Background Surgical acute abdomen is a sudden onset of severe abdominal symptoms (pain, vomiting, constipation etc.) indicative of a possible life-threatening intra-abdominal pathology, with most cases requiring immediate surgical intervention. Most studies from developing countries have focused on complications related to delayed diagnosis of specific abdominal problems like intestinal obstruction or acute appendicitis and only a few studies have assessed factors related to the delay in patients with acute abdomen. This study focused on the time from the onset of a surgical acute abdomen to presentation to determine factors that led to delayed reporting among these patients at the Muhimbili National Hospital (MNH) and aimed to close the knowledge gap on the incidence, presentation, etiology, and death rates for acute abdomen in Tanzania. Methods We conducted a descriptive cross-sectional study at MNH, Tanzania. Patients with a clinical diagnosis of the surgical acute abdomen were consecutively enrolled in the study over a period of 6 months and data on the onset of symptoms, time of presentation to the hospital, and events during the illness were collected. Results Age was significantly associated with delayed hospital presentation, with older groups presenting later than younger ones. Informal education and being uneducated were factors contributing to delayed presentation, while educated groups presented early, albeit the difference was statistically insignificant (p = 0.121). Patients working in the government sector had the lowest percentage of delayed presentation compared to those in the private sector and self-employed individuals, however, the difference was statistically insignificant. Family and cohabiting individuals showed late presentation (p = 0.03). Deficiencies in health care staff on duty, unfamiliarity with the medical facilities, and low experience in dealing with emergency cases were associated with the factors for delayed surgical care among patients. Delays in the presentation to the hospital increased mortality and morbidity, especially among patients who needed emergency surgical care. Conclusion Delayed reporting for surgical care among patients with surgical acute abdomen in underdeveloped countries like Tanzania is often not due to a single reason. The causes are distributed across several levels including the patient’s age and family, deficiency in medical staff on duty and lack of experience in dealing with emergency cases, educational level, working sectors, socioeconomic and sociocultural status of the country.

Introduction. The demand for haemodialysis among patients with end stage renal disease (ESRD) is rising worldwide, arteriovenous fistulas (AVF) are considered the gold standard vascular access modality for hemodialysis (HD) because of its longer patency, enhanced durability, and reduced risk of infection for those that mature compared to grafts and central venous catheters. This study will therefore assess the factors associated with arteriovenous fistula maturation for patients requiring hemodialysis in Dar es Salaam. Methods A multi-centre based prospective study conducted among patients with ESRD between April 2021 to May 2022 at Muhimbili National Hospital (MNH), Jakaya Kikwete Cardiac Institute (JKCI), Comprehensive Community Based Rehabilitation in Tanzania (CCBRT),Kairuki hospital (KH) in Dar es Salaam. Patients with End stage renal disease eligible for arteriovenous fistula (AVF) creation and Hemodialysis were included. Socio-demographic data were extracted from the patients, intraoperative and postoperative variables were obtained from medical records. Patients were assessed through eight weeks for maturation and complications. Data analyzed accordingly by IBM-SPSS version 27.0, Univariate and multivariate analysis were used to stratify the factors and control the confounders for the effects on outcome, and p-value of <5% was used to state the level of significance at 95% CI. Results. Total of 151 fistulas were created, most (80.8%) were created on male, (31.8%) in the age group of less than 50 Years old, 58.9% of the participants had normal Body Mass Index (BMI), with majority (45%) being suffered from Hypertension and 54% of them were using Antihypertensive medication. Brachial cephalic fistulas were the most common type of fistula created 77(51%) and most matured 67(52.7%) among ESRD patients who had AVF creation, while radial cephalic fistulas were the most failed created AVFs 13 (54%). The AVF maturation failure rate was 16%. Conculusion. Failure of newly created AVF is a major barrier to the successful establishment of hemodialysis access, in this study the failure rate of AVF maturation was 16 percent. The major factors associated with failure to mature were; extreme age group (50-59), being suffered with both hypertension and diabetes, long period of alcohol taking and distal location of AVF( radiocephalic fistula).Vascular imaging was not regularly done to assess the status of veins and arteries for AVF creation.