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    Knowledge and perception of birth and emergency preparedness among pregnant adolescents in Ndola district, Zambia.
    (The University of Zambia, 2019) Kachimba, Juness
    The 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.
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    Syphilis infection among female sex workers and single women in Lusaka: perceptions, practices and associated factors.
    (The University of Zambia, 2019) Choongo, Mwaka
    Introduction: 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.
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    Intestinal nontuberculous mycobacteria and environmental enteropathy in Zambia: hospital-based observations.
    (The University of Zambia, 2019) Chongwe, Gershom
    Background Environmental enteropathy is prevalent in many low and middle-income countries. Although its aetiology is unknown, we hypothesised that nontuberculous mycobacteria (NTMs), which are ubiquitous in the environment and are known to cause disease in the lungs, the gut, skin, bloodstream and joints, could play a role in pathogenesis. We estimated the prevalence of intestinal carriage of NTMs and investigated whether Mycobacterium avium antigens could contribute to environmental enteropathy through matrix metalloproteinase (MMP)-mediated intestinal damage. Methods This was a sequential multimethod design comprising a hospital-based cross sectional study as phase one followed by a quasi-experimental post-test study as phase two. In the first phase, 97 patients scheduled for routine endoscopy were surveyed to determine the prevalence of NTM in the gut. Stool, intestinal lavage samples, and biopsy samples from the descending colon and caecum were collected. The samples were analysed using the Mycobacteria Growth Indicator Tube (MGIT) liquid culture method. In the second phase of the study, 48 participants were recruited for an in-vitro study to determine gut immune responses to Mycobacterium avium. Small intestinal biopsies and whole blood samples were stimulated with M. avium lysate over 24 hours. Unstimulated biopsy or blood samples served as negative controls, while stimulation with Staphylococcal enterotoxin B served as a positive control. Supernatants were used to quantify MMP-1, -2, -8 and -9 expression using ELISA, and interleukin 17A (IL-17A), IL-10, IL-6, IL-4, IL-2, IL-1β, interferon (IFN) gamma and tumour necrosis factor (TNF) alpha by flow cytometric assay. Questionnaires were used to collect demographic and clinical information in both phases. Results From the survey, out of the 97 patients, 52 (53.6%) were males. The mean age was 46.6 (±15.9), range (18–80) years. The prevalence of NTM was 7.2% (95% CI 1.9–12.4), while that of Mycobacterium tuberculosis (MTB) was 6.2% (95% CI 2.3–13.0). Carriage of NTM was not significantly associated with age, sex or presenting symptoms such as diarrhoea, abdominal pain, weight loss as well as HIV status. Descending colon samples were the most likely to be positive (9.8%, 95% CI 3.7, 15.8) followed by stool samples (6.8%, 95% CI 1.0–12.6), caecal biopsy (6.1%, 95% CI 0.3–11.8) and intestinal lavage samples (5.9%, 95% CI 0.3– vii 11.5). In vitro experiments using duodenal biopsies from 48 patients (21 men, 27 women, median age 35 years) demonstrated that M. avium lysate induced the expression of many Th1, Th2 and Th17 cytokines in peripheral blood but only IL-1β and IL-6 in duodenal tissue. M. avium lysate induced the expression of MMP-1 in duodenal tissue (p=0.004) compared to negative controls, but expression of MMPs 2, 8, or 9 were not significantly increased. Discussion and Conclusion These results have revealed a prevalence of NTMs of seven percent in this population, suggesting an environmental contamination of the gut by potentially pathogenic NTMs that was not associated with any symptoms or demographic status. We have also shown that M. avium induced the expression of MMP-1 in duodenal tissue and in peripheral blood. M. avium also induced the expression of a restricted set of cytokines in duodenal tissue, namely IL-1β and IL-6 as well as eliciting a Th1 and Th2 response in the blood. These findings suggest that NTM can no longer be dismissed as mere contaminants during investigations for other diseases. We speculate that the induction of these molecules by M. avium suggests a possible pathway through which NTMs, and M. avium in particular, could remodel the intestinal mucosa and lead to environmental enteropathy. As techniques for isolation of these organisms improve, coupled with a deeper understanding of the scope of disease caused by the organisms, the case can be made for mechanisms to improve both surveillance and diagnostic capacity in resource-poor settings.
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    Determinants of stillbirth in the five general hospitals of Lusaka, Zambia: a case-control study.
    (The University of Zambia, 2023) Makasa, Musonda
    Background: About 98% of stillbirths that occur globally are recorded in low- and middle-income countries, where south Asia and sub-Saharan Africa account for 77% of the reported cases. An estimated 2.6 million stillbirths were reported every year since 2000. Recent data suggests a 25.5% decline from 24.7 to 18.4 per 1000 live births worldwide. Despite this reduction, sub-Saharan Africa (SSA) still recorded the slowest decline. Stillbirths are a consequence of multifactorial factors, and majority of them especially in low resource setting have no causal assignment. Objective: The main objective of this study was to evaluate the determinants of stillbirths among women who had childbirth at the five general hospitals of Lusaka, Zambia. Methods: This was a multi-facility based study conducted at Kanyama, Chipata, Chawama, Matero and Chilenje. An unmatched case-control study was designed at a ratio of 1:4. Cases (stillbirths) were consecutively enrolled, and controls randomly selected within 24 hours of occurrence of a case. A structured questionnaire was used to collect data. Summary proportions and frequencies for cases and controls were obtained from descriptive statistical analyses. Univariate analysis was conducted to obtain the crude association between stillbirth and independent variables. Multiple regression was used to assess determinants of stillbirths. A p-value of <0.05 was considered sufficient evidence of an association between stillbirth and independent variables. Results: total of 58 cases and 232 controls were included in the analysis with a ratio of 1:4 respectively. 77.6% cases belonged to the 20 – 34 years old age group while controls accounted for 74%. 52.6% cases had attained secondary education and 51.1% were in the control group. With employment 73.7% and 70.7% were cases and controls respectively. Babies with birthweight ≥2500g had higher odds of mortality (AOR=4.49; 95%CI: 2.84-8.99) than babies with birthweight <2500g. Antepartum hemorrhage was also noted to be a risk factor (AOR = 3.18; 95% CI: 1.21 – 8.09); another finding was previous experience of stillbirth had high odd of stillbirth (AOR=3.99; 95% CI: 1.73 – 6.73) compared with their counterparts without. Additionally, women with increase in parity > 2 (AOR = 3.02; 95% CI: 1.07 – 7.54) had higher odds of stillbirth compared to women with parity ≤ 2.Conclusion: this study revealed that babies with higher birth weight ≥2500g had higher risk of mortality probably attributed to haemorrhage. Antepartum haemorrhage, and previous stillbirth were noted as significant determinants of stillbirth. Program implementers should consider strategies that can mitigate these determinants to reduce stillbirth.
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    Direct biomarkers of microbial translocation as predictors of immune activation in adult Zambians with environmental enteropathy and hepatosplenic schistosomiasis.
    (The University of Zambia, 2019) Kaonga, Patrick
    Background: Microbial translocation is a poorly understood consequence of several disorders such as environmental enteropathy (EE) and hepatosplenic schistosomiasis (HSS) disease. Direct biomarkers of microbial translocation such lipopolysaccharide, 16S rRNA gene and Toll-like receptor ligands may predict immune activation. This study evaluated whether direct biomarkers of microbial translocation correlate and predict immune activation in adult Zambians with EE and HSS disease. The public health importance of biomarkers is that they can be used to predict individuals with EE or HSS who are likely to develop chronic immune activation or are at risk. The biomarkers may be used for early diagnosis and stratify for any treatment or intervention. Methods: An unmatched case-control study was conducted in participants with EE (n=67) recruited from Misisi compound, Lusaka, Zambia, with two comparison groups, HSS participants (n=86) from The University Teaching Hospital and healthy controls (n=41). Plasma lipopolysaccharide (LPS) was measured by Limulus Amoebocyte Lysate Assay, plasma 16S rRNA gene copy number was quantified by quantitative real-time PCR, Toll-like receptor ligands (TLRLs) activity by QUANTI-Blue detection medium, plasma biomarkers of host response (C-reactive protein, soluble CD14, soluble CD163 and lipopolysaccharide-binding protein) to microbial translocation were measured by ELISA and cytokines (TNF-α, IL-6, IL-10, IL-4, IL-2, IFN-γ and IL-17) from cell culture supernatant by Cytometric Bead Array. Results: Plasma lipopolysaccharide levels were elevated in EE group with median 378.9 (IQR, 82.7 - 879.5) EU/ml compared to participants with HSS with median 213.1 (IQR, 77.2 - 358.3) EU/ml; p=0.03 or healthy controls with median 202.3 (IQR, 43.2 - 251.1) EU/ml; p=0.01. The 16S rRNA copy number were significantly elevated in the EE group with median 2651 (IQR, 529 – 8779) copies/μl compared to the levels in participants with HSS with median 387 (IQR, 165 – 1990) copies/μl; p<0.001) or healthy controls with median 193 (IQR, 132 – 455) copies/μl; p<0.001. TLRLs activity was significantly higher in the EE group with median 0.49 (IQR, 0.0 - 0.8) OD units than in participants with HSS with median 0.13 (IQR, 0.0 - 0.8) OD units; p=0.01 or the healthy controls with median 0.02 (IQR, 0.0 - 0.12) OD units; p=0.004. Participants with HSS had higher TLRLs activity compared to healthy controls p=0.02. In multivariate multiple regression models LPS, 16S rRNA copy number, and TLRL activity were independent predictors of cytokines while controlling for baseline characteristics. In the EE group, a good model fit was obtained (R2 = 0.526, F = 47.53, p < 0.001) which predicted TNF-α, IL-6, and IL-10. In the HSS group, a less impressive but still significant fit was obtained (R2 = 0.382, F = 22.43, p = 0.002 which predicted 16S rRNA and TLRLs. In healthy controls, no satisfactory model was obtained (R2 = 0.040, F =1.03, p = 0.38). Conclusions: Direct biomarkers of microbial translocation were higher in EE and HSS participants compared to healthy controls. The biomarkers seems to correlate and predict immune activation in individuals with EE and HSS infection. This data support the model that proposes that biomarkers of microbial origin in the gastrointestinal tract move across a vii compromised intestinal barrier leading to heightened immune activation in conditions with intestinal barrier dysfunction. The study recommends measurement of microbial translocation using these biomarkers. They are cheaper, practical and non-invasive.