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On the guidebook list, I highly recommend and have just purchased copies of African Safari Journal (Mark Nolting) for all my traveling companions on our upcoming trip.All rights reserved. Search support or find a product: Search Our apologies No results were found for your search query. Tips To return expected results, you can: Reduce the number of search terms. Each term you use focuses the search further. Check your spelling. A single misspelled or incorrectly typed term can change your result. If so, follow the appropriate link below to find the content you need. Our apologies Search results are not available at this time. Please try again later or use one of the other support options on this page. No results were found for your search query. Tips To return expected results, you can: Reduce the number of search terms. Each term you use focuses the search further. Check your spelling. A single misspelled or incorrectly typed term can change your result. If so, follow the appropriate link below to find the content you need. Some applications such as the software fulfillment systems and IBM License Metric Tool use the new product name. However, the software and its product documentation continue to use the Tivoli Storage Manager product name. CLM includes long-form articles, events listings, publication reviews,A Field Guide to the Larger Mammals of Tanzania covers all the larger mammals of Tanzania, including marine mammals and some newly discovered species. Detailed accounts are provided for more than 135 species, along with color photos, color illustrations of marine mammals, and distribution maps. Accounts for land species give information on identification, subspecies, similar species, ecology, behavior, distribution, conservation status, and where best to see each species. A Field Guide to the Larger Mammals of Tanzania also features plates with side-by-side photographic comparisons of species that are easily confused, as well as first-time-ever species checklists for every national park. The definitive, most up-to-date field guide to the larger mammals of Tanzania, including marine mammals. It features detailed species accounts and numerous color photos throughout. It provides tips on where to see each species. It includes species checklists for every national park. Lara Foley is program manager of the Wildlife Conservation Society's Tarangire Elephant Project. Alex Lobora is senior research officer at the Tanzania Wildlife Research Institute. Daniela De Luca is senior scientist for the Wildlife Conservation Society's conservation programs in the Southern Highlands of Tanzania and Zanzibar. Maurus Msuha is head of wildlife information and education at the Tanzania Wildlife Research Institute. Tim R. B. Davenport is country director for the Wildlife Conservation Society in Tanzania. Sarah Durant is senior research fellow at the Zoological Society of London's Institute of Zoology. About the Five Boroughs Neighborhoods By Borough The Bronx Brooklyn Manhattan Queens Staten Island. Membership. Meeting Planners. Travel Trade. About Us English Back Language. English. Spanish. French. Portuguese. German Email Address By clicking Submit you agree to the Terms and Conditions. It's Official! You're now subscribed to nycgo.com's newsletters. Follow Us All rights reserved. About Us Advertise Terms of Use Privacy Policy Site Map. It is estimated that the incidence of CHD is constant worldwide, but data are rare for most African countries including Tanzania. Even less data are available on the prevalence of acquired heart diseases (AHD) in African children. Rheumatic heart disease (RHD) is the leading cause of AHD and is remaining a public health concern in Sub-Saharan Africa affecting especially the younger population. Both, CHD and AHD contribute substantially to morbidity and mortality during infancy and childhood. Methods This hospital-based, retrospective review of the registry at the paediatric cardiac clinic of Bugando Medical Centre in the Lake Zone of Tanzania analysed the spectrum of heart diseases of paediatric patients during their first presentation by using simple descriptive statistics. Results Between September 2009 and August 2016, a total of 3982 patients received cardiac evaluation including echocardiography studies. 1830 (46.0) pathologic findings were described, out of these 1371 (74.9) patients had CHD, whereas 459 (25.1) presented with AHD. 53.9 of the patients with CHD were female and the most common associated syndrome was Down syndrome in 12.8 of patients. In 807 patients (58.9) diagnosis of CHD was established within the first year of life. The majority of patients (60.1) were in need of surgical or interventional therapy at time of diagnosis and 6.3 of patients were judged inoperable at the time of first presentation. Nearly 50 of cases with AHD were RHDs followed by dilated cardiomyopathy and pulmonary hypertension without underlying CHD. Conclusions The spectrum of CHD and AHD from one centre in Tanzania is comparable to findings reported in other countries from the African continent. Echocardiography is a valuable diagnostic tool and the widespread use of it should be enhanced to diagnose heart diseases in a large number and reasonable time. Most patients present late and majority is in need of surgical or interventional treatment, which is still not readily available. Untreated heart diseases contribute substantially to morbidity and mortality during infancy and childhood. Adequate cardiac services should be established and strengthened. Methods This hospital-based, retrospective study was conducted at the Bugando Medical Centre (BMC), Mwanza, Tanzania. BMC is one of four referral hospitals of mainland Tanzania serving for a population of approximately 14 million. The paediatric cardiac echocardiography clinic at BMC is performed twice per week, being the only clinic of its kind in the Lake Zone of Tanzania. Patient data are recorded into a registration book and contain age, gender, type and severity of the heart disease as well as extracardiac malformations like Down syndrome (DS). Furthermore, a conclusion concerning the need for an intervention, e.g. surgery, is documented at the time of presentation. Children below 16?years of age who presented to the clinic for the first time and were diagnosed with an abnormal echocardiography study were included into the review. Cardiac consultation and echocardiography were performed by a paediatric cardiologist and by well-trained and supervised paediatricians (AZ, NM, TM). Echocardiography including two-dimensional-, colour-, pulse wave- and continuous wave-imaging was performed using two portable echocardiography machines, Sonosite M-Turbo and GE Loqic i. The leading lesion was recorded in cases of more than one cardiac lesion. The data were entered into Excel and then analysed by using simple descriptive statistics. Quality control was ensured through visiting international cardiologists during cardiac missions and through intraoperative findings and diagnostic cardiac catheterizations done outside the country. Results Between September 2009 and August 2016, a total of 3982 children underwent cardiac evaluation and echocardiographic examination at the paediatric cardiac clinic of BMC. In 1830 cases (46.0) pathologic findings were described. Out of these, 1371 (74.9) patients had CHD, and 459 (25.1) presented with AHD. Congenital heart diseases 53.9 of the patients with CHD were female and 19.3 of all cardiac patients presented with associated syndromes or extracardiac malformations. The most common associated syndrome was DS in 12.8 of the patients. Leading cardiac lesion was ventricular septal defect (VSD) in 358 patients (26.1) followed by patent ductus arteriosus (PDA) in 318 patients (23.2), which included also 51 premature infants admitted to the neonatal department of BMC. Most common cyanotic heart disease diagnosed at our clinic was Tetralogy of Fallot (ToF) in 10.1 of cases. The distribution and frequencies of CHD are shown in Table 1.Approximately 40 of the children with VSD as the leading CHD were diagnosed within the first 6?months of life, whereas children with ToF as the most common cyanotic CHD were usually diagnosed later in life, only one third being diagnosed within the first year of life. The overall age distribution at diagnosis and age distribution for VSD, PDA (excluding the PDA in premature infants) and ToF are presented in graph 1: age distribution for VSD, PDA, ToF and overall. At time of diagnosis approximately 60 of patients were judged to be in need of surgical or interventional treatment. Another 96 patients (7.0) were in need of diagnostic catheterization to assess eligibility for surgery. The largest sub-groups of patients for diagnostic catheterization were children diagnosed with AVSD (42 cases) beyond the first year of life followed by ToF with pulmonary atresia (16 cases), VSD (16 cases) and complex cyanotic heart diseases (8 cases). In 41 patients (3.0) signs of severe pulmonary arterial hypertension (PAH) were present at time of diagnosis. The largest group of patients with severe PAH were those with Truncus arteriosus communis diagnosed beyond the first year of life (18 cases), followed by VSD (7 cases) diagnosed beyond 15?months of life and AVSD (6 cases) diagnosed at the age between 5 and 11?years of life. The remaining patients who presented with severe PAH were diagnosed with AP-window, TAPVR (total anomalous pulmonary venous return), PDA, DORV (double outlet right ventricle) and TGA with large VSD. The distribution of cases with respect to need of further diagnostic assessment or treatment is shown in Table 2.All 7 patients were already pre-treated with different antibiotic regimes before referral to our centre and therefore, blood cultures taken on admission at BMC didn’t reveal the growth of any organism. Nearly every fifth patient (19.3) with congenital heart disease showed extracardiac malformations with DS being the leading associated syndrome. The distribution is depicted in Table 3. Table 4 is presenting the distribution and frequencies of AHD.Out of 3982 patients who underwent cardiac evaluation and echocardiographic examination during the study period of 7?years 1830 (46) presented with pathologic findings. Majority of patients (74.9) were diagnosed with CHD. Children with ToF do not present with heart failure, but with progressing signs of chronic cyanosis (e.g. finger clubbing) and frequent squatting. This is also supported by our findings of diagnosis specific age distribution among children with VSD, PDA and ToF. Approximately 60 of children born with VSD or PDA were diagnosed within the first year of life, whereas the majority of children suffering from ToF seen in our centre (65.9) was diagnosed beyond the first year of life. Interestingly, the frequency of AVSD (10.5) in our study was higher than in any other African study. Echocardiography is a valuable diagnostic tool as it is non-invasive and cost-effective. The widespread use of it should be enhanced with more paediatricians being trained in this technique, especially in settings with low resources. In a first step paediatricians trained and supervised by paediatric cardiologists to perform echocardiography in the rural areas with mobile echocardiography equipment has to be the goal to diagnose CHDs and AHDs in a large number and in a reasonable time. Limitations of the study: This study is a single centre, hospital based review and not a community based study. Therefore, the study does not provide information on the prevalence of heart diseases in the general paediatric population of Tanzania. Furthermore, it is a retrospective review of the echocardiography registry, which contains some incomplete data or missing information. Diagnostic tools like cardiac catheterization or cardiac CT scan were not available in Tanzania during the time of the study period so that cardiac diagnoses were mainly based on echocardiographic findings. Long-term outcome of the patients is incomplete as a substantial number of patients were lost to follow-up. Conclusion The spectrum of congenital and acquired heart diseases presenting to the paediatric cardiac echocardiography clinic of BMC is corresponding well to the findings reported in other countries from the African continent. The majority of children with heart disease presenting to our clinic is in need of surgical or interventional treatment, which is not readily available. Furthermore, diagnosis is often delayed and as a consequence a significant number of patients show severe complications and an advanced stage of the heart disease on initial diagnosis. Untreated heart diseases contribute substantially to morbidity and mortality during infancy and childhood. Adequate local cardiac services should be established and strengthened. Echocardiography is a valuable diagnostic tool as it is non-invasive and cost-effective. The widespread use of it should be enhanced with more paediatricians being trained in this technique, especially in settings with low resources. Children diagnosed with CHD should be carefully examined for extracardiac malformations due to the significant association between CHD and extracardiac malformations. All children with DS should routinely receive a cardiac examination because of the high association of CHD. A further study would be needed to determine the prevalence of CHD in children with DS in Tanzania. RHDs are certainly underreported as most patients were diagnosed with advanced findings and no cases of subclinical RHD were detected. Further population based prevalence studies are required to determine the real burden of this disease and to guide preventive programmes. Birth prevalence of congenital heart disease worldwide.The global burden of paediatric heart disease.Prevalence and patterns of congenital heart diseases in Africa: a systematic review and meta-analysis protocol. BMJ Open. 2017;7:e015633. PubMed Heart diseases and echocardiography in rural Tanzania: occurrence, characteristics, and etiologies of underappreciated cardiac pathologies. PLoS One. 2018;13(12):e0208931. PubMed Group a Streptococcus, Acute Rheumatic fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations. Curr Treat Options Cardiovasc Med. 2017;19:15. Article Spectrum of heart diseases in children: an echocardiographic study of 1,666 subjects in a pediatric hospital, Yaounde, Cameroon.The Challenge of Congenital Heart Disease Worldwide: Epidemiologic and demographic facts.Prevalence and Spectrum of congenital heart diseases in children.BMC Res Notes. 2013;6:53. PubMed Fetal heart disease: severity, associated anomalies and parental decision.Spectrum of congenital heart disease in children with Down syndrome in Ile-Ife, Nigeria.