Medicine

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A cadaveric study on variations of the cystic artery in the department of pathology, at the university teaching hospitals, Lusaka, Zambia.
(The University of Zambia., 2019) Sing`ombe, Isaac
The main source of blood supply to the gall bladder is the cystic artery which is a branch of the right hepatic artery. Anatomical variations of the cystic artery are frequent. Thus, careful dissection of the Calot`s triangle is necessary for conventional and laparoscopic cholecystectomy. The knowledge of variations of the origin, course, and length of the cystic artery is important for the surgeon as bleeding from the cystic artery during cholecystectomy can lead to death. The objectives of the study were; 1. To establish the origin of the cystic artery. 2. To determine the length of the cystic artery. 3. To establish the course of the cystic artery. 4. To establish the relationship of the cystic artery to the cystic duct. This was a descriptive cross-sectional study design in which 32 post-mortem human cadavers at the University Teaching Hospitals, Pathology Department, Lusaka were dissected and examined over a period of five weeks. A data collection form was used as a tool to gather the data and sample selection was done through systematic sampling. Data was entered and analyzed using Statistical Package for Social Sciences Statistics, version 22.0 (SPSS). A Chi-square and Fisher`s test was used to test association between variables. The cadavers dissected were aged between 22 and 66 years (mean 36.06±11.992) and of the 32, 27 were males and 5 females. Out of the 32 human cadavers, the cystic artery was found to be originating from the right hepatic artery in twenty-eight (87.5%), from hepatic artery proper in three (9.4%) and from the left hepatic artery in one (3.1%). In the twenty-nine (90.6%) cadavers dissected only one cystic artery was identified and in three (9.4%) others there were two arteries detected. The cystic artery length ranged from 2 – 6 cm (mean 3.56±1.0285 cm). The cystic artery was found to be inside Calot`s triangle in twenty-seven (84.3%) while in three (9.4%) it was outside the Calot`s triangle. The cystic artery was found to be passing supero-medial to the cystic duct in thirty (93.8%) while in two (6.3%) the cystic artery was passing anterior to the cystic duct. Demographic characteristic (gender and age) had no statistically significant association to variations of cystic artery (p>0.005). Five (18.5%) of males had variants of cystic artery and no females had variants of the cystic artery. Variations of the cystic artery origin, length, its course through the Calot`s triangle and its relation to the cystic duct are common. Knowledge of these variations is important and helpful in preventing and controlling haemorrhage or avoiding other complications during conventional and laparoscopic cholecystectomy.
A study on the detection of extended spectrum beta lactamase producers and class I intergrons in e. coli isolates from urinary tract infected patients at UTH.
(The University of Zambia, 2019) Chirwa, Emmanuel
Escherichia coli that produce extended spectrum beta lactamase (ESBL) enzymes pose a global challenge in the management of urinary tract infections (UTIs) caused by these organisms. Beta lactamases are the primary cause of resistance to beta lactam antibiotics. These enzymes confer multi drug resistance (MDR) thus limiting and complicating treatment options. The beta lactamase resistant genes are usually encoded on plasmids and often confer resistance to other classes of antibiotics, further underscoring their clinical significance. In Zambia there is paucity of data available in relation to UTIs caused by ESBL producing E. coli. There is little information about genes responsible for these enzymes and the organisms’ susceptibility patterns to commonly used antibiotics. This cross sectional study used urine samples from 327 consenting patients from the University Teaching Hospital in Lusaka, Zambia. The ESBL producing isolates were obtained by culturing urine samples on MacConkey agar supplemented with cefotaxime followed by polymerase chain reaction (PCR) to detect the resistant genes in positive isolates. A questionnaire was used to collect information from patients for assessment of risk factors relating to infection with ESBL producing E. coli. The antibiotic susceptibility pattern was determined by using the disc diffusion method. Of a total 327 samples analyzed, 15 (4.6%) were positive for ESBL producing E. coli. Genes of resistance significance that included the blaINT blaCTXM, blaSHV and blaTEM were detected. There was 100% resistance of the isolates to Cotrimoxazole, ampicillin and cefotaxime while no resistance (0%) was detected to Nitrofurantoin. All the ESBL producers had MDR (at least 30%) patterns. None of the risk factors was statistically significant in this study. This study detected the presence of ESBLs and class I integrons in MDR E. coli in UTIs at the University Teaching Hospital in Zambia. This prompts the need for antimicrobial resistance surveillance to monitor hospital resistance patterns for these microorganisms.
A study to determine the outcomes of laparoscopic appendicectomies at the university teaching hospital, Zambia.
(The University of Zambia, 2019) Parekh, Rajesh
Several studies have demonstrated the superiority of Laparoscopic appendicectomy in the management of acute appendicitis. Acute appendicitis has been managed solely by open appendicectomy at UTH. This was the first study that looked at the management of acute appendicitis by laparoscopy here at UTH. The aim of this study was to determine the outcomes of laparoscopic appendicectomy at the University Teaching Hospital. This was a prospective cohort study that included patients that were diagnosed with acute uncomplicated appendicitis. All patients admitted between August 2015 to March 2016 were included in the study. Variables analyses were patients data (age, gender, previous surgery, WBC count, symptoms, signs, symptoms), operating time, intra\post operative complications, and length of stay. A total of 9 laparoscopic appendicectomies were performed during the study period. The patients had a average age of 31.8 years, and were predominantly female (70%). One case was converted to open appendicectomy and was not included in the laparoscopic data group. The mean operative time for the procedure was 75.5 min (range 50-110min). The length of stay was on average 2.3 days (range 2-3 days), the patients in the study had no complications noted during the period of follow up. No patient developed an intra abdominal abscess during the study period. Laparoscopic appendicectomy for uncomplicated acute appendicitis resulted in good surgical outcomes in this institution when compared to the regional statistics as reference point. It may be used as a preferred technique in patients presenting with uncomplicated appendicitis or where the diagnosis is equivocal . Laparoscopic appendicectomy is recommended especially for the young female patients in our setting.
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 Haart by HIV-Positive Tuberculosis Patients in Livingstone District
(2013-01-18) Wahila, Ruth
The convergence of TB and HIV epidemics is a deadly threat to gains In survival among populations (Corbett et al., 2003). The dual epidemics are particularly pervasive in Africa, where HIV has been the single most Important factor contributing to the incidence of TB over the last 10 years. In Zambia, approximately 70% of the people with TB are co-Infected with HIV (MOH, 2006). With the high TB/HIV co-infection prevalence In Zambia, the majority of the population is at a great risk of dying unless the TB/HIV control measures are supported. TB/HIV co-Infected persons also have a higher chance of TB recurrence (Zambia AIDS law Research and Advocacy Network, 2007). In response to the effect of the TB/HIV co-Infection, WHO established the TB/HIV working group of the Stop TB Partnership In 2001 with the aim of coordinating the global response to the HIV associated TB epidemic (WHO, 2005). Four critical program components that serve as entry points for HIV case detection and treatment were identified as part of the TB/HIV collaborative activities. One of these components Is people diagnosed with TB as TB Is the most common opportunistic Infection in HIV patients worldwide (WHO, 2005). According to the British HIV Association (2005), starting Highly Active Antiretroviral Therapy (HAART) early in severely immunosuppressed HIV positive patients presenting with TB is associated with decreased mortality and a lowering of the rates of progression from HIV to Acquired Immune Deficiency Syndrome (AIDS).The TB/HIV collaborative activities were initiated In Livingstone district in 2004. Despite that the percentage of TB patients who accepted HIV counseling and testing Increased drastically in the district, those accepting and utilizing HAART is as low as 17% (Livingstone District Health Management Team - LDHMT, 2007). This study was therefore conducted in Livingstone district to explore the factors that Influence acceptability of HAART by eligible TB patients. An explorative descriptive study was conducted among the HIV/TB co-infected clients aged between 18 and 49 years In Livingstone district. Systematic sampling method was used to come up with individual respondents and a sample size of 131 HIV/TB co-Infected clients was selected. Data were collected using a structured interview schedule and a focus group discussion guide for a period of one month. Participants for the focus group discussion were selected purposlvely from among the other TB/HIV co-infected patients who met the inclusion criteria and were not be part of those interviewed Individually. A total number of six focus group discussions were held, two at each of the three ART sites. The first group for the focus group discussion involved participants aged between 18 and 32 years while the second group included participants aged between 33 and 49 years to facilitate free discussion. At Livingstone General Hospital, the first group was composed of four males and two females while the second group comprised five females and four males. The first group at Sepo health centre comprised five males and two females while in the second group, there were six males and two females. At Mahatma Gandhi health centre, the first group had five males and one female participants while the second group had six females and four males. The total number of participants for all the six focus group discussions was forty six (46). Epi-info version 6 and SPSS 12.0 for windows software computer packages were used to analyze the quantitative data. Chi-square was used to measure association between the dependent variable (acceptability of HAART by TB patients) and the Independent variables (TB/HIV and HAART knowledge, TB- and HIV-associated stigma and discrimination, amount and depth of counseling, support from health care providers, sex, age, marital status and educational level). With the confidence Interval set at 95%, the p value was used to ascertain the degree of significance by using the decision rule which rejects the null hypothesis If p value Is equal or less than 0.05. Qualitative data was presented in narrative form and a full report of the focus group discussions was written using the participants' own words. Key statements and Ideas expressed for each topic of discussion were listed down. Data was categorized and responses from the two subgroups (participants aged between 18 and 32; and those aged between 33 and 49) were compared. A summary was then written in narrative form. The most useful quotations that emerged from the discussion were selected to illustrate the main Ideas. The study revealed low levels of knowledge on TB and HIV relationship (28.1%) and safety of taking HAART while on TB treatment (42.3%). Majority (93.3%) of the respondents also felt that they were being stigmatized by health workers because they had TB disease while 66.7% noted that their concerns regarding HAART were not addressed by health care providers. In this study, the most significant factors found to be associated with acceptability of HAART by TB patients and accessibility of HAART were knowledge of TB and HIV relationship Including HAART, HIV-related stigma and discrimination and support from health care providers regarding HAART. A significant association was found between knowledge of TB and HIV relationship and safety of taking HAART while on TB treatment, 77.9% of the respondents who did not know the relationship between TB and HIV Indicated that It was not safe to take HAART concurrently with TB treatment (Chi square value = 13.585; df = 1; 2 value 0.000). there was also a significant association knowledge of commencement of HAART in TB patients and discussion of HAART and Its benefits with the counselor. Of the 52 respondents who did not know that HAART could be commenced in TB patients, majority (71.2%) did not discuss HAART and its benefits with the counselor (Chi square value = 10.880; df = 1; e value 0.001). In addition, there was a significant association between HIV-related stigma and discrimination and acceptability of HAART. Majority (78.7%) of the respondents who were treated differently because of HIV reported that they would not go back to the ART clinic for medication (Chi square value = 9.270; df = 1; e value 0.002). Furthermore, respondents whose HAART concerns were not addressed (74.1%) would not go back to the ART clinic for HAART (Chi square value = 9.785; df = 2; rvalue 0.008). The results further showed that factors such as TB-related stigma and discrimination, sex, age, marital status and level of education were not significantly associated with acceptability of HAART. Probably, TB-related stigma and discrimination is not associated to acceptability of HAART because TB is curable. The demographic characteristics were also not associated with acceptability of HAART probably because of personality attributes of an individual. Key words: Acceptability, Highly Active Antiretroviral Therapy (HAART), HIV positive. Tuberculosis, Eligible.
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 of the Human Papillomavirus(HPV) Vaccine among stakeholders in two selected Schools in Lusaka
(2016-05-13) Kucheba, Fortress
Human papillomavirus (HPV) is the most common STI and major cause of cervical cancer globally. Zambia has one of the highest cervical cancer rates in the world. Approximately 54 cases per 100 000 women are diagnosed with cervical cancer annually with 1,400 dying (SALC Report, 2012). Preliminary results from the pilot vaccine immunization program in Zambia had shown a mixed picture on the response to the vaccine. A qualitative case study was conducted in two schools (Kings Highway and Kalingalinga Primary) which participated in the pilot for HPV rollout to assess acceptability of the HPV vaccination. Data was collected through Key informant interviews, In-depth-interviews, Focus group discussions and analyzed using Thematic Framework Analysis. Media reports and commentaries from bloggers were also reviewed for triangulation. The study findings revealed that acceptability of the HPV vaccine was influenced by Individual, Interpersonal and Service factors. Individual characteristics like knowledge of the vaccine, perceived risks and benefits, attitude towards the vaccine, fear of injections and girls being perceived as too young to receive the vaccine, influenced acceptability. Interpersonal processes and primary groups like family, friends, and peers also influenced acceptability by shaping social identity, nature of support, and role definition. Services factors, which included regulations, policies, and informal structures, also influenced acceptability of the vaccine by either constraining or promoting recommended behaviours. The study identified factors that influenced acceptability at individual, interpersonal and service levels. The findings suggest low acceptance of the HPV vaccine due to low levels of knowledge and awareness of cervical cancer, HPV and HPV vaccine. There is therefore an urgent need to inform the public about HPV, HPV vaccine and cervical cancer if there is to be a high widespread acceptance of the HPV vaccine.
Acceptability of youth clubs focusing on comprehensive sexual and reproductive health education in rural Zambian schools: a case of Central Province
(University of Zambia, 2019) Chirwa-Kambole A, Eunice
Youths in Zambia have limited access to information concerning Sexual Reproductive Health (SRH) and this puts them at risk of unwanted pregnancy. The Research Initiative to Support the Empowerment of Girls (RISE) is a cluster randomized testing the effectiveness of different support packages on teenage pregnancies, early marriages and school dropout. One of the support packages included youth clubs focusing on comprehensive sexual and reproductive health education (CSRHE). Although similar interventions have been implemented in other settings, their integration process has been complex and comprehensive assessments of factors shaping acceptability of youth clubs is lacking. Through the use of diffusions of innovations theory, this paper qualitatively aimed to identify factors that shaped the acceptability of CSRHE youth clubs in rural schools in Central Province. A qualitative case study was conducted in which data gathered through eight focus group discussions from grade eight pupils, eight key informant interviews with teachers and document review were analyzed using thematic analysis. The perceived relative advantage of youth clubs and the simplicity related to the use of participatory learning methods, films and role plays to communicate sensitive reproductive health information and made the learners like the youth clubs. Further the perceived compatibility of the content of the sessions with the science curriculum increased the learners’ interest in the youth club as the meetings also helped them prepare for the school exams. However, cultural and religious beliefs among teachers and parents regarding the use of contraceptives complicated the delivery of reproductive health messages and the acceptability of youth club information among the learners. The study has demonstrated that acceptability of SRH interventions such as youth clubs in some schools of Central Province may be successful if pupils and teachers use interventions that depict real life. Teachers and pupils appreciated the introduction of CSRHE youth clubs and the provision of economic support to girls and their families that led to the reduction of early marriages, school drop-out and early pregnancies. Key words: Comprehensive sexual and reproductive health education, youth clubs, acceptability
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.
Access to sexual reproductive health services among HIV positive adolescents attending university teaching hospital (UTH) – PCOE (Pediatric Center of Excellence) Lusaka-Zambia.
(The University of Zambia., 2019) Ndongmo, Therese Ntigwa
An estimated 80,000 adolescents (10-19 years) are living with HIV in Zambia (UNICEF, 2011). As they mature into adulthood, adolescents encounter challenges related to sexuality and sexual reproductive health (SRH), coupled with dealing with a complex condition such as HIV infection. The current study aimed at exploring the experience, challenges and barriers encountered by adolescents in accessing reproductive health services at the Pediatric Center Of Excellence (PCOE) - University Teaching Hospital (UTH). It is hypothesized that adolescents living with HIV are also beginning to experience their sexuality, may have some challenges in accessing SRH services. The study was conducted using a mixed-method whereby adolescents aged 15-19 years were surveyed using a semi-structured questionnaire, about their needs and access to SRH. Services offered at the study setting (UTH PCOE) were also investigated through key informants’ in-depth interviews of healthcare workers. Emerging themes from open-ended questions qualitative data were explored using content analysis. The data was entered into an access database and exported to SPSS for analyses. Ethical clearance was obtained from the UNZABREC. A total of 148 adolescents aged 15-19 years were interviewed, including 63.5% females and 36.5% males. The majority (77%) had secondary education level. Those currently in school were 77.2%. About 68.9 % expressed intention to have children; 40.1 % admitted to having a boy or girl friends. Overall 15.1 % (21/139) have ever had sex. Of those sexually experienced, only 61.1 % reported consistent condom use. Two (2.1%) of the girls had been pregnant before. Ten out of 52 respondents indicated having had an STI before. Not being in school was found to be a positive predictor, not only for knowing where to go to talk about sex (OR= 2.53; 95% CI:1.10-5.82; p=0.02), but also for having ever gone to seek advice on sexual issues (OR=2.61; 95% CI:1.04-6.58; p=0.03). While SRH services are available, although not covering the full spectrum of needs at the PCOE, healthcare workers expressed challenges in terms of time and resources dedicated to these services. Overall access to SRH services (at least a counseling, FP, or STI service) was 31.5% in terms of availability and utilization combined. There was no significant factor that predicted access or not. We find evidence of reported “sexuality experience” illustrated by their expressed sexual desire and needs, presence of social friendships, and desire to have healthy children. HIV infected adolescent sexual reproductive needs were found to be similar to those of general population of the same age in terms of counseling in sexual matters, Family Planning (FP) and Sexual Transmitted Infection (STI) services. ALHIV face additional challenges within their family and social environments. This suggests that efforts should be made to provide one-stop center for all adolescent overall health care needs and to create an environment that is more aware, responsive, and tolerant of adolescent sexuality not only at tertiary but also a lower levels of healthcare settings. HCWs are available at the UTH PCOE to provide the services but still face challenges in terms of adequate training, time and recourses dedicated to these services.
Accessibility of HIV diagnostic services by exposed under five-year children in Muheza district in North-East Tanzania
(University of Zambia, 2019) Bwana, Veneranda Masatu
Introduction: Early diagnosis of HIV (Human Immunodeficiency Virus) among exposed infants gives an opportunity for early access to HIV care and treatment with potential for increased survival. Despite global efforts to scale up early infant diagnosis (EID) services, in resource-limited, high HIV burden countries including Tanzania, the coverage is still lower than the recommended levels. The study was carried out to determine HIV prevalence and factors associated with accessibility of EID among HIV exposed under five-year children in Muheza district, Tanzania. Methods: A concurrent mixed methods design comprising of cross sectional survey, health facility survey and case study design was conducted among mother/guardian-child pairs of HIV exposed child and health care providers at Muheza health facilities between June 2015 to June 2016. Information on HIV status, socio-demographic and other relevant data was collected using structured questionnaires, interview guides and health facility checklist. Multiple regression analyses were done by using STATA version 13.0 to examine the factors associated with accessibility to EID. Thematic generation and analysis were done using Nvivo version 10. Results: A total of 576 HIV exposed children with their respective mothers/guardians were recruited. Of the 576 mothers/guardians, 549 (95.3%) were the biological mothers with a median age of 34 years (inter-quartile range (IQR):30 to 38 years). The median age of the 576 children was 15 months (IQR: 8.5 to 38.0 months). A total of 251 (43.6%) children were born to mothers with unknown HIV status at conception. Only 329 (57.1%) children accessed EID between four and six weeks of age. In the district, EID testing sites were only available in 61% of health facilities. Children born to mothers with unknown HIV status at conception (AOR=0.6, 95% CI 0.4-0.8) and those with ages 13-59 months (AOR=0.4, 95% CI 0.2-0.6) were the significant factors of missed opportunity to access EID. Children living with the head of household with at least a high education level had higher odds of accessing EID (AOR= 1.8, 95% CI 1.1-3.3). Their likelihood of accessing EID services was three-fold higher among mothers/guardians with good knowledge of HIV infection prevention of mother to child transmission (PMTCT) (AOR=3.2, 95% CI 2.0-5.2) than those with poor knowledge. Mothers/guardians living in rural areas had poorer knowledge of PMTCT (AOR=0.6, 95% CI 0.4-0.9) than those living in urban areas. According to qualitative interviews, barriers identified to influence EID access at individual level included inadequate vii knowledge regarding EID and PMTCT, lack of transport cost to go to health facility, poverty, HIV stigma, culture, traditional and religious beliefs, geographical relocation, lack of psychosocial support, lack of paternal permission, poor patient-health care provider interaction and low satisfaction with health care services. Laboratory materials out of stock, weak health care infrastructures, lack of skilled health care providers, inadequate health care providers and delay of HIV results were an additional challenges to health care system that affect access to EID services. In addition, health care providers were not satisfied with their job due to high workload, lack of motivation, communication and transport allowances. Furthermore, the HIV prevalence among 576 under five children was 10.6% (95% CI 8.1-13.1%). The burden of HIV infection was observed among older children aged 25-59 months (AOR= 5.6, 95% CI 1.6-19.1) and those born to mothers with unknown HIV status at conception (AOR=3.9, 95%CI 1.6-9.3). The odds of HIV infection was higher among children who were delivered at home (AOR=2.6, 95% CI 1.0-6.6), received mixed feeding (AOR=2.4, 95% CI 1.1-4.9), and those living far from health facility (AOR 2.5, 95% CI 1.1-5.4). The odds of HIV infection was low among children with head of household who had at least attained high education level (AOR= 0.3, 95% CI 0.1-0.9). Conclusion: Accessibility of EID services among HIV exposed under five-year children in Muheza district is low and the HIV prevalence among this population is high. This does not show just limitations in testing efforts in the past, but it suggests a reshaping of current HIV testing for women and men so that pre-pregnancy HIV knowledge of status is prioritized. Further, these findings stress the need for continued HIV education and outreach services, particularly in rural areas in order to target reaching out to hard to reach and predominantly poor mothers and their children. Noting that there still exists many gaps in the EID system, creating a functioning surveillance system with strategy to generate context specific information for programming, should also be prioritized for improved PMTCT and EID programming.
Accessibility of women to secondary obstetric care in a rural district of Zambia and the implications for safe motherhood
(2012-08-20) Zulu, Alexandrina Alice
The study was conducted in Chipata District Health Centres and Chipata General Hospital as a secondary referral matremity care. The study included both rural and urban Centres. The purpose of the study was to determine the accessibility of women to secondary obstetric care in a rural district and the implications for safe motherhood.Observation and literature has shown that despite the launching of Safe motherhood initiative some eleven years ago in Sub Sahara Africa, Safe motherhood in Zambia is still a big challenge. Maternal and Perinatal mortality remain high and accessibility to safe pregnancy and childbirth are not adequate.Literature review was based on those factors that affect accessibility in terms of distances, aflfordabililty and quality of care and also the acceptability of care by the mothers themselves. Maternal mortality ratios were reviewed both locally in the country and worldwide.Data were collected between February and March 1998 in Chipata District by interviewing 100 mothers, 75 from the rural and 25 urban and 17 staff in the centres incvolved. The mothers were pregnant with at least one child but not more than four attending Ante Natal clinic. The maternity records at Chipata General Hospital were reviewed for the period January 1995 to December 1997. Normal and abnormal deliveries were noted, maternal and perinatal mortality ratios worked out.The findings of the study revealed that the proportion of rural women that were physically accessible to secondary obstetric care was very small, only 3%. Ante Natal care was free in all the health centres and this increased attendance of about 97%. In some of the rural health centres, a minimal fee was charged for a delivery but at the secondary referral hospital, a considerable amount of admission and delivery fees were charged though there was no extra charge for Caesarean Sections. For the rural poor, cost sharing of the maternity services might be a barrier to safe Motherhood. 53% of mothers delivered at home (ZDHS 1996) and this could be attributed to the problems of accessibility to obstetric care by women in the light of poor physical access and unaffordable costs. Little or no education of women in child bearing age was also found to be a barrier to safe motherhood. 32%o had no education at all while 56%) had some primary education and many did not even complete it.The women who had been referred to hospital in good time who had favourable pregnancy outcome were (78%). Review of obstetric records at the secondary obstetric care unit however, revealed a maternity mortality ratio of 795 per 100,000 live births and 53 per 1,000 perinatal deaths in the year 1997. It was further observed that on an average, 8% of the deliveries were by Caesarean sections and the main indication was obstructed labour due to Cephalo-pelvic disproportion in about 36% in 1997.Much of the information obtained makes this study important to the health personnel and it is hoped that initiatives to make pregnancy and child birth safe will be every one's concern.
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.

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