Hospital In Lusaka Research Articles

Editorial introductions.

Editorial introductions.

Antimicrobial susceptibility and genomic profiling of Salmonella enterica from bloodstream infections at a tertiary referral hospital in Lusaka, Zambia, 2018–2019

ObjectivesThis study investigated antimicrobial susceptibility and genomic profiling of S. enterica isolated from bloodstream infections at a tertiary referral hospital in Lusaka, Zambia, 2018–2019. MethodThis was a prospective hospital-based study involving routine blood culture samples submitted to the microbiology laboratory at the University Teaching Hospital. Identification of S. enterica and determination of antimicrobial susceptibility profiles was achieved through conventional and automated methods. Whole-genome sequencing (WGS) was conducted, and the sequence data outputs were processed for species identification, serotype determination, multilocus sequence typing (MLST) profile determination, identification of antimicrobial resistance determinants, and phylogeny. ResultsSeventy-six Salmonella enterica were isolated and 64 isolates underwent WGS. Salmonella Typhi (72%) was the most prevalent serotype. Notable was the occurrence of invasive non-typhoidal Salmonella Typhimurium ST313 (3%), resistance to cephalosporins (4%) and ciprofloxacin (5%), multidrug resistance (46%), and reduced susceptibility to ciprofloxacin (30%) and imipenem (3%). Phylogenetic cluster analysis showed multiple Salmonella serovars with a wide range of genetic diversity. ConclusionThe genetic diversity of Salmonella Typhi, high prevalence of multidrug resistance, and the emergence of ciprofloxacin and cephalosporin resistance warrants improved hygiene and water and sanitation provision, continued surveillance to apprise antibiograms and inform policy, and the introduction of the typhoid conjugate vaccine.

Predictors of in-hospital and 90-day post-discharge stroke mortality in Lusaka, Zambia

BackgroundFactors associated with stroke mortality are understudied in sub-Saharan Africa but have implications for designing interventions that improve stroke outcomes. We investigated predictors of in-hospital and 90-day post-discharge stroke mortality in Lusaka, Zambia. MethodsData from consecutive adults admitted with stroke at University Teaching Hospital in Lusaka, Zambia between October 2018 and March 2019 were retrospectively reviewed for clinical in-hospital outcomes. Vital status at 90-days post-discharge was determined through phone calls. Factors associated with stroke mortality were included in multivariable logistic regression models utilizing multiple imputation analysis to determine independent predictors of in-hospital and 90-days post-discharge mortality. ResultsIn-hospital mortality was 24%, and 90-day post-discharge mortality was 22% among those who survived hospitalization. Hemorrhagic and unknown strokes, ICU care, seizures, and aspiration pneumonia were significantly associated with in-hospital mortality. Among these, hemorrhagic stroke (OR 2.88, 95% CI 1.27–6.53, p = 0.01) and seizures (OR 29.5, 95% CI 2.14–406, p = 0.01) remained independent predictors of in-hospital mortality in multivariable analyses. Ninety-day post-discharge mortality was significantly associated with older age, previous stroke, atrial fibrillation, and aspiration pneumonia, but only older age (OR 1.04, 95% CI 1.01–1.06, p = 0.007) and aspiration pneumonia (OR 3.93, 95% CI 1.30–11.88, p = 0.02) remained independently associated with 90-day mortality in multivariable analyses. ConclusionThis Zambian stroke cohort had high in-hospital and 90-day post-discharge mortality that were associated with several in-hospital complications. Our data indicate the need for improvement in both acute stroke care and post-stroke systems of care to improve stroke outcomes in Zambia.

Serum antibodies to selected Helicobacter pylori antigens are associated with active gastritis in patients seen at the University Teaching Hospital in Lusaka, Zambia.

Little is known about specific bacterial characteristics of Helicobacter pylori (H. pylori) infection influencing gastric carcinogenesis in Zambia. The aim of this study was to evaluate the associations between pre-selected H. pylori antibodies with gastric cancer, premalignant lesions and active gastritis. This was cross-sectional study with multiple comparisons of patients with gastric cancer (GC), gastric premalignant (GP) lesions and active or chronic gastritis. A fluorescent bead-based antibody multiplex serology assay was used to quantify antibodies to thirteen immunogenic H. pylori antigens. Logistic regression models were used to examine the associations. Included were 295 patients with: 59 GC, 27 GP lesions, 48 active and 161 chronic gastritis. Overall, 257/295 (87%) were H. pylori positive. H. pylori seropositivity was not associated with sex, age, body mass index, socio-economic status, HIV infection, alcohol consumption or cigarette smoking (p-values all above 0.05). When compared to the patients with chronic gastritis, the presence of catalase and cinnamyl alcohol dehydrogenase (Cad) antibodies was positively associated with GP lesions (OR 3.53; 95% CI 1.52-8.17 and OR 2.47; 95% CI 1.08-5.67 respectively). However, seropositivity to Cad antibodies was significantly lower in GC patients (OR 0.28; 95% CI 0.09-0.83). Compared to chronic, active gastritis was significantly associated with (p<0.05) H. pylori sero-positivity (OR 9.46; 95% CI 1.25-71.52) and specific antibodies including cytotoxin-associated gene A, vacuolating cytotoxin A, Helicobacter cysteine-rich protein C, hypothetical protein HP0305 and outer membrane protein HP1564. Among Zambian patients seen at a single center, antibodies to H. pylori (CagA, VacA, Omp, HcpC, HP0305 and HpaA) were associated with active gastritis.

Characteristics of pregnant women who seroconvert after an initial negative Human Immunodeficiency Virus test result at antenatal booking at selected hospitals in Lusaka, Zambia.

ABSTRACT&#x0D; Objectives: To examine the role of demographic, socio-economic, health and reproductive characteristics of pregnant women and study the impact of their utilization of health services in relation to seroconversion after an initial negative HIV test result in women attending ANC at selected hospitals in Lusaka.&#x0D; Methods: This was a case control study conducted at the Women and Newborn Hospital and selected level 1 hospitals in Lusaka district between July 2018 and June 2019. Convenience sampling was used. Interviews were conducted using a structured interviewer administered questionnaire involving 47 women who seroconverted (as cases) and 140 women who did not seroconvert (as controls).&#x0D; Results: The study found that monthly income, age at sexual debut, number of sexual partners in a lifetime, children with the same father, partners who did not test for HIV before ANC booking, partner perceived to be faithful, frequent travel in partner and less than four ANC visits were associated with HIV seroconversion. However, when these factors where adjusted in multivariate logistic regression for confounders, women who had sexual debut before the age of 16 years were seven times more likely to seroconvert (AOR=6.67, 95%CI=1.103-39.805, P=0.039), those whose partners tested for HIV before ANC booking were 72 percent less likely to seroconvert (AOR=0.278, 95%CI=0.089-0.865, P=0.027), those who partners travelled out of town frequently were three times more likely to seroconvert (AOR=3.250, 95%CI=1.063-9.935, P=0.039) and those who attended less than four ANC visits were three times more likely to seroconvert (AOR=3.378, 95%CI=1.018-11.210, P=0.047). &#x0D; Conclusion: Pregnant women are at risk of seroconverting during pregnancy leading to MTCT of HIV. It is therefore imperative that HCT be strengthened during ANC and labour. Targeting adolescents with sexual and reproductive health education before they start engaging in sexual activities is key to keeping them HIV negative. Pre-exposure prophylaxis should be provided to pregnant women whose partners decline HCT or are HIV positive. Frequent travellers should be educated to practice safer sex. Lastly, there is need to implement the WHO 2016 ANC recommendation of at least 8 contacts during pregnancy.&#x0D; Key words: HIV seroconversion, elimination of mother-to-child transmission, window period.

Characteristics of pregnant women who seroconvert after an initial negative Human Immunodeficiency Virus test result at antenatal booking at selected hospitals in Lusaka, Zambia.

Objectives: To examine the role of demographic, socio-economic, health and reproductive characteristics of pregnant women and study the impact of their utilization of health services in relation to seroconversion after an initial negative HIV test result in women attending ANC at selected hospitals in Lusaka.&#x0D; Methods: This was a case control study conducted at the Women and Newborn Hospital and selected level 1 hospitals in Lusaka district between July 2018 and June 2019. Convenience sampling was used. Interviews were conducted using a structured interviewer administered questionnaire involving 47 women who seroconverted (as cases) and 140 women who did not seroconvert (as controls).&#x0D; Results: The study found that monthly income, age at sexual debut, number of sexual partners in a lifetime, children with the same father, partners who did not test for HIV before ANC booking, partner perceived to be faithful, frequent travel in partner and less than four ANC visits were associated with HIV seroconversion. However, when these factors where adjusted in multivariate logistic regression for confounders, women who had sexual debut before the age of 16 years were seven times more likely to seroconvert (AOR=6.67, 95%CI=1.103-39.805, P=0.039), those whose partners tested for HIV before ANC booking were 72 percent less likely to seroconvert (AOR=0.278, 95%CI=0.089-0.865, P=0.027), those who partners travelled out of town frequently were three times more likely to seroconvert (AOR=3.250, 95%CI=1.063-9.935, P=0.039) and those who attended less than four ANC visits were three times more likely to seroconvert (AOR=3.378, 95%CI=1.018-11.210, P=0.047). &#x0D; Conclusion: Pregnant women are at risk of seroconverting during pregnancy leading to MTCT of HIV. It is therefore imperative that HCT be strengthened during ANC and labour. Targeting adolescents with sexual and reproductive health education before they start engaging in sexual activities is key to keeping them HIV negative. Pre-exposure prophylaxis should be provided to pregnant women whose partners decline HCT or are HIV positive. Frequent travellers should be educated to practice safer sex. Lastly, there is need to implement the WHO 2016 ANC recommendation of at least 8 contacts during pregnancy.

RISK FACTORS AND OUTCOMES OF HIV-ASSOCIATED STROKE IN ZAMBIA

<h2>ABSTRACT</h2><h3>Objective</h3> To compare risk factors and clinical outcomes between people living with HIV (PLWH) and HIV-uninfected (HIV-) adults with stroke hospitalized in Zambia. <h3>Methods</h3> Weretrospectively reviewed charts of all adults admitted to the University Teaching Hospital in Lusaka, Zambia with a clinical diagnosis of stroke between October 2018 and March 2019. Standardized data collection instruments were used to collect demographic, clinical, laboratory and imaging results. Comparison between individuals with and without HIV infection was made using t-tests for continuous parametric variables, Wilcoxon rank-sum tests for continuous non-parametric variables, and chi-square analyses for categorical variables. <h3>Results</h3> 272adults with stroke were admitted of whom 58 (21%) were PLWH. Compared to HIV- participants, PLWH were younger (48 ± 14) years versus 62 ± 18) years, p<0.001). PLWH were less likely to have hypertension (65% vs 83%, p=0.003) and more likely to have no traditional cerebrovascular risk factors (34% vs 15%, p=0.01). Deep vein thrombosis (DVT) (4% vs 1%, p=0.04) was more common during hospitalization amongst PLWH, but there was no difference in in-hospital mortality (21% vs 23%, p=0.65). Among PLWH with stroke, factors associated with in-hospital mortality were Glasgow Coma Scale (GCS) on admission (7 vs 10, p=0.046), hypertension (92% vs 59%, p=0.04) and fever (58% vs 13%, p=0.003). <h3>Conclusion</h3> This Zambian cohort of PLWH and stroke is notable for being significantly younger with fewer traditional stroke risk factors but higher rates of DVT than their HIV-uninfected counterparts. GCS on admission, hypertension and fever were associated with in-hospital mortality.

PREDICTORS OF STROKE MORTALITY AT UNIVERSITY TEACHING HOSPITAL IN LUSAKA, ZAMBIA

<h3>Background</h3> Stroke burden in sub-Saharan Africa (SSA) is one of the highest in the world. However, systematic studies of stroke mortality and outcomes in SSA are lacking. <h3>Aim</h3> Determine predictors of mortality amongst patients with stroke in Zambia. <h3>Methods</h3> We completed a retrospective cohort study of consecutive stroke patients admitted to University Teaching Hospital in Lusaka, Zambia between October 2018 – April 2019. Standardized data collection instruments were used to prospectively capture pertinent. Clinic registers were used to determine ninety-day outcomes. Descriptive statistics are reported. T-tests were used to compare continuous variables and chi-square analyses for categorical variables. <h3>Results</h3> 324 stroke patients were enrolled with an average age of 60 (SD 18) years and 62% (n=201) female. Stroke subtypes were 58% ischemic, 28% hemorrhagic, and 14% unknown (i.e. no CT scan performed during hospitalization). Risk factors for both in-hospital and ninety-day post-discharge mortality included lower GCS [in-hospital: 8.0±3 (dead) vs 11±3 (alive), p<0.001; 90-day: 9.8±3.4 vs 11.7±3.3, p=0.02], fever during hospitalization (in-hospital: 27% vs 12%, p=0.001; 90-day: 22% vs 9%, p=0.01),abnormal mental status exam (in-hospital: 93% vs 49%, p<0.001; 90-day: 72% vs 41%, p<0.001), aspiration pneumonia (in-hospital: 34% vs 10%; 90-day: 31% vs 5%; p's<0.001) and NG tube placement during hospital admission (in-hospital: 35% vs 16%; 90-day: 41% vs 9%, p's<0.001). <h3>Conclusion</h3> Our results show higher mortality in patients with severe stroke symptoms and in-hospital complications such as aspiration pneumonia and fever. Our data highlights necessity of optimizing in-hospital stroke management in order to minimize in-hospital complications that will subsequently reduce in-hospital and 90-day post-discharge mortality.

SEX-SPECIFIC DIFFERENCES IN STROKE EPIDEMIOLOGY IN LUSAKA, ZAMBIA

<h3>Introduction</h3> Sex-specific characteristics of stroke and access to post-stroke care data remain limited in sub-Saharan Africa. <h3>Objective</h3> Evaluate sex-specific stroke risk factors and characteristics of stroke care among adults with stroke in Zambia. <h3>Methods</h3> We retrospectively collected demographic, clinical, laboratory and imaging results, and in-hospital mortality for consecutive adults admitted with stroke to University Teaching Hospital in Lusaka, Zambia between October 2018 – April 2019. Strokes were classified as ischemic or hemorrhagic based on CT appearance, and as unknown if neuroimaging was unavailable. Descriptive statistics were compared by sex among adults with stroke using t-tests for continuous variables and chi-squared analysis for categorical variables. <h3>Results</h3> Women constituted 62% (n=200) of the cohort, were older (61±19 years vs 57±16 years, p=0.06) and had lower rates of hemorrhagic stroke (22% vs 37%, p=0.001). Hypertension (84% vs 74%, p=0.04) and diabetes (19% vs 13%, p=0.04) were more frequent in women. Several delays exist between stroke onset and care for women, including lack of CT imaging during hospitalization (82% vs 94% men, p=0.002), and, among those with neuroimaging, a trend towards longer delays in obtaining imaging with 69% of women having ≥1 day delay between admission and CT imaging compared to 53% of men (p=0.10). <h3>Discussion</h3> Females with stroke have fewer hemorrhagic strokes and higher prevalence of stroke risk factors. Women experience delays in acquiring post-stroke care, including in obtaining CT imaging, compared to men. Our data necessitates further study of social and socioeconomic factors that may result in women having reduced access to quality acute stroke and preventative care.

A Rare Case of Bilateral Post Intravitreal Avastin Endophthalmitis with Bilateral Good Visual Outcome – A Case Report

This is a case report of post intravitreal injection endophthalmitis encountered at the University Teaching Hospitals–Eye Hospital in Lusaka, Zambia. Endophthalmitis is a clinical diagnosis made when intraocular inflammation involving both the anterior and posterior chambers is attributable to bacterial or fungal infection. Post injection endophthalmitis is a dreaded complication that occurs following intraocular surgery or procedures such as intravitreal administration of anti-vascular endothelial growth factors or corticosteroids. We attended to a rare case of bilateral post intravitreal injection endophthalmitis in a 51- year- old female patient who presented with bilateral severe pain and acute visual loss in both eyes following intravitreal injection of Avastin (bevacizumab) the previous day. On examination, there was severely decreased visual acuity from 6/36 right eye and 6/60 left eye to hand movement in both eyes. There was also corneal haziness, fibrin in the anterior chambers, hypopyon and vitreous cells in both eyes. A clinical diagnosis of bilateral post-injection endophthalmitis was made. There was immediate administration of intravitreal antibiotics of Vancomycin 1.0mg/0.1mL and Ceftazidime 2.25mg/0.1mL with intravitreal Dexamethasone 0.4mg/0.1ml stat dose and systemic ciprofloxacin 750mg 12 hourly for 7 days. Due to prompt diagnosis and treatment vision recovery was excellent in both eyes and both eyes were preserved.

Healthcare Providers’ Perspective on Barriers to Patient Safety Incident Reporting in Lusaka District

Background: Many studies from a number of different nations around the world have consistently demonstrated unacceptably high rates of medical injury and preventable deaths. However, research shows that patient safety from developing countries is still infrequent and that frontline healthcare practitioners have concerns about patient safety which are yet to be looked at. Therefore, this study aimed at exploring concerns related to safety of patients receiving clinical care.Methods: In-depth, face to face interviews with 33 frontline healthcare practitioners and managers were conducted. The sample was collected at two largest hospitals in Lusaka, one offering mental health and the other one acute health services. Results: The findings were broadly categorized into staff-related and institutional-related challenges. Most incidents committed by them were going unreported. Challenges in maintaining patient safety were also attributed to lack of guidelines, standardized reporting system, patient overcrowding, poor hospital building design and staff shortages. These make it challenging in maintaining patient safety measures.Conclusion: In as much as patient safety is one of the priority areas in most healthcare systems of developing countries, incident reporting is not being done across the board. A number of factors are acting as barriers. There is a lot more that need to be done in order to improve the safety of patients in most developing countries and thus, with the current trend, patient safety incidents will continue harming patients receiving clinical care as long as these barriers exist.

Advanced HIV disease management practices within inpatient medicine units at a referral hospital in Zambia: a retrospective chart review

BackgroundZambia recently achieved UNAIDS 90-90-90 treatment targets for HIV epidemic control; however, inpatient facilities continue to face a large burden of patients with advanced HIV disease and HIV-related mortality. Management of advanced HIV disease, following guidelines from outpatient settings, may be more difficult within complex inpatient settings. We evaluated adherence to HIV guidelines during hospitalization, including opportunistic infection (OI) screening, treatment, and prophylaxis.MethodsWe reviewed inpatient medical records of people living with HIV (PLHIV) admitted to the University Teaching Hospital in Lusaka, Zambia between December 1, 2018 and April 30, 2019. We collected data on patient demographics, antiretroviral therapy (ART), HIV biomarkers, and OI screening and treatment—including tuberculosis (TB), Cryptococcus, and OI prophylaxis with co-trimoxazole (CTX). Screening and treatment cascades were constructed based on the 2017 WHO Advanced HIV Guidelines.ResultsWe reviewed files from 200 charts of patients with advanced HIV disease; of these 92% (184/200) had been on ART previously; 58.1% (107/184) for more than 12 months. HIV viral load (VL) testing was uncommon but half of VL results were high. 39% (77/200) of patients had a documented CD4 count result. Of the 172 patients not on anti-TB treatment (ATT) on admission, TB diagnostic tests (either sputum Xpert MTB/RIF MTB/RIF or urine TB-LAM) were requested for 105 (61%) and resulted for 60 of the 105 (57%). Nine of the 14 patients (64%) with a positive lab result for TB died before results were available. Testing for Cryptococcosis was performed predominantly in patients with symptoms of meningitis. Urine TB-LAM testing was rarely performed.ConclusionsAt a referral hospital in Zambia, CD4 testing was inconsistent due to laboratory challenges and this reduced recognition of AHD and implementation of AHD guidelines. HIV programs can potentially reduce mortality and identify PLHIV with retention and adherence issues through strengthening inpatient activities, including reflex VL testing, TB-LAM and serum CrAg during hospitalization.

Barriers to implementation of placental transfusion of babies at birth in Zambia.

Delayed cord clamping (DCC) and umbilical cord milking (CM) have many benefits. However, a previous study done in Zambia showed that it was not a common practice among midwives. This study investigated possible barriers to DCC and CM, at the University Teaching Hospital in Lusaka. This was a qualitative study. A convenience sample was chosen, and snowball sampling was used. The midwives were interviewed using semi-structured interviews. Burnard's method of thematic content analysis was used. Through 14 interviews it became clear that the midwives were aware of DCC and used it whenever possible. The participants reported that the main barriers were the high workload and a variation in knowledge. A lack of facilities, such as heaters and resuscitation equipment in the delivery room also led to earlier cord clamping. The midwives were motivated to continue improving the routines. They expressed a need for more training as well as equipment and resources to facilitate DCC.

Iron Deficiency in Chronic Heart Failure Patients at the University Teaching Hospital in Lusaka, Zambia

Background: Iron plays a key role in oxygen uptake, transport, and storage, as well as oxidative metabolism in the muscle including myocardium and is essential for the formation of haemoglobin, myoglobin, cytochromes, cytochrome oxidase, peroxidase, and catalase. Iron deficiency (ID) often develop in chronic heart failure (CHF) patients due to depletion of iron stores, iron malabsorption and/or reduced availability of iron recycled in the reticuloendothelial system. Indeed iron content and transferrin receptor levels have been reported to be decreased in the myocardium of patients with ID. A cardinal manifestation of heart failure (both heart failure with reduced ejection fraction. HFrEF and heart failure with preserved ejection fraction, HFpEF) is impaired exercise capacity that is exaggerated in iron deficient patients. This easy fatigability is said to be a result of the reduced oxygen transport that is associated with the ID. ID leads to mitochondria and sarcomere dysfunction which reduces left ventricular functioning and hence reducing cardiac output. Reduced peak oxygen uptake has also been reported in patients withHFrEF.&#x0D; Objective: To determine iron status of CHF patients at University Teaching Hospital (UTH) in Lusaka.&#x0D; Methods: The study was conducted at UTH from May to August 2019. Using purposive sampling, data was collected from patients with CHF of New York Heart Association (NYHA) functional class II to IV. Information obtained included sex, age, height, weight and ejection fraction (reduced ifless than 45%). From the blood samples collected, serum iron levels, transferrin levels and ferritin concentration tests were done. The chi square test and logistic regression were used to analyze iron status in CHF patients.&#x0D; Results: Forty (40) patients were enrolled, 18 male and 22 female. The average age was 45.5 (19 to 60). 24 patients (60%) had (HFrEF) and 16 patients (40%) had (HFpEF). 22 patients (55%) had transferrin saturation of less than 20%, while 8 (20%) had ferritin concentration of less than l00ng/ml. Based on both factors, a total of22(55%) patients were iron deficient. Iron deficiency was negatively associated withHFrEF (p = 0.015).&#x0D; Conclusion: More than 55% of the participants in this study were iron deficient. However, ID may not be the primary cause of myocardial dysfunction as patients with HFrEF were less likely to be iron deficient. However, correction of ID in CHF patients in other studies has been reported to have clinical benefits. The observations of this study require further triangulation especially that the sample size was rather small.

The Obstetric outcomes associated with advanced maternal age at the University Teaching Hospitals Women and Newborn Hospital in Lusaka, Zambia

Introduction: Pregnant women aged 35 years and above have traditionally been termed as of advanced maternal age. These women are considered to have a higher incidence of obstetric complications than younger ones&#x0D; Objectives: To investigate socio-demographic characteristics and obstetric outcomes in women of advanced age who delivered at the Women and Newborn Hospital, in Lusaka, Zambia.&#x0D; Methods: This was a cross-sectional study in which a total of 226 postnatal women, both of advanced (35 years and above) and optimal age (20 - 34 years), that met the eligibility criteria were recruited. Systematic random sampling was used to recruit study participants and data was collected using a structured questionnaire, review of patient's hospital records, and the labour ward delivery registers. Statistical analysis was performed using a statistical package for social sciences (SPSS) version 26 software.&#x0D; Results: The prevalence of advanced maternal age was 14.1%. The mean ages were 38years (range 35 - 46 years) and 28 years in advanced and optimal maternal age groups respectively. Socio­ demographic characteristics that were found to be significantly associated with advanced maternal age included; education (P=0.036), occupation (P= 0.015), the cultural belief of large families (P=0.003), and contraception use (P= 0.001). There were more married women among advanced age women 105 (92.9%) than among optimal age women 99 (87.2%), however, there was no significant difference between the two groups (P=0.262). Divorce (P=0.689), income (P=0.701), and history of subfertility P=0.291) were also not found to be different between the two groups. With regards to maternal outcomes, advanced maternal age was significantly associated with severe pre­ eclampsia (AOR 2.131; 95% CI 1.190 - 3.816; P=0.011), postpartum haemorrhage (AOR 1.400; 95% CI 0.187 - 0.855; P=0.018), caesarean deliveries (AOR 1.395; 95% CI 1.115 - 4.719; P=0.028) and antepartum haemorrhage (AOR 2.425; 95% CI 1.029 - 5.714; P=0.043). On foetal outcomes, advanced maternal age was significantly associated with NICU admissions (AOR 3.075; 95% CI 1.298 - 7.287; P=0.011). However, there was no association with APGAR score at 5 minutes (P=0.174), birth weight (P=l.000), gestation age at birth (P=0.676), and PROM (P=0.557)&#x0D; Conclusion: Generally, women of advanced maternal age were associated with more adverse obstetric outcomes than women of optimal childbearing age. Hence, there is a need to sensitise these women and their spouses on the risk of advanced maternal age on obstetric outcomes and the need for not postponing conception until the late 3rd decade of life.

Iron Deficiency in Chronic Heart Failure Patients at the University Teaching Hospital in Lusaka, Zambia

Background: Iron plays a key role in oxygen uptake, transport, and storage, as well as oxidative metabolism in the muscle including myocardium and is essential for the formation of haemoglobin, myoglobin, cytochromes, cytochrome oxidase, peroxidase, and catalase. Iron deficiency (ID) often develop in chronic heart failure (CHF) patients due to depletion of iron stores, iron malabsorption and/or reduced availability of iron recycled in the reticuloendothelial system. Indeed iron content and transferrin receptor levels have been reported to be decreased in the myocardium of patients with ID. A cardinal manifestation of heart failure (both heart failure with reduced ejection fraction. HFrEF and heart failure with preserved ejection fraction, HFpEF) is impaired exercise capacity that is exaggerated in iron deficient patients. This easy fatigability is said to be a result of the reduced oxygen transport that is associated with the ID. ID leads to mitochondria and sarcomere dysfunction which reduces left ventricular functioning and hence reducing cardiac output. Reduced peak oxygen uptake has also been reported in patients withHFrEF.&#x0D; Objective: To determine iron status of CHF patients at University Teaching Hospital (UTH) in Lusaka.&#x0D; Methods: The study was conducted at UTH from May to August 2019. Using purposive sampling, data was collected from patients with CHF of New York Heart Association (NYHA) functional class II to IV. Information obtained included sex, age, height, weight and ejection fraction (reduced ifless than 45%). From the blood samples collected, serum iron levels, transferrin levels and ferritin concentration tests were done. The chi square test and logistic regression were used to analyze iron status in CHF patients.&#x0D; Results: Forty (40) patients were enrolled, 18 male and 22 female. The average age was 45.5 (19 to 60). 24 patients (60%) had (HFrEF) and 16 patients (40%) had (HFpEF). 22 patients (55%) had transferrin saturation of less than 20%, while 8 (20%) had ferritin concentration of less than l00ng/ml. Based on both factors, a total of22(55%) patients were iron deficient. Iron deficiency was negatively associated withHFrEF (p = 0.015).&#x0D; Conclusion: More than 55% of the participants in this study were iron deficient. However, ID may not be the primary cause of myocardial dysfunction as patients with HFrEF were less likely to be iron deficient. However, correction of ID in CHF patients in other studies has been reported to have clinical benefits. The observations of this study require further triangulation especially that the sample size was rather small.

The Obstetric outcomes associated with advanced maternal age at the University Teaching Hospitals Women and Newborn Hospital in Lusaka, Zambia

Introduction: Pregnant women aged 35 years and above have traditionally been termed as of advanced maternal age. These women are considered to have a higher incidence of obstetric complications than younger ones&#x0D; Objectives: To investigate socio-demographic characteristics and obstetric outcomes in women of advanced age who delivered at the Women and Newborn Hospital, in Lusaka, Zambia.&#x0D; Methods: This was a cross-sectional study in which a total of 226 postnatal women, both of advanced (35 years and above) and optimal age (20 - 34 years), that met the eligibility criteria were recruited. Systematic random sampling was used to recruit study participants and data was collected using a structured questionnaire, review of patient's hospital records, and the labour ward delivery registers. Statistical analysis was performed using a statistical package for social sciences (SPSS) version 26 software.&#x0D; Results: The prevalence of advanced maternal age was 14.1%. The mean ages were 38years (range 35 - 46 years) and 28 years in advanced and optimal maternal age groups respectively. Socio­ demographic characteristics that were found to be significantly associated with advanced maternal age included; education (P=0.036), occupation (P= 0.015), the cultural belief of large families (P=0.003), and contraception use (P= 0.001). There were more married women among advanced age women 105 (92.9%) than among optimal age women 99 (87.2%), however, there was no significant difference between the two groups (P=0.262). Divorce (P=0.689), income (P=0.701), and history of subfertility P=0.291) were also not found to be different between the two groups. With regards to maternal outcomes, advanced maternal age was significantly associated with severe pre­ eclampsia (AOR 2.131; 95% CI 1.190 - 3.816; P=0.011), postpartum haemorrhage (AOR 1.400; 95% CI 0.187 - 0.855; P=0.018), caesarean deliveries (AOR 1.395; 95% CI 1.115 - 4.719; P=0.028) and antepartum haemorrhage (AOR 2.425; 95% CI 1.029 - 5.714; P=0.043). On foetal outcomes, advanced maternal age was significantly associated with NICU admissions (AOR 3.075; 95% CI 1.298 - 7.287; P=0.011). However, there was no association with APGAR score at 5 minutes (P=0.174), birth weight (P=l.000), gestation age at birth (P=0.676), and PROM (P=0.557)&#x0D; Conclusion: Generally, women of advanced maternal age were associated with more adverse obstetric outcomes than women of optimal childbearing age. Hence, there is a need to sensitise these women and their spouses on the risk of advanced maternal age on obstetric outcomes and the need for not postponing conception until the late 3rd decade of life.

Antibiotic Prescribing Patterns and Prevalence of Surgical Site Infections in Caesarean Section Deliveries at Two Tertiary Hospitals in Lusaka, Zambia

Introduction: A caesarean section (CS) is one of the most frequently performed obstetric surgeries in the world and its use has increased dramatically in recent years. The number of caesarean section cases worldwide has been increasing each year, and the World Health Organization (WHO) reported an excess of 10% - 15% of CS procedures for all births. However, some women experience surgical site infections (SSIs) after undergoing CS delivery. This study investigated the prescribing patterns of antibiotics in CS deliveries and the prevalence of SSIs at two tertiary hospitals in Lusaka, Zambia. Materials and Methods: A retrospective cross-sectional study was conducted from January 2020 to December 2020 at the Women and Newborn University Teaching Hospital (UTH) and the Levy Mwanawasa University Teaching Hospital, in Lusaka, Zambia. Results: Of a total of 838 women who delivered via CS, more than half were aged between 21 and 25 years (n = 461, 55.0%), 56.3% were from low-cost residential areas, and 57% had emergency CS delivery. The prevalence of SSIs was 6.0%, with the level of education (OR 0.377, 95% CI 0.150 - 0.946), type of caesarean section (OR 6.253, 95% CI 2.833 - 13.803), and oral antibiotics post-caesarean (OR 0.218, 95% CI 0.049 - 0.963). The duration of IV antibiotic treatment significantly predicted SSI (p < 0.001), and 99.8% of the women received antibiotic(s). The antibiotic combination of benzylpenicillin, gentamicin, and metronidazole was the most commonly prescribed (n = 39, 146.7%), followed by ceftriaxone (n = 349, 41.6%). Conclusion: This study found that the third-generation cephalosporin (cefotaxime) and triple combination therapy (benzylpenicillin, gentamicin, and metronidazole) were the most frequently prescribed antibiotics before and after CS. The level of education, type of CS, oral antibiotics post-CS, facility, and duration of administering IV antibiotics were all predictors of SSIs.

Familiarity, Knowledge and Practices of Healthcare Professionals Regarding the Pharmacovigilance of Biological Medicines in Lusaka, Zambia: A Multi-Facility Cross-Sectional Study

Background: Pharmacovigilance of biological medicines is crucial because it ensures that medicines meet the World Health Organization (WHO) standards. In Zambia, there is little information on healthcare professionals’ familiarity, knowledge and practices on the pharmacovigilance of biological and biosimilar medicines. Therefore, this study investigated the familiarity, knowledge, and practices related to the pharmacovigilance (PV) of biological and biosimilar medicines at selected hospitals in Lusaka, Zambia. Methods: The study was an analytical questionnaire-based cross-sectional study conducted among healthcare professionals (HCPs) at the Adult hospital, Cancer Diseases hospital, Paediatrics hospital and Women and New Born Hospital in Lusaka. Data were collected over four weeks in May and June 2021 and subsequently analysed using IBM SPSS version 21. The statistical significance was set at a 95% confidence interval. Results: Of 245 participants, only 115 (48.9%) of the HCPs were familiar with biological medicines to a basic understanding. Regarding the term biosimilars, most of the HCPs (40.9%) never heard of this word. The mean score for knowledge regarding the PV considerations of biological medicines was 4.1 out of 8 questions. Most HCPs used non-proprietary names (44.2%) when prescribing, dispensing, or administering biological medicines. Additionally, more than half (57.3%) of HCPs did not record batch numbers when dispensing or administering biological medicines. Conclusion: Healthcare professionals were more familiar with the term biological medicines than biosimilars. Healthcare professionals generally scored poorly when their knowledge regarding the PV considerations of biological medicines was assessed. Thus, there is a need to provide adequate training and continuous professional development among healthcare professionals on the pharmacovigilance of biological and biosimilar medicines.

Attitudes and Practices Contributing to Vaginal Stenosis in Women with Cervical Cancer Following Brachytherapy at Cancer Diseases Hospital in Lusaka, Zambia. A Cross Sectional Study

Background: Vaginal stenosis is an important adverse effect of brachytherapy for cervicalcancer. This study aimed to determine attitudes and practices contributing to vaginal stenosis following brachytherapy at the Cancer Diseases Hospital in Lusaka—Zambia. Methods: An analytical cross-sectional study design was employed, where 163 respondents were randomly selected after meeting inclusion criteria. A researcher-administered questionnaire was used to collect data and SPSS version 25 was used for data analysis. Results: Out of the 163 women enrolled in this study, 42.3% had developed vaginal stenosis while 57.7% did not with age range 15 - 60+ years. 76% exhibited good practices to measures against vaginal stenosis while majority (93.9%) of the respondents demonstrated poor attitudes towards measures to prevent the condition. Women with poor practices versus good practices (OR = 1.07, CI = 0.52 - 2.21, p = 0.855), poor attitudes versus good attitudes (aOR = 1.28, CI = 0.29 - 5.71, p = 0.746) and those employed versus unemployed (aOR = 1.76, CI = 0.73 - 4.27, p = 0.210) had increased odds of vaginal stenosis. However, these increasing effects were not significant at 5% level of significance. Although length of brachytherapy showed no significant effect independently, the odds of having vaginal stenosis were over 2 times higher for women who had been on brachytherapy between 6 and 12 months compared to those on brachytherapy for less than 6 months (OR = 2.45, CI = 1.03 - 5.82, p = 0.042). Conclusions: Failure to practice recommended measures and poor attitudes towards therapy contributes to vaginal stenosis. Efforts should be channeled towards overcoming religious, traditional, cultural and personal impediments contributing to vaginal stenosis in women with cervical cancer receiving brachytherapy.