Clinical Medicine

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    The clinical associations of dyslipidaemia among hypertensive adults presenting to the university teaching hospital (UTH), Lusaka adult hospital, Zambia.
    (The University of Zambia, 2019) Mutengo, Katongo Hope
    Co-existence of hypertension and dyslipidaemia, also referred to as dyslipidaemic hypertension (DH), is known to have synergistic effect on the development of cardiovascular disease (CVD). In Zambia, there is scanty information on distinguishing features of dyslipidaemic hypertension. The study aimed at identifying factors associated with dyslipidaemic hypertension in adults at a tertiary hospital in Zambia. This was a cross-sectional study conducted from January 2017 to July, 2017. One hundred and sixty-one (161) participants were enrolled comprising 88 hypertensives and 73 controls. Relevant demographics, physical examinations, bio-electric impedance analysis and laboratory investigations were performed. Fasting lipid and lipoprotein parameters which included fasting serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDC-C) and triglycerides (TG) were analysed for lipid abnormalities. Data was analyzed using Stata version 15. The median age was 47 years (IQR; 39, 58) and 38 years (IQR; 38, 48) for the hypertensive and control groups, respectively. 53.3% of hypertensive and 46.7% of controls had at least one lipid abnormality. The factors associated with dyslipidaemic hypertension were; TC [aOR 2.41; 95%CI 1.57, 3.69; p<0.001], TG [aOR 3.28; 95%CI 1.12, 9.63; p=0.031] and HDL-C [aOR 0.10; 95%CI 0.03, 0.39; p=0.001]. On the other hand, the factors noted to be associated with dyslipidaemia only were; TC [aOR 3.61; 95%CI 2.08, 6.28; p<0.001], male gender [aOR 0.22; 95%CI 0.09, 0.53, p=0.001] and HDL-C [aOR 0.03; 95%CI 0.01, 0.11; p<0.001]. Traditional risk factors such as age, body mass index, waist circumference, waist-to-hip ratio did not show strong associations on multi-variate analysis. The study showed that increase in total cholesterol and triglycerides, and a reduction in high density lipoprotein cholesterol was significantly associated with dyslipidaemic hypertension. It is therefore imperative that management of hypertension should also focus on identifying and correcting associated lipid disorders.
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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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    Factors associated with unfavourable tuberculosis treatment outcomes in Lusaka, Zambia, 2015: a secondary analysis of routine surveillance data.
    (The University of Zambia, 2019) Nanzaluka, Francis H.
    Tuberculosis (TB) is a major public health challenge in low and middle income countries. Factors associated with unfavourable treatment outcomes have been known to affect treatment and control of the disease. However, analysis of routine data in Zambia does not show the factors associated. We determined the proportion of tuberculosis treatment outcomes and factors associated. Unfavourable outcome was defined as death, lost-to-follow-up, treatment-failure, or not-evaluated, and favourable outcome as a patient cured or completed-treatment. Data were abstracted from treatment registers at a referral hospital, an urban-clinic and peri-urban (purposively selected) for all TB cases on treatment from 1st January to 31st December, 2015. Proportions were calculated for treatment outcomes, and associations between unfavourable outcome and factors including age, HIV status, health facility, and patient type, were analysed using univariate logistics regression. Multivariable stepwise logistic regression was used to control for confounding, report adjusted odds ratios (AOR), and 95% confidence intervals (CI). A total of 1724 registered TB patients from the urban-clinic (40%), 1st Level Hospital (38%) and peri-urban-clinic (22%) were included in the study. Of the total patients overall unfavourable outcome was 43%. Total unfavourable outcome was treatment-failure (0.3%), lost-to-follow-up (5%), death (9%) and not-evaluated (29%). The odds of unfavourable outcome were higher among patients >59 years (AOR=2.9, 95%CI:1.44–5.79), among relapses (AOR=1.65, 95%CI:1.15–2.38), patients who sought treatment at the Urban clinic (AOR=1.76, 95%CI:1.27–2.42) and among TB/HIV co-infected patients (AOR=1.56, 95%CI:1.11–2.19). The overall unfavourable treatment outcome found in the study was high in the selected facilities. Being >59years old, being a relapse case, being HIV positive and seeking treatment at the urban clinic were factors found to be associated with unfavourable treatment outcomes. Special attention to patients of >59years old, relapse cases and HIV positive in the TB treatment is recommended and also close monitoring of health facilities in increasing efforts aimed at evaluating all the outcomes. Studies are required to identify and test interventions aimed at improving treatment outcomes.
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    Burden attributable to childhood and adolescent primary headache disorders in Lusaka and Ndola school children aged 7 - 17 years.
    (The University of Zambia, 2019) Kawatu, Nfwama
    Headache is a common complaint in the paediatric and adult populations. However, the prevalence, types and effects on the quality of life of the children that suffer from headache is not known. This study assessed the prevalence and burden of primary headache disorders in children and adolescents. The data collected and analysed produced a preliminary report of an ongoing study. This was a cross sectional study, conducted over a 6-month period which targeted participants aged 7-17 years in Lusaka and Ndola schools. It was conducted using a standardized questionnaire that was administered with the guidance of the principal investigator for ages 7-11 years and by self-administration for ages 12-17 years. Questions of interest included the prevalence, duration, intensity and frequency of any headache. Lost school days and parental work days highlighted the quality of life of these children in general. The data was analysed using a validated algorithm of classification of headache which is based on the International Classification of Headache Disorders III. The 1 year prevalence of headache in general was at 87.3% of the study population. Probable migraine was most common at 44.5% followed by migraine 19.6%. Girls (68.6%) suffered more migraine; boys displayed a high prevalence in tension type headache (39.9%), followed by probable migraine headache at 39.9%. A reduction in the quality of life was significantly associated with a longer duration of headache days, migraine headache and probable migraine headache whereas there was no significant association with other headache types. The prevalence of primary headache disorders in Zambia is significantly high at 873% with highest prevalences of migraine headache in girls and tension type headache in boys. The quality of life was not significantly altered in these children that suffered headache.
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    Determinants of underweight among under- five children in Zambia - evidence from 2001, 2007 and 2014 Zambia demographic and health surveys.
    (The University of Zambia, 2019) Nakawala, Tamika S.
    Over the past ten years, underweight levels in Zambia have remained static at 15%. Literature has shown that the mortality risk of children who are even mildly underweight is increased and this risk increases for those children who are severely underweight. The main objective of the study was to assess the determinants of underweight in under-five children over the last two decades in Zambia. This was a cross sectional study using data from the 2001, 2007 and 2013-14 Zambia Demographic and Health Survey’s. The study included a pooled estimate of about 26,735 under-five children, 6877 in the 2001 survey, 6401 in the 2007 survey and 13, 457 children in the 2013-14 survey. Multiple logistic regression showed that female children were 25% less likely to be underweight than male children [0R=0.75, 95% CI (0.69-0.82), p˂0.0001]. Children from rural areas had reduced odds of being underweight than those from urban areas [OR=0.77, 95%CI (0.68-0.89), p˂0.0001], Children aged 13-24 and 25-36 months had increased odds of being underweight [OR=1.71, 95% CI (1.48-1.98), p˂0.0001] and [OR=1.90, 95% CI (1.64-2.20), p˂0.0001] respectively than children aged 0-12 months. Having had diarrhoea [OR=1.33, 95% CI (1.18-1.50), p˂0.0001] or fever [OR=1.19, 95% CI (1.07-1.32), P=0.001] increased the odds of a child below five being underweight. The odds of underweight in under-five children reduced with an increase in the mother’s education and wealth index. Children whose mothers had tertiary education, came from the richest wealth quintile and children who were large at birth had the lowest odds of being underweight [OR=0.41 95% CI (0.27-0.64), p˂0.0001], [OR=0.40, 95%CI (0.32-0.50), p˂0.0001] and [OR=0.38, 95%CI (0.33-0.44), p˂0.0001] respectively. The study established that mothers with higher education, from the richest wealth index, an average sized child at birth, being female and residing in rural area were protective factors for underweight in children. On the other hand having had diarrhoea and fever was a disadvantage to the child as this promoted being underweight. In addition, older children were more likely to be underweight.