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- ItemAbortion statistics in Zambia: ‘implications for unsafe abortion, reproductive health programming, policy and research approaches’.(Zambia medical journal, 2010) Likwa, Ndonyo, Rosemary; Biddlecom, Ann; Ball, HaleyZambia has a liberal abortion law for termination of pregnancy on medical and social grounds for over three decades. Yet, it still faces serious consequences of increased morbidity and mortality associated with unsafe abortion. The extent of its national incidence remains unknown. There are substantial differences evident between legal abortions and illegal (unsafe) abortions demonstrating gaps in under reporting of abortion incidence which may require further estimation. Compiling Zambian abortion statistics as “research in brief” was essentially needed to provide direction to national abortion incidence measurements in Zambia, more strengthening of reproductive health services, possible review of policies and seek opportunities for further research approaches for understanding the magnitude of abortion problem and the means to prevent unsafe abortion occurrences. Thus contributing to reduction in abortion related morbidity and mortality in the country. An explorative descriptive survey was carried out in five (5) major hospitals to collect abortion statistics using a checklist tool for record review by the principal investigator with the assistance of five Ministry of Health professionals designated in these hospitals. Analysis employed aggregation compilation of annual abortion statistics collected from three (3) major tertiary hospitals and two (2) general hospitals for a period of nine years, 2000-2008 in five urban districts of four (4) provinces of Zambia. Analysis further involved application of descriptive statistics and significant tests, trend analysis and incidence rates A total number of 115886 abortions collected from five major hospitals in four provinces of Zambia over a period of nine (9) years, 2000-2008, show a varied distribution of 616 (0.5 %) for safe induced abortion, legally terminated pregnancy cases and 66687 (57.5%) abortion admissions with complications. Out of this figure, 474885 cases received post abortion care involving manual vacuum aspiration procedure (MVA) translating to over 70 percent of abortion complications had MVAs which reflect the extent of unsafe abortion exposure to Zambian women. Abortion morbidity and consequences of mortality are high and increasing in trend giving six per thousand women die of abortion complications, most likely due to unsafe, induced abortion. Access to safe induced abortion in major hospitals is quite low, yet Zambia has a liberal law for a termination of pregnancy on health and social grounds. IMPICATIONS: Abortion statistics show their relevancy for developing research priorities, policy review, reproductive health services to intensify abortion advocacy on its consequences, access to safe abortion care and contraception to prevent unwanted pregnancy. KEY WORD (S): Abortion statistics/ unsafe abortion/ abortion complications/ mortality/ post abortion care/ legal abortion/law/Zambia
- ItemAbortion statistics in Zambia: ‘implications for unsafe abortion, reproductive health programming, policy and research approcahes’.(Zambia medical journal, 2010) Likwa, Ndonyo, RosemaryZambia has a liberal abortion law for termination of pregnancy on medical and social grounds for over three decades. Yet, it still faces serious consequences of increased morbidity and mortality associated with unsafe abortion. The extent of its national incidence remains unknown. There are substantial differences evident between legal abortions and illegal (unsafe) abortions demonstrating gaps in under reporting of abortion incidence which may require further estimation. Compiling Zambian abortion statistics as “research in brief” was essentially needed to provide direction to national abortion incidence measurements in Zambia, more strengthening of reproductive health services, possible review of policies and seek opportunities for further research approaches for understanding the magnitude of abortion problem and the means to prevent unsafe abortion occurrences. Thus contributing to reduction in abortion related morbidity and mortality in the country. An explorative descriptive survey was carried out in five (5) major hospitals to collect abortion statistics using a checklist tool for record review by the principal investigator with the assistance of five Ministry of Health professionals designated in these hospitals. Analysis employed aggregation compilation of annual abortion statistics collected from three (3) major tertiary hospitals and two (2) general hospitals for a period of nine years, 2000-2008 in five urban districts of four (4) provinces of Zambia. Analysis further involved application of descriptive statistics and significant tests, trend analysis and incidence rates A total number of 115886 abortions collected from five major hospitals in four provinces of Zambia over a period of nine (9) years, 2000-2008, show a varied distribution of 616 (0.5 %) for safe induced abortion, legally terminated pregnancy cases and 66687 (57.5%) abortion admissions with complications. Out of this figure, 474885 cases received post abortion care involving manual vacuum aspiration procedure (MVA) translating to over 70 percent of abortion complications had MVAs which reflect the extent of unsafe abortion exposure to Zambian women. Abortion morbidity and consequences of mortality are high and increasing in trend giving six per thousand women die of abortion complications, most likely due to unsafe, induced abortion. Access to safe induced abortion in major hospitals is quite low, yet Zambia has a liberal law for a termination of pregnancy on health and social grounds. IMPICATIONS: Abortion statistics show their relevancy for developing research priorities, policy review, reproductive health services to intensify abortion advocacy on its consequences, access to safe abortion care and contraception to prevent unwanted pregnancy. KEY WORD (S): Abortion statistics/ unsafe abortion/ abortion complications/ mortality/ post abortion care/ legal abortion/law/Zambia
- ItemAcceptability and implementation experiences of the “test and treat” antiretroviral therapy policy guideline among patients and healthcare workers in Lusaka district of Zambia.(The University of Zambia, 2019) Mulinda, Mweemba BThe World Health Organization stated that there is now sufficient proof that earlier use of antiretroviral therapy results in better clinical outcomes for people living with human immunodeficiency virus compared with delayed treatment and thus recommended immediate antiretroviral therapy initiation irrespective of the stage of the disease or Cluster of Differentiation 4+ count for adults, adolescents and children. The new antiretroviral therapy policy is dubbed “Test and Treat” whose implementation started in October 2016 in Lusaka District of Zambia by the Ministry of health and cooperating partners. Test and Treat has since been rolled out to other districts. This is all to further accelerate efforts to meet the ambitious Fast-Track target for 2020, including achieving major reductions in the number of people dying from HIV-related causes. The main purpose of the study was to explore acceptability and implementation experiences of “Test and Treat” as a new antiretroviral therapy policy guideline among healthcare workers and patients in Lusaka District. The study further sought to investigate the health system’s capacity to support the policy in Lusaka District. This was a qualitative study that used exploratory case study. The research was undertaken in five Anti-retroviral therapy healthcare centres in Lusaka District, between July 2017 and May 2018. Five focus group discussions were conducted with individuals who were human immuno-deficiency virus positive and were on anti-retroviral therapy. Five In-depth interviews were held with at least two Psychosocial Counselors at each centre and twenty five key informant interviews with healthcare professionals involved in implementing the program. All interviews were audio-recorded and were conducted within the healthcare facility. From the information recorded in each discussion, major themes and sub-themes were identified which were linked to direct quotes from the respondents. Interviews were transcribed and accuracy was checked. Software called Nvivo 10 was used to analyze data and for easy information management. The findings of the study revealed that, there was high acceptability of “Test and Treat” among the patients and healthcare workers. They observed that the implementation of this policy has resulted in; improved health outcomes, no advancement to acquired immune-deficiency syndrome stage, higher productivity at work places and reduced hospital visits among the patients who were receiving treatment. The study however observed that; difficult disclosure; cultural implications; ethical implications; lack of initial physiological baseline parameters such as CD4 Count and Liver function test results and stigmatization and discrimination were major hindrances to acceptability and smooth implementation of the policy. “Test and Treat” was viewed to have relative advantage over other previous HIV/AIDS intervention strategies as it has been observed to be largely compatible with other health systems operations available in most healthcare facilities. It has been tried elsewhere with positive results according to literature reviewed as such there is no much complexities reported. Observed outcomes of clinical trials done so far reveal programme simplicity leading to high acceptability and smooth implementation.
- ItemAssessment of Level of Knowledge of Management of Acne vulgaris among Community Pharmacists and Prescribers in Lusaka Urban(Asian Online Journals, 2015-12) Prashar, Lavina; Kachipond, Fredrick; Nagalamika, OwenAcne is a common skin condition affecting almost 85% of the population. Everyone has the risk of developing acne at certain stages of life. The management of acne in early stages is important for disease prognosis. Patients with acne usually present at community pharmacies and clinics during the early stages of their disease. Assessment of knowledge and practice of community pharmacists and prescribers in treating these patients is required. The aim of this study was to assess the levels of knowledge in acne management among community pharmacists and prescribers in Lusaka urban. The study was designed as a cross-sectional survey and was conducted on 89 community pharmacists and prescribers working in Lusaka, Zambia. Participants were asked to answer a self administered questionnaire on the management of acne vulgaris that comprised questions evaluating the knowledge on disease causes, aggravating or relieving factors, treatment practices and use of reference materials. The study revealed that Pharmacists and prescribers had inadequate levels of knowledge on disease management; 21% had low levels of knowledge where as only 6% had high levels of knowledge. By category, 36% of the prescribers had low levels and 10% had high levels of knowledge. 8% of the pharmacists had low levels of knowledge and only 2% had high levels. Lack of knowledge was reflected in their treatment practices, 62.9% never classified acne when initiating treatment and less than a quarter managed acne cases independently. This study showed no association of levels of knowledge to referral of patients with severe acne (p>0.05). It was concluded from the study that pharmacists and prescribers have inadequate knowledge and practice for management of acne. Steps should be taken to update and improve their dermatological knowledge.
- ItemA Comparative Study for the Efficacy and Tolerability of Fluvoxamine and Venlafaxine in patients with Obsessive Compulsive Disorder(RA Publications, 2015-09-20) Prashar, Lavina; Paul, RaviTo compare the efficacy and tolerability of Fluvoxamine and Venlafaxine in patients with Obsessive Compulsive Disorder (OCD). A total of 50 newly diagnosed patients with OCD were randomly assigned 25 each to receive either fluvoxamine (Selective serotonin reuptake inhibitor) or venlafaxine (selective serotonin norepinephrine reuptake inhibitor). Primary efficacy was assessed by the change from baseline on the Yale Brown Obsessive Compulsive Scale (Y-BOCS). The Clinical Global Impression Improvement Scale (CGI-S) was used to measure symptom improvement. Each patient was followed as a single visit in a week wise manner following the order; Week0, Week 1, Week 2, Week 4, Week 6, Week 8, Week 12 and Week 16. At each visit if any adverse reaction to either of the drugs experienced by the patient were noted. Treatment group comparison of patients, demographic characteristics and baseline severity measurements were done using a Chi square test and the student t-test. Statistical significance was defined as a 2-sided p value ≤ 0.05. Both drugs showed significant reduction in the OCD symptoms as measured on the Y-BOC Scale over the 16-week follow up. When compared fluvoxamine showed statistically significant reduction in overall YBOC score and Obsessive mean score. The difference in compulsive mean score was not significant in the two treatment groups. Fluvoxamine is more efficacious than Venlafaxine in the treatment of OCD.
- ItemConfirmation by necropsy of a high prevalence of porcine cysticercosis in a rural district of Madagascar.(The University of Zambia, 2023) Mananjara, Diana Edithe Andria; Rakotoarinoro, Mihajamanana; Rakotoarison, Valisoa. C.; Raliniaina, Modestine; Razafindraibe, Nivohanitra P.; Ravonirina, Claudia; Randriamparany, Tantely; Rasamoelina-Andriamanivo, Harentsoaniaina; Rakotozandrindrainy, Raphaël; Cardinale, Eric; Lightowlers, Marshall. W.; Donadeu, Meritxell; Mwape, Kabemba E.Neurocysticercosis is recognized as an important health issue in the Malagasy population. To date, investigations into prevalence of infection with the causative agent, Taenia solium, in the parasite's natural animal intermediate hosts, have relied on serological methods which have been found to be non-specific. We determined the prevalence of porcine cysticercosis among pigs from a contiguous area of the Betafo and Mandoto administrative districts, Vakinankaratra Region, Madagascar. One hundred and four slaughter-weight pigs were examined by detailed necropsy examination including slicing of the heart, tongue, masseter muscles, diaphragm and carcase musculature. Thirty-seven animals (35.6%) were found infected with T. solium, representing one of the highest rates of infection ever reported, worldwide. These findings highlight the importance of T. solium in Madagascar and support the need for increased efforts to prevent the parasite's transmission to reduce its burden on the health of the Malagasy population. Keywords cysticercosis Madagascar necropsy pig prevalence Taenia solium
- ItemThe Effect of Kigelia africana Fruit Extract on Blood Glucose in Diabetes Induced Mice(RA Publications, 2015-09-20) Prashar, Lavina; Muyenga, Tumelo; Bwalya, Angela Gono; Muungo, L.T.MTo determine the effect Kigelia africana fruit extract has on blood glucose levels of diabetes mice and its phytochemical profile Mice were induced with diabetes using Alloxan monohydrate 90mg/kg. Blood glucose was checked before induction and 72 hours after induction to confirm diabetes. Treatment involved using oral administration of Kigelia fruit extract 1000mg/kg, Kigelia fruit extract 500mg/kg, Glibenclamide 0.25 mg/kg, Kigelia fruit extract 500mg/kg and Glibenclamide 0.25mg/kg and Normal Saline.The results showed a greater reduction in blood glucose of mice after treatment with Kigelia extract 1000mg/kg compared to Kigelia 500mg/kg [(5.3 +/- 0.5mmol/l) vs (6.3+/- 0.6mmol/l), (p= 0.005)]. Further, Glibenclamide 0.25mg/kg showed less reduction in blood glucose than Kigelia 1000mg/kg [(7.4+/-0.9mmol/l) vs (5.3 +/- 0.5), (p= 0.00)]. The mean blood glucose levels were lower in mice that received Kigelia extract than those that received both Kigelia extract and Glibenclamide [(5.3 +/- 0.5mmol/l) vs (7.8 +/- 0.6 mmol/l), (p=0.00)]. The fruit extract tested positive for Tannins, Saponins, Flavanoids, Alkaloids, Glycosides and Steroids. Findings of this study indicate that Kigelia africana fruit extract causes reduction in blood glucose of diabetes induced mice and gives better results when used alone than in concomitant use with Glibenclamide. The study also indicates that the fruit extract has alkaloids, saponins, steroids, glycosides, tannins and flavonoids. To determine the effect Kigelia africana fruit extract has on blood glucose levels of diabetes mice and its phytochemical profile Mice were induced with diabetes using Alloxan monohydrate 90mg/kg. Blood glucose was checked before induction and 72 hours after induction to confirm diabetes. Treatment involved using oral administration of Kigelia fruit extract 1000mg/kg, Kigelia fruit extract 500mg/kg, Glibenclamide 0.25 mg/kg, Kigelia fruit extract 500mg/kg and Glibenclamide 0.25mg/kg and Normal Saline. The results showed a greater reduction in blood glucose of mice after treatment with Kigelia extract 1000mg/kg compared to Kigelia 500mg/kg [(5.3 +/- 0.5mmol/l) vs (6.3+/- 0.6mmol/l), (p= 0.005)]. Further, Glibenclamide 0.25mg/kg showed less reduction in blood glucose than Kigelia 1000mg/kg [(7.4+/-0.9mmol/l) vs (5.3 +/- 0.5), (p= 0.00)]. The mean blood glucose levels were lower in mice that received Kigelia extract than those that received both Kigelia extract and Glibenclamide [(5.3 +/- 0.5mmol/l) vs (7.8 +/- 0.6 mmol/l), (p=0.00)]. The fruit extract tested positive for Tannins, Saponins, Flavanoids, Alkaloids, Glycosides and Steroids. Findings of this study indicate that Kigelia africana fruit extract causes reduction in blood glucose of diabetes induced mice and gives better results when used alone than in concomitant use with Glibenclamide. The study also indicates that the fruit extract has alkaloids, saponins, steroids, glycosides, tannins and flavonoids
- ItemEvaluation of quality of antenatal care services in selected healthcare centres of Mumbwa and Lusaka districts of Zambia: pregnant women’s perspectives(International Journal of Nursing and Midwifery, 2019-05) Mukwato, Patricia Katowa; Mwiinga, Kalusopa Victoria; Emmanuel, Musenge; Banda, Yolan; Muleya, Mutinta Crecious; Maimbolwa, Margaret CAntenatal care (ANC) has been recommended as a service that can reduce both maternal and newborn mortalities. However, even in areas recording high ANC attendance, there are unevenly high levels of maternal and new born mortalities. Evidence of a weak relationship between ANC use and maternal and newborn survival has motivated recent calls to focus on content and quality of care provided rather than mere ANC attendance. This was a descriptive cross sectional study which was designed to evaluate the quality of antenatal care services in two health facilities in Lusaka and two in Mumbwa districts of Zambia. The health facilities were selected purposively based on poor maternal outcomes such as high maternal mortality ratio. Women attending antenatal clinics were selected using simple random sampling. Data was collected using a client exist interview schedule designed by World Health Organization for assessing quality of antenatal care. Data was analyzed using Statistical Package for Social Scientist (SPSS) version 24.0. The study revealed a lot of variations in the care provided at the four sites. None of the women had all the blood tests for haemoglobin, grouping and X-match, HIV and syphilis conducted from three out of the four health facilities, while at the fourth, only 30% of women had all the blood tests conducted. Furthermore, less than 20% of women had a full head to toe examination. While less than 10% of women from each of the facility reported that the health providers met the requirements for provision of privacy. Despite not meeting the minimum standards of care, only less than 5% of women categorized the care as poor. All the four health facilities recorded low quality of care on all domains of antenatal care. Therefore, if antenatal care has to achieve its intended purpose of reducing adverse maternal and new born outcomes, then quality of care delivered during pregnancy should be the focus as opposed mere attendance. Key words:Quality, antenatal care services, evaluation.
- ItemExperiences, needs and coping strategies of pregnant and parenting teenagers: A perspective from Lusaka and North Western Provinces of Zambia(Journal of Research in Nursing and Midwifery, 2017-12) Mukwato, Patricia Katowa; Maimbolwa, Margaret.C.; Mwape, Lonia; Muleya, Mutinta CreciousPregnant and parenting teenagers have needs that are unique to the developmental stages of adolescence in addition to the needs common to all pregnant women. The study investigated the experiences, needs and coping strategies of pregnant and parenting teenagers. The study utilized a phenomenological approach, where in-depth interviews with pregnant and parenting teenagers were conducted to get an insight into their experiences, needs and coping strategies. Participants were purposively selected. A sample size was 27 participants which was determined using data saturation principle. Three themes emerged on the experiences of teenage pregnancy and parenting including, abandonment and rejection, loss of parental support and burden of being pregnant or being a parent, while three broad needs were identified; information about HIV status, physical materials for the unborn or new born baby and mother, and the desire to go back to school for those who fall pregnant while schooling. Both adaptive and maladaptive strategies were identified as a means for coping including, avoidance of negativity, support from parents, relatives and partner, repentance and dependence on God, focusing on own and the child’s future, and denial of pregnancy or motherhood. It was concluded that pregnant and parenting teenagers undergo diverse negative experiences, while negotiating the transition from teenage hood to adulthood and motherhood amidst unmet teenage and pregnancy related needs. As a means to cope with the negativity and live within circumstances of unmet teenage and motherhood needs, coping strategies are required. Keywords: Experiences, Needs, Coping Strategies, Teenage Pregnancy, Parenting.
- ItemExtraction and Demonstration of Uterotonic Activity from the Root of Steganotaenia araliacea Hochst.(Zambian Medical Association, 2017-09-14) Prashar, Lavina; Goma, Fastone; Ezeala, Christian; Nyirenda, James; Chuba, David; Simfukwe, Newton; Lengwe, ChilufyaThe root of Steganotaenia araliacea is used for assisting labour in folk medicine. Recent reports indicate that the root could possess uterotonic substances.The study aimed to evaluate three methods for the extraction of uterotonic principles from the root of S. araliacea growing in Zambia. Roots of the plant were collected from Chongwe District of Zambia. The air-dried roots were size-reduced, and the powdered material extracted with hot ethanol, hot distilled water, and cold distilled water. The solvent extracts were concentrated and dried at 110 0C. Solutions of the hot aqueous and cold aqueous extracts were prepared in distilled water and used for organ bath experiments to demonstrate uterotonic activities using strips of pregnant rat uterus. The frequencies and amplitude of contractile forces were recorded. The amplitudes were plotted against log concentration of extract with GraphPad Prism software, and the EC50 values determined. The percentage yields were 31.3 % for the hot aqueous extract, 8.15 % for the ethanolic extract, and 3.27 % for the cold aqueous extract. The cold aqueous extract showed higher potency (EC50 of 0.54 mg/ml) compared to the hot aqueous extract (EC50 of 2.09 mg/ml). Root extracts of S. araliacea possess demonstrable uterotonic effects. Extraction of the roots for this purpose could benefit from preliminary defatting with organic solvents, followed by successive extraction with hot and cold water.
- ItemFactors associated with obstetric fistula repair failures at St. Francis and Monze mission hospitals, Zambia, 2010—2016; a retrospective facility based cohort.(The University of Zambia, 2019) Kapaya, FredObstetric fistula causes significant maternal morbidity especially in sub-Saharan African. In Zambia the prevalence is about 0.53%. Despite a number of women receiving corrective surgery for fistula at a number of hospitals in Zambia, there is paucity of data on the quality of care. This study was conducted to determine the overall proportion of fistula repair failures and identify factors associated with failure in Eastern and Southern Provinces, Zambia. This was a retrospective cohort study using data extracted from hospital records of obstetric fistula repairs between January 2010 to December 2016 at St. Francis and Monze Mission Hospitals which are among the four major fistula repair hospitals in Zambia. All women who underwent repair for obstetric fistula between 2010 and 2016 were included while non obstetric fistulas and lack of dye test results at discharge were excluded from the study. The outcome of interest was failure of fistula repair at hospital discharge confirmed by a dye test. Descriptive statistics were calculated and STATA version 13 used to conduct multivariable logistic regression to determine factors associated with failure of fistula repair. A total of 453 obstetric fistula repairs were included in the analysis. Of these, 56 (12.4%) had failure of fistula repair at hospital discharge. The median age at fistula development was 23 years; at fistula repair was 27 years; and years with fistula was 1 (IQR: 0–5). In multivariable logistic regression, factors associated with increased odds of failure included having a fistula with urethral involvement (55.4 % versus 14.1%; AOR=6.0, 95% CI: 2.83—12.97; vaginal scarring (46.4% versus 18.6%; AOR=2.5, 95% CI: 1.17—5.35 ;) and experiencing post- operative complications (48.2% versus 2.3%; AOR=22.9, 95%CI: 9.33—55.97). Women with vaginal scarring, urethral involvement and post-operative complications, had greater odds of repair failure. It is therefore recommended that quality of post-operative care be improved and caution be paid to the repair of women who present with urethral damage, vaginal scarring and post-operative complications. The evidence generated would help the Ministry of Health to restructure and improve fistula care programs in Zambia.
- ItemGenetic analysis of resistance to cercospora arachidicola hori ingroundnut (arachis hypogaea l.) using simple sequence repeat markers(Journal of Social Research & Policy, 2017) Prashar, Lavina
- ItemIncreasing early infant male circumcision uptake in Zambia: like father like son.(The University of Zambia, 2023) Weiss, Stephen M.; Rodriguez, Violeta J.; Cook, Ryan R.; Bowa, Kasonde; Zulu, Robert; Mweemba, Oliver; Kamboyi, Royd; Castro, Jose; Orrego, Victoria; Maria, Dunleavy; Maria, Dunleavy L; Alcaide, Deborah L. JonesVoluntary Medical Male Circumcision (VMMC) is an effective strategy for HIV prevention in areas with high prevalence of, and risk for, HIV. More than 361,000 male neonates are born each year in Zambia, many of whom could be eligible for Early-Infant Medical Circumcision (EIMC). Building on successful implementation strategies utilized in our Spear & Shield program, this pilot study, “Like Father, Like Son” (LFLS), evaluated the feasibility and acceptability of offering combined EIMC and VMMC services and couple-level behavioral interventions. A total of N = 702 pregnant women and their male partners (n = 351 couples) were recruited and enrolled. Couples were assessed twice pre-birth, 2 weeks post birth, and 6 months post birth. Expectant mothers were an average of 15.05 weeks pregnant (SD = 8.83). Thirty-nine pregnancies did not result in a live birth (11%), 14 couples withdrew from the study or were lost to follow-up prior to delivery (4%), and 148 babies were born female (42%), leaving 150 couples with a male infant in the analytic sample (43%). The LFLS study achieved significantly higher EIMC rates (35%) in comparison with previously observed EIMC study rates in Zambia (11%), and significantly higher than hypothetical comparison rates up to 30%. Relative to baseline rates, odds of VMMC among couples’ older sons increased by 31% at post-intervention and by 90% at two-weeks following birth. Overall, this pilot study found the LFLS intervention to be feasible, acceptable, and effective in doubling the rate of EIMC in comparison with a previous longitudinal study in Zambia. Future research should consider a family-centric approach to promotion of male circumcision for infants and adolescents. LFLS may be effective in promoting father-son “bonding” by MC status; a bond that may be a bridge to increase both EIMC and VMMC uptake in newborns and couples’ older sons and is a novel leverage point for promotion of this HIV prevention strategy.
- ItemIndigenous Knowledge Systems for the Treatment of Hypertension in Lusaka, Zambia: Perceptions, Knowledge and Practice.(Zambian Medical Association, 2016-01) Prashar, Lavina; Goma, Fastone; Kalungia, Chichony Aubrey; Bwalya, Angela Gono; Hamachila, Audrey; Mutati, Ronald Kampamba; Zingani, Ellah; Mwila, Chiluba; Musoke, PamelaIndigenous knowledge systems and traditional technologies have made and can continue to make a significant contribution to modern medicines with discovery of novel molecules in the treatment of various conditions. The traditional knowledge in our communities is passed on from generation to generation. Scientific evaluation of these compounds from traditional medicines can lead to discovery drugs with better efficacy and novel mechanism. The study aimed at determining the indigenous knowledge based preparations used for hypertension in Lusaka, Zambia. The specific objectives were: a). To determine the knowledge and practice of Traditional Health Practitioners in the management of HTN, b). To identify the parts of the plants utilized in the preparation of the IKS-based preparation used in the management of hypertension. c). To determine the procedure employed in preparing the IKS-based preparations used in the management of hypertension. d). To recommend for further elucidation of the possible active compounds in the indigenous based preparations and postulate possible pharmacological mechanisms of actions. The study adopted structured interviews complemented by non-participatory observations. Samples used by traditional healers were collected for identification and characterization A total of twelve (12) traditional healers registered with Traditional Health Practitioners of Zambia who manage hypertension were interviewed. The traditional healers interviewed had knowledge of causes of hypertension, only three (3) indicated bewitchment as one of the causes. spiritual method constituted an important method of diagnosis. The beliefs of Traditional Healers with regard to hypertension indicates their alignment to agreeing the scientific understanding of hypertension in terms of its causes, risk factors and complications. Traditional Healers in Zambia believe hypertension can be managed by some mode of action of the herbs. Common themes that emerged to determine the effectiveness of the herbs used included; patient feedback, physical appearance, confirmation at local clinic and increased urine output. Majority (5/12) felt that there herbs take atleast 7-14 before the effects are seen. All the traditional healers indicated using atleast two (2) types of herbal preparations to manage hypertension. Of the preparations mentioned three (3) were not of plant origin. These include; crocodile fat, pebble and honey. This study observed that the traditional healers of Zambia knowledge of causes and complications of hypertension are alligned to the scientific knowledge. Divination is however still the most important (50%) method used for diagnosis and witchcraft/ spiritual method forms an important method for some for diagnosis of hypertension. It is noteworthy that traditional healers in Zambia believe hypertension can be managed by some mode of action of the herbs a belief shared by the conventional management.
- ItemOpuntia stricta cladode Extract reduces blood glucose levels in Alloxan-induced diabetic mice.(Scientific and Academic Publishing, 2018-07) Prashar, Lavina; Kalungia, Chichony Aubrey; Mataka, Mary; Kaonga, Patrick; Bwalya, Angela Gono; Munkombwe, DerrickOpuntia stricta (commonly called prickly pear cactus) is a natural plant that grows in some parts of Zambia where its fruits and cladodes are commonly consumed for nutritional and medicinal purposes, including glycaemic control among some patients with diabetes mellitus (DM). There is insufficient evidence whether Opuntia stricta indigenously growing in Zambia possess antidiabetic effects.To assess in vivo antidiabetic effects of the aqueous extract of Opuntia stricta cladodes in alloxan-induced diabetic mice. A laboratory-based experimental study was conducted involving 20 adult Swiss albino mice (Mus musculus) weighing 18-30 g. DM was induced using a single intraperitoneal dose of alloxan monohydrate 90 mg/kg. Opuntia stricta aqueous extract was administered orally and blood glucose levels (in mmol/L) monitored daily for 10 days. Alloxan induced a 4- to 5-fold sustained increase in blood glucose levels at 72 hours after administration in mice. Within a 10-day experimental period, Opuntia stricta cladode aqueous extract (1 mg/kg) significantly reduced blood glucose levels in vivo (from 16.6 ± 1.4 mmol/L, 95% CI: 14.9-18.3 at baseline to 7.5 ± 1.0 mmol/L, 95% CI: 6.2-8.9 at endpoint, p < 0.001, n = 5). Similarly, at a dose of 2 mg/kg, the extract significantly reduced blood glucose levels (from 18.7 ± 4.6 mmol/L, 95% CI: 13.0-24.4 at baseline to 6.9 ± 1.7 mmol/L, 95% CI: 4.7-9.0 at endpoint, p = 0.001, n = 5). Opuntia stricta cladode aqueous extract attained a greater reduction in blood glucose levels compared to Glibenclamide 0.25 mg/kg. Opuntia stricta cladode aqueous extract demonstrated a presence of alkaloids, flavonoids, saponins, sterols, carbohydrates, phenols and tannins. Opuntia stricta cladode from Zambia demonstrates antidiabetic effects to reduce blood glucose levels in vivo.
- ItemPerceptions and barriers on the feasibility of decentralizing the collection of blood samples for testing in the community through the community art group model in Lusaka, Zambia.(The University of Zambia, 2019) Siwingwa, MpanjiThe focus of Community ART Group (CAG) model is on drug refill, adherence and support groups. The laboratory services are completely neglected in implementing this model in Zambia, and stable patients still have to go to the clinic for blood draws after collection of drugs from the community. In addition, phlebotomy delivery system is congested and has challenges with shortage of staff, insufficient funding, shortages of supplies and delivery services. The purpose of this study was to identify the perceptions, barriers and potential resources in decentralizing the collection of blood samples for routine testing into the CAG model. A qualitative case study design was used. Data was collected through ten Focused group discussions among CAG members, community and health care workers at ART clinics and in-depth interviews with five key informants. Data was analyzed using thematic method and this was done with the help of Nvivo version 10. Positive perceptions were identified as those which contributed to decongesting phlebotomy rooms, reduced missing appointments for blood draws, work Load, and lost results. Improved quality of phlebotomy service delivery and testing coverage, innovative way of bringing lab services closer to the people and inspire patients to monitor each other’s blood draws. The negative perceptions were compromised sample integrity and less contact with clinicians. The study also identified barriers to decentralize phlebotomy services within CAG and these included: long distance and transportation costs, inadequate community sensitization, lack of skills from the community to draw quality samples for testing, lack of privacy and confidentiality, CHWs not recognized by regulatory bodies, low level of literacy, shortage of qualified health workers and lack of remunerations. In summing up, the clinical psychosocial counsellors, volunteers, CHWs and HCWs were identified by all stake holders as prospective community phlebotomist in the decentralization of phlebotomy services. Decentralizing phlebotomy services into CAG model was perceived as decongesting and reducing work in the phlebotomy room, improved testing coverage and compromised sample integrity. This process incurred challenges due to lack of community sensitization and technical skills in phlebotomy, transportation cost and community health workers not recognition by regulatory bodies. The potential resources needed in community phlebotomy services were identifying prospective phlebotomist, materials for community sensitization, trainers and training materials, experts in quality assurance programs and financial support.
- ItemPhysiological response of uterine muscle to Steganoteania araliacea in rat models(RA Publications, 2015-01) Prashar, Lavina; Lukubi, Lwindi; Goma, Fastone; Mushabati, Festus; Choongo, KennedyThe bark root of Steganotaenia araliacea Hochst (Umbelliferae) nicknamed “herbal pitocin” is used in the traditional circles in Zambia to induce and/or enhance labour. This work was aimed at investigating the contractile stimulatory effects of the aqueous extracts of Steganotaenia araliacea (SAEª) on isolated smooth muscle preparations of the rat uterus. Objectives: To determine the physiological effect of SAEª on isolated pregnant and non-pregnant uterine muscle. Methods: A gravid/non-gravid rat was sacrificed by cervical dislocation (decapitation) method and the abdomen opened to expose the internal organs. The two uterine horns were identified, dissected out and transferred to a dish containing De Jalon’s physiological solution. Acetylcholine (Ach) and Oxytocin (OT) were used as reference agonist with their corresponding antagonists; atropine (AT), and indomethacin and salbutamol (SBM) respectively. The effect of these reference agonists with their corresponding antagonist and that of aqueous extract of SAE on non-pregnant rat uterus pre-treated with 1 mg/kg stilboesterol for 24 h and on the pregnant rat uterus were investigated. Results: In vitro studies of SAEª on uterine tissue showed contractile (uterotonic) activity on both isolated gravid and estrogenized non-gravid rat uterus at the concentration shown in this study. SAE ª significantly increased the amplitude(from baseline value of 0.1471mN to 0.3003mN) and frequency of spontaneous uterine contractions. However, SBM significantly inhibited (p < 0.05) the frequency and amplitude of spontaneous uterine contractions on the isolated pregnant and non – pregnant rat uterus preparations but atropine and indomethacin could not modify the contractions produced by SAEª, hence indicating a non-muscarinic and non-prostaglandin biosynthesis dependant respectively. Conclusion: The inhibition of contractile effect of the crude aqueous extract of SAEª shown by Salbutamol (p < 0.05) suggests the probable stimulation of the Oxytocinergic receptors of the uterus by the extract. These physiological finding justify the traditional use of the plant for its uterotonic properties.
- ItemA Preliminary Study of Knowledge, Attitude and Practice of Adverse Drug Reaction Reporting in a Teaching Hospital in Lusaka, Zambia(Zambian Medical Association, 2014-12) Prashar, Lavina; Musoke, PamelaObjectives of the Study: The study was aimed at examining ADR reporting practices and barriers among medical doctors, pharmacists, nurses, clinical officers, and medical residents at the University Teaching Hospital, Lusaka, Zambia. The specific objectives were: a) to assess the knowledge of ADR reporting among health professionals, b) to assess attitudes of health professionals towards ADR reporting, and c) to assess the practice of ADR reporting among health professionals. Materials and Methods: The study adopted a questionnaire-based cross-sectional method. One hundred and forty questionnaires were administered to health professionals working at the University Teaching Hospital, Lusaka. Statistical Analysis Used: The Statistical Package for the Social Sciences (SPSS) version 20 was used to run various descriptive statistics and to draw charts. Pearson's Chi-square test was used to observe the association of knowledge and attitude with experience and position, at significance level of 0.05. Results: One hundred and twenty-eight questionnaires were successfully filled in and returned, giving a response rate of 91.4%. Knowledge of ADR reporting among the professionals was extremely very low. Only one respondent obtained 50% of the total scores, i.e. 19 marks out of 34 marks; and no respondent got above 50%. The minimum score obtained was 0, the maximum score was 19, and the average score was 12.6 with a standard deviation of 3.555. There was no association between knowledge level of ADR reporting and age of the respondent (r=0.003 (n=123); p=0.973). Furthermore, there was no association between knowledge levels of ADR reporting and length of respondents' practice at UTH (r=0.013 [n=120]; p=0.886). Low knowledge levels of ADR reporting were attributed to lack of training. Only 17.7% of respondents had been trained in ADR reporting. The major factors that encouraged ADR reporting included: if the reaction was serious (84.7%); if the reaction was unusual (77.4%); if the reaction was to a new product (73.4%); if the reaction was well recognized for a particular drug (60.5%); and confidence in diagnosis of an ADR (46.0%). Factors that discouraged ADR reporting included: lack of feedback (73.5%); the level of clinical knowledge to decide whether an ADR had occurred (49.0%); lack of time to actively look for ADRs (46.9%); the information reported may be wrong (37.8%); lack of time to fill in a report (36.7%); and lack of need to report a recognized ADR because it will make little difference to knowledge (30.6%). Very few (12.7%) respondents had reported an ADR case. The major factors found to be responsible for under reporting of ADR include ignorant of reporting procedures (52.0%), lack of reporting forms (31.8%), and lack of appreciation of the importance of ADR reporting. Conclusion: This study observed that knowledge of ADR reporting was very low among health professionals at UTH. These deficiencies in knowledge and attitudes require urgent attention not only to improve the rate of ADR reporting, but also in order to improve the safety of the patients. Furthermore, the hospital management should improve awareness and training on ADR reporting
- ItemPrevalence, predictors and HIV disease progression in immunovirogical discordant HIV patients at 12 months of first line antiretroviral therapy in Zambia.(The University of Zambia, 2019) Sivile, SuilanjiCombined antiretroviral therapy (cART) has improved mortality and morbidity among HIV-infected patients. However, a third of HIV-infected patients still present to care with advanced disease despite the rollout of cART. Some of these patients fail to appropriately reconstitute their immune system despite being on effective cART signified by a suppressed viral load. This phenomenon is termed immunovirological discordance. These patients remain immunocompromised and could still be at risk of opportunistic infections and subsequent mortality. As the HIV population is getting older, immune senescence and its impact on discordance has become topical. Understanding the prevalence and predictors of this phenomenon is crucial for the HIV response. A cross-sectional study was conducted in 20 health facilities throughout Zambia selected based on probability proportion to size method. Adult HIV patients with a suppressed viral load at 12 months of first line cART were enrolled. Relevant blood samples were drawn and a questionnaire was completed with the aid of the hospital chart . Adequate immune response was defined as an increase of baselines CD4cell count to >200cells/μL at 12 months of ART and/or an absolute CD4cell count change of >150cells/μL. We used multivariate logistic models to identify predictors for immunovirological discordance. 360 patients were enrolled. 57% were females. 68% were 25-44 years old. 17% had a CD4cell count below 200cells/μL at 12 months of ART and 54% had an absolute CD4cell count change of less than 150cells/μL. Females were 2 times more likely to have a CD4cell count above 200cells/μL (OR 2: 95%CI 1.00-3.62;P=0.028) and patients with a body mass index >25kg/m2 were 4 times more likely to have a high CD4 count compared to those underweight (OR 4:95% CI 1.29-13.73; P=0.017) . A baseline CD4cell count below 200cells/μL was a predictor for an absolute CD4cell count change of less than 150cells/μL (OR12:95% CI 4.04-33.41; P= <0.0001). Hepatitis B virus positive status (OR 0.03:95% CI 0.003-0.25; P= 0.001) and baseline WHO stageIV/III disease (OR 0.01:95% CI 0.01-0.59; P=0.0001) were predictors for suboptimal CD4cell response. Patient’s age, Positive RPR, TNF levels and CRP levels were not associated with suboptimal CD4cell recovery. There was no association between WHO Clinical Stage at 12 months of cART with immunovirological discordance. In patients with viral load suppression at 12 months of cART, immunovirological discordance is common. Baseline CD4cell count, male sex, baseline low BMI, HBV infection and baseline WHO clinical stage III/IV could predict immunovirological discordance. Markers of morbidity such as high CRP levels and advanced WHO clinical staging at 12 months of cART are not necessarily associated with suboptimal immune response. Early commencement of cART may prevent immunovirological discordance, a finding which supports the ‘test and start’ strategy. Further investigation in understanding the immunology of discordance and its clinical outcomes are proposed.
- ItemPsychological Distress during the Perinatal Period: Using Edinburgh Postnatal Depression Scale (EPDS) General Health Questionnaire (GHQ-12) and the Study Specific Measure of Perinatal Distress (SSMPD) on a Zambian Cohort(2016) Mwape, Lonia; Mukwato, Patricia Katowa; Mweemba, PrudenciaBackground: Psychological distress during the perinatal period affects the woman experiencing it, her baby, and the family a whole. It presents a challenge during this exciting and special time in woman’s life. Various screening instruments have been established to identify psychological distress. This paper reports results of the data collected to determine the prevalence of psychological distress using the EPDS, GHQ-12, and the Study Specific Measure of Psychological Distress. Aim: The study investigates the prevalence of psychological distress during the perinatal period in a Zambian cohort. Methods: A longitudinal descriptive study was conducted on a Zambian cohort consisting of 300 women during their antenatal and postnatal periods. The participants were accessed through antenatal and postnatal clinics in primary health care facilities. Findings: The study revealed high prevalence of psychological distress in the cohort under study in comparison to global estimations. This is as detected by the EPDS and GHQ-12, including the study specific measure of psychological distress. Conclusion: The prevalence of psychological distress during the perinatal period in Zambia is high. Therefore, the psychological well-being of a woman during the perinatal period needs to be given the attention that it deserves in order to safeguard the well-being of the baby and all the people around her. Recommendations: Screening women for the presence of psychological distress during the antenatal and postnatal periods should be mandatory. Appropriate referral should then be made depending on the outcome of the screening. Key words: Psychological distress, Perinatral period, Edinburgh Postnatal Depression Scale, General Health