African Digital Health Library (ADHL) - Zambia

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

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

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

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The 2012 List of Health Facilities
(University of Zambia, Medical Library, 2012) MInistry of Health
This report presents information on the List of Health Facilities in the country, for 2012. It is the fourth (4th) publication that the Ministry of Health has produced since 2002 with subsequent ones produced in 2008 and 2010. It provides comparable cross-sectional facility statistics on key public health interventions being implemented at all levels of the health service delivery system. Since 2008, the Ministry has been compiling this information for dissemination to the general public, every after two (2) years with the recent publication done in 2010. Therefore, in view of the dynamic growth in the number of health facilities that have been established (especially health centres and health posts), it has become imperative for the Ministry to update this list so that the report is disseminated to the general public and other policy makers. Unlike the 2008 and 2010 Health Facility Listing reports that only covered limited information for each health facility, this report presents detailed information on the following aspects: (i) Background statistics for each health facility such as facility type, facility owner, number of beds & cots, number of outreach sites, distance from the health facility to the furthest outreach site and distance of facility from District Medical Office. (ii) Key health services offered for each health facility such as PMTCT, Male circumcision, HIV and VCT services, availability of TB diagnostic services, EMONC services, dental services, X-ray, availability of CD4 machine theatre , mother waiting shelter, among others. (iii) Main communication mode, source of power, water & SMARTCARE for each health facility (e.g. radio or telephone system), main source of power the health facility uses (hydro, gen. set or solar), water source (500m radius from HF ), among others. Suffice to also mention that the report has included information for Muchinga Province, created from districts that were part of Northern Province (i.e. Chinsali, Isoka, Mpika and Nakonde) and Eastern Province, i.e Chama. The new district of Mafinga which forms part of the sixth district of the new Province of Muchinga was created by taking the whole of Isoka East Constituency. Since the new province was created by taking the districts, without altering existing district boundaries, health facility totals for the newly created province of Muchinga, have been easily extracted from the original areas that were part of Northern and Eastern provinces, accordingly. This therefore means that the new totals for Northern and Eastern provinces are lower for 2012 compared to the previous reports published, due to loss of four (4) and one (1) district from Northern and Eastern provinces, respectively. It is my sincere hope that this publication would make it easier to find specific information about the level, location and key services provided by each health facilities in the country. It is also my expectation that this publication would assist in data analysis and use of infrastructure- based information by policy makers, programme managers and co-operating partners in addressing challenges related to improving access and utilization of health services. In order to further improve the contents and presentation of subsequent publications, any feedback on this report would be greatly appreciated.
Abdominal actinomycosis
(Medical jornal of zambia, 1981-11) Elem, B.; Sinha, S. N.; Parmar, J.; Rao, B. A.
Actinomycosis is an uncommon chronic suppurative disease with a worldwide distribution. The causative organism, Actinomyces Israeli, presently classified as a gram +ve bacteria (Muir, 1975) is an oral commerisal in man. The gastro intestinal involvement is believed to be auto-genus. It is difficult to ascertain the incidence of this disease in Zambia. However, during a two year period (1976-1977) four cases of abdominal actinomycosis were managed at Ndola Central Hospital® This paper is concerned with the report of these cases and a critical evaluation of the problem of this form of the disease.
Abdominal Tuberculosis is common and under-diagnosed in HIV positive Adults in Zambia
(2012-07-25T13:24:16Z) Sinkala, Edford
Abdominal tuberculosis is a common form of extra- pulmonary tuberculosis especially in HIV/AIDS patients. A high index of suspicion is required for diagnosis of abdominal tuberculosis in these patients. A study was done at the University Teaching Hospital, Lusaka, Zambia to ascertain whether abdominal tuberculosis is common in HIV/AIDS patients, and whether under diagnosed. The inclusion criteria were fever and weight loss, with one or more of the following: diarrhoea persisting for >1 month, ascites, abdominal lymphadenopathy based on ultrasound, mesenteric masses based on ultrasound, hepatomegaly or splenomegaly, pancreatic enlargement, or unexplained focal or generalised pain/tenderness persisting over 7 days. The exclusion criteria included: HIV negative, solely pelvic and renal abnormalities, on antituberculous treatment for more than 1 week or too sick to undergo laparoscopy or colonoscopy. 31 subjects completed the algorithm and all the subjects had abdominal ultrasound scanning of which some had laparoscopy/laparotomy while others underwent colonoscopy. In order to determine if abdominal lymphadenopathy was attributable to HIV an equivalent number to those who met the criteria was recruited as controls and had abdominal ultrasound scanning. These subjects were HIV positive and had no features of tuberculosis. In this study 22 subjects had evidence of abdominal tuberculosis while 9 had no evidence of abdominal tuberculosis representing 71% and 29% respectively. Non of the controls had abdominal lymphadenopathy or any appreciable mass on abdominal ultrasound implying that abdominal lymphadenopathy indicate pathology. Good history and physical examination proved to be useful in diagnosing abdominal tuberculosis. Among the physical findings, abdominal tenderness was the commonest (86%) in subjects with evidence of abdominal tuberculosis. This study also revealed that abdominal ultrasound is an important tool in helping to make diagnosis of abdominal tuberculosis especially in poor resource set up where CT and MRI scans are not readily available. This study showed that 73% of those with evidence of abdominal tuberculosis had ascites and 54% of subjects with abdominal tuberculosis had ascites with fibrous strands. While laparoscopic studies plus biopsy will confirm abdominal tuberculosis, this study noted that it is possible for normal looking mucosa on colonoscopy to be colonised by Mycobacteria tuberculosis (this was found in 1 out of 5 subjects). No Mycobacterium was cultured from any of the blood samples drawn from the study subjects and positive culture of the ascitic fluid was low (13.6%). Many subjects with abdominal tuberculosis had low CD4 count (mean= 92 cell/ul). 20 subjects (HIV positive) who died of suspected pulmonary or abdominal tuberculosis had autopsy done on them. Disseminated tuberculosis was more frequent than either pulmonary or abdominal tuberculosis. Abdominal tuberculosis in quite common in HIV positive patients. Therefore it is important to take a detailed history and elicit signs pertaining to abdominal TB.
Abolishment of corporal punishment in Zambia: Evaluation alternative modes of discipline in selected Government Secondary Schools in Lusaka District
(The University of Zambia, 2016) Mtonga, Dingase E.
The study aimed at evaluating alternative modes of discipline educators use to instil discipline in pupils after the abolishment of corporal punishment in 2003 in Zambian schools. The objectives of this study were: to verify the alternative modes of discipline to corporal punishment educators use to instil discipline in pupils in Government Secondary Schools; ascertain their suitability; explore challenges educators encounter in using the alternative modes to instil pupils‟ discipline, and; solicit proposals to mitigate the challenges. The study implored qualitative approach and a descriptive survey design. Data was collected from the documents reviewed; and through individual interviews, focus group discussions from a sample of 51 participants which comprised 21 teachers, 21 pupils, 3 school administrators, 3 Parent Teachers Association (PTA) representatives, from three Government Secondary Schools, and 3 policy-makers from the Ministry of General Education (MoGE) and Human Rights Commission (HRC) offices. Purposive sampling was used to sample policy makers, school administrators and PTA representatives. Typical and homogeneous sampling was used to sample teachers and pupils. Data was analysed according to emerging themes, and presented on tables and graphs. The findings were that educators use dialogue, suspension, counselling, and manual to instil discipline in pupils. With regards to suitability, the findings were that alternative modes are suitable to use on pupils discipline as they are non-corporal, create a sense of responsibility in pupils, instil discipline and are lawful. The established challenges were that the modes consume time, are not effective to instil discipline, non-compliance by parents and pupils, lack of knowledge by teachers and pupils. The findings on mitigation of challenges were: the MoGE to prescribe alternative modes as a guide for educators and provide them with knowledge and skills to enhance the administration of discipline, teamwork by parents and teachers and insisting on pupils to adhere on school rules. In light of the findings, the study recommended that schools should have guidance and counselling departments with qualified counsellors to help in pupil discipline, educators to explore better contemporary trends on positive discipline, all schools to establish and strengthen child rights clubs and train peer educators on the importance of good discipline. Finally, more research to be conducted on ways of improving discipline in Government Secondary Schools.
Acceptability of Antiretroviral Drugs among adults living in Chawama, Lusaka
(2011-11-09) Munthali, Sharon C.
Acceptability of Antiretrovirals (ARVs) has been found to be associated with several factors. In this study we investigated the level of willingness among adults living in Chawama and factors likely to be associated with willingness to taking ARVs This was a cross sectional study. Only eligible adults 18 years and above were recruited by a simple random sampling. A structured questionnaire was used to collect data socio-demographic and other factors likely to influence willingness The Chi square test was used to determine association between variables of interest and multivariate analysis was performed to determine predictors of willingness Overall (n=409), 52.8% females and 46.9% males participated in the study. The non response rate was less than 1%. Overall (n=409), 52.8% females and 46.9% males participated in this study. The non response rate was less than 1%. A high level of willingness was observed with more than 50% of participants willing to take ARVs if they were found legible for ART. The mean age of participants was 31 years (SD±11.60). Some of the key factors that were found significantly associated with willingness were, the aspect of being male or female [OR: 2.27 (95%CI, 1.10 - 4.70)] with females being more likely to be willing than males, the perceived effectiveness of ARVs [OR: 3.50(1.71 - 7.82))], the need for consent to begin ARV treatment [OR: 1.30(95% CI, 1.40-2.72)] with females being more likely to needing consent than men, and fear of discrimination [OR: 2.47(95% CI,1.22 – 5.00)] A high willingness to take Antiretroviral drugs among community members was observed but there is need to increase intervention programs that promote acceptability and uptake of ARVs. Furthermore stigmatizing attitudes, gender and socio-cultural influences towards people taking ARVs still persist and interventions to reduce these influences are needed.
Acceptability of male circumcision in HIV prevention among the males aged 18 years and above in Mufulira Urban
(2011-11-04) Chiwele, George
HIV/AIDS is a major public health problem, not only in Zambia but the world as a whole. Millions of new infections are still being reported especially in the Sub-Saharan Africa. This has resulted in a number of interventions being put in place to halt the spread of the HIV infection. Male circumcision is one of the new interventions that is being considered in the prevention of HIV transmission from infected females to males.The overall aim of this study was to determine the acceptability of male circumcision in HIV prevention among the males aged 18 years and above in Mufulira urban. The specific objectives were: (1)To determine the proportion of uncircumcised respondents willing to undergo male circumcision. (2)To determine the reasons why circumcised respondents got circumcised. (3)To identify socio-cultural factors associated with the uptake of male circumcision. (4)To determine association between knowledge on male circumcision and willingness to undergo male circumcision. A cross sectional study was conducted in Mufulira urban in December, 2009 by the research team. The study comprised face to face interviews of 407 respondents using a structured interview schedule and two FGDs involving males aged 18 to 30 years and those aged 31 years and above respectively. Respondents were drawn from one high density area with a high HIV prevalence (Kantanshi Township). The Township was purposively selected. The households were systematically selected. One randomly selected male aged 18 years or older was interviewed from each selected household using a structured interview schedule. Individuals for the FGDs were purposively selected to ensure that groups were homogeneous.The confidence interval was set at 95%, and a result yielding a P value of 5% or less was considered to be statistically significant. The Chi Square test was used to compare the proportions. A full report of the FGDs was written using participants own words. The main ideas and key statements that were expressed were listed down. Data was coded and responses from the two FGDs were compared and a summary was written in narrative form.The study findings revealed that only 18.7% of the respondents were circumcised. The Study further revealed that 60.7% of the respondents expressed willingness to be circumcised if male circumcision could offer partial protection against acquisition of HIV/AIDS. 69% of the respondents had high knowledge on male circumcision. There was no association between knowledge and willingness to undergo male circumcision.The only significant association was between improvement in genital hygiene and willingness to undergo male circumcision.The results showed that though the level of male circumcision was low in Mufulira Urban, the procedure was perceived positively.
Acceptability of male midwives in birth/delivery care in Ndola
(2011-11-04) Chilumba, Janness Namusokwe
The study sought to determine acceptability of male midwives in birth and delivery in Ndola (both rural and urban). The literature reviewed has revealed that there are very few studies that have been conducted worldwide and at regional level which focus on gender perspectives, family planning and male circumcision.The study sought to answer research questions: To what extent have male midwives been accepted during birth and delivery? What is contributing to acceptability or non acceptability of male midwives in the community? And finally should training of male midwives continue? A cross sectional study was done in two urban health centres and two rural health centres of Ndola. A 1:5 systematic random sampling was used to select the respondents. Mothers were followed in their homes using the addresses from the register. A total of 420 respondents were requested to take part in the study of which only 403 were recruited, giving a response rate of 96%. And 60 husbands of antenatal mothers were purposefully selected into the study for focus group discussions that is 15 from each area. Quantitative and qualitative data were analysed using SPSS version 11.5 and content analysis respectively. The Chi-square test was used to determine the associations of independent variables with the dependent variable. The study revealed that the respondents accepted to be cared for by male midwives because they are trained and offer the same care as female counterparts and that they are caring and gentle. Significant findings were noted amongst antenatal mothers who had higher educational level (68%), higher income (69.8%) and those who were not sure of their cultural values and who said the idea of not accepting male midwives was being done away with had 83% acceptance rate of male midwives. Those with previous experience with male midwives, 87.1% felt very safe when they were being attended to by male midwives and 75% of antenatal mothers accepted to be attended to by male midwives but suggested that they should be confined to antenatal clinics and not labour ward. A higher acceptance rate (73%) was noted among respondents who said they would accept to be cared for by male midwives as this was a reality that was prevailing citing critical shortage of midwives in general and that male midwives have empathetic attitude than their female counterparts who are believed to be short tempered and screaming at women in labour. A few (39.8%) would not accept to be attended to by male midwives because they felt embarrassed and shy to undress for a man other than their husbands and traditionally (53.4%) it was a taboo undressing before a man you are not married to. The men folk were against the idea of male midwives in birth and delivery since they themselves were not allowed to enter labour ward when they escorted their wives. They emphasized that traditionally and culturally it was just not right. However the study also revealed that the men folk felt that they should be sensitized on new programs such as this because they understand issues better than their wives so that they are able to prepare their wives psychologically as they go for birth and delivery services The study has revealed that most of the respondents were for the idea of training male midwives and this is a challenge to Ndola District Health Management Team to consider capacity building in this area though a few felt that if men are trained, they should only work in antenatal clinic and not labour and delivery.
Acceptability of option B+ among HIV positive women receiving antenatal and postnatal care services at the University Teaching Hospital and Lusaka urban city clinics
(The University of Zambia, 2017) Chanda, Chomba Bridget
In 2013, Zambia accepted the immediate operationalization of Option B+, a policy used to try and eliminate mother to child transmission. This policy requires all HIV-positive pregnant and breastfeeding women to initiate antiretroviral treatment for life regardless of CD4 count. However, not all HIV positive women accept treatment for life. This study aimed to investigate acceptability of lifelong ART (Option B+) among HIV positive women receiving antenatal and postnatal services at the university teaching hospital and Lusaka urban city clinics. This was a cross sectional study conducted in November, 2016 to March 2017 at the University Teaching Hospital (Department of Obstetrics and Gynecology) and four clinics (Chawama, Kalingalinga, Matero Reference and Chilenje). The overall sample size was 427 and the study population comprised of HIV positive women in their reproductive age (15-49 years). A Structured questionnaire was used to collect data in a face to face interview with the participants. Data was entered in EpiData version 3.1 and analysed using Stata version 13. Multivariate logistic regression analysis was performed to determine predictors of acceptability. Overall, 427 women participated in this study. Their mean age was 30 years. Of the 427, over half (54%) had inadequate knowledge and about 30% of the women in the study still experience stigma and discrimination. 63.2% of the women had good attitude towards Option B+ and overall, the majority (77.8%) were willing to accept antiretroviral therapy for life. Multivariate analysis showed that only women with good attitude were 9.4 times more likely to accept Option B+ than those with a bad attitude [OR: 9.4: 95%CI, 5.8-15.2)]. This study showed that in general, women accepted initiation of Option B+. However, there is still a gap in the level of knowledge of Option B+ as well as stigma and discrimination in some communities, hence there is need to intensify programs that are aimed at educating the community on the importance of ART for life, combat stigma and discrimination and consequently promote acceptability of Option B+.
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.
Acceptability of routine HIV testing by pregnant women in Lusaka urban antenatal clinics, Lusaka District, Zambia
(The University of Zambia, 2016) Muyemba, Mercy K.
The study was done to investigate the factors that influence acceptability of routine Human Immuno deficiency Virus testing by pregnant women in Lusaka District clinics. Each year around 1.5 million women living with Human Immuno deficiency Virus(HIV) become pregnant, and without antiretroviral drugs there is a chance that their child will become infected. The risk of Human Immuno deficiency Virus transmission from mother to child can be reducedif pregnant women take a regimen of Anti-Retroviral drugs.Following the introduction of Routine Human immuno deficiency Virus testing policy in Zambia, the Human immuno deficiency Virus test is offered to all pregnant women unless they decline. However, more pregnantwomen are declining to be tested.The aim of the study was to investigate the factors that influence acceptability of routine HIV testing by pregnant women in Lusaka urban ante natal clinics. A cross sectional study using a quantitative approach was conducted in Lusaka Urban District clinics. The sample size comprised of 366 pregnant women selected by simple random sampling, from three (3) research settings. A pretested semi structured interview schedule was used to collect data. Data was entered and analysed with Statistical Package for Social Sciences (SPSS) version 20 program.Chi-square was used to test for associations between acceptability of routine HIV testing and other variables. Binary logistic regression modelling was carried out to predict the outcome. Study findings revealed that86.6% of respondents indicated non acceptability of routine HIV testing in pregnancy. Binary logistic regression revealed that maternal age, educational level and information education and communication contributed significantly to the model. The odds revealed that acceptability of routine HIV testing by older pregnant women (37- 49 years) were 8 times (OR- 7.67, p- 0.003) higher than the younger ones. The odds of acceptability by respondents with tertiary education were 141 times (OR-141.23, p-0.000), likely to accept HIV testing than those with primary or no education. The odds also revealed that acceptability by women who cited adequate information, education and communication (OR-2.6, p-0.024) were 3 times higher than those who cited inadequate IEC. The study showed that majority of the pregnant women did not accept Routine HIV testing despite the numbers of women taking the HIV test. Therefore there is need to address some factors that are likely to affect the routine HIV testing and impede the success of implementation of the prevention of mother to child transmission (PMTCT programme in the country which goes beyond testing for HIV alone. Key words: Acceptability, Routine HIV testing, pregnant women
Acceptability,Concerns and Experiences of Men Circumcised by Female Health Providers in Lusaka District
(University of Zambia, 2016) Mahule, Agness
Background: The Zambian government has endorsed voluntary medical male circumcision (VMMC) as a biomedical strategy for HIV prevention after a decade of debating its effectiveness in the local setting. The current policy recommends that male circumcision (MC) should be clinically based, as opposed to the alternative of traditional male circumcision (TMC). Acceptability concerns are among the challenges threatening the mass rollout of VMMC. In terms of acceptability, the gender of clinicians conducting the operations may particularly influence health facility-based circumcision. Currently, Zambia is advocating circumcising 80% of all HIV negative men. Most studies globally are on acceptability and barriers to access MC services in general and research is yet to profile the experiences of men who are to be attended to and have been attended to by female providers. Aim: This study explored the concerns and experiences of male clients, of female clinicians or providers taking part in the circumcision procedure. Methods: This was a qualitative study. Data was collected through in-depth interviews with 29 circumcised men at three health facilities. Interviews were audio recorded. Data were verbatim transcribed and analyzed thematically using NVIVO version 10. Results: All 29 participants got circumcised by a female provider. Reasons for accepting were mainly due to lack of choice and that most services offered in health facilities may be done by any experienced provider regardless of gender affiliation. Significant concerns are; shame, stigma and erection. To undress in presence of a female for circumcision purpose was accepted reluctantly owing to culture concerns and that some men erect inadvertently which is rather embarrassing. Additionally male circumcision is an elective procedure and one would wait until a male provider was available. However male circumcision offered in hospitals can be done by any trained health personnel. Conclusions: Concerns and experiences were shame and embarrassment associated with undressing in presence of an opposite sex and the negative attitude of the community to male circumcision offered by female providers. Sex of a provider may be communicated to people or possible clients at individual and community level to prepare clients psychologically. Since the Zambian government is recommending circumcising 80% of all HIV negative men, policy and practice must focus on educating the target group on myths, facts and assumptions surrounding male circumcision offered by female providers. There is room for improvement in modes of offering male circumcision services in health facilities.
Acceptance and utilization of condoms in the prevention of HIV/AIDS amongst christian men in Mwinilunga.
(2014-06-30) Lupili, Hellen Mulenga.
The title of this study is Acceptance and Utilization of Condoms in the Prevention of HIV/AIDS amongst Christian men in Mwinilunga. The main objective is to determine the factors that influence the acceptance and utilization of condoms in the prevention of HIV/AIDS among Christian men in Mwinilunga. The specific objectives are to determine the level of acceptance of condoms among Christian men, determine the level of utilization of condoms among Christian men, determine the factors that influence the acceptance and utilization of condoms and make recommendations to all the concerned parties on how to increase condom use among Christian men in order to prevent HIV/AIDS. The study was conducted between 23rd August and 1st October, 2004.The findings of the study revealed that the majority of the respondents were aged between 25-34 years (50%). The majority of the respondents were married 66%, 40% were Lunda and belonged to New Convenant Church. This could be attributed to the fact that marriage is universal in Zambia and people marry at any age sometimes as early as 16 years; and the study was conducted in a predominantly Lunda speaking area. Apart from that, the study also found that the majority of the respondents 23(46%) had attained college level of education and were in formal employment 23 (46%). This could be attributed to some cultural practices where families may opt to marry off their daughters instead of sending them to school therefore it is not surprising that the same son who was empowered with the education would easily find formal employment.
Accessing adolescent sexual and reproductive health services among undocumented migrants in South Africa
(University of Zambia, Medical Library, 2016) Mukondwa, K; Gonah, L
Adolescent sexual and reproductive health access continues to dominate the development agenda since the historic 1994 Cairo Conference and becomes a huge public health concern for the increasing diverse of undocumented adolescents who have become an important component as irregular migration patterns and profiles shifts in South Africa. The inherent nature of irregular migration poses exposure and vulnerabilities making access to sexual and reproductive health services(SRH) imperative. Findings from this study revealed that access to SRH services among undocumented adolescents migrants is poor attributed to diverse structural, socio-cultural and financial barriers. For SouthAfrica, conflicting health and migration policies leads to inconsistencies in service provision making it difficult for both adolescents and health service providers to strike a balance between migration and health considerations. Migration remains politically sensitive with punitive measures for those in undocumented state who are subsequently marginalized and excluded from accessing all social services, health included.Health policies on the other hand are non discriminatory, employing an all inclusive approach to all adolescents irrespective of migration status. While the study demonstrated that adolescent SRH services among undocumented adolescent in South Africa may be poor, such findings are however inconclusive to suggest that SRH outcomes are also poor.for this particular group. Access is further compromised by the fact that this group is often young, geographically clustered in certain areas and the need to stay in South Africa for considerably longer periods of time. However, possible source of care for this group is within government public health agencies as access to private sources of care is poor owing to actual or perceived costs.Owing to this factor, access to government run health agencies becomes a central issue to explore in this study.
Accetability of kangaroo mother care by mothers with premature babies: A case study of the women and newborn hospital,Lusaka,Zambia
(University of Zambia, 2017) Kampekete, Sibuchi Getrude.M.
Kangaroo Mother Care (KMC) is a low cost method of care for premature and low birth weight infants in areas with inadequate incubators and power outages. KMC has been found to be an evidence-based approach to reducing mortality and morbidity in preterm infants. This study aims to assess the acceptance levels of Kangaroo Mother Care by mothers with premature/low birth weight babies. A cross sectional analytical design using both qualitative and quantitative approach was used. Data was collected using semi structured interview schedule from 60 mothers with premature babies and five key informants using and interview guide. Respondent were purposively sampled at the University Teaching Hospital KMC unit. Data was analysed by using Statistical Package for Social Sciences (SPSS) version 22 program and chi-square test was used to test for associations among variables. Binary logistic regression modelling was employed to predict the outcome. Data obtained by interview guide was summarised in a narrative form. Study findings indicate that 60% of women found KMC acceptable and were able to practice continuously in spite of not having prior knowledge of KMC before admission. Acceptance changed in mothers with high knowledge, where acceptance rose to 74.2%. The observed pattern was found to be statistically significant as the chi-square test yielded a p-value of 0.02. This finding suggests an association between Mothers' knowledge about Kangaroo Mother Care and acceptance of care. The study revealed that the longest serving key informant at the KMC Unit had served for two (2) years and three (3) informants had not received any training on KMC. The current study revealed that Kangaroo Mother Care was acceptable by mothers and their families and that most mothers had relatively high knowledge on KMC. Despite mothers having relatively high knowledge on KMC, most mothers did not receive any information on KMC before admission to hospital. Acceptability was significantly associated with knowledge of the mother on KMC. There is need to intensify Information, Education and Communication (IEC) to the communities on Kangaroo Mother Care. Keywords: Kangaroo Mother Care, Acceptability, Knowledge, Premature, Low birth weight
Accuracy and completeness of medication histories in patients in medical admission ward at University Teaching Hospital
(The University of Zambia, 2015) Mutinta, Melody
Quality documentation of medication histories at the time of hospital admission with regard to accuracy and completeness is not documented at UTH. A medication history is a detailed, accurate and complete account of all prescribed and non-prescribed medications that a patient had taken or is currently taking prior to a newly established or ambulatory care. This clinical research was guided by the question of how accurate and complete are medication histories are at the time of hospital admission. The aims were to determine the accuracy and completeness of documentation of medication histories in clinical records at the time of hospital admission. A cross-sectional study that involved interviewing patients and reviewing their clinical records at medical admission ward, UTH, was conducted over a period of 3 months. The study enrolled 322 patients admitted to this ward who were above 18 years of age and were able to communicate verbally, if not, were accompanied by a caregiver. Clinical records of these patients were screened to review all medications the patient was taking and patients/caregivers were interviewed to obtain a complete medication history. An interviewer administered questionnaire was used to collect data according to specific objectives. All information obtained through interviews was compared with medications recorded in the patient’s clinical records at the time of admission to the hospital. The Statistical Package for Social Sciences (SPSS) version 22 was used for all statistical calculations. Categorical data were expressed as frequency and percentage and presented using tables. The association between accuracy of medication histories and completeness of documentation was assessed using Pearson chi-square test, p<0.05 was considered statistically significant. Ethical approval was obtained from the ERES CONVERGE IRB Biomedical Research Ethics Committee. Of 287 clinical records, 175 (61%) incidents of inaccurate medication histories at the time of admission were identified and that medication histories in clinical records of patients were incomplete or poorly documented. This study shows that 61% of medication histories in patients at the time of admission to hospitals are inaccurate. Quality documentation of medication histories in clinical records at the time of hospital admission is poor.
Acral nodular lichenification in Zambians - an artefact
(Medical Journal of Zambia, 1982-10) Dube, M.K.; Attfli, V. R.; Hira, S. K.
Acral nodular lichenification among two Zambians, acquired through a regular habit of scrubbing the body with stones, is discussed.
Acute Bacterial Meningitis in Zambian children: Highlighting the changing pattern in the Aetiology of Bacterial Meningitis in Zambia
(2012-06-22) Kankasa, Chipepo
A hospital based prospective study on Acute Bacterial Meningitis (ABM) in Zambian Children was done in the department of Paediatrics, University Teaching Hospital Lusaka over a period of six months in the hot dry season (1st August to the end of November) of the years 1992 and 1993. The aim and objectives of the study were to determine the prevalence, aetiology, risk factors, poor prognostic signs, clinical profile and outcome of ABM. Nine hundred children were recruited aged one month to 15 years as cohorts, 2 9 were excluded, 871 were followed up.It was found out that almost all age groups were at risk, with ABM being commonest around 5 and half years of age. There was no sexual predilection, male to female ratio was 1.2:1, almost 90% of cases came from high density areas of Lusaka. Clinical manifestations ranged from fever with neck stiffness alone, to associated septic shock with petechial rash. The commonest complaints were fever (99%), anorexia (88.5%), headache (73.8%), vomiting (71.3%), arthralgia (about 60%), the commonest signs were; neck stiffness (96.9%), Kernigs (77.4%), Brudzinski(73%), whilst in infants fever, irritability, refusing to suck and bulging anterior fontanelle were common.The most common pathogens isolated were N.meningitidis (77.9%), S. pneumoniae (15.4%), H. Influenzae (2.7%), others (2.6%). Young age, HIV sero positivity, S. Pneumoniae as pathogen , altered level of consciousness and seizures on admission were associated with a poor outcome. Case fatality rate was 10.7%. The highest mortality was seen in children with meningitis caused by S. Pneumoniae (38.75%), compared to influenzal meningitis (14.2%) and Meningococcal meningitis (6.6%) . Follow up was very difficult because more than 50% of the study group defaulted.
Acute flaccid paralysis surveillance in Zambia:Progress towards the Polio End Game
(Medical Journal of Zambia., 2016) Ndumba, I.M.; Mazaba M. L.; Matapo, B.; Chirambo, R. M.; Mwambi, P.; Musumbu, P.; Masaninga, F.; Songolo, P.; Mufunda, J.; Monze, M.
In the global polio eradication initiative acute flaccid paralysis cases are followed up two to three months after onset of paralysis to assess recovery of the children. In Zambia AFP cases are followed up regularly but there is no documentation of the clinical and laboratory findings. The purpose of this paper is to document the support WHO country office offers to the follow up of the AFP cases in Zambia to identify gaps which the WHO Country office could address.This study used secondary data from a case control study design, conducted and supported by WHO country office, which was aimed at assessing the association of NPEVs with AFP. Particularly this study aims at assessing the presence or absence of residual paralysis and the laboratory findings of the affected children. Results revealed that a total of 93 cases of, which over 55% were males were included in this study. Majority of the cases were aged between 24 and 35 months (28.4%). Regarding vaccination status, 77% of the cases had received 1 to 4 doses of the Oral Polio (OPV) vaccine. About 62% of the viruses isolated were identified as Cox B, and Echo 3, 6, 7, 11, 12, 14 and 29. Of all NPEVs 37.1% yielded no neutralization pattern. Only 9 (9.67%) cases were followed up; out of which 3 (33.3%) had residual paralysis with one of those with residual paralysis who later died. It was concluded that AFP surveillance and follow up of cases is carried out in Zambia. However, rehabilitation information of the affected children is not followed up, an issue which WHO country office with regards to the transformation agenda could pursue to ensure that the affected children are adequately supported as a contribution to the polio eradication end game.
Acute Poisoning in the Community and its Associated Mortality at the University Teaching Hospital, Lusaka, Zambia
(University of Zambia, Medical Library, 2017) Mwanza, B; Kanyimba, S.N
Acute poisoning is a common event in the community. Despite the high prevalence of acute poisoning in the community, there are very few studies done on the subject in Zambia. Lack of research on acute poisoning has resulted in lack of information on the pattern of poisoning, morbidity, mortality and pitfalls in management. Methods: A retrospective study of cases of acute poisoning presenting at the University Teaching Hospital during the period 1 January 2015 to 31 December 2015 was conducted. A total of 131 case records were reviewed. Demographic information, information on the type of poisoning, presenting clinical features, case management and outcome was extracted from the medical records. The data was analysed using descriptive statistics. Frequencies and percentages were calculated for categorical data. All statistical tests were at 5% significance level. The Pearson's chi squared test was used for comparison of proportions between groups. Results: Of the 131 cases reviewed, 67 were female (51%). The age group 20-39 years had the highest frequency of poisoning (50%). The majority of cases (59%) occurred in individuals of low socio-economic status. The most frequently taken poisons were organophosphates (38%). Other commonly used agents included household chemicals and medicines. The majority of cases were due to suicide attempt, and there were only 5 cases of accidental poisoning. Of the cases where due to self-poisoning with intent to cause selfharm. The reasons for self-harm behaviour were given in 115 cases, and 71 (62%) of these were due to interpersonal conflicts arising from disharmony in relationships. The rest were due to various psychological disorders including depressive illness. No reason for self-harm was indicated in 16 cases. The majority of cases (86%) recovered without any complications. Mortality rate was 5%. Conclusion: Most cases of poisoning with the intent of self-harm occur in individuals who are vulnerable to stress. A variety of chemical agents are ingested, with the organophosphates being the group of chemicals taken more often than other groups of chemicals. The majority of cases are intentional with very few poisoning cases being accidental. Most cases have good prognosis and the majority recover without any sequel. Mortality from acute poisoning cases seen at the University Teaching Hospital is low.
Adaptable lessons learnt on procurement from deployment to a deadly emergency outbreak: The case of Sierra Leone during Ebola outbreak 2015
(Medical Journal of Zambia, 2016) Siboonde, M.; Musumali, M.; Sikazwe, A.; Mufunda, J.
The WHO has standard operating procedures for procurement, travel and logistics for use at country level. Some of the guidance is waived during public health emergencies of international concern. Practical acumen on using the standards for emergency settings is limited at country level. WHO Zambia was one of the countries that responded to the call by WHO HQ to support the 2014 Ebola outbreak in West Africa. This paper aims to document lessons learnt by procurement staffs that were deployed to emergency settings.Desk review of documents on procurement during emergency settings, terms of reference of the mission, materials on prevention of getting infected by Ebola and general rules governing international deployment were analysed. The staff member was deployed for the duration of eight weeks in 2015 from where experiences gained were reviewed and systematically recorded. Results revealed that the deployment and exposure to an emergency setting was the first such experience to WCO Zambia staff. During the Ebola outbreak in Sierra Leone there was the “no touch person” practice from inherent profound fear of contracting the deadly disease. While the job description was similar with what was prevailing in non-emergency setting in Zambia, the quantities and implementation speed on assignments on average were more than ten times on emergencies. In that environment the procedure for procurement involved Invitation to Bid and Request for Proposal to interested parties occurring at the same time which is done differently from normal situations where there is first a request for quotations and procurement committee deliberate before making selection. In the Ebola set-up, there is a waiver of the competitive bidding requirements.The exposure of WCO staff to emergency setting allowed WCO staff to be more knowledgeable about preparation and award contract using additional procurement methods in compliance with WHO policies as adopted for emergencies. Secondment of staff to a setting of emergencies is beneficial to WCO staff in terms of capacity building and handling similar situations in future. Country Offices are encouraged in future to share human resources when situations dictate.

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