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).
Occipital Cerebral Infarction as a Complication of Traumatic Brain Injury: A Case Report.
Abstract Background: Post-traumatic cerebral infarction (PTCI) is a severe consequence of secondary brain injury which is associated with poor functional recovery and high mortality. Despite advances in neurocritical care and decompressive craniectomy, outcomes remain poor. Case Presentation: We report a 22-year-old female who sustained a severe TBI following a road traffic accident. On admission, her Glasgow Coma Scale (GCS) was 8/15 with sluggishly reactive pupils. A non-contrast CT scan revealed a left parietal-temporal acute subdural hematoma with 13 mm midline shift and multiple contusions. Emergency decompressive craniectomy was performed. Despite surgical decompression and neurocritical management, her neurological status deteriorated, and a follow-up CT scan on postoperative day three revealed a left occipital infarction in the PCA territory consistent with transtentorial herniation. The patient succumbed on postoperative day eight. Conclusion: PTCI remains a catastrophic but often under-recognized complication of TBI. Early detection through neurological monitoring and timely neuroimaging, coupled with intracranial pressure and cerebral perfusion control, may mitigate risk. However, prognosis remains guarded, emphasizing the need for improved neuroprotective and vascular-targeted interventions.
Copyright (c) 2026 Medical Journal of Zambia https://creativecommons.org/licenses/by-nc/4.0
ORBITOPALPEBRAL EMPHYSEMA IN RESOURCE-LIMITED ENVIRONMENT.A CASE REPORT
Background: Orbital Emphysema(OE) is the presence of air in the periorbital soft tissues. The most common cause is orbital wall fractures. However, other causes include infections secondary to gas-producing microorganisms, pulmonary barotrauma, airplane trips, intubation barotrauma, frontal sinus osteomas, and other iatrogenic causes. Non-traumatic causes, such as nose blowing and lifting weights, have also been reported. Though computer tomography (CT) is the gold standard diagnostic investigation, OE is radiologically detected in only 50% of orbital wall fractures. When not well managed, there is an increase in intra-orbital pressure leading to compressive effects on the central retinal artery and optic nerve, resulting in blindness. Results: in the case here, OE was diagnosed clinically in the absence of a CT scan, yet supported by a B-scan that revealed hyper-echoic air collection with acoustic shadowing, and thereafter the patient was managed conservatively. Conclusion: In resource resource-limited environment, a high index of suspicion for orbital wall fractures in orbital emphysema should prompt the attending clinician to advise the patient appropriately against Valsalva maneuvers.
A Mechanistic Elucidation of Pseudobulbar Palsy Secondary to Artery of Percheron Infarction
Introduction: Pseudobulbar palsy (PBP) is an upper motor neuron syndrome traditionally attributed to bilateral corticobulbar tract injury caused by multifocal vascular, demyelinating, or degenerative pathology. The emergence of PBP following a single-vessel occlusion—specifically, an infarction of the Artery of Percheron (AOP)—presents a striking clinical and anatomical paradox. The AOP, a rare variant of the posterior cerebral circulation, supplies both paramedian thalami and often the rostral midbrain, making its occlusion a unique model for studying bilateral motor deficits arising from a unilateral vascular event. Purpose: This study aims to elucidate the mechanistic relationship between AOP infarction and pseudobulbar palsy, investigating how a single ischemic lesion can produce a bilateral upper motor neuron syndrome. It seeks to integrate vascular anatomy, corticobulbar pathway organization, and thalamic-mesencephalic network function into a unified explanatory framework that accounts for both structural and functional aspects of this rare neurological presentation. Methodology: A comprehensive literature review was conducted, focusing on neuroimaging studies of AOP infarction published from 2019 onwards. Result/Conclusion: Analysis of published evidence supports a dual-mechanism model in which PBP arises through either structural tract damage or functional disconnection, depending on infarct distribution within the AOP territory. Cases with midbrain involvement typically demonstrate direct corticobulbar tract injury, whereas isolated thalamic lesions produce PBP through disruption of motor relay networks, resulting in “functional de-efferentation” of brainstem motor nuclei. The study proposes a unified spectrum of injury bridging these mechanisms, highlighting the AOP infarction as a natural experiment revealing the interdependence of vascular architecture and supranuclear motor network integrity. This framework not only clarifies the pathophysiology of AOP-related PBP but also underscores the broader principle that vascular anomalies can expose latent bilateral vulnerabilities in motor control systems, offering new avenues for targeted neuroimaging research and clinical interpretation.
Ultrasound's Pivotal Role in Diagnosing Pediatric Osteomyelitis After a Negative X-Ray: A Case Report
Acute osteomyelitis is a potentially severe bone infection that commonly affects children, and early diagnosis is essential to prevent complications. However, plain radiographs are often normal in the early stages, which can delay treatment. We report the case of a 9-year-old female who presented with acute pain, swelling, and tenderness over the distal right tibia. Initial plain radiographs showed no bony abnormalities, while ultrasound revealed a hypoechoic subperiosteal fluid collection with surrounding soft tissue oedema and increased vascularity on colour Doppler, consistent with early osteomyelitis. The patient was treated with antibiotics, and a follow-up radiograph obtained six weeks later demonstrated cortical destruction, periosteal elevation, and patchy osteolytic changes, confirming the diagnosis. This case highlights the value of ultrasound as a sensitive, accessible, and radiation-free tool for the early detection of acute osteomyelitis in children, especially in resource-limited settings where advanced imaging may not be readily available.
Clinical, biological and therapeutic profile of children hospitalized for anemia in Kisangani care establishments in DR Congo
Introduction: Anemia is one of the main causes of morbidity and infant mortality in the Democratic Republic of Congo. It is particularly frequent in children under the age of five, often aggravated by malaria, malnutrition and sickle cell anem. This study haswas carried out at the TSHOPO HGR in order to describe the clinical, biological and therapeutic characteristics of children hospitalized for anemia. Methodology: This is a descriptive transversal study carried out from January 1 to September 31, 2024. The sample concerned 135 children aged 0 to 5 hospitalized for anemia biologically confirmed. Soci -demographic, clinical, biological and therapeutic data have been collected and analyzed. Results: The frequency of severe anemia was 30 %, with an average age of 33 months and a female predominance (53.3 %). The main consultation reasons were fever (100 %), pallor (94.4 %), anorexia (88.8 %) and shortness of breath (75.5 %). The etiologies found were dominated by malaria (84.4 %), infections (60 %), nutritional deficiency (37.5 %) and sickle cell anemia (33.3 %). After treatment, 82 % of children had had rapid improvement, but 28 % had paid and 10 % weredeceased. Conclusion: Infantile anemia remains a major pediatric emergency in Kisangani, with strong hospital letters. Malaria, malnutrition and sickle cell anemia are the main causes. An integrated strategy combining prevention, access to quality care and strengthening of the health system is necessary to reduce the morbidity and mortality linked to anemia.
Scabies in Azerbaijan: Epidemiological Patterns and Challenges from 2000 to 2024
Background: Scabies is a highly contagious skin infestation caused by the mite Sarcoptes scabiei var. hominis, representing a significant public health challenge globally. This study analyzes the incidence trends of scabies in Azerbaijan over the period 2000–2024. Methods: A retrospective analysis was conducted using national surveillance data on reported scabies cases. Incidence rates per 100,000 population were calculated annually. Trends were examined to identify patterns and potential factors influencing disease dynamics. Results: The incidence of scabies showed a general decline from 2000 to 2015, followed by a notable increase from 2016 onward, peaking in 2023 with 2,934 reported cases and an incidence rate of 28.8 per 100,000 population. These fluctuations may relate to socio-economic factors and disruptions in healthcare services, including the COVID-19 pandemic. Conclusion: The resurgence of scabies in recent years highlights the need for enhanced public health interventions, including improved surveillance, community education, and accessible treatment programs. Targeted strategies are essential to control transmission and reduce disease burden in Azerbaijan.
DEVELOPING AN OPERATIONAL FRAMEWORK FOR OPTIMIZING OUT-PATIENT WAITING TIME IN LUSAKA’S PUBLIC HEALTH FACILITIES: A PRAGMATIC APPROACH
Background: Long outpatient waiting times remain a persistent challenge in most public health facilities, often resulting in patient dissatisfaction, frustration, and reduced trust in the healthcare system. Extended waiting periods not only inconvenience patients but also place additional strain on healthcare providers and service delivery processes. Methods: convergent parallel mixed-methods design was employed. Quantitative data was collected from 410 patients using structured questionnaires and analyzed with with Statistical Package for the Social Sciences (SPSS), version 25. In parallel qualitative data were obtained through in-depth interviews with 12 healthcare managers and supervisors, and analyzed thematically. Results: Most patients (46.1%) waited between 3-6 hours and nearly one in five waited over 6 hours, while only 3.9% were seen within an hour. The majority (78%) found these waiting times unacceptable. Commonly cited causes include long queue, poor patient flow, and understaffing. Statistical analysis showed that waiting time varied significantly by marital status, employment, residence, type of visit, and day of the week, or income. The study highlighted systematic inefficiencies such as inadequate staff during peak hours, reliance on paper based registration, weak supervision, and limited infrastructure. Conclusion: Waiting times in Lusaka's outpatient departments are unsatisfactorily long, driven by both systematic and patient related factors. Addressing them will require practical interventions such as appointment booking systems, stronger triage, additional staff during busy periods, and improved infrastructure. These findings offer a solid basis for an operational framework to enhance efficiency and patient satisfaction in Zambia's public health facilities.
FACTORS ASSOCIATED WITH OUTPATIENT WAITING TIME IN SELECTED FIRST LEVEL HOSPINATLS IN LUSAKA DISTRICT: A HEALTH CARE MANAGER’S PERSPECTIVE
Background: Waiting time serves as an important indicator in the health care system efficiency , when excessively long , it can result in adverse health outcomes , reduced patient adherence to care and compromised overall quality of services .Addressing this issue is therefore critical to enhancing the patient experience and strengthening effectiveness of health service delivery. Methods: The study employed a qualitative approach ,engaging 12 health care managers and supervisors through in-depth interviews and and these participants were selected purposively. The study analysis was done thematically and a number of themes were generated. Health care mangers methodology was part of the large mixed study. Findings: The study established that , on average ,patients wait between 3-6 hours before they are attended to especially on peak days such as monday and tuesday and this is due to factors such as shortage of staff , manual registration processes among others. Conclusion: Waiting time is a very essential indicator of quality health care delivery. It is very profound to ensure that patients do not wait longer than acceptable . Improving outpatient waiting time does not only improve the service delivery but improve health outcomes for citizens.
THE BURDEN AND MANAGEMENT OF CASTRATE RESISTANT PROSTATE CANCER IN SUB-SAHARAN AFRICA: A NARRATIVE REVIEW
Prostate cancer is the most common male-specific malignancy with associated significant morbidity and mortality. The management of advanced prostate cancer primarily involves the use of androgen deprivation therapy (ADT) via surgical or medical castration; however, this tends to eventually result in castrate resistance after a period of clinical and laboratory response. This narrative review aims at providing an insight into the current modalities of treatment for castrate resistant prostate cancer (CRPC), while highlighting the challenges in its management in Sub Saharan Africa (SSA), and making recommendations to improve the quality of care for patients with CRPC in SSA. Data was obtained through a review of published research articles, obtained via the use of online search engines - PubMed and Google Scholar, using the keywords; “Prostate Cancer”, “Castrate Resistant Prostate Cancer”, and “Sub-Saharan Africa”. CRPC represents a clinically important subset of the global prostate cancer burden but remains poorly captured in population statistics, especially in low‑and-middle‑income countries of SSA There have been various postulated theories on CRPC, which has guided the evolution of new and effective targeted therapy, however there are still peculiarities in the challenges of many developing countries, with respect to late presentation, high cost of treatment, and a low level of health insurance coverage, making majority of patients in SSA unable to benefit optimally from the advancements in the management of CRPC. Improving the access to timely, appropriate and affordable therapy in these regions would hence, lead to an improvement in the survival outcome of patients with CRPC.
Persistent Virologic Failure and Dynamic Genotypic Resistance Shifts in a Perinatally HIV-Infected Adolescent.
A 16-year-old female with perinatally acquired HIV had persistent virology failure despite documented adherence and multiple regimen changes. Sequential genotypic testing over 13 months showed an unusual shift: April 2024—HIV-1 subtype C with non-nucleoside reverse transcriptase inhibitors (NNRTI) mutation K103N (high-level EFV/NVP resistance) and no integrase strand transfer inhibitor (INSTI) resistance; May 2025—loss of K103N (NNRTI susceptibility restored) but emergence of major INSTI mutations G118R and E138K (± accessory P142T), conferring high-level resistance to all INSTIs (bictegravir, cabotegravir, dolutegravir, elvitegravir, raltegravir). NRTI and PI susceptibility persisted. This rare reversal–emergence sequence highlights viral evolution under selective pressure and the need for repeat resistance testing before regimen switches in resource-limited settings. The patient remains clinically stable. Viral load 197,000 copies/mL in May 2025, pending regimen optimization.
Conservative management of coin ingestion in a toddler using serial plain radiography in Zambia: An imaging case report
Coin ingestion is a frequent reason for paediatric radiology referrals, with most cases resolving spontaneously without complications. This imaging case report describes the diagnosis and conservative management of a 2-year-old boy who accidentally ingested a two-Kwacha coin at a public hospital in Zambia. The child remained asymptomatic throughout his hospital and home stay, allowing for a non-invasive approach involving serial plain film radiographs to monitor the coin’s progression through the gastrointestinal tract. Over three days, imaging confirmed the coin’s movement from the oesophagus to the mid-abdomen, culminating in its natural expulsion on the fourth day. This case highlights the crucial role of plain film radiography in both diagnosing and monitoring foreign body ingestion in children, particularly in low-resource settings. It also highlights significant systemic challenges, including the lack of paediatric radiographers, the absence of national paediatric imaging guidelines, a critical shortage of radiologists, and the unavailability of electronic systems for patient data and radiographic image management. Despite these limitations, the successful outcome supports existing evidence that asymptomatic paediatric patients with coin ingestion can be safely managed through careful observation and serial imaging, thus avoiding the risks associated with invasive procedures and sedation.
A CASE OF EXTENSIVE CEREBRIFORM NEVUS AT ARTHUR DAVISON CHILDREN'S HOSPITAL, NDOLA, ZAMBIA
Cerebriform nevus is an extremely rare hamartoma of the skin that is present at birth and typically presents as a hyperpigmented patch commonly on the scalp, trunk and lower limbs. It develops convolutions over the surface giving the characteristic cerebriform appearance and grows during puberty under the hormonal influence and can develop secondary neoplasms in adulthood. We report a case of extensive cerebriform nevus sebaceous in a 5 year old girl highlighting diagnostic challenges in a resource limited setting.
Ring-enhancing brain lesions in a patient with advanced retroviral disease
The patient is a 30-year-old man who was recently diagnosed with HIV infection and has a CD4 count of 30 cells/mm3. He presented with a one-week history of intermittent fever and right-sided body weakness, and upon examination, was found to have right hemiparesis. There were no other features of opportunistic infections noted. A contrast-enhanced computed tomography (CT) scan of the brain revealed a hypodense lesion with a rounded enhancing rim in the left basal ganglia, measuring 3 x 3 x 2.5 cm. The lesion was associated with marked deep white matter oedema, causing effacement of the lateral and third ventricles, as well as a slightly dilated temporal horn of the right lateral ventricle. The left cerebral sulci were also effaced (Figure 1).
Pseudoachalasia due to hepatic compression in an adolescent: A case of enlarged left and accessory liver lobes
Background: Achalasia cardia is a rare oesophageal motility disorder characterized by impaired lower oesophageal sphincter (LES) relaxation and absent peristalsis. While typically idiopathic, rare cases arise from external compression. Case Presentation: We report an 18-year-old male with a two-year history of progressive dysphagia to liquids and solids, chest pain, regurgitation, and weight loss. Barium swallow revealed oesophageal dilation with tapering ("bird's beak" sign). Definitive diagnosis was made intraoperatively, which revealed an enlarged left liver lobe and an accessory lobe compressing the distal oesophagus. Intervention: A modified Heller's oesophagocardiomyotomy was performed via laparotomy. Conclusion: This case highlights a rare cause of pseudoachalasia due to hepatic compression and underscores the importance of considering extrinsic causes in atypical achalasia, especially in resourcelimited settings.
CULTURAL FACTORS AFFECTING STROKE REHABILITATION: INSIGHTS FROM PHYSIOTHERAPY PRACTIONERS IN MANSA DISTRICT, ZAMBIA
Background: Despite progress in stroke prevention and rehabilitation, stroke continues to rank as the third leading cause of death and a major cause of long-term disability among adults. In Mansa District, only a small proportion of stroke patients access hospital care, largely due to cultural beliefs and perceptions. These cultural factors can greatly impact the delivery and effectiveness of rehabilitation services, as well as patient participation. However, there is limited understanding of how cultural beliefs and practices shape stroke experiences and rehabilitation in Mansa District. Objective: The aim of this study was to explore perceptions of physiotherapy practitioners on cultural influences on rehabilitation of stroke patients in Mansa District in Luapula Province of Zambia. Methods: An exploratory study design was adopted using qualitative methods. The study was conducted at Mansa General Hospital among eight (8) Physiotherapy Practitioners who were selected purposively. Data were collected through a focus group discussion using a structured focus group discussion guide adapted from related studies. Thematic analysis was used to analyse data, and results have been presented in narrative form. All ethical principles were strictly upheld. Results: The study revealed several features of the Mansa culture that were believed to affect the stroke rehabilitation process. These were cultural beliefs, family involvement, patient-centred factors linked to compliance to physiotherapy treatment, and patient/family knowledge about stroke. To address these cultural issues, patient and caregiver education, and counselling were among the strategies physiotherapy practitioners had put in place. Also allowing fellow patients and stroke survivors to share their experiences with other patients was helpful during the rehabilitation process. Conclusion: The study found that cultural beliefs, limited awareness, and traditional practices hinder stroke rehabilitation in Mansa. Addressing these requires culturally sensitive education and interventions, basic counselling training for physiotherapists, community engagement, tailored home programs, and peer support networks among stroke survivors to enhance recovery.
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.
Copyright (c) 2025 Medical Journal of Zambia https://creativecommons.org/licenses/by-nc/4.0
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.
Knowledge, Attitude and Practice Regarding Diabetes Self-Management Education and Support Among Healthcare Workers at Levy Mwanawasa University Teaching Hospital, Zambia
ABSTRACT Background: Diabetes mellitus is an escalating global health concern, especially in low- and middle-income countries like Zambia. This study examined healthcare workers’ (HCWs) knowledge, attitudes, and practices (KAP) regarding diabetes self-management education and support (DSMES) at Levy Mwanawasa University Teaching Hospital (LMUTH). Objectives: The primary objective was to assess DSMES-related KAP among HCWs. Secondary objectives explored the influence of professional background, work experience, and academic qualifications on KAP outcomes. Methods: A cross-sectional study was conducted using structured questionnaires administered to 100 HCWs. Data were analysed using SPSS version 29, employing descriptive statistics and bivariate logistic regression. Results: Most participants were female (72%) and aged under 35 years (73%). Nurses formed the majority (60%), with 62% holding diplomas and 53% having less than five years of experience. About 61% had good knowledge, 54% exhibited positive attitudes, and 84% demonstrated good DSMES-related practices. Participants over 35 years had significantly greater odds of possessing good knowledge (aOR = 5.806, p < 0.001). Nurses were more likely to demonstrate good knowledge (aOR = 14.389, p = 0.044) and positive attitudes (aOR = 25.700, p = 0.007) compared to physicians. DSMES resource use positively correlated with attitudes (aOR = 4.944, p = 0.026) and practices (aOR = 9.482, p = 0.017). Conclusions: Demographic and professional factors significantly influenced DSMES-related KAP among HCWs at LMUTH. Tailored interventions are necessary to address disparities and enhance DSMES delivery.
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.
Medical Semantics: medico-legal terminology and clinical documentation of cutaneous marks of violence
Background: There is relative illiteracy in the general knowledge of appropriate medico-legal terminology and clinical documentation of cutaneous marks of violence. In a resource-limited setting like in Zambia, appropriate diagnostic labels and accurate documentation of the injuries is critical as photographic and other scientific means of securing medical evidence becomes less cost effective. Objectives: The object of this review paper is to impart important lessons in standardizing medical terminology and documenting cutaneous marks of violence and highlight pitfalls in differential diagnoses of the injuries. Method: Asystemic literature search for cutaneous marks of violence was made in African Journals Online, PubMed and Forensic Medical journal websites for the period 2000 to 2025, using cutaneous trauma; injuries; wounds; forensic terminology and documentation of injuries as keywords. Results: There were several results of interest from the search for pertinent information. A narrative of the injuries was synthesised primarily from authoritative textbooks of Forensic Pathology augmented by authors' personal knowledge of medical jurisprudence. The injuries were conventionally categorised as bruises, abrasions, lacerations, incisional wounds and stab wounds. They were of varying severity ranging from minimal to clinically serious injuries. The injuries were caused by blunt or sharp force impacts in a variety of ways with many types of objects. They were accidental, self-inflicted or homicidal trauma, depending on the circumstances. An inspection of the clothes for fabric damage and bloodstain gravitation provided clues about the incident. Conclusion: Clinicians are reminded of innocent differential diagnoses which simulate accidental, self-inflicted and homicidal trauma. The diagnostic labels must be qualified with an objective clinical description, backed up by scaled colour photographs. The medical history should correlate with the pattern and distribution of injuries. It is good medical practice to ensure that the medical evidence withstands the rigour of clinical challenges in the judicial system. It may not be apparent at the outset whether the description and interpretation of the injuries would become considerably significant should medico-legal proceedings ensue.
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.