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Patient Safety Efforts in Tanzania: A Rapid Review of Two-Decades Efforts (2002-2022) to Inform Interventions towards Attainment of 2030 Targets

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Advances in Infectious Diseases 2022年第3期12卷 466-495页

作者： Joseph C. Hokororo Michael Habtu Radenta P. Bahegwa Ruth R. Ngowi Yohanes S. Msigwa Mbwana M. Degeh Erick S. Kinyenje Omary A. Nassoro Laura E. Marandu Chrisogone J. German Edwin Mkwama Bushi Lugoba Grace E. Saguti Zabulon Yoti Eliudi S. Eliakimu Health Quality Assurance Unit Ministry of Health Dodoma Tanzania World Health Organization Dar es Salaam Tanzania Centre for Distance Education Morogoro Tanzania Benjamin Mkapa hospital Dodoma Tanzania

Introduction: The need to address the problem of patient safety has been a focus of World Health Assembly (WHA) meetings of 2002, 2019 and 2021. The 2019 WHA Resolution urged the Member States to take action on patient safety. We aimed to review patient safety efforts in Tanzania from 2002 to 2022 to inform improvement efforts towards the 2030 target. Methods: A rapid literature review was conducted between January 2002 and April 2022. We searched Google, PubMed and PubMed Central in April and May 2022 using the following search terms: PubMed—“patient safety Tanzania”, “blood safety in Tanzania”, “safe surgery Tanzania”, and “healthcare-associated infections Tanzania”;Google—“blood safety in Tanzania”, injection safety in Tanzania”, “infection prevention and control”, “radiation safety in health facilities in Tanzania”;and PubMed Central—“injection safety in Tanzania. Results: The search identified 4160 articles, of which 4053 were removed in initial screening;21 were duplicates, giving 86 relevant articles for full screening. Of the 86 articles, 04 were removed after the full screening, hence remaining with 82 articles. Among the 82 eligible articles, 27 are on IPC, 26 on safe surgery, 12 on blood safety, 07 on radiation safety, 06 on injection safety, and 02 on medication safety. One article was relevant to—blood safety, IPC and injection safety;and one article was relevant to—IPC and injection safety. Conclusion: Most of the eligible literature was on IPC and safe surgery, followed by blood safety, radiation safety, injection safety and medication safety. The literature on IPC has highlighted the need to strengthen efforts to address AMR. Findings from the implementation of the safe surgery 2020 intervention warrants for its scale-up to other zones. There is a need to strengthen hemovigilance and pharmacovigilance functions;and strengthen quality management and assurance systems and regulatory functions to ensure radiation safety.

关键词： Patient Safety Safe Surgery Infection Prevention and Control Medication Safety Radiation Safety

Prognostic Value of the Matrix Metalloproteinase-9 and Its Relation to Clinicopathological Features in Women with Invasive Breast Cancer

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Journal of Cancer Therapy 2020年第7期11卷 448-461页

作者： Asmaa Mahmoud Fouad Ahmed Moustafa Elzawawy Sohair Elsayed Abdelmohsen Noha Noufal Clinical Oncology Department Faculty of Medicine Suez Canal University Ismailia Egypt Pathology Department Faculty of Medicine Suez Canal University Ismailia Egypt Basic Medical Science Department Faculty of Medicine Dar Al Uloom University Riyadh KSA

Background: Invasive breast cancer is the most common type of malignancy in women worldwide. Matrix Metalloproteinase-9 is a member of degrading enzymes required for tumor metastasis. Aim: To assess the prognostic significance of the Matrix Metalloproteinase-9 expression in invasive breast cancer and its association with the clinicopathological features. Patients and Methods: Cross-sectional study was conducted at the Oncology and Nuclear Therapy Unit, Suez Canal University Hospital. The study involved 33 females that were registered between January 1st, 2008 and December, 31st, 2012. The eligible participants had a confirmed non-metastatic invasive ductal carcinoma, underwent surgery that their paraffin blocks containing tumor were available. The participants’ tissue specimens were immune stained for Matrix Metalloproteinase-9 expression level in the hospital pathology lab. Survival analysis and correlation models were conducted to explore the association between Matrix Metalloproteinase-9 expression level with clinicopathological parameters and survival. Results: The mea

关键词： Prognosis Ductal Carcinoma Matrix Metalloproteinase-9

Smear positive pulmonary tuberculosis among diabetic patients at the Dessie referral hospital, Northeast Ethiopia

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Infectious Diseases of Poverty 2013年第1期2卷 39-46页

作者： Hiwot Amare Aschalew Gelaw Belay Anagaw Baye Gelaw Bahir dar Regional Health Research Laboratory Center Bahir DarEthiopia Department of Medical Microbiology School of Biomedical and Laboratory SciencesCollege of Medicine and Health SciencesUniversity of GondarGondarEthiopia

Background:Tuberculosis(TB)is an infectious disease which is still a major cause of morbidity and mortality throughout the *** with diabetes mellitus(DM)have a three times higher risk of developing active TB than people without ***,there is not enough credible information on the burden of pulmonary tuberculosis(PTB)among DM patients in Ethiopia,in general,and in the city of Dessie,in ***,this study aims to determine the prevalence and associated risk factors of smear positive PTB among diabetic patients at a referral hospital in ***:A cross-sectional study was conducted from February 2012 to April *** demographic characteristics were collected using a pre-tested standard questionnaire ***-morning-spot sputum specimens were collected from the study participants and examined for acid-fast bacilli using direct microscopy by the Ziehl-Neelsen staining *** was entered and analyzed using the SPSS version 16 statistical software and p-valueally ***:Out of 225 TB suspected diabetic patients,52%were males and 48%were *** ages ranged from 12 to 82 years,with a mean age of 47.2 *** residence(AOR:5.5;95%CI:1.07-28.20),history of TB(AOR:13.4;95%CI:2.74-65.73),contact with TB patients in the family(AOR:9.4;95%CI:1.822-48.50),and long duration of DM(AOR:8.89;95%CI:1.88-58.12)were independently associated with the development of active TB in people living with ***:The prevalence of smear positive PTB was 6.2%in TB suspected diabetic patients,which is higher compared with the general population(0.39%).Patients with a previous history of contact with TB patients,as well as those who had prolonged diabetes,were more prone to have ***,screening of diabetic patients for PTB infection during follow-up is necessary.

关键词： Dessie Diabetic patients Ethiopia Pulmonary tuberculosis(PTB)

Assessment of Maternal Near Miss at Debre Markos Referral hospital, Northwest Ethiopia: Five Years Experience

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Open Journal of Epidemiology 2014年第4期4卷 199-207页

作者： Molla Gedefaw Habtamu Gebrehana Ayu Gizachew Fentahun Taddess GAMBY College of Medical Sciences Bahir Dar Ethiopia Debre Markos Referral hospital Ethiopia Department of Reproductive Health Debre Markos University Debre Markos Ethiopia Debre Markos Town Administration Ethiopia

Maternal mortality in Ethiopia is one of the highest in the world. Data on maternal near miss cases and events among mothers who received care at health institutions is lacking. The main aim of this study was, therefore, to assess trend and correlates of maternal near miss case at a referral hospital. Case notes of clients who received care in obstetric and gynecologic ward of Debre Markos Referral hospital from 1st January 2008 to 30th December 2012 were reviewed. Case notes were selected using systematic random sampling technique. Tailored format was data collection tool. SPSS version 16 was used to analyze the data. Logistic regression was fitted to determine possible association, and strength of associations was measured using odds ratio at 95% confidence interval. A total of 1355 case notes were reviewed. Of them, 403 (29.7%) were near miss cases. The data showed that maternal near miss ratio over the study period was decreasing (X2 = 7.4, p = 0.007). Distance from the hospital, history of difficult labor, and antenatal care (ANC) utilization were found to be major determinates of maternal near miss cases. The most common types of near miss events were obstructed labor and hemorrhage. Majority of maternal near miss cases brought referral letter to hospital. although maternal near miss ratio is still high, it appears to decrease over the last five years period. This may reflect success of the government’s Endeavour to decrease maternal mortality. However, this effort needs to continue in a sustainable manner to avoid preventable causes of maternal mortality in Ethiopia.

关键词： Maternal Near Miss Maternal Near Miss Events Maternal Death

Characteristics of symptoms of imminent eclampsia: A case referent study from a tertiary hospital in Tanzania

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Open Journal of Obstetrics and Gynecology 2012年第3期2卷 311-317页

作者： John France Projestine S. Muganyizi Department of Obstetrics & Gynecology Muhimbili University of Health and Allied Sciences (MUHAS) Dar es Salaam Tanzania

Background: Maternal mortality in developing countries is unacceptably high with eclampsia being consistently among the top causes. As yet, primary prevention of this complication is not possible since causes of preeclampsia are largely unknown and bio-chemical, hematological and radiological markers have proved unsuitable for routine prediction of eclamptic fits. although headache, visual disturbance, abdominal pain, nausea, and vomiting are routinely elicited when managing pre-eclampsia and have been reported to predict eclamptic fits, the literature attempting to characterize them is scanty. We sought to establish characteristics of the prodromal symptoms of eclampsia and compare them with similar symptoms as experienced by normotensive pregnant women at Muhimbili National hospital (MNH) in Tanzania. Methods: This study was conducted at MNH in 2010 by enrolling 123 eclamptic and 123 normotensive women. Women in the two groups were interviewed about their experiences and characteristics of headache, visual disturbances, abdominal pain, nausea and vomiting using a semi structured questionnaire. The severity, nature and other characteristics of the symptoms were assessed using standard scale/methods and data compared among the two groups. Results: Prodromal symptoms of eclampsia were present in 90% of eclamptic women. Headache was more frequent among eclamptic women (88%) than the normotensive (43%), p also more perceived as severe among eclamptic (46.3%) than the normotensive (5.7%), p al in 65.7% of eclamptic women compared to frontal (41.5%) or generalized (39.6%) for the normotensive. Likewise, visual problems were significantly more frequent among eclamptic women (39%) compared to the normotensive (3%), p al pain was significantly more reported by eclamptic (36%) than normotensive women (0.9%), p = 0.001. The general occurrence of abdominal pain, nausea and

关键词： Eclampsia Symptoms Headache Blurring of Vision Abdominal Pain Tanzania

Epidemiology of Human Immuno-deficiency Virus and Quality of Life for People Living with HIV/AIDS in China

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2008年第2期28卷 230-233页

作者： Ommari Baaliy Mkangara 聂绍发王重建许奕华 Saumu Tobbi Mweri Theresia M Kobelo Mustaafa Bapumiia Department of Epidemiology and Biostatistics School of Public HealthTongji Medical CollegeHuazhong University of Science and Technology Wuhan 430030China Department of Pediatrics Tongji HospitalTongji Medical CollegeHuazhong University of Science and Technology Wuhan 430030 China Saint Francis hospital Ifakara Medical College Morogoro Agakhan University Agakhan HospitalDar-es-salaam

HIV/AIDS is increasing in prevalence in China and spread of infection from highly risk populations to the general populations was recognized. Despite the fact, there are still only few scientific reviews on quality of life （QOL） for people living with HIV/AIDS （PLWHAs）. However, many PLWHAs are struggling with social and psychological influences such as substances abuse, cultural beliefs, depression, stigma, poverty, which can affect their QOL. Public unawareness about infection and disease, willingness to seek medical care and motivation to follow therapy are indirectly influencing health outcome. In 2003 Chinese government has established the so-called the ＂Four Frees and One Care＂ policy. The policy was officially implemented from 2004 in some areas, yet to date it is not implemented nationwide. This paper discussed the epidemiology of HIV, underlying psychosocial factors affecting PLWHAs and their impact on QOL. We put forward some recommendations for stakeholders, advocacy groups, non-government organizations and Chinese government.

关键词： AIDS China epidemiology HIV quality of life

Prevalence of Pre-Operative Anxiety and Predictors among Elective Surgical Patients and Their Pre-Operative Hemodynamic Changes at Muhimbili National hospital

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Open Journal of Medical Psychology 2023年第2期12卷 55-70页

作者： Rukia Abdul-Ghany Himid Msoma Ramadhani H. Khamis Laurean P. Rwanyuma Larry O. Akoko Araika-Zawadhafsa Mkulo Peter Msinde MMed (General Surgery) Dissertation Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania

Background: Surgery is a traumatic process that may subject patients to physiological and psychological responses leading to pre and post-operative effects. Preoperative anxiety, if severe may be associated with several complications including cancellation of surgery, poor intra- and post-operative analgesic control, altered post-operative healing, and longer hospital stays to mention a few. Objective: The main purpose was to determine the prevalence and predictors of pre-operative anxiety among elective surgical patients and their hemodynamic changes in these patients in the Surgical department in MNH. Methodology: This was a prospective descriptive and analytical study performed at MNH which involved patients admitted for elective surgical procedures from June 2021 to February 2022. Information was gathered in a structured questionnaire along with APAIS scores. Results: 169 patients for elective surgery in General Surgery and Urology units were included in the study. Among them, 94 males and 74 females. The overall pre-operative anxiety was 11.8%, 80.5% had moderate to severe Information-Related anxiety, while 26% and 17.2% had moderate-to-severe surgery-related and anesthesia-related types of anxiety respectively. Conclusion: Pre-operative anxiety was comparatively lower in our settings as well no factor was found with a significant relation to pre-operative anxiety, hence further and broader evaluation is recommended to result in the assessment and management of patients before elective surgery.

关键词： Anxiety Elective Surgery Predictors APAIS

Univariate Risk Factors for Prolonged Mechanical Ventilation in Patients Undergoing Prosthetic Heart Valves Replacement Surgery

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2006年第6期26卷 693-695页

作者： Ommari Baaliy Mkangara 张凯伦杨运海 Saumu Tobbi Mweri Theresia.M.Kobelo Department of Cardiovascular Surgery Union HospitalTongji Medical CollegeHuazhong University of Science and Technology Department of Pediatric Cardiovascular Diseases Lugalo General Military HospitalDar-es-salaamTanzania Department of Surgery Saint Francis HospitalIfakara Medical CollegeMorogoroTanzania

Data from 736 patients undergoing prosthetic heart valve replacement surgery and concomitant surgery （combined surgery） from January 1998 to January 2004 at Union hospital were retrospectively reviewed. Univariate logistic regression analyses were conducted to identity risk factors for prolonged mechanical ventilation. The results showed that prolonged cardiopulmonary bypass duration, prolonged aortic cross clamp time and low ejection fraction less than 50 percent （50 %） were found to be independent predictors for prolonged mechanical ventilation. Meanwhile age, weight, and preoperative hospital stay （days） were not found to be associated with prolonged mechanical ventilation. It was concluded that. for age and weight, this might be due to the lower number of old age patients （70 years and above） included in our study and genetic body structure of majority Chinese population that favor them to be in normal weight, respectively.

关键词： prolonged mechanical ventilation prosthetic heart valves replacement surgery

Pregnancy outcomes in the extremes of reproductive age: A seven-year experience in Tanzania

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Open Journal of Obstetrics and Gynecology 2013年第1期3卷 51-57页

作者： Projestine S. Muganyizi Belinda Balandya Department of Obstetrics & Gynecology Muhimbili University of Health and Allied Sciences (MUHAS) Dar es Salaam Tanzania

Background: Extremes of reproductive age are associated with adverse pregnancy outcomes. although varieties of adverse outcomes are reported across international studies, it has been difficult to compare the results due to inconsistencies in design partly due to arbitrary age cut offs for low and high risk groups. This study utilized the international consensus age cut offs to separate low and high risk age groups and compared pregnancy outcomes among them. Methods: Data of all deliveries at the Muhimbili National hospital in dar es Salaam, Tanzania from 1st January, 2005 to 31st December, 2011 were analyzed retrospectively and compared using IBM SPSS statistics 19. Ages 12 - 17 years (teenage) and 35 - 50 years were classified as high risk and 18 - 34 years as low risk. We treated the presence of any prenatal complication as primary outcome and intra/postpartum variables as secondary outcomes. Chi square test was used to compare proportions and t-test for continuous data among two independent groups. ANOVA with Bonferroni adjustment was used to compare differences in means across age groups. Binary logistic regression analyses were performed to determine odds of developing primary and secondary outcomes with age as an independent (categorical) variable. P-values of 0.05 or less were interpreted as statistically significant. Results: In total 65,453 singleton deliveries were identified of which 64,818 (99%) were analyzed including 1680 (2.6%) teenage and 7961 (12.3%) deliveries at 35 - 50 years. Teenage deliveries had progressively declined from 39/1000 in2005 to 16/1000 in2011 incontrast to a rise from 103/1000 to 145/1000 deliveries for the 35 - 50 years. Across all age groups, prenatal complications were least for teenage (11.4%) and most for 35 - 50 years (32.7%, χ2 = 51.3, P e minutes (OR = 2.2, 95% CI: 1.9 - 2.6) and low birth weight (OR = 1.6, 95% CI: 1.4 - 1.8). In contrast, deliveries at 35 - 50 years had increased risks for Cesarean section (OR = 1.4, 95%

关键词： Maternal Age Pregnancy Outcome Trends Prenatal Postnatal Tanzania