Establishment of an interdisciplinary vascular anomalies program in Tanzania, East Africa

• Type of Material: Article
• Authors: Daniel Puhr-Westerheide, Ludwig Maximilian University of Munich; Max Masthoff, University Hospital Muenster; Jay Shah, Emory University; Alina Krechel, Ludwig Maximilian University of Munich; Mwivano Shemwetta, Muhimbili University of Health and Allied Sciences; Azza A. Naif, Muhimbili National Hospital; Ofonime N. Ukweh, Muhimbili University of Health and Allied Sciences; Ziad Abdul, Muhimbili University of Health and Allied Sciences; Abizer Sarkar, Muhimbili University of Health and Allied Sciences; Balowa Musa Baraka, Muhimbili University of Health and Allied Sciences; Furaha Malecela, Muhimbili University of Health and Allied Sciences; Praygod Justin Lekasio, Muhimbili University of Health and Allied Sciences; Latifa Rajab, Muhimbili University of Health and Allied Sciences; Abbas Mungia, Muhimbili National Hospital; William Sianga, Muhimbili National Hospital; Karim P. Manji, Muhimbili University of Health and Allied Sciences; Eric M. Mbuguje, Muhimbili National Hospital; Sarah Khoncarly, University of Michigan; Frank J. Minja, Emory University; Fabian M. Laage Gaupp, Yale New Haven Hospital; Moritz Wildgruber, Ludwig Maximilian University of Munich
• Language: English
• Date: 2023-01-10
• Publisher: FRONTIERS MEDIA SA
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Puhr-Westerheide, Masthoff, Shah, Krechel, Shemwetta, Naif, Ukweh, Abdul, Sarkar, Baraka, Malecela, Lekasio, Rajab, Mungia, Sianga, Manji, Mbuguje, Khoncarly, Minja, Laage Gaupp and Wildgruber.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3389/fmed.2022.1056539
• Title of Journal or Parent Work: FRONTIERS IN MEDICINE
• Volume: 9
• Start Page: 1056539
• End Page: 1056539
• Grant/Funding Information: This work was supported by RSNA Derek Harwood-Nash Grant, Doximity Foundation, and Road2IR Foundation.
• Keywords: Life Sciences & Biomedicine; health services needs and demand; DIAGNOSIS; radiology; Medicine, General & Internal; General & Internal Medicine; MALFORMATIONS; pediatrics; Science & Technology; developing countries; interventional; Tanzania; vascular malformations; education
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management

Abstract

Purpose: The aim of this project is the sustainable implementation of a vascular anomalies (VA) program in Tanzania. Materials and methods: In 2021 the first interdisciplinary VA program was initiated at Muhimbili National Hospital (MNH), Dar Es Salaam, Tanzania in a stepwise approach. During the planning phase the clinical need for minimally-invasive therapies of VAs and the preexisting structures were assessed by the local Interventional Radiology (IR) team at MNH. During the initiation phase, an IR team from two German VA centers joined the interdisciplinary team at MNH for clinical workup, image-guided procedures and follow-up. VA patients were recruited from existing patient records or seen at clinics as de novo presentations following nationwide advertisement. In the post-processing phase joined online conferences for follow-up and support in management of new patients were established. Further follow-up was supported by attending providers from other established VA centers, traveling to bolster the primary operators of MNH. Results: The first interdisciplinary VA program was successfully launched in Tanzania. Minimally-invasive treatments were successfully trained, by performing ultrasound-guided sclerotherapy with polidocanol and bleomycin in twelve patients with slow-flow malformations, one endovascular embolization of a high-flow malformation, and medical treatment of an aggressive infantile hemangioma. Regular online follow-up presentations have been initiated. Follow-up evaluation and required treatment was sustained when appropriate. Conclusion: The presented “hands-on” training set the ground for the first interdisciplinary VA program in Tanzania. This framework is expected to establish comprehensive and sustainable care of patients with VAs in East Africa and can serve as a blueprint for other sites.