Hospital In Zambia Research Articles

Leveraging a matrix of stakeholders to facilitate access to chemotherapy for women's cancers in the Democratic Republic of the Congo.

BackgroundCancer incidence is increasing worldwide. Over the next 20 years, the growing proportion of cases in low- and middle-income countries (LMICs) will account for an estimated 70% of all cancers diagnosed. The vast majority of cancer patients in LMICs will require chemotherapy, due to the advanced stage of their disease at the time of initial presentation. Unfortunately, the availability of cancer drugs in these environments is sparse, resulting in premature death and years of life lost. In an effort to lay a foundation for women’s cancer control in the Democratic Republic of the Congo (DRC), we implemented a programme which combined workforce development, infrastructure creation and cancer drug access. This manuscript reports on our experience with the latter.MethodsA private sector healthcare facility was selected as the programme implementation site. Workforce capacity was developed through a south–south partnership with an African national cancer centre. Cancer drugs were procured through a global cancer medicine access initiative.ResultsA new chemotherapy infusion unit was successfully established at the Biamba Marie Mutombo Hospital in Kinshasa, DRC. A team of Congolese healthcare providers was trained at the Cancer Disease Hospital in Zambia to safely and effectively administer chemotherapy for breast and cervical cancer. Over 100 breast and cervical cancer patients have been treated with 337 courses of chemotherapy, without any serious adverse events.ConclusionCommon barriers to cancer drug access and its administration can be eliminated using regional educational resources to build oncologic workforce capacity, private sector healthcare facilities for infrastructure support and pharmaceutical consortiums to procure low-cost cancer medicines. By leveraging a matrix of global, regional and local stakeholders, the prevailing status quo of very limited access to chemotherapy for women’s cancers was creatively disrupted in DRC, Africa’s largest fragile, conflict and violence-affected country.

Bacteriological profile and antimicrobial efficacy of alcohol-based hand rubs among health care workers and family caregivers at the children's university teaching hospital in Lusaka, Zambia

BackgroundHands of healthcare workers (HCWs) and family caregivers are a potential source of bacterial pathogens that may be transferred to susceptible individuals. However, there is a paucity of data regarding the effect of hand rubs used in Zambian hospitals. Therefore, we determined the effect of locally made alcohol-based hand rubs in three selected wards of the Children Hospital at the University Teaching Hospital in Zambia. MethodsThis was a cross-sectional study involving 31 participants (12 family caregivers, 5 doctors and 14 nurses). The samples were collected before and after the use of the alcohol-based hand rub by direct fingerprints. They were then cultured and identified using conventional microbiological methods. The Kirby-Bauer Disc Diffusion method was used for antimicrobial susceptibility testing. ResultsAll samples collected from the participants yielded bacterial growth with a total of 7 species isolated. These included coagulase-negative staphylococcus (33.3%), Bacillus species (28.9%), Staphylococcus aureus (22.2%), Enterobacter agglomerans (6.7%), Corynebacterium species (4.4%), Escherichia coli (2.2%) and Burkholderia pseudomallei (2.2%). Notably, all study participants hands were not only contaminated but with drug-resistant organisms as most of the bacterial isolates were resistant to routine antibiotics used at the hospital including ciprofloxacin. S. aureus was also resistant to oxacillin thus suggesting the presence of Methicillin-Resistant S. aureus. The use of alcohol-based hand rubs reduced the bacterial load by 92.6% on doctors and nurses’ hands and by 84.5% on the hands of family caregivers. ConclusionThis study confirms that the hands of HCWs and family caregivers may play a role in the transmission of drug-resistant bacteria and that alcohol-based hand rubs can be an effective way of reducing bacterial hand contamination among healthcare workers and family caregivers. Therefore, we recommend that measures be put in place by the hospital to ensure the availability of hand rubs to HCWs as well as caregivers.

The burden of post-stroke aspiration pneumonia (PSAP) on clinical outcomes in a Zambian hospital (1628)

The burden of post-stroke aspiration pneumonia (PSAP) on clinical outcomes in a Zambian hospital (1628)

Risk factors for delirium among hospitalized patients in Zambia.

ObjectiveTo identify risk factors for delirium among hospitalized patients in Zambia.MethodsWe conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. We report associations of exposures including sociodemographic and clinical factors with delirium over the first three days of hospital admission, assessed using a modified Brief Confusion Assessment Method (bCAM).Findings749 patients were included for analysis (mean age, 42.9 years; 64.8% men; 47.3% with HIV). In individual regression analyses of potential delirium risk factors adjusted for age, sex and education, factors significantly associated with delirium included being divorced/widowed (OR 1.64, 95% CI 1.09–2.47), lowest tercile income (OR 1.58, 95% CI 1.04–2.40), informal employment (OR 1.97, 95% CI 1.25–3.15), untreated HIV infection (OR 2.18, 95% CI 1.21–4.06), unknown HIV status (OR 2.90, 95% CI 1.47–6.16), history of stroke (OR 2.70, 95% CI 1.15–7.19), depression/anxiety (OR 1.52, 95% CI 1.08–2.14), alcohol overuse (OR 1.96, 95% CI 1.39–2.79), sedatives ordered on admission (OR 3.77, 95% CI 1.70–9.54), severity of illness (OR 2.00, 95% CI 1.82–2.22), neurological (OR 7.66, 95% CI 4.90–12.24) and pulmonary-system admission diagnoses (OR 1.91, 95% CI 1.29–2.85), and sepsis (OR 2.44, 95% CI 1.51–4.08). After combining significant risk factors into a multivariable regression analysis, severity of illness, history of stroke, and being divorced/widowed remained predictive of delirium (p<0.05).ConclusionAmong hospitalized adults at a national referral hospital in Zambia, severity of illness, history of stroke, and being divorced/widowed were independently predictive of delirium. Extension of this work will inform future efforts to prevent, detect, and manage delirium in low- and middle-income countries.

User Experience With Low-Cost Virtual Reality Cancer Surgery Simulation in an African Setting.

PURPOSELimited access to adequate cancer surgery training is one of the driving forces behind global inequities in surgical cancer care. Affordable virtual reality (VR) surgical training could enhance surgical skills in low- and middle-income settings, but most VR and augmented reality systems are too expensive and do not teach open surgical techniques commonly practiced in these contexts. New low-cost VR can offer skill development simulations relevant to these settings, but little is known about how knowledge is gained and applied by surgeons training and working in specific resource-constrained settings. This study addresses this gap, exploring gynecologic oncology trainee learning and user experience using a low-cost VR simulator to learn to perform an open radical abdominal hysterectomy in Lusaka, Zambia.METHODSEleven surgical trainees rotating through the gynecologic oncology service were sequentially recruited from the University Teaching Hospital in Lusaka to participate in a study evaluating a VR radical abdominal hysterectomy training designed to replicate the experience in a Zambian hospital. Six participated in semi-structured interviews following the training. Interviews were analyzed using open and axial coding, informed by grounded theory.RESULTSSimulator participation increased participants' perception of their surgical knowledge, confidence, and skills. Participants believed their skills transferred to other related surgical procedures. Having clear goals and motivation to improve were described as factors that influenced success.CONCLUSIONFor cancer surgery trainees in lower-resourced settings learning medical and surgical skills, even for those with limited VR experience, low-cost VR simulators may enhance anatomical knowledge and confidence. The VR simulator reinforced anatomical and clinical knowledge acquired through other modalities. VR-enhanced learning may be particularly valuable when mentored learning opportunities are limited.

Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia

ABSTRACTBackgroundChildren discharged from hospital following management of complicated severe acute malnutrition (SAM) have a high risk of mortality, especially HIV-positive children. Few studies have examined mortality in the antiretroviral therapy (ART) era.ObjectivesOur objectives were to ascertain 52-wk mortality in children discharged from hospital for management of complicated SAM, and to identify independent predictors of mortality.MethodsA prospective cohort study was conducted in children enrolled from 3 hospitals in Zambia and Zimbabwe between July 2016 and March 2018. The primary outcome was mortality at 52 wk. Univariable and multivariable Cox regression models were used to identify independent risk factors for death, and to investigate whether HIV modifies these associations.ResultsOf 745 children, median age at enrolment was 17.4 mo (IQR: 12.8, 22.1 mo), 21.7% were HIV-positive, and 64.4% had edema. Seventy children (9.4%; 95% CI: 7.4, 11.7%) died and 26 exited during hospitalization; 649 were followed postdischarge. At discharge, 43.9% had ongoing SAM and only 50.8% of HIV-positive children were receiving ART. Vital status was ascertained for 604 (93.1%), of whom 55 (9.1%; 95% CI: 6.9, 11.7%) died at median 16.6 wk (IQR: 9.4, 21.9 wk). Overall, 20.0% (95% CI: 13.5, 27.9%) and 5.6% (95% CI: 3.8, 7.9%) of HIV-positive and HIV-negative children, respectively, died [adjusted hazard ratio (aHR): 3.83; 95% CI: 2.15, 6.82]. Additional independent risk factors for mortality were ongoing SAM (aHR: 2.28; 95% CI: 1.22, 4.25), cerebral palsy (aHR: 5.60; 95% CI: 2.72, 11.50) and nonedematous SAM (aHR: 2.23; 95% CI: 1.24, 4.01), with no evidence of interaction with HIV status.ConclusionsHIV-positive children have an almost 4-fold higher mortality than HIV-negative children in the year following hospitalization for complicated SAM. A better understanding of causes of death, an improved continuum of care for HIV and SAM, and targeted interventions to improve convalescence are needed.

Blunt trauma to abdominal solid organs: an experience of non-operative management at a rural hospital in Zambia.

Introductionalthough non-operative management of patients with blunt trauma to abdominal solid organs has become standard care, the role of peripheral hospitals remains poorly defined. This study reviews treatment and outcomes in patients with liver and spleen injuries at a regional hospital over a 10-year period.Methodsa retrospective review of prospectively collected data was performed and supplemented by case notes retrieval. All patients with solid visceral injuries managed between 2009 and 2019 at a rural surgical hospital in Zambia were included. On admission, the patients were offered either urgent laparotomy or non-operative management (NOM) depending on their haemodynamic status. Continuous variables were expressed as median and mean ± standard deviation; categorical data were expressed as percentages. Statistical evaluation of data was performed by two-sample t-test. Statistical significance was assigned at p<0.05.Resultsfourty-three patients were included. The majority of victims sustained isolated spleen or liver injury. Twenty-three patients were urgently operated due to haemodynamic instability. Splenectomy performed in 17 patients, liver laceration sutured in 5 patients. One patient underwent concomitant splenectomy and liver repair. Conservative management was attempted in 20 (47%) patients and was successful in 18 (42%). In two patients NOM failed and splenectomy was performed urgently. Two patients died postoperatively. There were no deaths in NOM group.ConclusionNOM of patients with injury to solid abdominal organs could be safely initiated in rural hospitals provided there is uninterrupted monitoring of patients' condition, well-trained staff and unrestricted access to the operating theatre (OT).

Age distribution and mortality associated with intussusception in children under two years of age in nine sentinel surveillance hospitals in Zambia, 2007-2018.

Introductionrecipients of monovalent rotavirus vaccine have a low risk of developing intussusception (IS) in high- to medium-high-income countries. In sub-Saharan Africa, Zambia included, this risk of IS has not been assessed. Two-dose monovalent rotavirus vaccine, introduced in Zambia in 2012 in the capital of Lusaka, and rolled out countrywide in 2013, is administered at 6 and 10 weeks of age with no catch-up dose. Active IS surveillance monitoring in children < 2 years has been ongoing in Zambia since July 2009 and additional retrospective review was conducted from 2007- June 2009.Methodsretrospective review (January 2007-June 2009) and prospective (July 2009-December 2018) IS surveillance was conducted at nine hospitals and four large paediatric hospital departments in Zambia, respectively. Demographic and clinical data were collected from medical folder abstraction and supplemented by parental interview during prospective surveillance.Resultsa total of 248 children < 2 years with IS were identified; 57.3% were male. Most cases with IS were infants (85.5%). IS admissions remained stable during the surveillance period with no seasonality pattern although an increase in cases occurred between August and October, hot dry season. The median time from symptom onset to presentation for treatment was 2 days and 63.6% (154/242) of IS diagnoses were made during surgery. The bowel resection rate was 46.6%. A high CFR of 23.3% was observed.Conclusionthe number of intussusception cases in Zambia was relatively small and remained stable over the 12-year study period. However, a high CFR was observed among cases.

Determinants of Preterm Births at a National Hospital in Zambia: Application of Partial Proportional Odds Model

Background: Preterm birth (PTB), the delivery of a baby before 37 completed weeks of gestation, is responsible for increased childhood morbidity and mortality globally. However, in most developing countries, the determinats of PTB are usually underestimated and content-specific. Therefore, we assessed the determinants of ordered preterm birth levels at the Women and Newborn Teaching Hospital, Lusaka, Zambia. Methods: We reviewed admission and delivery registers from 1st January 2018 to 30th September 2019 for birth records. Preterm births were in four categories; term, moderate, late preterm and very preterm. We assessed the determinants of ordered levels of preterm birth using the partial proportional odds regression model. Data were analysed using Stata version 16, and statistical tests were done using 5% significance level and 95% confidence interval. Results: The study included a total of 3243 case records of women with a median age of 26 years (IQR, 22-33), of whom 399 (12.3%) delivered very preterm infants, 914 (28.18%) delivered moderate-term infants, 957 (29.51%) delivered late-term infants and 973 (30%) delivered term infants. There were disparities across infants born to HIV uninfected and HIV infected women, with the latter being more likely to be on the lower levels of preterm birth. However, attending antenatal clinic and a unit increase in maternal age were more likely to be on the higher levels of preterm birth. Pre-eclampsia's effect was not constant across the binary logistic regression models but generally showed a reduced odds of being in higher preterm birth levels for women with the condition. Conclusion: HIV infection and pre-eclampsia predict lower preterm birth levels while attending antenatal care (ANC), and increased maternal age is protective. Pregnant women presenting with pre-eclampsia and HIV infection should receive special considerations. Our findings support interventions aimed at increasing ANC uptake in the Zambian and other sub-Saharan Africa settings.

Experiences with the Use of Vaginal Dilator by Cervical Cancer Women Who Received Pelvic Radiotherapy at Cancer Diseases Hospital, Lusaka Zambia

Background: Cancer of the cervix is the commonest cancer in women seen at Cancer Diseases Hospital in Zambia and Pelvic Radiotherapy is the main treatment modality used on cervical cancer patients. Radiotherapy to the pelvis has a potential to causes vaginal stenosis but the stenosis can be prevented by regular sexual intercourse or use of vaginal dilators as recommended by cancer organizations. Despite the well-established benefits of vaginal dilators, there was reluctance by women to adopt this practice as seen by the number of survivors with vaginal stenosis at Cancer Diseases Hospital. The objective of this study was to explore experiences with the use of vaginal dilators by cervical cancer women who received Pelvic Radiotherapy. Methodology: A descriptive phenomenological design was used to explore experiences with the use of vaginal dilators by cervical cancer women. The study was conducted at Cancer Diseases Hospital in Lusaka District of Zambia. Participants were identified and purposefully sampled during the follow up clinics, they were then followed for interviews into their homes in Lusaka and data saturation was attained after interviewing 22 participants. Data were analyzed using thematic analysis. Results: Five themes from the study emerged on how women with cervical cancer experienced the use of vaginal dilator; such as uncomfortable dilators, pity for the husband, changed lifestyle, embarrassment and fear. Conclusion: It was acknowledged that the use of vaginal dilator was associated with negative experiences such as uncomfortable dilators, pity for the husband, changed lifestyle, fear and embarrassment. Therefore, this study recommends that Health care providers from CDH and other health institutions should give appropriate information to patients concerning the use of vaginal dilators and the Ministry of Health to provide vaginal dilators instead of 50 milliliter syringes currently in use.

Antimicrobialsusceptibility patterns of bacteria that commonly cause bacteremia at a tertiary hospital in Zambia.

Background: Bloodstream infections and antimicrobial resistance cause globalincreases inmorbidity and mortality. Aim: We evaluated the antimicrobial susceptibility patterns of bacteria that commonly cause bacteremia in humans. Materials & methods: We conducted a retrospective cross-sectional study at the University Teaching Hospitalsin Lusaka, Zambia, using Laboratory Information Systems. Results: The commonest isolated bacteria associated with sepsis were Klebsiella pneumoniae. The distribution of bacteria associated with bacteremia in different wards and departments pneumonia. The distribution of bacteria associated with bacteremia in different wards and departments at University Teaching Hospitals was were statistically significant (χ2=1211.518; p<0.001). Conclusion:K.pneumoniae, Escherichia coli, Pantoea agglomeransand Enterococcus species have developed high resistance levels against ampicillin, cefotaxime, ciprofloxacin, gentamicin and trimethoprim/sulfamethoxazole and a very low resistance levels against imipenem and Amikacin.

Why the misinformation, shame and guilt associated with coronavirus?

Mass media information, scientific articles and reports on measures to prevent infection are confusing at the least and figures from China and Iran lack cohesion. Reports suggest that Chinese scientists knew about coronavirus in early December 2019, but were told to conceal evidence by government. It is alleged that as cover-up, government officials intentionally withheld information that hospital workers had been infected by patients, a sign of how highly contagious the virus is. Researchers were also instructed to keep quiet and even ordered to destroy samples. Similar reports are also suggesting that Iran is under-reporting cases. In Africa, employees from a hospital in Zambia have also reported having been ordered not to speak publicly. They reported witnessing people who recently returned from China with coughs not being put in quarantine. Similar denials and cover-up strategies were seen in the 90s during the AIDS crisis. The guilt and shame that was associated with HIV were thought to have been associated with the intimate nature of transmission (mostly sexual) even though others got it through other routes including mother to child transmission etc. SARS-CoV-2 has not yet been proven to be intimately transmitted though having been isolated from semen. Why then the misinformation, shame, and guilt? How can countries move from the cover-up, blame games to responsibility as the virus defies containment? Some questions remain; How can cover-ups be prevented? How can governments be held accountable for cover-ups, misinformation, etc?

Application of the World Health Organization's Basic Emergency Care course in Zambia.

BackgroundIn 2013, the Zambian Ministry of Health identified action priorities for strengthening their emergency care system; one of these priorities was emergency care training for healthcare providers. To rapidly train the existing cadre of frontline providers, trainings were implemented in multiple provinces using the World Health Organization's Basic Emergency Care (BEC) course. The BEC course is open-access and emphasizes a practical syndrome-based approach to critical emergency conditions. This paper describes the first reported larger scale educational intervention of the BEC course in 7 provinces of Zambia.MethodsCourse delivery occurred at seven Zambian hospitals selected by the Ministry of Health over a 1 year period. Participant emergency care knowledge was assessed pre- and post-course with a 25-question multiple choice exam. Participant confidence levels related to emergency care provision and emergency care skills were assessed pre- and post-course using a Likert scale survey.ResultsOverall, 210 participants were trained at 7 sites. Participants demonstrated significant improvements in their multiple-choice exam scores; the overall pre-course mean was 61.47, and the post-course mean was 79.87 (p < 0.0001). Self-reported confidence in the care of ill and injured adults and children increased after taking the course, and participants generally agreed that the BEC course was highly valuable and applicable to local needs.ConclusionImplementation of the WHO's BEC course at seven hospitals throughout Zambia led to improvement in the participants' emergency care knowledge and confidence levels at all sites. The BEC course has the potential to be implemented in a nationwide initiative but would require allocation of significant human and physical resources. Additional work evaluating patient outcomes and long-term participant educational outcomes is needed.

Epidemiology and Management of Peritonitis at a Rural Hospital in Zambia

Background: Peritonitis is a common surgical emergency with varying etiologies encountered the world over. It is associated with significant morbidity and mortality despite intensive research and advances in management.&#x0D; Methods: Records of 119 patients operated on for peritonitis at a rural surgical hospital in Zambia over a 10-year period were retrospectively reviewed.&#x0D; Results: Common sources of peritonitis were perforated peptic ulcer, acute appendicitis, pelvic inflammatory disease, and perforated terminal ileum. Postoperative period became complicated in 42 patients (32.3%). Fourteen patients (11.8%) died postoperatively; the highest level of mortality was in patients with perforated peptic ulcer (26%). Organ failure was found in 29 patients (24.4%) and was associated with increased risk of death.&#x0D; Conclusions: Individual approach with identifying signs of organ failure is essential to determine the patient’s prognosis and decide on the level of care. Patients without organ dysfunction can be successfully managed in a rural surgical hospital.&#x0D; Keywords: Peritonitis, Epidemiology, Morbidity, Mortality, Rural hospital, Zambia

Correlates of Seizure Control Among Patients with Epilepsy at Two Referral Hospitals in Zambia

Background: Epilepsy is a neurological condition that has proven to be a major public health challenge worldwide, including Zambia. Despite the availability of many treatment alternatives, people with epilepsy still experience seizures. There is paucity of information on the control of seizures and associated factors in Zambia.&#x0D; Methods: A cross sectional study was conducted among epileptic patients at Kitwe and Ndola Teaching Hospitals, two referral hospitals in Northern Zambia, from September 2 to September 23, 2019. We performed a multivariate logistic regression analysis to identify independent predictors of seizure control. Adjusted odds ratios and their 95% confidence intervals are reported.&#x0D; Results: A total of 220 epileptic patients were enrolled in the study. Of these, 23.6% had controlled seizures while 76.4% had uncontrolled seizures. Occupation (p value=0.018), level of education (p value&lt;0.001), clinic attendance (p value&lt;0.001), drug adherence (p value&lt;0.001), belief about drugs (p value=0.006) and having friends (p value=0.025) were significantly associated with seizure control. A higher level of education (AOR:0.243, CI:0.080-0.738), regular clinic attendance (AOR:8.578, CI:3.327-22.112) and age at first seizure of 7-12 years (AOR: 1.035, CI:0.240-4.454) were predictors of controlled seizures.&#x0D; Conclusions and Implications for Translation: Our study showed that there was a low prevalence of controlled seizures among the study population.&#x0D; Key words: • Seizure • Control • Epilepsy • Zambia • Healthcare&#x0D; &#x0D; Copyright © 2020 Mwansa et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Retrospective Review of Loop Electrosurgical Excision Procedure (LEEP) Outcomes at a Tertiary Hospital in Zambia.

There is a lack of knowledge on the histologic outcomes of loop electrosurgical excision procedure (LEEP) biopsies in the diagnosis, treatment, and prevention of cervical cancer in Zambia. This study determined the outcomes of LEEP biopsies and associated factors at a tertiary hospital. We conducted a retrospective chart review of patients evaluated at a tertiary hospital cervical cancer screening centre. From the database, we identified patients who underwent LEEP between January 2015 and June 2018. We extracted demographic data, HIV data, and LEEP biopsy results. A P value less than 0.05 was considered statistically significant. 137 charts were identified, and 114 were included in the final analysis. 23 were excluded for missing histology. The mean age of participants was 36.3 ± 9.6. Histology outcomes revealed that 37% had cervicitis, while CIN 1, 2, and 3 contributed to 27%, 14%, and 3%, respectively. Squamous cell cancer was present in 8% (age groups 35–49) and was three times higher (13%) in HIV-positive compared to HIV-negative participants (3.8%). Normal histology accounted for 11%. Increasing age (P=0.029), less than tertiary education (P=0.0011), and being married (P=0.017) increased the chances of having cancer in the chi-square analysis, while single women had lower odds of having CIN 1 (OR = 0.012) in the multinomial logistic regression. There is a need for increased cervical cancer screening and training in precancer treatment and holistic consideration of other factors like age in addition to the positive VIA test in advising patients on treatment options.

Medical Ward In-Patient Mortality Patterns at a Tertiary Hospital in Urban Zambia: A One Year Review June 2018-June 2019

Background: Very little information exists about the causes of death in Zambian Hospitals. Recording of health related vital events in Zambia is often incomplete, and thus government relies on inaccurate verbal autopsies and models to guide policy and monitor increasing amounts of donor aid given towards the eradication of specific diseases. As most developing regions of the world are undergoing gradual epidemiologic transition, inpatient hospital mortality patterns become more important in reflecting this transition.Objectives: The purpose of this study was to establish the inpatient mortality patterns among patients admitted to the adult medical wards of Kitwe Teaching Hospital between June 2018 and June 2019.Methods: The files of patients who had died between June 2018 and June 2019 were reviewed and death information extracted by a combined team of clinicians. This information was then inputted and analysed using SPSS version 16.0 for Statistical Analysis.Results: It was observed that most (n=145, 56.60%) deaths occurred within 72 hours of admission, 47% of these deaths were of Human Immune-deficiency Virus (HIV) positive patients (p=0.04). 55% of all HIV positive related mortalities occurred within 72hours of admission. There was a bimodal distribution of causes of death with deaths due to communicable diseases (n=118, 46.09%) occurring in the younger age groups (median age 36, p=0.000) and HIV positive and deaths due to noncommunicable diseases (n=138, 53.9%) occurring in the older age groups (median age 54, p=0.000) and HIV negative. HIV (n=124, 48.44%) and TB (n=54, 21.10%) were the leading communicable causes of death. Stroke (n=37, 14.50%) and heart failure (n=24, 9.40%) were leading non-communicablecauses of death. Hypertension was the most common associated cause of death (n=38, 13.80%). Overall, more men died than women (male to female ratio 1.49:1), men died at a younger age (median age 42, p=0.180) compared to women (median age 46, p=0.180).Conclusion: Most patients died within 72 hours of admission, with the young dying mainly from communicable diseases associated with HIV and the elderly from non-communicable diseases associated with hypertension.

Medical Ward In-Patient Mortality Patterns at a Tertiary Hospital in Urban Zambia: A One Year Review June 2018-June 2019

Very little information exists about the causes of death in Zambian Hospitals. Recording of health related vital events in Zambia is often incomplete, and thus government relies on inaccurate verbal autopsies and models to guide policy and monitor increasing amounts of donor aid given towards the eradication of specific diseases. As most developing regions of the world are undergoing gradual epidemiologic transition, in-patient hospital mortality patterns become more important in reflecting this transition.The purpose of this study was to establish the inpatient mortality patterns among patients admitted to the adult medical wards of Kitwe Teaching Hospital between June 2018 and June 2019.The files of patients who had died between June 2018 and June 2019 were reviewed and death information extracted by a combined team of clinicians. This information was then inputted and analysed using SPSS version 16.0 for windows.It was observed that most (n=145, 56.60%) deaths occurred within 72 hours of admission, 47% of these deaths were of Human Immune-deficiency Virus (HIV) positive patients (p=0.04). 55% of all HIV positive related mortalities occurred within 72 hours of admission. There was a bimodal distribution of causes of death with deaths due to communicable diseases (n=118, 46.09%) occurring in the younger age groups (median age 36, p=0.000) and HIV positive and deaths due to non-communicable diseases (n=138, 53.9%) occurring in the older age groups (median age 54, p=0.000) and HIV negative. HIV (n=124, 48.44%) and TB (n=54, 21.10%) were the leading communicable causes of death. Stroke (n=37, 14.50%) and heart failure (n=24, 9.40%) were leading non-communicable causes of death. Hypertension was the most common associated cause of death (n=38, 13.80%). Overall, more men died than women (male to female ratio 1.49:1), men died at a younger age (median age 42, p=0.180) compared to women (median age 46, p=0.180).Most patients died within 72 hours of admission, with the young dying mainly from communicable diseases associated with HIV and the elderly from non-communicable diseases associated with hypertension.

Impact of maternal death reviews at a rural hospital in Zambia: a mixed methods study

BackgroundMaternal mortality in sub-Saharan Africa remains high despite programmatic efforts to improve maternal health. In 2007, the Zambian Ministry of Health mandated facility-based maternal death review (MDR) programs in line with World Health Organization recommendations. We assessed the impact of an MDR program at a district-level hospital in rural Zambia.MethodsWe conducted a mixed methods convergent study using hospital data on maternal mortality and audit reports of 106 maternal deaths from 2007 to 2011. To evaluate the overall impact of MDR on maternal mortality, we compared baseline (2007) to late (2010–11) post-intervention inpatient maternal mortality indicators. MDR committee reports were coded and dominant themes were extracted in a qualitative analysis. We assessed potential risk factors for maternal mortality in a before-and-after design comparing the periods 2008–09 and 2010–11.ResultsIn-hospital maternal mortality declined from 23 per thousand live births in 2007 to 8 per thousand in 2010–11 (P < 0.01). Maternal case fatality for puerperal sepsis and uterine rupture decreased significantly from 63 and 32% in 2007 to 10 and 9% in 2010–11 (P < 0.01). No significant reduction was seen in case fatality due to postpartum hemorrhage. Qualitative analysis of risk factors for maternal mortality revealed four core themes: standards of practice, health systems, accessibility, and patient factors. Specific risk factors included delayed referral, missed diagnoses, intra-hospital delays in care, low medication inventory, and medical error. We found no statistically significant differences in the prevalence of risk factors between the before-and-after periods.ConclusionsImplementation of MDR was accompanied by a significant decrease in maternal mortality with reductions in maternal death from puerperal sepsis and uterine rupture, but not postpartum hemorrhage. Qualitative analysis of audit reports identified several modifiable risk factors within four core areas. Comparisons of potential explanatory factors did not show any differences over time. These results imply that MDR offers a means for hospitals to curtail maternal deaths, except deaths due to postpartum hemorrhage, suggesting additional interventions are needed. Documentation of MDR meetings provides an instrument to guide further quality improvements.

Correlates of fear of hypoglycemia among patients with type 1 and 2 diabetes mellitus in outpatient hospitals in Zambia

Severe hypoglycemia is a burdensome complication of diabetes mellitus that can induce fear of hypoglycemia and contribute to suboptimal glycemic control. The challenge is to achieve and maintain adequate glycemic control while avoiding episodes of severe hypoglycemia. The purpose of the study was to determine how common fear of hypoglycemia was in Zambian out-patients with diabetes and also to explore correlates of fear of hypoglycemia. One hundred fifty-seven individuals with types 1 and 2 diabetes participated in the study. Fear of Hypoglycemia Scale, Diabetes Self-Care Inventory, Problem Areas in Diabetes, and the Major Depression Inventory were completed. Multiple linear regression models were computed to assess the association between fear of hypoglycemia and psychological factors. About 19% [16.3% type 1 and 12.6% type 2] of individuals with diabetes based on item endorsement expressed fear of hypoglycemia especially among individuals with type 1 diabetes. After controlling for demographic variables, diabetes self-care (s = 0.24, p < 0.05), and diabetes specific distress (s = 0.41, p < 0.001) were associated with fear of hypoglycemia. Fear of hypoglycemia was common and was positively associated with diabetes specific emotional distress and diabetes self-care. Interventions to avert fear of hypoglycemia are needed while optimizing glycemic control through managing diabetes care and emotion distress in individuals with diabetes.