Masters Dissertations

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    The Effect of Zinc Supplementation in ChildrenRecovering from Severe Protein Energy Malnutrition at Muhimbili Medical Center
    (University of Dar es Salaam, 1997) Mushi, Sophia M.
    Study Objective To determine the effects of zinc supplementation in children recovering from severe Protein energy malnutrition (PEM). Study Design A randomised controlled clinical trial. Setting The study was conducted at the Nutritional Rehabilitation Unit (NURU) popularly known as Makuti ward at MuhimbiliMedical Centre, from July 1996 to January 1997. Subjects A total of 66 children aged between 12 to 60 months who had recovered from severe PEM, were recruited for the study. Methodology Children were randomized into two groups; supplemented and unsupplemented group. 33 children were supplemented with zinc sulphate 2 mg/kg daily and 33 received placebo. The two groups were further matched for nutritional diagnosis for example each case of kwashiorkor in the supplemented group wasmatched with another case of kwashiorkor in the unsupplemented group. Both groups were followed monthly for three months during which time zinc plasma levels were determined by Atomic absorption spectrophotometry. Weight and height were taken on recruitment and fortnightly for three months. History of intercurrent infections on admission andduring fortnightly follow up was obtained from the mother/caretaker. Main Outcome Measures The main outcome measures were increment of plasrna zinc level, weight, length, and decrease of morbidity. Results Overall (45/66) 74% of the children were found to be zinc deficient at the beginning of the study. The mean plasma zinc level on recruitment was O .470 mg/l in supplemented group and O. 387 mg/l in the unsupplemented group, however the difference in the mean plasma zinc levels between the 2 groups was statistically not significant (t 1.54, p=0.13). The mean plasrna zinc level on the 90th day of rehabilitation was higher in the supplemented group than in the unsupplemented group. The difference was statistically highly significant (t = 7.22, P < 0.001).At the end of 90 days of rehabilitation period the mean weight and the mean length in the supplemented children was greater than that in the unsupplemented group and the difference in weight was statistically significant (F value = 9.4, P value = 0.003) , however, the difference in length was statistically not significant, (x2 = 0.849, p = 0.35). The morbidity due to pneumonia and diarrhea decreased substantially in the supplemented group compared to that in the unsupplemented group and the difference was statistically significant. Conclusion and recommendations Zinc supplementation in children recovering from severe PEM has a positive effect on plasma zinc level, weight, and infant morbidity. It is recommended that children recovering from severe PEM should be supplemented with zinc.
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    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.
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    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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    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.
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    Gynaecologic and Obstetrics Cases and Commentaries
    (University of Dar es Salaam, 1999) Mohamed, Shaffiq Hussein
    This dissertation has three parts. As shown in the contents both part one and two are each made up of 10 gynecological and 10 obstetrical cases and commentaries respectively. All these 20 case reports and commentaries were managed by the author himself. For each case a thorough history, examination, investigations and treatment have been narrated. Cases were managed according to standard laid down management protocols though investigations were at times not exhaustive because of limited facilities. After each case there is a commentary followed by relevant references. A long obstetrical commentary is in part three (3). A prospective study on maternal anthropometric measurements and gestational age in prediction of foetal weight in pregnant women at Muhimbili Medical Centre was done. A total of 600 patients were included in the study. The study revealed that maternal anthropometric measurements (symphysio- fundal height and abdominal girth) were good predictors by birth weight. An equation of great predictive value utilizing these anthropometric measurements was derived and tested in another sample of hundred patients. It was found that sensitivity and specificity of detecting birth weight less than 2kg was 88.2% and 84.3% respectively. Sensitivity and specificity for detecting birth weight more than 3.8kg was 83.3% and 68.1% respectively. Conclusively, it seems justified to investigate the value of equation of higher predictive value for use in antenatal care in developing countries.
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    Obstetric and Gynecology: a Cases and Commentaries
    (University of Dar es Salaam, 1995) Lipyoga, Rosina S.M.
    This dissertation is submitted in partial fulfillment for the award of the degree of Masters in Medicine (M.Med) of the University of Dar es Salaam. It comprises of three sections. Sections one and two consist of ten gynaceological and ten obstetric conditions which are encountered in the practice of obstetrics and gynecology. Discussions on the salient features in the presented patients appear at the end of each case. Section three is a research done over a nine-month period on the association between malaria and abruption placentae in Dar es Salaam. A statistical significant association was found between maternal malaria parasitemia and malaria parasitization of the placenta and abruption placentae.
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    Hypothermia, Associated Factors and Neonatal Outcome
    (University of Dar es Salaam, 1997) Kisenge, Rodrick Richard
    Hypothermia in newborn babies is a problem in tropical countries despite warm environmental conditions and it contributes to neonatal morbidity and mortality.This cohort study was done in the Neonatal Care unit, Muhimbili Medical Centre to determine the prevalence of hypothermia on admission, associated factors and neonatal outcome in terms of morbidity, weight loss, duration of stay in the neonatal unit and mortality. The study was conducted from July to October 1996 and the study population included all neonates admitted to the Neonatal Care Unit during the said period.The prevalence of hypothermia on admission was found to be 22.4% and hypothermia was not recorded or reported to be a reason for admission in any of the neonates in this study, despite that 13.1% of the hypothermic neonates had severe hypothermia on admission. There was no low reading thermometer in the unit.Hypothermia on admission was significantly associated with maternal intrapartum medications (P = 0.04), delivery by doctor (P = 0.000), delivery atMuhimbili Medical Centre Obstetrics Theatre (P = 0.000) or delivery in other hospitals(P = 0.00) , delivery by lower segment Caesarian section (P = 0.000) or by low cavity vacuum extraction (P = 0.01), low birth weight (P = 0.002), prematurity (P —0.001), longer duration of transfer from place of delivery to the Neonatal Care Unit (P = 0.000) and inadequate clothing of the baby after delivery (P 0.000). It was alsofound that hypothern1ic neonates stayed longer in the Neonatal Care Unit than normothermic ones, they had more postnatal weight loss and increased risk of both morbidity and mortality. It is concluded that hypothermia is a problem in the Neonatal Care Unit,Muhimbili Medical Centre and is associated with increased morbidity and mortality. Efforts should be made to raise awareness among health providers with more emphasis on prevention. Daily use of low reading mercury thermometers is recommended in order to detect severe forms of hypothermia that require more aggressive management.
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    Obstetrics and gynaecology cases and commentaries
    (University of Dar es Salaam, 1996) Kapona, Y.M.
    Mrs. S.I.; A 55 years old, para 2 + 0 postmenopausal lady was admitted in gynaecology ward with history of abnormal uterine bleeding accompanied by foul smelling vaginal discharge for five months. Clinical evaluation and investigations showed endometrial carcinoma; stage IBG3. She underwent total abdominal hysterectomy and bilateral salpingngophorectomy. This was followed with adjuvant radiation therapy with 4000 centigrays. She was discharged in fair condition to be followed in outpatient clinic. Management of endometrial carcinoma is discussed. History of presenting illness Mrs. S.I. 55 years old lady was about 10 years postmenopausal. She was admitted in gynaecology ward with history of abnormal uterine bleeding for about five months. The bleeding was irregular, and unprovoked by douching or sexual contact. It was not heavy and was not associated with clots. It was however, accompanied with foul smelling watery vaginal discharge, which was not itching. There was no history of haematuria, or passage of
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    Gynaecologic and obstetric cases and Commentaries.
    (University of Dar es Salaam, 1990) Sequeira, Brenda Maria
    The dissertation is submitted in partial fulfillment for the award of the degree of master of Medicine (M.Med) of the University of dar es Salaam. It consists of three parts, the first and second parts consists of 10 gynecologic and 10 obstetric cases which are a few of the many cases managed by the author. Standard management has been followed unless where facilities were limited. A short commentary comprising of salient features regarding the condition presented follows each case. The third part is a long commentary on a multidisciplinary community based study done over a one month period. It describes the perceptions, practices and health problems of the pre, peri and postmenopausal women in rural Dar es Salaam. The findings were interesting and extensive but only a part of it is presented to fulfill the requirements of the long commentary in this dissertation. The median age of menopause was found to be 47 years. A taboo against discussing matters concerning the menstrual period existed, leading to widespread misconceptions on the menopause. Generally it was viewed positively by 63.8% of the population, while 26.4% did not know about the menopause. Physical and sexual activity was not limited by menopausal status. The main health concerns were abdominopelvic and general body pains, paraesthesia of the extremities was related to the menopausal status but not the hot flush. It defined the need for further educational campaigns and larger scale collaborative studies on this issue.
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    Prevalence of iron deficiency in children with Sickle Cell Anaemia at Muhimbili National Hospital
    (University of Dar es Salaam, 2003) Mangosongo, Bona
    Bacground Sickle cell anaemia is a genetically inherited haemoglobinopathy and is among the major cause of severe anaemia in children in Tanzania. The anaemia is of haemolytic type but several studies have reported iron deficiency anaemia in these patients. (20,21,22) The possible cause of severe of iron deficiency in these children have been speculated to be similar to non-sickler children. (20) Objective To determine the prevalence of iron deficiency and possible contributing factors in sickle cell anaemia patients. Study design A cross section descriptive study Study setting The study was conducted at the paediatric out patient clinic for sickle cell anaemia of Muhimbili National Hospital in Dar es Salaam, from August 2002 to February 2003. Subjects A total of 100 children aged between 6 months to 10 years inclusive attending outpatient sickle cell clinic, were recruited into study. Methodology All haemoglobin SS patient between 6 and 10 years inclusive who actually attended the sickle cell clinic, and whose parents/guardians consented for study were enrolled. Simple random technique was used to select the patients. Five milliliters of blood was taken from all children for Serum ferritin, Serum iron, Total Iron Binding Capacity (TIBC), full blood count and peripheral smear. Main outcome measure The main outcome measure was the magnitude of iron deficiency anaemia Results One hundred patients were recruited during the study period. Males were forty-seven (47%) and fifty-three (53%) were females. Forty-five children (45%) were under five years of ages. Thirteen (13%) patients had iron deficiency. Females were more Iron deficient than males. The prevalence of iron deficiency was not significantly influenced by sex (p- value=0.208). there were slightly more patients with iron deficiency in children less than 60 months age (16.2%)compasred to those above 60 months age (10.5%) The difference was not statistically significant (p-value=0.397). dietary intake, presence of hookworm and level of hemoglobin concentration did not significantly influence the body iron status (p-values were 0.589, 0.426 and 0.491 respectively). Conclusions and Recommendation Iron deficiency occurs in patients with sickle cell anaemia, Age, sex, dietary iron intake, and hookworm infection did not influence body iron status. It is recommended that sickle cell anaemic patients on regular folic acid and chloroquine prophyaxis whose haemoglobin levels are consistently low without the apparent cause of severe anaemia should have blood taken for full blood picture. All patients with a microcytic hypochromic type of anaemia should be investigated for iron deficiency
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    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.
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    Oral Health habits in the district of Ilala, Tanzania
    (University of Dar es Salaam, 1989) Nyandindi, Ursuline Stanislaus
    Oral health habits were investigated together with other aspects of oral health in collaborative Ilala Oral Health Survey. The aim of this study was to provide baseline information which could then be used in planning and implementation of health promotion activities in Tanzania. In this analysis data collected through personal interviews on oral hygiene habits, sugar consumption and tooth mutilation of 1512 residents of Ilala district aged 7 to 70 years were used. The rate of response was 91%. It was found that nearly all subject brushed their teeth daily, most of them brushing teeth was higher in the urban areas, and in females, and appeared to increase with age. In urban areas, factory-made toothbrushes were commonly used than locally-made toothbrushes. The latter were more common in the rural areas. The majority (80%0 drank sugared tea daily. Cakes, “maandazi or Vitumbua” were eaten daily by 60%. Most subjects consumed the foods containing sugar less than three times per day. Sugar consumption was more common in the females and urban residents. Occasionally teeth were mutilated by opening bottles (15) and craping (10%), especially in the adolescents and working age groups. Extraction of teeth due to cultural habits was rare. In conclusion, the reported oral hygiene habits, sugar consumption and tooth mutilation were different in the various population subgroups. Mutilation of teeth was not common. There is a need for community based oral health promotion programmes in the population studied. Scrapping tooth surfaces using some hard objects. This was defined as the deliberate regular use of any hard object for crapping the surfaces of the teeth by the subjects. Responses were coded for data analysis as following: Code 1= yes, 2=no. use of teeth for opening bottles. This was defined as the regular utilization of teeth for forceful removing of caps from bottles of drinks by the subjects. Responses were coded for data analysis as following: Code 1=yes, 2= yes. Extraction of teeth for cultural purposes. This was defined as having lost at least one tooth due to cultural reasons. Responses were coded for data analysis as following: Code 1=yes, 2=no
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    A Dissertation of Ten Surgical Conditions
    (University of Dar es Salaam, 1983) Kinasha, A.D.A
    The specialist diploma course in surgery of the University of Dar es salaam covered three years, two of which are devoted to general surgery while one is spent in specialised area of orthopaedics and Truma, .ENT surgery, paediatric surgery, and cynocologic surgery. The candidate takes an active part in energy duties and elective clinical work apart from attending lectures and seminars. This dissertation forms part of the requirements for the award of the master of medicine in surgery degree. It consists of ten surgical conditions seen and party or entirely managed by the author. Five of the conditions are from general surgery, two from orthopaedics and Truma and three from urologic surgery. For each condition a series of cases is studied prospectively and literature on the subject reviewed at the end. I wish to thanks professor P.J. Philip for his undivided commitment to my training for beyond duty during my two years in general surgery and for his advice and criticiam during the properation of this dissertation. I sm in doubted to my teachers in surgery,; professor P.R Hiza , professor J.K Shija, professor .P.M Sarungi, Mr. B. Kiroi, Dr. B.M Minja , Dr .H. Reinearta, Dr M.R.Aziz, Dr S.H.Mlay and Dr D.D.Charles for their help and encouragement. Dr. T..K.Tan, Dr L. Eahlean Dr W. Schlabech and Dr. J.E Iyimo of K.C.M.C. have all assisted me in various ways. I wish especially to thank DR. Japhet Urasa, FRCS , whose advice and quidance before and during my training have been a source of constant inspiration and encouragement. Finally I thanks Dr. C. Likony for his help in photography and Mrs.V. Denzi FOR TYPING This Dissertation
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    The immediate management of head injuries a clinical a clinical experience at Muhimbili medical centre
    (University of Dar es Salaam, 1984) Mwafongo, Victor. Verckys. George
    Head injuries constitute a special and particularly tragic problem both in developing and developed countries: A number of lives are lost due to head injuries in all age groups commonest being below 40 years. The incidence being higher in the developed countries. A survey was made to know what immediate treatment was given to patients with head injuries in Dar es Salaam in the whole chain from the accident site, on the way to emergency department and 25 patients died after staying in the hospital for an average of 72 hours. There were 220 patients of head injuries admitted from 1st may 1982 to 30th may 1983. There were 45 deaths, of these 20 patients died or declared dead at the Emergency Department and 25 patients died after staying in the hospital for an average of 72 hours. The motor vehicle was the prime cause of head injury which constituted about 44.5%, the next commonest cause of fatal head injury being assault which recorded 16.3%. A number of shortfalls were noted, these include absence of resuscitation to the injured at the site and on the way to the hospital. Inadequate resuscitation at the emergency department. Poor ambulance services, with uncoordinated communications between the accident site and the hospital. Less aggressive management of head injuries due to lack or frequent shortage of essential drugs and important monitoring equipments, for example equipment for intracranial pressure monitoring. Among the suggested methods of improving the services include emphasy on resuscitation at the site of accident and on the way, decentralization of ambulance services with adequate equipment for resuscitation, introduction of Radio call to the hospital and finally imparting the knowledge on the art of cardiopulmonary cerebral resuscitation to ambulance services personnel and the hospital.
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    Caediovascular risk factors among primary school children aged 6 – 15 years in urban Dar es Salaam and rural Morogoro: Prevalence, Awareness and Knowledge
    (University of Dar es Salaam, 2002) Chillo, Pilly
    Background: Cardiovascular disease, once known as diseases of the Western world have recently been emerged as diseases of public health importance in many developing countries. Change in life style and socio-economic status associated with urbanization is thought to be the major contributing factor for this trend. In its message to the developing countries, the World Health Organization has urged for a prompt control of cardiovascular diseases at an early stage before the burden becomes more severe. The need for Primordial Prevention has highly been recommended. Objective: To determine the prevalence, awareness and knowledge of the conventional cardiovascular risk factors among primary school children aged 6 – 15 years in Urban Dar es Salaam and Rural Morogoro. Methods: Cross sectional survey of children aged 6 – 15 years from four primary schools in Urban Dar es Salaam and two primary schools in Rural Morogoro. Anthropometric and Blood Pressure measurements were done using the standard techniques, blood samples taken and analysed for sugar, total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides levels. A standard questionnaire was used to obtain socio-demographic characteristics and to assess the level of awareness and knowledge of the main cardiovascular diseases among the children. Results: the prevalence of systolic, diastolic and both (systolic and diastolic) hypertension was found to be 11.4%, 8.1% and 3.9% respectively among the 508 children studied. Twenty one (4.19%) subjects had high total cholesterol levels, while high LDL-C levels were found in 10 subjects (2%). The prevalence of obesity was found to be 5.3%. only six (1.2%) subjects were having active cigarette smoking. Passive smoking was found in 35% of the total study population. Majority of the study population were generally active. None of the subjects had blood sugar levels that were equivalent to diabetic levels. Subjects from the Urban Low Density schools were more likely to be hypertensive, obese and with high levels of total cholesterol and LDL-C, furthermore they were more likely to have less physical activities as compared to those from the Urban High Density and Rural schools. In addition, subjects from ULD schools were more likely to be aware and to have more knowledge of cardiovascular diseases as compared to those from the UHD and Rural schools. Conclusion: Cardiovascular risk factors are generally low among children in this society although certain groups of children have increased risk. There is low level of awareness and knowledge of cardiovascular diseases and their precursors among children.
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    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.
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    The prevalence and characteristics of cardiovascular disorders in children infected with Human immunodeficiency virus type 1 (HIV-1) at Muhimbili National Hospital.
    (University of Dar es Salaam, 2002) Kubhoja, Sulende D.M.
    Introduction and review of Literature The prevalence and characteristics of HIV cardiac disorders vary from one area to another and these have seldom been elucidated in African children. The cardiac disorders include disturbances of rhythm, pericardial effusions, cardiomyopathies, endocarditis, arteriopathies and other cardiac disease. Study objective To determine the prevalence and characteristics of cardiovascular disorders infected with Human Immunodeficiency Virus type 1 (HIV-1). Study design A cross-sectional comparative hospital based study. Setting The study was conducted in the General Paediatric wards and General paediatric outpatient elinics of Muhimbili National Hospital (MNH) in Dar es Salaam, from April 2001 to January 2002. Subjects A total of 280 children aged between 18 months to 7 years who were admitted in the wards or seen at outpatient clinic, were recruited for the study. Methodology All children aged between 18 months to 7 years attending paediatric outpatient clinics or admitted to MNII medical Paediatric wards whose parents/ guardians consented the study and for HIV testing were enrolled for study. A thorough history and physical examination was done on recruitment. All children who tested negative for HIV infection formed the comparable group. Both groups were further subjected to cardiovascular assessment including chest X-Ray, Electrocardiogram and echocardiogram. Main outcome measures The main outcome measures were the magnitude and characteristics of cardiovascular disorders among the two studied groups. Results The overall prevalence of cardiovascular disorders was 83/280 (29.6%). The prevalence of cardiovascular disorders in HIV infected children was higher at 36/78 (46.2%) compared to 47/202 (23.3%) in HIV uninfected children. The difference was statistically significant in the two studied groups, p=0.00017. The common cardiac disorders strongly associated with HIV- infected children were; pericardial effusion 26.9%, Left ventricular dysfunction 24.7%, cardiomyopathy 24.4% and tachycardia 20.5%. Conclusions and Recommendations 1. Cardiovascular disorders are common among HIV-I infected children at MNH. 2. Echocardiogram was the most important tool in diagnosing cardiac disorders. 3. Cardiac disorders in HIV-I positive children were similar to those reported in other centres. 4. It is recommended that a thorough cardiovascular evaluation including Echocardiogram should be done in HIV infected children so as to diagnose cardiac disorders easily and ofer better management.
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    A Study of mental retardation in children in Dar es Salaam
    (university of Dar es Salaam, 1988) Katole, Ntibayizi Batholomew
    Mental retardation is not a disease or a single entity. It is manifested by slow, incomplete maturation, impaired learning ability and poor social adjustment which happens during developmental.period^(1,2,3,4.) the commonly used definition in that by the American Academy of Mental Deficiency (AAMD) which states that mental retardation is significant subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifest during developmental 〖period.〗^5 this is further explained as a score on the standard tests that would be lower than that obtained by 97 to 98 percent of persons of same age meaning that certain individuals fail to meet standards of independence and social responsibility expected of the age and cultural group. There is failure to learn basic academic skills and participate in appropriate social group activities. All these should be observable during childhood. Problems of similar nature manifested only in adulthood would be classified as mental illness, not mental 〖retardation.〗^5 It should be pointed out that what is being stressed in this definition is adaptive behavior, intellectual subnormality and developmental 〖period.〗^5,6 In the past various synonyms of mental retardation have been used like mental subnormality, mental deficiency, mental handicap, mental deficit and 〖amentia.〗^(2,6,7,8,9,10,11.) However, mental retardation has gained more use in the United states of America than in England where mental subnormality is still 〖maintained.〗^2,6 Intelligence has always been difficult to define. When grouped together, four acceptable classes of definition have always emerged namely biological, psychological, operational and 〖development.〗^12 Other basic approaches used to define intelligence have been based on intelligence being the ability to adapt to the environment. It has also been taken as an ability to carry on abstract thinking or regarded on global 〖terms.〗^13 Binet and Simon while developing their intelligence scale considered the nature of intelligence as having goal direction to mental process involved. They also considered it to involve the ability to show adaptive solution and selectivity of judgment and critism of choices. Intelligence as defined by Wechsler in 1949 as being aggregate of global capacity of an individual to act purposefully to think rationally and to deal effectively with the environment is still a valid and useful definition. 〖definition.〗^14 Intelligence is therefore the capacity to comprehend 〖relation.〗^14 Intelligence is therefore the capacity to comprehend relations, the ability to think and solve problems and to adjust to new 〖solutions.〗^15
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    Strategies for reducing turnaround time on data reporting system for early infant diagnosis of HIV in Tanzania
    (University of Dar es Salaam, 2019) Msanjila, Upendo
    Long turnaround time of receiving early infant diagnosis of results at the health facilities is caused by scarcity of the HIV DNA'PCR laboratory-based test mg point due to the cost required to equip the labor atones at each health facility. The dried blood spot (DBS) samples are collected from lower level health fac1lity and being transported to a centralized HIV DNA/PCR laborato1y for testing and results are returned back to the health facility. This kind of a centralized test mg system has caused significant challenges on having long TAT in reporting the EID results. Th1s study aimed at proposing strategies for TAT in data repol1ing system for EID of HIV across health facilities in Tanzania. Specifically, the study examined the cu1Tent work practice on data reporting system in early infant diagnosis of HIV across health referral system in Tanzania and identified factors contributing to long turnaround time on data reporting system in early infant diagnosis of HIV across health referral system in Tanzania. Qualitative research design was used to understand in depth the current practice across health facilities from sample collection to the results reporting. Key infonnant interviews, observation and documentary review methods were used for data collection process and data were analysed through content analysis technique. The design-reality gap model by Richard heeks was used to identify factors affecting the TAT in data reporting system for EID of HIV. The identified factors include unreliable sample and result transportation, poor procedures on sample testing, lack of technical skills & knowledge, inadequate human resources & financial resources . The strategies that are to be taken into account to reduce the long TAT in receiving the EID results was proposed. These include introducing a transportation coordinator, defined transportation method, tracking system, first-in, first-out rule during testing, clear roles & responsibilities, clearly defined procedures, Job Aids & guidelines, adopted technology, adequate financial & human resources.
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    Jaundice in Dar es Salaam diagnosis and prognosis
    (University of Dar es Salaam, 1985) Ole-King’ori, Naphtal Loti
    Jaundice or “yellow eyes” as called by the laiety, is a problem that has been recognized for many centuries. The multifactorial causes have been pnly partially elucided since the 19th century. But there re still mysteries surrounding jaundice yet to be clarified. Despite the many causes identified so far, quite a number of people rquate jaundice with viral hepatitis. In this study as attempt in made to identify the various aetiologies of jaundice as seen in the medical wards of Muhimbili Medical Centre. The study comprises of two parts, A and B. part A reviews the literature as regards the pigment billirubin, which is responsible for jaundice. Its sources are sought, metabolic pathway closely followed to is excretion. A classification of jaundice is made, and the various causes and mechanism of causation are reviewed. The possible investigations known to date are also reviewed in reasonable detail. Part B is the study. This involves patients with jaundice seen and investigated by the author. The causes of jaundice in these patients were searched for as far as possible and each patient assigned into a particular classification according to predetermined criteria. The work is concluded by a discussion on the results of the study which showed that out of 113 patients admitted into the study, 54 (47.7%) had prehapatic jaundice, 49 (43.3%) had hepatic jaundice, 7(6.2%) had prehapatic jaundice, 49 (43.3%) had hepatic jaundice, 7(6.2%) had posthepatic and 3 (2.8%) had mixed jaundice. It is found that despite lack of sophisticated investigations, most patients with jaundice can have the aetiology discovered and properly classified by a good clinical avaluation. The literature cited is listed at the end.