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)

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

Knowledge, attitude and compliance with tuberculosis treatment, Lusaka, Zambia

More than 1.5 million TB cases occur in sub-Saharan Africa every year. Lack of compliance to TB treatment has contributed to the steady rise of TB incidence in Zambia. The prevalence of TB was 511 per 100,000 population in 2000. Much of the increase in incidence has been attributed to co-infection with HIV, there are HIV rates of 70-80% in TB patients Objectives: To determine knowledge, attitude and compliance with TB treatment by PTB patients attending chest clinic at a tertiary hospital. Design and Measures:A descriptive study was conducted on a convenience sample of 104 pulmonary PTB patients receiving health care at chest clinic of a tertiary hospital in Lusaka, Zambia. An Interview Schedule comprising of four sections (demographic, knowledge, attitude, and compliance) was used to collect data. Results: A total of 104 respondents aged 18 to 66 years took part in the study. Forty-nine percent were female, 51.9% were married and 42.3% had primary education only. About half of the respondents (49%) had no monthly income and majority of those with no income were female. Two thirds of the respondents (76%) lived in high-density areas. Half of the respondents (49%) had average knowledge of TB treatment. Majority of the respondents (89.4%) had positive attitude towards TB treatment rating high in all the attitude subscales 74 % in commitment, 84.6% in challenge and 55.8% in control. Most of the respondents’ (80.8%) reported complying with TB treatment regimens. There was a positive relationship between compliance and attitude, indicating that as the level of attitude increases, compliance level also increases (r = 0.59, p < 0.001). The results further showed that there was a significant positive correlation between knowledge and attitude (r = 0.25, p = 0.005). However, there was no relationship between knowledge and compliance (r = 0.12, p = 0.12) indicating that knowledge did not have an influence on compliance. Conclusion and Implications The trend of an increased prevalence of TB leading to increased incidence of infection needs to be broken in Zambia and the world over. There is great need to understand the problem of non-compliance with TB treatment. Compliance with TB treatment is one of the great determinants of TB control. The Study revealed a very important aspect that knowledge is not a direct determinant of compliance but that attitude has a lot of influence on compliance with TB treatment, indicating that attitude mediates the relationship between knowledge and compliance. It is vital therefore, to find ways of improving attitude in order to improve compliance. To improve compliance, there is need to adopt a very systematic and comprehensive view of patient compliance. The implication of this study is that there is need for health workers to better understand the attitude of individual patients, particularly those that influence compliance and to take these into account when developing teaching strategies to enhance assimilation of information. The results have shown that when knowledge level is high it influences a positive attitude that consequently influences compliance positively