Medicine

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    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.
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    HIV testing and associated factors among male long-distance truck drivers in Zambia.
    (The University of Zambia, 2019) Mutale, Lwito Salifya
    Globally, truckers have been reported to have an important role in the spread of sexually transmitted infections (STIs) and Human Immunodeficiency Virus (HIV). Evidence on uptake of HIV testing among this key population is not well established. We examined factors associated with HIV testing among male long-distance truck drivers (LDTDs) since HIV testing has been found to be an integral part of the preventive strategies. A cross sectional study was conducted among male LDTDs using secondary data from the 2015 Behavioral Surveillance Survey (BSS). The BSS was carried out in 5 of the 10 Corridors of Hope (COH) III project sites (Livingstone/Kazungula, Solwezi, Kapiri Mposhi, Chipata and Chirundu). The study recruited LDTDs from truck depots, border sites, Zambia Revenue Authority offices and those parked along the road. Face-to-face structured interviews were used to collect data on socio-demographic characteristics, HIV testing, HIV risk behaviors and knowledge towards HIV/AIDS. Multivariable logistic regression was done to improve predictive power and control for confounders. A total of 1,406 male LDTDs were included in the study, with age range 18-70 and mean age of 21 (± 0.2). Over 80% reported being currently married and living with spouse while 94% reported having only one wife. Uptake for ever having tested for HIV among LDTDs was 83%, while 39% were circumcised. Positive predictors for HIV testing included circumcision for health and hygiene (AOR 2.30, 95%CI 1.23-4.28), having prevention of genital infections (AOR 3.29, 95%CI 1.34-8.10) reasons. Other positive predictors were never having drank alcohol (AOR 1.75, 95%CI 1.16-2.65) and not having a relative or friend who was infected or died of HIV (AOR 1.63, 95%CI 1.07-2.47), while having more than three wives (AOR 0.41, 95%CI 0.25-0.67) was a negative risk factor for HIV testing uptake. Personal reasons for circumcision such as hygiene and infection prevention were strong drivers for HIV testing. These findings suggest the need to implement more focused interventions and messages on health and hygiene and prevention of genital infections to increase circumcision and uptake of HIV testing among LDTDs. Additionally, there is need to improve services targeting LDTDs, especially those who are less health-conscious.
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    Histomorphology of bone marrow from adult pancytopenic patients at the University teaching hospital in Lusaka, Zambia.
    (The University of Zambia., 2019) Musonda, Francis Kaoma
    Pancytopenia is a hematologic condition characterised by leukopenia, anaemia and thrombocytopenia. Pancytopenia is not a diagnosis and has to be qualified by determination of its cause. The aetiologies of pancytopenia are diverse, and study of bone marrow cytology and histology are key components that assist in the determination of the underlying cause. Pancytopenia is encountered regularly in medical practice in Zambia; however, no studies have been conducted on pancytopenia to date. A total of 45 bone marrow biopsies were collected over the study period. In all cases the indication was pancytopenia that had been confirmed by a full blood count done at the UTH and the biopsy site was either the anterior superior iliac spine or the posterior superior iliac spine. Demographic and clinical details were obtained using data collection sheets and from review of patient records. The collected data was analysed using the Statistical Package for the Social Sciences (SPSS) version 21 and excel 2016 data analysis tool pack. A Chi square test was used to measure association between categorical variables and Student’s t-test to measure association between categorical and numerical values. A p value of < 0.05 at 95% confidence interval was considered statistically significant. There were 32 females (71%) and 13 males (29%), and the age ranged from 15 to 72 years with an average age of 35 years. Forty percent (n=18) of the study participants had human immunodeficiency virus (HIV) and all of these all were on highly active antiretroviral therapy (HAART). There were 6 histologic patterns found the commonest being megaloblastosis seen in 38% of the patients, followed by malignancy and myelodysplasia both at 17.0%. Bone marrow aplasia accounted for 13.0%, non-megaloblastic erythroid hyperplasia accounted for nine percent and myelofibrosis for four percent. The bone marrow biopsies of the study population showed six histomorphologic pictures which in order of frequency were megaloblastosis, malignancy and myelodysplasia, bone marrow hypoplasia, non-megaloblastic erythroid hyperplasia and myelofibrosis.
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    Outcomes of neonates treated with continous positive airway pressure at the university teaching hospital neonatal intensive care unit, Lusaka, Zambia from 1st october 2015 to 31st October 2016.
    (The University of Zambia., 2019) Fundanga, Chailunga Mabo
    Severe respiratory distress is a common and serious complication in the newborn which may be due to premature birth, neonatal pneumonia and neonatal sepsis, accounting for over one-half of all neonatal deaths globally. Nasal continuous positive airway pressure (CPAP) is a noninvasive form of respiratory assistance that has been used to support spontaneously breathing infants with lung disease. The use of CPAP decreases the need for invasive mechanical ventilation and the combined outcome of death or bronchopulmonary dysplasia (BPD). This was a non-randomized convenience sample study to determine the efficacy of a low-cost bCPAP system in treating newborns with severe respiratory distress in the NICU at the UTH in Lusaka, Zambia. 206 files of Neonates weighing >1,000 g and presenting with severe respiratory distress who fulfilled the inclusion criteria were analyzed using IBM SPSS version 21.0. A greater proportion of the neonates, 145/206 (70.4%) were female compared to 46/206 (22.3%) male. The mean birth weight was 2.1 kg (SD = 1.01). There were 72/206 (35%) neonates with LBW, 69/206 (33.5%) with VLBW, and 65/206 (31.6%) were Term. The mean Apgar at 5 minutes 7.0 (SD = 1.60).There were 47/206 (22.8%) neonates with positive culture results. The mean RR at initial assessment was 71.3 (SD = 8.11).The mean SpO2 at initial assessment was 90.1 (SD = 2.79) and mean SpO2 follow-up was 96.6 (SD = 1.67. The most common sign of respiratory distress was grunting with 174/206 (84.5%) of the neonates, followed by nasal flaring with 149/206 (72.3%) and recessions 140/206 (68%). BCPAP can be safely and successfully administered in Zambian neonates presenting with signs of severe respiratory distress. Since most health care facilities do not have the capabilities to ventilate, this is an optimal alternative.
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    Experiences of family/informal caregivers of disabled stroke patients in Lusaka, Zambia.
    (The University of Zambia, 2020) Kunda-Ng’andu, Evelyn Muleba
    Background: Stroke is one of the leading causes of death and disability in the world. It is the leading cause of adult-onset disability, and causes nearly 80% of all global stroke mortalities. After suffering from a stroke, patients, suffer from varying degrees of disability that require management and extended care at home. Caregivers‟ responsibilities in caring for the patient result in stress, particularly when their own needs are inadequately addressed during the patient‟s recovery. Aims: This study aimed to document the experiences of family/informal caregivers of disabled stroke patients in Lusaka, Zambia. Settings and Design: A phenomenological qualitative study was conducted at the University Teaching Hospital and in three communities of Lusaka district. Methods and Materials: Participants for in-depth interviews were purposively selected for their experience in caring for their family members who survived a stroke. 12 participants in total were interviewed. With participant‟s permission, the interviews were audio-recorded to accurately capture the narratives. Field notes complemented the audio recorded data to account for non-verbal communication and in case of technological failure. Data was collected using an interview guide for the family caregivers and for the key informant interview a separate guide for the key informants was used. Analysis used: Phenomenological hermeneutic interpretation was used to analyse the data. Themes were generated and explained from the comprehensive understanding. Data were managed on Nvivo. Results: Caregiving absorbed the caregivers‟ strength and robes them of the freedom to be their own person as they had to adjust to the role of caregiving. Experiences of tiredness, giving up, sadness, hope, fulfilment and distress were intensely expressed present in the narratives. It was also found that more of the family caregivers were female compared to males. Conclusion: Family caregivers of disabled stroke patients experience physical, social, financial, and emotional challenges in their execution of care. Despite the stress that they go through in their care giving role, they receive very little support from society as a whole. It is important therefore, that caregivers are supported in their caregiving role in order to facilitate the rehabilitation of disabled stroke patients. Caring for the careers will also improve their mental health and overall wellbeing, and negate the development of non-communicable diseases which they are prone to as a result of their care giving role. It is recommended that the Ministry of Health looks into providing social support for the caregivers.