Hospital In Lusaka Research Articles

High-tech and low-tech orthopaedic surgery in Sub-Saharan Africa.

BackgroundZambia's governmental health system suffers from shortage of surgical supplies and poor management skills for the sparse resources at hand. The situation has been worsened by the dual epidemics of HIV disease and tuberculosis. On the other hand the private medical sector has benefited greatly from less bureaucracy under the goverment of the Movement for Multi-party Democracy.DiscussionThe Zambian-Italian Orthopaedic Hospital in Lusaka is a well organized small unit providing free treatment of physically disabled children. The running costs are met from the fees charged for private consultations, supplemented by donations. State of the art surgical techniques are being used for congenital and acquired musculo-skeletal abnormalities. Last year 513 patients were operated upon free of charge and 320 operations were performed on private patients.

Intestinal and systemic infection, HIV, and mortality in Zambian children with persistent diarrhea and malnutrition.

Persistent diarrhea-malnutrition syndrome is a complex of infection and immune failure that involves protein, calorie and micronutrient depletion, and metabolic disturbances. We report an analysis of the impact of HIV infection on infectious disease, clinical presentation, and mortality in Zambian children with persistent diarrhea and malnutrition. Two hundred children (94 boys and 106 girls, 6-24 months old) were examined on admission to the malnutrition ward of University Teaching Hospital in Lusaka, Zambia. There was then 1 month of follow-up. Antibodies to HIV were found in 108 of the children (54%). The common intestinal infections (Cryptosporidium parvum [26%] and nontyphoid Salmonella spp [18%]), septicemia (17%), and pulmonary tuberculosis confirmed by gastric lavage (13.5%) were not significantly more common in HIV-seropositive than in HIV-seronegative children. HIV-seropositive children were more likely to have marasmus whereas HIV-seronegative children were more likely to have kwashiorkor. Weight-for-age z scores at nadir (postedema) were lower in HIV-seropositive children (median, -4.4; interquartile range [IQR], -5.0 to -3.8) than in HIV-seronegative children (median, -3.7; IQR, -4.2 to -3.1; P < 0.0001). Height-for-age and weight-for-height z scores and mid-upper arm circumference showed a similar difference. Of the 200 children, 39 (19.5%) died within 28 days; cryptosporidiosis and marasmus were the only independent predictors of death. Although intestinal and systemic infections did not differ for HIV-seropositive and HIV-seronegative children, HIV influenced nutritional states of all children. Cryptosporidiosis and marasmus were associated with higher mortality.

Diagnosis of bacterial enteric infections in children in Zambia

The bacterial pathogens commonly responsible for diarrhea in children under the age of 5 in Zambia were identified and the most effective methods of diagnosis of such infections in laboratories with limited resources, such as those in developing countries, are recommended. Stool samples were collected from children under the age of 5 years who visited the Diarrhoea Training Unit (DTU) of Zambia University Teaching Hospital in Lusaka, Zambia, between May 1992 and May 1993. A total of 639 children were evaluated for the presence of bacterial infection using standard culture media. The prevalence of bacterial pathogens was compared with that reported from other developing countries. Pathogenic strains of Escherichia coli were isolated from 95 (14.9%) children, Shigella species from 65 (10.2%) children, and Vibrio cholerae from 21 (3.3%) children. The presence of visible blood in the feces was an early indicator of the presence of shigellosis. E. coli, Shigella species and Vibrio cholerae were the major causes of bacterial diarrhea in the Zambian children studied. Research is required to determine the prevalence of such enteropathogenic strains. The use of adequate diagnostic procedures is indispensable to appropriate management. The recommendations have been prepared as a manual for the identification of enteropathogenic bacteria to be used in laboratories with limited resources, such as in developing countries.

Characterization of VP6 subgroup, VP7 and VP4 genotype of rotavirus strains in Lusaka, Zambia.

In a previous study, rotavirus infection was determined in young children at the University Teaching Hospital in Lusaka. In this study, selected rotavirus strains were characterized by monoclonal antibody assay to the VP6 subgroup antigen present and by hybridization analysis of the VP7 and VP4 genes carried by the virus. The majority of the strains were characterized as a VP6 subgroup II, VP7 serotype G1 strain with a long electropherotype and bearing the VP4 P8 genotype. A further four minor rotavirus strains with a long RNA electropherotype and subgroup II antigen were also observed to be circulating bearing G1 or G4 VP7 genes and the VP4 P8 genotype. Two electrophoretic strains with differing short RNA electropherotypes and subgroup I antigenicity were also present. These strains hybridized to the VP7 type G2 and VP4 P4 genotype probes.

Safe motherhood at risk?

Health professionals' negative attitudes toward clients often exacerbate the problems women face in terms of health status and access to health care. Thus, the health professionals can themselves be obstacles to women seeking the health care they need. A key challenge to midwives, in addition to providing technically competent services, is gaining insight into the people for whom they are responsible so that childbirth traditions are treated with respect and women are offered dignity. Safe motherhood requires intersectoral collaboration. Many innovative approaches to safe motherhood are based on the community's participation in planning services that meet the needs of women. Other approaches are based on decentralization of services. For example, a large university teaching hospital in Lusaka, Zambia, set up birthing centers around the city to take the pressure off the hospital. Midwives head up these centers, which are close to the women's homes. Decentralization of delivery services has improved the physical and emotional outcomes for mothers and newborns. Midwives must be prepared to articulate concerns about inequalities and deficiencies in the health care system in order to persuade the government to change. Women, including midwives, need to form multidisciplinary alliances to work together to effect change. The front-line workers in maternity care are midwives. They should adopt the following strategies to become even more effective in their efforts to make motherhood safer. They should listen to what women say about their needs. They should scale services to a manageable, human scale. They should learn the skills to become politically active advocates. They should work with other midwives, women, leaders, and other professional groups. Motherhood can be safe when women have more control over their own decision making, the education to liberate themselves to make their own decisions, and access to skilled care.

Abortion as a public health problem in Zambia.

Contraception is not widely accepted in Zambia. Many unwanted pregnancies therefore result. Abortion law in Zambia allows a woman to seek the termination of pregnancy when her own life and health, or the health of other members of her family, may be put at risk by the pregnancy, or when the fetus may be expected to be damaged or diseased. Even so, many illegal abortions are performed each year in Zambia. The majority of women seeking to terminate an unwanted pregnancy seek help from friends, go to traditional healers or "wise women", or find and take the abortifacients of folklore or muti. This approach may either succeed or result in major complications, including death. Induced abortion is, however, provided at the main teaching hospital in Lusaka without anesthesia, on a day care basis with neither pain relief, sedation, nor follow-up. Unsafe abortion is a major cause of maternal mortality in Zambia, with maternal mortality estimated to be approximately 500 per 100,000 live births; abortion accounts for approximately 30% of such mortality. If available figures reasonably reflect the true situation, then approximately 2300 women die in childbirth or of factors related to pregnancy every year, and 700-1000 deaths are directly attributable to abortion. There is a need to improve the practice of family planning and the provision of sex education in the country.

Measles infection in hospitalized children in Lusaka, Zambia.

A 2-year hospital-based survey of measles infections were carried out at the University Teaching Hospital (UTH) in Lusaka, Zambia from January 1992 to December 1993. During this period, a total of 1066 children with a clinical diagnosis of measles were admitted to the paediatric isolation ward at UTH. Measles cases were seen throughout both 1992 and 1993. However, there was a peak from September to December, 1992. The number of cases decreased with age, and 370 (34.7%) were under 1 year old. It is noteworthy that 203 (19.0%) were less than the 9 months of age which is the recommended time for measles vaccination in Zambia. The overall case fatality rate was 12.6%, and was higher in children aged 0-3 years (14.3%) than in those aged 4 years and above (6.7%). Measles vaccination status could be checked from the child's immunization card for 343 measles cases over 9 months of age, 118 (34.4%) of these having previously received measles vaccine. Vaccinated children had a significantly lower case fatality rate (6.4%) than the unvaccinated group (17.0%). This suggests that while measles vaccine cannot prevent infection, it can reduce the severity of infection.

Tuberculin sensitivity and HIV-1 status of patients attending a sexually transmitted diseases clinic in Lusaka, Zambia: a cross-sectional study

A cross-sectional study to estimate the prevalence of latent tuberculosis (TB) in a group of Zambians at high risk of human immunodeficiency virus type 1 (HIV-1) infection and to examine the effect of HIV-1 infection on the tuberculin response was conducted in the University Teaching Hospital in Lusaka, Zambia during July to September 1990. Patients were selected from those presenting to the out-patient clinic for first referral with either sexually transmitted or skin diseases. 268 adults were included in the study; 158 (59%; 95% confidence interval [CI] = 53–65%) were HIV-1 antibody positive. Of 82 HIV-1 negative participants who returned for Mantoux skin test reading, 51 (62%; 95% CI = 57–67%) had a positive test reaction (diameter ⩾10 mm) after receiving 2 units of RT-23 tuberculin. Of 106 HIV-1 positive participants who returned, only 32 (30%; 95% CI = 26–34%) had a diameter ⩾10 mm. Nine (28%) of the HIV-1 positive and Mantoux positive participants had large reactions ⩾30 mm, compared to 4 (8%) of the HIV-1 negative, Mantoux positive participants ( P = 0.03). Results in the HIV-1 negative group indicated a prevalence of latent TB of 62% in this population. HIV-1 infection was associated with a much higher frequency of negative response to tuberculin and with a few large skin test responses. Thus, in populations where HIV seropositivity is high, Mantoux skin tests cannot be used to assess those with latent TB who might benefit from chemoprophylaxis.

The impact of HIV on infectiousness of pulmonary tuberculosis: a community study in Zambia.

To examine the impact of HIV on infectiousness of pulmonary tuberculosis (TB). A cross-sectional tuberculin survey carried out among household contacts of HIV-1-positive and negative patients with bacteriologically confirmed pulmonary TB. Contacts were also examined for active TB. Index cases were recruited from patients attending the University Teaching Hospital in Lusaka, Zambia and household contacts were examined during visits to their homes within Lusaka. A total of 207 contacts of 43 HIV-positive patients, and 141 contacts of 28 HIV-negative patients with pulmonary TB were examined. Proportion of contacts of HIV-positive and negative index cases with a positive tuberculin response (diameter of induration > or = 5 mm to a dose of 2 tuberculin units). Fifty-two per cent of contacts of HIV-positive pulmonary TB patients had a positive tuberculin response compared with 71% of contacts of HIV-negative patients (odds ratio, 0.43; 95% CI, 0.26-0.72; P < 0.001). This difference persisted after allowing for between-household variations in the tuberculin response. Tuberculin response in the contact was related to age of contact, intimacy with the index case and crowding in the household. However, the effect of HIV status of the index case was not confounded by these variables. Tuberculin response in the contact was also related to the number of bacilli seen in the sputum smear of the index case which partially explained the effect of HIV status of the index case. Active TB was diagnosed in 4% of contacts of HIV-positive and 3% of contacts of HIV-negative cases, respectively (P = 0.8). HIV-positive patients with pulmonary TB may be less infectious than their HIV-negative counterparts and this may partly be explained by lower bacillary load in the sputum.

Case definitions for paediatric AIDS: the Zambian experience.

For the purpose of surveillance of the acquired immunodeficiency syndrome (AIDS) in developing countries, the World Health Organization (WHO) has recommended criteria for the clinical case definition of AIDS in adults and children. In a preliminary examination of children in Zambia a number of patients with obvious AIDS did not fit the published WHO case definition for paediatric AIDS. Based on this the Zambia National AIDS Surveillance Committee designed local criteria for the clinical case definition of paediatric AIDS. We compared the Zambian criteria with the WHO criteria for the diagnosis of paediatric AIDS by studying 134 consecutively admitted children to one of the paediatric wards at the University Teaching Hospital in Lusaka. Twenty-nine of the patients were HIV-1 seropositive and 105 were HIV-1 seronegative. Among the 29 HIV-seropositive patients, the Zambian criteria identified 23, and the WHO criteria identified 20 children as having AIDS. The 105 HIV-seronegative children were classified as having AIDS in 9 cases by the Zambian criteria and in 38 cases by the WHO criteria. These results give the Zambian criteria for the diagnosis of AIDS a sensitivity of 79.3%, a specificity of 91.4% and a positive predictive value of 86.8% compared to a sensitivity of 69%, specificity of 64% and a positive predictive value of 38% for the WHO criteria. The current WHO criteria are inadequate for the diagnosis of paediatric AIDS. The need to refine the WHO criteria for the diagnosis of paediatric AIDS is discussed.

Psychosocial aspects of unwed adolescent pregnancy in Lusaka, Zambia.

Adolescent pregnancy in Zambia contributed to 22.5% of the pregnancies seen at the University Teaching Hospital in Lusaka in 1979/80. Some of the psychosocial factors in teenage pregnancy are examined among 80 teenage unmarried adolescents appearing at the prenatal clinic of the University Teaching Hospital (40) and at a low-income prenatal clinic in Lusaka (40). Participants were matched with controls on the basis of age, education, and socioeconomic status. In-depth interviews were conducted in 1987, when the girls were in their second to fifth month of pregnancy. Analysis was conducted on sex socialization, knowledge of and attitudes toward contraception, socioeconomic factors, and family coherence as preventive aspects of teenage pregnancy. The reaction to the pregnancy and management of the pregnancy were also determined. The mean age of menarche was 13.2 and 13.5 years for the participants and controls, respectively, which is somewhat lower than reports among other African populations. A formal initiation ceremony was conducted for 3% of participants and 8% of controls. Participants had 2.4 sex partners, and controls had 0.5 sex partners. Motives for getting pregnant were: economic support (85%); being in love and hoping for marriage (67%); peer pressure (54%);l and three other reasons. Both groups were similar in their knowledge of, attitudes toward, and use of contraception. 28% of the pregnant girls reported knowing about "counting days," but only 1% knew how to do this. Only 6% had knowledge of contraception. About 75% came from low-income families. The average age of formal education was 6.2 years for participants and 6.8 years for controls. 68% were in school at the time of the pregnancy; 29% dropped out of school before the end of the pregnancy. 52% of the male partners were of low socioeconomic status. 61% of pregnant girls lived with both real parents. 6% reported wanting to become pregnant. 67% of male partners had a negative reaction to the pregnancy; 16% rejected the pregnancy. 63% of mothers agreed to care for the baby while their daughters returned to school. The control group appears to have had stronger responses to avoid sexual encounters. Traditional social control has been replaced by "ignorance and secrecy." There has been a breakdown in the means of acquiring information about healthy reproduction and about birth control.

Improving Abortion Care in Zambia

In this commentary, the impact of the introduction of manual vacuum aspiration (MVA) for incomplete abortion patients and for early uterine evacuation is discussed for the University Teaching Hospital in Lusaka, Zambia. This 3-year training and service delivery program was begun in 1988 after it was clear that 15% of maternal deaths were due to illegally induced abortion. The prior procedure of dilation and curettage (D and C) required use of the main operating room and general anesthesia, which resulted in severe congestion and treatment delays. As a result of the new MVA procedure, congestion has decreased substantially, treatment is safer and more timely, and the staff's ability to provide abortions has increased. Family planning counseling is provided to postabortion patients in a more thorough fashion, and the savings in time has improved the quality of patient-staff interactions. Specifically, the patient flow has improved from a 12-hour wait to a 4-6 hour wait and rarely requires overnight hospitalization. The demand for the main operating room had decreased which frees space, time, and commodities for other gynecological treatment. The shorter procedure and release time means a minimal loss of earnings and productivity, and allows for greater privacy in explaining absences to families, schools, or employers. The improved quality of are is reflected in the figures for number treated, i.e., in 1989, 74% were treated with MVA for incomplete abortion 12 weeks and pregnancy termination 8 weeks compared with 26% treated with D and C. In 1990, the figures were 86% with MVA and 14% with D and C. The likelihood of complications from hemorrhage and sepsis have also been reduced. The MVA procedure is also less traumatic for the patient. The increased access to safe legal abortion services is reflected in the ratio of induced to incomplete abortions between 1988-1990 (1:25 to 1:5). Family planning counseling is provided by a full-time counselor who counsels preabortion and postabortion and schedules 2-week follow-up appointment. These achievements have been made in spite of a declining economy and difficulties in the health sector. Unfortunately, conditions throughout Zambia are such that access to safe abortion is restricted. Effort is underway to expand this MVA training and service delivery in provincial hospitals and to conduct research on other effective strategies to reduced unsafe abortion and improve family planning care.

Apparent vertical transmission of human immunodeficiency virus type 1 by breast-feeding in Zambia

To evaluate the epidemiologic significance of breastfeeding to the transmission of human immunodeficiency virus (HIV) in a country with a high prevalence of HIV infection, the 1720 seronegative women who delivered at the University Teaching Hospital in Lusaka, Zambia, in a 3- month period in 1987 were enrolled in a longitudinal study. Only 634 (37%) of these women returned for testing at the 1-year follow-up point. Of these, 19 (3%) had become seropositive. The infection was asymptomatic in all 19 women at the time of the 1-year follow-up; however, 5 of these women soon developed generalized persistent adenopathy and 3 had spontaneous abortions during the year in which seroconversion occurred. 30 of the spouses of the women in the study sample were HIV-positive; the relative risk of seroconversion was 3.84 in women with HIV-infected spouses compared to those with HIV-negative spouses. Other significant risk factors for HIV seroconversion included: history of genital ulceration after delivery (relative risk, 15.51), use of a cloth to remove vaginal secretions during intercourse (dry sex) (relative risk, 37.95), and blood transfusion (relative risk, 10.89). 3 infants born to these 19 women also seroconverted; 2 years after seroconversion, only 1 of the 3 infected children was symptomatic (persistent, generalized lymphadenopathy). Other sources of HIV infection 9e.g., scarification, blood transfusions, use of contaminated needles during immunization) aside from breastfeeding were not recorded in these 3 infants. Although there is a high prevalence of HIV infection in Zambia, the health benefits of breastfeeding (in terms of the prevention of mortality from diarrheal disease) still outweigh the small risk of HIV transmission.

Impact of HIV on tuberculosis in Zambia: a cross sectional study.

To examine the contribution of HIV infection to the apparently increasing incidence of tuberculosis in central Africa. Cross sectional study. Outpatient clinic in teaching hospital, Lusaka, Zambia. 346 Adult patients with tuberculosis. Overall, 206 patients (60%; 95% confidence interval 54% to 65%) were positive for HIV: in one or both assays used. The peaks for both tuberculosis and HIV infection were among men aged 25-34 years and women aged 14-24 years. Of patients with confirmed pulmonary tuberculosis, 73/149 (49%; 41% to 57%) were positive for HIV; 67/83 (81%; 70% to 89%) patients with pleural disease and 16/19 (84%; 60% to 97%) patients with pericardial disease were positive. HIV positive patients with positive sputum culture were less likely to have had a positive sputum smear, and their chest x ray films less often showed classic upper zone disease or cavitation. Of 72 patients who fulfilled clinical criteria for AIDS, 17 were negative for HIV. The high prevalence of HIV in patients with tuberculosis suggests that an epidemic of reactivating tuberculosis is arising in those who are infected with HIV. The redirection of public health priorities towards tuberculosis would focus on a major treatable and preventable complication of the AIDS epidemic.

Perinatal transmission of HIV-I in Zambia.

OBJECTIVE--To determine the occurrence of vertical transmission of HIV-I from women positive for the virus and the prognosis for their babies. DESIGN--Women presenting in labour were tested for HIV-I. Their newborn babies were also tested. Women positive for the virus were followed up with their babies for two years. SETTING--Teaching hospital in Lusaka, Zambia. SUBJECTS--1954 Women, of whom 227 were seropositive. Of 205 babies, 192 were positive for HIV-I. After birth 109 seropositive mothers and their babies and 40 seronegative mothers and their babies were available for follow up. MAIN OUTCOME MEASURES--Serological examination of mothers and their babies by western blotting. Birth weight and subsequent survival of babies. Women and babies were tested over two years for signs of seroconversion and symptoms of infection with HIV, AIDS related complex, and AIDS. RESULTS--Of the 109 babies born to seropositive mothers and available for follow up, 18 died before 8 months, 14 with clinical AIDS. Of the 91 remaining, 23 were seropositive at 8 months. By 24 months 23 of 86 surviving babies were seropositive, and a further five infected babies had died, four were terminally ill, 17 had AIDS related complex, and two had no symptoms. The overall rate of perinatal transmission was 42 out of 109 (39%). The overall mortality of infected children at 2 years was 19 out of 42 (44%). Before the age of 1 year infected children had pneumonia and recurrent coughs, thereafter symptoms included failure to thrive, recurrent diarrhoea and fever, pneumonia, candidiasis, and lymphodenopathy. All babies had received live attenuated vaccines before 8 months with no adverse affects. CONCLUSIONS--Vertical transmission from infected mothers to their babies is high in Zambia and prognosis is poor for the babies. Perinatal transmission and paediatric AIDS must be reduced, possibly by screening young women and counselling those positive for HIV-I against future pregnancy.

Midwifery Care Routines and Prevention of Heat Loss in the Newborn: A Study in Zambia

A number of midwifery practices might if properly applied prevent unnecessary heat loss in the newborn. The care of 62 normal newborns was observed following birth at 4 levels of institutions the majority being at the University Teaching Hospital in Lusaka. At discharge after an average of 14 hours 1/2 the babies had a body temperature below 36 degrees C i.e. mildly hypothermic. There was a significant decrease in body temperature between 30 and 120 minutes postpartum. Proper wiping and wrapping of the babies was rarely carried out. Unnecessary separation of babies from their mothers and no extra provision of heat during suction at the resuscitation table were common. Among both mothers and staff there was a lack of understanding of the newborns non-shivering thermogenesis. Traditional practices were often more appropriate than so-called modern. Midwifery education did not positively affect practices. With available resources it should be possible to limit neonatal heat loss. (authors)

Reproductive Mortality in Lusaka, Zambia, 1982-1983

In this study, age- and parity-specific birth data were used to estimate maternal mortality rates for 1982-83 at University Teaching Hospital in Lusaka, Zambia. Overall, 60 maternal deaths occurred during pregnancy or within 42 days after pregnancy termination, and four pregnancy-related deaths occurred more than 42 days after pregnancy termination. Nine of the 60 maternal deaths were caused by induced abortion, one by spontaneous abortion, twelve by hypertensive disease of pregnancy, ten by hemorrhage, nine by puerperal sepsis, and four by ectopic pregnancy. Of the 12 women who died from nonobstetric causes, one committed suicide because of an unwanted pregnancy. Women aged 35 years and older or who had had four previous pregnancies had a higher risk of dying than other women, especially by hemorrhage. The chief risk factors included not using an effective method of contraception, using an unsafe means to terminate unintended pregnancies, lack of prenatal care, refusing a blood transfusion (for religious reasons), and inadequately treating hypertensive disease of pregnancy. Overall, 31 of 60 women who died lacked adequate or appropriate medical care and 19 failed to obtain available health care. Medical management problems appeared to occur more frequently during the night-time medical shift.

Early congenital syphilis: clinico-radiologic features in 202 patients.

Venereal syphilis is highly prevalent among women of child-bearing age in Zambia. It is estimated to contribute 25-30% of the perinatal mortality rate of 50 per 1,000 births at the University Teaching Hospital in Lusaka. Because of multisystem involvement, early congenital syphilis, the offshoot of maternal syphilis, has varied criteria for its diagnosis. Therefore, in an attempt to draw guidelines for an easier and more reliable diagnosis, the authors analyzed the clinico-radiologic features of congenital syphilis in 202 patients. Although all infants were under the age of six months, there were several significant differences in the manifestations of the disease among neonates and the postneonates. The younger infants had a higher incidence of jaundice and mortality, whereas joint swellings, skin rash, snuffles, anemia, and periosteal reaction visible in x-rays of long bones were typical findings among the older group. The radiologic changes were seen in greater than 95% of patients in both groups. About 84% of mothers had attended prenatal clinics, but less than 20% of the women had been tested for syphilis. Since early congenital syphilis is common in many parts of the world and since all serologic tests have limitations, awareness of appropriate diagnostic criteria is recommended for all medical personnel.

Gonococcal infection in women with pelvic inflammatory disease in Lusaka, Zambia

Gonococcal infection is the most common disease in both male and female patients seen at the Sexually Transmitted Disease Clinic at the University Teaching Hospital in Lusaka, the capital city of Zambia. In this study, 100 women admitted to the gynecology wards for management of pelvic inflammatory disease were screened for gonococcal infection using an endocervical culture on modified Thayer-Martin medium. Forty-six of these women had gonococcal infection, including 65% of those women with PID of less than 2 weeks' duration. Because gonorrhea is so common among women with PID, “standard” antibiotic regimens must be reevaluated. We recommend for countries with a high incidence of gonorrhea that initial treatment of PID should include an antibiotic regimen effective for gonococcal infection.

Skin diseases in Zambia.

This is the first report on the incidence of skin diseases in Zambians. A diagnostic analysis of 12,610 patients seen over the past year in the Dermatology Clinic at the University Teaching Hospital in Lusaka, Zambia, is presented. The common diseases as well as the peculiarities are discussed. The need to develop research centres in various regions of Africa is emphasized in order to provide better insight into the special dermatological problems seen in the black Africans.