The Medical Journal of Zambia (MJZ) is a peerreviewed quarterly journal intended for the publication of papers from all specialities of medicine (Internal medicine, Surgery, Paediatrics and Obstetrics & Gynaecology) and their subspecialities, basic science, public health, social medicine and medical politics. The journal also welcomes contributions from experienced individuals describing the way they deal with particular problems (i.e. intended to pass on the art of medicine).
PLEOMORPHIC ADENOMA OF THE LOWER LIP WITH EXTENSION TO THE COMMISURE: A RARE CASE REPORT AND A REVIEW OF THE LITERATURE.
Pleomorphic adenoma is the most common benign salivary gland tumor, typically affecting the parotid and minor salivary glands of the palate and upper lip. Its occurrence lower lip is exceptionally rare and poorly documented in the literature. We report a rare case of pleomorphic adenoma in a 62-year-old female who presented with a painless, slowly enlarging nodular swelling of lower lip. Clinical examination revealed a firm, well-circumscribed mass measuring 1.5 cm in its widest dimension. Differential diagnoses included fibroma, fibrolipoma, and fibrosed mucocele. The lesion was excised via an intraoral approach under local anesthesia. Histopathological examination confirmed pleomorphic adenoma. No recurrence during a three-year follow-up. Pleomorphic adenomas of the lower lip are rare, with few cases reported. The lesion typically grows slowly. Diagnosis relies on clinical suspicion and histopathology. This case emphasizes the importance of including pleomorphic adenoma in the differential diagnosis of lower lip swelling.
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CHARACTERISTICS AND OUTCOMES OF COVID 19 PATIENTS AT LIVINGSTONE TEACHING HOSPITAL
Background COVID-19, an acute respiratory infectious disease transmitted through the respiratory tract, is a strain of coronaviruses and of zoonotic origins. The virus is widespread and has been declared a globe pandemic. As a result of no prior immunological exposure to SARS-COV-2, the human population is vulnerable to infection and disease. It is as such imperative that empirical evidence be provided bases on data from admitting Health facilities. Objective To determine the characteristics and outcomes of COVID-19 patients admitted at Livingstone Teaching Hospital. Methods This was a cross-sectional study that involved reviewing the hospital records of COVID-19 patients at Livingstone Teaching Hospital in Zambia's Southern Province. A structured data collection form was used to gather information on patient demographics, clinical characteristics, and comorbidities. Results From a total of 355 clients, 222 (62.54%) were male and 133 (37.46%) were female. Discharged 274 (77.18%), while 81 (22.82%) died. Among those who died were the older clients with a median age of 65 (p <0.001). The median interquartile range (IQR)] age was 48.5 years. Patients presented with a cough 180 (50.7%), chest pain 123 (34.65%) and shortness of breath 121 (34.04%). Statistically significant comorbidities recorded included Hypertension 121 (34.08%), Diabetes mellitus 69 (19.44%), and HIV 38 (10.7%). The most prevalent underlying condition observed was hypertension 121 (34.08). Conclusion Older age was associated with greater odds of COVID-19 infection. The main clinical manifestations of COVID-19 were cough, chest pain and shortness of breath. Our study findings highlight that older age, HIV positive status and the presence of Diabetes Mellitus are independent risk factors even after adjusting for other variables.
Factors influencing the high prevalence of Cholera cases in Masala Area, Ndola District – Zambia: A Case study of Masala.
Introduction : Background & Aim: Cholera, a severe diarrheal disease caused by Vibrio cholerae, is primarily transmitted through contaminated food and water, often due to poor sanitation and inadequate access to clean water. Globally, cholera affects 1.3 to 4 million people annually, leading to 21,000 to 143,000 deaths [2]. In Zambia, cholera was first recorded in 1977, with 29 outbreaks reported to date. The latest outbreak, beginning in October 2023, has resulted in over 20,500 cases and 699 deaths, with Lusaka as the epicenter. Ndola recorded more than 600 cases in a week, which over 50% of those cases came from Masala [5]. This study aimed to investigate factors influencing the high prevalence of cholera in Masala area. Methods: A cross sectional study was used, which applied simple random sampling of individuals and health care providers respectively. The sample size was determined using Fischer’s formula to obtain a sample of 384 respondents. Statistical analysis including demographics, logistic regressions, and descriptive analysis were performed. Results: Findings indicated that the majority of respondents were aged 20-39 years (60.3%), with more female participants 228(62.6%) than males 137(37.4%). Key protective factors included proper toilet use (ₐOR=1.38; 95% CI 0.80–2.37) and washing hands after using the toilet (ₐOR=3.54; 95% CI 1.42–8.81; p=0.01). Significant risk factors included not washing hands after handling children’s feces (ₐOR=1.98; 95% CI 1.13–3.46; p=0.02), consuming unwashed fruits or vegetables (ₐOR=0.41; 95% CI 0.25–0.69), and improper food cooking practices (ₐOR=0.52; 95% CI 0.28–0.96; p=0.04). Conclusion: Cholera occurrence is predicted by knowing prevention measures such as proper toilet use and washing hands after use of toilet. Hygiene factors including not washing hands regularly and proper food handling. Strengthening community health education on sanitation, ensuring safe drinking water, promoting toilet ownership, and increasing cholera vaccination awareness are critical to reducing cholera cases in Masala.
Knowledge and Information Needs About Anaesthesia Among Surgical Patients in a Nigerian Tertiary Hospital
Background and objectives: The practice of anaesthesia has been around for almost as long as the practice of surgery. Despite this, it appears that knowledge about the role of anaesthetists and the scope of anaesthesia practice among patients is very limited. Limited and inaccurate information among patients on anaesthesia may lead to undue anxiety among patients. The aim of this study is to ascertain what information surgical patients have on anaesthesia as well as what information they would be interested in obtaining about anaesthesia. Methods: The study was a prospective descriptive questionnaire based study. Two hundred consenting adults, with ASA I and II classification, scheduled for elective surgeries were recruited. Participants were interviewed during the routine pre-anaesthesia review a day before their scheduled surgeries using researcher administered questionnaires. The questionnaire assessed what they knew about anaesthesia and what further information they desired. Results: Ninety-six (48.0%) patients could not identify any of the roles of the anaesthetist. Ninety-eight (49.0%) responded that he puts patients to sleep with less participants aware of pain relief (26%), and even less of vital signs monitoring (16%). General anaesthesia was the most commonly known anaesthetic technique (57%), followed closely by subarachnoid block (46%). Thirty three percent (33%) of participants had no knowledge of any anaesthetic technique. Ninety eight per cent (98%) of patients desired information about the process of anaesthesia and 89%, on possible complications. Conclusion: Knowledge on the role of anaesthetists and anaesthesia techniques is low among surgical patients. A large percentage of patients desire to know the process of anaesthesia and the possible complications.
Patients knowledge, anaesthetic techniques, anesthesia roles
Perception Of Risk of Sexually Transmitted Infections Among Students at Getway to Better Living School of Nursing in Monze District- Zambia
Background: Sexually transmitted infections (STIs) remain a significant public health concern, particularly among young adults, including nursing students who are expected to have adequate knowledge of STIs. Understanding the perception of risk of STIs among students is crucial for informing preventive strategies. Therefore, this study assessed perception of risk of STIs among nursing students at Gateway to Better Living School of Nursing in Monze, Zambia. Methods: An Analytical cross-sectional study design was used, with a sample size of 384, who were selected using systematic random sampling method. Data was collected using a structured self-administered questionnaire. Statistical analysis was performed using SPSS version 22.0. Pearson’s Chi-square, Fisher’s Exact tests were used to determine associations between perceptions of risk and independent variables, additionally, Binary logistic regression was used to find predictor variables. Results: Most students (71.1%) were aged 20-24 years, 66.7% were female, and 78.4% were single. Most (97%) demonstrated a high level of STI knowledge, with (62.2%) had low risky sexual behaviour. Additionally, (62%) had a positive perception of risk of STIs. A significant association was found between STI knowledge and perception of risk of STIs (OR: 5.19; p = 0.016), while other factors such as age, gender, and marital status did not show a significant impact. Conclusion: Although knowledge is a crucial factor, it must be complemented by practical strategies that encourage safer sexual practices. The findings highlight the need for targeted interventions within nursing education and public health initiatives to strengthen STIs prevention efforts and promote long-term behavioral change among students.
A Retrospective Analysis of Endoscopic Variceal Ligation Outcomes for Secondary Prophylaxis of Esophageal Variceal Bleeding in Western India
Background: Acute oesophageal variceal bleeding remains a leading cause of early death in cirrhosis, and access to definitive endoscopic therapy is often limited in low- and middle-income countries (LMICs). Endoscopic Variceal Ligation (EVL) offers a simple, equipment-sparing option that could narrow this survival gap. Methods: We performed a retrospective analysis of prospectively maintained data on 34 cirrhotic adults treated with EVL for secondary prophylaxis at a public tertiary hospital in Western India. Primary outcomes were 90-day rebleeding and all-cause mortality. Multivariable logistic regression identified independent predictors of rebleeding. Results: EVL achieved immediate haemostasis in 100 % of patients. Ninety-day rebleeding occurred in 14.7 % (5/34) and all-cause mortality in 5.9 % (2/34). On multivariable analysis, an International Normalised Ratio (INR) > 1.5 (adjusted OR 5.1, p = 0.04) and Child–Pugh class C cirrhosis (adjusted OR 4.9, p = 0.04) independently predicted rebleeding. Conclusions: A structured EVL programme delivered in a resource-constrained LMIC setting achieved rebleeding and survival rates that equal or surpass reports from high-income countries. Recognition of coagulopathy and advanced liver disease as high-risk features can guide intensified surveillance and adjunctive therapy where resources allow. These findings support the scalable adoption of EVL as a cost-effective, life-saving intervention across LMIC public-sector hospitals.
Socio-economic determinants of early antenatal care utilization in Zambia, 2007–2019: Evidence from the Demographic and Health Surveys
INTRODUCTION: The World Health Organisation (WHO) through its member states has implemented Focused Antenatal Care (FANC) models and 2016 ANC guidelines. Conventional analyses on ANC uptake have focused on women having at least four ANC visits regardless of when the women have such visits. Therefore, we present the uptake of at least four early ANC (ANC4+) visits amongst women of reproductive age in Zambia between 2007 and 2019 using the Zambia Demographic and Health Survey (ZDHS). METHODS: We used data from ZDHS collected between 2007 and 2019. All women aged between 15-49 years were included in this analysis. The outcome was early ANC4+ defined as having at least four ANC visits and having the first ANC visit within four months of pregnancy. Weighted univariate, bivariate logistic regression and multivariate logistic regression was conducted in Stata version 17. To determine whether a factor was included in the model, the likelihood ratio test was used with a statistical significance of P< 0.05 as the threshold. RESULTS: Of the 20661, 11633 (56%) of the women had attended early initiation of ANC4+. We observed increasing trends in the proportion of women with early initiation of ANC4+ from 55% in 2007 to 63% in 2018/19. There was a decreasing trend in the odds in early initiation of ANC4+ with the number of parity while there was an increasing trend in the odds in early initiation of ANC4+ with higher level of education. Being from richer household was associated with reduction in the likelihood of ANC4+ (OR= 0.81, 95%CI: 0.66-0.99, P=0.03). Of the 12333 women with at least 4 ANC visits regardless of timing of their first visit, 27% reported late for ANC. CONCLUSION: The uptake of early ANC4+ increased between 2007 and 2019 in Zambia. However, there were inequalities due to wealth, education and parity. Our current analytical approach has demonstrated that 27% of the women that would have been misclassified as having at least ANC4+ using conventional analysis were actually late for ANC. We provide some key considerations in ensuring that Zambia and other similar settings are able to achieve universal coverage of antenatal care by 2030.
Experiences of emergency medical services staff on delivery of emergency medical services in Chobe district, Botswana
Background: Emergency Medical Services (EMS) personnel in Chobe, Botswana, operate in a remote region with limited infrastructure. They face challenges such as geographical isolation, wildlife risks, like encounters with elephants or lions during emergency calls and shortages of equipment and staff. These stressors can impact the effectiveness of emergency care provision and the well-being of EMS staff. Objectives: To explore lived experiences of EMS staff in Chobe, on the delivery of emergency medical services in Chobe District of Botswana. Methods: A qualitative case study design was employed to explore the lived experiences of EMS staff. This design enabled an in-depth understanding of participants' perspectives within their real-life context. Data were collected through in-depth, semi-structured interviews with eight EMS staff members selected using purposive sampling, ensuring the inclusion of participants with relevant knowledge and experience. Thematic analysis was used to analyze the data, following Braun and Clarke’s updated reflexive approach [1]. This involved six iterative steps: familiarization with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the final report. This method allowed for the systematic identification and interpretation of key themes that emerged from the data. Results: Four key themes emerged from the data, reflecting the lived experiences of Emergency Medical Services (EMS) staff in the Chobe region: (1) operational challenges, (2) Psychosocial stain and coping, (3) professional identity and team dynamics , and (4) environmental and safety risks. 1. Operational Challenges: Participants reported persistent shortages of essential resources, including ambulances, medical equipment, and staff. These constraints often resulted in delayed response times and hindered the delivery of effective emergency care. 2. Psychosocial strain and Coping: EMS personnel described experiencing significant physical exhaustion and emotional strain. Exposure to traumatic scenes, extended shifts, and lack of psychosocial support contributed to burnout. Coping strategies were mainly informal—such as peer debriefing and emotional withdrawal— and were perceived as inadequate. 3. Professional Identity and team dynamics: Respondents expressed frustration over limited training opportunities, unclear career progression, and a perceived lack of appreciation for their work. These factors negatively impacted morale and professional development. 4. Environmental and Safety Risks: The Chobe environment presented unique hazards, including encounters with wild animals, poor road infrastructure, and vast distances between emergency sites and healthcare facilities. These risks compromised both the safety of EMS staff and the quality of emergency response. Discussion: This study highlights that the delivery of Emergency Medical Services (EMS) in the Chobe region is significantly affected by a combination of operational limitations, professional challenges, staff well-being concerns, and environmental risks. These interconnected issues compromise the effectiveness and safety of EMS delivery. To address these challenges, it is essential to implement clear policies, allocate adequate resources, provide structured mental health support, and offer ongoing professional training. Such measures would improve both service delivery and the overall well-being of EMS personnel in remote and high-risk settings like Chobe. Keywords: Emergency Medical Services, pre-hospital care, psychological distress, staffing shortages, qualitative research.
UTILIZATION OF PRIMARY MENTAL HEALTH SERVICES BY ADOLESCENTS IN KITWE DISTRICT ZAMBIA.
Background: The utilisation of primary mental health services remains low in Zambia, particularly in Kitwe, despite efforts by the government to increase access. Adolescents are especially underrepresented among those seeking these services. This study aimed to assess the factors influencing the utilisation of primary mental health services by adolescents in Kitwe District. Objective: To investigate the factors contributing to the utilisation of primary mental health services among adolescents in Kitwe District. Methods: A quantitative, cross-sectional, non-interventional research design was used. Simple random sampling ensured fair representation, with a total of 191 adolescent respondents who had accessed mental health services at Kitwe Teaching Hospital. Results: Key barriers identified were lack of awareness, limited resources, and stigma. Males accounted for 60.7% of respondents, and females 39.3%. About 45.5% of adolescents had low knowledge of primary mental health services. Substance use was positively associated with service utilisation (β = 6.06, p < 0.001, OR = 428.5), while low knowledge significantly reduced the likelihood of accessing services (β = -3.95, p < 0.001, OR = 0.02). Resource availability was also a significant factor (β = 3.16, p = 0.01, OR = 23.6), with 57.1% reporting limited access. Furthermore, 63.4% of adolescents believed that stigma was associated with mental health service use, affecting their willingness to seek care. Conclusion: Despite integration efforts, primary mental health service utilisation among adolescents in Kitwe remains low. Enhancing knowledge, addressing stigma, and improving resource availability are essential to increasing uptake.
Comparing Electrocautery to Sharp Dissection in Flap Raising for Mastectomy: A Systematic Review and Meta-analysis
Background: Postoperative seroma prolongs hospital stay and increases the cost of healthcare, particularly in resource-constrained settings, where patients are often kept on admission for drain care after mastectomy. The choice of instrument could affect the seroma rate after mastectomy. Hence, we compared postoperative complications between sharp dissection (scalpel and scissors) and diatherm-raising skin flaps in mastectomy for breast cancer. Methodology: We performed a systematic review of studies that compared sharp dissection (using scalpels and scissors) and diathermy, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Google Scholar were used for the literature search. RevMan 5.4 was used for the analysis. The outcomes compared were seroma formation, total effluent volume, duration of surgery, and occurrence of flap necrosis between the two groups, as reported in the retrieved studies. Result: We incorporated data from ten randomised control studies. The seroma rate was low when sharp dissection (scalpel or scissors) was used during mastectomy (OR = 3.09 (2.11 to 4.53), p < 0.001, I2 = 0%). However, the duration of the operation was prolonged in the sharp dissection cohort compared to the diathermy cohort [MD = 24.59 minutes (3.07 to 46.11) p = 0.03, I2 = 99%]. There was no difference between the two techniques when the total volume of effluent and occurrence of flap necrosis were analysed. Conclusion: The outcomes of our study underscore the importance of considering the techniques used for flap raising in mastectomy. This finding challenges the prevailing over-reliance on diathermy, particularly in resource-constrained settings. This study provides valuable insights for surgical decision-making in the overall management of breast cancer.
Progress Towards SDG 3.1 in Zambia: A Narrative Review of Maternal Mortality, Health System Challenges, and Policy Responses
Introduction: Maternal mortality remains a critical public health challenge, particularly in low-resource settings such as Zambia in sub-Saharan Africa. This narrative review examines Zambia’s progress towards achieving Sustainable Development Goal 3.1 (SDG 3.1), which aims to reduce the global maternal mortality ratio to below 70 per 100,000 live births by 2030 (SDG 3.1.1) and increase the proportion of births attended by skilled health personnel (SDG 3.1.2). Methods: Sources were drawn from peer-reviewed journals, WHO databases, and regional policy documents published between 2014 to 2025. Particular focus was placed on SDG 3.1 indicators, with comparative data from Malawi, Tanzania, and Zimbabwe. Findings: Zambia has made significant progress towards reducing its maternal mortality ratio (SDG 3.1.1) and is projected to meet the target by 2030 with moderate effort. Zambia is ahead of its neighbours Tanzania (85%) and Zimbabwe (86%), but lags behind Malawi (96%). Targeted investments in skilled personnel and adolescent health education, as outlined in government-led frameworks such as The Seventh National Development Plan and The Zambia National Health Strategic Plan, are pivotal for improving maternal outcomes. Conclusion: Zambia is on track to achieve SDG 3.1 by 2030; however, continued progress will depend upon sustained political commitment, health workforce investment, and expanded efforts in adolescent reproductive health.
Performance of Community Animation Cells in the Management of Emerging Diseases: A Mixed Methods Study from Bukavu, DRC
Summary Introduction : A community animation unit displays a satisfactory managerial performance in the management of emerging diseases when it is able to define the objectives and implement all the means necessary for the achievement of the latter. This study aimed to assess the performance ofCommunity animation cells in the management of emerging diseases in three health zones in the city of Bukavu. Methodology: We conducted a case -approach case study mixed quantitative and qualitative approach during a period of one month, including members of community animation cells in three health areas of the city of Bukavu whose type of sampling was random; The data was collected with the KOBOCOCULLECT software and analyzed by the STATA-64 software, no details on the qualitative part. Results: the median age was 34 years (28 - 38), 51% of our population was married and had already heard of emerging diseases. Among them, 64.47% did not know emerging diseases. 57.69% had associated the occurrence of emerging diseases with the styles and life behavior of habitats; The lack of collaborations between community animation cells and health authorities on disease managementemerging was revealed at 63.16%. 7/10 or 70% of our respondents reported that there was a lack of the operational plan developed to combat emerging diseases in their health areas. A greater number had denounced non -support as a difficulty encountered, followed by resistance to change, 57.89% and 27.64%; Many have suggested training on emerging diseases and their management as a possible solution (61.84%). Conclusion: To get to get out of this bottleneck and the low level of performance, one must normally go through a good repetitive collaboration between health authorities and CACs on the management of emerging diseases, which will allow the development of an executive plan to fight these diseases and the training of CACs on the description and management of emerging diseases.
performance, emerging diseases, community animation cell.
Factors Influencing Neonatal Pain Management Practices Among Healthcare Providers at Nyangabgwe Referral Hospital and Princess Marina Hospital, Botswana: A Cross-Sectional Study
Background: Neonatal pain management is a global challenge, particularly in low and middle income countries like Botswana, due to inadequate resources, training, and evidence-based practice. This study therefore sought to assess neonatal pain management practices by Health Care Professionals at Nyangabgwe Referral Hospital and Princess Marina Hospital Neonatal Intensive Care Units, Francistown and Gaborone, Botswana. Methods: This descriptive cross-sectional study involved 110 Health Care Professionals selected by census method. Data was collected through a validated online questionnaire analyzed using Stata version 18 with descriptive and inferential statistics, including Chi-square, Fisher's exact, and logistic regression tests. A 95% confidence interval and 5% significance interval and 5% significance level were applied. Results: Results revealed that 79% of respondents had good neonatal pain management practices, while 21% had poor practices. Knowledgeable respondents were over six times more likely to have good practices than not knowledgeable ones (AOR=6.34; 95% CI: 0.10-22.7, p <.001). Those who received formal training in neonatal pain management were about four times more likely to exhibit good practices than those without training (AOR=3.97; 95% CI: 0.37-1.82, p =.046). Respondents who reported having protocols had a 1.13 likelihood of good practices (AOR= 1.13; 95% CI: 0.12-1.02, p= .012). Non-Christian respondents had 23% lower odds of good practices, while Christians had76.9% higher odds (AOR= 0.231; 95% CI: 0.98-1.25, p = .002). Conclusion: The results highlight the importance of consistent access to pain management protocols, improved nurses' training, and hands-on experiences.
Inter-disciplinary approach in management of a case with anterior Bolton’s discrepancy. “A Case Report”
The assessment of intermaxillary teeth width relationship is often overlooked during diagnosis and treatment planning of orthodontic patients. This is particularly true for individuals with no obvious teeth size discrepancy. Inter maxillary teeth size assessment is important for early detection of teeth size disproportion between upper and lower jaw. This allows formulation of the definitive treatment planning which may involve both restorative and orthodontic specialists. The current work is reporting a case of 16 years old female patient who complained of multiple spaces on the upper front teeth following braces treatment. The patient had been on fixed orthodontic treatment for 2 years and 8 months without any significant improvement. Past treatment history revealed an initial diagnosis of Angle’s class I malocclusion with bimaxillary protrusion and lip incompetence, which was treated by fixed orthodontic treatment with extraction first pre molars on both jaws. Examination of the patient revealed multiple spaces on third sextant with reduced Bolton’s anterior ratio. In this case, a satisfactory occlusion was achieved by both orthodontic tooth movements and crown build up.
Dermatopathology Practice in Sub Saharan Africa: Analysis of Skin Biopsies from a Dermatology Clinic in Nigeria
Introduction Dermatopathology serves as a critical foundation for accurate diagnosis in dermatology clinics; however, it remains underdeveloped or absent in many pathology departments across Sub-Saharan Africa Methods A cross sectional study of skin biopsies at a newly established dermatopathology unit of a sub-Saharan Africa was undertaken. Results A total of 404 skin biopsies were diagnosed during the study period. Inflammatory dermatoses comprised the predominant category diagnosed at 61.2%. Papulosquamous skin diseases formed the majority of inflammatory dermatoses group. Eczematous diseases and infections, which are predominately seen in the dermatology clinic, were less common in our study. Conclusion This study highlights the diverse patterns observed in dermatopathology practice at our institution. Papulosquamous disorders and cutaneous tumors emerged as the most commonly encountered conditions. Additionally, the study underscores the discrepancy between the spectrum of skin diseases initially seen in the dermatology clinic and those ultimately selected for biopsy.
Nurses' knowledge and compliance with standard operating procedures for prevention of ventilator-associated pneumonia among patients at Princess Marina Hospital Intensive Care Unitin Gaborone, Botswana
Background: Ventilator-associated pneumonia is a significant global healthcare concern, contributing to high mortality rates of 24% to 76%, high morbidity rates and prolonged lengths of hospital stay, particularly in low to middle-income countries. Intensive care unit nurses, who have constant contact with patients, must know how to prevent ventilator-associated pneumonia and comply with several standard prevention strategies. Aim: This study evaluated nurses' knowledge and compliance with standard operating procedures for preventing ventilator-associated pneumonia among patients in the Princess Marina Hospital intensive care unit in Gaborone, Botswana. Methodology: A descriptive cross-sectional study involved (n=19) from a population of 21 Princess Marina Intensive Care Unit nurses. Data was collected using a self-administered, structured questionnaire and an observational checklist and analysed using the Statistical Package for Social Sciences, version 29. Descriptive statistics were used, and the Fisher exact test determined relationships between variables, with significance set at P< 0.05. Results: The results showed 63.2% good knowledge, 31.6% self-reported good compliance, and 0% observed good compliance. There were no significant associations between years of intensive care unit experience, receipt of training on preventing ventilator-associated pneumonia, nurses' knowledge of VAP prevention and self-reported compliance. Conclusion: The identified knowledge gap among nurses and low compliance require enhanced in-service lectures and structured educational programs on ventilator-associated pneumonia prevention to enhance nurses’ knowledge. Regular updates to standard operating procedures and frequent file audits accompanied by feedback should be emphasised to improve nurses' compliance and guide nurses properly in current best practices.
Ventilator-associated pneumonia, compliance, knowledge, Intensive Care Unit nurses, standard operating procedures, prevention
Parental satisfaction with the quality of neonatal care services provided at Kamuzu Central Hospital, Ethel Muthalika Nursery Unit, Lilongwe, Malawi
Background: Parental satisfaction is a crucial indicator of the quality of neonatal care standards. Satisfied parents comply with treatment, thereby reducing readmission and neonatal mortality rates. Malawi had a Neonatal mortality rate of 24 per 1000 live births and minimal evidence of parental satisfaction levels with neonatal care services. Objective: The study assessed levels and factors associated with parental satisfaction with neonatal care at Kamuzu Central Hospital, Ethel Mutharika Nursery Unit, Lilongwe, Malawi. Methods: The research involved 250 systematically selected parents whose neonates were admitted for 48 hours. Satisfaction was measured using an Empowerment of Parents in THe Intensive Care-Neonatology (EMPATHIC-N) questionnaire translated to Chichewa, and pre-testing was done. The collected data was analyzed using SPSS version 26. Results: The results showed overall parental satisfaction of 68%, with the highest satisfaction in the care and treatment domain at 99.2% and lowest levels in the information domain at 88.8%. Factors such as education level, tribe, neonate's health condition, and admission ward were associated with parental satisfaction with neonatal care. Tribe, income, and admission ward were important in predicting parental satisfaction levels. Conclusion: The study found that parental satisfaction with neonatal care services is moderate at 68%, indicating a need for improved communication and overall satisfaction.
Parents satisfaction, neonatal care, quality care, family centered care.
Perceptions of critical care nurses on staff shortages in intensive care units at Princess Marina Hospital Gaborone, Botswana
ABSTRACT Background Staff shortages in intensive care units significantly affect global healthcare systems, compromising patient outcomes and placing considerable strain on nursing professionals. These shortages influence nurses’ perceptions of their roles, contributing to concerns about workload, job satisfaction, safety, career growth, and systemic inadequacies. This study aimed to explore the perceptions of critical care nurses regarding staff shortages in the ICU at Princess Marina Hospital in Gaborone, Botswana, with the goal of informing future interventions and policy improvements. Methods A case study design was used. Data were gathered through unstructured in-depth interviews with ten ICU nurses and direct observation using a checklist. Thematic analysis was employed to identify key patterns and themes from the data, allowing an in-depth exploration of nurses’ experiences and views. Results Analysis revealed four main themes and eleven subthemes. The first theme, Compromised Quality of Patient Care, included delayed patient responses, reduced monitoring, and increased risk of errors. The second theme, Physical and Psychological Impact on Nurses, addressed increased workload and physical fatigue, psychological stress, and reduced job satisfaction. The third theme, Ineffective Coping Strategies, included over-reliance on overtime, minimal use of support systems, and abuse of sick leave. The fourth theme, Role of Adequate Staffing in Patient Care, encompassed improved patient outcomes and enhanced nurse well-being. Conclusion ICU staff shortages have detrimental effects on both patient care and nurse well-being. Addressing these challenges through improved staffing and targeted recruitment policies is essential to enhance care quality, reduce nurse burnout, and ensure a sustainable healthcare workforce.
Perceptions, Critical care nurses, Intensive Care Unit, Staff shortages, Challenges, Coping strategies, Patient care quality
Knowledge and Attitude of Nurses Toward Occupational Hazards and Safety Practices at Kasama General Hospital, Kasama, Zambia
Background: Occupational health and safety are a critical aspect of nursing practice, ensuring a safe working environment for healthcare professionals. However, adherence among nurses remains a challenge despite established guidelines. This study aimed to assess the knowledge, attitudes towards OHS practices nurses at Kasama General Hospital. Methods: Cross-sectional analytical study design was used. Systematic random sampling method was employed to select 183 participants from 350 nurses. Data was collected using a structured self-administered questionnaire, and analyzed using SPSS version 22.0, with Chi-square tests, and Binary logistic regression. Results: Most respondents (64.4%) were female, median age 33 years (IQR: 29.0–41.0), with 41.2% aged (31-41). More than half (58.8%) were married. Forty-one percent had a diploma in nursing/midwifery, and 77.8% had 1–11 years of work experience, with a median of 7 years (IQR: 3.5–10.0). Most nurses (77%) demonstrated good knowledge of OHS practices. Attitudes, 60% exhibited positive attitudes and 51% reported good practices. Profession was statistically significant in influencing nurses' knowledge and attitudes toward occupational hazards and safety practices. The odds ratio suggests that nurse midwives were 3 times more likely than others to have better knowledge and a positive attitude toward occupational safety (AOR: 3.38; 95% CI: 1.04 – 10.96; p = 0.042). Conclusion: While the study revealed that nurses had adequate knowledge and generally positive attitudes towards OHS, this did not translate into strong adherence to safety practices. The lack of significant associations between knowledge, attitude, and practice suggests that other factors that may influence OHS compliance.
Occupational Health and Safety, Knowledge, Attitude, Practice, Nurses
Knowledge and Perceptions of Post-Operative Physiotherapy Management among Women with Obstetric Fistula: Experience at Mansa General Hospital, Zambia
Background: Obstetric fistula, resulting from neglected obstructed labour or childbirth injuries, can benefit from post-repair physiotherapy to enhance recovery. However, it is uncertain whether women in Mansa District are aware of the importance of physiotherapy in improving post-operative recovery. Objective: To explore knowledge and perceptions of post-operative physiotherapy management among women with obstetric fistula at Mansa General Hospital in Luapula Province, Zambia. Methods: This study used a qualitative phenomenological design and involved 12 women selected purposively, seeking obstetric fistula repair and rehabilitation at Mansa General Hospital in Luapula Province, Zambia. In-depth interviews guided by a structured interview guide were conducted, and thematic analysis was used to analyse the data, ensuring ethical standards were maintained. Results: The study found that participants had limited knowledge about obstetric fistula and the role of physiotherapy in its treatment. However, those who underwent at least two weeks of post-operative pelvic floor muscle training experienced significant improvements, especially in bladder control. Challenges in accessing physiotherapy included logistical issues, transportation difficulties, insufficient funds, lack of awareness about physiotherapy services, unavailability of trained physiotherapists in local facilities, and issues with remembering and understanding exercises taught during sessions. Conclusion: The study concluded that most women at Mansa General Hospital were unaware of physiotherapy's role in managing obstetric fistula, due to limited information and lack of local physiotherapy services. To enhance awareness and utilization of physiotherapy, the study recommends improving literacy and increasing the availability and accessibility of essential healthcare services, including rehabilitation, in the region. This would help better support women with obstetric fistula in the area.
knowledge, perception, obstetric fistula, post-operative physiotherapy, women
Prevalence and Associated Risk Factors of Work-Related Musculoskeletal Disorders Among Oral Health Personnel in Zambia.
Background and Aim. Musculoskeletal disorders (MSDs) are a major occupational health concern among healthcare professionals, including oral health personnel, due to prolonged static postures, repetitive movements, and awkward working positions. This study aimed to determine the prevalence and associated risk factors of MSDs among oral health personnel in Zambia, identifying significant associations between body regions, work activities, and MSD presentation. Methods. A cross-sectional survey using a quantitative approach was conducted. Convenient random sampling was applied to recruit participants from the Dental Therapist and Assistants Society of Zambia (DTASZ) database. Those with valid email addresses and telephone numbers were invited to participate. Data were collected using a modified Nordic Musculoskeletal Questionnaire, with 130 valid responses analysed. Results. The twelve-month prevalence of MSDs was 93%, affecting all body parts across all ages and genders. The most affected regions were the neck (61.54%), lower back (59.23%), and wrists/hands (51.54%). Significant risk factors included prolonged standing, bending, and maintaining the same posture for extended periods. No significant relationships were found between MSDs and gender, alcohol intake, smoking, or having children. However, a strong association existed between MSDs in the neck and lower back and work-related postures. Conclusion. The findings indicate a high prevalence of MSDs among oral health personnel in Zambia, necessitating further research on workplace ergonomics and interventions to reduce occupational strain. Addressing these issues could improve health outcomes and productivity among oral health professionals.
NURSES’ ADHERENCE TO NURSING CARE PRACTICES FOR VENTILATED PATIENTS IN THE ADULT INTENSIVE CARE UNIT AT THE UNIVERSITY TEACHING HOSPITAL, LUSAKA, ZAMBIA
ABSTRACT Background: Adherence to nursing care practices for ventilated patients is crucial for preventing complications, ensuring patient safety, and optimizing recovery outcomes. In the intensive care unit (ICU), maintaining high adherence to these practices is essential for delivering quality care.The demand for mechanical ventilation has been increasing steadily, with an annual rise of 10% over the last five years. However, existing literature has primarily focused on general nursing competencies for critically ill patients, leaving a gap in understanding adherence to nursing care practices specifically for mechanically ventilated patients. Aim: To assess nurses’ adherence to nursing care practices for ventilated patients in the adult intensive care unit (ICU) at the University Teaching Hospital in Lusaka. Method: This study employed a quantitative approach using a descriptive cross-sectional design. It was conducted in the ICU of the University Teaching Hospital, targeting all eligible nurses. Despite considering a census approach, not all nurses participated as some were unavailable at the time of data collection. In total, 58 nurses who met the inclusion criteria participated in the study. Data were collected using a semi-structured, self-administered questionnaire following ethical approval from the local Ethical Committee. Written informed consent was obtained from all respondents before participation. Data analysis was performed using Fisher’s exact test and binary logistic regression. Results: The study found that nurses’ adherence to nursing care practices was significantly associated with their qualifications (p = 0.033), knowledge (p = 0.025), and staffing levels (p =0.013). Nurses with degree qualifications were 4.2 times more likely to adhere to nursing care practices compared to those with diploma qualifications (OR = 4.2, 95% CI: 2.65 – 6.90), p = 0.033). Adequate knowledge was also a significant predictor, as knowledgeable nurses were 4.8 times more likely to adhere (OR = 4.8, 95% CI: 12.43–23.46, p = 0.025). Additionally, staffing levels played a crucial role, with nurses in well-staffed ICUs being 7.5 times more likely to adhere to nursing care practices (OR = 7.5, 95% CI: 3.28 - 4.54, p = 0.013). Conclusion: Adherence to nursing care practices for ventilated patients is significantly influenced by staffing levels, knowledge, and educational qualifications. To enhance adherence and improve patient outcomes, continuous education programs for ICU nurses should be prioritised, along with strategic staffing interventions. Keywords: Adherence, Nurses, Nursing Care Practices, Ventilated Patients, Intensive Care Unit.
Keywords: Adherence, Nurses, Nursing Care Practices, Ventilated Patients, Intensive Care Unit.
Incidental Diagnosis of Dextrocardia with Situs Inversus During Echocardiographic Examination: A Case Report from Zambia
Dextrocardia with situs inversus is a rare congenital condition characterised by the mirrorimage reversal of the heart and the abdominal organs. This congenital anomaly has a prevalence rate of approximately 1 in 10,000 people and is higher in males than in females. It is generally asymptomatic unless associated with congenital heart conditions. For this reason, most individuals are unaware of having dextrocardia with situs inversus until they seek medical attention for unrelated conditions, as in this case report. In this case report, we report a case of dextrocardia with situs inversus in a 27-year-old female patient diagnosed incidentally during echocardiographic examination in a private medical facility in Zambia. This case underscores the crucial role of imaging examinations such as echocardiography, plain film radiography, and ultrasound in diagnosing dextrocardia with situs inversus, especially in resource-limited settings where advanced imaging modalities are scarce. It further emphasises the need for thorough examination techniques and awareness of anatomical variations to avoid diagnostic errors and guide appropriate patient management. The challenges related to their availability in the Zambian healthcare system are also reviewed.
Ischemic Stroke in Cryptococcal Meningitis in an HIV-Infected Patient: A Case Study from Lusaka Zambia.
Cryptococcal meningitis, caused by Cryptococcus neoformans, is a severe fungal infection that primarily affects individuals with weakened immune systems, particularly those with HIV/AIDS. It is the most common central nervous system fungal infection among AIDS patients and can lead to complications such as elevated intracranial pressure, seizures, and visual loss. Despite advancements in antiretroviral therapy (ART), cryptococcal meningitis remains prevalent in regions with limited access to healthcare, contributing significantly to HIV-related mortality. Ischemic stroke is a rare but serious complication of cryptococcal meningitis, often associated with immune reconstitution inflammatory syndrome (IRIS) following the initiation of ART. IRIS can exacerbate inflammation and vascular damage, thereby increasing the risk of stroke. In this report, I presented a case involving a 44-year-old HIV-positive patient with cryptococcal meningitis complicated by ischemic stroke. The aim of this case report is to highlight the complexity of rehabilitating a patient with HIV and comorbid cryptococcal meningitis, and the effectiveness of physiotherapy interventions in improving functional recovery.
Pica and associated factors among pregnant women attending antenatal clinic at Chelstone Level One Hospital and Mtendere clinic, Lusaka District, Zambia
The present study assessed the prevalence of pica and associated factors among pregnant women at Chelstone Level-one Hospital and Mtendere clinic, in Lusaka district of Zambia. This was a descriptive cross-sectional study in which questionnaires were administered face to face to 372 pregnant women. The data was analyzed using Statistical Package for Social Sciences version 23. Statistical significance was set as p=0.05 at 95% confidence interval. The prevalence of pica was 38.2% (n=142), and of these, soil was the most common non-food item consumed (84.5%; n=120). Reasons stated by participants for practicing pica included cravings, sensory reasons such as the pleasant texture, taste, or smell, for controlling nausea and vomiting and others. There was no significant association between nutrition status, hemoglobin level and pica practice. Education level, culture, history of pica, religious affiliation and pica practice among family or friends were associated with the practice of pica (P = <0.050). The practice of pica is noteworthy among pregnant women as it is practiced by a considerable proportion of pregnant women in this area. There is need for increased awareness on pica practice and its harmful effects among pregnant women.
Association between Caspase-3 and miR-155-5p expression in Kaposi's Sarcoma in Zambia
Background: Kaposi’s sarcoma (KS) is a vascular tumor driven by the human herpesvirus 8 (HHV8). KS is the most prevalent HIV/AIDS associated cancer in the world and second most prevalent cancer in Zambia with 16% incidence and 15% mortality. While little is known about the molecular mechanisms that drive this disease, data suggests that HHV8 promotes KS tumorigenesis through inhibition of apoptosis by HHV8-encoded micro RNAs. One example is miR-155-5p which has been shown to promote tumor progression and inhibit expression of pro-apoptotic caspase 3. This study therefore aims to investigate the correlation between miR-155-5p and caspase 3 in KS. Method: An analytical cross-sectional approach compared miR-155-5p and caspase-3 mRNA and protein expression in KS tissues versus adjacent controls using RT-PCR and immunohistochemistry respectively. Comparison of miR-155-5p and caspase-3 expression levels in KS and normal controls was done using the Wilcoxon rank-sum test while Spearman’s rank was used to test for any correlation. Results: No significant difference was observed between miR-155-5p and Caspase-3 mRNA expression in KS vs normal controls, however, there was a significant negative correlation between miR-155-5p and Caspase-3 mRNA in KS tissues. Furthermore, there was no significant difference in caspase 3 protein in KS vs normal controls. Importantly, a positive correlation between miR-155-5p and viral load in KS tissues was observed. Conclusion: This suggests a potential inverse relationship between miR-155-5p and caspase 3 mRNA in KS. Additionally, miR-155-5p expression may be regulated by HIV viral load however the nature of this regulation remains to be investigated.
Kaposi’s sarcoma, Human Immunodeficiency Virus (HIV), tumorigenesis, apoptosis, miR-155-5p, Caspase 3
Determinants of Malaria in Pregnancy and women's experiences with prevention in Mansa District, Zambia: A Mixed-Methods Exploratory Study
Background: Malaria in pregnancy is predominant in Sub-Saharan Africa. It is one of the major causes of abortion, prematurity low birth weight and anaemia in pregnancy. One of the legacy goals for Ministry of health in Zambia was to eliminate Malaria by the year 2021. Many efforts are put in place but the prevalence is still high in some parts of Zambia. Therefore, this study explored the determinants of malaria in pregnancy and experiences of women on access to resources meant for Malaria prevention in Mansa district. Method: A mixed-methods and exploratory research design was conducted in four selected settings of Mansa district. Quantitative data was retrospectively collected from 236 antenatal records sampled by systematic random method. Qualitative data was collected from 25 post-natal women and 5 Nurses through in-depth face-to-face interviews; using semi-structured interview guide and participants were purposively sampled. Chi-square and thematic analysis were used for quantitative and qualitative data respectively. Results: Prevalence of Malaria in pregnancy was at 14.8% and ownership of insecticide-treated bed-nets was at 72%. Late antenatal booking led women to miss insecticide-treated bed-nets and Sulphadoxine-Pyrimethamine doses. Knowledge gap also affected the uptake of Sulphadoxine-Pyrimethamine and Insecticide treated bed-nets. Conclusion: The primary prevention of malaria in pregnancy was sub-optimal in Mansa district. This calls for improvement of timely antenatal booking and ensuring distribution of Insecticide-treated bednets to every pregnant woman. More resources are needed as well as civic education and effective participation of women attending antenatal services.
Perceptions and Practices Related to Breast Self-Examination Among Female University Students in Lahore, Pakistan: A Cross-Sectional Study
Objective: This study aims to evaluate the perception of Breast Self-Examination (BSE) among female university students in Lahore, Pakistan and to assess how familiar these students are with the concept of breast cancer and their knowledge about BSE practice. Methods: This descriptive cross-sectional study took place at Superior University in Lahore Pakistan, enrolling 100 female students all aged 18 years and older using a non-probability consecutive sampling technique. The study adhered to the ethical standards set forth in the 1964 Declaration of Helsinki, which was revised in 2000. Excluded from the study were females who had a current or past diagnosis of breast abnormalities such as cysts, mastitis or any benign or malignant tumors. To evaluate their perceptions and practices regarding BSE, participants completed a structured questionnaire. All data was entered into SPSS version 23 for analysis. Results: Out of the 100 students enrolled, 50 (50.0%) were ≤21 years in age and 95 (95.0%) were aware that BSE helps in early detection of breast cancer. Sixty (60.0%) respondents reported performing BSE themselves while only 09 (9.0%) did so monthly. Forty (40.0%) reported BSE should be done at anytime as per convenience where as 23 (23.0%) said BSE should be done during bath. Conclusion: This study emphasizes the need for increased awareness and education on BSE among female university students to overcome knowledge gaps and cultural barriers, promoting early detection and better health outcomes.
Impact of Delayed Cord Clamping on Newborn Haemoglobin Levels in Vaginal Deliveries at Women and Newborn Hospital and Public First-Level Hospitals, Lusaka, Zambia.
Background: Delayed cord clamping (DCC) is a recommended practice for all births, significantly improving neonatal outcomes by increasing haemoglobin levels and reducing neonatal anaemia. It enhances iron stores through additional placental blood transfer, supporting long-term developmental benefits. Despite these advantages, only 40% of midwives and obstetricians practice DCC, falling short of WHO’s recommendation. Given its low cost and effectiveness, underutilization in Zambia is concerning. This study assessed the impact of DCC on newborn haemoglobin levels, examined associations with maternal and neonatal factors, and determined its prevalence in vaginal deliveries at selected public health facilities in Lusaka, Zambia. Methodology: This analytical cross-sectional study included 489 mother-infant pairs at the Women and Newborn Hospital and public first-level hospitals in Lusaka. Data were collected using a structured questionnaire and medical records. Participants were categorized into DCC (cord clamping ≥1 minute) and Early Cord Clamping (ECC) (<1 minute) groups. Descriptive analysis and multivariate logistic regression evaluated DCC’s effect on neonatal haemoglobin levels and associated factors. Results: DCC was practiced in 71.4% of cases. No significant differences were found in maternal, obstetric, or neonatal characteristics between ECC and DCC groups. Newborns in the DCC group had significantly higher haemoglobin levels. They were nearly five times more likely to have levels of 13–14.9 g/dL (AOR = 4.97, p = 0.009) or ≥15 g/dL (AOR = 4.56, p = 0.015). Conclusion: DCC is associated with significantly higher newborn haemoglobin levels, supporting its routine implementation to improve neonatal health outcomes.
Imperforate hymen a cause of acute abdomen and hydronephrosis in a 15 year old girl . A case report
Imperforate hymen a cause of acute abdomen and hydronephrosis in a15 year old girl: A case report. Abstract Imperforate hymen is a type of congenital vaginal outflow tract anomaly due to failure of perforation of the hymen. It is a cause of hematocolpos, hematometria and urinary tract obstruction due to the pressure effect of the hematocolpos. Case: A 15-year-old girl who presented at puberty with a history of primary amenorrhea, cyclical and acute abdominal pain with ultrasound features of hematocolpos, hematometria and hydronephrosis. The obstruction was relieved by the cruciate incision of the hymen. Conclusion: Acute abdomen in a pubertal girl with primary amenorrhea may be due to imperforate hymen