Medicine
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- ItemThe role of communication in supporting community engagement in HIV clinical trials: the case of the HIV prevention trials network 071 study in Zambia.(The University of Zambia, 2019) Mulawa, Mulanda JosephCommunity based interventions and research are often affected by communication challenges. Community Engagement (CE) has thus become an integral part of the process of communication within public health interventions. However, the effectiveness of CE strategies depend on what information is communicated and how well it is communicated. The aim of the study therefore, was to explore the role of communication in CE processes in the HIV Prevention Trials Network (HPTN) 071 Population Effects of Antiretroviral Treatment to Reduce HIV Transmission (PopART) in Zambia. This was a qualitative case study conducted in two purposively selected HPTN 071 PopART communities from Livingstone and Lusaka Districts. Thematic analysis was used to analyse data collected that was from focused group discussions, key informant interviews and document review. HPTN 071 PopART employed both direct and representative CE. Direct engagement included the use of community meetings, door-to-door sensitisations, and facility based health talks while representative engagement used community Advisory Boards (CABs). Awareness creation strategies comprised of Video/film, IECs, drama, community meetings and the door to-door community sensitisations. Study implementers and community members felt door-to door was the best approach to use when introducing a program and when explaining complex issues within the study. However, it was established that IECs such as posters and flyers were not translated into local languages, posing a challenge to people who could not read English. Further, HPTN 071 PopART study did not have modes of communication for the visually and hearing impaired because none of the IEC materials were in brail format and none of the videos/film featured sign language interpreters. Communication approaches in HPTN 071 PopART helped support community engagement and participation by reducing the myths and misconceptions that people had towards the study. Communication through various media channels helped create mutual understanding and trust between the study team and the community because the approaches used to communicate required direct contact with the HPTN 071 PopART study participants. However, there is need to cater for the information needs of all people, including people with disabilities because such people are usually left out in the implementation of various interventions.
- ItemEffects of supportive group therapy on levels of hopelessness in patients with cervical cancer at cancer disease hospital in Lusaka, Zambia.(The University of Zambia, 2019) Mutelo, ChristineHopelessness is a subjective appraisal of negative expectations about the occurrence of a highly valued outcome coupled with the sense that one lacks control over desired events in the future. Hopelessness is an early symptom of depression and is comorbid with cervical cancer. Supportive Group therapy offers an economical and time efficient solution. This study aims to ascertain whether supportive group therapy can reduce levels of hopelessness in cervical cancer patients at Cancer disease hospital in Lusaka Zambia. The study design was a Single blinded Randomized Controlled Trial (RCT) conducted at Cancer Disease Hospital in Lusaka Zambia. 49 participants completed Pre (Hopelessness in illness Questionnaire) HAI questionnaire results noted. The participants were then randomised into control and intervention group. The intervention group then attended one hour Supportive group therapy sessions weekly for four weeks. The control group continued to receive the usual support of their family members and CDH staff. Both groups were then administered the post HAI questionnaire and results noted and analysed using SPSS.The null hypothesis was accepted as there was no difference between the control group and the intervention group. In conclusion, Supportive group therapy showed modest reduction in levels of Hopelessness. Such a minimal improvement, with a general trend toward overall reduction of levels of hopelessness and helplessness, was equally observed in other psychological interventions for cancer patients (Linn et al., 2002). Social/family support as the most dependant factor of hopelessness in cervical cancer patients should be enhanced by deliberating inquiring and facilitating its provision
- ItemFactors influencing adherence to antiretroviral therapy among HIV positive adolescents at adult infectious diseases center in Lusaka, Zambia.(The University of Zambia, 2019) Namoomba, Harrison ChimukaAdherence to combination antiretroviral therapy leads to restoration of the immune function and reduces HIV-related adverse outcomes. However non adherence to combination antiretroviral therapy has eroded this advantage leading to increased morbidity and compromised quality of life among HIV positive adolescents. The aim of this study was to assess factors influencing adherence to combination antiretroviral therapy among HIV positive adolescents at Adult Infectious Disease Center in Lusaka, Zambia. A descriptive quantitative cross sectional study was conducted on 173 HIV positive adolescents on antiretroviral therapy who were selected using a systematic random sampling method to ascertain factors influencing adherence. Data was collected using the structured interview schedule and analyzed using Statistical Package for the Social Sciences software, version 20. Chi square and fishers’ exact statistical tests to determine the association among dependable and independent variables and binary logistic regression was used to determine true predictors and to adjust confounders of adherence. The cut off point for statistical significance was set at 5%. This study established that 76(43.9%) of the respondents were found to be non adherent to their antiretroviral therapy. The study identified that stigmatization was high 99(57.2%) but did not significantly influence adherence to combination antiretroviral therapy on the study participants. Knowledge of HIV and disease progression was reported to be low but this did not have any statistical impact on antiretroviral therapy adherence. Factors which were found statistically significant for adherence to therapy when a binary logistic regression was performed were experiencing side effects to therapy (p-value 0.047, odds ratio= 0.412); Understanding reason for taking combination antiretroviral therapy (p-value 0.006, odds ratio= 5.978) and Being reminded to take drugs (p-value 0.006, odds ratio= 0.505). The study found that there was high level of non adherence to combination antiretroviral therapy which could in turn lead to emerging of more cases of treatment failure. More studies on factors influencing non adherence to combination antiretroviral therapy need to be conducted to develop evidence based impact based practice model for HIV positive adolescents care.
- ItemKnowledge and perception of birth and emergency preparedness among pregnant adolescents in Ndola district, Zambia.(The University of Zambia, 2019) Kachimba, JunessThe risk of maternal mortality and complications in pregnancy is highest for adolescent girls in sub-Saharan Africa and is a leading cause of death among adolescent girls. In Zambia, adolescent pregnancy rate is high and stands at 28.5% and maternal mortality rate is at 398 per 100 000 live births. Despite adolescents’ high risk for pregnancy-related complications antenatal care (ANC) uptake is believed to be low among adolescents as they start attending antenatal care late or never. Studies have shown that most adolescents do not attend the recommended ANC visits hence missing out on birth and emergency preparedness (BEP) messages. The objective of this study was to determine the levels of knowledge and perception of birth and emergency preparedness among pregnant adolescents in Ndola District, Zambia. A descriptive cross-sectional study that employed a quantitative approach was conducted in four (4) urban Health Centres in Ndola District, Zambia between October and November, 2018. A total of 124 pregnant adolescents aged between 10 to 19 years were selected by simple random sampling method. A semi-structured interview schedule was employed for data collection. Pregnant adolescents were interviewed one at a time. Statistical Package for Social Sciences (SPSS) version 24.0, Excel and Stata version 14 were used for data analysis. Chi-square tests was done to examine associations between variables. P-values < 0.05 was considered significant at 95% confidence level. Overall, 66.13% of the pregnant adolescents had low levels of knowledge of Birth and Emergency Preparedness, 33.87% had medium knowledge, and unfortunately none among pregnant adolescents had high levels of knowledge of BEP. About perception 74.2% of the pregnant adolescent mothers had a positive perception of BEP. ANC visits, parity and BEP key components were the predictors for knowledge and perception of BEP among adolescents as they had statistical significant association with BEP (p-value =0.001, 0.014 and ˂0.0001) respectively. Knowledge of BEP in the study area was found to be low among pregnant adolescents. It would have been preferred that majority were knowledgeable of BEP. There is need for corrective measures to address the low levels of knowledge of BEP among pregnant adolescents to help reduce neonatal and maternal morbidity and mortality burden in the country.
- ItemSyphilis infection among female sex workers and single women in Lusaka: perceptions, practices and associated factors.(The University of Zambia, 2019) Choongo, MwakaIntroduction: Syphilis is a sexually transmitted infection (STI) that remains a major global public health problem. Syphilis is caused by the bacterium called Treponema pallidum. There are 5.6 million new cases of syphilis worldwide each year and in Zambia the risk of acquiring HIV infection through sexual intercourse is increased 3–5 times in women who are infected with syphilis. The aim of this study was to identify the risk factors, experiences and perceptions associated with syphilis infection among female sex workers and single women in Lusaka. Method: The study used a mixed sequential explanatory method to collect and analyze the data. 349 participants were eligible to participate in this study where 165 were FSW and 184 were SU5. Stata Version 14.0 was used for data analysis Univariate logistic regression was used to determine the association with syphilis and multivariate adjusted odds ratios (AOR) together with their 95% confidence intervals (CI) were also reported. The qualitative part used expert opinion purposive sampling where those that tested syphilis positive within the inclusion criteria were selected to participate in the Focus Groups Discussions (FDGs). A FGD interview guide was used to collect the qualitative data and 3 FGDs were conducted, (FSW, SU5 and FSW/SU5). Results: The results for unadjusted and adjusted logistic regression both showed strong evidence that women who had a ‘History of Syphilis’ were 15 times more likely to contract syphilis again once exposed to the bacterium. The qualitative analysis showed that alcohol abuse, poverty, lack of steady income and sex for gifts and money were some main themes that caused women to indulge in risky behaviours. Conclusion: The findings of this study showed that women regardless of being a female sex worker or just a sexually active single woman were all at risk of acquiring Syphilis. The study showed that women that had a history of Syphilis were more likely to get infected again once exposed and understanding their experiences and perceptions for these behaviors is useful in developing effective syphilis public health campaigns.