African Digital Health Library (ADHL)The ADHL digital repository system captures, stores, indexes, preserves, and distributes digital research material.https://library.adhl.africa:4432024-03-29T08:02:27Z2024-03-29T08:02:27ZCorrelating the accuracy of fine needle aspiration cytology and Histopathology in diagnosis of parotid tumours at four major hospitals in Zambia.Kasuma, Manase Sekehttps://library.adhl.africa/handle/123456789/141702022-08-09T11:46:59Z2019-01-01T00:00:00ZCorrelating the accuracy of fine needle aspiration cytology and Histopathology in diagnosis of parotid tumours at four major hospitals in Zambia.
Kasuma, Manase Seke
Fine Needle Aspiration Cytology (FNAC) is a cheap, simple, quick, minimally invasive technique that is widely used for preoperative diagnosis of parotid tumours because the parotid gland is not amenable to preoperative sample collection techniques for histopathologic assessment to guide parotid surgery. Twenty-five (25) participants were prospectively studied over a two-year period at four major hospitals in Zambia. FNAC was done using a 10cc syringe and 20-22G needles for sample collection in consented participants. Specimen staining was done with Papanicolaou stain. Histopathology was assessed with haematoxylin and eosin (H&E) stained sections. FNAC correlated with histopathology with a sensitivity of 100% and specificity of 66.7%; positive and negative predictive values of 95.7% and 100% respectively and a likelihood ratio of 3. All parotid tumours were neoplastic with 76% benign and 24% malignant tumours on histopathology. FNAC accurately diagnosed 68% benign and 20% malignant tumours but was not able to diagnose 12% of the samples. This study found that FNAC correlated with histopathology in the diagnosis of parotid tumours. FNAC is useful in the preoperative assessment of parotid tumours as it provides a preoperative diagnosis that influences management by either avoiding surgery (inflammatory lesion) and limiting the extent of surgery for benign and malignant parotid tumours.
Key words: Parotid tumours, Fine Needle Aspiration Cytology (FNAC)
Thesis
2019-01-01T00:00:00ZReconstitution corono-radiculaire sur dents antérieures : inlay-core au service de la prothèse fixée du CHU-CNOShttps://library.adhl.africa/handle/123456789/141502022-08-09T11:39:53Z2022-01-01T00:00:00ZReconstitution corono-radiculaire sur dents antérieures : inlay-core au service de la prothèse fixée du CHU-CNOS
Notre étude a porté sur les cas d’aspects cliniques de dents antérieures avant réalisation de reconstitution corono-radiculaire par inlay-core qui se sont présentés au service de prothèse fixée au CHU-CNOS à Bamako.
L’objectif principal de cette étude était Evaluer la qualité des reconstitutions corono-radiculaires des dents antérieures par inlay core.
Le sexe féminin a été le plus représenté avec 61,40% des cas et un sex ratio de 0,62 en faveur des femmes.
La tranche d’âge la plus représentée était celle de 61 ans et plus soit 25,72% des cas avec une moyenne d’âge de 51 ans et des extrêmes allant de 20 à 72 ans.
Les fonctionnaires étaient les plus représentés avec 55,72% des cas et seulement 10% étaient des ménagères.
2022-01-01T00:00:00ZComparing central corneal thickness among primary open angle glaucoma and non-glaucoma patients at the university teaching hospitals eye hospital, Lusaka, Zambia.Tembo, Chimozihttps://library.adhl.africa/handle/123456789/141662022-08-09T11:46:23Z2020-01-01T00:00:00ZComparing central corneal thickness among primary open angle glaucoma and non-glaucoma patients at the university teaching hospitals eye hospital, Lusaka, Zambia.
Tembo, Chimozi
Background: Intraocular pressure (IOP) remains the only modifiable risk factor in the management of glaucoma. Accurate measurement of IOP is key in determining individuals at risk of glaucoma. Goldmann applanation tonometry (GAT) is the gold standard method for measuring IOP. In designing the GAT, it was assumed that the Central Cornea Thickness (CCT) was constant at 520 μm. CCT has been noted to vary greatly from one race to another and from one individual to another. The study compared CCT among POAG and non-glaucoma patients, and evaluated the correlation of CCT with Humphrey Visual Field (HVF) parameters (Mean Deviation (MD), Pattern Standard Deviation (PSD)) and Retinal Nerve Fibre Layer (RNFL) thickness based on Spectral Domain Optical Coherence Tomography (SD-OCT) in Primary Open Angle Glaucoma (POAG) patients.
Objective: To determine if there is a difference in the central corneal thickness between patients with Primary Open Angle Glaucoma (POAG) and non-glaucoma patients.
Methodology: A cross-sectional study was conducted in 2020 from February to March. The participants who met the inclusion criteria were POAG and non-glaucoma patients attending the University Teaching Hospitals – Eye Hospital during the study period. Using simple random sampling, patients were aged 40 years and above were recruited. Ophthalmic history was taken and a comprehensive eye examination done on all participants. The CCT was measured using contact ultrasound system and IOP was measured by GAT. Analyses were carried out considering the level of significance at 5%. Results: One hundred six patients were recruited. The mean CCT of the right eye for the POAG patients was 525.19 ± 36.10 μm and non-glaucoma patients was 549.23 ± 35.45 μm. The mean CCT of the left eye for the POAG patients was 527.51 ± 42.71 μm and for the non-glaucoma was 546.91 ±34.91 μm. We found no significant correlation between CCT and MD, PSD and RNFL (P > 0.05). We found a slight negative correlation between CCT and CDR in the RE (r = -0.28, P = 0.04).
Conclusion: There was significant difference in the CCT of POAG and non-glaucoma patients in both the right eyes and left eyes, with CCT being thinner in POAG patients.
Thesis
2020-01-01T00:00:00ZFactors associated with sexual behaviour among adolescents in Chipata district eastern province of Zambia.Zimba, Christopherhttps://library.adhl.africa/handle/123456789/141772022-08-09T11:49:07Z2019-01-01T00:00:00ZFactors associated with sexual behaviour among adolescents in Chipata district eastern province of Zambia.
Zimba, Christopher
Sub-Saharan Africa accounted for over 80% of adolescents living with HIV worldwide, while teenage pregnancy was 78% among adolescents. In Zambia, the situation is not very different, with 12.8% for HIV prevalence and 29% for teenage pregnancy demonstrating increased exposure to sexual behaviour. The purpose of the study was to determine factors associated with sexual behaviour among adolescents.
A cross-sectional study design employing use of quantitative approach was applied. A sample size of 225 adolescents comprising 113 females and 112 males aged 15 -19 years was determined. The study was conducted in Chipata Rural District of Eastern Zambia. Data was collected using a structured interview questionnaire for quantitative data and a follow-up focus group discussion for validation of data. Participants were selected by using Simple random sampling in the purposively selected schools. Quantitative data was analyzed using STATA 11.
The findings show a varied difference in the sexual behavioural practices among the adolescents. Female adolescents were highly sexually active with 52.4% compared with the male adolescents indicating 47.6% (P<0.026). This was attributed to factors such as; religion attendance of adolescents at, 94% (P<0.030).Peer pressure would have influenced 59.6 % of the respondents compared to 41% (P<0.005). Alcohol abuse also influenced sexuality among adolescents at 75.5 % compared to 24.5% (P<0.039). On the other hand, the study established that, 65.8 % of respondents wouldn’t deny having sex with familiar persons compared to 34.2% (P<0.017). Additionally, 85.7% of adolescents wouldn’t refuse to have sex with persons who have influence over them such as their teachers and employers compared to 14.7% (P<0.032). Furthermore, 2.5 % females contracted STIs in the last three months, indicating that females are at high risk of contracting HIV/AIDs compared to male adolescents to 0.4 %(P<0.002).It was found during the study that majority of adolescents 59.6% preferred withdrawal method rather than use of condoms as contraceptives during sex, making them more vulnerable to infections, compared to 41%(P<0.034). However, findings show no correlation on the adolescent level of education and sexuality, as well receiving of gifts among adolescents would lead to sexuality.
Therefore, a specific focus on further sensitization will be required. Ministry of General education should encourage schools to educate female adolescents about their sexuality and developmental processes since they lack understanding of their sexuality compared to their male counterparts. Furthermore, Ministry of Health should scale up adolescent-friendly services to meet the needs of both boys and girls. Additionally, religious leaders should also play an active role in educating the young people on sexuality.
Thesis
2019-01-01T00:00:00ZClinicopathologic characterization of vulvar lesions among HIV infected women at the university teaching hospital in Lusaka, Zambia.Maate, Fredhttps://library.adhl.africa/handle/123456789/141612022-08-09T11:45:52Z2020-01-01T00:00:00ZClinicopathologic characterization of vulvar lesions among HIV infected women at the university teaching hospital in Lusaka, Zambia.
Maate, Fred
A wide spectrum of vulvar lesions has been reported. However, few studies have characterized vulvar lesions among HIV infected women. HIV infected women have a higher risk of vulvar neoplasia than those who are not HIV infected. Furthermore, a rise in the incidence of vulvar cancer has been reported particularly among young women attributed to high risk human papillomavirus infection (HR HPV). In Zambia, vulvar lesions including cancer have not been previously characterized. The study set out to describe the clinical and histopathologic features of vulvar lesions and to determine the prevalence of HR HPV among HIV infected women with vulvar neoplasia among HIV infected women at the University Teaching Hospital (UTH) in Lusaka. The study enrolled 53 HIV infected women with vulvar lesions that were suspected to be cancer. The clinical features of the vulvar lesions were obtained using a questionnaire and focused clinical examination. Tissue for histologic evaluation of the lesions (Haematoxylin and eosin and immunohistochemistry- IHC), and determination of HR HPV (PCR) was collected by punch biopsy and fixed in 10% neutral buffered formalin and ATL buffer respectively. The histologic tissue samples were processed according to the standard protocol at the UTH and reported by two pathologists (including IHC for Ki67 and p53 for the invasive lesions). We analysed 38 samples histologically diagnosed as neoplastic, for HR HPV using X-pert® HPV after extraction of total deoxyribonucleic acid (DNA) using the NucliSens® easyMAG™ magnetic device. The data obtained was analysed using SPSS Version 22. The mean age of all respondents was 40 years (range 23-63, SD 9.5). The most frequent symptom reported was itching, the most frequent site involved was the labia majora and the most frequently reported lesion type was the warty type. Nine (17%) non- neoplastic lesions, three (5.7%) benign lesions, 20 (37.7%) vulvar intraepithelial lesions (VIN) and 21 (39.6%) invasive lesions were reported. Of the VINs, all were of the classic/ usual type. All the invasive lesions were of the SCC type. Of these, all were of the warty/ basaloid types. The prevalence of any type of HR HPV among all neoplastic lesions (in aggregate) and among invasive lesions was 81.6% and 88.9% respectively. The HIV infected women with vulvar lesions were young (mean 40 years); the lesions most frequently presented as itchy warty labia majora lesions including nonneoplastic and benign lesions, Classic VIN and Warty/basaloid type SCC. The prevalence of any type of HR HPV among all neoplastic lesions (in aggregate) and among invasive lesions was 81.6% and 88.9% respectively.
Thesis
2020-01-01T00:00:00ZA comparative study between early and late oral feeding post one stage sigmoidectomy for uncomplicated sigmoid volvulus at university teaching adult hospital, Lusaka, Zambia.Changwe, Frankhttps://library.adhl.africa/handle/123456789/141622022-08-09T11:45:55Z2020-01-01T00:00:00ZA comparative study between early and late oral feeding post one stage sigmoidectomy for uncomplicated sigmoid volvulus at university teaching adult hospital, Lusaka, Zambia.
Changwe, Frank
Background: Sigmoid volvulus accounts for more than 50% of colon obstruction here in Africa are usually associated with significant morbidity, and prolonged hospital stay post-operative. Traditionally, nil by mouth 4-5 days has been the practice post one stage sigmoidectomy and primary anastomosis for most surgical units at UTH for fear of anastomotic leakage, while others advocates for early oral feeding. Therefore, this study was conducted to compare outcomes between early oral feeding and late oral feeding (conventional) method post one stage sigmoidectomy and primary anastomosis for uncomplicated sigmoid volvulus.
Methods: A prospective block randomized comparative study was done at UTH for ten months (May 2019-February 2020). All patients who presented with intestinal obstruction secondary to uncomplicated sigmoid volvulus post one stage sigmoidectomy, and primary anastomosis were recruited in the study. Allocations of 48 patients were block randomized to either early oral feeding group 24-48 hours or under late oral feeding group 4-5 days post-operative respectively. Reinsertion of NGT was done for patients who could not tolerate oral feeds. The discharge criteria from the hospital were the same for both groups until the patient was able to tolerate a normal diet. The research was approved by ERES CONVERGE IRB Ethics Committee.
Results: Forty-eight patients were recruited in this study with the age range 22 to 72 years with the mean being 44.9±14.4 years, the majority of participants were male 47 (97.9%) except one female (2.1%), and all were black Africans. The length of hospital stay for early oral feeding was 5.833 days and 8.583 days for late oral feeding with an overall mean of 7.2±1.78 days, difference 2.75 days p-value 0.005, which was statistically significant. Majority of patients passed flatus on day one 22 (45%) day two 21 (43.6%) respectively, and it was noted that resolution of ileus was shorter in early oral feeding group, most patients opened bowels on day three 22(45.8%), about 39 (81.25%) had no abdominal distension while 9 (18.75%) had 22 (91.67%) patients under early oral feeding tolerated feeds well while 18 (75%) under late with the overall tolerability of 40 (83.33%) for both groups, 4 (8.3%) participants had surgical site infection, and all were from the late oral feeding group, there were two cases (4.2%) of anastomotic leakage all from the conventional group.
Conclusion: This study demonstrated that early oral feeding post one stage sigmoidectomy and primary anastomosis for uncomplicated sigmoid volvulus is safe, tolerated by majority patients, reduced length of hospital stay significantly and no anastomotic leakage, reduced morbidity or mortality. Therefore, early oral feeding is feasible, tolerable and beneficial to patients as compared to conventional approach nil by mouth 4-5 days.
Thesis
2020-01-01T00:00:00ZA cohort study on early outcomes of femur shaft fractures in adults treated by interlocking intramedullary nails at the university teaching hospital, Lusaka.Malao, Brian Mulemwahttps://library.adhl.africa/handle/123456789/141732022-08-09T11:47:26Z2021-01-01T00:00:00ZA cohort study on early outcomes of femur shaft fractures in adults treated by interlocking intramedullary nails at the university teaching hospital, Lusaka.
Malao, Brian Mulemwa
The management of femur shaft fractures has evolved from the historical non-operative methods to the most recent intramedullary nail fixation. Interlocking nails have broadened the roles for closed intramedullary nailing of femur fractures. Early ambulation after fractures of the femur shaft has been shown to have a significant advantage in terms of both joint mobility and economic impact, which are very well attained by the use of interlocking nails. Shortening of the limb and malalignment along with contractures of the knees due to prolonged immobilization have traditionally plagued the Orthopaedic surgeons’ management of patients with these injuries.
The proportion of Femur shaft fractures seen at the University Teaching Hospital (UTH) is anecdotally high. In keeping with this, the use of interlocking nails has equally increased. However, the outcomes of the use of interlocking nails in this setting are not documented. This study looked at the early outcomes of femur shaft fractures treated by interlocking intramedullary nails at UTH. Femur shaft fractures are serious injuries that generally result in short-term disability and pain; but also have a high risk of long term deformity and disability. This study was aimed at evaluating the early outcomes of using interlocking intramedullary nails in the treatment of patients with closed femoral shaft fractures at the University Teaching Hospital, Lusaka. The objective was to explore the early outcomes of closed fractures of the shaft of the femur that were treated using interlocking intramedullary nails at the University Teaching Hospital, Lusaka.
The study was a prospective cohort study carried out between August 2019 and February 2020 at the University Teaching Hospital, Lusaka. During this period, a total of 63 patients that underwent interlocking intramedullary nailing were followed up for 6 weeks. The study participants were evaluated using the Thoresen criteria for short term outcomes.
The rotational deformity was the most prevalent outcome, with 68% of participants having rotational deformity, external rotation was the most common (40%) deformity. There was a statistically significant correlation (p-.006) between comminution and rotational deformity. Infection was very low, as only one participant (1.6%) had recorded a superficial infection. A limb shortening prevalence of 59% was found in this study, significant shortening (more than 2cm) was 7.9%. However, 92 per cent had combined good or excellent Thoresen outcome scores. An overall knee flexion of less than 90 degrees was found in 24% of the patients in this study.
The early outcomes of treatment using interlocking IMN for femur shaft fractures at UTH is good to excellent (based on the Thoresen score criteria) in terms of limb length discrepancy, rotational deformity and knee flexion combined. The proportion of post-surgery infection among patients with femoral shaft fracture treated with interlocking IMN was low (1.6% -superficial infection).
Thesis
2021-01-01T00:00:00ZPrevelance of asymptomatic bacteria in pregnant women at women and newborn hospital, Lusaka, Zambia, common causative microbes and their drug sensitivity patterns.Ng'ambi, Chikwefuhttps://library.adhl.africa/handle/123456789/141642022-08-09T11:46:02Z2021-01-01T00:00:00ZPrevelance of asymptomatic bacteria in pregnant women at women and newborn hospital, Lusaka, Zambia, common causative microbes and their drug sensitivity patterns.
Ng'ambi, Chikwefu
Asymptomatic bacteriuria is a significant number of bacteria in the urine (2 consecutive specimens with isolation of at least 100,000 colony-forming units (CFU) per mL of the same bacterial species) that occurs without usual symptoms of urinary tract infection. Pregnant women are generally at high risk. Urinary tract infection is responsible for a number of pregnancy adverse outcomes such as low birth weight, premature labour, premature rupture of fetal membranes, anaemia, preeclampsia, respiratory failure and risk of septicaemia and shock. The purpose of this study was to determine the prevalence of asymptomatic bacteriuria and its associated factors in pregnant women presenting to the University Teaching Hospital – Women and New-born Hospital (UTH-WNH) antenatal clinic.
This was a cross sectional study involving 141 pregnant women. The participants were systematically selected among women attending antenatal clinics at UTH-WNH. The inclusion and exclusion criterion were applied. Consent was sought for those included. Data was collected from the participants in form of interviews and questionnaire. Clean catch urine specimens were collected from each of the study participants.
Of the 141 pregnant women studied, 13 women had asymptomatic bacteriuria and the prevalence was 9.2%. The most common bacterial isolates where Staphylococcus Aureus, Staphylococcus Saprophyticus, Enterobacter Aerogens and Enterobacter Agglomerans. Other isolates included E. coli, Enterococcus Species and Klebsiella Oxytoca. Most bacteria were susceptible to nitrofurantoin.
This prevalence is significantly high. The concern is that UTI in pregnancy may have serious consequences for both the mother and the child. Routine urine culture test should be carried out on all antenatal women to detect asymptomatic bacteriuria and provide appropriate antibiotics.
Thesis
2021-01-01T00:00:00ZIncidence and determinants of post-operative neuromuscular blockade in patients undergoing surgery at the university teaching hospital, Lusaka, Zambia.Munga, Tingadanehttps://library.adhl.africa/handle/123456789/141752022-08-09T11:48:52Z2021-01-01T00:00:00ZIncidence and determinants of post-operative neuromuscular blockade in patients undergoing surgery at the university teaching hospital, Lusaka, Zambia.
Munga, Tingadane
Background: Anaesthesia provision has advanced significantly over the years. This is in part due to the development of newer, better drugs. Some of these drugs include the muscle relaxants, which paralyze the body. However, drugs, particularly muscle relaxants, are not without fault. Various Western studies have highlighted some adverse effects of some of these drugs, such as post-operative muscle paralysis, leading to infections and death. Despite the routine use of these drugs at the University Teaching Hospital, there is lack of information regarding their potential for post-operative paralysis in the surgical population at this hospital.
Methods: a prospective cross-sectional study was conducted between September 2019 and January 2020 involving adult patients who presented for surgery (elective or emergency) at the University Teaching Hospital theatres. Data was collected from 38 participants regarding their demographics, anaesthetic factors including the type of drug, and surgical factors such as duration of operation. A Train of Four Scanner which measures the level of muscle function was used to determine post-operative paralysis in the participants. The datasets obtained were compared using Mann-Whitney tests, and a multivariable regression model was used to analyse determinants of non-recovery.
Results: post-operative neuromuscular blockade was determined to be present in 13 (34.2%) participants presenting for surgery under general anaesthesia. The risk of residual block increased with increasing age (AOR = 1.2, 95% CI [1.09 – 1.37]; p=0.044), use of pancuronium alone (AOR=2.3; 95% CI [1.21 – 14.9]; p=0.038) or in combination with atracurium (AOR=3.2; 95% CI [1.73-8.41]; p=0.029) and administering reversal agent (AOR = 1.9, 95% CI [1.33 – 5.21]; p=0.048).
Conclusion: Post-operative neuromuscular blockade had an incidence of 34.2% in the study population. It was significantly associated with use of pancuronium, even despite subsequent reversal. In fact, use of neostigmine for reversal was associated with inadequate muscle recovery as determined by the train of four ratio.
Thesis
2021-01-01T00:00:00ZPrevalence and associated risk factors of anaemia in children aged six months to fifteen years admitted at the university teaching hospital, Lusaka.Inambao, Namukolo, Muleyahttps://library.adhl.africa/handle/123456789/141742022-08-09T11:48:04Z2019-01-01T00:00:00ZPrevalence and associated risk factors of anaemia in children aged six months to fifteen years admitted at the university teaching hospital, Lusaka.
Inambao, Namukolo, Muleya
Anaemia is a public health problem globally affecting 293.1 million children and 28.5% of these children are in the sub Saharan Africa. The study was to determine the prevalence of anaemia and the associated risk factors of anaemia in children aged 6 months to 15 years admitted to the University Teaching Hospital. A cross sectional study was conducted from July 2016 to December 2016.A total of 351 children were studied;45.9% (161/351) were females and 54.1% (190/351) were males (p=0.5). The prevalence of anaemia was (45.9%)161/351.In terms of severity mild, moderate, severe anaemia were 47/161(29%), 86/161(53%) and 28/161(17%) respectively. The age group 6 months to 5 years was the most affected with 25.9% mildly, 55.6% moderately and 18.5% severely anaemic. The associated risk factors studied were malaria, sickle cell disease, malnutrition and HIV infection. Logistic regression analysis revealed that undiagnosed sickle cell disease with haemoglobin-S was the only clinical characteristic independently associated with anaemia (CI-0.2-0.7), p value-0. 001.Anaemia is a major health problem at UTH, and the under-five age group is the most affected. Previous undiagnosed sickle cell anaemia trait or disease was the significant clinical feature found to be associated with anaemia in this study. Therefore, improving on early screening for sickle cell disease and scaling up of deworming in the under five children and generally improving the diet of Zambian children should be advocated for. Preventative strategies including early screening of sickle cell disease, screening for anaemia, routine deworming must target all under-fives regardless of their clinical status or haemoglobin levels.
Key words: Anaemia, Prevalence, Risk factors, Zambia, Africa
Thesis
2019-01-01T00:00:00Z