Water, Sanitation and Hygiene in Lower-Level Health Care Facilities of Dar es Salaam Region in Tanzania: Status towards Achieving the Sustainable Development Goals and Way Forward

Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.

Traditional medicine in Tanzania:a review of historical perspective,current practices and challenges

The use of traditional medicine(TM)is essential for preventing and treating diseases and thus improving human health.Worldwide,TM has been used since time immemorial.In Tanzania,the use of TM was most common during precolonial era before it was discriminated during the Germany colonial rule.However,it regained the attention during the private sector emergence era(1985-2004).Currently,there are ongoing efforts to integrate TM and modern medicine to improve healthcare systems in developing countries for sustainable healthcare management.This review aims to provide an overview of the historical and current status,challenges,and future direction for TM in Tanzania.The analysis revealed that the development of TM was somehow underdeveloped during the colonial rule but regained its popularity after independence.Currently,there are many opportunities such as the presence of legal and institutional frameworks,a varied medicinal biodiversity,with some of them being endemic to Tanzania,political will etc.Despite the available opportunities,there are numerous challenges to the development and use of TM.These include inadequate financial and human resources for research,poor conservation of medicinal biodiversity;modernization;intellectual property rights of TM knowledge;lack of safety,efficacy,and quality data of medicinal products.The development and utility of TM as a resource is crucial to protect practise.Thus,the study recommends more capacity building in terms of finances,technology development,human resources training,advocacy and integration of TM into healthcare system.

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

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.

Postpartum Hemorrhage: Incidence, Causes and Maternal Outcomes at Muhimbili National Hospital, Tanzania—A Retrospective Descriptive Hospital-Based Study

Worldwide obstetric hemorrhage remains the leading cause of maternal mortality, accounting for over one quarter of maternal deaths. Over half of these deaths occur in Sub-Saharan Africa with mortality rates of 500 - 1000 per 100,000 births, compared to approximately 5 - 10 in developed countries. Over decades in Sub Saharan Africa preventive measures and treatment protocols have been made to reduce maternal mortality caused by PPH. While rates of postpartum hemorrhage have continued to rise, there is a need to evaluate if its etiology and patterns have changed over time. Broad Objective: This study aims at describing trends in incidence, causes and maternal outcomes of Postpartum Hemorrhage at Muhimbili National Hospital for a period of 7 years. Methodology: This is a retrospective descriptive hospital-based study that has included all cases of postpartum hemorrhage at Muhimbili National Hospital, a tertiary hospital in Tanzania from 2014 to 2020. The data was analyzed using SPSS Version 26 and presented using frequency tables, figures and percentages. The trends of postpartum hemorrhage over time were determined using chi-square test and P-value where less than 0.05 was considered statistically significant. Results: Overall, the incidence of postpartum hemorrhage has been fluctuating over the years with minimum of 1.78% and maximum of 2.87% with no statistical significance. Out of 1113 enrolled cases of PPH, 422 (37.9%) were attributed to genital tears followed by uterine atony 285 (25.6%). A statistically significant increase in linear trend was observed in the postpartum hemorrhage cases due to uterine atony, uterine rupture and sub analysis on genital tears (cervical tear). Overall, there was a statistically significant change in trend of maternal outcomes throughout the years, with a P-value < 0.001 and likelihood of complications increasing over time. Conclusion: The trend in the incidence of postpartum hemorrhage has been fluctuating over the years during the study period. The leading cause of postpartum hemorrhage was genital tears, followed by uterine atony with a significant increase in adverse maternal outcomes over the years. Continuous health education to medical personnel to improve timely and proper diagnosis of women in danger of PPH and timely referral, thus improve maternal morbidity and mortality.

Improper Disposal of Waste Water and Masks during COVID-19, and the Associated Increased Cycle of Infection to Human Health in Developing Countries: A Case Study of Tanzania

Since COVID-19 was declared by the World Health Organization (WHO), wearing of protective equipment, hand washing using soap and frequent use of antiseptic solution are being applied globally to reduce the transmission rate. This study was intended to investigate handling of after wash waste water and masks among Tanzanian residents on the COVID-19 pandemic after it has been, declared by the World Health Organization (WHO) that, wearing of protective equipment, hand washing using soap and frequent use of antiseptic solution should be applied globally to reduce the transmission rate. The assessment of health care waste management in the facilities was conducted in all the 26 regions of Tanzania Mainland. A standardized checklist and tools were used to assess and monitor various aspects related to healthcare waste using open source software for collection (ODK). Data were analyzed using SPSS computer software. It has been indicated that before disposing the used mask, the best protocol is to spray 0.5% (5000 ppm) of chlorine disinfectant on the surface. In this study, about 46% consider used mask as normal municipal waste and 3% do not care they throw away the face masks in the street. Only 18% and 5% of reported to disposal as infectious and highly hazardous waste respectively. It is well documented that due to potential infectious disease like SARS-CoV-2, wastewater should be treated either on-site or conveyed off-site and treated in well-designed method or technology to kill the micro-organisms. The analysis revealed that majority of respondents (74.7%, 73.8%, 48.1% and 65% for healthcare center, district hospitals, regional hospitals and consultant hospitals respectively);dispose the waste in the open space. Continuous awareness creation programs about the negative impact of contaminated face masks and waste water on the health of individuals and introducing laws that can prohibit improper disposal are among the solutions that could help reduce the problem.

Evaluation of Accuracy of Clinical Examination and MRI on Diagnosing Anterior Cruciate Ligament and Meniscal Tears in Comparison to Diagnostic Arthroscopy among Patients Attending at Muhimbili Orthopedic Institute

Routine use of Magnetic Resonance Imaging (MRI) as screening test after clinical diagnosis for meniscal and/or anterior cruciate ligament (ACL) has a detrimental effect on patients in limited resourced countries. This study was done to compare accuracy of clinical examination and that of (MRI) on diagnosing meniscal and or (ACL) tears. Methodology: A cross-sectional-descriptive study was done on 57 knees of patients. Clinical examination, MRI and then diagnostic arthroscopy, as the gold standard, were done to all the cases. Results were recorded;the accuracies of MRI and clinical examination were evaluated and their results were compared. Results: Median age of patients was 40 years. Clinical examination had sensitivity of 93.62% and specificity of 40% for diagnosing meniscal tears;and sensitivity of 100%;and specificity of 97.67% for diagnosing ACL tear. MRI had sensitivity of 85.11%, and specificity of 40% for meniscal tear diagnosis and 71% and 100% respectively for ACL tear diagnosis. Diagnostic accuracy was 84.21% for meniscal and 98.24% for ACL tears by clinical examination and by MRI was 77.19% and 92.98% respectively. Conclusion: Clinical examination has higher accuracy than MRI on diagnosing both ACL and meniscal tear. Thus patients may be scheduled for diagnostic and interventional arthroscopy if clinical examination reveals meniscal and or ACL injuries. MRI use should be reserved when clinical evaluation is inconclusive or cannot be done.

Estimation of Different Categories of Healthcare Waste Generated at Two Different Hospital Categories in Four Hospitals in Dar es Salaam City

This study aims to estimate the quantity of healthcare waste categorically generated in four different healthcare in Dar es Salaam city namely, Muhimbili National Hospital, Mwananyamala Regional Referral Hospital, Temeke Regional Referral Hospital and Ilala Regional Referral Hospital to evaluate the quantities of medical waste generated based on their level and capacity. Waste was collected in different categories of non-infectious, sharps, infectious, infectious plastics, and pathological waste which were measured daily for fourteen (14) consecutive days in all hospitals by using a weighting scale and observational checklist to document related waste management information and the assessment of the healthcare waste generation in each hospital. The average general healthcare waste generation rate per healthcare ranges from 298.9 kg/day to 1554.4 kg/day. The high fluctuation in general medical waste was established to be attributed to specialization difference between one hospital to the other, and the large number of in-patients and out patients between hospitals. The overall average sharps waste generation rate was established to range from 8.5 ± 2.7 - 13.9 ± 1.8 kg/day. Higher values of sharps waste generated observed at Muhimbili hospital are due to emergency cases referred to from other hospitals located within the city and from the surrounding districts and other regions of the country. The results from this study, raise alarm to hospital administrators, and other health stakeholders working in related fields to give special attention and priority in setting a related share in their budgets for proper management of medical waste in their health facilities.

Depression,suicidality and associated risk factors among police officers in urban Tanzania:a cross-sectional study

Background The WHO has classified depression as a disease of public concern.Police officers are a particular subpopulation group that is at an increased risk for mental health problems.This study examined the prevalence of depression,suicidality and associated risk factors among police officers in urban Tanzania.Aims The aim of this study was to examine the prevalence of depression,suicidality and associated risk factors among police officers in Tanzania.Methods A cross-sectional study was conducted between April 2019 and October 2020 among 550 participants in Dar es Salaam recruited using a multistage cluster sampling technique.The Patient Health Questionnaire-9 was used to screen for depression and suicidality.The Interpersonal Support Evaluation List-12 tool was used to measure perceived social support.Descriptive statistics were summarised using frequencies and percentages.Bivariate and multivariate analyses were used to establish associations between predictors of interest,depression and suicidality.Results There were 497 participants in the study.Of these,76.6%(376 of 491)were men,and the median(IQR)age was 37.0(17)years.Around 19.8%(96 of 486)of the police officers screened positive for depression and 15.4%(75 of 413)for suicidality.A significant proportion was either moderately(29 of 96,30.2%)or severely depressed(8 of 75,10.7%).Of those who experienced suicidal thoughts,10.7%(8 of 75)reported having daily suicidal thoughts.Perceiving low social support was associated with an increased risk of reporting depression(adjusted OR(aOR):28.04,95%CI:8.42 to 93.37,p<0.001)and suicidality(aOR:10.85,95%CI:3.56 to 33.08,p<0.001)as compared with those with high perceived social support.Conclusion The magnitude of depression and suicidality among police officers in urban Tanzania is alarmingly high.The study findings indicate the need for routine screening for depression and suicidality among police officers and design appropriate mental health responsive services in this population.

Assessment of Medicines Cold Chain Storage Conformity with the World Health Organization Requirements in Health Facilities in Tanzania

A descriptive study on assessment of medicines cold chain storage conformity with World Health Organization (WHO) requirements in public health facilities was carried out in Dar es Salaam and Dodoma regions. Storage conformity in selected health facilities was assessed by monitoring temperature using temperature data loggers mounted in the refrigerators for a period of 30 days. Results indicated almost half of the health facilities 48.5% visited, did not significantly (P = 0.031) comply with storage temperature (+2°C to +8°C) as per WHO requirement because all recorded Mean Kinetic temperature (MKT) > 8°C. In rural areas, 59.2% of visited health facilities adhered to the WHO recommended storage temperature while in urban areas only 31.6% complied. The study has established electricity failure in urban and lack of gas in rural areas coupled with absence of contingency plan as major challenges to WHO temperature conformity in storage of cold chain medicines in health facilities in Tanzania.

Prevalence and Factors Associated with Mortality among Chest Injury Patients Admitted at Muhimbili National Hospital in Dar es Salaam, Tanzania

Introduction: Accidents represent a significant proportional of non-communicable disease in the current century, and chest injury is common. However, management and outcome of these injuries is poor in low resource setting like Tanzania. The aim of this study was to determine the prevalence and factors associated with mortality among chest injury patients at a tertiary level health facility in Tanzania. Method: A prospective Cross-Sectional study of chest injuries among trauma patients attended at Muhimbili National Hospital between September 2019 and February 2020. Results: A total of 282 trauma patients were seen, out of which 51/282 (18.1%) sustained chest injury. Road Traffic Crashes were the leading cause of chest injury 41/51 (80.4%). Majority 17/51 (33.3%) presented with lung contusion, followed by pneumohemothorax and rib fractures each 8/51 (15.7%). Most of the patients 27/51 (52.9%) were managed by tube thoracostomy and 42.1% conservatively. Mortality was 11/51 (21.6%). Independent factors associated with mortality were: Associated injuries (Odds Ratio (OR) 0.07, 95% CI 0.01 - 1.16, p = 0.02), Multimodal analgesia (Odds Ratio (OR) 0.22, 95% CI 0.05 - 0.98, p = 0.05), more than 24 hours to treatment (Odds Ratio (OR) 5.53, 95% CI 1.25 - 24.3, p = 0.02), Bilateral chest involvement (Odds Ratio (OR) 4.61, 95% CI 1.12 - 18.7, p = 0.02), and Invasive ventilation (Odds Ratio (OR) 31.5, 95% CI 4.47 - 53.8, p = 0.00). Conclusion: Chest injuries prevail significantly among trauma patients in Tanzania, mostly due to road traffic crashes. Injury preventive measures especially for road traffic crashes need to be reinforced, and establishment of chest injury management protocol in Tanzania.

Outcome and Effectiveness of Inpatient Care of Malnourished under Five Children in District Hospitals of Mwanza Region, North Western Tanzania

Background: Malnutrition is a disease affecting commonly children from 0 to 5 years of age. In Tanzania it is still a problem with a prevalence of 36% and 28% mortality. Objective: This study aimed to compare the outcome and effectiveness of therapeutic regimes used by different district hospitals in the management of malnutrition of under five years old children in Mwanza Region. Methods: Patient charts were reviewed collecting social demographic attributes, diagnosis, type of therapeutic regimen given and treatment outcome. Results: The prevalence of malnutrition was found to be 30% with case fatality rate (CFR) of 8.8%, for the health facilities using WHO regime while 29% CFR for those using traditional regimen. The use of recommend malnutrition screening tests was generally poor. Conclusion: Malnutrition is still a public health problem with high mortality rate in Tanzania which is mainly caused by failure to use the WHO regimen. There is a need to use the available screening methods and recommended regimens to avert this.

Caretaker’s Perceptions on Caretaker-Adolescent Communication on Sexual and Reproductive Health in Unguja-Zanzibar: Implication for Intervention

Caretaker-adolescent communication is an appealing source for influencing adolescents’ knowledge, attitudes and behavior, because caretakers are an accessible and often willing source of information for their children. With the realization of the importance of caretakers in influencing adolescent behaviours, it becomes interesting to explore their perceptions about caretaker-adolescent communication on Sexual and Reproductive Health (SRH). An exploratory qualitative research design was conducted in all six districts of Unguja-Zanzibar. Twelve focus group discussions (FGDs) with caretakers who were purposively selected were conducted. Thematic analysis guided the interpretation of the data. The main themes that were identified are perceived the risk of adolescents;style, time and content of communication;barriers to parent-child communication on SRH;and helping our children pass through adolescence safely. The findings show that participants have acknowledged the apparent risky sexual behaviors of their adolescents, and that information on SRH should be offered to children before they reach puberty. Participants had the opinion that communication on SRH should be in the form of warning, threat and unidirectional. Topics such as teenage pregnancy, STIs and HIV, and drug and alcohol were proposed to be openly discussed. However, topics on condom and contraceptives use faced strong opposition. Lack of favorable time, caretakers’ limited knowledge and skills, myth on SRH communication, and being uncomfortable were among the caretaker-adolescent communication barriers identified by caretakers. The findings suggest that participants are keen to help their adolescents to avoid SRH problems, most importantly they emphasised on the need to empower caretakers by equipping them with knowledge of SRH, good communication skills and religious knowledge. Communal parenting on the other hand has been identified as the major weapon in shaping adolescents’ behaviour. This information provides insight in designing family-based intervention aiming at increasing communication about SRH between caretakers and adolescents.

Caretaker-Adolescent Communication on Sexuality and Reproductive Health: My Perceptions Matter;A Qualitative Study on Adolescents’ Perspectives in Unguja-Zanzibar

This study was conducted to explore the perceptions of adolescents on caretaker-adolescent communication on sexuality. Using an Information-Motivation-Behavioural Skills model, this article highlights areas to emphasise when planning strategies to improve caretaker-adolescent communication on sexuality. Twelve focus group discussions were held with adolescents aged between 15 and 19 years, and data were analysed using content analysis. The participants found it important for caretakers to communicate with adolescents about sexuality to avoid sexual and related health risks. Caretakers were the most preferred communicators, by adolescents, on sexuality matters. It became apparent that information about the use of condoms was the most unpopular topic during the discussions, while information about the use of contraceptives seemed to be more interesting to the majority of the participants. From the adolescents’ point of view, the barriers to communication about sexuality on the caretakers’ side, include, the belief that such information might encourage promiscuity;some caretakers do not find it easy to discuss matters related to sexuality with their children;and others feel that some adolescents know more about sexuality than themselves. On the other hand, barriers on adolescents’ side include, “fear” of the caretakers, some of whom seem harsh, unfriendly, and sometimes unapproachable. Following the findings, it is being suggested that intervention strategies that would help to alleviate communication barriers would consequently facilitate caretaker-adolescent discussions about sexuality and reproductive health.

Pain Management and Factors Associated with Its Severity among Post Surgical Patients Admitted in the Intensive Care Unit at Muhimbili National Hospital, Tanzania

Background: Pain is the common experience among post operative patients admitted to the intensive care unit. Inadequate management can lead to undesired complications which can increase risk for morbidity and mortality. Objective: The aim of this study was to assess pain management and factors associated with its severity among post surgical patients admitted in intensive care unit at MNH. Method: A prospective study was conducted from October 2017 to February 2018 involving a total of 123 post operative patients aged 18 years and above admitted to the surgical and obstetric intensive care units. Structured questionnaires were used to obtain the required perioperative information. Severity of pain was assessed by using the Numerical Rating Scale (NRS). Data was analyzed using SPSS version 23.0. Frequency, percentages, tables and charts were used to summarize the study findings. Bivariate analysis and multivariate logistic regression were done. P-value of Results: The prevalence of severe post operative pain within 24 and 72 hours was 32.1% and 41.5% respectively. Pre operative use of analgesia (OR: 2.66, CI: 1.15 - 6.12, P value = 0.02), abdominal surgery (OR: 4.12 CI: 1.12 - 15.88, P value = 0.03) and thoracic surgeries (OR;7.42, CI: 1.54 - 35.88, P value = 0.01) was significantly associated with severe pain. Age, sex, ASA class, duration of surgery, and level of education did not show significant association with pain severity. Opioids prescribed postoperatively were pethidine (70.7%), morphine (11.4%) and fentanyl (11.4%). Other analgesics used were paracetamol (60.2%) and diclofenac (22%). Conclusion: The magnitude of post operative pain was high. Pre operative uses of analgesia, abdominal and thoracic surgery were the factors associated with severe pain. Pethidine and paracetamol were the most prescribed drugs, however the prescription pattern used was inadequate to control pain.

Investigation of Factors Affecting Preparedness of Reporting Adverse Drug Reactions among Nurses in Public and Private Hospitals in Dar Es Salaam, Tanzania

The current study assessed preparedness among nurses about reporting adverse drug reactions in public and private hospitals. Nurses in hospitals are among health providers very close to patients and are involved in the process of administering medications especially to inpatients. A cross sectional study was conducted among nurses in public and private hospitals in Dar es Salaam city in Tanzania to compare their preparedness on reporting adverse drug reactions (ADRs). A total of 384 nurses were involved in this study, of which 50% were drawn from public hospitals and 50% from private hospitals. Majority of respondents (75.25%) in public and 84.73% in private hospitals said they have not received any training about reporting ADRs. Of the few trained nurses, 85.43% and 96.55%, in public and private hospitals, respectively, said they have been trained in a seminar only once, after they started working as nurses. Respondents in public (19.17%) and private (32.8%) hospitals reported to stock ADRS forms (Yellow cards). Less than 50% of respondents agreed to have access to reference materials such as a text books named “Good Dispensing Practice” and a “List of Registered Medicines”. Further results showed more than two third of all respondents in private (74.25%) and public (73.5%) hospitals reported that lack of training affects the process of reporting ADRs in terms of ability and tendency. In this study we found training, availability of Yellow cards and presence of a focal person are among important contributing factors to preparedness of reporting ADRs among nurses in public and private hospitals.

The impact of out-of-pocket expenditures on missed appointments at HIV r care and treatment centers in Northern Tanzania

Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect expenditures made while accessing HIV care.The objective of this study was to examine the relationship between out-of-pocket(OOP)health expenditures and the likelihood of missing appointments.Method:Totally 618 PLHIV older than 18 years attending two HIV care and treatment centres(CTC)in Northern Tanzania were enrolled in the study.Clinic attendance and clinical characteristics were abstracted from medical records.Information on OOP health expenditures,demographics,and socio-economic factors were self-reported by the participants.We used a hurdle model.The first part of the hurdle model assessed the marginal effect of a one Tanzanian Shillings(TZS)increase in OOP health expenditure on the probability of having a missed appointment and the second part assessed the probability of having missed appointments for those who had missed an appointment over the study period.Results:Among these 618 participants,242(39%)had at least one missed clinic appointment in the past year.OOP expenditure was not significantly associated with the number of missed clinic appointments.The median amount of OOP paid was 5100 TZS per visit,about 7%of the median monthly income.Participants who were separated from their partners(adjusted odds ratio[AOR]=1.83,95%confidence interval[CZ]:1.11-8.03)and those aged above 50 years(AOR=2.85,95%CI:1.01-8.03)were significantly associated with missing an appointment.For those who had at least one missed appointment over the study period,the probability of missing a clinic appointment was significantly associated with seeking care in a public CTC(P=0.49,95%CI:0.88-0.09)and aged between>25-35 years(P=0.90,95%CI:0.11-1.69).Conclusion:Interventions focused on improving compliance to clinic appointments should target public CTCs,PLHIV aged between>25-35 years,above 50 years of age and those who are separated from their partners.

Documentation and Phytochemical Screening of Traditional Beauty Products Used in Missenyi District of Tanzania

Background Information: The concept of beauty and cosmetics is as old as mankind and civilization. Raw materials for beauty products are dominated by petroleum and synthetic products. In recent years, there has been an increase of natural product-based cosmetics along with creating beauty from the inside by consumption of nutraceuticals. Tanzania traditional beauty products are still in use especially rural areas, but the documentation is lacking. Objectives: This work aimed at documenting traditional beauty products in Kagera region as an effort to avoid loss of useful information and available useful traditional findings for safe utilization in beauty products. Meth-odology: Information was obtained from knowledgeable people in Missenyi district by focus group discussion. Collected materials were identified in Botany and Zoology Departments at the University of Dar es Salaam followed by literature search and phytochemical screening. Results: This study afforded to record 13 plants, 4 animal products, mineral and other organic products. Most products are used for skin care (57%) followed by hair care (22%). Literature search supported the use of some of the products and plants subjected to qualitative analysis showed presence of phytochemicals relevant to beautification. Discussion: Some of the recorded plant and animal products are incorporated in natural based cosmetic products. Hazardous practice of using skin lightening plant products and dry cell powders was noted. Conclusion: The use of products which are already incorporated in the cosmetic products especially in countries where these products are well regulated should be promoted. Products reported for the first time require scientific studies to establish their effectiveness and safety. Since this study recorded the use of some dangerous materials, people need to be educated through media.

Pre-Formulation Development of Lamivudine 300 mg and Tenofovir Disoproxil Fumarate (TDF) 300 mg Fixed Dose Combination Tablets

Introduction: In this study, physical and chemical characteristics of Lamivudine, Tenofovir Disoproxil Fumarate (TDF) and potential excipients were systematically followed and documented [1]. Objective: The objective of this scientific work was to carry out pre-formulation studies including compatibility studies on Lamivudine and Tenofovir Disoproxil Fumarate with their potential excipients prior a direct compression process [2]. Methodology: The interaction was studied in three set of environments namely uncontrolled room conditions for Zone VI b (30°C ± 2°C), oven conditions in which the oven was set at 50°C and accelerated climatic conditions in which a climatic chamber was set at 40°C ± 2°C/75% ± 5% Relative Humidity (RH %). Sample preparation was done by mixing the amount of formulation excipients to active substances at a ratio of 1:10, whereas active substance to another active substance at a ratio of 1:1, active substance to coating materials at 1:4, coating materials to the whole set of excipients 1:4. The whole set of samples was geometrically mixed and triturated by mortar and pestle to very fine uniform powder to ensure homogeneity of the mixture. HPLC analytical method was used for simultaneous quantitative determination of lamivudine and tenofovir disoproxil fumarate. Transmittance of the mixture was determined by Near Infra-Red (NIR) technique. Results: The amount of Lamivudine as on day 0 was comparable to day 90 for in all tested conditions (Room, Oven and Climatic Chamber), whereas for Tenofovir Disoproxil Fumarate only the amount of the drug at Room (30°C ± 2°C) was comparable to results on day 90. A significant drop of amount of Tenofovir Disoproxil Fumarate (TDF) exposed to moisture (Climatic chamber at 40°C ± 2°C/75% ± 5% Relative Humidity (RH %)) and temperature of 50°C was observed. Colour change was observed for samples subjected to moisture (Climatic chamber at 40°C ± 2°C/75% ± 5% Relative Humidity (RH %)) and as well picked up in the NIR region 400 to 1500 cm-1 (Finger print region) by a significant shift in Transmittance. Conclusion: It can be concluded that microcrystalline cellulose, cross linked sodium carboxymethyl cellulose, magnesium stearate and sodium carbxymethyl cellulose can be compressed together with Lamivudine and Tenofovir Disoproxil Fumarate (TDF) to produce a pharmaceutically acceptable solid dosage form, tablet. The produced tablets should be packed in moisture and light protective containers as Tenofovir Disoproxil Fumarate (TDF) has diester linkages which can be hydrolysed into the active drug Tenofovir in the presence of moisture.

Assessment of Moisture Permeability and Closure Systems of High Density Polyethylene Plastic Bottles Used as Primary Packaging Containers for Moisture Sensitive Medicines

Introduction: Moisture permeability and a loose closure system might allow a significant gain of moisture into container and this could lead to significant loss of potency of drug sensitive to moisture and as well promoting the growth of microorganisms. Typical examples of the drugs sensitive to moisture include Tenofovir Disoproxil Fumarate (TDF). Product claimed to be a “Tight container” does not make it a tight container until proved practically. A plastic container is tight if “not more than one of the 10 tested containers exceeds 100 mg per day per L in moisture permeability. Objectives: The goal of this study was to determine rate of moisture permeability of selected High Density Polyethylene plastic bottles for packaging of moisture sensitive medicines in particular Lamivudine/Tenofovir Disoproxil fumarate tablets. Methodology: The determination of rate of moisture permeability was achieved by assessing closure systems of plastics as per USP 37 method, while the difference in absorption pattern was achieved by assessing the spectrum obtained through transmittance by Fourier Transform-Infrared (FT-IR). The plastic bottles were randomly selected from supplier A, B and C. Results: The plastic bottles from supplier A and B had an average moisture permeability of 12.57 and 51.55 mg/day/L with none of the containers exceeding moisture permeability of 100 mg/day/L whereas containers from supplier C had an average of 149.95 mg/day/L with seven of the containers exceeding of 100 mg/day/L. Conclusion: Containers from supplier A and B met the USP specifications hence could be used as primary packaging for moisture sensitive medicines whereas the containers from supplier C did not meet the USP specifications for them to be regarded as “Tight Containers” and hence, unsuitable for packaging of moisture sensitive medicines.

Clinical-Pathological Features and Treatment Modalities of Primary Brain Tumors in Tanzania—4 Years of Institutional Experience

Background: The profile of primary brain tumors and treatment modalities employed in Tanzania remains largely unknown. The study aimed to describe the baseline clinical-pathological profile and treatment modalities for primary brain tumors in adults treated at the Ocean Road Cancer Institute (ORCI) from 2017 to 2020. Materials and Methods: This was a retrospective study conducted at ORCI by reviewing 61 medical records of patients with primary brain tumors over the age of 15 from January 2017 to December 2020. A structured questionnaire was used to retrieve information on sociodemographic, clinical-pathological characteristics, and treatment modalities. The 2007 WHO classification system and the International Classification of Cancer Diseases (ICD-0-3) were used for classification and diagnosis. The X2 test and Fisher’s exact test were used to compare the proportions and an independent t-test was used to compare the means. A P-value less than 0.05 was deemed statistically significant. The Results: The mean age of the females was 41.8 years and the mean age of males was 42.9 years. Overall M: F ratio was 1:1.2. Meningioma was the only tumor that was more commonly found in women with M:F of 1:2.1. The most prevalent symptom was headache (57.4%). Glioblastoma (GBM) was the most common tumor among adults (38%), followed by astrocytomas (23%) and meningioma (18%). Approximately 91.8% of all tumors occurred in the supratentorial region. The Frontal lobe was the most common site (29.5%). Approximately 81.9% of patients received surgery. The gross tumor resection (GTR) rate was 26.2%, and the subtotal tumor resection (STR) rate was 55.7%. Roughly 18% of the tumors were inoperable. An estimated 80.3% of respondents received radiation therapy. The radiotherapy technique was 3DCRT in two-thirds of the patients and the rest received conventional 2D radiotherapy. The mean equivalent dose in the 2 Gy fractions (EQD2) was 43.9 Gy. Respondents with low-grade intracranial tumors were treated with a mean EQD2 of 47.3 Gy, while those with high-grade intracranial tumors were treated with a mean EQD2 of 44.3 Gy and the difference was statistically significant. Only half of the patients who received adjuvant radiotherapy received it concurrently with chemotherapy. Temozolomide was the most widely used cytotoxic medication. Conclusion: Mean age of the patients was 41 years old. Most tumors were in the supratentorial area and GBM was the most common tumor. Only meningioma was a bit more common amongst females. Overall, radiotherapy doses and the gross tumor resection rates were low. Concurrent chemotherapy with radiotherapy was given to a few patients.