Effect of Knowledge of Patients' HIV Positive Status on the Attitude of Health Workers in Zambia

Background: Zambia, Southern Africa, has one of the world's most devastating HIV and AIDS epidemics. More than one in every seven adults in the country is living with HIV1 and this disease is the leading cause for patient work load in all health institutions putting a strain on the depleted work force. Fear of contracting HIV from such patients is real and likely to impact negatively on the attitude of patients if they knew the HIV status of the patient to be positive. This study was undertaken to investigate the influence of knowing the HIV status of a patient to be positive on the various decisions of healthcare providers regarding provision of health care to such patients.Study design: This was a cross-sectional study conducted between 2001 and 2005 in Zambia among health workers during the costing of basic health care package among selected health centres.Outcome Measures: Information was obtained by questionnaire and scored on Likerts' scale regarding whether a patient with known HIV positive test result should be: nursed in isolation ward, staff and health professionals should be notified , beds of such patients should be specially marked, relatives should be informed (with and without consent), relatives to be the ones to nurse such a patient, the terminally ill one should be denied resuscitation, staff would refuse to handle a patient, they would encourage a patient to use herbs and prayers rather than HAART, medical treatment was ever refused, admission was ever refused and surgeon ever refused operating on patient with positive HIVtest.Results: Atotal 180 health workers comprising 120 (66.7%) nurses, 25(13.9%) physicians, 22 (12.2%) laboratory technicians and 13 (7.2%) environmental health technicians were studied. Most of interviewees felt that such patients should not be discriminated against. Over 80% felt that health staff should be availed this sero-status while 50% felt that relatives should be informed of the status even without consent and that the relatives nurse these patients .Half thought that resuscitation should not be done for terminally ill such patients and a third said they will offer prayers instead of HAART while half said they will recommend herbs. A third of physician reported having refused to operate on such patient. Conclusion: While most health-care professionals surveyed reported being in compliance with their ethical obligations the findings are a sources of concern. It would be useful to repeat this study now that HAART and post-exposure prophylaxis have been rolled out in Zambia. Keywords: Attitude, Health workers, Patient’s HIV statu

HIV/AIDS and Postnatal Depression at the University Teaching Hospital, Lusaka, Zambia

Objective: To study the contribution of HIV/AIDS to the problem of postnatal depression among women receiving postnatal care at University Teaching Hospital (UTH), Lusaka, Zambia.Background: Postnatal depression (PND), a major depressive episode during the puerperium, affects between 10% and 22% of adult women before the infant's first birthday. HIV seropositivity has been associated with increased risk of mental disease, but its influence on postnatal depression has not been fully explored.Methods: This was a cross-sectional study, involving 229 mothers receiving postnatal care at UTH. The presence of postnatal depression and mean scores on the Edinburgh Postnatal Depression Scale (EPDS) were assessed, along with the patients' HIV status and other demographic and clinical characteristics.Results: 146 of 229 patients (64%) had depressive symptoms as measured by an EPDS score ≥8. Sixtyfour women (28%) had severe PND, defined as an EPDS score ≥13. There were 46 HIV positive women (20.1%). HIV status was not associated with PND (adjusted OR 1.22, 95% CI 0.50-2.96) or severe PND (adjusted OR 1.77, 95% CI 0.68-4.61). Mixed mode of infant feeding and parity of 4-5 were independently associated with PND.Conclusions: Depression is a real health problem among mothers attending postnatal care at UTH. HIV status was not independently associated with increased risk of postnatal depression.Keywords: postnatal depression, puerperium, Edinburgh Postnatal Depression Scale, prevalence of HIV/AID

The Determinants and Outcomes of Second Trimester Abortion at the University Teaching Hospital

Background: Mid trimester abortion constitutes 10-15% of all induced abortions worldwide and accounts for the majority of complications. In Africa, studies demonstrating the proportion of second trimester abortions are few.  However to appropriately intervene with a view to reducing the morbidity and mortality due to mid trimester   abortions, the determinants in our setting must be established as well as the outcomes of uterine evacuation in  this trimester. The aim of this study was to explore the determinants and outcomes of second trimester abortions at UTH.Design: Cross sectional non interventional descriptive study.Setting: University Teaching Hospital, a tertiary referral hospital in Lusaka, ZambiaPopulation: Pregnant women requiring second trimester abortion care.Methods: A total of 145 second trimester cases were seen, involving women aged 13-46 years of age eitherrequesting termination of pregnancy or presenting with spontaneous or induced abortion. The enrolled studyparticipants all underwent a standard clinical assessment during which their respective clinical findings wererecorded on data sheets. Data analysis was done using SPSS version 17.Results: The point prevalence of second trimester abortion was 15.3%. The mean frequency of abortion per patient was 1. The index abortion was for a first pregnancy in 84% of the women. Out of 145 women who were  admitted 119 (82.1%) were linked to spontaneous abortions, 16(11%) with medically/surgically induced abortion  and 10(6.9%) with self-induced abortions. More women, 128(88%) were not using some form of contraception to  avoid pregnancy. Few, 17(12%) actually used some form of contraception prior to index pregnancy. Five (3.4%)  out of 26 who had induced abortion had desired pregnancy. Of the delay factors, the most frequent was conflict  with partner. Amongst those who had spontaneous abortion, illness was reported as most frequent determinant  (49.7%). It was observed that there was no statistically significant association between seeking care and with any  delay factors. With regard to standard of care or health system factors, overall 89% were provided with  ppropriate uterine evacuation method while the rest were not. Fifty percent did not receive analgesia. The mean time   between expulsion of fetus and uterine evacuation was 4.31 hours. Complications noted included uterine  perforation, hemorrhage, cervical or vaginal lacerations, shock and even death.Conclusion: The determinants of the second trimester abortion cases at the University Teaching Hospital are social, economic, health system factors, trauma, illness and unknown factors. The outcomes of second trimester  abortion in terms of complications are varied. These are due to patient factors and methods used for uterine  evacuation. The outcomes included uncomplicated complete abortion, retained products of conception,   haemorrhage, uterine perforation, pain, shock, infection, lacerations, delayed vaginal bleeding and death. The  methods of uterine evacuation varied from patient to patient but the overall outcome of the patient was not   significantly affected by this.Key Words: Second trimester,Abortion, determinants and outcomes

Incidence of abortion-related near-miss complications in Zambia: cross-sectional study in Central, Copperbelt and Lusaka Provinces

OBJECTIVES: To describe the magnitude and severity of abortion-related complications in health facilities and calculate the incidence of abortion-related near-miss complications at the population level in three provinces in Zambia, a country where abortion is legal but stigmatized. STUDY DESIGN: We conducted a cross-sectional study in 35 district, provincial and tertiary hospitals over 5 months. All women hospitalized for abortion-related complications were eligible for inclusion. Cases of abortion-related near-miss, moderate and low morbidity were identified using adapted World Health Organization (WHO) near-miss and the prospective morbidity methodology criteria. Incidence was calculated by annualizing the number of near-misses and dividing by the population of women of reproductive age. We calculated the abortion-related near-miss rate, abortion-related near-miss ratio and the hospital mortality index. RESULTS: Participating hospitals recorded 26,723 births during the study. Of admissions for post-abortion care, 2406 (42%) were eligible for inclusion. Near-misses constituted 16% of admitted complications and there were 14 abortion-related maternal deaths. The hospital mortality index was 3%; the abortion-related near-miss rate for the three provinces was 72 per 100,000 women, and the near-miss ratio was 450 per 100,000 live births. CONCLUSIONS: Abortion-related near-miss and mortality are challenges for the Zambian health system. Adapted to reflect health systems capabilities, the WHO near-miss criteria can be applied to routine hospital records to obtain useful data in low-income settings. Reducing avoidable maternal mortality and morbidity due to abortion requires efforts to de-stigmatize access to abortion provision, and expanded access to modern contraception. IMPLICATIONS: The abortion-related near-miss rate is high in Zambia compared with other restrictive contexts. Our results suggest that near-miss is a promising indicator of unsafe abortion; can be measured using routine hospital data, conveniently defined using the WHO criteria; and can be incorporated into the frequently utilized prospective morbidity methodology

The WOMAN trial: clinical and contextual factors surrounding the deaths of 483 women following post-partum haemorrhage in developing countries.

BACKGROUND: Post-partum haemorrhage (PPH) is a leading cause of maternal death worldwide. The WOMAN trial assessed the effects of tranexamic acid (TXA) on death and surgical morbidity in women with PPH. The trial recorded 483 maternal deaths. We report the circumstances of the women who died. METHODS: The WOMAN trial recruited 20,060 women with a clinical diagnosis of PPH after a vaginal birth or caesarean section. We randomly allocated women to receive TXA or placebo. When a woman died, we asked participating clinicians to report the cause of death and to provide a short narrative of the events surrounding the death. We collated and edited for clarity the narrative data. RESULTS: Case fatality rates were 3.0% in Africa and 1.7% in Asia. Nearly three quarters of deaths were within 3 h of delivery and 91% of these deaths were from bleeding. Women who delivered outside a participating hospital (12%) were three times more likely to die (OR = 3.12, 95%CI 2.55-3.81) than those who delivered in hospital. Blood was often unavailable due to shortages or because relatives could not afford to buy it. Clinicians highlighted late presentation, maternal anaemia and poor infrastructure as key contributory factors. CONCLUSIONS: Although TXA use reduces bleeding deaths by almost one third, mortality rates similar to those in high income countries will not be achieved without tackling late presentation, maternal anaemia, availability of blood for transfusion and poor infrastructure

Quantifying bias between reported last menstrual period and ultrasonography estimates of gestational age in Lusaka, Zambia

Objective To quantify differences in assessing preterm delivery when calculating gestational age from last menstrual period (LMP) versus ultrasonography biometry. Methods The Zambian Preterm Birth Prevention Study is an ongoing prospective cohort study that commenced enrolment in August 2015 at Women and Newborn Hospital of University Teaching Hospital in Lusaka, Zambia. Women at less than 20 weeks of pregnancy who were enrolled between August 17, 2015, and August 31, 2017, and underwent ultrasonography examination were included in the present analysis. The primary outcome was the difference between ultrasonography‐ and LMP‐based estimated gestational age. Associations between baseline predictors and outcomes were assessed using simple regression. The proportion of preterm deliveries using LMP‐ and ultrasonography‐derived gestational dating was calculated using Kaplan–Meier analysis. Results The analysis included 942 women. The discrepancy between estimating gestational age using ultrasonography and LMP increased with greater gestational age at presentation and among patients with no history of preterm delivery. In a Kaplan‐Meier analysis of 692 deliveries, 140 (20.2%, 95% confidence interval [CI] 17.7–23.0) and 79 (11.4%, 95% CI 9.6–13.6) deliveries were classified as preterm by LMP and ultrasonography estimates, respectively. Conclusion Taking ultrasonography as a standard, a bias was observed in LMP‐based gestational age estimates, which increased with advancing gestation at presentation. This resulted in misclassification of term deliveries as preterm