Women's Intention to Prevent Vesico Vaginal Fistula Recurrence in Two Repair Centres in Zambia

Objective: The study purpose was to determine the association between intention to prevent Vesico-Vaginal Fistula recurrence and knowledge of the risk factors of Vesico Vaginal Fistula recurrence, attitude towards Vesico Vaginal Fistula prevention and self esteem among women with Vesico-Vaginal Fistula in two repair centers in Zambia.Design: This was a descriptive cross sectional correlational study in which data were obtained through the structured interview schedule.Main Outcomes: Vesico vaginal fistula has been recognized as a preventable tragedy and a challenge in areas where access to health care with emergency obstetric care is poor. The situation is getting worse among women, and the key to ending fistula is to prevent it.Measures: The Ministry of Health need to introduce waiting homes in hospitals with emergency obstetric care so that repaired women with VVF can wait for delivery. The MOH needs to support community sensitization orpublic education on attitudes towards Vesico vaginal fistula prevention which will in turn improve intentions to prevent Vesico vaginal fistula  recurrence. Management at katete and Chilonga mission hospitalsshould ensure that counseling services are intensified to women with a repaired VVF so as to prevent recurrence. Antenatal clinics should be used as an opportunity for teaching Vesico Vaginal fistula since the study findingreview that 45% of the respondents did not know the risk factors of recurrence.Results: Majority of the respondents (97%) had positive intentions to prevent VesicoVaginal Fistula recurrence. More than half of the respondents (55%) knew the risk factors of VVF recurrence, 61% had positive attitudes towards Vesico Vaginal Fistula prevention and 52% had low level of self esteem. There was a significant positive relationship between intentionto prevent Vesico Vaginal Fistula recurrence and attitude towards Vesico Vaginal Fistula prevention and a significant negative relationship between intention to prevent Vesico Vaginal Fistula recurrence and self esteem. Knowledge of the risk factors of Vesico vaginal fistula recurrence was not significant. Using multiple regressions, attitude and self esteem were significant explaining 15% of the variance in intention to preventVVF recurrence.Conclusion: Vesico vaginal fistula is a very unpleasant experience for women. Corrective measures have been started by UNFPA but these need to be strengthened. There is need for innovation to consider other solutions that has not been tried before. This is important in order to prevent recurrence of Vesico vaginal fistula among repaired women in subsequent pregnancies

Quality of Life of Zambians Living with HIV & AIDS

Introduction: The HIV/AIDS disease has changed individual lifestyles and quality of life, as the HIV disease progresses, quality of life deteriorates. It is vital that the quality of life of PLWHA is assessed regularly so that they are given holistic care that is able to ameliorate the symptoms of ill health and improve their quality of life.Purpose: The purpose of this study was to determine the quality of life of Zambians living with HIV/AIDSMethod: The study used a cross-sectional descriptive design. This study was conducted in both rural and urban antiretroviral clinics in Zambia on 160 PLWHAof various HIV ranging from asymptomatic to full blown AIDS. Three scales, “Zambian WHOQOL-HIV Scale” (á = .896); “Zambian WHOHIV SRPB Scale” (á = .699); “Zambian WHOHIV medication dependence Scale” (á = .801); derived from the WHOQOL-HIV were used to assess quality of life.Results: A third of the participants reported very high medication dependence (32.5%). Two thirds of the participants (66%) had good or very good spirituality. Majority of the participants (82.2%) had good or very good quality of life. The results show that the quality of life, medication dependence and spirituality for the Zambian sample were all above average. Quality of life had significant positive relationships with all of its domains and a significant positive relationship with spirituality.Conclusion: Because little investigation has been done on quality of life in HIV/AIDS in developing countries such as Zambia, the current study is a vital step in addressing the issue of quality of life. The finding that quality of life of Zambian people living with HIV/AIDS is above average may mean that thepreventive and health care programs that are being used for education and provision of antiretroviral medication are yielding good results, this progress should be harnessed.Keywords: Quality of Life, HIV & AIDS, Zambia

Stress and Coping Mechanisms Among Breast Cancer Patients and Family Caregivers: A Review of Literature

Background: Breast cancer is the most common malignancy of women worldwide accounting for 23% of all newly diagnosed cancer cases. It is also the leading cause of cancer mortality, representing 14.1%. In Zambia, it is second to cervical cancer and its incidence is steadily increasing. A diagnosis of cancer regardless of stage is a stressful event impacting on all facets of the patient’s life and that of her family caregivers. To minimize the impact, adaptive coping mechanisms are required.Aim of the review: The aim of the review was to gain an in-depth understanding of the stress and coping mechanisms used by breast cancer patients and family caregivers.Materials and methods: A comprehensive review of publications for the period 1980-2010 cited on Pub Med, Hinari, British National Index, African Journal Online was undertaken. Search terms included “stress”, “coping”, “breast cancer”, “coping mechanisms”, “coping mechanisms by breast cancer patients and family care givers”.Search Results: Of the 22 articles reviewed, 13 focused on coping with breast cancer, 5 on stress and adaptation to cancer and the last 4 on experiences of family members on care of the terminally ill. Eighteen of the 22 used solely qualitative methodology while 4 used mixed methods. Analysis of the articles revealed 4 predominant coping mechanisms for both the patient and family: (a) seeking social support, (b) reliance on God, (c) positive suggestion/attitude or re-affirmation and (d) acquisition of information and education.Conclusions: A diagnosis of breast cancer is a stressor to both the patient and the family caregivers.Coping mechanisms/strategies are therefore required in order to adapt. Keywords: Breast cancer, Stress, Coping, Patient and Family caregiver

Gastric adenocarcinoma in Zambia: A case-control study of HIV, lifestyle risk factors, and biomarkers of pathogenesis

Background. Gastric cancer is a leading cause of cancer deaths worldwide but there are few data from Africa. We recently observed a trendtowards diagnosis in younger patients.Objective. To test the hypothesis that HIV might have altered risk factors for acquisition of gastric cancer, in a case-control study in theUniversity Teaching Hospital, Lusaka, Zambia.Methods. Patients (n=52) with confirmed gastric adenocarcinoma and controls (n=94) undergoing endoscopy but with no macroscopicgastric pathology. Established risk factors and HIV status were compared.Results. HIV status did not differ significantly between cases and controls (odds ratio 1.03; 95% CI 0.2 - 4.3; p=1.00) and seroprevalencein cases was similar to that of the Zambian population. Smoking, regular alcohol intake, and gastric atrophy were all associated with cancerin univariate and multivariate analysis. Helicobacter pylori serology was positive in 84% of patients studied and cytotoxin-associated gene A(cagA) serology in 66%; neither serological marker was associated with cancer. Atrophy was common in cases (57%) and controls (30%) andassociated with both smoking and alcohol use. Intestinal metaplasia was present in 17% of the controls, but was not associated with atrophy.Conclusions. HIV was not associated with gastric cancer and does not explain the apparent younger age distribution. Atrophy was commonand was not essential for the development of intestinal metaplasia, suggesting that gastric carcinogenesis in Africa does not always followthe pathway from atrophy to intestinal metaplasia to gastric carcinoma (the so-called Correa pathway)

The burden and natural history of cardiac pathology at TB diagnosis in a high-HIV prevalence district in Zambia: protocol for the TB-Heart study.

BACKGROUND: Tuberculosis (TB) continues to be a major cause of death across sub-Saharan Africa (SSA). In parallel, non-communicable disease and especially cardiovascular disease (CVD) burden has increased substantially in the region. Cardiac manifestations of TB are well-recognised but the extent to which they co-exist with pulmonary TB (PTB) has not been systematically evaluated. The aim of this study is to improve understanding of the burden of cardiac pathology in PTB in those living with and without HIV in a high-burden setting. METHODS: This is a cross-sectional and natural history study to evaluate the burden and natural history of cardiac pathology in participants with PTB in Lusaka, Zambia, a high burden setting for TB and HIV. Participants with PTB, with and without HIV will be consecutively recruited alongside age- and sex-matched TB-uninfected comparators on a 2:1 basis. Participants will undergo baseline assessments to collect clinical, socio-demographic, functional, laboratory and TB disease impact data followed by point-of-care and standard echocardiography. Participants with PTB will undergo further repeat clinical and functional examination at two- and six months follow-up. Those with cardiac pathology at baseline will undergo repeat echocardiography at six months. DISCUSSION: The outcomes of the study are to a) determine the burden of cardiac pathology at TB diagnosis, b) describe its association with patient-defining risk factors and biochemical markers of cardiac injury and stretch and c) describe the natural history of cardiac pathology during the course of TB treatment

Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3L) utility index

10.1186/s12955-019-1135-8Health and Quality of Life Outcomes1718

Knowledge and Utilization of ICU Admission Criteria and Guidelines, Lusaka, Zambia

The University Teaching Hospital is the only national tertiary hospital in Zambia. During the period the University Teaching Hospital Main Intensive Care Unit was developed, the yearly admissions had risen from 450 to over 900 between 1984 and 1988. The increase was contained by keeping an average bed- occupancy rate of six patients per day. The ICU team concentrated on prompt diagnosis, treatment and insisted on discharge once patient's condition stabilized and was out of danger. In 2001, the admission criteria and guidelines for ICU were developed. However, since the formulation of the criteria and guidelines in 2001 there has been no formal evaluation.Purpose: To determine nurses' knowledge and utilization of intensive care unit admission criteria and guidelines.Design and Measures: A descriptive study was conducted on a randomly selected sample of fifty nurses working in the emergency department, obstetric wards, medical wards, surgical wards and theatres at the University Teaching Hospital. A self administered questionnaire was used to collect data.Results: Atotal of 50 respondents aged 24 to 59 took part in the study. Eighty six percent were female, 48% were single and 36% had worked as nurses for 8 to 14 years. Two-thirds (60%) of the respondents were registered nurses and only 4% were specialized in critical care nursing. Majority of the respondents had high level of knowledge of ICU admission criteria (94%), and admission guidelines (92%). Almost all respondents (98%) had high level of utilization of ICU admission criteria and all respondents had high level of utilization of ICU admission guidelines.Conclusion and Implications: The results of the study have shown that although nurses have a high level of both knowledge and utilization of ICU admission criteria and guidelines, almost all of them have not trained in critical care nursing. High knowledge influences utilization of the criteria and guidelines positively. The implication of this study is that, nurses should appreciate the importance of utilizing ICU admission criteria and guidelines so that only the type of patients enshrined in the criteria are admitted to ICU. In this way, admissions for social reasons will be avoided and the scarce resources will be reserved for those patients who really need critical care.&nbsp