Tanzania Journal of Health Research 2020-09-10T08:25:17+00:00 Prof John P.A. Lusingu Open Journal Systems <p class="MsoNormal" style="margin: 0in 0in 0pt;"> </p><p class="MsoNormal" style="margin: 0in 0in 0pt; text-align: justify;"><em style="mso-bidi-font-style: normal;"><span style="font-size: 10pt;" lang="EN-GB">Tanzania</span></em><em style="mso-bidi-font-style: normal;"><span style="font-size: 10pt;" lang="EN-GB"> Journal of Health Research</span></em><span style="font-size: 10pt;" lang="EN-GB"> (<em style="mso-bidi-font-style: normal;">TJHR</em>) aims to facilitate the advance of health sciences by publishing high quality research and review articles that communicate new ideas and developments in biomedical and health research. TJHR is a peer reviewed journal and is open to contributions from both the national and the international communities. </span></p><p class="MsoNormal" style="margin: 0in 0in 0pt; text-align: justify;"><span style="font-size: 10pt;" lang="EN-GB"> </span></p><p class="MsoNormal" style="margin: 0in 0in 0pt;"><em style="mso-bidi-font-style: normal;"><span style="font-size: 10pt;" lang="EN-GB">TJHR</span></em><span style="font-size: 10pt;" lang="EN-GB"> is published quarterly in January, April, July and October as an organ of the Tanzania Health Research User’s Trust Fund</span></p><p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-size: 10pt;" lang="EN-GB"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-size: 10pt;" lang="EN-GB">Other websites associated with this journal: <a title="" href="" target="_blank"></a><br /></span></p> Contributions of the lay workers in providing home-based treatment adherence support to patients with advanced HIV/AIDS disease in low-income settings: Lessons learned from the field in Tanzania and Zambia 2020-09-10T08:24:59+00:00 Godfather Dickson Kimaro Christian Bottomley Amos Kahwa Lorna Guinness Sokoine Kivuyo Victoria Simms Bernard Ngowi Duncan Chanda Shabbar Jaffar Godfrey S. Mfinanga Sayoki Mfinanga <p><strong>Introduction:</strong> In 2018, there were appropriately 20.6 million [18.2 million–23.2 million] people living with HIV in Eastern and Southern Africa, and an estimated 67% of them were on antiretroviral therapy (ART). A major challenge in the scale-up of ART services in Sub-Saharan Africa is the severe shortage of clinical staff.</p> <p><strong>Methods:</strong> We conducted a randomised trial in Tanzania and Zambia to test an innovative intervention that involved the use of lay health workers and screening for cryptococcal meningitis and tuberculosis. Here we describe the model of care with a particular focus on the trained lay worker component. Lay workers carried out home visits to patients in the intervention arm to deliver antiretroviral drugs, provide adherence counselling, and conduct simple monitoring for treatment side effects and other medical conditions. Lay workers were responsible for referring patients with conditions that might require further medical attention as well as discouraging self-referral. A total of 1999 participants were enrolled in the trial. Lay workers were recruited through public advertisements.</p> <p><strong>Results:</strong> Six lay workers were recruited in each country and trained for two weeks. Each lay worker was paid a monthly salary of US$ 487.61 in Zambia and US$ 524.61in Tanzania. They were also paid communication and transport expenses for home visits. The median number of visits per patient was 3 for Tanzania and 4 for Zambia. On average a lay worker was responsible for 72.3 patients in Tanzania and 94.5 in Zambia for 1 year. Referrals were made in 9% of the home visits and self-referral was discouraged in 64% of visits.</p> <p><strong>Conclusion:</strong> The use of paid lay workers to provide HIV/AIDS services in urban settings where there is a shortage of clinical staff may help to identify ART related side effects/adverse reactions and prevent unnecessary referrals.&nbsp;</p> 2020-09-04T14:54:50+00:00 Copyright (c) 2020 Tanzania Journal of Health Research A cross-sectional study on knowledge and implementation of the nursing process among nurses at Muhimbili National Hospital-Tanzania 2020-09-10T08:25:02+00:00 Happiness Obonyo Edith A.M. Tarimo Fatina Ramadhan Secilia Ng’weshemi Kapalata <p><strong>Background:</strong> The nursing process involves a series of actions that begin with assessing the patient, identifying problems, setting goals with expected outcomes, implementing care to achieve those goals, and finally evaluating the effectiveness of the care given. Utilization of the nursing process to guide nursing care enhances the quality of patient care and outcomes for both the patient and family members. The purpose of this study was to assess the knowledge and implementation of the nursing process among nurses working at Muhimbili National Hospital, Dar es Salaam, Tanzania.</p> <p><strong>Methods:</strong> We conducted a descriptive cross-sectional study design. A convenient sample of 102 registered nurses (RN) completed a self-administered questionnaire in April 2016. Descriptive statistics and non-parametric tests were used to assess the significance levels of associated variables.</p> <p><strong>Results:</strong> Of 102 respondents, only 16 (15.7%) had high knowledge of the nursing process. Similarly, a few (11, 10.8%) respondents had a high level of practice. The majority of RN (94, 92.2%) were aware of the role of the nurses in providing care to admitted patients. However, only a few (32, 31.4%) were aware of the purpose of the nursing process. Respondents were more likely to have high knowledge in the nursing process if they had a diploma in nursing education (95% CI 0.000-0.029, <em>p </em>&lt; 0.01). The small number of nurses in the ward and inadequate motivational strategies were reported to deprive the implementation of the nursing process.</p> <p><strong>Conclusion:</strong> Overall, low knowledge of the nursing process, understaffing and workload have contributed to the ineffective implementation of the nursing process.&nbsp; On-the-job refresher courses are a short-term strategy that may improve the nurses’ knowledge and motivation to implement the nursing process. This study underscores the need for policymakers to advocate for the employment of a sufficient number of nurses to enable implementation of the nursing process to all admitted patients.</p> 2020-09-04T15:09:01+00:00 Copyright (c) 2020 Tanzania Journal of Health Research Etiology, pattern and outcome of management of facial lacerations in Dar es Salaam, Tanzania 2020-09-10T08:25:05+00:00 Karpal Singh Sohal Jeremiah Robert Moshy <p><strong><em>Background:</em></strong> Facial laceration is amongst the commonly encountered soft tissue injury in the care of the traumatized patients, and its optimal treatment is important for minimizing subsequent complications. This study aimed at determining the etiology, pattern, and outcome of management of facial lacerations among patients attended at Muhimbili National Hospital, Tanzania.</p> <p><strong><em>Methods:</em></strong> This was a four months’ prospective study of all consecutive patients with facial lacerations who were attended in the department of oral and maxillofacial surgery of the Muhimbili National Hospital (MNH). The variables examined included socio-demographic characteristics, etiology of a facial laceration, prior management before referral to MNH, and the outcome of treatment. The data were analysed using IBM SPSS statistics for windows version 22 (Armonk, NY: IBM Corp) software.</p> <p><strong><em>Results:</em></strong> Seventy-six patients with facial lacerations were included in the study. The male to female ratio was 8:1. The age of the patients ranged from 16 to 57 years, with a mean age of 31.63 ± 10.02 years. Motor traffic crashes (51, 67.1%), violence (18, 23.7%) and falls (7, 9.2%) were the etiological factors. The commonest affected facial esthetic zones were forehead (25, 32.9%), and the upper lip (24, 31.6%). The majority (60%) of wounds that were sutured/repaired in other health facilities prior to referral to MNH had a poor approximation of wound edges. Scarring was the commonest complication.</p> <p><strong><em>Conclusion:</em></strong> Facial laceration affected males eight times more than females. Road traffic crash was the most common etiological factor. The forehead was the most frequently affected facial esthetic zone. The majority of patients treated in other health facilities prior to referral to a tertiary hospital had poorly approximated wound edges. Scarring was the most common complication of facial lacerations.</p> 2020-09-04T15:18:50+00:00 Copyright (c) Some Traits on the Outcome of the Treatment of Cervical Cancer in Tanzania: A Case Study of Ocean Road Cancer Institute (ORCI) 2020-09-10T08:25:08+00:00 Bakari L Leguma Rajabu Rocky Akarro Amina Suleiman Msengwa Francis Joseph Sichona <p><strong>Background:</strong> In Tanzania, like in many other poor African countries, cervical cancer is a major problem facing women especially for those aged 30 years and above. This study aimed at constructing a statistical model to enable the prediction of the outcome of treatment for cervical cancer patients in Tanzania.</p> <p><strong>Methods:</strong> Data were collected retrospectively from patient’s files with histological proven cervical cancer who were treated at Ocean Road Cancer Institute (ORCI) from year 2009 and followed up to year 2011. The factors considered are screening status, HIV status, disease stage, age, treatment type and the intent of the treatment. The study employed the Chi-square (χ2) test and the logistic regression model for its analysis.</p> <p><strong>Results:</strong>&nbsp; The Chi-square (χ2) test result showed that there was a significant relationship between outcome of treatment and the patient screening status, HIV status, disease stage and intent of treatment at 5% level of significance. On the other hand, the logistic regression results found patient disease stage and intent of the treatment to be statistically significant at 95 percent. Logistic regression results also showed that patients who attended ORCI when their disease at a late stage had an odds ratio of 0.128 less likely to have favorable outcomes compared to those patients who attended ORCI when their disease stage was at early stages. The odds ratio for cervical cancer patients who received both treatment, radiotherapy, and chemotherapy was 2.643 more likely to have favorable outcomes</p> <p><strong>Conclusion:</strong>&nbsp; More emphasis and campaigns should be made in order to encourage women all over the country to attend cancer centers for screening and treatment at early stages or even before any symptoms for cervical cancer and other types of cancers.</p> 2020-09-04T15:42:46+00:00 Copyright (c) Stem Cells: Prospects and Potential Applications in Tanzania: A review 2020-09-10T08:25:10+00:00 Afadhali Denis Russa <p>Stem cell technology and its application in regenerative medicine is the future gateway for the treatment of most non-communicable diseases (NCDs). As the burden of NCDs continues to rises globally, regenerating the cells, tissues and organs will be the mainstream treatment option. The world is prepared for this intriguing but promising avenue of biomedical technology and medicine but Africa is grossly lagging far behind. African governments, universities, research and health institutions need to take a leading role in empowering and mainstreaming stem cell research.&nbsp; Moreover, for Africa, there is a huge potential for translating stem cell technology into clinical treatments due to the fact that there are limited treatment options for life-threatening forms of NCDs.&nbsp; Some African countries have well-developed stem cell facilities and large-scale stem cell therapy centers. The use of adult stem cells in liver failure, diabetes and cardiac infarcts has shown success in some African countries. The present work reviews the status, potential and future prospects of stem cell technology and regenerative medicine in Tanzania with particular emphasis on the adult stem cells applicability into the immediate use inpatient care.&nbsp; The paper also reviews the available cell identification systems and markers and moral and ethical aspects of stem cell science necessary in the translational treatment regimens.&nbsp;</p> 2020-09-04T15:48:57+00:00 Copyright (c) 2020 Tanzania Journal of Health Research Ceftriaxone Prescription at Muhimbili National Hospital 2020-09-10T08:25:12+00:00 Philip Galula Sasi <p>S</p> <p><strong>Background:</strong> Since their discovery, antibiotics have contributed to a dramatic fall in morbidity and mortality from bacterial infections. However, the emergence and spread of antibiotic resistance continues to threaten the effectiveness of these agents. Ceftriaxone is one of the most important medications needed in a basic health system. Yet high levels of inappropriate use have been reported increasing the likelihood of emergence and spread of resistance.</p> <p><strong>Methods:</strong> We conducted a descriptive study to characterize ceftriaxone prescription and resistance at a tertiary hospital.</p> <p><strong>Results:</strong> Three hundred and sixty prescriptions were observed and 194 (54 %) deviated from the National Treatment guidelines with regards to indication. For patients with conditions for which ceftriaxone is recommended, 93 % (154 out of 166) prescriptions deviated from the guideline with regard to dosing frequency and 67 % deviated with regards to the duration of administration. <em>Coagulase Negative Staphylococcus (CoNS), Escherichia coli, Klebsiella spp, and Pseudomonas aeruginosa</em> were the most common isolates and with the highest ceftriaxone resistance rate (up to 80%).</p> <p><strong>Conclusions:</strong> At MNH, ceftriaxone is commonly inappropriately prescribed and the risk of emergence and spread of ceftriaxone resistant isolates may be high.&nbsp; The majority of <em>CoNS and</em> <em>Klebsiella species </em>are resistant, thus cautious ceftriaxone prescription is needed.</p> 2020-09-04T22:24:38+00:00 Copyright (c) Antimicrobial activities and phytochemical analysis of extracts from Ormocarpum trichocarpum (Taub.) and Euclea divinorum (Hiern) used as traditional medicine in Tanzania 2020-09-10T08:25:14+00:00 Mhuji Kilonzo Chrispinus Rubanza Upendo Richard Gideon Sangiwa <p><strong>Background: </strong>Medicinal plants have been of great value to human healthcare in most parts of the world for thousands of years. In Tanzania, over 12,000 species of higher plants have been reported, and about 10% are estimated to be used as medicines to treat different human health conditions. The present study aimed to determine <em>in vitro</em> antimicrobial activities and phytochemical analysis of <em>Ormocarpum trichocarpum</em> and <em>Euclea divinorum</em> which are commonly used as a traditional medicine in Tanzania.</p> <p><strong>Methods:</strong> Minimum Inhibitory Concentration (MIC) of plants extracts against tested bacterial and fungal species were determined using 96 wells microdilution method. In this method, 50 μL of nutrient and saboraud’s dextrose broth for bacteria and fungus respectively were loaded in each well followed by 50 μL of extract to make final volume of 100 μL. Subsequently 50 μL were transferred from first rows of each well to the second rows and the process was repeated down the columns to the last wells from which 50 μL were discarded. Thereafter, 50 μL of the selected bacterial and fungal suspension was added to each well thus making final volume of 100μL. The lowest concentration which showed no microbe growth was considered as MIC. The study also evaluated phytochemical compounds present in the ethyl acetate extracts from <em>O. trichocarpum</em> stem bark and <em>E. divinorum</em> root bark extract using Gas Chromatography-Mass Spectrometry (GC-MS) technique.</p> <p><strong>Results:</strong> It was revealed that 66% of the tested microbes were susceptible to plant extracts at MIC value of 0.39 mg/mL whereas 83% being susceptible to extracts at MIC value of 0.781 mg/mL. Interestingly, four out of 18 tested plant extracts exhibited high antifungal activity below that of the standard antifungal drug, fluconazole. The GC-MS analysis revealed the presence of various low molecular weight phytochemicals which belongs to six groups of secondary metabolites namely dieterpenes, alphatic hydrocarbons, tetraterpenes, sesquiterpenes, steroid and triterpenes.</p> <p><strong>Conclusion:</strong> It was concluded that the presence of various phytochemicals in the tested plant extracts may be associated with pharmacological properties of <em>O. trichocarpum</em> and <em>E. divinorum</em> and therefore justifying ethnomedical usage of such plants.</p> <p>&nbsp;</p> <p><strong>Keywords: </strong>Antibacterial, antifungal, Ormocarpum trichocarpum, Euclea divinorum</p> 2020-09-10T07:38:51+00:00 Copyright (c) Giant vulva fibroma presenting as a genital mass: a case report 2020-09-10T08:25:17+00:00 Edgar Ndaboine Dismas Matovelo Arnold Itemba Cosmas Mbulwa <p><strong>Introduction:</strong> Even though vulva fibroma is rare, it is among the solid tumors of the vulva. Its cause is unknown although it has been associated with physiological hormonal changes. We report a patient with a unique vulva fibroma which has grown to the extent of interfering with her gait and urination.</p> <p><strong>Case presentation:</strong> A 22-year-old woman presented with a genital mass which had been present for the duration of 2 years and felt embarrassed to report to the hospital early as the growth was in the genital area, with the perception of it being a sexually related illness, despite having not yet started engaging in sexual activity. On physical examination, a palpable pendulous mass of about [30 x 22] cm was seen originating from the right labia and extending to the right perineum. The mass was firm, nodulated, non-tender and had limited mobility. Surgical excision was performed under spinal anesthesia. Histologically, features suggestive of mixoid fibroma were reached after the mass was excised.&nbsp; No recurrence has been observed.</p> <p><strong>Conclusion:</strong> Clinicians should be aware of this rare disease which can be associated with recurrence if there is incomplete excision. Again, the unusual finding of the genital mass can be very embarrassing to the patient affecting her psychosocial well-being. It needs to be treated immediately upon diagnosis.</p> <p>&nbsp;</p> 2020-09-10T08:23:32+00:00 Copyright (c)