Hospital In Zambia Research Articles

Tracking Progress Toward Elimination of Mother to Child Transmission of HIV in Zambia: Findings from the Early Infant Diagnosis of HIV Program (2009-2017).

BackgroundWe carried out analyses of early infant testing results at Livingstone Central Hospital in Zambia to assess time of testing, linkages to care and availability of test results for clinical decision making.MethodsWe abstracted data from registers of HIV-exposed infants who had dried blood spots cards (DBS) collected for DNA-PCR from January 2009 to December 2017. Only those tested from 2014 to 2017 had additional data which were used to estimate risk factors for mother-to-child HIV transmission using logistic regression models.ResultsDBS were collected from 2630 children. The proportion of HIV-positive tests decreased from 21% in 2009 to 2% in 2016 and 2017. Median turnaround time for results was 9 weeks (IQR: 5, 15) for HIV-negative, 7 weeks (IQR: 5, 13) for HIV-positive children. Only 2% of infants whose mothers took antiretroviral therapy (ART) were HIV positive, while 18% of infants whose mothers took short course antiretroviral drugs (ARVs) were infected. Infants of mothers who did not take ARVs had 9 times the odds of an HIV positive test (OR = 8.9, 95% CI: 3.6, 22.6). Infants of mothers who received short course ARVs were 40% less likely to get an HIV test within the first 2 months of life (OR = 0.6, 95% CI: 0.4, 0.9) compared to infants of mothers who received ART. Only 52% had a third test at median age 52 weeks (IQR: 50, 54).ConclusionsLong turnaround time for test results and low retention in care after the initial HIV test were critical challenges to clinical decision making.

Significance of pre-hospital care to reduce the morbidity of eclampsia in rural Zambia.

Preeclampsia (PE) is the 2nd leading cause of maternal mortality in developing countries. Maternal deaths caused by PE mainly result from eclampsia. The aim of this study was to survey the current status of PE at a local hospital in Zambia and identify preventive measures against eclampsia. The obstetric data of normal pregnant women and patients complicated with gestational hypertension (GH), PE, and eclampsia in 2017 at Zimba Mission Hospital, Zambia were collected from admission and delivery registries and analyzed. The mode of delivery, maternal and perinatal mortality. Among 1704 deliveries, 42 women (2.5%) were complicated with hypertensive disorders of pregnancy (HDP) (GH: 17, PE: 25). There were 2 stillbirths and 1 neonatal death in PE. Magnesium sulfate (MgSO4) was administered to severe PE patients (11 cases) based on the Pritchard regimen for a resource poor setting. No eclampsia happened after starting MgSO4. All eclampsia (8 cases) happened out of hospital at the gestational age of 35-40 weeks. All the eclamptic patients were primigravidae aged 15-23 years old. MgSO4 injection was started on admission. Cesarean section was performed in 7 cases. All the patients of PE including eclampsia were discharged without any sequelae. The Pritchard regimen is considered to be suitable in the setting. However, the morbidity of eclampsia was high out of hospital. We have to educate pregnant women about the risks of PE and encourage the measurement of blood pressure at health facilities.

English

Admission of a new born to the Neonatal Intensive Care Unit (NICU) is a stressful and unexpected event to most parents. This quantitative study aimed at identifying factors that contribute to stress in mothers nursing babies in the NICU at the Women and New Born Hospital in Zambia. A cross sectional study was conducted among 280 mothers who were randomly selected over a three-month period. Stress levels were assessed using Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) questionnaire. Informed consent was obtained from the mothers for the study. Inclusion criteria for the study were mothers of admitted neonates and their neonates who had to remain in the NICU for at least 24 h. Stata software version 13 was used to analyse data Chi square test to determine association between stress and maternal and infant characteristics. Kruskal wallis test was used to determine association between subscales of the PSS: NICU tool and interquartile and median were calculated since the data was not normally distributed. Results revealed that participants were more stressed by alteration of the parental role and the appearance and behaviour of their neonate. All participants rated admission of the neonate as being stressful. Maternal characteristics that were associated with stress included education level and duration of stay in Kruskal-Wallis test showed a statistical difference between the stress subscales with alteration of parental role being the most stressful subscale. Mothers have different stress levels with most of them experiencing moderate and extreme stress; appropriate counselling targeted towards specific stressors identified is required. The limitation of this study is that it did not monitor levels of stress at different times of admission Future research should monitor how maternal stress changes throughout the neonate’s NICU stay. This information can be used to design effective support programme to help mothers adopt coping strategies during their infant’s hospitalization. Key words: Maternal stressors, neonatal intensive care, Stressor Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU). &nbsp

Echocardiography in patients with chest x-ray diagnosis of cardiomegaly at an academic hospital in Zambia


 Background: Cardiomegaly is the most diagnosed condition on Chest X-ray (CXR) at the study site. However, little is found on the association between cardiomegaly and echocardiography (ECHO) findings at this site. The main objective of this study was to establish whether there is an association between cardiomegaly diagnosed on a CXR and ECHO findings of the same patient.
 Methods and Materials: This retrospective study involved the retrieving of data from files of 124 patients who had cardiomegaly diagnosed on CXR and had undergone an ECHO examination. The study sought to establish whether there is an association between cardiomegaly diagnosed on a CXR and ECHO findings of the same patients.
 Results: There was a positive association between cardiomegaly diagnosed on CXR and ECHO findings and the association was significant at 5%. In addition, there was also a strong association between age and cardiomegaly and the association was also significant at 5%. The Chi-square results at 5% level of significance showed that there is not enough evidence to suggest an association between gender and cardiomegaly. Therefore, both women and men have an equal chance of acquiring cardiomegaly. Left Ventricular Diastolic Dysfunction was the most prevalent condition, having been seen in more than 50% of patients. Most of the conditions identified in patients were very severe. In addition, 70% of these patients had a raised blood pressure with 43% having severely raised blood pressure.The test results also showed that 66% of patients in the sample had increased blood flow on Doppler measured at certain points of the heart with 6% of the patients having severely increased blood flow. Patients with increased blood flow showed an increase in blood pressure with those with severe increased blood flow showing a strong positive association with severe high blood pressure.
 Conclusion: These findings show that there is a strong association between cardiomegaly diagnosed on CXR to ECHO findings of the same patient. Therefore, echocardiography should be done on all patients diagnosed with cardiomegaly on CXR. In addition, priority should be given to elderly patients (65 years and above) as most of these had both severe cardiomegaly and one or more cardiovascular diseases.

Echocardiography in Patients with Chest X-ray Diagnosis of Cardiomegaly at an Academic Hospital in Zambia

Background: Cardiomegaly is the most diagnosed condition on Chest X-ray (CXR) at the study site. However, little is found on the association between cardiomegaly and echocardiography (ECHO) findings at this site. The main objective of this study was to establish whether there is an association between cardiomegaly diagnosed on a CXR and ECHO findings of the same patient.
 Methods and Materials: This retrospective study involved the retrieving of data from files of 124 patients who had cardiomegaly diagnosed on CXR and had undergone an ECHO examination. The study sought to establish whether there is an association between cardiomegaly diagnosed on a CXR and ECHO findings of the same patients.
 Results: There was a positive association between cardiomegaly diagnosed on CXR and ECHO findings and the association was significant at 5%. In addition, there was also a strong association between age and cardiomegaly and the association was also significant at 5%. The Chi-square results at 5% level of significance showed that there is not enough evidence to suggest an association between gender and cardiomegaly. Therefore, both women and men have an equal chance of acquiring cardiomegaly. Left Ventricular Diastolic Dysfunction was the most prevalent condition, having been seen in more than 50% of patients. Most of the conditions identified in patients were very severe. In addition, 70% of these patients had a raised blood pressure with 43% having severely raised blood pressure.The test results also showed that 66% of patients in the sample had increased blood flow on Doppler measured at certain points of the heart with 6% of the patients having severely increased blood flow. Patients with increased blood flow showed an increase in blood pressure with those with severe increased blood flow showing a strong positive association with severe high blood pressure.
 Conclusion: These findings show that there is a strong association between cardiomegaly diagnosed on CXR to ECHO findings of the same patient. Therefore, echocardiography should be done on all patients diagnosed with cardiomegaly on CXR. In addition, priority should be given to elderly patients (65 years and above) as most of these had both severe cardiomegaly and one or more cardiovascular diseases.

Social and economic barriers to adherence among patients at Livingstone General Hospital in Zambia.

BackgroundZambia is one of the countries hardest hit by the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) pandemic with a national HIV prevalence estimated at 14% among those aged 15–49 years in 2012. Antiretroviral therapy (ART) has been available in public health facilities in Zambia since 2003. By early 2016, 65% of the 1.2 million Zambians living with HIV were accessing ART. While access to ART has improved the lives of people living with HIV globally, the lack of adherence to ART is a major challenge to treatment success globally.AimThis article reports on social and economic barriers to ART adherence among HIV patients being attended to at Livingstone General Hospital in Zambia.SettingLivingstone General Hospital is located in the Southern province of Zambia, and had over 7000 patients enrolled for HIV care of whom 3880 patients were on ART.MethodsAn explorative, qualitative study was conducted with 42 patients on ART where data were collected through six focus group discussions (3 male and 3 female groups) and seven in-depth interviews. Data were audio-recorded and transcribed verbatim and subjected to thematic content analysis.ResultsEconomic factors such as poverty and unemployment and the lack of food were reported as major barriers to adherence. Furthermore, social factors such as traditional medicine, religion, lack of family and partner support, and disclosure were also reported as critical barriers to adherence to ART.ConclusionInterventions to improve adherence among ART patients should aim to redress the socio-economic challenges at community and individual levels.

Use of broad consent and related procedures in genomics research: Perspectives from research participants in the Genetics of Rheumatic Heart Disease (RHDGen) study in a University Teaching Hospital in Zambia

ABSTRACT The use of broad consent for genomics research raises important ethical questions for the conduct of genomics research, including relating to its acceptability to research participants and comprehension of difficult scientific concepts. To explore these and other challenges, we conducted a study using qualitative methods with participants enrolled in an H3Africa Rheumatic Heart Disease genomics study (the RHDGen network) in Zambia to explore their views on broad consent, sample and data sharing and secondary use. In-depth interviews were conducted with RHDGen participants (n = 18), study staff (n = 5) and with individuals who refused to participate (n = 3). In general, broad consent was seen to be reasonable if reasons for storing the samples for future research use were disclosed. Some felt that broad consent should be restricted by specifying planned future studies and that secondary research should ideally relate to original disease for which samples were collected. A few participants felt that broad consent would delay the return of research results to participants. This study echoes findings in other similar studies in other parts of the continent that suggested that broad consent could be an acceptable consent model in Africa if careful thought is given to restrictions on re-use.

Baby survival in Zambia: stillbirth and neonatal death in a local hospital setting

BackgroundGlobally, 2.6 million stillbirths occur every year. Of these, 98% occur in developing countries. According to the United Nations Children’s Fund, the neonatal mortality rate in Zambia in 2014 was 2.4%. In 2016, the World Health Organization released the International Classification of Diseases - Perinatal Mortality (ICD-PM) as a globally applicable and comparable system for the classification of the causes of perinatal deaths. However, data for developing countries are scarce. The aim of this study was to evaluate the rates and causes of stillbirths and neonatal deaths at a local hospital in Zimba, Zambia to identify opportunities for preventive interventions.MethodsAll cases of stillbirths and neonatal deaths at Zimba Mission Hospital in Zambia in 2017 were included in this study. Outborn neonates who were transferred to the hospital and later died were also included in the study. Causes of stillbirths and neonatal deaths were analyzed and classified according to ICD-PM.ResultsIn total, 1754 babies were born via 1704 deliveries at the hospital, and 28 neonates were transferred to the hospital after birth. The total number of perinatal deaths was 75 (4.2%), with 7 deaths in the antepartum, 25 deaths in the intrapartum, and 43 deaths in the neonatal period. Most antepartum deaths (n = 5; 71.4%) were classified as fetal deaths of unspecified causes. Intrapartum deaths were due to acute intrapartum events (n = 21; 84.0%) or malformations, deformations, or chromosomal abnormalities (n = 4; 16.0%). Neonatal deaths were related primarily to complications from intrapartum events (n = 19; 44.2%); low birth weight or prematurity (n = 16; 37.2%); or infection (n = 3; 7.0%).ConclusionsPerinatal deaths were associated with acute intrapartum events and considered preventable in 40 cases (53.3%). Effective interventions to prevent perinatal deaths are needed.

Assessment of maternal referral systems used for a rural Zambian hospital: the development of setting specific protocols for the identification of complications.

In resource-limited countries, it is estimated that up to 75% of maternal deaths are preventable. Maternal referral systems are an effective measure to help prevent these deaths. The objective of this study was to delineate criteria that health care workers use to identify obstetrical emergencies and make referrals, in order to evaluate the effectiveness of the established referral system and to implement improvements to this system. Using a qualitative study design, the individuals with the highest level of formal obstetrics training at 10 health posts that refer to a rural Zambian hospital were surveyed using semi-structured interviews regarding their referral protocols. Data were analyzed through open-coding. At the conclusion of the interview, standardized referral protocols for obstetric emergencies derived from published guidelines and local practices were distributed. Identified complications resulting in referral most commonly included post-partum hemorrhage (70%), prolonged labor (70%), malpresentation (50%), antepartum hemorrhage (40%), and retained placenta (40%). While numerous reasons for referral were identified, there was little consensus on the referral protocol used for each complication. Obstacles to successful referral most commonly included cellular network disruptions (70%), distance (50%), and lack of transportation (30%).The referral protocols distributed to health posts covered only 11 of the 23 complications cited as the most common reason for referral. The referral criteria and protocols were updated to include all of the reported complications. We propose this document for others working in resource-limited settings attempting to establish or evaluate a maternal referral systems.

Challenges of Medical Records Interoperability in Developing Countries: A Case Study of the University Teaching Hospital in Zambia

The University Teaching Hospital (UTH) is an integral national referral Hospital made up of eight departments. Standardized systems and semantic interoperability is key for successful flow of patient information from one department to another and from section to section within a department. Lack of a SNOMED CT E.H.R System in surgery departments causes inefficient scheduling of surgical procedures, insufficient and inaccurate pertinent patient historical information, misconceptions and error arising from ambiguities in terminology usage. The result is unhealthy clinician working environment leading to high death rates among patients. Baseline Survey was conducted using questionnaire to establish the major drawbacks of the current manual system in use at the department. Record inspection was done followed by roundtable discussion with stakeholder. Convenient sampling was used, out of 40 respondents 72.5% had computers in their section, 27.5% did not have, 60% were using partial electronic records and paper based, 37.5% were using manual system, 2.5% reported that they were using electronic record system. The result reviewed more than 50% of the medical practitioner ranging from nurses to surgeon reported to be dissatisfied with the current system. In addition, record inspection was conducted by going to each section of the department to understand the business process and the form and format of data storage; this exercise reviewed redundancy in the capture, storage and management of patient records due to the fact that in every section where a patient pass, while undergoing diagnosis procedure, basic details are collected afresh for the same patient. This situation has brought about unnecessary duplication of work. The other drawback is the storage of patient records arising from lack of storage space. Record which are ten years old are destroyed to create space for new ones. This destruction of records robs researchers of the much-needed data for trends analysis and patient disease history. Because of these draw backs, it is very apparent that a standardized E.H.R is implemented.

Nutritional risk and associated factors of adult in-patients at a teaching hospital in the Copperbelt province in Zambia; a hospital-based cross-sectional study

BackgroundNutritional risk and undernutrition are common problems among medical and surgical patients. In hospital, malnutrition is frequently under-diagnosed and untreated thereby contributing to morbidity and mortality. The purpose of this study was to determine the prevalence of nutritional risk among adult inpatients at a teaching hospital in Zambia. In addition, the study sought to establish factors associated with nutritional risk.MethodsA hospital-based cross-sectional study comprising of 186 consecutive in-patients aged 18–64 years admitted in medical and surgical wards was conducted at a teaching hospital. Out of one hundred and ninety eight (198) patients eligible to participate, complete data were collected from 186, representing a response rate of 93.9%. The Malnutrition Universal Screening Tool was used to collect data over a period of six months. Evaluated patients were dichotomized into no risk and nutritional risk. Binary logistic regression was performed to identify variables associated with nutritional risk.ResultsThe mean age of adult in-patients was 40.72 ± 14.4 years. Majority of the patients were male (61.8%), while 38.2% were female. Results indicate that 59.7% of hospitalized patients were at nutritional risk. Vomiting, weakness, appetite decrease, dysphagia and weight loss were significantly associated (p = 0.019, p = 0.008, p < 0.001, p = 0.007, and p < 0.001 respectively) with nutritional risk. However, weight loss and appetite decrease were the most significant factors associated with nutritional risk (OR = 50.16, 95% CI = 5.75–36.70, p < 0.001 and OR = 28.06, 95% CI =1.49–8.12, p = < 0.001 respectively).ConclusionFindings of our study suggest that close to 60% of adult inpatients at the teaching hospital were at nutritional risk. Nutritional risk is an issue of major concern at the teaching hospital and is associated with a number of variables. Identification of nutritional risk using Malnutrition Universal Screening Tool among adult inpatients is feasible in resource-poor settings like ours.

Dietary adequacy of adult surgical orthopaedic patients admitted to a teaching hospital in Zambia; a hospital-based cross-sectional study

BackgroundSub-optimal dietary intake among in-patients including those with orthopaedic injuries is one of the factors that contributes to malnutrition and poor clinical outcomes in hospitals. The purpose of this study was to determine adequacy of intake of selected nutrients among adult surgical orthopaedic patients on standard hospital diet.MethodsA hospital-based cross-sectional study involving 98 adult surgical orthopaedic patients aged 18–64 years and admitted in low cost wards was conducted. A 24 h dietary recall was used to record food intake in the previous 24 h. Adequacy of energy, protein, calcium, iron, zinc, dietary fibre, sodium, folic acid and vitamin C were determined using nutrition standards for adult inpatients in one state of Australia. Food frequency of consuming selected foods was assessed using standard 7-day food frequency questionnaires. Data was collected over a period of three months.ResultsThe findings on nutrient intake indicated that mean energy, protein, calcium, sodium, iron, zinc, folic acid, dietary fibre and vitamin C intake were all below the recommended values (1919Cal, 61.67 g, 160.05 mg, 222.91 mg, 10.19 mg, 2.55 mg, 165.98 μg, 20.09 g and 22.60 mg respectively). Further, 24.4%, 8.5%, 26.7%, 5.5% and 15.2% of the participants met the Recommended Dietary Intakes (RDIs) of energy, protein, iron, vitamin C and dietary fibre respectively. Hospital food contributed more than 60% of the total nutrient intake of energy, protein, folic acid and dietary fibre.ConclusionIn this study, the mean consumption intake for all the selected nutrients was below the recommended dietary intakes. Since sub-optimal dietary intake is associated with malnutrition and poor clinical outcomes, it is recommended that the hospital should provide diets that meet the nutrient demands of adult inpatients.

The cost of providing and scaling up surgery: a comparison of a district hospital and a referral hospital in Zambia.

The lack of access to quality-assured surgery in rural parts of sub-Saharan Africa, where the numbers of trained health workers are often insufficient, presents challenges for national governments. The case for investing in scaling up surgical systems in low-resource settings is 3-fold: the potential beneficial impact on a large proportion of the global burden of disease; better access for rural populations who have the greatest unmet need; and the economic case. The economic losses from untreated surgical conditions far exceed any expenditure that would be required to scale up surgical care. We identified the resources used in delivering surgery at a rural district-level hospital and an urban based referral hospital in Zambia and calculated their cost through a combination of bottom-up costing and step-down accounting. Surgery performed at the referral hospital is ∼50% more expensive compared with the district hospital, mostly because of the higher cost of hospital stay. The low bed occupancy rates at the two hospitals suggest underutilization of the capacity, and/or missing elements of needed capacity, to conduct surgery. Nevertheless, our study confirms that scaling up district-level surgery makes sense, through bringing economies of scale, while acknowledging the need for more comprehensive assessments and costing of capacity constraints. We quantified the economies of scale under different scaling scenarios. If surgery at the district hospital was scaled up by 10, 20 or 50%, the total cost of surgery would increase proportionately less than that, i.e. by 6, 12 and 30%, respectively. If this were to lead to less demand for surgery at the referral hospital, say 10% less surgery, it would result in a reduction of 2.7% in the total cost. Although the health system as a whole would benefit, the referring hospitals would not derive the full economic benefit, unless Government increased resources for district-level surgery.

Acceptance of kangaroo mother care by mothers of premature babies

Background: Kangaroo Mother Care (KMC) is a low-cost method of care for premature infants in areas with inadequate incubators and/or power outages. Assessing mothers' acceptance of KMC will help in the scale-up of interventions. Aims: To investigate factors that influence the acceptance of KMC in the care of premature babies at University Teaching Hospital, Lusaka, Zambia. Methods: This was a cross-sectional analytical design using a mixed approach, conducted at the University Teaching Hospital in Zambia. A total of 60 mothers and 5 key informants made up the participants. Findings: Overall, 60% of women found KMC acceptable and were able to practise continuously, in spite of not having prior knowledge of KMC. The longest-serving key informant at the KMC unit had served for 2 years, and 3 of the 5 informants had not received any training on KMC. Conclusions: Mothers accepted KMC after they were given information and education through good communication.

Chronic hepatitis B virus monoinfection at a university hospital in Zambia.

AIMTo characterize antiviral therapy eligibility among hepatitis B virus (HBV)-infected adults at a university hospital in Zambia.METHODSHepatitis B surface antigen-positive adults (n = 160) who were HIV-negative and referred to the hospital after a routine or clinically-driven HBV test were enrolled. Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), platelet count, hepatitis B e-antigen, and HBV DNA were measured. Liver fibrosis/cirrhosis was assessed by physical examination, AST-to-platelet ratio index, and transient elastography. In antiviral therapy-naïve individuals, we described HBV stages and antiviral therapy eligibility per World Health Organization (WHO) and by HBV test (routine vs clinical). Elevated ALT was > 19 in women and > 30 U/L in men. Among treatment-experienced individuals, we described medication side effects, adherence, and viral suppression.RESULTSThe median age was 33 years, 71.9% were men, and 30.9% were diagnosed with HBV through a clinically-driven test with the remainder identified via routine testing (at the blood bank, community events, etc.). Among 120 treatment-naïve individuals, 2.5% were categorized as immune tolerant, 11.7% were immune active, 35.6% were inactive carriers, and 46.7% had an indeterminate phenotype. Per WHO guidelines, 13 (10.8%) were eligible for immediate antiviral therapy. The odds of eligibility were eight times higher for those diagnosed at clinical vs routine settings (adjusted odds ratio, 8.33; 95%CI: 2.26-29.41). Among 40 treatment-experienced HBV patients, virtually all took tenofovir, and a history of mild side effects was reported in 20%. Though reported adherence was good, 12 of 29 (41.4%) had HBV DNA > 20 IU/mL.CONCLUSIONApproximately one in ten HBV-monoinfected Zambians were eligible for antivirals. Many had indeterminate phenotype and needed clinical follow-up.

9. Perinatal care for zambian pregnant women complicated with preeclampsia: The medication rooted in the region to stabilize its local management in zimba

Background Preeclampsia (PE) is a hypertensive disorders of pregnancy (HDP) that is associated with proteinuria or some organ failure and it is still a major cause of perinatal death worldwide. Maternal mortality in developing countries is high due to PE. To reduce the maternal mortality in Zambia, it is important to survey the status of PE and prevent eclampsia. At first, we aimed at surveillance of obstetric status in Zambia. Objectives In this study, we surveyed detailed obstetric profile including PE morbidity in local area of Zambia and aimed at raising awareness of PE statistics at a low-income local area in Zambia. Methods All deliveries from January through December in 2017 at Zimba Mission Hospital, Zambia were enrolled in this study. The number of patients complicated with preeclampsia and eclampsia were analyzed, and the clinical condition, the treatment, and the outcome were also analyzed. Results Among the 1712 deliveries in Zimba, 42 women (2.6%) were complicated with HDP (gestational hypertension (GH): 17, PE: 25). There was two still births in PE. All eclampsia (n = 8; 19.0%) happened out of hospital and the patients were taken to our hospital. Magnesium sulfate was administered to PE patients by intramuscular injection to prevent the occurrence of eclampsia along the suitable protocol for low-income pregnant women proposed by University Teaching Hospital (UTH) in Zambia and no eclampsia happened later. Conclusions We surveyed and evaluated the obstetric profile and morbidity of PE. The protocol for preventing eclampsia by UTH was suitable for a local clinic and hospital for low-income pregnant women in Zambia. However, the morbidity of eclampsia is still high out of hospital. We have to educate pregnant women about the seriousness of PE and encourage to measure BP of pregnant women in local clinic and hospital in Zambia.

Clinical Nursing Tasks and Information Needs in a University Teaching Hospital in Zambia

Clinical Nursing Tasks and Information Needs in a University Teaching Hospital in Zambia

Children infected by human herpesvirus 6B with febrile seizures are more likely to develop febrile status epilepticus: A case-control study in a referral hospital in Zambia.

Human herpesvirus 6B (HHV-6B) is the causative agent of Roseola infantum, and has also been suggested to play a role in the pathogenesis of febrile seizures in young children, a percentage of whom go on to develop febrile status epilepticus (FSE), but the existing data is conflicting and inconclusive. HHV-6A is a distinct species, rarely detected in most parts of the world, but prior studies suggest a higher prevalence in febrile African children. We describe a case-control study comparing the frequency of HHV-6A and/or HHV-6B infections in children with febrile seizures (including FSE) and a control group of febrile children without seizures. We recruited children aged 6 to 60 months admitted with a febrile illness with (cases) or without (controls) seizures presenting within 48 hours of commencement of fever. Three milliliters of whole blood was centrifuged and plasma stored at -80°C for pooled screening for HHV-6B and HHV-6A by Taqmanreal-time polymerase chain reaction. 102 cases and 95 controls were recruited. The prevalence of HHV-6B DNA detection did not differ significantly between cases (5.8% (6/102)) and controls (10.5% (10/95)) but HHV-6B infection was associated with FSE (OR, 15; 95% CI, [1.99-120]; P= 0.009). HHV-6A was not detected. Prevalence of HHV-6B was similar among cases and controls. Within the FS group, HHV-6B infection was associated with FSE, suggesting HHV-6B infections could play a role in the pathogenesis of FSE.

Krishan Mohan Khurana

Krishan Mohan Khurana was a consultant radiologist in hospitals in Zambia and Fiji from 1964 to 1975 and a well loved general practitioner in Partington, Manchester, from 1975 to 1996....

Surgical Capacity at District Hospitals in Zambia: From 2012 to 2016.

Sub-Saharan Africa has one of the highest burdens of surgically treatable conditions in the world and the highest unmet need, especially in rural areas. Zambia is one of the countries in the region taking steps to improve surgical care for its rural populations. To demonstrate changes in surgical capacity in Zambia's district hospitals over a 3-year period and to provide a baseline from which future interventions in surgical care can be assessed. A cross-sectional assessment of surgical capacity, using a modified WHO questionnaire, was administered in first-level hospitals in nine of Zambia's ten provinces between November 2012 and February 2013 and again between February and April 2016. The two assessments allowed measurement of changes in surgical workforce, infrastructure, equipment, drugs and consumables; and numbers of major surgical procedures performed over two 12-month periods prior to the assessments. There was a significant increase, 2013-2016, in number of theatre staff, from 174 (mean 4.4; SD 1.7) to 235 (mean 6; SD 2.9), P = 0.02. However, the percentage of hospitals with functioning anaesthetic machines dropped from 64 to 41%. There was also a drop in hospitals reporting availability of instruments, drugs and consumables from 38 to 24 (97-62%) and from 28 to 24 (72-62%), respectively. The median number of caesarean sections in 2012 was 99 [interquartile range (IQR) 42-187] and 100 (IQR 42-126) in 2015 (P value =0.53). The median number of major surgical procedures in 2012 was 54 (IQR 10-113) and 66 (IQR 18-168) in 2015 (P = 0.45). An increase in the first-level hospital surgical workforce between 2013 and 2016 was accompanied by reductions in essential equipment and consumables for surgery, and no changes in surgical output. Periodic monitoring of resource availability is needed to address shortages and make safe surgery available to rural populations.