Patterns and outcomes of patients with abdominal trauma on operative management from northern Tanzania: a prospective single centre observational study.

BACKGROUND: The abdomen is one of the most commonly injured regions in trauma patients. Abdominal injury surgeries are common in Tanzania and in many parts of the world. This study aimed to determine the relationships among the causes, characteristics, patterns and outcomes of abdominal injury patients undergoing operations at Kilimanjaro Christian Medical Centre. METHODS: A prospective observational study was performed over a period of 1 year from August 2016 to August 2017. A case was defined as a trauma patient with abdominal injuries admitted to the general surgery department and undergoing an operation. We assessed injury types, patterns, aetiologies and outcomes within 30 days. The outcomes were post-operative complications and mortality. Multivariate logistic regression was used to explore the association between factors associated with morbidity and mortality. RESULTS: Out of 136 patients, 115 (84.6%) were male, with a male-to-female ratio of 5.5:1. The most affected patients were in the age range of 21-40 years old, which accounted for 67 patients (49.3%), with a median age (IQR) of 31.5 (21.3-44.8) years. A majority (99 patients; 72.8%) had blunt abdominal injury, with a blunt-to-penetrating ratio of 2.7:1. The most common cause of injury was road traffic accidents (RTAs; 73 patients; 53.7%). Commonly injured organs in blunt and penetrating injuries were, respectively, the spleen (33 patients; 91.7%) and small bowel (12 patients; 46.1%). Most patients (89; 65.4%) had associated extra-abdominal injuries. Post-operative complications were observed in 57 patients (41.9%), and the mortality rate was 18 patients (13.2%). In the univariate analysis, the following were significantly associated with mortality: associated extra-abdominal injury (odds ratio (OR): 4.9; P-value< 0.039); head injury (OR: 4.4; P-value < 0.005); pelvic injury (OR: 3.9; P-value< 0.043); length of hospital stay (LOS) ≥ 7 days (OR: 4.2; P-value < 0.022); severe injury on the New Injury Severity Score (NISS) (OR: 21.7; P-value < 0.003); time > 6 h from injury to admission (OR: 4.4; P-value < 0.025); systolic BP < 90 (OR: 3.5; P-value < 0.015); and anaemia (OR: 4.7; P-value< 0.006). After adjustment, the following significantly predicted mortality: severe injury on the NISS (17 patients; 25.8%; adjusted odds ratio (aOR): 15.5, 95% CI: 1.5-160, P-value < 0.02) and time > 6 h from injury to admission (15 patients; 19.2%; aOR: 4.3, 95% CI: 1.0-18.9, P-value < 0.05). CONCLUSION: Blunt abdominal injury was common and mostly associated with RTAs. Associated extra-abdominal injury, injury to the head or pelvis, LOS ≥ 7 days, systolic BP < 90 and anaemia were associated with mortality. Severe injury on the NISS and time > 6 h from injury to admission significantly predicted mortality.

Colorectal cancer in a patient with intestinal schistosomiasis: a case report from Kilimanjaro Christian Medical Center Northern Zone Tanzania.

BACKGROUND: Colorectal cancer associated with chronic intestinal schistosomiasis has been linked with the chronic inflammation as a result of schistosomal ova deposition in the submucosal layer of the intestine. Among all species Schistosoma japonicum has been more linked to development of colorectal cancer as compared to Schistosoma mansoni due to absence of population-based studies to support the association. Despite the weak evidence, some cases have been reported associating S. mansoni with development of colorectal cancer. CASE PRESENTATION: We report a patient who presented to us as a case of intestinal obstruction and found to have a constrictive lesion at the sigmoid colon at laparotomy, then later found to have colorectal cancer with deposited S. mansoni ova at histology. CONCLUSION: Given the known late complications of schistosomiasis, and as S. mansoni is endemic in some parts of Tanzania, epidemiological studies are recommended to shed more light on its association with colorectal cancer.

The effect of social integration on outcomes after major lower extremity amputation.

OBJECTIVE: Major lower extremity (MLE) amputation is a common procedure that results in a profound change in a patient's life. We sought to determine the association between social support and outcomes after amputation. We hypothesized that patients with greater social support will have better post amputation outcomes. METHODS: From November 2011 to May 2013, we conducted a cross-sectional, observational, multicenter study. Social integration was measured by the social integration subset of the Short Form Craig Handicap Assessment and Reporting Technique. Systemic social support was assessed by comparing a United States and Tanzanian population. Walking function was measured using the 6-minute walk test and quality of life (QoL) was measured using the EuroQol-5D. RESULTS: We recruited 102 MLE amputees. Sixty-three patients were enrolled in the United States with a mean age of 58.0. Forty-two (67%) were male. Patients with low social integration were more likely to be unable to ambulate (no walk 39% vs slow walk 23% vs fast walk 10%; P = .01) and those with high social integration were more likely to be fast walkers (no walk 10% vs slow walk 59% vs fast walk 74%; P = .01). This relationship persisted in a multivariable analysis. Increasing social integration scores were also positively associated with increasing QoL scores in a multivariable analysis (ß, .002; standard error, 0.0008; P = .02). In comparing the United States population with the Tanzanian cohort (39 subjects), there were no differences between functional or QoL outcomes in the systemic social support analysis. CONCLUSIONS: In the United States population, increased social integration is associated with both improved function and QoL outcomes among MLE amputees. Systemic social support, as measured by comparing the United States population with a Tanzanian population, was not associated with improved function or QoL outcomes. In the United States, steps should be taken to identify and aid amputees with poor social integration.

Schistosomiasis and cancer: Experience from a zonal hospital in Tanzania and opportunities for prevention.

Schistosomiasis infection is endemic in many parts of Tanzania. The morbidity due to Schistosomiasis and its association with cancer remains to be of great concern and poses greater challenge that needs to be assessed. Cancer is an increasing public health problem in most sub-Saharan African countries, and yet, cancer control programs and the provision of early detection and treatment services are limited despite this increasing burden. This article aims to discuss case series of patients diagnosed with urinary bladder, prostate and colorectal cancer together with Schistosoma infection. We further highlight the opportunities for combating new Schistosomiasis infection, a potential to reduce its oncological complications particularly in low-resource setting.

Colorectal Cancer in Northern Tanzania: Increasing Trends and Late Presentation Present Major Challenges.

PURPOSE: A trend of increasing incidence of colorectal cancer (CRC) has been observed in northern Tanzania. Studies have shown a six-fold increase in CRC in the past decade, with 90% of patients presenting in late stages, with resultant high morbidity and mortality rates. In this study, we aimed to document the burden of CRC in the northern zone of Tanzania from 1998 to 2018, focusing on patient presentation, clinical features, and treatment at a tertiary hospital. METHODS: Pathological and clinical records for all patients from 1998 to 2018 were identified and reviewed. Records of patients whose CRC was diagnosed histologically were retrospectively reviewed. RESULTS: Approximately 313 CRC cases were documented. The majority age group (29.1%) was between 50 and 64 years (mean [standard deviation], 54.28 [16.75] years). However, together, the age groups of patients younger than 50 years was 41.5% (n = 130). Of 174 patients with complete records, most (29.3%) were between 35 and 49 years of age. The median age was 52 (interquartile range, 40-67) years. Men accounted for 62.1% of patients and were mostly from the Kilimanjaro region. More than half (54.7%) presented > 3 months after symptom debut; 62.6% first sought care at lower-level health facilities. Most (64.9%) presented as emergencies, necessitating colostomy for fecal diversion as the initial surgical procedure in 60.3% of patients. Colonoscopy was performed for 38.6% of the study participants. Most tumors (72.7%) originated from the sigmoid and rectum. Adenocarcinoma was the most prevalent histologic type. CONCLUSION: High proportions of young individuals with CRC pose great concern and a need for further appraisal. Furthermore, late emergency presentation and low colonoscopy rates highlights underlying system challenges and need for education campaigns.

Tubular Duplication of the Midgut Presenting with Acute Abdomen and Hematochezia: A Case Report from Northern Tanzania.

Enteric duplication is one of the rare malformations affecting the small intestine more than the other parts of the gastrointestinal tract. It poses a challenge in diagnosis due to nonspecific symptoms that may mimic other pathologies. Furthermore, the management options including total resection, mucosal striping, and internal drainage of the duplicate depend on the presentation of the patient, site, and length of the involved bowel. We present the first documented case of enteric duplication in Tanzania, a 3-year-old male, who was found to have a 90 cm long jejunoileal duplicate. We discuss the presentation and management offered.