East and Central African Journal of Surgery

Celebrating 25 Years of Transformative Impact In Surgery Through The College of Surgeons of East, Central And Southern Africa (COSECSA)

Abebe Bekele — 2024-09-15

As we approach December 2024, we mark a significant milestone in the history of the College of Surgeons of East, Central, and Southern Africa (COSECSA) – its 25th anniversary. It is with immense pride and heartfelt congratulations that we, the East and Central African Journal of Surgery (ECAJS), celebrate this landmark achievement with our esteemed College.

Thyroid abscess in a postpartum woman with subclinical hyperthyroidism: A Case Report

Kizito Mulamba Changachanga Kabongo — 2024-09-13

Thyroid abscess is a rare condition, and acute suppurative thyroiditis (AST) accounts for <1% of all thyroid diseases. It is a potentially fatal infection. The risk factors include pre-existing thyroid disorders, immunosuppression, and neck procedures. Staphylococcus aureus is the most common causative organism.

The case report aims to demonstrate the rarity of a huge thyroid abscess caused by Serratia odorifera in a postpartum woman.

A 42-year-old female with no known comorbidity but a 2-year history of an un-investigated thyroid mass and 1 month postpartum presented with 3 weeks of a painful anterior neck mass. She had no clinical features of hyperthyroidism although the thyroid hormone levels were consistent with subclinical hyperthyroidism. The thyroid abscess was confirmed by ultrasound scan. It was managed with appropriate antibiotics, ultrasound-guided needle aspiration, and surgical drainage with a good outcome.

We present a rare case of thyroid abscess caused by Serratia odorifera in a postpartum woman with subclinical hyperthyroidism. For a huge thyroid abscess, we recommend incision and drainage, and a minimum of two weeks of appropriate antibiotics.

Indications and Outcome of Patients Managed with Tube Thoracostomy at AIC Litein Hospital: A Prospective Case Series

Wycklife Ooko Owuor — 2024-09-13

Background

Tube thoracostomy (TT) allows for the drainage of air or fluid from the pleural space. We aimed to describe the indications, management, and outcomes of patients managed with TT at AIC Litein Hospital in Southwestern Kenya.

Methods

This prospective study was undertaken between November 2020 and August 2022. All consecutive patients with TT were included. Data were collected on demographics, presentation, indications for TT, management, and outcome. Ethical approval was obtained from the Institutional Ethics and Research Committee.

Results

The study included 39 (33 male, 6 female) patients who had a mean age of 35 years (range 3-75) and 45 TTs placed for a median duration of 6 days (1-26). Hemopneumothorax (n=19), empyema thoracis (n=8), and pneumothorax (n=7) were the most common indications for TT. Trauma was noted in 28 cases presenting as assault (n=17), road traffic collision (n=8), fall (n=1), and barotrauma (n=1). Preadmission traumatic injuries led to four deaths, while fourteen (35.9%) patients developed TT-related complications, with three requiring TT replacement.

Conclusions

In this series, TT was mainly indicated for hemopneumothorax, empyema thoracis, and pneumothorax.

An Assessment of Progress and Challenges in the Implementation of the National Surgical, Obstetric, and Anesthesia Plan (NSOAP) in Tanzania

Augustino M Hellar — 2024-09-13

Introduction

There are significant disparities in access to safe and affordable surgery, particularly in LMICs. National Surgical Obstetric and Anesthesia Plans (NSOAPs) emerged as crucial national policy frameworks to address this gap. Although some Sub-Saharan African countries have developed and launched NSOAPs, there is limited information on evaluation of the progress and effectiveness of these plans. This study aimed to assess progress and challenges in implementing Tanzania’s NSOAP.

Methodology

We sent an electronic survey to all 26 Regional Health Management Teams (RHMTs) in mainland Tanzania to record their insights and understanding of the NSOAP and the state of Surgical Obstetric and Anesthesia (SOA). The RHMTs are key stakeholders in the NSOAP implementation as they oversee day-to-day implementation of all health interventions at the regional level.

Results

Only 4% of the surveyed RHMTs reported participating in the NSOAP development process, and 58% were unaware of the policy. The WHO Surgical Safety Checklist was rarely used, and surgical outreach programs were non-existent. There were gaps in the availability of SOA equipment and lack of radiological, intensive care and biomedical services. SOA specialists were few (1.96 specialists per 100,000 population). Most regions were excluded during the NSOAP dissemination meetings with no dedicated NSOAP coordinators at the regional level.

Conclusion

The NSOAP implementation faced various challenges in service delivery, infrastructure, equipment, human resources, information management and governance. Although slow progress has been made, there is a need for concerted efforts to achieve the NSOAP objectives. Future research should focus on comprehensive NSOAP evaluation and the establishment of an effective monitoring and evaluation framework.

Limb Amputations at A Rural Tertiary Hospital: Evaluating Patient Characteristics, Risk Factors for Mortality, and Functional Outcomes

Danny M. Araka — 2024-09-13

Introduction

Amputation is the surgical removal of a body part. Trauma, infections, and non-communicable diseases are among indications of amputations, but changing trends have been highlighted in various regions. We aimed to describe the experience of limb amputations at our hospital to highlight patient characteristics, risk factors for mortality, and functional outcomes.

Methods

The study was a descriptive, retrospective case series of all patients who underwent limb amputation from January 1st 2018 to December 31st 2019. Patient data, including demographics, details of presentation, laboratory values, comorbidities, operations, and outcomes, were extracted from the electronic medical record. The primary outcomes were postoperative function and mortality. Comparison by risk factors for mortality was performed.

Results

154 patients underwent amputation. 121 (78.5%) were lower limb amputations. The average age was 52.2 years. Average duration of illness was 120 days. 93 (60.4%) patients were men. 82 (53.9%) had at least one comorbidity. Trauma was an indication for 57 (37%) patients and 74 (48%) had arterial disease. Diabetes was the most common comorbidity (N=62; 40%). The in-hospital mortality rate was 10.4% (N=16). Patients with a presenting diagnosis of diabetes had increased mortality when compared to those without diabetes (19.2% vs. 5.9%; p=0.01). For the functional outcome, 59 (47.2%) were ambulant on crutches and 27 (21.6%) were using a wheelchair.

Conclusions

Trauma and vascular disease frequently contributes to the need for amputation in our region. Diabetes was present in one third of the patients, and was a significant risk factor for mortality. Recognition of the impact of medical comorbidities is warranted given these findings.

Revision Knee Arthroplasties Done at Muhimbili Orthopaedic Institute, Tanzania, between 2007 and 2018

Allen Obadia Kisanga — 2024-09-13

Introduction

There has been a steady rise in the need for Revision Total Knee Arthroplasty (RTKA) due to increasing longevity and expanding indications of primary TKA. Worldwide revision rates vary between 4.9-7.9%. However, in the sub-Saharan African region, revision total knee arthroplasty has rarely been studied.

Broad Objective

To determine the rate and indications for RTKAs in primary TKA surgeries operated at MOI between 2007 and 2018.

Methodology

This was a retrospective study. Revision TKA surgery data was collected from the TKA registry. Univariate analysis and descriptive statistics were used for analysis and presentation of categorical and continuous data. Statistical significance was determined in all relevant associations.

Results

Out a total of 607 primary TKA procedures recorded, 40 required revision, with a mean age of 69.1 years, a female predominance (60%) and a left knee predominance (62.5%), giving a revision rate of 6.59%. The causes of revision TKA included aseptic loosening (47.5%) and periprosthetic infections (32.5%). Both femoral and tibial components were revised in 50% of the surgeries. The mean duration from primary surgery until revision surgery was 4.1 years. Prosthesis infection was associated with early revision surgery (p value 0.008) but most patients had late revision TKA surgery (p value 0.02).

Conclusion

The rate of revision TKA at MOI was similar to worldwide rates. Most revisions were done late (after 2 years), and the predominant cause of revision was aseptic loosening, but infection was positively associated with early revision.

Molecular Subtypes of Receptor-defined Breast Cancer from Nakuru, Kenya

Samuel Wanjara — 2021-09-15

Introduction

The incidence of breast cancer in Sub-Saharan-Africa (SSA) is rising. Expression of hormone receptors and molecular-subtyping is paramount in rationalizing prognosis and therapy. There exists significant variation in molecular status of breast cancer in SSA. We aimed to describe the receptor status and molecular subtypes of breast cancer at our centre.

Methods

We conducted a retrospective study on patients with breast cancer enrolling for oncological care at our centre beginning May 2018 to December 2021.

Results

We included 345 patients with a median age of 49 years, 331 female and 14 males. The most common histological variant was invasive-ductal -carcinoma of no-special-type from both biopsy (84.3%) and mastectomy specimens (82.8%). DCIS accounted for only 2.9%. ER positive tumours accounted for 62.8% from biopsy and 66.7% from mastectomy specimens. The majority of the female patients had luminal-type disease (Luminal A or B) with 65.2% from biopsy specimens and 67.3% from mastectomy specimens. About 20% had TNBC.

Conclusion

Breast cancer patients from Nakuru, Kenya, are likely to be young and with luminal-subtype invasive ductal carcinoma. In contrast to some previous reports, less than a quarter of our patients have TNBC. We recommend prioritization, standardization and scaling of receptor testing and molecular-subtyping to optimize treatment protocols and personalized management strategies for breast cancer patients.

Barriers to National Surgical Healthcare Policy Development & Implementation in the Southern African Development Community

Jennifer ML Hon — 2024-09-15

Background

Despite high-level commitment from governments, national surgical healthcare policy development has been slower than expected across the Southern African Development Community (SADC). This regional survey study aims to identify perceived barriers to policy formulation and, where applicable, implementation.

Methods

A combination of convenience, purposive and snowball sampling techniques were used to distribute an electronic survey to SADC surgical care stakeholders. Adaptive questioning was utilised to evaluate perceived potential barriers by each respondent, including government support for national surgical policy, the existence of a taskforce, resourcing for policy development, and specific challenges mapped to domains of the National Surgical, Obstetric and Anaesthesia Plan (NSOAP) Manual.

Results

Of 182 participants that consented to participation, 60% (n=109) responded in full and 22% (n=40) logged a partial response that was included in the analysis. 14/16 SADC countries were represented. 60% of respondents identified as healthcare professionals, 23% were academics and 24% represented government; there was poor representation from NGOs, civil society and potential donors. Twenty-seven percent (n=32) of respondents indicated that their country’s government supports and is driving the NSOAP development process. Financing (n=41, 82%) and stakeholder engagement (n=40, 80%) were the domains most commonly cited as barriers to developing a national surgical health plan. Respondents from three countries that had published NSOAPs cited inadequate integration into existing health plans and insufficient funding as common barriers to implementation.

Conclusions

There is a generalised perception of limited political conviction to drive national surgical improvement across the region, as well as funding and stakeholder engagement being significant barriers. For safe, timely, and affordable surgical care to become a reality, SADC governments need to exhibit strong leadership and engage potential funders (national treasury, intergovernmental and non-governmental organisations, philanthropies, private industry) early, to envision a sustainable financing model for surgical healthcare.

Correction Notice: Preliminary results of sentinel lymph node biopsy using blue dye for early breast cancer staging: A single-center experience in Addis Ababa, Ethiopia

Philimon Getu Bekele — 2024-09-13

In the originally published article-in-press version of the manuscript “Preliminary results of sentinel lymph node biopsy using blue dye for early breast cancer staging: A single-center experience in Addis Ababa, Ethiopia,” the author list was composed of; Philimon Getu Bekele, Sukmal Saha, Efeson Thomas Malore, Michael Girma Mamo, Soliyana Demelash Gizachew, Taye Jemberu Robele, Filagot Bizuneh Mikru, and Tadesse Mitiku Alemu.

The published corrected proof version of the manuscript features three new additional authors; Nigusse Ahmed Mohammed, Abel Asfaw Bizuneh, and Hermela Addis Gebregziabher.