Tanzania Journal of Health Research

Prevalence and Trend of Oral and Maxillofacial Injuries among Patients Attended at Mbeya Zonal Referral Hospital, Tanzania: A four - years retrospective study

Msafiri Birigi — 2024-06-26

Background: Oral and maxillofacial injuries pose a significant public health burden, but data on their patterns and prevalence is lacking in many developing countries like Tanzania. This study aimed to establish baseline data on these injuries' prevalence, patterns, and associated factors among Mbeya Zonal Referral Hospital (MZRH) patients.

Methods: A retrospective assessment of electronic medical records was conducted for all patients presenting with oral and maxillofacial trauma at MZRH between January 2019 and December 2022. Data on demographics, injury types, and admission status were extracted. Descriptive statistics and logistic regression models were used for analysis.

Results: Of 608 patients, 82.9% were males, and the median age was 28. Fractures of the mandible (53%) were most common, followed by malar/maxillary fractures (34%) and soft tissue injuries (12%). Malar/maxillary fractures had the highest odds of admission. Males had 1.84 times higher odds of malar/maxillary fractures than females. The 0-17 age group had higher odds of soft tissue injuries than older ages. Patients aged 18-34 years had twice the odds of mandibular fractures versus the youngest group.

Conclusion: Oral and maxillofacial injuries predominantly affected young adult males in this region. Mandibular fractures were most common, but malar/maxillary fractures required more admission. Age and gender were associated with anatomical patterns of injuries. The findings highlight the need for preventive strategies and management protocols tailored to regional epidemiology.

Keywords: Oral and maxillofacial injuries, mandibular fractures, malar and maxillary fractures, soft tissue injuries, retrospective study, Tanzania

Education and Fertility preference among women in Uganda

James Kizza — 2024-06-26

Background: Women's education is pivotal in addressing elevated fertility rates, particularly in developing nations. Despite declining fertility rates, Uganda sustains a high fertility rate of 6.2, surpassing the sub-Saharan Africa regional average of 4.6. This heightened fertility poses a significant obstacle to Uganda's sustainable development goals. This study investigates the relationship between female education and fertility preference among Ugandan women in 2006, 2011 and 2016.

Methods: The study used data from the Uganda Demographic and Health Survey for 2006, 2011, and 2016, with a sample of 6,216, 5,205, and 10,741 women, respectively. A multivariable logistic model was utilized to establish the relationship between female education and fertility preference.

Results: Findings revealed the existence of an inverse relationship between female education and fertility preference over the years 2006, 2011 and 2016 (Primary OR=0.67, 95% CI 0.53-0.84; OR=0.58, 95% CI 0.45-0.74; OR=0.70, 95% CI 0.57-086) respectively. For secondary or more education, OR =0.43, 95% CI 0.22-0.87; OR=0.56, 95%CI 0.34-0.92, OR =0.80, 95% CI 0.56-1.14) respectively. Fertility preference is inversely related to the mother’s income status, age and number of living children. Fertility preference is positively associated with the ideal number of children and contraceptive use.

Conclusion: This study has shown that female education helps to manage women’s fertility preferences. Educated women can access information and get better employment to decide on the desired family size. The study advocates for the continued education of females to empower them in actively shaping their desired family size. It is recommended that government efforts to strengthen universal access to education at both primary and secondary levels. To cater for those outside the school setting, we recommend the strengthening of programmes on sexual reproductive health that should include an open discussion on the ideal family size.

Implementation and challenges towards hospital information system deployment for improving the quality of care for women and people with disabilities

Mercy Komba — 2024-06-26

This study explored the use of hospital information system (HIS) to improve care for underprivileged groups, especially women and people with impairments. It thoroughly investigated HIS dynamics and issues in healthcare through focus groups, questionnaires, and interviews using a mixed-method approach. The study was carried out at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), a Tanzanian healthcare institution focused on enhancing the health of mothers and newborns and providing care for those with impairments. The study shows significant advancements in HIS deployment and enhanced data accessibility. Still, it also points out challenges, such as a lack of ICT skills, an excessive reliance on technology, data problems, inadequate connectivity, and financial limitations. Optimizing the use of HIS in healthcare requires addressing these issues.

Incidence, predictors and early outcomes of acute kidney injury among patients undergoing abdominal surgery at Bugando Medical Centre, Mwanza, Tanzania

Rashid Said — 2024-06-26

Background: Acute kidney injury (AKI) is a frequent occurrence following major surgery and is independently associated with high morbidity and mortality. Data regarding AKI following abdominal surgery is limited in the sub-Saharan Africa and Tanzania in particular. This study aimed to determine the incidence, predictors and early outcome of AKI among patients undergoing abdominal surgery at Bugando Medical Centre (BMC).

Methods: This was a longitudinal study to determine the incidence, predictors and early outcome of acute kidney injury among patients undergoing abdominal surgery at BMC between March 2022 and July 2022.

Results: A total of 172 patients were studied (M: F= 1.1: 1). The overall median age of patients at presentation was 34 years. Forty-six (26.7%) patients developed AKI postoperatively. Among the patients who had AKI, 30(65.2%) were classified as KDIGO stage1, 12 (20.1%) as stage 2 and 4 (8.7%) as stage 3. On multivariate analysis, the age ≥45 years (p=0.036), pre-existing medical illness (p=0.015), pre-existing renal dysfunction (p= 0.007), duration of surgery (p=0.007) and emergency surgery (p= 0.001) were the main predictors of postoperative AKI. The overall median length of hospital was 8.7 days and the overall mortality rate was 5.8%. The mortality rate among patients with AKI was significantly high compared to patients without AKI (15.2% v/s 2.4%; p= 0.020). Postoperative AKI was independently significantly associated with prolonged length of hospital stay (p= 0.001) and mortality (p=0.020). Recovery was observed in 63% of patients who developed post-operative AKI.

Conclusion: AKI incidence is high among patients undergoing abdominal surgery at BMC and is associated with high mortality and increased LOS. Prompt identification and aggressive treatment of postoperative AKI risk factors offer the potential of reducing the burden of AKI in this group of patients.

Traditional medicines that are used to treat witchcraft-related diarrhoea among under-five children in northern Tanzania children in northern Tanzania

Edwin Liheluka — 2024-06-26

Introduction: Diarrhoea continues to be a severe public health concern, particularly in developing nations. The illness is responsible for various bacterial, viral, and other physiological changes. However, it has also been perceived by the community that diarrhoea among under-five children could be due to witchcraft. In principle, all forms of diarrhoea can be managed with well-established contemporary therapies; nonetheless, it has been suggested that perceived witchcraft-related diarrhoea among under-five children can only be managed by traditional medicines. In northern Tanzania, the use of conventional drugs in the management of perceived witchcraft-related diarrhoea among under-five children is substantial. Yet, there are limited studies on this subject. The present study explored traditional medicines that are used to treat perceived witchcraft-related diarrhoea among under-five children.

Methods: A cross-sectional study using a qualitative research approach was carried out in Korogwe and Handeni districts in northern Tanzania. The study population included paediatric health workers, caretakers of under-five children, and traditional healers. In-depth interviews and focus group discussions served as the data collection methods. Thematic analysis was employed for data analysis.

Results: A total of 247 participants were enrolled, which included 127 males and 120 females. Most participants, especially caretakers and traditional healers, preferred the use of conventional medicines in treating diarrhoea among under-five children and held the belief that a specific form of diarrhoea among under-five children is caused by witchcraft. It was also revealed that traditional medicines are the only types of medication that can treat this form of diarrhoea among under-five children. Plants were the primary source of many traditional remedies that were purported to be able to treat perceived witchcraft-related diarrhoea among under-five children.

Conclusion: Most participants believed that there is a specific form of diarrhoea among children that is caused by witchcraft, and they boldly stated that traditional medicines are the only treatment option for this form of diarrhoea. Thorough research on this topic is essential. If additional research confirms that conventional remedies effectively treat the illness, these treatments should be extended to other serious illnesses the community suffers from.

Understanding Knowledge Levels and Influencing Factors among Implementers of the Prime Vendor System: A Case Study of Tanzania Mainland

Mathew Mganga — 2024-06-26

Background: The United Republic of Tanzania's government has implemented various significant health commodities supply chain management reforms, including introducing and national rollout of the Prime Vendor System in October 2018. This initiative aimed to address and complement the 40% health commodities supply chain gap observed at the Medical Stores Department (HRSC-2017). Over the five years since its implementation, the Prime Vendor System has shown high acceptability by the Government, implementers, and the beneficiaries of the intervention; it resulted in increased availability of health commodities at health facilities, improved order fulfilment rates, and timely delivery of commodities, it made contributions to Tanzania's public health sector. However, despite the Government's strong commitment to the health sector, administrative reports indicate regional disparities in the Prime Vendor System bridging the health commodities supply chain gap.

Little has been done to explore the knowledge level and influencing factors among Prime Vendor System implementers in addressing health commodities supply chain challenges. Therefore, this study aimed to understand the level of knowledge and its influencing factors among implementers regarding the Prime Vendor System Implementation in Tanzania Mainland.

Methods: A quantitative cross-sectional study was conducted between June and September 2023, collecting data via the ODK application from 356 respondents across the Dodoma, Morogoro, Mtwara, and Mwanza regions. Statistical analysis was performed using SAS version 9.4, with significance set at a 95% confidence level.

Results: All respondents (100%) were aware of the Prime Vendor System, with only 30.9% receiving formal orientation training. Most respondents (78.93%) reported having no prime vendor contracts in their health facilities yet recognized and acknowledged the PVS as complementary to the Medical Stores Department (MSD). However, only 60.76% knew of changes made since the PVS's introduction. Factors such as age and position within the healthcare organization influenced PVS knowledge.

Conclusion: Respondents have a high level of knowledge and awareness of the prime vendor system's basic structure and transitional phases. However, there is a need for more sensitization and training in prime vendor contracts and continuous refresher training of the prime vendor system, especially for lower-level health facilities.

Development and rapid assessment of Community-Based Health Education Package for the Control of Taenia solium Taeniasis/Cysticercosis in Tanzania

Chacha Joseph Nyangi — 2024-06-26

Background: We conducted this study to develop and rapidly assess a community-based health education package (CHEP) to serve as a guide to improving knowledge, attitude, and practices (KAP) for controlling T. solium cysticercosis Taeniasis (TSCT) in endemic areas in Tanzania.

Methods: Data for the development of the (CHEP) was collected through a questionnaire and observation of household infrastructure. We conducted and analyzed 12 focus group discussions (FGDs) and 38 key informant interviews (KIIs) using ATLAS.ti 8. A household survey using a questionnaire was conducted on 480 respondents and analyzed using SPSS by conducting a chi-square test.

Results: The developed CHEP included the following key messages: (1) improving knowledge and attitudes towards TSCT transmission, causes, health effects, treatment, and control measures, (2) proper pork preparation and general food handling practices, (3) good pig husbandry practices, and (4) improving water, sanitation, and hygiene (WASH) practices. The CHEP developed comprises a Training of Trainers (TOT) manual, a leaflet/brochure, a poster, and a handbook. The results from the rapid assessment reported a statistically significant improvement in knowledge regarding the link between epilepsy and cysticercosis (p<0.001) and in the practice of washing fruits and vegetables (p=0.025).

Conclusion: Therefore, it is recommended that critical stakeholders conduct one health approach toward implementing CHEP in areas affected by TSCT to control the disease.

Blood utilization practice in elective orthopaedic surgeries at Muhimbili Orthopedic Institute, Dar-es-salaam.

Justice Mwambashi — 2024-06-26

Background: The average requirement of blood and it’s products for a particular elective orthopedic procedure is usually based on subjective anticipation of blood loss rather than an evidence-based estimate. Currently, there is no specific evidence based guidelines for the appropriate amount of blood products to be ordered for specific procedures. Therefore this study aimed to fill the knowledge gap in the effectiveness of blood utilization practice. It is expected to add information on formulating a practical institution based protocol for proper optimizing the use of blood components.

Methodology: A hospital based descriptive study was done at Muhimbili Orthopedic Institute from July 2018 to April 2019 in which patients scheduled for elective orthopaedic surgeries for whom blood was requested were include. Demographic data and blood utilization data was collected which was analyzed using SPSS version 20 . Blood utilization was calculated by the following indices: (i) Crossmatch to transfusion ratio (C/T), (ii) Transfusion probability (T %), (iii) Transfusion index (TI), (iv) Maximum surgical blood ordering schedule (MSBOS).

Results: A total of 286 patients undergoing 27 different types of elective orthopedic surgeries were included in this study. Five hundred and twenty seven units of blood were cross-matched, of which only 224 units (42.5%) of blood were transfused to 146(51%) patients. The overall crossmatch to transfusion ratio(C/T) calculated was 2.4, transfusion index (TI) was 0.8 and transfusion probability (T %) was 51.0%. All these figures were found to be within the optimal range

Conclusion: This study revealed an adequate overall ratio of C/T, T%, and TI blood utilization considerable to significant, except for a few surgeries that showed transfusion above or below-accepted levels. Male patients and patients above 60 years of age had more transfusion rate. The highest proportion of blood transfusion was observed in lower limb surgeries. Knee arthroscopy showed the lowest blood transfusion rate while pelvic and acetabular surgeries showed the highest transfusion rate.

Recommendations: There is a need for formulating and practicing institution-based blood ordering policy to guide clinician regarding blood usage

Dental Wastes and Practices Among Dental Students and Practitioners

Somalee Mahapatra — 2024-06-26

Background: The increasing worldwide worry about dental waste stems from the widespread use of materials in dental treatments. Therefore, it was crucial to conduct a comprehensive analysis to evaluate how dental waste is handled by dentistry professionals and students, resulting in important discoveries.

Objectives: This study seeks to investigate dental waste management procedures among dental students and practitioners while assessing the various forms of dental waste produced in different departments. Moreover, it aims to explore possible strategies for improving the handling and disposal of dental waste.

Methods: Students, interns, teachers, and practitioners completed an online questionnaire to provide primary data. A survey was conducted using random sampling procedures to obtain a sample of 406 persons from different dental institutions and hospitals.

Results: The research findings indicated that a significant percentage of staff members and students exhibited awareness of appropriate disposal techniques for different categories of dental waste. The Department of Oral Medicine & Radiology faculty members have shown exceptional skill. In general, the participants demonstrated a significant understanding of proper disposal methods, especially for items linked to dentistry. However, there were differences in knowledge levels across other departments, as shown by a more significant proportion of skilled staff in departments like Oral Pathology & Oral Microbiology and Orthodontics compared to the students in such departments.

Conclusion: This research highlights the need to include thorough waste management education in dentistry schools to tackle the increasing environmental and health issues related to dental waste.

Multiple Risk Exposure and Chronic Obstructive Pulmonary Disease Characteristics among Men in a Mining Community in Northern Tanzania

Ngweina Francis Magitta — 2024-06-26

Background: COPD contributes to a substantial burden of diseases globally. The existing unregulated small scale mining activities in Africa could expose miners to excessive air pollution levels and subsequent development of COPD. The understanding of the co-existent multiple risk factors for COPD is crucial for local public health action.

Methods: We conducted a cross-sectional study in a small-scale, informal mining site Tanzania. We recruited eligible active miners, ex-miners and non-miners aged ≥30 years. We assessed respiratory symptoms and risk factors and performed spirometry, with COPD defined based on post-bronchodilator FEV₁/FVC<70%. We monitored air pollution based on PM₁₀ level in mining pits using TSI Side Pak^TM AM510 samplers.

Results: A total of 702 men [480 active miners, 170 ex-miners and 52 non-miners⦌ were recruited with a mean age of 40.95 ± 9.21 years and two-thirds were cigarette smokers. The prevalence of COPD was estimated at 15.20%, 17.10% and 15.40% for active miners, ex-miners and non-miners respectively. Over 18% of current cigarette smokers had significant nicotine dependence which was associated with the duration of smoking (p= 0.028) and the number of pack years (p = 0.002). The majority of COPD patients presented with cough and had frequent exacerbations but with mild to moderate airway limitation. The survey revealed up to 20,000µg/m³ of PM₁₀in the underground microenvironment exceedingly higher than the acceptable limits.

Conclusion: The prevalence of COPD among the mining communities is substantial in Tanzania. The patients are largely young and many smoke cigarettes. The mining activities are typically carried out without protective gear. A multifactorial approach is critical in the prevention of COPD in this community.

Phytochemical screening of selected medicinal plants of the West Usambara Mountains in Tanzania

Elias N Mussa — 2024-06-26

Background: Medicinal plants have been vital for human health for many years due to their restorative properties. Phytochemicals contribute to medicinal plants' healing power, including flavonoids, tannins, glycosides, exudates, terpenes, alkaloids, and phenolics. Several medicinal herbs used by the local community have unknown phytochemical compositions. Knowing the phytochemical composition helps identify bioactive compounds that can be further developed into pharmaceutical drugs. Hence, this study aims to look into the phytochemical composition of Vernonia iodocalyx and Myrica. salicifolia, which is extensively used in Tanzanian traditional medicine.

Methodology: The extracts from methanol and petroleum ether were obtained through the Soxhlet extraction technique. Preliminary phytochemical screening was conducted using standard methods, while GC-MS analysis was used for in-depth analysis of the identified phytochemicals.

Results: According to the test tube reaction method data, methanolic extract outperformed petroleum ether extracts regarding phytochemical compositions. GC-MS analysis revealed that Vernonia iodocalyx and Myrica salicifolia contained 21 and 22 phytochemicals, respectively. Out of the identified phytochemicals, 7 from Vernonia iodocalyx and 5 from Myrica salicifolia have been reported to possess different bioactive compounds essential for drug synthesis.

Conclusion: Methanolic leaf extract of both Vernonia iodocalyx and Myricasalicifolia has a satisfactory number of phytochemicals. Hence, these plants are recommended for the isolation of active compounds for pharmacological studies.

Prevalence, predictors and management of pre-eclampsia among pregnant women attending antenatal clinics in Zanzibar

Salma Ali Rashid — 2024-06-26

Background: Pre-eclampsia is a significant public health concern worldwide that is responsible for severe maternal and neonatal morbidity and mortality. This study determined pre-eclampsia's prevalence, predictors, and management among pregnant women attending antenatal clinics in Zanzibar.

Methodology: This was a cross-sectional study involving 138 pregnant women attending antenatal clinics randomly selected from all levels of healthcare facilities in Zanzibar. A protein-in urine test and blood pressure measurement were performed to diagnose pre-eclampsia, and the patient’s case files were reviewed to assess pre-eclampsia management. The Chi-square test and logistic regression models determined the association between variables. The adjusted odds ratio and a 95% confidence interval were reported, and the significance level was set at 5%.

Results: The prevalence of pre-eclampsia was 20(14.25%), and it was predicted by a family history of pre-eclampsia (adjusted odds ratio=5.7, 95% confidence interval: 1.34-24.7), a previous history of pre-eclampsia (adjusted odds ratio =12.9, 95% confidence interval: 2.5-55.6), and current medication use (adjusted odds ratio =19.3, 95% confidence interval 3.9-95.6). A slight majority of mild pre-eclampsia cases were properly managed 7(53.8%), while only 9(29.50%) of severe pre-eclampsia cases were adequately managed. The proportion of cases of severe pre-eclampsia that were managed correctly was higher among cases admitted to national referral hospitals (68.5%) compared to those admitted to district hospitals (22.8%) and health centres (10.83%) (p < 0.002). However, for mild pre-eclampsia, there was no statistically significant difference in its management between facility levels (p>0.05).

Conclusion: The prevalence of pre-eclampsia among pregnant women attending antenatal clinics is high. The possible risk factors for pre-eclampsia are having a family history of pre-eclampsia, having a previous history of pre-eclampsia, and current medication use. The standard guidelines for the management of pre-eclampsia are not followed, and severe pre-eclampsia is mostly mismanaged at lower-level healthcare facilities. The findings are relevant to identifying high-risk pregnancies, improving maternal healthcare delivery, and saving lives.

Erythrocyte indices under conditions of energy drink consumption in Ukraine

Khrystyna Partsei — 2024-06-27

Background: The consumption of energy drinks, especially among young people, is constantly growing worldwide despite warnings about their safety. Therefore, determining the consequences of their impact on the human body and well-being is an actual issue. This work aimed to study the state of endogenous intoxication and the antioxidant system of erythrocytes in experimental animals that consumed energy drinks.

Methods: The study was conducted on rats that consumed energy drinks for a month. Samples for analysis were taken on the 10th day after the end of the experiment. The biochemical methods of analysis were used to assess the state of endogenous intoxication by the erythrocyte intoxication index and the content of middle mass molecules (MMM), the state of oxidative modification of proteins, and the state of the antioxidant system by the fermentative activity of catalase (CAT) and superoxide dismutase. Statistical methods were used to determine the reliability of the study results.

Results: It was found that the value of the erythrocyte intoxication index significantly increased by 1.8 times (p<0.001), the content of MMM254 by 1.2 times (p<0.001), and the content of MMM280 – by 3 times (p<0.001), indicating the development of endogenous intoxication. The activation of the processes of oxidative modification of proteins is proved by the increase in the oxidative modification of the protein index by 1.1-1.3 times. It was shown that the enzymatic activity of superoxide dismutase decreased by 1.1 times, and CAT activity increased by 1.3 times (p<0.001). A 1.5-fold decrease in the ratio between superoxide dismutase and CAT enzymes was also found.

Conclusions: The results indicate damage in the antioxidant system, a decrease in the effectiveness of antioxidant protection, and the development of oxidative stress. The results obtained in this work may help study the potential adverse health effects of energy drinks consumption.

Inspection Practices for Regulating Prescription Handling and Antibiotics Control in Ilala Community Pharmacies of Dar es Salaam, Tanzania: Qualitative Assessment

Lilian Chuwa — 2024-06-28

Aim: The study aimed to explore inspection practices of prescription handling and antibiotics control in the context of Tanzania’s community pharmacies.

Design: Qualitative exploratory study.

Methods: This qualitative study held 14 in-depth interviews with pharmacists (three), pharmaceutical technicians (seven), and pharmacy council representatives (four) to collect data on the inspection processes for regulating prescription handling and antibiotic control in community-based pharmacies. The data was then subjected to content analysis with the help of NVivo12.

Results: The study found that even though routine inspections were conducted to regulate prescription handling and antibiotic control in community pharmacies, there were inconsistencies in prescription retention, inadequate documentation in the inventory system, and improper antibiotic storage, with less attention paid to inspecting antibiotic sales practices. Implicitly, the efficiency and effectiveness of such inspections were open to question. Moreover, many clients frequented these visits to community pharmacies without prescriptions, yet they were dispensed with non-over-the-counter antibiotics. Furthermore, there were generally disparities between regulatory expectations and practical implementation in community pharmacies.

Conclusion: More emphasis is necessary on antibiotic prescriptions and retention in community pharmacies coupled with standardized inspection protocol to help enhance inspection regulation activities and promote better dispensing practices for prolonged medicine life, improved efficacy, and health outcomes.

High Mumps virus IgG seropositivity among women with spontaneous abortion attending health care facilities in Mwanza, Tanzania

Helmut Nyawale — 2024-06-26

Introduction: Mumps virus infection is a public health concern mainly in low- and middle-income countries and has been associated with complications such as spontaneous abortion and post-pubertal orchitis that may result in testicular atrophy and, consequently, infertility. Mumps vaccination is not currently implemented in Tanzania, and the data regarding its magnitude is limited, with no data among women with spontaneous abortions.

Objective: This study aimed to determine seropositivity and factors associated with specific mumps virus IgG antibodies among women with spontaneous abortion in Mwanza, Tanzania.

Methodology: From July to August 2022, a laboratory-based analytical cross-sectional study involving 212 sera collected between 2015 and 2019 from women with spontaneous abortions in Mwanza was conducted. Mumps IgG antibodies were detected by an indirect Enzyme-Linked Immunosorbent Assay. Descriptive data analysis was done using Stata version 15.

Results: The median age of enrolled participants was 27 [IQR: 24-32] years. The overall seroprevalence of mumps virus IgG antibodies was 117/212(55.19%) [95% CI: 48.39-61.80]. Being an urban resident (OR: 3.23, 95% CI 1.83-5.96, P= 0.000) and an increase in the number of household members (OR: 1.18, 95% CI: 1.01-1.38, P=0.040) predicted seropositivity of mumps IgG antibodies among women with spontaneous abortion in Mwanza, Tanzania.

Conclusion: More than half of the women with spontaneous abortion live in the urban settings in the city of Mwanza, Tanzania, and those living in houses with a high number of household members are Mumps virus IgG seropositive. More studies on the causal effect relationship between women with spontaneous abortion and mumps virus are warranted.

Understanding Implementers' Perceptions on the Prime Vendor System: A Case Study of Tanzania Mainland

Mathew Mganga — 2024-06-26

Introduction: Access to safe, effective, quality and affordable essential medicines for all is a central component of Universal Health Coverage (UHC). However, the availability of quality medicines in low and middle-income countries is often limited, especially in peripheral health facilities. MSD, as the sole supplier of drugs and medical supplies to all public health facilities, has been facing difficulties that hinder its efficiency in supplying 100% of all facility’s needs. Despite significant reforms, including introducing the Prime Vendor System in 2018, challenges persist, leading to regional disparities in commodity availability at the facility level. Successfully establishing an intervention based on PPPs within the public sector in the health commodities supply chain system mostly requires high acceptability by the Government, implementers, and beneficiaries. Furthermore, the effectiveness of any activity is primarily influenced by the participants' attitudes. While most studies have extensively researched the effectiveness of the prime vendor system in bridging the supply chain gap, none have researched implementers' perceptions of the prime vendor system in complementing health commodities. This study seeks to understand the Implementer's perceptions of the prime vendor system implementation.

Materials and Methods: This was a quantitative cross-sectional study. Data was collected from June to September 2023 using the ODK application from 356 respondents from Dodoma, Morogoro, Mtwara, and Mwanza in Tanzania. The data was analysed using SAS version 9.4. Statistical significance was determined at a 95% confidence level.

Results: 77.84% of study participants strongly agreed that involving the private sector in health commodities supply chain management is the best approach to solving supply chain problems. Additionally, 81.53% of all study participants believe that the Prime Vendor System has contributed positively to the improved availability of health commodities at the facility level.

Conclusion: Perceptions regarding the prime vendor system vary across different areas, including its impact on the overall availability of health commodities, streamlining of procurement processes, and the role of the private sector in addressing supply chain challenges within the country. Notably, the level of experience in the workplace emerges as a considerable influence on respondents' perceptions regarding the Prime Vendor System and its implementation nationwide.

Retrospective Study of Epidemiological Profiles of Cardiorespiratory Pathologies Before and After the Covid-19 Era at Kenitra Provincial Hospital, Morocco

Mustapha Zghaid — 2024-06-26

Background: The present study aims to assess the impact of COVID-19 on the epidemiological profile of circulatory, respiratory, and haematological pathologies at the provincial Hospital of Kenitra, Morocco, utilizing a before-and-after comparative approach.

Methods: This work consists of a retrospective investigation involving 13,067 cases (excluding cases related to COVID-19) admitted to the provincial hospital of Kenitra between January 1, 2017, and April 30, 2022.

Results: The findings revealed a substantial reduction in the overall number of consultations, decreasing from 11,956 consultations before the emergence of COVID-19 to 1,111 consultations afterwards, indicating a 90% decline. Furthermore, there was a notable shift in the gender distribution for respiratory diseases, transitioning from a male predominance with a sex ratio of 2.03 before the COVID-19 pandemic to a female predominance with a sex ratio of 0.83 post-pandemic. Regarding age group distribution, no significant difference was observed between before and after Covid-19. A comparison of the duration of hospital stays before and after Covid-19 pandemic revealed a notable decrease in respiratory (t = 4.96; p< 0.001) and haematological (t = 3.62; p< 0.001) pathologies, with no significant difference for circulatory pathologies. Before COVID-19, patients with circulatory pathologies had a twofold higher risk of mortality compared to other patients, whereas respiratory patients faced a three times higher risk of death. No significant risk of death was associated with haematological pathologies. Following the COVID-19 pandemic, the mortality risk increased for respiratory pathologies but decreased for circulatory pathologies. The risk of mortality for haematological pathologies remained insignificant.

Conclusion: the COVID-19 pandemic substantially impacted the epidemiological profile of circulatory, respiratory, and haematological pathologies.

Prevalence of Type II Topoisomerase Mutations Among Quinolone Resistant Escherichia coli from Broiler Chickens in Dar es Salaam, Tanzania

Victor Anacletus Makene — 2024-06-26

Background: Quinolone-resistant Escherichia coli may easily be transmitted from poultry to humans and animals. Quinolone misuse in veterinary medicine, therefore, poses a significant public health risk. This study aimed to assess the prevalence of type II topoisomerase mutations commonly associated with resistance to quinolones in E. coli; in Dar es Salaam, Tanzania.

Methods: One hundred sixty E. coli samples isolated from broiler cloacal swabs in Dar es Salaam between March and August 2022 were evaluated and analyzed for quinolone resistance by disc diffusion and genetic methods. The study used two Polymerase Chain Reaction (PCR) techniques, one a Mismatch Amplification Mutation Assay (MAMA-PCR) and the other employing enzyme digestion of amplified products (PCR-RFLP). Both approaches targeted regions in type II topoisomerases (gyrA and parC) to determine quinolone resistance (QRDR).

Results: Results showed considerable levels of quinolone resistance among E. coli isolated from broiler chickens, where 42.5% of the strains demonstrated non-susceptibility to both ciprofloxacin and norfloxacin. Moreover, a significant minority of isolates (5%) were non-susceptible only to ciprofloxacin. All isolates non-susceptible to both drugs harboured a substitution mutation (S83L) at the gyrA Ser-83 target site (a resistance marker) as revealed by PCR-RFLP. The genotypic-to-phenotypic agreement ratio for norfloxacin was 100%, in contrast to that of ciprofloxacin, which was 89.47%. However, as revealed by MAMA-PCR results, none of the isolates under study harboured parC80 (S80I) substitution mutation (a resistance marker) on the topoisomerase IV gene.

Conclusion: Type II topoisomerase mutations other than the ones assayed in this study (gyrA Ser-83 or parC80) or other mechanisms of resistance might be contributing to the resistance against quinolones in E. coli strains circulating in broiler chickens in Dar es Salaam. The level of quinolone resistance revealed by this study calls for immediate intervention to mitigate its spread.

Lived experiences of women who had hysterectomy for uterine prolapse in Southeast Nigeria

Perpetua Ngozi Eze — 2024-06-26

Background: Hysterectomy aims to relieve symptoms and improve patients’ lives. Yet, the lived experiences of women who had a hysterectomy for uterine prolapse in sub-Saharan Africa have primarily been unexamined. This study explored their experiences after hysterectomy at a specialist hospital in Southeast Nigeria.

Objective: To explore the women’s physical, psychological, social, and economic experiences after hysterectomy.

Method: Individual in-depth interviews were conducted on 21 women aged 31-72 at 3- 6-month check-ups after hysterectomy. The interview transcripts were subjected to hermeneutic phenomenological interpretation.

Results: Loss of the uterus was particularly distressing to the women. They questioned their womanhood at its loss. Some continued to experience body pains and symptoms of depression months after hysterectomy, making them limit their economic activities. Their narrations showed dissonant grieving: consoled by the relief of the prolapse but bothered by uncertainty about the surgery and poor empathy from their spouses. Expecting stigmatisation, they reduced their social relationships. They tried to cope by depending more on their children and parental family members, seeking guidance and support from other women who previously underwent hysterectomy, and increasing their spiritual relationship.

Conclusion: The findings suggest that pre- and post-surgery counselling, incorporating verbalization and problem sharing, and self-help groups can be helpful to women who have had hysterectomy.

Sub-chronic Toxicological evaluation of extract of Lavandula stoechas on Liver, haematological parameters, and feed consumption of Wistar rats

Oyepata Joseph — 2024-06-26

Introduction: Lavandula stoechasare commonly used to treat various medical ailments. This study aims to determine its toxicological impact on Wistar rats’ meal consumption, liver, and haematological markers.

Method: Animals of either sex were selected. Group 1 received normal saline (10 ml/kg), while groups 2, 3, and 4 received 50, 100, and 200 mg/kg, respectively, of Lavandula stoechas. The animals were kept in standard cages and given oral access to the extract for 28 days before being weighed and killed. A cardiac puncture was utilized to get blood, which was then immediately tested. The haematoxylin and eosin (H&E) staining technique evaluated the plant's histological hepatotoxic potential.

Result: Compared to the control, ethanol leaf extract of Lavandula stoechas generated a substantial (P<0.05) increase in body weight in the first, third, and fourth weeks but not in the second. There was a significant (P<0.05) drop in RBC, HGB, and MCV but no change in neutrophils, basophils, eosinophils, or platelets. At 100 mg/kg dose, Lavandula stoechas generated a substantial (P<0.05) rise in ALP and BILD. Other metrics did not differ substantially (P<0.05) across doses delivered. A histological examination revealed minor tubular deformation.

Conclusion: Though the plant is primarily safe, the study results show that it may have a minor effect on the liver, implying that it should be used cautiously for an extended period. A histological examination revealed minor tubular deformation.