Tanzania is experiencing a serious Human Resource for Health (HRH) crisis. Shortages are 87.5% and 67% in private and public hospitals, respectively. Mal-distribution and brain drain compound the shortage. The objective of this study was to improve knowledge on the HRH status in Tanzania
IntroductionAntimicrobial prophylaxis for urologic procedures is a major issue, as potential advantages of antibiotic administration should be carefully weighed against potential side effects, microbial resistance, and health care costs. This study aimed to review a six years trend of antibiotic use in urological surgeries at Muhimbili National Hospital (MNH) being an experience in a typical third world environment.MethodsThis was a six years hospital based descriptive, retrospective study conducted of which all case notes of urological patients operated on in between January 2007 to December, 2012 were reviewed by using a structured data collecting tool. The data were analyzed using SPSS software.ResultsMale patients were the majority at 62% (450). The age range was 0 - 90 years, with a mean of 30 ± 22.09. Among the urological surgeries done at MNH 86.5% (628) received prophylactic antibiotics regardless of the type surgery done. Majority 63.7% (463) received antibiotics during induction. Ceftriaxone was the commonly given antibiotic regardless of the type of urological surgery done. Most of patients (86.4%) were given antibiotics for five days regardless whether it was for prophylactic or treatment intention.ConclusionAntibiotic use is still a challenge at our hospital with over use of prophylactic antibiotics without obvious indications. Prolonged use of prophylactic antibiotics beyond five days was the main finding. Ceftriaxone was the most given antibiotic regardless of the urological surgery done and its level of contamination. Antibiotic stewardship needs to be addressed urgently to avoid serious drug resistances leaving alone the cost implication.
Background: Fournier’s gangrene (FG) is a rapidly progressive and potentially fatal infective necrotizing fasciitis which affects the perineal and perianal regions as well as the external genitalia. This study aimed at evaluating the management of FG and its outcomes at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, TanzaniaMethods: This was a retrospective hospital based study involving case notes of all patients who had Fournier’s gangrene at KCMC from January 2003 to December 2013. Patients managed for Fournier’s gangrene and the medical records of the patients eligible for the study retrieved manually.Results: A total of 25case notes of patients treated for Fournier’s gangrene during the study period were reviewed. All were males and majority of them (60%) were ≥50 years (mean=57.4 years). Hypertension was the commonest reported risk factor (41%). Diabetes mellitus was reported as a risk factor in 20% of all patients with FG. These risk factors were mentioned as comorbid conditions in traumatic urethral catheterization and suprapubic catheterization. All patients received a combination treatment of wound debridement, antibiotics, fluid replacement, analgesics and daily wound dressing. The average hospital stay for patients with FG was about 25 days.Conclusion: Fournier’s gangrene at KCMC is exclusively a male disease affecting those above 50 years. Hypertension and diabetes mellitus were the common comorbid condition in patients with Fournier’s gangrene.
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: Hypospadias is one of the common congenital anomaly that affects children. It can present classically with abnormal ventral opening, chordee and dorsal hood however isolate hypospadias do also exist. Hypospadias repair is one of the commonly performed surgical procedures at Muhimbili National Hospital (MNH) and the outcome of repair is influenced by several factors. Our study aimed to assess the Profile and Early Outcome of Hypospadias repair at Muhimbili National Hospital. Methodology: This was a cross sectional study which involved all children with hypospadias aged ≥6 months and underwent first repair recruited by convenient sampling at Muhimbili national Hospital from March 2018 to January 2019 with a follow up of 30 days from surgery. We excluded children who had Repair before, those who underwent hypospadias repair and died within 24 hours post-operative. Mothers of each participating patient gave an informed consent. Data were collected by a standardized questionnaire and analyzed by using SPSS program version 20. Results: Sixty-three children were enrolled in the study with mean age of 3.7 years. Majority of our patient had Subcorona hypospadias with Snodgrass tubularized incised plate urethroplasty being the common surgical technique. Thirty-seven (58.7%) patients had successful hypospadias repair while 26(41.3%) had complications. The most commonly found early complications were surgical site infection, hematoma, oedema, flap necrosis, urethrocutenous fistula, urethral stricture, wound dehiscent and meatal stenosis. Age>3.5 years at repair, previous circumcised, type and duration of urine drainage< 7 days, type of dressing and changing the 1st dressing < 3 days were found to influence complications rate. Conclusion: Hypospadias is still the common pediatric urological condition with Snodgrass technique being preferred for repair. The outcome of the repair can be influence by different factors regardless of the technique of repair.
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