The effect of reproductive, hormonal, nutritional and lifestyle on breast cancer risk among black Tanzanian women: A case control study.

PURPOSE: This study aimed to determine the effect of reproductive, hormonal, lifestyle and nutritional factors on breast cancer development among Tanzanian black women. METHODOLOGY: We undertook a case-control study age-matched to ±5years in 2018 at Muhimbili National Hospital. The study recruited 105 BC patients and 190 controls giving it 80% power to detect an odds ratio of ≥2 at the alpha error of <5% for exposure with a prevalence of 30% in the control group with 95% confidence. Controls were recruited from in patients being treated for non-cancer related conditions. Information regarding hormonal, reproductive, nutritional and lifestyle risk for breast cancer and demography was collected by interviews using a predefined data set. Conditional multinomial logistic regression used to determine the adjusted odds ratio for variables that had significant p-value in the binomial logistic regression model with 5% allowed error at 95% confidence interval. RESULTS: The study recruited 105 cases and 190 controls. Only old age at menopause had a significant risk, a 2.6 fold increase. Adolescent obesity, family history of breast cancer, cigarette smoking and alcohol intake had increased odds for breast cancer but failed to reach significant levels. The rural residency had 61% reduced odds for developing breast cancer though it failed to reach significant levels. CONCLUSION: Older age at menopause is a significant risk factor for the development of breast cancer among Tanzanian women. This study has shed light on the potential role of modifiable risk factors for breast cancer which need to be studied further for appropriate preventive strategies in similar settings.

Supervision and support in surgical practice using mobile platform: a case of mass hydrocele surgeries in remote regions.

BACKGROUND: Globally, nearly 19 million people with Lymphatic filariasis (LF) who require surgery have not been attended. To reach them needs the scaling up and expansion of surgical services. In Tanzania, hydrocele is more prevalent in the coastal belt, where surgical workforce is also scarce. Thus, scaling up hydrocele surgery services would require the use of non-physician clinicians (NPCs) that are currently based there by offering procedure specific training. With new technique of partial sac excision, constant support and mentorship would be required. We therefore sought to test if use of mobile platform would be an adjunct to supervision and support to practicing non surgeon clinicians in Tanzania. METHODS: This was a prospective cohort study done in Mtwara and Lindi regions during the period of 2014-2015. Training model followed the West African Morbidity Management protocol for hydrocele followed by practical sessions in the operating room in each locality. Subsequently, patients were screened and discussed by sharing pictures on WhatsApp created to link the hydrocele teams and the two consultant surgeons. Patients with simple hydrocele not to require scrotoplasty and with non-coexistent of hernia were recruited. Data collected included: number of cases performed, time spent per procedure, hematoma formation and adherence to local anesthesia. Descriptive statistics was used to summarize the findings. RESULTS: Fifteen NPCs were successfully trained and mentored throughout the study period and were subsequently able to perform 1,337 hydrocelectomies in 1,250 patients with 387 having bilateral hydrocele. The use of local anesthesia was successful in nearly all the patients and case selection was appropriate as can be seen with only 7/1,250 requiring additional procedures other than hydrocelectomy. The mean procedure duration was 50.2±0.24 minutes and complications rates were low at 2.16%. CONCLUSIONS: Mobile platform with instant photo and video sharing capacity can be a reliable tool in offering support and supervision in surgical service provision.