Digital Commons Network^™

Furrowed Tongue, Fatten Lip And Facial Droop, Philip Adebayo, Hanifa Mbithe

Internal Medicine, East Africa

No abstract provided.

Magnitude Of Screening For Gestational Diabetes Mellitus In An Urban Setting In Tanzania; A Cross-Sectional Analytic Study, Akampa Mukuve, Mariam Noorani, Ibrahim Sendagire, Miriam Mgonja

Faculty of Health Sciences, East Africa

Background

Medical screening detects risk factors for disease or presence of disease in otherwise well persons in order to intervene early and reduce morbidity and mortality. During antenatal care (ANC) it is important to detect conditions that complicate pregnancy, like gestational diabetes mellitus (GDM). Despite international and local guidelines recommending screening for GDM during ANC, there is evidence to suggest that the practice was not being carried out adequately. A major challenge may be lack of consensus on uniform GDM screening and diagnostic guidelines internationally and locally.

The primary objective was to determine the magnitude of screening for GDM among …

Post-Vaccination Pharyngeal-Cervical-Brachial Variant Of Guillain-Barré Syndrome, Funmilola T. Taiwo, Daniel E. Ezuduemoih, Philip Adebayo

Internal Medicine, East Africa

The pharyngeal-cervical-brachial (PCB) variant of Guillain-Barré syndrome (GBS) is very rare. It is characterized by weakness of the upper extremities associated with bulbar symptoms and facial diplegia. Documented cases were post-infectious, a post-vaccination occurrence has not been documented in the available literature. Even rarer is the occurrence of any variant of GBS following the mumps measles rubella (MMR) vaccine. The neurophysiological hallmark of PCB variant of GBS is a combination of myelinopathy and axonopathy, hence, its consideration as a subtype of the acute motor axonal neuropathy (AMAN) variant. It should be suspected in any case of acute-onset flaccid symmetrical weakness …

Video Analysis Of Newborn Resuscitations After Simulation-Based Helping Babies Breathe Training, Ingunn Anda Haug, Kari Holte, Catherine L. Chang, Carolyn Purington, Joar Eilevstjønn, Anita Yeconia, Hussein Kidanto, Hege L. Ersdal

Obstetrics and Gynaecology, East Africa

Background: Simulation-based Helping Babies Breathe (HBB) training is currently rolled-out in around 80 low-income countries with various results.

Method: Workflow was analyzed in 76 video-recorded newborn resuscitations performed by regularly HBB-trained nurse-midwives over 3 years in rural Tanzania.

Results: Actual newborn resuscitation practice deviated from HBB intention/guideline: most newborns underwent prolonged suction and stimulation before ventilation; ventilation was delayed and frequently interrupted. Nurse-midwives often worked together.

Conclusions:There is a gap between training intention and clinical practice. HBB trainings should focus more on urgency, ventilation skills, and team training. Combining clinical debriefing with HBB simulations could facilitate continuous learning and …

Postoperative Myocardial Injury In A Patient With Left Ureteric Stone And Asymptomatic Covid-19 Disease, Nadeem Kassam, Omar Aziz, Ally Zain Ismail, Rodgers Swai, Samina Somji, Robert Mvungi, Mustaafa Bapumia, Ali Akbar Zehri, Salim Surani

Internal Medicine, East Africa

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8thDecember 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes …

Invasive Liver Abscess Syndrome Caused By Klebsiella Pneumoniae: First Tanzanian Experience, Nadeem Kassam, Omar Aziz, Samina Somji, Zainab Yusuf Fidaali, Salim Ramzan Surani

Internal Medicine, East Africa

Over the past 20 years there has been growing awareness of community-acquired primary liver abscess caused by strains of Klebsiella pneumoniae (K. pneumoniae) especially in patients of Asian descent, a minority of which are characterized by metastatic spread. A common and frequent destructive complication is endophthalmitis as well as the involvement of the central nervous system (CNS), causing suppurative meningitis or brain abscess. Here we report a case of invasive liver abscess caused by K. pneumoniae in an Asian patient who presented to our hospital in Tanzania with bilateral lower limb swelling for 6 weeks with acute onset of difficulty …

Comparison Of Prescribed From Delivered Dose To Cancer Of Cervix Patients Treated By Theratron Equinox 80 Cm Source-To-Axis Distance (Sad) Technique At Ocean Road Cancer Institute In Tanzania, Khamis Amour, Khamza Maunda, Najat K. Mohammed, Peane Maleka, Peter Msaki

Tanzania Journal of Science

Abstract The aim of the present study was to investigate deviations between prescribed from delivered dose for cervical cancer patients treated at Ocean Road Cancer Institute using Equinox 80 Tele-cobalt machine. In this work, anterior-posterior (AP) and posterior-anterior (PA) fields using Source-to-Axis Distance (SAD) technique was used. Measurements of entrance doses were taken using calibrated diode detector in three groups of patients. In group 1, only 15 patients out of 31 curative intent patients received doses lower than ± 5% of 2 Gy as compared to the prescribed dose. In group 2, 1 measurement was done for 9 patients who …

The Mbeya Antimicrobial Stewardship Team: Implementing Antimicrobial Stewardship At A Zonal-Level Hospital In Southern Tanzania, Jeffrey W. Hall, Jeannette Bouchard, P Brandon Bookstaver, Matthew S. Haldeman, Peter Kishimbo, Godlove Mbwanji, Issakwisa Mwakyula, Davance Mwasomola, Megan Seddon, Mark Shaffer, Stephanie C. Shealy, Anthony Nsojo

Faculty Publications

In 2017, Mbeya Zonal Referral Hospital (MZRH) and the University of South Carolina (UofSC) agreed to collaboratively strengthen antimicrobial prescribing in the southern highlands of Tanzania and train a new generation of clinicians in responsible antimicrobial use. Key stakeholders and participants were identified and the Mbeya Antimicrobial Stewardship Team (MAST) was created. The team identified assets brought by the collaborators, and four investigations of baseline needs were developed. These investigations included (a) a baseline clinician survey regarding antimicrobial resistance and stewardship, (b) a serial chart review of inpatient antimicrobial prescribing practices, (c) an investigation of antimicrobial resistance rates using existing …

Myocardial Echinococcosis: Rare Manifestation Of A Common Parasitic Disease In Northern Tanzania, Ahmed Jusabani, Clement F. Kalambo, Mubashir Jusabani, Salim Surani

Imaging & Diagnostic Radiology, East Africa

Hydatid (Echinococcal) disease often involves the liver and lungs but in sporadic cases, it can involve cardiac structures. A 24-year-old male was referred with symptoms of cough and shortness of breath and a provisional diagnosis of metastatic disease of unknown primary to the lung, which was based on a chest X-ray (CXR). Incidentally, on echocardiogram, he was found to have right ventricular (RV) and myocardial multiseptated cysts, which were compatible with cardiac echinococcosis, as the patient had multiple bilateral lung cysts as well. Imaging with ultrasound, computed tomography (CT) scan, and magnetic resonance imaging (MRI) has ameliorated the diagnosis of …

Establishing The College Of Pathologists Of East, Central And Southern Africa – The Regional East Central And Southern Africa College Of Pathology, Shahin Sayed, Rudo Mutasa, Ephata Kaaya, Victor Mudenda, Erasmus Rajiv, Edda Vuhahula, Jamilla Rajab, Robert Lukande, Edwin Walong, Angela Mutuku, Kenneth Fleming

Pathology, East Africa

Issues: The scarcity of pathologists in sub-Saharan Africa is a well established fact that is attributable to few training programmes in the region; this is further compounded by the lack of harmonised curricula, training and exams within and without member countries.

Description of the intervention: Through the Association of Pathologists of East, Central and Southern Africa, the College of Pathologists of East, Central and Southern Africa (COPECSA) was formed with the clear-cut goal of establishing a regional and internationally recognised college to support and inform good quality medical and laboratory practice by promoting leadership, mentorship and excellence in the safe …

Trends In Hospitalisation For Human Immunodeficiency Virus In A Tertiary Hospital In Dar Es Salaam, Tanzania: A Case Study, Grace Shayo, Tumaini Nagu, Lilian Msele, Patricia Munseri, Columba Mbekenga, Stephen Kibusi, Kisali Pallangyo, Ferdinand Mugusia

School of Nursing & Midwifery, East Africa

Background: Reports on a systematic evaluation of the impact of antiretroviral therapy(ART) on patients’ hospitalisation in Sub Saharan Africa (SSA) and Tanzania, in particular, are scarce. We aimed at documenting the trends of hospital admissions at Muhimbili National Hospital (MNH) following scale-up of free access to ART in Tanzania.

Methods: Records for all admissions at MNH from June 2005 to June 2015 were reviewed. We extracted data from the Hospital Information Management System as well as from patients’ charts. Data extracted included diagnosis at discharge, the reason for admission and thereafter assessed admission trends over the decade. We summarised …

Male Involvement Interventions And Improved Couples’ Emotional Relationships In Tanzania And Zimbabwe: ‘When We Are Walking Together, I Feel Happy’, Liz Comrie-Thomson, Webster Mavhu, Christina Makungu, Quamrun Nahar, Rasheda Khan, Jessica Davis, Erica Stillo, Saadya Hamdani, Stanley Luchters, Cathy Vaughan

Population Health, East Africa

Male involvement in maternal and child health is recognised as a valuable strategy to improve care-seeking and uptake of optimal home care practices for women and children in low- and middle-income settings. However, the specific mechanisms by which involving men can lead to observed behaviour change are not well substantiated. A qualitative study conducted to explore men’s and women’s experiences of male involvement interventions in Tanzania and Zimbabwe found that, for some women and men, the interventions had fostered more loving partner relationships. Both male and female participants identified these changes as profoundly meaningful and highly valued. Our findings illustrate …

Predictors Of High Hiv+ Prevalence In Mozambique: A Complex Samples Logistic Regression Modeling And Spatial Mapping Approaches, Jerry John Nutor, Precious Adade Duodu, Pascal Agbadi, Henry Ofori Duah, Kelechi Elizabeth Oladimeji, Kaboni W. Gondwe

College of Nursing Faculty Research and Publications

Introduction The burden of HIV infection in southern Africa is a public health concern with an increasing number of new infections. This study sought to investigate the predictors of HIV prevalence in Mozambique through a complex samples logistic regression and spatial mapping approach using nationally representative data. Methods We conducted a secondary data analysis using the 2015 Mozambique Demographic and Health Survey and AIDS Indicator Survey. The analysis performed in four stages while incorporating population survey sampling weights did the following: i) created a complex sample plan file in SPSS, ii) performed the weighted estimate of HIV prevalence, iii) performed …

Determinants Of Occupational Hazards Knowledge And Safety Practices Among Textile Workers In Karachi, Pakistan: A Cross Sectional Study, Natasha Shaukat, Hasan Nawaz Tahir, Tanzil Jamali, Mohammed Moizul Hassan, Asaad Ahmed Nafees

Community Health Sciences

Objective: To determine the factors associated with good knowledge and safe practices regarding occupational hazards among textile workers.
Methods: The cross-sectional study was conducted in Karachi from September 2015 to February 2016, and comprised male workers from seven textile mills. A 45-item structured questionnaire was developed and pretested in Urdu, the local language. One part of the questionnaire comprised 31 items related to good knowledge, and the other part comprised 14 items related to safe practices. Data was analysed using SPSS 19.
Results: Of the 300 subjects, 123(41%) were aged 18-27 years, 183(63%) were educated, 184(61.3%) worked more than eight …

Religious Leader’S Support Toward Individual At Risk Ofhiv/Aids To Attend Voluntary Counselling And Testing Service, Imelda Februati Ester Manurung, Chatarina Umbul Wahyuni, Ari Probandari

Kesmas

Religious leader is a figure who is believed to have the gift of healing. A person with illness will follow any advice the religious leader gives for his/her recovery.Based on the phenomenon, religious leader is a potential local figure to give support for individuals at risk of human immunodeficiency virus (HIV) andacquired immune deficiency syndrome (AIDS). This study aimed to determine factors related to religious leader’s support toward individuals at risk of HIV andAIDS to attend voluntary counselling and testing (VCT) service. This study was an observational analytical with cross-sectional design. The population of thisstudy was religious leader in Kupang …

Endobronchial Tuberculosis: A Rare Presentation, Nadeem Kassam, Omar M. Aziz, Samina Somji, Grace Shayo

Internal Medicine, East Africa

Endobronchial tuberculosis (EBTB) is an infection of the tracheobronchial tree by Mycobacterium tuberculosis. It is common among young females. Patient can present with fever, cough, wheeze, with or without any constitutional symptoms. It presents as a diagnostic dilemma, as patient sputum smear can be false negative. CT scan may or may not show any abnormality, or any endobronchial lesion. Bronchoscopy with bronchoalveolar lavage and biopsy offers the diagnostic choice. We hereby report a case of a young immunocompetent Asian female who was found to have endobronchial pathology, leading to diagnosis and timely therapy.

Disseminated Carcinomatosis Of Bone Marrow In An African Man With Metastatic Descending Colon Carcinoma, Harrison Chuwa, Nadeem Kassam, Casmir Wambura, Omar Sherman, Salim Surani

Internal Medicine, East Africa

Colorectal cancer (CRC) is ranked third worldwide and seventh in Tanzania. The liver and lungs are the most commonly involved sites. Disseminated carcinomatosis of the bone marrow (DCBM) from colorectal carcinoma is rare and typically indicates widespread disease and poor prognosis. We report a case of a 40-year-old African male, who presented to us with abdominal distension, weight loss, fever and change in bowel habit over the past month. He underwent colonoscopy which revealed a necrotic mass in the descending colon. Biopsies were taken, and histopathology confirmed the presence of poorly differentiated mucin-producing adenocarcinoma. The patient suffered a colonic perforation …

Religious Beliefs, Social Pressure, And Stigma: Rural Women’S Perceptions And Beliefs About Vasectomy In Pwani, Tanzania, Eunice Pallangyo, Agnes Msoka, Sharon Brownie, Eleanor Holroyd

School of Nursing & Midwifery, East Africa

Despite being a reliable and cost effective family planning method, vasectomy remains underutilized in many low resource settings such as East Africa. We explored rural women’s perceptions and beliefs regarding barriers to vasectomy use in the low resource setting of Pwani, Tanzania. The qualitative study used in-depth semi-structured interviews to obtain data. Purposive sampling was used to recruit 20 married/cohabiting women with two or more children. Thematic analysis guided the data analysis, with qualitative data reporting informed by COREQ guidelines. Most participants were Muslim and had between two and six children. Most had completed primary-level education and were engaged in …

Pilot Study: Educational Tool Reduces Parental Stress At Home Post Pediatric Cardiac Surgery, Rachel Barsella

College of Science and Health Theses and Dissertations

Congenital heart disease is a prevalent health issue in patients around the world. Approximately 8 in 1,000 live births are complicated by congenital heart disease (Ndile & Kohi, 2011). Increased levels of stress and anxiety have been reported by parents of children with congenital heart disease throughout the process of cardiac surgery, hospitalization, and especially discharge home (Brown & Smith, 2018). This pilot research study utilized pre-intervention and post-intervention survey methodology to examine the impact of an educational tool on parental stress while caring for their child at home post cardiac surgery. The educational tool created by the researcher was …

Neutrophil Infiltration Into The Cervical Compartment Is Suppressed By Hiv Infection, Madeline Maschka

Honors Program: Senior Projects (Public)

Human Papillomavirus (HPV), is a small circular dsDNA virus with at least 200 different genotypes; each genotype is identified by at least 10% difference at the DNA level in the L1 capsid gene. Each HPV genotype affects the body in different tissues, either mucosal or cutaneous. Mucosal HPVs type 16 and 18 are known as high-risk strains, since HPV infection is the most common cause of cervical cancer and plays a central role in formation of precancerous lesions. Human immunodeficiency virus (HIV) damages the body’s immune system by targeting CD4+ T cells. Once CD4+ T cells are infected, the body …

Family Medicine In Tanzania: Seize The Moment, Riaz Ratansi, Bernhard M. Gaede

Faculty of Health Sciences, East Africa

In the context of addressing the pressing health needs for the global population, the World Health Organization has repeatedly called for universal health coverage (UHC) to be prioritised by its member countries. This is to be achieved through a high-quality primary health care (PHC) approach that provides comprehensive and integrated generalist care as close to where people live as well as links the clinical care to health promotion and disease prevention. In this paper, we argue for the introduction of family medicines as a critical player in the healthcare system of Tanzania to strengthen the strategies towards UHC. The paper …

Adherence To Universal Precautions And Associated Factors Among Nurses Caring For Critically Ill Patients In Dar Es Salaam Tanzania, Salma A. Wibonela, Columba Mbekenga, Fatina B. Ramadhani, Ally Mwanga, Pedro Palangyo

School of Nursing & Midwifery, East Africa

Background: Globally, it is known that heath care workers particularly in critical care settings are at higher risk of occupational exposure to infections. Surveillance systems to monitor body fluid exposure have been established in developed world. However, such systems are not available and consequently, exposure to body fluids is rarely reported, documented and monitored in many African countries.

Objectives: To assess knowledge, practice and factors influencing adherence of Universal Precautions of infection prevention among nurses at Muhimbili national hospital and Muhimbili orthopaedic institute Dar es salaam Tanzania.

Design: Quantitative cross-sectional and observational study. SPSS was used for data …

Factors Associated With First Antenatal Care Booking Among Pregnant Women At A Reproductive Health Clinic In Tanzania: A Cross Sectional Study, Lucy Kisaka, Sebalda Leshabari

School of Nursing & Midwifery, East Africa

Background: Antenatal care (ANC) is a key basic intervention targeting maternal and perinatal morbidity and mortality. The World Health Organization (WHO) recommends the first ANC booking before 12 weeks of gestation. This enhances positive maternal and fetal outcomes through early detection of complications, prompt treatment, referral, and management of expected physiological changes. Despite high ANC coverage (98%), free contacts, and easy accessibility, little is known why few (24%) pregnant women in Tanzania book their first ANC-visit early. This study aimed to identify factors associated with first ANC booking among pregnant women in a Tanzanian reproductive health clinic.

Methods: Systematic …

Surveillance Of Culex And Aedes Mosquitoes In Lincoln, Lancaster County, Nebraska, William Noundou

Department of Entomology: Dissertations, Theses, and Student Research

In 2018, West Nile virus (WNV) was identified as the leading cause of mosquito-borne disease in the continental United States. In response to this very serious problem, the Lincoln-Lancaster County Public Health Department (LLCHD) reinforced their mosquito surveillance program, which constitutes one of the best available tools to fight against this serious threat to human health. The objectives of this study were to 1) expand knowledge of the activity and relative abundance of mosquito communities in understudied areas and 2) evaluate differences in mosquito communities by urban and rural location, especially focusing on known vector species. A total of 6 …

Adequacy Of Hemodialysis And Its Associated Factors Among Patients Undergoing Chronic Hemodialysis In Dar Es Salaam, Tanzania, Samina Somji, Pascal Ruggajo, Sibtain Moledina

Internal Medicine, East Africa

The worldwide prevalence of maintenance hemodialysis continues to rise. An adequate delivery of hemodialysis dose as measured by Kt/V or urea reduction ratio is a crucial determinant of clinical outcome for chronic hemodialysis patients. )e aim of this study was to assess the adequacy of hemodialysis and its associated factors among patients undergoing chronic hemodialysis in Dar es Salaam. )is was a cross-sectional study done on patients undergoing chronic hemodialysis in four dialysis centers in Dar es Salaam. Sociodemographic information and treatment characteristics were collected. Urea reduction rate and single-pool Kt/V were calculated to determine the adequacy of hemodialysis. )e …

Adequacy Of Hemodialysis And Its Associated Factors Among Patients Undergoing Chronic Hemodialysis In Dar Es Salaam, Tanzania, Samina S. Somji, Pascal Ruggajo, Sibtain Moledina

Internal Medicine, East Africa

The worldwide prevalence of maintenance hemodialysis continues to rise. An adequate delivery of hemodialysis dose as measured by Kt/V or urea reduction ratio is a crucial determinant of clinical outcome for chronic hemodialysis patients. The aim of this study was to assess the adequacy of hemodialysis and its associated factors among patients undergoing chronic hemodialysis in Dar es Salaam. This was a cross-sectional study done on patients undergoing chronic hemodialysis in four dialysis centers in Dar es Salaam. Sociodemographic information and treatment characteristics were collected. Urea reduction rate and single-pool Kt/V were calculated to determine the …

Menstrual-Related Headaches Among A Cohort Of African Adolescent Girls, Philip Adebayo, Folajimi M. Otubogun, Rufus O. Akinyemi

Internal Medicine, East Africa

Introduction: Migraine attacks associated with menstruation are generally perceived as more severe than attacks outside this period.

Aim and Objective: The study aimed at determining the frequency of menstrual-related headaches among a cohort of senior secondary school girls in Abeokuta, Nigeria. We also determined its burden among these school girls.

Methodology: This study was cross-sectional using a validated adolescent headache survey questionnaire. A self-administration of the instrument was done during a school visit. A headache was classified using the ICHD-II criteria.

Results: Of the 183 students interviewed, 123(67.2%) had recurrent headaches. Mean age ±SD, 16.18± 1.55 (range 12– …

Profile Of Cardiac Arrhythmia In Acute Stroke Patients, Julius Stephen Nkhondeya Msukuya

Master of Medicine in Internal Medicine

Introduction: Cardiac arrhythmias are common and can be fatal in acute strokes, but they are often under-recognized. The presence of cardiac arrhythmia in acute stroke doubles the mortality. Objectives: This study aimed to determine the types of cardiac arrhythmia in acute stroke patients admitted in two urban hospitals in Dar es Salaam, The Aga Khan Hospital, Dar es Salaam and Muhimbili National Hospital. The secondary objectives were to determine the associations between the characteristic of stroke and cardiac arrhythmias as well as to determine the impact of cardiac arrhythmia on 30- days stroke outcomes. Methods: This was a prospective longitudinal …

Validation Of Kiswahili Version Of World Health Organization Quality Of Life-Hiv Bref Questionnaire Among People Living With Hiv/Aids In Tanzania., Nuru Abdallah Kondo

Master of Medicine in Family Medicine

Background: WHO has developed an HIV specific quality of life tool (WHOQOLHIV-BREF) for assessing Quality of life of HIV positive individuals. This tool takes to account the different cultural variations that exist worldwide and hence enable assessment of the quality of life across different cultures/context. This tool has been validated in different cultures and is cross-culturally a promising tool. It is simple to use in routine clinics as it is self-administered. Despite its sound validity and reliability from several studies, the developers recommend it to be validated in different cultures to fully assess its psychometric properties before its adaptation. Objectives: …

Revisiting Caroli Syndrome In A Tanzanian Patient, Casmir Wambura, Sharma, Munishi, Salim Suran

Faculty of Health Sciences, East Africa

Caroli disease and Caroli syndrome are two rare congenital diseases of the intrahepatic bileducts. Caroli syndrome is characterized by the saccular dilatation of intrahepatic bile ductsassociated with congenital hepatic fibrosis. It is rarely diagnosed in childhood. We herebydescribe a case of Caroli syndrome in a young Tanzanian female who had abdominal pain anddistension since childhood. Her history suggested the presence of portal hypertension possiblyfrom congenital hepatic fibrosis. The diagnosis was reached based on ultrasound, computedtomography (CT) scan of the abdomen, and magnetic resonancecholangiopancreatography (MRCP)