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Predictors of lower limb amputation in diabetic foot ulcer among adults in Dar-es-salaam regional referral hospitals, Tanzania
(Hubert Kairuki Memorial University, 2023-11) Salim, Khamis R.
Background: Risk factors for Lower Extremity Amputation (LEA) in Diabetic Foot Ulcer (DFU) patients are peripheral arterial disease, peripheral neuropathy, uncontrolled blood glucose level, and a history of diabetic foot ulcers or amputations. However, DFU is the main cause of prolonged hospital stays because of late presentation, but the prognosis of the patients will be good if the problem is identified early and optimal treatment is initiated. Objectives: To determine the predictors of LEA in DFU among adults in Dar-es-Salaam RRH, Tanzania. Methods: An observational prospective hospital-based study was conducted in Amana, Mwananyamala, and Temeke in Dar-es-Salaam (RRH), Tanzania. Between February 2023 and July 2023, patients' details and data were collected using a questionnaire form from each participant who was admitted with a diagnosis of DFU. Written informed consent was sought from all patients who were eligible for the study before including them in the study. A total of 195 adult patients with DFUs were included in this study. Logistic regression was used to evaluate the associations between risk factors and amputation. Results: The study recruited and followed up on 195 adult diabetics. The median age was 53 (IQR: 47–57) years, with female preponderance (54.9%). The median random blood glucose level (mmol/L) of participants was 15 (IQR: 12–18) mmol/L, with a median duration since diabetes mellitus diagnosis of 7 (IQR: 3–10) years. About three-fifths (59.5%) of study participants ended up with LEA. Post-tibial artery pulse (A.O.R.: 0.01, 95% C.I.: 0.00–0.021), dorsalis pedis artery pulse (A.O.R.: 0.005, 95% C.I.: 0.001 0.045), as well as the Ipswich test (A.O.R.: 0.001, 95% C.I.: 0.000–0.342) were significant factors associated with lower extremity amputation. More than half (55.9%) of study participants had Wagner-grade 4- or 5-foot ulcers. Dorsalis pedis artery pulse had an almost perfect negative correlation with LEA (r =-0.928, p = 0.000). Conclusion: Amputation rates were high in this study population. On average, most study participants were in the 4th grade Wagner classification. Undetectable of Ipswich tests, absence of posterior tibia artery pulse and absence dorsalis pedis artery pulse were significant risk factors associated with amputation in this study population. Recommendations: Glycaemic control strategies need to be emphasized in order to achieve wound healing and reduce the amputation rate among adult diabetic foot ulcers in Dar-es-Salaam.
Hindrance factors towards a healthy lifestyle among the medical and the non medical higher learning students of ilala district Dare salaam, 2014
(Hubert Kairuki Memorial University, 2015) Simba, Brenda M.
Background The occurrence and progress of chronic non-commun (cable diseases (NCDs) is associated with unhealthy lifestyles and behaviours. The purpose of this study was to identify barriers to adhere to physical activity and healthy diet among university students as a preventive strategy to NCDs risk factors. Materials and Methods: This cross sectional comparative study involved 130 students from CBE (Male, N=74, Female, N=56), 145 from IFM (Male, N=103, Female, N= 42) and 115 from HKMU (Male, N=66, Female, N=49). In addition to demographics, level of knowledge, lifestyle practice and barriers to adhere to physical activity and healthy diet were identified in a self-reported physical activity and dietary habits questionnaires also several physical measurements were taken such as BMI, blood pressure, and fasting blood glucose. The findings revealed that higher awareness levels did not positively influence neither physical activity nor dietary practices since participants from HKMU were significantly more inactive (ft.- 0.00), consumed fast food (p= 0.028), bottle beers (p= 0.002), wine glasses (p= 0.002), less fruits (p= 0.01) and less fish (p= 0.00). Under barriers, lack of resources, lack of time, lack of energy and lack of will power were more reported under physical activity whereas lack of time, lack of social influence and lack of willpower were mostly reported as barriers to healthy diet. From these findings it is concluded that longitudinal studies be done to explore the relationship between healthy and unhealthy behaviours. Intervention studies are also suggested to improve health-related behaviours and quality of life among university students.
To assess the impact of community efforts towards elderly welfare in Temeke Dar es Salaam, Tanzania
(Hubert Kairuki Memorial University, 2015) Urio, Martha D.
This study attempts to Assess the Impact of Community Effort Towards Elderly Welfare in Tanzania, A case study of Temeke municipality towards helping older people in Tanzania in Dar es Salaam. The study employed cross-section data that was collected through open ended and close ended questionnaires from the study area. Sampling with probability proportional to size procedure was applied to come up with the sample size since respondents were sought from different wards within the study area. The SPSS software was used a tool of analysis to generate the descriptive statistics about respondents who were obtained through stratified sampling procedures, various table and charts to address the objectives of the study; that is to determine the perceptions and attitude of the community towards elderly people, to examine of the community resources available and dedicated to support health interventions programs for the older people and to analyze the social contexts of abuse of the elderly people. The study revealed that, there is modest to poor perception and attitudes about the elderly people in the community. Also, the community resources available are not well used for the benefits of the target group, which are the elderly people. Lack or low education and poverty was established to be the core caused of the social context of the abuse of the elderly people. The study recommends for appropriate action to support older people to be taken. In the course of this research, financial and time constraints emerged to be the main limitations towards generation of enriched research findings.
Factors affecting HIV sero status disclosure among people living with HIV/aids attending care and treatment clinics in Temeke municipal council, Dar es salaam, 2014
(Hubert Kairuki Memorial University, 2014) Temba, Maria F.
Background: Currently an estimated 1,411,829 Tanzanians are living with HIV of whom approximately 28% are children (0-14 years) and 11.2%are young people aged 15-24 years. As of December 2013, an estimated 78,843 new HIV infections were occurring annually, approximately 45.1% of whom were men and 54.9% women. Previous studies in Africa on HIV status disclosure have documented low rates of disclosure that vary between countries. Limited data indicates that the disclosure rate in Tanzania ranges from 16.7% to 55%. PLWHA have difficulties in disclosing their HIV status to others for fear of negative consequences. This attitude affects the tempo of HTV prevention. Objective: To assess the magnitude of HIV status disclosure and explore determinants of disclosure among PLWHA attending care and treatment centre in selected Temeke Municipal Health facilities in January 2015. Materials and methods: A cross- sectional study design, whereby both quantitative and qualitative data were collected from consenting PLWHA by using semi structured questionnaire, in-depth interview, then Univariate, bivariate and multivariate analyzed by using SPSS statistical software. Results: A total of 352 PLWHA were recruited, among them, 87 (24.7%) were males with majority aged between 40-50. The overall disclosure rate was 92.9% for male while spouses were 26.1%. The greater number of study participants (27.3%) disclosed their status to five people or more. Conclusion and recommendations Overall disclosure rate is high among males compared to spouses. Male gender, education, religion and ARV were the most important positive determinants of disclosure.
Uptake of HIV re-testing among postpartum women who initially tested negative during antenatal visit in Ubungo district, Dar es salaam
(Hubert Kairuki Memorial University, 2021) Syikilili, T.
Background: Human Immunodeficiency Virus (HIV) remains a serious public health problem affecting all walks of life and women in the reproductive ages. Global response to the pandemic recommends HIV retesting during the third trimester, at labour and should be followed with a third test at six months postpartum. The uptake of HIV re-testing among mothers is still tow. Aim: To determine the uptake of HIV re-testing among postpartum women after Initial HIV negative test result among mothers at ANC clinic in Ubungo district, Dar es salaam. Method: A cross sectional analytical study was conducted among women who were delivered during the study period and met the criteria for inclusion. Study participants were selected through convenience sampling until the desired sample was attained. Data was collected through a standardized questionnaire, secondary data from Health Information System and ANC clinic card. Statistical Package for the Social Sciences (SPSS) version 28 was used to analyze the data. Bivariate and multivariate logistic regression models were used to calculate the adjusted odds ratio (AOR) with their 95% confidence intervals (CI) to quantify the association. Results: 426 women participated in the study. The overall HIV retesting rate was 324 (76.1%), 102(23.9%) did not re-test and 9(2.1%) were infected with HIV after the second test. Married women have higher re-testing rate (52.8%) than single, separated, and divorced. Women aged 25-34 had a significant higher (84.6%) proportion of retesting for HIV than those below 25 and those above 34 years of age (p< 0.001); Other significant predictors for HIV retesting were women who made at least five or more visits to ANC [AOR=2.121, 95% CI: 1.046-4.301] and those who knew the HIV status of their partner [AOR=2.035, 95% Q: 1.217 3.403]. Conclusion: The uptake of HIV retesting was higher but still has not reached the Tanzania national target of 95%. Efforts to sensitize communities to appreciate the importance of early booking at ANC, making more visits to ANC and retesting for HIV during labour, delivery and postpartum should be enhanced. Innovate motivational methods should be developed to complement existing strategies.
Assessment of quality of focused antenatal care and its effectiveness among women attending selected clinics in ilala district in Dar-es-salaam Tanzania from March 2012 March 2013
(Hubert Kairuki Memorial University, 2013) Shinyala, A.
Background: The present study was conducted to investigate on the overall quality of provision of antenatal care services and its effect on the reduction of Maternal and Fetal Mortality and Morbidity among women attending selected health facilities at ilala municipality in Dare s salaam. Methods: A cross sectional comparative study was performed in ten months and follow up in the Antentenal Clinics from March 2012 to December 2012. Target population was all women attending antenatal clinics and government health workers providing services to those women. A sample size of 350 women has been attained in this study. Tools used were checklists and questionnaires and data analysis was performed through SPSS version 11.0. Frequencies and percentages were used to describe variables Univariate and multivariate logistics, regression analysis were used determine the odd ratio. T test and chi square tests were used to assess the statistical significance at a confidence level of 95%, where p values less than 0.005 indicated a statistical significance. RESULTS: The study has revealed that only 38% of the recruited mothers attending antenatal clinics had adequate awareness on pregnancy danger signs. A higher level of education was the most predictive factor for increased awareness of danger signs. Other factors associated with awareness include skilled health care providers, employment, attendance to health facilities and counseling of women during antenatal care services. In this study the number of children (parity) significantly associates with the use of ITN (P<0.05. more for those who had one parity. DISCUSSION: Educated women had higher awareness on danger signs than women with no formal education. Better education is associated with enlightenment and awareness of different health conditions although exposure to information is crucial. A study done by Okour in Jordan revealed that education level of study participants and receiving information about danger signs and symptoms were all associated with awareness (P=0.02 for all associations). Studies in Tanzania and elsewhere indicate that a higher level of education is associated with awareness on danger signs whereas other studies have shown no association. CONCLUSION AND RECOMMENDATION: The study concludes that there is still a need to improve quality of Antenatal Care Services in developing countries and that pregnant women are not aware of the pregnancy danger signs. There is suboptimal quality of counseling during antenatal care visits on pregnancy danger signs.
To assess the factors affecting home base care programme to address PLHIV patients lost to follow up: the case of Lugalo military hospital
(Hubert Kairuki Memorial University, 2015) Shomari, A.
This study aimed at exposing HBC services as solution towards addressing the problem of lost to follow-up for people living with HIV attending clinics in different hospitals. The study was guided by one general objective and three specific objectives, both designed to meet the researcher's goal. The general objective of the study is to assess the factors affecting the implementation of HBC services to HIV/AIDS patients lost to follow-up in care and treatment clinics at Lugalo Military Hospital. Specifically, the study aims at identifying the factors hindering the implementation of HBC services to HIV/AIDS patient's lost to follow up in care and treatment; examining the knowledge and awareness of the community on HBC Programme to the HIV/AIDS patients' LTFU in care and treatment as well as exploring the strategies for effective implementation of HBC services to address LTF problem and ensuring retention of clients to Care and Treatment Centres. The study deployed the mix-up of qualitative and quantitative approaches to incorporate all respondents' views and suggestions. Questionnaires and interviews were used in collecting data from respondents including general HIV patients, peer educators, health personnel and administrators from Lugalo Hospital, TPDF headquarters and Pharm Access Foundation. The study results showed that HBC services were recommended as an effective measure towards addressing LTFU by 74 percent of all respondents. On the other hand, 17 percent of respondents suggested on the need of improving health services to PLHIV by Increasing motivations towards patients and service providers, improving privacy and confidentiality in CTC and ensuring the integrations of all social and economic issues of PLHIV in the treatment process. The challenges affecting effective implementation of LTFU was contributed by several factors including distance from homes to clinics by (87%), Social norms of attending family rituals (86%), Social obligations (65%), and Patient's time consuming at the ART clinics (58%). The study found out that 75 percent of the mentioned factors had their root causes in social and economic issues, a situation which emphasized the need for HBC programme to address LTFU among PLHIV. In conclusion, the expression still on the effectiveness of HBC and emphasizes to all stake holders to take up affirmative efforts to work together towards promoting and improve HBC program and address challenges associated with it. Recommendations has been done to the government, Civil Society Organizations, health workers, policy makers, researchers, as well as the general community so as to insure patients retention and improve care and treatment services to PLHIV.
Duration of symptoms and clinical outcomes post treatment among patients with aids-related Kaposi’s Sarcoma seen at ocean road cancer institute
(Hubert Kairuki Memorial University, 2009) Mohammed, Shaaban I.
The number of patients with Epidemic Kaposi's Sarcoma (EKS) is increasing, bringing suffering to the patients and affecting the manpower of our society. While prevalence in developed countries is going down due to wide use of HAART, the case is different in our set up, where the modality of treatment differs from the west. Data to substantiate the study were gathered from the Medical Registry Office at ORCI using ail available medical documents (files, etc). The findings which were obtained revealed that most affected personnel reach ORCI late. The median duration of onset was twelve months. Only 61.5% of patients were on ARV for different periods of time before attending ORCI. Chemotherapy was not always sustainable. The number of patients, whose fate was not stated, was not negligible. For the period of time of the data collected, it can be concluded that despite being on ARV the outcomes are not convincing, probably there are other contributing factors for the prognosis among patients with AIDS-KS. Duration or rather onset of symptoms does not play a major role in the expected clinical outcome. Women had worse results than men despite the former reported early to the centre. Compared to other modalities of treatment available at the centre external radiotherapy has shown relatively good results. Therefore, it is recommended that external radiotherapy is a fairly better treatment modality in our set up than other regimens, which so far do not meet basic requirements such as compliance and affordability.
Disease pattern predictors and outcome of children admitted into paediatric intensive care unit at Muhimbili national hospital, Dar es salaam
(Hubert Kairuki Memorial University, 2020) Shalongo, S.
Background: Morbidity and mortality in PICU remains a common challenge in many hospitals particularly in resources limited setting like Tanzania. Muhimbili National Hospital (MNH) which is the teaching and highest referral level for Tanzania receives a number of critically ill children admitted into its PICU, but who do not show a clear pattern of disease and outcome. Objective: The general objective of this study was to determine the disease pattern, predictors and outcome of children admitted into Paediatric Intensive Care Unit (PICU) at Muhimbili National Hospital. Methodology: This was a prospective cohort study involving children admitted into PICU between March and June 2020. In-depth monitoring and follow-up were carried out to conceptualize all key information for the study population and data was entered in computer. Data analysis was done using Strata 13.0. Causes of admission and death of all study children in PICU during the study period were summarized using figures and tables. Bivariate and multivariate logistic regression analyses for the odds ratio were used to identify predictors of mortality at 95% confidence interval. Result: A total of 155 children aged one month to 14 years admitted in PICU between March and June 2020 were enrolled in the study. The majority 124 (80%) were under-five years of age. Most diseases presented as co morbidities. Each child (except two) admitted in PICU presented with several diseases. There was no clear disease pattern. Some children were diagnosed. with 2, 3 or >3 diagnoses. Severe pneumonia 58(37.4%), sepsis 42 (27.1%), severe malaria 15 (9.7%) and meningitis 12 (7.7%) presented more frequently as co-morbidities. Young age below 12 months of age 124 (80%) was the greatest risk for admission into PICU. An average length of stay In PICU was 3 days with IQR between 1 and 5 days. Death occurred in 66 of patients during the study period; a mortality rate of 42.6%. Respiratory failure (56%) and cardiac arrest (41%) were the two most immediate causes of death. Low level of consciousness Glasgow Coma Scale of less than 8 at admission and prolonged requirement of mechanical ventilation were significant predictors for children mortality in PICU. Conclusion; There was no clear disease pattern as most diseases had presented as co-morbidities. The majority of children in PICU were admitted with two, three or more diagnoses. The diseases which presented as co morbidities in order of frequency were severe pneumonia, sepsis, severe malaria and meningitis. Younger children less than 12 months of age had the highest risk for admission into PICU. Mortality was 42.6%. Low level of consciousness (Glasgow score less than 8) and prolonged requirement of mechanical ventilation were highly significant predictors for mortality in PICU. Recommendation: More comprehensive studies with larger and more representative samples are needed to delineate the disease pattern, predictors and outcome of children admitted into PICU for policy advice. Muhimbiii national hospital should establish a continuous paediatric critical care training Programme for health care providers who are working and those who will work in Paediatric Intensive Care Units and regional hospitals throughout the country where the severely ill children are referred from. Priority should be directed to improving regional hospitals with well-equipped paediatric intensive care units and well-trained staff in order to reduce the burden related to late referrals from many miles to PICU at MNH.
Prevalence of adverse pregnancy outcome and associated risk factors among HIV infected women delivered at Mwananyamala hospital from May to October 2008
(Hubert Kairuki Memorial University, 2008) Sangawe, Grace D.
Background: HIV infection among pregnant women has been associated with various perinatal and maternal complications. Studies conducted in the developing world have associated HIV infection with this poor outcome such as prematurity, low birth weight, and stillbirths. Others are premature rupture of membranes, postpartum haemorrhage and puerperia infections and delayed wound healing. However, some social demographic factors have been found to be predictors of this poor perinatal and maternal outcome among HIV infected women. Objectives: The main objective of this study was to determine the prevalence of pregnancy complications and the associated social demographic factors among HIV infected women delivered at Mwananyamala hospital in Dar es Salaam, Tanzania. Material and methods: Patients who were admitted in the labor ward due to labor pains or premature rupture of membranes were randomly recruited. Questionnaires were filled, antenatal cards were assessed, and, in some blood, samples were collected for VDRL Hb level and HIV status. These participants were then followed up on the seventh day postpartum and were assessed for presence of fever, abnormal lochia, episiotomy site and post C/ section wound were examined. Results: A total of 280 pregnant women were included in the study. Among them 9.3% presented with PROM. These pregnant women with PROM were found to have a poor weight gain OR 8.89 (95% CI 8.08 - 9.68). PPH was more observed following C/ section than normal delivery 11% and 0.4% respectively. Age between 30-39 yrs was found to be associated with this outcome OR 3.35 (6.63 - 17.02). Among the study population 2.9% developed wound sepsis following C/ section, primigravidae were at higher risk of this complication OR 1.41 (95% CI 0.73 - 2.73). primigravidae were also found to have higher risk of developing postpartum fever OR 2.32 (95% CI 6.05 - 8.87), but this was not statistically significant. Women who reported back with infected lochia were 5.4% of the study population. Infants born prematurely were more observed among women aged between 20 and 29 yrs. Prevalence of preterm delivery was 9.6%. In univariate logistic analysis low parity was found to be associated with this poor outcome, OR 6.09 (95% CI 0.23 - 16.16). Anaemia was also found to be associated with prematurity (<0.0001). Prevalence of still births in this study was 6%, Among them 2.5% were MSB and 3.6% were FSB. Reactive VDRL results and poor maternal weight gain during pregnancy were associated with MSB, OR 2.82 (95% CI 0.53-15.0) and OR 5.39 (95% CI 1.14 -25. 38) respectively. The prevalence of LB W babies was 11.8%. Among them 6% were due to prematurity while 15.4% were bom at term. Poor maternal weight gain was found to be the predictor of this poor neonatal outcome, OR 5.60 (95% CI 2.01-16.0). CONCLUSION High prevalence of HIV infection was observed among young, married women with low parity and literate. Most of them were housewives. Anemia and poor weight gain during pregnant was very high, and this was found to be associated with prematurity and LBW. Maternal HIV and syphilis co-infection was found to increase the risk of MSB. Operative delivery was associated with postpartum morbidity. Also, PPH was observed following C/section as compared to normal deliveries. It was observed that social demographic factors influence the poor pregnant outcome among HIV infected women.
Prevalence of hypertension and associated factors among children aged 2 to 5 years attending outpatient clinics in Dar es salaam, Tanzania2
(Hubert Kairuki Memorial University, 2022) Rutashobya, Adelina G.
Background: Hypertension in children has become a matter of concern and a growing problem around the world. In both developed and developing countries Paediatric hypertension has been underdiagnosed due to little attention even though the risk factors start early in life. This may be associated with late diagnosis and complications. In Tanzania, little data is available on hypertension in children below the age of five years. Objective: To determine the prevalence of hypertension and associated factors among children aged 2 to 5 years attending outpatient clinics in Dar es Salaam. Methodology: This was a hospital-based cross-sectional study design augmented by a brief follow-up period that was conducted among children aged 2 to 5 years from four health facilities in Dar es Salaam from June to July 2022. A structured questionnaire was used to collect socio-demographic characteristics, parental factors, children's factors, and anthropometric measurements. Among the study participants with high blood pressure, blood pressure measurements were taken on three separate occasions to confirm the diagnosis of hypertension. The blood pressure of each child was compared to the standard charts for age, height, and gender of the American Academy of Pediatrics 2017. Descriptive results were analyzed as percentages, means, or medians with standard deviations or interquartile ranges whenever appropriate. Binary logistic regression analysis was used to assess factors associated with hypertension. A /7-value of equal or less than 0.05 was considered statistically significant. Results: A total number 1131 of children who fulfilled eligibility criteria were enrolled in the study out of which 40 (65.4%) were from OPD and 391 (34.6%) were from RCH. The median age was three years and 568 (50.2%) were males and 563 (49.8%) were females. Among 1131 children; 182 (16.01%) had elevated blood pressure (previously known as pre-hypertension); and 16(1.41%) had hypertension. Low and high birth weight, overweight/obesity, underweight, having a positive history of hypertension, and maternal gestational hypertension were significantly associated with elevated blood pressure {p value= 0.013, 0.004, <0.0001,<0.0001and0.002) respectively. There was no significant gender difference observed among those with high blood pressure. Conclusions: Prevalence of hypertension was found in all age groups of children between 2 to 5 years and in both sexes in this study. The main associated factors for developing hypertension among children were overweight/obesity, underweight, low- and high-birth weight, maternal gestational hypertension, positive family history of hypertension, and Diabetic Mellitus. Dietary intake of food rich in protein, fruits, and vegetables is a protective factor against developing hypertension among children. Recommendations: 1. Blood pressure should be routinely screened in children attending outpatient clinics and those at risk among the pediatric group (i.e. overweight/obesity, low birth weight, family history of hypertension, and Diabetic mellitus) for early diagnosis and management. 2. Further studies should be conducted using prospective cohort study designs to improve the findings on the risk of childhood hypertension and screen for more factors that were not looked at in this study such as genetic factors and dietary intake.
Early outcomes of laparoscopic cholecystectomy among patients in Dar es salaam hospitals from April to June 2023
(Hubert Kairuki Memorial University, 2023) Mavji, Hashimita
Background: Cholecystectomy is a surgical removal of the gall bladder. It can be done laparoscopically or by open surgery. The traditional open cholecystectomy (OC) has been replaced with laparoscopic cholecystectomy (LC), which is regarded as the gold standard for treating symptomatic gall bladder stones. In High Income Countries, laparoscopic procedures are currently used to manage both simple and complicated biliary diseases surgically. Available published data reveal the superiority of the laparoscopic cholecystectomy include reduced subjective incapacity for work, a shorter postoperative stay, less pain medication, less wound dressing, quicker return to normal food intake, and smaller scars. Aim: The aim of the study is to assess the early outcomes of laparoscopy cholecystectomy among patient in Dar es Salaam Hospital. Methodology: The study was conducted from April to June 2023 which included all the patients who have undergone laparoscopic cholecystectomy in Dar es Salaam at Kairuki Hospital and Muhimbilli National Hospital. It is a hospital-based prospective exploratory observational study. Data was analyzed by using STATA, an integrated statistical software package. Bivariate and multivariate analyses was used to find association between dependent and independent variables. Results: A total of 50 patients were enrolled in the study based on the inclusion and exclusion criteria outlined above. Majority of the study population were females amounting to 43(86%) with a female to male ratio of 6:1. The mean age of the study population was 49.4 ± 9. 4years.The mean BMI was 26.4± 2.9. Patients who were hypertensive were 25 (50%) and diabetic were 19(38%). The median duration of operation time was 90 minutes (range: 80 120).Patients who developed complications were 21(42%).The predominant complication was surgical site infection at 8(16%), followed by spillage of gall stones 5(10%), bleeding from cystic artery 2(4%), bleeding from gall bladder fossa 2(4%), port site bleeding 2(4%) and bile leak 1(2%).In our study, bowel injury, intra-operative and postoperative death did not occur. The median hospital stay was 2 days. There were 2 conversions to open cholecystectomy in this study giving a conversion rate of 4%. Conclusion: The surgical experience and laparoscopic techniques have demonstrated that laparoscopic cholecystectomy is a safe and successful procedure in our setting to the accepted standard as compared to the national and international research. We believe that the advantages of laparoscopic surgery are even higher in the developing world, where there is a high demand for hospital beds, widespread lack of health insurance and a financial need for an early return to work. Recommendation: In our study surgical site infection (16%) was the leading complication followed by bleeding. These complications can be reduced by availability of instruments such as endo-bags which would reduce the surgical site infection, clip applicators and clips would reduce the risk of bleeding and also reduce the duration of surgery. Proper training of new surgeons are the main areas of concern to further improve the outcome of LC.
Use of procalcitonin as a guide for antibiotic prescriptions in acute respiratory infections among school children in Dar es Salaam Tanzania
(Hubert Kairuki Memorial University, 2018) Rioux, Juliette
Antibiotic resistance has become a global concern, with the inappropriate use of antibiotics which includes over prescription, inadequate dosage and its use in nonbacterial infections becoming a problem both locally and internationally. Procalcitonin (PCX) is elevated in bacterial infection and there is a growing body of evidence that supports the use of PCX to improve diagnosis of bacterial infections, including the use of its algorithm to guide the decision about initiation ± discontinuation of antibiotic therapy. This study used PCX to assess its effectiveness in reducing unnecessary use of antibiotics amongst school children with acute respiratory infections (ARIs) in two selected hospitals in Dar es Salaam, Tanzania. In this cross sectional study conducted between January and March 2018; 146 consecutive school children with suspected ARIs were enrolled. Exit interviews were conducted with study participants using a standard questionnaire, information about their clinical manifestations and treatment prescribed were recorded. Blood samples were collected from all study participants for PCX analysis using a sandwich immuno-detection method. Data collected from the participants was stored in Microsoft Excel file 2007 and then transferred to EPI Info version 7.2 statistical software for analysis. PCX algorithm (see Fig 2) was used to assemble the participants in two groups; group one included those with a high likelihood of nonbacterial infection (PCX 0.25ng/ml). Analysis of the data revealed that the most common clinical symptoms present were cough and fever which were present in 139(93.3%) and 120(82.2%) of study participants consecutively. The most common respiratory system examination findings were crackles 23(15.7%) and chest in drawing, 16(10.9%). A total of 105(71.9%) had a low PCX level which translated into a high likelihood of a nonbacterial infection. Odds ratio and 95% confidence interval showed a positive association with all clinical manifestations (symptoms and signs) that were present in each study participants with regard to their PCX level; however, no statistical significant association could be demonstrated. The total antibiotic prescription rate was 52.1 % (76/146), and as per the PCX algorithm (see Fig.2), 76.3 % (58/76) of study children received antibiotics which were not indicated. The current study observed a high rate of antibiotic prescriptions in school children with ARIs in Dar es Salaam, for which the etiology was most likely nonbacterial, and use of antibiotics was not indicated. Results of this study have highlighted the need to consider inflammatory biomarkers like PCX as a predictor to guide antibiotic prescriptions in children with ARIs.
Assess awareness of patients' rights in health facilities in Kinondoni district
(Hubert Kairuki Memorial University, 2014) Nguruwe, Piensia F.
Low understanding of patient's rights in Tanzania health care facilities exposes patients to maltreatment, especially members of marginalized communities. That is why a researcher in this study aimed at assessing awareness of patient's rights in health facilities. Data were collected through semi structured interview and observation from 70 respondents (admitted patients and nurses) from Mwananyamala Regional hospital and Palestina Hospitals. Data collected were analyzed by using thematic technique method and SPSS 20 version. Findings revealed that about 65 percent of the inpatients were not aware of their rights. The study also revealed unavailability of patients 'rights charter from both health facilities under the study. Based on these finding it was concluded that inpatients from the two hospitals of Mwananyamala and Palestina had low understanding of their rights, which expose them to mistreatment, unsafe care and low quality of care. Furthermore, management procedures and protocols do not address patient's rights and there were no patient's charter. A researcher recommended to the Government to develop a National Patient Right Charter and that patients need to be educated of their rights as an initiative to improve quality of health care in the health facilities in Tanzania.
Prevalence of anaemia, severity, and morphological classification among children aged 2 to 59 months attending paediatric outpatient clinics in Temeke municipal, Dar es Salaam, Tanzania
(Hubert Kairuki Memorial University, 2022) Omary, Salha A.
Background: Anaemia is a significant secondary clinical diagnosis among children less than five years of age. However, there is a paucity of findings on morphological characteristics and severity of anaemia among children aged 2 to 59 months in Tanzania. Objectives: To determine the prevalence of anaemia, severity, and morphological classification among children aged 2 to 59 months attending paediatric outpatient clinics in Temeke Regional Referral Hospital (TRRH) and Mbagala Rangi tatu, Dar es Salaam. Materials and methods: A cross-sectional health facility-based study was conducted among children aged 2 to 59 months in the above-mentioned facilities in Temeke Municipality. Data on the demographic, clinical history, and complete blood count results were collected among the participants. Data were analysed using SPSS version 20. Results: A total of 250 children were enrolled in the study. The male: female ratio was 1:1. The median age of children was 18 (IQR: 9-35) months. Two thirds (67%) of children had anaemia whereby mild, moderate and severe anaemia were (n=50, 20%); (n=85, 34%); and n=32, 12.8% respectively. The most common morphological classification was normocytic normochromic anaemia (48%) followed by microcytic hypochromic anaemia (13.6%) Conclusions: Anaemia was prevalent in this study population. Almost half of the study participants had normocytic normochromic anaemia and one-third had moderate anaemia. Recommendations: To prevent the detrimental effect of anaemia in children, routine screening and determination of the causes of anemia should be a priority at all primary health care facilities. Health information and education sessions need to be emphasized. Short and long -term effects of anaemia in children needs to be addressed accordingly.
Assessment of social support services for cancer patients in palliative care a case of ocean road cancer institute, Dar es Salaam
(Hubert Kairuki Memorial University, 2015) Nyarukunyo, Mwanaidi S.
The social support offered during palliative care by health care providers and caregivers in supporting patients with chronic illnesses like cancer is well recognized. However, there is little data available about social support particularly emotional and informational provided to Cancer patients in the country. Therefore, this study aimed to assess the social support received by cancer patients on palliative care from health care providers and their caregivers through different services at Ocean Road Cancer Institute in Dar es Salaam Region, Tanzania. This study was guided by the general objective of assessing the social support services for cancer patients on palliative care with specific objectives of assessing the informational support provided by health care providers and caregivers to cancer patients on palliative care, assessing the emotional support provided by health care providers and caregivers to cancer patients on palliative care and identifying the type of emotional support provided by caregivers to cancer patients on palliative care. A cross-sectional study was conducted at Ocean Road Cancer Institute in Dar es Salaam region among admitted Cancer patients between July and November 2015. Data on emotional and informational support was collected through medical records review and administration of the structured questionnaire to all 125 cancer patients. Analysis of data was done using SPSS Software. More than half (61.6%) of study participants were females. More than two third (71.2%) aged 46 years and above and few (7.2%) had higher education. Informational support received from health care providers were information about the disease (30%), information of what to do when treatment is over (20%) whereas diet education (59%) and coping with side effects (40%) were from caregivers. Emotional support showed to cancer patients from healthcare providers were receiving information about their disease (30%), talking with other patients (18%), being listened and cared (15%) while from caregivers included encouraging treatment compliance.(53%) and educational support (45%). This study identified both informational and emotional support provided to cancer patients on palliative care, but it is not effective as it should be, due the fact that Ocean Road Cancer Institute being the only hospital in the Country treating cancer which become overloaded and thus create a lot of inconveniences to patients and health workers. With these findings, the researcher think that there is a need for the government to increase and improve the cancer treatment facilities at Ocean Road Cancer Institute, develop cancer policy for easy coordination of cancer treatment and its concerns, establish other cancer treatment centres in different areas to overcome an increasing number of cancer patients in Tanzania, health care workers need to change their attitudes on service provision since some of them are blamed to cause psychological and emotional torture to patients and their relatives.
Types and severity of neural tube defects among neonates admitted at Muhimbili national hospital, Dar es salaam, Tanzania
(Hubert Kairuki Memorial University, 2022) Nyagabona, Rehema C.
Background: Congenital disabilities represent 13.2% of all mortality rates in Tanzania, with neural tube defects being the most common and significantly contributing to the morbidity and mortality of neonates. In Tanzania, effective interventions such as folic acid supplementation and folic acid fortification of food staples have been done in the country since 2013, Since then, the trend including types of NTDs have not been studied. Material and methods: A cross-sectional study was conducted among neonates admitted at the Neonatal Unit at MNH. All eligible neonate-mother pairs were enrolled consecutively until the desired sample size was attained. A structured questionnaire was used to collect data. Data were analyzed and presented using frequencies and percentages. Results: Sixty neonates with NTDs were enrolled in the study. Most of them 96.7% had spina bifida, while a small proportion 3.3% had encephalocele, but no cases of anencephaly were found. Furthermore, 65% of the neonates had severe forms of neural tube defects. Conclusions: The study found the common type of neural tube defect was spina bifida, followed by encephalocele. Among the spina bifida detected, the common type was meningoceles. The severe form was found in myelomeningoceles. Recommendations: Further studies, with a large sample size and prospective follow up design should be carried out to determine the outcomes together with the quality of life among children with NTDs.
Assessment of factors influencing low male's involvement in prevention of mother to child transmission (PMTCT) of HIV/AIDS a case study of Muhimbili national hospital in Dar es Salaam
(Hubert Kairuki Memorial University, 2015) Ngwahi, Maria A.
The study aimed at assessing the factors influencing the low involvement of men in prevention of mother to child transmission (PMTCT) of HIV programmes in the Ilala district, Tanzania. The factors studies were grouped as knowledge and awareness, socio cultural, programmatic and demographic characteristics. The study employed a case study design with questionnaires, focus group discussion and documentation review as the main data collection methods. This study used both Qualitative and Quantitative approaches and 127 men were interviewed. The major findings of the study revealed that, about 88 percent of the respondents they had knowledge that HIV positive mother could transmit the virus to her baby through breastfeeding and only 9 percent did not know and 3 percent of the respondent were not sure. Again, about 65 percent of the respondents were aware that, MTCT can occur during pregnancy, 30 percent did not know and 5 percent were not sure. The study also fm a culture have an influence to the involvement of men in the program. The results show that, about 67 percent thought women should get permission from their male before undergoing a test for PMTCT. On the other hands, 70 percent of the respondents did not think that men who accompanied their female partner to PMTCT clinics were bewitched. Programmatic factors found that, about 65 percent of the respondents did not think men should have male only PMTCT clinic and about 70 percent of the total respondents did not think that at the PMTCT clinics men should be attended by male health workers only. Among the demographic characteristics, age and level of education were positively associated with an increase in the level of involvement, while the duration of the relationship with the female partner was negatively associated with the level of men involvement. There is great need to design culturally appropriate and gender sensitive health promotion interventions that can address the reasons why men are afraid of HIV Testing and Counseling (HTC). The study further recommended that, in order to improve men's involvement in PMTCT the knowledge and awareness about PMTCT information should be given to all men and in particular to those in relationship with women in reproductive age. This information could be provided through couple concealing or campaigns to sensitize men to the issue. PMTCT clinics should be made friendlier to men and service provider should ensure that all efforts are made to involve men from the beginning in every PMTCT intervention.
Prevalence and factors associated with late antenatal care booking among pregnant women attending public health facilities of Kigamboni municipality in Dar es Salaam region, Tanzania
(Hubert Kairuki Memorial University, 2021) Ndomba, Alana K.
Background: Good care during pregnancy is Important for the health of the mother and development of the unborn baby. Inadequate care during this time breaks a crucial link in the continuum of care and affects both mother and babies. The purpose of this study was to determine the prevalence and factors associated with ANC booking among pregnant women in Kigamboni Municipality in Dar es Salaam Region, Tanzania. The study was conducted between September and October 2021. Method: It was an analytical cross- sectional study design of pregnant women attending ANC services in their second and third trimester at the selected health facilities. The study recruited 204 respondents who were selected through consecutive sampling technique. A standardized data collection tool was used to obtain information direct from participants through questionnaire. Data entered through SPSS data capturing sheet then the data was analyzed using statistical package for social sciences (SPSS) version 25.0 and multivariate logistic regression was used to calculate the adjusted odds ratio (AOR) with 95% confidence interval to check the association between variables. Result: The findings of this study shows that late ANC booking was high 174 (85.3%) to pregnant women who attended clinic week 13 and later compared to those who attended earlier than 13 weeks 30 (14.7%). Being a pregnant woman with tertiary education was a significant factor that contribute to late booking of ANC [AOR= 10.174, 95%CI: 1.002-103.301] and pregnant women who were prime gravida [AOR=0.101, 95%CI: 0.170-0.605]. Conclusion: Late booking of ANC visit was highly associated with tertiary education was significant factor that contribute to late booking and pregnant women who were at prime gravida due to inadequate information about when to start ANC clinics according to number of visit recommended by WHO. Therefore, provision of Continuous health education from the community level up to high Authority about the important of Early booking or timely seeking ANC Services should be part and parcel for every meeting and official activities in order make the community understand the advantage of early booking and disadvantage of late booking.
Prevalence and risk factors of iron deficiency anaemia in children 3 - 59 months in Kinondoni municipality Dar es salaam
(Hubert Kairuki Memorial University, 2017) Mushi, Joyce E.
Iron deficiency (ID) and Iron deficiency anaemia (IDA) are considered a major public health problem in developing countries, contributing significantly to morbidity and mortality in children less than five years. The aim of this study was to determine the prevalence and risk factors of iron deficiency anaemia in children aged 3- 59 months in BCinondoni Municipality Dar-es-salaam. Method - This was a cross sectional analytical study conducted from May 2016 to June 2017 in three reproductive and child health clinics including: Kambangwa, Kairuki hospital and Sinza all in Kinondoni region. By convenience the method of enrolment of healthy children into the study was carried out at the exit point, this was done after complete activities related to the child at the clinic and the mothers had been informed about the study. Their nutritional status were determined using WHO weight for height z score. Blood samples were collected and analysed for complete blood counts using the Automated haematology analyse Mind ray BC 5380, German and serum ferritin using Huma star 300 machine, German. Results - A total of 350 children were enrolled into the study. Out this number 255(72.8%) were found to be anaemic. Among 255 children with anaemia 147(42%) had iron deficiency anaemia. Age below 24 months 134 (50%) of the study children was the most common risk factor of iron deficiency anaemia. Of the 147 children found with IDA only 13(15.9%) were above 24 months of age. Males 90(46.6%) more than females 57(36.3%) children were affected by IDA. Pallor was an important presentation of children with IDA. Children with IDA presented more with pallor than those without IDA 72.8% vs 7.8%. The majority of children 318(90.9%) below six months in this study were exclusively breastfed. About 233 (67%) of the study children received less than four meals per day. IDA was found to be hi^ in children who did not take tea/coffee at all more than those who took tea/coffee once or more times per day 50.7% vs 36.4%. Children who did not receive balanced diet were more at risk of IDA than children who received balanced diet 70.6% vs 40.5%. Conclusion The current study has confirmed a hi^ prevalence of anaemia with the majority of them children (42%) having iron deficiency anaemia. This rate of prevalence IDA in children below five years of age was alarmingly high. Toddlers were more affected with IDA compared to older children while males were more affected than females. Taking unbalance diet and presence of pallor on physical examination were commonly associated with Iron deficiency anaemia. Recommendation Based on the findings of this study it is recommended to re-emphasize nutritional and educational counselling at the reproductive and child health clinics and wherever the child is in contact with health care providers. The focus should be on exclusive breastfeeding and proper choices of weaning foods rich iron. Routine physical examination is recommended for detection of early signs of iron deficiency anaemia and where possible, Hb and ferritin levels should be measured for early diagnosis and treatment.

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