African Digital Health Library (ADHL) - Zambia

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The African Digital Health Library (ADHL), Zambia node, makes available health related content ranging from theses, dissertations, and Ministry of Health reports from Zambia.

ADHL currently operates in 5 Sub Saharan African Countries and is supported by the medical librarians. It is a collaborative effort among medical librarians at major universities in sub Saharan Africa and is funded by the office of Global AIDS/US Department of State. The Zambian node is managed through the University of Zambia (UNZA) Medical Library.

For more information, please contact Celine Mwafulilwa at: cmwafulilwa@unza.zm

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Possible chloroquine resistant malaria in Zambia
(Medical Journal of Zambia, 1967-04) Himpoo, B.; MacCallum, J. B.
In the fight against malaria the synthetic anti-malarials were greeted with great hopes. However,since their introduction there has been the disturbing evolution of strains of malaria resistant to them. In1947 resistance was reported to proguanil in Malaya and the Far East. In 1954 pyrimethamine resistance was reported in Kenya and afterwards in West Africa, South America and the Far East (Jones 1954, Lasch and N'Guyen 1965, W.H.O. Tech. Ser. 266). The devaluation of these potent prophylactic drugs was to be regretted, but far more alarming was the emergence of resistance to chloroquin. This was first reported in 1961 when, in Columbia, strains of Plasmodium falciparum were discovered to be resistant to therapeutic doses of chloroquin. Later it was reported in the Far East and more recently in West and Central Africa (Harinas uta et al. 1965). The size of the problem can be gauged from the report (Montgomery and Eyles) in 1962 of 10 % evidence of resistance in Commonwealth troops in Malaya, and in 1963 Contactos et al. confirmed that 4 out of 5 Asian strains suspected of resistance were definitely resistant to chloroquin in normally curative doses. In Central Africa the first report of malarial resistance to chloroquin came in 1966 from Malawi(Stevenson 1966) and we would like to report on a further three cases that we feel may well come under this category. These cases were all observed in the latter half of 1966 at the General Hospital in Broken Hill, Zambia.
Possible encephalitis following B.C.G vaccination
(Medical Journal of Zambia, 1967-04) Savage, F. M. A.
Four cases of an encephalitis-like illness 3 week after BCG vaccination are described, and alternative explanations of the occurrence are discussed. As none of these explanations account for all the features of the illnesses, it is felt that it is worth recording the observation.
Multiple pregnancy in Zambia
(Medical Journal of Zambia, 1967-04) Lucas, C.; Hassim, Abu M.
An analysis of 151 twin pregnancies and 4 triplets delivered during 1966 is presented. The incidence of twin pregnancy is 1 in 37 and triplets 1 in 1,414. The maternal mortality in this series was nil. The perinatal mortality is 23.5%. Prematurity is the most important single cause of foetal wastage. The etiological factors associated with multiple pregnancy are briefly discussed. The evidence at present indicates that heredity, climatic conditions, age and parity are important factors. The importance of antenatal care and its relation to foetal wastage is emphasized.
Haemosiderosis osteoporosis and scurvy
(Medical Journal of Zambia, 1967-04) Lowenthal, M. N., creator; Siddorn, J. A., creator; Fine, J., creator; Patel, R. P., creator
A case of haemosiderosis, osteoporosis, vertebral collapse and scurvy occurring in a Zambian African male is described in detail.
Kwashiorkor: Some Reflections
(Medical Journal of Zambia., 1967-10) Collins, J.
The subject of malnutrition in Zambia is one receiving an increasing amount of attention and publicity. Work is being undertaken to assess the incidence and severity of this condition as well as its causation and to plan the best approach to its elimination. This has led to reflection of ideas on this subject and my experience in dealing with malnutrition over the last 22 years and is the excuse for this paper. Malnutrition in this country exists essentially in two main forms. One is found most frequently in the very young and is largely due to protein deficiency and the other is found in all age groups and is caused by multiple food deficiencies. It is with the former, known as Kwashiorkor, that I have been most concerned and it is some aspects of this serious condition that are the subject of these reflections.
The diagnosis of leprosy - common errors
(Medical journal of zambia, 1967-10) Imkamp, F.M.J.H.
Would the correct diagnosis of leprosy have been easier if this disease had been described in textbooks on Neurology instead of Dermatology? The emphasis on the changes in the skin of the patient with leprosy may well be the cause of misdiagnosis in many cases. Leprosy is a chronic infective disease and it is generally accepted to be caused by Mycobacterium Leprae discovered by Dr. A. Hansen in 1873 and published by him in 1874. M. Leprae is an acid-alcohol fast bacillus. So far no artificial medium has been found in which to culture the bacillus, but it can be kept alive and will multiply in the earholes and foot pads of the mouse and hamster. The foot pads are used solely as a culture medium enabling the testing of the effect of drugs on the bacillus. It is important to know that M. Leprae has a special affinity for the Schwann cells of the sensory nerves in which they lie, protected by the basement membrane, (only seen by electron microscopy) and if conditions are suitable multiply. Only nerves of the Peripheral Nervous system are affected in leprosy. Therefore without symptoms showing nerve involvement the diagnosis of leprosy should not be made in the absence of positive skin smears. The great auricular nerve-the ulner and median and peroneal nerves are easy to palpate and possess predominantly cutaneous sensory fibres. In the early stages of the disease the bacillary invasion is directed to the sensory fibres while later on all types of fibres are affected due to granulomatous infiltration, scarring, ischaemic damage or even possibly tramsneuronal spread. Autonomic nerve fibres are commonly involved early in the disease, shown by the characteristic dryness and roughness of the skin and anhydrosis. This article is mainly written for doctors who have never worked in countries where leprosy is prevalent and therefore have some difficulty in recognising the disease. To be Leprosy-conscious is as important and essential as to be Malaria-conscious and this applies to patients of all races. Leprosy can occur in ALL races and at any age. It should bc born in mind that Europeans are not exempt from leprosy and unfortunately it has happened that Europeans have been treated for many years for an unidentified skin disease which later proved to be leprosy.
Cushing's Syndrome in a Zambian Youth
(Medical Journal of Zambia., 1967-10) Kihn, R.B.; Davidson, J.C.
A case of Cushing's Syndrome treated by adrenalectomy is described. CUSHING'S syndrome is an uncommon disorder in the European and has seldom been reported in the African. This case is reported as no record of the condition in Zambian has been found. The case history is of a male African patient of 15 years who was referred to hospital by the Late Mr. L. Nixon health inspector in the Gwembe Valley as a case of pituitary tumour. For a year he had suffered from backache, morning occipital headache, generalised pruritus and increasing obesity. He had had an ulcer on his left foot for five months. On examination, he was Obese, marked buffalo hump, short stature-height 53 ins: moon face, drooping right eye lid (old injury); (Fig. I). (Hg. 2.) Purple striae on the hips, thighs and abdominal wall; ulcer dorsum on left foot. C.V.S. Apex beat displaced to the left.; Aortic second sound exaggerated; B.P.190/120: Fundi-grade 2 hypertensive retinopathy.
Urban Clinics in Lusaka
(Medical Journal of Zambia., 1967-10) Noak, J. L.
There are five large urban clinics in Lusaka (urban and peri-urban population 150,000 in 1966)1. These clinics are open from 8 a.in. to 4 p.in. on weekdays and from 8 a.in. to 10 a.in. on Sundays. They are extremely overworked as js the outpatient department of Lusaka Central Hospital to which clinic [)atients are referred. For six weeks during December 1965 and January 1966 a survey was conducted to see exactly what work the clinics and outpatient department were doing, with a view to planning future work. The survey was necessary because the official clinic returns are based on the patient's complaint and not on the diagnosis.
Aspects of renal disease in Zambia
(University of Zambia, Medical Library, 1968-10) Johnston, S. M.
Chronic renal disease is a problem seen not infrequently on the medical wards of hospitals in Zambia. This paper represents an attempt to study the types seen both clinically and at post-mortem, as have occurred throughout the year 1967 on the medical wards at Lusaka Central Hospital. Both the adult and children's medical wards are included in the study but the surgical wards are excluded.
Aneurysm of the left ventricle: a report of two cases from Zambia
(Medical Journal of Zambia, 1968-10) Lowenthal, M.N.; Fine, J.
Two cases of aneurysm of the left ventricle occurring in Zambians are described: the probable congenital nature of such aneurysms usually found in the African races is contrasted with the origin from myocardial ischaemia generally found in the European races. The condition often presents with mitral incompetence and congestive cardiac failure, as it did in the two cases described.
The geography of Lusaka city clinics
(Medical Journal of Zambia., 1968-10) McGlashan, N. D.
The following account describes a study undertaken by senior geography and social work students of the University of Zambia in a fact-finding exercise for the Ministry of Health. The aims were to enumerate all out-patients treated in the city in a single working day, to obtain information on the distances and the means of travel to seek medical assistance, and to assess the cost to the patient of the journey. Adminstrative, rather than medical, data was to be gathered.
Endomyocardial fibrosis in a Zambian
(University of Zambia, Medical Library, 1968-10) Lowenthal, M. N.; Fine, J.
The purpose of this communication is to report a proven case of endomyocardial fibrosis 03.M.F.) in a Zambian African. Most of Zambia is situated on a high plateau 4,000 feet or more above sea level. and the country enjoys a temperate climate with sharp differentiation between the rain season (November-April) and the dry season (May-October). Parry (1964, 1965) points out that endomyocardial fibrosis (E.M.F.) has been extensively reported from the hot, wet parts of Africa, but not from the drier or more temperate parts at the northern and southern extremeties of the continent. Brockington et al. (1967) in reviewing the cases of E.M.F. that have been reported in Europeans resident in tropical Africa, state that the disease is one of humid tropical zones in Africa and South America. Cases have also been reported from Ceylon and Malaya (Nagaratnam and Dissanayake, 1959; La'Brooy 1957) and South India and Brazil (W.H.O. Chronicle 1967). Davidson and Ross (1966) briefly described a case from the Ndola General Hospital who at autopsy. was found to have a "thin, fibrotic film covering the endocardium of the left ventricle"` and in whom, microscopically, the endocardium showed fibrosis. Davidson subsequently, (1967), stated that this case was one of E.M.F. A case of endomyocardial fibrosis proved at postmortem is described in a young Zambian African male.This is probably the first well-documented case report of the condition from Southern Africa. It is believed that the condition will not prove to be a rarity locally.
The Red Eye
(Medical Journal of Zambia., 1969-01) Phillips, C. M.
The majority of recently-qualified practitioners approach the red eye with considerable trepidation, presumably because ophthalmology occupied a small part of their training, or, more likely, that it was improbable that an `eye case' would feature in the written or clinical parts of their final examination and so could be ignored with a high degree of safety-for the student, if not for subsequent patients. Once qualified, there seems to be a marked reluctance on the part of most practitioners to close this gap in their medical knowledge. Here in Zambia it is safe to say that nearly every person develops ocular pathology at some time in his life, and I do not include errors of refraction in the category of pathology. The diagnosis of the red eye is made more difficult for the practitioner by the fact that seldom is any attempt made to take a proper history, and even less attempt to record the eye's function, i.e. to record the visual acuity. Even such basic factors as to whether the pathology was spontaneous or the result of trauma and the duration of the complaint are usually omitted. Any previous ophthalmic history, including surgery, is only recorded if the patient vouchsafes the information. I hope that no practitioner would refer a patient to a consultant surgeon with the entire contribution towards a diagnosis being "abdominal pain" or to a consultant physician with "coughing" but it is extremely common to find a patient referred to a consultant ophthalmologist with "sore eyes" "poor sight" or "bad eyes" as the total sum of symptoms and signs. It is to help the general duties Medical Officers, especially those far distant from consultant help that the following article has been prepared. Trauma as will be appreciated this covers an enormous field in ocular pathology and is extremely common. Such trauma may be from physical contact or instrumental injury such as is seen so frequently with beer hall fights, car, industrial and other accidents, burns, caustic and chemical injuries (including cobra-venom), thermal as with eclipse scotoma and abiotic as with `arc eyes'. Many of these require specialist attention, but the following are listed as frequent and/or important
A Diet Survey in Kalene Hill Area
(Medical Journal of Zambia., 1969-01) MCGlashan, N. D.
This survey of local diet was undertaken into two chiefdoms near Kalene Hill hospital during September, 1968. The inquiry was' undertaken` as a corollary to, and at the same time as, clinical studies of nutritional, state in the same areas. Special emphasis was `given to blood sugar testing in view ' of in earlier geographical suggestions that a high incidence of diabetes mellitus The area lies in the protrusion of Mwinilunga district into a bulge north-westwards between Angola and the Congo (Kiushasa) Republic. The soils are ferrallitic sandy textured sediments which have been strongly leached and have very low inherent fertility. Drainage, although locally north and west, forms the headwaters of the south and east flowing Zambezi. Watertemperatures ncar this continental water parting are cold, which accounts for the absence of bilharziasis locally. The rainy season is longer here in the extreme north-west than in the rest of Zambia, extending usually from mid-October to late April. In this period 60 inches (150cms.) of rain is received, mostly in heavy deluges.
Disseminated Cryptococcosis
(Medical Journal of Zambia., 1969-01) Bhagwandeen, S.
Infection with C. neoformans, a yeast-like fungus is being recognised more frequently than hitherto. The clinical diagnosis of Cryptococcosis is difficult. Symptoms of meningo-encephalitis are the commonest presenting feature of disseminated Cryptococcosis due to the predeliction of the fungus for the C.S.F. (Moss 1960). The disease is frequently diagnosed by the discovery of the organism in the C.S.F. Although neurological symptoms are common their presentation may be bizzare. The signs may be of meningeal irritation, a Space occupying lesion, encephalitis, hemiplegia or coma, (Aberfeld and Gladstone 1967). The case presented below is interesting as a clinicobathological correlation. The wide spread systemic dissemination of the organism in relation to the paucity of presenting signs and symptoms is alarming.
Four Cases of Extra Uterine Pregnancy
(Medical Journal of Zambia., 1969-01) Nightingale, E. A.
On 16.2.67 an African women from 140 miles away was admitted with severe abdominal pain. She appeared to be at term There was some fluid in the abdomen and the foetus appeared to be lying in the abdomen transversely. She was given a blood transfusion and lml of spinal nupercaine injected. After 5 minutes the respiration became laboured but she responded to ephedrine, adrenaline and oxygen. At operation the amniotic sac and placenta were adherent to the abdominal wall, omentum, spleen and uterus. The foetus was extracted but the haemorrhage was severe. A subtotal .hysterectomy was preformed as most of the placenta remaining was adherent to the uterus. The placental site was covered with oxycel gauze and the abdomen closed, but the patient collapsed and died. The infant weighed 7 1bs. 8ozs. It is obvious that any attempts to remove the placenta should be avoided.
Schistosomiasis Mansoni: A survey of its incidence at Luampa Hospital
(Medical Journal of Zambia, 1969-01) Henderson, A. C.
Because of the frequent finding of Schistosoma Mansoni in the stools of patients seen at Luampa Mission Hospital, it was decided to endeavour to determine the incidence of the parasite in this area. Luampa Mission is located on the Luampa River in the Mankoya District of Barotse Province, 35 miles S-W. of Mankoya Boma. The report is based on stool examinations of 436 patients picked at random from people attending the OutPatient Department between June lst and July 31st,1968. The specimens were examined by the direct smear method, and many of those proving negative were then concentrated and examined again. However few of the latter were found to be positive, and we came to the conclusion that it was not worth the extra time to repeat the examination. Also because of shortage of personnel, we examined only one specimen in the majority of patients. (Where a second or third examination was made the parasite was found in at least a few cases, justifying the assumption that the incidence in this locality is even higher than our figures show.) Urinalysis was done on most of the patients in this series, but Schistosoma Haematobium was not found in a single instance in the urine. In one patierit both S.mansoni and S. haematobium were found in the stool. (In the past two years only about 5 cases of urinary b`ilharzia have been diagnosed in this Hospital.) One patient in this series, and one seen prior to the commencement of this survey had clinical and X-Ray evidence of cor pulmonale. Both had S. mansoni. present in the stools, and enlargement of both liver and spleen. (The latter of these two was also one of the few cases of urinary bilharzia we have seen here.) 67 of the patients were children (i.e. under 15 years) and 369 were adults, of whom 265 were women and 104 men. There was an equal number of boys and girls in the series, and the incidence of positive results was approximately the same-60%. Among the adults however, there was a much higher incidence among women than among men-65 % and 43 % respectively.
Investigation of suspected Resistance of P. falciparum to Chloroquine in Zambia
(Medical Journal of Zambia, 1969-01) Wolfe, H. L.; Hudleston, J. A.
In 1967 Himpoo and MacCallum (1967) reported three cases of possible chloroquine resistance of P. falciparum in Broken Hill (Kabwe), Zambia. Although a number of such claims of chloroquine resistance in Africa have been published, a report by a World Health Organization Scientific Group (1967) on the Chemotherapy of Malaria stated that such reports are, as yet, unsubstantiated. So far, therefore, there has been no confirmed incidence of a chloroquine resistant strain of P. Faciparum in Africa. For this reason, it was decided to investigate the Suspected chloroquine resistance reported in Kabwe. This investigation has not yet been completed and it will be continued during the main malaria season 1968-1969. The aim of this paper is to present the results of this investigation during the malaria season 1967-.68.
A Surgical Aspect of Pulmonary Tuberculosis in African Children
(University of Zambia, Medical Library, 1969-01) Crawshaw, G. R.
The main purpose of this paper is to present a plea for a rational approach to hilar lymphadenectomy in the prevention of bronchiectasis, destroyed lung, emphysema and a massive tally of crippling respiratory disease. Operation should be considered at an early stage if drug therapy and physiotherapy are not clearly relieving bronchial compression or perforation by mediastinal lymph glands, either where the bronchial obstruction in itself is causing symptoms or where the resulting pulmonary lesion may be regarded as still reversible. This is an infinitely more attractive proposition to me as a surgeon than to be presented with the late effects of bronchostenosis and to be asked to salvage a respiratory cripple. I want to condemn in the strongest possible terms the indiscriminate use of drugs and bed rest in pulmonary tuberculosis when an obvious mechanical problem exists.
Symphysiotony for mild cephalopelvic disproportion
(Medical Journal of Zambia., 1970-01) Mottiar, Y.; Sarla, G.
The operation of symphysiotomy was first performed by Claude-De La Corvee in 1655 on a recently dead patient (Munro Kerr and Chassar Moir 1956). Signault (quoted by Greig 1964) performed the first modern operation in 1777 on a patient who had a true conjugate of 6.5cms., and who had had 4 previous stillbirths. He obtained a live healthy baby but the mother unfortunately suffered from a urinary fistula for the rest of her life. For the next hundred and fifty years the operation enjoyed several brief periods of popularity in Europe, but because it was performed on patients with gross pelvic contraction the inevitable urinary complications of damage to the bladder, urethra and vestibule followed.The incidence of haemorrhage and sepsis was also very high, and the operation never gained general acceptance. In 1931 Zarate (1955) revived the operation with his technique of subcutaneous, partial or intracapsular symphysiotomy. Subsequently, Spain (1949) and Barry (1950, 1952) further popularized the operation in Ireland with their open technique. Barry (1950) declared that symphysiotomy offers a cure for disproportion, not a treatment.. Crichton and Seedat (1963) exhaustively evaluated the operation as a method of managing cases of mild cephalo-pelvic disproportion and reported on 1,200 cases with excellent results.

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