Birthweight and neonatal outcome at the Muhimbili Medical Centre, Dar es Salaam, Tanzania.

A prospective study of neonatal morbidity and mortality was made over four months in 1990 at the neonatal unit in Muhimbili Medical Centre. The incidence of low birthweight (LBW) was 16%. Seven hundred and eighty four LBW infants and 612 heavier infants admitted for care in the unit were followed up for six weeks. The mean birth weight was 2854 grams. LBW carried a seven-fold increased risk of mortality (291/784;37%); this was 64% (291/341) of the total. The risk of morbidity in LBW infants was increased three-fold (436/784;56%) being 73% (436/598) of the total. Factors significantly associated with increased morbidity and mortality were prematurity, birth asphyxia, sepsis, respiratory distress syndrome, hypothermia and hypoglycaemia. The majority of the deaths (83%) occurred within the first week of life.

Measurement of transepidermal water loss in Tanzanian cot-nursed neonates and its relation to postnatal weight loss.

In healthy cot-nursed Tanzanian neonates (n = 92, gestation 26-42 weeks) measurements of trans-epidermal water loss (TEWL) and weight change were performed during the first 24 h after birth at an average ambient humidity of 70% and an environmental temperature of 32 degrees C. Urine production on day 1 (ml/kg per 24 h) was documented for a subgroup of 13 preterm and 8 term infants. In a limited group of preterm infants (n = 5) TEWL measurements, weight and 24 h urine volume measurements were repeated daily for 7 days. Maximum weight loss was determined in 7 preterm (gestational age 30-36 weeks) and 6 term infants. TEWL was estimated by measuring the evaporation rate at three sites of the body using the water vapour pressure gradient method. On day 1, TEWL was highest in the most preterm infants, whereas TEWL and urine production were higher in large for gestational age infants as compared to appropriate for gestational age (AGA) infants of the same gestational age (31-36 weeks). For the whole group, weight loss on day 1 was correlated with TEWL (r = 0.49, p < 0.05). At follow-up TEWL in preterm infants remained almost constant during the first 4 days and decreased after the fourth day, at which time weight gain commenced. Preterm AGA infants (gestational age 24-37 weeks) showed a mean postnatal weight loss of 4.4% of the birth weight, while in term infants this loss was only 2.6%. A reduced postnatal weight loss as compared to Caucasian infants may be explained by a lower water loss during the first days after birth, through both skin evaporation and urine excretion.

The conjoined twins of Shinyanga, Tanzania: case report.

The first recorded set of conjoined twins in Tanzania was successfully separated on the 10th of February 1994 at the Muhimbili Medical Centre (MMC) in Dar es Salaam. The male omphalopagus twins were born to a 22-year-old para 1 gravida 2 mother by normal vaginal delivery at a Rural Health Centre in Shinyanga Region two months earlier, and had been transferred to the National Referral Hospital at the age of two weeks. At the age of about four months, the first twin died following multiple complications which necessitated several re-operations, while the second twin is still thriving and has been discharged to his home village since May 1994. This paper describes and discusses the medical, surgical and anaesthetic aspects of the management of these historic twins, and emphasizes the importance of teamwork in the evaluation, separation and care of such babies for a successful outcome. A brief review of the literature is also included, with special reference to the African experience.

Free amino acid levels of mother and child immediately after delivery in Dar es Salaam, Tanzania.

The pattern of the free serum amino acids was analysed in 20 healthy mothers immediately after delivery and from their term appropriate for gestational age infants in cord blood. The free amino concentrations were higher in Tanzanian women, when compared to Swedish standards, whereas slightly higher or similar values were found in cord blood, resulting in a marked reduction of the fetal/maternal ratio for the individual amino acids. It is suggested that under 'basal nutritional conditions' the reduced placental gradient could be one of the compensatory mechanisms to facilitate an adequate supply of amino acids to the human fetus. The validity of the glycine/valine index to recognize early protein malnutrition in pregnant women and their offspring or in small for dates is disputed.