Outcomes of traumatic brain injury patients with acute epidural and subdural hematoma who underwent burr hole surgery: A two-year study at Kilimanjaro Christian Medical Centre, Tanzania.

Background: Traumatic brain injury is a leading cause of mortality and morbidity in Africa. Craniotomy is the surgical standard for acute extra-axial hematomas that is not realistic in LMIC due to deficient human and operative resources. Burr hole surgery may be an alternative in resource-limited settings. This study aimed at determining outcomes and factors associated with burr hole surgery as definitive management of traumatic extra-axial hematomas. Methods: Hospital-based cross-sectional study of patients with acute traumatic extra-axial hematomas who underwent burr hole surgery. Data were extracted from the patient's medical records after confirmation of the surgery and CT scan findings. The data were entered to SPSS 25 for analysis where a bivariate analysis was done. Results: 156 participants were enrolled; 149 (95.5 %) were males. The mean age of the participants was 35.33 (SD 15.37) years. The mean arrival GCS was 11.76 ± 3.59. Most participants had mild, followed by severe then moderate (55.8 %, 24.4 %, and 19.9 % respectively) TBI. 118 (75.6 %) participants had good outcomes and the overall in-hospital mortality was 18.6 %. 109 (69.9 %) had epidural hematomas mostly (21 %) in the parietal lobe. 30 (19.2 %) had brain herniation syndromes. Poor outcomes were associated with age above 50 years, severe TBI, motor response <4, abnormal pupil size, other injuries, ICU admission, SDH, midline shift >10 mm, cerebral edema, and brain herniation syndromes. Surgical site infection and hemostasis by packing were associated with a long length of hospital stay. Conclusion: Burr hole surgery is still a safe, effective, and simple life-saving procedure in patients with acute hematomas in resource-constrained areas.

Willingness of advanced cancer patients to receive palliative care and its determinants: A cross-sectional study in Northern Tanzania.

BACKGROUND: The purpose of this study was to assess willingness of advanced cancer patients to receive palliative care and its determinants at Cancer Care Centre in Kilimanjaro Christian Medical Centre Northern Tanzania. OBJECTIVE: The purpose of this study was to assess willingness of advanced cancer patients to receive palliative care and its determinants at Cancer Care Centre in Kilimanjaro Christian Medical Centre Northern Tanzania. METHODS: This was an institution-based cross-sectional study and the target population was all advanced cancer patients attending care at Cancer care Centre in Northern Tanzania. Data was collected using a structured questionnaire and analysed using Stata for windows 15. A descriptive analysis was conducted to summarize the data using mean standard deviation, while categorical data was summarized using frequency and percentages. Both bivariate and multivariate logistic regression analysis was used to determine the predictors associated with willingness to receive palliative care. RESULTS: The results showed that more than half of the respondents had willingness to accept palliative care. The degree of willingness PC among advanced cancer patients was high 60.6% (95%CI: 55.8-65.3). The predictors which remained significant associated with willingness to receive palliative care in multivariate analysis were the knowledgeable of palliative care [AOR: 2.86; 95%CI: 1.69-4.85] and high perceived benefits of palliative care [AOR: 3.58; 95%CI: 2.12-6.04]. CONCLUSION: Willingness to accept palliative care services was more than half of the patients just 60.6% among patients with advanced cancer from the study site. Advanced age of a patient, occupations, better knowledge, and perceived benefits for palliative care was the significant predictor for patients' willingness to accept palliative care.

Intermittent catheterisation for individuals with disability related to spinal cord injury in Tanzania.

STUDY DESIGN: Cross-sectional pilot study on spinal cord injury (SCI) among in- and outpatients. OBJECTIVES: To evaluate the challenges faced by individuals with SCI during Clean Intermittent Catheterisation (CIC). SETTING: Kilimanjaro Christian Medical Center (KCMC), a tertiary referral hospital in Moshi, Tanzania. METHODS: A questionnaire was sent to individuals with SCI who were either admitted to the Orthopedic Rehabilitation Unit or attended the Outpatient clinic between January and April 2018. Inpatients were less than 1 year post-injury and outpatients were one to 3 years post-injury. RESULTS: In total, 48 individuals responded: 28 outpatients and 20 inpatients. Among the inpatient group, 80% were performing CIC as compared with 25% of outpatient group. Of the entire cohort, 35.4% reported doing well without catheter-based management. Failure to perform CIC was present in 16.7% of all individuals. CIC-equipment was unavailable in local villages for 58.3% of all patients. The most frequent complications of CIC were urinary tract infections (20.8%) and mild bleeding (14.6%). The majority of individuals (79.2%) reported satisfaction with their situation, regardless of the severity. CONCLUSIONS: Some individuals performed CIC upon discharge, but the majority discontinued use, for which unavailability of CIC-equipment was a major determinant. While all individuals reported concerns prior to CIC, only a small minority actually experienced anxiety, pain or shame. Through targeted counselling and enhanced regular follow-up we will likely improve compliance to CIC. SPONSORSHIP: We are grateful to the International Network of SCI Nurses in collaboration with Wellspect Health Care for funding this study.

Parents and nurses telling their stories: the perceived needs of parents caring for critically ill children at the Kilimanjaro Christian Medical Centre in Tanzania.

BACKGROUND: Parents have significant responsibility in the care of their critically ill children who have been admitted to the intensive care unit (ICU). When staying with their children in the hospital, they also have particular needs that should be adequately acknowledged and responded to by healthcare providers. Moreover, when their needs are not identified and addressed, parents may experience stress and anxiety as a result. This study describes the needs of parents caring for hospitalized critically ill children, as perceived by parents and nurses. METHODS: This study used a descriptive qualitative research design. Five focus group discussions with nurses and parents of critically ill children, who were purposefully recruited, were conducted at the Kilimanjaro Christian Medical Centre Hospital. A qualitative content analysis guided the analysis of the data. RESULTS: Two themes emerged from the perceptions of parents and nurses about the needs of parents caring for hospitalized critically ill children. These were: "engaging parents in the care of their children" and "receiving psychosocial support". Both parents and nurses identified the importance of providing adequate information about their children's progress, encouraging and involving parents in the care of their children and having flexible visiting time for parents was vital when caring for critically ill children. CONCLUSIONS: This study provides an in-depth understanding of parents' needs when caring for critically ill children in the hospital setting. Nurses caring for these children should understand the needs of parents and integrate the parents into the daily care of their children. Nurses should also continuously support, inform and engage parents during child-caring procedures. Finally, visiting times for intensive care units should be flexible and allow more time for parents to connect with their hospitalized children.