Renal replacement therapy (RRT) is the treatment of choice for patients with End Stage Renal disease (ESRD), RRT include dialysis and kidney transplantation. Some sub-Saharan African countries including Tanzania have improved nephrology services dialysis and kidney transplant. This study aimed to assess knowledge, attitude and practices towards kidney transplantation among patients undergoing dialysis at Muhimbili National Hospital. This was a hospital based cross-sectional study that was conducted at Muhimbili National Hospital. A total of 190 patients were interviewed, majority were males 133(70%) with the age range of 18-80 years. Most patients 183(96.35%) were aware of Kidney transplantation the main source of information 175(95.6%) being hospital with 159 (86.9%) patients being aware of rules guiding kidney transplantation and 166 (90.7%) were aware of lifelong medication use after kidney transplantation. Knowledge on transplant was noted in 115(62.8%) with all of them being willing to receive kidney from blood related relatives. Majority 188 (64.5%) patients were not sure whether live kidney donation was better than deceased kidney donation. Better knowledge may ultimately translate into the act of donation. Effective measures should be taken to educate people with relevant information with the involvement of media, doctors and religious scholars. Large proportion considers Kidney Transplant positively but it limited by shortage of donors.
Background; Early child cognitive development is important throughout one’s life span. It is estimated that more than 200 million children under five years of age fail to achieve full cognitive development in the world and 80% of them are in south Asia and sub-Sahara-Africa. Genetic and environmental factors play a role in early child development (ECD). Most of the ECD occurs in the first 2years of life, but largely during infancy. Malnutrition, poverty and poor health care to children have been found to have association with poor cognitive development and create a vicious cycle of poverty. This study gives the proportion and factors that are associated with infants’ cognitive developmental delay in our setting. Knowing these factors enhance early intervention to break the viscious cycle.This study aimed to determine the proportion and factors associated with cognitive developmental delay among infants attending RCH clinics in Dar es Salaam. Patients/ Material and Methods; This was a health facility based descriptive cross-sectional study conducted by using a structured data collecting tool done in three health centers in Dar es Salaam from July to December 2012. A two- stage sampling technique and Lottery were used to get the health centers. The data were analyzed using SPSS software by Pearson’s chi-square, Fisher exact test and logistic regressions. Results; A total of 350 infants were assessed for cognitive development in a period of six months. Male infants were the majority by 50.6%. Our study Participants aged 1to 12 months with a mean (SD) of 7.26 (3.43) months with their birth weight ranging from 1.3 to 4.6kg with mean (SD) of 3.11(0.50) kg. The Proportion of infants with cognitive developmental delay was 12.3%. Age of the child, caretakers and wasting were significantly associated with cognitive developmental delays even after adjusting for confounders. Infants aged less than 6months were 14 times more likely to have cognitive developmental delay compared to those aged six months and above (adjusted oddis ratio{aOR=14; 95%CI 5.3-38.3, P<0.001}). Infants cared by assistant caretakers especially during day-time, were 12 times more likely to have cognitive developmental delay compared to infants who stayed with their mothers (aOR=12.1; 95%CI 3.0-53, P=0.001). Wasted infants were 4 times more likely to have cognitive developmental delay (aOR=3.9; 95%CI 1.1-13.3, P=0.032) compared to infants with good nutritional status. Conclusion; The proportion of cognitive developmental delay among infants attending Reproductive and Child Health( RCH) clinics in Dar es Salaam was 12.3%. Young age of the child, use of other caretakers in absence of the mother, and wasting were associated with cognitive developmental delays. Infants need Mothers to spend time with them and prevention of malnutrition plays a role in cognitive development.
Chronic kidney disease (CKD) is increasingly diagnosed and thus more patients are in need of hemodialysis (HD) to sustain their life. The quality of vascular access for HD should be suitable for repeated puncture and allow a fast blood flow rate for high-efficiency dialysis with minimal complications. Our study aimed to document local experience and early outcomes after arteriovenous fistula (AVF) creation for hemodialysis access including complications related to AVF creation.This was a hospital based clinical audit in which case notes of patients who had undergone AVF creation between May, 2017 and March, 2018 at Muhimbili National Hospital (MNH) were reviewed using a structured data collection tool. Information regarding preoperative assessment for AVF creation, outcome of AVF, and age of the patients were collected. Descriptive statistics were prepared and summarized as tables. A total of 57 case notes of patients who underwent AVF creation for HD access with males contributing majority of patients (77.2%) were reviewed. The predominant age group was 41 to 60 years of age (56.2%) with mean age 47 years and age range of 18 -69 years. Three patients had procedure abandoned on the table due to sclerotic vein. The functional maturation rate was found to be 64.9% and post AVF complications in 15 patients (26.3%). Recorded post AVF creation complications were fistula stenosis/revision (27.8%), bleeding/haematoma (22.2%), limb oedema (22.2%), aneurysm (11.1%), surgical site infection [SSI] (11.1%) and thrombus formation (5.6%).AVF creation for HD access is common at MNH with a functional maturation rate of 64.9%, which is an acceptable rate. The preoperative vascular assessment in this survey was mainly found to be physical examination while preoperative vascular imaging was not commonly done to assess suitability of veins and arteries for AVF creation although post AVF complications are relatively few.
Background: Diabetic Kidney Disease is a complication of Diabetes Mellitus (DM) following the natural history of diabetes. Worldwide up to 40 % of patients with diabetes mellitus will develop Diabetic Kidney Disease. Kidney Disease Outcome Quality Initiative (KDOQI) guidelines recommends monitoring for proteinuria, blood sugar, renal functions and blood pressure in the patients with DM so that progression to complications including renal failure is prevented. Our study aimed to audit on effective monitoring of progressive chronic kidney disease among patients attending diabetic clinic at Muhimbili National Hospital. Material and methods: This was a retrospective clinical audit which included patients who attended diabetic clinic at Muhimbili National Hospital in 1st January 2017 to 31st December 2017. Simple random sampling technique using software called OpenEpi Random Program was used to get the sample of 120 patients. Patients with missing clinical notes were excluded from the audit. Records of the clinical notes, socio-demographic characteristics and investigations of the selected patients were retrieved from the Jeeva system and recorded using a structured questionnaire. We analyzed our data using Statistical Package for Social Sciences (SPSS) version 20.0 Results: One hundred and fourteen DM patents records were reviewed. Around 79% of the patients involved in the study were aged above 45years, 60% were females. Majority had type 2 DM (76.3%). Minority i.e. 15/114 (13.2%) of the patients had their urine for protein checked in the year 2017 as well as serum creatinine in the last 3months. Seven percent had HbA1c test done i.e. 8/114 (7%). Blood pressure was monitored in 72.8% (83/114) of the patients. Only16 out of 66 patients (24.2%) had blood pressure controlled. Majority of the patients 10/15 (66.7%) who had renal functions records had normal eGFR. Findings on monitoring for proteinuria, renal functions, control of HbA1c and Blood pressure control were all below audit standards. Conclusion: Our study found that there is generally poor monitoring of diabetic outpatient for progressive chronic kidney disease when compared to the KDOQI standards which calls the health care providers to adhere on set SOPs according to the guidelines available aiming at improving services and quality of life to diabetic patient.
patients in 2 cases. There was no significant relationship between nonfollow up with location of residence, maternal literacy, number of siblings, and gender of neonate. Conclusions: Postnatal follow-up rate in neonates with a history of fetal hydronephrosis after one month of birth is incomplete despite education at birthtime. Postnatal ultrasound should be performed at the time the baby is discharged from the hospital.
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