Medicine

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A short term evaluation of Transurethral Ablation of the Prostate as a treatment option for Benign Prostatic Hyperplasia at the University Teaching Hospital,Lusaka
(2012-06-21) Chituwo, Omega
A prospective study evaluating the procedure, Transurethral ethanol ablation of the prostate (TEAP), as a treatment option in the University Teaching Hospital, Lusaka.Twenty-five patients from the Urology clinic, UTH, were included in the study. The patients had mild to moderate BPH, determined by symptoms and on examination. Other factors taken into consideration were in the inclusion and exclusion criteria e.g. No history of urinary retention or other related complications, pelvic surgery or trauma etc. The details of each patient were collected and included name, age, file number, date of admission, date of discharge, preoperative prostate size. IPSS, operating time, intraoperative complications, and postoperative assessment. The mean age was 68 years. Preoperatively, the patients had a mean of IPSS of 22 with a range of 18 - 25. The average operating time was ten minutes. Simple analgesia was used to relieve any discomfort postoperatively. Patients were kept overnight and discharged with a catheter. This was removed after 5 days. Two patients went into acute retention following catheter removal. They were catheterized for a further 5 days and did not develop any problems thereafter. Postoperatively, mean IPSS reduced from 18 at one month to 11 at six months indicating an improvement in symptoms of patients. Ease of voiding improved with time as was evidenced by the increase in mean peak flow rate of urine (Q-max) of 11ml/s at one month to a mean of 19ml/s at 6 months. In terms of cost, TEAP was found to be much cheaper than the traditional forms of treatment at UTH, i.e. TURP and open prostatectomy TEAP was found to be a feasible, safe and cost effective method of treating mild to moderate BPH at UTH. Guidelines for its use have been set down.
The impact of highly active antiretroviral therapy (HAART) in selected private clinics in Lusaka
(2012-06-21) Chiyenu, Kaseya O.R.
The advent of HIV/AIDS has brought pessimism to the practice of medicine, especially in the developing world. More so because of the discrepancy between the advances made in the knowledge of the biology of the human immunodeficiency virus (HIV) that causes the acquired immune deficiency syndrome (AIDS) and how far away medical science is from a cure to this deadly disease.^ But the introduction of antiretroviral therapy for the treatment of HIV infection has ushered in another dimension to the management of HIV infection. With the widespread use of highly active antiretroviral therapy (HAART) in developed countries there has been a decline in the morbidity and mortality of HIV infected patients.The management of HIV infection has fast moved from that of solely prevention to treatment. Prevention benefits only those who are not yet infected with the HIV, and those who are already infected do not benefit from prevention methods; their requirement being treatment, whether curative or otherwise, without which opportunistic infections and death are inevitable.
A Retrospective Study on the Prevalence of Breast Carcinoma in the Catchment area of the University Teaching Hospital, Lusaka
(2012-07-18) Phiri, Yotham
A retrospective study of the prevalence of breast cancer in the catchment area of the University Teaching Hospital (UTH), Lusaka (determined on the basis of the documentation available at the Hospital during a five year period) is presented. A total of 547 breast biopsies were received in the Pathology Department: Breast cancer was the commonest diagnosis with 23%, followed by fibroadenomas 22.5%, inflammatory lesions 11.3% and fibrocystic diseases 8.3%. A total of 627 patients with different cancers attended the Tumour Clinic: the commonest single diagnosis was breast cancer with 109 patients, followed by lymphomas with 70 patients. The Cancer Registry notified 1792 cancer cases and breast cancer was the fourth commonest cancer. Reference is also made to how common breast cancer is in this sub-region of Africa.
A one year study of relaparatomies at the University Teaching Hospital, Lusaka
(2012-07-18) Nthele, Mzaza
A Prospective Study Of Relaparotomies At The University Teaching Hospital (UTH), Lusaka was carried out over a period of one year ( 1^* may 2005 to 30*'' April 2006). It was aimed to establish the profile of patients undergoing relaparotomy at UTH. The study also looked at the after monitoring and related assessment and preparations and the short term outcome of relaparotomies. The inclusion criteria were all Patients undergoing relaparotomy whose indication was a complication of the first laparotomy. These were all from the general surgical units only. Planned relaparatomy e.g. removal of haemostatic pack and patients where the first laparotomy was done more than six weeks earlier were excluded from the study. The details of each patient were collected and entered on an evaluation form designed for the study. The information collected included name, age of the patient, file number, evolution of disease, physical examination, results of investigations, indication of first laparotomy, procedure, operative findings, indication for relaparotomy and outcome of surgery. Each patient was followed up for at least six weeks after relaparotomy except for those who died in less than six weeks. There were 276 laparotomies during the period of the study and 9% (25) of these were relaparotomies. 60% of relaparotomies were due to anastomotic leaks. There was no anastomotic leak that had a relaparatomy earlier than 7 days. There was 40% mortality on relaparotomies, 67% of which were secondary to Anastomotic leaks. There was a lot of standardization in the approach to patients. This includes the making of the diagnosis, resuscitative measures and the rush to operate immediately. Patients undergoing relaparotomy must therefore be adequately prepared with full investigations done. Given limited investigative facilities, the decision to go back should be as soon as suspicions are raised of complications based on clinical findings.
The pattern of heart diseases in children at the university teaching hospital, Lusaka, Zambia
(2012-07-18) Nyumbu, Mutinta M
HIV/AIDS and Adolescents:Knowledge, Attitude and Practice in secondary school Adolescents in Lusaka
(2012-07-18) Mwinga, Kasonde G
The HIV/AIDS pandemic has markedly increased the morbidity and mortality of people worldwide. In Zambia the number of cases of HIV/AIDS have been rapidly increasing, the main mode of transmission being heterosexual.In the last few years, there has been a significant increase in the number of adolescents worldwide infected with HIV. Adolescents and young adults comprise one of the fastest growing categories of AIDS cases. Half of the people with HIV worldwide are said to have been infected between the ages of 15 and 24 years. In Zambia the rates of newly acquired HIV infection are highest in the 15 to 24 year olds. Many adolescents in Zambia engage in HIV risk behaviour. Prevention of HIV/AIDS among adolescents has thus become an important public health priority. School based HIV prevention strategies have been effective in decreasing HIV risk behaviours among adolescents.In this light, a cross sectional study to evaluate the knowledge, attitude and practice of secondary school adolescents was conducted. The performance of Anti-AIDS clubs was also discussed. Data was collected using a self administered questionnaire, focus group discussions and open interviews.Quantitative data was stored and analysed using EPI INFO statistical software.From the study results, overall level of knowledge on HIV and its transmission is good. Misconceptions about HIV/AIDS transmission exist. Negative attitudes towards people with HIV/AIDS are relatively low. A significant percentage of the adolescents are sexually active and the mean age at sexual debut is 13 years. Majority of sexually active adolescents had multiple partners in the previous year. Condom use is inadequate and inconsistent. Females seemed less inclined to discuss their involvement in sexual activity than males. The chief sources of HIV/AIDS information is the media, friends and Anti-AIDS clubs. Most adolescents communicate about HIV prevention mainly with friends/peers. Anti-AIDS club membership is low and self reported benefit from club activities is poor.From the study findings it would be necessary to develop peer-led HIV education programs in schools. Improved dialogue and improved health workers input in health education is needed. HIV education should be supplemented with sustainable behavioural change strategies. Cultarally sensitive and sex specific techniques should be used to collect data on sensitive issues like sexual behaviour among adolescents. Studies to critically evaluate the impact of the present anti-AIDS strategies among adolescents should be designed.
A study of perforated acute appendicitis at the University Teaching Hospital, Lusaka
(2012-07-18) Phiri, Samuel
A prospective descriptive study of perforated appendicitis as seen at The University Teaching hospital (UTH), Lusaka, Zambia, was carried out over a period of nine months.(l^' March to 30* November 2007). The aim was to establish the appendiceal perforation rate, to describe some of the factors associated with perforated appendicitis as well as to describe the major associated early complications.The inclusion criteria were a confirmed intra operative diagnosis of perforated or non perforated appendicitis. All Patients were recruited into the study until the sample size was reached. The details of each patient were entered on an evaluation form designed for the study. Each patient was followed up for four weeks. A total of 71 appendicectomies were done. The appendiceal perforation rate was at 43.6 percent. 64.5 percent presented with generalized peritonitis necessitating laparotomy through the midline. The male to female ratio of perforation was 2.5:1. The commonest perforations were in the 30 to 40 year age group. The majority of those with perforation presented between the third and fifth days after the onset of symptoms whereas the majority of those with non-perforated acute appendicitis presented within the first forty eight hours. The main factor attributed to perforation was pre- hospital delay by the patient. 50 percent of those with perforation came from highly populated residential areas and with poor socioeconomic background and subsequent poor access to quality health care. 11 percent used traditional medicine prior to admission to UTH. There was no in-hospital delay attributed to the surgeons or surgery. Perforation was associated with high levels of morbidity with a 33.3 percent wound infection and a further 22.2 percent requiring relaparotomies for intra abdominal abscesses. The overall mortality rate was 1.4 percent.The high rate of perforated appendicitis is due to pre-hospital patients' delay, therefore, public education, specifically targeting those groups at risk, may provide a significant solution to the problem.
Mortality trends at the University Teaching Hospital over a period of 10 years (1990 - 1999 )
(2012-07-18) Nyirenda, Soka
A study on tuberculosis treatment compliance among paediatric patients in Lusaka urban
(2012-07-18) Mugala, Nanthalile
Patient non-compliance is a major cause of treatment failure in tuberculosis (TB).The rising prevalence of tuberculosis in adults is expected to be paralleled by a similar rise in children, hi Zambia, no studies have been done looking at compKance issues in children. It is with this back-ground that this study was under-taken, whose objectives were to look at factors which influence comphance with TB treatment among children in Lusaka urban. And at the same time to have an idea of the organisation of the TB comers in the various clinics.The study was a descriptive cross sectional survey which was carried out by use of a questionnaire which had previously fixed response options in order to identify possible factors related to compliance. A check Ust was also filled in after interviewing the health workers at the TB comers looking at overall organisation of the TB comers. This study was carried out in 12 of the 22 clinics in Lusaka urban. All children who had received 75% or more of expected treatment were considered compUant.Overall, comphance was 88.6%.Comparatively lower compUance rates were associated with care-givers who lived far fi-om the health centres, had more than two children below five years in the household, did not think that TB could be cured, sought help elsewhere before bringing the child to the hospital and did not think the health workers were friendly.Some of the "comphanf patients as per study definition were on an incorrect treatment regimen or incorrect dosage for weight.None of the clinics practiced directly observed therapy short course (DOTS) as per WHO definition. The TB comers were being managed by health persormel without specific training on TB management.The findings in this study indicate that compliance with TB treatment in children as defined by this study was good but there is need to look at other aspects of comphance such as dosage for weight and treatment regimen. Operational factors such as distance to the health centres and attitudes of the health personnel need to be assessed. There is also need to improve awareness of TB cause, signs and symptoms, treatment and outcome among care-givers. Community based DOTS is the best option for our environment.
Factors affecting Voluntary Blood donation in Zambia
(2012-08-03) Kongwa, Patricia Namukolo Mutumba
The study attempted to investigate those factors that affect voluntary blood donation - in relation to the supply of a safe and adequate blood to hospitals in Zambia. A'cross sectional survey of a systematic, randomly selected, secondary school students, was done using a self administered questionnaire. A self administered questionnaire was also used to inquire about the prescription and use of blood among doctors working in four major hospitals in Zambia. Discussions were held with blood bank staff in the four hospitals using the Focus Group Discussion model.In all,165 students, 16 prescribers and 14 blood bank staff, from Lusaka, Livingstone,Kitwe and Ndola cities were included.The outcome of the study showed that:The fear of the HIV test discourages people from voluntarily donating blood.The lack of a blood donor recruitment programme has had an adverse effect on voluntary donations. Lack of knowledge in communities on blood donation adversely affected voluntary blood donation. The supplies of blood to the hospitals were inadequate.
Outcome of Surgery in HIV-positive and negative patients; a general comparative study
(2012-08-15) Mugala, Duncan Dan
There have been anecdotal reports that patients who a;'e infected with the human Immune Deficiency Virus (HIV) do not fare well when they undergo surgery (Gkong 1988). Clinical experience in the University Teaching Hospital Lusaka seems to support this (Watters 1988), especially in orthopaedics where a rather high rate of late post operative i«nfection nas been noted; particulary in those patients with surgical implants (Jellis 1988). •Studies documenting the morbidity after surgery on asymptomatic HIV-positive people-are, however, nard to come by {Greene 1990 ).In Africa, changes in the presentation and behaviour of common diseases are being seen. Complication patterns are also changing due to infection with HIV. Entirely nev^ syndromes are appearing. Several important changes are being recognised. (Bayley 1 990) Some of these are;a. Increased incidence of sepsis arising spontaneously or as a complication of elective surgery: A study done by D.A.K. Watters in 1987 and 1988 showed; that out of 65 patients admitted to the I.C.U., 29 (44%) were HIV-positive in contrast to 13% of the 70 patients admitted to the unit during the same period for obstetric problems (Watters 198S). The difference was statistically significant. The outcome of surgery was worse in the HIV-positive group, of whom 65% died compared to the HIV-negative group with a mortality of 42%. The difference was not however statistically significant.b.Impaired wound healing. This is largely an anecdotal observation, and nt)t all surgeons agree that HIV disease impairs wound nealing (Bay ley 1990; Wakeman 1990). It has been noted however that HIV patients have a higher tendency to wound dehiscence and may develop pressure sores usually after a short period of confinement to bed (Bay ley 1990).In the United Kingdom, the most frequent reason for surgical referral of HIV-positive patients is anorectal disease (Miles 1990). In our setting the whole spectrum of surgery appears to be affected by HIV infection (Bayley 1990).
A study on malaria control measures among community members in Lusaka urban
(2012-08-15) Sikazwe, George Mweupe
Malaria is an illness caused by Plasmodium of the falciparum, maiariae, vivax and ovale species. 90% to 95% of the malaria cases occurring in Zambia are due to Plasmodium falciparum. The malaria parasites are transmitted by the vector mosquito. The important malaria vectors in Zambia are Anopheles gamibiae, anopheles Arabiensis and Anopheles funestus, all these are fresh water breeders (Bransby - Williams, 1979). Approximately 500 million cases occur worldwide per year. 90% of these happen in Sub-Saharan Africa. On the Zambian scene, the disease has been identified as one of the leading cause of both morbidity and mortality. By 1999 the incidence rate for malaria was 308.4 per 1,000 people. While the fatality rate among those admitted to health centres and hospitals was 51.3 per 1,000. Malaria has also been documented as the most common cause of both outpatient attendance and hospital admission in all age groups. Figures for 1999 show that 35.1% of total health centre admissions were due to malaria. The disease affects all age groups but is mot serious among younger children and pregnant women.It has been suggested that community involvement and their full participation would provide a solution to bringing the vexing problem down. The questions therefore are, what does the community l
Community perspectives towards mandatoty testing for HIV in Macha
(2012-08-15) Sitali, Doreen Chilolo
Zambia's national HIV policy does not support mandatory testing of individuals on public health grounds. However, due to the low uptake of voluntary counseling and testing which is only 20% of the population, there have been recent proposals by the Ministry of Health to introduce mandatory HIV testing for individuals attending health facilities. This proposal has triggered various views from various backgrounds in society. The aim of this study was to explore community perspectives on mandatory testing. The study also'acted as a model through which the community was involved in decision making for public policy which is an important aspect of community involvement that enhances policy formulation and helps to avoid social engineering.The study was a cross-sectional descriptive design. The study used both qualitative and quantitative approaches. Multistage sampling was used to select households for interviews. Adults above 18 years, of age were interviewed from the selected households using a structured interview questionnaire. The questionnaire was translated into the local language to enhance understanding of the subject. Purposive sampling was instituted to select key informants for in-depth interviews. The study was undertaken within the Diffusion of Innovation Theory. The theory enhances understanding of the factors that influence ccJmmunities to embrace new ideas or practices.Quantitative data was analyzed using SPSS version 16 for windows. Preliminary analyses were done followed by cross tabulations to measure associations between variables. Logistic regression was applied to determine independent predictors for supporting mandatory HIV testing. In-depth interviews were translated and transcribed into computer files; common themes were identified, after which data was categorized using the Nvivo statistical package. Interpretation of qualitative data was done manually.A total of 809 respondents and 12 (twelve) key informants participated in the study. The age range for the cohort was 18-80 years, with mean age of 35.8 years. Of the whole study population, 42.8% were males while 57.2% were females. The study found that the majority of respondents (61.9%)) had never heard about mandatory HIV testing before. Despite this scenario, the majority (80.3%) of respondents and all the key informants supported the policy. Furthermore; most (89.5%) respondents indicated that they would accept to be tested without consent if they were to be hospitalized. Support for the policy was on the premise that the community has realized the importance of HIV testing as an entry point to HIV care, treatment, and support. Concerning issues of stigma and discrimination it was found that the majority of respondents (76.2%) felt that this is likely to reduce if mandator^^ HIV testing is introduced. In -depth interviews revealed that stigma and discrimination in the community had tremendously reduced due to increased awareness of HIV disease and the introduction of ARV's.The study established that while 52.6% of the cohort thought that mandatory testing is not a violation of human rights, 47.4% felt so. The majority of respondents (71.8%) indicated that they still valued their right to privacy and autonomy, although they were ready to forego the same for the sake of knowing their status. Prior knowledge about the policy and relative advantage were found to be very significant independent predictors for supporting mandatory HIV testing. It was found that those who had heard about the policy before were 1.5 times more likely to support the policy than those who had not (p value 0.044). On the other hand, those who thought that the policy will offer more benefits than risks were ten times more likely to support the policy than those who thought otherwise (p value 0.001). The study established that the cornmunity was in support of mandatory HIV testing policy. It was also established that the commun|ty had realized the vital role that testing plays in accessing HIV care and treatoient and was more willing to be tested. However, issues of human rights are still debatable and need to be explored more in the light of the new policy. Furthermore, it has been established that the community had began to respond more favorably to testing using other strategies such as mobile VCT which need to be strengthened. It was also evident from the study that the poor response to VCT is not exclusively due to fear of being tested but largely due to the African culture of not wanting to be screened when one is not sick. This therefore explains why there was an increased response to mobile VCT.lt is therefore evident that strengthening mobile VCT and increasing access to testing centers can significantly increase uptake of testing in the communities. Sensitization of communities is also key in increasing awareness and changing attitudes towards HIV testing and reducing stigma and discrimination.
Factors influencing use of traditional medicine to precipitate labour by antenatal mothers in Mpika District
(2012-11-15) Bwalya, Pearson
Reproductive Health is becoming a great concern to consumers of services, health care providers and policy makers. This is because of the escalating maternal morbidity and mortality some of which can be prevented through consented efforts. Use of herbs to precipitate labour is common especially in rural areas and in most cases may lead to complications like ruptured uterus, severe hemorrhage, birth asphyxia, still births, fetal and maternal deaths (WHO, 1993). The study sought to identify factors influencing use of Traditional Medicine to precipitate labour by antenatal mothers in Mpika District. The research hypothesis was that Antenatal mothers use Traditional Medicine to precipitate labour because of inadequate knowledge on progress of normal labour and dangers of using the herbs. A descriptive quantitative and cross sectional survey was used. A pilot study was conducted at Chilonga Mission Hospital in Mpika District. The research was conducted in five centres within Mpika District which is situated in Northern Province of Zambia and the centers were selected by random sampling. A sample of fifty (50) antenatal mothers attending antenatal clinics from the five health centres was randomly selected. A structured interview schedule was used to collect data which was analyzed manually by using of a scientific calculator. The findings of the study showed that 30% of the respondents have had used herbs to precipitate labour before, 68% knew someone who have had used the herbs to precipitate labour and 44% said they wouldn't tell a health personnel when asked whether they have used the herbs. Of the respondents who had used the herbs, 80% used the herbs to precipitate labour and 53.3% had a quick delivery. The study further revealed that respondents who had low levels of knowledge on labour were more likely to use the herbs. Out of 15 respondents who used the herbs, 53.3% had low level of knowledge on normal labour. The study revealed an association between distance to the health facility and use of herbs. Majority (86.3%) of the respondents who used herbs had to take more than half an hour to reach the nearest health facility. The study further revealed that there is an association between attendance of health talk on normal labour; dangers of using herbs and actual use of herbs. Out of 15 respondents who used the herbs, 60% did not attend any health talk on normal labour and dangers of using herbs respectively. The study findings further showed that there is a relationship between cultural background and use of herbs. Majority (80%) of respondents whose culture encourages use of herbs actually used the herbs.
A study to determine the factors associated with underutilisation of postnatal care services among postpartum women in mazabuka district.
(2012-11-15) Jacobs, Choolwe Nkwemu
The postpartum period constitutes a critical period for the mother and her newborn, during which physiological and emotional adjustments take place. Postnatal period covers the six weeks after delivery. During this period care is provided to the mother and her newborn so as to promote health behaviors and identify and manage complications, if and when they arise. Immediate postpartum care can detect and manage problems arising after delivery, such as haemorrhage, infections and problems with breastfeeding. The highest maternal and infant morbidity and mortality occur during the post maternal period. It is assumed that this is due to underutilization of postnatal care services hence this study is being undertaken. In its effort to reduce this problem of underutilization of PNC services, the MOH has put in place several activities aimed at improving the Reproductive health Programme so as to reduce the maternal mortality rate in line with the Millennium Development Goals. It has, however, been noted that postnatal care is being underutilized in Mazabuka district. The aim of this study was to determine the factors associated with underutilization of postnatal services among puerperal women in Mazabuka district. The literature review of relevant studies was done on a global, regional and on a national level. The studies show that poor socio economic status, inadequate health centers and ineffective interventions, traditional practices, lack of women empowerment, geographical disadvantage (the hard to reach areas) inadequate knowledge are some of the factors influencing low utilization of PNC services. The study was conducted at Mazabuka District Hospital and Research Urban clinic. It was a non-experimental descriptive, explorative and non-interventional study. The respondents were chosen using simple random sampling technique. Data was collected from 50 mothers (25 from each health facility) who attended under five children's clinic. A structured interview schedule was developed for data collection from the mothers and data analysis was done manually using a data master sheet and a scientific calculator. The findings from this study revealed that several factors are associated with the underutilization of the postnatal care services. Some of these factors include inadequate information education and communication, some traditional beliefs and cultural practices of the mothers and poor attitude of nurses towards the health services. However, there are several other factors which influence the women's ability to utilize postnatal care services, these are the age of the women, the parity, educational level and the socio economic status.
A study to determine the attitudes of women in the child bearing age towards voluntary HIV testing in lusaka urban.
(2012-11-28) Anaba, Ellen
The aim of this study was to determine the attitudes of women in the child bearing age toward voluntary HIV testing which is one of the prophylaxis measures in the transmission of HIV to unborn children. The study was descriptive in nature. Data was collected using a structured interview method from a sample of 50 women who came for services at the MCH unit of the health centre. The study revealed that there was high acceptance rate 37 (74%) of the women who were willing to have an HIV test. The main determinants for this acceptance was their concern for the future of their families i.e. that knowing their HIV status will help them plan for the future of their families. Fear of the stress due to positive HIV results was the main factor found to prevent women from Volunteering to have HIV testing. The following recommendation were made:- 1. Strategies to be developed to improve the acceptance rate for voluntary HIV testing especially in high risk groups. 2. Increase the accessibility/availability of HIV Counselling services to expel fears towards HIV testing. 3. Coordinate the activities on voluntary HIV testing. 4. Further work in this area to include larger sample studies of women from both urban and rural areas and women from different socio-economic, occupational and educational backgrounds.
Effect of party, maternal age and pre-eclampsia on birth weight .
(2012-11-28) Anim, Mamle
A case control study was carried out in Lusaka to find the effect of parity, maternal age, pre-eclampsia and its severity on birth weight. 100 pre-eclamptic cases were selected from University Teaching Hospital, department of Obstetrics and Gynaecology. 200 controls were selected from Chilenje Clinic, a peripheral Clinic in Lusaka. All samples were randomly selected. Average birth weight for this study was 3.233kg. This was the average birth weight for controls. From this study it was shown pre-eclampsia reduces the average birth weight of a child. Average birth weight for cases was 2.9521kg and that for controls was 3.2136kg. The difference was significant (P value>0.05). Average birth weight for mild pre-eclampsia cases was 2.978kg, for moderate was 3.016kg and severe was 2.850kg. These values were not significantly different. Average birth weight increased with maternal age but the differences were not statistically significant. Ideal maternal age for ideal average birth weight was the 20-29 year group. Birth weight increased with parity. The ideal parity for ideal average birth weight was Para 2 and Para 3.
Effect of Bacteraemia and HIV infection on treatment outcome in children with severe acute malnutrition admitted to the University Teaching Hospital Malnutrition Ward, Lusaka, Zambia
(2013-01-09) Mwambazi-Mweene, Mwate
Background:Severe malnutrition remains a major cause of mortality in children less than 5 years at the University Teaching Hospital, with rates ranging between 30-40 % among patients admitted in the malnutrition ward. The effects of bacteraemia and HIV infection on outcome to treatment remain unknown. Objective:To establish the magnitude of bacteraemia and HIV infection in children with severe acute malnutrition (SAM) admitted to the Zambian University Teaching Hospital (UTH) malnutrition ward, describe the types of bacteria and antimicrobial sensitivity, and effect on treatment outcome. Method: Children admitted to the malnutrition ward at the UTH from August to December of 2009 were included in the study after acquiring informed consent. Data on nutritional status, social demographic factors and admission medical conditions were collected. In addition blood sample was collected from every child. Identification of positive culture yielding pathogenic bacterial strains were done using BACTEC machine, and completed with morphologic and biochemical tests. Antibiotic susceptibility tests were performed using Kirby-Bauer susceptibility testing method. Results: Data were collected from 441 children aged six to 59 months old, 55.3% (244/441) of whom were boys. Median age of the cohort was 17 months (inter quartile range, IQR 12-22). 68.9% (295/428) had edema at admission; 57.4% (247/430) had weight for height Z score < -3SD at admission. The majority, 67.3% (261/388) of the children presented with diarrhea. 38.9 % (162/420) tested HIV-positive; 21.4% (91/425) of the children had one or more bacteria isolated from their blood samples; 40.5% (174/430) of the children died. The predominant organisms isolated were Coagulase negative Staphylococcus (20.7%), E. coli (15.5%), Staphylococcus aureus (15.5%), Salmonella (12.1%,), Pseudomonas (8.6%), Diphteriods (6.9%) and Klebsiella pneumonia (6.9%). Crystalline Penicillin had 85.7% (12/14) resistance; ranging from 66.7% to S.Aureus to 100% to E.coli and klebsiella. Gentamycine had 23.6% (5/19) resistance; ranging from 0% to E.coli to 100% to Klebsiella; Ciprofloxacin had 27.9% (13/43); ranging from 0% to Salmonella, Klebsiella and Psuedomonas to 55.6% to E.Coli. HIV positive children had increased odds of mortality, adjusted 0R= 1.70 (95% CI 1.04-2.83, P=0.04). Children with bacteremia had increased odds of mortality compared to those with no bacteremia, adjusted OR=1.90 (95% CI 1.04-3.40, P=0.04). There was no interaction between bacteremia and HIV infection on outcome (P=0.77). Conclusion: SAM children admitted in UTH suffer from high prevalence of bacteremia on admission. This has increased their odds of death by almost two folds regardless of their admission nutritional status, diarrhea, age, sex, and HIV status. The baseline mortality and HIV prevalence in the malnutrition ward was higher than other similar studies. The drug resistance, to first line antibiotics mainly to penicillin, calls for an in-depth review of drug management.
Knowledge and attitude of antenental mothers towards danger signs in pregnancy in lusaka urban
(2013-02-19) Banda, Jeane Ngala
The main objective of this study was to determine the knowledge and attitude of antenatal mothers towards danger signs in pregnancy in selected Lusaka Urban clinics. The major hypothesis for this study was inadequate health education on danger signs in pregnancy may contribute to women being unaware on the danger signs in pregnancy. A descriptive, non interventional, cross section study design was used to determine the levels of knowledge and attitude of pregnant women towards danger signs in pregnancy. Data was collected using a structured interview schedule from 50 respondents. The study populations consisted of women attending antenatal clinic at five selected health centers. The sampling procedure involved the use of purposive sampling in choosing the five antenatal clinic and simple random sampling for choosing the 50 respondents. The study results revealed that (50) 100% of respondents participated in the health education during antenatal clinics but only 18% were taught on the danger signs in pregnancy .It further revealed that 80% of the respondents who had low educational level had inadequate knowledge on the danger signs. Despite the respondents having inadequate knowledge on the danger signs in pregnancy, the study revealed that 83.3% had positive attitude towards danger signs in pregnancy as they indicated that they would seek help from the clinic if they experienced any danger signs in pregnancy. The study further revealed that out of the 46% who indicated that they got the information from the Community Health Workers 44% had inadequate knowledge on the danger signs and 2% had moderate knowledge. There was a relationship between inadequate IEC given on danger signs in pregnancy contributing to inadequate levels of knowledge on danger signs in pregnancy (the P-value was 0.041). However, there was no relationship between the low educational levels of antenatal mothers and low levels of knowledge on the danger signs in pregnancy (the p-value was 0.995). Recommendations have been made: Ministry of Health should ensure that Community Health Workers are trained or offered with refresher courses on the danger signs in pregnancy. Lusaka Health District Management Team should intensify awareness programs on the danger signs in pregnancy with some modification in the presentation of information by use of pictures, also use of language that the women will understand.
Knowledge and practice of midwives in management of eclampsia in chipata district
(2013-02-20) Banda, Esther Namwaba
Eclampsia is the new onset of convulsions during pregnancy. The midwife is in a unique position to identify those women with a predisposition to pre-eclampsia which is a precursor to eclampsia. The purpose of the study was to determine knowledge and practice of midwives in management of eclampsia in Chipata Urban District. The major hypothesis was that "there is a relationship between knowledge and practice of midwives in management of eclampsia". A cross sectional, quantitative study design was used. The study population included midwives working at Chipata General Hospital and five (5) health centres that were conveniently selected. A sample of 50 midwives was purposively selected from the study setting. Data was collected using a self administered questionnaire. Data was analysed manually using single counting and a scientific calculator. Data from this study was presented according to the sequence and sections in the questionnaire. The findings of the study were presented in frequency tables, pie charts, histographs and bar charts to illustrate principal findings of the study to the reader. Cross tabulations of the variables helped to show clearly the relationship between demographic data and knowledge as well as demographic data and practice. The study revealed that midwives who were working at the hospital had high knowledge levels and were competent in management of eclampsia than midwives working at the clinics. The study further revealed that enrolled midwives had high levels of knowledge and were well competent in management of eclampsia as practice levels was excellent as compared to registered midwives. While 70% of respondents had high levels of knowledge, only 40% of respondents knew the steps to take when managing eclampsia. The study also revealed that magnesium sulphate the drug of choice in management of eclampsia was not always available in the hospital/clinic. Only (48%) of the respondents were testing urine for pregnant women while (52%) were not. The study revealed that only (8%) of the respondents had urinalysis reagents always while (92%) had them sometimes, rarely or never. The study therefore concludes that there is a relationship between knowledge and practice in management of eclampsia as evidenced by the majority (80%) of respondents who had high knowledge levels and also were competent in management of eclampsia as they had excellent practice levels.

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