Medicine
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- 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.
- ItemHealth research knowledge translation into policy in Zambia: policy makers and researchers’ perspectives.(The University of Zambia, 2020) Malama, AnnieTranslation of public health research evidence into policy is critical to strengthening local health systems capacity to respond to eminent health challenges. However, limited public health research evidence generated in developing countries is translated into policy because of various factors. This study sought to explore the process of health research knowledge translation into policy through mapping of key actors, assessing the policy environment for knowledge translation, exploring the engagement between health researchers and policy makers, as well as identifying factors that shape the uptake of health research into policy in Zambia. This study was an exploratory qualitative research comprising two phases. Firstly, a document review of health policies and strategic frameworks was undertaken to understand the macro environment for knowledge translation. Secondly, key informant interviews with those responsible for health research and policy formulation were conducted. The study interviewed 15 key informants, and thematic analysis approach was used. The main actors in the process of knowledge translation include funders, health researchers and policy advocates, media, Ministry of Health and the community as beneficiaries. They are policy efforts to promote knowledge translation through improvement of the research environment, health research regulation and capacity building. However, coordination of the knowledge generation and policy making process remains a challenge because of inadequate research systems, as well as lack of research knowledge translation capacity. Engagement between policy makers and researchers comprised direct engagement and knowledge brokering. However, inadequate engagement, weak research infrastructure and financing systems are some of the barriers to knowledge translation. Emerging local research leadership and the existing stock of underutilized local research data were identified as enablers to knowledge translation into policy efforts in Zambia. Public health research knowledge translation into policy remains a challenge in Zambia. To enhance the uptake of research evidence in policy making, this study recommends the need for improved coordination, financing and capacity building in knowledge translation processes for both health researchers and policy makers.
- 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.