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Factors influencing the treatment outcomes of patients undergoing Urethroplasty for urethral stricture at Muhimbili national hospital
(Muhimbili University of Health and Allied Sciences, 2024) Mtafu, N.H
ABSTRACT
Background: Urethral stricture disease poses a substantial challenge in Sub-Saharan
Africa, where the prevalence is notably high. This condition predominantly impacts
men, and the underlying causes in the region are diverse and varied. There is a
significant research gap in understanding the patient-related factors that contribute to
the outcomes of urethroplasty for urethral strictures at Muhimbili National Hospital.
Objectives: To determine the factors influencing treatment outcomes among patients
undergoing urethroplasty for urethral stricture at Muhimbili National Hospital.
Methodology: This cross-sectional analytical retrospective study was carried out at
Muhimbili National Hospital. Through convenient sampling, data from the hospital’s
patient database, specifically from patients aged 10 years and above, were extracted
using a structured abstraction form. Patient information, clinical findings, treatment
offered and treatment outcomes were collected. The collected data were analyzed
using SPSS 23.
Results: This study examined 126 patients with urethral stricture who underwent
urethroplasty at MNH between January 2020 and December 2022. The mean age was
51 years, with the bulbar urethra being the most common stricture site (54%) and
trauma the leading cause (44.4%). The comorbidities included diabetes (21.4%) and
hypertension (71.4%). Most strictures were short (77%). Excision and primary
anastomosis (EPA) procedures were preferred over buccal mucosal grafting (BMG)
procedures (60.3% vs. 39.7%). The success rate of urethroplasty was 85.7%, with a
15.9% complication rate. Early complications included surgical site infections (54.5%),
painful scrotum (36.4%), and wound dehiscence (9.1%). Late complications
predominantly consisted of irritative lower urinary tract symptoms (83.3%), stress
incontinence (5.6%), and erectile dysfunction (11.1%). Younger patients (<60 years)
and those with infectious etiologies had significantly higher success rates. The type of
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stricture, length of stricture, surgical approach, and catheter type did not significantly
impact outcomes.
Conclusion: Urethroplasty had a high success rate of 85.7%, particularly in younger
patients and those with infectious etiologies. Trauma was identified as the most
common cause of urethral strictures, primarily affecting the bulbar urethra.
Postoperative complications, both early and late, were observed, indicating the need
for careful postoperative monitoring. Factors such as stricture level, length, surgical
approach, and catheter type did not significantly impact the success of urethroplasty.
Key words: Influencing factors, treatment outcomes, urethroplasty
Clinical demographic characteristics, and their predictors of outcome among burn children treated at Muhimbili National Hospital burn unit.
(Muhimbili University of Health and Allied Sciences, 2024) Abdatam, M.I.A
ABSTRACT
Background: Burn victims' children are the local and global medical issue and cause
morbidity as well as mortality universally. It can be the source of the worst illness
condition and severe pain injuries a child can receive and may lead to prolonged
physical and mental effects. About 70% of all burns occur in LMICs, especially in
African and Southeast Asian regions, while children under the age of 15 in LMICs are
more often burned than children in HICs from scalding or flames. Likewise, in Tanzania,
the prevalence of burn injury is reported to be 16% of all injuries; a one-month incidence
was calculated to be 1.73%.
Objective: To establish the clinical demographic, outcome and its predictor of mortality
among scald injured pediatric patients admitted at MNH burn unit.
Methodology At Muhimbili National Hospital we conducted a retrospective cohort
study designee, from January 2019 to December 2020. The study aimed to enroll all
children who had scald injuries and were no older than 12 years. We used observation
checklist tools to collect data on social demographics and clinical factor variables from
the medical records. However, we excluded the files containing missing information
and obtained the remaining information through a phone interview with the patient's
guardian. We sent the proposal to the MUHAS IRB for review and approval and then
sought permission from the MNH research, training, and consultancy bureau. The
SPSS Version 23.0 package analyzed the data.
Data analysis: The continuous variable consisted of the median (IQR), while the
categorical variables included frequency and proportion. Chi-square was used to test
for a significant association between categorical variables and outcomes, and p < 0.05
was considered statistically significant.
Results: During the study period, 300 children who sustained scald injury were
recruited of which majority (92.3%) were under five years of age. A mortality rate of
25% was observed with factors found to have significant association being residence
in a rural area (aOR 23.71, 95% CI 3.82-147.58, p-value <0.001), a TBSA of >20% (OR
19.98, 95% CI 6.00-66.50, p-value <0.001)
Conclusion: Scald injuries in young children pose a substantial risk of mortality,
particularly in those living in rural areas and those with extensive injuries. These
findings emphasize the need for targeted preventive measures and resources in
vulnerable populations to reduce the incidence and severity of scald injuries in children
Quality of life and the associated determinants among adult patients with Urolithiasis attending Muhimbili National Hospital
(Muhimbili University of Health and Allied Sciences, 2024) Mhaya, J.K
ABSTRACT
Introduction: Urolithiasis, a common urinary condition, varies in prevalence globally,
from 1% to 20%. Treatment options include extracorporeal shock wave lithotripsy,
ureterorenal copy contact lithotripsy, percutaneous nephrolithotomy and open surgical
procedure for larger stones. However, the current care approach lacks integration of
patient-reported outcomes, alignment with treatment preferences, and resource
optimization. Clinical aspects receive more focus in the evidence, while understanding
patient quality of life (QoL), disease impact, and treatment effects remains insufficient.
Objective: This study aimed at determining the factors that influence the QoL and
predictors of QoL among urolithiasis patients undergoing treatment at Muhimbili
National Hospital.
Methodology: An analytical cross-sectional study involving patients with stone-related
issues between October 2023 and March 2024 was carried in Muhimbili National
Hospital. Patients completed stone history surveys, SF-36 questionnaire to assess
Quality of life. Data were cleaned and analyzed using SPSS version 27.
Results: This study included 103 patients meeting inclusion criteria, with a mean age
of 47 years (SD = 11.8). Proportion of urolithiasis was 0.67%. Gender distribution was
52.4% male and 47.9% female. The median BMI was 25.7 kg/m2, with 54.4% falling
within the normal weight range. Stone-related factors included 85.4% first-time stone
formers and 14.6% recurrent formers. Stone sites varied, with 42.7% having stones
≤1cm and 42.7% presenting with hydronephrosis. Analyses revealed no significant
differences in renal stone distribution by age or sex (p > 0.05). However, proximal
ureteric stones were more prevalent among males (p < 0.05). SF-36 domain scores
showed significant differences in role limitations due to emotions and pain between new
and recurrent stone formers. Multivariate regression indicated that higher body mass
index is associated with lower SF-36 PCS scores (β = -1.198, p = 0.004), highlighting
its impact on physical HRQoL.
Conclusion: While no significant age or sex differences were found in renal stone
distribution, proximal ureteric stones were more prevalent among males. Short form-36
domain scores showed significant disparities in emotional limitations and pain between
new and recurrent stone formers, with higher BMI associated with lower physical health
related quality of life.
Incidence of Tuberculosis disease and associated factors in children living with HIV on anti-retro viral treatment and isoniazid preventative therapy in Dar es salaam Tanzania: a retrospective cohort study.
(Muhimbili University of Health and Allied Sciences, 2024) Ngalya, E.F
ABSTRACT
Introduction: Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) continue to
be major causes of morbidity and mortality among children due to their synergistic effects.
Although significant strides have been made in reducing morbidity and mortalities due to
HIV through strategies such as the '95-95-95' targets for HIV diagnosis, antiretroviral
therapy (ART) initiation, and viral suppression among Children Living with HIV (CLHIV),
TB remains a prevalent cause of morbidity and deaths. Isoniazid Preventive Therapy (IPT)
is a critical intervention recommended by the World Health Organization (WHO) for high
risk groups, including CLHIV, to treat latent TB and prevent active TB disease. Despite its
established efficacy in adults, evidence supporting IPT's effectiveness in reducing TB
disease and mortality in children remains scarce.
Objective: This study was set to assess the impact of IPT on the incidence of TB disease
and mortality among CLHIV aged 1-15 years who are on ART and attending high-volume
Care and Treatment Clinics (CTCs) in Dar es Salaam, Tanzania.
Methodology: A retrospective open cohort study was conducted using data from the
National AIDS Control Program (NACP)—Centre of Treatment and Care (CTC) database.
The study included children aged 1-15 who were newly diagnosed with HIV and enrolled
in care between January 1, 2019, and December 31, 2022. The cohort consisted of 480
eligible newly diagnosed CLHIV on ART. Participants were followed up for IPT use of
which 268 received IPT and 212 did not receive IPT and assessed for the development of
TB disease and mortality outcomes.
Results: Among the 480 participants, the median follow-up time was 6979.1 for IPT users
and 1752.4 person-months for non-users. Most participants were aged 5-15 years (57.9%),
with most attending Ilala Municipal Council clinics (46.3%) and Mbagala Rangi Tatu
Health Centre (17.3%). A significant portion of the participants had advanced HIV (WHO
clinical stages 3 and 4) (63.4%) and were underweight (26.3%). During the follow-up
period, 13 CLHIV developed TB which 3 were diagnosed microbiologically, 3 clinically, 3
by chest x-ray 2 by combination of chest x-ray and microbiological evidence, most cases
occurring within the first six months.
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The incidence rate of TB showed higher trends among non-IPT users (228.3 cases per
100,000 CLHIV) compared to IPT users (129.0 cases per 100,000 CLHIV) however these
were not statistically significant.
IPT usage significantly protected against mortality (cHR = 0.01, 95% CI: 0.001 – 0.08, P
value <0.001). Most deaths occurred within the first six months of follow-up (79.6%), with
an incidence rate of 1649.6 per 100,000 CLHIV. The overall mortality rate was 639.3 per
100,000 CLHIV over 7664.6 person-months.
Conclusion and Recommendation: IPT used concurrently with ART significantly
reduces the incidence of TB and mortality among CLHIV on ART. The incidence rate of
TB was over 40% lower among IPT users, and mortality was reduced by more than 99% in
the IPT group. These findings are in alignment with WHO recommendations and IPT use
should be implemented consistently alongside other TB prevention strategies for all
eligible CLHIV to reduce TB disease rates and improve survival outcomes effectively.
magnitude of unmet healthcare needs of the elderly in Temeke district by using the frailty index
(Muhimbili University of Health and Allied Sciences, 202) Mgumia, S.O
ABSTRACT
Background: It is uncertain if the frailty rate of the elderly population in Tanzania (7.3%
to 19.1%) matches the rate of unmet health needs of this population; if it does, it will
effectively aid in structuring strategic policy vision for their care.
Objective: To estimate the magnitude of unmet healthcare needs of the elderly in Temeke
District by using the frailty index as a determinant.
Methods: An analytical cross-sectional study of 237 elderly population (60+ years) in
Temeke district determined the prevalence of unmet health needs using the frailty index.
Using a stratified multiple and random sampling, we estimated the prevalence estimates
presented by percentage and 95% Confidence Interval. Using IBM SPSS version 25,
logistic regression was employed to identify factors associated with unmet healthcare
needs, presenting Odds Ratios and 95% confidence intervals.
Results: The mean age of participants was 69 years ±8SD, and 42.19% (n=100) were
women. The prevalence of frailty was 5.06% (n=12;95%CI;2.9 - 8.6), while the proportion
of unmet healthcare needs was statistically high at 51.05% (n=121;95%CI;44.7 – 57.6).
Distance and transportation challenges were the main barriers to accessing healthcare.
Conclusion: The prevalence of frailty was relatively low and may not be a good proxy
measure of unmet healthcare needs. It is plausible that those with severe frailty are more
likely to die early and, hence, affect the prevalence estimate. A multifaceted approach by
a collaboration of health, social welfare, rural/urban development and legal sectors may
be necessary to strategize how to estimate the health needs of elderly citizens, hence its
use in the policy.