Medicine
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- ItemA study on the detection of extended spectrum beta lactamase producers and class I intergrons in e. coli isolates from urinary tract infected patients at UTH.(The University of Zambia, 2019) Chirwa, EmmanuelEscherichia coli that produce extended spectrum beta lactamase (ESBL) enzymes pose a global challenge in the management of urinary tract infections (UTIs) caused by these organisms. Beta lactamases are the primary cause of resistance to beta lactam antibiotics. These enzymes confer multi drug resistance (MDR) thus limiting and complicating treatment options. The beta lactamase resistant genes are usually encoded on plasmids and often confer resistance to other classes of antibiotics, further underscoring their clinical significance. In Zambia there is paucity of data available in relation to UTIs caused by ESBL producing E. coli. There is little information about genes responsible for these enzymes and the organisms’ susceptibility patterns to commonly used antibiotics. This cross sectional study used urine samples from 327 consenting patients from the University Teaching Hospital in Lusaka, Zambia. The ESBL producing isolates were obtained by culturing urine samples on MacConkey agar supplemented with cefotaxime followed by polymerase chain reaction (PCR) to detect the resistant genes in positive isolates. A questionnaire was used to collect information from patients for assessment of risk factors relating to infection with ESBL producing E. coli. The antibiotic susceptibility pattern was determined by using the disc diffusion method. Of a total 327 samples analyzed, 15 (4.6%) were positive for ESBL producing E. coli. Genes of resistance significance that included the blaINT blaCTXM, blaSHV and blaTEM were detected. There was 100% resistance of the isolates to Cotrimoxazole, ampicillin and cefotaxime while no resistance (0%) was detected to Nitrofurantoin. All the ESBL producers had MDR (at least 30%) patterns. None of the risk factors was statistically significant in this study. This study detected the presence of ESBLs and class I integrons in MDR E. coli in UTIs at the University Teaching Hospital in Zambia. This prompts the need for antimicrobial resistance surveillance to monitor hospital resistance patterns for these microorganisms.
- ItemMaternal complications (outcomes) of severe pre-eclampsia at a tertiary-level hospital in Zambia.(The University of Zambia, 2019) Nyirenda, JamesPreeclampsia is a multi-systemic disorder typically unique to pregnancy and characterised by blood pressure above or equal to 140 systolic or 90 diastolic and proteinuria of 300g in a 24 hours urine sample collection. Preeclampsia complicates 3 - 8% of pregnancies and is a major cause of maternal mortality and morbidity. Although the etiology of preeclampsia is still unclear, some epidemiological findings support the hypothesis of a genetic and immunological etiology. The disease has a complex pathophysiology, the primary cause being abnormal placentation early in pregnancy. Without treatment the disorder leads to serious maternal and perinatal complications that includes; HELLP syndrome, abruption placentae, DIC, pulmonary oedema, renal failure, eclampsia, and death. This descriptive study analysed cases of 175 women with Severe Preeclampsia admitted to the Mother and New Born Hospital between June and December 2017. Women meeting the criteria were identified antenatal and enrolled into the study after delivery to obtain data using the maternity record book and face-face interviews for clarification. The data was analysed using SPSS to obtain frequency distributions of outcomes of interest that was illustrated in charts and tables. The age range for the women was 15 - 41 years. Frequency of complications from SPE increased with advancing age towards 35 years and above. Unemployment and living in low cost housing was associated with higher risk of complication from SPE. HELLP Syndrome occurred in 10.3% of women with SPE and so did placental abruption. IUFD was a complication in 28% of the pregnant women. Most women (34%) delivered through induction of labour. The 30-34 weeks was the peak gestation period associated with the most complications of SPE in the pregnant women. SPE is a pregnancy condition with serious potential consequences for the mother and the fetus.
- ItemAssessing the impact of the response to gender-based violence (GBV) interventions in Gwembe district.(The University of Zambia, 2023) Malambo, Morris DebsonBackground: Records at the Victim Support Unit (VSU) of the Zambia Police Service show that reported GBV cases annually from 2012 indicate an upward increase from 12,924 cases in 2012 to 18,080 in 2015, and 22,073 cases in 2018, to 25,121 cases in 2019, while in 2020 cases shot to 26,370 before showing a slight drop to 20,540 in 2021. (www.zambiapolice.gov.zm). Main objective: To assess the effectiveness of the response to Gender based violence interventions against women and girls in Gwembe district. Method: A quantitative cross sectional survey that was “Assessing the impact of the response to Gender Based Violence (GBV) intervention in Gwembe District-Zambia’’ The study was a descriptive cross-sectional in nature where a multistage random sampling procedure was used to select 8 wards and 16 villages. A systematic sampling was used to determine household interval in each village. A total of 102 respondents had either experienced or survived GBV in Gwembe district plus 17 key informants (implementers/stakeholders) comprised the sample under study. The study used semi-structured questionnaires to collect primary data. The study report is presented using descriptive statistics namely, frequencies and percentages. The findings were as follows: women realization of corporal punishment as being abuse stood at 89.9%, while whether GBV cases had declined in Gwembe district declined was 76.5%. However, reporting of cases of abuse to VSU stood at only 9.8%. With regard to impact of the response interventions against GBV in Gwembe district, efforts to bring the perpetrators to book by VSU was (10) 100% of 10 survivors, however the (92) 90.2% of 102 survivors did not report their abuse to VSU but handled the abuse domestically, usually by survivors’ relatives who charged the perpetrator with an animal e.g cow or some goats. The study found a significant relationship between distance and reporting of abuse to VSU as the majority of women (72) 70.6% of 102 women who survived GBV lived within 5km radius, while survivors that lived beyond 15 km accounted for (22) 21.6 %, thus distance was a hindrance to reporting of cases. The study recommends that Government and cooperating: i. Establish a GBV response centre within Gwembe valley. ii. To consider establishing a GBV one stop centre in Gwembe.
- ItemThe role of communication in supporting community engagement in HIV clinical trials: the case of the HIV prevention trials network 071 study in Zambia.(The University of Zambia, 2019) Mulawa, Mulanda JosephCommunity based interventions and research are often affected by communication challenges. Community Engagement (CE) has thus become an integral part of the process of communication within public health interventions. However, the effectiveness of CE strategies depend on what information is communicated and how well it is communicated. The aim of the study therefore, was to explore the role of communication in CE processes in the HIV Prevention Trials Network (HPTN) 071 Population Effects of Antiretroviral Treatment to Reduce HIV Transmission (PopART) in Zambia. This was a qualitative case study conducted in two purposively selected HPTN 071 PopART communities from Livingstone and Lusaka Districts. Thematic analysis was used to analyse data collected that was from focused group discussions, key informant interviews and document review. HPTN 071 PopART employed both direct and representative CE. Direct engagement included the use of community meetings, door-to-door sensitisations, and facility based health talks while representative engagement used community Advisory Boards (CABs). Awareness creation strategies comprised of Video/film, IECs, drama, community meetings and the door to-door community sensitisations. Study implementers and community members felt door-to door was the best approach to use when introducing a program and when explaining complex issues within the study. However, it was established that IECs such as posters and flyers were not translated into local languages, posing a challenge to people who could not read English. Further, HPTN 071 PopART study did not have modes of communication for the visually and hearing impaired because none of the IEC materials were in brail format and none of the videos/film featured sign language interpreters. Communication approaches in HPTN 071 PopART helped support community engagement and participation by reducing the myths and misconceptions that people had towards the study. Communication through various media channels helped create mutual understanding and trust between the study team and the community because the approaches used to communicate required direct contact with the HPTN 071 PopART study participants. However, there is need to cater for the information needs of all people, including people with disabilities because such people are usually left out in the implementation of various interventions.
- ItemEffects of supportive group therapy on levels of hopelessness in patients with cervical cancer at cancer disease hospital in Lusaka, Zambia.(The University of Zambia, 2019) Mutelo, ChristineHopelessness is a subjective appraisal of negative expectations about the occurrence of a highly valued outcome coupled with the sense that one lacks control over desired events in the future. Hopelessness is an early symptom of depression and is comorbid with cervical cancer. Supportive Group therapy offers an economical and time efficient solution. This study aims to ascertain whether supportive group therapy can reduce levels of hopelessness in cervical cancer patients at Cancer disease hospital in Lusaka Zambia. The study design was a Single blinded Randomized Controlled Trial (RCT) conducted at Cancer Disease Hospital in Lusaka Zambia. 49 participants completed Pre (Hopelessness in illness Questionnaire) HAI questionnaire results noted. The participants were then randomised into control and intervention group. The intervention group then attended one hour Supportive group therapy sessions weekly for four weeks. The control group continued to receive the usual support of their family members and CDH staff. Both groups were then administered the post HAI questionnaire and results noted and analysed using SPSS.The null hypothesis was accepted as there was no difference between the control group and the intervention group. In conclusion, Supportive group therapy showed modest reduction in levels of Hopelessness. Such a minimal improvement, with a general trend toward overall reduction of levels of hopelessness and helplessness, was equally observed in other psychological interventions for cancer patients (Linn et al., 2002). Social/family support as the most dependant factor of hopelessness in cervical cancer patients should be enhanced by deliberating inquiring and facilitating its provision