Management of a road traffic accident poly-trauma patient in a limited regional resource hospital setting in Tanzania: Review of literature and case report.

INTRODUCTION AND IMPORTANCE: Poly-trauma is among the top ten leading causes of mortality and morbidity in developing countries. Road traffic injuries are the major cause of mortality in the overall burden of deaths related to injuries. The aim of this publication is to show how important are the principles of management in saving life even in austere limited resource settings. CASE PRESENTATION: We herein present a case of a 17-year-old male who presented to our emergency department about an hour after being involved in motor traffic accident in a semiconscious state, in hypovolemic shock and sustained multiple injuries. He had multiple limb and ribs fractures and blunt abdominal injury. He was rushed to the hospital where he was resuscitated at the emergency department and admitted in the Intensive Care Unit (ICU). He was scheduled for surgery the following day. His post-operative recovery was uneventful and was discharged after one month. CLINICAL DISCUSSION: The scarce resources and efforts spent on these patients prove to be futile in many situations because of delayed admission, lack of proper pre-hospital care and associated complications which cause irreversible damage. Management of a Poly-trauma patient should start from the scene of accident, during transportation and finally in the hospital by following all the principles of poly-trauma management using a multi-disciplinary approach. CONCLUSION: Timely diagnosis and proper management of a Poly-trauma patient can save life even in limited resource Centers.

Evaluation of an E-Learning Course for Clubfoot Treatment in Tanzania: A Multicenter Study.

In total, 80% of clubfoot cases occur in low- and middle-income countries, where lack of clinical knowledge of the Ponseti method of treatment presents as a major barrier to treatment. This study aims to determine the effectiveness of an electronic learning course to teach clinicians in Tanzania Ponseti method theory. A total of 30 clinicians were recruited from clinics with high referral rates for clubfoot patients and invited to 1 of 3 training sites: Mbeya (n = 15), Zanzibar (n = 10), and Mwanza (n = 5). Baseline knowledge, measured through a pretest, was compared to performance on a posttest after e-learning course completion. Scores for Mbeya and Zanzibar participants improved from 44 ± 12.5 to 69.8 ± 16.5 (P < .0001) and 44.3 ± 14.0 to 67.9 ± 21.4 (P = .01), respectively. Our results suggest that an e-learning course may be an effective method of disseminating Ponseti method theory in Tanzania. Successful implementation requires an understanding of the device availability and technology literacy of the users.

Cefepime versus Ceftriaxone for perioperative systemic antibiotic prophylaxis in elective orthopedic surgery at Bugando Medical Centre Mwanza, Tanzania: a randomized clinical study.

BACKGROUND: Antimicrobial prophylaxis reduces the incidence of postoperative wound infections especially among patients undergoing orthopedics surgery. However, there is dearth of information on the clinical effectiveness, spectrum limitations and practical contextual information on third and fourth generation cephalosporins. The aim of this study was to evaluate the efficacy and safety of cefepime and ceftriaxone as peri-operative systemic antimicrobial prophylaxis in elective orthopedic surgery in our center. METHODS: This study was a prospective, randomized, open label comparative clinical study of patients undergoing elective orthopedic procedures at the Bugando Medical Centre (BMC) between June 2014 and February 2015. Two hundred thirty participants were enrolled in the study and randomly assigned into Ceftriaxone regimen (group A) or Cefepime regimen (group B). Participants in ceftriaxone or cefepime group received 50 mg/kg up to 2 g single dose perioperative intravenous infusion at least 30 min before incision. Both groups were followed for 30 days using a Center for Disease Control superficial surgical site infection criterion for the outcome. A two-tailed margin of equivalence was set at 5% analyzed on the intent to treat. RESULTS: All 230 participants were subjected to final analysis with no patient being lost to follow-up. Superficial surgical site infection occurred in 5 out of 117 (4.3%, 0.6 to 7.9 at 95% CI) patients receiving cefepime compared to 3 out of 113 (2.7%, 0.3 to 5.6 at 95% CI) among patients receiving ceftriaxone regimen. The absolute difference of 1.6% (95% Confidence Interval: -6.3 to 3.1), equivocally lies outside the 5% statistically significant margin of presumed clinical equivalence. CONCLUSION: The difference between cefepime and ceftriaxone in preventing SSIs following elective clean orthopedic surgery was not statistically significant. TRIAL REGISTRATION: Pan African Clinical Trial Registry: PACTR201406000803420.

Multi-institutional neurosurgical training initiative at a tertiary referral center in Mwanza, Tanzania: where we are after 2 years.

BACKGROUND: The paucity of neurosurgical care in East Africa remains largely unaddressed. A sustained investment in local health infrastructures and staff training is needed to create an independent surgical capacity. The Madaktari organization has addressed this issue by starting initiatives to train local general surgeons and assistant medical officers in basic neurosurgical procedures. We report illustrative cases since beginning of the program in Mwanza in 2009 and focus on the most recent training period. METHODS: A multi-institutional neurosurgical training program and a surgical database was created at a tertiary referral center in Mwanza, Tanzania. We collected clinical data on consecutive patients who underwent a neurosurgical procedure between September 9th and December 1st, 2011. All procedures were performed by a local surgeon under the supervision of a visiting neurosurgeon. Since the inception of the training initiative, comprehensive multidisciplinary training courses in Tanzania and an annual visiting fellowship for East African surgeons to travel to a major U.S. medical center have been established. RESULTS: At initial visits infrastructure and feasibility of complex case scenarios was assessed. Surgeries for brain tumors and complex spinal cases were performed. During the 3-month training period, 62 patients underwent surgery. Pediatric hydrocephalus comprised 52% of patients, 11% suffered from meningomyelocelia, and 6% presented with an encephalocele. A total of 24% of patients were treated for trauma-related conditions, representing 75% of the adult patients. A total of 10% of patients had surgery because of traumatic spine injury, and 15% of operations were on patients with severe head injury. A total of 6% of patients presented with degenerative spine disease. One patient sustained a fatal perioperative complication. At the end of the training period, the local general surgeon was able to perform all basic neurosurgical cases independently. CONCLUSIONS: Neurosurgical care in Tanzania needs to address a diverse, unique disease burden. We found that local surgeons could be enabled to safely perform basic cranial and spinal neurosurgical procedures through immersive, 1-on-1 on-site collaborations, multidisciplinary courses, and educational visiting fellowships.

Expanding neurosurgical care in Northwest Tanzania: the early experience of an initiative to teach neurosurgery at Bugando Medical Centre.

OBJECTIVE: Tanzania suffers from a severe lack of health practitioners trained in neurosurgical procedures. To address this problem, we have implemented an initiative, modeled after the experience of other pioneers in international neurosurgery, to establish cost-effective and sustainable neurosurgical care by teaching fundamental neurosurgical skills to local surgeons. In this report we describe our early experience in Northwest Tanzania and discuss the potential for this training model to improve neurosurgical care to a region in need. METHODS: Between September 2009 and October 2010, three residents and two attendings from our institution spent a total of 15 weeks at Bugando Medical Centre in Mwanza, Tanzania. During this time, we focused on teaching neurosurgical techniques, intraoperative decision-making, and clinical management skills to two local surgeons. The emphasis of our presence was on teaching and providing sustainable neurosurgical care. RESULTS: During this period, we performed 41 neurosurgical procedures with one of two local surgeons. The most common procedures performed were ventriculoperitoneal shunts (22%), myelomeningocele repairs (22%), and cranial trauma cases (17%). Five (12%) cases required the placement of spinal instrumentation. Thirty-nine (95%) patients remained stable or improved at discharge. There were 2 (5%) perioperative deaths. CONCLUSION: Although numerous challenges remain, our experience demonstrates the potential of this teaching model in providing sustainable neurosurgical care in Northwest Tanzania.