Effects of medication knowledge on medication adherence among hypertensive patients at Matero level one hospital, Lusaka city, Zambia: a cross sectional study

Background: Medication adherence is the mainstay to good treatment outcomes. Failure to adhere to medication in hypertensive patients may lead to considerable deterioration of the disease resulting in increased costs of healthcare and mortality. Knowledge about the name of the drug, indications and side effects may enhance medication adherence. Therefore, the aim of this study was to assess effects of medication knowledge on medication adherence among hypertensive patients.Methods: This was a cross-sectional study that involved 120 hypertensive patients. A structured questionnaire was used to collect data on demographic characteristics. Adherence was assessed using the 8-item Morisky medication adherence scale while patient’s medication knowledge was assessed using a 7-item scale. Multiple logistic regression was used to assess factors associated with medication adherence.Results: The mean age of participants was 59 years (SD±14.9) and 10 (8.3%), 42 (35%) and 68 (56.7%) had adequate, average and poor medication knowledge respectively. The prevalence of adherence in this study was 37.5%. In multivariable logistic regression analysis, uncontrolled blood pressure (BP) (AOR: 0.38, CI: 0.16-0.90) was associated with lower likelihood of adhering to medication.Conclusions: The adherence level to treatment was low and medication knowledge of hypertensive patients was generally poor. Uncontrolled BP was associated with non-adherence. Patients with uncontrolled hypertension should be given health education and counselling regarding their condition to improve medication adherence.

Improving validity of informed consent for biomedical research in Zambia using a laboratory exposure intervention.

BACKGROUND: Complex biomedical research can lead to disquiet in communities with limited exposure to scientific discussions, leading to rumours or to high drop-out rates. We set out to test an intervention designed to address apprehensions commonly encountered in a community where literacy is uncommon, and where complex biomedical research has been conducted for over a decade. We aimed to determine if it could improve the validity of consent. METHODS: Data were collected using focus group discussions, key informant interviews and observations. We designed an intervention that exposed participants to a detailed demonstration of laboratory processes. Each group was interviewed twice in a day, before and after exposure to the intervention in order to assess changes in their views. RESULTS: Factors that motivated people to participate in invasive biomedical research included a desire to stay healthy because of the screening during the recruitment process, regular advice from doctors, free medical services, and trust in the researchers. Inhibiting factors were limited knowledge about samples taken from their bodies during endoscopic procedures, the impact of endoscopy on the function of internal organs, and concerns about the use of biomedical samples. The belief that blood can be used for Satanic practices also created insecurities about drawing of blood samples. Further inhibiting factors included a fear of being labelled as HIV positive if known to consult heath workers repeatedly, and gender inequality. Concerns about the use and storage of blood and tissue samples were overcome by a laboratory exposure intervention. CONCLUSION: Selecting a group of members from target community and engaging them in a laboratory exposure intervention could be a useful tool for enhancing specific aspects of consent for biomedical research. Further work is needed to determine the extent to which improved understanding permeates beyond the immediate group participating in the intervention

Rifaximin Reduces Markers of Inflammation and Bacterial 16S rRNA in Zambian Adults with Hepatosplenic Schistosomiasis: A Randomized Control Trial

We thank the Wellcome Trust through the Southern Africa Consortium for Research Excellence for funding this study (WT087537MA)

Predicting Mortality in Hospitalized COVID-19 Patients in Zambia: An Application of Machine Learning

The coronavirus disease 2019 (COVID-19) has wreaked havoc globally, resulting in millions of cases and deaths. The objective of this study was to predict mortality in hospitalized COVID-19 patients in Zambia using machine learning (ML) methods based on factors that have been shown to be predictive of mortality and thereby improve pandemic preparedness. This research employed seven powerful ML models that included decision tree (DT), random forest (RF), support vector machines (SVM), logistic regression (LR), Naïve Bayes (NB), gradient boosting (GB), and XGBoost (XGB). These classifiers were trained on 1,433 hospitalized COVID-19 patients from various health facilities in Zambia. The performances achieved by these models were checked using accuracy, recall, F1-Score, area under the receiver operating characteristic curve (ROC_AUC), area under the precision-recall curve (PRC_AUC), and other metrics. The best-performing model was the XGB which had an accuracy of 92.3%, recall of 94.2%, F1-Score of 92.4%, and ROC_AUC of 97.5%. The pairwise Mann–Whitney U-test analysis showed that the second-best model (GB) and the third-best model (RF) did not perform significantly worse than the best model (XGB) and had the following: GB had an accuracy of 91.7%, recall of 94.2%, F1-Score of 91.9%, and ROC_AUC of 97.1%. RF had an accuracy of 90.8%, recall of 93.6%, F1-Score of 91.0%, and ROC_AUC of 96.8%. Other models showed similar results for the same metrics checked. The study successfully derived and validated the selected ML models and predicted mortality effectively with reasonably high performance in the stated metrics. The feature importance analysis found that knowledge of underlying health conditions about patients’ hospital length of stay (LOS), white blood cell count, age, and other factors can help healthcare providers offer lifesaving services on time, improve pandemic preparedness, and decongest health facilities in Zambia and other countries with similar settings

Acceptability and associated factors of indoor residual spraying for malaria control by households in Luangwa district of Zambia: A multilevel analysis.

The global burden of malaria has increased from 227 million cases in 2019 to 247 million cases in 2020. Indoor residual spraying (IRS) remains one of the most effective control strategies for malaria. The current study sought to measure the acceptability level and associated factors of indoor residual spraying. A cross sectional study was conducted from October to November 2020 in sixteen urban and rural communities of Luangwa district using a cluster sampling method, Multilevel analysis was used to account for the hierarchical structure of the data. The acceptability level of indoor residual spraying among household heads was relatively high at 87%. Individuals who felt the timing was not appropriate were associated with decreased odds of accepting IRS (AOR = 0.55, 95% CI: 0.20-0.86). Positive attitude was associated with increased odds of accepting IRS (AOR = 29.34, 95% CI: 11.14-77.30). High acceptability level was associated with unemployment (AOR = 1.92, 95% CI: 1.07-3.44). There were no associations found between acceptability levels and community-level factors such as information, education, communication dissemination, awareness achieved through door-to-door sensitization, and public address system. Acceptability level of indoor residual spraying was relatively high among households of Luangwa District suggesting that the interventions are more acceptable which is essential in reaching malaria elimination by 2030. Finding that community factors known to influence acceptability such as information, education and communication as well as awareness were not important to influencing acceptability suggests need for reinforcing messages related to indoor residual spraying and redefining the community sensitization approaches to make indoor residual spraying more acceptable

Escherichia coli Antimicrobial Susceptibility Reduction amongst HIV-Infected Individuals at the University Teaching Hospital, Lusaka, Zambia

Increased antimicrobial resistance among Human Immunodeficiency Virus (HIV)-infected individuals to commonly used antibiotics in the treatment of gastroenteritis is a public health concern, especially in resource-limited settings. We set out to compare the antimicrobial susceptibility pattern of Escherichia coli (E. coli) isolates from HIV-infected and HIV-uninfected individuals at a tertiary hospital in Lusaka, Zambia. An analytical cross-sectional study was conducted at the University Teaching Hospital from May 2019 to August 2019. Stool samples were screened, and 79 HIV-infected individuals matched by age and sex with 84 HIV-uninfected individuals that presented with E. coli associated gastroenteritis were studied. Demographics were collected from the Laboratory Information System (LIS) and stool samples were collected in a sterile leak-proof container. Samples were cultured and only those where E. coli was isolated were included in the study and tested for antimicrobial susceptibility by the Kirby–Bauer disk diffusion technique. HIV-positive individuals were 3 times (adjusted odds ratio (AOR) = 3.17; 95% CI (1.51, 6.66); p < 0.001) more likely to be resistant to quinolones compared with their HIV-negative counterparts. Similarly, HIV-positive individuals were almost 4 times (AOR = 3.97, 95% CI (1.37, 11.46); p = 0.011) more likely to have multidrug-resistant E. coli compared with those who were HIV-negative. HIV infection was associated with reduced E. coli susceptibility to commonly used antibiotics, and most cases showed resistance

Self-perceived Versus Supervisor-rated Technical Competence in Plain Film X-ray Evaluation by Newly Graduated radiographers: Implications for Curriculum Development and Practice in Zambia

Purpose: The purpose of the study was to determine and compare the self-perceived versus supervisor-rated technical competence in plain film X-ray image evaluation using seven standard parameters among newly recruited radiographers working in tertiary teaching hospitals in Zambia. This was done to evaluate the value of measuring technical competence as a feedback to curriculum development and review. Methods: A parallel convergent mixed-methods study was conducted. Two focus groups with a total of 17 radiography supervisors purposefully selected from teaching hospitals and training institutions across Zambia were held to solicit their views on technical image evaluation capability of the newly graduated radiographers. A descriptive cross-sectional survey involving 31 newly recruited radiographers from five Zambian teaching hospitals was conducted to assess self-perceived competence in plain film x-ray evaluation. We used thematic analysis to analyse qualitative data, whilst analysis for quantitative data, STATA version 13 and Graph pad prism 5 was used. Results: Among the 17 radiography supervisors, 11 rated the technical competence of entry-level radiography graduates as low. Reasons advanced included insufficient clinical training, uncoordinated clinical training, lack of focus on core radiography training, and lack of attention and commitment to work. In the cross-sectional study, the mean score for self-evaluated competence was 76%. The frequency of performing chest X-rays predicted self-rated competence score (p<0.001). Conclusions: There was variation between self-perceived and supervisor-rating of technical competence of entry-level radiography graduates in Zambia. A need exists to perform an actual workplace-based assessment to establish actual competence of the new graduates to inform curriculum development and review in Zambia

Rotavirus breakthrough infections responsible for gastroenteritis in vaccinated infants who presented with acute diarrhoea at University Teaching Hospitals, Children's Hospital in 2016, in Lusaka Zambia.

BackgroundIn Zambia, before rotavirus vaccine introduction, the virus accounted for about 10 million episodes of diarrhoea, 63 000 hospitalisations and 15 000 deaths in 2015, making diarrhoea the third leading cause of death after pneumonia and malaria. In Zambia, despite the introduction of the vaccine acute diarrhoea due to rotaviruses has continued to affect children aged five years and below. This study aimed to characterise the rotavirus genotypes which were responsible for diarrhoeal infections in vaccinated infants aged 2 to 12 months and to determine the relationship between rotavirus strains and the severity of diarrhoea in 2016.MethodsStool samples from infants aged 2 to 12 months who presented to the hospital with acute diarrhoea of three or more episodes in 24 hours were tested for group A rotavirus. All positive specimens that had enough sample were genotyped using reverse transcriptase Polymerase Chain Reaction (RT-PCR). A 20-point Vesikari clinical score between 1-5 was considered as mild, 6-10 as moderate and greater or equal to 11 as severe.ResultsA total of 424 stool specimens were tested of which 153 (36%, 95% CI 31.5% to 40.9%) were positive for VP6 rotavirus antigen. The age-specific rotavirus infections decreased significantly (p = 0.041) from 2-4 months, 32.0% (49/118) followed by a 38.8% (70/181) infection rate in the 5-8 months' category and subsequently dropped in the infants aged 9-12 months with a positivity rate of 27.2%. 38.5% of infants who received a single dose, 34.5% of those who received a complete dose and 45.2% (19/42) of the unvaccinated tested positive for rotavirus. The predominant rotavirus genotypes included G2P[6] 36%, G1P[8] 32%, mixed infections 19%, G2P[4] 6%, G1P[6] 4% and G9P[6] 3%.Discussion and conclusionResults suggest breakthrough infection of heterotypic strains (G2P[6] (36%), homotypic, G1P[8] (32%) and mixed infections (19%) raises concerns about the effects of the vaccination on the rotavirus diversity, considering the selective pressure that rotavirus vaccines could exert on viral populations. This data indicates that the rotavirus vaccine has generally reduced the severity of diarrhoea despite the detection of the virus strains

Knowledge, attitude and practice towards cervical cancer screening among women living with human immunodeficiency virus: Implication for prevention strategy uptake

Abstract Aim To explore the knowledge, attitude and practices of cervical cancer screening among HIV‐infected women in public health facilities in Lusaka, Zambia. Design Cross‐sectional study. Methods The study was conducted from 1st January 2020 to 28th February 2020. We used a structured questionnaire for data collection. The Structural Equation Modelling (SEM) was used to analyse relationships among latent variables (knowledge, attitude and practice). Results The overall knowledge, attitude, and practice scores of cervical cancer screening among women living with HIV were 6.86/11 (62.4%), 6.41/7 (91.6%) and 2.92/8 (36.5%), respectively. Overall, knowledge was positively and significantly associated with attitude (r = .53, p < .001) and practice (r = .38, p < 0.001). Additionally, attitude and practice were significantly associated (r = 0.29, p < .001). Our findings support the reinforcement of current public health interventional programmes to improve the knowledge about cervical cancer and screening uptake

Maternal COVID-19 infection and associated factors: A cross-sectional study

Background Since the declaration of COVID-19 as a global pandemic, several studies have been conducted to examine associated factors. However, few studies have focused on pregnant women infected with COVID-19 in sub-Saharan Africa. Therefore, this study investigated the prevalence and factors associated with COVID-19 infection among pregnant women at the Levy Mwanawasa University Teaching Hospital and Women and Newborn Hospital of the University Teaching Hospitals in Lusaka, Zambia. Methods A cross-sectional study was conducted between March and July 2021. Women were recruited as they presented for antenatal care. Data was collected using a structured questionnaire to capture variables of interest (socio-demographic, clinical and obstetric). COVID-19 diagnosis was made using a nasopharyngeal swab by PCR test. Multivariable logistic regression was used to control for confounding and calculate the odds ratios for each explanatory variable and respective 95% confidence intervals. Results The study enrolled 352 participants with a mean (standard deviation [SD]) age of 30.1 years (5.6). One hundred thirty of 352 (36.9%; 95% CI: 31.9 to 42.2) participants had a confirmed positive SARS-CoV-2 test result. At univariable analysis, factors associated with COVID-19 were increased gestational age, education status and maternal HIV serostatus. Women with a secondary level of education were less likely to have COVID-19 infection than those with a primary level of education (AOR = 0.23, 95% CI: 0.09–0.63). On the other hand, a one-week increase in gestational age was associated with higher odds of COVID-19 infection (AOR = 1.03, 95% CI: 1.01–1.06). Conclusion The results showed that the prevalence of COVID-19 infection among pregnant women was 36.9% and was associated with increased gestational age and a lower level of education. To mitigate adverse maternal outcomes, there is a need to screen for COVID-19 strictly and broadly monitor prenatal women presenting for healthcare