The East African health research journal最新文献

Background: Pelvic peritonitis is a rarely reported pathological condition in literature and emergency laparotomies are a common surgical procedure performed for these conditions in developing countries. This study was designed to investigate factors that are associated with short-term surgical outcomes among women with pelvic peritonitis.

Methods: The study included retrospective and prospective data obtained between November 2021 and May 2022 from Bugando Medical Centre (BMC). Standardized data collection tool was used to capture clinical, surgical and laboratory data. Descriptive data analysis was done using STATA version 13.

Results: A total of 101 participants were recruited; 22 prospectively and 79 retrospectively. The median age was 29[Interquartile range (IQR) 24 to 35] years. Majority (76.2%) of participants were referred patients. Obstetric related peritonitis 82.2% (83/101) was the most frequently detected with a necrotic and or dehiscent lower uterine segment (LUS) that necessitated a subtotal abdominal hysterectomy (STAH) being the commonest (40.8%) intraoperative finding. Postoperative complications were reported in 36.7% (36/98) and were significantly associated with pulse rates >100b/min (P=.041) and platelets <150 × 10³ mm³ (P=.049). The median length of hospital stay was 19[IQR: 7 to 35] days and temperature >37.5°C (aOR=5.08, 95% CI 1.23-20.97, P=.025) independently predicted prolonged hospital stay. Death occurred in 9.2% of patients and having ASA score of 5 (P=.045) was associated with death. Multi-drug resistant (MDR) gram-negative bacteria (85.2%) were the predominant pathogens causing pelvic peritonitis.

Conclusion: A significant proportion of patients with pelvic peritonitis and deranged sepsis markers develop short-term surgical complications with a significant number of those with fever stay more than 14 days. There is a need of timely complete sepsis work up of the patients with pelvic peritonitis to ensure appropriate management is instituted to prevent associated morbidity and mortality.

Background: Chest trauma is a major cause of morbidity and mortality in the region. Lacking data in our environment has been a challenging part of knowing the burden of the problem. Long hospital stays and associated injuries are an essential measure of morbidity. The study results will provide a basis for planning prevention strategies and establishment of treatment protocols.

Objectives: To determine the prevalence, pattern, and management outcomes of chest injury patients at Kilimanjaro Christian Medical Center (KCMC), a Tertiary Hospital in Northern zone Tanzania from October 2021 to April 2022.

Methodology: A hospital-based cross-sectional study was conducted among patients with chest injuries who were admitted and managed at Tertiary Hospital Northern Zone (Kilimanjaro Christian Medical Center-KCMC) in the Emergency medicine and General Surgery departments. Using a designated data collection tool, details of the mechanism of injury, radiological and laboratory investigations, management, and outcomes were recorded.

Results: A total of 114 chest injury patients were studied. Males outnumbered females by a ratio of 7.14:1. Their ages ranged from 2 to 83 years (mean = 36.18 years). The Majority of patients (95.58%) sustained blunt injuries. Road traffic crush was the most common cause of injuries affecting 65.79% of patients. Lung contusion, hemothorax, and rib fractures were the most common type of injuries accounting for 54.4%, 27.2%, and 21.1%, respectively. Associated injuries were noted in 85.7% of patients, and head injury (60.5%) was found in most patients. The Majority of patients (60.5%) were treated successfully with a non-operative approach. Underwater seal drainage was performed at (38.9%). One Patient (0.9%) underwent a thoracotomy. 14% of patients had complications of surgical site infection, and 69% were found in the Majority of patients. The median length of hospital stay was 4.5 days. The mortality rate was 21.

Conclusion: Motor traffic crash was the principal cause of chest trauma. Young male patients were most affected by chest trauma and the majority of patients were treated conservatively. Chest X-ray remains to be the main imaging modality for diagnosing thoracic trauma lesions. Associated injuries such as head injuries, were found to contribute to a high mortality rate.

Background: Chronic kidney diseases (CKD), Type 2 Diabetes Mellitus (T2DM) and cardiovascular diseases (CVDs) are the recent worldwide late age chronic conditions that could be a consequence of renal glycosuria during childhood. This study aimed at determining the extent of glycosuria in secondary school students to obtain information that could be predictive of the situation in late age life of Tanzanians living in Mkuranga District.

Methodology: This was school-based cross-sectional study that was conducted in assenting and consenting 800 students from July to October 2019 in Mkuranga district, Pwani-Tanzania. Socio-demographic information was collected using well-structured questionnaires while weight and height were measured using beam balance and tape measure, respectively. Dipstick strip was used to determine urine glucose on clean catch mid-stream urine collected specimens.

Results: From a total of 800 enrolled students, 0.6% (5/800) had glycosuria from whom 80% were males and 20% (1/5) were females (p = 0.37). The proportion of glycosuric males was 4 folds higher than that found in females. While height, body mass index (BMI) and waist-hip circumference ratio were associated with renal glycosuria (p < 0.05), other factors showed no association (p > 0.05).

Conclusion: Despite the low proportion (0.6%) of glycosuria in this study, the contribution of young age renal glycosuria to old age CKD, T2DM and CVDs cannot be ruled out with males being more prone than females. Thus, it signals for consideration of regular screening for glycosuria in the school health programmes as an intervention strategy to prevent potential late age chronic disease complications.

Background: Day-case tonsillectomy is becoming popular with varying patients' satisfaction. Whether day-case or overnight tonsillectomy is safe and preferred by patients has been debatable among otorhinolaryngologists. To date, majority of otorhinolaryngologists in Tanzania are practicing overnight tonsillectomy unlike what is being practiced in other parts of the world. There is scarce literature regarding whether day-case or overnight surgical option is preferred by patients.

Objective: To assess the time preferred by patients to undergo surgery by ascertaining the proportion of patients who would prefer day-case to overnight tonsillectomy or adenotonsillectomy.

Methods: We conducted a hospital based cross sectional study at Ekenywa Specialised Hospital from January to December 2021. The study recruited 200 patients who underwent elective tonsillectomy or adenotonsillectomy. A structured questionnaire adopted from previously published studies and thereafter modified accordingly to fit the current study was used to collect relevant data. Data were analysed using Statistical Package for Social Sciences (SPSS) version 21.

Results: The study had more male participants 104(52%) than females, 96 (48%) with a male to female ratio of 1.1:1. Majority of the study participants were aged below 5 years. Male participants aged below 5 years accounted for 50% while females aged <5 years accounted for 65.6%. Of the 200 (100%) patients who returned the questionnaires, 135(67.5%) preferred discharge on the 1^st day post surgery while 65 (32.5%) preferred discharge on the 2^nd postoperative day or later. Similarly, five (2.5%) would have wished day-case tonsillectomy/adenotonsillectomy while 195(97.5%) preferred an overnight surgery. Patients with postoperative pyrexia, older patients and those discharged on the 2^nd day post surgery or later were more likely to prefer a longer postoperative hospital stay.

Conclusion: Day-case surgery seems feasible due to less risk of postoperative complications such as haemorrhage and fever. Majority of the participants in this study preferred overnight tonsillectomy/adenotonsillectomy.

Background: Viral infections such as Human cytomegalovirus (HCMV), Rubella virus (RV) and Herpes simplex virus-2(HSV-2) are implicated in causing adverse pregnancy outcomes with limited data from Africa. Here we report the magnitude of these viruses among women with unfavorable pregnancy outcomes (WUP) in Mwanza, Tanzania.

Methods: A cross sectional study involving 198 WUP was conducted between March and June 2019 in Mwanza. Enzyme linked immunosorbent assay was used to detect HCMV and RV IgM and IgG antibodies while immunochromatographic test was used to detect HSV-2 IgM and IgG antibodies. Data were analyzed by using STATA version13.0.

Results: The median age of enrolled women was 28(IQR, 24-34) years. Of these 194(98%) were HCMV IgG seropositive while only 2(2.1%) were IgM seropositive. Out of 180 women tested for RV, 175(96.7%) were IgG seropositive while only 1(1.2%) was RV IgM seropositive. Regarding HSV2; out of the 146 women tested, 21(14.4%) were seropositive for HSV2 IgG, and only 3(2.1%) were HSV-2 IgM seropositive. Having primary education (p=.046) and being married (p=.035) were significantly associated with HSV-2 IgG seropositivity.

Conclusion: A substantial proportion of WUP have markers of viral infections for potential pathogens that might be associated with unfavorable pregnancy outcomes necessitating further studies to establish causal effect relationship.

Background: Early sexual debut among adolescents' results in sexual and reproductive health consequences including unplanned pregnancies, pregnancy complications and sexually transmitted diseases.

Objective: This study investigated the factors influencing early sexual debut among 13-19 years old students in secondary schools in Kiambu County, Kenya.

Methodology: A descriptive cross-sectional study was carried out in two secondary schools in Kiambu County. A sample of 208 was calculated using Fischer's two stage formula and proportionately distributed per school population size. Students in each school were stratified into classes and respondents were selected by simple random sampling from each stratum. Responses were sought using self-administered questionnaires.

Results: Among the respondents 11(66.5%), 48(28.7%) and 8(4.8%) were aged 13-15, below 13 and above 15 years, respectively. Eighty-four (50.2%) respondents were male, 105(62.9%) lived with both parents while 41(24.6%) lived with mothers. Early sexual debut was (60.5%), being higher in males, 57 (67.9 %) compared to females, 44 (39.6 %). More than half of the respondents, 117(69.6%), thought sex before marriage was appropriate, among whom 75(64.1%), have had sex. Most of those who reported sexual debut, 69.9%, said that sexual encounter happened during school breaks. Reasons for refraining included fear of guardian (49.4%) and fear of HIV/AIDS 89(52.7%). However, more than two thirds, 71(70.3%) of those who feared HIV/AIDS and STI as a consequence of early sexual debut have had sex. Gender (P=.032), knowledge on sex (P=.025), use of mobile phones (P=.019), peer pressure (P=.046) and poverty (P =.037) were significantly associated with early sexual debut.

Conclusion: A significant proportion of secondary school adolescents were engaged in early sexual debut. Thus, public health interventions should consider the broader determinants of early sexual debut, including the ecological factors in which the behavior occurs.

Background: Obesity and the associated non-communicable diseases contribute significantly to the disease burden in Tanzania. Obesity can be attributed to the consumption of Sugar Sweetened Beverages (SSB) due to their high sugar content that leads to high caloric intakes. This study estimates the effect of SSB tax on the prevalence of obesity.

Methods: A mathematical model that compares the reference population which is unchanged and a counterfactual population in which tax intervention has been introduced is developed. Changes in price and consumption of SSBs, and subsequent changes in energy intake are applied to estimate the body mass change by age groups. The change in body mass by age groups is merged with the reference population to estimate changes in body mass index and obesity.

Results: Imposing a 20% SSB tax in Tanzania is estimated to reduce the average overall energy intake by 76.1 kJ per person per day. This change is associated with an overall reduction of prevalence of obesity by 6.6%; and by 12.9% and 5.2% in adult males and adult females, respectively. The number of obese people will potentially decrease by about 47,000 among adult males and about 85,000 among adult females from the current levels.

Conclusions: The SSB tax is a potential strategy to complement efforts to reduce obesity prevalence in Tanzania. The revenue generated from the tax should be channelled towards public health promotion programs.