Medical Journal of Zambia

Phytochemical Studies and Blood Glucose Lowering Effect of Zambian Cultivars of Piliostigma thonningii in Alloxan - Induced Diabetic Rats

Elimas Jere — 2021-08-19

Background: There is anecdotal evidence among some Zambian traditional medicine practitioners that Piliostigma thonningii possesses antidiabetic effects. This study assessed the in-vivo antidiabetic effects of ethanol extract of the plant in alloxaninduced diabetic wistar rats.
Study design: A laboratory-based experimental study involving 24 rats divided into 4 groups of 6 and administered the extract, glibenclamide and placebo.
Methods: Diabetes was induced by a single intraperitoneal injection of 150mg/kg alloxan monohydrate. The in-vivo glucose lowering effect of ethanol extract of stem bark of Piliostigma thonningii was evaluated in comparison to normal saline as negative control and glibenclamide as positive control. Standard methods for identification of alkaloids, flavonoids, saponins, tannins, glycosides, terpenoids and anthraquinones were employed in the phytochemical analysis of the extract.
Results: Piliostigma thonningii ethanol stem bark extract showed presence of alkaloids, flavonoids, saponins, tannins, glycosides and terpenoids. The extract caused a 55.3% (P=0.002) reduction in blood glucose of the experimental animals over the treatment period from the initial 19.7±7.0 mmol/l to 8.8±2.5 mmol/l, compared with glibenclamide which caused 68.3 % (P=0.001) lowering blood glucose levels from 24.0±4.5 mmol/l to 7.6±5.9 mmol/l.
Conclusions: Stem bark extract of Piliostigma thonningii showed a significant glucose lowering effect in diabetic rats. The study also demonstrated presence of secondary plant metabolites which could be responsible for some of the medicinal properties of the plant. Further studies are required to purify the plant and identify active fractions responsible for the anti-diabetic effect observed.

Geo-Spatial Distribution of Frequencies of MTB/RIF Detected Specimens based on Requesting Health Facilities in Manicaland Zimbabwe for 2017 and 2018

K. Zvinoera — 2021-08-19

Objectives: The aim of this study was to produce Geo Spatial Distribution of Frequencies of MTB/RIF Detected Specimens based on Requesting Health Facilities in Manicaland Zimbabwe for 2017 and 2018, so as to give insight to TB program managers. Focusing elimination interventions on hot pockets of Tuberculosis (TB) strengthens rationale use of resources in resource limited countries like Zimbabwe. Early detection and early treatment is backbone of breaking TB transmission. Drug resistant tuberculosis (DRTB) control interventions like Programmatic Management of Drug Resistant TB or mentoring on Short, all Oral Regimen for Rifampicin resistant Tuberculosis (ShORRT) will be driven by science.
Materials and Methods: The retrospective study was carried out in Manicaland, Zimbabwe. Manicaland one of the 10 provinces in Zimbabwe, has 7 districts with 308 health facilities. During this retrospective cross sectional study 2221 MTB detected results of 2017 and 2018, downloaded from 14 of the 15 Genexpert sites in Manicaland were employed to generate hotspot maps. Fifteenth Genexpert site lost its electronic records when Genexpert CPU crushed. Geographical Positioning System (GPS) of the health facilities were recorded. The study used MTB detected frequencies at a facility in relation to surrounding facilities in Manicaland, then ran optimised hotspot analysis function in Arc Map 10.5 to implement the Gi*statistic.
Results: Overall provincial MTB detected positivity was 2221/36055 (6.2%).Overall provincial Rifampicin Resistant (RR) positivity was .111.2221(5.0%).Geo-spatial map of Manicaland showed 10 facilities that are RR hotspots with 7/10 (70%) of the facilities in Buhera district. Chipinge district had facilities that were MTB detected high hotspots.For the whole of Manicaland, Buhera district had100% MTB detected low hotspots facilities. Ninety percent hotspots were clustered around 2 of the 15 Genexpert Sites in Manicaland, namely Murambinda Mission Hospital and Chipinge District Hospital.
Conclusion: Study identified health facilities with high frequencies of RR areas. For the identified health facilities with high frequencies of RR specimens, NTP may focus DRTB control interventions like PMDT, or mentoring on ShORRT. For the health facilities with high frequencies of MTB detected NTP can focus trainings in TB Case Management. Instead of uniformly spreading the limited resources to all 325 facilities, efforts streamlined to manageable number of 20 facilities in commensurate with identified gap( e.g. objective selection of cadres for training, data driven supportive supervision & targeted awareness campaigns).

The Interactions of Public Health Organisational Leadership with its Environment: A Case Study of the Sally Mugabe Central Hospital in Harare, Zimbabwe

Tonderai I. Kasu — 2021-08-19

Introduction and Background: This paper presents a case study from Sally Mugabe Central Hospital; that examines the interactions of public health organisational leadership with its environment, within the context of Zimbabwe's unique social, economic and political circumstances.

Objective: To investigate how the local context and local environment of Zimbabwe's unique social, economic and political situation have interacted with the leadership of Sally Mugabe Central Hospital as a Zimbabwean public health institution.

Methods: A combination of semi-structured interviews and document analysis were used to conduct the research. Purposive sampling and expert sampling were used to select respondents for interviews. Content analysis of relevant administrative and management documents kept at the participating institution was carried out. This research is located within the theoretical framework of Health Policy and Systems Research (HPSR); and examines the institutional level or meso-level of the healthcare system.

Results and Discussion: Research findings are discussed under subheadings that correspond to the interactions of social, economic and political factors with public health institutional leadership.

Recommendations: Based on the research findings of this case study, recommendations are made on relevant and effective changes to practice, for the leadership of Zimbabwean public health institutions, recommendations that may have some applicability elsewhere as well, on the basis of lessons learnt.

Conclusion: The problem of chronic underfunding; as well as the social, economic and political challenges that have been experienced at the institutional level in the Zimbabwean public health system; require innovative and adaptive public health leadership that can confront adversity in a complex environment.

Effectiveness of Cefotaxime in the prevention of surgical site infections in children undergoing elective inguinal surgery at the University Teaching Hospital, Lusaka, Zambia

Azad Patel — 2021-08-19

Introduction and objectives: Inguinal operations are the most performed surgeries in children. There is a divergent view on use of pre-operative antibiotic prophylaxis to prevent Surgical site infections (SSI) after these surgeries. The aim of this study was to detect if the use of cefotaxime had a significant impact on prevention of SSI in children under 8 years undergoing elective inguinal surgery at the University Teaching Hospitals (UTHs), Lusaka.

Method: This was a cohort study. A total of 170 patients below 8 years of age undergoing elective inguinal herniotomy, orchidopexy or patent processus vaginalis (PPV) ligation at UTHs were enrolled. Group A with 85 patients received preoperative cefotaxime while group B with 85 patients did not receive any antibiotics. A data collection sheet was used to record pre-operative demographic details. Intraoperative variables and post-operative outcomes. No patient received post-operative antibiotics. Follow up to look for SSI was done at 2 weeks and 30 days.

Results: Out of 170 patients, 11(6.47%) had SSI. Six of the 85 that received surgical antibiotic prophylaxis (SAP) had SSI while 5 of the 85 that did not receive SAP had SSI (P=0.551). Deep SSI were seen in 2 patients that did not receive SAP (p=0.155) and grew Staphylococcus aureus in their cultures. Only 1 adverse allergic reaction to preoperative antibiotics was noted.

Conclusion: Despite a low risk of adverse reactions, there is no benefit of using pre-operative antibiotics to prevent SSI in children undergoing elective inguinal surgery.

Sedation of Children undergoing Magnetic Resonance Imaging in a Resource Poor Setting using low doses of Ketamine and Diazepam

J.G. Otokwala — 2021-08-19

We aimed to describe the successful use of low doses of ketamine hydrochloride with diazepam premedication to sedate children with ages between 3days to five years who presented at three diagnostic centres in Port Harcourt Nigeria for magnetic resonance imaging (MRI) within a five-year period. This was done in an environment with no MRI compatible anaesthetic machine and monitoring was done by the anaesthetist within the suites. The average age of the children was ten months with a mean dose of 18mg of ketamine used. The mean duration of the procedures was 44.92 minutes and constant presence of the anaesthetist was required throughout the procedures for monitoring. Two incidences of self-limiting laryngospasm occurred with a safe outcome for all of the patients. Children can be satisfactorily sedated with low doses of ketamine for MRI in some less than ideal situations.

Management of Severe Pre-eclampsia within 24hours Postpartum at a Tertiary Hospital in Lusaka, Zambia: A clinical Audit

Kasakula Kaunda — 2021-08-19

No Abstract.

Head and Neck Lymphatic Malformation Management Algorithm: An Experience from a Tertiary Centre in Tanzania

Abbas M. Mungia — 2021-08-19

Background: Lymphatic malformations are localized areas of malformed lymphatic system that can either be congenital or acquired which commonly occur in the head and neck region. Several treatment options for lymphatic malformations have been proposed, despite this, there is no consensus as to optimal management.
Objective: To determine the pattern and management of head and neck lymphatic malformations in a tertiary health facility in Tanzania.
Material and Methods: This was a one-year crosssectional study that involved patients with head and neck lymphatic malformations treated in Muhimbili National Hospital. A structured questionnaire was used to collect information including age and sex of the patient, chief complaint and, duration, size and site of the lesion. The treatment modalities were surgery and/or intralesional bleomycin injection (IL-Bleo) using a locally developed algorithm. A standard dose of bleomycin was 0.3 to 0.6 mg/kg per injection not exceeding 15 units per cycle with a maximum of 6 cycles.
Results: a total of 33 patients were included in the study. Males were 21 (63.6%) and the male to female ratio was 1.8:1. The age of patients ranged from 5 months to 28 years with a median age of 6 years. In 29 (87.9%) patients, the lesions were evident during birth. The median area covered by the lesion in patients was 12.00 cm2. Nine (27.3%) patients were managed by surgery alone, while majority (24, 72.7%) were given intralesional bleomycin (ILBleo), of whom majority (20, 83.3%) required surgical intervention subsequently. The overall outcome of management of patients was considered successful in 87% of patients.
Conclusion: Head and neck lymphatic malformations are more common in males. Most of the lymphangiomas are of congenital type. Combining IL-Bleo and surgery an effective way of managing head and neck lymphatic malformations.

Mental Health Research in Namibia: A scoping Review of Literature

Mwakanyadzeni Abigail Chipare — 2021-08-19

Background: Mental disorders contribute significantly to the global burden of diseases affecting about 30% of the population. In Namibia, there has been very little research on mental health to inform policy and interventions.
Aim: This review sought to explore the extent to which mental health disorders have been researched in the southern African country.
Methods: A scoping review of studies conducted in pre- and post-independent Namibia was carried out. Electronic databases of published articles were searched using the terms such as: “mental illness”, “psychological disorders”, “Namibia”, and “South West Africa”.
Results: The searches produced 11 900 hits and 14 studies met the inclusion criteria. Results indicated that there have been relatively few publications on mental health. Studies focused mainly on depression as compared to other mental illnesses.
Conclusion: There is still need to invest more in research on mental health in Namibia in order to craft appropriate evidence based interventions to improve mental well-being of the population.

Image Interpretation and Reporting by Radiographers in Africa: Findings from the Literature Review and their Application to Zambia

Osward Bwanga — 2021-08-19

Background: The need for having reporting radiographers has been a part of the discussion in the last decade in Zambia. This is due to acritical shortage of radiologists, an increase in demand for imaging services, and the radiographers' desire for professional recognition in providing formal reports on radiographic images similar to those they undertake in ultrasonography.
Objective: The study aimed at reviewing the evidence relating to image interpretation and reporting by radiographers in Africa and apply the findings to Zambia.
Methodology: A literature review was used to bring together studies on image interpretation and reporting by radiographers in Africa. Online databases, radiography journals, cited references, grey literature, and the internet were searched for relevant studies.
Results: Thirteen studies were included in this review. The findings revealed that radiographers in Africa have a positive attitude towards image interpretation and reporting. In addition, their accuracy at image interpretation is comparable to radiologists. The main benefit identified by the establishment of reporting radiographers is improved access to imaging reports. The review also found that medical doctors are in support of the establishment of reporting radiographers. However, the main limitations are a lack of postgraduate courses in this speciality and the limitation of their scope of practice.
Conclusion: Reporting radiographers contribute significantly to the delivery of quality imaging services by assisting radiologists in reporting on radiographic images. There is a need for policymakers in Africa, including Zambia, to extend the scope of practice of radiographers and establish postgraduate image interpretation courses.

Management of patient with a ruptured pancreatic pseudocyst at Ndola Teaching Hospital, Zambia: Case report and literature review

Seke M.E. Kazuma — 2021-08-19

A pancreatic pseudocyst (PP) is a localized collection of pancreatic juice in pancreatic tissue or peripancreatic space reach, in amylase and other enzymes, surrounded by a cyst wall composed of fibrous wall or granulation tissue, and a cyst wall lacking epithelium. A PP develops after acute pancreatitis, chronic pancreatitis, pancreatic trauma, or obstruction of the main pancreatic duct. PP commonly presents with symptoms of abdominal pain, early satiety, nausea and vomiting in the setting of an abdominal mass. Diagnosis is based on clinical and laboratory tests (persistent high levels of amylase) and on imaging by abdominal ultrasound or computer tomography (CT) scan of a persistent pancreatic fluid collection present for at least 4 weeks. Pseudocysts cannot be removed until 6 weeks after an episode of pancreatitis, to allow the walls to thicken to at least 6mm and the pseudocyst to grow to at least 6cm in size; however, pseudocyst formation is difficult to date. We present a patient who had a ruptured PP and therefore underwent emergency laparotomy. The cyst wall was immature and therefore a cystenterostomy was not possible. PP excision was chosen because the PP was already ruptured and had dense immature cyst-bowel adhesions, a thin wall and absence of abnormality of pancreatic main duct; in addition, expertise was available. Our patient recovered well without complications in the 90-day follow-up and was subsequently discharged.

Diagnostic Imaging of Non-Accidental Injury and Percutaneous Foreign Bodies: A Case Report from Zambia

Ernest Chanda — 2021-08-19

This case report presents the role imagingplayed in the diagnosis and surgical removal of multiple percutaneous foreign bodies in a 5-year-old child who presented with non-accidental injuries (NAI) to medical facilities in Zambia. Children are commonly referred for imaging with suspected accidental foreign bodies, but percutaneous foreign bodies due to NAI are rare. NAI is caused due to child physical abuse and therefore, imaging plays a major role in the diagnosis and provision of legal evidence. In this case report, conventional radiography (plain film) of askeletal survey was the first imaging requested. This was supplemented with a computed tomography (CT) scan of the thorax and abdomen. Lastly, foreign bodies were removed under the guidance of the image intensifier. Although, the cases of NAI reported and presented in medical facilities in Zambia are rare, this case shows that physical child abuse is practiced in our communities. Thus, radiographers and radiologists should pay attention to such cases during imaging and reporting, respectively.

Management of a Patient with Foreign Body Ingestion at Ndola Teaching Hospital, Zambia

Boniface Kaela — 2021-08-19

Foreign body (FB) ingestion refers to intentional swallowing of indigestible, non-nutritious solid substances. It is more common in children and psychiatry adult patients. Adult psychiatry patients have the highest incidence of recurrent ingestion of multiple FB that results from poor impulse control by care-givers and as a response to stress. Foreign bodies longer than 6cm, wider than 2.5cm and sharp edged are unlikely to pass without getting imparted or causing perforation. These warrant removal by endoscopy where available or laparotomy. We
report on the management of a case of intentional swallowing of multiple FBs by a known psychiatric patient at Ndola Teaching Hospital, in Ndola, Zambia.