Mental Health of HIV Positive Adolescents in Zambia

Objectives: To assess the mental health of HIV positive Zambian adolescents by comparing with Zambian school sample and an age matched British normative sample.Design: This was a cross-sectional study of adolescents from school in the age range of 11-15 and HIV positive adolescents from clinics in Lusaka.Main outcomes: Mental health of HIV positive Zambian adolescents.Measures: Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ).Results: When compared to the school sample it is found that both the groups are almost similar in the SDQ scales. Although the HIV group seem to have more peer problems, the difference does not reach a level of significance. The HIV sample was also less likely to be in the abnormal range for conduct problems (OR = 1.8). But when compared to a British community sample the Zambian HIV positive adolescents had increased emotional symptoms (OR= 3.6) and peer problems (OR= 7.1).Conclusion: Zambian HIV positive adolescents had increased mental health problems compared to a British Community sample.Keywords: HIV, adolescents, mental health, SDQ, Za

The effect of hypertension on neurocognitive functioning and quality of life

Objectives: Hypertension has been reported as one of the most important etiologic factors in cardiovascular disease. The objectives of this study were to investigate the effect of hypertension on neurocognitive functioning and quality of life.Design: The study was cross sectional, and clinic based. The sample comprised of 50 adult Zambians aged 40- 65years.Main outcomes: The main outcomes were neurocogntive functioning and quality of life.Measures: The measures used in this study were the Zambian neurobehavioral test battery as a measure of neuro cognitive functioning and the SF12 Health survey as a measure of quality of life.Results: There was no significant difference in neuropsychological test performance on all the seven ability domains measured. On Global Deficit Scores impairment index, Chi square showed more impairment in the hypertensive group; however this was not statistically significant. Pearson's correlations test showed that at 0.05 sig. side effects correlated negatively with Physical functioning (r=0.593) and mental health (r=0.598) and at 0.01 sig. with vitality scale (r=0.6340 and social functioning (r=0.618) of the SF12 health survey domains.Conclusion: Quality of life seems to be more affected than neurocognitive functioning in the hypertensives in this study

Managing Children with Spina Bifida in sub-Saharan Africa: The Zambian experience?

Purpose:To investigate the management of children with SB and outcome measures used in Zambia.Methods: Aretrospective cross-sectional study was done. Between 2001 and 2010, a total number of 253 children with SB who were managed at both the University Teaching Hospital (UTH) and Beit Cure Hospital (BCH) were identified.Results: Majority (56%) of the patients were aged between 1-6 months (p < 0.001). Hydrocephalus was prevalent in 61% of the patients. Myelomeningocele was the most common (61%) defect and the lumbar region was the common site (60%) (p < 0.001). Majority (28%) of children came from the Southern Province of Zambia (p < 0.001). The majority (81%) of patients were lost to follow-up (p < 0.001). None of the files had outcomes measuring instruments.Conclusions: There is evidence that interventions were given although the outcomes were not measured. The majority of the children came from the Southern Province of the country. Astudy ought to be done to investigate the predominance of the prevalence of SB in that part of Zambia. Many patients were lost to lack of follow-up, hence proper follow-up mechanisms must be instituted by both hospitals. Researchers are challenged to develop measuring instruments that are culturally sensitive and appropriate to the needs of Zambian children

Endoscopic third ventriculostomy and choroid plexus cauterization in childhood hydrocephalus in Zambia

Background: Endoscopic third ventriculostomy (ETV) and Choroid Plexus Cauterization (CPC) have been recommended as reliable surgical options in developing countries for childhood hydrocephalus owing to reported shunt failures in shunt dependency.Objective: To evaluate outcomes of the ETV and ETV-CPC procedures as surgical options for selected forms of hydrocephalus in Zambia.Methods: Between 2007 and 2010, 131 children with hydrocephalus underwent the ETV or ETVCPC procedures at Beit Cure Hospital (BCH) and were eligible for the analysis. Failed ETV was defined as cases that needed subsequent surgical procedures within 6 months of operation.Results: A total number of 110 (84%) children underwent ETV-CPC and 21 (16%) had ETV alone. The overall success rate was 74%, whereas ETV-CPC was 76% and ETV alone was 62% (p < 0.0001). ETV success rate was more likely with children aged one year and above (p < 0.06) and with non-post infectious hydrocephalus (p < 0.29). Age and etiology were not significantly associated with the outcomes.Conclusions: Endoscopic third ventriculostomy is a safe, reliable and effective option for selected forms of hydrocephalus in Zambia. The combination of ETV and CPC was more effective than ETV alone. It is highly recommended that such services be extended to other referral hospitals as options to shunt placement, especially in cases where access for treatment failure is likely to be delayed.Keywords: Hydrocephalus, endoscopic third ventriculostomy, choroid plexus cauterization, Outcomes, Physiotherapy, Zambi

Adolescence As Risk Factor for Adverse Pregnancy Outcome in Central Africa – A Cross-Sectional Study

BACKGROUND: Sub-Saharan Africa has the highest rates of maternal and neonatal mortality worldwide. Young maternal age at delivery has been proposed as risk factor for adverse pregnancy outcome, yet there is insufficient data from Sub-Saharan Africa. The present study aimed to investigate the influence of maternal adolescence on pregnancy outcomes in the Central African country Gabon. METHODOLOGY AND PRINCIPAL FINDINGS: Data on maternal age, parity, birth weight, gestational age, maternal Plasmodium falciparum infection, use of bednets, and intake of intermittent preventive treatment of malaria in pregnancy were collected in a cross-sectional survey in 775 women giving birth in three mother-child health centers in Gabon. Adolescent women (≤16 years of age) had a significantly increased risk to deliver a baby with low birth weight in univariable analysis (22.8%, 13/57, vs. 9.3%, 67/718, OR: 2.9, 95% CI: 1.5-5.6) and young maternal age showed a statistically significant association with the risk for low birth weight in multivariable regression analysis after correction for established risk factors (OR: 2.7; 95% CI: 1.1-6.5). In further analysis adolescent women were shown to attend significantly less antenatal care visits than adult mothers (3.3±1.9 versus 4.4±1.9 mean visits, p<0.01, n = 356) and this difference accounted at least for part of the excess risk for low birth weight in adolescents. CONCLUSION: Our data demonstrate the importance of adolescent age as risk factor for adverse pregnancy outcome. Antenatal care programs specifically tailored for the needs of adolescents may be necessary to improve the frequency of antenatal care visits and pregnancy outcomes in this risk group in Central Africa

The Unknown Risk of Vertical Transmission in Sleeping Sickness—A Literature Review

Children with human African trypanosomiasis (HAT) present with a range of generally non-specific symptoms. Late diagnosis is frequent with often tragic outcomes. Trypanosomes can infect the foetus by crossing the placenta. Unequivocal cases of congenital infection that have been reported include newborn babies of infected mothers who were diagnosed with HAT in the first 5 days of life and children of infected mothers who had never entered an endemic country themselves

A building classification scheme of housing stock in Malawi for earthquake risk assessment

This study presents a building classification scheme for residential houses in Malawi by focusing upon informal construction, which accounts for more than 90% of housing in the country, which has the highest urbanisation rate in the world. The proposed classification is compatible with the Prompt Assessment of Global Earthquakes for Response (PAGER) method and can be used for seismic vulnerability assessments of building stock in Malawi. To obtain realistic proportions of the building classes that are prevalent in Malawi, a building survey was conducted in Central and Southern Malawi between 10th and 20th July 2017. The results from the survey are used to modify the PAGER-based proportions of main housing typologies by reflecting actual housing construction in the surveyed areas. The results clearly highlight the importance of using realistic building stock data for seismic risk assessment in Malawi; relying on global building stock information can result in significant bias of earthquake impact assessment

Sleeping sickness and its relationship with development and biodiversity conservation in the Luangwa valley, Zambia

The Luangwa Valley has a long historical association with Human African trypanosomiasis (HAT) and is a recognised geographical focus of this disease. It is also internationally acclaimed for its high biodiversity and contains many valuable habitats. Local inhabitants of the valley have developed sustainable land use systems in co-existence with wildlife over centuries, based on non-livestock keeping practices largely due to the threat from African Animal Trypanosomiasis. Historical epidemics of human sleeping sickness have influenced how and where communities have settled and have had a profound impact on development in the Valley. Historical attempts to control trypanosomiasis have also had a negative impact on conservation of biodiversity. Centralised control over wildlife utilisation has marginalised local communities from managing the wildlife resource. To some extent this has been reversed by the implementation of community based natural resource management programmes in the latter half of the 20th century and the Luangwa Valley provides some of the earliest examples of such programmes. More recently, there has been significant uncontrolled migration of people into the mid-Luangwa Valley driven by pressure on resources in the eastern plateau region, encouragement from local chiefs and economic development in the tourist centre of Mfuwe. This has brought changing land-use patterns, most notably agricultural development through livestock keeping and cotton production. These changes threaten to alter the endemically stable patterns of HAT transmission and could have significant impacts on ecosystem health and ecosystem services. In this paper we review the history of HAT in the context of conservation and development and consider the impacts current changes may have on this complex social-ecological system. We conclude that improved understanding is required to identify specific circumstances where win-win trade-offs can be achieved between the conservation of biodiversity and the reduction of disease in the human population.Ecosystem Services for Poverty Alleviation (ESPA

Perceived acceptability of progesterone to prevent preterm births and low birth weight among HIV-infected and HIV-uninfected Zambian pregnant women

Jeffrey Man Hay Wong,1 Neha Kanga,1 Nupur Dogra,1 Mary Shilalukey Ngoma,2 Lena Serghides,3 Michael Silverman4 1Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 2Department of Pediatrics, University of Zambia, Lusaka, Zambia; 3Toronto General Research Institute, University Health Network, Toronto, ON, Canada; 4Department of Infectious Diseases, Western University, London, ON, Canada Introduction: Intramuscular and vaginal progesterone are recommended for prevention of preterm labor (PTL) in women with risk factors. Studies are emerging to indicate that HIV-infected women on combination antiretroviral therapy (cART) are at risk of PTL and low birth weight (LBW), and may benefit from supplemental progesterone. This study aims to determine the perceived acceptability of various modes of progesterone supplementation to prevent PTL and LBW in HIV-infected and HIV-uninfected women.Methods: HIV-infected and HIV-uninfected women were recruited in Lusaka, Zambia. The participants completed a questionnaire to assess their willingness to take oral, vaginal, or intramuscular progesterone supplementation for preventing PTL and LBW, preferred modes of supplementation, and concern for PTL and LBW.Results: The study questionnaire was completed by 147 participants. Of the participants, 98.6% would consider using a medication to help prevent PTL and LBW, of whom 97.9% would consider using an oral form of progesterone.&nbsp;In addition, 83.3% and 84.0% of women would consider intramuscular and vaginal (gel or tablet) administration of progesterone respectively. Between intramuscular and vaginal modes of progesterone, 60.5% of participants (n=147) preferred intramuscular progesterone, while 39.5% preferred vaginal progesterone. There was no difference in preference between HIV-infected (n=70) and HIV-uninfected (n=77) women.Conclusions/implications: Pregnant Zambian women demonstrated a high degree of acceptance for all modes of progesterone supplementation for the prevention of PTL and LBW. Women preferred intramuscular over vaginal supplementation. Progesterone supplementation can be considered a feasible intervention for preventing PTL and LBW in both HIV-infected and HIV-uninfected pregnant Zambian women. Keywords: HIV/AIDS, progesterone, preterm labor, low birth weight, global healt

Maternity Waiting Home Use by HIV-positive Pregnant Women in Zambia: Opportunity for Improved Prevention of Maternal to Child Transmission of HIV

Background: Maternity waiting homes (MWHs), defined as residential lodging near health facilities, are an intervention to improve access to maternal care recommended by the World Health Organization. Little is known about utilization of MWHs by HIV-positive women. This paper describes: 1) maternal awareness and utilization of MWHs in rural Zambia among HIV-positive women, and 2) health outcomes for HIVpositive women and their infants with regards to utilization of MWHs. Methods: Data were collected from recently delivered women (delivered after 35 weeks in the previous 12 months) living >9.5 km from 40 health facilities in rural Zambia. For our analysis, primary outcomes were compared between self-identified HIV-positive and HIV-negative women in the sample. Primary outcomes include: 1) awareness of MWHs and 2) utilization of MWHs. We summarized simple descriptive statistics, stratified by maternal self-reported HIV status. We conducted bivariate analyses using chi-square tests, t-tests and Wilcoxon rank sum test. Results: Among 2,381 women, 50 (2.4%) self-identified as HIV-positive. HIV-positive women were older and had more pregnancies and children than HIV-negative women (p<0.001). There was no difference in awareness of MWHs, but HIV-positive women were more likely to use a MWH than HIV-negative women. There was no difference in receipt of infant antiretroviral prophylaxis between women who did or did not stay at a MWH. Conclusion and Global Health Implications: Though HIV prevalence in this sample was lower than expected, MWHs may represent a useful strategy to improve prevention of mother to child transmission of HIV in high prevalence, low-resource settings. Key words: Maternity waiting homes • HIV • PMTCT • Zambia Copyright © 2019 Bonawitz et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cite