Cervical cancer awareness and uptake of pap-smear services among women above 18 years of age

Cervical cancer is a significant public health problem among women in Zambia. The purpose of the study was to determine the awareness of cancer of the cervix and Pap smear uptake among the women aged 18 years and above. This was a mixed method study that used both quantitative and qualitative methods that was conducted in Maramba coumpound in Livingstone. Multistage and convenient sampling methods were used to select 389 respondents who participated in the study. Quantitiative Data was collected using face to face interviews. Purposive sampling of 2 Focus Group Discussion (FGD) participants that had 6 participants per FGD was carried out. The first group comprised participants who were 18 - 35 years old and the second group was participants above 35 years old. The findings revealed that 52.2% (203) of the respondents had never heard of cancer of the cervix whilst slightly less than half 47.8% (186) of the respondents had heard of cancer of the cervix, while 55.8% (217) had heard of Pap smear. None had ever done a Pap-smear, when asked why none of them did not do a Pap smear, 56.3% (219) of the respondents said that they were not aware of Pap smear services offered at Livingstone general hospital, while 40.4% (157) did not do Pap smear because of fear of positive results. The respondents were asked to identify women who were at risk of cervical cancer, 39.1% (152) said all women, 32.1% (125) said women who are sexually active and 26.5% said married women. There was an association between Socio-Demographic characteristics Educational Level (P-value 0.368), Age (P-value, 0.136) and respondents' response of those who are at risk of developing cancer of the cervix. Economic status was significantly associated with awareness of cancer of the cervix (P-value 0.004). There is need to for the Health care professionals to intensify Information, Education and Communication (IEC) on cancer of the cervix and its prevention

Reduction in mortality from HIV-related CNS infections in routine care in Africa (DREAMM): a before-and-after, implementation study

BACKGROUND: Four decades into the HIV epidemic, CNS infection remains a leading cause of preventable HIV-related deaths in routine care. The Driving Reduced AIDS-associated Meningo-encephalitis Mortality (DREAMM) project aimed to develop, implement, and evaluate pragmatic implementation interventions and strategies to reduce mortality from HIV-related CNS infection. METHODS: DREAMM took place in five public hospitals in Cameroon, Malawi, and Tanzania. The main intervention was a stepwise algorithm for HIV-related CNS infections including bedside rapid diagnostic testing and implementation of WHO cryptococcal meningitis guidelines. A health system strengthening approach for hospitals was adopted to deliver quality care through a co-designed education programme, optimised clinical and laboratory pathways, and communities of practice. DREAMM was led and driven by local leadership and divided into three phases: observation (including situational analyses of routine care), training, and implementation. Consecutive adults (aged ≥18 years) living with HIV presenting with a first episode of suspected CNS infection were eligible for recruitment. The primary endpoint was the comparison of 2-week all-cause mortality between observation and implementation phases. This study completed follow-up in September, 2021. The project was registered on ClinicalTrials.gov, NCT03226379. FINDINGS: From November, 2016 to April, 2019, 139 eligible participants were enrolled in the observation phase. From Jan 9, 2018, to March 25, 2021, 362 participants were enrolled into the implementation phase. 216 (76%) of 286 participants had advanced HIV disease (209 participants had missing CD4 cell count), and 340 (69%) of 494 participants had exposure to antiretroviral therapy (ART; one participant had missing ART data). In the implementation phase 269 (76%) of 356 participants had a probable CNS infection, 203 (76%) of whom received a confirmed microbiological or radiological diagnosis of CNS infection using existing diagnostic tests and medicines. 63 (49%) of 129 participants died at 2 weeks in the observation phase compared with 63 (24%) of 266 in the implementation phase; and all-cause mortality was lower in the implementation phase when adjusted for site, sex, age, ART exposure (adjusted risk difference –23%, 95% CI –33 to –13; p<0·001). At 10 weeks, 71 (55%) died in the observation phase compared with 103 (39%) in the implementation phase (–13%, –24 to –3; p=0·01). INTERPRETATION: DREAMM substantially reduced mortality from HIV-associated CNS infection in resource-limited settings in Africa. DREAMM scale-up is urgently required to reduce deaths in public hospitals and help meet Sustainable Development Goals. FUNDING: European and Developing Countries Clinical Trials Partnership, French Agency for Research on AIDS and Viral Hepatitis. TRANSLATIONS: For the French and Portuguese translations of the abstract see Supplementary Materials section

Mental distress in the general population in Zambia: Impact of HIV and social factors

<p>Abstract</p> <p>Background</p> <p>Population level data on mental health from Africa are limited, but available data indicate mental problems to represent a substantial public health problem. The negative impact of HIV on mental health suggests that this could particularly be the case in high prevalence populations. We examined the prevalence of mental distress, distribution patterns and the ways HIV might influence mental health among men and women in a general population.</p> <p>Methods</p> <p>The relationship between HIV infection and mental distress was explored using a sample of 4466 participants in a population-based HIV survey conducted in selected rural and urban communities in Zambia in 2003. The Self-reporting questionnaire-10 (SRQ-10) was used to assess global mental distress. Weights were assigned to the SRQ-10 responses based on DSM IV criteria for depression and a cut off point set at 7/20 for probable cases of mental distress. A structural equation modeling (SEM) was established to assess the structural relationship between HIV infection and mental distress in the model, with maximum likelihood ratio as the method of estimation.</p> <p>Results</p> <p>The HIV prevalence was 13.6% vs. 18% in the rural and urban populations, respectively. The prevalence of mental distress was substantially higher among women than men and among groups with low educational attainment vs. high. The results of the SEM showed a close fit with the data. The final model revealed that self-rated health and self perceived HIV risk and worry of being HIV infected were important mediators between underlying factors, HIV infection and mental distress. The effect of HIV infection on mental distress was both direct and indirect, but was particularly strong through the indirect effects of health ratings and self perceived risk and worry of HIV infection.</p> <p>Conclusion</p> <p>These findings suggest a strong effect of HIV infection on mental distress. In this population where few knew their HIV status, this effect was mediated through self-perceptions of health status, found to capture changes in health perceptions related to HIV, and self-perceived risk and worry of actually being HIV infected.</p

‘Mankind owes to the child the best that it has to give’: Prison conditions and the health situation and rights of circumstantial children incarcerated in Sub Saharan African prisons.

Background: In recent times, sub-Saharan African (SSA) prisons have seen a substantial increase in women prisoners, including those incarcerated with children. Methods: A scoping review mapped what is currently known about the health situation and unique rights violations of children incarcerated with their mothers in SSA prisons. A systematic search collected and reviewed all available and relevant published and grey literature (2000-2018). Following application of exclusion measures, 64 records remained, which represented 27 of the 49 SSA countries. These records were charted and thematically analysed. Results: Four main themes were generated as follows: 1) the prison physical environment; 2) food availability, adequacy and quality; 3) provision of basic necessities and 4) availability and accessibility of health services for incarcerated children. Conclusions: The review highlights the grave situation of children incarcerated with their mothers in SSA prisons, underpinned by the lack of basic necessities, inadequate hygiene, sanitation and safe drinking water, exposure to diseases in overcrowded cells, inadequate nutrition, lack of provision of clothing and bedding, and difficulties accessing paediatric care. Reported paediatric morbidity and mortality associated with such prison conditions is deeply concerning and contrary to international mandates for the rights of the child, right to health and standards of care

Exclusive Breast Feeding Practice in Zambia

Background: Exclusive Breast Feeding (EBF), the best feeding practice for infants aged from birth to six (6) months has faced challenges of adherence, exposes infants to infections such as diarrhoea, despite information on its importance being given to mothers. The main objective of this study was to establish levels of EBF practice among breast feeding mothers who had infants aged from birth to six months, factors influencing the practices and support required for mothers in Luangwa district.Methods: A descriptive cross section study design was used and a total sample of 171 breast feeding mothers with infants aged from birth to six months were selected using systematic sampling method. The study was conducted in five randomly selected health facilities. The respondents were interviewed using a pretested semi-structured interview schedule and five focus group discussions each group with seven participants, were conducted using a focus group discussion guide at study sites. Quantitative data was analysed using SPSS computer software package and Fishers Exact test was used to test the association between the dependent and independent variables. Qualitative data from the focus group discussions was analysed using content analysis with the help of qualitative research computer software Nvivo.Results: The prevalence of exclusive breast feeding practice was at 61%. The factors that were found to be statistically significant to exclusive breast feeding were age of infant and support breast feeding mothers received. The others factors were found not to be statistically significant to exclusive breast feeding and these were educational level of the mother, knowledge on benefits of breast feeding and support from spouse.The study revealed that mothers found it difficult to practice Exclusive Breast Feeding because of the amount of work at home and spouses found it difficult to help with house chores because culturally it was a woman's work.Conclusion: Though exclusive breast feeding practice had improved in the district, there was still need to strengthen the practice in the district through education of spouses, family and the community on infant feeding for them to support breast feeding mothers. With the support, mothers will have time to exclusively breast feed their infants