Medical Journal of Zambia

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Abdominal actinomycosis
(Medical jornal of zambia, 1981-11) Elem, B.; Sinha, S. N.; Parmar, J.; Rao, B. A.
Actinomycosis is an uncommon chronic suppurative disease with a worldwide distribution. The causative organism, Actinomyces Israeli, presently classified as a gram +ve bacteria (Muir, 1975) is an oral commerisal in man. The gastro intestinal involvement is believed to be auto-genus. It is difficult to ascertain the incidence of this disease in Zambia. However, during a two year period (1976-1977) four cases of abdominal actinomycosis were managed at Ndola Central Hospital® This paper is concerned with the report of these cases and a critical evaluation of the problem of this form of the disease.
Acral nodular lichenification in Zambians - an artefact
(Medical Journal of Zambia, 1982-10) Dube, M.K.; Attfli, V. R.; Hira, S. K.
Acral nodular lichenification among two Zambians, acquired through a regular habit of scrubbing the body with stones, is discussed.
Acute flaccid paralysis surveillance in Zambia:Progress towards the Polio End Game
(Medical Journal of Zambia., 2016) Ndumba, I.M.; Mazaba M. L.; Matapo, B.; Chirambo, R. M.; Mwambi, P.; Musumbu, P.; Masaninga, F.; Songolo, P.; Mufunda, J.; Monze, M.
In the global polio eradication initiative acute flaccid paralysis cases are followed up two to three months after onset of paralysis to assess recovery of the children. In Zambia AFP cases are followed up regularly but there is no documentation of the clinical and laboratory findings. The purpose of this paper is to document the support WHO country office offers to the follow up of the AFP cases in Zambia to identify gaps which the WHO Country office could address.This study used secondary data from a case control study design, conducted and supported by WHO country office, which was aimed at assessing the association of NPEVs with AFP. Particularly this study aims at assessing the presence or absence of residual paralysis and the laboratory findings of the affected children. Results revealed that a total of 93 cases of, which over 55% were males were included in this study. Majority of the cases were aged between 24 and 35 months (28.4%). Regarding vaccination status, 77% of the cases had received 1 to 4 doses of the Oral Polio (OPV) vaccine. About 62% of the viruses isolated were identified as Cox B, and Echo 3, 6, 7, 11, 12, 14 and 29. Of all NPEVs 37.1% yielded no neutralization pattern. Only 9 (9.67%) cases were followed up; out of which 3 (33.3%) had residual paralysis with one of those with residual paralysis who later died. It was concluded that AFP surveillance and follow up of cases is carried out in Zambia. However, rehabilitation information of the affected children is not followed up, an issue which WHO country office with regards to the transformation agenda could pursue to ensure that the affected children are adequately supported as a contribution to the polio eradication end game.
Adaptable lessons learnt on procurement from deployment to a deadly emergency outbreak: The case of Sierra Leone during Ebola outbreak 2015
(Medical Journal of Zambia, 2016) Siboonde, M.; Musumali, M.; Sikazwe, A.; Mufunda, J.
The WHO has standard operating procedures for procurement, travel and logistics for use at country level. Some of the guidance is waived during public health emergencies of international concern. Practical acumen on using the standards for emergency settings is limited at country level. WHO Zambia was one of the countries that responded to the call by WHO HQ to support the 2014 Ebola outbreak in West Africa. This paper aims to document lessons learnt by procurement staffs that were deployed to emergency settings.Desk review of documents on procurement during emergency settings, terms of reference of the mission, materials on prevention of getting infected by Ebola and general rules governing international deployment were analysed. The staff member was deployed for the duration of eight weeks in 2015 from where experiences gained were reviewed and systematically recorded. Results revealed that the deployment and exposure to an emergency setting was the first such experience to WCO Zambia staff. During the Ebola outbreak in Sierra Leone there was the “no touch person” practice from inherent profound fear of contracting the deadly disease. While the job description was similar with what was prevailing in non-emergency setting in Zambia, the quantities and implementation speed on assignments on average were more than ten times on emergencies. In that environment the procedure for procurement involved Invitation to Bid and Request for Proposal to interested parties occurring at the same time which is done differently from normal situations where there is first a request for quotations and procurement committee deliberate before making selection. In the Ebola set-up, there is a waiver of the competitive bidding requirements.The exposure of WCO staff to emergency setting allowed WCO staff to be more knowledgeable about preparation and award contract using additional procurement methods in compliance with WHO policies as adopted for emergencies. Secondment of staff to a setting of emergencies is beneficial to WCO staff in terms of capacity building and handling similar situations in future. Country Offices are encouraged in future to share human resources when situations dictate.
Adenocarcinoma of The Kidney in a 17 Year Old Zambian Male
(Medical Journal of Zambia, 1983-10) Elem, B.; Patil, P.S.; Patel, J.
A case of adnocarcinoma of the kidney in a 17 year old Zambia male has been presented; the rarity of this tumour in children emphasized. It has been suggested that one should not altogether exclude renal cell carcinoma in the differential diagnosis of a typical renal mass in a young patient.
An adult of the use of CT myelography (CTM) in the evaluation of spinal lesions at the University Teaching Hospital, Zambia
(Medical Journal of Zambia., 2007-01) Chunmin, L.; Khare, R.
To evaluate the diagnostic value of the computer tomographic myelography (CTM) in patients with spine or spinal cord pathology. A retrospective study in 132 cases of CTM with clinical and radiological details in UTH between Jan, 2004 to Nov. 2006. All the cases of CTM were performed on Philips CT Aura scanner, helical scan using 1.5mm to 5mm axial slices depending on spinal segment. Coronal and sagittal reconstructions were performed; soft tissue and bony windows were also displayed. All patients came from inward after keeping the patient in supine position for 4-6 hrs after intrathecal injection of 5-10ml Omnipaque contrast agent. There are 4 cases (4/132, ratio 3%) unsuccessful; the others including normal group (n=25, 20%) traumatic spine fracture (n=16, 12%), tumour (n=24,18%) disc protrusion (n=28, 21%) inflammatory (n=23, 17%) spondylosis and other (n=12, 9%). The CTM still plays an important role in places where the magnetic resonance imaging MRI is not available as in Zambia in diagnosing spinal diseases especially in patients with neurological deficits.
Advance in Dermatology II
(University of Zambia, Medical Library, 1980-02) Ratnam, A.V.
When patients see blisters they believe they are serious. The dermatologist is also concerned because there are more than 30 recognised bullous diseases and many are chronic, needing prolonged and careful management. The early clinical features are often deceptive precluding a correct diagnosis except a few simple ones like bullous impetigo and insect bite reactions. The aetiology of many remains unknown and the management depends on clinical and especially histological diagnoses.
Advanced Abdominal Pregnancy
(Medical Journal of Zambia, 1980-12) Narone, K.S.; Roy, S.S.; Narone, J.N.; Chatterjee, T.K.
Two cases of ;advanced abdominal pregnancy have been reviewed and two live babies have been delivered. Emphasis has been given to suggestive clinical features which may help in the pre-operative diagnosis of this rare condition.A short resume is given of both the cases. Special emphasis is given to the presenting features and the clinical signs which were suggestive of abdominal pregnancy. Radiological pictures and hystero-salpingogram confirmed the diagnosis before laparatomy
Antihypertensive therapy with diureties without potassium supplement
(Medical Journal of Zambia., 1981-11) Wadhawa, D.N.
Compliance is a major problem in maintaining optimum anti-hypertensive therapy, particularly in a asymptomatic mild hypertensives. Drugs with side dose regimen and minimum of side effects have the maximum chance of compliance. The present investigations assesses the efficacy and safety of Furosemide (Lasix) and hydrochlorothiazide in low single dose without potassium supplement.
Asymptomatic bacteriuria of pregnancy in Zambia
(Medical Journal of Zambia, 1974) Jenkinson, D.
A survey of 500 Zambian antenatal patients revealed a 3.8% incidence of asymptomatic bacteriuria. Interest in asymptomatic bacteriuria has increased since large groups of individuals were studied by Kass (1956). Subsequent studies by the same authors (Kass,1960a,1960b) appeared to show an increased incidence of acute pyelonephritis and pre-maturity when this condition was associated with pregnancy. Further studies in many parts of the world have confirmed that this condition is present in approximately 4% of all pregnant women. The condition is not confined to pregnancy. It is believed that there is a variable 4% of all women who demonstrate asymptomatic bacteriuria and that pregnancy is a state in which the condition may become symptomatic and recognised.
Bacterial Liver Abscess
(Medical Journal of Zambia, 1977-06) Gill, G.V.; Kyle, I.W.
Bacterial abscess of the liver receives scant attention compared to its amoebic counterpart. However, even with surgical drainage and antibiotic therapy the mortality rate of this condition is about 50%, and without such treatment 100% of patients die (Ostermiller and Carter,1967). There is also evidence that these unacceptable figures are due to failure or delay in diagnosis (Schraibman,1974; and Young,1976) and inadequate drainage at the time of operation (Block et. al., 1964). We are therefore recording in this paper our experiences with two cases of bacterial liver abscess which presented in a recent 18 month period, in order to highlight the difficulties in diagnosis and treatment of this obscure condition. Two cases of bacterial liver abscess presented to a hospital during an 18 month period. Both involved male caucasians who had been resident in Zambia for many years. The cases are recorded with a review of the recent literature. The difficulty in diagnosis and importance of adequate surgical drainage are stressed.
Bacterial Throat Flora in Children with Sickle Cell Anaemia (Hbss)
(Medical Journal of Zambia., 1983-10) Chintu, C.; Gupta, K.; Osborne, C.; Masona, J.
ln 181 cases of sickle cell anaemia (Hbs.S) bacterial throat flora was studied. The commonest organisms' isolated in all age groups were alphahaemolytic streptococci of the viridans group (93.90/o) and neisseria-like species t82.3%). The pattern of bacterial flora in these patients does not differ from that of non sickle cell anaemia patients.
Bacteriology of chronic suppurative otitis media among children at the Arthur Davidson Children's Hospital, Ndola, Zambia
(University of Zambia, Medical Library, 2016) Matundwelo, N; Mwansasu, C S
The study aimed to determine the bacteria that cause CSOM and their sensitivity to drugs used in children attending at the Ear Nose and Throat (ENT) clinic at Arthur Davidson Children's Hospital (ADCH) in Ndola. It was a retrospective descriptive hospital based cross sectional study whereby the medical files of 60 patients aged between 0-15 years who diagnosed with CSOM from January 2014 to January 2016 at Arthur Davison Children Hospital were reviewed and the socio-demographic data, type of bacteria isolated and their antibiotic sensitivity were analysed using quantitative methods Statistical Package for the Social Sciences(SPSS version 16.0). Results revealed that of the 60 patients included in the study, more than half (56.7%) of the participants were 7 years old or younger and majority (86.7%) of participants came from high density areas. CSOM seemed to be more common in females (55%) than males (45%). The common organisms isolated included; Staphylococcus species (36%), Proteus vulgaris species (35%), Pseudomonas species (15%), Streptococcus species (7%), E. coli species (3%), Enterobacter species (2%) and Serratia marcens species (2%). Antimicrobial sensitivity tests showed that Ciprofloxacin was more sensitive to most of the microbial isolates. In conclusion,It is important to know that Staphylococcus was the commonest isolated pathogen responsible for CSOM at ADCH. This will ensure success in the choice of suitable antibiotics according to susceptibility tests as they guide the treatment and thus reduce complications of CSOM and curbing resistance to antibiotics.
Bacteriology of Rural Water Supplies of Mutenda Community District of Chingola, Zambia
(Medical Journal of Zambia, 1980-02) Fayinka, O.A.
The sources of water supply for drinking and other domestic uses available to the rural population of Mutenda was analysed bacteriologically by standard techniques presumptive and Differential Coliform tests Wilson et al 1935), Ministry of Health (1946). The water sources include wells, bore holes, springs and rivers. Assessment of suitability by standard criteria crowed that, the bore hole water was the only source of supply bacteriologically safe for drinking. The need for further research on the microbiology of surface and underground water resources is stressed. Reassessment of the standards for water quality, which have largely been based on the experience from waters in temperate, more developed countries and development of suitable tests for sound epidemiological studies to establish realistic standards applicable to the developing countries is advocated.
Bacteriology of Rural Water Supplies of Mutenda Community District of Chingola, Zambia
(Medical Journal of Zambia, 1980-06) Fayinka, O.A.
The sources of water supply for drinking and other domestic uses available to the rural population of Mutenda was analysed bacteriologically by standard techniques ( presumptive and Differential Coliform tests Wilson et al. (1935), Ministry of Health (1946). The water sources include wells, bore holes, springs and rivers. Assessment of suitability by standard criteria crowed that, the bore hole water was the only source of supply bacteriologically safe for drinking. The need for further research on the microbiology of surface and underground water resources is stressed. Reassessment of the standards for water quality, which have largely been based on the experience from waters in temperate, more developed countries and development of suitable tests for sound epidemiological studies to establish realistic standards applicable to the developing countries is advocated.
Bed-wetting in Lusaka suburb
(Medical journal of zambia, 1981-11) Haworth, A.
Bed wetting may sometimes be the result of physical pathology or psycho-social stress or it may be due simply to stow maturation - Kolvin (1975) but even when it occurs in older children it may •neither be classed as a behaviour disorder nor as an illness by the parents. There is no clearly accepted age by which a child should be dry and Swift and Asuni (1975) have stated for example that, "Among the Achofi of Uganda and among most tribes in Ghana parents become concerned only if bed wetting continues into the fifth year. In Nigeria the practice of permissiveness . . . is reported until the age of 6 or 7 (while) . . . in Tanzania this ready relaxed approach . . . changes to threats and punishment when bed wetting occasionally persists into the fourth year." In the investigation to be described the arbitrary definition will be taken (after Sin, 19_74) that "Enurests is said to exist when a child after the age of 3 frequently wets his bed." This investigation is a study of bed-wetting in children aged 4` to 15 years, living in.a Lusaka suburb.
Biliary lipids and the paucity of cholesterol gallstone disease in Zambia
(Medical Journal of Zambia, 1974) Lewis, K.O.
The concept that cholesterol gallstone formation is the result of precipitation of cholesterol from super-saturated bile has been confirmed by the demonstration that gallstone-containing bladder bile had a concentration of cholesterol at or near the limit of its solubility (Admirant and Small,1968). Apparently closing a prolonged debate as to whether the primary defect was in the hepatic cell or in the gallbladder, the demonstration that hepatic bile from gallstone patients is saturated or supersaturated with cholesterol has led to the widely held view that cholesterol gallstone disease results from a derangement of liver metabolism(Vlahcevic et al, 1970) Some workers consider that this derangement of metabolism is due to an external factor such as diet. The evidence implicates the Western type of diet comprising largely of refined foods and in particular sucrose. Cholesterol gallstone disease has become increasingly common among the Japanese, for example, since their introduction of a Western way of life.
Biomechanical basis of the tibial recurvation osteotomy
(Medical Journal of Zambia., 1983-07) Veli, L.; Gurbur, C.; Ahmet, S.; Bari, E.
Tibial recurvation osteotomy which was introduced by Lok, et al more than ten years ago has been applied to over 140 patients with a high rate of success. Results depend on the preoperative functional status of the different muscles of the hip and the lower extremity. The operation is primarily performed on poliomyelitis patients with loss of quadriceps function where there are no other muscles of substantial mass for surgical transfer and knee arthrodesis is not desirable. In principle it is aimed at modifying the knee joint angle so that the knee is locked at an angle of recurvation early during stance. This allows the patient to walk without the aid of his hand to stabilise the knee or without the support of a prosthetic device. Knee stabilisation is thus accomplished with minimal muscle power that is with whatever muscle function exists (Fig. 1 & 2). The technique and the complications that may arise were reported previously. The size of the recurvation angle appropriate for each patient is different and depends on available muscle strength; particularly of the gluteus maximus and the triceps muscles. Determination of the recurvation angle has until now been based on experience. In what follow is we attempt to establish objective criteria for determining the recurvation angle appropriate for each patient by following a biomechanical approach.
The brain in AIDS: some observations on CT scan
(University of Zambia Medical Library, 2007-01) Khare, R.; Khare, A. K.; Chunmin, L.
The incidence and severity of the HIV epidemic varies widely in various regions resulting from variations in risk behavior, duration of disease and the availability of treatment. HIV is highly neurotropic and crosses the blood brain barrier at an early stage in the disease process. Thus the CNS is a major target of HIV with approximately 2/3 of the patients developing CNS involvement during the course of the disease. The incidence of sub clinical neurological disease is even higher; autopsy studies of patients with advanced HIV disease have demonstrated pathological abnormalities of the nervous system in 7590% of the cases 1,2. Though the availability of HAART has been associated with a dramatic decline in the incidence and severity of opportunistic infection in CNS, in developing poor countries where health resources are limited, the disease pattern is complex and diseases of the CNS remain a dominant cause of morbidity and mortality in AIDS patients. Poverty, inability to afford the treatment, inadequate diagnostic facilities,treatment and monitoring etc. are very straightforward underlying factors. Many advances in laboratory diagnostic techniques have increased the ability to make a specific diagnosis; however a large part of the diagnostic process still relies on radiological examination. MRI is the best possible choice of imaging technique. In poor countries like Zambia where MRI scan is unavailable, CT allows it to remain a first line screening tool prior to lumbar puncture or any other invasive investigation.
Can all research strengthen links between policy and practice in HIV and AIDS prevention, care and support, in Zambia?
(Medical Journal of Zambia., 2007-01) Shilalukey-Ngoma, M.; Menon, M. A.; Mac'wangi, M.; Serpel, R.
This reflection on research and policies on HIV and AIDS is to identify issues that assist to close the policy-practice gap in the prevention, care and support of HIV and AIDS programming, in a resource constrained, setting like Zambia. The paper focuses on a study on assertiveness towards services, by pregnant women, done in Zambia. It reflects on the policy-practice gap, which is wide and challenges the paradigm of compartmentalization of activities pertaining to the areas of research, policy and practice. The weakly coordinated national efforts in countries like Zambia, in research are discussed, while the wealth of existing research, which could be better utilized, is acknowledged. A number of studies with potential to influence research- policy- practice linkages to save lives are noted. The assertiveness study done in Zambia, demonstrates the potential to integrate Reproductive Health and HIV services and also, the intricate relationship of research, policy and practice. Others studies, like the prevention of mother -to-child transmission, narrow this gap and give hope to families to have sero-negative offspring. There is need to redirect the mindset of various stakeholders to the synergistic existence and the potential of research to add value to practice, while it also influences policy, to save lives in the fight against HIV and AIDS.

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