Medical Theses and Dissertations

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Abdominal Tuberculosis is common and under-diagnosed in HIV positive Adults in Zambia
(2012-07-25T13:24:16Z) Sinkala, Edford
Abdominal tuberculosis is a common form of extra- pulmonary tuberculosis especially in HIV/AIDS patients. A high index of suspicion is required for diagnosis of abdominal tuberculosis in these patients. A study was done at the University Teaching Hospital, Lusaka, Zambia to ascertain whether abdominal tuberculosis is common in HIV/AIDS patients, and whether under diagnosed. The inclusion criteria were fever and weight loss, with one or more of the following: diarrhoea persisting for >1 month, ascites, abdominal lymphadenopathy based on ultrasound, mesenteric masses based on ultrasound, hepatomegaly or splenomegaly, pancreatic enlargement, or unexplained focal or generalised pain/tenderness persisting over 7 days. The exclusion criteria included: HIV negative, solely pelvic and renal abnormalities, on antituberculous treatment for more than 1 week or too sick to undergo laparoscopy or colonoscopy. 31 subjects completed the algorithm and all the subjects had abdominal ultrasound scanning of which some had laparoscopy/laparotomy while others underwent colonoscopy. In order to determine if abdominal lymphadenopathy was attributable to HIV an equivalent number to those who met the criteria was recruited as controls and had abdominal ultrasound scanning. These subjects were HIV positive and had no features of tuberculosis. In this study 22 subjects had evidence of abdominal tuberculosis while 9 had no evidence of abdominal tuberculosis representing 71% and 29% respectively. Non of the controls had abdominal lymphadenopathy or any appreciable mass on abdominal ultrasound implying that abdominal lymphadenopathy indicate pathology. Good history and physical examination proved to be useful in diagnosing abdominal tuberculosis. Among the physical findings, abdominal tenderness was the commonest (86%) in subjects with evidence of abdominal tuberculosis. This study also revealed that abdominal ultrasound is an important tool in helping to make diagnosis of abdominal tuberculosis especially in poor resource set up where CT and MRI scans are not readily available. This study showed that 73% of those with evidence of abdominal tuberculosis had ascites and 54% of subjects with abdominal tuberculosis had ascites with fibrous strands. While laparoscopic studies plus biopsy will confirm abdominal tuberculosis, this study noted that it is possible for normal looking mucosa on colonoscopy to be colonised by Mycobacteria tuberculosis (this was found in 1 out of 5 subjects). No Mycobacterium was cultured from any of the blood samples drawn from the study subjects and positive culture of the ascitic fluid was low (13.6%). Many subjects with abdominal tuberculosis had low CD4 count (mean= 92 cell/ul). 20 subjects (HIV positive) who died of suspected pulmonary or abdominal tuberculosis had autopsy done on them. Disseminated tuberculosis was more frequent than either pulmonary or abdominal tuberculosis. Abdominal tuberculosis in quite common in HIV positive patients. Therefore it is important to take a detailed history and elicit signs pertaining to abdominal TB.
Abolishment of corporal punishment in Zambia: Evaluation alternative modes of discipline in selected Government Secondary Schools in Lusaka District
(The University of Zambia, 2016) Mtonga, Dingase E.
The study aimed at evaluating alternative modes of discipline educators use to instil discipline in pupils after the abolishment of corporal punishment in 2003 in Zambian schools. The objectives of this study were: to verify the alternative modes of discipline to corporal punishment educators use to instil discipline in pupils in Government Secondary Schools; ascertain their suitability; explore challenges educators encounter in using the alternative modes to instil pupils‟ discipline, and; solicit proposals to mitigate the challenges. The study implored qualitative approach and a descriptive survey design. Data was collected from the documents reviewed; and through individual interviews, focus group discussions from a sample of 51 participants which comprised 21 teachers, 21 pupils, 3 school administrators, 3 Parent Teachers Association (PTA) representatives, from three Government Secondary Schools, and 3 policy-makers from the Ministry of General Education (MoGE) and Human Rights Commission (HRC) offices. Purposive sampling was used to sample policy makers, school administrators and PTA representatives. Typical and homogeneous sampling was used to sample teachers and pupils. Data was analysed according to emerging themes, and presented on tables and graphs. The findings were that educators use dialogue, suspension, counselling, and manual to instil discipline in pupils. With regards to suitability, the findings were that alternative modes are suitable to use on pupils discipline as they are non-corporal, create a sense of responsibility in pupils, instil discipline and are lawful. The established challenges were that the modes consume time, are not effective to instil discipline, non-compliance by parents and pupils, lack of knowledge by teachers and pupils. The findings on mitigation of challenges were: the MoGE to prescribe alternative modes as a guide for educators and provide them with knowledge and skills to enhance the administration of discipline, teamwork by parents and teachers and insisting on pupils to adhere on school rules. In light of the findings, the study recommended that schools should have guidance and counselling departments with qualified counsellors to help in pupil discipline, educators to explore better contemporary trends on positive discipline, all schools to establish and strengthen child rights clubs and train peer educators on the importance of good discipline. Finally, more research to be conducted on ways of improving discipline in Government Secondary Schools.
Acceptability of Antiretroviral Drugs among adults living in Chawama, Lusaka
(2011-11-09) Munthali, Sharon C.
Acceptability of Antiretrovirals (ARVs) has been found to be associated with several factors. In this study we investigated the level of willingness among adults living in Chawama and factors likely to be associated with willingness to taking ARVs This was a cross sectional study. Only eligible adults 18 years and above were recruited by a simple random sampling. A structured questionnaire was used to collect data socio-demographic and other factors likely to influence willingness The Chi square test was used to determine association between variables of interest and multivariate analysis was performed to determine predictors of willingness Overall (n=409), 52.8% females and 46.9% males participated in the study. The non response rate was less than 1%. Overall (n=409), 52.8% females and 46.9% males participated in this study. The non response rate was less than 1%. A high level of willingness was observed with more than 50% of participants willing to take ARVs if they were found legible for ART. The mean age of participants was 31 years (SD±11.60). Some of the key factors that were found significantly associated with willingness were, the aspect of being male or female [OR: 2.27 (95%CI, 1.10 - 4.70)] with females being more likely to be willing than males, the perceived effectiveness of ARVs [OR: 3.50(1.71 - 7.82))], the need for consent to begin ARV treatment [OR: 1.30(95% CI, 1.40-2.72)] with females being more likely to needing consent than men, and fear of discrimination [OR: 2.47(95% CI,1.22 – 5.00)] A high willingness to take Antiretroviral drugs among community members was observed but there is need to increase intervention programs that promote acceptability and uptake of ARVs. Furthermore stigmatizing attitudes, gender and socio-cultural influences towards people taking ARVs still persist and interventions to reduce these influences are needed.
Acceptability of male circumcision in HIV prevention among the males aged 18 years and above in Mufulira Urban
(2011-11-04) Chiwele, George
HIV/AIDS is a major public health problem, not only in Zambia but the world as a whole. Millions of new infections are still being reported especially in the Sub-Saharan Africa. This has resulted in a number of interventions being put in place to halt the spread of the HIV infection. Male circumcision is one of the new interventions that is being considered in the prevention of HIV transmission from infected females to males.The overall aim of this study was to determine the acceptability of male circumcision in HIV prevention among the males aged 18 years and above in Mufulira urban. The specific objectives were: (1)To determine the proportion of uncircumcised respondents willing to undergo male circumcision. (2)To determine the reasons why circumcised respondents got circumcised. (3)To identify socio-cultural factors associated with the uptake of male circumcision. (4)To determine association between knowledge on male circumcision and willingness to undergo male circumcision. A cross sectional study was conducted in Mufulira urban in December, 2009 by the research team. The study comprised face to face interviews of 407 respondents using a structured interview schedule and two FGDs involving males aged 18 to 30 years and those aged 31 years and above respectively. Respondents were drawn from one high density area with a high HIV prevalence (Kantanshi Township). The Township was purposively selected. The households were systematically selected. One randomly selected male aged 18 years or older was interviewed from each selected household using a structured interview schedule. Individuals for the FGDs were purposively selected to ensure that groups were homogeneous.The confidence interval was set at 95%, and a result yielding a P value of 5% or less was considered to be statistically significant. The Chi Square test was used to compare the proportions. A full report of the FGDs was written using participants own words. The main ideas and key statements that were expressed were listed down. Data was coded and responses from the two FGDs were compared and a summary was written in narrative form.The study findings revealed that only 18.7% of the respondents were circumcised. The Study further revealed that 60.7% of the respondents expressed willingness to be circumcised if male circumcision could offer partial protection against acquisition of HIV/AIDS. 69% of the respondents had high knowledge on male circumcision. There was no association between knowledge and willingness to undergo male circumcision.The only significant association was between improvement in genital hygiene and willingness to undergo male circumcision.The results showed that though the level of male circumcision was low in Mufulira Urban, the procedure was perceived positively.
Acceptability of male midwives in birth/delivery care in Ndola
(2011-11-04) Chilumba, Janness Namusokwe
The study sought to determine acceptability of male midwives in birth and delivery in Ndola (both rural and urban). The literature reviewed has revealed that there are very few studies that have been conducted worldwide and at regional level which focus on gender perspectives, family planning and male circumcision.The study sought to answer research questions: To what extent have male midwives been accepted during birth and delivery? What is contributing to acceptability or non acceptability of male midwives in the community? And finally should training of male midwives continue? A cross sectional study was done in two urban health centres and two rural health centres of Ndola. A 1:5 systematic random sampling was used to select the respondents. Mothers were followed in their homes using the addresses from the register. A total of 420 respondents were requested to take part in the study of which only 403 were recruited, giving a response rate of 96%. And 60 husbands of antenatal mothers were purposefully selected into the study for focus group discussions that is 15 from each area. Quantitative and qualitative data were analysed using SPSS version 11.5 and content analysis respectively. The Chi-square test was used to determine the associations of independent variables with the dependent variable. The study revealed that the respondents accepted to be cared for by male midwives because they are trained and offer the same care as female counterparts and that they are caring and gentle. Significant findings were noted amongst antenatal mothers who had higher educational level (68%), higher income (69.8%) and those who were not sure of their cultural values and who said the idea of not accepting male midwives was being done away with had 83% acceptance rate of male midwives. Those with previous experience with male midwives, 87.1% felt very safe when they were being attended to by male midwives and 75% of antenatal mothers accepted to be attended to by male midwives but suggested that they should be confined to antenatal clinics and not labour ward. A higher acceptance rate (73%) was noted among respondents who said they would accept to be cared for by male midwives as this was a reality that was prevailing citing critical shortage of midwives in general and that male midwives have empathetic attitude than their female counterparts who are believed to be short tempered and screaming at women in labour. A few (39.8%) would not accept to be attended to by male midwives because they felt embarrassed and shy to undress for a man other than their husbands and traditionally (53.4%) it was a taboo undressing before a man you are not married to. The men folk were against the idea of male midwives in birth and delivery since they themselves were not allowed to enter labour ward when they escorted their wives. They emphasized that traditionally and culturally it was just not right. However the study also revealed that the men folk felt that they should be sensitized on new programs such as this because they understand issues better than their wives so that they are able to prepare their wives psychologically as they go for birth and delivery services The study has revealed that most of the respondents were for the idea of training male midwives and this is a challenge to Ndola District Health Management Team to consider capacity building in this area though a few felt that if men are trained, they should only work in antenatal clinic and not labour and delivery.
Acceptability of option B+ among HIV positive women receiving antenatal and postnatal care services at the University Teaching Hospital and Lusaka urban city clinics
(The University of Zambia, 2017) Chanda, Chomba Bridget
In 2013, Zambia accepted the immediate operationalization of Option B+, a policy used to try and eliminate mother to child transmission. This policy requires all HIV-positive pregnant and breastfeeding women to initiate antiretroviral treatment for life regardless of CD4 count. However, not all HIV positive women accept treatment for life. This study aimed to investigate acceptability of lifelong ART (Option B+) among HIV positive women receiving antenatal and postnatal services at the university teaching hospital and Lusaka urban city clinics. This was a cross sectional study conducted in November, 2016 to March 2017 at the University Teaching Hospital (Department of Obstetrics and Gynecology) and four clinics (Chawama, Kalingalinga, Matero Reference and Chilenje). The overall sample size was 427 and the study population comprised of HIV positive women in their reproductive age (15-49 years). A Structured questionnaire was used to collect data in a face to face interview with the participants. Data was entered in EpiData version 3.1 and analysed using Stata version 13. Multivariate logistic regression analysis was performed to determine predictors of acceptability. Overall, 427 women participated in this study. Their mean age was 30 years. Of the 427, over half (54%) had inadequate knowledge and about 30% of the women in the study still experience stigma and discrimination. 63.2% of the women had good attitude towards Option B+ and overall, the majority (77.8%) were willing to accept antiretroviral therapy for life. Multivariate analysis showed that only women with good attitude were 9.4 times more likely to accept Option B+ than those with a bad attitude [OR: 9.4: 95%CI, 5.8-15.2)]. This study showed that in general, women accepted initiation of Option B+. However, there is still a gap in the level of knowledge of Option B+ as well as stigma and discrimination in some communities, hence there is need to intensify programs that are aimed at educating the community on the importance of ART for life, combat stigma and discrimination and consequently promote acceptability of Option B+.
Acceptability of Oral Immunization Against Cholera and Typhod Fever among School Children in Lusaka
(2011-07-13) Masebe, Mukokomena Esther
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. There were 14.4 million individuals worldwide living with TB including half a million cases of Multidrug-resistant (MDR) TB in 2006. A most serious aspect of the problem has been the emergence of MDR-TB and extensively drug-resistant (XDR) TB. MDR-TB is defined as a strain of Mycobacterium tuberculosis that is resistant to at least Isoniazid and Rifampicin whether there is resistance to other drugs or not. XDR-TB is defined as resistance to at least rifampicin, isoniazid, a second line injectable drug (capreomycin, kanamycin or amikacin) and a fluoroquinolone.China, India and the Russian Federation are thought to carry the largest MDR-TB global caseload. World Health Organization (WHO) estimates that there were 66,700 MDR-TB cases in Africa in 2006. In 2005 approximately 50 cases were reported as having MDR-TB in Zambia. Treatment of MDR-TB requires prolonged and expensive chemotherapy. The main objective of this study was to determine the prevalence of and factors associated with MDR-TB among adults with TB at University Teaching Hospital (UTH) in Lusaka, Zambia. Specific objectives were to describe the demographic characteristic of patients presenting with MDR-TB, determine the proportion of MDR-TB cases among TB culture-positive patients, and to determine the association between HIV/AIDS, previous TB treatment and compliance on one hand and MDR-TB on the other.A cross-sectional study was conducted in UTH TB Laboratory in Lusaka among culture-positive TB patients. Facility TB records and databases for M tuberculosis isolates which were cultured and had drug-sensitivity testing performed against four first-line anti-TB drugs were studied retrospectively. All the records and databases available between 2003 and 2008 were reviewed. The results have been presented in graphical and tabular form. The proportion of MDR-TB among the TB culture-positive patients was 10.9%. The association between age and MDR-TB was not statistically significant. The observed proportions of females between positive and negative were statistically different. There was no significant association between employment status and MDR-TB. There was an association between HIV/AIDS and MDR-TB. There was an association between compliance and MDR-TB.We conclude that there is need for continuous monitoring of MDR-TB and XDR-TB.
Acceptability of routine HIV testing by pregnant women in Lusaka urban antenatal clinics, Lusaka District, Zambia
(The University of Zambia, 2016) Muyemba, Mercy K.
The study was done to investigate the factors that influence acceptability of routine Human Immuno deficiency Virus testing by pregnant women in Lusaka District clinics. Each year around 1.5 million women living with Human Immuno deficiency Virus(HIV) become pregnant, and without antiretroviral drugs there is a chance that their child will become infected. The risk of Human Immuno deficiency Virus transmission from mother to child can be reducedif pregnant women take a regimen of Anti-Retroviral drugs.Following the introduction of Routine Human immuno deficiency Virus testing policy in Zambia, the Human immuno deficiency Virus test is offered to all pregnant women unless they decline. However, more pregnantwomen are declining to be tested.The aim of the study was to investigate the factors that influence acceptability of routine HIV testing by pregnant women in Lusaka urban ante natal clinics. A cross sectional study using a quantitative approach was conducted in Lusaka Urban District clinics. The sample size comprised of 366 pregnant women selected by simple random sampling, from three (3) research settings. A pretested semi structured interview schedule was used to collect data. Data was entered and analysed with Statistical Package for Social Sciences (SPSS) version 20 program.Chi-square was used to test for associations between acceptability of routine HIV testing and other variables. Binary logistic regression modelling was carried out to predict the outcome. Study findings revealed that86.6% of respondents indicated non acceptability of routine HIV testing in pregnancy. Binary logistic regression revealed that maternal age, educational level and information education and communication contributed significantly to the model. The odds revealed that acceptability of routine HIV testing by older pregnant women (37- 49 years) were 8 times (OR- 7.67, p- 0.003) higher than the younger ones. The odds of acceptability by respondents with tertiary education were 141 times (OR-141.23, p-0.000), likely to accept HIV testing than those with primary or no education. The odds also revealed that acceptability by women who cited adequate information, education and communication (OR-2.6, p-0.024) were 3 times higher than those who cited inadequate IEC. The study showed that majority of the pregnant women did not accept Routine HIV testing despite the numbers of women taking the HIV test. Therefore there is need to address some factors that are likely to affect the routine HIV testing and impede the success of implementation of the prevention of mother to child transmission (PMTCT programme in the country which goes beyond testing for HIV alone. Key words: Acceptability, Routine HIV testing, pregnant women
Acceptability,Concerns and Experiences of Men Circumcised by Female Health Providers in Lusaka District
(University of Zambia, 2016) Mahule, Agness
Background: The Zambian government has endorsed voluntary medical male circumcision (VMMC) as a biomedical strategy for HIV prevention after a decade of debating its effectiveness in the local setting. The current policy recommends that male circumcision (MC) should be clinically based, as opposed to the alternative of traditional male circumcision (TMC). Acceptability concerns are among the challenges threatening the mass rollout of VMMC. In terms of acceptability, the gender of clinicians conducting the operations may particularly influence health facility-based circumcision. Currently, Zambia is advocating circumcising 80% of all HIV negative men. Most studies globally are on acceptability and barriers to access MC services in general and research is yet to profile the experiences of men who are to be attended to and have been attended to by female providers. Aim: This study explored the concerns and experiences of male clients, of female clinicians or providers taking part in the circumcision procedure. Methods: This was a qualitative study. Data was collected through in-depth interviews with 29 circumcised men at three health facilities. Interviews were audio recorded. Data were verbatim transcribed and analyzed thematically using NVIVO version 10. Results: All 29 participants got circumcised by a female provider. Reasons for accepting were mainly due to lack of choice and that most services offered in health facilities may be done by any experienced provider regardless of gender affiliation. Significant concerns are; shame, stigma and erection. To undress in presence of a female for circumcision purpose was accepted reluctantly owing to culture concerns and that some men erect inadvertently which is rather embarrassing. Additionally male circumcision is an elective procedure and one would wait until a male provider was available. However male circumcision offered in hospitals can be done by any trained health personnel. Conclusions: Concerns and experiences were shame and embarrassment associated with undressing in presence of an opposite sex and the negative attitude of the community to male circumcision offered by female providers. Sex of a provider may be communicated to people or possible clients at individual and community level to prepare clients psychologically. Since the Zambian government is recommending circumcising 80% of all HIV negative men, policy and practice must focus on educating the target group on myths, facts and assumptions surrounding male circumcision offered by female providers. There is room for improvement in modes of offering male circumcision services in health facilities.
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.
Acute Bacterial Meningitis in Zambian children: Highlighting the changing pattern in the Aetiology of Bacterial Meningitis in Zambia
(2012-06-22) Kankasa, Chipepo
A hospital based prospective study on Acute Bacterial Meningitis (ABM) in Zambian Children was done in the department of Paediatrics, University Teaching Hospital Lusaka over a period of six months in the hot dry season (1st August to the end of November) of the years 1992 and 1993. The aim and objectives of the study were to determine the prevalence, aetiology, risk factors, poor prognostic signs, clinical profile and outcome of ABM. Nine hundred children were recruited aged one month to 15 years as cohorts, 2 9 were excluded, 871 were followed up.It was found out that almost all age groups were at risk, with ABM being commonest around 5 and half years of age. There was no sexual predilection, male to female ratio was 1.2:1, almost 90% of cases came from high density areas of Lusaka. Clinical manifestations ranged from fever with neck stiffness alone, to associated septic shock with petechial rash. The commonest complaints were fever (99%), anorexia (88.5%), headache (73.8%), vomiting (71.3%), arthralgia (about 60%), the commonest signs were; neck stiffness (96.9%), Kernigs (77.4%), Brudzinski(73%), whilst in infants fever, irritability, refusing to suck and bulging anterior fontanelle were common.The most common pathogens isolated were N.meningitidis (77.9%), S. pneumoniae (15.4%), H. Influenzae (2.7%), others (2.6%). Young age, HIV sero positivity, S. Pneumoniae as pathogen , altered level of consciousness and seizures on admission were associated with a poor outcome. Case fatality rate was 10.7%. The highest mortality was seen in children with meningitis caused by S. Pneumoniae (38.75%), compared to influenzal meningitis (14.2%) and Meningococcal meningitis (6.6%) . Follow up was very difficult because more than 50% of the study group defaulted.
Adherence to ART among pregnant women living with HIV/AIDS in Lusaka Urban
(The University of Zambia, 2015) Nthala, Victoria C,
Introduction Adherence to ART is a challenge among pregnant women living with HIV/AIDS. This has an effect on the health of the mother and the unborn child. While studies have been done, it has shown that adherence during pregnancy is a challenge. Ensuring adherence to the prescribed ART continues to be a major Public Health concern in both high income and low income countries. Virological and clinical success depend critically on high adherence to ART because with low adherence the virus quickly develops therapy limiting drug resistance, which may lead to the usage of second line treatment which is very expensive, and sometimes not available. With non-availability of second line treatment there has been maternal disease progression and risk of Vertical Mother to Child Transmission (MTCT). Promoting adherence to ART among pregnant women living with HIV/AIDS requires an understanding of potential factors that influence adherence and this study explored how interventions can be developed in order to address this low level of adherence to ART among pregnant women living with HIV/AIDS. This study was carried out to determine factors that influence adherence to antiretroviral therapy among HIV positive pregnant women in Lusaka district of Zambia. Methodology This was a qualitative study which used a case study approach. Data was collected through in-depth interviews. The collected data as was analysed using a thematic analytical approach. Results 17 out of 30 among pregnant women living with HIV /AIDS in Lusaka had Challenges with adherence to ART. The study explained factors related to adherence to ART among pregnant women living with HIV/AIDS. ART adherence was found to be low and reasons for low adherence to ART among pregnant women were divided into threats that included Economical factors( lack of food), Physical factors ( Drug side effects), Environmental factors ( long waiting hours with long queues) and social stigma. The findings call for the need to improve on food programs, improve on drug regimens, improve on staffing levels at the health facility in order to reduce on long waiting hours and long queues and reduce on social stigma. The results confirmed that there is low adherence to ART among pregnant women living with HIV /AIDS in Lusaka, and they also confirm that adherence to ART among pregnant women is a big challenge. Conclusion Adherence to ART among pregnant women living with HIV/AIDS is a challenge for Zambian pregnant women. Improved levels of adherence to ART is hampered by fear of social stigma, Drug side effects, lack of food and fear of being blamed by partners if they disclosed their status. Stigmatisation needs to be addressed because nearly all the participants expressed this factor. There is need to address the HIV/AIDS stigma very seriously in order for society to look at HIV/AIDS like any other illness. The success of this strategy will depend on careful consideration of the barriers and enablers to pregnant women’s access to and use of ART. Managing these barriers and enhancing known enablers will require the development of respectful and locally acceptable HIV and ANC service delivery models, that are responsive to women’s needs and perspectives, and support them as they enter and move through the maternal ART cascade. It will also require better understanding of the ways women live outside the clinic affect their chances of entering into, and staying adherent to and retained in care.
Adherence to treatment by patients with type 2 diabetes mellitus at Monze Mission Hospital,Monze,Zambia
(The University of Zambia, 2017) Nyirongo, Sanford;
Diabetes mellitus is one of the most common non-communicable diseases and one of the leading cause of disability, morbidity and mortality globally (Jackson et al., 2014). The aim of the study was to assess adherence to treatment by type 2 Diabetes mellitus patients aged 20 years and above at Monze Mission Hospital in Monze district. It sought to answer the research questions: (1) What is the level of adherence to treatment by patients with type 2 Diabetes mellitus receiving care from Monze Mission Hospital? (2) What factors influence adherence to treatment by patients with type 2 Diabetes mellitus? A cross-sectional study design was used at Monze Mission Hospital in Monze district. Simple random sampling method was used to select 138 patients who sought medical services from the Out-patient medical clinic as well as admitted patients in the hospital. A structured interview schedule was used to collect data. Data was entered and analyzed using the IBM® Statistical Package for Social Sciences (SPSS®) for Windows version 22 to predict levels of adherence to treatment as well as to identify factors which influenced adherence among type 2 DM patients. Chi – Square (X2) test was used to test the associations between variables. The binary logistic regression was used for multivariate analysis to determine true predictors of adherence. The findings showed that, 56.5% patients had poor adherence to treatment while 44.2% had good adherence to treatment. More than half of the patients (55.6%) had knowledge about Diabetes mellitus treatment. About 65.2% of patients indicated that distance to the hospital and financial challenges were a hindrance to seeking regular medical reviews. The study results showed a statistically significant association between adherence and knowledge of type 2 Diabetes mellitus treatment (p = 0.024). Distance to the hospital, health care services and attitude to self-care management were statistically insignificant despite influencing adherence to Diabetes mellitus treatment (p > 0.05) The study showed that poor adherence to treatment reduced as knowledge about Diabetes mellitus increased. However, distance to hospital impacted negatively to adherence as vii patients‟ adherence to treatment reduced as distance to the hospital increased. There is need to consider educational programs to strengthen adherence to dietary advice, regular exercise and follow up, to achieve normal glycemic levels as opposed to adhering to either oral hypoglycaemic drugs or insulin or both, to improve the management of type 2 Diabetes mellitus patients at Monze Mission Hospital. Adherence to type 2 Diabetes mellitus; Treatment; Patients.
Adverse obstetric outcomes in adolescent pregnancy in rural Zambia-the case of Kawambwa and Mansa Districts of Luapula Province
(The University of Zambia, 2015) Moraes, Albertina.M.N
Objectives: Adolescent pregnancy is a major public health problem throughout the world. It has been associated with adverse obstetric outcomes. In Zambia, Luapula province has the highest rate of adolescent pregnancy. The aim of this study was to investigate the maternal and perinatal outcomes among adolescents aged between 10 and 19years compared to older mothers aged between 20-24years delivering at selected health facilities in Kawambwa and Mansa. Methods: A retrospective cross-sectional analysis was carried out of all deliveries to mothers aged between 10 and 24 years for the period January 2012 to January 2013. A total of 2,797 ANC and delivery records were reviewed; 1,291 adolescents aged between 10-19years and 1,504 older mothers aged 20-24 years. Among the outcomes evaluated were eclampsia, anaemia, haemorrhage, fistulae, CPD, low birth weight, asphyxia and pre-term delivery. The crude and adjusted odds ratios for the association between maternal age and adverse obstetric outcomes were obtained through logistic regression models Results: The mean age of the adolescent mothers was 17.5years. Compared to those aged 20 to 24 years, mothers younger than 16years were found to face a higher risk factor for eclampsia (OR 40.56, 95%CI 13.09-125.65), haemorrhage (OR 3.59, 95% CI 1.01-12.74), CPD (OR 5.40, 95% CI 2.46-11.85), prolonged labour (OR 1.49, 95% CI 0.43-5.13) and caesarean section (OR 3.33, 95%CI 1.93-5.76) but not for anaemia, sepsis, fistulae, PROM and maternal death. After adjustment for four potential confounders, the association between maternal age and adverse obstetric outcome diminished; young maternal age remained a risk factor only for eclampsia. Children born to mothers younger than 16 were also at significant risk for LBW (OR 1.65, 95% CI 0.87-3.15), PTD (OR 2.26, 95% CI 0.51-10.14), low Apgar score (OR 1.82, 95% CI 0.87-3.83) and neonatal death (OR 1.83, 95% CI 0.63-5.31); the risk for asphyxia, however, tended to increase with age. The maternal death rate among adolescents was found to be 5 deaths per 1,000 live births, whereas the neonatal death rate was 36 deaths per 1,000 live births. Conclusion: The high rates of adolescent pregnancies in Luapula province are likely as a result of the predominantly rural and poor population. The findings of this study demonstrate that young maternal age is a risk factor for adverse obstetric outcomes. Understanding the factors that contribute to the high levels of adolescent pregnancy in the region will be vital in addressing the situation and subsequently reducing the high maternal and perinatal morbidity and mortality rates.
Aetiology, antibiotic resistance and risk factors for neonatal sepsis at the University Teaching Hospital in Lusaka, Zambia
(The University of Zambia, 2015) Kabwe, Mwila Patrick
Although neonatal sepsis occurs in approximately 15% of neonatal admissions in Sub-Saharan Africa, there is minimal data on its causes and antimicrobial resistance (AMR) that might guide policy and practice. Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Group B streptococcus (GBS) and other gram negative bacteria are the most common causes. These organisms especially the Enterobacteriaceae have AMR rates higher than 50%, for both first (Ampicillin and Gentamycin) and second line (Cephalosporins) drugs. Data on prevalence, aetiology, AMR patterns and risk factors for neonatal sepsis at the University Teaching Hospital (UTH) in Zambia has not been collected systematically making it difficult to utilize such information on patient management. Thus, this cross sectional study conducted in the Neonatal Intensive care Unit at UTH was aimed at providing baseline data that can be used to formulate guidelines for neonatal sepsis management. Among 313 neonates with clinically suspected sepsis, the prevalence of culture-confirmed sepsis was 33% with early onset sepsis (EOS) accounting for 85% of the cases. K. pneumoniae was the most prevalent pathogen accounting for 75% of the cases, followed by S. aureus and E. coli at 6% and 5%, respectively. During the study, it was observed that an increase in prevalence of neonatal sepsis due to K. pneumonia correlated with a high mortality rate, implying a potential outbreak. For WHO-recommended first line and second line therapy, AMR ranged from 96-99% and 94-97%, respectively. Bacterial culture diagnosis had minimal impact on treatment and outcome as only 25% of the neonates had received results for culture and drug sensitivity before discharge/death. Increasing neonatal age in days, and parity were associated with a significant increase in the odds of culture-confirmed neonatal sepsis, whereas irritability and pallor were negatively associated. Maternal human immunodeficiency virus infection was also associated with a significant reduction in the odds of culture-confirmed neonatal sepsis. These data, therefore, indicate a high burden of neonatal sepsis that needs immediate intervention. This could be done through implementation of simple and scalable infection control strategies that can reduce the frequency and rate of transmission of these infections
An analysis of leadership practices and their influence on providers and service delivery in Lusaka province-Zambia
(The University of Zambia, 2017) Mulenga, M Regina
In an evolving health care environment, hospitals need managers with high levels of technical and professional expertise who do not only concentrate on patient care, but also go further to demonstrate good leadership practices. In Zambia, the health sector’s mission is “to provide equity of access to cost-effective quality health services as close to the family as possible”. Only competent leadership can drive such an agenda. This study, conducted in selected 1st level Lusaka hospitals aimed at establishing the existing common leadership practices and their influence on healthcare providers and service delivery. The study used a two-phase cross sectional concurrent, mixed method design, to examine leadership practices through 12 health system managers and 30 healthcare providers. Quantitative data was obtained using a Multifactor Leadership Questionnaire (MLQ) and analysed using Statistical Package for Social Sciences Version 20 (SPSS 20). Qualitative data was obtained using in-depth interviews, focus group discussion, participant observation and document review. Quantitative analysis used averages and Pearson Chi-square tests to assess the interaction between Transformation, Transaction and Laissez-faire as independent variables and extra effort, effectiveness, motivation, satisfaction as dependent variables. The P- value of 5% was used to determine the significance. Qualitative data analysis was done by first transcribing audio-recorded interviews and grouping them into data sets (matrixes) where emerging themes were categorised manually. Qualitative data was used to build on the quantitative data to make conclusions and interpretations by providing prominent explanations. The common leadership practices preferred and perceived or experienced was the transformational leadership followed by transactional leadership while laissez-faire was rare type. The significant p-value of 0.001 demonstrated this. These practices were explained as networking, interpersonal relationship, human/material resources management, monitoring and evaluation, dictatorial tendencies and overworking of employees. Furthermore, the above practices were seen to have strong influence on healthcare providers through enhanced confidence, motivation for hard work and compromised quality of care. The resultant impact on service delivery was high quality performance as well as poor performance. Conclusion: The Ministry of Health policy makers should focus their attention on planning and implementing ongoing leadership and management trainings strategies that would strengthen the prevailing transformational and transactional leadership styles. This will help to strengthen health systems in leadership and governance, human resources for health and service delivery. The recommendation is that a similar study be done to compare the impact of leadership styles between government and private or mission hospitals.
Analysis of the effect of community sensitization on the outcome of indoor residual spraying program against mosquitoes in Mpika Districts, Zambia
(2015-11-11) Mumba, Chola
This study sought to analyze the effect of community sensitization on the outcome of indoor residual spraying program against mosquitoes in Mpika district of Zambia. Indoor residual spray using carbamate insecticide was carried out in two phases: phase one march to April, phase two October to November 2012 in Mpika district. Two catchment areas were selected based on community sensitization on the IRS program. Boma area where sensitization took place was considered as cluster A and Mpumba area where community sensitization did not take place was considered as cluster B. The objectives of the study were comparing IRS outcome between cluster A and B, identify the best way to sensitize local community on IRS and identify perceived benefits of IRS by households exposed to IRS in the study areas. A retrospective cohort study design was used in this study which involved collection of 2012 data of households planned for IRS program, sample size of 369 and 345 households were randomly selected from cluster A and cluster B respectively. In order to achieve some of the objectives of the study such as the best way to sensitize local community in IRS and identify perceived benefits of IRS by households exposed to IRS, the focus group discussions were also conducted in the two study sites. However IRS program outcome was defined as a total number of households who had their structures sprayed.The annual proportion of households who had their structured sprayed per phase were 74.6% and 40.8% in Cluster A (n= 369) and B (n= 345) respectively. The chances of improving IRS program outcome were 4.23 times higher for cluster A than cluster B with statistical significance of 95% C.I. (3.08, 5.81). Furthermore the results revealed that there was a statistically significant association between community sensitization and IRS program outcome (χ2 = 83.05, df = 1, ρ <0.0001). The results also revealed that the chance of getting positive responses to IRS program from case cluster A was 5 times larger than the chance of getting positive responses in cluster B. [ 95% C.I. (0.17, 0.33)]. Discussions revealed that the best way to sensitize community is to involve them in all stages of IRS program. Reduction of malaria incidence was seen as a benefit of IRS program. This study revealed a higher proportion of households who had their structures sprayed where local people had been sensitized on the IRS program than where sensitization was not done. Community sensitization was the only factor associated with IRS program outcome. The responsiveness to IRS program was high in the area where sensitization was done; hence, local people need to be sensitized on all stages of IRS program.
Anatomical Variations of the Circle of Willis as seen at the University Teaching Hospital,Lusaka,Zambia
(The University of Zambia, 2016) Zulu, Hilda
ABSTRACT BACKGROUND: The ideal distribution of blood to the brain and the collateral potential of the Circle of Willis (CW) is believed to be dependent largely on the morphology and the presence of all the component vessels of the CW. However, there is a considerable individual variation in the pattern and calibre of vessels that make up the CW. The anatomical variations of the CW that have been observed may affect the occurrence and severity of symptoms of cerebrovascular disorders such as stroke, aneurysms, infarctions among others. The study aimed to determine the anatomical variations of the CW as seen at the University Teaching Hospital, Zambia. METHODS: A cross-section design was used to ascertain variations in 185 postmortem brains with respect to completeness of the circle, aneurysms and external diameter of the posterior communicating arteries (PcoA). The circle completeness was observed whereas the external diameter of the PcoA was measured using a digital vernier caliper. The median diameter was chosen to describe hypoplasia with a cutoff point at less than 1mm chosen based on earlier reports from other autopsy studies. Photographs were taken after dissection using a digital camera Canon power shot SX400IS 16 mega pixels. The brain specimen was placed back into the cranium upon completion of the examination. STATA version 12.0 was used for data analysis. RESULTS: Out of a sample of 185, the proportion of males 149 (80.5%) were significantly higher (p < 0.0001) than females 36 (19.5%). Complete CW was found in 90.3% of the cadavers. Hypoplasia of the PcoA was noted in 30.3% on the right and 36.2% on the left side. The median age for individuals with hypoplasia (<1.0mm) of the right PcoA was 48 years (range; 17-86) and those without it was 34 years (1772); the medians were statistically different (p < 0.0001). In case of hypoplasia of the left PcoA, the median age for the affected was 46 years (range; 17-86) and for those unaffected was 33 years (range; 17-75); there was a statistical difference, p < 0.0001. Multivariate analysis showed that one unit increase in age statistically increased the likelihood of having hypoplasia of the left and right PcoA by 9% (OR 1.09; 95%CI 1.06, 1.12; p < 0.001) and 10% (OR 1.10; 95%CI 1.06, 1.13; p < 0.001) respectively. CONCLUSION: The study revealed significant variations in the CW in the brain specimens studied at the University Teaching Hospital, Zambia. Hypoplasia in the PcoA was the most common noted variation with CW incompleteness in a few cases. No aneurysm was observed. These anomalies could predispose one to developing neurological deficit especially in patients with internal carotid artery (ICA) occlusion. Studying the variability of the CW is important academically and for clinical reasons because such considerations can influence the mode of presentation, plan of investigation and treatment of various neurological disorders. Key Words: Circle of Willis, Anatomical Variations, Hypoplasia, Posterior communicating arteries.
Antibiotic prescribing patterns among physicians at the University Teaching Hospital in Lusaka, Zambia
(2015-04-13) Hangoma, Jimmy M.
Background:Prescribing patterns can greatly have a negative impact on patient care outcomes if not underpinned by use of ideal standards and evidence-based medicine. The overall aim of this clinical research was to determine the antibiotic prescribing patterns among physicians and compare compliance of antibiotic prescribing with adopted National treatment guidelines.Methods :A cross-sectional study was undertaken which involved reviewing of patients’ records in wards, administration of a questionnaire to physicians and clinical heads as well as the head of pharmacy department. Systematic sampling was used for selection of patient files. The study was conducted over four months.The study was conducted in the medical wards in the departments of Obstetrics and Gynaecology (OBGY), Internal Medicine (IM) and Surgery at University Teaching Hospital.A sample of 385 patients were selected whose records and charts were reviewed. Of these, 165 were from the department of OBGY, 120 were from IM and 100 were from Surgery. Physicians were sampled using convenience sampling method.Outcome measures were compliance with Gyssens et al. recommendations, Zambian Standard Treatment Guidelines (STG) and Traffic-light system. Documentation of clinical indication, dose, frequency, route and duration and collection of culture samples before initiation of treatment were used to measure appropriateness of a prescription.Results: Of the 385 study patients evaluated, 270(70.1%) were prescribed with antibiotic(s). Out of 165 study patients from OBGY, 121(73.3%) were prescribed with antibiotic(s); out 120 from IM, 72(60%) were prescribed with antibiotics and those from Surgery, 77(77.0%) out of 100 study patients were prescribed with antibiotics. The average number of antibiotics per prescription was 1.8. The individual departments had prescriptions complying with Gyssens et al. recommendations of 59(24.3%), 18(12.4%) and 20(22.2%) for OBGY, IM and Surgery respectively. Out of 270 study patients who were prescribed with antibiotics, only 86(31.9%) had bacteriological tests ordered and only 27/86(31.4%) had the culture results ready at the time of review. The study has found that the association between position of physician and factors influencing prescribing tendencies was not statistically significant (p=0.084).The association between position held by study physicians and the ordering of bacteriological tests was found to be statistically significant (p=0.001). The study also found that there was only the Drug and Therapeutics Committee (DTC) and no other systems, structures or processes regulating the use of antibiotics at UTH.Conclusion :It can be concluded from the findings of this study that prescribing patterns do not comply with recommended standards of care. Antibiotics were prescribed without bacteriological tests. It can also be concluded that no structures and systems are available to control use of antibiotics at the hospital.

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