Hospital In Lusaka Research Articles

THE ROLE OF NUTRITIONAL STATUS IN THE PERSISTENCE OF MEASLES IMMUNITY AMONG CHILDREN: A MULTIVARIATE ANALYSIS

<p><strong>Background:</strong> The persistence of measles immunity in children is influenced by multiple factors, including nutritional status. This study aimed to assess the role of body mass index (BMI) as a proxy for nutritional status in the persistence of measles immunity, alongside other socio-demographic factors, in a pediatric population. <strong>Methods:</strong> A multivariate logistic regression analysis was conducted on 200 children (2-15 years) attending the University Teaching Children's Hospital in Lusaka, Zambia. Immunity retention was measured through IgG serology. BMI represented nutritional status, and the analysis adjusted for key variables such as HIV status, breastfeeding history, sex, and education level. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to determine the association between nutritional status and immunity persistence. <strong>Results:</strong> Children categorized as well-nourished had significantly lower odds of waning immunity (OR = 0.37, 95% CI = 0.16–0.83, p = 0.016). However, for children with over or under malnutrition, the association was not statistically significant (OR = 0.23, 95% CI = 0.03–1.62, p = 0.140). Additionally, HIV-positive status was associated with decreased immunity retention (OR = 0.28, 95% CI = 0.14–0.56, p < 0.001). Breastfeeding was positively associated with immunity persistence (OR = 3.34, 95% CI = 1.53–7.29, p = 0.003), while other socio-demographic factors such as sex and education level showed no significant effect. <strong>Conclusion:</strong> Nutritional status, as measured by BMI, plays a significant role in the persistence of measles immunity among children, with over- and under-nourished children being associated with lower immunity retention. These findings suggest that nutritional interventions may be necessary to improve vaccine efficacy, particularly in populations with high rates of malnutrition or obesity. The results also highlight the need for further investigation into the mechanisms linking nutritional status to immune response and the development of targeted public health strategies to optimize measles immunization outcomes in children.</p><p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/soc/0722/a.php" alt="Hit counter" /></p>

Childhood tuberculosis outcomes and factors associated with unsuccessful treatment outcomes in selected public hospitals of Lusaka Zambia from 2015 to 2019.

Treatment outcomes of tuberculosis in children are rarely evaluated. Childhood tuberculosis has been a low priority for tuberculosis programs due to difficulties in diagnosis and treatment. This study evaluated childhood tuberculosis outcomes and factors associated with unsuccessful treatment outcomes in selected public hospitals in Lusaka, Zambia from 2015 to 2019. This was a cross-sectional study conducted in eight public hospitals in Lusaka. All children aged 0-14 years, treated with tuberculosis and had treatment outcomes evaluated were included. The WHO tuberculosis treatment outcomes were grouped into successful treatment outcome (cured, treatment completed) and unsuccessful treatment outcome (death, loss to follow-up, failure). Taking unsuccessful treatment outcome as the outcome variable, logistic regression models were performed. All analyses were done at a 95% confidence interval. Out of 2,531 children managed for TB from 2015 to 2019, only 1,495 (59.1%) had treatment outcomes evaluated. Out of 1,495 participants, majority were 5 to 14 years old (50.9%), males (51.1%), HIV-negative (58.7%), and had pulmonary tuberculosis (74.2%). Bacteriological tests were performed on 59.8% of children, where 21.6% had positive bacteriological results. Bacteriologically confirmed TB was higher in children over 5 years (29.5%), pulmonary TB (25.6%), and retreatment (28.6%). The majority of children (84.2%) completed treatment, while 10.7% were cured, 1.5% were lost to follow-up, 3.1% died, and 0.5% failed treatment. Overall, unsuccessful treatment outcome was 5.1% while successful treatment outcome was 94.1%. Extrapulmonary tuberculosis was associated with unsuccessful treatment outcomes (AOR 1.64; 95% CI: 1.02-2.62). The tuberculosis successful treatment outcome met the World Health Organization's threshold goal of 90%. Children with extrapulmonary tuberculosis should be targeted as a high-risk group to improve treatment outcomes. Tracking children whose treatment outcomes were not evaluated would provide more precise estimates of TB treatment outcomes.

Carriage and antimicrobial susceptibility patterns of rectal ESBL E. coli in surgical patients at the University Teaching Hospitals in Lusaka, Zambia.

Surgical site infections (SSIs) are on the rise and are a global concern as they complicate the recovery of patients postoperatively. Bacterial colonization of the patient's skin and alimentary tract are known to be major contributing sources to SSIs. However, Zambia lacks data relating to carriage rates of antibiotic-resistant rectal Escherichia coli among surgical patients. This was a cross-sectional study aimed at determining the preoperative (preop) and postoperative (postop) carriage and antimicrobial susceptibility patterns of rectal ESBL-producing E. coli (ESBL-Ec) in elective surgery patients at the highest tertiary hospital in Lusaka, Zambia. Phenotypic methods were used in the identification of E. coli. Antibiotic susceptibility patterns and identification of ESBL-Ec was determined by Kirby-Bauer disc diffusion. A total of 120 study participants were recruited, of which 75 were followed up at least 72 h after surgery. From 195 rectal swabs cultured, 177 (90.8%) were positive for E. coli, of which 53 (29.9%) were ESBL-Ec, with a significantly (P < 0.0001) higher proportion in postop (47.9%) than preop (17.3%) participants. Overall, ESBL-Ec isolates showed higher resistance in postop than preop to cefotaxime (100% versus 88.9%, respectively), ampicillin (100% versus 94.4%), ciprofloxacin (88.3% versus 83.3%), amoxicillin/clavulanic acid (80% versus 66.7%) and cefepime (80% versus 77.8%). MDR ESBL-Ec strains were more frequent in postop than in preop participants (91.4% versus 88.9%). The study showed a significantly higher rate of antimicrobial-resistant rectal E. coli in postop than preop participants. There is a need to ascertain the source of the resistance and to institute robust infection control measures, preop screening of surgical patients for ESBL-Ec, and to raise awareness on prudent use of antibiotics.

Preterm birth among women with HIV: impact of preconception cART initiation.

To examine the risk of preterm birth (PTB) and small for gestational age (SGA) among women with HIV compared to women without HIV. Secondary objectives were to explore the role of maternal immune activation (IA) and effect of cART timing on these outcomes. Prospective observational cohort. Urban government-run clinic at Chawama Hospital in Lusaka, Zambia. A total of 1481 women with and without HIV with singleton pregnancies enrolled before 26 weeks' gestation by ultrasound dating. From August 2019 to November 2022, pregnant women were enrolled in a 1 : 1 ratio of HIV infection. Maternal baseline clinical factors were collected, as well as CD4 + , viral load and CD8 + T-cell IA in women with HIV. Birth outcomes were also collected. The association of HIV-exposure and cART timing on outcomes was assessed by multivariable logistic regression. The independent role of IA was determined by mediation analysis. PTB (<37 weeks) and SGA. There were 38 fetal deaths and 1230 singleton live births. Maternal HIV infection was associated with PTB [adjusted odds ratio (AOR) 1.60, 95% confidence interval (CI) 1.11-2.32] and to a lesser extent SGA (AOR 1.29, 95% CI 0.98-1.70). Maternal cART timing impacted these associations, with highest risk in women who started cART after conception (PTB AOR 1.77, 95% CI 1.09-2.87, SGA AOR 1.52, 95% CI 1.04-2.22). Maternal IA was not associated with PTB independent of HIV infection. HIV is associated with PTB. Risk of PTB and SGA was highest in women with HIV who started cART in pregnancy, a modifiable risk factor.

Brain Imaging in New-Onset Seizure of Children Living With Human Immunodeficiency Virus in Zambia

BackgroundThere are an estimated 1.5 million children living with human immunodeficiency virus (CLHIV), most residing in sub-Saharan Africa. A common hospital presentation of CLHIV is new-onset seizure, for which imaging is helpful but not routinely performed due to scarce resources. We present imaging findings and their association with clinical risk factors and outcomes in a cohort of Zambian CLHIV presenting with new-onset seizure. MethodsIn this prospective cohort study, participants were recruited at the University Teaching Hospital in Lusaka, Zambia. Various clinical and demographic characteristics were obtained. Computed tomography (CT), magnetic resonance imaging (MRI), or both were obtained during admission or shortly after discharge. If both studies were available, MRI data was used. Two neuroradiologists interpreted images using REDCap-based NeuroInterp, a tool that quantifies brain imaging findings. Age-dependent neuropsychologic assessments were administered. ResultsNineteen of 39 (49%) children had a brain MRI, 16 of 39 (41%) had CT, and four of 39 (10%) had both. Mean age was 6.8 years (S.D. = 4.8). Children with advanced HIV disease had higher odds of atrophy (odds ration [OR] 7.2, 95% confidence interval [CI] 1.1 to 48.3). Focal abnormalities were less likely in children receiving antiretroviral therapy (ART) (OR 0.22, 95% CI 0.05 to 1.0). Children with neurocognitive impairment were more likely to have atrophy (OR 8.4, 95% CI 1.3 to 55.4) and less likely to have focal abnormalities (OR 0.2, 95% CI 0.03 to 0.9). ConclusionsFocal brain abnormalities on MRI were less likely in CLHIV on ART. Brain atrophy was the most common imaging abnormality, which was linked to severe neurocognitive impairment.

Exploring the Use of Ambientally Stored Methylene Diphosphonate Radiopharmaceutical Aliquots in Solving Challenging Situations in Developing Countries

Abstract Objectives The primary aim was to evaluate the prolonged quality characteristics of methyl diphosphonate (MDP) aliquots during ambient storage over a specified duration. This study further investigated potential additives that could enhance the stability of MDP aliquots stored under such conditions. Materials and Methods This was a laboratory-based experimental study conducted at the University Teaching Adult Hospital in Lusaka, Zambia. A total of 36 MDP aliquots stored at ambient conditions and 4 MDP aliquots stored at conventional refrigerated frozen conditions were labeled with technitium-99m (99mTc) and tested for radiochemical purity (RCP) and other quality characteristics. A comparative analysis of the stability and quality of MDP aliquots from the two cohorts was then conducted. Statistical Analysis Stata 14 was used to analyze the data on the RCP of all MDP aliquots. Results The RCP of ambient stored MDP aliquots was found to be ranging from 98 to 99%, while that for frozen and refrigerated ones ranged from 99 to 100%. There was also a 1% increase in RCP for both cohorts with argon gas purging (98 and 99%, respectively). Conclusion The RCP of MDP aliquots from both cohorts was much higher than the required minimum of 90% implying that there was no significant association of their stability and quality with the mode of storage. However, purging with argon gas seemed to increase the stability further in both streams. The study findings show potential for application in resource-constrained environments and centers, especially in developing countries, where challenges to maintain the cold storage chain of these important radiopharmaceuticals are likely to be encountered due to power outages.

Evaluation of knowledge and practices on antibiotic use: a cross-sectional study on self-reported adherence to short-term antibiotic utilization among patients visiting level-1 hospitals in Lusaka, Zambia.

Antimicrobial resistance (AMR) is a global public health problem affecting healthcare systems. Short-term antibiotic non-adherence is thought to be one of the factors contributing to antibiotic resistance. This study aimed to evaluate knowledge and practices towards short-term antibiotic use on self-reported adherence among patients visiting level-1 hospitals in Lusaka, Zambia. This was a multicentre institutional-based cross-sectional study conducted among 385 adult participants from 11 September to 30 September 2023 using an adopted structured questionnaire. Analysis of the data involved descriptive and inferential statistics, where significance was determined at P < 0.05. Of the 335 participants, 56.7% displayed good knowledge and 77.3% low adherence towards antibiotic use. 54.6% thought that antibiotics were effective for viral infections, and 43.9% correctly recognized the definition of AMR. Being in formal employment (crude OR: 2.5, CI: 1.08-5.78, P: 0.032) was significantly associated with a higher likelihood of good knowledge about antibiotics while being divorced (adjusted OR: 2.5, CI: 1.23-6.10, P: 0.013) and having good knowledge (adjusted OR: 2.9, CI: 1.73-5.10, P = 0.048) were significantly associated with a higher likelihood of adherence to antibiotics. Regarding antibiotic practices, half (50. 0%) of the respondents had utilized antibiotics in the previous year while 58.2% had taken antibiotics for addressing a common cold. Furthermore, 74% reported to have bought antibiotics without a prescription. This study found that participants attending level-1 hospitals had relatively good knowledge and poor adherence towards antibiotic use. Additionally, the participants demonstrated poor antibiotic use practices in almost all statements related to antibiotic usage.

Factors Associated with Outcomes at 1 Year in Paediatric Post-nephrectomy Patients for Nephroblastoma at the University Teaching Hospital and Cancer Diseases Hospital in Lusaka, Zambia.

Nephroblastoma is the most common primary malignant renal tumour of childhood. The survival rates in high-income countries are approximately 90%. However, low-income countries have low survival rates of 20%-50%. This study assessed factors associated with treatment outcomes of children post-nephrectomy for nephroblastoma at the University Teaching Hospital and Cancer Diseases Hospital in Lusaka, Zambia. A retrospective observational cohort study was conducted, where all children diagnosed with unilateral Wilms tumour below the age of 16 years who had nephrectomy from July 2016 to June 2019 were enrolled. Sociodemographic, clinical characteristics and treatment outcomes were noted. All data were coded and stored in a tabular format using Microsoft Excel. Statistical software STATA version 13 was used for analysis. Thirty patients were enrolled. The male-to-female ratio was 1:1. The 1-year event-free survival was 46.7%. Treatment abandonment accounted for 36.6% of the participants. 16.7% of the patients had disease progression. No patient had a relapse or died during the 1-year follow-up period. 66.7% had advanced disease stages III and IV. Advancement in age (above 4.3 years), living in a rural environment more than 100 km away from Lusaka and advanced disease stage were all associated with a poor outcome. Factors associated with a poor outcome in this study were advanced age and late presentation.

Magnitude and Determinants of Pregnancy Induced Hypertension in Selected General Hospitals in Lusaka, Zambia: A Cross-Sectional Study

Background:Hypertension in pregnancy continue to be among the major causes of maternal and perinatal morbidity and mortality, affecting 5-6% of pregnancies globally and contributing to a significant diseaseburden. Aims and objectives: To assess prevalence and factors associated with pregnancy induced hypertension among pregnant women aged 15 to 49 years at three general hospitals of Lusaka District. Methodology:Conducted cross sectional study with 413 systematically selected pregnant women attending antenatal clinics at Chawama, Chipata and Matero general hospitals from January 2019 to July 2020. The sample size for each hospital was determined proportionally based on twelve months of antenatal care visit data. Blood pressure, heights, weights, Body mass index and urinalysis were measured on all the study participants. A structured questionnaire collected data on social demographic and economic factors, reproductive and medical history. Data was analyzed using STATA version 13. Chi-square and fisher’s exact tests identified association between PIH and various variables with multiple logistic regression used to control for confounders. Statistical significance was set at &lt;0.05. Results:The prevalence of Pregnancy induced hypertension was found to be 21%. Significant predictors of PIH included Stress during pregnancy (AOR = 2.28, 95% CI =1.35-3.85, p=0.002), lack of exercise (AOR = 0.48, 95% CI =0.28-0.81, p=0.007), high BMI (AOR = 1.57, 95% CI =1.12-2.19, p=0.007) and consuming alcohol (AOR = 2.29, 95% CI =1.03-5.09, p=0.042).Conclusion:The prevalence of PIH was 21% with significant association observed between PIH and stress, alcohol consumption, lack of exercise and high BMI during pregnanc. Keywords: Pregnancy Induced hypertension; Prevalence; Associated factors, Antenatal mothers.

Lived Experiences of Cervical Cancer Patients Receiving Chemotherapy at Cancer Diseases Hospital in Lusaka, Zambia

Background: Cervical Cancer poses a significant global health challenge, especially in lowresource settings. It is a significant health problem worldwide, with over half a million new cases diagnosed each year, accounting for approximately 6.6% of all gynecological Cancer cases and over 300,000 deaths each year. In Zambia, it is the leading cause of mortality and morbidity among women. The number of cases has increased by approximately 40%. This study explored the lived experiences of Cervical Cancer patients undergoing chemotherapy at the Cancer Diseases Hospital in Lusaka, Zambia, focusing on their subjective experiences. By examining their journeys through chemotherapy, the study aimed to highlight the subtle complexities in which treatment impacts patients’ lives and well-being. Methods and procedures: Employing a qualitative descriptive phenomenological study design, in-depth interviews were conducted with 10 participants with diverse demographics. The sample size was determined by data saturation and saturation was reached at 10. Ethical protocols were ensured, and Study approval was obtained from UNZABREC and the National Health Research Authority. Thematic analysis was conducted on audio-recorded interviews with cervical cancer patients, ensuring confidentiality and accuracy while discerning significant patterns and themes in their narratives. Results/findings: Emotional experiences ranged from anxiety to gratitude. Psychological challenges encompassed coping mechanisms, stress management, emotional adjustments, and treatment-related fears. Socially, community support, workplace accommodations, and healthcare provider roles were key. Physical experiences revealed side effects managed through coping strategies. Financial challenges significantly impacted individuals and families. Conclusions and recommendations: The study revealed that cervical cancer patients undergoing chemotherapy face complex challenges spanning emotional, psychological, social, physical, and financial domains, underscoring the imperative for comprehensive patient-centered care. Recommendations suggest focusing on financial aid for cancer patients and tackling treatment expenses and insurance issues. The Cancer Diseases Hospital should establish multidisciplinary teams for holistic care, and enhance patient education efforts. Nurses should adopt strategies integrating cultural competence and patient-centered care to address diverse challenges during chemotherapy. These aim to enhance the well-being and care quality of Cervical Cancer patients.

Seizures in Asphyxiated Term Newborns Based on Admission Thompson Score at the Women and Newborn Hospital, University Teaching Hospitals in Lusaka, Zambia.

Purpose: The main purpose of the study was to investigate seizures in asphyxiated term neonates based on the admission Thompson score at the University of Zambia, Women and New-born Neonatal Intensive Care Unit. Methodology: A cross-sectional descriptive study design was used to conduct the study between (May 2022 to April 2023) in the Neonatal Intensive Care Unit (NICU) at the University Teaching Hospital for Women and Newborns in Lusaka Zambia. Stratified sampling was used to collect 217 files of neonates born at the tertiary facility as well as those referred from other centres with Apgar scores of ≤ 7 at one and five minutes of life. A structured questionnaire was used to collect data from medical records, the Thompson score (TS) was assessed on admission and details of neonatal seizures were analyzed using chi-square, fisher’s exact test and multivariable logistic regression. Findings: On admission, TS assessment was conducted on all 217 neonates of which 169 (77.9 %) neonates were classified with mild HIE,45 (20.9 %) moderate and 3(1.4 %) with severe HIE. Most neonates (77.4%) presented with seizures on admission. Results of the chi-square and fisher's exact tests showed that Thompson's score on admission was significantly associated with seizure occurrence (p=0.001). On multivariable binary logistic regression neonates with moderate HIE had over 10 times more odds of seizure occurrence compared to neonates with a mild HIE score (aOR=10.6, CI=2.32, 48.1, p=0.002). A unique contribution to theory, practice, and policy: The study concluded that seizures were present in all categories of HIE, the majority of who were classified with moderate HIE based on the Thompson score. Therefore, improving the quality of intrapartum care at the Women and Newborn Hospital can significantly reduce the occurrence of asphyxia and its complication.

Single-test syphilis serology: A case of not seeing the forest for the trees

Introduction There have been few empirical studies for diagnostic test accuracy of syphilis using a sequence of rapid tests in populations with low prevalence of syphilis such as pregnant women. This analysis describes syphilis test positivity frequency among pregnant women at an antenatal clinic in Zambia using a reverse-sequence testing algorithm for antenatal syphilis screening. Methods Between August 2019 and May 2023, we recruited 1510 pregnant women from a peri-urban hospital in Lusaka, Zambia. HIV positive and HIV negative women were enrolled in a 1:1 ratio. Blood collected at recruitment from the pregnant mothers was tested on-site for syphilis using a rapid treponemal test. Samples that tested positive were further tested at a different laboratory, with rapid plasma reagin using archived plasma. Results Of the total 1,421 sera samples which were screened with a rapid treponemal test, 127 (8.9%) were positive and 1,294 (91.1%) were negative. Sufficient additional samples were available to perform RPR testing on 114 of the 127 (89.8%) RDT positive specimens. Thirty-one (27.2%) of these 114 were reactive by RPR and 83 (72.8%) were negative, resulting in a syphilis overtreatment rate of 3 fold (i.e, 84/114). Insufficient sample or test kit availability prevented any testing for the remaining 89 (5.9%) participants. Conclusion Use of only treponemal tests in low prevalence populations, like pregnant women, subjects individuals with non-active syphilis to the costs and possible risks of overtreatment. The use of the dual treponemal and non-treponemal tests would minimize this risk at some additional cost.

The effects of HIV and oncogenic human papillomavirus on the tumor immune microenvironment of penile squamous cell carcinoma.

Penile squamous cell carcinoma (PSCC) occurs more frequently in some developing countries compared to developed countries. Infection with HIV and/or high-risk human papillomavirus (hrHPV) are risk factors for penile cancer development. The tumor microenvironment of PSCC may predict prognosis and may inform on the best targets for immunotherapy. We evaluated the immune microenvironment of penile tumors histologically, and determined whether and/or how HIV and/or hrHPV infections affect this tumor microenvironment. We conducted a prospective analytical cross-sectional study in which penile cancer tumors from 35 patients presenting at the University Teaching Hospital in Lusaka, Zambia were histologically staged and assessed for presence of tumor infiltrating immune cells and expression of immune checkpoints. Immunohistochemistry was used to evaluate immune checkpoints and infiltrating immune cells, while multiplex real-time polymerase chain reaction was used for hrHPV genotyping. The median age of all participants was 55 years. About 24% had advanced histological stage, 83% were HIV+, and 63% had hrHPV detected in their tumors using multiplex real-time polymerase chain reaction. PDL1 expression was significantly higher in HIV- participants than HIV+ participants (p = 0.02). Tumors with multiple hrHPV infections had a significantly higher number of cells expressing TIM3 than those with one hrHPV (p = 0.04). High grade tumors had a significantly higher infiltrate of FoxP3+ cells (p = 0.02), CD68+ cells (p = 0.01), CD163+ cells (p = 0.01), LAG3+ cells (p = 0.01), PD1+ cells (p = 0.01) and TIM3+ cells (p = 0.03) when compared with low grade tumours. There was significant moderate to strong positive correlation of cells expressing PD1 and LAG3 (⍴ = 0.69; p = 0.0001), PD1 and TIM3 (⍴ = 0.49; p = 0.017) and TIM3 and LAG3 PDL1 (⍴ = 0.61; p = 0.001). In conclusion, the tumor microenvironment of penile squamous cell carcinoma seems to be affected by both HIV and HPV infections. TIM3 appears to be a potential therapeutic target in PSCC patients with hrHPV infections.

Characteristics of Adults with Stroke and Post Stroke Epilepsy at the University Teaching Hospital in Lusaka, Zambia (P3-15.002)

Characteristics of Adults with Stroke and Post Stroke Epilepsy at the University Teaching Hospital in Lusaka, Zambia (P3-15.002)

EEG and Seizure Characteristics of Adults with Neurocysticercosis-associated Epilepsy at the University Teaching Hospital in Lusaka, Zambia (P6-1.005)

EEG and Seizure Characteristics of Adults with Neurocysticercosis-associated Epilepsy at the University Teaching Hospital in Lusaka, Zambia (P6-1.005)

CAREGIVERS’ EXPERIENCES IN CARING FOR CHILDREN WITH HYDROCEPHALUS AT THE UNIVERSITY TEACHING HOSPITALS, LUSAKA ZAMBIA

Background: Hydrocephalus represents a serious public health problem and a major cause of disability as well as poor quality of life. Children who are born with hydrocephalus or acquire it later in life are often cared for in the home setting by a family caregiver, and in some cases by professional caregivers. Care giving can often stressful and can result in negative effects on the family caregiver. &#x0D; Objective: The aim of this study was to explore caregivers’ experiences in caring for children with hydrocephalus seen at the University Teaching Hospitals in Lusaka, Zambia. &#x0D; Methods: A qualitative phenomenological study design was adopted. This study was conducted at the University Teaching Hospitals in Lusaka, Zambia, among a population of family caregivers for children with hydrocephalus. Purposeful sampling method was used to select ten (10) participants. Data were collected through face-to-face in-depth interviews using a semi-structured interview guide. Data obtained from the interviews was transcribed verbatim and analyzed using thematic analysis. All ethical considerations were upheld accordingly.&#x0D; Results: The findings of this study revealed that caregivers for children with hydrocephalus experience a great deal of psychological, social and socioeconomic challenges in caring for their children. These experiences range from emotional distress; sleep deprivation; deterioration of social support; to financial impoverishment associated with needs and expenses of caring for a child with hydrocephalus.&#x0D; Conclusion: While most studies and interventions primarily focus on the restoration of function in children with hydrocephalus, it is important to develop and/or strengthen programmes that provide holistic support for caregivers of children with hydrocephalus because of the various experiences associated with caring for children with hydrocephalus.&#x0D; Key words: caregivers, experiences, care-giving, children, hydrocephalus

COVID-19 mortality sentinel surveillance at a tertiary referral hospital in Lusaka, Zambia, 2020-2021.

Deaths from COVID-19 likely exceeded official statistics in Zambia because of limited testing and incomplete death registration. We describe a sentinel COVID-19 mortality surveillance system in Lusaka, Zambia. We analyzed surveillance data on deceased persons of all ages undergoing verbal autopsy (VA) and COVID-19 testing at the University Teaching Hospital (UTH) mortuary in Lusaka, Zambia, from April 2020 through August 2021. VA was done by surveillance officers for community deaths and in-patient deaths that occurred <48 hours after admission. A standardized questionnaire about the circumstances proximal to death was used, with a probable cause of death assigned by a validated computer algorithm. Nasopharyngeal specimens from deceased persons were tested for COVID-19 using polymerase chain reaction and rapid diagnostic tests. We analyzed the cause of death by COVID-19 test results. Of 12,919 deceased persons at UTH mortuary during the study period, 5,555 (43.0%) had a VA and COVID-19 test postmortem, of which 79.7% were community deaths. Overall, 278 (5.0%) deceased persons tested COVID-19 positive; 7.1% during waves versus 1.4% during nonwave periods. Most (72.3%) deceased persons testing COVID-19 positive reportedly had fever, cough, and/or dyspnea and most (73.5%) reportedly had an antemortem COVID-19 test. Common causes of death for those testing COVID-19 positive included acute cardiac disease (18.3%), respiratory tract infections (16.5%), other types of cardiac diseases (12.9%), and stroke (7.2%). A notable portion of deceased persons at a sentinel site in Lusaka tested COVID-19 positive during waves, supporting the notion that deaths from COVID-19 might have been undercounted in Zambia. Many had displayed classic COVID-19 symptoms and been tested before death yet nevertheless died in the community, potentially indicating strained medical services during waves. The high proportion of cardiovascular diseases deaths might reflect the hypercoagulable state during severe COVID-19. Early supportive treatment and availability of antivirals might lessen future mortality.

Accuracy of diagnosing early ocular surface squamous neoplasia using methylene blue in Zambia

Background: Ocular surface squamous neoplasia (OSSN) includes pre-invasive and invasive squamous lesions of the ocular surface. Current diagnosis relies on surgical excision and histology, with potential complications. This study assessed the reliability of methylene blue staining as a non-invasive diagnostic tool for OSSN at the University Teaching Hospitals – Eye Hospital in Lusaka, Zambia.Aim: This study aimed to evaluate the accuracy of methylene blue staining in diagnosing OSSN.Setting: The study took place at the University Teaching Hospitals-Eye Hospital, Lusaka, Zambia, between February 2022 and February 2023.Methods: A cross-sectional study design compared methylene blue staining to histology in diagnosing OSSN. Participants underwent staining before excision biopsy on the same day. Data were analysed using SPSS and SAS OnDemand, employing Chi-square and McNemar’s tests for paired diagnostic test comparison.Results: The study involved 79 participants, with a high OSSN prevalence (62%), primarily among females (62%), with an average age of 40. Ocular surface squamous neoplasia correlated significantly with employment (P = 0.02) and HIV infection (P = 0.03). The most common symptom was nasal conjunctival growth. Duration of symptoms did not consistently indicate disease severity. Methylene blue staining showed 87.8% sensitivity, 83.33% specificity, a positive predictive value of 89.6%, and a negative predictive value of 80.7%.Conclusion: Methylene blue staining is an effective alternative diagnostic method for OSSN, offering high accuracy. However, it cannot replace histology.Contribution: This study contributes valued insights into the reliability of methylene blue staining for diagnosing OSSN and delineation of surgical margins during excision biopsy.

Primary headache disorders among people living with HIV in Lusaka, Zambia

ObjectiveWe completed a cross-sectional survey study to determine headache prevalence and its association with HIV characteristics among people living with HIV (PLHIV) in Lusaka, Zambia. BackgroundHeadaches are common but their association with HIV status is unknown. MethodsThe HARDSHIP survey, a headache epidemiology questionnaire previously validated in Zambia, was distributed during a 3-month period to 3666 consecutive adult PLHIV attending routine clinic appointments at the Adult Infectious Diseases Centre at the University Teaching Hospital in Lusaka, Zambia. HIV disease characteristics were abstracted from their charts. Results1015 (27.7%) participants responded to the survey. Adjusted for age, 64% reported having a headache within the last year unrelated to another illness. Among participants, 201 met criteria for migraine (20%), 259 for tension-type headache (26%), 18 for probable medication-overuse headache (2%), and 121 for undetermined headache (12%). Prevalence for tension-type headache was significantly higher than that of migraine (P < 0.001). After adjusting for age and sex, higher CD4 counts were associated with migraine. No other associations were observed between overall headache or headache type with HIV disease characteristics including CD4 count, viral load, antiretroviral regimen, and time since HIV diagnosis. ConclusionsHeadaches are highly prevalent among this cohort of PLHIV in Zambia. Optimizing headache treatment and integrating it into routine HIV care may improve quality of life for a substantial proportion of PLHIV in Zambia.

Factors Influencing Physiotherapy Attendance among Stroke Patients during the COVID-19 Era

Background: Stroke can greatly impact both physical capabilities and overall quality of life (An and Shaughnessy, 2011, Bártlová et al., 2022). While the 2019 novel Coronavirus (COVID-19) significantly impacted various sectors including access to healthcare services, access to routine stroke rehabilitation were not well documented in referral hospitals of Lusaka. Objectives: To assess factors affecting routine rehabilitation of stroke survivors during COVID-19 in referral hospital settings of Lusaka. Method: This was a cross-sectional study involving 26 stroke survivors who were present before and during the COVID-19 pandemic lockdown. All respondents were from 5 referral hospitals in Lusaka. Data was collected using researcher-administered structured questionnaires and analyzed using SPSS v27.0. Bivariate analysis was carried out using chi-squared and Fishers exact test of association. Results: There was an overall higher stroke patient response rate from females (57.7%, n=15) than males (42.3%, n=11). The outcome variable was significantly associated with only two intrinsic factors namely fear (mean rank of 1.69) seconded by patients’ perception of physiotherapist’s attitude (mean rank of 2.50). An overall decline in physiotherapy attendance from 2-3 times a week (69.2%, n=18) to once in a week (54%, n=14) was observed. Conclusion: A notable shift inclination towards home-based rehabilitation raises important considerations for healthcare practitioners and policymakers. It prompts a critical examination of the potential consequences of this shift on the quality and effectiveness of rehabilitation. Clinical implications: The identified barriers, particularly fear, highlight the need for targeted interventions. The study serves as a reminder of the complexities inherent in balancing patient needs, safety considerations, and healthcare system capacities.