The East African health research journal最新文献

Background: Anastomotic leakage is among the most common complications after bowel resection and primary anastomosis, causing considerable morbidity and mortality. As a result it tends to affect the quality of life and increase burden to the patients and caretakers. This study focused on the assessment of the predictors and outcome of anastomotic leakage among patients who underwent large bowel surgery that involved resection and primary anastomosis.

Methodology: Hospital based prospective observational study at Muhimbili National Hospital. Data of the patients who underwent colorectal resection and primary anastomosis were collected by using a structured questionnaire. Consecutive recruitment sampling technique was applied to get the required sample size and followed for 30 days. Subjects' information including age, sex, perioperative information was documented and analyzed by using Statistical Package for the Social Sciences (SPSS) version 23 software.

Results: The study included 141 participants. Among those operated, 23 (16.3%) developed anastomotic leakage with a mortality rate of 30.4%. Predictors which were statistically significantly associated with anastomotic leakage were hypertension, body mass index > 30kg/m², history of radiation therapy, female sex, high American Society of Anesthesiologists (ASA) grade III-IV score and peritonitis. Increased length of hospital stay, re-admission and re-operation rate together with high mortality are among the outcomes of anastomotic leakage found in this study. No loss to follow up event occurred.

Conclusion: Anastomotic leakage remains a considerable problem among patients undergoing large bowel surgery at Muhimbili National Hospital. From the study site, factors such as peritonitis, HIV/AIDS, hypertension, history of radiation, obesity, high ASA score (III-IV) and female sex were found to be independent predictors of anastomotic leakage. Optimization of co-morbidities conditions before surgery, choosing best surgical option such as creating temporary stoma versus primary anastomosis in dirty wound may help to reduce the rate of anastomotic leakage.

Background: About one-fifth of women undergo repeated caesarean section (RCS) deliveries worldwide. However, an increase in the number of RCS may lead to maternal and foetal morbidity and mortality. This study aimed to determine the rates of RCS deliveries and associated maternal and foetal complications at a tertiary hospital in northern Tanzania.

Methods: This was a hospital-based cross-sectional study conducted at Kilimanjaro Christian Medical Centre (KCMC), Northern Tanzania. A total of 253 women who underwent caesarean section (CS) deliveries during the study period were included. Information from patient files was reviewed to abstract specific variables of interest, including maternal demographic and obstetric characteristics, maternal complications such as adhesions, postpartum haemorrhage, infections, anaesthetic complications, hysterectomy, and maternal deaths. Foetal complications related to RCS were also extracted, including the Apgar score, admission to the neonatal unit, neonatal infections, respiratory problems, and perinatal death.

Result: A total of 253 women were enrolled in this study. Of these, 133 (52.5%) had RCS delivery. The mean (± standard deviation) age of women at enrolment was 29.9 (±6.5) years. The overall complications rate was 56.5% (32.9% among women having first CS and 67.1% RCS, P<.001). For women who underwent RCS, 37.2% had anaesthesia-related complications, including hypotension, nausea, bradycardia, difficult intubation, aspiration, and respiration. Other complications were sepsis (15%), postpartum haemorrhage (PPH) (11.9%), and wound dehiscence (5.5%). Only sepsis was independently associated with repeated CS delivery (adjusted odds ratio (aOR=11.3, 95% confidence interval [CI], 3.3 to 8.9; P<.001).

Conclusion: The reported RCS in this study was high, associated with high CS complications. Necessary measures should be taken by healthcare providers to avoid unnecessary primary CS delivery, and counselling for trial of labour with close monitoring of labour for successful vaginal birth after caesarean section should be emphasised to avoid RCS and its complications.

Background: Lack or inadequate implementation and enforcement of legal frameworks for accessing and benefit sharing arising from the use of traditional and indigenous knowledge is associated with sub-optimal exploitation of traditional medicine knowledge and related research outputs in many African countries.

Objectives: This study assessed the practice of protecting the rights of holders of traditional medicine knowledge, and identified challenges in regulating, registering and protecting traditional medicine based services, processes and products in Tanzania.

Methods: Practice of protecting the rights of holders of traditional medicine knowledge in Tanzania was assessed through interviews with 12 knowledge holders and practitioners of traditional medicines, and 12 key informants from national regulatory authorities, and research and high learning institutions involved in traditional medicine research and development in Tanzania.

Results: Absence of frameworks for accessing and benefit sharing arising from the use of tradition medicine knowledge, mistrust and inadequate knowledge on procedures for protection of traditional medicine based intellectual property hampers the practice of protecting the rights of holders of traditional medicine knowledge in Tanzania. Costly and bureaucratic procedures are among the challenges encountered by knowledge holders and practitioners of tradition medicine in registration of their traditional medicine products and practices. Poor network relationship between holders of traditional medicine knowledge and research community slow down the progress of traditional medicine research and development. Lack of guidelines for regulation of traditional medicine research may be the result of overlapping roles of the National Institute for Medical Research and the Council of Traditional and Alternative Medicine.

Conclusion: In Tanzania, the environment for protecting the rights of holders of traditional medicine knowledge is suboptimal. To stimulate exploitation of traditional medicine for economic growth, there is a need to develop and implement national and institutional frameworks for accessing and benefit sharing arising from the use of traditional knowledge.

Background: Child disability is a significant public health concern which impacts 1 in 20 children. Children with disabilities (CwDs) encounter deprivation of rights, biases in society, and a lack of access to necessary services, all of which are exacerbated by structural obstacles. This study assessed the coverage of child disability prevention, management and rehabilitation services in four districts of Central Uganda after two years of interventions to improve these services.

Methods: The Lot Quality Assurance Sampling (LQAS) rapid health facility assessment method was employed to assess coverage of services based on sixteen indicators. The indicators were set based on constructs of: provision of disability-related services to CwDs; use of rehabilitation services; readiness of the health facilities (HFs) to provide basic disability management and rehabilitation services; community structures for linkage to disability management and rehabilitation services; psychosocial support provision; and upholding and protecting the rights of CwDs. A district-level decision rule was set based on 80% coverage target.

Results: Despite the interventions, the services have yet to provide the desired level of benefit to CwDs and their caregivers. Out of the sixteen indicators for healthcare service coverage for CwDs, only three attained the 80% coverage target.

Conclusion: The findings suggest that greater focus by health service planners and project implementers is still needed, especially at the community and health facility levels to enhance the prevention, management and rehabilitation of CwDs. Psychosocial health services for caregivers of CwDs need special attention in order to achieve better service approaches.

Background: Delayed Developmental Milestones is a physical disability affecting the child development, occurs when the child fails to attain normal milestones compared to other children. Globally, 180-200 million infants have signs of developmental delay, and 86% are from developing countries. In Dar es Salaam, proportion of children with cognitive delay is 12.3%.

Objectives: This study explored the experiences and challenges of mothers in caring for infants with delayed developmental milestones.

Methods: In-depth interviews with ten mothers explored their experiences and identified challenges they encountered while caring for infants with delayed developmental milestones. NVIVO plus software was used for content analysis.

Results: Results showed that parents raising infants with delayed developmental milestones had negative experiences on the cause and types of delayed milestones. They lost hope. They were facing different challenges like lack of specialists, conflict in marriage and stigma.

Conclusion: Mothers of infants with delayed developmental milestones had negative experiences about this problem and they face many challenges in caring the infants.

Background: Decision-making is the cognitive process that results in the selection of a course of action from several possible alternative options. The complexity of nurses' decisions requires a broad knowledge base and access to reliable sources of information; as well as a supportive working environment therefore requiring that decision making be evidence based with robust knowledge translation platforms to disseminate the evidence. This review aimed to assess interventions for enhancing the use of evidence-based decision making for quality care among nurses.

Methods: This study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis review (PRISMA 2020) checklist. This study protocol was registered with PROSPERO number CRD42021262318.

Results: The search revealed a total of 143 papers divided as follows: PubMed- 65 papers, CINAHL 25 papers and Cochrane 53 papers. In addition, references of included studies were scanned manually for potential papers and another 46 papers extracted. A total of 133 papers were chosen for detailed extraction following removal of 10 duplicate studies.

Conclusion: Results of this review revealed that the interventions that have been used to enhance the use of evidence for decision making are majorly educational. A few interventions have taken the form of modelling, guidelines and programming. Online solutions have also been seen to enhance the use of evidence for clinical practice of nurses.

Background: Cervical cancer is the fourth most common cause of death among women of reproductive age (15-49 years). In Tanzania, cervical cancer is the first cause of mortality and morbidity among females with cancers. The disease impact is highly associated with a lack of adequate knowledge and a negative attitude toward cervical cancer screening among healthcare workers (HCWs).This study aimed to assess knowledge and attitude toward cervical cancer screening among female students as future HCWs from allied health colleges in the Shinyanga region.

Method: Descriptive cross-sectional study data was collected from 420 students in allied health colleges using a self-administered questionnaire. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 22, Likert, and brooms cut-off points. The association between cervical cancer screening and the independent variables on knowledge, attitude, and other related factors was established by using logistic regression, and the Odds Ratio (OR) of greater than one, 95% confidence interval, and a P-value of <.05 was statistically significant.

Results: Two-thirds of the respondents 276 (65.7%) had low knowledge, while only 34 (8.1%) had very good knowledge of cervical cancer and screening. Most of the respondents 298 (70.1%) had a favorable attitude toward cervical cancer screening. Only 52 (12.1%) had ever screened for cervical cancer. Logistic regression showed odds at 2.37 (95% CI, 1.30-4.31, p=.005) of taking the cervical screening test to students with the correct knowledge and positive attitude to cervical screening at 1.42 (95% CI, 0.32-6.29, p=.647).

Conclusion: The study showed there is low knowledge of cervical cancer screening among female students in health and allied colleges, despite a favorable attitude toward the practice of screening. A well-integrated approach to providing comprehensive and practical aspects of cervical cancer screening during formal training in the curriculum for female students should be adopted to increase their knowledge and positive attitude toward screening.

Ruptured parasitic dermoid cyst is one of the rare conditions that results from auto-amputation and re-implantation following torsion from the ovary and omentum, among other sites. Due to trauma to the abdomen, it may rupture, resulting in spillage of its contents and causing chemical peritonitis. The diagnosis is based on clinical presentation complimented by abdominal ultrasound in low resource settings. A case of a 44-year-old (Iraqw by tribe) who presented with clinical features of acute generalized abdominal pain and distension for two days following blunt abdominal trauma. The abdominal ultrasound revealed a mass of mixed echogenicity with intraperitoneal free fluid. She underwent laparotomy, revealing ruptured parasitic dermoid cyst adhered to the anterior abdominal wall and urinary bladder, then excised. The high degree of suspicion of ruptured parasitic dermoid cyst is justified in adult patient with chemical peritonitis manifestation. The laparotomy is surgical management of choice in low-resource settings followed by prolonged follow-up.

Background: The human immunodeficiency virus (HIV) prevalence among transport workers in sub-Saharan Africa remains high, estimated at as high as 9.9% in western Uganda compared with the national prevalence of 5.4%. The prevalence of HIV among transport workers has been partly attributed to the level of knowledge regarding HIV prevention, perceived HIV risk, and stigma. Accordingly, these have been linked to high-risk HIV transmission behaviours that increase the chances of acquiring HIV among adults. Therefore, this study investigated the predictors of HIV knowledge, perceived HIV risk, and stigma among transport workers in Mbarara city in southwestern Uganda.

Methods: The survey was conducted between November 2021 and February 2022 among transport workers (motorcycle taxi riders, motor vehicles taxi, and truck drivers), aged 18 to 55 years. Face-to-face interviews using a semi-structured questionnaire were conducted with the study's participants. Chi-square and binary multivariate logistic regression statistics were used to assess the predictors of knowledge about HIV prevention, HIV perceived risk, and stigma.

Results: Out of 420 participants, 69.3%, 75.4%, and 62% had good knowledge of HIV prevention, a high perceived HIV risk, and stigma, respectively. Predictors of knowledge of HIV prevention comprised education level (AOR=2.28, 95% CI=1.36-3.84), knowing HIV status (AOR=0.47, 95% CI=0.27-0.81), and perceived HIV risk (AOR=3.04, 95% CI=1.74-5.32). Whereas the determinants of perceived HIV risk included education level (AOR=1.34, 95% CI=1.34-4.24), knowing HIV status (AOR=0.26, 95% CI=0.15-0.48), HIV knowledge (AOR=2.38, 95% CI=1.36-4.178), and perceived stigma (AOR=0.47, 95% CI=0.24-0.89). Last, the predictors of perceived HIV stigma included perceived HIV risk (AOR=0.41, 95% CI=0.21-.791), and knowledge of HIV prevention (AOR=0.29, 95% CI=0.16-0.54).

Conclusions: The study found a high proportion of participants with good knowledge about HIV prevention, a high HIV perceived risk, and HIV-related stigma. In addition, this study suggests that the level of education and awareness of one's HIV status positively influences HIV knowledge and perceived risk. Whereas HIV-related stigma was in turn negatively influenced by the transport workers' HIV knowledge and perceived risk. This calls for multifaceted approaches at individual, group (interpersonal), and community levels to reduce HIV stigma among this study group. Incorporating continuous health education programs about HIV and encouraging HIV testing among transport workers remains critical.