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4. Surgical Safety Checklist Use and Post-Caesarean Sepsis in the Lake Zone of Tanzania: Results from Safe Surgery 2020

Author

Wurdeman, Taylor, primary, Staffa, Steven J., additional, Barash, David, additional, Buberwa, Ladislaus, additional, Eliakimu, Eliudi, additional, Maina, Erastus, additional, Maongezi, Sarah, additional, Meara, John G., additional, Munyonyela, William, additional, Mushi, Rahma, additional, Reynolds, Cheri, additional, Strader, Christopher, additional, Varallo, John, additional, Washington, Leonard, additional, Zurakowski, David, additional, Alidina, Shehnaz, additional, and Kapologwe, Ntuli A., additional

Published
2021
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5. Outcomes of a multicomponent safe surgery intervention in Tanzania’s Lake Zone: a prospective, longitudinal study

Author

Alidina, Shehnaz, primary, Menon, Gopal, additional, Staffa, Steven J, additional, Alreja, Sakshie, additional, Barash, David, additional, Barringer, Erin, additional, Cainer, Monica, additional, Citron, Isabelle, additional, DiMeo, Amanda, additional, Ernest, Edwin, additional, Fitzgerald, Laura, additional, Ghandour, Hiba, additional, Gruendl, Magdalena, additional, Hellar, Augustino, additional, Jumbam, Desmond T, additional, Katoto, Adam, additional, Kelly, Lauren, additional, Kisakye, Steve, additional, Kuchukhidze, Salome, additional, Lama, Tenzing, additional, Lodge, William, additional, Maina, Erastus, additional, Massaga, Fabian, additional, Mazhiqi, Adelina, additional, Meara, John G, additional, Mshana, Stella, additional, Nason, Ian, additional, Reynolds, Chase, additional, Reynolds, Cheri, additional, Segirinya, Hannington, additional, Simba, Dorcas, additional, Smith, Victoria, additional, Strader, Christopher, additional, Sydlowski, Meaghan, additional, Tibyehabwa, Leopold, additional, Tinuga, Florian, additional, Troxel, Alena, additional, Ulisubisya, Mpoki, additional, Varallo, John, additional, Wurdeman, Taylor, additional, Zanial, Noor, additional, Zurakowski, David, additional, Kapologwe, Ntuli, additional, and Maongezi, Sarah, additional

Published
2021
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6. Improving surgical quality in low-income and middle-income countries: why do some health facilities perform better than others?

Author

Alidina, Shehnaz, primary, Chatterjee, Pritha, additional, Zanial, Noor, additional, Alreja, Sakshie Sanjay, additional, Balira, Rebecca, additional, Barash, David, additional, Ernest, Edwin, additional, Giiti, Geofrey Charles, additional, Maina, Erastus, additional, Mazhiqi, Adelina, additional, Mushi, Rahma, additional, Reynolds, Cheri, additional, Sydlowski, Meaghan, additional, Tinuga, Florian, additional, Maongezi, Sarah, additional, Meara, John G, additional, Kapologwe, Ntuli A, additional, Barringer, Erin, additional, Cainer, Monica, additional, Citron, Isabelle, additional, DiMeo, Amanda, additional, Fitzgerald, Laura, additional, Ghandour, Hiba, additional, Gruendl, Magdalena, additional, Hellar, Augustino, additional, Jumbam, Desmond T, additional, Katoto, Adam, additional, Kelly, Lauren, additional, Kisakye, Steve, additional, Kuchukhidze, Salome, additional, Lama, Tenzing N, additional, Menon, Gopal, additional, Mshana, Stella, additional, Reynolds, Chase, additional, Segirinya, Hannington, additional, Simba, Dorcas, additional, Smith, Victoria, additional, Staffa, Steven J, additional, Strader, Christopher, additional, Tibyehabwa, Leopold, additional, Troxel, Alena, additional, Varallo, John, additional, Wurdeman, Taylor, additional, and Zurakowski, David, additional

Published
2021
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7. In-Hospital Postoperative Mortality Rates for Selected Procedures in Tanzania’s Lake Zone

Author

Wurdeman, Taylor, primary, Strader, Christopher, additional, Alidina, Shehnaz, additional, Barash, David, additional, Citron, Isabelle, additional, Kapologwe, Ntuli, additional, Maina, Erastus, additional, Massaga, Fabian, additional, Mazhiqi, Adelina, additional, Meara, John G., additional, Menon, Gopal, additional, Reynolds, Cheri, additional, Sydlowski, Meaghan, additional, Varallo, John, additional, Maongezi, Sarah, additional, and Ulisubisya, Mpoki, additional

Published
2020
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8. Effectiveness of a multicomponent safe surgery intervention on improving surgical quality in Tanzania’s Lake Zone: protocol for a quasi-experimental study

Author

Alidina, Shehnaz, primary, Kuchukhidze, Salome, additional, Menon, Gopal, additional, Citron, Isabelle, additional, Lama, Tenzing N, additional, Meara, John, additional, Barash, David, additional, Hellar, Augustino, additional, Kapologwe, Ntuli A, additional, Maina, Erastus, additional, Reynolds, Cheri, additional, Staffa, Steven J, additional, Troxel, Alena, additional, Varghese, Asha, additional, Zurakowski, David, additional, Ulisubisya, Mpoki, additional, and Maongezi, Sarah, additional

Published
2019
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9. Towards equitable surgical systems: development and outcomes of a national surgical, obstetric and anaesthesia plan in Tanzania

Author

Citron, Isabelle, primary, Jumbam, Desmond, additional, Dahm, James, additional, Mukhopadhyay, Swagoto, additional, Nyberger, Karolina, additional, Iverson, Katherine, additional, Akoko, Larry, additional, Lugazia, Edwin, additional, D'Mello, Brenda, additional, Maongezi, Sarah, additional, Nguhuni, Boniface, additional, Kapologwe, Ntuli, additional, Hellar, Augustino, additional, Maina, Erastus, additional, Kisakye, Steve, additional, Mwai, Patrick, additional, Reynolds, Cheri, additional, Varghese, Asha, additional, Barash, David, additional, Steer, Michael, additional, Meara, John, additional, and Ulisubisya, Mpoki, additional

Published
2019
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10. The Situation of Safe Surgery and Anaesthesia in Tanzania: A Systematic Review

Author

Nyberger, Karolina, primary, Jumbam, Desmond T., additional, Dahm, James, additional, Maongezi, Sarah, additional, Makuwani, Ahmed, additional, Kapologwe, Ntuli A., additional, Nguhuni, Boniface, additional, Mukhopadhay, Swagoto, additional, Iverson, Katherine R., additional, Maina, Erastus, additional, Kisakye, Steve, additional, Mwai, Patrick, additional, Hellar, Augustino, additional, Barash, David, additional, Reynolds, Cheri, additional, Meara, John G., additional, and Citron, Isabelle, additional

Published
2018
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11. Characterization Of Demographic, Behavioral, Immunologic, And Virologic Factors Associated With Incident And Prevalent Hepatitis C Virus Infection Among Hiv-Infected Men: Analysis Of 1948 Hiv-Infected Men In Baltimore, Maryland

Author

Maina, Erastus Njuguna

Subjects
Incident, Prevalent, Epidemiology, HIV-Infected, virus diseases, Hepatitis C, digestive system diseases
Abstract

Recent reports around the world show that hepatitis C virus (HCV) infection rates among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) have increased in the past decade. The main goal of this thesis research was to characterize HCV infection among HIV-infected men with an aim of identifying new risk factors associated with HCV acquisition. This study assessed the cumulative prevalence of HCV and determined risk factors associated with prevalent and incident HCV infection. We employed a cross-sectional study evaluating 1948 HIV-infected men who had at least one HCV antibody test at Chase Brexton Health Care (CBHC) between 2011 and 2013. Multinomial logistic regression was used to establish crude and adjusted odds ratios at 95% confidence intervals (CI). The overall HCV prevalence for this sample of HIV-infected men was 24% (95% CI; 22–26), 85% among those who reported injection drug use (IDU), and 9% among those who did not report a history of IDU. Bivariate analyses suggested that lower education was less likely to be associated with HCV incidence, and those with prevalent HCV infection were more likely to be unemployed. In multivariate analysis, IDU was the only significant risk factor associated with incident HCV infection. Being ≥ 40 years old, having a history of IDU, and previous exposure to hepatitis B virus were positively associated with prevalent HCV infection, whereas, being MSM was negatively associated with HCV prevalence. Traditional risk factors typically associated with prevalent HCV infection, excluding IDU, were not associated with HCV incidence. Our study suggests that there may be a change in HCV risk factors between prevalent and incident HCV infection. The permucosal route seems to be the new mode of transmission driving HCV infection among this sample of HIV-infected MSM. We also found that a significantly larger proportion of those with incident HCV spontaneously cleared HCV compared to those with prevalent HCV infection. To add, we observed a high rate of sustained virologic response (SVR) among those with incident HCV, which may correspond to the high treatment completion rate. Our findings point to a changing epidemiology of HCV infection among HIV-infected men in Baltimore and highlight the emerging issue of sexual transmission of HCV among HIV-infected MSM in this area.

Published
2016
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12. Effectiveness of a multicomponent safe surgery intervention on improving surgical quality in Tanzania’s Lake Zone: protocol for a quasiexperimental study.

Author

Alidina, Shehnaz, Kuchukhidze, Salome, Menon, Gopal, Citron, Isabelle, Lama, Tenzing N., Meara, John, Barash, David, Hellar, Augustino, Kapologwe, Ntuli A., Maina, Erastus, Reynolds, Cheri, Staffa, Steven J., Troxel, Alena, Varghese, Asha, Zurakowski, David, Ulisubisya, Mpoki, and Maongezi, Sarah

Abstract

Introduction Effective, scalable strategies for improving surgical quality are urgently needed in low-income and middle-income countries; however, there is a dearth of evidence about what strategies are most effective. This study aims to evaluate the effectiveness of Safe Surgery 2020, a multicomponent intervention focused on strengthening five areas: leadership and teamwork, safe surgical and anaesthesia practices, sterilisation, data quality and infrastructure to improve surgical quality in Tanzania. We hypothesise that Safe Surgery 2020 will (1) increase adherence to surgical quality processes around safety, teamwork and communication and data quality in the short term and (2) reduce complications from surgical site infections, postoperative sepsis and maternal sepsis in the medium term. Methods and analysis Our design is a prospective, longitudinal, quasi-experimental study with 10 intervention and 10 control facilities in Tanzania’s Lake Zone. Participants will be surgical providers, surgical patients and postnatal inpatients at study facilities. Trained Tanzanian medical data collectors will collect data over a 3-month preintervention and postintervention period. Adherence to safety as well as teamwork and communication processes will be measured through direct observation in the operating room. Surgical site infections, postoperative sepsis and maternal sepsis will be identified prospectively through daily surveillance and completeness of their patient files, retrospectively, through the chart review. We will use difference-in-differences to analyse the impact of the Safe Surgery 2020 intervention on surgical quality processes and complications. We will use interviews with leadership and surgical team members in intervention facilities to illuminate the factors that facilitate higher performance. Ethics and dissemination The study has received ethical approval from Harvard Medical School and Tanzania’s National Institute for Medical Research. We will report results in peer-reviewed publications and conference presentations. If effective, the Safe Surgery 2020 intervention could be a promising approach to improve surgical quality in Tanzania’s Lake Zone region and other similar contexts. [ABSTRACT FROM AUTHOR]

Published
2019
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14. A mixed-methods assessment of surgical capacity in Tanzania's Lake Zone.

Author

DiMeo, Amanda, Lama, Tenzing N., Sydlowski, Meaghan, Barash, David, Maina, Erastus, Menon, Gopal, Gruendl, Magdalena A., Cainer, Monica, Kapologwe, Ntuli, Maongezi, Sarah, Hellar, Augustino, and Alidina, Shehnaz

Subjects
*HEALTH facilities, *PHYSICIANS, *INTENSIVE care units, *CESAREAN section, *OPERATING budgets
Abstract

Background Five billion people across the world do not have access to safe and affordable surgical, obstetric, and anaesthesia care when they need it. In 2018, Safe Surgery 2020 was launched in Tanzania's Lake Zone region to improve the quality of surgical services. A baseline assessment of surgical capacity was undertaken to provide the context for the implementation of Safe Surgery 2020. Methods The surgical capacity assessment focused on 5 domains of the surgical system: workforce, service delivery, infrastructure, information management, and financing. We used a mixed-methods study design, including (1) a cross-sectional survey of 20 health facilities and (2) semistructured interviews (n=34) with surgical team members at 10 health facilities in the Lake Zone of Tanzania between April and July 2018. We used descriptive analysis to quantify surgical capacity and thematic analysis of interview data to gain a deeper understanding of underlying capacity issues and implications. Results Surgical, obstetric and anaesthesia workforce density was low at 0.08 surgical, obstetric and anaesthesia providers per 100 000 population. Surgery was performed primarily by general physicians or nonphysician providers and anaesthesia by nurse-anaesthetists. Among 4993 operations captured across the 3 months of baseline data collection in the 5 regions, only 2 of the 3 bellwether procedures--caesarean delivery (n=2640, 54%) and laparotomies (n=388, 8%) were performed. Oxygen, blood, water and electricity were not consistently available in all 20 facilities. The majority of facilities lacked postoperative recovery and intensive care units. The majority of facilities (n=18, 90% of facilities) reported that 1% to 25% of their patients had health insurance. The majority of facilities (n=12, 60%) had specific funds allocated to surgery in their hospital operating budgets. Conclusions The surgical capacity assessment revealed critical gaps in each of the 5 domains of the surgical system. Results served as a baseline for the Safe Surgery 2020 intervention and can guide interventions to strengthen the surgical system in Tanzania's Lake Zone and other low-resource settings with similar contexts. [ABSTRACT FROM AUTHOR]

Published
2021
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