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- ItemFactors influencing the use of HIV self-testing kits among adolescents: a case of Kalingalinga compound, Lusaka.(The University of Zambia, 2024) Mwansa, EthelIn Zambia, HIV self-testing is vital for HIV prevention, but there's limited understanding of its use among adolescents. In Zambia, HIV self-testing has become integral to HIV prevention and control, yet a knowledge gap exists regarding its prevalence, utilization trends, and determinants among adolescents. This cross-sectional investigation, conducted in the Kalinglinga compound of Lusaka district, engaged 391 participants, with a robust response rate of 97.7%. Employing a pretested questionnaire, data were analyzed at univariate, bivariate, and multivariate levels. Univariate analysis revealed a 79% non-usage prevalence. Bivariate analysis showed significant associations between non-usage and marital status (χ² = 7.064, p = 0.029), monthly income (χ² = 11.058, p = 0.030), kit availability (χ² = 16.868, p = 0.000), accessibility (χ² = 12.066, p = 0.002), and cost perception (χ² = 10.016, p = 0.007). Age, gender, education, religion, having a sexual partner, unprotected sex, and drug use didn't significantly affect usage (p > 0.05). The analysis identified several key factors associated with a higher prevalence of non-usage of HIV self-test kits among the study participants. These factors included being aged 18-19 years, male gender, having primary or no formal education, being single, having a higher income, lacking a sexual partner, never engaging in unprotected sex, residing in areas with limited availability and accessibility of self-test kits, and having uncertainty about the cost of acquiring these kits. These demographic and situational characteristics collectively contributed to a greater likelihood of non usage among the surveyed individuals. Multivariate analysis found higher income as a barrier (OR = 1.473, 95% CI: 1.222 - 2.252), while being single increased non-usage odds (OR = 2.424, 95% CI: 1.432 - 4.102). Areas without kits had higher non-usage odds (OR = 1.827, 95% CI: 1.129 - 2.956). Uncertainty about kit costs led to higher non-usage odds (OR = 2.708, 95% CI: 1.230 - 5.964). These findings underscore the need for tailored interventions addressing specific demographic, socioeconomic, and predisposing factors impeding HIV self-testing. The study enriches the body of knowledge on HIV self-testing, offering insights for policy and program development to bolster public health strategies for HIV prevention and control.
- ItemDeterminants of gender-based violence (GBV) among women in Zambia : evidence from the 2007, 2013/14 and 2018 Zambia demographic & health surveys (ZDHS).(The University of Zambia, 2024) Masha, MaguswiGender-Based Violence can have a devastating impact on the health of women and girls, depriving them of the opportunity to live a safe and secure life, restricting their access to land, education, and other productive resources. This creates a power imbalance that prevents women and girls from having full control of their lives. As a result, women are disproportionately affected by poverty, unemployment, illiteracy, and HIV/AIDs, while their participation in other spheres of life such as politics and decision-making is limited. The study utilized data from the Zambia Demographic Health Surveys (ZDHS) conducted in 2007, 2013/14, and 2018, focusing on women in the reproductive age group (15-49 years). Analytical methods including descriptive analysis, Chi-square tests, Fisher’s exact tests, and multivariate logistic regression were employed to test associations with socio economic and demographic factors and establish relationships. Findings revealed that the highest prevalence of sexual GBV reported by women occurred in the age group 45-49 years, represented by 16.6% in the 2018 survey year, 35-39 years with 18.2% in the 2013/14 ZDHS, and 19.4% in the 2007 ZDHS. Only the age group in the 2007 survey year showed statistical significance with a p-value of 0.012. Regarding emotional violence, age group 40-44 recorded the highest prevalence at 34.0% in 2018 ZDHS, while 35-39 was the highest in the 2013/4 ZDHS at 34.0% and 25-29 in the 2007 ZDHS at 27.8%. Age with both severe and emotional violence was statistically significant in the survey years p-value (<0.05). Education was statistically significant in all survey years as the p-values were less than 0.05. Results of chi-square test examining the association between socio-economic and demographic factors and emotional violence in the three survey years, 2007, 2013/14 and 2018 revealed that age, area of residence, educational attainment, marital status, and household wealth index were statistically associated with emotional violence in all survey years, with a p-value less than 0.05. The results also showed that age, educational attainment, marital status was significant in all survey years when employed to determine the association between socio-economic and demographic characteristics of respondents with severe violence. Religion was only significant with severe violence and socio-economic characteristic in 2013/14 ZDHS (p-value 0.040). A multinomial logistic regression model was utilized to assess the likelihood of a woman experiencing various forms of GBV, using the 2013/14 ZDHS data. The independent variables considered were, age of the women, residence, education, wealth index, religion, and region. The results show that age and residence are the most prominent factors associated with emotional violence. There is a positive and significant association between age and emotional violence, with older age groups between 30-44 and 40-44 years experiencing higher levels of emotional violence as indicated by higher coefficients 0.09 to 0.11. The p-values confirm that these findings are statistically significant, in addition, there is a negative and significant association between rural residence and emotional violence, as indicated by a negative coefficient (-0.07) and a p-value of 0.00. This suggests that women living in rural areas are less likely to experience emotional violence by their partners than women living in urban areas. It is evident that gender-based violence among women of reproductive age group 15-49 years in Zambia is influenced by socio-economic and demographic factors. Factors associated with GBV were highlighted, therefore, any interventions aimed at curbing the vice should be designed to address the factors associated with the vice.
- ItemFactors associated with the outcome of cataract surgery at university teaching hospitals - eye hospital in Lusaka, Zambia.(The University of Zambia, 2020) Umerji, FatimaCataract is a major cause of blindness universally. The 2012 report from the World Health Organization stated that cataract was accountable for 50% of avoidable blindness in sub-Saharan Africa. The objective of this study was to determine the factors associated with the outcome of cataract surgery at UTHs-Eye Hospital in Lusaka Zambia. A hospital based quantitative cross-sectional study was done on 197 patients who under-went cataract surgery at the UTHs Eye Hospital from May 2019 to November 2019. Data was collected using a well-organized data extraction sheet that consisted of variables concerning demographic data, preoperative information, surgical techniques, intra-operative complications and postoperative findings. The postoperative evaluations were done at day one, week two and week six. Post-operative visual acuity at six weeks was transformed into a dichotomous variable with borderline and poor outcomes as one and good outcomes as other. Data was analyzed using univariate and multivariate logistic regression analysis. The mean age was 65 (SD 15.15) years old and 118 patients (59.9%) were males. Ninety-six patients (48.7%) had systemic co-morbidities and 50 (25.5%) patients had an ocular pathology. Intra-operative complications were seen in 45 (22.8%) patients. Immediate post-operative complications were seen in 56 (28.4%) patients while late post-operative complications were present in 16 (12.8%). A good outcome was seen in 75.2% of patients based on best-corrected visual acuity (BCVA), 15.2% had an intermediate outcome and 9.6 % had a poor outcome at six weeks follow up. Using multivariable analysis, poor visual outcomes were significantly higher in patients with ocular pathology (OR 3.3; 95% CI 1.64, 6.60), intraoperative complications (OR 3.7; 95% CI 1.87, 7.42), those with immediate post-operative complications (odds ratio 2; 95% CI 1.04, 3.66), and late post-operative complications (OR 5.8; 95% CI 2.19, 13.84). This study showed that monitoring visual outcomes and working on reducing intra-operative and post-operative complications can significantly improve the outcome of cataract surgery.
- ItemSeroprevalence, risk factors in cattle and molecular investigation in ticks of crimean-congo hemorrhagic fever virus (CCHFV) in central Malawi.(The University of Zambia, 2021) Phonera, Marvin CollenCrimean- Congo Hemorrhagic Fever virus (CCHFV) is zoonotic, causing subclinical infections in animals but fatal infections in humans. The virus is endemic in Africa, Asia, and Eastern Europe and its distribution corresponds to that of its principal vector, Hyalomma ticks. In Malawi, no case of CCHF has been reported and there is no evidence of CCHFV circulation in the country despite the presence of Hyalomma ticks. This study aimed to investigate the epidemiology of CCHFV in traditional cattle herds and ticks in central Malawi. A cross sectional study was conducted in April 2020 in seven districts of central Malawi. Sera were collected from 416 randomly selected cattle (from 117 herds) and screened for CCHFV specific antibodies using a double antigen sandwich ELISA test. Ticks were collected from cattle and screened for the presence of the CCHFV genome using nested RT-PCR. Data on associated risk factors for CCHFV exposure in cattle were collected from cattle farmers using a structured questionnaire. CCHFV nucleoprotein specific antibodies of 46.86% (195/416; 95% CI: 42.02-51.82) was determined. This seropositivity was significantly associated (significance level: p-value <0.25) with cattle age sex, presence of ticks, district, type of grazing land, cattle herd size, and source of cattle. In a binary logistic regression model (significance level: (p-value < 0.05), cattle from Lilongwe West (OR 2.7; 95% CI 1.191- 6.037) and Ntchisi (OR 5.0; 95% CI: 1.383-18.111) were more likely to be infected with CCHFV compared to those from Mchinji. Cattle aged 25-48 months and >48 months, were two and three times more likely to be CCHFV infected (OR= 4.33; 95% CI: 2.196-8.533; OR= 4.229; 95% CI: 2.032-8.798), respectively compared to cattle of 1-12 months old. Female cattle were 2.5 times more likely to be CCHFV infected than males (OR= 2.478; 95% CI: 1.568-3.944). There was a strong association between cattle grazing in uplands and being CCHFV seropositive (OR=4.489; 95% CI: 1.799-11.2). Cattle infested with ticks were three times more likely to be CCHFV seropositive than those that had no ticks (OR= 3.206; 95% CI: 1.208- 8.509). Amblyomma variegetum, Rhipicephalus appendiculatus, Rhipicephalus (Boophilus) decoloratus, Rhipicephalus (Boophilus) microplus, and Hyalomma truncatum were identified from the collected ticks. CCHFV S-segment genome was detected in 64.44% (29/45) of the RNA pools extracted from the ticks. These results indicate higher exposure of cattle to CCHFV in the study area. Therefore, good cattle management practices and awareness of the existing risk rae required to reduce chances of contracting the deadly CCHFV among cattle-keeping communities
- ItemAetiology of encephalitis and meningitis in children aged 1-59 months admitted to the children’s hospital, Lusaka, Zambia.(The University of Zambia, 2019) Imamba, AkakambamaMeningitis and encephalitis are important causes of admissions and mortality in Zambia. There is a worldwide geographical and regional variation in the causative agents. Apart from bacteria, little is known about viral agents that cause the disease in Zambia. To identify the viral and bacterial causative organisms, we conducted a prospective descriptive study at the Children’s Hospital, in Lusaka, Zambia. To determine the causative organisms of viral encephalitis and meningitis, and pyogenic meningitis; determine biochemical and cellular changes in cerebrospinal fluid (CSF) and the associated clinical features in children aged 1-59 months admitted at the Children’s Hospital, Lusaka. Between November 2016 and February 2018, we collected CSF samples and clinical details from children aged 1-59 months with meningitis and encephalitis who met the inclusion criteria. Macroscopic examination, microscopy, bacterial culture, real-time (Multiplex) PCR and biochemistry were performed on the CSF samples. A total of 106 children were enrolled. The female to male ratio was 1.2:1. The median age of the study patients was 10 months. There were 81 (76.4%) cases with meningitis and 25 (23.6%) with encephalitis. The median duration of symptoms was 3 days. There was only one (0.9%) participant with Haemophilus influenzae bacteria detected by both culture and PCR. Two (1.9%) cases had Neisseria meningitidis while 5 (4.7%) had Streptococcus pneumoniae detected only by PCR. Viruses were only detected in 26.4% (28/106) of the cases. The viral agents detected were Epstein-Bar virus (10%) and parvovirus B19, Human herpes virus type 6, Human herpes virus type 7 and CMV at 2.8% each. Viral agents were detected in 64% and 36% of patients with meningitis and encephalitis, respectively. Bacterial agents were detected in 75% and 25% of patients with meningitis and encephalitis respectively. Ninety percent of cases had a history of fever and 50% had a history of a seizure. A raised CSF white blood cell counts (WBC) was significantly associated with case definition of meningitis (P=0.01). Patients that were alive at discharge point had on average 3.6 times increased odds for meningitis case definition (OR = 3.6, CI = 1.96 – 6.68, P-value <0.001). Viral infections of the central nervous system (CNS) are the commonest causes of both encephalitis and meningitis in children aged 1-59 months admitted at the Children’s Hospital in Lusaka, Zambia. The causative agents were not significantly associated with a case definition of encephalitis or meningitis. A raised WBC was significantly associated with meningitis.