Masters Dissertations

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Twenty surgical
(University of Dar es Salaam, 1972) Kivambe, Dr. David Maurice
Manpower is one of biggest problems facing any developing country today. Tanzania is not exceptional. In her struggle to achieve self reliance, Tanzania has made another encouranging step in the field of Medioine. The introduction of Postgraduate studies in different branohfts of Medicine has been received with great applause. In Surgery until the end of 1978/79 academic year^ thirteen doctors have been awarded with degrees of Master of Medicine (M. Med. Surgery). These are working not only in the three National Consulting Hospitals, but also in the Regional Hospitals, in the country.
Traditional Herbal for Bronchial asthma in Tanga Region: an Evaluation of their Efficient and bronchodilator activity
(University of Dar es Salaam, 1976) Nkinda, Siegfried J.
Thirty-five prominent traditional medicines—men in Tanga region were interviewed with respect to the treatment of bronchial asthma. 40% of them claimed to be able to cure the disease. Sample recipes of their remedies and brief histories of asthmatic patients who had received traditional treatments are described. The plant which were regarded as the most effective in treating asthma (sixteen different species) were collected for botanical identification; some of these were tested for bronchodilator properties and other smooth muscle relaxing actions in guinea pigs and compared with aminophylline and adrenaline. Only aqueous extracts of dry plants ware tested; the methods used failed to demonstrate actions that should prove to be therapeutically useful in treating asthma. With respect to the methods used in this study, it is felt that they should be regarded as merely one approach to the screening for drug activity. The plants should not be considered to be inactive until other approaches are tried. This investigation has identified plants which are administered to patients with asthma in Tanga region, and this is a most important aspect in the study of traditional medicine. Studies employing similar and several screening methods and covering a wider area will broaden knowledge of our traditional medicine.
A Dissertation of ten surgical conditions is presented as part of the requirements for the award of the Degree of Mastrer of Medicine (Surgery) in University of Dar es Salaam
(University of Dar es Salaam, 1976) Wella, Landolin B.M
This dissertation consists of three sections A, B and C which deal with ten common surgical conditions in Tanzania. Section “A” is made up of five common general surgical conditions. This section includes Burns in adults, simple goiter, cancer of the Oesophagus and Breast as important malignant lesions of the gastrointestinal tract in the male and the mammary gland in the female, while Traumatic rupture of the Spleen is identified as one of the commonest indication for emergency abdominal surgery. Section “B” is composed of three urological conditions. Cancer of the urinary bladder and Benign prostatic hyperplasia are important urological conditions affecting the adult population in particular males. Urethral stricture as a difficult urological condition to manage is stressed. Section “C” is comprised of two cases of Orthopaedic and Trauma. It outlines the management of supracodylar fractures of the Humerus and fractures of the Ankle joint. Road traffic accidents and falling from heights are identified as the main causative factors. For each condition a brief summary is given and an illustrative case presented. Recommendations where valuable are given at the end of the discussion of each condition.
Pattern of some diabetic complications in African diabetic patients in Dar es Salaam
(University of Dar es Salaam, 1976) Mhando, Peter A.
It is recognized now that the occurrence of diabetes in Tanzania and in East Africa as a whole is not as rare as it was previously contended. To date there has been no comprehensive study on the pattern of the disease in Tanzania. The purpose of this study was to review the pattern of diabetic complications in African diabetics in Dar es Salaam using standard methods and to study the significance of various risk factors in the development of these complications. It was found that in a series of 122 African diabetics, 75.4 per cent had at least one complication. The prevalence of retinopathy was 43.4 per cent, peripheral neuropathy 33.3 per cent, hypertension 25.4 per cent, and renal disease 15.6 per cent. Ischaemic heart disease was detected by standardized history or electrocardiography in 13.1 per cent of patients. Cerebralvascular disease and peripheral vascular disease including foot gangrene were found to be rare. The prevalence of complications showed no relationship to the quantity of control of diabetes but were positively related to age and, excepting ischaemic heart disease, to the duration of the disease. Obesity showed no correlation with any complication. The pattern of these complications and associated risk factors are discussed in relation to observations made in other African countries and elsewhere.
Causes of acute diarrhoeal disease in adults in Dar es Salaam
(University of Dar es Salaam, 1976) Mmuni, Konrad Alois
Acute Diarrhoeal disease in adults in Dar Es Salaam was investigated between July 1975 and October 1975 at Muhimbili hospital and Mnazi Mmoja dispensary to find out the cause. A total of 109 patients were seen and the results of 98 patients (15.3%) the diarrhoea was of bacterial origin. In 43 patients (43.87%) parasites were identified. Malaria, strongyloidesstecoralis, schislosamamansoni and trichura which were isolated were thought to have contributed to the development of diarrhoea, while Hookworm and Ascaris were thought not to cause diarrhoea. In 3 patients the diarrhoea was considered to be secondary to diet previously taken. Most of the admitted patients (30 cases) were ill and dehydrated enough to require intravenous infusions. Specific antibiotic therapy was necessary in cases of typhoid. Three patients out of seven with shigella improved without antibiotics. The results of this study, however appear to agree with the earlier findings (Knox et al 1967, Morley 1973) that the aetiology of most of the diarrhoea is unknown.
Ten surgical conditions
(University of Dar es Salaam, 1976) Mwamgimba, Landolin Bernard
This dissertation consists of three sections A, B and C which deal with ten common surgical conditions in Tanzania. Section "A" is made up of five common general surgical conditions. This section includes Burns in adults, simple goitre, cancer of the Oesophagus and Breast as important malignant lesions of the gastrointestinal tract in the male and the mammary gland in the female, while Traumatic rupture of the Spleen is identified as one of the commonest indication for emergency abdominal surgery. Section "B" is composed of three urological conditions. Cancer of the urinary bladder and Benign prostatic hyperplasia are important urolo¬gical conditions affecting the adult population in particular males. Urethral stricture as a difficult urological condition to manage is stressed. Section "C" is comprised of two cases of Orthopaedic and Trauma. It outlines the management of supracondylar fractures of the Humerus and fractures of the Ankle joint. Road traffic accidents and falling from heights are identified as the main causative, factors. For each condition a brief summary is given and an illustrative case is presented. Recommendations where valuable are given at the end of the discussion of each condition.
The pattern of skin disease in Dar es Salaam dispensaries.
(University of Dar es Salaam, 1977) Mwanukuzi, Elizabeth
570 skin patients were seen in three Dar es Salaam dispensaries between June and July1976. A thorough history was taken and complete body examination was carried out, a clinical impression made and specimens taken for mycological, bacteriological and histololgical investigations. The majority of patients suffered from lacute infective conditions, superficial fungal infections occurred in 49.3% of patients, with Tines cruris as the commonest infection. Scabies occurred in 20% of patients and pyoderma in 12% Trichophyton mentagrophytes, Trichophyton rubrum and Candida species were the commonest is olates from fungal infection and Staphylococeus aureus and B- hemolytic streptococci were isolated from p. yoderma lesons. There were no facilities for isolation of carynebaterium diptheriae. Eczema, lichen planus, psoriasis and leprosy were some of the chronic conditions commonly seen. Among the uncommon conditions include under “others” were vitiligo viral warts, pellagra and secondary syphilis. Some of the factors affecting the disease picture in white and black skinned race are analysed and the problems facing dermatologic services in Tanzania reviewed.
Prevalence rates of intestinal parasites in four communities in Kilimanjaro, Tanzania
(University of Dar es Salaam, 1977) Kihamia, Charles M.
Accumulating hospital data indicating high endemicity of intestinal parasites causing considerable morbidity and appreciable mortality unsupported by accurate epidemiological information about the real situation in the communities particularly the economically active rural agricultural population prompted this prevalence survey to the conducted in Kilimanjaro. It should be obvious that such epidemiological information would not only serve as base-line data for comparison with other and future studies but would also be a useful tool for the evaluation of control measures. In view of the accumulating clinical evidence of high endemicity of both intestinal helminthes and protozoa it was decided to carry out a survey to determine the prevalence rates of these parasites in this part of the country. The areas surveyed were from East to West, Shimbi-Kati in Rombo district; Mamba Kotela in Moshi rural district; Njoro area of Moshi urban district and Masama Modio in Hai district. The survey showed intestinal helmths to be very prevalent in Kilimanjaro. A total of 1,333 stools were examined from four localities and the data show that Ascaris lumbricoides and Trichuris trichiura are very prevalent in the rural areas. The overall prevalence of intestinal helminthes ranged from 17.1% in the urban area to 68.1% in Mamba Kotela (rural area). Rainfall is suggested as a possible cause of differences in prevalence of Ascaris and Trichuris in different localities. Taeniasis is found to be relatively highly prevalent in some localities. People’s habits as well as the importation of infected cattle are possibly responsible for the high prevalence and the differences in different areas. Hookworm, on the other hand, is less prevalent. This could be due to the clay soils which are known to be prohibitive to this parasite. Environmental sanitation is poor and in some areas as Masama Modio could be described as appalling. The level of insanitation reflects a failure on the part of health education to make an impact in people’s minds. It is suggested that efforts on this aspect should be redoubled and should be strongly backed politically. Combined and sustained control measures rather than single episodic efforts should be instituted. A study of the water supply shows that piped water is generally safe. But unsafe water from furrows is not uncommonly used in some areas and may even be the chief source of drinking water
Asthma at Muhimbili: a clinical and laboratory study of pattern of presentation, provoking and aggravating agents, and complicating factors.
(University of Dar es Salaam, 1977) Kilonzo, Gad P.
The purpose of this study was to examine asthma patients presenting at Muhimbili Hospital with the view to: 1. Describe social and psychological features associated with asthma patient presenting at Muhimbili. 2. Describe the pattern of the disease here and compare this with that described in other parts of the worlds, with paticular emphasis on atopic disease. 3. Find out what agents provoke and influence severity of illness. 4. Determine the clinical status of these patients 5. Find out what complications accompany the disease with special attention paid to the cardiopulmanary system.50 asthma patients and a group of 44 non-asthmatic control patients presenting at Muhimbili were studied. Asthma patients referred to Muhimbili casualty department and those admitted through medical outpatient clinics during September, October and November 1976 were included. Cases were taken consecutively as far as possible. They were interviewed, examined and investigated. The methods included (i) Personal interview with the patient using a check list. (ii) General physical examination with emphasis placed on cardio-resperatory system, and in particular noting signs of chronic chest hyper-inflamation due to chronic airway obstruction. (iii) Investigations were done to asthmatic patients. Only those investigations which required to be controlled were done to control patients, mainly stool examination, and serum estimation for IgE. The results showed late onset of asthma more marked among the females with crippling social and psychological stresses which accompany the disease. Accompanying a topic illnesses were high resembling the picture seen in temperate countries, and unlike that reported in several tropical countries. History was not a good indicator of offending allergens, and skin testing is suggested as a better method of identifying sensitizing allergens. Asthma in Muhimbili resembled other tropical countries in having a high eosinophil count, but this count was not higher than that of control patients. Asthma patients also have lower intestinal parasite load than a group of control patients. Patients with severe asthma have significant dehydration at the time of hospital admission. Chest radiographic changes were similar to the observations of other clinical workers in tropical countries and consisted of signs of chronic hyperinflation and tuberculosis reactivation. Results of skin testing identified two major allergens, house dust mites and mixed threshings. House dust mites and their secretions in dust were more important. Implications for management and therapy include the following: (a) Severe asthma patients should be rehydrated with at least 2 litres of fluid. This may be given as a vehicle for bronchodilators. (b) Asthma patients on corticosteraids whether continuous or intermittent should receive prophylactic anti-tuberculous therapy or followed closely with chest radiographs and sputum culture. (c) On the basis of sensitivity pattern tetracycline is the drug of choice at the first instance in cases of asthma complicated by infection before culture and sensitivity are available. The author concludes that major clinical conditions accompanying asthma are few, and complications of asthma are dehydration, reactivated tuberculosis, and chest deformities.
Symptoms, signs and complications associated with hypertension in indigenous African patients in Dar es Salaam.
(University of Dar es Salaam, 1977) Mtulia, Idrisu Ali Tulyai
In this study 4739 medical admissions had hypertension on the World Health Organisation Criteria. 16 patients were discharged prematurely and 172 African Patients, 103 males and 69 females were studied for symptoms, clinical signs and complications associated with hypertension in Dar es Salaam for a period of 6 months (January to June, 1976). There were no differences between the sexes in terms of their average ages and average erterial blood pressures. Dyspnoea headaches, oedima/ascites and palpitations were the commenest presentation in that order. The increase in headaches rate has been discussed. Only 3 patients had no complaints. 118 (68.6%) patients had hypertensive heart failure; one (0.6%) patients had heart failure; one (0.6%) Myocardial inforction, 30 (17.4%) patients had hypertensive cerebravascular disease and 23 (13.3%) patients had renal failure. 77 patients had hypertensive neuroretinopathy but only 5 (2.9%) patients had Grade IV neuroretinopathy and 17 (10.0%) patients Grade III. There were positive correlation between diastolic blood pressure level and Grade IV hypertensive encephalopathy respectively. There was also a positive correlation between strokes and age above 50 years. 10 (5.8%) patients died in hospital. 8 (4.7%) of them were related to hypertension. Results have been discussed and agree with those obtained from other studies elsewhere. Hypertension is common and a major disease in Africa's in the hospital environment deserving a priority position. Hypertensive neuroretiono pathy in African hypertensive calls for further reappraisal. A community based study should be considered in order to define the actiological pattern and prevalence of the disease in the population.
Obstetric and gynaecology case and comentaries
(University of Dar es Salaam, 1977) mberesero, Ben sabath
Dar es Salaam has a population of about one million people and is served by three district hospitals, Temeke, Magomani and Mwananyamala. These three district hospitals cater for several dispensaries within their catchment area. There are also several private hospitals and dispensaries within the town which offer maternal and child health services. There is not domiciliary practice but with introduction of health for all by the year 2,000 it might become an important part of our obstetric services. Muhimbili Consultation hospital is a referral hospital for the East and Southern zone of Tanzania; it also serves the whole country for some special services that are not available in the other consultant hospitals of K.C.M.C. and Bugando such as radiotherapy. Muhimbili also serves as a regional hospital for the city of Dar es Salaam. The Muhimbili Medical Centre holds the New Materiality Block with 296 beds and two gynecology wards with a bed capacity of 73beds in addition to pediatric, surgical, medical and psychiatric ward. All women with normal pregnancies and have attended their materials clinics in the dispensaries deliver at Ocean Road hospital. All our statistics for the obstetric services in New Maternity Block usually include the Ocean Road hospital. Ocean Road hospital also provides outpatient care for workers in Government and Parasternal Organizations. It has two post natal wards and one ward for patients on cancer treatment. The New Maternity Block provides antenatal, delivery and postnatal services to all at risk patients referred to the Centre and also to all grade one patients. Patients in the New Maternity Block and Gynecological wards are attended consultants, specialists, residents and intern doctors. Most of the district hospitals have graduate general duty medical officers. The health centers and dispensaries are supervised by medical assistants and rural medical aids respectively. Facilities in our three district hospitals and the consultant hospital are far from adequate. The new facilities provided cannot be expanded to meet the increased demands brought by village exodus; due to overstitched budgets in developing countries. The New Maternity Block; has one labour ward with 20 bed, one theatre which is not fully untilised and a small laboratory. A sideroom in the labour war houses our ultrasound machine and other electronic fetal monitoring devices. Our obstetric services are very strained by inadequate blood bank facilities, lack of staff, transport and drugs. All the three district hospital rely on Muhimbili Medical Centre bank. Only two private hospitals, Aga khan and Hindu Mandal have their own blood bank facilities. The important of having a separate blood bank for the maternity block is realized through the implementation has already ancoutrered both financial and administrative constraint. 2. OBSTETRIC SERVICES Detection and screening for at risk factors is primarily done at the peripheral antenatal clinics. Those patients with risk factors on booking or who develop complications during the pregnancy or during delivery are referred to New Maternity Block. Ideally all referrals from the dispensaries and health centers should be directed to the district hospitals but the absence of surgical facilities at these hospitals necessitates direct referral of most of the obstetric emergencies form the dispensaries to New Maternity Block. Once these facilities are provided and a co-coordinating committee for material services in Dar es Salaam is formed the careening would be smoother and the congestion is New Maternity Block would possibly be lose felt.
Obstetric and Gynaecologic Case Records and Commentaries
(University of Dar es Salaam, 1978) Semiono, C. P
The review is on patients managed and supervised by the author in Muhimbili Medical Centre, Dar es Salaam, Tanzania. The Centre in cooperates the Faculty of Medicine, University of Dar es Salaam. Some of the main functions of the Centre include; I. teaching undergraduate and postgraduate Doctors, Nurses, Midwives? and Paramedical Cadres; II. Serving as the main Consultant Hospital in the country. It has the largest laboratory and the only radiotherapy facilities in the country; III. serving as a zonal Consultant Hospital for the Southern and Eastern Zones comprising of Dar es Salaam, Coast, Mtwara, Lindi, Ruvuma, Iringa, Mbeya and Morogoro Regions; (see figure 1/1); IV. Acting as a Regional and referral Hospital for Dar es Salaam and Coast Regions. The Department of Obstetrics and Gynaecology functions as an independent unit although it is a subdivision of the Surgical Services Department. The Department is subdivided into 4 Firms each with at least 2 Consultants/ Specialists. Each Firm works independently with its own outpatient clinics, beds, operation schedules, and emergency duties. The Department of Obstetrics and Gynaecology has 363 beds. 67 beds are used for gynecologic patients and 296 beds for obstetric cases. The beds are distributed in different locations as follows: Sewa Haji Block, Muhirnbili: There are 2 wards for gynaecologic services. Ocean Road Hospital: For normal (Obstetric) deliveries. Muhimbili Maternity Block; A unit for high risk obstetric services. The public demand for Obstetric and Gynecological services is very high. The Department is often overwhelmed. For example, although there are 363 beds, the daily average bed state is between 600 and 700 patients.
The relationship between anaemia in pregnant women and a positive enzyme anti-human globulin test in Dar es Salaam, Tanzania
(University of Dar es Salaam, 1978) Magesa, Pius Mwita
The purpose of this dissertation was to determine the relationship between anaemia in pregnant women and a positive enzyme anti-human globulin test in Dar es Salaam, Tanzania. Sixty pregnant women attending the antenatal clinic at the Muhimbili Medical Centre were screened for antibodies to red cells using a newly developed technique of enzyme anti-human globulin (coombs) test. Thirty normal male donors were used as controls. Enzyme antibodies were frequently detected in both the expectant women and the donors. Twenty-three of the thirty donors were positive for enzyme antibodies. Fourteen sera out of the twenty three positive sera from the pregnant women were further analysed for antibody specifically, immunoglobulin class, title at 370C and at 40C and complement binding properties. It was demonstrated that two sera had IgManti Le (a) specificity. Four sera had doubtful anti e specificity, the last three of the four sera had, in addition, doubtful anti PI specificity, and only the first of the four sera was classified as IgM and the immunoglobulin class of the other three sera was not determined. Seven sera contained non-specific antibodies; three of these sera were IgM in type. One serum sample contained complement binding IgG antibody. The antibody titres at 370C ranged from 2 to 32 and at 40C from 0 to 16, i.e., the antibodies occurred at low titres. Complement components (C3) were frequently detected bound onto the red cells but without causing haemolysis complement inactivation enhanced the activity of certain antibodies. There was no conclusive evidence that anaemia in pregnancy was associated with the enzyme antibodies. Similarly pregnancy per se did not appear to predispose expectant mothers to the development of those antibodies. There was no significant statistical difference between the means of haemoglobin of pregnant women with a positive EDAGI and those with a negative EDAGT on one hand and pregnant women with a positive EDAGT and those with a positive EIAGT on the other. Enzyme antibodies were, however, found to occur with increased frequency below 19 years of age and particularly among primiparas and in low parity women. The new technique was more sensitive in detecting incomplete antibodies than the conventional anti-human globulin (coombs) test. The significance of these findings is discussed and possible lines of future research suggested.
Carcinoembryonic antigen: a review of literature
(University of Dar es Salaam, 1978) Kitinya, James Nyaga Nonga
This study was undertaken through literature review on carcinoembryonic antigen. The study indicate that carcinoembryonic antigen is a glycoprotein that consists of one polipeptide chain which accounts for 20 50% weight. The carbohydrate. Protein bond is between asparagine and N-acetylglucosamine. Carbohydrate content is 40-60% by weight (and there is variation in sugar residues). It is a heterogenous molecule, this being due to variations in carbohydrate protein ratio and the proportion of individual amino acid and sugar residues. Sialic acid variation is frequent and gives rise to differences in the surface change of the molecule. Further review of literature revealed that carcinoembryonic antigen is a normal constituent of foetal gut in the first and second trimesters of pregnancy when its synthesis ceases. It is in the glycocalyx layer of the cell surface on the luminal aspect. It appears mainly in carcinomas of the gastrointestinal tract but also in a variety of other cancers especially bronchus and breast and in inflammatory conditions of the gastrointestinal tract and respiratory system. It is found also in the serum of the patients with these disorder. Review further show that it was discovered by Gold when he produced monospecific antiserum by injecting into rabbits tumour extracts of colon carcinomas then absorbed the antiserum with normal colon tissue extract. Review of literature also showed that Serum assays are mainly by radioimmunoassay methods. The main application of carcinoembryonic antigen assays is in the detection of residual tumour after resection as levels in serum promptly decline; and serial levels are useful in the follow up of patients as its reappearance proceeds clinical detection of tumour by at least three months.
Studies on Dipetalonema viteae (Filarioidea) in the golden hamster ( mesocricetus auratus): detection of antibodies to microfilarial cuticular antigens by immune adherence
(University of Dar es Salaam, 1978) Kigoni, Emmanuel Paul
Immune adherence to human erythrocytes was used in the detection of antibodies to microfilarial cuticular antigens of Dipetalonema viteae in the course of a primary infection in the golden hamster, mesocricetus auratus. The immune adherence test was comparable in sensitivity to the indirect fluorescent antibody test in detecting microfilarial cuticular antibodies. These antibodies were present in the latent amicrofilaraemic stage of infection. They apperead only sporadically towards the end of microfilaraemia. Antibody neutralization by excess circulating antigen and the blocking effect of immune complexes were probably responsible for this phenomenon. Hamster serum may contain natural antibodies against human erythrocytes. The anterior and posterior portions of microfilariae seemed to be the most reactive in immune adherence. Anticuticular antibody activity was present in the 19S fraction and was probably of IgM class. Egg membrane bound complement directly. The main biological significance of immune adherence in primates seems to be the promotion of microfilarial phagocytosis, by cells the macrophage phagocytic system. It is suggested that efforts should be made to develop the immune adherence test for the serodiagnosis of human filariasis using the intact microfilarial surface as antigen.
Twenty case Histories and Comentaries in Surgery
(University of Dar es Salaam, 1978) Lyimo, J,E
The need for postgraduate training of surgical specialist in the environment in which they will eventually work in well recognized. Such training provides the opportunity of learning the “Art and Science of Surgery” in the environment which the Specialist are to practice and they can make a contribution to service in the local community, the training of their junior colleagues students and auxiliary staff. In 1973, the University of Dar es Salaam, started a three-year post graduate training course in secretary and one of its requirements for entry to the final M. Med. Examination is the preparation and submission of dissertation of 20 different clinical case studies with the review of the relevant literature. This dissertation is made up of 20 case histories divided into three sections:- A. General Surpery 10 marks B. Orthopaedics and traumatic Surgery 5 marks C. Genitourinary surgery 5 marks The cases in general surgery reflects the common in the digessive system that constitutes the largest group of admissions in adult general surgical wards in Muhimbili. Section B covers the common traumatic and infective conditions seen in the Orthopnedic-Trauma department of Muhimbili. In section C the author’s specialist some interesting genitourinary clinical conditions commonly seen in Muhimbili are presented. The author participated actively in the management of these patients under supervision of his teachers. All these 20 case histories with their respective literature review offered an excellence varied learning opportunities of the noble “Art and science of surgery” in Muhimbili Medical Centre.
Twenty surgical case studies
(University of Dar es Salaam, 1980) Kivambe, David Maurice
There were five cases of typhoid peritonitis treated between July 1977 and April, 1979. Isparotomy was done in four of these five. Perforation of the terminal ileum was seen in three patients who five. Successfully treated by simple closure. One case treated by simple suture closure is discussed. The review of literature on the different methods of management is briefly presented, and the surgical intervention against the orthodox management has also been discussed. Enteric fever remains a pressing clinical problem in the developing countries. Ilesl perforation, which is the most serious complication has a very high mortality ranging between 20 and 40 percent 10.20. in Ghana, for instance until the late sirties, the incidence has been unusually high.2,3. Today, the opinion still varies regarding the role of surgery in the management of typhoid perforation. While buckestep 11 advocated conservative measures. Li14 on the other hand favoured active surgical by active surgery combined with antibiotic therapy are reported. Mr. J. K., Reg. Mo. 10124, a 30 year old African Male, Mluguru by tribe and a shopkeeper by occupation, was admitted to Muhimbili Medical centre on November, 10, 1978. He compilained of severe headaches and fevers which have been on and off with treatment at various dispensaries for about ten days. He also complained of drowness and aching of his limbs for five days. About two days prior to admission he experienced sharp abdominal pains which initially were localized in the right lower abdomen, but later spread to the whole andomen. The pains were associated with vomiting and diarrboea. There was no haematemesis nor melaena. He had no cough nor expistaxis. He also gave history of experiencing.
Infective endocardities at autopsy in Muhimbili Hospital: A 22 years retrospective study
(University of Dar es Salaam, 1980) Gabone, Reverianus M
A retrospective study of 45 autopsy cases of infective endocartis (IE) in Muhimbili hospital Dar Es Salaam is presented. This study covers a period of 22 years between 1954 and 1975. IE represented about 4.4 percent of the clinical autopsy population and roughly 15.3 percent of those who died of cardiovascular problems in this period. Males were slightly more frequent than females, the sex ratio being 2.8:1 in favour of males. The peak age incidence was found in the groups between 30 and 54 years, the youngest being nine months and the oldest being 74 years. It was not possible to get accurate data about the duration of the disease from many of the patients. In 31 percent the duration was less than seven days and in about 21 percent the duration was more than 52 weeks. Cardiomegaly with congestive heart failure (CHF) was present in 55.5 percent of the cases. Congenital Heart Disease (CHD) with Infective endocarditis (IE) was not seen. Disease of the mitral valve was present in 29 of the cases while the aortic valve was diseased in 21 cases. Mitral stenosis was diagnosed more frequently than insufficiency, whereas the opposite was true for the aortic valve. Mural endocarditis was present in seven cases, while in 15 cases the disease probably started on previously normal valves. Sequelae of chronic rheumatic valvular disease still remain the most frequent predisponsing factor of IE in this series, being present in about 55.5 percent of the cases. Complications due to embol were present in 67 percent, the kidneys, spleen, central nervous system (CNS) and lungs being affected in that order of frequency. Two cases of myocardial infarction secondary to coronary embolism were found. Fever, gastrointestinal complaints, dyspnea and chest pain were the most frequent complaints. Toxic encephalopathy (Acute brain syndrome) had been present in 26.7 percent. Mitral valvular murmurs had been diagnosed in 17.8 percent and aortic valvular murmurs in 13 percent. Gram negative bacilli were isolated in 55.5 percent of the cases while stretococcuspyogenes and streptococcus viridans were each isolated in 14.8 percent. Culture was negative in 22.8 percent. CHF was considered the major cause of death in 55.5 percent. CNS involvement was present in 10 (22.2 percent) cases. A possible cause of death was found in 79.9 percent of the cases. There is urgent need to identify and study all cases of IE with a view of documenting its causes and change of its patterns if there are any in our environment.
A case control study on the relationship between tetanus toxoid immunization and the development and prognosis of neonatal tetanus at Muhimbili and Bugando hospitals
(University of Dar es Salaam, 1980) Ndawi, Benedict Thobias
A case-control study on the relationship between tetanus toxoid immunization and the development and prognosis of neonatal tetanus was done at Muhimbili and Bugando hospitals. A total number of neonatal tetanus cases studied was 78 and an estimated reported incidence of 2.2% live births in Dar Es Salaam was obtained. 41% of the total neonatal tetanus cases had their mothers immunized with 2 or 3 doses during pregnancy indicating immunization failure. The relative risk of neonatal tetanus for the non-immunized (0-1 dose) was found to be 2.6 times higher as compared to the immunized group. Considering the different vaccination groups the relative risk of getting neonatal tetanus of the 0 dose vaccination group as compared to the 3 dose vaccination group was 4.6 times higher, which gives an estimated effectiveness of about 80% for the 3 doses vaccination. However the case fatality rate was about the age at onset of symptoms and time from admission to death was about 65% for each of the different vaccination groups. But the age at onset of symptoms and time from admission to death was delayed in the 3 dose vaccination group as compared to 0 dose vaccination. Among the cases of neonatal tetanus in Dar Es Salaam the majority were from home deliveries, as compared to institutional deliveries. With the results, from the study recommendations have been made in order to reduce the morbidity and mortality of neonatal tetanus.
Childhood accident in Dar es Salaam
(University of Dar es Salaam, 1981) Mgeni, Samwel Stima
A total of 1051 childhood accident cases admitted to the Muhimbili Medical Center surgical andmedical pediatric wards over the period of 12 months of 1980 were reviewed to determine the pattern of childhood accidents and the influence of sex, age, social and environmental factors on their causation.Childhood accidents in 1980 occupied the 5th overall position in the hospital morbidity list, the other causes of morbidity being acute diarrhoeal diseases; respiratory tract infections other than TB measles, and low birth weight. The commonest form of accident (31%) was trauma and the other forms of accidents were, accidental poisoning (27%) accidents from foreign bodies (25%), and burns (17%). The commonest form of trauma was fractures and the other forms were head injuries, and a group of other injuries. The commonest mode of injury was falls, particularly from trees, and falls happening while the child was running. The commonest form (45%) of' accidental poisoning was kerosene poisoning the other forms of poisoning were due to drugs and chemicals (26%), food agents (23%) and a miscellaneous group (6%) of other forms of poisoning. In the majority of cases of accidents from foreign bodies the foreign bodies were seeds lodged into the nostrils and ears.Thecommonest form (82.4%) of burns were scalds, the other forms (17.6%) were due to open fires.The majority of cases in all the accidents except trauma, were under the age of 5 years and the peak occurred in the age group 1 - 3 years.In trauma, the majority of the cases were under7 years and peak occurred in the ace croup 5-7 years. A Male preponderance was noted in all the accidents.Remarkable monthly and diurnal variations in the occurrence of childhood accidents were noted for trauma, kerosene poisoning and burns only.

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