Tanzania Medical Journal

A Retrospective Study of Patients with Castrate Resistant Prostate Cancer at Muhimbili National Hospital, Tanzania

2020-07-23T08:29:46+00:00

Background: Prostate cancer (PC) is a common health problem among men globally with high incidence and mortality. The mortality following PC is associated with advanced disease progressing to castrate resistance following androgen ablation therapies. While advances to address
castrate resistant prostatic cancer (CRPC) have shown good results, the burden of castrate resistant cancer in Tanzania has remained unknown hence our patients cannot benefit from such advances. This study therefore aimed to determine the magnitude and clinical presentation among patients with a diagnosis of castrate resistant cancer at Muhimbili National Hospital in 2018-2019.

Methods: This was a retrospective descriptive hospital based study carried out at Muhimbili National Hospital. Patients who were treated with androgen blockade, had evidence of attainment of castrate levels of testosterone with a diagnosis of castrate resistant prostate cancer were identified. Information regarding primary prostatic cancer treatment, clinical disease progression symptoms, and age of the patients were collected. Descriptive statistics were prepared and summarized as tables and figures.

Results: We recruited 293 patients with prostate cancer treated by androgen deprivation therapy. Bilateral orchiectomy was the most common treatment modality offered for advanced PC. Castrate levels of testosterone were achieved in 189 (95.5%) of the patients who had testosterone levels checked. Ninety-Six (50.8%) had met the criteria for diagnosis of castrate resistant prostate cancer with mean age of 71.23±4.2 years. Patients presented with lower urinary tract symptoms and metastatic features. Most of the patients had a poorly differentiated histology with prostate specific antigen (PSA) over 100ng/l. Only 13.5% of the patients had spine magnetic resonance imaging (MRI) for their work up.

Conclusion and recommendation: Half of patients treated for advanced PC at MNH will progress to castrate resistance following androgen deprivation therapy. More studies are needed to understand the predictors of CRPC and related treatment strategies.

Key words: Castrate Resistant Prostate cancer, androgen deprivation therapy, advanced prostate cancer

Assessing Concordance to an Intensified Upendo Ward Wilms Tumor Treatment Protocol in Tanzania: An Institutional Review

2020-07-23T14:36:10+00:00

Background: In Tanzania Wilms tumor (WT) ranks second among the most frequently diagnosed childhood cancer. Due to late presentation an intensified treatment protocol was established aiming for tumor reduction before surgery for achieving better surgical outcomes. We used two indicators for measuring the protocol concordance. First indicator was assessing the number of patients that received radiotherapy and second was number of patients treated with the high-risk regimen as per the protocol indications.
Methodology: This was a cross sectional study. Data was collected using a retrospective chart review of all children with WT at Muhimbili National Hospital Pediatric Oncology Unit for a period between April 2016 to May 2017 who were treated using the intensified treatment protocol (combination of two WT protocols with neoadjuvant as per SIOP-PODC and adjuvant as per modified SIOP International). Analysis was conducted using excel sheet and SPSS v20.
Results: A total of 74 children were eligible. The median age was 3 years ranging from 6 months to 17 years with small female predisposition of 57% (n=42). On clinical presentation all patients presented with history of abdominal swelling. In terms of clinical stage; 45% (n= 33) and 43% (n= 32) presented with stage 4 and 3 disease, respectively. Radiotherapy treatment was administered to 30% (n=22). As per protocol stage III and IV disease require radiotherapy thus only 34% of eligible candidates received radiotherapy. On histology report; 34% (n = 25) reports were never found and 66% (n=49) were available. High-risk cases were 27% (n = 20). We noted high-risk regimen was given to 12% (n=9) of study participants; thus only 45% of eligible candidates received high-risk regimen. All patient had intention to treat on admission with noted 19% (n = 14) default rate.
Conclusion: Measuring concordance with guidelines allows for identification of best practices, which in turn inform on quality improvements. This snapshot identified opportunities for improvement in protocol uptake in our unit.

Key words: Wilms Tumor, low income country, pediatric malignancy.

Antibacterial Efficacy of Commonly Available Alcohol-Based Hand Sanitizers on Escherichia Coli

2020-07-23T09:13:01+00:00

Background: The WHO estimates that approximately 600 million people fall ill after consumption of contaminated food and over 420 000 die every year, resulting in loss of 33 million healthy life years. Hand hygiene is considered by the WHO to be the most effective preventive measure for infectious diseases including food borne diseases.
Methods: A laboratory-based study involving convenient sampling of common brands alcohol-based hand sanitizers (ABHS) from retail community pharmacies and local supermarkets was conducted in Ilala District, Dar es salaam, Tanzania. The study was conducted, between December 2018 to January 2019. A modified protocol of The European Norm (EN) 1500 was used for in vivo testing of sampled ABHs. Efficacy was evaluated using standard strain of Escherichia coli. A total of 26 healthy volunteers were used for hand sanitization. The percentage of bioburden/microbial reduction was assessed at baseline and after treatment, and the log reduction factor calculated.
Results: A total of 10 gel ABHS were purchased and assayed for antibacterial efficacy. Majority (70%) of ABHS were imported products and contained ethanol as the sole active ingredient. About 60% of them did not correctly indicate the label disclosure information on concentration of active ingredients. Only one product was efficacious against E. coli with log reduction of 3.75; while majority (70%) of the samples had poor bacterial efficacy with log reduction ranging from 0.140 -0.664.
Conclusions: Most of ABHS gel products available in the Dar es Salaam market were not efficacious as per FDA and EN 1500 guidelines. Post market surveillance is recommended of the circulating ABH to safe guard consumers.

Keywords: Hand sanitizers, efficacy, E. coli, EN 1500.

What is known about Prostate Cancer? Response from Men Aged 50 Years and Above in Lindi Municipal, Tanzania

2020-07-23T09:25:29+00:00

Background: The incidence of prostate cancer in Tanzania is among the highest recorded in Africa. Prostate cancer is also the most common cancer among men aged 50 years and above in Tanzania. Our study aimed to determine the awareness, knowledge, and attitudes among adult men with age 50 years and above regarding prostate cancer.
Methods: This was a cross-sectional study that included 250 adult men aged 50 years and above in Lindi municipal being purposively selected and we interviewed them by using a structured questionnaire. A stratified random sampling method was used for obtaining our participants. All men who had stayed for not less than one year in Lindi and willing to participate were enrolled in the study. These men were selected at households without screening whether or not they had taken prostate screening test or had been diagnosed with prostate cancer Quantitative data were cleaned and analyzed with SPSS version 20.
Results: Majority, 216(86.7%) of our study participants were aged 50–69 years and most of them, 142(56.8%) had primary education with 93.2% of them being married. Among the study subjects 7.2% had positive family history of cancer and 195(78%) were aware of prostate cancer with source of information being mass media (62.6%). Majority of them, 63.2%, did not know the risk age group. Few, 20.8% of our participants had good knowledge while majority, 95.2% had negative attitude toward prostate cancer. We found a statistically significant association between level of education, family history and level of knowledge regarding prostate cancer with p < 0.005.
Conclusion: This study revealed high level of awareness, but poor knowledge regarding prostate cancer and negative attitude toward prostate cancer among men with age ≥50 years in Lindi municipal Tanzania.

Key words: Awareness, knowledge, attitude, prostate cancer.

Exodus of Clinicians from Public Sector to Non-Clinical Practice in Private Sector in Dar es Salaam Tanzania; Exploring the Drivers

2020-07-23T09:55:01+00:00

Background: Globally, shortage of clinicians health workforce is among the major challenges facing the health systems of many countries including Tanzania. Migration of medical doctors from clinical practice to non-clinical practice partly contributes to this challenge. This study aimed to explore factors influencing Medical Doctors’ decision to migrate from clinical practice in the public sector to non-clinical practice in the private sector in Dar es Salaam Tanzania.
Methods: An exploratory qualitative study was conducted using 12 in-depth interviews with medical doctors working in the private sector but formerly worked in the public health sector. Interviews were digitally recorded, transcribed verbatim and thematically analyzed.
Results: Three main themes emerged; health system-level drivers that has three sub-themes, namely poor work environment, heavy workload due to shortage of clinicians and underfunded public health sector; individual-level drivers, which include four sub-themes: Age, area of specialization, marital status and empathy to patients; and external environment drivers consisting of two sub-themes: peer pressure and community culture.
Conclusion: Improving the work environment through increased funding will partly address the main health system drivers underlying migration from the clinical practice. Furthermore, nurturing junior doctors to be enthusiastic and adapting to cultural shocks can partly help to address the individual and external drivers.

Keywords: Shortage, Medical Doctors, Clinicians, Physicians, migration, health workforce, Tanzania Clinical Practice, Non-Clinical Practice.

Impact of Training to Improve Knowledge on Blood Transfusion among Health Care Providers from Tertiary Hospitals in Tanzania

2020-07-23T10:07:55+00:00

Background: Blood transfusion is a lifesaving therapy which is linked to the adverse outcome when given inappropriately. Inadequate knowledge and skills among health care providers have been reported to contribute to safety issues for recipients and wastage of the precious resource. This study was conducted to determine the impact of training of health care providers in Tanzania on improving the knowledge regarding the transfusion of blood and blood components.
Methodology: This was a cross-sectional study which used secondary data from pre and post training assessment questionnaire whereby trainees answered the same set of questions before training (pre-test) and after training (post-test). The questionnaire consisted of two Likert scale questions and eight YES/NO questions which assessed the perception of clinicians, nurses and Laboratory personnel on blood transfusion practices. Moreover, there were thirty multiple-choice questions for assessment of basic knowledge related to usage of blood and blood components.
Results: One hundred and eleven (111) health care providers who attended training on blood transfusion were recruited into this study, out of which 72.1% (80/111) were from secondary health care facilities and 6.3% (7/111) were from tertiary health care facilities. The pre-test mean percent score was 32.8% (SD ±12.9%), while the post-test mean percent score was 56.6% (SD ±12.9%). The mean percentage of knowledge gain was 26.6% (SD±13.0%) and 27.1% (SD±12.5%) for health care providers and National Blood Transfusion Service staff respectively. It was observed that only 25.8% (24/93) and 19% (19/100) of participants were aware of the transfusion timing of various blood components and principles of platelet transfusion, respectively. Regarding bedside blood handling practices, only 52.9% (46/87) responded, ‘warm whole blood unit and packed red blood by putting under room temperature for 30 minutes and the majority of participants 63.1% (65/103) reported not to ask for consent before blood transfusion.
Conclusion: There was a modest improvement in the knowledge on blood transfusion practice among participants. The overall performance of participants increased from 33% in the pre-test to 57% in the post-test. Therefore, this study has shown the positive impact of training for health care providers in improving their knowledge. We recommend regular on job training courses and mentorship program for health care providers for proficiency in clinical transfusion practice.

Key words: Blood Transfusion, Training and Health care providers.

Giant Uterine Fibroid in a Low Resources Setting: A Case Report

2020-07-23T14:09:56+00:00

Background: Uterine leiomyomas represent the most common benign tumors of the female reproductive tract. Giant uterine leiomyomas are exceedingly rare neoplasm and represents a great diagnostic and therapeutic challenge. The aim of this publication is that though the present era is of advanced technology and minimally invasive surgery but this may not be available everywhere and feasible in every case. Diagnosis and management of giant uterine myoma should permit greater management flexibility with safe options, which must be tailored to the individual clinical situation.
Case presentation: A 45-year old woman presented with a 12-month history of progressive increasing abdominal size, prolonged menstrual bleeding, menorrhagia, gradual weight gain, vague abdominal pressure sensations, dysmenorrhea, abdominal and pelvic pain, frequent urination, relative constipation and symptom of anemia but not in failure. Physical examination, laboratory evaluation and a trans-abdominal ultrasound were done and findings suggested a giant abdominal-pelvic mass. Abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy was performed. Histologically, the specimen was 16.2 Kg uterine leiomyoma measuring 30/24/20 cm, intramural and subserosal myomatous, cellular leiomyoma that occurred without secondary changes, necrosis, cellular atypia, or mitosis.
The patient’s postoperative progress was uneventful and she was discharged from the hospital on the seventh postoperative day.
Conclusion: In uterine leiomyomas patient, the preferred imaging modality for initial evaluation is ultrasonography because it is the least invasive and most cost effective investigation especially in low resource settings where magnetic resonance imaging (MRI) and computed tomography (CT) Scan are usually not available and majority of the patients cannot afford its cost. The chosen treatment should be individualized, both severity of symptoms and patients desire to preserve fertility are very important. There is no single best approach to uterine fibroid treatment. However, women with giant uterine fibroids are best treated surgically and require adequate pre-operative preparations and an experienced skillful surgeon.

Keywords: Giant uterine leiomyoma, diagnosis, supracervical hysterectomy.

Newborn Screening for Sickle Cell Disease in Tanzania: The Past, Present and Future

2020-07-23T14:22:11+00:00

Sickle Cell Disease (SCD) is an inherited disorder of the Haemoglobin molecule of the red blood cells that is associated with serious complications and reduced life expectancy. Over 75% of people with SCD live in Sub-Saharan Africa (SSA), and this proportion are projected to increase to 85% by the year 2050. In Tanzania, approximately 11,000 babies are born with SCD each year, ranking 5th in the world. The high prevalence of SCD in SSA is compounded by the disproportionately higher mortality compared to that observed in the high-income countries. In Tanzania, SCD is a major contributor to under-five mortality and is estimated to account for 7% of all-cause mortality in this age group. Newborn screening (NBS) is the practice of testing babies right after delivery to ascertain whether they have diseases that are potentially lethal if not treated early. Where routinely practiced, NBS has significantly reduced morbidity and mortality associated with such diseases. The Sickle Cell Programme at Muhimbili University of Health and Allied Sciences (MUHAS) in Dar-es-salaam and Bugando Medical Center in Mwanza have both conducted pilot NBS for SCD, showing that the intervention is generally feasible and acceptable in Tanzania. The successful introduction and expansion of NBS in Tanzania will require careful planning and advocacy at community to national level.