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Abstract Background Bowel perforation though rarely reported is a serious complication of induced abortion, which is often performed illegally by persons without any medical training in developing countries. A sudden increase in the number of patients in our centre in recent years prompted the authors to analyze this problem. The study was conducted to describe our own experiences in the surgical management of these patients. Methods This was a retrospective study involving patients who were jointly managed by the surgical and gynecological teams at Bugando Medical Centre (BMC) for bowel perforation secondary to illegally induced abortion from January 2002 to December 2011. The statistical analysis was performed using SPSS version 17.0. Results A total of 68 patients (representing 4.2% of cases) were enrolled in the study. Their ages ranged from 14 to 45 years with a median age of 21 years. Majority of patients were, secondary school students/leavers (70.6%), unmarried (88.2%), nulliparous (80.9%), unemployed (82.4%) and most of them were dependent member of the family. Previous history of contraceptive use was reported in only 14.7% of cases. The majority of patients (79.4%) had procured the abortion in the 2nd trimester. Dilatation and curettage (82.4%) was the most common reported method used in procuring abortion. The interval from termination of pregnancy to presentation in hospital ranged from 1 to 14 days (median 6 days ). The ileum (51.5%) and sigmoid colon (22.1%) was the most common portions of the bowel affected. Resection and anastomosis with uterine repair was the most common (86.8%) surgical procedure performed. Complication and mortality rates were 47.1% and 10.3% respectively. According to multivariate logistic regression analysis, gestational age at termination of pregnancy, delayed presentation, delayed surgical treatment and presence of complications were significantly associated with mortality (P Conclusion Bowel perforation following illegally induced abortion is still rampant in our environment and constitutes significantly to high maternal morbidity and mortality. Early recognition of the diagnosis, aggressive resuscitation and early institution of surgical management is of paramount importance if morbidity and mortality associated with bowel perforation are to be avoided.

Background: Trichomonas vaginalis is a sexually transmitted parasitic infection known to cause vaginitis especially in women of child bearing age. The objective of this study was to determine the prevalence and factors associated with T. vaginalis among pregnant women attending public health facilities in Mwanza City, Tanzania. Methods: This cross sectional study was conducted among pregnant women aged 17-46 years attending three public antenatal clinics in Mwanza City, north-western Tanzania. Wet preparation and Giemsa stained thick smears techniques were used to diagnose T. vaginalis infection. Sociodemographic characteristics and other risk related behaviours were collected. Results: A total of 365 pregnant women participated in this study, 38 (10.41%) and 84 (23.01%) of them had trichomoniasis based on wet preparation and Giemsa stained thick smears respectively. On multivariable analysis, being HIV seropositive (AOR=11.65, 95%CI; 1.15-117.49, P<0.03) and having other sexual transmitted disease such as syphilis (AOR=4.40, 95%CI: 1.32-14.7, P<0.01) were significantly associated with T. vaginalis. Conclusion: The prevalence of T. vaginalis in pregnant women in Mwanza city is high and the infection is associated with sexually transmitted diseases such as syphilis and HIV. Routine screening of T. vaginalis during ante-natal care clinics is highly recommended to reduce pregnancy complications related to T. vaginalis infection. [ABSTRACT FROM AUTHOR]

Background: Preoperative over-ordering of blood for surgical intervention, in excess of the actual and anticipated needs is a common practice in many developing countries. This can be decreased by simple means of changing the blood cross matching and ordering schedule depending upon the type of surgery performed. The aim of this study was to assess the blood transfusion practice in surgery at Bugando Medical Centre in northwestern Tanzania. Methods: This was a retrospective study among patients undergoing major operations at Bugando Medical Centre. We evaluated blood ordering and transfusion practices in emergency and elective surgical procedures and calculated different indices such as cross-match to transfusion ratio (C/T ratio), transfusion probability (% T) and transfusion index (TI). Next Maximal Surgical Blood Ordering System (MSBOS) was estimated for each procedure. Results: The overall blood utilization was only 28.2%, consisting of 17.1% in the elective operations and 26.9% in the emergency operations. There was no blood utilization for most of the routine elective cases suggesting cross-matching of blood to be a culture than necessity. Generally, the overall blood transfusion of the requested blood as indicated by indices of C/T ratio, %T, TI and MSBOS were 3.5, 28.7%, 0.33 and 0.45, respectively. The overall CT ratio, %T, TI and MSBOS in the elective operations were 5.8, 15.9%, 0.2 and 0.3, respectively. In the emergency operations, the overall CT ratio, %T, TI and MSBOS were 3.7, 22%, 0.32 and 0.48, respectively. Conclusion: This study demonstrated that over-ordering of blood in excess of the actual needs is a common practice at BMC. Blood ordering pattern needs to be revised and over-ordering of blood should be minimized. This can be possible by the estimation of MSBOS for each procedure and requisition as calculated. [ABSTRACT FROM AUTHOR]

Background: Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity and even mortality. There is paucity of data regarding iatrogenic ureteric injuries in Tanzania and Bugando Medical Centre in particular. This study describes our experience in the management and outcome of ureteric injuries following abdomino-pelvic operations outlining the causes, clinical presentation and outcome of management of this condition in our local setting. Methods: This was a retrospective descriptive study of patients with iatrogenic ureteric injuries following abdomino-pelvic operations that were managed in Bugando Medical Centre between July 2004 and June 2014. Results: A total of 164 patients (M: F = 1: 1.6) were studied. Of these, 154 (93.9%) were referred to Bugando Medical Centre having had their initial surgeries performed at other hospitals, whereas 10 (6.1%) patients sustained ureteric injuries during abdomino-pelvic surgery at Bugando Medical Centre. The median age at presentation was 36 years. The most common cause of iatrogenic ureteric injuries was total abdominal hysterectomy occurring in 69.2% of cases. The distal ureter was more frequently injured in 75.6% of cases. Suture ligation was the commonest type of injury accounting for 36.6% of patients. One hundred and sixteen (70.7%) patients had delayed diagnosis but underwent immediate repair. Ureteroneocystostomy was the most frequent reconstructive surgery performed in 58.0% of cases. Of the 164 patients, 152 (92.7%) were treated successfully. Twelve (7.3%) patients died in hospital. The main predictors of deaths were delayed presentation, deranged renal function tests on admission, missed ureteric injuries and surgical site infections (P < 0.001). The overall median length of hospital stay was 12 days. Follow up of patients was generally poor as more than half of patients were lost to follow up. Conclusion: Total abdominal hysterectomy still accounts for most cases of iatrogenic ureteric injuries in our environment. Meticulous surgical technique as well as identification of the course of the ureter and associated anatomic locations where injury is most likely to occur is important to decrease the risk of ureteric injury. Timely recognition of ureteric injury and its management is associated with good outcome. [ABSTRACT FROM AUTHOR]