Medicine
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- ItemThe coverage of pneumococcal conjugate vaccine (PCV) and rotavirus vaccine (RV) with the supply-side factors in select health centres of Chilanga and Chirundu districts of Lusaka province in Zambia: a mixed methods study.(The University of Zambia, 2019) Chabaputa, RhodaZambian children under age 5 continue to face multiple obstacles with respect to their survival and development. Specifically, beyond the neonatal period, Pneumonia, and Diarrhoea are leading contributors to the high under-5 mortality rate. While vaccinations have been introduced to counter these conditions, a serious weakness of the new vaccines has been identified in their poor coverage. Essentially, data indicate that delivery of Pneumococcal Conjugate Vaccine (PCV) and Rotavirus Vaccine (RV) have remained lower than existing vaccines in the Zambian immunisation schedule. This study aimed at establishing the coverage of Pneumococcal Conjugate vaccine (PCV) and Rotavirus vaccine (RV) and exploring supply-side factors in select health centers of Chilanga and Chirundu districts of Lusaka province in Zambia. This study used an embedded mixed method study design that combined a cross sectional design to compute quantitative data on immunisation coverage rates for the year 2017 and an exploratory case study to obtain a qualitative component that contextualised the results of the quantitative data. 4 health facilities were included in the study. Using complete enumeration of children under age 1, Chilanga health center and Makeni health center from Chilanga district provided a total sample 770 and 822 respectively. Chipepo health center and Lusitu health center from Chirundu district provided total samples of 664 and 1531 correspondingly. 6 In-depth interviews were included. Chilanga health center recorded coverage rates of 124%, 127% and 127% for RV 2 PCV 3 and DPT 3 respectively. The percentages of over 100 came as a result of the facility servicing populations outside its catchment thereby inflating the numerator. In the same order of vaccines, Makeni Konga recorded 44%, 47% and 47%. In Chipepo health center 71%, 73% and 73% were the coverage rates for RV 2, PCV 3 and DPT 3. In Lusitu health center, the immunization coverage rates for RV 2, PCV 3 and DPT 3 were recorded at 14%, 14% and 14% respectively. A further analysis of the ratio of PCV, representing new vaccines, and DPT, representing the older vaccines, obtained a ratio of 1.00 for all 4 health facilities. Since every child being given a dose of PCV is expected to also receive a corresponding dose of DPT, the ratio of 1.00 implied that the delivery of the new vaccines was in tandem with the older vaccines. The major supply side factors that are affecting the progress of the program are community engagement as a result of limited transportation, fuel and meal allowances for field workers. The shortage of staffing is also a challenge. Out of the 4 health facilities under investigation, only 1 is above the set national target of 90% per specific antigen when it comes to DPT, PCV and RV coverage rate. The supply side factors that seem to explain the observed coverage rates are community engagement and staffing. Comparison of new vaccines and traditional vaccines found them to be equally distributed. For these facilities, there are no supply issues that are influencing only the new vaccines. Resource allocation to alleviate lack of transport, fuel and allowances for field workers must be put in place to improve immunization coverage rates.
- ItemOptimization of early diagnosis of glucose metabolism impairment for patients receiving antipsychotic medications at outpatient psychiatric clinic of the university teaching hospital.(The University of Zambia, 2022) Pandu, Makame HajiPatients using antipsychotic drugs are more likely than the general population to suffer glucose metabolism dysfunctions, yet these problems are frequently overlooked. According to several research findings, patients who take antipsychotic drugs, particularly second-generation antipsychotics, are four times more likely to develop overweight, obesity, and diabetes type 2. Furthermore, studies have indicated that failing to recognize these metabolic issues puts an individual at risk of getting comorbid disorders such as cardio-metabolic diseases and others which potentially worsen psychiatric problems. For controlling and enhancing potential psychiatric treatment outcomes, early diagnosis and treatment of glucose metabolism dysfunction is crucial. Between June and September 2021, a descriptive cross-sectional study was conducted at the University Teaching Hospital outpatient psychiatric clinic to optimize the early diagnosis of glucose metabolism deficits in patients with psychiatric disorders taking antipsychotic medications. A systematic sampling method was applied to all patients who were receiving antipsychotic drugs. All participants were checked for their weight, height, Body Mass Index (BMI), waist circumference, random and fasting blood glucose levels, respectively. The results were analyzed by using SPSS software versions 20, while Fisher’s exact test was used to determine the relationship between categorical variables. A total of ninety patients with psychotic disorders aged 18 years and above were recruited for the study; 47.8% were male and 52.2% were female. 26.7% were overweight (BMI 24.5-29.5kg/m2), 14.4% were obese (BMI>30kg/m2) and 11.1% were under weight (BMI <18.5kg/m2), and 38.9% had higher waist circumferences. The proportion of individuals with impaired fasting blood glucose levels found in this study was 11.1% and that of individuals with diabetes was 10.0%, respectively which is higher compared to the general population. Patients who were receiving second-generation antipsychotics showed a slightly higher proportion of impaired fasting blood glucose levels compared to those on conventional antipsychotic medications. Increased waist circumference and increased age were significant factors associated with impaired glucose metabolism. It is, therefore, recommended that screening of glucose metabolic parameters should be a routine practice by psychiatrists and other health professionals working in psychiatric clinics before treatment with antipsychotic medications is started; there should be a regular follow up and monitoring of glucose metabolic parameters for all patients who are on treatment with antipsychotic medications. Education on a healthy lifestyle should also be disseminated in every visit, multidisciplinary approach involving other specialists input like physician and endocrinologist should always be applied to all patients who are diagnosed with glucose metabolism impairments.
- ItemA cadaveric study on variations of the cystic artery in the department of pathology, at the university teaching hospitals, Lusaka, Zambia.(The University of Zambia., 2019) Sing`ombe, IsaacThe main source of blood supply to the gall bladder is the cystic artery which is a branch of the right hepatic artery. Anatomical variations of the cystic artery are frequent. Thus, careful dissection of the Calot`s triangle is necessary for conventional and laparoscopic cholecystectomy. The knowledge of variations of the origin, course, and length of the cystic artery is important for the surgeon as bleeding from the cystic artery during cholecystectomy can lead to death. The objectives of the study were; 1. To establish the origin of the cystic artery. 2. To determine the length of the cystic artery. 3. To establish the course of the cystic artery. 4. To establish the relationship of the cystic artery to the cystic duct. This was a descriptive cross-sectional study design in which 32 post-mortem human cadavers at the University Teaching Hospitals, Pathology Department, Lusaka were dissected and examined over a period of five weeks. A data collection form was used as a tool to gather the data and sample selection was done through systematic sampling. Data was entered and analyzed using Statistical Package for Social Sciences Statistics, version 22.0 (SPSS). A Chi-square and Fisher`s test was used to test association between variables. The cadavers dissected were aged between 22 and 66 years (mean 36.06±11.992) and of the 32, 27 were males and 5 females. Out of the 32 human cadavers, the cystic artery was found to be originating from the right hepatic artery in twenty-eight (87.5%), from hepatic artery proper in three (9.4%) and from the left hepatic artery in one (3.1%). In the twenty-nine (90.6%) cadavers dissected only one cystic artery was identified and in three (9.4%) others there were two arteries detected. The cystic artery length ranged from 2 – 6 cm (mean 3.56±1.0285 cm). The cystic artery was found to be inside Calot`s triangle in twenty-seven (84.3%) while in three (9.4%) it was outside the Calot`s triangle. The cystic artery was found to be passing supero-medial to the cystic duct in thirty (93.8%) while in two (6.3%) the cystic artery was passing anterior to the cystic duct. Demographic characteristic (gender and age) had no statistically significant association to variations of cystic artery (p>0.005). Five (18.5%) of males had variants of cystic artery and no females had variants of the cystic artery. Variations of the cystic artery origin, length, its course through the Calot`s triangle and its relation to the cystic duct are common. Knowledge of these variations is important and helpful in preventing and controlling haemorrhage or avoiding other complications during conventional and laparoscopic cholecystectomy.
- ItemImmunopathology of hypertension in HIV-infected adults(The University of Zambia., 2020) Masenga, Sepiso K.Hypertension is a risk factor for stroke, end-organ damage and death. HIV positive individuals are more likely to have hypertension compared to the HIV-negative population, however, the underlying mechanisms are still unknown. Recently, researchers have discovered that chronic immune-activation/inflammation induces and propagates hypertension in humans. Excess dietary salt and infections among others, have been implicated as contributors to hypertension in the HIV-negative population but have not been well studied in HIV-positive individuals. This study was therefore conducted to determine the risk factors, and inflammation markers associated with hypertension as well as to confirm the effect of salt intake on blood pressure and immune cell activation in HIV positive patients. This study was a mixed research designs namely cross-sectional, interventional and systematic studies. Six cohorts were recruited at Livingstone Central Hospital (Zambia) and Vanderbilt University (USA) to achieve the objectives. Flow cytometry was employed to analyse cell markers and quantify cytokines. Cells were stimulated using lipopolysaccharide and Phorbol-12-Myristate-13-Acetate (PMA) in Roswell Park Memorial Institute (RPMI) media. Ion-selective electrode technology was used to quantify electrolytes in plasma and urine. For data collection, the international physical activity questionnaire (IPAQ), 24-hour recall form and the World Health Organisation STEPwise approach to surveillance form was adapted and used. Wilcoxon rank-sum test, Kruskal Wallis test, Chisquare and Dunn’s multiple comparisons test were used for data analyses. Finally, regression models to predict the impact of selected variables on hypertension, salt sensitivity and all the response variables was used. Results In multivariate logistic regression, age, body mass index, employment status, table salt consumption, fasting blood sugar, waist circumference, minutes of moderate physical activity, and sedentary hours, were risk factors significantly associated with hypertension in a Zambian cohort of 226 HIV positive participants, p<0.05. Neutrophil count, neutrophil-to-lymphocyte ratio, erythrocytes and creatinine, and a low glomerular filtration were also associated with hypertension. In a cohort of 43 HIV positive participants and 42 HIV negative control group, hypertensives in the HIV positive group had higher IL-6, IL-10, CD80+ expression on total leucocytes and isolevuglandin expression inside monocytes adjusted for sex, age, body mass index and duration on antiretroviral therapy. In a cohort of 70 HIV positive participants from the United States of America (USA), eosinophil count was associated with hypertension and this report was consistent in two HIV-negative control cohorts comprising of 50 and 81, 039 participants respectively. In a systematic study comprising 45 African countries, Norway and the USA, studies revealed that IL-17A, interferon-gamma, and CD4 cells were associated with hypertension in HIV-infected adults. In a Zambian cohort of 85 participants, salt sensitivity was associated with higher levels of IL-6, monocytes, isolevuglandin-adducts inside monocytes, 24-hour sodium and chloride excretion. Hypertensive HIV positive individuals exhibit high inflammatory (IL-6, IL-10, Isolevuglandin-laden monocytes) and immune-activation markers (CD45 CD80+) compared to normotensives. Eosinophilia is a likely feature of inflammation associated with hypertension in virally suppressed HIV positive individuals. Salt-sensitive hypertension was highly prevalent. Hence, high dietary salt is likely to be a risk factor for the development of, or may worsen already existing hypertension. Salt sensitivity testing in clinical practice is therefore, recommended.
- ItemImpact of public health expenditure on child health outcomes in Tanzania.(The University of Zambia, 2019) Byaro, MwoyaThis Thesis examined whether public health expenditure had an impact on infant and under-five mortality in Tanzania. Additionally, it examines whether domestic government and donor expenditure on malaria had an impact on under-five malaria specific mortality in Tanzania Mainland. The average public health expenditure (% of GDP) in Tanzania increased from 1.36% in 1995/2000 to 3.21% in 2006/2013. In the same years, the average infant and under-five mortality declined from 89 deaths per 1000 live births to 45 deaths per 1000 live births and 145 deaths per 1000 live births to 67 deaths per 1000 live births respectively. In turn, the average domestic expenditure on malaria control decreased from 33 US $ million in 2004/2007 to 4 US $ million in 2012/2015, while average donor expenditure increased from 29 US $ million in 2004/2007 to 105 US $ million in 2012/2015. Likewise, the average under-five malaria deaths decreased from 9065 deaths in 2004/2007 to 3606 deaths in 2012/2015.Are these remarkable improvements in overall child health outcomes contributed by the increase or decrease of public health spending in Tanzania? Aggregate secondary data information was used with different quantitative methods. Bayesian Markov Chain Monte-Carlo (MCMC) simulation was used to examine the impact of public health expenditure on child health outcomes in Tanzania between 1995 and 2013. Again, Bayesian MCMC and frequentist correlation analysis were utilized to study the impact of government health expenditure on malaria (domestic and donor) and under-five malaria mortality in Tanzania Mainland using a number of control variables such as real GDP per capita, availability of physicians and nurses and number of Insecticide Treated Nets (ITNs) distributed over 2004 to 2015. Lastly, an aggregate panel data technique was used to find out determinant factors for infant and under-five mortality differentials in Tanzanian zone using data from Tanzania Demographic and Health Survey of 1992, 1996, 2004 and 2010. The dependent variables used in the Thesis are infant mortality, under-five mortality and malaria specific under-five mortality. Explanatory variables were chosen guided by the reviewed literature and availability of data. There is no evidence to suggest that, public health expenditure had an impact on infant and under-five mortality in Tanzania between 1995 and 2013 despite various efforts shown by the government on increasing public health budget. Moreover, there is no evidence to suggest that domestic and donor expenditure on malaria had an impact on malaria specific under-five mortality between 2004 and 2015. The failure might be attributed to factors such as misuse of public health expenditure and inadequate funds (health budget less than 15% of National budget) to finance the whole health system in the country. In turn, there is no evidence to suggest that Insecticide Treated Nets (ITNs) had an impact in reducing under-five malaria mortality between 2004 and 2015. Overall, the results show that improvement in child health outcomes in Tanzania was contributed by income (real GDP per capita), availability of nurses and physicians, antenatal care; skilled birth attendant’s (nurses, doctors, midwives), immunization coverage (vaccine measles), ever breastfeeding and maternal education. Combining results from study objectives lead to policy implications that, public health expenditure or public health expenditure resources on malaria (domestic and donor) might be poorly targeted to bring gains in child health outcomes in Tanzania. Thus, it should be channeled towards improving the investments in human resources infrastructures (education and health personnel) as a strategy to improve child health outcomes. In addition, public health expenditure could be diverted towards strengthening specific interventions and programs related to child care than raising overall public health spending. Policy makers in Tanzania should focus either within public health spending composition or beyond to other close determinants of child health outcomes. The Thesis recommends increasing the supply of physicians and nurses, boost/increase economy (real GDP per capita), expanding schools and educating more women in primary, secondary or higher levels to progress reducing infant and under-five mortality. There is need to expand and strengthen stronger health system in access to health care services including immunizations coverage, skilled birth attendants and antenatal care in the country to avoid health inequity within the country to achieve Sustainable Development Goals.