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Item Spirulina (Arthrospira fusiformis, Gomont 1892) as a high-quality feed ingredient for Nile Tilapia Fingerlings(African Journals Online (AJOL), 2023) Michael, Angelina; Kyewalyanga, Margareth S.; Lugomela, Charles V.A partially randomized experimental design was conducted to evaluate the effect and potential of spirulina species (Arthrospira fusiformis) isolated from Momela Lakes, Tanzania, on the growth, antioxidant capacity, feed utilization, and body composition of Nile tilapia fingerlings. Five dietary treatments were formulated, including spirulina meal at 5%, 10%, and 15% of the total diets, as well as control diets with freshwater shrimp or Lake Victoria sardine. The protein content of the experimental diets was 25, 28, and 35% for a treatment containing spirulina at 5, 10, and 15% inclusion, respectively, while the control diets had 35% crude protein each. After eight weeks of feeding, fish fed with a lower inclusion level of spirulina showed the best growth performance and feed utilization efficiency, similar to the fish fed with control diets. The group fed with 5% spirulina exhibited excellent protein efficiency ratio compared to all other fish groups. All spirulina-fed fish groups demonstrated higher protein deposition and strong antioxidant activity against free radicals compared to those fed with control diets. In conclusion, spirulina proves to be a superior feed ingredient for high-quality Nile tilapia farming, providing comparable results to control feeds.Item Morphostructure, paleostress and kinematics of the southern kilombero rift basin, southern Tanzania(Elsevier BV, 2024) Keraka, Godfrey R.; Macheyeki, Athanas S.; Shaban, M.In recent years, there has been exploration for hydrocarbons in the Kilombero rift basin. However, detailed information regarding the structural pattern and kinematics within the basin, as well as the border fault has not been established. Structures play a crucial role in determining the presence of gas/and oil in a reservoir, making them vital in assessing hydrocarbon resources. Specifically, understanding whether the basin, its border fault (s) and intrabasinal faults are seismically active or not is essential in evaluating the potential for hydrocarbon re serves in a given area. This study therefore, focuses on conducting a morphostructural and paleostress analysis of the southern Kilombero rift to establish important fault parameters, including the current rift kinematics. In the morphostructural analysis, we find that the southern Kilombero rift border fault is a nearly 100 km long segmented structure characterized by an escarpment height of approximately 1300 m. Additionally, analysis of about 40 fault/extensional fracture surfaces indicates that the border fault, which is believed to be from the Early Pliocene period (around 5 ± 1 million years ago) and trending about 042◦/222◦ (NE-SW), is under pure extensional stresses characterized by horizontal minimum principal stress axis (Shmin) of about 060◦, implying that faults trending 330◦/150◦ (NW-SE) are the ones associated with this extensional direction. However, a computed stress tensor from focal mechanisms show Shmin = 112◦ (ESE-WNW) meaning that NNE-SSW trending faults (i.e. 022◦/202◦) are currently active. Presence of these two pure extensional regime (with minor compression component) imply that the stress regime has either rotated through 52◦ in a clockwise direction from Shmin = 60◦ to Shmin = 112◦ in the Quaternary or that this latter extensional direction computed from seismic data represents a local/temporary tectonic phenomenon caused by changing far-field stresses. The stress tensors derived from our modeling efforts shed light on the regional stress conditions within the southern segment of the East African Rift System (EARS), to which our study area belongs. These revelations collectively suggest a transitional evolution of the geomorphology within the southern Kilombero rift basin, with a shift from a half graben configuration towards a full graben-horst-full graben system. This structural transformation en hances the basin’s potential as a viable candidate for hydrocarbon accumulation. Strike-slip faults are also present but are not significant.Item Impact of distance and/or travel time on healthcare service access in rural and remote areas: A scoping review(Elsevier BV, 2024) Mseke, E.P.; Jessup, B.; Barnett, T.Introduction People living in rural and remote communities often have to travel long distances to access healthcare services. However, the complex relationship between distance and/or travel time and healthcare service access remains unclear. This scoping review of the literature aimed to further understand the nuances between distance and/or travel time and rural and remote residents’ access to healthcare services in developed countries. Methods A review of published research papers from OECD countries cited in five databases (PubMed, PsycINFO, Medline, CINAHL and Scopus) between 1993 and mid-2023. Results From a total of 1418 articles identified, 135 met study inclusion criteria. One hundred and thirteen (83.7%) studies showed evidence of distance and/or travel time decay. Distance and/or travel time decay occurred at a distance as short as 16.1 km or 30 min, and as great as 90–100 km or 60 min. Studies showed that rural and remote residents travel further and longer to access specialist rather than generalist health services. Conclusions Distance and travel time are important considerations for rural and remote residents of OECD countries when accessing healthcare services. Travel time may be a more meaningful measure than distance when assessing healthcare access decisions in non-metropolitan populations. Further well-designed research is needed to better understand under what circumstances rural and remote people will travel for healthcare services.Item 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 SamwelPurpose: 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.Item Healthcare managers' managerial competency in enabling and managing changes: evidence from primary healthcare managers in Tanzania(Sapientiae, 2024) Kingu, Ukende A.; Ismail, Ismail J.; Kibusi, Stephen M.This research article examined the primary healthcare managers' managerial competency in enabling and managing changes. The study was conducted in Tanzania. This study used a cross-sectional research approach. A census sampling approach was used to gather data from one hundred and two healthcare managers. Utilizing SPSS version 25, statistical product and service solutions were used to analyze the data that had been gathered. Results show that, about the indicators within the preparation for change, implementation of change, evaluation of change, and leadership qualities concerning lead changes constructs, respectively, (73.53%), (65.69%), and (76.47%) of the healthcare managers are competent, and (26.47%), (34.31%), and (23.53%) are less competent. The study concludes that primary healthcare managers in Tanzania have shown both levels of competence and less competent practices in facilitating and managing changes.Item Development of a rapid and highly sensitive nucleic acid-based diagnostic test for schistosomes, leveraging on identical multi-repeat sequences(Frontiers Media SA, 2024) Ally, Ombeni; Kanoi, Bernard N.; Kamath, Shwetha; Shiluli, Clement; Ndombi, Eric M.; Odiere, Maurice; Misinzo, Gerald; Nyanjom, Steven Ger; Kumar, Chunduri Kiran; Ochola, Lucy; Lolabattu, Srinivasa Raju; Gitaka, JesseIntroduction: Schistosomiasis(Bilharzia), a neglected tropical disease caused by Schistosoma parasites, afflicts over 240 million people globally, disproportionately impacting Sub-Saharan Africa. Current diagnostic tests, despite their utility, suffer from limitations like low sensitivity. Polymerase chain reaction (PCR) and quantitative real-time PCR (qPCR) remain the most common and sensitive nucleic acid amplification tests. Still, the sensitivity of nucleic acid amplification tests is significantly affected by the copy number of amplification targets, resulting in underestimation of true Schistosoma infections, especially in low transmission settings. Additionally, lengthy qPCR run times pose challenges when dealing with large sample volumes and limited resources. In this study, the identical multi-repeat sequences (IMRS) were used as a novel approach to enhance the sensitivity of nucleic acid-based Bilharzia diagnosis. Methods: To identify novel genomic repeat regions, we utilized the IMRS algorithm, with modifications to enable larger target region (100-200bp) identification instead of smaller sequences (18-30bp). These regions enabled customised primer-probe design to suit requirements for qPCR assay. To lower the qPCR amplification times, the assay was conducted using fast cycling condition. Regression analysis, and qPCR data visualization was conducted using Python programming. Results: Using Schistosoma mansoni and S. haematobium, we found that IMRS based qPCR, employing genus-specific primers and TaqMan probes, offer exceptional analytical sensitivity, detecting as little as a single genome copy per microliter within 36 minutes. Discussion: The lowest concentration of DNA detected using IMRS-based PCR and qPCR represented tenfold improvement over conventional PCR. As part of further development, there is a need to compare IMRS-based qPCR against other qPCR methods for Schistosoma spp. Nonetheless, IMRS-based diagnostics promise a significant advancement in bilharzia diagnosis, particularly in low transmission settings, potentially facilitating more effective control and treatment strategies.Item Predictors of microvascular complications in patients with type 2 diabetes mellitus at regional referral hospitals in the central zone, Tanzania: a cross-sectional study(Springer Science and Business Media LLC, 2024) Shillah, Wilfred B.; Yahaya James J.; Morgan, Emmanuel D.; Bintabara, DeogratiusMicrovascular complications encompass a group of diseases which result from long-standing chronic effect of diabetes mellitus (DM). We aimed to determine the prevalence of microvascular complications and associated risk factors among patients with type 2 diabetes mellitus (T2DM). A cross-sectional analytical hospital-based study was conducted at Singida and Dodoma regional referral hospitals in Tanzania from December 2021 to September 2022. A total of 422 patients with T2DM were included in the analysis by determining the prevalence of microvascular complications and their predictors using multivariable logistic regression analysis. A two-tailed p value less than 0.05 was considered statistically significant. The prevalence of microvascular complications was 57.6% (n = 243) and diabetic retinopathy was the most common microvascular complication which accounted for 21.1% (n = 89). Having irregular physical activity (AOR = 7.27, 95% CI = 2.98–17.71, p < 0.001), never having physical activity (AOR = 2.38, 95% CI = 1.4–4.01, p = 0.013), being hypertensive (AOR = 5.0, 95% CI = 2.14–11.68, p = 0.030), having T2DM for more than 5 years (AOR = 2.74, 95% CI = 1.42–5.26, p = 0.025), being obese (AOR = 2.63, 95% CI = 1.22–5.68, p = 0.010), and taking anti-diabetic drugs irregularly (AOR = 1.94, 95% CI = 0.15–0.77, p < 0.001) were the predictors of microvascular complications. This study has revealed a significant proportion of microvascular complications in a cohort of patients with T2DM. Lack of regular physical activity, being obese, taking anti-diabetic drugs irregularly, presence of hypertension, and long-standing duration of the disease, were significantly associated with microvascular complications.Item Prevalence, medication adherence, and determinants of type 2 diabetes mellitus during Coronavirus Disease 2019 pandemic among adults in Tanzania(SAGE Publications, 2024) Yustus, Isaack M; Millanzi, Walter C; Herman, Patricia ZIntroduction: Excessive consumption of comfort foods, which are mostly high in carbs, and limitations on outdoor and gym-based physical activities, for instance, are associated with foods high in the glycemic index and raise the risk of obesity and type 2 diabetes. In pandemic and or epidemic situations, peoples’ lifestyles may change significantly to lead them to non-communicable diseases. However, lifestyle changes and the occurrence of type 2 diabetes mellitus during the Coronavirus Disease 2019 pandemic among adults have not been well established in Tanzania. This study assessed the prevalence, medication adherence, and determinants of type 2 diabetes mellitus among adults in the country. Methods: A community-based analytical cross-sectional study was conducted in Dodoma region, Tanzania between September and October 2020 of which 107 adults aged above 18 years were studied regardless of whether they were newly diagnosed with type 2 diabetes mellitus or not using a quantitative research approach. Interviewer-administered lifestyle habits and medication adherence structured questionnaires benchmarked from previous studies served as the main tools of data collection. The statistical package for social sciences computer program was used to analyze the data descriptively for frequencies and percentages and by regression analysis model to determine the association between variables with a 95% confidence interval and 5% significance level. Results: With a mean age of 31 ± 2.527 years, 59.8% of the respondents were female. 60.7% and 11.7% of the respondents had unhealthy and moderate lifestyle choices respectively. The prevalence of type 2 diabetes mellitus accounted for 63.9% of the respondents of which 44.6% were diagnostically confirmed during the Coronavirus Disease 2019 pandemic against 19.3% of respondents who were diagnosed before the pandemic. Medication adherence among the type 2 diabetes mellitus respondents accounted for 77.9% of the study respondents. Type 2 diabetes mellitus was significantly associated with being in the 36–55 age group (AOR = 1.054; 95% CI: 0.292, 3.162; p < 0.05); being female (AOR = 1.398; 95% CI: 0.205, 3.048; p < 0.05); having a job (AOR = 2.597; 95% CI: 1.243, 4.402, p < 0.05); and having unhealthy lifestyle habits (AOR = 3.301; 95% CI: 1.199, 6.52; p < 0.05). Conclusion: The majority of adults had type 2 diabetes mellitus of which most of them were confirmed to have the disease during the Coronavirus Disease 2019 pandemic. Few type 2 diabetes mellitus adults did not adhere to their medications as recommended. Their sociodemographic characteristics profiles and unhealthy lifestyles significantly led them to have the problem. The treatment of the disease above and health promotion activities may need to take unhealthy lifestyle choices and certain sociodemographic profiles of adults into consideration to assist in preventing the problem.Item An integrative review of home care recommendations for women after caesarean section(Wiley, 2024) Mdoe, Mwajuma Bakari; Mselle, Lilian Teddy; Kibusi, Stephen MathewAim To describe home-based care and practices recommended for mothers after caesarean section (CS), existing in the literature. Design Systematic review. Methods This integrative literature review was conducted by using Google Scholar, PubMed and Hinari databases from its inception to June 2021. The search included research articles, protocols and guidelines that describe home care practice after CS and assessed for their quality. Synthesis of recommendations from the included literature was classified based on the type of study design, and the review was guided by methodology registered in Prospero (ID CRD42021276905). Results A total of 681 literatures were found, and 12 met the criteria. Recommended home care components were divided into four major categories; wound care practice (wound cleaning, drying and bandage change); nutrition (high-protein diet, vitamin C, fibre and balanced diet); exercise (pelvic floor muscle, walking and breathing exercise) and hygiene (bathing and wearing clean clothes). There was limited literature addressing the components of perineal care and home environment. Varying recommendations were found regarding wound cleaning and dressing in the studies done in low- and high-income countries.Item Intimate partner violence influences modern family planning use among married women in Tanzania: cross-sectional study(Springer Science and Business Media LLC, 2024) Baritwa, Mrimi S.; Joho, Angelina A.Background Married women who experience intimate partner violence (IPV) are less likely to negotiate with their partners on modern family planning (FP) use. This study aimed to determine the influence of intimate partner violence and sociodemographics on modern family planning use. Methods A community-based cross-sectional study was conducted in the Mara region, Tanzania from April to July 2020. A total of 366 married women were interviewed. Data were collected using a structured interviewer-administered questionnaire. Analysis was done using SPSS version 25, and a binary logistic regression model was used to determine the predictors of modern FP use. The significance level was set at a p-value less than 0.05. Results The overall prevalence of IPV was 73% with 54.1% physical, 36.3% psychological, and 25.4%, sexual violence. The prevalence of modern FP use was 62%, and the most (49.1%) common method practiced by married women was injection (Depo Provera). Physical violence (AOR = 0.32, p = 0.0056), and psychological violence (AOR = 0.22, p = 0.0022) had significantly reduced odds of modern FP use. Religion (AOR = 4.6, p = 0.0085), and availability of preferred modern FP methods (AOR = 9.27, p < 0.0001) had significantly increased odds of modern FP use. Conclusion In this study, there is a positive association between the use of modern FP methods and IPV. To prevent IPV and its negative health consequences, it is crucial to involve community leaders and primary healthcare workers. They can help in identifying the best strategies to prevent IPV and promote the use of modern FP methods. It is equally important to involve male partners in reproductive health decisions, including the use of modern FP methods. This approach will help reduce reproductive coercion.Item Healthcare managers' managerial competency in enabling and managing changes: evidence from primary healthcare managers in Tanzania(2024) Kingu, Ukende A.; Ismail, Ismail J.; Kibusi, Stephen M.This research article examined the primary healthcare managers' managerial competency in enabling and managing changes. The study was conducted in Tanzania. This study used a cross-sectional research approach. A census sampling approach was used to gather data from one hundred and two healthcare managers. Utilizing SPSS version 25, statistical product and service solutions were used to analyze the data that had been gathered. Results show that, about the indicators within the preparation for change, implementation of change, evaluation of change, and leadership qualities concerning lead changes constructs, respectively,(73.53%),(65.69%), and (76.47%) of the healthcare managers are competent, and (26.47%),(34.31%), and (23.53%) are less competent. The study concludes that primary healthcare managers in Tanzania have shown both levels of competence and less competent practices in facilitating and managing changes.Item Angiographic characteristics of coronary artery disease in patients undergoing diagnostic coronary angiography at a tertiary hospital in Tanzania(Springer Science and Business Media LLC, 2024) Meda, John R.; Kusima, Happiness L.; Magitta, Ng’weina F.Background Coronary artery disease (CAD) is an important cause of global burden of disease. There is a paucity of data on the burden and risk factors for CAD in sub-Saharan Africa (SSA), despite the rising trends in the shared risk factors across regions. The recent introduction of cardiac catheterization laboratory services in SSA could shed light on the burden of CAD in the region. We aimed to assess the angiographic characteristics among patients undergoing diagnostic coronary angiography (CAG) at a single tertiary care hospital in Tanzania. Methods This study was a retrospective chart review. A total of 728 patients ≥ 18 years of age who underwent CAG from January 2020 to December 2022 were recruited into the study. Basic demographic variables, risk factors and clinical characteristics including CAG findings were obtained from the registry. In addition, CAG images were retrieved for assessment of angiographic features. The luminal vessel stenosis was assessed based on eyeballing and the degree of obstruction was agreed by two independent and experienced cardiologists. The coronary stenosis of ≥ 50% was considered significant for obstructive CAD. The study was approved by the local ethics committee. Results Of patients who were recruited into the study, 384 (52.23%) were female. The study participants had a mean age of 59.46 ± 10.83 standard deviation (SD) and mean body mass index (BMI) of 31.18 kg/m2. The prevalence of CAD of any degree was estimated at 24.43% (34.18% in male, 15.50% in female), while that of obstructive CAD was 18.27%. Forty six percent of those with obstructive CAD had multiple vessel disease (MVD). Nearly 77% of patients were found to have ≥ 50–70% luminal stenosis and while those with ≥ 70% luminal coronary artery stenosis constituted 56.65%. Right coronary artery (RCA) was the most commonly affected vessel, accounting for 36.84% when any vessel disease or 56% when single vessel disease were considered. Being 65 years or older and comorbidity with type 2 diabetes (T2D) were independent risk factors for developing CAD. Conclusion There is a high prevalence of obstructive CAD among patients undergoing diagnostic CAG in Tanzania, with male gender preponderance and increasingly higher in older age, often with severe disease. A large, prospective study is needed to provide epidemiological and clinical data for developing a locally-relevant cardio-preventive strategy for CAD intervention in Tanzania.Item Prevalence of and factors associated with uncontrolled hypertension among patients with early chronic kidney disease attending tertiary hospitals in Dodoma, Tanzania: a cross-sectional study(BMJ, 2023) Katatwire, Denis D; Meremo, AlfredObjective To determine the prevalence of uncontrolled hypertension and its associated factors among patients with early chronic kidney disease (CKD) attending medical outpatient clinics at tertiary hospitals in Dodoma, Tanzania. Design Cross-sectional study. Setting Two tertiary hospitals in Dodoma, Tanzania. Participants The participants in this study were adult patients (≥18 years) with early CKD stages (1, 2 and 3) who were attending nephrology and medical outpatient clinics from November 2020 to March 2021. Patients who had been attending the clinic for at least 3 months, had baseline clinical data on their files, had estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2 and who provided written informed consent were eligible. A total of 352 patients were enrolled, of whom 182 were men and 170 were women. Outcome measure The dependent variable was uncontrolled hypertension among patients with early CKD, based on blood pressure measurements. Results The prevalence of hypertension was 58.5% (206 of 352) and the prevalence of uncontrolled hypertension was 58.3% (120 of 206). Among patients with uncontrolled hypertension, 88.3% (106 of 120) had CKD stage 3, 80.2% (96 of 120) reported non-adherence to antihypertensives, 76.7% (92 of 120) were overweight or obese, 72.5% (87 of 120) reported current alcohol use and 26.7% (32 of 120) had diabetes mellitus. Factors that contributed to higher odds of uncontrolled hypertension were: age ≥50 years (OR=5.17, 95 % CI 2.37 to 13.33, p=0.001), alcohol use (OR=11.21, 95% CI 3.83 to 32.84, p=0.001), non-adherence to antihypertensives (OR=10.19, 95% CI 4.22 to 24.61, p=0.001), overweight/obesity (OR=6.28, 95% CI 2.54 to 15.53, p=0.001) and CKD stage 3 (OR=3.52, 95% CI 1.32 to 9.42, p=0.012). Conclusion Uncontrolled hypertension was highly prevalent among patients with early CKD in this setting and was associated with age, current alcohol use, non-adherence to antihypertensives, overweight/obesity and declining eGFR.Item Depressive symptoms among adolescents in six sub-Saharan African countries: A pooled analysis of associated factors(Elsevier BV, 2023) Partap, Uttara; Nyundo, Azan; Manu, Adom; Regan, Mathilda; Ismail, Abbas; Chukwu, Angela; Dessie, Yadeta; Njau, Tasiana; Kaaya, Sylvia F.; Fawzi, Wafaie W.There is a need to identify risk factors, including nutrition-related factors, for depressive disorders among sub- Saharan African (SSA) adolescents. We examined the association of multiple measures with depressive symptoms among adolescents living across six SSA countries. Building on previous analyses, we used data from a cross-sectional study conducted from 2015 to 2017 among adolescents aged 10–19 years in six SSA countries (N = 7512). Depressive symptoms were defined as highest tertile of the 6-item Kutcher Adolescent Depression Scale score. Using mixed-effects Poisson regression models, we pooled data across sites and examined the association of sociodemographic, nutrition, and other indices with depressive symptoms. We additionally assessed effect modification by sex, age, and school-going status. We observed higher risk of depressive symptoms among girls (adjusted risk ratio [RR]: 1.29, 95 % confidence interval [95 % CI]: 1.05–1.58, P = 0.016), older adolescents (RR for 18–19 years: 1.59, 95 % CI: 1.44–1.76, P < 0.001), and adolescents experiencing bullying (RR: 1.43, 95 % CI: 1.26–1.62, P < 0.001) or violence (RR: 1.34, 95 % CI: 1.24–1.45, P < 0.001). Adolescents experiencing food insecurity also had a higher risk of depressive symptoms (RR: 1.90, 95 % CI: 1.64–2.19, P < 0.001) along with those consuming ≥ 5 servings of fruit and vegetables per day (RR: 1.18, 95 % CI: 1.03–1.34, P = 0.015); conversely, those who consumed grains, roots and tubers in the past day were at decreased risk (RR: 0.73, 95 % CI: 0.69–0.77, P < 0.001). There was no strong evidence of effect modification of associations. This study reinforces the potential role of multiple sociodemographic and nutrition-related measures on risk of depressive symptoms in these populations.Item Acute soft head syndrome in a teenager with sickle cell anemia: A case report(Wiley, 2023) Ng'weina F. Magitta; Francisca B. Komanya; Baraka O. Alphonce; Mbelwa D. Bitesigilwe; Emmanuel M. Sindato; John R. MedaASHS is a rare complication of SCD, invariably occurring near puberty with hitherto elusive pathogenic mechanisms. ASHS often resolves spontaneously on conservative management, however, lack of awareness in the context of limited access to brain imaging could pose diagnostic challenges resulting in inappropriate management and untoward outcome. We present a case of a teenager who presented with subtle symptoms for which the diagnosis of sickle cell anemia (SCA) was delayed until he developed ASHS. LTM was a 16 years old boy with a history of recurrent joints pain since the age of 6 years, with a family history of SCA, but had initial negative sickling test. He presented with episodes of multiple joints pain, unprovoked scalp and left orbital swelling, low-grade fever and mild headache without any evidence for bleeding diathesis. The diagnosis of SCA was confirmed by hemoglobin electrophoresis. Computed tomography (CT) scan of the head revealed subgaleal heamatoma (SGH) and intraorbital haematoma without intracranial hemorrhage (ICH). He was managed conservatively with analgesics and hydration together with antibiotics for associated sepsis with complete resolution of clinical symptoms within 2 weeks. This case represents a rare scenario for a relatively mild SCA phenotype presenting with ASHS whose diagnosis poses an enigma in the resource-limited contex. It is therefore, prudent to recognize ASHS to avoid judicious interventions which could potentially result in untoward clinical outcome.Item Aneurysmal bone cyst of the mandible: a rare case report and literature review(Ovid Technologies (Wolters Kluwer Health), 2023) Yahaya, James J.; Morgan, Emmanuel D.; Abraham, Zephania S.; Othieno, EmmanuelIntroduction and importance: Aneurysmal bone cysts (ABCs) are benign, non-neoplastic cystic lesions composed of multiple blood-filled cavities, which are separated by connective tissue septa and they constitute ~6 and 1.5% of all cases of the skull and jaws lesions, respectively. Case presentation: Herein, the case of an 80-year-old male with a histologically confirmed diagnosis of ABC involving the body of the left mandible was presented. The patient underwent partial mandiblectomy after confirmation of the diagnosis using orthopantomography, a computed tomography scan, and a tissue biopsy. The patient was free from pain after 1-year of follow-up, and the control orthopantomography showed no evidence of recurrence. This was followed by reconstruction of the healed part of the bone with titanium plates and a piece of bone from the lateral two-thirds of the left femur and thereafter he was cosmetically well. Clinical discussion: Patients with ABCs present with expansile and radiolucent bone lesions, which may be associated with displacement and loss of teeth due to alveolar bone erosion. Complete excision of the lesions is mandatory for the prevention of recurrence and increased morbidity. Conclusion: ABCs that involve the jaws are extremely rare and are more likely to pose a diagnostic challenge as they are more likely to be confused clinically with other expansile radiolucent bone lesions such as ameloblastoma, osteoblastoma, and giant cell tumor among many others. Also, those with extensive bone matrix formation may sometimes be confused histologically with other bone forming tumors including osteosarcoma. Recurrence is common but it can be avoided or minimized by complete resection of the lesion.Item 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, HafidhBackground: 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.Item Caregivers’ Experiences Regarding Antibiotic Usage in Treating Children’s Upper Respiratory Tract Infections in Southern Tanzania(East African Health Research Commission, 2023) Mahega, Paulo; Kahingab, Aveline Aloyce; Abrahama, Zephania SaitabauIntroduction: Upper respiratory tract infections(URTIs) are common illnesses, especially in children and account globally for a substantial proportion of consultations with family doctors. The objective of this study was to assess knowledge, attitude and practice of caretakers regarding antibiotic usage in treating URTIs in Southern Tanzania Methods: A cross-sectional hospital-based study was conducted at Iringa Regional Referral Hospital in Southern Tanzania from March to June 2022 involving 300 caregivers. Data was analyzed using Statistical Package for Social Sciences(SPSS) version 23. Results: About two-thirds(71.7%) of the caregivers had poor knowledge regarding antibiotic usage in treating children’s URTIs. In this study, 96.7% of the caregivers correctly identified amoxicillin as the most prescribed medication for treatment of children’s URTIs. However, about two-thirds(65.0 %) of the parents were aware of the antibiotic resistance that could be caused by misuse of antibiotics. In this study 50.7% of the respondents had poor attitude while 49.3% had good attitude regarding antibiotic usage in treating children’s URTIs. Similarly, 53% of the respondents thought local medications are better than antibiotics in treatment of URTIs. Regarding practices, 75.3% of the respondents used to complete the dose of antibiotics when prescribed for treatment of URTIs and 69.7% used to treat their children at home when having URTIs. A significant association was found between the majority of the socio-demographic characteristics of the respondents and the level of knowledge. Similarly, there was a statistically significant association between knowledge and attitude of caregivers pertaining to antibiotic usage in treating children’s URTIs. Conclusions: There is lack of knowledge among caregivers regarding antibiotic usage for treating children’s URTIs at the regional hospital and also more than half of the caregivers had poor attitude towards antibiotic usage. Therefore, caregiver’s educational interventions should be implemented through health promotions and educational campaigns that should be mainly conducted by medical doctors since they were reported by the caregivers to be the commonest source of information.Item 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 SaitabauBackground: 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.Item 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 SamwelPurpose 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