Medical Research in Zambia |
A sixth year research project submitted to the School of Medicine Department of Community Medicine.The study aims at determining what proportion of patients presenting at the dermatology clinic of the University Teaching Hospital ( UTH ) with a rash are positive for syphillis serology ( RPR and TPHI ) , what proportion of these rashes may be attributable to secondary syphillis and the spectrum of dermatological presentations syphillis. And finally to demonstrate any unusual dermatological practice features of secondary syphillis that may be encountered in dermatological practice and that may lead to misdiagnosesHH. The findings of the research revealed that 16% of the respondents all between the ages of 16-39 years were seropositive for syphillis; majority were female ( 65% ). While accurate diagnoses of secondary syphillis was made in 37.5% of the seropositive group, it may have been missed in the other 63.5% mainly because serotesting for syphillis is not routine at the clinic.The most common presenting rash among seropositive patients was popular or maculopapular. Vesicular and pustular eruptions were seen in a limited number of patients. It is recommended that all patients between the ages 15-45 years presenting at the skin clinic with rash should undergo serologic tests for syphillis. The importance of early detection and treatment can not be over-emphasized!
The objective of the study is to find out the impact of violence on the health system and to examine aspects that promote violence and the relationship between population and neighbourdhoods and try to estimate cost of violence acts from a health/ hospital point of view. The study was conducted at the University Teaching Hospital, Kasama General Hospital, Kalingalinga Compound and Rhodes Park. The study established that of every five emergency laparotomies, one is a direct consquence of violence that is stab wounds, gun shot wounds etc.It was also noted that violence clusters in young people and more in males than females. The study was retrospective on the other hand, that is data of emergency laparotomies in UTH 1990- 1993 with emphasis on violence related laparotomies; Laparotomies at Kasama General Hospital emphasised on the same. A questionnaire was used to establish other features which were thought to foster maladjustment and violence. The study is divided in a hospital and community with a view to marry the two.
The aims and objectives of the study are to determine how long Zambian mothers breast feed their babies and the reasons why they breast feed and to ascertain the level of awareness of the importance of breast feeding also to investigate whether eductional level, income, traditional or religious beliefs and parity have a bearing on the duration and the awareness of the importance of breast feeding.
The study tries to determine BCG coverage of under 5 paediatrics admission at UTH. It further attempts to evaluate percentage coverage of BCG at UTH under the age 5 years and the percentage of children not covered by BCG and the percentage of children diagnosed as tuberculosis cases, the presence and absence of BCG scars percentages amongst those vaccinated, finally to compare BCG percentage coverage with other immunisation given in UCI.
The Impact of Enviromental Factors on the resurgence of malaria in Lusaka is a study which was done at Chainama College Teaching Hospital, selected peri-urban areas and the inner city shanties. The study was done over a period of 8 weeks starting from 1st January to 28th Febraury, 1995. The diagnosis criteria of malaria was based on a case defination of malaria that is high index of suspicion and a positive malaria blood slide. Out of 1601 Out-patients seen I January, and 1553 in February, 295 and 255 had malaria respectively. This means 1 in 5 out-patients had malaria. There was no significant difference in population from which samples in January and February were drawn x2 0.05 >p > 0.02. Although there was no significant differences in the incidence of malaria between the peri-urban/ inter city shanties and the urban area, x2 0.50 >p >0.10 and x2 p< 0.50 for January and February respectively, peri-urban areas and inner city shantie had relatively high degree of bleeding and potential malaria bleeding sites. Thus offering offering a fertile ground for a vicious infection transmission cycle of malaria. Observations made during the surveys of some eri-urban areas and inner- city shanties reviewed that these areas lack basic services and infrastructure which form the basis of malaria control strategy. Thus until either the local authority recognise all settlements and / or facilities the provision of basic services and infrastructure, malaria control will remain un achievable dream.
The study on traditional practices related to breast feeding was conducted in 4 peri-urban areas of Lusaka.Those mothers re-attending antenatal clinics ( ANC ) and had an experience of breast feeding of children through their previous pregnancies were selected and the study was conducted during the month of June 1995. Almost all the mothers had routinely breastfed their children well into the second year of life. The median was 18 months with the range of 11 to 27 months reflects generally sound nutritional practice. The negative reasons given for stopping breast feeding include:
- illiness of the child when, on the contrary the child needs even more breast feeding;
- beginning of another pregnancy. There is a popular belief among the uneducated, even the educated mothers to some extent, that the milk of a pregnant mother is harmful to the child;
- child refusing to eat supplementary feeds, which infact indicates that the child is doing well on breast milk, or a form of protest for not being breast fed regulary; and
- the belief that if breast feeding is prolonged for more than 18 months the child start feelinng ill since breast milk become less nutritious and slowly turns sour. Such beliefs are not only invalid but also harmful to the child’s health. The information on exclusive breast feeding shows that most mothers do understand nutritional and health messages for various reasons thyey are not able to effect such messages in practical terms.
The major objective of the study is to observe common eye problems found in children reporting to the UTH Eye Clinic. Their frequencies, age distribution, sex distribution and mode of management was ascertained. From a total sample of ninty-six ( 96 ) children, it was noted that eye injuries represented 31.9% corneal ulcers 21.9% tumours 10.4%, cataracts 9.4% and conjuctivitis 9.4%. Major sex distribution difference was in eye injuries, with boys having almost twice as much chance of being injured than girls . Age distribution showed much higher incidence in older children. Most cases are observed to report late to hospital , after the start of the eye problem. In management of problems , variation was noted in that surgical treatment is the most preferred in tumours, cataracts and injuries. Corneal ulcers and conjuctivitis usually were attended to with antibiotics and vitamin supplements. Finally it was reccommended that a greater degree of supervision and teaching of older children about dangers of eye injury causing activities be undertaken. Mothers are identified as the key partners in promotion of eye health. Vitamin supplementation is also recommended to be taken widely.
Aims and objectives of the study is to assess the nutritional status of the street children in Lusaka, to determine dietary intake of energy and protein in boys and girls aged 10-16 years of age, to measure body weights and heights in the target group, combining these into Body Mass Index ( BMI ), to calculate the deficit between nutritional requirements and intake and relate this to any signs of nutrient depletion seen on clinical examination.Methodology used was to asses the nutritional status of street children conducted over a period of 1 month in various parts of Lusaka. These included : main railway station, main bus terminus, the markets at: Kamwala, City Centre and Soweto. A randomised selection of 50 children between the ages of ten ( 10 ) and sixteen ( 16 ) years of age were taken . The intetion was to include both boys and girls. However no girls was found at any of these sites. A questionnaire was used, and the children were interviewed on site. A clinical examination of each was also conducted. For dietary assessment, the 24 hor Recall Method was used. Body weights and heights were measured and the Body Mass Index ( BMI ) calculated. All calculations were done manually using standard formulate and chart.
The study aims at determining the relationship between socio-economic status and mental illness of in-patients at Chainama Hills Hospital , Psychiatric Wing. It specifically tries to assess the occupational, residential, marital, birth order and educational status including the economic independence of in-patients.One hundred and four case files were seen, in some cases patients interviewed at ( CHHPW ) to determine their socio-economic status. 57 females ( 55% ) and 47 ( 45% ) males were recruited. 16% were of average socio-economic class. The population studied showed higher numbers with low birth orders ( 1,2,3 ), 63% , dependancy on others for well being ( 55% ) and mostly never married ( 46% ) and education going up to Primary School level ( 34% ) . These were mainly from high density areas ( 58% ) . The study showed that in-patients at Chainama ( June- July 1995 ) were predominantly of a low socio-economic status.
The study reviews the outcome of Teenage Pregnancy aged between 13 and 19 at the UTH in Lusaka during the 2 moths ( January and February ) 1994. In the study the following areas were looked into: Incidence of teenage pregnancy, Age and parity, Labour complications, Method and delivery, Fetal outcome in teenage pregnancy and Birth weight distribution. A total of 1833 deliveries were recorded in the 2 months under study. This number includes the non-teenage mothers. Out of 1833, 376 deliveries took place in teenagers giving an incidence of 20.5% and this is consistent with what Mupakile found ( Mupakile, C. Teenage pregnancy and its outcome 1988-89 , 6th year project ). There were more deliveries in late teenage age group than early teenage group. Age group 19 recorded the highest parity followed by age group 17 while age 13 was the lowest with parity 0. The commonest complication in this study was that of prolonged labour followed by Pre-eclampsia. The commonest mode of delivery was spontanous vaginal delivery 266 ( 70.7% ). The number of both fresh still birth and macerated still birth were higher in all mothers than in teenage mothers. Birth weight distribution showed that there more babies of low birth weight born to teenage mothers than to non-teenage mothers. The study was done on patients admitted at the University Teaching Hospital Labour ward during the months of January and February of 1994 to look at the outcome of Pregnancy in Teenage mothers. The criteria for selection of the patients for the study was that the patient should be a teenage and with a full term pregnancy about to go into labour.
A retrospective study using case files in Psychiatric Out Patient department from January to March 1995 to determine epilepsy and association with socio economic status. To assess the socio economic status, the following factors were used : Level of education, Occupation and Residential area. However the income would have also been a good factor to include but due to the nature of the study it was not possible.The sample size was 150 case files chosen by using random sampling method of which 97 were male 53 were female. The data was analysed manually. The statistics shows that 20% of the patients seen in the psychiatric clinic were epileptic. The were more male than female epilepstics. The highest percentage for age of onset of epilepsy was 41.3% in the 10-19 year age group.57.8% of the patient had only primary school level of education while only 3.7% had tertiary level of education ( College, University ) , 68% of the patient live in high density residential areas, 60% of the patients were unskilled. Thus it appears from the study that the majority of epileptics are in the low socio economic group which consist of poorly educated individuals living in high density areas which are over crowded and have poor living conditions.
The aims and objectives of the study were to find out prevalence of epilepisy, the sex ratio and the socio economic group most affected.
The study was done at Lubwe Mission Hospital to try and determine the distribution of HIV/AIDS at Lubwe Parish, elicit some predisposing factors, impact on society and the Hospital to ascertain the rol,e of the community. 89 HIV positive clients had accumulated since 1986. 194 patients who statisfied the modified criteeria for the WHO clinical diagnosis of AIDS were considered. 80 tested positive with ELISA and WESTERN BLOT so that the total number of cases with the already known 80 became 169. The 112 negative become controls. Cases were attached to specific Home Based Care teams. First case was reported in 1986. Only 14 deaths had since been reported. Out of 169 cases, only 5 were below 5 years of age. 146 ( 86.4% ) fell between 20 and 49 years. The male to female ratio was 1 to 1.09, whereas the male peak was 30-39 years, the female was 25-29 years. Education was poor. 131 ( 80.4% ) cases were married . 119 ( 73.0% ) had only 2 sexual partners in the past 5 years. 35.6% of cases had hitory of STD compared to 37.5% controls. Cases were responsible of having produced 415 children who were below 15 years of age.The study concluded that the predisposing factors are multifactorial. The extent of the problem is largely unknown cases continue to increase. Poverty, infidelity, STD’s poor education, low ststus of women, non provision of condoms and some traditional values are important risk factors. The author recommends that a prospective study be done, sex education be stressed vigorously, traditional values re-oriented and possibly an HIV test before marriage for risk groups.
HYPOTHESIS
The following aspects of life were suspected to be likely factors contributing to the spread of HIV in Lubwe Parish:
- 1.Promiscuity
- Early involvement in sexual activities by girls
- Girl - child sexual abuse
- Acute and chronic poverty
- radication of good traditional values
- STD’s
- Urban- rural drift by infected people
- Low status of women - education/ employment
- Ignorance about sex
- Non availability of condoms because of Anti-condom Catholic Crusade.
OBJECTIVES
- To obtain age distribution of HIV infected persons and see if it falls out of the already known national distribution curve.
- To determine sex difference if any
- To elicit- predisposing factors precipitating factors maintaining factors where possible
- Establish or estimate impact on:
Families viz: Widows, Widowers, Orphans
Health instution: Hospital space, Drugs, Food- Establish the role of immediate community in not only assisting victims but in the prevention of the disease.
- Identify priority areas
- Make practical recommmendations based on the findings to reduce and contain the problem.
METHODOLOGY
The project was done in two phases. The first involved a retrospective study of the HIV/AIDS records where from the cumulative numbers were worked out . From this a total of 89 serving HIV positive attached to the Home Based Care Team were incorporated into the project. The second phase was a short prospective for 3 months, where a total of 283 patients who satisfiied the WHO case defination of clinical HIV/AIDS, individuals for voluntary testing and blood donors were considered. A consent was obtained for those who accepted, pre-test counselling was done, test done, post counselling done and results revealed.The methods used were:
They were fully clerked. Emphasis was placed on previous illnesses, STD’s, sexual partners, protected nsex, family history, and educational level. Since 89 were co-opted with known HIV ( positive ) only 194 were tested out of whom only 80 tested positive giving a total 169 cases. The negatives became the controls. People whose areas of residence fell outside Lubwe Parish were not included in the project. All HIV positive clients from Lubwe Parish were attached to the Home Based Care Team which operate along the Basic Christian Community Demarcations. Results were carefully recorded and stored in a file. At the end they were analyzed and information transferred to tables and graphs where necessary.
- Spot test
- ELISA
- Western blot ( confirmatory )
The study investigated the planning and management of primary health care in Zambia. The overall objective was to explore how far planning and management facilitated an integrated approach to primary health care ( PHC ). This was to be achieved by :The used case study and survey designs. A mix of methods was used to collect data from the Ministry of Health ( MHO ), 2 provinces, 2 districts, 6 rural health centres, 25 community health workers ( CHWs ), 17 village committees ( VHCs ), 3 traditional birth attendants TBAs ), 2 traditional medical practitioners, and 209 health team members in the districts nationally. These were: participant and non-participant observation structured and non-structured interviews, focus group discussions and a postal questionnaire.
- determining the planning practices for primary health care ;
- appraising the extent to intersectoral collaboration was promoted at all levels of primary health care services;
- assessing the management of and teamwork in primary health care as well as the preparation of primary workers;
- ascertaining the extent of community involvement in planning and management through existing and newly set up community organizations.
The first four methods were used at each level in the case studies while focus group discussions were held in one province, the two districts with and staff in four rural health centres. At village level, data from community workers were collected using the structured interviews. Unstructured interviews provided information from birth attendants, district council staff, political leaders and traditional medical practitioners. Further information was gathered from village health committees through focus group discussions, interviews and observation. The postal questionnaire generated data from key health team members in the 55 districts not included in this study.
Financial constraints in the last sixteen years in Zambia has had profound effects on an already weak infrastructure. Logistics to support PHC-transport, drugs and manpower have been scarce. Strong central MHO control, inadequate planning and management practices, and unclear national and peripheral goals for PHC delivery have exacerbated the station. Other constraints have been weak coordination, uncertainty about intersectoral collaboration and decentralization. These problems compounded by unclear roles of the health workers and district hospitals, and inadequate substantive incentives. Consequently, primary health care is fragmented by inadequate/ lack of teamwork and is based on activities rather than on a coherent conceptual frame of reference. Community participation is an exception, rather than the rule and receives little or no support from the health teams. It appears that the top-down planning and management initiatives have not reached the periphery.
Last updated February 19, 2001