Perspectives of the inaugural medical research and mentorship symposium for medical students and junior doctors in Zambia, Southern Africa: planning, outcomes and lessons learnt

Africa is the second largest continent, with about 13% of the world's population yet bears 24% of the global disease burden.1 Despite this  unacceptably high disease burden, only less than 1% of healthrelated research originates on the continent.2 In a cross-sectional study of six sub-Saharan African countries with 424 participants, Ngongalah et al explored the challenges faced by African researchers2. Their results showed areas of weakness including lack of training and awareness of the importance of research, inadequate support and collaborations amongst researchers in Africa. Thus, initiatives are needed to build a foundation for research that are home grown. In another study of medical schools in Sub-Saharan  Africa, 168 medical schools were identified, 145 surveyed, 105 responded, reporting that of the approximately 10,000 medical student graduates on the continent, 68% leave the African continent workforce.1 Some of the challenges reported were lack of mentorship and career structure. Mentorship is an integral part of our educational structure and career development. Mentorship can be formal with pairing of the mentee/mentor or informal by mentees seeking out a mentor. Mentorship provides an opportunity for trainees to gain constructive criticism, develop career goals and an opportunity for overall support through the learning process.3 With this background in mind we sought to organize a medical research and mentorship symposium targeted towards both medical students and junior resident doctors. This was a collaborative event by the Pan-African Organization for Health, Education and Research (POHER), Young Emerging Scientist Zambia (YES Zambia), and Copperbelt University School of Medicine (CBU-SOM) Mentorship Program. POHER is a non-governmental organization (NGO), co-founded by Drs Asombang and Mazimba, with a focus on the soundness of the health sector as the cornerstone of social and economic development of all African countries. YES Zambia is an  initiative by Drs Kabwe and  Lubeya, which has envisioned the creation of a renowned career and research hub for the young scientists that is cardinal in underpinning their career progression and leverage science to solve global challenges. CBUSOM mentorship program is a formal program co-founded by medical students and faculty at CBUSOM whose core value is to culture a pool of medical personnel that can receive andimpart knowledge for academic and professional excellence. &nbsp

Prevalence of persistent hypertension following pregnancy complicated by hypertensive disorders in low- and middle-income countries: a systematic review

Background: Hypertensive disorders of pregnancy can lead to persistent hypertension (pHTN) in the months and even years following delivery. However, its prevalence in low- and middle-income countries (LMICs) is not well characterized. Objective: To synthesize available evidence on the pHTN prevalence following a pregnancy complicated by hypertensive disorders of pregnancy in LMICs. Search strategy: PubMed, CINAHL Plus, Global Health (EBSCOhost), and Scopus from inception through a search date of July 12, 2022, and updated on January 2, 2024. Selection criteria: Cross-sectional studies and cohort studies reporting pHTN prevalence were eligible. Data collection and analysis: We conducted a narrative synthesis of data and categorized reported prevalence time points into several broader categories. We used the Newcastle-Ottawa checklist to assess the risk of bias. The protocol is registered in PROSPERO (CRD42022345739). Results: We reviewed 1,584 abstracts and identified 22 studies that reported pHTN between 2000 and 2023 from 14 LMICs. The overall prevalence of pHTN ranged between 6.9% and 62.2%, with the highest prevalence noted within African studies and the lowest in South American studies. Estimates at different follow-up periods postpartum were 6.9%–42.9% at six weeks, 34.0%–62.2% at three months, 14.8%–62.2% at six months, 12.7%–61.2% at 12 months, and 7.5%–31.8% at more than 12 months. The quality score of the selected studies ranged from 50% to 100%. Conclusions: The extant literature reports a high prevalence of pHTN in LMICs following a pregnancy complicated by hypertensive disorders. To reduce long-term complications of pHTN, programs should emphasize early screening and linkages to long-term care for at-risk women. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=345739, PROSPERO (CRD42022345739

Quantifying bias between reported last menstrual period and ultrasonography estimates of gestational age in Lusaka, Zambia

Objective To quantify differences in assessing preterm delivery when calculating gestational age from last menstrual period (LMP) versus ultrasonography biometry. Methods The Zambian Preterm Birth Prevention Study is an ongoing prospective cohort study that commenced enrolment in August 2015 at Women and Newborn Hospital of University Teaching Hospital in Lusaka, Zambia. Women at less than 20 weeks of pregnancy who were enrolled between August 17, 2015, and August 31, 2017, and underwent ultrasonography examination were included in the present analysis. The primary outcome was the difference between ultrasonography‐ and LMP‐based estimated gestational age. Associations between baseline predictors and outcomes were assessed using simple regression. The proportion of preterm deliveries using LMP‐ and ultrasonography‐derived gestational dating was calculated using Kaplan–Meier analysis. Results The analysis included 942 women. The discrepancy between estimating gestational age using ultrasonography and LMP increased with greater gestational age at presentation and among patients with no history of preterm delivery. In a Kaplan‐Meier analysis of 692 deliveries, 140 (20.2%, 95% confidence interval [CI] 17.7–23.0) and 79 (11.4%, 95% CI 9.6–13.6) deliveries were classified as preterm by LMP and ultrasonography estimates, respectively. Conclusion Taking ultrasonography as a standard, a bias was observed in LMP‐based gestational age estimates, which increased with advancing gestation at presentation. This resulted in misclassification of term deliveries as preterm

Maternal HIV Infection and Spontaneous Versus Provider-Initiated Preterm Birth in an Urban Zambian Cohort

Objective: We investigated the effect of maternal HIV and its treatment on spontaneous and provider-initiated preterm birth (PTB) in an urban African cohort. Methods: The Zambian Preterm Birth Prevention Study enrolled pregnant women at their first antenatal visit in Lusaka. Participants underwent ultrasound, laboratory testing, and clinical phenotyping of delivery outcomes. Key exposures were maternal HIV serostatus and timing of antiretroviral therapy initiation. We defined the primary outcome, PTB, as delivery between 16 and 37 weeks’ gestational age, and differentiated spontaneous from provider-initiated parturition. Results: Of 1450 pregnant women enrolled, 350 (24%) had HIV. About 1216 (84%) were retained at delivery, 3 of whom delivered,16 weeks. Of 181 (15%) preterm deliveries, 120 (66%) were spontaneous, 56 (31%) were provider-initiated, and 5 (3%) were unclassified. In standardized analyses using inverse probability weighting, maternal HIV increased the risk of spontaneous PTB [RR 1.68; 95% confidence interval (CI): 1.12 to 2.52], but this effect was mitigated on overall PTB [risk ratio (RR) 1.31; 95% CI: 0.92 to 1.86] owing to a protective effect against provider-initiated PTB. HIV reduced the risk of preeclampsia (RR 0.32; 95% CI: 0.11 to 0.91), which strongly predicted provider-initiated PTB (RR 17.92; 95% CI: 8.13 to 39.53). The timing of antiretroviral therapy start did not affect the relationship between HIV and PTB. Conclusion: The risk of HIV on spontaneous PTB seems to be opposed by a protective effect of HIV on provider-initiated PTB. These findings support an inflammatory mechanism underlying HIV-related PTB and suggest that published estimates of PTB risk overall underestimate the risk of spontaneous PTB

Psychosocial issues and coping mechanisms of pregnant and postnatal women diagnosed with COVID-19: A qualitative study

Objective There is a paucity of data on the psychosocial issues and coping mechanisms among pregnant and postnatal women with COVID-19 infection. We, therefore, aimed to explore the psychosocial issues and coping mechanisms of pregnant and postnatal women diagnosed with COVID-19 at tertiary-level hospitals. Methods This was a qualitative phenomenological study conducted in 2021 with a sample size of 16 women admitted at two referral hospitals serving as COVID-19 admission facilities for pregnant and postnatal women in Lusaka, Zambia. In-depth interviews were conducted via telephone to understand what these women experienced when diagnosed with COVID-19. All the interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted using the six steps approach to develop emerging themes. Results Two major themes emerged: psychosocial issues and coping mechanisms. The primary psychosocial issues were worry and stigma. Women worried about infecting their unborn baby or neonate, being separated from the baby, the general safety of the baby, and the health of other family members. Women also worried about the attitude of health care providers and faced discrimination or stigma because of their infection. Thus, some coping mechanisms were developed that helped them, such as a positive attitude, keeping the disease secret, reliance on family members for support and using positive information from social media. Conclusion This study provides unique insights into the psychosocial experiences of pregnant and postnatal women diagnosed with COVID-19. Women were particularly concerned about the unborn baby's well-being and discrimination.This study suggests the need for policy and clinical practice to consider the integration of effective mental health services into the provision of maternal health and COVID-19 services

Anaemia in pregnancy among pregnant women in Lusaka District, Zambia

Objectives: This study investigated the problem of anaemia in pregnancy and its associated factors.Methods: The study involved 216 women booking for antenatal care between September 2015 and January 2016. A structured questionnaire was administered to all eligible women to determine their socio demographic and economic status, reproductive factors, health seeking behaviour and clinical state. Blood for a full blood count was collected. Women found with anaemia were immediately referred to their clinicians for further management. Data was analysed using SPSS software.  Inferential analyses were conducted using Chi square and Ttest. For the historical independent variables with a known significant association with anaemia, a stepwise backward logistic regression was done.Results: Out of 216 women enrolled in the study, Seventy nine (36.2%) were found to be anaemic. The mean haemoglobin was 11.2g/dl. Thirty six women (45.6%) had mild anaemia, forty one (51.9%) had moderate anaemia while two (2.5%) had severe anaemia. In analysis lower family income and lower intake of vegetables were statistically significant with p values of 0.020 and 0.023 respectively. After adjusting for confounders, HIV infection remained significant with HIV positive women being 2.7 times more likely to have anaemia (OR 2.7, CI 1.06-6.70) univariateConclusion: Anaemia remains a public health problem among pregnant women in Zambia. Risk factors include HIV infection, Low intake of vegetables and low family income. Recommendations: Women need continued education on importance of vegetable intake during pregnancy and involvement in legal income generating activities to boost family income. Women of reproductive age under HIV care need continuous education on anaemia prevention in pregnancy