Background The abdomen is one of the most commonly injured regions in trauma patients. Abdominal injury surgeries are common in Tanzania and in many parts of the world. This study aimed to determine the relationships among the causes, characteristics, patterns and outcomes of abdominal injury patients undergoing operations at Kilimanjaro Christian Medical Centre. Methods A prospective observational study was performed over a period of 1 year from August 2016 to August 2017. A case was defined as a trauma patient with abdominal injuries admitted to the general surgery department and undergoing an operation. We assessed injury types, patterns, aetiologies and outcomes within 30 days. The outcomes were post-operative complications and mortality. Multivariate logistic regression was used to explore the association between factors associated with morbidity and mortality. Results Out of 136 patients, 115 (84.6%) were male, with a male-to-female ratio of 5.5:1. The most affected patients were in the age range of 21–40 years old, which accounted for 67 patients (49.3%), with a median age (IQR) of 31.5 (21.3–44.8) years. A majority (99 patients; 72.8%) had blunt abdominal injury, with a blunt-to-penetrating ratio of 2.7:1. The most common cause of injury was road traffic accidents (RTAs; 73 patients; 53.7%). Commonly injured organs in blunt and penetrating injuries were, respectively, the spleen (33 patients; 91.7%) and small bowel (12 patients; 46.1%). Most patients (89; 65.4%) had associated extra-abdominal injuries. Post-operative complications were observed in 57 patients (41.9%), and the mortality rate was 18 patients (13.2%). In the univariate analysis, the following were significantly associated with mortality: associated extra-abdominal injury (odds ratio (OR): 4.9; P -value< 0.039); head injury (OR: 4.4; P -value < 0.005); pelvic injury (OR: 3.9; P -value< 0.043); length of hospital stay (LOS) ≥ 7 days (OR: 4.2; P -value < 0.022); severe injury on the New Injury Severity Score (NISS) (OR: 21.7; P -value < 0.003); time > 6 h from injury to admission (OR: 4.4; P -value < 0.025); systolic BP < 90 (OR: 3.5; P -value < 0.015); and anaemia (OR: 4.7; P -value< 0.006). After adjustment, the following significantly predicted mortality: severe injury on the NISS (17 patients; 25.8%; adjusted odds ratio (aOR): 15.5, 95% CI: 1.5–160, P -value < 0.02) and time > 6 h from injury to admission (15 patients; 19.2%; aOR: 4.3, 95% CI: 1.0–18.9, P -value < 0.05). Conclusion Blunt abdominal injury was common and mostly associated with RTAs. Associated extra-abdominal injury, injury to the head or pelvis, LOS ≥ 7 days, systolic BP < 90 and anaemia were a...

Background District-level hospitals (DLHs) can play an important role in the delivery of essential surgical services for rural populations in sub-Saharan Africa if adequately prepared and supported. This article describes the protocol for the evaluation of the Scaling up Safe Surgery for District and Rural Populations in Africa (SURG-Africa) project which aims to strengthen the capacity in district-level hospitals (DLHs) in Malawi, Tanzania and Zambia to deliver safe, quality surgery. The intervention comprises a programme of quarterly supervisory visits to surgically active district-level hospitals by specialists from referral hospitals and the establishment of a mobile phone-based consultation network. The overall objective is to test and refine the model with a view to scaling up to national level. Methods This mixed-methods controlled pilot trial will test the feasibility of the proposed supervision model in making quality-assured surgery available at DLHs. Firstly, the study will conduct a quantitative assessment of surgical service delivery at district facilities, looking at hospital preparedness, capacity and productivity, and how these are affected by the intervention. Secondly, the study will monitor changes in referral patterns from DLHs to a higher level of care as a result of the intervention. Data on utilisation of the mobile based-support network will also be collected. The analysis will compare changes over time and between intervention and control hospitals. The third element of the study will involve a qualitative assessment to obtain a better understanding of the functionality of DLH surgical systems and how these have been influenced by the intervention. It will also provide further information on feasibility, impact and sustainability of the supervision model. Discussion We seek to test a model of district-level capacity building through regular supervision by specialists and mobile phone technology-supported consultations to make safe surgical services more accessible, equitable and sustainable for rural populations in the target countries. The results of this study will provide robust evidence to inform and guide local actors in the national scale-up of the supervision model. Lessons learned will be transferred to the wider region.

The Ministry of Health, Community Development, Gender, Elderly and Children is charged with improving the health and welfare of all Tanzanian citizens. In considering the high burden of disease due to surgically treatable conditions in the country, the MOHCDGEC in collaboration with partners has developed the first National Surgical, Obstetric and Anaesthesia Plan (NSOAP) 2018-2025, to address challenges in access to high quality surgical, obstetrics and anaesthesia (SOA) services in Tanzania. Access to safe, timely and affordable SOA care is limited for a significant proportion of Tanzanians especially those in rural areas. This lack of access is in large part due to human resources challenges. At present, of the recommended 20 physician surgeons, obstetricians and anaesthesiologists per 100,000 population, there are only a total of 0.46 per 1000,000 Tanzanians in the country making widespread access impossible. Additionally, there are factors such as limited access to surgical and anaesthesia equipment, supplies, medicines, blood and blood products and essential utilities like clean water, oxygen and electricity which exacerbate this situation. Strengthening the Tanzanian SOA system is imperative to reducing surgically preventable mortality and morbidity. Currently about 19.3% of deaths and 17 % of Disability-Adjusted Life Years (DALY) in Tanzania are attributable to diseases amenable to surgery. Surgical, Obstetric, and Anaesthesia services are critical in reducing the unacceptably high levels of maternal mortality, one of the key sustainable development goals, by making Caesarian sections, post-partum hemorrhage, uterine rupture, ectopic pregnancy and retained products of conception amongst other conditions safer for mothers. Surgery and anaesthesia is also essential in preventing deaths resulting from road traffic accidents, also one of the key sustainable development goals. Additionally, as outlined in the LCoGS, the economic benefits from preventing lives lost and averting disabilities from surgically treatable conditions will be substantial and promote economic development of our Country. The high costs of seeking and receiving surgical care often places patients at the risk of being impoverished as a result of seeking or receiving surgical care. Currently, about 66% of Tanzanians risk catastrophic expenditure and 86% risk impoverishing expenditure from seeking surgical care. Addressing all components of SOA access, including risk of impoverishment, is crucial to achieving Tanzania Vision 2025, the Global Sustainable Development Goals (SDGs) and Universal Health Coverage. This NSOAP lays out the necessary steps to improve each of the 6 major domains of the surgery, anaesthesia and obstetric health system: (a) service delivery, (b) infrastructure, (c) workforce, (d) information management and technology, (e) finance and (f) governance. It will be key to act synergistically across all of these health system building blocks to guarantee an impact. This NSOAP is designed to align with and complement existing ...

Inadequately controlled postoperative pain (POP) subjects individuals to complications which may be fatal or leading to prolonged hospital stay. Complications from inadequately controlled POP may alleviate the existing shortage of hospital human resource for health in health facilities in developing countries. The burden and challenges of POP management at health facilities in Tanzania is not known. This study was therefore carried out to evaluate postoperative pain management and patient satisfaction with care given at Kilimanjaro Christian Medical Centre (KCMC). This descriptive prospective hospital based study, was conducted at the Kilimanjaro Christian Medical Centre in Moshi, Tanzania from August 2011 to March 2012. POP and patients' satisfaction with pain relief scores were assessed using pain and satisfaction numerical rating scales. Pain assessment was done at 24 hours and 48 hours after operation. Satisfaction was assessed on 48 hours post surgery. All adult patient aged 18 years and above whom were operated in general surgery ward, KCMC and accepted by signing consent were involved in the study. Patients suffering from nervous system were excluded from the study. A total number of 124 patients were recruited and participated in the study. Sixty-five (52.4%) were males and 59 (47.6%) females. Mean age (SD) years 40.9 ± 15.4. The largest percentage of individuals had mild pain both at rest (45.2%) and during movement (44.4%). Patients whose analgesia was administered intravenously were more likely to be satisfied with POP management than those given intramuscular analgesics (P= 0.028). Analgesia used in combination increased significantly the proportion of pain free individuals 48 hours postoperative compared to 24 hours postoperative (P= 0.003). In conclusion, the postoperative pain management is still a challenge in our centre as nearly half of the patient had mild pain in the first 48 hours post surgery. ______________________________________________________________________________________________

No abstract