A study to determine factors contributing to acceptability of Haart by HIV-positive tuberculosis patients in Livingstone district, Zambia

Objective: The objective of the study was to determine factors contributing to acceptability of Highly Active Anti-Retro Therapy (HAART) by HIV-positive clients co-infected with tuberculosis accessing care at health facilities in Livingstone district, Zambia.Design: An explorative descriptive design study was conducted at three major chest clinics in Livingstone; namely Livingstone General Hospital, Mahatma Gandhi and Sepo health centers. The study population was all the TB/HIV co-infected patients aged between 18 and 49 years who were referred for HAART in the previous one month or more prior to the study and were not critically ill. The respondents were selected using systematic sampling method. A total number of 131 TB/HIV coinfected patients who were being attended to at the selected chest clinics in Livingstone were enrolled into the study. Data were collected using a structured interview schedule and focus group discussion guide to enable the investigator collect both quantitative and qualitative data. Epi-info version 6 and SPSS 12.0 for windows software computer packages were used to analyze the quantitative data. Chi-square was used to measure association between the dependent variable (acceptability of HAART by TB patients) and the independent variables. With the confidence interval set at 95%, the p value was used to ascertain the degree of significance by using the decision rule which rejects the null hypothesis if p value is equal or less than 0.05.Results: This study revealed that the most significant factors associated with acceptability of HAART by TB patients and accessibility of HAART were knowledge of TB and HIV relationship including HAART, HIV-related stigma and discrimination and support from health care providers regarding HAART. A significant association was found between knowledge of TB and HIV relationship and safety of taking HAART while on TB treatment, 77.9% of the respondents who did not know the relationship between TB and HIV indicated that it was not safe to take HAART concurrently with TB treatment (p value 0.000). There was also significant association knowledge of commencement of HAART in TB patients and discussion of HAART and its benefits with the counselor. Of the 52 respondents who did not know that HAART could be commenced in TB patients, majority (71.2%) did not discuss HAART and its benefits with the counselor (p value 0.001). In addition, there was a significant association between HIV-related stigma and discrimination and acceptability of HAART. Majority (78.7%) of the respondents who were treated differently because of HIV reported that they would not go back to the ART clinic for medication (p value 0.002). Furthermore, respondents whose HAART concerns were not addressed (74.1%) would not go back to the ART clinic for HAART (p value 0.008). The results further showed that factors such as TB-related stigma and discrimination, sex, age, marital status and level of education were not significantly associated with acceptability of HAART. Probably, TB-related stigma and discrimination is not associated to acceptability of HAART because TB is curable. The demographic characteristics were also not associated with acceptability of HAART probably because of personality attributes of an individual.Conclusion: From this study, it is evident that there are certain factors that are significantly associated with low acceptability of HAART by TB patients. These factors include TB patients' level of knowledge on TB/HIV coinfection and HAART, TB- and HIV-associated stigma and discrimination, amount and depth of information provided to the TB patient during the pre- and post-test counseling and provision of support to TB patients by health care providers. The other factors identified to be associated with acceptability of HAART by TB patients were integration of the TB and HIV services and number of health facilities offering the TB and HIV services. Most of the clients indicated that integration of TB and HIV services will be beneficial to them as it limits the number of time spent in these facilities, minimizes the cost of travelling to the sites and allows them more time to rest. The study further revealed that certain factors were not associated with acceptability of HAART in this study. These factors were sex, age, marital status and educational level of respondents. However, in similar studies, these factors were found to be statistically significant to acceptability of HAART by patients coinfected with TB/HIV. As revealed from this study, the burden of being diagnosed with concurrent TB and HIV infections on individuals can be lessened by uptake of HAART. This in turn will have a positive impact on the development of the nation

Compliance With Infection Prevention Guidelines By Health Care Workers at Ronald Ross General Hospital Mufulira District

Objective: To determine the level of health-care workers’ compliance with Infection Prevention Guidelines and identify factors that influence compliance at Ronald Ross General Hospital, Mufulira District. Methods: A quantitative study was carried out in 2007. Convenient sampling method was used. Data was obtained using a self administered interview schedule and an observation checklist. A total of 77 health care workers who included Doctors, Registered Midwives and Nurses, Enrolled Midwives and Nurses, clinical Officers, Laboratory Technicians and physiotherapists took part in the study. Additionally, 40 out of the 77 interviewed health workers were observed carrying out at least one procedure requiring compliance with the Infection Prevention (IP) guidelines. Results: The study revealed that, high compliance was associated with inclusion of Guidelines in the Curricular, high knowledge of infection prevention/hospital acquired infections, positive attitude towards infection prevention and availability of materials for infection prevention. The study further reviewed revealed varied levels of compliance on different components of infection prevention. The highest level of compliance (100%) was with single use of needles and syringes while the lowest (35.1) was with decontamination of needles and syringes with 0.5% chlorine solution prior to disposal. Compliance with hand hygiene was moderate (61%). Conclusion: The study findings suggest a need for inclusion of Infection Prevention Guidelines in the health workers’ curricular, provision of in-service training in infection prevention protocols and improvements in the supply of materials for infection prevention

Cost-effectiveness of intermittent preventive treatment of malaria in infants (IPTi) for averting anaemia in Gabon: a comparison between intention to treat and according to protocol analyses

ABSTRACT: BACKGROUND: In Gabon, the impact of intermittent preventive treatment of malaria in infants (IPTi) was not statistically significant on malaria reduction, but the impact on moderate anaemia was, with some differences between the intention to treat (ITT) and the according to protocol (ATP) trial analyses. Specifically, ATP was statistically significant, while ITT analysis was borderline. The main reason for the difference between ITT and ATP populations was migration. METHODS: This study estimates the cost-effectiveness of IPTi on the reduction of anaemia in Gabon, comparing results of the ITT and the ATP clinical trial analyses. Threshold analysis was conducted to identify when the intervention costs and protective efficacy of IPTi for the ATP cohort equalled the ITT cost-effectiveness ratio. RESULTS: Based on IPTi intervention costs, the cost per episode of moderate anaemia averted was US$12.88 (CI 95$11.30 (CI 95% 4.56, 26.66) using the ATP analysis. In order for the ATP results to equal the cost-effectiveness of ITT, total ATP intervention costs should rise from US$118.38 to US$134 or the protective efficacy should fall from 27% to 18.1%. The uncertainty surrounding the cost-effectiveness ratio using ITT trial results was higher than using the ATP results. CONCLUSIONS: Migration implies great challenges in the organization of health interventions that require repeat visits in Gabon. This was apparent in the study as the cost-effectiveness of IPTp-SP worsened when drop out from the prevention was taken into account. Despite such challenges, IPTi was both inexpensive and efficacious in averting cases of moderate anaemia in infant

Cotrimoxazole Prophylaxis Compliance Among HIV Exposed Infants in Chikankata District in Southern Zambia

Objectives and design: The general objective of the study was to determine factors associated with cotrimoxazole prophylaxis compliance among HIV exposed infants so that strategies are designed to improve cotrimoxazole prophylaxis uptake and compliance. A cross sectional study was conducted at Chikankata Mission hospital catchment area in Chikankata district.Measures: The study comprised face to face interviews of 102 mothers/caretakers of HIV exposed infants aged 6 weeks to 18 months selected using convenient sampling method. These mothers/caretakers of HIV exposed infants were interviewed using a structured interview schedule. The study data collection was done from September to November 2014 over a period of 2-3 months whereby 3-5 questionnaires were administered per day due to limited sampling frame. SPSS statistical package was used for data entering and analysis Descriptive statistics were employed to illustrate the data and chi-square test was used test associations among variables. The p values of less than 0.05 were considered statistically significant.Results: The findings showed that 78.7% of the respondents were non compl i ant with cotrimoxazole prophylaxis, 95% had heard about cotrimoxazole prophylaxis and their source of information was the health worker (98%). Though knowledge on the uses of cotrimoxazole prophylaxis stood at sixty percent (60%) only 51% knew the benefits of cotrimoxazole prophylaxis. 75.5% of the respondents stated that cotrimoxazole was not available at the health facilities, 89.2% stated that the road between their respective homes and the nearest health facility was passable, 73% said that the health workers at their nearest health facility did not encourage them to collect the drug when it ran out and 53.9% said that nurses at the nearest health facility did not follow them up when they did not go back for resupply of the drug. 77.5% of the respondents stated that their spouses did not allow them to collect cotrimoxazole when it ran out, 89.2% reported that their spouses knew about their HIV status and 65.7% said that they felt free to give their child cotrimoxazole in public. 61.8% of the respondents did not know that there was a social support group for mothers/caretakers of HIV exposed infants in their community and 74.5% stated that there were misconceptions about cotrimoxazole in the communities where they live.Conclusions: The study showed a significant association between compliance to cotrimoxazole prophylaxis and the following factors: non availability of drugs (P=<0.0001), attitude of the health care providers at nearest health facility (P=<0.001), lack of follow up (P=0.009), and impassable roads (P=0.026) as service related factor. There was also a significant association between compliance to the drug and the following sociocultural factors; misconceptions (P=<0.001), spouse not allowing mother/caretakers to collect the drug when it ran out (P=0.001), lack of social support (P=0.002), lack of knowledge of the benefit of cotrimoxazole (P=0.002) and mother/caretaker feeling free to give cotrimoxazole to the child in public (P=0.009).Keywords: Cotrimoxazole, prophylaxis, compliance, HIV exposed infant

Perceptions of Child Sexual Abuse among Convicted Prisoners in Zambia

Background: Child sexual abuse occurs worldwide including in Zambia. Despite Government efforts to minimize the scourge, the prevalence of defilement is still very high.Objective: The purpose of the study was to explore and describe convicted prisoners' perceptions of child sexual abuse.Methods: This was a qualitative study that was carried out among inmates in Lusaka central Prison. Purposive sampling method was used to select the study sample. Eighty nine males aged between 17 and 80 consented and participated in the study. Data were collected using a focus group discussion guide and the discussions were tape recorded. A total of twelve focus group discussions were conducted with the inmates. Each group comprised 6-12 participants with similar characteristics. Data were analyzed using content analysis. The narrative data from participants was analysed to identify prominent themes and patterns among the themes. The analysis of data was conducted simultaneously with data collection. The audio-taped discussions were transcribed and translated from vernacular into English and compared with the field notes. Open coding was done line by line and paragraph by paragraph. Similar responses were grouped together into categories and regrouped into subcategories. Data were constantly compared throughout the process of coding.Results: Participants were aware of the meaning of child sexual abuse and a girl child was more vulnerable to sexual abuse than a boy child. They attributed child sexual abuse was to lack of parental guidance and supervision, men's lack of sexual self control, alcohol and drug abuse and poverty and HIV/AIDS. Participants stated that child sexual abuse occurs in hidden places and any male is a potential abuser. The inmates reported that traditional beliefs and practices associated with child sexual abuse exist and this scourge can be prevented by punishing the perpetrators.Conclusion and recommendations: The present study showed that the child sexual abuse is common in Zambia. Therefore, there is a need to intensify information education and communication messages on prevention of child sexual and to strengthen and enforce laws regarding child sexual abuse

Modelling the action potential propagation in a heart with structural heterogeneities: From high‐resolution MRI to numerical simulations

International audienceMathematical modelling and numerical simulation in cardiac electrophysiology have already been studied extensively. However, there is a clear lack of techniques and methodologies for studying the propagation of action potential in a heart with structural defects. In this article, we present a modified version of the bidomain model, derived using homogenisation techniques with the assumption of existence of diffusive inclusions in the cardiac tissue. The diffusive inclusions represent regions without electrically active myocytes, for example, fat, fibrosis, and so forth. We present an application of this model to a rat heart. Starting from high-resolution MRI, the geometry of the heart is built and meshed using image processing techniques. We perform a study of the effects of tissue heterogeneities induced by diffusive inclusions on the velocity and shape of the depolarisation wavefront. We present several test cases with different geometries of diffusive inclusions. We reach the conclusion that the conduction velocity is not affected in the best cases, while it is affected by up to 76% in the worst case scenario. Additionally, the shape of the wavefront was affected in some cases