Medical Theses and Dissertations

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Doctors and Nurses Knowledge and Use of Pain Assessment Tools: A Case Study of Two Tertiary Hospitals
(2011-07-01) Kalolo, Donald Muma
This study was necessitated by many gaps in pain research in Zambia. The percentage of doctors and nurses that assess pain using any indicator and what doctors and nurses do to treat pain. Therefore this study sought to answer the following overarching question. What do doctors and nurses do to patients that have pain? A cross-section non interventional comparative study in three clinical areas (medicine, surgery and oncology) was done using a 33 item survey questionnaire. SPSS software, version 17.0 (SPSS, Chicago, IL), was used for statistical analyses. The Pearson’s Chi-squared test was used to compare proportions. The cut off point for statistical significance was set at 5%. Totals of 26 doctors and 76 nurses took part in the study. Concerning knowledge of the World Health Organization Pain Relief ladder, the proportions of doctors and nurses who reported to be aware of it was surprising low across the two professions (Fisher’s exact test, p=0.246) with 26.9% of doctors and 15.8% of nurses reporting being familiar with the WHO ladder. Significantly more nurses (27.6%) than doctors (3.8%) reported that doctors and nurses rated pain (c2=6.48, p=0.011). Most respondents (26.3% of doctors and 32.4% of nurses) treated pain just like all other manifestations. Pain assessment and management are poorly done by both nurses and doctors. Though pain is assessed, it is not by using any pain assessment tools. The doctors and nurses seem to use subjective assessments in their practice. The hospital authorities ought to endeavour to facilitate the development of pain management tools and guidelines based on local practices or consider the use of the five tools which are: Visual Assessment Scale, the Visual Rating Scale and the Numeric Pain Inventory Scale (NPIS), the Simple Descriptive Pain Intensity Scale (SDPIS) and the WHO pain ladder management tool.
Attitude and Determinant of Lumbar Puncture Acceptability Among Caregivesr at Three Hospitals In Zambia
(2011-07-01) Hampande, Lynette Munachonga
Lumbar puncture (LP) acceptability is a problem at Arthur Davison Hospital, Ndola Central and Kitwe Central Hospitals, evident by a growing trend of lumbar puncture refusals over a four year period (2003-2006). Obtaining Cerebral Spinal Fluid by LP for microscopic examination is essential in the diagnosis of Central Nervous System infections and inflammatory conditions such as meningitis. The study aimed at determining attitudes and determinants of LP acceptability among caregivers at three tertiary hospitals in Zambia. An explorative study design was conducted at three health care facilities; Arthur Davison Children's Hospital, Kitwe and Ndola Central Hospitals from November, 2008 to April 2009. Some of the variables in the study were attitudes towards lumbar puncture, knowledge of lumbar puncture and educational level. A total of 584 caregivers were recruited through purposive sampling. The sample size was calculated using EPI INFO version 6 at 95 percent confidence level. Data was collected using structured interview schedules and analysed using SPSS 11.6 and EPI INFO software packages. The majority, (93.5 %) of the respondents had negative attitudes towards LP. They would not accept LP to be performed on themselves, neither would they recommend a patient to undergo LP for fear that they or their patient would die. There was no significant association between education level and advising a patient to undergo LP, (p = 0.642). 66 % of the respondents revealed that they would not accept LP because the outcome of LP is death. The study also revealed that majority, (56 %) of the respondents lacked knowledge on LP hence this influenced decision making. It is recommended that the Ministry of Health should rigorously disseminate information to members of the public on the importance of this diagnostic procedure through the media in order to strengthen its use in hospitals. Further, the Ministry of Health should bridge the gap between Resident Medical Doctors and consultants, in order to build capacities of the former so that they are able to perform LP. Health care providers at all levels should also endeavour to increase awareness of the role of LP in their institutions. The study must be conducted on a larger scale in order to allow for generalization of results.
Occurrance of Adverse Hematological Events at one and Six Weeks in infants following Perinatal Exposure to Antiretroviral Drugs for the prevention of Mother to Child transimission of VIV at UTH/ Musaku Mwenechanya
(2011-07-01) Mwenechanya, Musaku
Perinatal transmission of Human Immunodeflency Virus (HIV) from mother to her new born can be prevented in most cases using a combination of Antiretroviral drugs reducing the risk to less than one percent(l%). However despite the beneficial effects of these drugs, maternal-fetal transfer of these potentially toxic drugs during pregnancy is of increasing concern. Among other concerns, of note is adverse hematological events both in the short and long term and this remains largely unknown with contradictory findings in the few studies done The aim of this study was to document the short term hematological outcomes at one week and six weeks in infants perinatally exposed to Antiretroviral Drugs used for the prevention of Mother to Child Transmission of HIV at UTH, One hundred and thirty-nine HIV exposed but uninfected infants as Confirmed by DNA/PCR at six weeks, were prospectively followed up until six weeks of age. Perinatal transmission prophylaxis regimens comprised Zidovidine(AZT) based regimens and non-AZT based regimens. Blood counts and differentials were determined at one and six weeks and adverse hematological events were documented and compared with documented normal values. The main focus was to document hemoglobin, absolute neutrophil and platelet count indices at one and six weeks. Data was further analysed according whether maternal prophylaxis included AZT or another nucleoside reverse transcriptase inhibitor. The proportion of infants that were found to have anaemia was 13.5% at one week and this increased to 20.3% at 6weeks .This study found 13.5% and 21.3% of infants developed neutropenia at one and six weeks respectively and 0.06 and 0.1% of infants developed thrombocytopenia at one and six weeks respectively in preterm babies. In term babies the proportion of neutropenia increased from 13.5% at one week to 24.1% at six weeks while the proportion of thrombocytopenia reduced from 4.1% at one week to 3.5% at six weeks VIII This study shows that a significant proportion of infants developed anaemia and neutropenia following prenatal and postnatal exposure to antiretroviral drugs However the proportion was less so with thrombocytopenia.
Challenges HIV positive married persons attending Kanyama Clinic face in using Condoms
(2011-07-07) Chelu, Lazarous Chinoyi
The ideal situation is that HIV positive married individuals ought to use condoms throughout their sexual life in view of preventing themselves from HIV reinfection except when the couple opts to have a child. However, from the time the ART program was scaled up in various health centers in Zambia almost five years ago, the rate of condom use among concordant HIV positive couples has not been studied and there are many issues that remain unknown. This study was designed to answer four research questions which are: (i) what is the condom use rate like among HIV positive married couples? (ii) Regarding their status of being HIV positive and married, what challenges do they experience sexually? (iii) In what ways do they cope? and (iv) noting the rate of condom use, why do they sexually behave in the manner they do ? The study was specifically carried out at Kanyama ART clinic in one of the consulting rooms and a qualitative research rooted in the abductive research was used. The data for this study were drawn only from HIV positive married patients on ARV’s attending the ART clinic. Theoretical sampling of HIV positive married patients was the main stay for the study. Each respondent was interviewed in-depth and data was analyzed using content analysis informed by grounded theory. The findings were that 14 (25 per cent) of the couples were consistent in using condoms when having sexual intercourse, 27 (47 per cent) were inconsistent and 16 (28 per cent) did not use any condoms at all. Respondents in this study experienced nine challenges which ranged from : (i) experiencing adverse effects due to condom use (ii) violence when denied sex without a condom, (iii) failure to convince partner to use a condom, (iv) desiring to have children and stopping to use a condom (v) quarrels on account of refusing to use a condom,(vi) desire for maximum pleasure (vii) lack of availability of condoms at the facility and cost of condoms which seemed to be high , (viii) refusal of advice and (ix) no problems at all with using the condom. On account of these challenges, the respondents used cognitive strategies and behavioral strategies to cope. Cognitive strategies included attempts to change the way one thinks about sex with condom use or not and behavioral strategies included one taking an attempt to reduce the impact of sexual stress. Specifically respondents coped in the following six ways (i) saying no to sex (ii) abstaining from sex if no condoms were not to be used (iii), rarely having sex , (iv) sought an alternative sexual partner because condoms were demanded in marriage (,iv) negotiating sex proved difficult and (vi) others did nothing at all. The reasons for selecting various coping strategies and whether to use or not use a condom were varied and the following stood out: (i) gender and the influence of patriarchy or (ii) one resigned and agreed to have sex with a condom in order for peace to prevail or (iii) one had to have sex because culture prescribed so, or (iv) one had experienced adverse effects warranting to use condoms or not to use condoms at all, or (vi) sex without a condom was pleasurable , or one had a number of fears and (viii) the fact that both were of the same status, sex with a condom was of no consequence. The conclusion is that there are marked challenges of adhering to the condom prescription in marriage among people living with HIV and AIDS and on HAART as observed by the low rates of condom use. The challenges that women mostly face than men with condom use within marital partnerships are extremely immutable. It is recommended that Kanyama clinic considers the following measures to fortify HIV and AIDs health promotion and prevention programs within the ART Clinic: 1. The government with its collaborating partners concern, should consider coming up with economic empowerment programmes for women, such as micro credit loans, in order to empower the disadvantaged women and in the long run, alleviate themselves from the economic dependence they have on their husbands, so that they would be able to mitigate their failures the perpetually encounter with their husbands, in deciding to use a condom as it is often outside of their control due to poverty they face. 2. Adherence counseling ought to be holistic in the sense that it encompasses messages that include effective pleasure-based safer sex information and emphasize: on the benefits of treatment adherence and also to deliberately draw appointments that enables couples to be counseled together rather than have separate appointments in order to enable the disadvantaged women to bring up issues/matters their husbands hold off using condoms in the midst of the adherence counselor to address. 3. Introducing during regular screening or adherence assessments checking for biological markers such as sperm on vaginal smears, screening for pregnancy at random visits and evidence of sexually transmitted infection, so that the verb consent HIV positive married individuals indicate for condom use when they are asked during adherence counseling is clinically backed up or supported and also in order not to overestimated condom use basing on the manner condoms are collected from the clinic, but be estimated basing on the use. 4. The results of this study confirm that some married men are unwilling to use condoms at least some of the times and others all of the times. The promotion of condoms within such relationships needs to be strengthened in all HIV prevention programs, largely because resistance against condom use is difficult to overcome.
Factors affecting CD4+T-lymphocyte count response to HAART in HIV/AIDS patients within 24 months of treatment at Chreso Ministries Art Centre
(2011-07-07) Bwalya, Marlon
The general objective of this study was to identify factors that affect CD4-TLymphocyte count response in patients commenced on HAART within 24 months of treatment at Chreso Ministries VCT and ART centres. The elements of this study were files of clients of all age groups on HAART above 5 years of age who had at least four consecutive repeat CD4 count rechecks within 24months of treatment with all other necessary information of variables required for this study captured in smartcare at treatment initiation. According to May 2009 statistical report, Chreso Ministries ART centre which happened to be a study site had 7000 HIV positive clients on care and 3900 clients on HAART. This study was a retrospective cohort design and had a sample size of 340 files of clients. The sampling frame generated from the study population was subjected to computerized random selection to come up with the sample size of 340 medical files. The study was purely quantitative and involved reviewing clients’ records that have been captured on the smartcare database on clients who have been on HAART for more than 24months. The extracted data was entered in Epidata using Epi Info and was exported to SPSS for analysis. The Chi-Square test at 5% with crosstabulation tables was used to determine associations between the identified variables and CD4-Lymphocyte count response to HAART and the logistic regression analysis was used to predict the probability of CD4 count response to HAART using the variables of this study. The study was completed in 3months following approval from the Ethics Committee of the University of Zambia. The statement of the problem was the observed poor CD4 count response to treatment in most of the clients commenced on HAART. The factors at hand involved the social demographic factors (age, sex, income, alcohol consumption and employment status) ART factors (Adherence and ART regimen) and immunological factor (CD4 count at treatment initiation). In this study it was found that gender, alcohol consumption, nadire and regimen affects CD4 count response to HAART. It was found that men, non alcohol consumers and those that start HAART with baseline CD4 count above 350 cell/µL experienced a good CD4 response to HAART. Additionally, those who commenced treatment on truvada and devoted themselves to 95% adherence also experienced a good CD4 count response to HAART. On the other hand, age, smoking and employment status did not affect CD4 count response to HAART.
The Impact of Rhodesia’s Unilateral Declaration of Independence (UDI) on Zambia’s Economic and Socio-political Developments, 1965-1979
(2011-07-07) Chongo, Clarence
On 11 November 1965, Ian Douglas Smith defied world opinion and proclaimed a Unilateral Declaration of Independence (UDI) in Rhodesia. Rhodesia’s UDI posed a major challenge in the context of politics of decolonisation generally in Africa and southern Africa in particular. The Zambian government interpreted UDI as a moral affront to African freedom, independence and dignity as well as posing a grave danger to the country’s national security. Inevitably, in its response to the Rhodesian act of rebellion, the Zambian government firmly opposed the white supremacist illegal regime in Rhodesia. The confrontational stance adopted by the Zambian government against UDI had serious consequences for the country’s economic and socio-political stability. This study attempts to examine the impact of Rhodesia’s UDI on Zambia’s economic and socio-political developments from 1965 to 1979. The study contends that the effects of UDI on the Zambian economy were far-reaching largely because Zambia’s economy was firmly dependent on Rhodesia. The study further analyses the impact of UDI on socio-political processes in Zambia. This analysis is based on the assumption that a country’s pursuance of certain foreign policy objectives usually has implications on the country’s domestic politics. This is mainly because diverse groups in society tend to contest or call for adjustment of the government’s foreign policy on a wide range of international issues. In Zambia’s case, the study argues that the Zambian government was subjected to a barrage of criticism by the opposition political parties, the members of parliament and the business community for adopting a hostile foreign policy on UDI. The basis of this vilification was premised on the argument that Zambia’s foreign policy on UDI was pursued at the expense of the country’s economic stability.
Doctors and Nurses Knowledge and use of pain assessment tools: A case study of two tertially Hospitals
(2011-07-08) Kalolo, Donald Muma
This study was necessitated by many gaps in pain research in Zambia. The percentage of doctors and nurses that assess pain using any indicator and what doctors and nurses do to treat pain. Therefore this study sought to answer the following overarching question. What do doctors and nurses do to patients that have pain?A cross-section non interventional comparative study in three clinical areas(medicine, surgery and oncology) was done using a 33 item survey questionnaire.SPSS software, version 17.0 (SPSS, Chicago, IL), was used for statistical analyses.The Pearson’s Chi-squared test was used to compare proportions. The cut off point for statistical significance was set at 5%. Totals of 26 doctors and 76 nurses took part in the study. Concerning knowledge of the World Health Organization Pain Relief ladder, the proportions of doctors and nurses who reported to be aware of it was surprising low across the two professions (Fisher’s exact test, p=0.246) with 26.9% of doctors and 15.8% of nurses reporting being familiar with the WHO ladder. Significantly more nurses (27.6%) than doctors(3.8%) reported that doctors and nurses rated pain (2=6.48, p=0.011). Most respondents (26.3% of doctors and 32.4% of nurses) treated pain just like all other manifestations.Pain assessment and management are poorly done by both nurses and doctors.Though pain is assessed, it is not by using any pain assessment tools. The doctors and nurses seem to use subjective assessments in their practice. The hospital authorities ought to endeavour to facilitate the development of pain management tools and guidelines based on local practices or consider the use of the five tools which are: Visual Assessment Scale, the Visual Rating Scale and the Numeric Pain Inventory Scale (NPIS), the Simple Descriptive Pain Intensity Scale (SDPIS) and the WHO pain ladder management tool.
A review of factors which influence learner participation in University extension education in Chipata District
(2011-07-08) Ngoma, Flora
The main purpose of the study was to review factors which influence learner participation in University extension education. The specific objectives were to determine factors that encouraged learner participation in University extension education; to determine whether or not University education was meeting the needs of the learners; to determine the extent of community response to University extension education; to determine whether or not University Extension Education programmes encountered constraints in meeting the expectations of learners. A survey research method, which included self-administered questionnaires and a structured interview guide, was used to collect data from a sample of 100 respondents. The respondents were made up of 89 learners, one (1) Resident Lecturer and nine (9) part-time Tutors in programmes in Chipata District. Purposive sampling technique was used to select the sample. The findings showed that learners participate in University Extension Education due to factors that include the need to develop new skills, acquire knowledge, promotion, acquire academic and professional qualifications, and getting better jobs. The findings also showed that University extension education was meeting the needs of learners. The findings revealed that the extent of community response to University Extension Education was high. Although the response was high, the number was not to the expectation of most of the respondents. The findings showed that University Extension Education experienced constraints in meeting the expectation of learners. Some of the major constraints included: lack of teaching and study materials; shortage of part-time Tutors; and lack of a library. In view of the findings, practical recommendations were suggested. Some of these recommendations included, more adequate evaluation of University Extension Education programmes, recruiting more part-time tutors specialized in their various fields and using participatory research approaches to identify the needs of learners and University Extension Centre.
Factors influencing indoor residual spraying in Lusaka district's Mtendere, Kanyama and Matero Compounds
(2011-07-08) Banda, Anne
Monitoring and evaluation assessments of the IRS programmes reveal an inability to meet set IRS coverage targets. The purpose of this was to determine the factors that influence the low IRS coverage. A cross sectional household study was carried out in Lusaka District’s Mtendere, Kanyama and Matero Compounds. Data was collected from heads of households by an interactive method using a scheduled questionnaire.295 households were randomly selected. The sample size was calculated for the coverage rate of 78% plus or minus 5% and at 95% confidence interval. The 78% was derived from the IRS coverage of the 2006/2007 season during which 85% of eligible structures in Lusaka District were targeted Using Epi Info Version 6.0 the Yates corrected P values were calculated using chi square and used to determine relationships and associations between variables. The study established that IRS Coverage was 48.6% which was less than the targeted 85%. There was 36% coverage in Kanyama, 52.2% in Matero and 62% in Mtendere Compounds. Most of the houses (60%) were sprayed during the peak malaria season which is also the rainy season and that Willingness to have IRS had influence on IRS Coverage while community participation in IRS was nonexistent. Significant relationships were found between IRS Coverage and study area (P value<0.001), knowledge of the institution that carried out IRS (P value <0.001) and access to IRS related IEC (P value 0.042). The study found a significant relationship between the respondent’s willingness to have IRS: ability to remember what was heard and/or seen during IRS related IEC (P value 0.040), knowledge of the institution which sprayed (P value <0.001) and benefits anticipated from IRS (<0.001). 66.3% of the respondents own and use mosquito nets of which 45% were untreated, 20% were long lasting nets and 35% were locally treated nets. 62.3% of the respondents whose houses were not sprayed indicated that the sprayers did not come to their houses. Of the 143 houses that were sprayed 2.1% altered the walls after IRS, 34.3% reacted negatively to IRS, sprayers left pesticides on the floor in 7% of the houses there houses. The Ministry of Health (MOH) and National Malaria Control Centre (NMCC) shall find these results useful in planning for the IRS as it highlights areas that need attention. The policy makers ought to continue informing the communities regarding IRS and involving them in IRS activities as well as to monitor the activities of the sprayers whilst carrying out IRS
Barriers to Condom utilisation among mobile police officers in paramilitary camping sites:A case of Sondela Camp in Kafue rural District
(2011-07-08) Mulenga, Fred
research was conducted to establish the barriers associated with condom utilization among mobile police officers in Sondela paramilitary camp in Kafue rural district. The study was prompted by the fact that Zambia police service had scanty information on officers’ condom utilization and since there had been STIs, pregnancies and also failure to achieve 100% use of condoms among mobile police officers in Sondela, a need arose to establish factors that could have led to this situation. The sample size was determined to be 240 respondents. We used simple random sampling method to select respondents. A research design was cross sectional and data was collected using a self administered questionnaire. The study was approved by the UNZA graduate forum, and cleared by UNZA Research Ethics Committee and Police high command. Consistency condom use was estimated at 32.5%. Multivariate analysis revealed that predictors of consistency condom use were: age, low level of education, lack of adequate information and care giving about condoms and a belief that condoms promote promiscuity. Arising from these findings, Police command should conduct HIV/AIDS sensitization among mobile officers targeting age category of 25-34 years dispelling myths regarding condom use, provide in-service courses to mobile police officers and train service providers on consistency condom use for effective service delivery. Embrace male circumcision services for male police officers; introduce the condom wallet intervention where a police officer on operational duty is provided with a condom wallet filled with condoms. These suggestions will at a large scale increase the consistency use of condoms among mobile officers and benefit other police mobile camps in the Zambia.
The effectiveness of teaching indigeous languages under the team teaching arrangement in primary(Basic)Colleges of Education in Zambia
(2011-07-11) Sinfukwe, Michael George
This study sought to establish the effectiveness of teaching indigenous languages under the team teaching arrangement. The research methodology of the study involved both qualitative and quantitative data which was collected through questionnaires, lesson observations, curriculum materials and structured interview schedules. The sample comprised twelve teacher educators from Kitwe and Malcolm Moffat Colleges of Education in Zambia, who were selected purposively from the Literacy and Language Education study area to take part in the study. The data collected was analysed using both qualitative and quantitative techniques. The major findings of this study revealed that teacher educators regarded indigenous languages as important as English though teaching them under team teaching was not practicable as they were not qualified teacher educators for Indigenous Languages. The study also revealed that only English was taught and group discussion among other methods was more commonly used to teach it. From the findings, it was also observed that until teacher educators with both content and pedagogical knowledge in the two contributing subjects in the Literacy and Language study area were recruited into colleges of education, teaching of Indigenous Languages and English integratively (team teaching) would not work. In view of the research findings, recommendations were made that Teacher Education should address the issue of recruitment and staff professional development in colleges of education. To my beloved parents, brothers and sisters. I dedicate this piece of work to them for their love, care, guidance, support and several other things that have enabled me to be what I am today. I will forever be indebted to them.Above all, may the Almighty God be honoured.
Attitude and Determinant of Lumbar Puncture Acceptability Among Caregivesr at Three Hospitals In Zambia
(2011-07-11) Hampande, Munachoonga Lynette
Lumbar puncture (LP) acceptability is a problem at Arthur Davison Hospital, Ndola Central and Kitwe Central Hospitals, evident by a growing trend of lumbar puncture refusals over a four year period (2003-2006). Obtaining Cerebral Spinal Fluid by LP for microscopic examination is essential in the diagnosis of Central Nervous System infections and inflammatory conditions such as meningitis. The study aimed at determining attitudes and determinants of LP acceptability among caregivers at three tertiary hospitals in Zambia. An explorative study design was conducted at three health care facilities; Arthur Davison Children’s Hospital, Kitwe and Ndola Central Hospitals from November, 2008 to April 2009. Some of the variables in the study were attitudes towards lumbar puncture, knowledge of lumbar puncture and educational level. A total of 584 caregivers were recruited through purposive sampling. The sample size was calculated using EPI INFO version 6 at 95 percent confidence level. Data was collected using structured interview schedules and analysed using SPSS 11.6 and EPI INFO software packages.The majority, (93.5 %) of the respondents had negative attitudes towards LP. They would not accept LP to be performed on themselves, neither would they recommend a patient to undergo LP for fear that they or their patient would die. There was no significant association between education level and advising a patient to undergo LP, (p = 0.642). 66 % of the respondents revealed that they would not accept LP because the outcome of LP is death. The study also revealed that majority, (56 %) of the respondents lacked knowledge on LP hence this influenced decision making. It is recommended that the Ministry of Health should rigorously disseminate information to members of the public on the importance of this diagnostic procedure through the media in order to strengthen its use in hospitals. Further, the Ministry of Health should bridge the gap between Resident Medical Doctors and consultants, in order to build capacities of the former so that they are able to perform LP. Health care providers at all levels should also endeavour to increase awareness of the role of LP in their institutions. The study must be conducted on a larger scale in order to allow for generalization of results.
Effectiveness of intermittent Preventive Treatment of Full Course Of Sulphadoxine-Pyrimethamine in Clearance of Placenta Malaria Parasites In Pregnance in Kafue District
(2011-07-11) Kakonkanya-Kambole, Gertrude Namunji
Malaria infection during pregnancy is a major public health problem in the tropical and subtropical regions of the world. Pregnant women in developing countries are the worst affected. Malaria in pregnancy has serious consequences both to the mother and her baby. It leads to abortion, prematurity, low birth weight, foetal death, neonatal death, severe anaemia and maternal death. The current stratagem in the prevention of malaria in pregnancy includes use of ITNs and IPT/SP. The purpose of this study was to determine the effectiveness of IPT/SP in clearing placental malaria parasites in pregnant women in Kafue District. A case-control study was conducted in two health centres in Kafue District. The cases were the postnatal women whose placentas had malaria parasites. The controls comprised of postnatal women whose placentas had no malaria parasites. The study was conducted in two health centres in Kafue District. Data was analyzed using SPSS software. Chi-Squared [x²], Fisher’s exact test and Odds Ratio (OR) were used. Multivariate logistic regression analysis was used to control for confounding factors. Statistical significance was achieved if p<0.05. Totals of 25 cases and 146 controls were enrolled into the study. Compared to the age at which the woman started attending ANC [booking] of above 20 weeks, those who started at gestational age of 12-20 weeks were 49% [p=0.002] less likely to be cases. Compared to the gestational age when the woman had her last dose of IPT of more than 36 weeks, those who had the last dose at less than 36 weeks of gestational period/age were 4.46 [p=0.001] times more likely to be cases. Compared to HIV negative women, those who were positive were 1.73 [p=0.014] times more likely to be cases.In conclusion, the study revealed that the effectiveness of IPT/SP in clearance of placental malaria parasites in pregnancy in Kafue District is affected by three factors. These include timing for antenatal booking, frequency of antenatal visits as well as the HIV status of the antenatal woman.
Acceptability of Oral Immunization Against Cholera and Typhod Fever among School Children in Lusaka
(2011-07-13) Masebe, Mukokomena Esther
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. There were 14.4 million individuals worldwide living with TB including half a million cases of Multidrug-resistant (MDR) TB in 2006. A most serious aspect of the problem has been the emergence of MDR-TB and extensively drug-resistant (XDR) TB. MDR-TB is defined as a strain of Mycobacterium tuberculosis that is resistant to at least Isoniazid and Rifampicin whether there is resistance to other drugs or not. XDR-TB is defined as resistance to at least rifampicin, isoniazid, a second line injectable drug (capreomycin, kanamycin or amikacin) and a fluoroquinolone.China, India and the Russian Federation are thought to carry the largest MDR-TB global caseload. World Health Organization (WHO) estimates that there were 66,700 MDR-TB cases in Africa in 2006. In 2005 approximately 50 cases were reported as having MDR-TB in Zambia. Treatment of MDR-TB requires prolonged and expensive chemotherapy. The main objective of this study was to determine the prevalence of and factors associated with MDR-TB among adults with TB at University Teaching Hospital (UTH) in Lusaka, Zambia. Specific objectives were to describe the demographic characteristic of patients presenting with MDR-TB, determine the proportion of MDR-TB cases among TB culture-positive patients, and to determine the association between HIV/AIDS, previous TB treatment and compliance on one hand and MDR-TB on the other.A cross-sectional study was conducted in UTH TB Laboratory in Lusaka among culture-positive TB patients. Facility TB records and databases for M tuberculosis isolates which were cultured and had drug-sensitivity testing performed against four first-line anti-TB drugs were studied retrospectively. All the records and databases available between 2003 and 2008 were reviewed. The results have been presented in graphical and tabular form. The proportion of MDR-TB among the TB culture-positive patients was 10.9%. The association between age and MDR-TB was not statistically significant. The observed proportions of females between positive and negative were statistically different. There was no significant association between employment status and MDR-TB. There was an association between HIV/AIDS and MDR-TB. There was an association between compliance and MDR-TB.We conclude that there is need for continuous monitoring of MDR-TB and XDR-TB.
Current Epidemiological and Historical Characteristics of Cancer of the Oesophagus(CoO) at the University Teaching Hospital
(2011-07-13) Musowoya, Joseph
Barriers to Accessing HIV Care and Treatment Services by TB patients who are co-Infected with HIV in Lusaka District Clinics
(2011-07-13) Munthali, Loyce Chapeta
The objective of the study was to identify barriers to accessing HIV services by TB patients who are co-infected with HIV in Lusaka District clinics. CIDRZ program monitoring data shows that 30% of TB patients refuse HIV testing and that 45% of HIV-positive TB patients identified through DCT do not enrol in HIV care (Harris et al., 2007).This was a cross-sectional qualitative study using free listing and interview guides. The first part of the study involved 32 TB patients who attended a TB clinic. The criteria for selection included: those who refused DCT, those who accepted DCT but tested HIV negative, those who accepted DCT and tested HIV positive and were referred as well as those who refused referral to an ART clinic. The data was collected using free-listing technique which entails that the patient lists all the possible responses and gives a small description to each of those responses. The study further collected information from 31 key informants using an unstructured interview guide. These informants were selected by the respondents in during the free listing exercise. The study was conducted in 8 Lusaka Urban District Clinics and analysed using thematic analysis.Both free listing and key informants‟ questions were based on people‟s understanding of causes of TB/HIV co-infection and how these can be reduced. The respondents associated TB/HIV co-infection to a lot of issues, notably prostitution and poor diet. They emphasized the need for provision of more information on TB/HIV to patients as a way of the spread of these diseases.The study revealed that lack of confidentiality was seen as a barrier for most respondents. Many people do not access TB/HIV services because of fear of lack of confidentiality on the part of the health workers which is associated with stigma and discrimination by the general public. Suggestions to curb this vice included calling for Government to merge the services for both TB and HIV patients. Taking of TB/HIV treatment at the same time is seen as a „good thing‟ by the general community but there is need to sensitize the people affected on its importance. Many people avoid taking drugs for these diseases at the same time because they believe the drugs are too strong to be taken together‟ and can kill a patient‟.The results of this survey have helped identify community perceptions that contribute to the under-utilization of HIV services by TB patients who are co-infected with HIV in Lusaka District clinics. The hypothesis generated from this study is that underutilization of TB/HIV co-treatment services is associated to the barriers identified in this study.
Young Men's Perception of Male Circumcision at the University of Zambia in Lusaka: Implications for HIV/AIDS Prevention
(2011-07-13) Lisulo, Monde
This is a report of the study that was conducted at The University of Zambia (UNZA) main campus to explore the perceptions of male students towards male circumcision (MC) and its effectiveness as a complimentary method of HIV/AIDS prevention. It was an exploratory study that used both qualitative and quantitative methods for data collection and analysis. The population of the study was students at UNZA main campus. Data was collected using semistructured questionnaires and through focus group discussions (FGD). Forty-two respondents answered the semi-structured questionnaires and 40 participants were involved in the FGDs. A tape recorder was used during the FGDs. The recordings were later transcribed for data analysis and interpretation. The age range of the study participants was 18 to 38 years, with a median age of 23 years. The study shows that perception towards male circumcision is influenced by a number of factors including cultural and social upbringing, friends and the media. The media seemed to have greater influence on the perception (48%); because it was said to put forward facts about MC. The media in this case included television, radio, brochures, posters and workshop handouts. Cultural influence was minimal (18%). Moreover, 71% of the participants said their cultures did not have any preconceived beliefs about MC. Most of these also said their families would not react negatively if they decided to get circumcised, even if they were from non-circumcising cultures.There was no particular non-circumcising tribe that was more against MC than other tribes. The case was similar with age, school, programme, year of study and areas where participants were brought up. Most students said they did not think that people who were circumcised were stigmatized. However, analysis of the findings revealed that there was some level of stigmatization because of the negative perceptions that some people seemed to have about MC as stated by the participants. The general perception that came out about MC was that it is an “ok practice” although slightly over half of the study participants (57%) felt that it could not be used as an effective method of HIV/AIDS prevention. They felt that evidence available so far in favour of its effectiveness was not enough to convince them. However, about half (51%) of the study participants nevertheless felt that it should still be promoted and left for men to make their own decisions whether to adopt it or not. They also said that more research should be conducted, here in Zambia also and more evidence be presented to show just how effective it could be. Some participants felt that promoting MC might encourage men to abandon use of condoms, and consequently increase infection rates. There was an indication that risk compensation did actually exist among the circumcised students. However, the tendency not to use any protection like condoms during sexual intercourse was reported even among non-circumcised students and those who had multiple sexual partners, making a conclusion that risk compensation exists among circumcised students inconclusive and invalid for now. In conclusion, most male students’ perception about MC is mainly influenced by information they receive through various media. The campaigns to promote MC could therefore continue and work to provide the students with more information and facts about MC and its role in reducing the risk of HIV infection in men.
A cross sectional questionnaire-based study on client satisfaction with Community pharmacy care in Lusaka District
(2011-07-13) Mulubwa, Victor
The main objectives of this study are to estimate the levels of patron satisfaction with community pharmacy care, to describe those with low satisfaction scores and to determine the reasons for purchase of drugs. This was a cross sectional questionnaire based study that was conducted in Lusaka involving six community pharmacies representing zones used by the pharmaceutical society for monitoring. The study was conducted in eight geographical units which are Chawama,Chilenje,City Centre , Matero , Manda hill , UTH , Chelstone and Kanyama.Patrons were asked to fill in a standard questionnaire. Patrons were asked about demographic data, referral, reason for purchase of drugs, pattern of drug use, men’s and women’s problems, duration of drug use, satisfaction domains and tangibles. These clients were between 18 and 49 years old. Patrons had to fill in a questionnaire and consent had to be obtained before filling in. The key concluding remarks are as follows:- 1. Only 36% of patrons were satisfied. 2. Assurance had the highest score 52.6% and reliability had the lowest score 21.2% on the satisfaction domains. 3. On reason for purchase of drugs sugar disease had the highest score 42.9% and diarrhoea had the lowest scores 27.3%. Despite the above findings, much work remained to be done. There is need to do similar research in other parts of the country so that the picture obtained elsewhere can be compared to the findings. This could help to:- • Identify pharmacy care that needs improvement • Identify potential area of pharmacy care that needs performance assessment • Inform managers and policy makers. • Guide the training of pharmacists from University of Zambia.
Determinants of Teenage Pregnancy in Lusaka District
(2011-10-31) Katayamoyo, Patrick
A pregnant teenager who drops out of school has her child predisposed to live in abject poverty as she joins the poverty cycle. Society pays a heavy price for children who are likely to lack proper parenting, economic security and at high risk of behavioral problems and vices such as crime, substance abuse and prostitution. Additionally there are serious and sometimes irreversible effects on the mother such as the emotional, psychological and gynaecological complications. The burden of reproductive health problems falls largely on female adolescents. Maternity registry statistics specifically reveal significantly high numbers of teenagers passing through these centers. This was a major thrust of this study, which intended to determine the predisposing factors to teenage pregnancy in order to add to the body of knowledge on the subject of teenage pregnancy and make necessary recommendations based on evidence. This research was a case control study. The study population were female teenagers (13 to 19 years old) attending clinic at centers where antenatal services are available. The sample populations were two groups of female teenagers. One group constituted cases comprising pregnant teenagers attending antenatal clinic and another group constituted controls comprising female non-pregnant teenagers attending same clinic for any other ailments (with no reported history of pregnancy or abortion). Selection of sites was purposive of four clinics with the highest teenage delivery rates in Lusaka as well as University Teaching Hospital (UTH). Sample size was determined through an initial pilot study. Data was collected using a structured questionnaire through direct (one to one) interviews. Analysis of data resulted in testing the association of the various exposure factors i.e. socio-demographic, contraception, tradition and culture and illicit sex. The results on multivariate backward logistics regression indicated the following: teenagers below 16 years were 70% less likely to get pregnant compared to those above, singles were 60% less likely to be pregnant compared to those who are married, while participants with breadwinners who were not in gainful employment were two times more likely to get pregnant. Parental/guardian reprimand was shown to have a deterrent effect on teenage pregnancy. Lack of knowledge on female physiology or hormones was shown to predispose to teenage pregnancy by three times whereas lack of knowledge on condoms had similar effect by twofold. Shyness to access contraceptives by teenagers increased chances of pregnancy by fifty percent.
Patient's Psycho-Social,Treatment and Health Services Factors Affecting ART Adherence in Choma(Zambia)
(2011-11-04) Nsakanya, Richard
Research relating to factors responsible for adherence in Zambia has been limited. Clinic records at Choma show that the defaulter rate is at 9.9% (CIDRZ, 2007). This cross sectional study looked at common adherence problems like: level of adherence, patient factors, treatment factors, substance and alcohol, dietary restrictions, side effects and other factors that may be specific to poor settings. Respondents were drawn from; (i) patients on ARVs with a history of defaulting from the defaulter patient’s register or (ii) a member in a household with an adult taking ARVs (care giver). Data was collected using patient medical records and one to one interviews. Tests of associations using the Chi-square test or the Fisher’s exact test were done. SPSS logistic regression was used to determine predictability. Results showed that the majority of the respondents were from the 26-35 age group (35.2%) and women tended to be younger than males (26-53 age group). Most had never been to school or had only gone up to primary school (58.9%), were unemployed (34.6%), divorced or single (60.3%) and had no social support (52.4%). From treatment and service factors, 79.5% of respondents were not keen to take drugs, 63% experienced side effects and 61% said clinic waiting times were long. There was significant association between non-adherence to ART and some known social factors; social support P = 0.001, marital status p < 0.001 and one’s responsibility to take drugs p = 0.001.No significant association was found between non-adherence to ART and treatment factors; side effects p = 0.960 and discomforts p = 0.960. Service factors also had no association; patient education p = 0.066, availability of drugs p = 0.732, patient follow-ups p = 0.301 and long clinic waiting time p = 0.187. Married respondents were 48% (AOR = 0.52, 95% CI [0.31, 0.87]) less likely to miss clinic appointments, compared to respondents who were single.Respondents who had social support were 47% (AOR = 0.53, 95% CI [0.32, 0.90]) less likely to miss clinic appointments, compared to those who did not have social support.Respondents who were not keen to take medication were 72% (AOR = 1.72, 95% CI [1.03, 2.86]) more likely to miss clinic appointments, compared to those who were keen to take medication.To enhance ART adherence, the study recommends that, all patients should be encouraged to receive adherence counseling. Ministry of Health should promote Health education campaigns.

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