HIV and male fertility at the University Teaching Hospital Lusaka

Background: There has been anecdotal evidence of a declining male fertility in Zambia over the last 10 years1. This prospective study of men seen in the fertility clinic was designed to look for an association between the increasing HIV infection in the population and male fertility.Methods: This prospective study compared the prevalence of HIV in men with a confirmed diagnosis of infertility seen at the Urology Clinic, to the national HIV prevalence among men of child bearing age. The study was done from October 2006 to October 2007.Results: A total of 34 men were diagnosed with infertility and included in the study. Among these patients 9 were seropositive. This gave an HIV prevalence of 26%. There was a statistically significant difference with the normal population of 13% (p = 0.043).Conclusion: HIV infection is higher in men seeking fertility treatment than in the general population. Further studies are required to determine the precise relationship between HIV and Male Fertility at the University Teaching Hospital Lusaka

Relationship between glycated haemoglobin and fasting plasma glucose among diabetic out-patients at the University Teaching Hospital, Lusaka, Zambia

Background: Glycated haemoglobin (HbA1c) measurement provides an accurate result of glycaemic levels from blood drawn at any time of day without reference to prandial state. We established the relationship between HbA1c and fasting plasma glucose (FPG) in diabetic out-patients among diabetic outpatients in Lusaka, Zambia.Methods: This cross-sectional study was carried out at the University Teaching Hospital diabetic clinic, Lusaka, Zambia. A total sample of 198 consenting participants was selected randomly from diabetic out-patients between September and December 2013. A structured interview schedule was used to capture data on socio-demographics and laboratory examination results. The Pearson’s correlation coefficient, Student’s t-test and Paired Samples t-test were used for data analysis.Results: A total of 198 patients (mean age+SD= 53.19±13.32 years) were involved in the study. Majority (60.10%) of the patients were females while 39.90 per cent were males. The mean±SD of FPG of the patients slightly increased from the previous 10.75±7.78 mmo/L to the current 11.09±6.23 mmo/L (p = 0.592). The mean±SD of HbA1c of the patients was 54.77±17.12 mmol/mol. There was a statistically significant weak and moderate positive correlation between HbA1c and the previous and current FPG (r = 0.282, P = 0.001 and (r = 0.385, p = 0.001), respectively. However, there was a statistically significant but weak negative correlation between HbA1c and age (r = -0.163, p = 0.023).Conclusion: We found evidence of an association between HbA1c and FPG proposing that as the FPG levels increase, the HbA1c levels also increase in a predictable way. There is need to sensitise more especially the major stakeholders in the management of diabetes mellitus to consider FPG as an alternative in glycaemic control monitoring in the absence of HbA1c

The Pattern of Urological Cancers in Zambia

Objective: To examine the pattern of urological malignancies, particularly cancer of the bladder, seen at the University Teaching Hospital (UTH) in Lusaka and to compare the findings with previous studies on the same parameters done at UTH. Material and Methods: A retrospective study of urological cancers in Zambia was performed, based on histopathology reports of specimens reviewed at the UTH Pathology Laboratory inLusaka, Zambia, between January 1990 and December 2005. The parameters studied were the histological type of the cancer, patient age and trends over a 15-year period. Results: In total, 8829 cancers were diagnosed during the study period, of which 749 (8.5%) were urological malignancies affecting the kidney, bladder, prostate, testis or penis. The maleto- female ratio of the urological cancers was 10.7 to 1. Cancer of the prostate was the most common urological malignancy (54.6%), followed by bladder cancer (21.1%) and penile cancer (18.6%). The histological type of bladder cancer was mainly squamous cell carcinoma (46.2%), transitional cell carcinoma (23.4%) and adenocarcinoma (22.2%); other types (8.2%) included rhabdomyosarcoma, small cell carcinoma and lymphoma. The majority of patients (79%) with bladder cancer were between 56 and 65 years of age. Whereas 20 years ago prostate cancer comprised only 26% of urological malignancies, it accounted for 55% of urological cancersdiagnosed in Zambia between 1990 and 2005. In contrast, cancer of the penis, kidney and testis have shown no change in frequency distribution compared to 20 years ago. Conclusion:Over the last 15 years there has been an increasing proportion of cancer of the prostate and squamous cell carcinoma of the bladder. This is associated with high levels of schistosomiasis, cystitis (some of which is HIV-related) and bladder stones. It may also be due to the extension of urological services and the diagnostic armamentarium (PSA, cystoscopy and histologicaldiagnosis) to indigent rural populations, where the incidence of squamous cell carcinoma is likely to be higher than in affluent urban populations

Health and healthcare access among Zambia's female prisoners: a health systems analysis.

BackgroundResearch exploring the drivers of health outcomes of women who are in prison in low- and middle-income settings is largely absent. This study aimed to identify and examine the interaction between structural, organisational and relational factors influencing Zambian women prisoners' health and healthcare access.MethodsWe conducted in-depth interviews of 23 female prisoners across four prisons, as well as 21 prison officers and health care workers. The prisoners were selected in a multi-stage sampling design with a purposive selection of prisons followed by a random sampling of cells and of female inmates within cells. Largely inductive thematic analysis was guided by the concepts of dynamic interaction and emergent behaviour, drawn from the theory of complex adaptive systems.ResultsWe identified compounding and generally negative effects on health and access to healthcare from three factors: i) systemic health resource shortfalls, ii) an implicit prioritization of male prisoners' health needs, and iii) chronic and unchecked patterns of both officer- and inmate-led victimisation. Specifically, women's access to health services was shaped by the interactions between lack of in-house clinics, privileged male prisoner access to limited transport options, and weak responsiveness by female officers to prisoner requests for healthcare. Further intensifying these interactions were prisoners' differential wealth and access to family support, and appointments of senior 'special stage' prisoners which enabled chronic victimisation of less wealthy or less powerful individuals.ConclusionsThis systems-oriented analysis revealed how Zambian women's prisoners' health and access to healthcare is influenced by weak resourcing for prisoner health, administrative biases, and a prevailing organisational and inmate culture. Findings highlight the urgent need for investment in structural improvements in health service availability but also interventions to reform the organisational culture which shapes officers' understanding and responsiveness to women prisoners' health needs

Analysis of the Effects of Grind Size on Production of Copper Concentrate: A Case Study of a Mining Company in Zambia

The trend did not attain terminal values, an indication that further increase in the fineness of grind may still result in improvement in the copper recovery as compared to the current plant recovery of 87% achieved at the grind of 40% passing 75microns. From the results obtained, the researchers recommended that further tests can still be carried out at finer grinds until optimal recovery values are obtained. A mining company treats underground ores of complex mixture of copper sulphide and small amount of copper oxide minerals. However, a number of flotation parameters have not been optimized to meet concentrate standards and grind size is one of the parameter. The purpose of this research project was to analyze the effect of grind size on concentrate production at a mining company in Zambia. The researcher set objectives which were to determine the current grind size and the output obtainable and also to determine the grind size and range of grind size that will produce the most concentrate. Literature relevant to answer the research questions was reviewed. The research design used was experimental in which direct observations and laboratory experiments were used to gather data. Samples from the ball mill feed were collected for the investigations at the mine laboratory

How do farmers and seed producers get information and provide feedback on varieties in the public domain: the case of common bean in eastern Zambia?

A Study conducted by the Zambia Agriculture Research Institute (ZARI) and Seed Control and Certification Institute (SCCI) with the International Center for Tropical Agriculture (CIAT)A study was conducted in 2015 to investigate the channels used by farmers and seed producers to access information on bean varieties in the Eastern Province of Zambia, particularly in Chadiza, Chipata, Lundazi and Vubwi districts. Stakeholders, key informants and a sample of 300 bean-producing households were interviewed. Two focus group discussions (FGDs) were also conducted in Chadzombe and Chiwoko Agricultural Camps to contextualize the survey responses. The 300 households produced beans under rain-fed and irrigated wetland conditions, and also grew maize (87 %) and other legumes such as groundnut (66 %) and soybean (61%). Concerning bean production, the majority of respondents (88%) grew only local varieties while 6 % grew only improved varieties, 6% grew both varieties and the remainder (less than 1 %) were unware whether their varieties of choice were local or improved

Evaluation of pharmacological prophylaxis for deep venous thrombosis in hospitalized patients with risk factors at the university teaching hospitals, Lusaka, Zambia

Background: Deep venous thrombosis is a common clinical problem accounting for high rates of morbidity and mortality. The existence of risk factors, which include trauma, venous stasis, and hypercoagulability, is linked to the occurrence of the condition. Objective of current study was to evaluate DVT risk factors and prophylaxis pattern of use for patients who were admitted at the University Teaching Hospitals in Lusaka, Zambia.Methods: A cross-sectional study was conducted using medical files for patients who were hospitalized at the University Teaching Hospitals in Lusaka, Zambia from May 2020 to June 2021. Two hundred and ninety-six patient files were reviewed, and the Caprini risk assessment model was used to stratify patients into DVT risk categories. Multilinear regression analysis was used to identify factors associated with DVT prophylaxis.Results: Of the 296 patient files that were sampled from ICU, medical, and surgical wards, 198 (66.9%) (>2 caprini score) were eligible for DVT prophylaxis, but only 77 (38.9%) of these eligible patients received prophylaxis. The number of eligible patients for DVT prophylaxis per department was as follows; ICU 50 (100%), Medical 71 (57.7%) and Surgery 77 (62.6%) wards. However, DVT prophylaxis was given to 21 (42%), 33 (46.5%), and 23 (29.9%) patients from the ICU, medical, and surgery, respectively. Enoxaparin was the most commonly used anticoagulant for Venous thromboembolism (VTE) prophylaxis with a mean dose of 60mg (SD±5). Across all departments, the most common predisposing risk factors for DVT were bed confinement for >72 hours (167, 56.4%) and age of 41-60 years (118, 39.8%). In the adjusted model, swollen legs (AOR: 3.6, CI: 1.97, 6.57) and history of VTE (AOR: 21.3, CI: 9.87, 46.08) were significantly associated with a higher likelihood of DVT prophylaxis.Conclusions: Pharmacologic thromboprophylaxis is underutilized in patients in ICU, medical and surgical wards at the university teaching hospitals in Lusaka, Zambia. This study underscores the importance of implementing a DVT risk assessment technique for patients in ICU, medical and surgical wards and administering prophylaxis unless contraindicated

Evidence for Histidine-Rich Protein 2 Immune Complex Formation in Symptomatic Patients in Southern Zambia

Background: Rapid diagnostic tests based on histidine-rich protein 2 (HRP2) detection are the primary tools used to detect Plasmodium falciparum malaria infections. Recent conflicting reports call into question whether α-HRP2 antibodies are present in human host circulation and if resulting immune complexes could interfere with HRP2 detection on malaria RDTs. This study sought to determine the prevalence of immune-complexed HRP2 in a low-transmission region of Southern Zambia. Methods: An ELISA was used to quantify HRP2 in patient sample DBS extracts before and after heat-based immune complex dissociation. A pull-down assay reliant on proteins A, G, and L was developed and applied for IgG and IgM capture and subsequent immunoprecipitation of any HRP2 present in immune complexed form. A total of 104 patient samples were evaluated using both methods. Results: Immune-complexed HRP2 was detectable in 17% (18/104) of all samples evaluated and 70% (16/23) of HRP2-positive samples. A majority of the patients with samples containing immune-complexed HRP2 had P. falciparum infections (11/18) and were also positive for free HRP2 (16/18). For 72% (13/18) of patients with immune-complexed HRP2, less than 10% of the total HRP2 present was in immune-complexed form. For the remaining samples, a large proportion (≥ 20%) of total HRP2 was complexed with α-HRP2 antibodies. Conclusions: Endogenous α-HRP2 antibodies form immune complexes with HRP2 in the symptomatic patient population of a low-transmission area in rural Southern Zambia. For the majority of patients, the percentage of HRP2 in immune complexes is low and does not affect HRP2-based malaria diagnosis. However, for some patients, a significant portion of the total HRP2 was in immune-complexed form. Future studies investigating the prevalence and proportion of immune-complexed HRP2 in asymptomatic individuals with low HRP2 levels will be required to assess whether α-HRP2 antibodies affect HRP2 detection for this portion of the transmission reservoir

Esophageal squamous cell cancer in a highly endemic region

AIM: To identify risk factors associated with esophageal cancer in Zambia and association between dietary intake and urinary 8-iso prostaglandin F2α (8-isoPGF2α). METHODS: We conducted a prospective, case control study at the University Teaching Hospital. Subjects included both individuals admitted to the hospital and those presenting for an outpatient upper endoscopy. Esophageal cancer cases were compared to age and sex-matched controls. Cases were defined as patients with biopsy proven esophageal cancer; controls were defined as subjects without endoscopic evidence of esophageal cancer. Clinical and dietary data were collected using a standard questionnaire, developed a priori. Blood was collected for human immunodeficiency virus (HIV) serology. Urine was collected, and 8-isoPGF2α was measured primarily by enzyme-linked immunosorbent assay and expressed as a ratio to creatinine. RESULTS: Forty five controls (mean age 54.2 ± 15.3, 31 male) and 27 cases (mean age 54.6 ± 16.4, 17 males) were studied. Body mass index was lower in cases (median 16.8) than controls (median 23.2), P = 0.01. Histopathologically, 25/27 (93%) were squamous cell carcinoma and 2/27 (7%) adenocarcinoma. More cases smoked cigarettes (OR = 11.24, 95%CI: 1.37-92.4, P = 0.02) but alcohol consumption and HIV seropositivity did not differ significantly (P = 0.14 for both). Fruit, vegetables and fish consumption did not differ significantly between groups (P = 0.11, 0.12, and 0.10, respectively). Mean isoprostane level was significantly higher in cases (0.03 ng/mg creatinine) than controls (0.01 ng/mg creatinine) (OR = 2.35, 95%CI: 1.19-4.65, P = 0.014). CONCLUSION: Smoking and isoprostane levels were significantly associated with esophageal cancer in Zambians, but diet, HIV status, and alcohol consumption were not