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Abortion statistics in Zambia: ‘implications for unsafe abortion, reproductive health programming, policy and research approaches’.
(Zambia medical journal, 2010) Likwa, Ndonyo, Rosemary; Biddlecom, Ann; Ball, Haley
Zambia has a liberal abortion law for termination of pregnancy on medical and social grounds for over three decades. Yet, it still faces serious consequences of increased morbidity and mortality associated with unsafe abortion. The extent of its national incidence remains unknown. There are substantial differences evident between legal abortions and illegal (unsafe) abortions demonstrating gaps in under reporting of abortion incidence which may require further estimation. Compiling Zambian abortion statistics as “research in brief” was essentially needed to provide direction to national abortion incidence measurements in Zambia, more strengthening of reproductive health services, possible review of policies and seek opportunities for further research approaches for understanding the magnitude of abortion problem and the means to prevent unsafe abortion occurrences. Thus contributing to reduction in abortion related morbidity and mortality in the country. An explorative descriptive survey was carried out in five (5) major hospitals to collect abortion statistics using a checklist tool for record review by the principal investigator with the assistance of five Ministry of Health professionals designated in these hospitals. Analysis employed aggregation compilation of annual abortion statistics collected from three (3) major tertiary hospitals and two (2) general hospitals for a period of nine years, 2000-2008 in five urban districts of four (4) provinces of Zambia. Analysis further involved application of descriptive statistics and significant tests, trend analysis and incidence rates A total number of 115886 abortions collected from five major hospitals in four provinces of Zambia over a period of nine (9) years, 2000-2008, show a varied distribution of 616 (0.5 %) for safe induced abortion, legally terminated pregnancy cases and 66687 (57.5%) abortion admissions with complications. Out of this figure, 474885 cases received post abortion care involving manual vacuum aspiration procedure (MVA) translating to over 70 percent of abortion complications had MVAs which reflect the extent of unsafe abortion exposure to Zambian women. Abortion morbidity and consequences of mortality are high and increasing in trend giving six per thousand women die of abortion complications, most likely due to unsafe, induced abortion. Access to safe induced abortion in major hospitals is quite low, yet Zambia has a liberal law for a termination of pregnancy on health and social grounds. IMPICATIONS: Abortion statistics show their relevancy for developing research priorities, policy review, reproductive health services to intensify abortion advocacy on its consequences, access to safe abortion care and contraception to prevent unwanted pregnancy. KEY WORD (S): Abortion statistics/ unsafe abortion/ abortion complications/ mortality/ post abortion care/ legal abortion/law/Zambia
Abortion statistics in Zambia: ‘implications for unsafe abortion, reproductive health programming, policy and research approcahes’.
(Zambia medical journal, 2010) Likwa, Ndonyo, Rosemary
Zambia has a liberal abortion law for termination of pregnancy on medical and social grounds for over three decades. Yet, it still faces serious consequences of increased morbidity and mortality associated with unsafe abortion. The extent of its national incidence remains unknown. There are substantial differences evident between legal abortions and illegal (unsafe) abortions demonstrating gaps in under reporting of abortion incidence which may require further estimation. Compiling Zambian abortion statistics as “research in brief” was essentially needed to provide direction to national abortion incidence measurements in Zambia, more strengthening of reproductive health services, possible review of policies and seek opportunities for further research approaches for understanding the magnitude of abortion problem and the means to prevent unsafe abortion occurrences. Thus contributing to reduction in abortion related morbidity and mortality in the country. An explorative descriptive survey was carried out in five (5) major hospitals to collect abortion statistics using a checklist tool for record review by the principal investigator with the assistance of five Ministry of Health professionals designated in these hospitals. Analysis employed aggregation compilation of annual abortion statistics collected from three (3) major tertiary hospitals and two (2) general hospitals for a period of nine years, 2000-2008 in five urban districts of four (4) provinces of Zambia. Analysis further involved application of descriptive statistics and significant tests, trend analysis and incidence rates A total number of 115886 abortions collected from five major hospitals in four provinces of Zambia over a period of nine (9) years, 2000-2008, show a varied distribution of 616 (0.5 %) for safe induced abortion, legally terminated pregnancy cases and 66687 (57.5%) abortion admissions with complications. Out of this figure, 474885 cases received post abortion care involving manual vacuum aspiration procedure (MVA) translating to over 70 percent of abortion complications had MVAs which reflect the extent of unsafe abortion exposure to Zambian women. Abortion morbidity and consequences of mortality are high and increasing in trend giving six per thousand women die of abortion complications, most likely due to unsafe, induced abortion. Access to safe induced abortion in major hospitals is quite low, yet Zambia has a liberal law for a termination of pregnancy on health and social grounds. IMPICATIONS: Abortion statistics show their relevancy for developing research priorities, policy review, reproductive health services to intensify abortion advocacy on its consequences, access to safe abortion care and contraception to prevent unwanted pregnancy. KEY WORD (S): Abortion statistics/ unsafe abortion/ abortion complications/ mortality/ post abortion care/ legal abortion/law/Zambia
Acceptability and implementation experiences of the “test and treat” antiretroviral therapy policy guideline among patients and healthcare workers in Lusaka district of Zambia.
(The University of Zambia, 2019) Mulinda, Mweemba B
The World Health Organization stated that there is now sufficient proof that earlier use of antiretroviral therapy results in better clinical outcomes for people living with human immunodeficiency virus compared with delayed treatment and thus recommended immediate antiretroviral therapy initiation irrespective of the stage of the disease or Cluster of Differentiation 4+ count for adults, adolescents and children. The new antiretroviral therapy policy is dubbed “Test and Treat” whose implementation started in October 2016 in Lusaka District of Zambia by the Ministry of health and cooperating partners. Test and Treat has since been rolled out to other districts. This is all to further accelerate efforts to meet the ambitious Fast-Track target for 2020, including achieving major reductions in the number of people dying from HIV-related causes. The main purpose of the study was to explore acceptability and implementation experiences of “Test and Treat” as a new antiretroviral therapy policy guideline among healthcare workers and patients in Lusaka District. The study further sought to investigate the health system’s capacity to support the policy in Lusaka District. This was a qualitative study that used exploratory case study. The research was undertaken in five Anti-retroviral therapy healthcare centres in Lusaka District, between July 2017 and May 2018. Five focus group discussions were conducted with individuals who were human immuno-deficiency virus positive and were on anti-retroviral therapy. Five In-depth interviews were held with at least two Psychosocial Counselors at each centre and twenty five key informant interviews with healthcare professionals involved in implementing the program. All interviews were audio-recorded and were conducted within the healthcare facility. From the information recorded in each discussion, major themes and sub-themes were identified which were linked to direct quotes from the respondents. Interviews were transcribed and accuracy was checked. Software called Nvivo 10 was used to analyze data and for easy information management. The findings of the study revealed that, there was high acceptability of “Test and Treat” among the patients and healthcare workers. They observed that the implementation of this policy has resulted in; improved health outcomes, no advancement to acquired immune-deficiency syndrome stage, higher productivity at work places and reduced hospital visits among the patients who were receiving treatment. The study however observed that; difficult disclosure; cultural implications; ethical implications; lack of initial physiological baseline parameters such as CD4 Count and Liver function test results and stigmatization and discrimination were major hindrances to acceptability and smooth implementation of the policy. “Test and Treat” was viewed to have relative advantage over other previous HIV/AIDS intervention strategies as it has been observed to be largely compatible with other health systems operations available in most healthcare facilities. It has been tried elsewhere with positive results according to literature reviewed as such there is no much complexities reported. Observed outcomes of clinical trials done so far reveal programme simplicity leading to high acceptability and smooth implementation.
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.
Assessment of Level of Knowledge of Management of Acne vulgaris among Community Pharmacists and Prescribers in Lusaka Urban
(Asian Online Journals, 2015-12) Prashar, Lavina; Kachipond, Fredrick; Nagalamika, Owen
Acne is a common skin condition affecting almost 85% of the population. Everyone has the risk of developing acne at certain stages of life. The management of acne in early stages is important for disease prognosis. Patients with acne usually present at community pharmacies and clinics during the early stages of their disease. Assessment of knowledge and practice of community pharmacists and prescribers in treating these patients is required. The aim of this study was to assess the levels of knowledge in acne management among community pharmacists and prescribers in Lusaka urban. The study was designed as a cross-sectional survey and was conducted on 89 community pharmacists and prescribers working in Lusaka, Zambia. Participants were asked to answer a self administered questionnaire on the management of acne vulgaris that comprised questions evaluating the knowledge on disease causes, aggravating or relieving factors, treatment practices and use of reference materials. The study revealed that Pharmacists and prescribers had inadequate levels of knowledge on disease management; 21% had low levels of knowledge where as only 6% had high levels of knowledge. By category, 36% of the prescribers had low levels and 10% had high levels of knowledge. 8% of the pharmacists had low levels of knowledge and only 2% had high levels. Lack of knowledge was reflected in their treatment practices, 62.9% never classified acne when initiating treatment and less than a quarter managed acne cases independently. This study showed no association of levels of knowledge to referral of patients with severe acne (p>0.05). It was concluded from the study that pharmacists and prescribers have inadequate knowledge and practice for management of acne. Steps should be taken to update and improve their dermatological knowledge.
Burden attributable to childhood and adolescent primary headache disorders in Lusaka and Ndola school children aged 7 - 17 years.
(The University of Zambia, 2019) Kawatu, Nfwama
Headache is a common complaint in the paediatric and adult populations. However, the prevalence, types and effects on the quality of life of the children that suffer from headache is not known. This study assessed the prevalence and burden of primary headache disorders in children and adolescents. The data collected and analysed produced a preliminary report of an ongoing study. This was a cross sectional study, conducted over a 6-month period which targeted participants aged 7-17 years in Lusaka and Ndola schools. It was conducted using a standardized questionnaire that was administered with the guidance of the principal investigator for ages 7-11 years and by self-administration for ages 12-17 years. Questions of interest included the prevalence, duration, intensity and frequency of any headache. Lost school days and parental work days highlighted the quality of life of these children in general. The data was analysed using a validated algorithm of classification of headache which is based on the International Classification of Headache Disorders III. The 1 year prevalence of headache in general was at 87.3% of the study population. Probable migraine was most common at 44.5% followed by migraine 19.6%. Girls (68.6%) suffered more migraine; boys displayed a high prevalence in tension type headache (39.9%), followed by probable migraine headache at 39.9%. A reduction in the quality of life was significantly associated with a longer duration of headache days, migraine headache and probable migraine headache whereas there was no significant association with other headache types. The prevalence of primary headache disorders in Zambia is significantly high at 873% with highest prevalences of migraine headache in girls and tension type headache in boys. The quality of life was not significantly altered in these children that suffered headache.
A Comparative Study for the Efficacy and Tolerability of Fluvoxamine and Venlafaxine in patients with Obsessive Compulsive Disorder
(RA Publications, 2015-09-20) Prashar, Lavina; Paul, Ravi
To compare the efficacy and tolerability of Fluvoxamine and Venlafaxine in patients with Obsessive Compulsive Disorder (OCD). A total of 50 newly diagnosed patients with OCD were randomly assigned 25 each to receive either fluvoxamine (Selective serotonin reuptake inhibitor) or venlafaxine (selective serotonin norepinephrine reuptake inhibitor). Primary efficacy was assessed by the change from baseline on the Yale Brown Obsessive Compulsive Scale (Y-BOCS). The Clinical Global Impression Improvement Scale (CGI-S) was used to measure symptom improvement. Each patient was followed as a single visit in a week wise manner following the order; Week0, Week 1, Week 2, Week 4, Week 6, Week 8, Week 12 and Week 16. At each visit if any adverse reaction to either of the drugs experienced by the patient were noted. Treatment group comparison of patients, demographic characteristics and baseline severity measurements were done using a Chi square test and the student t-test. Statistical significance was defined as a 2-sided p value ≤ 0.05. Both drugs showed significant reduction in the OCD symptoms as measured on the Y-BOC Scale over the 16-week follow up. When compared fluvoxamine showed statistically significant reduction in overall YBOC score and Obsessive mean score. The difference in compulsive mean score was not significant in the two treatment groups. Fluvoxamine is more efficacious than Venlafaxine in the treatment of OCD.
Confirmation by necropsy of a high prevalence of porcine cysticercosis in a rural district of Madagascar.
(The University of Zambia, 2023) Mananjara, Diana Edithe Andria; Rakotoarinoro, Mihajamanana; Rakotoarison, Valisoa. C.; Raliniaina, Modestine; Razafindraibe, Nivohanitra P.; Ravonirina, Claudia; Randriamparany, Tantely; Rasamoelina-Andriamanivo, Harentsoaniaina; Rakotozandrindrainy, Raphaël; Cardinale, Eric; Lightowlers, Marshall. W.; Donadeu, Meritxell; Mwape, Kabemba E.
Neurocysticercosis is recognized as an important health issue in the Malagasy population. To date, investigations into prevalence of infection with the causative agent, Taenia solium, in the parasite's natural animal intermediate hosts, have relied on serological methods which have been found to be non-specific. We determined the prevalence of porcine cysticercosis among pigs from a contiguous area of the Betafo and Mandoto administrative districts, Vakinankaratra Region, Madagascar. One hundred and four slaughter-weight pigs were examined by detailed necropsy examination including slicing of the heart, tongue, masseter muscles, diaphragm and carcase musculature. Thirty-seven animals (35.6%) were found infected with T. solium, representing one of the highest rates of infection ever reported, worldwide. These findings highlight the importance of T. solium in Madagascar and support the need for increased efforts to prevent the parasite's transmission to reduce its burden on the health of the Malagasy population. Keywords cysticercosis Madagascar necropsy pig prevalence Taenia solium
Determinants of underweight among under- five children in Zambia - evidence from 2001, 2007 and 2014 Zambia demographic and health surveys.
(The University of Zambia, 2019) Nakawala, Tamika S.
Over the past ten years, underweight levels in Zambia have remained static at 15%. Literature has shown that the mortality risk of children who are even mildly underweight is increased and this risk increases for those children who are severely underweight. The main objective of the study was to assess the determinants of underweight in under-five children over the last two decades in Zambia. This was a cross sectional study using data from the 2001, 2007 and 2013-14 Zambia Demographic and Health Survey’s. The study included a pooled estimate of about 26,735 under-five children, 6877 in the 2001 survey, 6401 in the 2007 survey and 13, 457 children in the 2013-14 survey. Multiple logistic regression showed that female children were 25% less likely to be underweight than male children [0R=0.75, 95% CI (0.69-0.82), p˂0.0001]. Children from rural areas had reduced odds of being underweight than those from urban areas [OR=0.77, 95%CI (0.68-0.89), p˂0.0001], Children aged 13-24 and 25-36 months had increased odds of being underweight [OR=1.71, 95% CI (1.48-1.98), p˂0.0001] and [OR=1.90, 95% CI (1.64-2.20), p˂0.0001] respectively than children aged 0-12 months. Having had diarrhoea [OR=1.33, 95% CI (1.18-1.50), p˂0.0001] or fever [OR=1.19, 95% CI (1.07-1.32), P=0.001] increased the odds of a child below five being underweight. The odds of underweight in under-five children reduced with an increase in the mother’s education and wealth index. Children whose mothers had tertiary education, came from the richest wealth quintile and children who were large at birth had the lowest odds of being underweight [OR=0.41 95% CI (0.27-0.64), p˂0.0001], [OR=0.40, 95%CI (0.32-0.50), p˂0.0001] and [OR=0.38, 95%CI (0.33-0.44), p˂0.0001] respectively. The study established that mothers with higher education, from the richest wealth index, an average sized child at birth, being female and residing in rural area were protective factors for underweight in children. On the other hand having had diarrhoea and fever was a disadvantage to the child as this promoted being underweight. In addition, older children were more likely to be underweight.
The Effect of Kigelia africana Fruit Extract on Blood Glucose in Diabetes Induced Mice
(RA Publications, 2015-09-20) Prashar, Lavina; Muyenga, Tumelo; Bwalya, Angela Gono; Muungo, L.T.M
To determine the effect Kigelia africana fruit extract has on blood glucose levels of diabetes mice and its phytochemical profile Mice were induced with diabetes using Alloxan monohydrate 90mg/kg. Blood glucose was checked before induction and 72 hours after induction to confirm diabetes. Treatment involved using oral administration of Kigelia fruit extract 1000mg/kg, Kigelia fruit extract 500mg/kg, Glibenclamide 0.25 mg/kg, Kigelia fruit extract 500mg/kg and Glibenclamide 0.25mg/kg and Normal Saline.The results showed a greater reduction in blood glucose of mice after treatment with Kigelia extract 1000mg/kg compared to Kigelia 500mg/kg [(5.3 +/- 0.5mmol/l) vs (6.3+/- 0.6mmol/l), (p= 0.005)]. Further, Glibenclamide 0.25mg/kg showed less reduction in blood glucose than Kigelia 1000mg/kg [(7.4+/-0.9mmol/l) vs (5.3 +/- 0.5), (p= 0.00)]. The mean blood glucose levels were lower in mice that received Kigelia extract than those that received both Kigelia extract and Glibenclamide [(5.3 +/- 0.5mmol/l) vs (7.8 +/- 0.6 mmol/l), (p=0.00)]. The fruit extract tested positive for Tannins, Saponins, Flavanoids, Alkaloids, Glycosides and Steroids. Findings of this study indicate that Kigelia africana fruit extract causes reduction in blood glucose of diabetes induced mice and gives better results when used alone than in concomitant use with Glibenclamide. The study also indicates that the fruit extract has alkaloids, saponins, steroids, glycosides, tannins and flavonoids. To determine the effect Kigelia africana fruit extract has on blood glucose levels of diabetes mice and its phytochemical profile Mice were induced with diabetes using Alloxan monohydrate 90mg/kg. Blood glucose was checked before induction and 72 hours after induction to confirm diabetes. Treatment involved using oral administration of Kigelia fruit extract 1000mg/kg, Kigelia fruit extract 500mg/kg, Glibenclamide 0.25 mg/kg, Kigelia fruit extract 500mg/kg and Glibenclamide 0.25mg/kg and Normal Saline. The results showed a greater reduction in blood glucose of mice after treatment with Kigelia extract 1000mg/kg compared to Kigelia 500mg/kg [(5.3 +/- 0.5mmol/l) vs (6.3+/- 0.6mmol/l), (p= 0.005)]. Further, Glibenclamide 0.25mg/kg showed less reduction in blood glucose than Kigelia 1000mg/kg [(7.4+/-0.9mmol/l) vs (5.3 +/- 0.5), (p= 0.00)]. The mean blood glucose levels were lower in mice that received Kigelia extract than those that received both Kigelia extract and Glibenclamide [(5.3 +/- 0.5mmol/l) vs (7.8 +/- 0.6 mmol/l), (p=0.00)]. The fruit extract tested positive for Tannins, Saponins, Flavanoids, Alkaloids, Glycosides and Steroids. Findings of this study indicate that Kigelia africana fruit extract causes reduction in blood glucose of diabetes induced mice and gives better results when used alone than in concomitant use with Glibenclamide. The study also indicates that the fruit extract has alkaloids, saponins, steroids, glycosides, tannins and flavonoids
Evaluation of quality of antenatal care services in selected healthcare centres of Mumbwa and Lusaka districts of Zambia: pregnant women’s perspectives
(International Journal of Nursing and Midwifery, 2019-05) Mukwato, Patricia Katowa; Mwiinga, Kalusopa Victoria; Emmanuel, Musenge; Banda, Yolan; Muleya, Mutinta Crecious; Maimbolwa, Margaret C
Antenatal care (ANC) has been recommended as a service that can reduce both maternal and newborn mortalities. However, even in areas recording high ANC attendance, there are unevenly high levels of maternal and new born mortalities. Evidence of a weak relationship between ANC use and maternal and newborn survival has motivated recent calls to focus on content and quality of care provided rather than mere ANC attendance. This was a descriptive cross sectional study which was designed to evaluate the quality of antenatal care services in two health facilities in Lusaka and two in Mumbwa districts of Zambia. The health facilities were selected purposively based on poor maternal outcomes such as high maternal mortality ratio. Women attending antenatal clinics were selected using simple random sampling. Data was collected using a client exist interview schedule designed by World Health Organization for assessing quality of antenatal care. Data was analyzed using Statistical Package for Social Scientist (SPSS) version 24.0. The study revealed a lot of variations in the care provided at the four sites. None of the women had all the blood tests for haemoglobin, grouping and X-match, HIV and syphilis conducted from three out of the four health facilities, while at the fourth, only 30% of women had all the blood tests conducted. Furthermore, less than 20% of women had a full head to toe examination. While less than 10% of women from each of the facility reported that the health providers met the requirements for provision of privacy. Despite not meeting the minimum standards of care, only less than 5% of women categorized the care as poor. All the four health facilities recorded low quality of care on all domains of antenatal care. Therefore, if antenatal care has to achieve its intended purpose of reducing adverse maternal and new born outcomes, then quality of care delivered during pregnancy should be the focus as opposed mere attendance. Key words:Quality, antenatal care services, evaluation.
Experiences, needs and coping strategies of pregnant and parenting teenagers: A perspective from Lusaka and North Western Provinces of Zambia
(Journal of Research in Nursing and Midwifery, 2017-12) Mukwato, Patricia Katowa; Maimbolwa, Margaret.C.; Mwape, Lonia; Muleya, Mutinta Crecious
Pregnant and parenting teenagers have needs that are unique to the developmental stages of adolescence in addition to the needs common to all pregnant women. The study investigated the experiences, needs and coping strategies of pregnant and parenting teenagers. The study utilized a phenomenological approach, where in-depth interviews with pregnant and parenting teenagers were conducted to get an insight into their experiences, needs and coping strategies. Participants were purposively selected. A sample size was 27 participants which was determined using data saturation principle. Three themes emerged on the experiences of teenage pregnancy and parenting including, abandonment and rejection, loss of parental support and burden of being pregnant or being a parent, while three broad needs were identified; information about HIV status, physical materials for the unborn or new born baby and mother, and the desire to go back to school for those who fall pregnant while schooling. Both adaptive and maladaptive strategies were identified as a means for coping including, avoidance of negativity, support from parents, relatives and partner, repentance and dependence on God, focusing on own and the child’s future, and denial of pregnancy or motherhood. It was concluded that pregnant and parenting teenagers undergo diverse negative experiences, while negotiating the transition from teenage hood to adulthood and motherhood amidst unmet teenage and pregnancy related needs. As a means to cope with the negativity and live within circumstances of unmet teenage and motherhood needs, coping strategies are required. Keywords: Experiences, Needs, Coping Strategies, Teenage Pregnancy, Parenting.
Extraction and Demonstration of Uterotonic Activity from the Root of Steganotaenia araliacea Hochst.
(Zambian Medical Association, 2017-09-14) Prashar, Lavina; Goma, Fastone; Ezeala, Christian; Nyirenda, James; Chuba, David; Simfukwe, Newton; Lengwe, Chilufya
The root of Steganotaenia araliacea is used for assisting labour in folk medicine. Recent reports indicate that the root could possess uterotonic substances.The study aimed to evaluate three methods for the extraction of uterotonic principles from the root of S. araliacea growing in Zambia. Roots of the plant were collected from Chongwe District of Zambia. The air-dried roots were size-reduced, and the powdered material extracted with hot ethanol, hot distilled water, and cold distilled water. The solvent extracts were concentrated and dried at 110 0C. Solutions of the hot aqueous and cold aqueous extracts were prepared in distilled water and used for organ bath experiments to demonstrate uterotonic activities using strips of pregnant rat uterus. The frequencies and amplitude of contractile forces were recorded. The amplitudes were plotted against log concentration of extract with GraphPad Prism software, and the EC50 values determined. The percentage yields were 31.3 % for the hot aqueous extract, 8.15 % for the ethanolic extract, and 3.27 % for the cold aqueous extract. The cold aqueous extract showed higher potency (EC50 of 0.54 mg/ml) compared to the hot aqueous extract (EC50 of 2.09 mg/ml). Root extracts of S. araliacea possess demonstrable uterotonic effects. Extraction of the roots for this purpose could benefit from preliminary defatting with organic solvents, followed by successive extraction with hot and cold water.
Factors associated with obstetric fistula repair failures at St. Francis and Monze mission hospitals, Zambia, 2010—2016; a retrospective facility based cohort.
(The University of Zambia, 2019) Kapaya, Fred
Obstetric fistula causes significant maternal morbidity especially in sub-Saharan African. In Zambia the prevalence is about 0.53%. Despite a number of women receiving corrective surgery for fistula at a number of hospitals in Zambia, there is paucity of data on the quality of care. This study was conducted to determine the overall proportion of fistula repair failures and identify factors associated with failure in Eastern and Southern Provinces, Zambia. This was a retrospective cohort study using data extracted from hospital records of obstetric fistula repairs between January 2010 to December 2016 at St. Francis and Monze Mission Hospitals which are among the four major fistula repair hospitals in Zambia. All women who underwent repair for obstetric fistula between 2010 and 2016 were included while non obstetric fistulas and lack of dye test results at discharge were excluded from the study. The outcome of interest was failure of fistula repair at hospital discharge confirmed by a dye test. Descriptive statistics were calculated and STATA version 13 used to conduct multivariable logistic regression to determine factors associated with failure of fistula repair. A total of 453 obstetric fistula repairs were included in the analysis. Of these, 56 (12.4%) had failure of fistula repair at hospital discharge. The median age at fistula development was 23 years; at fistula repair was 27 years; and years with fistula was 1 (IQR: 0–5). In multivariable logistic regression, factors associated with increased odds of failure included having a fistula with urethral involvement (55.4 % versus 14.1%; AOR=6.0, 95% CI: 2.83—12.97; vaginal scarring (46.4% versus 18.6%; AOR=2.5, 95% CI: 1.17—5.35 ;) and experiencing post- operative complications (48.2% versus 2.3%; AOR=22.9, 95%CI: 9.33—55.97). Women with vaginal scarring, urethral involvement and post-operative complications, had greater odds of repair failure. It is therefore recommended that quality of post-operative care be improved and caution be paid to the repair of women who present with urethral damage, vaginal scarring and post-operative complications. The evidence generated would help the Ministry of Health to restructure and improve fistula care programs in Zambia.
Factors associated with unfavourable tuberculosis treatment outcomes in Lusaka, Zambia, 2015: a secondary analysis of routine surveillance data.
(The University of Zambia, 2019) Nanzaluka, Francis H.
Tuberculosis (TB) is a major public health challenge in low and middle income countries. Factors associated with unfavourable treatment outcomes have been known to affect treatment and control of the disease. However, analysis of routine data in Zambia does not show the factors associated. We determined the proportion of tuberculosis treatment outcomes and factors associated. Unfavourable outcome was defined as death, lost-to-follow-up, treatment-failure, or not-evaluated, and favourable outcome as a patient cured or completed-treatment. Data were abstracted from treatment registers at a referral hospital, an urban-clinic and peri-urban (purposively selected) for all TB cases on treatment from 1st January to 31st December, 2015. Proportions were calculated for treatment outcomes, and associations between unfavourable outcome and factors including age, HIV status, health facility, and patient type, were analysed using univariate logistics regression. Multivariable stepwise logistic regression was used to control for confounding, report adjusted odds ratios (AOR), and 95% confidence intervals (CI). A total of 1724 registered TB patients from the urban-clinic (40%), 1st Level Hospital (38%) and peri-urban-clinic (22%) were included in the study. Of the total patients overall unfavourable outcome was 43%. Total unfavourable outcome was treatment-failure (0.3%), lost-to-follow-up (5%), death (9%) and not-evaluated (29%). The odds of unfavourable outcome were higher among patients >59 years (AOR=2.9, 95%CI:1.44–5.79), among relapses (AOR=1.65, 95%CI:1.15–2.38), patients who sought treatment at the Urban clinic (AOR=1.76, 95%CI:1.27–2.42) and among TB/HIV co-infected patients (AOR=1.56, 95%CI:1.11–2.19). The overall unfavourable treatment outcome found in the study was high in the selected facilities. Being >59years old, being a relapse case, being HIV positive and seeking treatment at the urban clinic were factors found to be associated with unfavourable treatment outcomes. Special attention to patients of >59years old, relapse cases and HIV positive in the TB treatment is recommended and also close monitoring of health facilities in increasing efforts aimed at evaluating all the outcomes. Studies are required to identify and test interventions aimed at improving treatment outcomes.
Genetic analysis of resistance to cercospora arachidicola hori ingroundnut (arachis hypogaea l.) using simple sequence repeat markers
(Journal of Social Research & Policy, 2017) Prashar, Lavina
Increasing early infant male circumcision uptake in Zambia: like father like son.
(The University of Zambia, 2023) Weiss, Stephen M.; Rodriguez, Violeta J.; Cook, Ryan R.; Bowa, Kasonde; Zulu, Robert; Mweemba, Oliver; Kamboyi, Royd; Castro, Jose; Orrego, Victoria; Maria, Dunleavy; Maria, Dunleavy L; Alcaide, Deborah L. Jones
Voluntary Medical Male Circumcision (VMMC) is an effective strategy for HIV prevention in areas with high prevalence of, and risk for, HIV. More than 361,000 male neonates are born each year in Zambia, many of whom could be eligible for Early-Infant Medical Circumcision (EIMC). Building on successful implementation strategies utilized in our Spear & Shield program, this pilot study, “Like Father, Like Son” (LFLS), evaluated the feasibility and acceptability of offering combined EIMC and VMMC services and couple-level behavioral interventions. A total of N = 702 pregnant women and their male partners (n = 351 couples) were recruited and enrolled. Couples were assessed twice pre-birth, 2 weeks post birth, and 6 months post birth. Expectant mothers were an average of 15.05 weeks pregnant (SD = 8.83). Thirty-nine pregnancies did not result in a live birth (11%), 14 couples withdrew from the study or were lost to follow-up prior to delivery (4%), and 148 babies were born female (42%), leaving 150 couples with a male infant in the analytic sample (43%). The LFLS study achieved significantly higher EIMC rates (35%) in comparison with previously observed EIMC study rates in Zambia (11%), and significantly higher than hypothetical comparison rates up to 30%. Relative to baseline rates, odds of VMMC among couples’ older sons increased by 31% at post-intervention and by 90% at two-weeks following birth. Overall, this pilot study found the LFLS intervention to be feasible, acceptable, and effective in doubling the rate of EIMC in comparison with a previous longitudinal study in Zambia. Future research should consider a family-centric approach to promotion of male circumcision for infants and adolescents. LFLS may be effective in promoting father-son “bonding” by MC status; a bond that may be a bridge to increase both EIMC and VMMC uptake in newborns and couples’ older sons and is a novel leverage point for promotion of this HIV prevention strategy.
Indigenous Knowledge Systems for the Treatment of Hypertension in Lusaka, Zambia: Perceptions, Knowledge and Practice.
(Zambian Medical Association, 2016-01) Prashar, Lavina; Goma, Fastone; Kalungia, Chichony Aubrey; Bwalya, Angela Gono; Hamachila, Audrey; Mutati, Ronald Kampamba; Zingani, Ellah; Mwila, Chiluba; Musoke, Pamela
Indigenous knowledge systems and traditional technologies have made and can continue to make a significant contribution to modern medicines with discovery of novel molecules in the treatment of various conditions. The traditional knowledge in our communities is passed on from generation to generation. Scientific evaluation of these compounds from traditional medicines can lead to discovery drugs with better efficacy and novel mechanism. The study aimed at determining the indigenous knowledge based preparations used for hypertension in Lusaka, Zambia. The specific objectives were: a). To determine the knowledge and practice of Traditional Health Practitioners in the management of HTN, b). To identify the parts of the plants utilized in the preparation of the IKS-based preparation used in the management of hypertension. c). To determine the procedure employed in preparing the IKS-based preparations used in the management of hypertension. d). To recommend for further elucidation of the possible active compounds in the indigenous based preparations and postulate possible pharmacological mechanisms of actions. The study adopted structured interviews complemented by non-participatory observations. Samples used by traditional healers were collected for identification and characterization A total of twelve (12) traditional healers registered with Traditional Health Practitioners of Zambia who manage hypertension were interviewed. The traditional healers interviewed had knowledge of causes of hypertension, only three (3) indicated bewitchment as one of the causes. spiritual method constituted an important method of diagnosis. The beliefs of Traditional Healers with regard to hypertension indicates their alignment to agreeing the scientific understanding of hypertension in terms of its causes, risk factors and complications. Traditional Healers in Zambia believe hypertension can be managed by some mode of action of the herbs. Common themes that emerged to determine the effectiveness of the herbs used included; patient feedback, physical appearance, confirmation at local clinic and increased urine output. Majority (5/12) felt that there herbs take atleast 7-14 before the effects are seen. All the traditional healers indicated using atleast two (2) types of herbal preparations to manage hypertension. Of the preparations mentioned three (3) were not of plant origin. These include; crocodile fat, pebble and honey. This study observed that the traditional healers of Zambia knowledge of causes and complications of hypertension are alligned to the scientific knowledge. Divination is however still the most important (50%) method used for diagnosis and witchcraft/ spiritual method forms an important method for some for diagnosis of hypertension. It is noteworthy that traditional healers in Zambia believe hypertension can be managed by some mode of action of the herbs a belief shared by the conventional management.
Opuntia stricta cladode Extract reduces blood glucose levels in Alloxan-induced diabetic mice.
(Scientific and Academic Publishing, 2018-07) Prashar, Lavina; Kalungia, Chichony Aubrey; Mataka, Mary; Kaonga, Patrick; Bwalya, Angela Gono; Munkombwe, Derrick
Opuntia stricta (commonly called prickly pear cactus) is a natural plant that grows in some parts of Zambia where its fruits and cladodes are commonly consumed for nutritional and medicinal purposes, including glycaemic control among some patients with diabetes mellitus (DM). There is insufficient evidence whether Opuntia stricta indigenously growing in Zambia possess antidiabetic effects.To assess in vivo antidiabetic effects of the aqueous extract of Opuntia stricta cladodes in alloxan-induced diabetic mice. A laboratory-based experimental study was conducted involving 20 adult Swiss albino mice (Mus musculus) weighing 18-30 g. DM was induced using a single intraperitoneal dose of alloxan monohydrate 90 mg/kg. Opuntia stricta aqueous extract was administered orally and blood glucose levels (in mmol/L) monitored daily for 10 days. Alloxan induced a 4- to 5-fold sustained increase in blood glucose levels at 72 hours after administration in mice. Within a 10-day experimental period, Opuntia stricta cladode aqueous extract (1 mg/kg) significantly reduced blood glucose levels in vivo (from 16.6 ± 1.4 mmol/L, 95% CI: 14.9-18.3 at baseline to 7.5 ± 1.0 mmol/L, 95% CI: 6.2-8.9 at endpoint, p < 0.001, n = 5). Similarly, at a dose of 2 mg/kg, the extract significantly reduced blood glucose levels (from 18.7 ± 4.6 mmol/L, 95% CI: 13.0-24.4 at baseline to 6.9 ± 1.7 mmol/L, 95% CI: 4.7-9.0 at endpoint, p = 0.001, n = 5). Opuntia stricta cladode aqueous extract attained a greater reduction in blood glucose levels compared to Glibenclamide 0.25 mg/kg. Opuntia stricta cladode aqueous extract demonstrated a presence of alkaloids, flavonoids, saponins, sterols, carbohydrates, phenols and tannins. Opuntia stricta cladode from Zambia demonstrates antidiabetic effects to reduce blood glucose levels in vivo.
Perceptions and barriers on the feasibility of decentralizing the collection of blood samples for testing in the community through the community art group model in Lusaka, Zambia.
(The University of Zambia, 2019) Siwingwa, Mpanji
The focus of Community ART Group (CAG) model is on drug refill, adherence and support groups. The laboratory services are completely neglected in implementing this model in Zambia, and stable patients still have to go to the clinic for blood draws after collection of drugs from the community. In addition, phlebotomy delivery system is congested and has challenges with shortage of staff, insufficient funding, shortages of supplies and delivery services. The purpose of this study was to identify the perceptions, barriers and potential resources in decentralizing the collection of blood samples for routine testing into the CAG model. A qualitative case study design was used. Data was collected through ten Focused group discussions among CAG members, community and health care workers at ART clinics and in-depth interviews with five key informants. Data was analyzed using thematic method and this was done with the help of Nvivo version 10. Positive perceptions were identified as those which contributed to decongesting phlebotomy rooms, reduced missing appointments for blood draws, work Load, and lost results. Improved quality of phlebotomy service delivery and testing coverage, innovative way of bringing lab services closer to the people and inspire patients to monitor each other’s blood draws. The negative perceptions were compromised sample integrity and less contact with clinicians. The study also identified barriers to decentralize phlebotomy services within CAG and these included: long distance and transportation costs, inadequate community sensitization, lack of skills from the community to draw quality samples for testing, lack of privacy and confidentiality, CHWs not recognized by regulatory bodies, low level of literacy, shortage of qualified health workers and lack of remunerations. In summing up, the clinical psychosocial counsellors, volunteers, CHWs and HCWs were identified by all stake holders as prospective community phlebotomist in the decentralization of phlebotomy services. Decentralizing phlebotomy services into CAG model was perceived as decongesting and reducing work in the phlebotomy room, improved testing coverage and compromised sample integrity. This process incurred challenges due to lack of community sensitization and technical skills in phlebotomy, transportation cost and community health workers not recognition by regulatory bodies. The potential resources needed in community phlebotomy services were identifying prospective phlebotomist, materials for community sensitization, trainers and training materials, experts in quality assurance programs and financial support.

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