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Awareness about first aid management of epistaxis among medical students of the State University of Zanzibar, Tanzania
(2023) Abraham, Zephania Saitabau; Kahinga, Aveline Aloyce; Mohamed, Hafidh
Background: Epistaxis is the most common otorhinolaryngology emergency and can be unilateral or bilateral due to a variety of pathologies of the nose, paranasal sinuses, and nasopharynx. It tends to be self-limiting on most occasions. It may be severe enough to necessitate medical attention and lead to life-threatening complications when left without prompt intervention. There is a scarcity of published data regarding awareness of first aid management of epistaxis among medical students in Zanzibar, Tanzania, thus the study aimed to address such an existing gap. Methods: This was an analytical cross-sectional study that recruited 395 medical students. Data was collected using semi-structured questionnaires and analysis was done by Statistical Package for Social Sciences (SPSS) version 23 and a p-value <0.05 was considered to be statistically significant. Results: About two-thirds (89.4%) of the medical students had good knowledge of first aid management of epistaxis and 85.3% of the participants had a good attitude toward first aid management of epistaxis. Almost half of the respondents of this study (52.7%) had good practice regarding first aid management of epistaxis. A significant association was found between academic year and overall knowledge, attitude and practices on first aid management of epistaxis among medical students. Conclusions: Medical students of the State University of Zanzibar were found to have adequate knowledge about first aid management of epistaxis thus empowering them to provide first aid management of epistaxis and also with good attitude and practices towards handling patients with epistaxis.
Clinical profile of paediatric head and neck cancers at a tertiary hospital in Tanzania
(RBC / Rwanda Health Communication Centre, 2020) Abraham, Zephania Saitabau; Massawe, Enica Richard; Kahinga, Aveline Aloyce; Mapondella, Kassim Babu; Massawe, Willybroad Augustine; Swai, Henry; Mithe, Siwillis; Yahaya, James Joseph; Ntunaguzi, Daudi
Background: Paediatric head and neck cancers represent an important group of childhood cancers that require maximum attention at large. They are often diagnosed at advanced clinical stages at Muhimbili National Hospital (MNH). Objective: To describe the clinical profile of paediatric head and neck cancers at a tertiary hospital in Tanzania Method: A hospital based descriptive cross-sectional study was conducted involving 180 paediatric patients. Data were analyzed using SPSS program version 21. Results: A total of 180 paediatric patients were recruited where 61.1% were males and 38.9% were females. Majority belonged to the age group 0-5 years (53.9%). A total of 10 primary anatomical sites were found with the neck (cervical lymph node) predominating (36.1%), followed by the orbit/eye (34.4%) and the least anatomical sites were oral cavity (1.1%) and parapharyngeal space (0.5%). Leukocoria (93.9%), red eye (93.9%) and orbital cellulitis (77.6%) predominated in retinoblastoma but in patients with lymphomas, predominant features were night sweats (100%), weight loss (100%) and fevers (95.8%). Conclusion: The clinical profile depicted in this study appears to correlate with advanced clinical stages.
Clinico-pathological profile of hypopharyngeal cancer at two largest tertiary hospitals in Tanzania
(African Journals Online (AJOL), 2023) Kasongwa, Joyce Michael; Massawe, Enica Richard; Liyombo, Edwin; Kimario, John; Kahinga, Aveline Aloyce; Abraham, Zephania Saitabau
Background: Hypopharyngeal cancer being one of the upper aerodigestive malignancies has a very poor prognosis due to its late presentation, delay in diagnosis and initiation of treatment. The study aimed to determine the clinicopathological profile of hypopharyngeal cancer at the two largest tertiary hospitals in Tanzania. Materials and methods: This study was conducted at Muhimbili National Hospital (MNH) and Ocean Road Cancer Institute (ORCI) both located in Dar es Salaam, Tanzania and it was conducted from September 2019 to February 2020 where 119 patients were recruited after a thorough clinical evaluation and histopathological confirmation of the tissue biopsies. Structured questionnaires were used to collect data and it was analyzed using the Statistical Package for Social Sciences (SPSS) version 20. The chi-square test was used to determine the relationship between independent and dependent variables and a p-value <0.05 was considered statistically significant. Results : The study depicted male preponderance (male to female ratio being 2.6:1) and the majority of the patients (87.23%) were aged above 60 years. Progressive dysphagia and persistent sore throat (100%) were the predominant clinical features. Regarding the involvement of anatomical subsites of the hypopharynx by cancer, the majority of patients had more than one anatomical subsite involvement (89.08%) followed by the pyriform fossa (5.88%) posterior pharyngeal wall (3.36%) and least affected site is the post cricoid space (1.68%). Postcricoid space was found to affect women only. The majority of the patients (88.2%) were diagnosed at advanced stages. Histopathologically, the predominant subtype was found to be carcinoma (98.5%) with invasive squamous cell carcinoma (95.8%) predominating. Conclusion : Progressive dysphagia and persistent sore throat were the predominant clinical features whilst the majority of patients had more than one anatomical site involved. Most patients presented at advanced stages due to delayed diagnosis and similarly, the predominant histopathological subtype was carcinoma.
Clinico-pathological profile of nasopharyngeal carcinoma at Muhimbili national hospital, Dares Salaam, Tanzania
(Scientific Research Publishing, 2019) Abraham, Zephania Saitabau; Massawe, Enica Richard; Ntunaguzi, Daudi; Kahinga, Aveline Aloyce; Yahaya, James Joseph; Mithe, Siwillis Elizabeth
Background: Nasopharyngeal carcinoma (NPC) is an uncommon malignant tumor which has been reported invariably and cases have been encountered in Tanzania. Though rare they are associated with potential morbidity and mortality. The aim of this study was to characterize the clinico-pathological profile of such neoplasm in our set up. Methods: A retrospective review of 25 cases from hospital archives for 3 consecutive years was done where all patients with a histopathologically confirmed diagnosis of NPC were recruited. Data was analyzed using SPSS version 21. Results: Of the 25 eligible cases, 15 (60%) were males and 10 (40%) were females. Age range was 15-70 years. The peak age was 30-50 years in males and 50-59 years in females. Highest incidence was in the 5th decade. The commonest presenting features were cervical lymphadenopathy (92%) epistaxis (80%), hearing loss (80%) and nasal obstruction (76%) while the least common feature was seizures (4%). Histologically, undifferentiated carcinoma (76%) was the commonest variant while the least common one was differentiated non keratinizing squamous cell carcinoma (8%). Identifiable risk factors were consumption of salted smoked fish (80%), tobacco use (60%), alcohol intake (52%) and occupational exposure to wood dust (32%). Majority of patients (80%) were diagnosed with advanced stage of the disease (Stage IV). Conclusions: Findings from this study correlate with what has been reported elsewhere. Clinicians should have a higher index of suspicion in diagnosing NPC to enable early referral and prompt treatment of such malignant neoplasm.
An endoscopic study on the prevalence of accessory maxillary sinus ostium in patients with chronic rhinosinusitis in Dar es Salaam, Tanzania
(Dove Medical Press, 2020) Abraham, Zephania Saitabau; Kahinga, Aveline Aloyce; Mapondella, Kassim Babu; Massawe, Enica Richard; Ntunaguzi, Daudi
We aimed to determine the prevalence of and characterize accessory maxillary sinus ostium (AMO) in patients with chronic rhinosinusitis at a private health facility which serves the largest number of patients seeking treatment under private practice in Tanzanias largest city. Chronic rhinosinusitis is a common condition in otorhinolaryngology practice. It has been postulated in the available literature that accessory maxillary ostium may play a role in the development of chronic maxillary sinusitis. AMO has been frequently identified during routine nasal endoscopy. Its found in the medial wall of the maxillary sinus and located in the lateral wall of the nose. There is no study to date that has been conducted in Tanzania to characterize AMO in patients with chronic rhinosinusitis when seen at the clinic despite the growing use of endoscopy on an outpatient basis. Fifty adult patients with symptoms of chronic rhinosinusitis attending the ENT clinic on an outpatient basis were selected and then computerized tomography scan of the nose and paranasal sinuses (CT scan PNS) was performed. Nasal endoscopy was done to all patients to determine the presence and location of AMO. Of all the 50 studied patients, CT scan PNS depicted positive signs of rhinosinusitis in 35 patients (70%). Upon nasal endoscopy of the 35 patients, AMO was found in 25 patients (71.4%). Of the 15 patients with no depicted CRS upon CT scan, AMO was found in 4 (26.7%) patients. Nasal endoscopy provides additional evidence of obstruction of natural sinus ostia thus leading to chronic maxillary rhinosinusitis apart from CT PNS. Such observation is of importance to clinicians who are to execute management of these patients.
Indications and postoperative outcomes of pediatric adenotonsillectomy at a private hospital in Dar es Salaam, Tanzania
(Dove Medical Press, 2020) Abraham, Zephania Saitabau; Kahinga, Aveline Aloyce; Mapondella, Kassim Babu; Massawe, Enica Richard; Ntunaguzi, Daudi
We aimed to describe indications and postoperative outcomes of adenotonsillectomy among pediatric patients at a private hospital that serves the largest number of patients with otorhinolaryngological complaints seeking treatment in private health facilities in Tanzania’s largest city. Adenotonsillectomy is one of the commonest surgical procedures in otorhinolaryngology, and indications reported, though scarce in the literature, are infections and sleep-disordered breathing (SDB). Some studies in the last few decades have documented SDB superseding infection. There have been no studies in Tanzania documenting indications and postoperative outcomes of adenotonsillectomy, despite this being a commonly performed surgical procedure. A hospital-based descriptive cross-sectional study was conducted from January to December 2018, where children aged 0– 18 years who had undergone adenotonsillectomy at a private hospital were recruited. Data were analyzed using SPSS version 21. A total of 350 patients aged 0– 18 years were recruited: 60% were children aged < 5 years, 35% 6– 11 years, and 5% 12– 17 years. SDB accounted for a total of 247 (70.5%) indications, while infection accounted for only 60 (17.1%), and when both indications were combined, it accounted for 43 (12.4%) cases. SDB as an indication was proportionally higher in younger children, while infection was higher in older children. Postoperative hemorrhage was encountered in five patients (1.4%). Secondary hemorrhage predominated in four cases (80%), whilst one patient (20%) had primary hemorrhage. Sepsis at the surgical site was found to be the cause for all four patients (100%) with secondary hemorrhage, and the patient with primary hemorrhage had isolated thrombocytopenia as the underlying cause of hemorrhage. SDB was the commonest indication for adenotonsillectomy and postoperative complications were rare encounter, with secondary hemorrhage being predominant.
Knowledge about continuous positive airway pressure machine usage among nurses at a tertiary hospital in Tanzania
(South Sudan Doctors' Association, 2020) Lomnyack, Wilson Paulo; Mwansisya, Tumbwene; Mbelwa, Stewart; Isangula, Kahabi; Abraham, Zephania Saitabau
Continuous Positive Airway Pressure (CPAP) provides an air pressure that maintains the patency of the airway in patients with a variety of breathing problems. Nurses provide the hour to hour management of patients who require CPAP. The aim of this study was to assess the knowledge of nurses about CPAP machine usage at the tertiary hospital in Tanzania which serves the largest number of patients who require CPAP. A hospital-based descriptive cross-sectional study was carried out from March to June 2019 at Muhimbili National Hospital (MNH) and Jakaya Kikwete Cardiac Institute (JKCI) where 149 nurses who consented to participate were recruited. Data were collected using structured questionnaires and analysed using a statistical package for social sciences (SPSS) version 20. P-value<0.05 was considered to be statistically significant. Of the149 nurses recruited 80(53.7%) were female and 69 (46.3%) were male; 99 (66.4.%) were aged 26-35 years; 78 (52.3%) had a diploma in nursing as the highest level of education and 138 (93.9%) had work experience of less than ten years. Forty five percent of nurses had moderate knowledge about CPAP machine usage. High and moderate level of knowledge among nurses about CPAP general information each equally accounted for 38.9% and poor level of knowledge accounted for 2.7%. Moreover, moderate level of knowledge about CPAP device contraindications accounted for 43% whilst poor knowledge attributed 8.7%. There was no significant association between nurses’ knowledge and their socio-demographic characteristics. Just under half of the nurses had moderate knowledge of CPAP device use and most of them had attended only a single training session on CPAP device use and the range of time from training until completing questionnaires was at least six months. Regular training on CPAP machine usage should be provided to nurses since they are in the front line in management of patients requiring CPAP.
Pattern and causes of tympanic membrane perforation at a private hospital in Dar es Salaam, Tanzania
(South Sudan Doctors' Association, 2019) Abraham, Zephania Saitabau; Kahinga, Aveline Aloyce; Mapondella, Kassim Babu; Massawe, Enica Richard; Lengine, Emmanuel Ole; Ntunaguzi, Daudi
Introduction: There is variation in the size, shape and position of tympanic membrane perforations; the degree of conductive hearing loss depends on the size and position of perforation. Objective: To determine the pattern and causes of tympanic membrane perforation at a private health facility in Tanzania Method: A hospital-based cross-sectional study in the ENT clinic at Ekenywa Specialised Hospital was conducted from January to May 2019. Ears were examined thoroughly by an Otorhinolaryngologist. Data were analysed using SPSS Version 21 Results: Two hundred and fifty patients were examined and 50 (20%) were found to have tympanic membrane perforations. Thirty (60%) were new patients while twenty (40%) were under review. Most 35(70%) were males. Central perforation predominated in 30 (60%), followed by subtotal in 10 (20%), total in 8 (16%) and marginal perforations in 2 (4%). The left ear was more affected in (60%) than the right ear. Bilateral perforations accounted for 5 (10%) of cases. Chronic suppurative otitis media was found in 35 (70%); other causes were acute suppurative otitis media in 13 (26%) and trauma in 2 (4%) patients Conclusions: The clinical picture depicted in this study is similar to that found elsewhere. There is a need for prompt diagnosis of tympanic membrane perforation. Proper education on ear care in patients with perforated tympanic membrane is of paramount importance.
Pediatric soft tissue and bone sarcomas in Tanzania: epidemiology and clinical features
(American Society of Clinical Oncology, 2021) Siwillis, E. Mithe; Dharse, Nazima J.; Scanlan, Trish; Ngoma, Mamsau; Abraham, Zephania Saitabau; Kahiu, Josephine W. N.; Million, Lynn
Pediatric sarcomas represent an important group of childhood tumors that require treatment at Muhimbili National Hospital (MNH), the largest pediatric oncology center in Tanzania. Treatment is often adapted from established childhood protocols validated in clinical trials from the United States and the United Kingdom. There are no studies describing the types of pediatric sarcomas most commonly seen in Tanzania to understand similarities and disparities with other countries and which sarcomas to prioritize in adapting treatment protocols. The objective of this study was to establish a baseline of the epidemiologic and clinical features of pediatric sarcomas diagnosed at MNH. Information was collected on clinical and tumor features of all children seen at MNH pediatric oncology unit between 2011 and 2016 with a confirmed histologic diagnosis of either bone or soft tissue sarcoma (STS). A total of 135 cases were analyzed; 89 (66%) were STS and 46 (34%) were bone sarcomas. There was a slight female predominance (n = 69; 51%), and the mean age (SD) of patients was 6.3 (5.1) years. Greater than 90% (n = 123) of the cases presented with a painless swelling. The commonest STS, accounting for almost three-fourths of the cases (n = 66) was rhabdomyosarcoma (RMS), with embryonal subtype being the most common RMS (n = 49; 74%). Osteosarcoma was the most common bone sarcoma, accounting for greater than 80% (n = 40) of the cases. Ewing sarcoma accounted for less than 15% (n = 6). Most of the patients presented with stage IV disease (n = 57; 87%) and lung was the commonest metastatic site. To our knowledge, this report is the first study documenting the epidemiologic and clinical features of pediatric sarcomas in a modern Tanzanian pediatric hospital. Embryonal RMS and osteosarcomas should be prioritized for adapting treatment protocols from other countries.
Prevalence of Cerumen Impaction and Associated Factors Among Primary School Pupils at an Urban District in Northern Tanzania
(Springer Science and Business Media LLC, 2023) Abraham, Zephania Saitabau; Dismas, Dismas Samwel
Purpose Cerumen impaction is a public problem of great concern due to associated hearing impairment. Despite cerumen impaction being one of the commonest causes of hearing loss among primary school children, there is no any published study to date from northern Tanzania focused on this topic. This study aimed to address this gap. Methods A cross-sectional study design was used where 307 primary school pupils were recruited using a multistage cluster sampling technique and it was conducted from January to July 2023. Data was collected using Swahili translated semistructured questionnaires. Results The prevalence of cerumen impaction was 10.7% with the right ear being mostly affected (57.6%). A statistically significant association was found between prevalence of cerumen impaction and mother’s education level though no association was found between sex, residence, father’s education level and mother’s occupation status. Predisposing factors like history or presence of ear infection, habit of cleaning ears and using hearing aids or earphones showed a statistically significant association The commonest clinical presentation was otalgia (36.4%) and washing ears with water (71.5%) was the commonly applied method of cleaning the ears apart from hospital based interventions. The commonest method of wax removal for those who visited health facilities was ear syringing (42.9%). Conclusion Lesser prevalence of cerumen impaction was found in this study though majority had previous history of impacted wax. Cotton bud was the commonest predisposing factor for cerumen impaction. The commonest clinical presentation among those with impacted cerumen was otalgia though some pupils reported asymptomatic cerumen impaction
Prevalence of cerumen impaction and associated factors among primary school pupils at an Urban District in Northern Tanzania
(Springer Science and Business Media LLC, 2024) Abraham, Zephania Saitabau; Dismas, Dismas Samwel
Purpose: Cerumen impaction is a public problem of great concern due to associated hearing impairment. Despite cerumen impaction being one of the commonest causes of hearing loss among primary school children, there is no any published study to date from northern Tanzania focused on this topic. This study aimed to address this gap. Methods: A cross-sectional study design was used where 307 primary school pupils were recruited using a multistage cluster sampling technique and it was conducted from January to July 2023. Data was collected using Swahili translated semi-structured questionnaires. Results: The prevalence of cerumen impaction was 10.7% with the right ear being mostly affected (57.6%). A statistically significant association was found between prevalence of cerumen impaction and mother's education level though no association was found between sex, residence, father's education level and mother's occupation status. Predisposing factors like history or presence of ear infection, habit of cleaning ears and using hearing aids or earphones showed a statistically significant association The commonest clinical presentation was otalgia (36.4%) and washing ears with water (71.5%) was the commonly applied method of cleaning the ears apart from hospital based interventions. The commonest method of wax removal for those who visited health facilities was ear syringing (42.9%). Conclusion: Lesser prevalence of cerumen impaction was found in this study though majority had previous history of impacted wax. Cotton bud was the commonest predisposing factor for cerumen impaction. The commonest clinical presentation among those with impacted cerumen was otalgia though some pupils reported asymptomatic cerumen impaction.
A rare case report of aural myiasis in a 24-day old neonate in Tanzania
(Scientific Research Publishing, 2019) Abraham, Zephania Saitabau; Ntunaguzi, Daudi; Kahinga, Aveline Aloyce; Lengine, Emmanuel Ole; Mhamilawa, Lwidiko Edward; Massawe, Enica Richard
Aural myiasis refers to the infestation of the ear by the larvae of certain dipterous flies. The disease-producing flies prefer a warm and humid environment and higher incidence occur in tropics and subtropics of Africa and America. Aural myiasis is rare during neonatal life and children with tendencies of poking the ear need immediate review by otorhinolaryngologists for thorough otological review. The objective is thus to report the case of a 24-day old neonate who was diagnosed to have aural myiasis upon otoendoscopy at a private health facility in Tanzania. This is the first reported case of neonatal aural myiasis in our country. Neonates with tendencies to poke ears and with irritability should be handled with care by having immediate Otorhinolaryngologist review to exclude aural pathologies such as aural myiasis. Removal of the maggot, instilling ototopical antibiotics admixed with aural antiseptics, systemic antibiotics and close follow up for meticulous aural toilet remains the main stay in management of aural myiasis.
A rare incidental encounter of a foreign body in the nasopharynx during adenotonsillectomy: A case report from Tanzania
(Zambia Medical Association, 2019) Abraham, Zephania Saitabau; Massawe, Enica Richard; Mapondella, Kassim Babu; Kahinga, A veline Aloyce; Mithe, Siwillis; Ntunaguzi, Daudi
Foreign bodies may become lodged in various parts of the upper aerodigestive tract and establishing the presence of such foreign bodies is expected from health care practitioners. Foreign bodies may be classically organic or inorganic and their insertion into various parts of the aerodigestive tract may be deliberate or accidental. Majority of inhaled foreign bodies are reported in children and may even go unnoticed. There are scarce reported studies of foreign bodies in the nasopharynx. We are reporting an unusual case in which a foreign body in a child's nasopharynx went unnoticed for 9 months and was found incidentally during adenotonsillectomy.
A rare incidental encounter of unilateral choanal atresia during adenotonsillectomy in a 5-year-old child: a case report from Tanzania
(Mansa STM Publishers, 2020) Abraham, Zephania Saitabau; Massawe, Enica Richard; Mapondella, Kassim Babu; Kahinga, Aveline Aloyce; Ntunaguzi, Daudi
Unilateral choanal atresia refers to a congenital anomaly whereby a child is born with unilateral imperforate posterior nare. In most cases, the diagnosis is established several years after birth. The establishment of the diagnosis requires a high index of suspicion by clinicians. We report an unusual case of a 5-year-old girl who was diagnosed intraoperatively to have unilateral choanal atresia (right) during elective adenotonsillectomy after the failure of introducing a nasal catheter into the oropharynx and on digital palpation of the choanae intraorally. Endoscopic perforation of the membranous atretic choanal plate was done in the same sitting with adenotonsillectomy. The objective of this case report was thus to report an unusual case which went undiagnosed for 5 years and was diagnosed intraoperatively during elective adenotonsillectomy and also to review the few available pieces of the literature. To the best of our knowledge, this is so far the second reported case worldwide of unilateral choanal atresia incidentally diagnosed during adenotonsillectomy.
Unilateral pyoderma gangrenosum of the external ear in a resource-limited setting: case report and literature review
(John Wiley & Sons Ltd, 2021) Abraham, Zephania Saitabau; Thomas, Edwin Peter; Kahinga, Aveline Aloyce
Involvement of the external ear by PG is a rare encounter, and steroids remain to be the main stay in its treatment

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