ml to 0.5 mg/ml and 1.5 mg/ml to 2.0 mg/ml ranges, which indicated that not only an intermediate but also a weak drunkenness level could be a risk factor of being involved in forensic fatalities. There were no differences in mean ethanol concentrations in the blood samples of the right, left and whole heart blood collected from each victim. The femoral blood, however, was slightly higher than those of heart blood. N-Propanol, an indicator for postmortem ethanol production, was detected in 14.7% of stomach contents samples as early as 6 to 12 hours of post mortem intervals, whereas it was not remarkable in urine and femoral vein blood.
Evaluation of risk factors for Alzheimer's disease in elderly east Africans
(Brain Res Bull, 1997) Chande, Hassan M.
A number of biological risk factors have been implicated for Alzheimer's disease (AD). The investigation of prevalence rates of AD in crosscultural populations has much potential in validating these factors. We previously assessed brain amyloid beta (A beta) protein deposition and other lesions associated with AD as possible markers for preclinical AD in elderly nondemented East Africans. In further analysis, we demonstrate that 17-19% of elderly East African subjects without clinical neurological disease exhibited neocortical A beta deposits and minimal neurofibrillary changes at necropsy that was qualitatively and quantitatively similar to that in an age-matched elderly control sample from Cleveland, OH. A beta deposits varied from numerous diffuse to highly localized neuritic plaques and were predominantly reactive for the longer A beta 42 species. In parallel studies, we evaluated another recently implicated factor in AD, the apolipoprotein E genotype. We found relatively high frequencies of the apolipoprotein E-epsilon 4 allele in elderly nondemented East Africans. The frequencies were comparable to those in other African populations but higher than in subjects from developed countries. Our limited study suggests that elderly East Africans acquire cerebral lesions found in AD subjects but the apolipoprotein E-epsilon 4 allele may not be a highly specific factor for the disease among East Africans.
Evaluation of Xpert® MTB/RIF and Ustar EasyNAT™ TB IAD for diagnosis of tuberculous lymphadenitis of children in Tanzania: a prospective descriptive study
(BMC infectious diseases, 2016) Chande, Hassan M.
Background: Fine needle aspiration biopsy has become a standard approach for diagnosis of peripheral tuberculous lymphadenitis. The aim of this study was to compare the performance of Xpert MTB/RIF and Ustar EasyNAT TB IAD nucleic acid amplification assays, against acid-fast bacilli microscopy, cytology and mycobacterial culture for the diagnosis of TB lymphadenitis in children from a TB-endemic setting in Tanzania. Methods: Children of 8 weeks to 16 years of age, suspected of having TB lymphadenitis, were recruited at a district hospital in Tanzania. Fine needle aspirates of lymph nodes were analysed using acid-fast bacilli microscopy, liquid TB culture, cytology, Xpert MTB/RIF and EasyNAT. Latent class analysis and comparison against a composite reference standard comprising “culture and/or cytology” was done, to assess the performance of Xpert MTB/RIF and EasyNAT for the diagnosis of TB lymphadenitis. Results: Seventy-nine children were recruited; 4 were excluded from analysis. Against a composite reference standard of culture and/or cytology, Xpert MTB/RIF and EasyNAT had a sensitivity and specificity of 58 % and 93 %; and 19 % and 100 % respectively. Relative to latent class definitions, cytology had a sensitivity of 100 % and specificity of 94.7 %. Conclusions: Combining clinical assessment, cytology and Xpert MTB/RIF may allow for a rapid and accurate diagnosis of childhood TB lymphadenitis. Larger diagnostic evaluation studies are recommended to validate these findings and on Xpert MTB/RIF to assess its use as a solitary initial test for TB lymphadenitis in children. Keywords: Mycobacterium tuberculosis, Lymphadenitis, Childhood, Fine needle aspiration, Nucleic acid amplification, Xpert MTB/RIF, Ustar EasyNAT, Culture, Cytology, Ziehl-Neelsen
Evaluation of Xpert® MTB/RIF and Ustar EasyNAT™ TB IAD for diagnosis of tuberculous lymphadenitis of children in Tanzania: a prospective descriptive study
(BMC infectious diseases, 2016) Chande, Hassan M.
Background Fine needle aspiration biopsy has become a standard approach for diagnosis of peripheral tuberculous lymphadenitis. The aim of this study was to compare the performance of Xpert MTB/RIF and Ustar EasyNAT TB IAD nucleic acid amplification assays, against acid-fast bacilli microscopy, cytology and mycobacterial culture for the diagnosis of TB lymphadenitis in children from a TB-endemic setting in Tanzania. Methods Children of 8 weeks to 16 years of age, suspected of having TB lymphadenitis, were recruited at a district hospital in Tanzania. Fine needle aspirates of lymph nodes were analysed using acid-fast bacilli microscopy, liquid TB culture, cytology, Xpert MTB/RIF and EasyNAT. Latent class analysis and comparison against a composite reference standard comprising “culture and/or cytology” was done, to assess the performance of Xpert MTB/RIF and EasyNAT for the diagnosis of TB lymphadenitis. Results Seventy-nine children were recruited; 4 were excluded from analysis. Against a composite reference standard of culture and/or cytology, Xpert MTB/RIF and EasyNAT had a sensitivity and specificity of 58 % and 93 %; and 19 % and 100 % respectively. Relative to latent class definitions, cytology had a sensitivity of 100 % and specificity of 94.7 %. Conclusions Combining clinical assessment, cytology and Xpert MTB/RIF may allow for a rapid and accurate diagnosis of childhood TB lymphadenitis. Larger diagnostic evaluation studies are recommended to validate these findings and on Xpert MTB/RIF to assess its use as a solitary initial test for TB lymphadenitis in children.
Fatal intussusception in infancy: an experience in forensic autopsy
(Legal medicine, 2003) Ng'walali, Paul M.
Intussusception, although a common cause of pediatric surgical emergencies, is a rarely fatal condition. A 7-month-old infant who was discovered in her cot was unresponsive and pronounced dead after 2 h of uneventful cardiopulmonary resuscitation in an emergency hospital. Forensic autopsy which was performed in order to clarify the circumstances surrounding the death revealed intussusceptions at two sites of the ileum. Although morbidity and mortality rates from the condition have progressively declined in recent decades but avoidable deaths still occur as was experienced in the present case. The forensic pathology significance in this case was the occurrence of ‘painless intussusception’ whereby the affected child clinically exhibited no discomfort or characteristic features of acute abdomen until death. In summary, the present case has exhibited an uncommon fatal occurrence and demonstrated the importance of forensic autopsy in such unexpected sudden infant deaths.
Filling the gap for healthcare proffessionals leadership training in Africa: the Afya bora consortium fellowship
(Annals of Global Health, 2017) Mashalla, Yohana J.
Program/Project Purpose: The Afya Bora Consortium is a partnership of five African and four U.S. universities with the mission of providing future global health leaders with advanced skills that are beyond the traditional patient-centered training programs for healthcare professionals. Each year, an interdisciplinary group of twenty physicians, nurses and public health professionals participate in a 12-month African-based intensive fellowship to improve skills in leadership, resource management, program monitoring and evaluation, implementation, and applied research. Structure/Method/Design: The Afya Bora Fellowship provides leadership training in the form of eight in-person and four online modules as well as two 4.5-month mentored attachments at governmental and non-governmental organizations in Botswana, Cameroon, Kenya, Tanzania, and Uganda. The fellows come together during three, month-long highly interactive sessions held in different African countries during which interdisciplinary and multinational learning is encouraged. Afya Bora Fellows complete evaluations of the modules and program as well as self-assessments of learning throughout the year. Data presented here are from all cohorts since 2011 using qualitative analysis of personal reflection reports. Outcome & Evaluation: Fellows described multiple training gaps the fellowship helped fill. Fellows reported that increased skills in communication would help them to better motivate and align others to address pressing problems in their healthcare systems. Improved understanding of and capacity to use data for programmatic purposes was also identified as essential to their ongoing leadership. Fellows reported that their organizational and management abilities had improved both from didactic learning and modeling of program faculty and staff. Finally, fellows reported that the rich cohort experience provided them with an added appreciation of the advantages of inter disciplinarity when solving problems. Going Forward: Well-structured and targeted leadership training is necessary to fill the gaps in traditional medical and nursing education programs. Such training can catalyze healthcare professionals to become more effective in leadership and improve the healthcare systems in their countries while not contributing to “brain drain” (all fellows thus far have remained in their respective countries). The Afya Bora Fellowship can serve as a model for training and research institutions as well as organizations in resource-limited settings to sustainably strengthen human resource capacity to lead and improve health systems.
The forensic exhumation and human remain identification of an individual with albinism
(Forensic Science International, 2022-06-06) Ng'walali, Paul M.
This article reports on an exhumation of an individual identified to be a victim of albinism from a trench dug for a well on 16 April 2018, Ukonga, Dar es Salaam, Tanzania. The skeletal remains were sent to the Forensic Bureau of the Tanzania Police Force for further investigation. Ante-mortem and postmortem information, the deoxyribonucleic acid (DNA) and skeletal diagnosis were used in the identification. Skeletal diagnosis suggests that the victim was a young African male aged between 19 and 26 years old with stature of 157–166 cm. Ante-mortem trauma suggest that the individual was wounded with a sharp object on the left shoulder resulting in severe infection. The victim had a problem with acute dental caries suggesting the existence of biochemical reaction. He also had porosity lesions on cranium and vertebral column which is indicative of chronic malaria infection or anemic condition. The distal end of the tibia exhibited a peri-mortem pilon fracture on the articular surface of the malleolus. This signifies he fell into that long edge trench either intentionally or accidentally or pushed by people and that is the circumstances of death. This article also provides a general picture of challenges facing people with albinism in Africa. People with albinism have been victimized in many ways such as restricted right of self-expression, deficiency of freedom, being hunted or repudiated to death, and deficiency of medical treatment. They also are suffering from dermal diseases, injuries and infections that can easily lead to skin cancer and skeletal diseases due to their disability. In fact, this problem requires urgent resolution for health departments and those involved in the protection of civilians, especially the security agencies. It is an intolerable life; therefore, African governments should take serious measures to curtail atrocities committed to people with albinism.
Forensic exhumation and human remains identification: A gap between the Inquest Act 1980 and medico legal education in Tanzania
(Forensic Science International, 2022-07-30) Ng'walali, Paul M.
This article discusses the gap between the Inquest Legislation of Tanzania and the medical practitioner's teaching curriculum which also covers the medico-legal field. The Tanzanian law clearly states that ‘any Government medical practitioner’ may be given the responsibility of exhumation, provision of post mortem order and then examination of the corpse where there are ample circumstances requiring an inquest to assist police investigation and the Judiciary in determining whether the cause of death was natural. However, the medical training curriculum in Tanzania for many years did not offer any courses of forensic exhumation and identification of human skeletal remains. Therefore, there has been a gap between the legal entities and the curriculum organization of medical practitioner: a condition that leads to medical practitioners failing to fully support the criminal investigation departments and the judicial system. The article highlights the existing gap and its challenges, shortage of experts in the field of forensic science services and provides some suggestions on how to address these challenges where the proposed methods can be applied to both short- and long-term plans.
High prevalence of tuberculosis diagnosed during autopsy examination at Muhimbili National Hospital in Dar es Salaam, Tanzania
(Tanzania journal of health research, 2013) Chande, Hassan M.
The primary aims of tuberculosis (TB) control programmes is early diagnosis and prompt treatment of infectious cases to limit transmission. Failure to diagnose and adequately treat TB could lead to premature death and unrecognized transmission of Mycobacterium tuberculosis. The proportion of missed TB cases has not been reported in Tanzania. The objective of this study was to quantify the number of cases of TB identified by autopsy. Deceased morbid bodies from Muhimbili National Hospital were involved. Retrieval of admission, diagnostic and other important records used to manage the patient after admission was done. Demographic information, site and type of disease, past medical history, chest x-ray report, clinical diagnosis and cause of death reported upon death certification were recorded. Lung tissues, lymphnodes and blood clots for HIV testing were collected. Biopsy tissues were processed through Ziehl Nielsen staining and examined by microscopy. The study involved 74 deceased individuals where 56 (75.7%) were males. Information for duration of seeking health care before death was available for 41(55.4%) subjects. Thirty-four (45.9%) cases received diagnosis before death. The main diagnoses were pneumonia 10(13.5%), heart failure 6(8.1%), AIDS-related illnesses 6 (6.8%) and malaria 5 (6.8%). The main clinical findings were wasting (51/74 (68.9%)) and abnormal fluid collection in different body cavities, 61(50.8%). In 24 out of 71(33.8%) biopsies acid fast bacilli (AFB) were detected. Records of lymphnodes examination were available in 63 cases and 22 of them had AFB. Twenty-two (34.9%) from the paratracheal and hilar lymphnodes were observed to have AFB. HIV was detected by ELISA in 19 (33.3%) out of 57 deceased, and 12 (63.2%) of the HIV positive deceased were co-infected with TB. Out of the 22 cases positive for AFB on tissue-biopsies 12 (54.5%) were HIV positive. There is a high number of TB cases diagnosed after death that could not be detected before they died. There is a need for increased awareness and to include postmortem data in the annual statistics of TB for precise reporting of the magnitude of the TB burden in the country.

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