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Kidney Disease

World Kidney Day 2018

Kidney disease: What you need to know

By Dr. Mohamed, H. M

“Dar es Salaam – Sali International Hospital (SIH) continues to express optimism in meeting the healthcare needs of the Tanzanian people. The Masaki based hospital operates in a private healthcare and keen to support and advise Tanzanian people on health issues.”


According to statistics by World Health Organization, it is known that kidney (Renal) disease affects over 500 million people worldwide with prevalence of around 14% in Sub-Saharan Africa. The risk of developing kidney disease is as high in women as in men. The kidneys are important because they filter blood, remove extra fluid/wastes from blood, control body's chemical balance, help control blood pressure, help keep bones healthy and help make red blood cells.


What can happen if one has kidney disease? There can be reduction of the normal functioning of the kidneys leading to rise in serum creatinine and/or fall in urine output. Can be acute or chronic. In acute kidney injury, there is sudden and rapid loss of kidney function within hours or days. Having risk factors, increases chances of kidney failure.


What causes acute injury or failure? Some causes include; reduced blood supply to kidneys, damage caused by drugs/medicines, toxins/chemicals, severe systemic infection, physical injury and, blockage or reduction of urine passage.


What symptoms? Generally, early disease may not have symptoms. Symptoms may include reduction/no passage of urine, feeling tired, and shortness of breath, chest tightness, confusion, seizures, drowsiness, reduced appetite, nausea, abdominal / flank pain, dry itchy skin, and muscle cramping at night and, swelling of feet, ankles and around eyes.


Risk factors include; Diabetes mellitus (high blood sugar), Advancing age, Hypertension (high blood pressure), High blood cholesterol, Family history of heart or kidney disease, Smoking cigarettes, Autoimmune diseases like lupus, Excessive use of alcohol, Being overweight/obesity, Having sedentary lifestyle (lack of exercise) and, African-American and other ethnic minorities have higher risk.


What must be done? Know the risk factors/causes, reduce your risks, early detection and management can protect the kidneys. Some may require dialysis (using machine to remove toxins/ wastes from blood) and/or renal transplant when in advanced disease.


Reduce your risks now. What to do? Physical activity at least 30 mins/day for at least 5 days/week of brisk walking/or aerobics, avoid using over the counter pills like antibiotics, analgesic (diclofenac, ibuprofen) etc, stop smoking, stop/ reduce alcohol consumption, adequately control blood sugar and blood pressure, maintain healthy weight. Eating healthy foods low in fats/oils, less salt, reduce consumption of red meats and, maintain healthy fluid intake daily.


For more information on a Kidney Disease, visit Sali International Hospital or call us at 0222601276/0222601296/0222601283.


“Your Health is Important to us”


Pictures Courtesy of Sali international Hospital 







 What to Expect in a C-Section.

Let's start by defining a C-section. A vaginal delivery occurs when the baby is delivered through the vagina by natural means. In a C-section the baby does not go through the birth canal, but rather is pulled out through an incision made in the mother's abdomen and uterus. Unlike a Vaginal delivery,a C-section involves a surgical procedure and is performed in an operating room under sterile conditions.

In the United States, approximately one in four babies is delivered by C-section, according to the American College of Obstetricians and Gynecologists. In developing countries maternal and fetal morbidities are found due to lack of caesarian delivery.

When to Perform a C-Section
It's important to note that, in most cases, doctors will opt for a vaginal delivery over a C-section. The reason is that a vaginal delivery is almost always considered to be safer for the mother and baby unless extreme health conditions warrant otherwise. C-sections may be scheduled in advance if certain conditions are present and both the mother and doctor agree that it is necessary.

Often, however, C-sections are performed in emergency circumstances because conditions indicate that the mother or baby is at risk for a potential problem. If the mother's or baby's health is at risk, then a c-section might become the immediate alternative for saving lives. So, you may go into the delivery room anticipating a "normal" delivery and suddenly find that you're going to have a C-section. It's impossible to tell when this will occur, but your doctor will explain why you need to go through C-section.

 Fortunately, with the advent of antibiotics and improvements in surgical techniques, it is a relatively normal procedure that is performed routinely and successfully every day around the world.

Preference of anesthesia is a subject many have less knowledge, Spinal anesthesia is preferred generally in obstetrics so the mother will have numbness from her navel downwards, and the anesthetic drug does not go to the baby’s circulation. Due to improved Anesthesia this procedure is very safe and some people believe that it is even safer than vaginal delivery. In countries like Brazil more than 60% go this procedure for safety measures and also for their sexuality. The muscles of vagina are not cut and therefore these women can still continue enjoying their intercourse. In normal delivery usually pelvic floor muscles are cut by a procedure called episiotomy and therefore sensitivity of the perineum is interfered with and many women do suffer. This is a bit exaggerated but it is true

General anesthesia is used in anxious mothers and emergency caesarian sections where mother is having other maternal complications.

How many caesarean can a woman have
They used to say ' once a caesarean always a Caesarean'   and also once they have had three caesareans a woman should be sterilized. These two jargons are no longer true. It is still possible for a woman to deliver vaginally under good observation provided the reason for the first caesarean was not due to pelvic contraction. Also provided an elective caesarean procedure is 
performed before labour  starts one can have as many as 10. Dr Sali has had  a  patient who he carried out the  8th caesarean procedure. Provided labour has not started, and with good Hospital proximity and communication women should be encouraged to complete their families without being threatened by we obstetricians


After theater the recovery area patient is taken back to the ward and kept 8 to 10 hours flat on the bed without a pillow for the spinal anesthesia patient. (Patient is instructed not to lift her head) This will prevent the spinal headache which everyone is talking about. The spinal needle is very small nowadays, so there is not so much CSF leak, and post-operative complaints are very minimal.

After 8 hours the patient is asked to sit on the bad, because it is common to feel dizzy, have some black tea with sugar.  Then after wards can have some soft food for the first day. Then slowly the mother is asked to stand up and walk, she can be encouraged to go to the toilet  urinate on her own after the catheter is removed, she can clean herself and normally we use water proof band aid the normal routine things becomes easy.

In normal situations the obstetrician does not touch the bowels, so there is no necessary to wait for flatus to pass. Early ambulation makes the recovery quicker and it minimizes the hospital stay to maximum of two nights.

Wound care

Actually in many settings the incision is cosmetic and minimal handling will give you a good scar, so nowadays there is no suture removal, the skin is done by absorbable sutures. The Band-Aid will be removed on the 6th or 7thday.

After that the mother has no worries, can wash and shower etc, It is very important for abdominal support, so there are post caesarian abdominal support belts in the market, can help to keep the belly fat away.( many women complain about a belly fat after caesarian section, with abdominal support the mother gets her body back to normal .She can even get back to her normal exercises after 6 weeks.

Home care

Don't forget to make a follow-up appointment with the OB who delivered your baby. Make the appointment within four to six weeks after the delivery (that means you'll have to always make an appointment at discharge from the hospital). If you have any questions regarding your recovery, however, always call your doctor ASAP.

In conclusion, as we have seen from above, C-Section delivery needs team work, the medical team as well as the family support. At Sali international hospital we have modern facility with appropriatepersonal to do the procedure and help you through the recovery period.

Dr.Vindhya Pathirana -OBGY.  








Antibiotic Resistance


If you get an infection today – even a serious one that lands you in a hospital bed – you probably feel confident you will be prescribed some medicine that will cure you. Antibiotics are those medicines used to treat infections caused by germs, called bacteria. They are used to treat infections such as urinary tract infections, skin infections and infected wounds.

Antibiotics have saved millions of lives since they were first introduced in the 1940s. However, because they have been overused/ misused, bacteria have developed RESISTANCE to many of them, that is, they are no longer effective against the bacteria they once killed or inhibited from reproducing.


It is inevitable that any medicine will lose its ability to kill bacteria over time since bacteria naturally, through genetic adaptation, become resistant to antibiotics. We are however speeding up this process by our bad medicine use habits such as:

·      Self-Medication:  This is when medicine is used to treat self-recognized symptoms without consulting a doctor. This can cause bacteria to continue multiplying irrespective of presence of the medicine because the medicine taken may be unnecessary, inadequate, or used in incorrect doses.

·      Non-compliance with recommended treatments: This occurs when one forgets to take medication, prematurely discontinues the medication as they begin to feel better, or cannot afford a full course of therapy.

·     Inappropriate use of antibiotics by doctors: Sometimes doctors, because they lack all the necessary information to make an accurate diagnosis, may prescribe an antibiotic that is not specific to the infection being treated. When that antibiotic is taken, susceptible bacteria are killed, and the resistant bacteria are left to grow and multiply.


Do not take an antibiotic when it is not prescribed for you by your doctor. Antibiotics do not treat viral infection like a cold or the flu.

Do not save some of your antibiotic for the next time you get sick. Return any leftover medication to the pharmacy once you have completed your prescribed course of treatment.

Take an antibiotic exactly as your doctor or pharmacist tells you. Do not skip doses. Complete the prescribed course of treatment even if you are feeling better. If the concern is about the cost, ask your doctor to recommend a cheaper equally effective alternative.

Do not take antibiotics prescribed for someone else. They may not be appropriate for your illness.

If your doctor determines that you do not have a bacterial infection, ask about ways to help relieve your symptoms. Do not pressure them to prescribe an antibiotic.

 Jacquellyn Ssanyu — Pharmacist





















































































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