Epidemiology of Cancers in Zambia: A significant variation in Cancer incidence and prevalence across the nation

BackgroundCancer is one of the leading causes of death worldwide. More than two-thirds of deaths due to cancers occur in low- and middle-income countries where Zambia belongs. This study, therefore, sought to assess the epidemiology of various types of cancers in Zambia.MethodsWe conducted a retrospective observational study using the Zambia National Cancer Registry (ZNCR) population based data from 2007 to 2014. Zambia Central Statistics Office (CSO) demographic data were used to determine catchment area denominator used to calculate prevalence and incidence rates of cancers. Age-adjusted rates and case fatality rates were estimated using standard methods. We used a Poisson Approximation for calculating 95% confidence intervals (CI). ResultsThe seven most cancer prevalent districts in Zambia were Luangwa, Kabwe, Lusaka, Monze, Mongu, Katete and Chipata. Cervical cancer, prostate cancer, breast cancer and Kaposi’s sarcoma were the four most prevalent cancers as well as major causes of cancer related deaths in Zambia. Age adjusted rates and 95% CI for these cancers were: cervix uteri (186.3; CI = 181.77 – 190.83), prostate (60.03; CI = 57.03 – 63.03), breast (38.08; CI = 36.0 – 40.16) and Kaposi’s sarcoma (26.18; CI = 25.14 – 27.22). CFR were: Leukaemia (38.1%); pancreatic cancer (36.3%); lung cancer (33.3%); and brain, nervous system (30.2%). The cancer population was associated with HIV with p- value of 0.000 and a Pearson correlation coefficient of 0.818.ConclusionsThe widespread distribution of cancers with high prevalence observed in the southern zone may have been perpetrated by lifestyle and sexual culture (traditional male circumcision known to prevent STIs is practiced in the northern belt) as well as geography. Intensifying cancer screening and early detection countrywide as well as changing the lifestyle and sexual culture would greatly help in the reduction of cancer cases in Zambia

Trends and factors associated with acute respiratory infection among under five children in Zambia: evidence from Zambia´s demographic and health surveys (1996-2014)

Introduction: acute respiratory infection (ARI) is one of the leading causes of morbidity and mortality among children under the age of five years globally accounting for 16% of deaths. In Zambia, ARI accounts for 30-40% of children's outpatient attendance and 20-30% of hospital admissions. We assessed trends and factors associated with ARI among under-five children in Zambia from 1996 to 2014. Methods: we analysed the Zambia demographic and health survey data for 1996, 2002, 2007 and 2014 of under five children and their mothers. We extracted data using a data extraction tool from the women's file. We analysed trends using chi square for trends. We conducted a complex survey multivariable logistic regression analysis, reported adjusted odds ratios (AOR) 95% confidence intervals (CI) and p-values. Results: we included a total of 6,854 and 2,389 (8%) had symptoms consistent with ARI. A 2% upward trend was noted between the 1996 and 2002 surveys but a sharp decline of 10% occurred in 2007. The chi2 trend test was significant p < 0.001. Children whose mothers had secondary or higher education were less likely to have ARI (AOR 0.30 95% CI 0.15-0.58) compared to those with no education. Underweight children had 1.50 times increased odds of having ARI (AOR 1.50 95% CI 1.25 - 1.68) compared with children who were not. Use of biomass fuels such as charcoal (AOR 2.67 95% CI 2.09 - 3.42) and wood (2.79 95% CI 2.45 -3.19) were associated with high odds for ARI compared to electricity. Conclusion: the prevalence of ARI has declined in Zambia from 1996 to 2014. Factors associated with occurrence of ARI included being a child under one year, underweight, use of biomass fuel such as charcoal and wood. Interventions to reduce the burden of ARI should be targeted at scaling up nutrition programs, as well as promoting use of cleaner fuels

Prevalence of oral fluorosis in Luangwa district of Lusaka Province, Zambia

Background: A fluorosis is a chronic form of hypoplasia of the dental enamel initiated by consumption water with high fluoride content during the time of tooth formation. Excessive ingestion of fluoride can result in fluorosis (mottling) of enamel which presents as opaque or white areas, lines, or flecks in the enamel surface. These teeth are more prone to dental caries and can be cosmetically disfiguring when they occur on anterior teeth. In spite of this fact, no study has been conducted to measure the prevalence of fluorosis in Luangwa district of the Eastern Province of Zambia. Aim: The study was to determine the prevalence of fluorosis and its treatment needs among the population affected in Luangwa district in the Eastern Province of Zambia. Methodology: A cross-sectional study was conducted with outreach descriptive survey and was conducted on patients that attended dental care during the mobile hospital outreach that was conducted in Luangwa district of Lusaka Province of Zambia. Results: Out of the total of 195 subjects examined, 56 (28.8%) patients were seen in Luangwa district clinic, out of which 1 (1.78%) had fluorosis. In Mwavi, at the secondary school, 71 (36.4%) were seen and 29 (40.84%) had fluorosis. At Luangwa Secondary School, a total of 68 (34.87% of the total subjects) were examined and out of that 7 (10.29%) had fluorosis. An aggregated total of 37 (18.97%) subjects of the 195 seen had fluorosis. Conclusion: The survey could elicit the presence of fluorosis in the Luangwa district of Lusaka Province. The baseline data suggest that the subjects who were seen from the clinic in the cannabidiol exhibited low levels (1.78%) of fluorosis because the water they consumed was treated by the local authority as compared to high prevalence of fluorosis in other sites outside the district where the water source was primarily river and wells which lacked treatment. Clinical Significance: This pilot study suggests the need to conduct a larger research study on the prevalence and impact of fluorosis in the population. This would help to plan future upstream dental public health programs

Decline in HIV Prevalence among Young Women in Zambia: National-Level Estimates of Trends Mask Geographical and Socio-Demographic Differences

Background: A decline in HIV incidence has been reported in Zambia and a number of other sub-Saharan countries. The trend of HIV prevalence among young people is a good marker of HIV incidence. In this study, different data sources are used to examine geographical and sub-population group differentials in HIV prevalence trends among men and women aged 15–24 years in Zambia. Design and Methods: We analysed ANC data for women aged 15–24 years from 22 sentinel sites consistently covered in the period 1994–2008, and HIV data for young men and women aged 15–24 years from the ZDHS 2001/2 and 2007. In addition, we systematically reviewed peer-reviewed articles that have reported findings on HIV prevalence and incidence among young people. Findings: Overall trends of the ANC surveillance data indicated a substantial HIV prevalence decline among young women in both urban and rural areas. However, provincial declines differed substantially, i.e. between 10 % and 68 % among urban women, and from stability to 86 % among rural women. Prevalence declines were steeper among those with the highest educational attainments than among the least educated. The ZDHS data indicated a significant reduction in prevalence between the two survey rounds among young women only. Provincial-level ZDHS changes were difficult to assess because the sample sizes were small. ANC-based trend patterns were consistent with those observed in PMTCT-based data (2002

Epidemiological Context of Sexually Transmitted Infections in Zambia: Determinants, aetiological agents and trends over time

Background: Sexually transmitted infections (STIs) remain a challenge mainly in developing countries, and in particular in sub-Saharan Africa, which also faces a serious HIV epidemic. Sexually Transmitted Infections can lead to serious complications such as infertility, spontaneous abortions, still births, cervical cancer and also enhance transmission of HIV. Control of STIs is thus important. Many STIs are curable, and prompt care seeking shortens the duration of an STI and prevents complications in the source patient as well as secondary spread of the infection. The World Health Organization recommends the use of syndromic guidelines for the management of STIs in countries with limited diagnostic facilities. A search of the literature showed gaps in current information on STIs in Zambia. This thesis focused on the causes of genital ulcer disease (GUD), its predictors, healthcare seeking and sexual behaviour among individuals with genital ulceration, and further examined syphilis trends in pregnant women compared with changes in the general population. Methods: The thesis utilised data from the Antenatal Clinic (ANC) sentinel surveillance system, the Zambia Demographic and Health Surveys (ZDHS) and a cross sectional survey of 200 patients with GUD in Lusaka district. Both the ANC and ZDHS data comprised information from interviews as well as syphilis and HIV test results. In the GUD study, swabs from the genital ulcers were tested for Treponema pallidum, Herpes Simplex types 1 and 2, Haemophilus ducreyi, and Chlamydia trachomatis using polymerase chain reaction (PCR). Results: The ANC surveys showed an overall significant decline in syphilis trends between 1994 and 2008 among urban and rural women. The decline was sharp irrespective of educational level, however, there were striking provincial variations noted. A comparison with the ZDHS 2001/2 and 2007 data also showed an overall reduction (though not significant), in syphilis prevalence among urban and rural men and women in the general population. The pathogens detected by PCR from the 200 patients with GUD in Lusaka were as follows: Herpes Simplex Virus type 2 (HSV-2) was detected in 28% of ulcers, Treponema pallidum in 11%; Chlamydia trachomatis in 3%; Herpes Simplex Virus type 1 in 0.5%, and Haemophilus ducreyi was not detected at all. Fifty five percent of the patients did not have any pathogens detected from their ulcers. The 2007 ZDHS showed a low prevalence of self-reported genital ulcers (GU) in the general population (3%). Important predictors for GU were age (25-39 years), being widowed/separated/divorced and having had a high number of lifetime sexual partners. No differences in care-seeking for GU were observed by age and gender, and more than half the respondents sought care from public health facilities. Among patients that presented with GUD in Lusaka, 57% reported sex after onset of symptoms and only 15% of these reported consistent condom use. Conclusion: Syphilis declined by about 60% or more in rural and urban pregnant women between 1994 and 2008. The variations however that were noted at provincial level need to be studied further to understand the local context of the epidemics, and to guide STI prevention and control programmes in the different geographical settings. Detection of pathogens using PCR showed that HSV-2 was the commonest cause of GUD among patients with genital ulceration in primary health care clinics in Lusaka. The fact that Haemophilus ducreyi was not detected in any of the patients requires further studies. If the findings are validated, treatment guidelines for GUD need to be revised in Zambia. Since the majority of the respondents who reported symptoms of GU also reported having sex and only a minority had used a condom, there is need for awareness campaigns on the importance of abstinence or use of condoms when experiencing symptoms of GUs

Risk factors, healthcare-seeking and sexual behaviour among patients with genital ulcers in Zambia

Background: Genital ulcers (GU) are associated with an increased risk of HIV transmission. Understanding risk factors for genital ulcers and sexual behaviour patterns after onset of symptoms and health seeking behaviour among GU-patients can provide useful information to aid design effective prevention strategies for genital ulcers. We investigated risk factors of self-reported GUs and care-seeking in the general population, and assessed GU patients regarding past care-seeking, recent sexual behaviour and partner awareness of the disease. Methods: We analysed national data on genital ulcers from the 2007 Zambia Demographic and Health Survey, and data from a cross-sectional survey of genital ulcer patients from primary health care facilities in Lusaka, Zambia. Results: The prevalence of GU in 2007 in the general population of Lusaka was 3.6%. Important predictors for genital ulcers were age 25–29 years, being widowed/separated/divorced and having a high number of life-time sexual partners. No differences in care-seeking were observed by residence, wealth and gender, and 60% of the respondents sought care from public health facilities. Among patients with GUs in Lusaka, 14% sought care >2 weeks after symptom onset. Forty-two percent were not aware of their HIV status, 57% reported sex after onset of symptoms and only 15% reported consistent condom use. Conclusions: Low awareness of HIV status despite high probability of being infected and low condom use after onset of genital ulcer symptoms leads to a high potential for transmission to sexual partners. This, combined with the fact that many patients with GUs delayed seeking care, shows a need for awareness campaigns about GUs and the importance of abstinence or use of condoms when experiencing such symptoms

Developing family medicine in Zambia

No abstract available

Hepatitis B vaccination coverage and the determinants of vaccination among health care workers in selected health facilities in Lusaka district, Zambia: an exploratory study

Abstract Background Hepatitis B is a viral infection of the liver and causes both acute and chronic disease. It is transmitted through contact with an infected person’s bodily fluids. It is an occupational hazard for healthcare workers and can be prevented by the administration of a vaccine. It is recommended that healthcare workers be vaccinated against vaccine preventable diseases including hepatitis B. The study objective was to determine the prevalence and determinants of hepatitis B vaccination among healthcare workers in selected health facilities in Lusaka. Methods The study took place in seven health facilities across Lusaka district in Zambia. A total sample size of 331 healthcare workers was selected of which; 90 were nurses, 88 were doctors, 86 were laboratory personnel and 67 were general workers. A self-administered structured questionnaire was given to a total of 331 healthcare workers. Investigator led stepwise approach was used to select the best predictor variables in a multiple logistic regression model and all analyses were performed using STATA software, version 12.1 SE (Stata Corporation, College Station, TX, USA). Results Only 64(19.3%) of the healthcare workers were vaccinated against hepatitis B, with 35 (54.7%) of these being fully vaccinated and 29 (45.3%) partially vaccinated. Analysis showed that; age of the healthcare worker, sharp injuries per year and training in infection control were the variables that were statistically significant in predicting a healthcare worker’s vaccination status. Conclusion It is reassuring to learn that healthcare workers have knowledge regarding hepatitis B and the vaccine and are willing to be vaccinated against it. Health institutions should bear the cost for vaccinating staff and efforts should be made for appropriate health education regarding hepatitis B infection and its prevention. Establishment of policies on compulsory hepatitis B vaccination for healthcare workers in Zambia is recommended

Risk factors, healthcare-seeking and sexual behaviour among patients with genital ulcers in Zambia

Abstract Background Genital ulcers (GU) are associated with an increased risk of HIV transmission. Understanding risk factors for genital ulcers and sexual behaviour patterns after onset of symptoms and health seeking behaviour among GU-patients can provide useful information to aid design effective prevention strategies for genital ulcers. We investigated risk factors of self-reported GUs and care-seeking in the general population, and assessed GU patients regarding past care-seeking, recent sexual behaviour and partner awareness of the disease. Methods We analysed national data on genital ulcers from the 2007 Zambia Demographic and Health Survey, and data from a cross-sectional survey of genital ulcer patients from primary health care facilities in Lusaka, Zambia. Results The prevalence of GU in 2007 in the general population of Lusaka was 3.6%. Important predictors for genital ulcers were age 25–29 years, being widowed/separated/divorced and having a high number of life-time sexual partners. No differences in care-seeking were observed by residence, wealth and gender, and 60% of the respondents sought care from public health facilities. Among patients with GUs in Lusaka, 14% sought care >2 weeks after symptom onset. Forty-two percent were not aware of their HIV status, 57% reported sex after onset of symptoms and only 15% reported consistent condom use. Conclusions Low awareness of HIV status despite high probability of being infected and low condom use after onset of genital ulcer symptoms leads to a high potential for transmission to sexual partners. This, combined with the fact that many patients with GUs delayed seeking care, shows a need for awareness campaigns about GUs and the importance of abstinence or use of condoms when experiencing such symptoms.</p

Access factors linked to maternal deaths in Lundazi district, Eastern Province of Zambia: a case control study analysing maternal death reviews

Abstract Background Access factors associated with maternal death are important to understand because they are considered to be an essential measure of women’s health and indicative of the performance of health care systems in any community globally. This study aimed to analyse the access risk factors linked to maternal deaths in Lundazi district of the Eastern Province of Zambia using secondary data obtained from maternal death reviews and delivery registers. Methods This was a case-control study with cases being recorded maternal deaths for Lundazi district (n = 100) while controls were randomly selected Lundazi District Hospital deliveries (n = 300) for the period 2010 to 2015. STATA™ (Stata Corporation, Texas, TX, USA) version 12.0 was used to analyse data. Odds ratio and 95% confidence intervals with associated p-values were used to analyse disparities between cases and controls while bivariate and multivariate regression analyses were done to show associations. Results The likelihood of experiencing maternal death was 94% less among women who completed their scheduled antenatal care visits than those who did not (OR 0.06, 95% CI = 0.01–0.27, p = < 0.001). Delayed referral associated with maternal deaths and complications were 30% (30) for cases, 12% (37) for controls and 17% (67) for both cases and controls. Long distances, unskilled deliveries were 3%, (15) for both cases and controls with 13% (13) for cases and 1% (2) for controls only. Conclusion Antenatal care is important in screening for pre-existing risk conditions as well as complications in early stages of pregnancy that could impact adversely during pregnancy and childbirth. Delay in seeking health care during pregnancy could be minimised if health services are brought closer to the communities to reduce on distances covered by pregnant women in Lundazi. Maternal education appears to influence antenatal health care utilisation because greater knowledge and understanding of the importance of antenatal care might increase the ability to select most appropriate service. Therefore, there is need for Lundazi District Health Office to scale up interventions that motivate women to make at least four scheduled antenatal care visits during pregnancy as recommended by the World Health Organization