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Acceptability of the direct health facility financing (DHFF) initiative in Tanzania: a mixed methods process evaluation of the moderating factors
(John Wiley & Sons, Inc, 2021) Kalolo, Albino; Kapologwe, Ntuli A.; Samky, Hendry; Kibusi, Stephen M.
Despite wide agreement that stakeholder acceptability plays a critical role in an intervention's effectiveness, gaps remain on understanding acceptability of complex health financing interventions. We aimed to understand the moderators of acceptability of the Direct Health Facility Financing (DHFF) initiative across primary health facilities in Tanzania. Employing a mixed methods approach and guided by the theoretical framework for acceptability (TFA), we collected data from implementers and their supervisors using a structured questionnaire and semi-structured interview guides. We analysed data using a chi square test, logistic regression, and thematic analysis. We recruited 238 participants, of whom 71% were females and 54% were below 37 years old. Acceptability was found to be 63% and received high rating in qualitative interviews. Moderators of acceptability included sex (AOR = 1.93, p = 006), work experience (AOR = 3.47, p = 0.001), knowledge (13.8, p = 0.00), supportive work environment (AOR = 2.28, p = 0.019), and capability to implement the programme (AOR = 0.12, p = 0.00). Moderators reported in qualitative interviews related to individual and contextual factors. This study suggests that the DHFF initiative is acceptable and influenced by factors operating at the individual level and beyond. Addressing moderators of acceptability as programs are designed and implemented is the holy grail of acceptability of complex interventions.
Accessibility to sexual and reproductive health and rights education among marginalized youth in selected districts of Tanzania
(Pan African Medical Journal, 2016) Ngilangwa, David Paul; Rajesh, Sharanya; Kawala, Mercy; Mbeba, Rita; Sambili, Benatus; Mkuwa, Serafina; Noronha, Rita; Nyagero, Josephat; Meremo, Al-fred Jackson
Access to information, education and services is central in the promotion of sexual and reproductive health and rights (SRHR) among young people. It enables young people make informed choices on sexuality matters, hence reduce teenage pregnancies and sexually transmitted infections (STIs). This study assessed accessibility of SRH rights information among marginalized young people in three municipalities of Iringa, Ilala and Kinondoni in Tanzania. A cross-sectional study design using mixed methods was conducted in 2013 in three selected districts of Tanzania. We randomly selected 398 young people including those with disabilities to partake in quantitative survey while 48 community members were purposely selected for qualitative part. Quantitative data analysis was done using descriptive statistics and chi square test with the assistance of the Statistical Package for Social Science (SPSS) version 20, while qualitative data was thematically analyzed. There were 396 (99%) participants (144 Males and 251 females), with a mean age of 20.1years. The majority were out of school female, cohabiting and had completed secondary education. Overall, 317 (79.6%) had SRH rights knowledge. The leading sources of SRH rights information were peer educators (36.7%) and radio (22.8%). Awareness regarding laws and policies related to SRH right was 55.1%. However, young people living with HIV and school truants had more access to SRHR education and services than the other youth groups(χ2 30.69, p< 0.0001). The qualitative study revealed that parents and teachers perceived themselves to be incompetent in providing SRH information to their youngsters despite of being mostly trusted. Access to SRH rights information is high but decreases when it is disaggregated across different age groups. There is a need for diversified approach for reaching specific groups of young people depending on their needs and circumstances
Accessory lobes, accessory fissures and prominent papillary process of the liver
(Anatomy Journal of Africa, 2015) Pryakhin, Alexey; Yukhimets, Sergey; Chernomortseva, Elena; Gesase, Ainory P.
Often unreported hepatic variations include accessory fissures, lobes and processes. Variant hepatic fissures further show variations in location and depth. Accessory lobes of the liver have different size, shape, situation, connection with maternal organ. These abnormalities in the anatomy of human liver have the unspecified clinical significance. We described four examples with a combination of accessory lobes, accessory fissures and prominent papillary processes. Clinicians should be aware of such variations to prevent diagnostic and therapeutic misadventures.
Accuracy of clinical methods for the estimation of fetal weight in single tone pregnancy at term at Iringa regional referral hospital
(The University of Dodoma, 2019) Abdalla, Hassanat Mohammed
Background: Prediction of fetal weight accurately is an important parameter in planning proper managements of labor and delivery, so as to reduce the rate of complications associated with the delivery of macrosomic or low birth weight fetus especially in second stage of labor and during puerperium. Fetal weight can be estimated correctly by various clinical methods but require selection of the valid method. In the present study, an effort was done to find which formula is more accurate in estimating fetal weight as compared to actual birth weight. Objectives: This study aimed to assess the accuracy of clinical methods for the estimation of fetal weight in single tone pregnancy at term. Methods: This analytical cross section study with quantitative research approach was conducted on 401 single tone pregnant women by a convenient sampling technique in latent phase of labor or who were admitted for elective cesarean delivery with a gestational age of 37- 40 weeks. Structured questionnaire was used to collect social demographic characteristics, fetal weight was estimated clinically by Johnson’s, Insler’s and Dawn’s formula and actual birth weight was measured within 15 minutes after delivery. Analysis was done by SPSS vision25; frequency and percentage were used to present categorical variables. Wilcoxon signed-rank test was used to find the similarities and mean absolute error and mean absolute percentage error was used to find the accuray. P-value of< 0.05 was considered significant. Results: The mean weights obtained from three formulas under the study were compared with the mean of actual birth weight. Mean of Johnson’s formula (3.470kg) and Insler’s formula (3.412 kg) were almost similar to the mean actual birth weight (3.18), while Dawn’s formula had higher mean birth weight (4.574kg). Also correlation between three formulas and actual birth weight was done by Pearson’s correlation coefficient (r) which found to be 0.495, 0.508 and 0.479 for Johnson’s, Insler’s and Dawn’s respectively. Mean absolute error and mean absolute percentage error was used in order to find the accuracy of the formulas hence Johnson’s formula found to have less error in all birth weight categories followed by Insler’s except in underweight and Dawn’s being the least. Conclusion: In this study it was found that Johnson’s found to be more accurate than the other formulas in estimating fetal weight.
Accuracy of the montreal cognitive assessment in detecting mild cognitive impairment and dementia in the rural African population
(Oxford University Press, 2020) Masika, Golden M; Yu, Doris S F; Li, Polly W C
Objective The incidence of dementia in the sub-Saharan Africa is rising. However, screening tools for cognitive decline that fits their linguistic and cultural context are lacking. The aim of this study was to determine the accuracy of the Kiswahili version of Montreal Cognitive Assessment (K-MoCA) to detect mild cognitive impairment or dementia among older adults in the rural Tanzania. Methods We recruited 259 community-dwelling older adults in Chamwino district, Tanzania. The concurrent validity and discriminatory power of K-MoCA were examined by comparing its score with IDEA cognitive screening and psychiatrist’s diagnosis using DSM-V, respectively. All the questionnaires were administered in face-to-face interview. Results K-MoCA demonstrated acceptable reliability (Cronbach’s alpha = 0.780). Concurrent validity was evident by its significant correlation with the IDEA screening test (Pearson’s r = 0.651, p < 0.001). Using the psychiatrist’s rating as the reference, the optimal cut-off score for MCI and dementia was 19 and 15, respectively, which yielded the sensitivity of 70% and specificity of 60% for MCI, and sensitivity of 72% and specificity of 60% for dementia. Further analysis indicated that education and age influence performance on K-MoCA. Conclusion Overall, the K-MoCA is a reliable and valid tool for measuring cognitive decline. However, its limited discriminatory power for MCI and dementia may be compromised by the cultural irrelevance of some items.
Accuracy of WHO immunological criteria in identifying virological failure among HIV-infected adults on first line antiretroviral therapy in Mwanza, North-western Tanzania
(BioMed Central, 2017) Gunda, Daniel W.; Kidenya, Benson R.; Mshana, Stephen E.; Kilonzo, Semvua B.; Mpondo, Bonaventura C. T.
Optimal HIV treatment monitoring remains a big challenge in resource limited settings. Guidelines recommend the use of clinical and immunological criteria in resource limited settings due to unavailability of viral load monitoring; however their utility is questionable. This study aimed at assessing the accuracy of immunological criteria in detecting treatment failure among HIV infected Tanzanian adults receiving first line ART. A clinic based cross sectional study was conducted between February and July 2011 at Bugando Medical centre (BMC) HIV care and treatment clinic (CTC) involving HIV infected patients aged 18 years and above, receiving first line ART; followed up for at least 1 year. Viral load was tested for every enrolled patient. Standard WHO criteria were used to define immunological failure. Virological failure was defined as one viral load measurement of >5000 copies/ml and was used as a gold standard. A 2 × 2 table was used to assess the accuracy of immunological criteria in detecting treatment failure. A total of 274 HIV-infected adults were enrolled into the study. Out of these, 65.7% were females, the median age was 39 years (IQR 33–45), the median BMI 21.9 kg/m2 (IQR 19.7–24.0). Out of the 274 study participants 156 (56.9%) had immunological failure. Only 60 of the study participants (21.9%) had viral load >5000. Only 42 patients (70%) were found to have both immunological failure and virological failure. The sensitivity of immunological criteria in detecting treatment failure was 70%, specificity 46.7%, positive predictive and negative predictive values of 26.9 and 84.7% respectively. WHO immunological criteria have low sensitivity and positive predictive value for detecting treatment failure. Relying on CD4 counts for treatment monitoring would therefore lead to misclassifications of treatment failure that could result into unnecessary or delayed switch to second line ART. Access to viral load monitoring is important to avoid these misclassifications.
Acute renal failure in a caucasian traveler with severe malaria: A case report
(US National Library of Medicine, 2014) Meremo, Alfred J.; Kilonzo, Semvua B.; Munisi, David; Kapinga, Janet; Juma, Mwinyikondo; Mwanakulya, Simfukwe; Mpondo, Bonaventura
Acute renal failure (ARF) secondary to severe malaria is uncommon. We report a case of a patient visiting Africa for the first time presenting with malaria and ARF. There was complete recovery after hemodialysis. Early initiation of hemodialysis proves to be useful in the restoration of renal function.
Addressing the huge poor–rich gap of inequalities in accessing safe childbirth care: a first step to achieving universal maternal health coverage in Tanzania
(Public Library of Science, 2021) Bintabara, Deogratius
Despite skilled attendance during childbirth has been linked with the reduction of maternal deaths, equality in accessing this safe childbirth care is highly needed to achieving universal maternal health coverage. However, little information is available regarding the extent of inequalities in accessing safe childbirth care in Tanzania. This study was performed to assess the current extent, trend, and potential contributors of poor-rich inequalities in accessing safe childbirth care among women in Tanzania.This study used data from 2004, 2010, and 2016 Tanzania Demographic Health Surveys. The two maternal health services 1) institutional delivery and 2) skilled birth attendance was used to measures access to safe childbirth care. The inequalities were assessed by using concentration curves and concentration indices. The decomposition analysis was computed to identify the potential contributors to the inequalities in accessing safe childbirth care. A total of 8725, 8176, and 10052 women between 15 and 49 years old from 2004, 2010, and 2016 surveys respectively were included in the study. There is an average gap (>50%) between the poorest and richest in accessing safe childbirth care during the study period. The concentration curves were below the line of inequality which means women from rich households have higher access to the institutional delivery and skilled birth attendance inequalities in accessing institutional delivery and skilled birth attendance. These were also, confirmed with their respective positive concentration indices. The decomposition analysis was able to unveil that household’s wealth status, place of residence, and maternal education as the major contributors to the persistent inequalities in accessing safe childbirth care.The calls for an integrated policy approach which includes fiscal policies, social protection, labor market, and employment policies need to improve education and wealth status for women from poor households. This might be the first step toward achieving universal maternal health coverage.
Adenoid cystic carcinoma of the nasal cavity—the great mimicker of chronic rhinitis: A rare case report with literature review
(Edorium Journals, 2019) Yahaya, James; Abraham, Zephania
Introduction: Adenoid cystic carcinoma (ACC) of the nasal cavity is one of the rarest malignant entities reported in the literature with the known incidence of up to 5%. It commonly poses a diagnostic challenge due to lack of diagnostic suspicion index because of its rarity and especially when it is associated with a long history of benignity. Adenoid cystic carcinoma is a tumor of salivary glands even though it is not frequent. Moreover, it can rarely occur in other body parts, such as nose, paranasal sinuses, lungs, uterine cervix, and many others. Case Report: We present a case of an 18-year-old boy with a diagnosis of ACC of the nasal cavity. The patient had a 10-year history of long-standing chronic inflammatory condition presenting as rhinitis. However, after a period of two years later following the initial diagnosis, the tumor became aggressive and it presented with ulceration, causing erosion of the nasal bone as well as auto-exenteration of the right eye. Conclusion: Adenoid cystic carcinoma involving the nose and other paranasal sites ought to be deemed as a tumor with sometimes long-standing history of benignity which needs high index of suspicion for being able to detect it in order to improve outcome of the patients.
Adenovirus infection is predicted by prolonged duration of diarrhea among rotavirus-vaccinated children below five years of age in Mwanza, Tanzania
(Hindawi, 2020) Msanga, Delfina R.; Masoza, Tulla S.; Mahamba, Dina; Kwiyolecha, Elizabeth; Rwezaula, Raphael; Charles, Happiness; Kessy, Regan; Silago, Vitus; Mshana, Stephan E.; Mirambo, Mariam M.
Diarrhea is the commonest cause of morbidity and mortality in many resource-limited countries including Tanzania among children below five years of age. A significant number of diarrhea cases associated with severe dehydration are still being reported among children despite five years of rotavirus vaccine implementation in Tanzania necessitating the need to investigate other causes of diarrhea in this population. This study is aimed at determining the prevalence of human adenovirus infection and associated factors among rotavirus-vaccinated children with acute diarrhea in Mwanza, Tanzania. A cross-sectional study was conducted from June to August 2017 involving 137 children less than two years of age admitted with acute diarrhea in the health facilities located in Mwanza, Tanzania. Sociodemographic and other relevant information were collected using standardized rotavirus surveillance tool adopted from WHO. Stool specimens were collected and tested for human adenovirus antigen using immunochromatographic tests. Data were analyzed by using STATA version 13. The median age of enrolled children was 12 (IQR 8-17) months. The prevalence of human adenovirus was found to be 46 (33.6%, 95% CI: 25-41). By multivariable logistic regression analysis, only prolonged duration of diarrhea (OR: 1.619, 95% CI: 1.142-2.295, p = 0:007) was found to predict human adenovirus infection among rotavirus-vaccinated children with acute diarrhea. A significant proportion of rotavirus-vaccinated children with prolonged acute diarrhea have adenovirus infection. There is a need to consider other viral pathogens as potential cause of diarrhea especially in this postrotavirus vaccination period
Adequacy of fluid resuscitation and outcome of emergency surgical patients, attended at Iringa regional referral hospital
(The University of Dodoma, 2020) Haule, Clemence Herman
Background: Fluid resuscitation is an extremely important part of patients management in clinical settings. Different common surgical conditions e.g. excessive vomiting and acute severe hemorrhage, can lead to an increased fluid loss and disturb the patients physiological status leading to worse outcomes. Proper fluid administration to a surgical patient, can lead to patients improvement from their illness, and hence reducing morbidity and mortality which are the main problems. Therefore, this study was assessing Adequacy of Fluid Resuscitation and Outcomes of Emergency Surgical Patients, Attended at Iringa Regional Referral Hospital. Methods: A hospital-based descriptive cross sectional study design of 162 emergency surgical patients was conducted at Iringa Regional Referral Hospital in Tanzania from February 2019 to April 2020 Results: Among the 162 study participants who were studied, majority 44 (27.2%) had intestinal obstruction while the least group had wet foot gangrene 2(1.2%). The rest were Peritonitis, Appendicitis/appendicular abscess, Chest injuries, Visceral injuries and multiple cut wounds (22.8%, 14.2%, 13.6%, 9.3%, 8.6%) respectively. Fluid resuscitation caused changes in pulse rate (96.16 ± 14.295 vs. 86.70 ± 22.441), respiratory rate (21.02 ± 2.796 vs. 18.96 ± 2.796), SBP (101.81± 20.727 mmHg vs. 106.70 ± 22.441 mmHg) and DBP (62.54 ± 13.648 mmHg vs. 65.12 ± 18.152 mmHg), MAP (75.254 ± 15.459 mmHg vs. 78.778 ± 21.4426 mmHg) and temperature 37.10± 1.159 vs.35.756±7.068 as from the time of admission and 24 hours post resuscitation. Conclusion: This study has shown a significant improvement of patients clinical conditions following fluid administration basing on vital signs, from time of admission up to 24hrs post resuscitation. Personalized fluid administration in patients requires clinicians to integrate abnormal physiological parameters into a clinical decision making. The physiological parameters include; vital signs, urine output and body weight recordings.
Adequacy of macro and micronutrients in infants and young children’s diets in Zanzibar, Tanzania
(Makerere university medical school (Uganda), 2019) Kinabo, Joyce; Mamiro, Peter; Mwanri, Akwilina; Bundala, Nyamizi; Kulwa, Kissa; Picado, Janeth; Ntwenya, Julius; Nombo, Aneth; Mzimbiri, Rehema; Ally, Fatma; Salmini, Asha; Juma, Abuu; Macha, Elizabeth; Cheung, Edith; Msuya, John
A study was conducted in Zanzibar using ProPAN software to assess nutrient adequacy of foods given to infants and children aged 6-23 months old in Zanzibar. The 24-hr dietary recall method embedded in ProPAN software was used to determine the adequacy of energy, protein, iron, calcium, zinc and vitamin A in foods consumed by children. Sample of 200 mothers/caretakers with children aged 6-23 months were interviewed. Most frequent foods given to infants and children were tea, bread, white rice and fish. Key nutrients such as iron, zinc and vitamin A were below the recommended levels except for vitamin C from the diets consumed by children aged 11-23 months. Energy and protein were considered to be adequate as more than 90% of the children received enough of these nutrients. Mean age of introduction of complementary foods was four months. Children diets were limited in fruits and vegetables that caused micronutrients of nutritional importance such as iron, zinc and vitamin A to be supplied below recommended level. Equally, fat intake was below recommended level. Nutrition education on appropriate complementary foods should be given to caregivers. Promotion of consumption of diversified diets and locally available nutrient dense foods should be emphasized so as to achieve adequate intake of nutrients to infants and young children. Keywords: ProPAN, children, nutrient adequacy, Zanzibar.
Adherence to standards of first-visit antenatal care among providers: A stratified analysis of Tanzanian facility-based survey for improving quality of antenatal care
(PLoS ONE, 2019) Bintabara, Deogratius; Nakamura, Keiko; Ntwenya, Julius; Seino, Kaoruko; Mpondo, Bonaventura C. T.
Introduction Despite the benefits of early antenatal care visits for early prevention, detection, and treatment of potential complications in pregnancy, a high level of provider adherence to first-visit antenatal care standards is needed. However, little information is available regarding provider adherence to antenatal care in Tanzania. This study was performed to assess provider adherence to first-visit antenatal care standards and to apply stratified analysis to identify associated factors in Tanzania. Methods Data from the 2014–2015 Tanzania Service Provision Assessment Survey were used in this study. Provider adherence to first-visit antenatal care standards was measured using 10 domains: client history; aspects of prior pregnancies; danger signs of the current pregnancy; physical examination; routine tests; HIV testing and counseling; maintaining a healthy pregnancy; iron/folate supplements; tetanus toxoid vaccination, and preparation for delivery. A composite score was then created in which the highest quantile (corresponding to �60.5%) considered to provider adhering to first-visit antenatal care standards. Initially, a series of unadjusted logistic regression analyses according to the type of facility and managing authority were performed separately at each level (i.e., facility, provider, and client). Thereafter, all variables with P < 0.2 were fitted into the respective stratified multivariable logistic regression analysis using a 5% significance level. Results A total of 1756 first-visit antenatal care consultations performed by 822 providers in 648 health facilities were analyzed. The overall median [Interquartile range, IQR] adherence to first-visit antenatal care was relatively low at 47.1% [35.7%–60.5%]. After adjusting for selected variables from each level in specific strata, at dispensary; female providers [AOR = 5.5; 95% CI, 1.8–16.4], at health centre; performance of quality assurance [AOR = 2.2; 95% CI, 1.3–3.9], at hospital; availability of routine tests [AOR = 2.5; 95% CI, 1.3–4.8] and basic medicine [AOR = 2.8; 95% CI, 1.4–5.7], at public facilities; availability of medicine [AOR = 1.8; 95% CI, 1.1–3.2] and receiving refresher training [AOR = 1.8; 95% CI, 1.1–3.1], and at private facility; receiving external fund from government [AOR = 3.0; 95% CI, 1.1–8.4] were significantly associated with better adherence to first-visit antenatal care standards. Conclusions The study highlighted the important factors, including the provision of refresher training, regular distribution of basic medicines, and diagnostics equipment which may influence provider adherence to first-visit ANC standards.
Adrenal insufficiency: A forgotten diagnosis in HIV/AIDS patients in developing countries
(Hindawi, 2019) Nassoro, David D; Mwakyula, Issakwisa Habakkuk; Mkhoi, Mkhoi L; Sabi, Issa; Merem, Alfred J.; Lawal, Paul S
Adrenal insufficiency (AI) is one of the most common endocrine diseases in patients with HIV/AIDS, leading to high morbidity and mortality in HIV patients who become critically ill. Various etiologies are associated with the condition, including cytomegalovirus (CMV), Mycobacterium tuberculosis, lymphoma, Kaposi’s sarcoma, and drugs such as rifampin, among others. HIV patients with advanced disease develop relative cortisol deficiency largely due to the reduction of cortisol reserve, which predisposes patients to the adrenal crisis in periods of stress or critical illness. The prevalence of AI in HIV/AIDS patients during HAART era is higher in developing than developed countries, probably due to limited access to both diagnosis and adequate treatments which increases the risk of opportunistic infections. The clinical features of functional adrenal insufficiency in HIV/AIDS patients can be masked by various infectious, noninfectious, and iatrogenic causes, which reduce clinical recognition of the condition. Development of simple screening algorithms may help clinicians reach the diagnosis when approaching these patients. In many low-income countries, most HIV patients are diagnosed with advanced disease; thus, further research is necessary to elucidate the prevalence of adrenal insufficiency in HIV/AIDS patients and the condition’s impact on mortality in this population.
Adverse childhood experiences and intimate partner violence during pregnancy and their association to postpartum depression
(Elsevier, 2018) Mahenge, Bathsheba; Stöckl, Heidi; Mizinduko, Mucho; Mazalale, Jacob; Jahn, Albrecht
Adverse childhood experiences (ACEs) and intimate partner violence (IPV) are recognized global health problems. Both ACEs and IPV have been linked to adverse physical and mental health problems for both mothers and infants. The aim of this study was to determine the prevalence of physical and/or sexual ACEs and IPV and their association to symptoms of postpartum depression among postpartum women in sub-Saharan Africa. A cross-sectional survey was conducted in three health centers in the three districts of Dar es Salaam, comprising Ilala, Kinondoni and Temeke. A total of 500 women were interviewed by two trained midwife nurses during their routine postnatal care. The women were asked about their experiences of adverse childhood experiences, intimate partner violence and symptoms of postpartum depression. Of the 500 women who were interviewed, 39.4% (n = 197) reported to have experienced physical and/or sexual ACE and 18.8% (n = 94) experienced physical and/or sexual IPV during their index pregnancy. Physical ACE (AOR 2.6, 95% CI: 1.50–4.57), sexual ACE (AOR 2.7, 95% CI: 1.35–5.41), physical IPV (AOR 5.8, 95% CI: 2.98–11.43) and Sexual IPV (AOR 5.5, 95%CI: 2.51, 12.09) were significantly associated with symptoms of postpartum depression. Four out of ten women reported to have experienced ACEs and two out of ten women reported IPV in the index pregnancy which was significantly associated with symptoms of postpartum depression. These results are alarming and call upon the attention of health workers and the community at large in prevention, screening and early intervention of ACEs, IPV and symptoms of postpartum depression.
Aetiology and predictors of early surgical outcomes of pediatric hydrocephalus at Benjamin Mkapa hospital and Muhimbili orthopaedic institute
(The University of Dodoma, 2022) Rashidi, Salim
Ventriculoperitoneal shunt surgery is the mainstay treatment modality of pediatric hydrocephalus in low and middle-income countries. This treatment is effective, but it has complications. The aim was to determine the early surgical outcomes of Ventriculoperitoneal shunt surgery and the predictors of poor outcomes. This was a prospective, hospital-based study, that included pediatric hydrocephalus patients treated with Ventriculoperitoneal shunt at Benjamin Mkapa hospital and Muhimbili orthopaedic institute from October 2021 to June 2022. Early surgical outcomes and predictors of poor outcomes of Ventriculoperitoneal shunt surgery were analysed and presented in tabular and descriptive forms. A total of 138 patients were operated on with ventriculoperitoneal shunt with a median age of 5.5 months(interquartile range 2 to 11 months). The mean time from diagnosis to surgery was 31.9±4.5. The etiologies of hydrocephalus were post infectious(49.28%) non-postinfectious (23.91%), myelomeningocele(14.49%), and hydrocephalus of prematurity(1.45%). Early surgical outcomes were hunt infection (33.3%), mechanical shunt failure(10.9%), surgical site infection(11.05%), and mortality related to ventriculoperitoneal shunt surgery (6.5%). The independent predictors of poor surgical outcomes of Ventriculoperitoneal shunt surgery were post-infectious hydrocephalus, myelomeningocele, poor nutritional status, haemoglobin level below 9g/dl and delayed time from diagnosis to surgery. Shunt infection is the main complication of Ventriculoperitoneal shunt surgery. Poor early surgical outcomes are associated with post-infectious hydrocephalus, myelomeningocele, poor nutritional status, haemoglobin level below 9g/dl, and delayed time from diagnosis to surgery. Further studies are recommended to determine the predictors of Ventriculoperitoneal shunt infection which is the most common complication of Ventriculoperitoneal shunt surgery. Alternative surgical treatment for patients with myelomeningocele, post infectious hrocephalus, hemo
Analysis of phytoconstituents of medicinal plants for the treatment (management) of type 2 diabetes mellitus (T2DM): a review
(AkiNik Publications, 2018) Raj, Resal; Awan, Mohd Tahir; Kumari, Khushaboo; Navis, Silvia
Gradual development of hyperglycemia, hyperlipideamea, insulin resistance, beta cell dysfunction, defects in GLUT4 translocation and insulin signaling receptors etc. lead to the development of type 2 diabetes mellitus, T2DM. The parallel research focuses on glucose homeostasis is gluconeogenesis/glycogenesis, absorption of glucose by gut and re-absorption of glucose by kidney etc. Different medicinal plants have different phyto-molecules which can be used for the treatment of the above said defects/metabolic syndromes. The effect of some phyto-molecules used for the treatment of T2DM can be compared with the already existing drugs and the phyto-molecules may not have side effects. Extraction and use of suitable phyto-molecules in the form of crude drugs for the treatment of the above said defects/metabolic syndromes are now on the research focus and this review analyzes the various phyto-molecules involved in the treatment of these different defects/metabolic syndromes of T2DM. Formulation of crude drug containing effective phyto-molecules from poly-herbs to activate different pathways, to treat the metabolic syndromes and to increase the health of the islet cells is the need of the hour.
Anatomical pattern of placenta and umbilical cord in relation to fetal adverse outcome in Dodoma regional referral hospital.
(The University of Dodoma, 2020) Komba, Joseph M.
Background: Placenta and umbilical cord are highly specialized organs of pregnancy which support the normal growth and development of the fetus. Any alteration in gross anatomy of the placental appearance, location, number of cotyledons, weight, thickness and circumference and umbilical cord length, entanglement, nuchal cord, cord knots, thickness, insertion and number of umbilical blood vessel may result into adverse fetal outcome such as birth weight, Apgar score and fetal status. The gross anatomy of placenta and umbilical cord are routinely not examined. Objective: The study intended to determine anatomical pattern of placenta and umbilical cord in relation to fetal adverse outcome at Dodoma Regional Referral hospital. Methodology: It was a quantitative cross-sectional study involving pregnant women admitted in labor ward. It employed simple random sampling technique by lottery method to recruit sample size of 300 term single tone pregnant women without no comorbidities. A structured questionnaire and sonoscape E2 ultrasound machine with color Doppler system were used to collect data and SPSS program version 21 was used during data entry and analysis. Result: In this study majority of participants were aged between 21-30 years with the mean age of 25.46 and the median age of 23.00 ±7.017. BMI, cord length and cord entanglement were significantly associated with fetal status (P<0.05). Also it was found that BMI, placental appearance, cord entanglement and cord length were significantly associated with Apgar score (P<0.05).Furthermore BMI, parity, number of cotyledon, placental shape and placental circumference were significantly associated with birth weight (P<0.05). Conclusion and recommendations: A study revealed that, abnormalities of the gross anatomical pattern of placenta and umbilical cord are significant contributors to fetal outcomes. So efforts prior to and during pregnancy to prevent stillbirth, low Apgar score and abnormal birth weight will be most effective in conjunction with effective monitoring interventions in pregnancy.
Antenatal care services utilization and their associated factors among postnatal women in Dodoma city, a cross-sectional study
(The University of Dodoma, 2023) Kimario, Athanasia D.
Introduction: Antenatal care is an essential component of maternal and child health services, aimed at ensuring safe pregnancy and childbirth. In 2016, the World Health Organization (WHO) updated its antenatal care guidelines to improve the quality and effectiveness of antenatal care services. Thus, the aim of this research study was to assess the utilization of antenatal care services in line with the antenatal care guidelines among postnatal women. Methods: An analytical cross-sectional study design was employed. A face-to-face data collection approach using an interviewer-administered questionnaire and the abstraction of data from the ANC card was used to collect relevant data from 426 postnatal women. Data were collected using a researcher developed questionnaire based on information from the literature and the ANC guideline of 2018. Results: Most women received education about the use of bed nets to prevent malaria during pregnancy (92.9%, n = 247) and received the Tetanus Toxoid (TT) vaccination (86.8%, n = 231) during the first trimester. Nevertheless, in the second trimester, SP medication (90.8%, n = 387) and mebendazole medication to treat or prevent parasitic infections (90.1%, n = 384) were the most prominent services given to women during the second trimester. As for the third trimester, most of the women (> 85%) received the recommended intervention services for the third trimester. The majority of the postnatal women (63.2%, n = 266) initiated ANC visits during their first trimester of gestation (less than 12 weeks). Only 6.8% (n =29) of postnatal women were able to meet the minimum of 8 contacts as recommended by the WHO. Availability of an ANC support person was associated with early initiation of ANC services (AOR = 1.726, 95% CI = 1.055-2.822, p = 0.030), whereas living more than 5 km was associated with high frequency of ANC contacts (AOR = 3.890, 95% CI = 1.168, 12.958, p = 0.027). Conclusion: Adequate utilization of antenatal care services is vital to achieving good maternal and child health outcomes in developing countries such as Tanzania. By addressing the factors identified in this study, policymakers and healthcare providers can work together to enhance and ultimately improve maternal and child health outcomes.
Antenatal corticosteroid therapy for foetal maturation in women with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania
(BioMed Central Ltd., 2016) Mooij, R.; Mwampagatwa, I. H.; Dillen, J. van; Stekelenburg, J.
Preterm birth is a major cause of neonatal mortality, especially in low and middle income countries. Antenatal corticosteroid therapy for foetal maturation could have a significant impact and therefore is often referred to as an important strategy to reduce neonatal mortality. A recently conducted large multinational trial showed that antenatal corticosteroids can have adverse effects in low income countries, but this is likely to depend on the specific setting. In our hospital preterm birth is only recognized in patients with severe maternal disease, due to physician-initiated delivery. Spontaneous preterm births are rarely seen in the hospital and often take place in the community or while on the road to a health facility. To investigate the effects of antenatal corticosteroid therapy in a rural hospital in Tanzania. A secondary analysis of a retrospective medical records study of women with severe pre-eclampsia and eclampsia performed in Ndala Hospital between July 2011 and December 2012. We used data on gestational age, birth weight, Apgar score, time between admission and birth, use of corticosteroids and maternal and foetal survival. Ethical clearance was obtained from the directorate of research and publications of the University of Dodoma. Thirty-six women with forty live foetuses were analysed. Twelve women (13 neonates) were given corticosteroids and could be compared to 24 women (27 neonates) who did not get corticosteroids. The incidence of fresh stillbirths (antenatal death) was 20 %. The 13 neonates who received corticosteroids had significantly smaller birth weight, longer interval between admission and delivery and poorer outcomes (stillbirth and neonatal death). An analysis of 24 neonates with a birth weight between 1.5 and 2.5 kg showed a trend toward better outcome in neonates who did not receive antenatal corticosteroid therapy. Small retrospective studies as these have a low level of evidence, but this study helped to gain more knowledge of local conditions affecting the effectiveness of antenatal corticosteroid therapy in our setting of a small rural hospital. Reliability of estimating gestational age, epidemiology of preterm birth, exposure to infections, foetal monitoring and quality of neonatal care are likely to influence the effect of antenatal corticosteroid therapy. Further larger prospective studies should be conducted to determine the exact preconditions of antenatal corticosteroid therapy in low-income countries. Until that time, the WHO precautions seem reasonable and audits and small observational studies like ours can help in assessing whether a specific hospital is suited for antenatal corticosteroid therapy.

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