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5;1 INFORMED CONSENT TO PARTICIPATE IN THE RESEARCH

Introduction

Aim of this study is to determine the profile of carcinoma of esophagus in our society.Carcinoma of oesophagus can be defined as Cancer of……?. The participation is freely and voluntarily. If you decide not to participate in the research it will not affect the access to the health services at any health facility in the United Republic of Tanzania including MNH.

Benefits

There are no direct benefits a participant gets in this research but you will be appreciated as one of contributors in findings about the facts on profile of the esophageal cancer in Muhimbili National Hospital and University teaching hospital.

Risks

The participants will not get any serious risks from this research since the rigid/flexible oesophagoscopy procedure will be performed in standard procedure followed by biopsy taking then standard histopathological procedure work at Central Pathology Laboratory.

Confidentiality

The information obtained from this research will be confidential and will only be used for improvement of our national health policy management on carcinoma of esophagus and knowledge to health personnel’s.

I will be glad to receive your consent in the participation for this research.

DR MALEKO, Andrew Simon

Signature ……………………………………………………….. Investigator

Communication

For any query concerning this research, please do not hastate to contact

DR MALEKO, Andrew Simon The principal investigator, Muhimbili University of Health and Allied Sciences (MUHAS). P.O Box 65013. Mobile +255 718440156

If you have queries concerning your rights as a participant in the research, please contact:

Prof. E.F Lyamuya, MD, MMed, PhD, The Director of research and publications

Muhimbili University of Health and Allied Sciences (MUHAS). P.O Box 65001 Dar es salaam. Tel.2151489.

I will be grateful if you will agree to participate in this study.

I………………………………………………………………………… (Participant)

I have read and understood the information provide to me as it is written also my questions have been properly answered by the investigator. I personally without any coercion I agree to participate in this research.

Name of Participant ………………………………………..Tel.…………………. Signature……………………………………………… (Participant) Date…………………………

RIDHAA YA KUSHIRIKI KATIKA UTAFITI

Utangulizi

Lengo la utafiti huu ni kujua hali halisi ya tatizo la saratani ya koo la chakula. Ushiriki katika utafiti huu ni hiari. Iwapo utahiari kutoshiriki utafiti, haitaadhiri huduma upatazo katika kituo/hospitali yoyote katika Jamhuri ya Muungano wa Tanzania ikiwemo MNH.

Faida

Hakuna faida ya moja kwa moja utakayopata kutokana na kushiriki katika utafiti huu bali utadhaminiwa kama mojawapo wa watu waliochangia kupatikana kwa taarifa juu ya ukweli kuhusu hali halisi na kwa kiasi gani juu ya tatizo la saratani ya koo la chakula katika jamii yetu

Madhara

Washiriki hawatapata madhara yoyote makubwa kutokana na utafiti huu kwa kuwa tendo la kufanyiwa kipimo cha kuchunguza njia ya koo la chakula kitafanywa na pia kutolewa kinyama kwa ajili ya uchunguzi katika maabara kuu ya pasolojia. Kipimbo hiki hata kama hutashiriki kwenye utafiti huu inabidi ufanyiwe pia. Madhara madogo ni kama maumivu madogo yanaweza kukupata ambayo hupozwa kwa kutumia dawa za kuondoa maumivu,

Usiri

Taarifa zote zipatikanazo kutokana na utafiti huu zitatunzwa kwa usiri mkubwa na zitatumikuboresha utoaji wa huduma na utungwaji wa sera za kuboresha matibabu ya saratani ya koo la chakula Tanzania.

Nitashukuru kupata ridhaa yako ya kushiriki utafiti huu.

DR MALEKO, Andrew Simon

Sahihi ……………………………………………Mtafiti

25

Mawasiliano

Kwa maswali yoyote yahusuyo utafiti, tafadhali usisite kuwasiliana na mtafiti DR MALEKO,Andrew Simon simu ya mkononi +255 718440156 Chuo Kikuu cha Afya na Sayansi za Tiba(MUHAS) SLP 65013. Iwapo una swali juu ya haki yako kama mshiriki katika utafiti wasiliana na:

Prof. E.F Lyamuya, Mkurugenzi wa machapisho na utafiti, S.L.P 65001 Dar es salaam. Simu .2151489.

Mimi …………………………………………………………………………. (Mshiriki)

Nimesoma na kuelewa habari zilizotolewa kwangu kama zilivyoandikwa na pia nimejibiwa maswali yangu kwa usahihi na mtafiti. Mimi bila kushawishiwa nimekubali kushiriki utafiti huu.

Jina la Mshiriki ………………………………………………SIMU……………………

Sahihi………………………………………………….(Mshiriki) Tarehe…………………………………

Appendices 2

Data Collection Tool S/No………………..

1.0.0 Introduction

Hospital registration number --------------------------------------------------------

Patient age -------------------------Sex -----------------------------

Patient level of education ------------------------------------------------------------------

Patient occupation -----------------------------------------------------------------

Patient residence ----------------------------------------------------------------

2.0.0 Clinical Presentation

Dysphagia yes/no

Weight loss yes/no

yes/no

Anaemia yes/no HB -----------------------------

Others ---------------------------------------------------------------------------------

3.0.0 Associated risks factors

Cigarettes smoking

Yes…… How long……………

Quantity/day ………..

NO………..

Alcohol taking

Yes……. How long……………

Ouatity/units/day……….

No………..

4.0.0 Rigid/Flexible oesophagoscopy findings

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

6.0.0 Histopathology diagnosis

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