Medical Theses and Dissertations
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- ItemAssessment of prevalence and associated factors for urinary schistosomiasis among primary school going children in Mpongwe district,Zambia(The University of Zambia, 2019) Sakubita, PatrickSchistosomiasis, also known as bilharziasis is a disease that results from infection with parasitic trematode worms of the genus Schistosoma. Schistosomiasis is acquired when free-swimming parasitic larvae known as cercariae penetrate the skin of people exposed to infested freshwater. The disease impedes school attendance and leads to absenteeism, ill-health and weak memory, poor performance and productivity, disability and death. In tropics and sub-tropics, human and water contacts can be potential risk factors of schistosomiasis. Domestic activities such as washing clothes and fetching water in infected water expose women and children to infection. In Zambia, urinary schistosomiasis caused by the trematode Schistosoma haematobium has been a major public health problem for many years. We conducted this study to investigate the prevalence of schistosomiasis among school going children and associated factors for contracting urinary schistosomiasis in Mpongwe district. We used a multi-stage cluster sampling method to select study participants. The first stage involved selection of schools, at second stage selection of classrooms and the third stage consisted of simple random sampling for selection of respondents from the various classes. Probability proportion sampling to size was applied in assigning appropriate numbers of pupils that constituted the sample size. Data were collected using structured questionnaires on electronic tablets. A questionnaire was administered to all selected pupils providing a urine sample to collect information on the sex, age, water contact activities, symptoms of urinary schistosomiasis, knowledge about the disease, and past praziquantel treatment. We collected urine samples to analyse for presence of schistosome eggs to determine prevalence and geographical distribution of the disease. Schistosomiasis risk factors were assessed by Fisher’s exact test to compare categorical variables. The level of significance was set at 95% and all p-values less than 0.05 were considered statistically significant. We interviewed a total of 390 (100%) pupils between the ages of 5-14years from 15 schools of which 206 (52.8%) were female and 184 (47.2%) were male. The median age for the study participants was 12 years (IQR 7, 14) and all the four positive cases were males accounting for 1% prevalence rate. Of the four positive male case-patients, two (50%) reported previous history of suffering from schistosomiasis atleast once prior to the current infection. The majority of the pupils, 330 (85.5%) reported taking preventive chemotherapy for Schistosomiasis during the mass drug administration conducted in May 2017 with a therapeutic coverage of 83%. Our study found that urinary schistosomiasis prevalence rate was currently at 1%. We found that previous history of schistosomiasis was associated with acquiring new infections. Mass drug administration may have contributed to the decreased prevalence rate. We recommend strengthened community health education to target the at-risk age groups, regular screening of children and the community in order to facilitate early access and linkage to health services. Active disease surveillance for schistosomiasis is also recommended for prompt detection of outbreaks. We also recommend that future studies should employ different study designs at different times of the year. Key words: Schistosomiasis, Mpongwe, Prevalence, Risk factors, Primary School Children
- ItemInformation needs of breast cancer patients at cancer diseases hospital, Lusaka, Zambia(The University of Zambia, 2019) Namushi, Lilala BeautyBreast cancer is the second most common cancer worldwide and the second most common among women in Zambia. The diagnosis of breast cancer is a stressful experience; therefore information provision is one of the most important factors for providing high quality cancer care across the whole cancer continuum. Understanding the information needs of breast cancer patients is significant in improving the care. The main objective of the study was to assess information needs of breast cancer patients at the Cancer Diseases Hospital in Lusaka, Zambia. A descriptive cross sectional design was used to elicit the information needs of breast cancer patients. One hundred and ten (110) participants were selected using simple random sampling method and data was collected using a modified structured interview schedule adopted from the Toronto Information Needs Questionnaire-Breast Cancer (TINQ-BC). Stata 10.0 (StataCorp, 2008) was employed for all quantitative data analysis. Logistic regression was done to examine the effect of each independent variable on information needs with a level of significance of p< 0.05 while controlling for the confounding effects of the other co-variates. The study revealed that 80% of the 110 respondents ranked information in all the five categories as moderately important. Of the five categories, the most important information participants ranked was from the subscale of investigative tests (76.4%), followed by treatment modalities (73.6%), physical and disease information were at 71.8% and lastly psychosocial needs (70%). The Logistic Regression analysis showed that ‘levels of anxiety, University Education, Presence of co-morbidites and being on treatment were significant factors influencing information needs of cancer patients (p values <0.05). The diagnosis of breast cancer is a stressful experience; therefore information provision is one of the most important factors for providing high quality cancer care across the whole cancer continuum. Appreciating the information needs of breast cancer patients is substantial in improving care. These findings suggest that increased information supply to cancer patients can be used as a management strategy by cancer care professionals, in particular the importance of an awareness of specific patterns of communication which may improve quality of life for cancer patients. Key words: Information needs, Breast cancer, Breast cancer patients
- ItemThe value of procalcitonin and C-reactive protein as early markers of bacteraemia among patients with haematological malignancies receiving chemotherapy: a cross-sectional study(Medical Journal of Zambia, 2018-04) Kingsley, M. Kamvuma, creator; Sumbukeni, Kowa, creator; Kaile, Trevor , creator; Masenga, Sepiso K., creator; Hamooya, Benson M., creator; Musalula, Sinkala, creator; Simakando, Marah, creatorThe immune system of patients with haematological malignancies is suppressed during chemotherapy. This renders them vulnerable to frequent infections especially of the bacterial type. Timely diagnosis of these infections is difficult, because a severe infection may be asymptomatic or manifest only in the form of fever or malaise. There is need for laboratory markers that can detect an infectious process at an early stage. This study was aimed at determining the value of using Procalcitonin (PCT) and C reactive protein (CRP), for early diagnosis of infection in patients with haematological malignancies receiving chemotherapy. Methods: This was a cross sectional study consisting of sixty eight (68) patients with haematological malignancies. Data from each participant including sex, age, clinical and laboratory data were collected after obtaining informed consent. Blood specimens were then collected for measurement of PCT, CRP and bacteriological analysis. Patients were divided into two groups; those with a culture positive and negative result. PCT and CRP concentrations were compared between groups using t-test and nonparametric statistical tests respectively. The area under ROC curve, sensitivity, specificity, likelihood ratio, and Spearman's correlation coefficient were also calculated. Results: A total of 14 (20.6%) microorganisms were isolated, of which 10 were gram-positive bacteria and 4 were gram-negative bacilli. The mean values of PCT which were 6.1ng/mL in the bacteraemia group and 5.1ng/mL in the non-bacteraemia group, p=0.023 and median CRP values were 24.2 (6.4348.15) in the bacteraemia and 23.5 (6.03-75.44) in the non-bacteraemia group, p=0.832. The area under curves was 0.52 (95% CI=0.57-0.84) for CRP and 0.70 (95% CI=0.35-0.69) for PCT. PCT value of greater than 4.7 ng/mL is diagnostic for infections (sensitivity 86%, specificity 54%) while that of CRP was 21mg/mL with the sensitivity and specificity of 64% and 44% respectively. Elevated levels of PCT as well as fever were significantly associated with bacteraemia.
- ItemConcentration of lead in imported plastic toys, safety to children and associated factors in Lusaka city, Zambia(The University of Zambia, 2017) Sakala, DoreenLead poisoning has been a constant public health concern because children absorb more lead compared to adults. The resulting health effects are irreversible and include decreased cognitive functions development and death. Lead exposure to children is in various ways and one of the ways is use of toys contaminated with lead. The allowable international standards for Lead in plastic toys is 90 ppm and this study established levels ranged from 0.001 to 2,100 ppm. The study used an analytical cross-sectional design in which 108 toys were collected from 18 randomly selected stores in Lusaka City. The toys were subjected to X-ray Fluorescence using Nilton gun machine to determine lead concentration. Stata version 12.0 was used for statistical analysis. Bivariate regression was used to test for association between independent and dependent variables at P < 0.05. Toys with lead levels above the recommended international standard of 90 ppm constituted 18.5% (20) of the total sample while 81.5% (88) toys had lead concentration within the standard. The concentration of lead had a median of 0.001 ppm and (IQR 0.001 – 60.5 ppm). Toys for children above the age of 2 years had higher lead levels of 105 ppm compared to those for children below 2 years with levels of 9.75 ppm. Toys in the midrange cost category of 16 -25 ZMK had higher levels of 232.5 ppm compared to toys in the low and high cost category of 2-15 and 36-190 ZMK. Lead levels were high in multi coloured toys (102 ppm) compared to the mean for single colours Toys of animal shape had higher lead levels of 105.5 ppm compared to toys in the miscellaneous and repetitive shape categories which had 90 and 0.001 ppm respectively. However, the association between these factors (colour, type, cost, child age category of the toy) and the concentration of lead in the toys was not statistically significant with P > 0.05. This study established that 18.5% of the toys were above the acceptable limit of lead, with some toys having lead levels 23 times higher than the internationally acceptable standard of 90ppm. There is therefore urgent need for regulatory bodies (ZEMA and ZABS) to develop standards and policy on lead in toys to ensure protection of children from lead poisoning.
- ItemUptake of intermittent preventive treatment for malaria during pregnancy with sulphadoxine-pyrimethamine(IPTP-SP)among postpartum women in Zomba district,Malawi: a cross-sectionals study(The University of Zambia, 2017) Azizi, Chifundo StevenMalaria in pregnancy causes adverse birth outcomes. Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended as a chemoprevention therapy. Despite the effectiveness of the intervention, Zomba district has below national average uptake of 43% of pregnant women who took at least two doses of SP. The study was conducted to assess determinants of IPTp-SP uptake during pregnancy among postpartum women in Zomba district. The study used a cross-sectional survey with simple random sampling in selecting two public health facilities (HFs) from two strata (urban and rural). One HF was selected from each stratum. Study participants were selected by using exit poll method from HFs. A total of 463 postpartum women were interviewed using structured questionnaire from the two HFs. Univariate and multiple binary logistic regression was employed in data analysis. Out of all the enrolled participants (n=463), 92% women had complete information for analysis. Of these, (n=426)women, 127 (29.8%, 95% CI: 25.6-34.3) received three (optimal) or more doses of SP, 299 (70.2%, 95% CI: 65.7-74.4) received two or less doses (poor uptake or suboptimal). Women receiving SP from rural HF were less likely to get at least three doses of SP than urban women, (AOR=0.31, 95% CI 0.13-0.70); Others less likely were those with three or few antenatal care (ANC) visits versus four or more visits (AOR=0.29, 95% CI 0.18-0.48); not taking SP under direct observation therapy (DOT) (AOR=0.18, 95% CI (0.05-0.63). The prevalence of low birth was 6.5% (95% CI 4.0-10.3, n=248) and there was no evidence of an association between poor IPTp-SP uptake and low birth weight even after adjusting for other variables, (AOR=0.59, 95% CI 0.19-1.78). There is low utilisation of SP in this population and this seems to be associated with the number of ANC visits, use of DOTs and distance to health facility. These determinants may therefore be important in shaping interventions aimed at increasing the uptake of IPTp in this district. In addition, the rural urban differential suggests the need for further research to understand the barriers and enablers of uptake in each context in order to improve the health of the community.