Anatomical variations of the vertebral artery in a Zambian indigenous adult population undergoing computerised tomography angiography at the university teaching hospitals Lusaka, Zambia

Vertebral artery is an important source of blood supply to the brain which arises from the subclavian arteries. Anatomical variations have been incidentally reported during autopsy and angiograms. These variations predispose to development of aneurysms, dissections and may lead to vertebrobasilar ischaemia and posterior circulation stroke. Knowledge of variations of the great vessels of the neck is important for endovascular interventionists and diagnostic radiologists, more so in the era of new therapeutic options for intracranial interventions. Forty-two computerised tomography angiograms at the University Teaching Hospitals, Radiology Department Lusaka were examined to investigate vertebral artery variations in a Zambian population and determine the origin of the vessels. These paired vessels were examined thoroughly individually. Eighty-four arteries were examined eighty one (96.4%) had origin from the subclavian artery while three (3.6%) left took origin from the aortic arch. Variations found were two (2.4%) right vertebral arteries had fenestrations, ten (11.9%) had dual origin and one (1.2%) left was hypoplastic. The age ranged from 18 and 81 with mean age of (42.5±) of these seven females and four males had variations. Demographic characteristic (gender and age) had no statistically significant association to variations of vertebral artery (P>0.05). Variations of the vertebral artery are common. Knowledge of these variations is important and helpful in preventing iatrogenic injuries and haemorrhage during endovascular intervention and diagnostic procedures.Keywords: Vertebral artery, duplication, fenestrations, hypoplasi

Interventional Treatment of Symptomatic Uterine Fibroid by Uterine Artery Embolisation at the University Teaching Hospital in Lusaka, Zambia

Objective: To investigate the clinical effect of interventional therapy for symptomatic uterine fibroid by transcatheter uterine artery embolisation. Methods: Sixteen patients of symptomatic uterine fibroids were treated with selective uterine artery embolisation, and the relief of  symptoms and reduction of fibroids were observed. Results: Bilateral uterine artery embolisation was done in 16 patients. Follow-up for 5 ~ 7 months showed that the clinical symptoms  of 14 patients were obviously improved, and the re-examination of 1 patient of a very large myoma showed no obvious change after 6 months. B-Ultrasound showed that the size of the tumor was reduced by 43% ~ 92%. The major complication was being is  postoperative lower abdominal pain. Conclusion: Uterine artery embolisation is a safe and effective method to treat uterine fibroid. Keywords: Uterine Fibroid; Embolism; Uterine Arter

An audit of licenced Zambian diagnostic imaging equipment and personnel

Introduction: estimates indicate that two-thirds of the world's population lack adequate access to basic medical imaging services integral to universal health coverage (UHC). Furthermore, sparse country-level radiological resource statistics exist and there is scant appreciation of how such data reflect healthcare access. The World Health Organisation posits that one X-ray and ultrasound unit for every 50,000 people will meet 90% of global imaging demands. This study aimed to conduct a comprehensive review of licensed Zambian radiological equipment and human resources. Methods: an audit of licensed imaging resources, using the national updated Radiation Protection Authority and Health Professions Council of Zambia databases. Resources were quantified as units or personnel per million people, stratified by imaging modality, profession, province and healthcare sector, then compared with published Southern African data. Results: over half of all equipment (153/283 units, 54%) and almost two thirds of all radiation workers (556/913, 61%) are in two of ten provinces, serving one third of the population (5.49/16.4, 33.5%). Three-quarters of the national equipment inventory (212/283 units, 75%) and nearly ninety percent of registered radiation workers (800/913, 88%) are in the public sector, serving 96% of the population. Southern African country-level public-sector imaging resources principally reflect national per capita healthcare spending. Conclusion: to achieve equitable imaging access pivotal for UHC, Zambia will need a more homogeneous distribution of specialised radiological resources tailored to remedy disparities between healthcare sectors and provincial regions. Analyses of licenced radiology resources at country level can serve as a benchmark for medium-term radiological planning

Non-tuberculous mycobacteria (NTM) in Zambia: prevalence, clinical, radiological and microbiological characteristics

Non-tuberculous mycobacteria (NTM) infection is an emerging health problem. We present here the Zambia-specific national level data of prevalence, symptomatic, radiological and microbiological characteristics of NTM, using results from a national Tuberculosis (TB) prevalence survey. This was a cross-sectional study of the prevalence of NTM among adults aged 15 years and above, who were participants in a national TB prevalence survey. Participants who had either an abnormal chest x-ray or were symptomatic were considered presumptive TB cases and submitted sputum for smear and culture analysis. HIV testing was performed on an opt-out basis. Symptomatic NTM prevalence was estimated from individual level analysis. Of the 6,123 individuals with presumptive TB, 923 (15.1%) were found to have NTM, 13 (0.2%) were MTB/NTM co-infected and 338 (5.5%) were contaminated (indeterminate). The prevalence of symptomatic NTM was found to be 1,477/100,000 [95% CI 1010-1943]. Smear positivity, history of cough or chest pain and HIV positivity were risk factors for NTM. This first study to estimate the national prevalence of NTM in Zambia indicates that the burden is high. The NTM occurrence in Zambia constitutes both a public health and ethical issue requiring action from health manager

The Prevalence of Tuberculosis in Zambia: Results from the First National TB Prevalence Survey, 2013-2014.

BACKGROUND:Tuberculosis in Zambia is a major public health problem, however the country does not have reliable baseline data on the TB prevalence for impact measurement; therefore it was among the priority countries identified by the World Health Organization to conduct a national TB prevalence survey. OBJECTIVE:To estimate the prevalence of tuberculosis among the adult Zambian population aged 15 years and above, in 2013-2014. METHODS:A cross-sectional population-based survey was conducted in 66 clusters across all the 10 provinces of Zambia. Eligible participants aged 15 years and above were screened for TB symptoms, had a chest x-ray (CXR) performed and were offered an HIV test. Participants with TB symptoms and/or CXR abnormality underwent an in-depth interview and submitted one spot- and one morning sputum sample for smear microscopy and liquid culture. Digital data collection methods were used throughout the process. RESULTS:Of the 98,458 individuals who were enumerated, 54,830 (55.7%) were eligible to participate, and 46,099 (84.1%) participated. Of those who participated, 45,633/46,099 (99%) were screened by both symptom assessment and chest x-ray, while 466/46,099 (1.01%) were screened by interview only. 6,708 (14.6%) were eligible to submit sputum and 6,154/6,708 (91.7%) of them submitted at least one specimen for examination. MTB cases identified were 265/6,123 (4.3%). The estimated national adult prevalence of smear, culture and bacteriologically confirmed TB was 319/100,000 (232-406/100,000); 568/100,000 (440-697/100,000); and 638/100,000 (502-774/100,000) population, respectively. The risk of having TB was five times higher in the HIV positive than HIV negative individuals. The TB prevalence for all forms was estimated to be 455 /100,000 population for all age groups. CONCLUSION:The prevalence of tuberculosis in Zambia was higher than previously estimated. Innovative approaches are required to accelerate the control of TB