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    Zambia abortion survey report : incidence and determinants of abortion in Zambia.
    (Golden Touch Graphical Printers, 2009) Likwa, Rosemary Ndonyo
    Abortion remains the major risk factor to maternal morbidity and mortality in many parts of Africa and more so in the Zambian situation, even though the level of its incidence is still uncertain. Despite Zambia having the most favourable and liberal abortion law in Africa, morbidity and mortality that have accounted for unsafe abortion remain a major reproductive health challenge, demonstrating gaps in application of abortion law compounded by institutional and socio-cultural barriers, as social norms of Zambian societies. The purpose of a national abortion survey in Zambia was to estimate abortion incidence ratio rate and examine its determinants in order to better understand the magnitude of unsafe abortion and seek further approaches for improving safe abortion services and other related reproductive health services in the country. Specifically, it involved collecting annual abortion data, from June 2008 to May 2009 in major referral hospitals, alongside determining abortion complications by demographic characteristics in relation to age, education, occupation, marital status, religion, parity and method used for abortion over a period of six months. The other objective was to examine the mode of abortion practice and its occurrence by type of abortion complications, as whether legal, unsafe (illegal practice), or spontaneous abortion prevalent at the health facilities. Aretrospective cross sectional hospital-based survey was conducted to review 4174 abortion case records over a period of six months, January to June 2009, in four major hospitals of Kitwe Central, Ndola Central, University Teaching Hospital (UTH) and Kabwe General Hospital in three provinces of Lusaka, Copperbelt and Central. These study sites were selected purposively on the basis of population concentration and serving as major referral hospitals in the country. A ratio estimation of abortion incidence rate was applied to the annual abortion data for June 2008 to May 2009 estimated on the basis of annual expected pregnancies for 2009. Other measures included demographic characteristics and abortion status in relation to its classification as, legal termination of pregnancy (TOP), unsafe abortion (Illegally induced), or spontaneous, method used for abortion and parity as main variables. A record review checklist was used to collect all abortion data. Data were analyzed by SPSS statistical package for descriptive statistics and statistical tests for associations in the occurrence of abortion and its characteristics, method used and parity. The findings show the abortion incidence ratio rate of 12.3 percent per 100 live births of expected annual number of pregnancies for 2009 for the three provinces. There are greater significant associations in the prevalence of abortion with education, marital status, occupation, religion, parity, methods used for abortion and type of health facility (pvalue< 0.000- 0.001), which determines the extent to which abortion affects women in Zambia. Age was not found significantly statistical difference in its association with the prevalence of abortion (pvalue > 0.558). However, abortion affected all age-groups of women in the age range from 10 to 49 years, with a mean of 26.29 years, even though there were some variations in the distribution of abortion incidences according to their age-groups. Significant differences were also observed in the practice of legal abortions (2.5 percent) and those presenting with complications of unsafe abortion and spontaneous abortions as incomplete abortion accounting for 92.4 percent (pvalue < 0.000). Mortality is highest in Ndola Central (45.5 percent) followed by Kitwe Central (27.3 percent) than UTH and Kabwe General Hospital with limited figures, giving the overall percent of 0.3 percent of all abortion deaths. More women are surviving from the risk of abortion morbidity in Zambia. Use of MVA is found highly significant in reducing abortion mortality at health facilities. The findings suggest greater unmet needs for family planning and safe abortion services directing to improvement in family planning programme, policies and future innovation research approaches including the effective process of monitoring and evaluating abortion trend and strategies alongside strengthened health information system are imperative. Abortion is a highly risk factor to morbidity more than mortality which directs to better effective preventive measures of unwanted pregnancies than reliance on case management strategies of abortion care.
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    Tafenoquine: A New 8- Aminoquinoline
    (Zambian Medical Association, 2009) Prashar, Lavina; Paul, Ravi
    Malaria remains one of the major health hazards, with high associated morbidity and mortality in addition to having a crippling effect on the economy. Worldwide, malaria is the cause of morbidity in 300- 500 million people annually, out of whom, 2-3 1 million die . The disease is endemic within most tropical and subtropical regions of the world but 90% of all malaria deaths currently occur in Sub-Saharan Africa. In Africa, official figures show that a child dies of malaria every 45 seconds and the disease is 2 responsible for 20% of all childhood deaths . In Zambia, an estimated 3 million cases are said to occur every year and in the year 2006, the estimated 3 number of deaths because of the disease was 6,484 .The parasites responsible for malaria include P. falciparum, P. vivax, P. ovale and P. malariae. P. vivax and P. ovale exhibit the exoerythrocytic stage responsible for relapses, but of critical importance in Sub-Saharan region is P falciparum.
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    Abortion statistics in Zambia: ‘implications for unsafe abortion, reproductive health programming, policy and research approcahes’.
    (Zambia medical journal, 2010) Likwa, Ndonyo, Rosemary
    Zambia has a liberal abortion law for termination of pregnancy on medical and social grounds for over three decades. Yet, it still faces serious consequences of increased morbidity and mortality associated with unsafe abortion. The extent of its national incidence remains unknown. There are substantial differences evident between legal abortions and illegal (unsafe) abortions demonstrating gaps in under reporting of abortion incidence which may require further estimation. Compiling Zambian abortion statistics as “research in brief” was essentially needed to provide direction to national abortion incidence measurements in Zambia, more strengthening of reproductive health services, possible review of policies and seek opportunities for further research approaches for understanding the magnitude of abortion problem and the means to prevent unsafe abortion occurrences. Thus contributing to reduction in abortion related morbidity and mortality in the country. An explorative descriptive survey was carried out in five (5) major hospitals to collect abortion statistics using a checklist tool for record review by the principal investigator with the assistance of five Ministry of Health professionals designated in these hospitals. Analysis employed aggregation compilation of annual abortion statistics collected from three (3) major tertiary hospitals and two (2) general hospitals for a period of nine years, 2000-2008 in five urban districts of four (4) provinces of Zambia. Analysis further involved application of descriptive statistics and significant tests, trend analysis and incidence rates A total number of 115886 abortions collected from five major hospitals in four provinces of Zambia over a period of nine (9) years, 2000-2008, show a varied distribution of 616 (0.5 %) for safe induced abortion, legally terminated pregnancy cases and 66687 (57.5%) abortion admissions with complications. Out of this figure, 474885 cases received post abortion care involving manual vacuum aspiration procedure (MVA) translating to over 70 percent of abortion complications had MVAs which reflect the extent of unsafe abortion exposure to Zambian women. Abortion morbidity and consequences of mortality are high and increasing in trend giving six per thousand women die of abortion complications, most likely due to unsafe, induced abortion. Access to safe induced abortion in major hospitals is quite low, yet Zambia has a liberal law for a termination of pregnancy on health and social grounds. IMPICATIONS: Abortion statistics show their relevancy for developing research priorities, policy review, reproductive health services to intensify abortion advocacy on its consequences, access to safe abortion care and contraception to prevent unwanted pregnancy. KEY WORD (S): Abortion statistics/ unsafe abortion/ abortion complications/ mortality/ post abortion care/ legal abortion/law/Zambia
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    Abortion statistics in Zambia: ‘implications for unsafe abortion, reproductive health programming, policy and research approaches’.
    (Zambia medical journal, 2010) Likwa, Ndonyo, Rosemary; Biddlecom, Ann; Ball, Haley
    Zambia has a liberal abortion law for termination of pregnancy on medical and social grounds for over three decades. Yet, it still faces serious consequences of increased morbidity and mortality associated with unsafe abortion. The extent of its national incidence remains unknown. There are substantial differences evident between legal abortions and illegal (unsafe) abortions demonstrating gaps in under reporting of abortion incidence which may require further estimation. Compiling Zambian abortion statistics as “research in brief” was essentially needed to provide direction to national abortion incidence measurements in Zambia, more strengthening of reproductive health services, possible review of policies and seek opportunities for further research approaches for understanding the magnitude of abortion problem and the means to prevent unsafe abortion occurrences. Thus contributing to reduction in abortion related morbidity and mortality in the country. An explorative descriptive survey was carried out in five (5) major hospitals to collect abortion statistics using a checklist tool for record review by the principal investigator with the assistance of five Ministry of Health professionals designated in these hospitals. Analysis employed aggregation compilation of annual abortion statistics collected from three (3) major tertiary hospitals and two (2) general hospitals for a period of nine years, 2000-2008 in five urban districts of four (4) provinces of Zambia. Analysis further involved application of descriptive statistics and significant tests, trend analysis and incidence rates A total number of 115886 abortions collected from five major hospitals in four provinces of Zambia over a period of nine (9) years, 2000-2008, show a varied distribution of 616 (0.5 %) for safe induced abortion, legally terminated pregnancy cases and 66687 (57.5%) abortion admissions with complications. Out of this figure, 474885 cases received post abortion care involving manual vacuum aspiration procedure (MVA) translating to over 70 percent of abortion complications had MVAs which reflect the extent of unsafe abortion exposure to Zambian women. Abortion morbidity and consequences of mortality are high and increasing in trend giving six per thousand women die of abortion complications, most likely due to unsafe, induced abortion. Access to safe induced abortion in major hospitals is quite low, yet Zambia has a liberal law for a termination of pregnancy on health and social grounds. IMPICATIONS: Abortion statistics show their relevancy for developing research priorities, policy review, reproductive health services to intensify abortion advocacy on its consequences, access to safe abortion care and contraception to prevent unwanted pregnancy. KEY WORD (S): Abortion statistics/ unsafe abortion/ abortion complications/ mortality/ post abortion care/ legal abortion/law/Zambia
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    A Preliminary Study of Knowledge, Attitude and Practice of Adverse Drug Reaction Reporting in a Teaching Hospital in Lusaka, Zambia
    (Zambian Medical Association, 2014-12) Prashar, Lavina; Musoke, Pamela
    Objectives of the Study: The study was aimed at examining ADR reporting practices and barriers among medical doctors, pharmacists, nurses, clinical officers, and medical residents at the University Teaching Hospital, Lusaka, Zambia. The specific objectives were: a) to assess the knowledge of ADR reporting among health professionals, b) to assess attitudes of health professionals towards ADR reporting, and c) to assess the practice of ADR reporting among health professionals. Materials and Methods: The study adopted a questionnaire-based cross-sectional method. One hundred and forty questionnaires were administered to health professionals working at the University Teaching Hospital, Lusaka. Statistical Analysis Used: The Statistical Package for the Social Sciences (SPSS) version 20 was used to run various descriptive statistics and to draw charts. Pearson's Chi-square test was used to observe the association of knowledge and attitude with experience and position, at significance level of 0.05. Results: One hundred and twenty-eight questionnaires were successfully filled in and returned, giving a response rate of 91.4%. Knowledge of ADR reporting among the professionals was extremely very low. Only one respondent obtained 50% of the total scores, i.e. 19 marks out of 34 marks; and no respondent got above 50%. The minimum score obtained was 0, the maximum score was 19, and the average score was 12.6 with a standard deviation of 3.555. There was no association between knowledge level of ADR reporting and age of the respondent (r=0.003 (n=123); p=0.973). Furthermore, there was no association between knowledge levels of ADR reporting and length of respondents' practice at UTH (r=0.013 [n=120]; p=0.886). Low knowledge levels of ADR reporting were attributed to lack of training. Only 17.7% of respondents had been trained in ADR reporting. The major factors that encouraged ADR reporting included: if the reaction was serious (84.7%); if the reaction was unusual (77.4%); if the reaction was to a new product (73.4%); if the reaction was well recognized for a particular drug (60.5%); and confidence in diagnosis of an ADR (46.0%). Factors that discouraged ADR reporting included: lack of feedback (73.5%); the level of clinical knowledge to decide whether an ADR had occurred (49.0%); lack of time to actively look for ADRs (46.9%); the information reported may be wrong (37.8%); lack of time to fill in a report (36.7%); and lack of need to report a recognized ADR because it will make little difference to knowledge (30.6%). Very few (12.7%) respondents had reported an ADR case. The major factors found to be responsible for under reporting of ADR include ignorant of reporting procedures (52.0%), lack of reporting forms (31.8%), and lack of appreciation of the importance of ADR reporting. Conclusion: This study observed that knowledge of ADR reporting was very low among health professionals at UTH. These deficiencies in knowledge and attitudes require urgent attention not only to improve the rate of ADR reporting, but also in order to improve the safety of the patients. Furthermore, the hospital management should improve awareness and training on ADR reporting
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    Physiological response of uterine muscle to Steganoteania araliacea in rat models
    (RA Publications, 2015-01) Prashar, Lavina; Lukubi, Lwindi; Goma, Fastone; Mushabati, Festus; Choongo, Kennedy
    The bark root of Steganotaenia araliacea Hochst (Umbelliferae) nicknamed “herbal pitocin” is used in the traditional circles in Zambia to induce and/or enhance labour. This work was aimed at investigating the contractile stimulatory effects of the aqueous extracts of Steganotaenia araliacea (SAEª) on isolated smooth muscle preparations of the rat uterus. Objectives: To determine the physiological effect of SAEª on isolated pregnant and non-pregnant uterine muscle. Methods: A gravid/non-gravid rat was sacrificed by cervical dislocation (decapitation) method and the abdomen opened to expose the internal organs. The two uterine horns were identified, dissected out and transferred to a dish containing De Jalon’s physiological solution. Acetylcholine (Ach) and Oxytocin (OT) were used as reference agonist with their corresponding antagonists; atropine (AT), and indomethacin and salbutamol (SBM) respectively. The effect of these reference agonists with their corresponding antagonist and that of aqueous extract of SAE on non-pregnant rat uterus pre-treated with 1 mg/kg stilboesterol for 24 h and on the pregnant rat uterus were investigated. Results: In vitro studies of SAEª on uterine tissue showed contractile (uterotonic) activity on both isolated gravid and estrogenized non-gravid rat uterus at the concentration shown in this study. SAE ª significantly increased the amplitude(from baseline value of 0.1471mN to 0.3003mN) and frequency of spontaneous uterine contractions. However, SBM significantly inhibited (p < 0.05) the frequency and amplitude of spontaneous uterine contractions on the isolated pregnant and non – pregnant rat uterus preparations but atropine and indomethacin could not modify the contractions produced by SAEª, hence indicating a non-muscarinic and non-prostaglandin biosynthesis dependant respectively. Conclusion: The inhibition of contractile effect of the crude aqueous extract of SAEª shown by Salbutamol (p < 0.05) suggests the probable stimulation of the Oxytocinergic receptors of the uterus by the extract. These physiological finding justify the traditional use of the plant for its uterotonic properties.
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    The Effect of Kigelia africana Fruit Extract on Blood Glucose in Diabetes Induced Mice
    (RA Publications, 2015-09-20) Prashar, Lavina; Muyenga, Tumelo; Bwalya, Angela Gono; Muungo, L.T.M
    To determine the effect Kigelia africana fruit extract has on blood glucose levels of diabetes mice and its phytochemical profile Mice were induced with diabetes using Alloxan monohydrate 90mg/kg. Blood glucose was checked before induction and 72 hours after induction to confirm diabetes. Treatment involved using oral administration of Kigelia fruit extract 1000mg/kg, Kigelia fruit extract 500mg/kg, Glibenclamide 0.25 mg/kg, Kigelia fruit extract 500mg/kg and Glibenclamide 0.25mg/kg and Normal Saline.The results showed a greater reduction in blood glucose of mice after treatment with Kigelia extract 1000mg/kg compared to Kigelia 500mg/kg [(5.3 +/- 0.5mmol/l) vs (6.3+/- 0.6mmol/l), (p= 0.005)]. Further, Glibenclamide 0.25mg/kg showed less reduction in blood glucose than Kigelia 1000mg/kg [(7.4+/-0.9mmol/l) vs (5.3 +/- 0.5), (p= 0.00)]. The mean blood glucose levels were lower in mice that received Kigelia extract than those that received both Kigelia extract and Glibenclamide [(5.3 +/- 0.5mmol/l) vs (7.8 +/- 0.6 mmol/l), (p=0.00)]. The fruit extract tested positive for Tannins, Saponins, Flavanoids, Alkaloids, Glycosides and Steroids. Findings of this study indicate that Kigelia africana fruit extract causes reduction in blood glucose of diabetes induced mice and gives better results when used alone than in concomitant use with Glibenclamide. The study also indicates that the fruit extract has alkaloids, saponins, steroids, glycosides, tannins and flavonoids. To determine the effect Kigelia africana fruit extract has on blood glucose levels of diabetes mice and its phytochemical profile Mice were induced with diabetes using Alloxan monohydrate 90mg/kg. Blood glucose was checked before induction and 72 hours after induction to confirm diabetes. Treatment involved using oral administration of Kigelia fruit extract 1000mg/kg, Kigelia fruit extract 500mg/kg, Glibenclamide 0.25 mg/kg, Kigelia fruit extract 500mg/kg and Glibenclamide 0.25mg/kg and Normal Saline. The results showed a greater reduction in blood glucose of mice after treatment with Kigelia extract 1000mg/kg compared to Kigelia 500mg/kg [(5.3 +/- 0.5mmol/l) vs (6.3+/- 0.6mmol/l), (p= 0.005)]. Further, Glibenclamide 0.25mg/kg showed less reduction in blood glucose than Kigelia 1000mg/kg [(7.4+/-0.9mmol/l) vs (5.3 +/- 0.5), (p= 0.00)]. The mean blood glucose levels were lower in mice that received Kigelia extract than those that received both Kigelia extract and Glibenclamide [(5.3 +/- 0.5mmol/l) vs (7.8 +/- 0.6 mmol/l), (p=0.00)]. The fruit extract tested positive for Tannins, Saponins, Flavanoids, Alkaloids, Glycosides and Steroids. Findings of this study indicate that Kigelia africana fruit extract causes reduction in blood glucose of diabetes induced mice and gives better results when used alone than in concomitant use with Glibenclamide. The study also indicates that the fruit extract has alkaloids, saponins, steroids, glycosides, tannins and flavonoids
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    A Comparative Study for the Efficacy and Tolerability of Fluvoxamine and Venlafaxine in patients with Obsessive Compulsive Disorder
    (RA Publications, 2015-09-20) Prashar, Lavina; Paul, Ravi
    To compare the efficacy and tolerability of Fluvoxamine and Venlafaxine in patients with Obsessive Compulsive Disorder (OCD). A total of 50 newly diagnosed patients with OCD were randomly assigned 25 each to receive either fluvoxamine (Selective serotonin reuptake inhibitor) or venlafaxine (selective serotonin norepinephrine reuptake inhibitor). Primary efficacy was assessed by the change from baseline on the Yale Brown Obsessive Compulsive Scale (Y-BOCS). The Clinical Global Impression Improvement Scale (CGI-S) was used to measure symptom improvement. Each patient was followed as a single visit in a week wise manner following the order; Week0, Week 1, Week 2, Week 4, Week 6, Week 8, Week 12 and Week 16. At each visit if any adverse reaction to either of the drugs experienced by the patient were noted. Treatment group comparison of patients, demographic characteristics and baseline severity measurements were done using a Chi square test and the student t-test. Statistical significance was defined as a 2-sided p value ≤ 0.05. Both drugs showed significant reduction in the OCD symptoms as measured on the Y-BOC Scale over the 16-week follow up. When compared fluvoxamine showed statistically significant reduction in overall YBOC score and Obsessive mean score. The difference in compulsive mean score was not significant in the two treatment groups. Fluvoxamine is more efficacious than Venlafaxine in the treatment of OCD.
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    Assessment of Level of Knowledge of Management of Acne vulgaris among Community Pharmacists and Prescribers in Lusaka Urban
    (Asian Online Journals, 2015-12) Prashar, Lavina; Kachipond, Fredrick; Nagalamika, Owen
    Acne is a common skin condition affecting almost 85% of the population. Everyone has the risk of developing acne at certain stages of life. The management of acne in early stages is important for disease prognosis. Patients with acne usually present at community pharmacies and clinics during the early stages of their disease. Assessment of knowledge and practice of community pharmacists and prescribers in treating these patients is required. The aim of this study was to assess the levels of knowledge in acne management among community pharmacists and prescribers in Lusaka urban. The study was designed as a cross-sectional survey and was conducted on 89 community pharmacists and prescribers working in Lusaka, Zambia. Participants were asked to answer a self administered questionnaire on the management of acne vulgaris that comprised questions evaluating the knowledge on disease causes, aggravating or relieving factors, treatment practices and use of reference materials. The study revealed that Pharmacists and prescribers had inadequate levels of knowledge on disease management; 21% had low levels of knowledge where as only 6% had high levels of knowledge. By category, 36% of the prescribers had low levels and 10% had high levels of knowledge. 8% of the pharmacists had low levels of knowledge and only 2% had high levels. Lack of knowledge was reflected in their treatment practices, 62.9% never classified acne when initiating treatment and less than a quarter managed acne cases independently. This study showed no association of levels of knowledge to referral of patients with severe acne (p>0.05). It was concluded from the study that pharmacists and prescribers have inadequate knowledge and practice for management of acne. Steps should be taken to update and improve their dermatological knowledge.
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    Psychological Distress during the Perinatal Period: Using Edinburgh Postnatal Depression Scale (EPDS) General Health Questionnaire (GHQ-12) and the Study Specific Measure of Perinatal Distress (SSMPD) on a Zambian Cohort
    (2016) Mwape, Lonia; Mukwato, Patricia Katowa; Mweemba, Prudencia
    Background: Psychological distress during the perinatal period affects the woman experiencing it, her baby, and the family a whole. It presents a challenge during this exciting and special time in woman’s life. Various screening instruments have been established to identify psychological distress. This paper reports results of the data collected to determine the prevalence of psychological distress using the EPDS, GHQ-12, and the Study Specific Measure of Psychological Distress. Aim: The study investigates the prevalence of psychological distress during the perinatal period in a Zambian cohort. Methods: A longitudinal descriptive study was conducted on a Zambian cohort consisting of 300 women during their antenatal and postnatal periods. The participants were accessed through antenatal and postnatal clinics in primary health care facilities. Findings: The study revealed high prevalence of psychological distress in the cohort under study in comparison to global estimations. This is as detected by the EPDS and GHQ-12, including the study specific measure of psychological distress. Conclusion: The prevalence of psychological distress during the perinatal period in Zambia is high. Therefore, the psychological well-being of a woman during the perinatal period needs to be given the attention that it deserves in order to safeguard the well-being of the baby and all the people around her. Recommendations: Screening women for the presence of psychological distress during the antenatal and postnatal periods should be mandatory. Appropriate referral should then be made depending on the outcome of the screening. Key words: Psychological distress, Perinatral period, Edinburgh Postnatal Depression Scale, General Health
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    Indigenous Knowledge Systems for the Treatment of Hypertension in Lusaka, Zambia: Perceptions, Knowledge and Practice.
    (Zambian Medical Association, 2016-01) Prashar, Lavina; Goma, Fastone; Kalungia, Chichony Aubrey; Bwalya, Angela Gono; Hamachila, Audrey; Mutati, Ronald Kampamba; Zingani, Ellah; Mwila, Chiluba; Musoke, Pamela
    Indigenous knowledge systems and traditional technologies have made and can continue to make a significant contribution to modern medicines with discovery of novel molecules in the treatment of various conditions. The traditional knowledge in our communities is passed on from generation to generation. Scientific evaluation of these compounds from traditional medicines can lead to discovery drugs with better efficacy and novel mechanism. The study aimed at determining the indigenous knowledge based preparations used for hypertension in Lusaka, Zambia. The specific objectives were: a). To determine the knowledge and practice of Traditional Health Practitioners in the management of HTN, b). To identify the parts of the plants utilized in the preparation of the IKS-based preparation used in the management of hypertension. c). To determine the procedure employed in preparing the IKS-based preparations used in the management of hypertension. d). To recommend for further elucidation of the possible active compounds in the indigenous based preparations and postulate possible pharmacological mechanisms of actions. The study adopted structured interviews complemented by non-participatory observations. Samples used by traditional healers were collected for identification and characterization A total of twelve (12) traditional healers registered with Traditional Health Practitioners of Zambia who manage hypertension were interviewed. The traditional healers interviewed had knowledge of causes of hypertension, only three (3) indicated bewitchment as one of the causes. spiritual method constituted an important method of diagnosis. The beliefs of Traditional Healers with regard to hypertension indicates their alignment to agreeing the scientific understanding of hypertension in terms of its causes, risk factors and complications. Traditional Healers in Zambia believe hypertension can be managed by some mode of action of the herbs. Common themes that emerged to determine the effectiveness of the herbs used included; patient feedback, physical appearance, confirmation at local clinic and increased urine output. Majority (5/12) felt that there herbs take atleast 7-14 before the effects are seen. All the traditional healers indicated using atleast two (2) types of herbal preparations to manage hypertension. Of the preparations mentioned three (3) were not of plant origin. These include; crocodile fat, pebble and honey. This study observed that the traditional healers of Zambia knowledge of causes and complications of hypertension are alligned to the scientific knowledge. Divination is however still the most important (50%) method used for diagnosis and witchcraft/ spiritual method forms an important method for some for diagnosis of hypertension. It is noteworthy that traditional healers in Zambia believe hypertension can be managed by some mode of action of the herbs a belief shared by the conventional management.
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    Extraction and Demonstration of Uterotonic Activity from the Root of Steganotaenia araliacea Hochst.
    (Zambian Medical Association, 2017-09-14) Prashar, Lavina; Goma, Fastone; Ezeala, Christian; Nyirenda, James; Chuba, David; Simfukwe, Newton; Lengwe, Chilufya
    The root of Steganotaenia araliacea is used for assisting labour in folk medicine. Recent reports indicate that the root could possess uterotonic substances.The study aimed to evaluate three methods for the extraction of uterotonic principles from the root of S. araliacea growing in Zambia. Roots of the plant were collected from Chongwe District of Zambia. The air-dried roots were size-reduced, and the powdered material extracted with hot ethanol, hot distilled water, and cold distilled water. The solvent extracts were concentrated and dried at 110 0C. Solutions of the hot aqueous and cold aqueous extracts were prepared in distilled water and used for organ bath experiments to demonstrate uterotonic activities using strips of pregnant rat uterus. The frequencies and amplitude of contractile forces were recorded. The amplitudes were plotted against log concentration of extract with GraphPad Prism software, and the EC50 values determined. The percentage yields were 31.3 % for the hot aqueous extract, 8.15 % for the ethanolic extract, and 3.27 % for the cold aqueous extract. The cold aqueous extract showed higher potency (EC50 of 0.54 mg/ml) compared to the hot aqueous extract (EC50 of 2.09 mg/ml). Root extracts of S. araliacea possess demonstrable uterotonic effects. Extraction of the roots for this purpose could benefit from preliminary defatting with organic solvents, followed by successive extraction with hot and cold water.
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    Experiences, needs and coping strategies of pregnant and parenting teenagers: A perspective from Lusaka and North Western Provinces of Zambia
    (Journal of Research in Nursing and Midwifery, 2017-12) Mukwato, Patricia Katowa; Maimbolwa, Margaret.C.; Mwape, Lonia; Muleya, Mutinta Crecious
    Pregnant and parenting teenagers have needs that are unique to the developmental stages of adolescence in addition to the needs common to all pregnant women. The study investigated the experiences, needs and coping strategies of pregnant and parenting teenagers. The study utilized a phenomenological approach, where in-depth interviews with pregnant and parenting teenagers were conducted to get an insight into their experiences, needs and coping strategies. Participants were purposively selected. A sample size was 27 participants which was determined using data saturation principle. Three themes emerged on the experiences of teenage pregnancy and parenting including, abandonment and rejection, loss of parental support and burden of being pregnant or being a parent, while three broad needs were identified; information about HIV status, physical materials for the unborn or new born baby and mother, and the desire to go back to school for those who fall pregnant while schooling. Both adaptive and maladaptive strategies were identified as a means for coping including, avoidance of negativity, support from parents, relatives and partner, repentance and dependence on God, focusing on own and the child’s future, and denial of pregnancy or motherhood. It was concluded that pregnant and parenting teenagers undergo diverse negative experiences, while negotiating the transition from teenage hood to adulthood and motherhood amidst unmet teenage and pregnancy related needs. As a means to cope with the negativity and live within circumstances of unmet teenage and motherhood needs, coping strategies are required. Keywords: Experiences, Needs, Coping Strategies, Teenage Pregnancy, Parenting.
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    Vitamin B12 and Folate deficiency in Megaloblastic Anaemia diagnosed morphologically at the University Teaching Hospital, Lusaka, Zambia
    (The International Journal of Multi-Disciplinary Research, 2018) Munsaka, Soddy Mweetwa; Ndhlovu, Jacob
    Background: Vitamin B12 and folate deficiency is a well-known health problem world-wide. Deficiencies of folic acid and vitamin B12 are known to cause megaloblastic anaemia, which is characterised by presence of abnormally large erythrocyte precursor cells, megaloblasts, in the bone marrow and macrocytic red cells in the peripheral blood. These megaloblasts arise because of impaired deoxyribonucleic acid (DNA) synthesis followed by ineffective erythropoiesis. However, vitamin B12 or folate levels have not been described in Zambia, whether normal levels or in relation to anaemia. The study aimed to determine vitamin B12 and folate levels in megaloblastic anaemia, diagnosed morphologically, in patients at the University Teaching. Methods: This was a cross sectional study which was undertaken at the University Teaching Hospital (UTH) in Lusaka, Zambia. Full blood count (FBC), Peripheral smears and ELISA were assessed on blood samples received from megaloblastic anaemia and non-anaemic patients. Vitamin B12 and folate concentrations were compared between groups using t-test. Results: The age range was between 18 – 54 years (Mean age-31 years). Among the 40 megaloblastic patients, 35% (14/40) were male and 65% (26/40) were female with a male to female ratio of 1:1.9. Full blood count and peripheral smear findings revealed that bicytopenia was present in 22.5% (9/40) and pancytopenia in 72.5% (29/40) patients. Furthermore, the megaloblastic anaemia participants had statistically significant lower median vitamin B12 concentration 175(150-333) pg/ml than non-anaemic control participants 299.5 (238-571) pg/ml p=0.0001. Megaloblastic anaemia participants also had a statistically significant lower folate concentration (12.32± 2.28 ng/ml) than non-anaemic control participants (19.28 ± 2.84 ng/ml) p=0.029. Of the megaloblastic anaemia patients, vitamin B12 deficiency was in 60% (24/40), pure folate deficiency in 30% (12/40) and combined deficiency was observed in 15% (6/40) patients. Conclusion: This study shows that majority of patients with megaloblastic anaemia, diagnosed morphologically at the University Teaching Hospital have a deficiency of vitamin B12 deficiency which further implicates vitamin B12 and folate in the disease process of megaloblastic anaemia.
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    Use of research evidence in policy and decision-making: views, attitudes and practices of health policy makers in Lusaka province of Zambia
    (Scientific research publishing, 2018-04) Mukwato, Patricia Katowa; Mwape, Lonia; Siwale, Mwaba Chileshe; Musenge, Emmanuel Mwila; Maimbolwa, Margaret
    Background: The integration of relevant high-quality research evidence into the health decision and policy formulation process is a key strategy for improving health systems especially in developing countries such as Zambia. However, the lack of capacity to understand and value research evidence by policy and decision makers makes it difficult for them to find and use research evidence in a timely manner even when motivated to do so. This study aimed to establish the views, attitudes and practices of policy makers on the use of research evidence in policy and decision-making process in Zambia. Methodology: This descriptive cross-sectional study was conducted in Lusaka, Zambia among selected public health decision and policy making institutions. A purposive sample of 21 consenting policy makers who were working in different positions in the Ministry of Health Headquarters, Provincial and District Health Offices, Health Professions Regulatory Bodies, United Nations Agencies, International Non-Governmental Organizations and University Deans from the University of Zambia participated in the study. A self-administered questionnaire was used to collect data. The IBM? SPSS? Statistics for Windows Version 20.0 was used for data analysis. Results: The concept of Evidence Informed Health Policy was not well understood such that only less than half (47.5%) of the participants reported having heard specifically about Evidence Informed Health Policy meanwhile almost two thirds (61.9%) reported that they used research evidence in decision making and policy formulation. Similar discrepancy was expressed in the understanding of and use of rapid response mechanisms such that although (47.6%) of the participants reported having heard about it, (57%) had never used rapid response mechanisms for deci-sion-making. With regard to the sources of information, about half (52.3) of the participants reported scholarly articles as their main source of evidence. Con-clusion and Recommendations: There is need for more sensitization and ca-pacity building among the decision and policy makers on the importance of using research evidence in decision and policy making process as incorporation of relevant high-quality research evidence into the health policy making pro-cess is a key strategy for improving health systems. Keywords Evidence-Informed Health Policy, Rapid Response Mechanisms, Decision-Making
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    Opuntia stricta cladode Extract reduces blood glucose levels in Alloxan-induced diabetic mice.
    (Scientific and Academic Publishing, 2018-07) Prashar, Lavina; Kalungia, Chichony Aubrey; Mataka, Mary; Kaonga, Patrick; Bwalya, Angela Gono; Munkombwe, Derrick
    Opuntia stricta (commonly called prickly pear cactus) is a natural plant that grows in some parts of Zambia where its fruits and cladodes are commonly consumed for nutritional and medicinal purposes, including glycaemic control among some patients with diabetes mellitus (DM). There is insufficient evidence whether Opuntia stricta indigenously growing in Zambia possess antidiabetic effects.To assess in vivo antidiabetic effects of the aqueous extract of Opuntia stricta cladodes in alloxan-induced diabetic mice. A laboratory-based experimental study was conducted involving 20 adult Swiss albino mice (Mus musculus) weighing 18-30 g. DM was induced using a single intraperitoneal dose of alloxan monohydrate 90 mg/kg. Opuntia stricta aqueous extract was administered orally and blood glucose levels (in mmol/L) monitored daily for 10 days. Alloxan induced a 4- to 5-fold sustained increase in blood glucose levels at 72 hours after administration in mice. Within a 10-day experimental period, Opuntia stricta cladode aqueous extract (1 mg/kg) significantly reduced blood glucose levels in vivo (from 16.6 ± 1.4 mmol/L, 95% CI: 14.9-18.3 at baseline to 7.5 ± 1.0 mmol/L, 95% CI: 6.2-8.9 at endpoint, p < 0.001, n = 5). Similarly, at a dose of 2 mg/kg, the extract significantly reduced blood glucose levels (from 18.7 ± 4.6 mmol/L, 95% CI: 13.0-24.4 at baseline to 6.9 ± 1.7 mmol/L, 95% CI: 4.7-9.0 at endpoint, p = 0.001, n = 5). Opuntia stricta cladode aqueous extract attained a greater reduction in blood glucose levels compared to Glibenclamide 0.25 mg/kg. Opuntia stricta cladode aqueous extract demonstrated a presence of alkaloids, flavonoids, saponins, sterols, carbohydrates, phenols and tannins. Opuntia stricta cladode from Zambia demonstrates antidiabetic effects to reduce blood glucose levels in vivo.
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    Prevalence, predictors and HIV disease progression in immunovirogical discordant HIV patients at 12 months of first line antiretroviral therapy in Zambia.
    (The University of Zambia, 2019) Sivile, Suilanji
    Combined antiretroviral therapy (cART) has improved mortality and morbidity among HIV-infected patients. However, a third of HIV-infected patients still present to care with advanced disease despite the rollout of cART. Some of these patients fail to appropriately reconstitute their immune system despite being on effective cART signified by a suppressed viral load. This phenomenon is termed immunovirological discordance. These patients remain immunocompromised and could still be at risk of opportunistic infections and subsequent mortality. As the HIV population is getting older, immune senescence and its impact on discordance has become topical. Understanding the prevalence and predictors of this phenomenon is crucial for the HIV response. A cross-sectional study was conducted in 20 health facilities throughout Zambia selected based on probability proportion to size method. Adult HIV patients with a suppressed viral load at 12 months of first line cART were enrolled. Relevant blood samples were drawn and a questionnaire was completed with the aid of the hospital chart . Adequate immune response was defined as an increase of baselines CD4cell count to >200cells/μL at 12 months of ART and/or an absolute CD4cell count change of >150cells/μL. We used multivariate logistic models to identify predictors for immunovirological discordance. 360 patients were enrolled. 57% were females. 68% were 25-44 years old. 17% had a CD4cell count below 200cells/μL at 12 months of ART and 54% had an absolute CD4cell count change of less than 150cells/μL. Females were 2 times more likely to have a CD4cell count above 200cells/μL (OR 2: 95%CI 1.00-3.62;P=0.028) and patients with a body mass index >25kg/m2 were 4 times more likely to have a high CD4 count compared to those underweight (OR 4:95% CI 1.29-13.73; P=0.017) . A baseline CD4cell count below 200cells/μL was a predictor for an absolute CD4cell count change of less than 150cells/μL (OR12:95% CI 4.04-33.41; P= <0.0001). Hepatitis B virus positive status (OR 0.03:95% CI 0.003-0.25; P= 0.001) and baseline WHO stageIV/III disease (OR 0.01:95% CI 0.01-0.59; P=0.0001) were predictors for suboptimal CD4cell response. Patient’s age, Positive RPR, TNF levels and CRP levels were not associated with suboptimal CD4cell recovery. There was no association between WHO Clinical Stage at 12 months of cART with immunovirological discordance. In patients with viral load suppression at 12 months of cART, immunovirological discordance is common. Baseline CD4cell count, male sex, baseline low BMI, HBV infection and baseline WHO clinical stage III/IV could predict immunovirological discordance. Markers of morbidity such as high CRP levels and advanced WHO clinical staging at 12 months of cART are not necessarily associated with suboptimal immune response. Early commencement of cART may prevent immunovirological discordance, a finding which supports the ‘test and start’ strategy. Further investigation in understanding the immunology of discordance and its clinical outcomes are proposed.
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    Burden attributable to childhood and adolescent primary headache disorders in Lusaka and Ndola school children aged 7 - 17 years.
    (The University of Zambia, 2019) Kawatu, Nfwama
    Headache is a common complaint in the paediatric and adult populations. However, the prevalence, types and effects on the quality of life of the children that suffer from headache is not known. This study assessed the prevalence and burden of primary headache disorders in children and adolescents. The data collected and analysed produced a preliminary report of an ongoing study. This was a cross sectional study, conducted over a 6-month period which targeted participants aged 7-17 years in Lusaka and Ndola schools. It was conducted using a standardized questionnaire that was administered with the guidance of the principal investigator for ages 7-11 years and by self-administration for ages 12-17 years. Questions of interest included the prevalence, duration, intensity and frequency of any headache. Lost school days and parental work days highlighted the quality of life of these children in general. The data was analysed using a validated algorithm of classification of headache which is based on the International Classification of Headache Disorders III. The 1 year prevalence of headache in general was at 87.3% of the study population. Probable migraine was most common at 44.5% followed by migraine 19.6%. Girls (68.6%) suffered more migraine; boys displayed a high prevalence in tension type headache (39.9%), followed by probable migraine headache at 39.9%. A reduction in the quality of life was significantly associated with a longer duration of headache days, migraine headache and probable migraine headache whereas there was no significant association with other headache types. The prevalence of primary headache disorders in Zambia is significantly high at 873% with highest prevalences of migraine headache in girls and tension type headache in boys. The quality of life was not significantly altered in these children that suffered headache.