University of Dar es Salaam School of Health Sciences

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Acceptance of counseling HIV testing and prophylactic use of Nevirapine in labour and immediate puerperium at Muhimbili national hospital, Tanzania.
(University of Dar es Salaam, 2005) Ngarina, Matilda Michael
Background: Mother to child transmission contributes significantly to the incidence of HIV in our country. A PMTCT program exists in MNH and some surrounding public hospitals since 2000. In spite of this it has been observed that a substantial number of women delivering at MNH have not had VCT and therefore are not benefit from the PMTCT intervention. Objective: To determine the acceptance of counseling, voluntary HIV testing and prophylactic use of Nevirapine among pregnant women during labour / immediate postpartum at Muhimbili National Hospital. Methodology: Study setting: The labour ward of Muhimbili National Hospital. Study design: Descriptive Cross-sectional study. Study population: All pregnant women delivering at MNH during the study period of 3 months. (12thAugust-4thNovember 2004) Sample size: 885 women with unknown sero-status and 355 women who were sero-negative more than 3 months prior to delivery. Data collection: Trained counselors invited all women who met inclusion criteria as they were admitted. Women who accepted counseling were taken to private rooms for discussion and those who consented were screened for HIV using rapid tests. Direct observed therapy with Nevirapine was done. Data was filled in a structured questionnaire. Results: The overall acceptance of pre-test counseling in labour among women with unknown sero-status was 71.7%, and voluntary HIV testing 56%. Among women with unknown sero-status who accepted pre-test counseling in labour, 78.9% accepted HTV testing and 8.6% of these were diagnosed to be HIV infected. The overall acceptance of pre-test counseling in labour among those who were sero-negative more than 3 months prior to delivery was 70.5% while that of counseling and voluntary HIV testing was 64.1%. Ninety-one percent of women in this group accepted HIV testing in labour ward and 6% were diagnosed to be HIV infected. Eighty-three percent of women diagnosed to be HTV infected from the unknown sero-status group accepted NVP while all HTV infected women from the group of women who were initially sero-negative accepted prophylactic Nevirapine. Conclusion and recommendation: The results of this study show that HIV testing during labour and use of prophylactic ARV is acceptable in our setting. Acceptance of counseling, testing and use of NVP was higher among women who had HTV test during antenatal period compared to women who were admitted with unknown serostatus. Women with unknown serostatus in labour and those with a negative test more than three months prior to admission in the labour ward should be offered counseling and testing services in order to prevent MTCT of HIV.
Acceptance of post abortion contraception among women presenting with abortion at Mwananyamala municipal hospital Dar es Salaam
(University of Dar es Salaam, 2003) Kallanga, Matthew H.
Unwanted pregnancies may be a result of lack of access to family planning information and supplies, method failure, rape, incest, lack of support from sexual partners and abandonment or financial hardships. Most of these will end in pregnancy termination which can be safe or unsafe. Post abortal contraception can therefore prevent the next unwanted pregnancy. The aim of this study was to determine the acceptance of post abortal contraception among women admitted with abortion at Mwananyamala hospital, and to asses their pre-existing knowledge and use of contraception before the index pregnancy
Accessibility and sustainability of health services Iramba District: three years after community health fund implementation
(University of Dar es Salaam, 2001) Mwendo, Hamis Msengi
Community Health Fund (CHF) was introduced in Iramba district in June 1998. CHF is one of the alternative financing mechanisms that has been introduced following the government failure to meet the cost of the public health services in the rural communities. Low CHF enrollment has negative implications on both revenue generation and exemption for the poor. The trend of low CHF enrollment may lead to unsustainable health care services. Several factors might have influenced the enrollment. Therefore, the study focused on the important factors which may influence the improvement of access and sustainability of health care system. The broad objectives were: To assess the accessibility to health care services among CHF and non-CHF members at the household level and to assess sustainability of health services under CHF scheme in Iramba district. A household survey, Focus Group Discussion (FGD) and key informant interviews were used to collect information. The study population constituted heads of households or their representatives in Iramba district. In this respect, a household was defined as a monogamous marriage or single parent or a guardian and children who are under eighteen years of age. In case of polygamous relationship, the different wives were regarded as belonging to different households. This definition was adopted from the CHF scheme in Tanzania. Multistage random sampling was used to select households for the structured questionnaire interviews. A simple random sampling was used to select health facilities and correspondingly, households were selected by the same method from the facilities catchment areas. A total of four health facilities were selected and for each health facility, two villages were selected. In total of 212 households were interviewed. For the focus group discussion, a total of eight health workers, two from each health facility were selected. The in-depth interview was conducted with CHF managers. Selection was done according to their position in the managements of the CHF. The data was analyzed using an EPI Info program. Where appropriates, statistical tests were carried out. The 0.05 cut off point was used to interpret the p value. Most of households were found to be located not more than five kilometers from health facility. It was found that most (95.8%) of the households were aware of CHF. Village meetings and health facilities were identified as the main source of awareness about CHF. The study findings revealed that the current household membership rate was 50%, where, 43.5% were members who enrolled since 1998, and among household interviewed, about 9% had dropped from CHF. The rate of recruitment of new members was 4.1 % in the year 2001. The level of education and the nature of occupation were found to have a substantial influence on CHF enrolment. As the level of education increases awareness and CHF enrolment also increases. Association between self reported income of the household and CHF membership was found not to be a determinant of CHF enrolment. The willingness of people to enroll CHF was conditioned by the availability of drugs, easy accessibility of services ai improvement of the general quality of care of the services. It was seen that, the promises from CHF management to health workers likebenei packages were not fulfilled up to the time this research was conducted.. Hence, tha may have affected the health care provision. The CHF scheme in Iramba district was not yet fully functioning despite the fact tha revenue collection continued. The funds were still kept unused in the bank. Delivery a health care services was not yet improved, so consumers' expectationsof good qualit; health care were not yet met. Recommendations: Guidelines for utilization of funds should be transparent, and the bureaucracy for approval of funds use should be shortened for the purpose of improving quality of service and that would attract more individuals to enroll in the CHF. To ensure sustained CHF promotion campaigns should be continuous, and more focuses for individuals' benefits of enrolling as a CHF member.
Acute traumatic epidural and subdural haematomas: a clinical study
(University of Dar es Salaam, 1989) Mlay, S. M
A clinical study of patients with head injury who develop acute epidural and subdural haematomas has been done. Clinical monitoring of patients with head injury to detect development of intracranial haematoma is vital. This study sets to identify clinical symptoms and signs which influenced decisions towards further observations, referal to bigger centres investigation for haematoma or operation in patients with head injury who developed acute intracranial haematomas. It further looks into the incidence and pattern of skull fractures among these patients and the incidence of delayed and recurrent haematomas. In addition the factors which influence the initial mortality after surgery in these patients have been investigated. Clinical records of patients with acute traumatic epidural and subdural haematoma who were managed at the Neurological centre Nijmegen, the Netherlands between 1975 - 1985 were studied. Information was extracted using questionnaire. There were 134 patients of whom 71 had epidural, 58 subdural and 5 a combination of epidural and subdural haematomas. On admission 53.8% of EDH and 69% of ASDH patients had signs or symptoms suggestive of haematoma and were initially investigated. The rest i. e 46.5% of patients with EDH and 31% of ASDH patients were initially observed. The main clinical signs which influenced further investigation in the observed group of patients were deteriorating level of consciousness, pupillary dilatation anal hemiparesis. 73.2% of EDH patients and 50% of ASDH patient had skull fractures, 5.2% of the 134 patients developed delayed haematoma while 3% of all patients developed reaccu- mulation of haematoma. Factors which influenced the initial mortality after surgery were age of patient, type of haematoma, level of consciousness at time of admission and presence of contusion at operation. Mere presence of skull fracture did not significantly influence the mortality.
Adjudication of land disputes in mainland Tanzania: an examination of legal and institutional challenges.
(University of Dar es Salaam, 2018) Ngwala, Atuganile Florida
This study mainly focuses on addressing problems and challenges in land adjudication in Tanzania. The study reveals that disputes over land are inescapable because land is the principal means of production. Protracted land disputes undermine effective land utilization. The competing interests over land have necessitated the need to have specialised machinery for land dispute settlement in the country. Nonetheless, it has never been a simple task to establish ideal land dispute machinery that strikes the balance between competing interests while maintaining peace, security and social order. The study argues that the legislative process by Parliament to implement the National Land Policy (1995) that emphasized on the establishment of the land disputes settlement machinery has never been fully realised. Despite the enactment of the Land Act, [Cap.113 R.E 2002], the Village Land Act [Cap. 114 R.E 2002] and the land Disputes Courts Act [Cap 216 R.E 2002] to implement the National Land Policy 1995 that objective has not been fully realised. Therefore, the study calls for the re-integration of the Land Disputes Resolution System into the Judiciary. It also urges the government to reform and amend existing laws to clearly address issues of jurisdiction of land court, adjudication procedures and other dispute settlement methods that cater for the needs of both rich and poor. Further, it makes a case for harmonizing land laws and other related laws such as mining, conservation, wildlife and environment. Additionally, it advocates involvement of stakeholders in land disputes resolution.
Aetiology and antimicrobial susceptibility patterns of orofacial infections at Muhimbili National Hospital in Dar-es-salaam, Tanzania.
(University of Dar es Salaam, 2006) Sianga, William Charles
Background: Orofacial infections are common in dental practice. They constitute major medical conditions. Effective management of such patients requires current knowledge on the pattern of causative organisms and their antimicrobial susceptibility patterns to common available and recommended agents. Objective: To investigate the aetiology and antimicrobial susceptibility patterns of orofacial infections in patients attending the Muhimbili National Hospital in Dar-es-Salaam, Tanzania. Results: A total of 108 patients with ofacial infections were studied .There were more male patients with orofacial infections compared to females and that males were slightly older than females. Abscesses formed the highest proportion among patients with infections and were mainly due to pulp caries of mandibular second and third molars. Osteomyelitis mainly followed extraction of the lower second and third molars. Bacteroides, P. aeruginosa, S. pneumoniae, anaerobic streptococci and enterococci were highly associated with abscesses. E. coil, S. aureus and K pneumoniae were the most common isolates from patients with osteomyelitis. Bacteroides, anaerobic streptococci, K pneumoniae and S. pyogenes were the most common isolates in patients with necrotizing fasciitis. P. aeruginosa, S. aureus, K. pneumoniae and P. mirabilis were the most common isolates from cases of infected tumours. S. pyogenes isolates were fully sensitive to erythromycin and augumentin. S. aureus isolates were sensitive to erythromycin, cloxacillin and clindamycin while all P. aeruginosa strains were sensitive to gentamicin
The aetiology and prognosis of nontraumatic coma in Dar es Salaam.
(University of Dar es Salaam, 1984) Rwiza, Henry Tinka
A study of non-traumatic coma was carried out in Muhimbili Medical wards and intensive care unit over a period of 7 months. A total of 100 patients were studied. Seventy four males and 25 females were seen (male: female sex ration 3.6:1) the causes of come in the 100 patients were a cerebral malaria 37% hepatic failure 19% meningitis 9%, cerebrobrovascular disease 9% poisons and toxins 6%, diabetic coma 4%, miscellaneous causes 8, and in 8% of cases the diagnosis could not be determined. Of the 93 patients fully followed up 66 (71%) survived the first week while only 31 (33.3%) survived to the end of the 4 first month, making a one month mortality of 66.7%. Factors determining prognosi’s were the underlying disease condition, the durations of come, the neurological sign on admission and their subsequent evolution and the development of complication. Age, sex and the presence of convulsions (the latter being commonest in cerebral malaria) did not affect prognosis. Cerebral malaria carried the best prognosis with 25(67.6%) of the patients achieving an independent existence and was responsible for the generally good outcome of the whole series. Clinical sign had a strong predictive value. The chances of regaining independent existence were greater in patient who after 24 hours had orienting or confused verbal responses, opened eyes spontaneously or to noise had orienting eye movements, had normal oculocephalic responses and obeying or localizing motor responses. Conversely, the change of regarding an independent existence fell in patients who after one day lacked the following eye opening, spontareous eye movements, papillary light reflexes, full oculocephalic responses,. Motor responses skeletal muscle tone, deep tendon reflexes and corneal reflexes. It is concluded that most of the causes of coma were potentially treatable even without the use of sophisticated facilities. The supply of a few specific drugs such as neomycin and lactulose for hepatic encephalopalhy or pralidoxime for or organophosphorus in secticide poisoning and improvement of the nursing care facilities are recommended as measures for improving outcome especially if intensive care-cabicals with improved nurse to patient rations are established.
Alternative anthropometric measurements of a new born as surrogates for birth weight
(University of Dar es Salaam, 1990) Ngowi, Judith A
The need for other anthropometric measurements as surrogates for birth weight has been necessitated by the failure to attain accurate birth weight measurements in the majority of births in the developing countries. Mid-arm and chest circumference have been suggested as reliable measurements for the purpose. In this study 1,666 Tanzanian newborns were measured in order to evaluate the correlation between mid-arm, chest-circumference and birth weight in Tanzanian newborns and to determine the stability of these measurements over the first five days of life. The study also determined values of chest and mid-arm circumference predictive of birth weights of 2,000 gm and 2,500 gm and assessed the sensitivity, specificity and predictive values of these cut-off points in the prediction of low birth weight. The results showed a high correlation between birth weight and mid-arm circumference (r=0.88) and chest circumference (r=0.92). The correlations remained high throughout the first five days of life, ranging from 0.938 to 0.987 for mid-arm circumference and from 0.944 to 0.989 for chest circumference. The mean differences between measurements taken on day one and measurements taken on subsequent days did not exceed 0.46 cm for mid-arm circumference and 0.3 cm for chest circumference, indicating stable and repeatable measurements over the five days. Chest circumference of 26.9 cm and 29.6 cm and mid-arm circumferences of 8.4 cm and 9.5 cm corresponded to birth weights of 2,000 gm and 2,500 gm respectively. These values were associated with sensitivities ranging from 86.4% to 95.2% for chest circumference and 87.1% to 93.2% for mid-arm circumference in predicting birth weights less than 2,500 gm. Predictions of low birth weight using measurements of chest or mid-arm circumference taken on subsequent days agreed with predictions using measurements taken on day one in at least 98.7% of the cases. It is concluded that these anthropometric measurements can be used reliably as surrogate of birth weight. A tricoloured tape is recommended for inclusion in rural delivery kits to simplify the measurements.
The application of a geographical information system in the health services management to support evidence based planning and decision making. the case study of Kinondoni District
(University of Dar es Salaam,, 2012) Swai, Aleswa Zebedayo
Use of evidence in planning is essential for the rational management of health services. Funding for the health sector is an essential input, but alone, is not sufficient for positive change. Rather, ability to allocate and use resources in a strategic manner is vital. Several health systems are characterized by sub-optimal use of evidence to guide planning and decisions (Namibia, Uganda and Tanzania HIS Assessment reports, 2005, 2007). The reason for limited use of evidence in decision making is the fact that data are often not available in formats that allow easy interpretation. Geographical Information System (GIS) technology has shown the potential to support data exploration and easy interpretation (Pick 2005, Suresh 2004). This present case study at Kinondoni Municipal Council in Dar es Salaam, Tanzania aimed at exploring the level of use of GIS in public health at district level for planning and decision making. The goal is to propose a framework for GIS deployment and test its feasibility and potential upscaling. Data were collected along with a review of literature on various parameters of GIS. Key findings include; GIS and its application have not yet been integrated into health planning circles, however such an application already exist within the same council as demonstrated in tax administration and revenue collection. Workers had limited knowledge of GIS for health, although awareness of planning processes was high. The DHIS2 based GIS module needs to be improved rather than adapting other separate software application to support spatial analysis. A framework for the operation of GIS within the council has been proposed. However, additional work is required for effective mainstreaming of GIS services the district health planning mechanism.
Arthroscopy of the knee joint: diagnostic and therapeutic potentials.
(University of Dar es Salaam, 1990) Sharif, Sharif Ismail
In Tanzania, diagnostic arthroscopy was introduced in the early 80's, and to many clinicians, arthroscopy is not as popular as other endoscopic methods like gastroscopy, cystoscopy, laparascopy and bronchoscopy. The evolution of arthroscopy dates back to 1918, but the most important milestone in arthroendoscopic examination and surgery was in the 70's and 80's. Many centres are now specialising in arthroscopic surgery as a routine outpatient procedure, and this has greatly improved the quality of knee treatment. Eight hundred and fourty-seven (847) arthroscopies were performed on seven hundred and eighty two (732) patients from January 1985 to December 1986 at the KKH Dormagen. There were 462 (59.1%) male patients and 320 (40.9°0) female patients. The ages of the patient ranged between 11 and 71 years, average age being 36.5 years. Analysis is made to compare the clinical, radiological arthroscopic and whenever possible intraoperative findings pertaining to the causes of internal derangement of the knee joint. Analysis is made based on arthroscopic findings on the causes of internal derangements of the knee joint and the ultimate plan for final treatment of the patient. Arthroscopic anatomy and pathology is discussed. Biomechanics and the patho-anatomic changes causing internal derangements of the knee is discussed. With these facts it is shown that improving the facilities available with the limited resources at hand, arthroscopy has a definite place in Tanzania as far as improving the quality of knee treatment, decreasing morbidity in knee treatment, reducing hospital stay as well as providing a basis for research as to the common causes of gonarthralgia in Tanzania.
Assessment of HIV/AIDS knowledge and sexuality among primary school youth in Mwanza region.
(University of Dar es Salaam, 2004) Mondea, Pastory L.
A descriptive cross sectional study was undertaken in Mwanza Region during June 2004, to assess HIV/AIDS knowledge and sexuality among primary school youth of class VI and VII. Self-administered questionnaire was used to collect data. Of 1630 study participants, 888 (54.5%) were from HIV/AIDS intervention schools (Magu District) and 742 (45.5%) from no-intervention schools (Ilemela District); 577 (35.4%) were boys and 1053 (64.6%) were girls. The study results indicated that 94% of respondents from intervention group were aware of HIV/AIDS as compared with 74% in non-intervention group (p= 0.00001). Respondents who scored high level of HIV/AIDS knowledge were 83% from intervention group as compared with 86.4% from non-intervention group. However, 71 % of respondents from non-intervention group knew 3 preventive measures against HIV infection compared with 64.2% respondents from intervention group. Pupils from the intervention group were twice as likely to be more sexually active than pupils from non-intervention group, 20.7% vs 11.3% (OR=2.03, 95% CI 1.52, 2.71). Condom awareness was significantly higher in intervention group than in nonintervention group, 96% vs 87% (p<0.0003). For respondents who are sexually active they reported to have higher condom use in intervention group (28.8%) than in nonintervention group (20.2%). Sources of information on HIV/AIDS and sexuality reported did not differ among study groups except peer educators were more common for the intervention group than in nonintervention group. This study concludes that school HIV/AIDS education program using peer educators did not demonstrate success in reduction of sexual activity among pupils. Development of appropriate teaching strategies and learning materials for HIV/AIDS education for school youth to bring positive sexual behaviour change is required.
An assessment of impact of Lumberers population mobility on HIV/AIDS prevalence in Makete district, Tanzania
(University of Dar es Salaam., 2019) Ndossi, Furaha
The study assessed the impact of lumbering and population mobility on HIV/AIDs in Makete district in Tanzania. The study specifically (i) examined the socio-economic and external factors influencing HIV prevalence in Makete district, (ii) examined the impact of lumbering and population mobility on HIV prevalence in Makete district and (iii) evaluated possible intervention measures of lumbering and population mobility in influencing HIV prevalence in the district. A sample of 130 respondents was taken from Makete population which has a total of 97266. The total population was divided into strata of urban and rural to reveal real impact to HIV/AIDs spread in the area. Qualitative data collection methods such as; focus group discussions and key informant interviews were used to reveal the inner factors and reasons for the situation. The study found that occupation, land issues, market forces or conditions and poverty as socio economic factors leading to HIV prevalence at Makete District in Tanzania. The study also observed that migration of people, insufficient and accessibility of health services and intensive agriculture activities are the external factor for HIV prevalence at Makete District in Tanzania. The study revealed that lumbering project in Makete District in Tanzania brought a high impact on improving economic status of people, destruction of environment, population decrease at the area, creation of employment activities and increase of infection of HIV AIDS. It is observed that to large extent lumbering project influences HTV prevalence at Makete District in Njombe Region, Tanzania. The study recommends that socio economic factors and the external factors that have been found to facilitate HIV prevalence at Makete District Njombe Region in Tanzania have to be critically studied in order to provide the best mechanism of addressing or reducing HIV prevalence in the area.
Assessment of implementation of home based care services in Dar es salaam: a case Study of Ilala Municipality
(University of Dar es Salaam, 2019) Mbogo, Neema
This study assessed implementation of Home Based Care services in Ilala District in Tanzania. The overall objective of the study was to assess implementation of home based care programs in Ilala district Dar es Salaam. Specifically, the research intended to assess knowledge and perception of providers and clients towards HBC, assess roles of HBC providers and finally to explore challenges faced by HBC provide. A descriptive design was deployed in undertaking this study. The study adopted a qualitative research approach. A purposive sampling method was used to select participants for the study and a total of 45 participants were involved in the study. The study results indicate high knowledge among PLWHA on HBC services. It was revealed that all groups of participants had positive perception toward home based care services. Furthermore the study revealed a number of core challenges that face home based care providers whereby in one way or another affect effective implementation of HBC programs. Lack of resources for delivering services, and poor financial benefit for HBC providers were the key challenges raised by HBC providers. Based on the findings the study recommends the HBC providers to be included into permanent employment basis for provision of services. Government through the Ministry of Health, Community Development, Gender, Elderly and Children should cooperate with other stakeholders particularly NGOs in funding HBC services so as to make them sustainable. Further studies should be conducted to explore implementation of HBC services particularly in rural areas.
Assessment of quality of Malaria care in pregnancy at Mkuranga district Hospital
(University of Dar es Salaam, 2002) Idindili, Boniphace Myolela
A descriptive cross- sectional study was conducted in May 2002, at Mkuranga District Hospital. The aim of the study was to assess different aspects of quality of malaria care in pregnancy with emphasis on infrastructure input, the process of provision of malaria care to pregnant women and its impact. In addition the impacts were assessed in terms of pregnant women's knowledge of the causes of malaria, prevention and treatment. The study comprised of 282 pregnant women and 8 clinicians. All of the pregnant women studied were peasants with absolute age range of 14 to 40 years old. Structured questionnaires were used to collect information from both clinicians and pregnant women. A checklist with a number of items was used to assess the availability of resources, such as human, resources, physical infrastructure and equipments. The major findings of the study were as follows: - Majority of pregnant women interviewed (92.3%) knew that mosquito's transmits malaria. About 61% of pregnant women mentioned Insecticide Treated bed nets as one of the most effective method of malaria prevention at household level. While about 87% of pregnant women prefer to seek Hospital care once they suspect malaria infection, and few reported to seek malaria care from traditional healers and selfmedication. However, the majority had little awareness about common complications of malaria in pregnancy. Majority (90%) had positive feelings about communication between them and health care providers. Deficiencies were recorded in relation to the size of the hospital buildings and staffing levels of different hospital cadres. The hospital buildings were found to be too small to accommodate a district Hospital. With regard to staffing level, the most affected cadre was the lower level cadre of nurses and medical assistants with a shortage amounted to 82% deficit. The study further found that clinicians had no proper protocols for malaria diagnosis and treatment; neither followed the National Guidelines for malaria management in pregnancy. This study concludes that, there are deficiencies in various aspects of quality of malaria care in pregnancy. Most of the problems identified are due to the fact that the District is newly established. However recommendations for improvement of the situation are provided.
Assessment of quality services in primary health care facilities in Moshi-Rural District
(University of Dar es Salaam, 2001) Adam, Nicholas
A cross sectional study was conducted in Moshi Rural- district from 15th June to 15th July 2001. Eight primary health care facilities were studied including four public, two private and two voluntary health units.The main objective of the study was to assess the quality of services in primary health care facilities, also to find out the perceptions patients had on the quality of services delivered at these units. Service providers were also interviewed about their perceptions on their working environment, as it relates to quality care A total of 147 patients and 43 service providers were interviewed, health facility observations were made and five focus group discussion were also conducted among the patients Study results showed that the commonest perceived determinant of quality in dispensaries was the availability of drugs. Approximately two third; (65.8%) of patients in public units got their prescribed drugs, as compared with 96.6% in private and 92.3% in voluntary health units. Lack of access to drugs and non-availability of diagnostic equipment in government owned facilities were commonest reasons for patients seeking care from alternative health units. This study also showed existence of a gap between what perceptions patients had on the quality of care delivered and their expectations. These gaps were perceived both in structural and process quality, and they ranged from the infrastructures, environmental sanitation, management of patients, to technical competence of service providers. A gap was also found in manpower deployment at all the three types of health units. The deficiencies were found to be 70% in private, 47.7% in public and 60% in private health facilities. Results of the observations made on sanitation showed that 100% of the outpatients department toilets in public facilities were non-functional while the reverse was true in private and voluntary health units. Supervisory visits from the DMO's office were done regularly in public health units only, but this was not case for the private and voluntary units. It is recommended that improvements to be made on drug availability and supply of necessary working gears in public units. To meet the community expectation for quality care it is recommended public health units should have better drug management also be equipped with the basic diagnosis facilities. A review of manpower deployment in public, privates and voluntary units should be also made to identify the deficiencies and take necessary measures to secure that regulations on manpower deployment adhered to.
Assessment of the impact of periodic treatment of soil-transmitted helminth infections on the health status of primary school children in Muheza district
(University of Dar es Salaam, 2003) Kimwerimtoi, Tom
A cross-sectional study was carried out in mid-June 2003, in Muheza district. The main objective of the study was to assess the impact of periodic treatment of Soil-Transmitted Helminth (STH) infections on the health status of the school children in the district after four years of intervention of school-based deworming project. The main focus was on the reduction of the prevalence and intensity and improvement of the health status as well as knowledge on disease transmission and prevention and compares it with the data from the baseline survey done in 1996. A simple random sampling method was used to select four primary schools, whereby all pupils from class V to VII totaling 339 were investigated. Prevalence and intensity of STH (geohelminths) was assessed by stool examination using Kato-Katz technique. Nutritional status was measured for wasting, stunting and underweight by using Weighing scale and Stadiometer. Knowledge, attitude and practices regarding geohelminthiasis were explored by using semi¬structured interviews using questionnaires. The findings of the study are as follows:- The overall prevalence dropped from 70% during the baseline to 47.1%, intensity of infection dropped from moderate during the baseline to light for hookworm, Ascaris lumbricoides and Trchuris trichiura. Children’s understanding of STH improved and there was improvement of anthropometrical nutritional indices. Stunting dropped from 66% to 43.1%, underweight dropped from 50.5% to 26.5% and wasting dropped significantly from 1.8% to 0.6%. Therefore it is recommended that more research should be carried out to determine the prevalence of STH and the worm burden among the school children in rural and urban areas in order to assist policy makers in rational planning for control of STH. Relevant authorities should upscale the deworming programme throughout the country by involving various sectors like the government, NGOs and the community in the control of Soil-Transmitted Helminthiasis.
The association between placental malaria parasitization and pre-eclampsia/ eclampsia in promigravidac at Muhimbili National Hospital Dar es Salaam, Tanzania
(University of Dar es Salaam, 2002) Lipingu, Chrisostom Clarence
Objective: To determine the association between placental malaria parasitazation and pre-eclampsia/ eclampsia at Muhimbili National Hospital - Tanzania. Design: Unmatched case control study. Setting: Muhimbili National Hospital ( MNH ) labor ward. Population: Primigravidae with pre-eclampsia/ eclampsia as cases and those without as controls who delivered at MNH. Methods Peripheral blood smear to detect malaria parasite was done by taking venous blood. Pieces of placental tissue were taken and histological analysis was done to detect the presence of placental malaria parasites and pigments. Results: The study did not find statistical significant difference between pre eclampsia/eclampsia and the control group when malaria parasites and/or pigments were analyzed in the blood and in the placenta. Overall there has been a clinical significantly higher prevalence of placental malaria parasites and pigments in cases than controls but it has not been proved statistically in this study. Conclusion: Therefore the study has found no association between the presence of placental malaria parasitization and occurrence of pre eclampsia/ eclampsia.
The association of intestinal parasites with chronic diarrhoea in adult AIDS patients in North-Eastern Tanzania.
(University of Dar es Salaam, 1995) Tarimo, Donath S.
A study on the association of intestinal parasites with chronic diarrhoea among adult AIDS patients was conducted in the North-Eastern zone of Tanzania. Diarrhoea was found to be a major problem among the patients. More than 70% of the patients had diarrhoea during their illness. Intestinal parasites were detected in 123 out of 352 (34.9%) patients. The proportion of patients with intestinal parasites and chronic diarrhoea was 62.6% (77 out of 123). The prevalence of chronic diarrhoea in patients who were in clinical stage III-IV of AIDS was highest among patients harbouring parasites that are known to cause diarrhoea. The association of diarrhoeagenic parasites (combined together) with chronic diarrhoea was found to be statistically significant. The adjusted associations were also found to be statistically significant. Cryptosporidiums Isospora belli and Strongylostercoralis were only isolated from patients with chronic diarrhoea. It was concluded that chronic diarrhoea was a major complaint of adult AIDS patients in North-Eastern Tanzania. Parasites known to cause diarrhoea considered together were the most likely cause of chronic diarrhoea in such patients. Cryptosporidium spp, Isospora bell, and Strongyloides stercoralis were the most likely cause of chronic diarrhoea among the patients. Development of clinical infection due to parasites known to cause diarrhoea was found to be related to the immunological status (clinical stage) of the AIDS patients. It is recommended to strengthen home based care for AIDS patients as well as laboratory facilities at all levels of health care delivery centres for diagnosing specific intestinal parasites in AIDS patients so as to institute specific therapies thereby improving the quality of life of such patients. A comprehensive case-control study, to establish cause and effect of the various agents isolated from AIDS patients with chronic diarrhoea is proposed. There is a need to determine the type of drugs which will be suitable for the treatment of opportunistic infections which may interact with AIDS in our set up.
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.
Asymptomatic bacteriuria: screering and prevalence among pregnant women attending clinic at Muhimbili National Hospital: a cross sectional study.
(University of Dar es Salaam, 2002) Kamugisha, Gelase Kalibashubao
Background: Prevalence of Asymptomatic bacteriuria in pregnancy ranges from 2.0% to 23.9% and if not attended about 20% to 40% of these will develop symptomatic disease. None of various screening methods have been found to have satisfactory sensitivity and specificity. Objective: To determine the reliability of nitrite reductase and leucocyte esterase methods in screening for ABU in pregnant women. Settings: Muhimbili National Hospital - Antenatal clinic Study design: Cross sectional. Population: Pregnant women attending antenatal clinic. Methods: Systematic sampling was used and morning urine samples were screened using Dipstick methods. Bacterial culture and antimicrobial susceptibility was done. Analysis was done using EPI info version six and specificity and sensitivity were calculated. Results: The prevalence of ABU was 23.0 %. Both nitrite reductase and leucocyte esterase tests had poor sensitivity ranging from 10.5% to 65.8%. Klebsiella spp and E.coli were the commonest microorganisms comprising 44.8% and 23.2% respectively. Conclusion: ABU represents a considerable public health problem among pregnant women attending MNH-ANC and leucocyte esterase and nitrite reductase tests are not ideal for screening. Recommendation: There is a need to look for other screening tests.

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